Effect of a Bundle of Non-pharmacological Interventions on the Stress Response to Surgery

Rationale: Surgical trauma and post-surgical pain induce a physiological stress response that can be detrimental to the patient. Non-pharmacological interventions aimed at stress reduction are known to reduce pain scores and opioid consumption. The effect of these interventions on the surgical stress response are unknown.Objective: To assess the effect of a bundle of non-pharmacological interventions implemented in the post-anesthesia care unit on the total serum cortisol levels after intermediate and major surgery.Study design: This is a prospective before-after study. Study population: Patients scheduled for intermediate or major oncological surgery in a tertiary referral cancer center.Intervention: The implementation of a bundle of four non-pharmacological interventions aimed at stress reduction in the post-anesthesia care unit. The bundle consists of: access to music, aromatherapy, natural images on the walls and ceiling and communication techniques aimed at reduction of stress and pain.Main study parameters/endpoints: Serum cortisol levels on the first postoperative day.

Inclusion Criteria:ASA 1-3scheduled for intermediate to major oncological surgerywith a minimum duration of 120 minsExclusion Criteria:Neuraxial anesthetic techniqueplanned for postoperative ICU admissionday case surgeryIndication for peri-operative steroidschronic use of steroidsBronchial hyperreactivity