title: Skin surgery under local anesthesia leads to stress-induced alterations of psychological, physical, and immune functions.
abstract: BACKGROUND
  Although excision of nevi under local anesthesia is a frequent and harmless operation, it apparently causes increased stress in many patients. However, thus far no studies have focused on the question of whether there are measurable effects on psychological, physiological, and immunological parameters.
  
  
  OBJECTIVE
  To assess the perioperative stress reactions of patients undergoing skin surgery under local anesthesia for nevocellular nevi.
  
  
  METHODS
  Fifty consecutive patients with pigmented nevi were examined at five points of measurement: 1 week and 30 minutes before the operation, during the operation, 30 minutes and 1 week after the operation. Somatic parameters included blood pressure, pulse, respiratory rate, and the level of pain. Lymphocyte subpopulations, white blood cell count, and cortisol in saliva were determined. Anxiety and general psychological distress were evaluated with validated questionnaires.
  
  
  RESULTS
  There was a significant increase in anxiety at the time of surgery. In parallel, the physiological parameters as well as the CD56+ lymphocytes changed significantly. Preoperation anxiety and intraoperation pain were significantly higher in women (P <.001), but did not depend on age.
  
  
  CONCLUSIONS
  There appears to be an interaction between physiological and emotional components in the operative stress reaction under local anesthesia. In patients with skin cancer, the perioperative stress may lead to transient impairment of immune function.
authors.affiliation: Department of Dermatology, University Clinics of Freiburg, Germany. augustin@haut.ukl.uni-freiburg.de
authors.forename: M
authors.initials: M
authors.lastname: Augustin
authors.forename: I
authors.initials: I
authors.lastname: Zschocke
authors.forename: N
authors.initials: N
authors.lastname: Godau
authors.forename: A
authors.initials: A
authors.lastname: Buske-Kirschbaum
authors.forename: M
authors.initials: M
authors.lastname: Peschen
authors.forename: B
authors.initials: B
authors.lastname: Sommer
authors.forename: G
authors.initials: G
authors.lastname: Sattler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D001007:Anxiety / Q000209:etiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007108:Immune Tolerance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000523:psychology*; D009508:Nevus, Pigmented / Q000601:surgery; D010807:Physical Endurance / Q000502:physiology*; D011379:Prognosis; D012878:Skin Neoplasms / Q000601:surgery; D013315:Stress, Psychological / Q000209:etiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires