Types of anesthesia for different sacroiliac joint interventions

There are a variety of anesthetic techniques commonly used for sacroiliac joint (SIJ) procedures. For example, diagnostic SIJ injections do not necessitate anesthesia, while open SIJ fusions require general anesthesia. This chapter, targeted to practitioners performing SIJ procedures, covers the basic elements of these techniques. After a brief discussion of the history of anesthesia in relation to SIJ procedures, each common anesthetic technique is discussed, in order of increasing sedation. Local anesthesia is discussed for intraarticular joint injections, blocks of the nerves innervating the SIJ, and radiofrequency ablations of these same nerves. Monitored anesthesia care is discussed for procedures such as minimally invasive SIJ fusions and the Simplicity radiofrequency ablation technique. The use of neuraxial anesthesia, via either spinal or epidural blocks, is considered for lateral SIJ fusions. Finally, the use of general anesthesia for lateral and open fusions is reviewed.

Preoperative Anxiety and Fear of Anesthesia in Patients admitted in Tertiary Care Hospitals of Rawalpindi

Background: Preoperative apprehension is a widespread global problem. This anxiety and apprehension can significantly affect all aspects of anesthesia and surgery. Thus, it is essential to detect and address the patient's anxiety to assist in recovery after surgery and improve the patient's outcome. Materials and Methods: This is a cross-sectional study conducted over one year in the allied hospitals of Rawalpindi Medical University (RMU). Our sample size was 380 preoperative patients, who were selected by convenience sampling. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used.Results: The overall prevalence of anxiety was 30.5%, while the prevalence of information requirement was 33.2%. The mean total APAIS was 12.73±8.56, the mean anxiety subscore was 8.25±5.58, and the mean need for information subscore was 4.48±3.16. A statistically significant difference was found in the scores of the patients based on age, gender, education, type of anesthesia, and type of surgery (p< 0.05). The previous history of anesthesia and the presence of comorbidities did not bring a significant difference in the scores of the patients (p>0.05). Postoperative pain was the most important concern, found in 32% of the patients. Conclusion: Younger age group, female gender, having no formal education, surgery under regional anesthesia, and undergoing C-section, IOL implantation and septoplasty are associated with higher preoperative anxiety, while the presence of comorbidities and previous history of anesthesia are factors that do not significantly affect preoperative anxiety in our population.

Wood’s and Guedel’s Legacies Return to the Heartland

Pioneering anesthesiologists Paul Wood, M.D., and Arthur Guedel, M.D., were Hoosiers who migrated from America’s Heartland to opposite coasts. Dr. Wood moved east to New York in 1913; Dr. Guedel, west to California in 1928. By 1962, each pioneer had been honored with a namesake anesthesia museum. Fast-forwarding 55 yr, two young anesthesia historians, California’s Jane Moon, M.D., and Pennsylvania’s Melissa Coleman, M.D., met at the 2017 International Symposium of the History of Anesthesia in Boston. Today, these women are chairs of the Wood Library-Museum’s Archives and Museum Committees, respectively. As the newest authors of “Anesthesiology Reflections,” Drs. Coleman and Moon leave their coastal states semiannually for board meetings at the Wood Library-Museum of Anesthesiology, returning as legacies of Drs. Wood and Guedel…back to the American Heartland.

Anxiety in the Operating Room Before Elective Surgery

The experience of pre-operative anxiety in patients is a common and accepted issue; however, anxiety can potentially increase the patients' need for care, the level of post-operative pain, and ultimately patients' morbidity and mortality. The goal of this study was to determine the patients' pre-operative anxiety level right before they undergo surgery in the operating room. This study was conducted as a prospective crosssectional study. Accordingly, completed State-Trait Anxiety Inventory questionnaires as well as demographic and contextual variables of 230 patients undergoing surgery were evaluated. Data analysis was taken out using SPSS v24. P of less than 0.05 was considered significant. 230 patients with an average age of 48.95 (14.68) years were enrolled. The frequency of mild, moderate, and severe anxiety among the patients was 50.8%, 37%, and 12.2%, respectively. The analysis revealed that the patients' age, gender, occupation, awareness about the type of anesthesia, and place of residence, as well as the type of anesthesia, had no significant correlation with the patients' pre-operative anxiety. However, a significant difference was found regarding patients’ preoperative anxiety level and their educational, marital, awareness of post-operative complications, and trait anxiety status as well as their history of anesthesia. Therefore, to reduce post-operative complications, it is recommended that the patients with these characteristics be given priority for interventions aimed at reducing pre-operative anxiety.

Prilocaine-Induced Methemoglobinemia

Local anesthetics are used to anesthetize surface areas in several procedures. The history of anesthesia exposure has been established as an important factor for correct diagnosis. When they are used excessively, some systemic side effects such as methemoglobinemia, respiratory failure, cardiovascular arrhythmias, or neurological manifestations may occur. Methemoglobinemia which usually presents with nonspecific symptoms is a serious entity. It is a rare but severe side effect of anesthetics. We herein present a case of methemoglobinemia due to local anesthesia with prilocaine.

Adding moments to history of Anesthesia of Nepal: Truth or fiction?

This article describes about a person who might have served as anesthesia provider during 1930s at the Bir Hospital, Kathmandu, Nepal. However, concrete evidence of the person’s work as an anesthesia provider has not been found yet.