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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the letter published by Sorensen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> We agree that patient anxiety is lower when dermatologic surgery is performed under local anesthesia&#46; It is our opinion&#44; that when training&#44; dermatologic surgeons are taught lots of technical procedures &#40;anesthesia techniques&#44; suture knots&#44; an array of closures with flaps or grafts&#44; Mohs micrographic surgery&#44; &#8230;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The fact that the surgeries are usually short &#40;with the exception of Mohs micrographic surgery&#41; and the patients is usually awake&#44; sometimes implies a sensation of easiness to the patient&#46; However&#44; in our opinion the patient feels pain or has bothersome sensations&#44; feels the blood running when the hemostasia is not good or even hears the surgical team discuss unpleasant things about the procedure causing on the short-term different degrees of anxiety&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Many dermatologists talk to the patients while operating&#44; namely talkesthesia&#44; however&#44; the effect of this on patient anxiety has not been studied&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to describe the degree of anxiety of two different ways of doing dermatologic surgery under local anesthesia with preoperative and postoperative visual analog scale for anxiety &#40;VAS-A&#41;&#46; From 1st of June 2020&#44; we randomized consecutive surgeries performed at Clinica Dermatologica Internacional &#40;Madrid&#44; Spain&#41; in two groups&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Group A patients were talked along during the whole procedure about general topics and classical music was playing on the background&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Group B patients were operated with the same music playing but the surgical team did not initiate any kind of conversation during the procedure&#46;</p></li></ul></p><p id="par0025" class="elsevierStylePara elsevierViewall">Inclusion criteria were patients that had not had previous dermatologic surgery in our center and underwent excisions with reconstructions either with flap or grafts with a minimum duration of 60<span class="elsevierStyleHsp" style=""></span>min&#46; None of the patients had anxiety problems in their past medical history nor were under anti-anxiety medication&#44; and all procedures were conducted by the same surgical team and the dermatologist conducted the conversation with the patient&#46; Patients were blinded&#46; All patients gave informed consent to fulfill the surveys and the study was conducted in accordance with the declaration of Helsinki and the pertinent regional laws&#46; The VAS-A scale was used because it has been used in similar designed articles&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and due to its application simplicity&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Results are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Group A patients were slightly older and had a higher Amsterdam Preoperative Anxiety and Information Scale &#40;APAIS&#41; score&#46; However preoperative VAS-A was higher on group B&#46; Anxiety decrease was better on group A&#46; Statistical analysis did not show any difference due to the sample size&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Preoperatory anxiety seems to be very variable among dermatology patients and VAS-A has been proved to show accurately the degree of anxiety in this group of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> Music has demonstrated in many studies that helps controlling patient&#39;s unpleasant sensations and anxiety throughout all the procedure&#44; from the waiting area to the postoperative care&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;5</span></a> In our study&#44; we go one step forward and hypothesize that talking to our patients can enhance the tranquilizing effect of music creating a relaxed atmosphere&#46; A limitation of our study is the lack of control group of only conversation and no music&#44; in order to establish the real effect of &#8220;talkesthesia&#8221;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We think this small and low-cost intervention helps increasing the patient satisfaction with the surgical team&#46; In this modern era where artificial intelligence and teledermatology are taking over&#44; showing closeness to our patients remains an important value&#46; Training new generations of dermatologist should include the art of conversation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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Case and Research Letter
The Art of Surgery Under Local Anesthesia. Conversation Reduces Anxiety: A Pilot Study
Claves para la cirugía con anestesia local. El diálogo con los pacientes reduce su nivel de ansiedad: un estudio piloto
P. Rodríguez-Jiménez
Corresponding author
pedro.rodriguez@clinicacdi.com

Corresponding author.
, F.J. Vicente-Martín, E. Tévar, R. Ruiz-Rodríguez
Clínica Dermatológica Internacional, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the letter published by Sorensen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> We agree that patient anxiety is lower when dermatologic surgery is performed under local anesthesia&#46; It is our opinion&#44; that when training&#44; dermatologic surgeons are taught lots of technical procedures &#40;anesthesia techniques&#44; suture knots&#44; an array of closures with flaps or grafts&#44; Mohs micrographic surgery&#44; &#8230;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The fact that the surgeries are usually short &#40;with the exception of Mohs micrographic surgery&#41; and the patients is usually awake&#44; sometimes implies a sensation of easiness to the patient&#46; However&#44; in our opinion the patient feels pain or has bothersome sensations&#44; feels the blood running when the hemostasia is not good or even hears the surgical team discuss unpleasant things about the procedure causing on the short-term different degrees of anxiety&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Many dermatologists talk to the patients while operating&#44; namely talkesthesia&#44; however&#44; the effect of this on patient anxiety has not been studied&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to describe the degree of anxiety of two different ways of doing dermatologic surgery under local anesthesia with preoperative and postoperative visual analog scale for anxiety &#40;VAS-A&#41;&#46; From 1st of June 2020&#44; we randomized consecutive surgeries performed at Clinica Dermatologica Internacional &#40;Madrid&#44; Spain&#41; in two groups&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Group A patients were talked along during the whole procedure about general topics and classical music was playing on the background&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Group B patients were operated with the same music playing but the surgical team did not initiate any kind of conversation during the procedure&#46;</p></li></ul></p><p id="par0025" class="elsevierStylePara elsevierViewall">Inclusion criteria were patients that had not had previous dermatologic surgery in our center and underwent excisions with reconstructions either with flap or grafts with a minimum duration of 60<span class="elsevierStyleHsp" style=""></span>min&#46; None of the patients had anxiety problems in their past medical history nor were under anti-anxiety medication&#44; and all procedures were conducted by the same surgical team and the dermatologist conducted the conversation with the patient&#46; Patients were blinded&#46; All patients gave informed consent to fulfill the surveys and the study was conducted in accordance with the declaration of Helsinki and the pertinent regional laws&#46; The VAS-A scale was used because it has been used in similar designed articles&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and due to its application simplicity&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Results are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Group A patients were slightly older and had a higher Amsterdam Preoperative Anxiety and Information Scale &#40;APAIS&#41; score&#46; However preoperative VAS-A was higher on group B&#46; Anxiety decrease was better on group A&#46; Statistical analysis did not show any difference due to the sample size&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Preoperatory anxiety seems to be very variable among dermatology patients and VAS-A has been proved to show accurately the degree of anxiety in this group of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> Music has demonstrated in many studies that helps controlling patient&#39;s unpleasant sensations and anxiety throughout all the procedure&#44; from the waiting area to the postoperative care&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;5</span></a> In our study&#44; we go one step forward and hypothesize that talking to our patients can enhance the tranquilizing effect of music creating a relaxed atmosphere&#46; A limitation of our study is the lack of control group of only conversation and no music&#44; in order to establish the real effect of &#8220;talkesthesia&#8221;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We think this small and low-cost intervention helps increasing the patient satisfaction with the surgical team&#46; In this modern era where artificial intelligence and teledermatology are taking over&#44; showing closeness to our patients remains an important value&#46; Training new generations of dermatologist should include the art of conversation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">APAIS&#58; Amsterdam Preoperative Anxiety and Information Scale&#58; MMS&#58; Mohs micrographic surgery&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex&#44; male &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgery duration &#40;mean&#44; min&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgery location &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
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ISSN: 00017310
Original language: English
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