What can help relieve anxiety before surgery?

It is very normal to feel anxious before having an operation, especially the day or two beforehand, which are often spent in the hospital preparing for the operation. Sometimes people have day surgery, where they go to the hospital or practice, have the procedure and then go home on the same day. But even then it can be hard not to worry about the operation, the possible risks and the anesthetic beforehand.

Severe anxiety can cause unpleasant symptoms and stress. Typical symptoms include a pounding heart, a racing heart (fast pulse), irregular heartbeat, nausea, a nervous stomach, shortness of breath and sleep problems. These anxiety-related symptoms can be particularly worrying for people who have pain due to a heart condition. Anxiety can make pain worse, as well as making it harder to cope with the pain. But the physical signs of anxiety are usually not a sign that a heart condition is getting worse.

Anxiety also becomes a problem if it makes it harder to understand and remember important things you are told about the operation, such as advice about how to prepare for it or about recovering afterwards.

The first thing you can do to reduce anxiety is learn to understand how it affects you. Anxiety is a very strong feeling. One of its functions is to protect us from danger. So anxiety may stop you from getting into dangerous situations in the first place. It also prepares your body so you can defend yourself or quickly escape from the danger – a reaction also known as the “fight-or-flight response.” That's why anxiety increases your heart rate, increases your blood pressure and keeps you awake. But if there is no real danger, this response isn't helpful and can have negative consequences.

Over time, most people learn how to manage their own anxiety and handle frightening situations. They develop suitable strategies to cope with what is causing the anxiety. But going into the hospital and having an operation is often a completely new situation. Here they often need emotional and practical support from friends and family too.

People might cope with pre-surgery anxiety in very different ways: Some try to prevent anxiety or stress by getting information early on and talking with other people about their concerns. Others distract themselves by reading, or use exercise or relaxation techniques like slow and deep breathing. Several studies have suggested that listening to music before surgery can relieve anxiety. Music can help you relax and distract you. Different people will find different types of music helpful, depending on their personal taste in music.

There are some things that patients should be able to take for granted in a hospital: For example, that the staff understand the needs of the patients, waiting times are kept as short as possible, and the hospital stay is made as pleasant as possible.

Most hospitals provide contact with counselors, social workers or volunteers who offer support and assistance. The most suitable type of professional support will depend on what is causing the anxiety. For example, someone who is afraid of having an anesthetic will need a different type of support than someone who is mostly anxious about being in a hospital.

Relaxation techniques such as breathing exercises, meditation or muscle relaxation can be helpful. These techniques can be learned in classes or with the help of pre-recorded audio training courses.

Massages, acupuncture, homeopathy, aromatherapy or hypnosis are sometimes offered before surgery too. But they haven't been scientifically proven to help relieve anxiety before surgery.

People who are already in hospital the night before an operation are usually given medicine to help them sleep or a sedative to reduce anxiety. Benzodiazepines are often used for this purpose. These drugs reduce anxiety, help you to relax, and make you sleepy at the same time. They might also make you feel drowsy or nauseous. The sleep hormone melatonin is used in some hospitals. But this medication has only been approved for use in people who are 55 and older. The possible side effects include dizziness, nausea and headaches.

Sedatives are also given before the operation, usually in the last two hours before the anesthetic is given.

Studies show that melatonin can relieve anxiety before surgery. It seems to have an effectiveness similar to benzodiazepines.

It is important to tell your doctor if you already took a sedative before arriving at the hospital.

Many people who smoke tend to smoke even more when they’re feeling anxious. Even if that calms their nerves in the short term, smoking increases the risk of complications after surgery – particularly related to the wound-healing process. Starting nicotine replacement therapy one to two months before surgery can reduce the risk of complications.