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,weight loss/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

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 decisions about their management. -ways of dealing with fear of lack of control-listening to music -reassurance

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.

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.

*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.