More data needed for anxiety reduction in Mohs micrographic surgery

Personalized music may be a viable option for reducing perioperative anxiety in patients undergoing Mohs micrographic surgery, but more data are needed to determine its effects, according to a systematic review.

“Perioperative anxiety is associated with negative patient outcomes in Mohs micrographic surgery,” Angie Y. Wan, BA, of the department of dermatology at University Hospitals Case Medical Center, Cleveland, and colleagues wrote. “Both pharmacologic and nonpharmacologic therapies have been used to alleviate perioperative anxiety in [Mohs micrographic surgery].”

The researchers performed a systematic analysis of a number of databases — including PubMed, Medline, Cochrane Central Register of Controlled Trials, metaRegister of Controlled Trials, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform — to assess which interventions were used to reduce perioperative anxiety in this patient population.

The initial analysis yielded 183 abstracts. Of those, five met study protocols and were ultimately included.

Results from three of these studies showed that use of midazolam (Pfizer), educational videos or personalized music had an effect in reducing patient anxiety. Two of the other studies showed no such effect.

Looking closer at pharmacotherapeutic interventions, in one study, while midazolam yielded a decrease from baseline in anxiety among patients at 60 minutes, the effect was not present by 120 minutes.

Guided imagery was used as an educational tool in another study. Results showed that while patient anxiety did not decrease with a guided imagery program 4 days before surgery, anxiety among surgeons was reduced.

In one of the studies that used an educational video, a 19% reduction in anxiety was reported among patients who watched the video compared with those who did not.

Another study used a one-on-one phone call about the Mohs procedure as an educational intervention. No difference in anxiety was reported for patients who received the phone call compared with those who did not.

Of the two studies that employed music as an intervention, one yielded a statistically significant reduction in anxiety among patients who listened to personalized music, while the other showed that surgeons reported a decrease in anxiety in the operating theater.

“Overall, the biggest takeaway is that the evidence does not exactly strongly support the efficacy of interventions for reducing perioperative anxiety in patients undergoing [Mohs micrographic surgery],” Wan told Healio in an interview. “While midazolam and other anxiolytics might be useful, given the population of people who undergo Mohs, it may not be an acceptable tradeoff given the known risks of anxiolytics in elder populations. Music is the most promising avenue, given its low risk/buy-in, but would benefit from most robust studies.”

Wan then cited two other studies conducted by members of her group, one of which investigated the utility of a 3D model to improve patient understanding of the Mohs procedure and another that looked at educational videos. Neither study offered significant results in favor of these interventions in reducing periprocedural anxiety associated with Mohs micrographic surgery.

“These two studies are fairly in line with other studies across the board in terms of reducing pre-procedural anxiety, which is fairly resistant to a lot of education-based approaches,” Wan said. “They are also consistent with what we found in our limited sample of education-based methods in the paper.” – by Rob Volansky

Disclosures: The authors report no relevant financial disclosures.