title: The power of words: sources of anxiety in patients undergoing local anaesthetic plastic surgery.
abstract: BACKGROUND
  With local or regional anaesthesia being employed for more as well as more complex surgical procedures, an increasing number of patients remain fully conscious during their operation. This is generally perceived as being advantageous to the patient as less time  is spent in hospital and the side effects of general anaesthesia are avoided. However, there is no direct measure of the patient experience during 'awake surgery', in particular of which aspects of the process may be distressing.
  
  
  METHODS
  Seventy patients undergoing day case plastic  surgery under local anaesthesia were asked to complete a short questionnaire immediately following their operation. This was designed to identify specific factors likely to either increase or reduce anxiety during surgery. The questionnaire was initially validated on a pilot group of ten patients.
  
  
  RESULTS
  Unsurprisingly, painful stimuli such as injections were identified as potential stressors. More interestingly, the data highlighted that some commonly used surgical terms such as 'knife' and 'scalpel' provoke considerable anxiety in the conscious patient. This varied according to age and sex  with younger and female patients being most vulnerable. Other events identified as potential stressors, such as casual conversations and movements among theatre staff, were actually shown to be non-stressful and, in some cases, stress relieving.
  
  
  CONCLUSIONS
  Technical jargon used  by surgical staff can elevate anxiety levels among patients who are awake for their operation. Careful consideration of the words we use may reduce this, particularly in female patients.
authors.affiliation: Mid Yorkshire Hospitals NHS Trust, UK. jennycaddick@doctors.org.uk
authors.forename: J
authors.initials: J
authors.lastname: Caddick
authors.forename: S
authors.initials: S
authors.lastname: Jawad
authors.forename: S
authors.initials: S
authors.lastname: Southern
authors.forename: S
authors.initials: S
authors.lastname: Majumder
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000523:psychology; D000772:Anesthesia, Local / Q000523:psychology*; D001007:Anxiety / Q000517:prevention & control*; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013511:Minor Surgical Procedures / Q000523:psychology; D019651:Plastic Surgery Procedures / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D009626:Terminology as Topic; D055815:Young Adult