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CARDIOVASCULAR ANESTHESIA

The Influence of Medical Information on the Perioperative Course of Stress in Cardiac Surgery Patients

Peter Bergmann, MD^*, Stefan Huber, MD^*, Heinrich Mächler, MD^*, Eva Liebl, PhD^*, Helmut Hinghofer-Szalkay, MD, Peter Rehak, PhD^*, and Bruno Rigler, MD^*

Divisions of *Cardiac Surgery and Physiology, Karl-Franzens University Hospital, Graz, Austria

Address correspondence and reprint requests to Dr. Peter Bergmann, and Karl-Franzens University Clinic, Division of Cardiac Surgery, Auenbruggerplatz 29, A-8036 Graz, Austria. Address e-mail to peter.bergmann{at}kfunigraz.ac.at

Cardiac surgery correlates with increased perioperative stress and anxiety. We tested whether preoperative extensive oral information in combination with more personal attention by the surgeon is associated with any effect on patients’ perioperative stress, anxiety, and well-being. Sixty patients awaiting open heart surgery were divided into two groups. Group I consisted of 30 patients who received routine medical information through an informative pamphlet. In Group II (n = 30 patients), additional, extensive oral medical information and more personal attention by the surgeon was provided before surgery. Salivary cortisol, plasma cortisol, state anxiety, and patients’ well-being were measured perioperatively. Extensive preoperative oral information in combination with more personal attention by the physician did not have any significant influence on the perioperative psychoendocrinologic course of stress. During transport to the operating room, salivary cortisol increased significantly (P < 0.001) in both groups (ranges are 95% confidence intervals) (Group I, 23.2 nmol/L [17.1–31.5]; Group II, 14.6 nmol/L [9.9–21.3]) versus the first day in the hospital (Group I, 8.4 nmol/L [6.2–11.4]; Group II, 6.7 nmol/L [5.3–8.6]). After the induction of anesthesia, plasma cortisol decreased significantly (P < 0.001) in both groups (Group I, 170.1 nmol/L [143.6–201.4]; Group II, 172.0 nmol/L [142.2–208.1]) versus preoperative levels. After surgery, well-being decreased (P = 0.003) in all patients, and patients’ state anxiety was reduced (P = 0.001) after surgery. Our data demonstrate a lack of effect of extensive oral medical information that was presented as part of clinical routine on the perioperative psychoendocrinologic course of stress. High levels of stress during transport to the operating room were detected.

IMPLICATIONS: The quantity of stress during transport to the operating room and the perioperative psychoendocrinologic course of stress in combination with two different methods of preoperative medical information are described in 60 consecutive patients awaiting cardiac surgery.

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