Wednesday, November 28, 2007

Relaxation Strategies for Pre-operative Settings

Surgery pre-op. Blank walls, metal and tubes. Bright lights and cold air. People come and go with the urgency of holiday shopping, providing cursory nods and perfunctory statements to the people on beds blocking their way. Certainly it is not always like this, but in general, the pre-surgery holding area is very lonely, with different professionals visiting you intermittently to take vital signs, blood or signatures. The environment is well formed for nurturing anxiety.

The prospect of surgery usually presents patients with an array of feelings and worries. These anxieties are counterproductive to maintaining the calm and positive state of mind that is beneficial for successful recovery after an operation. I have had the opportunity to assist patients in several different pre-operative settings to help them cope with the stress of their situation. Through these experiences, I have discovered some simple strategies that can be used by patients and their caregivers to help them relax directly before surgery.

1. Pre-op partner - Obtain permission for someone to stay with you in the pre-op area and, if possible, all the way into the operating room. This partner can offer silent companionship or conversation depending on how you feel. In my experience, some people become very talkative as they are nervous while there are others who just wish for me to hold their hand. A pre-op partner can be very helpful in distracting you from the sights and sounds of the pre-op area and focusing your attention on other subjects. A partner can also be helpful in facilitating deep breathing or relaxation routines. If the partner is allowed to go into the operating room, he or she can be responsible for collecting music recordings or personal effects that were helpful during relaxing in the pre-op area. On many occasions I have been able to stay with a patient until they are fully under anesthesia in the operating room. Family members are usually not allowed in pre-op after a certain time. Suggested candidates for a pre-op partner are a music therapist, clergy or patient services representative that work at the medical facility. The best way to obtain permission for someone to be with you is to ask the surgeon. The surgeons usually have authority over the operating room procedures and can smooth the way for you to talk with nursing staff about the possibilities.

2. Music - Bring an MP3 or CD player and your favorite music. Music may be used to distract you from the activity in the pre-op room. The music will serve to mask environmental noises and help you focus your attention on something other than needle sticks and blood pressure monitors. Consider using your preferred music, whether you are trying to facilitate relaxation or provide distraction. Preferred music will hold your attention better than trying to use music that you have never heard or that is unappealing. The advantage to using an MP3 player is that you can bring both sedative and preferred upbeat music. I have found that many people cannot start out with sedative music right away. It takes time to adjust your mood and stress level. I recommend that you start with preferred music with a moderate beat and intensity and then gradually change to more relaxing music. In this way you will be able to help yourself move in the preferred direction to a less anxious state.

3. Relaxation methods - Use breathing to induce a more relaxed state. Close your eyes and allow yourself to breathe normally, focusing on breathing in through your nose and out through your mouth. After your breathing has fallen into a natural rhythm, begin elongating the cycle by counting slowly to four on each inhale and exhale. Gradually count to higher numbers so that you have a deep breath happening on eight counts in and eight counts out. Once your breathing has slowed, begin relaxing muscle groups from your head to your feet by tensing and releasing one by one. Begin with your facial muscles by scrunching them up, holding for a moment, and then releasing. Feel the tension melt away and notice the difference in feeling between tense and relaxed states. As you work your way through a progressive muscle relaxation, be sure to drop your jaw so that it hangs loose and your tongue feels heavy and relaxed. If you are able to have a music therapist with you as a pre-op partner, then consider allowing the therapist to facilitate guided imagery to your music listening. Even without a music therapist you can imagine a peaceful place with pleasant scents and attractive sights and sounds.

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