Brown, Sarah Mercia; (1993) The quantification of stress in patients undergoing surgery for renal calculus disease. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The anxiety experienced by patients undergoing surgical procedures is well documented and may affect the outcome of any operation. This has not been considered in modern urological surgery which is moving away from highly invasive techniques towards minimal and even non-invasive procedures. Little work has been carried out to examine the patients' reaction to this new technology. This work had two aims; to assess patient anxiety before and after different procedures for renal calculus removal and to identify, where possible, factors that contribute to pre- and post-operative anxiety. The main method of quantifying stress for this work was the measurement of palmar sweat by means of an evaporimeter. Other measurements used were heart rate, a bi-polar visual analogue scale, and the Spielberger State Anxiety questionnaire. It was possible to perform continuous measurement of palmar sweat in patients during lithotripsy and in view of the high values obtained simultaneous monitoring of heart rate was also performed. Four patients prescribed beta-adrenergic blocking agents were studied since the role of the adrenergic nerves in the innervation of the palmar sweat glands is uncertain and it was not known whether or not the response would be influenced by such medication. The results of the main study demonstrated a highly significant reduction in the palmar sweat production and score obtained for the analogue scale following open surgery but no changes before and after treatment in any of the variables in patients undergoing percutaneous nephrolithotomy or lithotripsy. Analysis of the data in relation to the invasive nature of the surgery demonstrated a significantly higher pre-operative analogue score in patients undergoing open surgery compared with lithotripsy. Post-operatively patients undergoing lithotripsy had a significantly higher palmar sweat response compared with patients undergoing open surgery. Pre-operatively fear of a general anaesthetic was identified as a factor contributing to anxiety and post-operatively pain was the most commonly identified stressor. Measurement of palmar sweat in patients during lithotripsy demonstrated significant increases throughout the procedure with a return to pre-treatment levels afterwards. The correlation of palmar sweat with heart rate during lithotripsy was generally poor. There was no difference between the responses obtained from beta- blocked and un-beta-blocked patients. The implications of these results to the patient and to both nursing and medical staff in terms of practice are discussed and recommendations for appropriate intervention made. This must include a careful pre-operative explanation.

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