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Relaxing the patient

A relaxed patient means a more relaxed surgery

Roibeard O’hEineachain

Posted: Tuesday, September 1, 2020

Relaxing a patient who is undergoing surgery reduces their stress and that of the surgeon and can be best achieved with a coherent and consistent team-based approach, said Andrew Presland FRSA, PhD, at the 37th Congress of the ESCRS.

“My hypothesis is that a relaxed, comfortable patient, tended by caring professional colleagues and surrounded by an experienced familiar team, results in a relaxed surgeon,” said Dr Presland, of Moorfields Eye Hospital, London, UK.

Relaxing the patient ideally begins before the day of surgery, he noted. Patients should receive succinct information, free of jargon, on what to expect in their surgical experience. Consideration must also be taken of language barriers. The surgical team needs to have a common understanding of the objectives and limitations.

“Expectation management is the single most important concept. Getting this wrong – at any stage – sows the seeds of dissatisfaction,” Dr Presland said.

Expectation management is relevant to general anaesthesia but more relevant to local anaesthesia. The local anaesthetic should be sufficient on its own for the patient’s comfort, as sedation and deep breathing is a poor substitute. Patients must also understand what is and what is not normal light touch and pressure.

During surgery it is best to avoid medical terms, he said. For example, instead of saying “I’m going to put a speculum in your eye”, perhaps say “I’m going to place a clip to keep your eyelid where I need it”, Dr Presland suggested.

Reassurance measures such as hand-holding can help relax the patient, as can ambient music. Patients with experience with self-hypnosis, progressive muscle relaxation and mindfulness techniques can also use those approaches to achieve further relaxation.

He added that the person administering sedation needs to consider such factors as the length of the procedure and the invasiveness of the procedure. In addition, one practitioner should be dedicated to monitoring the patient both during and after surgery. Dr Presland stressed that an over-sedated patient is much more difficult to deal with in a surgical situation and requires postoperative recovery facilities.

“Expectation management is absolutely key. You have to tailor your approach to the patient and the circumstances that you find yourself working in. Fostering a team approach that is coherent and consistent is going to achieve success,” Dr Presland summarised.

Andrew Presland: a.presland@nhs.net