Extended Abstract
1. Introduction
Preoperative anxiety is a part of the surgical experience and a pervasive problem [1] that affects patients’ health [2]. Anxiety could delay the patient’s recovery due to reduced ability to fight infections, delayed wound healing, and the exacerbation of stress [3]. Furthermore, the effective dose of analgesics and anesthetics increase with anxiety [4].
Previous studies have indicated that red rose essential oil has an antidepressant effect; therefore, it could be effective in treating postpartum depression and the symptoms of Premenstrual Syndrome (PMS). Additionally, applying rose essential oil has been effective in reducing the severity of anxiety in mothers and infants without any adverse effects [5, 6]. Mohebi-Tabar et al. also supported that this plant has anti-anxiety effects and relieves biopsychological pain [7]. Red rose essential oil has a significant impact on reducing anxiety in nulliparous women during the active phase of labor [8]. In Iranian traditional medicine, using red rose has been recommended to improve migraine pain [9], dysmenorrhea [10], musculoskeletal pain, morning sickness in pregnant women, depression, and PMS [11].
The present study aimed to investigate the effect of aromatherapy with red rose essential oil on the severity of anxiety before abdominal surgery.
2. Methods
This clinical trial was conducted on patients undergoing abdominal surgery who were hospitalized in 15-Khordad Hospital in Bidokht of Gonabad City, Iran, in 2017. In total, 90 patients undergoing inpatient abdominal surgery were selected by random sampling method. EmsiG oral thermometer, CF02 model; sphygmomanometer; ALPK2 stethoscope; Spielberger inventory, and red rose essential oil were implemented in the present research.
3. Results
The Mean±SD age of the investigated patients in the intervention and placebo groups was 37.13±31.35 and 44.15±51.65 years, respectively. The most frequent type of operation in both groups was inguinal hernia surgery. Prior to the intervention, there were no statistically significant differences between the study groups in terms of the severity of anxiety (P>0.05); however, after the intervention, the statistical difference was significant in terms of the severity of apparent and total anxiety scores (P<0.05), the same value was not significant in terms of the severity of latent anxiety (P>0.05) (Tables 1 & 2).

4. Discussion
The present study results suggested that red rose essential reduced the severity of apparent anxiety before surgery, i.e. consistent with other studies [5, 8, 12]. Moreover, the levels of apparent and latent anxiety in patients were moderate to high before the intervention. A study explored the effect of inhaled aromatherapy on the severity of patients’ anxiety before surgery. Accordingly, the mean severity of apparent anxiety before surgery was moderate to high (51.00±8.94) [13]. In Kohnegi’s study, however, the mean score of apparent anxiety was relatively high. This discrepancy may be due to differences in the surgery type performed on patients undergoing coronary artery bypass graft surgery; it naturally results in more severe anxiety, compared to abdominal surgery [14].
It is recommended that studies be performed with a larger sample size; the effect of rose essential oil on other anxiety-generating interventions be considered, and other psychological variables, like stress, be assessed.
5. Conclusion
Factors, such as the intervention type, the therapeutic outcomes, patient’s characteristics, family support, and insurance coverage also affect the severity of the patient’s anxiety. These elements could impact the research results, i.e. beyond the researchers’ control. Another study limitation was the impossibility of blinding the specimens and researchers, as well as the highly stressful preoperative condition, which may have complicated the studied patients’ assessment of their anxiety severity.
Ethical Considerations
Compliance with ethical guidelines
This project was approved by the Ethics Committee of the Regional Ethics Committee of Gonabad University of Medical Sciences (Code: IR.GMU.REC.1395.43). Moreover, all the instructions approved by this committee have been considered in this study.
Funding
The present research was funded by the Student Research Committee of Gonabad University of Medical Sciences.
Authors' contributions
Conceptualization: Samaneh Najafi, Moosa Sajjadi, Amirreza Nasirzadeh, Hossein Jeddi; Methodology, Samaneh Najafi, Moosa Sajadi; Investigation: Hossein Jeddi; Writing-original draft: Samaneh Najafi, Moosa Sajjadi, Amirreza Nasirzadeh, Hossein Jeddi; Writing-review & editing: Samaneh Najafi, Moosa Sajjadi, Amirreza Nasirzadeh, Hossein Jeddi; Funding acquisition: Samaneh Najafi, Moosa Sajadi; Supervision: Samaneh Najafi, Moosa Sajadi.
Conflicts of interest
The authors declared no conflicts of interest.
Acknowledgements
We express our gratitude for the support of the Vice-Chancellor for Research and Technology, as well as the Student Research Committee of Gonabad University of Medical Sciences and the esteemed staff of the surgical wards of Gonabad 15-Khordad Hospital and the patients who contributed to this research.