Citrus aurantium for stress relief -
Routine sedative premedication was not offered to patients participating in this study, instead premedication with either Citrus aurantium blossom distillate CABd or placebo was assumed for two groups of study two hours before operation.
Patients enrolled in this study were assigned into two groups of 30 each; using a computer-base random allocation and double blind manner. Fresh petals and stamens of Citrus aurantium blossoms were collected from adult sour orange plants, existing in south Iran, at Medicinal Plants Research Center of Shahrekord University of Medical Sciences.
Citrus aurantium blossom distillate CABd was obtained by steam distillation and then protected until pharmacological assays.
CABd was standardized based on measurement of linalool, total phenolic and flavonoid compounds as follows:. Linalool concentration was determined by a reversed phase HPLC method C18 column, Agilent, Germany An ultraviolet UV detector was used with wavelength of nm to obtain the chromatograph corresponding to linalool.
Mobile phase consisted of 0. Flow rate was 1. min -1 and injection volume was µL. A standard curve was drawn using the area under the curves resulted from different doses of linalool. The experiment was repeated for three times and the amount of linalool in the sample was determined using this standard curve.
The amount of total phenolic compounds in CABd was determined colorimetrically with the Folin-Ciocalteu reagent, using the method described by Kim A solution of 5 mL CABd or Gallic acid standard phenolic compound was mixed with Folin Ciocalteu reagent diluted with distilled water and aqueous Na 2 CO 3 4 mL, 1 M.
The mixtures were allowed to stand for 15 min and the total phenols were determined by colorimetry at nm. A standard curve was prepared using 0, 50, , , , and mg. Total phenol values were expressed in terms of Gallic acid equivalent mg.
g -1 , which is a common reference compound. The experiment was repeated for three times. The amount of total flavonoids in the CABd was determ ined using colorimetric method as described by Chang A solution of 0. Then the absorbance of the reaction mixture was measured at nm with a double beam spectrophotometer Unico UV, Japan.
The calibration curve was prepared using Rutin solutions at concentrations of 25 to ppm in methanol. Total flavonoids were expressed in terms of Rutin equivalent mg. The retention time of linalool with the condition described in Methods section was 2.
The amount of linalool in the sample was 10 ppm part per million. Total phenolic contents of CABd were 33 ± 0. g -1 equivalent to Gallic acid and the total flavonoids in CABd were 29 ± 0.
gr -1 equivalent to Rutin. The average amounts of total flavonoid and phenolic compounds were 29 ± 0. g -1 Rutin and 33 ± 0. gr -1 Gallic acid , respectively. The linalool concentration in the sample was 10 ppm. Finally, the concentrations of total flavonoid, phenolic compound and linalool in CABd were 29 mg.
mL -1 and 0. mL -1 , respectively. Preoperatively, all patients were admitted to the same holding area near the operating room while waiting for outpatient surgery.
For all subjects the environment, the nursing staff and the anesthesiologist as well as the psychologist were the same in the holding area. As a baseline, preoperative anxiety was assessed using both State-Trait Anxiety Inventory STAI-state and Amsterdam Preoperative Anxiety and Information Scale APAIS by an expert psychologist.
Heart rate HR and blood pressure BP were also obtained two hours before operation just before premedication in the holding area by a nurse anesthetist. Then subjects of the two groups received oral CABd 1 mL.
kg -1 as test C - group or Saline solution 1 mL. kg -1 as placebo P - group , respectively; according to a computer based randomization just after collecting the baseline values. Two hours later right before inducing anesthesia anxiety was assessed using the same methods by other anesthesiologist and psychologist who were blinded to the groups and patients' baseline values.
The State-Trait Anxiety Inventory STAI is a item self report measure that contains 20 items measuring state anxiety and 20 items measuring trait anxiety 2.
Total scores for state and trait sections separately range from 20 to 80 with higher scores denoting higher levels of anxiety. Amsterdam Preoperative Anxiety and Information Scale APAIS consist of 6 questions and ranged from In this study, we used state component of STAI rage and sum C component of APAIS range to evaluate preoperative anxiety.
Both heart rate HR and blood pressure BP , which have been widely used as dependent variables in behavioral studies to alter levels of anxiety and are frequently cited as physiological indices of stress in psychology, aviation medicine, and anesthesia 2 were obtained in two steps as baseline and just before induction of general anesthesia.
Regarding the normal distribution of variables, the data between groups were analyzed using Chi-Square and independent t tests and the data within groups were analyzed using paired t test.
Sixty patients were enrolled and completed the study. Chi-Square test demonstrated no significant difference among male and female distribution between groups. According to independent t test no significant differences were seen between groups in terms of age, baseline values of STAI-state, APAIS, and baseline hemodynamic values.
Table I. Hemodynamic variables except pulse rate in group P , were not changed within the two groups after pre-medication when paired t test was used. Tables II and III.
Preoperative anxiety is not only an unpleasant emotional state but may lead to significant psychological and physiological disorders The main finding of this study is that the anxiolytic effect of Citrus aurantium blossom distillate CABd when used orally was highly significant as measured by STAI-state and APAIS.
Both STAI-state and APAIS were decreased by CABd. On the other hand, neither STAI-state nor APAIS was changed in the placebo group. We found no studies related to the effect of CABd on preoperative anxious situation or even anxiolytic effect of this herbal medicine in human in the literature review.
Only a few studies reported that some similar components of citrus may reduce anxiety 17, Lehrner et al. Although the main components of the essential oil in their study, demonstrated by gas chromatography, was in part different from that obtained in our study, the essential similar component was limonene, a flavonoid compound, which could be addressed as anxiolytic component.
The main component of CABd in our study was not similar to that of Carvalho and Costa They obtained d-limonene In their study, sleeping time induced by pentobarbital, anxiolytic activity, and anticonvulsant activity were evaluated in mice model.
Chemical analysis of flowers of Sour orange has been previously reported by an investigation as flavonoids, which are its main constituents Flavonoids are complex chemical molecules that may act as ligands for benzodiazepine recept ors The notion that flavonoids may be agonists of benzodiazepine receptors, suggest that the flavonoid, which was extracted from the CABd in our study, might behave as an agonist of benzodiazepine receptors and reduce preoperative anxiety.
The phenolic component threshold toxicity level has been confirmed between and mg. L -1 , as stated in other studies, the concentration components of CABd used in our study was too low to induce toxicity in the patients However, based on traditional use of this herb in our society, we believe that the dose of CABd used in this study has no side effect on physiological responses.
Fortunately, we observed no adverse effect during and after operation. Citrus aurantium interferes with many drugs. Some of these drugs related to anesthesia are anti-anxiety, anti-hypertensive agents, and sedatives as well as antiemetic agents Although these interactions are due to Citrus aurantium peel and fruit and there is no study establishing the interaction of CABd components with other medications, the patients with no history of medication and disease were included to prevent any bias in the study.
Despite anxiety related to anesthesia and surgery, there are several sources of fear that may interfere with an anxiety model study.
The main preoperative anxiety risk factors have been listed in recent studies. These studies concluded that concern history about cancer, psychiatric disorders, depression, trait-anxirty level, postoperative pain, history of smoking, extend of the proposed surgery, and physical status according to ASA, as well as patient education are the main risk factors for anxious situation before surgery 3, Mariana P.
Leite I ; Jaime Fassin Jr. I ; Eliane M. Baziloni I ; Reinaldo N. br, Tel. José R. Leite I. I Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Botucatu , Ed.
Ciências Biomédicas, São Paulo-SP, Brazil. II Laboratório de Tecnologia Farmacêutica, Universidade Federal da Paraíba, Caixa Postal , João Pessoa-PB, Brazil. Keywords: Essential oil, Citrus aurantium , Rutaceae, orange oil, anxiety, inhalation, plus-maze. Unitermos: Óleo essencial, Citrus aurantium , Rutaceae, óleo de laranja, ansiedade, inalação, labirinto em cruz elevado.
The medicinal use of essential oils has been known since the early times Umezu et al. Popularly, they are used in the control of emotions and mood, for their sedative, anxiolytic Lehrner et al. Some studies suggest that they act by modulating the central neurotransmission Komiya et al.
A relation between the perception of odors and the emotional behavioral response has been suggested, showing neuroanatomical correlation orbitofrontal cortex, amygdala, pyriform cortex, and insular and anterior cingulate cortex between emotion and smell Pollatos et al.
Clinical studies suggest that the exposure to the inhalation of various kinds of essential oils is effective in reducing psychological stress, anxiety state, as well as the levels of cortisol in hypertensive patients Hwang, The positive effects of essential oils on anxiety and depression symptoms have aroused interest, since they might be an alternative to synthetic substances which induce various side effects such as sedation, memory alterations and interaction with other drugs Gumnick and Nemeroff, Among the aromatic plants, Citrus aurantium L.
Rutaceae is indicated in the popular medicine as an alternative in the treatment of anxiety, which suggests a possible central action Pultrini et al.
The orange essential oil OEO showed a depressant activity on the central nervous system CNS after the intraperitoneal administration to mice Carvalho-Freitas and Costa, Such response might be attributed to a specific or synergetic effect of the many components present in the OEO, among which we should mention limonene and mircene, which have an attested action on the CNS Pultrini et al.
Studies carried out with rats, evaluated in depression models, provide evidence that citrus essences act by strengthening the immune response as well as potentiating the anti-depressant effects of the imipramine Komori et al.
In this sense, considering the relation between smell and emotions, and the strong effect of fragrances on emotional states Van Toller, , the present study aimed at assessing a possible anxiolytic effect on rats exposed to the inhalation of OEO, evaluated in experimental models of anxiety.
In order to do so, we considered the following aspects: different behavioral parameters in the open-field, the number of entries in the open arms and the time spent in each arm of the elevated plus maze EPM , time of active social interaction TSI and the determination of the phytochemical profile of the essential oil.
Were used months old male Wistar rats weighing g. The animal laboratory of the Department of Psychobiology - UNIFESP supplied the animals. The temperature was kept at 20 ± 2 °C, and water and food were provided ad libitum. All tests were carried out between and p. All procedures were conducted in accordance with the animal scientific procedures.
The OEO was supplied from International Flavors and Fragrance IFF Ltda. It was obtained from the orange peel, C. Diazepam was acquired from Roche.
The OEO was analyzed by gas chromatography. The quantification of the oil constituents was calculated from the GC with a flame ionization detector.
CG analysis was carried out on an Agilet-HP gas chromatograph with a FID detector and a COV-1 capillary column 30 m x 0. Groups with 12 rats each were used.
The animals were placed individually in acrylic boxes and treated as follows: different groups were exposed to the inhalation of OEO 1. All the procedures were carried out for 7 min. immediately before the tests, as described by Almeida et al.
The open-field test was originally proposed as a measure of emotionality, with the animals being exposed to excessive light or noise. The rats were individually placed in the center of the open-field, which was circular, divided into 3 concentric circles subdivided by straight line segments into 19 equal parts measuring 80 cm of diameter and 30 cm of height.
The lighting was equivalent to 3 light bulbs of 60 watts placed cm above the floor of the open-field. We recorded the behavioral parameters regarding locomotion in the center of the arena and its peripheral walls; frequency of rearing number of times the animals stood on their hind limbs , freezing total motionless time and the number of fecal boluses for 5 min.
Candland and Campbell, In order to minimize the possible influence of circadian alterations, we observed the animals between and p. This procedure is based on the observation that animals tend to reduce or even suppress their interaction with other animals under conditions of new environments or excessive light.
The device we used was the same as described above for the open-field behavioral test. Pairs of rats with up to 10 g difference in weight were placed in the center of the arena for us to quantify their activities of active social interaction: grooming, sniffing, biting or having a sexual behavior toward the other animal.
We recorded the social interaction of the animals for 5 minutes between and p. as described by File and Hyde , irrespectively of the place in the arena where the animals were. The maze consists of two open arms and two closed arms by 30 cm high walls. Each arm measures 50 cm of length by 10 cm of width and contains a central square of 10 x 10 cm.
The maze was 60 cm above the floor. We placed the animals in the maze and recorded the number of times they entered the open and closed arms, as well as how long they stayed there within 5 min. In order to evaluate their level of emotionality, we considered their number of entries in the open arms and the time they remained there: the higher the number, the lower their level of emotionality Pellow et al.
Student's t test was used to analyze the behavioral parameters observed in the open-field, as well as the one-way ANOVA, followed by the Tukey's and the Duncan's tests, to analyze the data we obtained in the TSI and the EPM, respectively.
The chromatographic analysis of the OEO showed a phytochemical profile that confirms the presence of the main classes of components characteristic of the species Citrus aurantium L. The animals previously exposed to the inhalation of OEO 2.
The time of rearing or freezing were not changed Figure 2B. The time of active social interaction of the animals exposed to the inhalation of OEO 2.
This time difference was even greater than that between the animals in the OEO and the animals in the standard group that received diazepam Figure 3. The data indicate that the numbers of entries into the open and closed arms in the EPM were not significantly changed by inhalation of OEO Fig.
On the other hand, the OEO 2. Essential oils, especially those of citrus fragrances, are popularly used as therapies for their effects on mood states and depression Rovesti and Colombo, ; Agra et al. The results of our study suggest that the orange essential oil, at the concentration of 2.
Such response might be correlated with the activation of the olfactory system by the volatile components present in the oil, which suggests a possible central action.
We should highlight the fact that anxiolytic drugs lessen fear and inhibit the exploratory activity of animals Jones et al. Different studies point to a potential antidepressant effect in rats exposed to citrus fragrances Komori et al.
Similar results were obtained with rats previously exposed to the inhalation of rose essential oil and submitted to the EPM, since it was observed an increase both in the number of times they entered the open arms and the time they remained there.
The anxiolytic action was attributed to the presence of the components citronellol and 2-phenethyl alcohol Almeida et al. Considering that anxious rats do not socialize with one another, the results we obtained with the animals exposed to the inhalation of OEO 2. These results corroborate those obtained in the EPM.
The decrease in the level of emotionality of the animals was also observed in the open-field evaluations, since they presented a decrease in the number of fecal droppings when compared with the animals in the control group.
That response might be correlated with a low level of emotionality of the animals, since rats exposed to anxiogenic situations present a larger number of fecal droppings in the open-field Pal et al. When inhaled, these molecules create a relaxing response by calming, balancing, and stimulating, which can lower the levels of the stress hormones cortisone and cortisol in the body.
The main parts of lavender are linalool and linalyl acetate, which can help reduce anxiety and act as a sedative, anticonvulsant, and antidepressant [ 24 ]. For health reasons, chamomile is used to treat anxiety disorders [ 24 ].
Using both chamomile and lavender in aromatherapy at the same time can help with depression and anxiety [ 25 ]. On the other hand, Julianto demonstrated that citrus aromatherapy has a significant effect on people who are about to have major surgery at Palembang Muhammadiyah Hospital, with a p-value of 0.
Figure 2: Irritation test Kligman's method. Tests show that aromatherapy massage oil containing lavender, chamomile, and petitgrain essential oils has excellent organoleptic, pH, and viscosity stability.
The authors would like to thank the respondents who are willing to help with this research. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. All authors contributed to data analysis, drafting, and revising of the paper and agreed to be responsible for all the aspects of this work.
Formulation of Aromatherapy Massage Oil from Lavender Lavandula Angustifolia , Chamomile Matricaria Recutita , and Petitgrain Citrus Aurantium for Stress Relief.
Journal of Medicinal and Chemical Sciences , 6 12 , doi: Journal of Medicinal and Chemical Sciences , 6, 12, , Journal of Medicinal and Chemical Sciences , ; 6 12 : Home Formulation of Aromatherapy Massage Oil from Lavender Lavandula Angustifolia , Chamomile Matricaria Recutita , and Petitgrain Citrus Aurantium for Stress Relief.
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Editorial Board. Guide for Authors. Submit Manuscript. Contact Us. Full Text. Introduction Stress is a non-specific physical and psychological body response to a burden imposed on an individual [ 1 ]. Materials and Methods Materials Virgin coconut oil VCO , lavender essential oil, chamomile essential oil, and petitgrain essential oil were obtained from PT Darjeeling Sembrani Aroma, Bandung, Indonesia.
Methods This research has passed the ethical proper test at the Health Research Ethics Committee State Polytechnic of Health Malang no.
Formulation of aromatherapy massage oil The formulation of massage aromatherapy oil was based on empirical use [ 8 ], and is presented in Table 1. Characteristics test A characteristic test involves observing the organoleptic properties, pH, and viscosity.
The viscosity testing was done using an Ostwald viscometer, and then calculated using this formula: Stability test The stability test was done by observing organoleptics, pH, and viscosity on days 0, 1, 3, 5, 7, 14, 21, and Hedonic test The hedonic test is a way to judge how aromatherapy massage oil looks based on its smell, color, texture, and how comfortable it is to use.
Irritation test The irritation testing procedure was carried out by taking 0. Results and Discussion After formulation and evaluation of aromatherapy massage oil, the following results were obtained: Characteristics test Organoleptic observation with color parameters showed a greenish-blue result, as displayed in Figure 1.
Figure 1: The formulas appearance Table 1: The formulas of aromatherapy massage oil Table 2: Characteristic test of the formulas All the formulas were clear and in the form of homogeneous liquids due to the good solubility of the essential oils and the carrier oil, virgin coconut oil VCO.
Stability test Organoleptic testing was done by looking at the color, smell, and shape of the formulas after they had been kept at room temperature for 4 weeks.
Hedonic test The data obtained from 30 respondents was analyzed using SPSS. The Use of Aromatherapy Massage oil as a Relaxation Media The use two or more essential oils together for relaxation is better than using just one.
Table 3: The pH test of the formulas Table 4: Viscosity test of the formulas Table 5: Hedonic Test results Figure 2: Irritation test Kligman's method Conclusion Tests show that aromatherapy massage oil containing lavender, chamomile, and petitgrain essential oils has excellent organoleptic, pH, and viscosity stability.
Acknowledgements The authors would like to thank the respondents who are willing to help with this research. Disclosure Statement No potential conflict of interest was reported by the authors. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' Contributions All authors contributed to data analysis, drafting, and revising of the paper and agreed to be responsible for all the aspects of this work.
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Preoperative visit and use ffor premedication are popular methods aueantium achieve this goal, but stgess role of anxiolytic premedication remains coffee bean metabolism booster and postoperative side-effects may result Citrus aurantium for stress relief routine premedication. Citrus aurantium Citrus aurantium for stress relief tor as an alternative medicine in some countries reoief treat anxiety, and recently the anxiolytic role of this medicinal plant was established in an animal model study. The aim of this study was to assess the anxiolytic effect of Citrus aurantium blossom on preoperative anxiety. METHODS: We studied 60 ASA I patients undergoing minor operation. In a randomized double-blind design, two groups of 30 patients received one of the following oral premedication two hours before induction of anesthesia: 1 Citrus aurantium blossom distillate 1 mL. kg-1 C-group ; 2 Saline solution 1 mL.
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