Managing anxiety before an operation

I am feeling very anxious about my operation. What can I do?

It is very common to be anxious before an operation. There is much you can do, however, to help yourself at this time.

If it is your first time having an operation, it is usually helpful to find out more about going into hospital. There are many resources here on the patient information part of the website to help you.

You can also read some information about your operation. There is a lot of information you can read in leaflets or on the internet, as well as video clips you can watch online. It is important, though, to use reliable and evidence based information – internet browsers can bring up unreliable information on rare side effects that could scare you unnecessarily. The hospital will give you useful information to read. It will usually also suggest some recommended websites or links that you can visit. Organisations that have been awarded the Patient Information Forum tick logo (as we do at the RCoA) have been shown to produce reliable and well-researched information for patients.

You will usually be invited to see a nurse or anaesthetist for a preoperative assessment visit. This is your opportunity to ask questions and say what you are worried about. Consider writing your questions down before you go so you don’t forget them. Don’t worry if you think that your questions aren’t very good, as all questions are important and staff are very used to explaining what will happen and the choices you have.

Your nurse will give you an information sheet to remind you of what to do before you go into hospital, as it is easy to forget if you are anxious. If your anxiety is very severe, mention it to your anaesthetist who may sometimes be able to offer you a sedative before your operation.

If you have mental health problems, it is important that you talk to your nurse about these and anything that can affect this. If you are taking medication for mental health problems it is important to let the nurse at the hospital know about your medication. They will usually not want you to stop this. They can help organise any particular support you need for your time in hospital or return home.

In the time before your operation, it can help to exercise and eat healthily if you are able to. It is good to spend some time with friends or family and focus on planning for when you are home after the operation (so you do not need to worry when you are in hospital about, for example, childcare, paying bills). If you ask friends or family to help you with childcare, they may need to arrange time off work.

Many techniques including mindfulness, relaxation and breathing exercises or yoga could help you relax before and after your surgery. You can often find helpful information on line or on YouTube or a nurse at your surgery may be able to help you find some useful resources.

It is useful to plan ahead and organise things to take into hospital to keep your mind occupied. You might want to read a book, listen to music through headphones or take some magazines to read. Try to imagine yourself recovering calmly and doing well – perhaps reward yourself with something special to look forward to when you get home.

For more information, please see our Fitter Better Sooner resources.

I don't like needles – what happens when I go for surgery?

It is normal to have some anxiety about needles. Most people have concerns that they will feel pain when a needle is put into a blood vessel or other part of the body. That’s normal.

Some people can have more severe anxiety or a phobia. In most cases healthcare professionals can help people who are afraid of needles so they can have the procedure they need.

If you are having an operation or procedure it is likely that your healthcare team will need to use needles. You may need some blood tests before your surgery and you will also need a cannula (a thin plastic tube that goes into a blood vessel) for your operation. The anaesthetist will use this to give you the anaesthetic and medication you need during surgery.

It is important to try and manage your fear or phobia and seek help well in advance of your planned operation. You can speak with your GP about any support available in your area. Psychotherapy or support from a mental health professional may be recommended for those who have severe anxiety or phobia.

When you meet your preoperative assessment nurse at the hospital, it is important to think about what you are worried about and discuss your concerns with him/her. It’s a good idea to write your questions down so you don’t forget to ask.

If you worry about pain, you can discuss whether you could have some local anaesthetic cream to numb the area. Be aware though that this may take 40 minutes or so to work.

If healthcare professionals have found it difficult to take blood or put in a cannula in the past, it can be helpful to say which vein usually works best. Veins can be more difficult to find if you have had chemotherapy or have needed many cannulas in the past. Veins can be more difficult to find in people who have obesity. An anaesthetist might be able to use an ultrasound machine to see where the veins are, which can make inserting the needle easier and quicker.

If you are worried that you become very anxious or have a tendency to faint, you should tell the staff. They may suggest that you lie down, and they will talk to you to help you relax and to distract you. You might find that watching something on your phone/tablet may help. Try to take deep slow breaths and look away.

More rarely, if the fear or phobia cannot be easily managed, your anaesthetist may discuss the option for starting your anaesthetic by breathing the anaesthetic gas through a mask. They will then put the cannula in when you are anaesthetised. However, this option is not suitable for every patient. There can be risks when starting your anaesthetic this way, especially if you have obesity or acid reflux and your veins are not easy to find. You will need to discuss with your healthcare team if this option is possible for you well in advance of the operation.

Guy’s and St Thomas’ Hospital has a guidance leaflet for patients to help them overcome fear of needles which can be accessed here.