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Stress and the Anaesthesiologist(June 2003)(June 2005)

Stress management in anaesthesia practice(Dec 2003)

Introduction

-Stress is thought as a negative ,producing psychological and

physiological ill health;but it is also positive because it enables a person

to respond effectively in new situations and to learn from them.

Definition

-Stress is response to a new stimulus which varies with each individual

and depends on previous experience and individual perceptions.

Response to stress

1)Behavioural-irritability,anxiety,depression,self-destructive

behavior,obsessive compulsive disorder,increased smoking,increased

alcohol intake,increased drug usage.

2)Physical-altered heart rate or rhythm,hypertension,weightloss/gain,sleep disturbance.

3)Personal response-poor concentration,lack of judgement,lack of

creativity.

Stress(per se)

1)Stress in patients-fear of the unknown

-fear of lack of control

-intensive care

2)Stress in relatives

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3)Stress in staff-anaesthesia

-ICU unit staff

1)Stress in patients

-Patient is about to undergo anaesthesia and surgery,are inevitably

anxious due to underlying fears;most common of which are-fear of

unkownand fear of not being in control.

-Measures to reduce stress should be aimed at reducing anxiety by

making the experience less new and by giving the patient as much

control as possible.

a)Fear of the unkown

*can be reduced by giving the patient ,information;and making the

experience less unknown.

*information needs to be delivered in a way that respects cultural and

religious differences.

*ways of dealing with fear of unknown-giving information

-anxiolysis

-guided imagery.

b)Fear of lack of control

-can be reduced by encouraging patients to participate in decisionsabout their management.

-ways of dealing with fear of lack of control-listening to music

-reassurance

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c)Intensive care

-Patient in the ICU are physiologically stressed by their illness,which is

augmented by infusing catecholamines.

-critically ill patients cannot communicate effectively.

-patients memories of intensive care include-anxiety

-depression

-passivity

-boredom

-fatigue

-outcome-(PTSD) post traumatic stress disorder

-can be minimized by allowing to express

-barriers to communication-tracheal intubation.

2)Stress in relatives

-relatives of a patient in hospital are stressed because,they are faced

with a new situation in a strange environment.

-support is vital for the relatives of the critically ill

-support can be given by ICU staff/relatives/friends

3)Stress in staff

-Groups-i)Managers/Doctors-less stress-due to achievement of aim and

feeling of being valued.

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ii)Nurses/Therapists-more stress-lack of sense of achievement

iii)Technicians-most stress-due to lack of direct patient contact.

-Anaesthesia

*Many doctors have Type A personality that renders them susceptible

to stress.

*Anaesthetists suffer from occupational stress

*Stressful elements include

i)lack of control at work

ii)Adminstrative responsibilities

iii)Work/Home conflict

iv)Strained professional relationship

v)work overload

vi)Money

vii)Teaching responsibilities

viii)Difficult work

ix)Peer review

x)Potential litigation

ICU Staff

*ICU staff suffer more from the perception of their career development

and from organizational bureaucracy,they cope with stress in more

emotional than logical ways.

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*Type A individuals characteristically suppress symptoms of fatigue and

may sacrifice their own and their families social needs to their pursuit

of a successful career.

OUTCOME OF STRESS

-Stress could have a negative outcome,when the stressful stimulus is

repeated and the individuals coping strategies are either overwhelmed

or cannot be employed effectively.