Introduction
In the orthopedic operating theater at Bispebjerg Hospital approximately 5600 patients annually undergo surgery due to suffering in bones, joints and muscles. Accelerated patient flow has led to an increasing amount of surgical procedures being performed under local or regional anesthesia. As a consequence, the patient is exposed to anxiety-inducing sounds and visible impacts from the operating environment for a longer period of time.
Anxiety is common amongst surgery patients and a review estimates the prevalence to be between 21-77%. Anxiety can cause tachycardia, an increase in blood pressure, nausea and clammy sweating. Furthermore, the patient can feel increased sensitivity regarding touch, sound and smell prior to surgery. This physiological stress response may complicate postoperative progress, the immune system becomes suppressed and there is an increase in both the need for analgesics and the risk of chronic pain.

Aim
To examine the effect of non-pharmacological interventions on anxiety experienced in patients undergoing conscious surgery.

Methods
From October 2017 until May 2018 the database PubMed was reviewed for randomized controlled trials with anxiety in not critically ill adults undergoing conscious surgery as a primary outcome.

Results
The three studies included examined preoperative multimedia information and simple intraoperative distraction interventions such as music, DVD, stress balls, interacting with nurses and Bedscapes.

Discussion
All included studies showed limitations in terms of either the design of the intervention, the population examined or the use of measuring tools. However, the studies also indicates some positive effects as a consequence of interaction with nurses, by way of a distraction technique, and preoperative multimedia information.

Implication for practice
Though research in the area seems insufficient, this study highlights the importance of interacting with nurses and solid preoperative visual information. Therefore the operating theater at Bispebjerg Hospital should likely investigate the effect of these interventions upon a selected representative group of patients.

Non-pharmacological interventions to reduce anxiety in patients undergoing conscious surgery