POSTOPERATIVE FATIGUE FOLLOWING CORONARY-ARTERY BYPASS-SURGERY - RELATIONSHIP TO EMOTIONAL STATE AND TO THE CATECHOLAMINE RESPONSE TO SURGERY

Post-operative fatigue is an important subjective problem for surgical patients, but its basis is unknown, and the possibility of a psycholo gical component has been neglected. To investigate its putative physio logical and psychological bases, 74 patients undergoing coronary arter y bypass graft surgery were studied. Circulating catecholamine levels were measured at intervals perioperatively and questionnaires were use d to measure fatigue, depression and anxiety up to 30 days post-operat ively. We tested whether fatigue was related either to the catecholami ne or to the emotional responses to surgery. The second element to the design was a controlled randomized study: patients underwent differen t forms of psychological preparation or a no-treatment control procedu re in an attempt to test whether post-operative fatigue was amenable t o psychological manipulation. Psychological preparation had no effect. Fatigue at 30 days was greatest in patients whose noradrenaline level s were greatest perioperatively. Independently of this relationship, f atigue at 30 days correlated with concurrent levels of depression and anxiety. Post-operative fatigue has both physiological and psychologic al correlates.