Comparing the Effects of Rose Essential Oil and Benson Relaxation Technique on

* Corresponding Author: Ebrahim Nasiri, PhD. Address: Department of Anesthesiology, Operating Room, Traditional and Complementary Medicine Research Center, School of Allied Medical Sciences, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. Tel: +98 (911) 1517836 E-mail: ebrahimnasiri7836@gmail.com 1. Department of Operating Room, Medical Student Research Committee, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran. 2. Department of Anesthesiology, Operating Room, Traditional and Complementary Medicine Research Center, School of Allied Medical Sciences, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. 3. Department of Plastic and Reconstructive Surgery, Mazandaran University of Medical Sciences, Sari, Iran. 4. Department of Anesthesiology and Operation Room, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran. Maliheh Shirzad1 , *Ebrahim Nasiri2 , Mohammad Hossein Hesamirostami3 , Hooshang Akbari4


Introduction
hinoplasty is a stressful and challenging method among plastic surgeries. Anxiety R before this surgery is an important problem for patients and the care and treatment team have always tried to reduce or eliminate this problem with appropriate methods. Concern of rhinoplasty candidates about maintaining the beauty of the nasal structure is also very important which can cause their anxiety. According to Shauly et al. [3], about 57.84% of Rhinoplasty candidates suffer from anxiety in the preoperative stage. Anxiety causes a person to respond to a threatening condition and its increase causes physiological changes and the secretion of catecholamines which causes adverse changes in the person's heart, arteries and hemodynamics. Optimal control of anxiety before surgery helps maintain hemodynamic stability and appropriate conditions during surgery and recovery and faster discharge from the hospital. There are various pharmacological and non-pharmacological methods for controlling preoperative anxiety, but various complications such as fatigue, dizziness, restlessness, and respiratory and cardiovascular complications have been reported. Iranian traditional medicine sources consider mental stability as one of the six principles of health and relaxation of body and soul, and suggest medicinal plants to be suitable and useful for creating mental stability and relaxation.. This study aims to compare the effect of rose essential oil and Benson Relaxation Technique (BRT) on anxiety and hemodynamics before rhinoplasty.

Materials and Methods
In this interventional study, participants were 68 patients who were candidates for rhinoplasty referred to Zare Hospital in Sari, Iran. After obtaining their consent, they were randomly divided into two groups of Aromatherapy (n=34) and BRT (n=34). Inclusion criteria were: age 18-40 years, ability to understand Persian language, hospitalization at least 4 hours before the intervention, having consent, no hearing or vision problems, no muscle paralysis, and no history of relaxation therapy. Exclusion criteria were sensitivity to rose essential oil, eczema, and having any unpleasant side effects. The sample size was determined 34 for each group with 95% confidence interval and considering beta error of 20% and a sample drop of 10% based on a similar study. Demographic and clinical characteristics and anxiety in both groups were recorded two times, 3-5 hours and 30-60 minutes before surgery. Hemodynamic status was measured before and after the intervention using a digital sphygmomanometer. Anxiety before and after the intervention was assessed by Spielberger's State-Trait Anxiety Inventory. Intraoperative bleeding, agitation in recovery, nausea and vomiting were also assessed 24 hours after surgery. T-test or Mann-Whitney U test were used for analyzing quantitative variables and Chi-square test was used for qualitative variables.

Results
The results showed no significant difference between the two groups in terms of gender, age, educational level, and occupation. Systolic and diastolic blood pressure decreased more in the aromatherapy group than in the BRT group. The number of pulses between the two groups after intervention was significantly different (P=0.038). The Mean±SD rate of intraoperative bleeding was 18.6±2.4 ml in the BRT group and 18.2±3.8 ml in the aromatherapy group (P=0.626). Nausea and vomiting and surgeon satisfaction during the surgery were similar in the two groups. The level of overt and covert anxiety in both groups was significantly reduced compared to pre-intervention scores where the level of reduction was higher in the aromatherapy group (Table 1). The mean score of overt anxiety in the pre-and post-intervention stages decreased by 8.9(20.4%) in the BRT group Paired T test results showed significant differences before and after intervention in both groups (P<0.001). The mean score of covert anxiety in the pre-and post-intervention stages decreased by 9.7(20.8%) in the BRT group and by 12.7(27.2%) in the aromatherapy group. Paired T test results showed that this difference before and after intervention in both groups was significant (P<0.001).

Conclusion
Due to significant effectiveness of rose essential oil and BRT in reducing preoperative anxiety and maintaining the hemodynamic status of Rhinoplasty candidates, their use is recommended.

Compliance with ethical guidelines
This study obtained its ethical approval form the ethics committee of Mazandaran University of Medical Sciences (Code: IR.MAZUMS.REC.1398.1445).

Funding
This study was extracted from the MSc thesis of first author at the Department of Operating Room, School of Allied Medical Sciences, Medical Student Research Committee, Mazandaran University of Medical Sciences, Sari.