Preoperative Anxiety

Moegi Tanaka et al. (2021) · PloS one

This randomized controlled trial with 77 analyzed women explored whether Yokukansan, a traditional Japanese Kampo herbal formula, can reduce anxiety around breast cancer surgery. Kampo is the Japanese adaptation of traditional herbal medicine, and Yokukansan combines seven herbal extracts that are traditionally prescribed for irritability, restlessness, and insomnia. Perioperative anxiety (anxiety in the period around an operation) matters because the authors link it to faster heart rate, higher blood pressure, longer postoperative pain, and a higher risk of postoperative delirium. Common anxiety medicines such as benzodiazepines can cause sedation, which is why a short-course herbal option was tested. Women aged 20 to 60 undergoing partial or total mastectomy at two Niigata hospitals in Japan were randomly assigned to a Yokukansan group or a control group. The Yokukansan group took two 2.5 g doses of a standardized extract granule, one at bedtime the night before surgery and one 2 hours before anesthesia; the control group received water. Anxiety was measured objectively with salivary alpha-amylase (an enzyme that rises with stress) and subjectively with two questionnaires, the Hospital Anxiety and Depression Scale and the State-Trait Anxiety Inventory. Pain was rated on a 100-mm scale the day after surgery. Salivary alpha-amylase just before surgery was lower in the Yokukansan group than in controls (0.88 versus 1.14 on a log scale, p = 0.03), meaning a smaller physiological stress signal at that moment. HADS-Anxiety scores dropped by 2.77 points with Yokukansan and 1.43 points in controls (both significant, though the difference between groups did not reach significance, p = 0.083), and the authors suggest part of the drop may reflect reassurance once surgery was complete. Trait anxiety on the STAI fell by 4.23 points with Yokukansan and did not change in controls (p = 0.92), with a significant group-by-time interaction (p = 0.009). On both questionnaires higher scores mean more anxiety, so falling scores indicate improvement. Pain scores were nearly identical (1.4 versus 1.36, p = 0.70), and no adverse events were observed. The authors suggest two preoperative doses may reduce perioperative anxiety and that further research is justified. Several limitations apply. Patients knew which group they were in because no matching placebo exists for Kampo medicines, so reassurance may explain some of the effect. Salivary alpha-amylase measures stress generally, and the analyzed groups fell short of the planned size, leaving statistical power at 0.708. Pain was low in both groups, so any pain effect remains untested. Larger double-blind, placebo-controlled trials, including more invasive surgeries, are called for.

Katarzyna Janda et al. (2020) · Nutrients

This systematic review pooled nine randomised clinical trials to ask whether passionflower (Passiflora incarnata) helps with anxiety, sleep and related neuropsychiatric symptoms. Passionflower is a perennial climbing vine whose aerial parts, flowers and fruit are used medicinally, and whose activity is attributed to flavonoids such as apigenin and luteolin and to flavonoid glycosides including vitexin and isovitexin. The European Medicines Agency recognised it as a medicinal product in a 2014 herbal monograph. The review frames the problem as stress — the body's response to physical and psychological stressors, which becomes pathological when prolonged and can impair concentration and memory. The authors searched PubMed, Embase and ClinicalTrials.gov to October 2019 and screened 417 records down to nine trials run between 2017 and 2019, five of them in Iran. Participants were all adults, between 16 and 128 per trial, and eight of the nine trials enrolled healthy volunteers rather than diagnosed patients. Preparations varied widely — drops, tablets, syrup, a standardised extract and herbal tea — over periods from a single day to 30 days. Anxiety was measured with instruments including the State-Trait Anxiety Inventory and the Corah Dental Anxiety Scale, sedation with the Ramsey scale, and sleep with polysomnography. Most trials found reduced anxiety, though the benefit was smaller in people whose anxiety was mild to begin with. In generalised anxiety disorder, 45 drops daily for 28 days matched oxazepam without impairing work performance. Before surgery, 500 mg tablets lowered anxiety more than oxazepam, and a 700 mg per 5 mL syrup given 30 minutes before spinal anaesthesia reduced anxiety with haemodynamics unchanged. Compared with midazolam before wisdom-tooth extraction, 260 mg gave similar calming with markedly less somnolence (50% versus 82.5%) and no amnesia at all, against 20% on midazolam — although more participants would still choose midazolam again (52% versus 27.5%), which the authors attribute to that same amnesia preventing negative memories. Herbal tea drunk nightly for a week improved self-reported sleep quality by 5.2% over placebo. No adverse effects, memory loss or collapse of psychometric function were reported anywhere in the review. The practical reading is that passionflower performs comparably to two established sedatives for procedural anxiety, with a different side-effect profile — less somnolence, no amnesia — which may matter where alertness is wanted afterwards. The evidence is genuinely limited, though: nine small trials, too heterogeneous to pool statistically, three of them rated low quality, and most never recorded which part of the plant was used. Its anxiolytic action is thought to work through the GABA system. Larger trials across more varied populations are needed before firm dosing guidance is possible.