Almost all patients have a feeling of fear before the upcoming operation under general anesthesia. This state is characterized by strong feelings that are completely inconsistent with the cause of fear. The occurrence of a phobia is influenced by eyewitness accounts of possible postoperative complications or the psychological trauma experienced while communicating with medical workers.
Name and description of the phobia
The fear of surgery is called tomophobia. The person is very worried about the upcoming surgical intervention, while he remains conscious and has no delusional thoughts or speech. The phobia can be so strong that a person may refuse the upcoming procedure.
Tomophobia paralyzes the will and causes a number of somatic and psychological problems. The person lacks confidence in the favorable outcome of the procedure. His imagination paints terrible pictures of the development of the situation related to the upcoming treatment. The phobia occurs immediately before surgery.
Fear of surgery is often uncontrollable. Fear has no rational basis, it is far-fetched and can cause an inappropriate reaction. Fear arises against the will of a person. At this moment he himself may realize that the upcoming operation is not dangerous and will most likely be successful. However, he cannot cope with anxiety on his own.
How to properly prepare for heart surgery (acquired heart defects)
Preparing for surgery
The thought of heart surgery frightens many people, and this is quite natural. The degree of fear you and your family feel depends on how aware you are of the surgery, the procedures you will need to undergo, and what you can expect during the recovery process.
To best prepare for surgery, strictly follow your doctor's recommendations regarding medications and physical activity.
Surgery and resuscitation period
The duration of heart valve surgery may vary. On average it lasts 5-6 hours.
In the operating room, measuring instruments will be attached to your arms and legs. Thin catheters will be inserted into the vein and artery; this procedure is usually painless. The anesthesiologist will administer an anesthetic, you will fall into deep sleep, you will not feel pain, and you will not remember the progress of the operation.
After the operation, you will be admitted to the intensive care unit. The duration of action of painkillers and sedatives varies; some people recover within a few hours after surgery; for most patients it takes longer.
At first you will only be able to hear and look, then you will be able to move, and gradually you will be able to fully control your body. During this time, you will have a breathing tube in your mouth. The breathing apparatus will help you until you can do it on your own. You will not be able to talk, but there will always be qualified personnel nearby with whom you can communicate using verbal and written signs. After removing the breathing tube, you will need to immediately begin doing breathing exercises; this will help avoid pneumonia and will be an important condition for a quick recovery.
Drainage tubes will be placed in the chest to prevent fluid from accumulating around the heart and will be removed 1-2 days after surgery.
Early postoperative period
After transfer to the department, the attending physician will determine the required degree of your activity, and 7-10 days after the operation, your stitches will be removed (2-3 stitches from the lower 1/3 of the wound), and the electrodes will be removed. The skin suture of a postoperative wound is usually cosmetic (intradermal), applied with absorbable thread.
Many patients complain of poor sleep, nightmares, weakened memory, tearfulness, and inability to concentrate for several days or weeks. These are common reactions after cardiopulmonary bypass that go away on their own within a few days or weeks.
If you have a mechanical valve implanted, then in the first days after the operation the doctor will prescribe you an indirect anticoagulant drug (warfvrin, phenylin, syncumar). Even a very good mechanical heart valve is a foreign body to the body and can contribute to the formation of blood clots. You will need to take anticoagulants for life. The effect of the drug should be monitored using a blood test - this is the Quick prothrombin index (PTI) and/or the international normalized ratio (INR). During your stay in the department, the doctor will select the necessary dosage of the drug for you to keep your blood counts within certain parameters (prothrombin index 35-45%, INR 2.5-3.5). If you have a mechanical prosthesis implanted in the tricuspid position, PTI should be 25-35%, INR 3.0-3.5.
In Russia, phenylin, warfarin, syncumar, and pelentan are commonly used. All drugs belong to the group of indirect-acting anticoagulants, but have different periods of accumulation and elimination from the body. When switching to a new drug, careful monitoring of blood tests and selection of the drug dose is necessary. The doctor will tell you how often it is necessary to monitor the blood test, but with the selected dose of the drug, the interval between control tests is 2-4 weeks.
What are anticoagulants?
Anticoagulants are medications that reduce blood clotting and thus prevent the formation of blood clots (thrombi).
Blood clotting is a physiological, protective reaction of the body to damage to the vascular wall. In this case, the resulting blood clot prevents bleeding. However, in some cases, blood clots can be dangerous for a person. They can form not only with traumatic damage to a vessel, but also in the cavity of the heart, for example, with atrial fibrillation (atrial fibrillation), or on artificial heart valves in patients who have undergone replacement. Such blood clots can disrupt the activity of the organ in which they develop, or break off and enter the vessels of other vital organs, clogging them and thereby disrupting their functioning. To prevent thrombotic complications (including in patients with artificial heart valves), it is necessary to thin the blood. It is for these purposes that anticoagulants are used.
Factors influencing the effectiveness of anticoagulants
The effectiveness of anticoagulant therapy can be affected by: diet, various medications, liver function, thyroid function, acute diseases, hereditary resistance to the drug.
DIET
Eating foods rich in vitamin K may lead to the development of resistance to the anticoagulant used. Clinically, this is rarely a problem, and patients can continue to eat foods containing vitamin K. However, it is worth remembering that changes in dietary intake of vitamin K may alter the effect of the drug, so it is recommended to consume such foods in a constant amount, or monitor blood clotting parameters more often . Some over-the-counter products contain vitamin K, so even infrequent or accidental use of this product may change the effectiveness of the anticoagulant drug.
Poor nutrition or poor absorption can lead to decreased vitamin K levels and increased anticoagulant effects. Any disease accompanied by intoxication, diarrhea, and vomiting can quickly lead to vitamin K deficiency and enhance the effect of the anticoagulant drug.
Amount of vitamin K in some foods:
| Product | Amount (µg/100 g) |
| Green tea | 712 |
| Spinach | 415 |
| Soybean oil | 193 |
| Broccoli | 175 |
| Salad | 129 |
| Cabbage | 125 |
| Liver | 93 |
| Cauliflower | 80 |
| Beans | 45 |
| Coffee | 38 |
| Cheese | 35 |
| Butter | 30 |
| Potato | 16 |
| Egg | 11 |
| Milk | 1 |
SOME EXAMPLES OF DRUG INTERACTIONS
They enhance the effect of indirect anticoagulant drugs - amiodarone (cordarone), ciprofloxacin, disulfiram, cimetidine, erythromycin, metronidazole, fluconazole, aspirin, metronidazole, omeprazole, ranitidine, sulfonamides, thyroid hormones, fluconazole, quinidine, glucagon, anabolic steroids.
Reduce the effect - barbiturates, cholestyramine, nafcillin, carbamazepim, rifampicin, vitamin K, paracetamol, oral contraceptives, haloperidol, antihistamines, antacids.
LIVER FUNCTION
Since all vitamin K-dependent factors are synthesized in the liver, any impairment of liver function can lead to an increase in prothrombin time, a decrease in the prothrombin index, even without therapy with anticoagulant drugs. When prescribing appropriate therapy, monitoring of these indicators should be more frequent.
Predisposition measures for anticoagulant treatment
An overdose of an anticoagulant drug is dangerous to the life and health of the patient. Indirect signs may include pinpoint hemorrhages and bruises on the body, bleeding gums, black stools, dark (red) urine, changes in the menstrual cycle in women.
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Reasons for fear of surgery
Tomophobia develops in people who are emotional, overly sensitive, and with a rich imagination. If a person grew up in a family in which from early childhood he was raised to perceive the world as a dangerous environment, then even just being in the hospital can cause anxiety or a panic attack.
Causes of phobia:
- negative experience of communication with medical workers;
- lack of complete information about the nature of the disease and the stages of surgical intervention;
- fear of not recovering from anesthesia;
- eyewitness accounts of negative consequences during or after surgery;
- possible negligence of medical staff;
- fear of waking up during surgery and feeling pain;
- mystical fear based on the fact that under the influence of anesthesia the soul is on the verge of death.
The development of a phobia is influenced by fear of the unknown, fear of losing a vital organ, remaining crippled or dying after unsuccessful surgical treatment. The cause of anxiety and panic may be a person’s good awareness of his condition and the understanding that in the postoperative period he will have to live for a long time on special medications that support normal body functions.
Stage 2. Examination
For the patient, this is a dreary and not very clear stage, however, for the doctor, the examination results carry very important information.
Before the operation, we conduct a clinical examination. We find out what diseases, injuries, and operations the patient has suffered. If there have been operations, we always examine the scars to understand how the patient’s wounds are healing. Indeed, during plastic surgery, the aesthetic result depends not only on the surgical technique, but also on the processes of skin regeneration (restoration).
We also find out if the patient has allergies, especially to medications. We ask whether the patient smokes, drinks alcohol, or takes medications. The conversation can be quite detailed, since many of the “little things” are actually very important.
This is followed by a laboratory examination. General and biochemical blood tests, a general urine test, determination of blood group and Rh factor, tests for infections (hepatitis, HIV, syphilis are the reason for refusal of surgery), fluorography and an electrocardiogram are required. Based on the results of the examination, we can, in general, judge the functioning of all body systems, which allows us to identify “weak points” that can become an obstacle during the operation.
In some cases, especially for operations on the abdominal wall, it is necessary to check the function of external respiration. If the abdominal volume decreases during the intervention, respiratory complications are possible subsequently, so a preliminary targeted examination is necessary. The fact is that when the pressure in the abdominal cavity increases, the contents of the abdomen begin to put pressure on the diaphragm - the main respiratory muscle - and prevent it from contracting during inhalation.
Finally, consultations with specialized specialists may be required, such as an ophthalmologist for eyelid surgery, an endocrinologist for removal of fat deposits, a mammologist for breast surgery, and others.
The duration of this stage depends on the number of consultations, but in multidisciplinary medical centers it is possible to examine the patient quite quickly. We receive the results of most tests the very next day.
Symptoms of tomophobia
Tomophobia can cause severe stress and even insomnia on the eve of surgery. There are a number of signs that characterize a phobia and correspond to neurological and vegetative-vascular symptoms. A person’s health deteriorates and somatic disorders arise.
Signs of tomophobia:
- rapid pulse;
- throat spasms or choking;
- increased sweating;
- fainting;
- gastrointestinal disorder;
- trembling of limbs;
- numbness;
- loss of sense of reality.
As the danger increases in a person's imagination, the feeling of fear before the operation increases. When in a phobic situation, people are sometimes unable to calm down or transfer their thoughts to something else. This condition complicates the work of anesthesiologists; due to abnormal heart rhythm and high blood pressure, they cannot calculate the dose of anesthesia.
How to overcome fear of surgery?
Every person has the right to choose. You can agree or refuse surgical treatment. If you disagree with the method proposed by the medical specialist, you must sign a refusal. This document will relieve the surgeon of all responsibility for a possible unfavorable outcome of the disease. If a person decides that he needs treatment, he should get rid of tomophobia on his own or with the help of a psychologist.
Ways to get rid of fear before surgery:
- distract yourself from frightening thoughts (watch a comedy movie, read a magazine or book);
- pray (in your thoughts turn to the Almighty, God and ask for a successful outcome of the operation);
- talk with the surgeon and anesthesiologist, find out everything related to the upcoming procedure;
- think not about treatment, but about what positive changes will come after it;
- do not listen to stories about unsuccessful surgical interventions, do not search the Internet for statistics of deaths after a specific type of operation.
A sincere conversation with a loved one, relative or friend will help get rid of negative thoughts before an important procedure. You need to talk about abstract topics not related to treatment. You can talk about work, plans for the future, upcoming vacation. The main thing is to distract a person from negative thoughts and instill in him faith in a positive outcome of the upcoming procedure.
Psychological attitudes
Preparing for surgery is a necessity. The less stable the patient is, the more time he needs for psychological preparation. How to reduce the level of fear before surgery:
- get distracted, do a monotonous task that requires attention;
- talk with loved ones and relatives;
- draw up a rehabilitation plan;
- come up with a small ritual that will serve as a signal to calm down.
The patient begins to delve into his own anxious thoughts if he has nothing to do. Boredom is a favorable environment for the development of fear. On the eve of the operation, the patient needs to spend his free time reading, playing games or watching interesting films. If he has no time left to think about possible consequences, the internal tension will go away.
Conversations with loved ones have a beneficial effect. These are people who know how to calm and support a patient. Planning for the near future, after surgery, will allow you to get used to the idea that anesthesia and surgery are only one of the stages of recovery. The inner attitude in such situations is very important.
Preparation before surgery - how to get ready and not be afraid?
To overcome the fear of surgery, you need to make sure that the surgeon is a professional who has saved many lives. For this purpose, it is necessary to collect information about the clinic where the treatment will take place and about the medical staff. A few days before the operation, you need to undergo preoperative preparation: take tests, fully examine the body, cure chronic diseases; go on a diet, give up bad habits.
How to overcome fear of surgery:
- do not panic, soberly assess your situation;
- tune in to a positive mood;
- take sedatives prescribed by a specialist.
It should be understood that surgical treatment with general anesthesia is the only way that can save life and restore health. You cannot be guided solely by fear of surgery to make a fateful decision. After surgical treatment, a person will have a chance for a healthy future. If surgery is not done, the disease may worsen.
