Conscious surgery: influence of the environment on patient anxiety

Aims: i) To investigate anxiety arising from the experience of the clinical environment during surgery under local/ regional anaesthesia and, ii) to uncover the specific aspects patients find anxiety provoking and possibly dissuade them from opting for such anaesthesia. Background: Operating theatres have historical been designed for safe, efficient surgery on the unconscious patient and not primarily designed for the care of the ‘awake’ patient. However, with the rise in day surgery, the quantity of surgery performed under local/ regional anaesthesia is increasing. Method: As part of a larger study investigating anxiety within modern elective day surgery, adult patients undergoing surgery and local/ regional anaesthesia (n=214) were provided with a questionnaire on the day of surgery for return by mail 24 - 48 hours following surgery. Findings: The experience of being awake, possibly feeling surgeon, seeing body cut open or surgery being more painful were anxiety provoking aspects. Utilising factor analysis ‘intra-operative apprehension’, ‘anaesthetic information provision and ‘health control’ were identified as central features. Moreover, when employing multiple regression, apprehension associated with the intra-operative experience and anaesthetic information provision were significantly associated with an increase in the overall level of anxiety. Conclusions: Although the surrounding clinical environment has previously been a cause of apprehension, the sensations associated with the physical act of surgery on the conscious self appear also to have a considerable influence. Focusing care upon managing patient intra-operative experience and providing anaesthetic information in advance may help limit anxiety and expel the apparent misapprehensions associated with conscious surgery

Review article: Use of ultrasound in the developing world

As portability and durability improve, bedside, clinician-performed ultrasound is seeing increasing use in rural, underdeveloped parts of the world. Physicians, nurses and medical officers have demonstrated the ability to perform and interpret a large variety of ultrasound exams, and a growing body of literature supports the use of point-of-care ultrasound in developing nations. We review, by region, the existing literature in support of ultrasound use in the developing world and training guidelines currently in use, and highlight indications for emergency ultrasound in the developing world. We suggest future directions for bedside ultrasound use and research to improve diagnostic capacity and patient care in the most remote areas of the globe