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ORIGINAL ARTICLE
Year : 2013  |  Volume : 7  |  Issue : 4  |  Page : 415-419

Analyzing the effects of intra-operation video-clip display on hemodynamic and satisfaction of patients during lumbar discectomy under spinal anesthesia


1 Department of Anesthesiology, Kashani Hospital, Isfahan, Iran
2 Department of Neurosurgery, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Correspondence Address:
Farnaz Rouhani
Department of Anesthesiology, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.121058

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Date of Web Publication7-Nov-2013
 

  Abstract 

Objective: Most neurosurgeons and anesthesiologists prefer the less invasive intervention for most surgeries; recently, the lumbar anesthesia is more popular method. In this study we have tried to distract the attention of the patients to their favorite video-clip instead of their surrounding operating room background to evaluate the hemodynamic as well as their satisfaction during the operation. Methods: 80 patients who were scheduled for an elective one level discectomy under the regional spinal anesthesia enrolled in this prospective randomized clinical trial. The patients were randomized with sealed envelope method and each envelope was randomly assigned from this set of envelops to be either in case group one (video group) or control groups two (no audio and video and only head phone on their ears) group. In all patients, systolic and diastolic blood pressure, pulse rate and SPO2 were measured and recorded in the questionnaire charts. Results: Of the 80 patients with Lumbar disk herniation, 53 patients were male and 27 female. The mean age for all patients was 44 year. Systolic and diastolic blood pressure at the end of surgery was significantly lower in video group ( P=0.045 and 0.004). Systolic Blood pressure differences between 3 rd and 5 th and the end of the surgery with minute zero was significantly less in the video group. ( P=0.025, 0.018 and 0.030). Diastolic blood pressure differences between 3 rd and 5 th and the end of the surgery with minute zero was significantly less in the video group.( P=0.051, 0.019 and 0.15). Pulse rate differences between first, 3 rd , 5 th and exactly before leaving the recovery room with minute zero was significantly less in the video group. ( P=0.015, 0.028, 0.030 and 0.008). Conclusion: According to our study, by displaying patient's favorite video clip during the surgical intervention we could highly reduce the patient`s attention to what is happening in operating room and therefore, decrease their anxiety and stress.

Keywords: Discectomy, lumbar disk, spinal anesthesia


How to cite this article:
Masoudifar M, Abrishamkar S, Rouhani F, Fard SA, Noorian A. Analyzing the effects of intra-operation video-clip display on hemodynamic and satisfaction of patients during lumbar discectomy under spinal anesthesia. Saudi J Anaesth 2013;7:415-9

How to cite this URL:
Masoudifar M, Abrishamkar S, Rouhani F, Fard SA, Noorian A. Analyzing the effects of intra-operation video-clip display on hemodynamic and satisfaction of patients during lumbar discectomy under spinal anesthesia. Saudi J Anaesth [serial online] 2013 [cited 2021 Sep 23];7:415-9. Available from: https://www.saudija.org/text.asp?2013/7/4/415/121058


  Introduction Top


Lumbar disc operation is one of the most common surgical interventions in the field of neurosurgery. [1],[2],[3] Because most neurosurgeons and anesthesiologists prefer the less invasive intervention for most surgeries, recently the lumbar anesthesia is more popular method. [1],[4],[5] Meanwhile, some anesthesiologist have some problems with regional methods because they believe that the patients may suffer from hearing the common dialogues between anesthesia and surgical stuffs as well as incomprehensive sound in operating rooms such as anesthesia monitoring and sounds of surgical equipments. [1] These sounds could have a great negative impression on hemodynamic and satisfaction of the patients. [1],[3],[5] In study of Maeyama A. and his colleagues have shown that music listening during operation reduced Bispectral Index (BIS) value and had beneficial effect on patient's anxiety during regional spinal anesthesia. [2]

In another study by Zhang et al. to establish whether listening to music or overcrowding noise can reduce BIS standards during propofol sedation. [3] He divided the patients in 3 groups; noise, silence, and music. BIS quantity was recorded seven times throughout the surgery. Finally, this study proved that overcrowding noise is more valuable than playing music in reducing BIS scores during propofol sedation. [3]

In previous studies which have used handset free with or without music for the patients under regional anesthesia had been more or less successful for the coverage of undesirable operation room sounds and noises. [6]

Studies of Ayoub CM, Lepage C and Koch ME showed that hearing music during regional anesthesia could diminish sedative requirements. [4],[5],[7]

We believe that in all cases the problem of patients who is completely conscious and see what is going on in the operating room could have the same negative effects on process of anesthesia. Therefore, in this study we have tried to attract the attention of the patients to their favorite video-clip instead of their surrounding operating room background to evaluate the hemodynamic as well as their satisfaction during operation.


  Methods Top


This is a randomized clinical trial performed at Isfahan University of medical school and Kashani general hospital. With the approval of the institutional ethics committee and the written well-versed consent of the patients only those patients who, after a primary interview, expressed a need to voluntarily participate in the study. This was accordingly documented in our informed Consent Form, were included in the groups. 80 ASA physical statuses I, II patients of both genders, aged between 18-65 years who were scheduled for elective one level discectomy (the removal of a herniated disk to relieve pressure on a single nerve root) under spinal anesthesia enrolled in this prospective randomized clinical trial. Four patients were excluded from our study, two refused to participate, and one was addicted to opium and one was partially deaf. Patients were randomized with sealed envelope method and each envelope was randomly assigned from this set of envelops (number 1 to 80) to be either in case group one (video group) or control groups two (no audio and video and only head phone on their ears) group.

All the patients were fasting for 8 hours before surgery and meanwhile, they received one liter of Lactated Ringer's solution and no patient received premedication. Then all individuals were given Bupivacaine intrathecally in a volume of 3mL. Spinal anesthesia was performed in sitting position and using a 23 gauge Quincke needle with a midline approach at either L2/L3, L3/L4 or L4/L5 (determined by palpation of the bony landmarks) injection was done slowly (at least 10 seconds) with barbotages technique by one anesthesiologist. In the operating room, all of the patients had both of their legs wrapped with an elastic bandage to prevent hypotension and blood stasis. The surgical procedure was started as soon as an analgesic affects riches at level T10. Then the patients turned to prone position with a pillow under their head. Oxygen (2-3 L/min) was given via a nasal cannula. After turning back, the patient in prone position could watch a video clip and hear its sound with a handset free (DVD player with 10 inch LCD screen/LG DP-1400T). The patients could choose their favorite video clip among different cases. Subjects were monitored non-invasively for blood pressure, peripheral oxygen saturation (SPO2) and electrocardiography evaluations (Datex Ohmeda/Finland) before insertion of needle, 1, 2, 3, 5, 10, 15 minute later and after arriving in the recovery and finally after releasing from recovery. In all patients, systolic and diastolic blood pressure, pulse rate and SPO2 were measured and recorded in the questionnaire chart. If nausea and vomiting occurred were treated by administration of 10mg metoclopramid. Other parameters including ephedrine and atropine injection, patient satisfaction (1-10, 10 was full satisfaction and 1 was the worst) and stress (1-10, 1 was no stress and 10 was the most stress can be experienced in their life) were recorded. All data and finding were statistically analyzed by SPSS-16 Software.


  Results Top


Of the 80 patients with LDH, 53 patients were male and 27 female. The mean age for all patients was 44 year. The sex and age did not show any significant difference between two groups. The duration of hospital stay for all of the patients in two groups was 48 hours. Complication such as death, systemic or local infection, major or minor neurological deficits and anesthesia complication didn't occur.

The systolic blood pressure (SBP), diastolic blood pressure (DBS), mean arterial pressure (MAP), pulse rate (PR) and arterial blood saturation (SPO2) were measured before, during and after the operation. SBP, DBP, MAP, PR and SPO2 were measured just before the lumbar puncture and after one, three, five, ten, and fifteen minutes and at the time of patients' arrival at recovery room and immediately before discharge of patients from recovery. All of the results are shown in [Table 1] and [Table 2].
Table 1: Values of SBP, DBP; before lumbar puncture and after one, three, five, ten, fifteen after LP and at the time of patients' arrival at recovery room and immediately before discharge of patients from recovery

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Table 2: Values of SPO2, before lumbar puncture and after one, three, five, ten, fifteen after LP and at the time of patients' arrival at recovery room and immediately before discharge of patients from recovery and amounts of bleeding, duration of operation and ephedrine administration

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Duration of the operation in group one and two were 56 and 57.5 minutes respectively which didn't show any significant difference ( P=0.625). The mean volume of bleeding during the operation in group one and two were 69.25 cc and 90 cc ( P=0.031).

Six patients suffered from nausea in two groups, four in video presentation and two in non-video ( P=0.338) but vomiting didn't occurred at all.

According to [Table 3], stress was highly meaningful in non-video presentation group ( P=0.001). On the other hand, satisfaction was highly meaningful in video presentation group ( P=0.002).
Table 3: Frequency of intra‑operative patients' stress according to 1 to 10 scale in two groups

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For atropine and ephedrine administration there was not any differences between two groups (atropine, P=0.247 and ephedrine P=0.596).

Ephedrine was injected when it was necessary during the operation to overcome hypotension. However, there was not any significant difference between two groups ( P=0.596).


  Discussion Top


Lumbar disc herniation is one of the most frequent operations in the field of spine surgery. [2],[3] With evolution that had occurred in field of neuroanesthesiology most of the surgeons prefer regional methods instead of general anesthesia. On the other hand, many patients have tremendous phobia of spine anesthesia because they claim that one could hear the sounds of operating room and also see what is going on at their surroundings.

Meanwhile, the consciousness of the patients could be in some aspects troublesome, for example the patients may suffer from hearing the common dialogues between operating room crew including anesthesia and surgical stuffs, as well as incomprehensive sound of operating rooms such as anesthesia monitoring and surgical equipment's sounds. [4],[5],[7]

The problem of patients hearing had been the subjects of many clinical studies, with more or less advantageous successes. [1],[6],[8],[9] Although it is possible to mask the hearing ability of the patients by different techniques [6],[8],[9] but they could still see what is happening in the operating room and this is the points of view that have not been included in other studies.

Although, in study of Maeyama et al. they used Bispectral index monitoring (BIS) and interview type psychology test, State Trait Anxiety Inventory (STAI), to estimate music-therapy on reducing anxiety but still the vision of the patients wasn't considered in their conclusion. [2] To reduce attention of the patients propofol sedation is helpful [1] and meanwhile playing music or blocking noise can reduce BIS. [1] It seems that sedation could decrease the attention of patients may be partially by reduction of their vision.

The sedative effects of music play were also evaluated by other studies with more or less beneficial effects by BIS during target-controlled infusion with administration of propofol. [1],[3]

Although, the music itself or by masking the operating room noise could decrease the anxiety of patients or even reduce the dosage of intraoperative sedative requirements in other studies. [4],[5],[7] We believe that by displaying video clip it is possible to not only reduce the attention of the patients but also to provide a favorable operating room ambiance for them. In our study we didn't use any kinds of sedative because it could have a disadvantageous effect on patients hemodynamic but also reduce the attention of patients to enjoy from watching video clip. Applying different methods for reduction of patients to what is going on in operating room had more or less favorable results, [6],[8],[9] so as an alternative way, we decided to attract the patients' look to a DVD player monitor while it's showing their favorite video clip.

Our records during surgery showed that the mean of systolic and diastolic blood pressure at the end of the surgery was significantly lower in video group ( P=0.045 and 0.004).

Systolic Blood pressure differences between 3 rd and 5 th and the end of the surgery with minute zero was significantly less in video group ( P=0.025, 0.018 and 0.030).

Diastolic blood pressure differences between 3 rd 5 th and the end of the surgery with minute zero was significantly less in video group ( P=0.051, 0.019 and 0.15).

Pulse rate differences between first, 3 rd , 5 th and exactly before leaving the recovery room with minute zero was significantly less in video group ( P=0.015, 0.028, 0.030 and 0.008).

There was no significant difference between nausea and vomiting ( P=0.338 and 0.224).

Patient satisfaction was significantly more and stress was significantly less in video group ( P=0.000 and 0.002).

Only one patient in the non-video group was treated with intraoperative atropine.

There was no difference between partial blood saturation in two groups.

The amount of bleeding during surgery was significantly more in non-video group ( P=0.041).


  Conclusion Top


According to our study we believe that by displaying patient's favorite video clip during the surgical intervention we could highly reduce their attention to what is happening in the operating room and therefore decrease their anxiety and stress. By this means, we could divert the hearing abilities of the patients as well as their vision.

 
  References Top

1.Kang JG, Lee JJ, Kim DM, Kim JA, Kim CS, Hahm TS, et al. Blocking noise but not music lowers bispectral index scores during sedation in noisy operating rooms. J Clin Anesth 2008;20:12-6.  Back to cited text no. 1
    
2.Maeyama A, Kodaka M, Miyao H. Effect of the music-therapy under spinal anesthesia. Masui 2009;58:684-91.  Back to cited text no. 2
    
3.Zhang XW, Fan Y, Manyande A, Tian YK, Yin P. Effects of music on target-controlled infusion of propofol requirements during combined spinal-epidural anaesthesia. Anaesthesia 2005;60:990-4.  Back to cited text no. 3
    
4.Ayoub CM, Rizk LB, Yaacoub CI, Gaal D, Kain ZN. Music and ambient operating room noise in patients undergoing spinal anesthesia. Anesth Analg 2005;100:1316-9.  Back to cited text no. 4
    
5.Koch ME, Kain ZN, Ayoub C, Rosenbaum SH. The sedative and analgesic sparing effect of music. Anesthesiology 1998;89:300-6.  Back to cited text no. 5
    
6.Irgens J. Alternative for sedation? Music via headset during surgery. Sykepleien 1984;71:12-5.  Back to cited text no. 6
    
7.Lepage C, Drolet P, Girard M, Grenier Y, DeGagne R. Music decreases sedative requirements during spinal anesthesia. Anesth Analg 2001;93:912-6.  Back to cited text no. 7
    
8.Cornell EL. Music as a diverter in local or spinal anesthesia and analgesia. Am J Obstet Gynecol 1948;56:582.  Back to cited text no. 8
    
9.Uhrbrand B, Juncker Y, Pedersen J, Hartmann-Andersen JF. Music during surgery for patients with spinal anesthesia. Ugeskr Laeger 1988;150:1664-6  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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