Psychosomatic Medicine 18:243-251 (1956)
© 1956 American Psychosomatic Society

Response During Anesthesia and Surgery

Effect of Psychological Factors

¹ Veterans Administration Hospital, Fort Lyon, Colo.

This research received its impetus from the occurrence of several cardiac arrests during surgery, with attendant newspaper publicity, plus the more frequent situation in surgical suites of highly unstable cardiac and cardiovascular response without demonstrable organic causation. The empirical evidence of the importance of the effects of psychological factors in surgical response led to the hypothesis that there is a relationship between psychological or personality factors and stability of response during surgery.

Four classes of variables were identified: (1) "predictor" variables or psychological and/or physiological measurements of preoperative patients, (2) predictions made by clinical psychologists using the psychological measures in an effort to forecast the surgical stability, and the "criterion" variables of (3) physiological measurements made during surgery, and (4) clinical evaluations made by anesthesiologists using these measures. Thus it was possible to search for relationships between any of the factors considered pertinent.

After a sample of psychological variables and tests to measure them were selected, 25 patients were examined preoperatively. Clinical psychologists attempted to predict the patients' stability of response in the operating room by using only the psychological test protocols. Patients were given extra clinical tests to assure normal physical status, and their surgical and anesthesiological management was standardized. Comparable types of surgery were performed on the patients. Physiological measures taken during surgery were evaluated by anesthesiologists who determined the stability of surgical response.

Spearman rank-difference correlations (rho) were computed between the ranked measures of the four classes of variables, and the following conclusions were suggested:

The study demonstrated the possibility of finding a relationship between psychological factors and patient response to surgery under anesthesia.

Rorschach reaction time, deformed responses on the Rorschach, and cold pressor test results appeared to show promise for continued investigation of specific factors which may help to predict unstable response during surgery.

Clinical psychologists utilizing a variety of psychological test protocols were able to predict somewhat in excess of chance not only the physiological surgical stability but also the evaluations of anesthesiologists of patients' clinical stability.

There was objective confirmation of the importance of changes in systolic blood pressure as a major index used by anesthesiologists.

Further research effort is being applied to extend the investigation by the author, and it appears that interest may have been generated elsewhere to assist surgeons and anesthesiologists in one of their major problems.