Characteristics of Patients Who Need Hypnotics on the Night before Elective Surgery

Lee, S I; Yoon, J S; Lee, H Y

Abstract

OBJECTS: This study was carried out to investigate characteristics of patients who need hypnotics on the night before elective surgery as well as contributing variables for the necessity of hypnotics.
METHODS
After reviewing the clinical charts of patients who were scheduled to receive surgery by general anesthesia the following day, researchers had semistructural interviews with patients. In addition, Spielberger's State-Trait Anxiety Inventory(SSTAI), Beck Depression Inventory(BDI), Zung's Self-Rating Pain and Distress Scale (ZPDS), and Presleep and Postsleep Questionnaires were administered to patients. A total of 167 patients, who gave reliable information, were divided into two groups based on subjective judgement regarding the necessity for hypnotics on the night before surgery; 29 eligibles for hypnotics and 138 non-eligibles for hypnotics. Demographic and clinical characteristics of patients, some possible factors affecting sleep, psychological characteristics of patients and daytime status and nighttime sleep before surgery were compared between the two groups. In addition, discriminant function analysis was done to find the variables which would best discriminate among patients who differ in terms of necessity for hypnotics on the night before surgery.
RESULTS
There was no difference in demographic and clinical characteristics between the two groups; however, the satisfaction level with ward environment was significantly lower in the eligible group for hypnotics than the non-eligible group. Psychologically, the eligible group for hypnotics, compared to the non-eligible group, showed significantly more severe depression, pain, and distress; whereas anxiety level was not different between the two groups. For nighttime sleep before surgery, the eligible group for hypotics, compared to the non-eligible group, expected poorer sleep before retiring and in fact, reported poorer sleep the following morning. In discriminant function analysis,'expectation for sleep' and 'pain and distress' were the most potent contributors to discriminate the necessity of hypnotics.
CONCLUSION
For the improvement of the patient's sleep on the night before elective surgery, giving hypnotics and/or analgesics should be determined by patient's opinion about the necessity of the drugs rather than by the therapist's own judgement or any other objective indices.