The objective of this study was to compile existing scientific evidence regarding the effects of essential oils (EOs) administered via inhalation for the alleviation of nausea and vomiting. CINAHL, PubMed, and EBSCO Host and Science Direct databases were searched for articles related to the use of EOs and/or aromatherapy for nausea and vomiting. Only articles using English as a language of publication were included. Eligible articles included all forms of evidence (nonexperimental, experimental, case report). Interventions were limited to the use of EOs by inhalation of their vapors to treat symptoms of nausea and vomiting in various conditions regardless of age group. Studies where the intervention did not utilize EOs or were concerned with only alcohol inhalation and trials that combined the use of aromatherapy with other treatments (massage, relaxations, or acupressure) were excluded. Five (5) articles met the inclusion criteria encompassing trials with 328 respondents. Their results suggest that the inhaled vapor of peppermint or ginger essential oils not only reduced the incidence and severity of nausea and vomiting but also decreased antiemetic requirements and consequently improved patient satisfaction. However, a definitive conclusion could not be drawn due to methodological flaws in the existing research articles and an acute lack of additional research in this area. The existing evidence is encouraging but yet not compelling. Hence, further well-designed large trials are needed before confirmation of EOs effectiveness in treating nausea and vomiting can be strongly substantiated.

J Altern Complement Med. 2012 Jun;18(6):534-40. Lua PL, Zakaria NS. Centre for Clinical and Quality of Life Studies, Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia. peilinlua@unisza.edu.my

Full title: The effects of clinical aromatherapy for anxiety and depression in the high risk postpartum woman - a pilot study.

The aim of this study was to determine if aromatherapy improves anxiety and/or depression in the high risk postpartum woman and to provide a complementary therapy tool for healthcare practitioners. The pilot study was observational with repeated measures. Private consultation room in a Women's center of a large Indianapolis hospital. 28 women, 0-18 months postpartum. The treatment groups were randomized to either the inhalation group or the aromatherapy hand m'technique. Treatment consisted of 15 min sessions, twice a week for four consecutive weeks. An essential oil blend of rose otto and lavandula angustifolia @ 2% dilution was used in all treatments. The non-randomized control group, comprised of volunteers, was instructed to avoid aromatherapy use during the 4 week study period. Allopathic medical treatment continued for all participants. All subjects completed the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder Scale (GAD-7) at the beginning of the study. The scales were then repeated at the midway point (two weeks), and at the end of all treatments (four weeks). Analysis of Variance (ANOVA) was utilized to determine differences in EPDS and/or GAD-7 scores between the aromatherapy and control groups at baseline, midpoint and end of study. No significant differences were found between aromatherapy and control groups at baseline. The midpoint and final scores indicated that aromatherapy had significant improvements greater than the control group on both EPDS and GAD-7 scores. There were no adverse effects reported. The pilot study indicates positive findings with minimal risk for the use of aromatherapy as a complementary therapy in both anxiety and depression scales with the postpartum woman. Future large scale research in aromatherapy with this population is recommended.

Complement Ther Clin Pract. 2012 Aug;18(3):164-8. Epub 2012 Jun 27. Conrad P, Adams C. Wellspring Pharmacy, Community Hospital North, Community Health Network, Indianapolis, IN 46077, USA. pconrad@ecommunity.com

Postoperative nausea and vomiting (PONV) is a common source of patient discomfort and decreased satisfaction. Aromatherapy has been identified as a complementary modality for the prevention and management of PONV. The purpose of this study was to assess the effect of aromatherapy on the severity of postoperative nausea (PON) in women undergoing surgical procedures in the postanesthesia care unit. Women complaining of PON received traditional antiemetics, inhalation of peppermint oil, or saline vapor. A visual analog scale was used to rate nausea at the first complaint; at 5 minutes after intervention; and, if nausea persisted, at 10 minutes after intervention. At both 5 and 10 minutes, statistical analysis showed no significant differences between intervention and nausea rating. Obtaining eligible subjects was challenging. Although many women consented, most received intraoperative antiemetics and did not report nausea postoperatively.

J Perianesth Nurs. 2012 Aug;27(4):246-51. Ferruggiari L, Ragione B, Rich ER, Lock K. Molloy College, 1000 Hempstead Avenue, Rockville Centre, NY 11571, USA.

This purpose of this analysis was to study risk factors of postoperative nausea (PON) and their strength. Data were obtained during the screening phase of a controlled clinical trial of aromatherapy for PON. In a sample of 1151 postsurgical subjects, 301 (26.2%) reported PON. Significant risk factors identified in the order of odds ratios for nausea were female gender, gastrointestinal surgery, use of volatile anesthesia gases, history of PON, history of motion sickness, and use of opioids after surgery. Although still over 1.0, the risk factors of length of surgery over 1 hour and gynecologic surgery had the lowest odds ratios. Likelihood of nausea increased significantly with the number of significant risk factors (P<.0001). Administration of preventive antiemetic medication also increased with the number of significant risk factors (P<.0001). Among 301 subjects reporting nausea, 49 (16.28%) received preventive medication. Despite prevention efforts, PON remains a substantial side effect for many surgical patients.

J Perianesth Nurs. 2012 Aug;27(4):252-8. Dienemann J, Hudgens AN, Martin D, Jones H, Hunt R, Blackwell R, Norton HJ, Divine G. School of Nursing, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA. jadienem@uncc.edu

The objective of this study was to evaluate the potential anxiolytic effect of sweet orange (Citrus sinensis) aroma in healthy volunteers submitted to an anxiogenic situation. Design: Forty (40) male volunteers were allocated to five different groups for the inhalation of sweet orange essential oil (test aroma: 2.5, 5, or 10 drops), tea tree essential oil (control aroma: 2.5 drops), or water (nonaromatic control: 2.5 drops). Immediately after inhalation, each volunteer was submitted to a model of anxiety, the video-monitored version of the Stroop Color-Word Test (SCWT). Outcome measures: Psychologic parameters (state-anxiety, subjective tension, tranquilization, and sedation) and physiologic parameters (heart rate and gastrocnemius electromyogram) were evaluated before the inhalation period and before, during, and after the SCWT. Results: Unlike the control groups, the individuals exposed to the test aroma (2.5 and 10 drops) presented a lack of significant alterations (p>0.05) in state-anxiety, subjective tension and tranquillity levels throughout the anxiogenic situation, revealing an anxiolytic activity of sweet orange essential oil. Physiologic alterations along the test were not prevented in any treatment group, as has previously been observed for diazepam. Conclusions: Although more studies are needed to find out the clinical relevance of aromatherapy for anxiety disorders, the present results indicate an acute anxiolytic activity of sweet orange aroma, giving some scientific support to its use as a tranquilizer by aromatherapists.

J Altern Complement Med. 2012 Aug;18(8):798-804. Epub 2012 Jul 31. Goes TC, Antunes FD, Alves PB, Teixeira-Silva F. 1 Departamento de Fisiologia, Centro de Ciências Biológicas e da Saúde, Universidade Federal de Sergipe , Sergipe, Brazil.

The Namaste programme is a systematic method of treating people with advanced dementia. It uses sensory approaches - such as massage and aromatherapy - to reach people who are often overlooked at the end of their lives. Here, nurses in south London care homes explain how it has brought comfort and pleasure to the'silent residents' and made nursing more purposeful and rewarding.

Nurs Stand. 2012 Jun 27-Jul 3;26(43):20-2. Trueland J.

Full title: Living with pleasure in daily life at the end of life: Recommended care strategy for cancer patients from the perspective of physicians and nurses.

One of the most important goals of palliative care is achieving a good death. Most Japanese believe that "having some pleasure in daily life" is necessary at the end of life. The aim of this study was to identify, from the perspective of physicians and nurses, a care strategy that ensures that cancer patients have pleasure in daily life at the end of life. Method: We conducted semistructured interviews with experts in palliative care units. A total of 45 participants included 22 palliative care physicians and 23 nurses. Transcripts of the interviews were analyzed using a content analysis method. Results: Care for end-of-life cancer patients that ensures they have some pleasure in daily life was classified into five categories: "Pain assessment and pain easing" aimed to offer physical and psychological pain assessment and relief. "Maintenance of recuperative environment" aimed to offer care that arranged for assistive devices and equipment in the patient's room. "Support of daily life" aimed to offer care that eased accomplishment of daily activities. "Care that respects individuality" aimed to offer care that assessed sources of pleasure for the patient. "Events and complementary and alternative therapies" aimed to offer such care as aromatherapy and massage. Significance of results: The elements of care identified in this study are useful for all end-of-life cancer patients, even those who do not enter palliative care units. The next step of research is to test the efficacy of interventions that reflect the five identified categories of care for end-of life cancer patients.

Palliat Support Care. 2012 Jul 6:1-9. Nakano K, Sato K, Katayama H, Miyashita M. Saiseikai Central Hospital, Nursing Department, Minato-ku, Tokyo, Japan.

Full title: Aromatherapy and Massage Intrapartum Service Impact on Use of Analgesia and Anaesthesia in Women in Labor: A Retrospective Case Note

Abstract Background: Over the past decade, interest in complementary therapies and alternative medicine has escalated among midwives and the general public in response to increased demand from expectant mothers for more choice, control, and continuity in labor. Objective: The aim of this study was to explore if an aromatherapy and massage intrapartum service (AMIS) reduced the need for analgesia during labor. This article reports results related to the effects of an AMIS on type of analgesia chosen by women in labor, and on rates of anesthesia-one aspect of the full study. Setting/location: The study was conducted in a general maternity unit in southwest England, UK. Design: A quantitative research approach was taken, whereby contemporaneously completed service evaluation forms of 1079 women (601 nulliparous women and 478 multiparous women; AMIS group) were retrospectively analyzed in comparison with the birth records of an equal number of similar women (comparison group). Data analysis was achieved by entering data from the forms and comparison sample into an SPSS package and running statistical tests. Results: In the AMIS group, overall analgesia usage was higher for transcutaneous electrical stimulation at 34%, compared with 15.9% (p<0.001 allowing for parity), and for nitrous oxide and oxygen at 87.6%, compared with 80.8% (p<0.001). Pethidine use did not differ after adjustment for parity at 30.1%, compared with 24.2% (p=0.27) in the AMIS and comparison groups, respectively. Rates were lower in the AMIS group for epidural anaesthesia at 29.7%, compared with 33.8% (p=0.004 allowing for parity) in the comparison group; spinal anesthesia at 6%; compared with 12.1% (p<0.001) in the comparison group; and general anesthesia at 0.8%, compared with 2.3% (p=0.033) in the comparison group. Conclusions: Having an AMIS appears to have a positive impact on reducing rates of all types of intrapartum anaesthesia. The Service is a beneficial addition to conventional midwifery practice that may influence mode of delivery and reduce general anesthesia rates.

J Altern Complement Med. 2012 Aug 16. Dhany AL, Mitchell T, Foy C. 1 The Birthing Unit, Gloucestershire Royal Hospital , Gloucester, Gloucestershire, United Kingdom

Full title: Anxiolytic-like activity and GC-MS analysis of (R)-(+)-limonene fragrance, a natural compound found in foods and plants.

Aim: This systematic review was aimed at critically evaluating the evidence regarding the adverse effects associated with aromatherapy. Method: Five electronic databases were searched to identify all relevant case reports and case series. Results: Forty two primary reports met our inclusion criteria. In total, 71 patients experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects. Conclusion: Aromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition.

Int J Risk Saf Med. 2012 Jan 1;24(3):147-61. Posadzki P, Alotaibi A, Ernst E. Complementary Medicine, Peninsula Medical School, Exeter, UK.

Full Title: The effect of lavender oil on stress, bispectral index values, and needle insertion pain in volunteers.

OBJECTIVES: The purpose of this study was to investigate whether lavender oil aromatherapy can reduce the bispectral index (BIS) values and stress and decrease the pain of needle insertion in 30 volunteers. SUBJECTS AND METHODS: Thirty (30) healthy volunteers were randomly allocated to 2 groups: the experimental group received oxygen with a face mask coated with lavender oil for 5 minutes, and the control group received oxygen through a face mask with no lavender oil for 5 minutes. The stress level (0=no stress, 10=maximum stress), BIS value, and pain intensity of needle insertion (0=no pain, 10=worst pain imaginable) were measured. RESULTS: There were no significant differences in age, sex, height, and weight between the two groups. Stress level, BIS value, and pain intensity of needle insertion before aromatherapy were similar between the two groups. However, the stress values (p<0.001) and BIS value (p<0.001) after aromatherapy were significantly reduced compared with the control. In addition, the pain intensity of needle insertion was significantly decreased after aromatherapy compared with the control (p<0.001). CONCLUSIONS: Lavender aromatherapy in volunteers provided a significant decrease in the stress levels and in the BIS values. In addition, it significantly reduced the pain intensity of needle insertion.

J Altern Complement Med. 2011 Sep;17(9):823-6. Kim S, Kim HJ, Yeo JS, Hong SJ, Lee JM, Jeon Y. Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea.

The objective of this study is to determine the effects of 12 weeks of lavender aromatherapy on self-reported sleep and heart rate variability (HRV) in the midlife women with insomnia. Sixty-seven women aged 45-55 years, with a CPSQI (Chinese version of Pittsburgh Sleep Quality Index) greater than 5, were recruited from communities in Taiwan. The experimental group (n = 34) received lavender inhalation, 20?min each time, twice per week, for 12 weeks, with a total of 24 times. The control group (n = 33) received health education program for sleep hygiene with no intervention. The study of HRV was analyzed by time- and frequency-domain methods. Significant decrease in mean heart rate (HR) and increases in SDNN (standard deviation of the normal-to-normal (NN) intervals), RMSDD (square root of the mean squared differences of successive NN intervals), and HF (high frequency) of spectral powers analysis after lavender inhalation were observed in the 4th and 12th weeks of aromatherapy. The total CPSQI score of study subjects was significantly decreased in the experimental group (P < 0.001), while no significant difference was observed across the same time period (P =0.776) in the control group. Resting HR and HRV measurements at baseline 1 month and 3 months after allocation showed no significant difference between the experimental and control groups. The study demonstrated that lavender inhalation may have a persistent short-term effect on HRV with an increase in parasympathetic modulation. Women receiving aromatherapy experienced a significant improvement in sleep quality after intervention. However, lavender aromatherapy does not appear to confer benefit on HRV in the long-term follow up.

Evid Based Complement Alternat Med. 2012;2012:740813. Chien LW, Cheng SL, Liu CF. Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.

PURPOSE: The purpose of this study was to verify the effect of aroma massage on constipation in advanced cancer patients. METHODS: This study employed a randomized control group pre- and post test design and included an aroma massage group, plain massage group, and control group. To evaluate the effect of aromatherapy, the degree of constipation was measured using a constipation assessment scale, severity level of constipation and the frequency of bowel movements. Data was analyzed by repeated measures of Mann-Whitney U test, Wilcoxon signed ranks test, Spearman's rho and ANOVA using SPSS program. RESULTS: The score of the constipation assessment scale of the aroma massage group was significantly lower than the control group. Apart from the improvement in bowel movements, the results showed significantly improved quality of life in physical and support domains of the aroma massage group. CONCLUSION: The findings of this study suggest aroma massage can help to relieve constipation in patients with advanced cancer.

Complement Ther Clin Pract. 2011 Feb;17(1):37-43. Epub 2010 Jun 12. Lai TK, Cheung MC, Lo CK, Ng KL, Fung YH, Tong M, Yau CC. Department of Oncology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Hong Kong, China. laitk@ha.org.hk

Episiotomy is the most common perineal incision in obstetric and midwifery. Nowadays alternative and complementary methods such as Aromatherapy using essential oils are established as an alternative therapy. This research was carried out to assess the effect of lavender oil in wound healing. This randomized control trial was conducted on 120 primiparous women with singleton pregnancy, without any acute and chronic disease and allergy who had undergone normal spontaneous vaginal delivery and episiotomy. They were randomly allocated in case and control groups. Case group received lavender oil and controls received povidone-iodine. Incision sites were assessed on the 10th day postpartum. 25 out of 60 women in lavender group and 17 mothers in control group had no pain (p = 0.06). There was no significant difference between two groups in surgery site complications. However, redness in lavender group was significantly less than controls (p < 0.001). This study suggests application of lavender essential oil instead of povidone-iodine for episiotomy wound care.

Complement Ther Clin Pract. 2011 Feb;17(1):50-3. Epub 2010 Jun 17. Vakilian K, Atarha M, Bekhradi R, Chaman R. Nursing and Midwifery College, Arak University of Medical Sciences, Arak, Tehran, Iran. swt_f@yahoo.com

Full title: Orange Interventions for Symptoms Associated With Dimethyl Sulfoxide During Stem Cell Reinfusions: A Feasibility Study.

BACKGROUND:: For over 2 decades, oncology nurses at a regional comprehensive cancer center offered sliced oranges to patients during the reinfusion of autologous hematopoietic progenitor cells (HPCs) to relieve symptoms associated with the preservative dimethyl sulfoxide (DMSO). OBJECTIVES:: This randomized pilot study examined feasibility and efficacy of sliced orange intervention (OI), orange aromatherapy intervention (OAI), or deep breathing (control) to address unpleasant adverse effects during HPC infusion. METHODS:: Orange intervention sniffed or tasted a quartered orange, OAI sniffed orange aromatherapy, and control took deep breaths. Perceived "symptom intensity" for tickle/cough urge, nausea, retching, and perceived "relief" were measured on 0- to 10-point numerical scales. RESULTS:: Sixty of 72 eligible patients consented to participate and were randomized to OI (n = 19), OAI (n = 23), or control (n =18). Study personnel successfully administered study procedures. Over the course of 2 bags of cells infused, the OI group reported significantly greater relief with the intervention (P = .032). Among participants less than 90 kg, OI group reported significantly lower symptom intensity (P = .012). CONCLUSIONS:: Results suggest a feasible protocol and potential efficacy of sliced oranges for treating symptoms associated with DMSO-preserved stem cells. Study procedures provide a tested protocol for future studies. Follow-up study is warranted to confirm these findings and evaluate other treatment options. IMPLICATIONS FOR PRACTICE:: Oranges offer a simple, noninvasive intervention for relieving symptoms associated with DMSO preservative during autologous HPC infusion.

Cancer Nurs. 2011 Mar 2. Potter P, Eisenberg S, Cain KC, Berry DL. Author Affiliations: School of Nursing, University of Portland, Portland, Oregon (Dr Potter); Infusion Services, Seattle Cancer Care Alliance, Seattle, Washington (Mr Eisenberg); Department of Biostatistics and Office for Nursing Research, Seattle, Washington (Dr Cain); Dana-Farber Cancer Institute, Boston, Massachusetts (Dr Berry).

AIM: To evaluate the effects of a new aromatherapy intervention introduced within an acute cancer care setting in the UK. BACKGROUND: Aromatherapy is a popular complementary therapy within oncology settings and is known to help relieve patients' anxiety. A new method of delivering aromatherapy to patients was adopted by a complementary therapy service at a UK hospital; aromasticks are similar in design to the Vicks® Vapour Inhaler®, with the intention of helping patients manage anxiety, nausea and sleep disturbance. DESIGN: A retrospective service evaluation. METHOD: Patients referred to the complementary therapy service were, if appropriate, offered an aromastick. If the offer was accepted patients' details were captured on an evaluation form. One week later the patients were followed up by a different therapist. Frequency of using the aromastick and perceived benefits were documented. A total of 160 patients were included in this evaluation. RESULTS: 77% (n = 123) of all patients reported deriving at least one benefit from the aromastick. In anxious patients, 65% reported feeling more relaxed and 51% felt less stress. 47% of nauseous patients said that the aromastick had settled their nausea and 55% of those experiencing sleep disturbances felt that aromastick helped them sleep. The results also suggest that the effects of the aromastick may be directly proportional to the frequency of their use. RELEVANCE TO CLINICAL PRACTICE: Evidence demonstrating physiological changes associated with aroma inhalation plus the data presented in this paper highlight the potential for aromasticks within the clinical setting. Although the results of this evaluation of patient perspectives are not controlled, the data does underline the worth of further investigation. Future research is needed to show that aromasticks represent a tool patients can use to self-manage their own symptoms and help them retain an internal locus of control.

Complement Ther Clin Pract. 2011 May;17(2):116-21. Stringer J, Donald G. The Christie NHS Foundation Trust, Wilmslow Road, Manchester, United Kingdom. jacqui.stringer@christie.nhs.uk

This study investigated the potential for the aromas of the essential oils of Salvia species to affect cognition and mood in healthy adults. Research has demonstrated that orally administered Salvia officinalis and Salvia lavandulaefolia are capable of modulating cognition and mood. The active compounds in the herbal products might also be present in the aromas and so produce similar effects. In an independent groups design, three conditions, S. officinalis aroma, S. lavandulaefolia aroma and no aroma were employed. One hundred and thirty-five healthy volunteers acted as participants, with 45 in each condition. Cognitive performance was assessed via the Cognitive Drug Research (CDR) System. Bond-Lader mood scales measured the participants' mood on three dimensions before and after the cognitive tasks. Data analysis revealed that the S. officinalis aroma group performed significantly better than the control group on the quality of memory and secondary memory primary outcome factors from the test battery. The Alert mood measure displayed significant differences between both aromas and the control condition. These findings suggest that the aromas of essential oils of Salvia species reproduce some but not all of the effects found following oral herb administration, and that interesting dissociations occur between subjective and objective responses.

Hum Psychopharmacol. 2010 Jul;25(5):388-96. Moss L, Rouse M, Wesnes KA, Moss M. Department of Psychology, Brain, Performance and Nutrition Research Centre, Northumbria University, Newcastle upon Tyne, United Kingdom.

Full Title: A systematic review on the anxiolytic effects of aromatherapy on rodents under experimentally induced anxiety models.

PURPOSE: We reviewed studies from 1999 to 2009 on anxiolytic effects of different essential oils toward rodents in anxiety-related behavioral models. METHOD: Journal papers that evaluated the anxiolytic effects of essential oils for rodents were extracted from available electronic data bases. RESULTS: The results based on 14 studies showed that different rodent species were recruited including ICR mice and Swiss mice. Most of studies applied the Elevated Plus Maze (EPM) as the animal behavioral model. Lavender oil was the most popular within the 14 studies. Lavender and rose oils were found to be effective in some of the studies. Only one study reported the underlying neurophysiological mechanism in terms of concentrations of emotionally related neuro-transmitters such as dopamine, serotonin, and their derivatives, in various brain regions. CONCLUSION: Some essential oils are found to be effective to induce anxiolytic effect in rodents under different animal anxiety models. However, more standardized experimental procedures and outcome measures are needed in future studies. Translational research to human subjects is also recommended.

Rev Neurosci. 2010;21(2):141-52. Tsang HW, Ho TY. Neuropsychiatric Rehabilitation Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Honk Kong. rshtsang@inet.polyu.edu.hk

Lavenders and their essential oils have been used in alternative medicine for several centuries. The volatile compounds that comprise lavender essential oils, including linalool and linalyl acetate, have demonstrative therapeutic properties, and the relative abundance of these metabolites is greatly influenced by the genetics and environment of the developing plants. With the rapid progress of molecular biology and the genomic sciences, our understanding of essential oil biosynthesis has greatly improved over the past few decades. At the same time, there is a recent surge of interest in the use of natural remedies, including lavender essential oils, in alternative medicine and aromatherapy. This article provides a review of recent developments related to the biosynthesis and medicinal properties of lavender essential oils.

Planta Med. 2011 Jan;77(1):7-15. Woronuk G, Demissie Z, Rheault M, Mahmoud S. Irving K. Barber School of Arts & Sciences Unit 2, University of British Columbia - Okanagan, Kelowna, Canada.

Olfactory stimuli are used in aromatherapy to enhance mood, well-being and work efficiency. Nevertheless, the impact of fragrances on cognitive performance in humans is not well understood. The present investigation aimed to evaluate the effects of 1,8-cineol, jasmine absolute ether, linalyl acetate and peppermint essential oil on human vigilance performance. The odorants were administered by means of inhalation and, except for peppermint essential oil, were tested at 2 different dosages. Performance in a standard visual vigilance task was measured in terms of speed and accuracy and subjective ratings of the odorants were assessed in terms of pleasantness, intensity, arousal and stress. We hypothesized that 1,8-cineol, jasmine absolute ether and peppermint essential oil would improve vigilance performance, whereas linalyl acetate would impair such performance. Comparison of the performances of the seven independent experimental groups with that of a control group did not show any of the expected effects. In contrast, inhalation of linalyl acetate decreased reaction times. Within-group analyses, however, revealed significant interactions between subjective ratings of the odorants and task performance. The results of the present investigation emphasize the high impact of subjective factors on the modulation of attentional functions by olfactory stimuli in humans.

Nat Prod Commun. 2010 Sep;5(9):1441-6. Heuberger E, Ilmberger J. Department of Clinical Pharmacy and Diagnostics, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria. eva.heuberger@univie.ac.at

In concert with growing public interest in complementary and alternative medicine (CAM), these therapies and products have been increasingly studied over the past two decades for the treatment of sleep disorders. While systematic reviews have been conducted on acupuncture and valerian in the treatment of insomnia, to date no comprehensive review has been conducted on all major CAM treatments. We sought to address this via a rigorous systematic review of hypnotic CAM interventions, including herbal and nutritional medicine, acupuncture, acupressure, yoga, tai chi, massage, aromatherapy and homoeopathy. The electronic databases MEDLINE (PubMed), CINAHL, PsycINFO, and The Cochrane Library were accessed during late 2009 for CAM randomized controlled trials (RCTs) in the treatment of chronic insomnia. Sixty-four RCTs were identified, of which 20 studies involving eight CAM interventions met final inclusion criteria. Effect size calculations (where possible) and a quality control analysis using a modified Jadad scale were undertaken. Many RCTs lacked methodological rigor, and were commonly excluded due to small sample size or an inadequate control condition. Among the studies that met inclusion criteria, there was evidentiary support in the treatment of chronic insomnia for acupressure (d=1.42-2.12), tai chi (d=0.22-2.15), yoga (d=0.66-1.20), mixed evidence for acupuncture and L-tryptophan, and weak and unsupportive evidence for herbal medicines such as valerian. Surprisingly, studies involving several mainstream CAM therapies (e.g., homoeopathy, massage, or aromatherapy) were not located or did not meet basic inclusion criteria. If CAM interventions are to be considered as viable stand-alone or adjuvant treatments for sleep disorders, future researchers are urged to use acceptable methodology, including appropriate sample sizes and adequate controls. RCTs evaluating other untested CAM therapies such as massage, homoeopathy, or osteopathy are encouraged, as is the exploration of using CAM therapies adjuvantly with conventional therapies.

Sleep Med Rev. 2010 Jun 5. Sarris J, Byrne GJ. Department of Psychiatry, Faculty of Medicine, The University of Melbourne, 130 Church St. Richmond 3121, Melbourne, Victoria, Australia; Brain Sciences Institute, Swinburne University of Technology, 400 Burwood Rd, Hawthom 3123, Melbourne, Victoria, Australia.

Chamomile is one of the most ancient medicinal herbs known to mankind. It is a member of Asteraceae/Compositae family and represented by two common varieties viz. German Chamomile (Chamomilla recutita) and Roman Chamomile (Chamaemelum nobile). The dried flowers of chamomile contain many terpenoids and flavonoids contributing to its medicinal properties. Chamomile preparations are commonly used for many human ailments such as hay fever, inflammation, muscle spasms, menstrual disorders, insomnia, ulcers, wounds, gastrointestinal disorders, rheumatic pain, and hemorrhoids. Essential oils of chamomile are used extensively in cosmetics and aromatherapy. Many different preparations of chamomile have been developed, the most popular of which is in the form of herbal tea consumed more than one million cups per day. In this review we describe the use of chamomile in traditional medicine with regard to evaluating its curative and preventive properties, highlight recent findings for its development as a therapeutic agent promoting human health.

Mol Med Report. 2010 Nov 1;3(6):895-901. Srivastava JK, Shankar E, Gupta S. Department of Urology & Nutrition, Case Western Reserve University, Cleveland, Ohio 44106.

Full Title: Effects of aromatherapy on changes in the autonomic nervous system, aortic pulse wave velocity and aortic augmentation index in patients with essential hypertension.

PURPOSE: To investigate the effectiveness of aromatherapy on blood pressure, heart rate variability, aortic pulse wave velocity and the aortic augmentation index of essential hypertensive patients. METHODS: Using a coin toss, 22 participants were assigned to the experimental group and 20 to the control. The experimental group was given a blend of oils of lemon (Citrus limonum), lavender (Lavandula angustifolia), and ylang ylang (Cananga odorata) which were prepared in the ratio of 2:2:1, respectively. The control group was given an artificial lemon fragrance of Limonene (35 cc) and Citral (15 cc) mixture. The experiment, inhalation, was conducted for 3 weeks (2 min per inhalation, 2 times per day) to both groups. RESULTS: There was a noticeable difference in systolic blood pressure between the groups (p=.001), however the difference in diastolic blood pressure between the two groups was not significant. There was a notable difference in sympathetic nerve system activity of heart rate variability (p=.047). However, the differences in aortic pulse wave velocity or the aortic augmentation index were not significant. CONCLUSION: Aromatherapy is effective in lowering systolic blood pressure and sympathetic nerve system activity.

J Korean Acad Nurs. 2010 Oct;40(5):705-13. [Article in Korean] Cha JH, Lee SH, Yoo YS. Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

OBJECTIVES: We aimed to determine the feasibility of conducting a randomised controlled trial (RCT) on the use of aromatherapy during labour as a care option that could improve maternal and neonatal outcomes. DESIGN: RCT comparing aromatherapy with standard care during labour. SETTING: District general maternity unit in Italy. SAMPLE: Two hundred and fifty-one women randomised to aromatherapy and 262 controls. METHODS: Participants randomly assigned to administration of selected essential oils during labour by midwives specifically trained in their use and modes of application. MAIN OUTCOME MEASURES: Intrapartum outcomes were the following: operative delivery, spontaneous delivery, first- and second-stage augmentation, pharmacological pain relief, artificial rupture of membranes, vaginal examinations, episiotomy, labour length, neonatal wellbeing (Apgar scores) and transfer to neonatal intensive care unit (NICU). RESULTS: There were no significant differences for the following outcomes: caesarean section (relative risk [RR] 0.99, 95% CI: 0.70-1.41), ventouse (RR 1.5, 95% CI: 0.31-7.62), Kristeller manoeuvre (RR 0.97, 95% CI: 0.64-1.48), spontaneous vaginal delivery (RR 0.99, 95% CI: 0.75-1.3), first-stage augmentation (RR 1.01, 95% CI: 0.83-1.4) and second-stage augmentation (RR 1.18, 95% CI: 0.82-1.7). Significantly more babies born to control participants were transferred to NICU, 0 versus 6 (2%), P = 0.017. Pain perception was reduced in aromatherapy group for nulliparae. The study, however, was underpowered. CONCLUSION: This study demonstrated that it is possible to undertake an RCT using aromatherapy as an intervention to examine a range of intrapartum outcomes, and it provides useful information for future sample size calculations.

BJOG. 2007 Jul;114(7):838-44. Epub 2007 May 16. Burns E, Zobbi V, Panzeri D, Oskrochi R, Regalia A. School of Health and Social Care, Oxford Brookes University, Oxford, UK. eburns@brookes.ac.uk

OBJECTIVE: Behavioural and psychological symptoms in dementia (BPSD) are common and distressing to both patients and carers. The use of antipsychotics to treat BPSD is associated with a high burden of side-effects and alternative strategies are required. Aromatherapy is an option that has been recommended for use in dementia. We aimed to review the evidence supporting the use of aromatherapy in BPSD. METHODS: We searched Medline, Cochrane and EMBASE for randomised controlled trials of aromatherapy in patients with dementia. RESULTS: Eleven prospective randomised studies of aromatherapy in BPSD were identified. The aromatherapy oils tested, method of administration and outcome measures used varied widely across the studies. Most of the studies included very small numbers of patients and were designed in such a way that made interpretation of the findings difficult. CONCLUSION: Data supporting the efficacy of aromatherapy are scarce; available studies reported positive and negative consequences for both people with dementia and their carers. The side-effect profile of commonly used oils is virtually unexplored. Although a potentially useful treatment for BPSD, the expectations of clinicians and patients with respect to the efficacy and tolerability of conventional medicines should equally apply to aromatherapy.

Int J Geriatr Psychiatry. 2008 Apr;23(4):337-46. Nguyen QA, Paton C. Oxleas NHS Foundation Trust, Dartford, Kent, UK. Quynh-Anh.Nguyen@oxleas.nhs.uk

Full Title: Expectancies, not aroma, explain impact of lavender aromatherapy on psychophysiological indices of relaxation in young healthy women

OBJECTIVES: In aromatherapy, lavender aroma is reputed to assist with relaxation. However, while there is much anecdotal evidence to that effect, the empirical literature is very inconsistent. Failure to employ adequate placebos, proper blinding, objective measures, or screening of prior beliefs about aromatherapy means that many previous findings could have been influenced by expectancy biases. The present study sought to establish whether lavender aroma and/or expectancies affect post-stress relaxation. DESIGN: A double-blind, 3 (aroma) x 3 (instruction) x 10 (time in minutes) mixed-factorial placebo-controlled trial. METHOD: In a laboratory, 96 healthy undergraduate women were exposed to lavender, placebo, or no aroma during physiologically assessed relaxation after an arousing cognitive task. Where an aroma was presented, an instructional priming procedure was used to manipulate participants' expectancies about the aroma's likely impact on their ability to relax. RESULTS: Results showed no effect of aroma on galvanic skin response during relaxation. However, the nature of instructional prime was associated with relaxation patterns: when expecting the aroma to inhibit them, participants relaxed more; when expecting facilitation, participants relaxed less. The effect was not seen with regard to self-reported relaxation (as represented by changes in state anxiety) and was independent of ratings of attitudes towards aromatherapy. CONCLUSIONS: The findings imply that the previous associations of lavender aroma with assisted relaxation may have been influenced by expectancy biases, and that the relevant expectancies are easily manipulable.

Br J Health Psychol. 2008 Nov;13(Pt 4):603-17. Epub 2007 Sep 7. Howard S, Hughes BM. National University of Ireland, Galway, Ireland.

Preoperative anxiety is prevalent in surgical patients who may require anxiety medications, thus impacting preoperative teaching and patient satisfaction. No studies were found in a comprehensive search on the effect of essential oils on anxiety in the preoperative setting. The purpose of this experimental study was to investigate whether the essential oil lavandin is more effective than standard care in reducing preoperative anxiety. A convenience sample of 150 adult patients were randomly assigned to either control (standard care), experimental (standard care plus essential oil lavandin), or sham (standard care plus jojoba oil) groups. Visual analog scales were used to assess anxiety on admission and OR transfer. Controlling for baseline anxiety and pain, the lavandin group had significantly lower anxiety on OR transfer, suggesting that lavandin is a simple, low-risk, cost-effective intervention with the potential to improve preoperative outcomes and increase patient satisfaction. Future studies should test the effects of lavandin in the postoperative phase and in specific populations with documented high anxiety.

J Perianesth Nurs. 2009 Dec;24(6):348-55. Braden R, Reichow S, Halm MA. United Hospital, St Paul, MN, USA.

OBJECTIVES: To review the effect of lavender scent on anticipatory anxiety in dental participants. METHODS: In a cluster randomized-controlled trial, patients' (N = 340) anxiety was assessed while waiting for a scheduled dental appointment, either under the odor of lavender or with no odor. Current anxiety, assessed by the brief State Trait Anxiety Indicator (STAI-6), and generalized dental anxiety, assessed by the Modified Dental Anxiety Scale (MDAS) were examined. RESULTS: Analyses of variance (anovas) showed that although both groups showed similar, moderate levels of generalized dental anxiety (MDAS F((1,338)) = 2.17, P > 0.05) the lavender group reported significantly lower current anxiety (STAI: F((1,338)) = 74.69, P < 0.001) than the control group. CONCLUSIONS: Although anxiety about future dental visits seems to be unaffected, lavender scent reduces state anxiety in dental patients.

Community Dent Oral Epidemiol. 2010 Feb;38(1):83-7. Epub 2009 Nov 23. Kritsidima M, Newton T, Asimakopoulou K. King's College London, Dental Institute, Denmark Hill, London, UK.

PURPOSE: This study was done to examine the effects of aromatherapy on stress and stress responses in adolescents. METHODS: A two-group cross-over design was used for this study. The experimental treatment was aroma essential oil inhalation and the placebo treatment was carrier oil inhalation using a necklace. The sample included 36 female high school students. Fisher's exact test, t-test, and paired t-test using SPSS/WIN program were used to analyze the data. RESULTS: Stress levels were significantly lower when the students received the aroma treatment compared to when they received the placebo treatment. The stress responses except salivary IgA levels were significantly lower when the students received the aroma treatment. CONCLUSION: Aroma inhalation could be a very effective stress management method for high school students. Therefore, it is recommended that this program be used in clinical practice as an effective nursing intervention for high school students.

J Korean Acad Nurs. 2009 Jun;39(3):357-65. Seo JY. Department of Nursing, Youngnam Foreign Language College, Gyeongsan, Korea. marseo@hanmail.net

OBJECTIVE: Recently, the importance of non-pharmacological therapies for dementia has come to the fore. In the present study, we examined the curative effects of aromatherapy in dementia in 28 elderly people, 17 of whom had Alzheimer's disease (AD). METHODS: After a control period of 28 days, aromatherapy was performed over the following 28 days, with a wash out period of another 28 days. Aromatherapy consisted of the use of rosemary and lemon essential oils in the morning, and lavender and orange in the evening. To determine the effects of aromatherapy, patients were evaluated using the Japanese version of the Gottfries, Brane, Steen scale (GBSS-J), Functional Assessment Staging of Alzheimer's disease (FAST), a revised version of Hasegawa's Dementia Scale (HDS-R), and the Touch Panel-type Dementia Assessment Scale (TDAS) four times: before the control period, after the control period, after aromatherapy, and after the washout period. RESULTS: All patients showed significant improvement in personal orientation related to cognitive function on both the GBSS-J and TDAS after therapy. In particular, patients with AD showed significant improvement in total TDAS scores. Result of routine laboratory tests showed no significant changes, suggesting that there were no side-effects associated with the use of aromatherapy. Results from Zarit's score showed no significant changes, suggesting that caregivers had no effect on the improved patient scores seen in the other tests. CONCLUSIONS: In conclusion, we found aromatherapy an efficacious non-pharmacological therapy for dementia. Aromatherapy may have some potential for improving cognitive function, especially in AD patients.

Psychogeriatrics. 2009 Dec;9(4):173-9. Jimbo D, Kimura Y, Taniguchi M, Inoue M, Urakami K. Department of Biological Regulation, School of Health Science, Faculty of Medicine, Tottori University, Yonago, Japan.

The aim of this study was to investigate the effect of aromatherapy massage with jasmine oil (Jasminum sambac L., Oleaceae) on humans. Human autonomic parameters, i.e. blood pressure, pulse rate, blood oxygen saturation, breathing rate, and skin temperature, were recorded as indicators of the arousal level of the autonomic nervous system. In addition, subjects had to rate their emotional condition in terms of relaxation, vigor, calmness, attentiveness, mood, and alertness in order to assess subjective behavioral arousal. Forty healthy volunteers participated in the experiments. Jasmine oil was applied topically to the skin of the abdomen of each subject. Compared with placebo, jasmine oil caused significant increases of breathing rate, blood oxygen saturation, and systolic and diastolic blood pressure, which indicated an increase of autonomic arousal. At the emotional level, subjects in the jasmine oil group rated themselves as more alert, more vigorous and less relaxed than subjects in the control group. This finding suggests an increase of subjective behavioral arousal. In conclusion, our results demonstrated the stimulating/activating effect of jasmine oil and provide evidence for its use in aromatherapy for the relief of depression and uplifting mood in humans.

Hongratanaworakit T. Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Srinakharinwirot University, Rangsit-Ongkharak Road, Nakhonnayok 26120, Thailand. tapanee@swu.ac.th

We examined how aromatherapy massage influenced psychologic and immunologic parameters in 12 breast cancer patients in an open semi-comparative trial. We compared the results 1 month before aromatherapy massage as a waiting control period with those during aromatherapy massage treatment and 1 month after the completion of aromatherapy sessions. The patients received a 30 min aromatherapy massage twice a week for 4 weeks (eight times in total). The results showed that anxiety was reduced in one 30 min aromatherapy massage in State-Trait Anxiety Inventory (STAI) test and also reduced in eight sequential aromatherapy massage sessions in the Hospital Anxiety and Depression Scale (HADS) test. Our results further suggested that aromatherapy massage ameliorated the immunologic state. Further investigations are required to confirm the anxiolytic effect of aromatherapy in breast cancer patients.

Evid Based Complement Alternat Med. 2009 Mar;6(1):123-8. Imanishi J, Kuriyama H, Shigemori I, Watanabe S, Aihara Y, Kita M, Sawai K, Nakajima H, Yoshida N, Kunisawa M, Kawase M, Fukui K. Department of Microbiology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamikyo-ku, Kyoto 602-8566, Japan. imanishi-micro@nifty.com.