The Origins and Development of Pre-emptive Dermatologic Anesthesia: A Systematic Review.

This study delves into the historical trajectory of dermatological anesthesia, tracing its roots from ancient civilizations to modern times. It emphasizes the relentless pursuit of pain relief in dermatologic procedures and the transformative impact of anesthesia on surgical practices. A comprehensive analysis was conducted through an extensive literature review, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review model on the PubMed and Embase databases. A total of 1304 articles were initially identified, with six publications from these databases and 10 additional sources from the World Wide Web included in the study. This systematic approach allowed for a thorough examination of the historical journey of dermatological anesthesia. The historical trajectory outlined in this study highlights the progress in dermatological anesthesia, showcasing its impact on contemporary procedures with a continual emphasis on patient comfort and safety. As medical knowledge expands, the ongoing quest for enhanced pain control in dermatology remains a central focus.

Effectiveness of Radiofrequency Ablation for Treatment of Glossopharyngeal Neuralgia: A Systematic Review of the Current Literature.

BACKGROUND: Glossopharyngeal neuralgia (GPN) is a rare cause of facial pain that has an incidence of less than one per 100,000 people. The excruciating stabbing pain experienced by patients with GPN can be debilitating, leading to difficulties in activities of daily living, such as eating and speaking. As a result, there has been a recent increase in research on the effectiveness of radiofrequency ablation (RFA) for treating GPN. OBJECTIVE: The objective of our study was to evaluate the effectiveness of (RFA for treating GPN while examining its impact on patients' quality of life and assesses for any associated side effects. STUDY DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) model was employed to identify articles from 2 comprehensive medical databases. The patient outcomes and numbers from each article were aggregated and calculated in order to determine the percent efficacy of RFA for treating pain associated with GPN. METHODS: In this systematic review, the PRISMA review model was utilized to search through the PubMed and EMBASE databases. A comprehensive literature review was conducted. Of the initial 1,580 articles identified, 18 articles were included for analysis. Studies included in this systematic review encompassed idiopathic cases and secondary causes, such as an elongated styloid process, oropharyngeal cancers, and postsurgical/traumatic pain. RESULTS: Of the 288 patients treated with RFA, 231 experienced relief or complete resolution of pain, yielding an efficacy rate of 80.2%. Most of the patients experienced immediate pain relief after RFA; however, some patients reported numbness, dysphagia, and changes in taste. Our study examines the potential use of RFA as a minimally invasive and effective treatment for GPN. LIMITATIONS: Limitations of our study include the absence of comparisons between different types, modes, and settings of RFA procedures. The use of only 2 medical databases is another limitation. Finally, our systematic review does not include any randomized controlled trials. CONCLUSION: RFA is efficacious in treating GPN with over 80% of patients experiencing postprocedure pain relief. However, further research in the form of clinical and controlled trials is needed to contribute to a better understanding of RFA's long-term outcomes for patients with GPN.

Assessment and Recommendations for Website Platforms of Neuroanesthesiology Fellowship Programs.

BACKGROUND: Websites serve as recruitment and educational tools for many fellowship programs, including neuroanesthesiology. Since the COVID-19 pandemic, when interviews, conferences, and institutional visits were moved online, websites have become more important for applicants when deciding on their preferred fellowship program. This study evaluated the content of the websites of neuroanesthesiology fellowship programs. METHODS: Neuroanesthesiology fellowship program websites were identified from the websites of the International Council on Perioperative Neuroscience Training and the Society for Neuroscience in Anesthesiology and Critical Care. The content was assessed against 24 predefined criteria. RESULTS: Fifty-three fellowship programs were identified, of which 42 websites were accessible through a Google search and available for evaluation. The mean number of criteria met by the 42 fellowship websites was 12/24 (50%), with a range of 6 to 18 criteria. None of the evaluated fellowship websites met all 24 predefined criteria; 20 included more than 50% of the criteria, whereas 7 included fewer than 30% of the criteria. Having a functional website, accessibility through a single click from Google, and a detailed description of the fellowship program were the features of most websites. Information about salary and life in the area, concise program summaries, and biographical information of past and current fellows were missing from a majority of websites. CONCLUSION: Important information was missing from most of the 42 evaluated neuroanesthesiology fellowship program websites, potentially hindering applicants from making informed choices about their career plans.

Radiation Exposure in Interventional Pain Management Physicians: A Systematic Review of the Current Literature.

BACKGROUND: Millions of interventional pain procedures are performed each year to address chronic pain. The increase in these procedures also raises the concern of health risks associated with ionizing radiation for interventional pain management physicians who perform fluoroscopy-guided operations. Some health concerns include cancers, cataracts, and even pregnancy abnormalities. Little is known regarding the long-term and cumulative effects of small radiation doses. OBJECTIVES: The objective of this systematic review was to identify common body parts that are exposed to ionizing radiation during interventional pain procedures and examine methods to help physicians reduce their radiation exposure. STUDY DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist was used to comprehensively identify articles from 2 medical databases. The radiation dose to interventional pain management physicians obtained from relevant peer-reviewed articles were aggregated and used for analysis. METHODS: PubMed was first used to collect the articles for two broad keyword searches of "radiation exposure pain management" and "radiation exposure interventionalist" with years ranging from 1956 - February 2023. EMBASE was also used to collect the articles for the two keyword searches of "radiation exposure pain management" and "radiation exposure interventionalist" with years ranging from 1969 - February 2023. This systematic approach yielded a total of 2,736 articles; 24 were included in our paper. The risk of bias for these articles was performed using the Cochrane Risk of Bias tool and the National Institutes of Health tool. RESULTS: Through our systematic literature search, more than 3,577 patients were treated by 30 interventional pain management physicians. Some areas of exposure to radiation include the physician's neck, chest, groin, hands, and eyes. One common body region that is exposed to radiation is the chest; our review found that wearing lead aprons can lower the radiation dose by more than 95%. Wearing protective equipment and managing the distance between the operator and fluoroscope can both independently lower the radiation dose by more than 90% as well. Our literature review also found that other body parts that are often overlooked in regard to radiation exposure are the eyes and hands. In our study, the radiation dose to the outside (unprotected) chest ranged from 0.008 ± 27 mrem to 1,345 mrem, the outside neck ranged from 572 mrem to 2,032 mrem, the outside groin ranged from 176 mrem to 1,292 mrem, the hands ranged from 0.006 ± 27.4 mrem to 0.114 ± 269 mrem, and the eyes ranged from 40 mrem to 369 mrem. When protective equipment was worn, the radiation exposure to the inside chest ranged from 0 mrem to 108 mrem, the inside neck ranged from 0 mrem to 68 mrem, and the inside groin ranged from 0 mrem to 15 mrem. LIMITATIONS: Limitations of this study include its small sample size; only the radiation exposure of 30 interventional pain management physicians were examined. Furthermore, this review mainly consisted of observational studies rather than randomized clinical trials. CONCLUSION:   Implementing safety precautions, such as wearing protective gear, providing educational programs, and keeping a safe distance, demonstrated a significant decrease in radiation exposure. The experience of interventional pain management physicians also factored into their radiation exposure during procedures. Radiation is a known carcinogen, and more research is needed to better understand its risk to interventional pain management physicians.

Cardiac Anesthesia Intraoperative Interpretation Accuracy of Transesophageal Echocardiograms: A Review of the Current Literature and Meta-Analysis.

Background: In the United States, echocardiography is an essential component of the care of many cardiac patients. Recently, increased attention has been given to the accuracy of interpretation of cardiac-based procedures in different specialties, amongst them the field of cardiac anesthesiology and primary echocardiographers for transesophageal echocardiogram (TEE). The purpose of this study was to assess the TEE skills of cardiac anesthesiologists in comparison to primary echocardiographers, either radiologists or cardiologists. In this systematic review, we evaluated available current literature to identify if cardiac anesthesiologists interpret TEE procedures at an identical level to that of primary echocardiographers. Methods: A PRISMA systematic review was utilized from PubMed from the years 1952-2022. A broad keyword search of "Cardiology Anesthesiology Echocardiogram" and "Echocardiography Anesthesiology" to identify the literature was used. From reviewing 1798 articles, there were a total of 9 studies included in our systematic review, 3 of which yielded quantitative data and 6 of which yielded qualitative data. The mean accuracy from each of these three qualitative studies was calculated and used to represent the overall accuracy of cardiac anesthesiologists. Results: Through identified studies, a total of 8197 TEEs were interpreted by cardiac anesthesiologists with a concordance rate of 84% to the interpretations of primary echocardiographers. Cardiac anesthesiologists had a concordance rate of 83% when compared to radiologists. On the other hand, cardiac anesthesiologists and cardiologists had a concordance rate of 87% in one study and 79% in another study. Conclusion: Based on these studies, cardiac anesthesiologists are shown to interpret TEEs similarly to that of primary echocardiographers. At this time, there is no gold standard to evaluate the accuracy of TEE readings. One way to address this is to individually assess the TEE interpretation of anesthesiologists and primary echocardiographers with a double-blind study.

Both lavender fleur oil and unscented oil aromatherapy reduce preoperative anxiety in breast surgery patients: a randomized trial.

STUDY OBJECTIVE: The objective of this study was to determine whether lavender fleur oil (LFO) aromatherapy would reduce anxiety when administered to women before undergoing breast surgery. DESIGN: This was a single-site, randomized study comparing the effect of LFO to unscented oil (UO). SETTING: The study was conducted in the preoperative holding area of the ambulatory surgery department of NYU Langone Medical Center. PATIENTS: Ninety three women, 18 years and older, scheduled for breast surgery. Women meeting inclusion/exclusion criteria were randomized to either LFO or UO aromatherapy and were blind to their assigned treatment. OUTCOME MEASURES: Subjects completed a Speilberger State Anxiety Inventory for Adults (STAI) before and after aromatherapy. Vital signs were recorded before and after aromatherapy. RESULTS: STAI-State questions were divided into positive and negative emotions for analysis. Before aromatherapy, there was no significant difference between groups by individual questions or overall average answer of either positive or negative questions. The use of both LFO and UO increased the positive STAI score totals, with the LFO group having a slightly, but statistically significant, greater increase. Both resulted in a statistically significant decrease in the negative score totals after treatment. There were no differences in vital signs between groups for either treatment. Following the conclusion of the trial LFO was analyzed and found to contain a very low content of the 2 major Lavandula angustifolia constituents. CONCLUSIONS: Both LFO and UO aromatherapy treatments lowered anxiety before surgery despite no significant changes in vital signs. LFO treatment generated a slight but statistically significant increase in positive feelings compared with UO treatment. It is probable that the beneficial effect observed was due to both aromatherapy with LFO and a placebo effect related to the added attention given to the patients.

Treatment with lavender aromatherapy in the post-anesthesia care unit reduces opioid requirements of morbidly obese patients undergoing laparoscopic adjustable gastric banding.

BACKGROUND: Parenteral administration of opioids and NSAIDs has been the mainstay for postoperative pain control in patients undergoing laparoscopic adjustable gastric banding (LAGB). Both classes of drugs, however, are associated with serious adverse effects. An addition of complimentary analgesic techniques may decrease requirement for traditional analgesics, thus reducing the incidence of side-effects. We designed the study to evaluate the effectiveness of Lavender aromatherapy in reducing opioid requirements after LAGB. METHODS: A prospective randomized placebo controlled study was carried out on 54 patients undergoing LAGB. Upon arrival to the post-anesthesia care unit (PACU), patients in the study group were treated with lavender oil, which was applied to the oxygen face mask; the control group patients received nonscented baby oil. Postoperative pain was treated with morphine. Numerical rating scores (0-10) were used to measure the level of pain at 5, 30, and 60 min. Sedation was evaluated using the Observer Assessment of Alertness/Sedation scale (0-5). Data analyzed included the amount of opioids, NRS, OAA/S, PACU discharge time, as well as the incidence of side-effects. RESULTS: The two groups were comparable with regard to patient characteristics, intraoperative drug use, and surgical time. Significantly more patients in the Placebo group (PL) required analgesics for postoperative pain (22/27, 82%) than patients in the Lavender group (LAV) (12/26, 46%) (P = .007). Moreover, the LAV patients required significantly less morphine postoperatively than PL patients: 2.38 mg vs 4.26 mg, respectively (P = .04). There were no differences in the requirements for post-operative antiemetics, antihypertensives, or PACU discharge time. CONCLUSIONS: Our results suggest that lavender aromatherapy can be used to reduce the demand for opioids in the immediate postoperative period. Further studies are required to assess the effect of this therapy on clinically meaningful outcomes, such as the incidence of respiratory complications, delayed gastric emptying, length of hospital stay, or whether this therapy is applicable to other operations.

Anesthesia Residents Have a Negative Opinion on Proposed ACGME Changes to the Curriculum: A Pilot Study.

BACKGROUND: The ACGME has proposed changes to the curriculum for anesthesia residents. These changes include increasing critical care from 2 to 4 months, pain from 1 to 3 months, and obstetrics, pediatric, neuroanesthesia, and cardio thoracic anesthesia from 1 to 2 months. In addition, they have included a preoperative clinic for 1 month. METHODS: With IRB approval, a survey of the anesthesia residents at New York University was distributed. The residents questioned ranged from the CA-1 to the Ca-3 class. The survey questioned the residents on their current curriculum and the proposed changes. RESULTS: 22 Residents completed the questionnaire. Seventy-seven percent of the residents polled felt they had enough experience in critical care with the current requirements and 82% did not want the increase to 4 months (p=0.007). Seventy-three percent of the residents responded that their pain management exposure was sufficient and 82% did not want it increased (p=0.011). Overwhelmingly, 82% of those polled felt an entire month of preoperative clinic was not necessary. Seventy-three percent of those residents polled would not be comfortable on subspecialty rotations as early as August of their CA-1 year. 82% felt that too much of their training would be spent outside of the operating room, and the majority (59%) thought more residents would be on each rotation. Moreover, 55% think that the proposed changes will adversely affect residents in training. DISCUSSION: The results of this survey demonstrate that most residents at New York University do not think the current curriculum should change. The majority opinion is that it will negative impact their education.

Evaluation of aromatherapy in treating postoperative pain: pilot study.

This study compared the analgesic efficacy of postoperative lavender oil aromatherapy in 50 patients undergoing breast biopsy surgery. Twenty-five patients received supplemental oxygen through a face mask with two drops of 2% lavender oil postoperatively. The remainder of the patients received supplemental oxygen through a face mask with no lavender oil. Outcome variables included pain scores (a numeric rating scale from 0 to 10) at 5, 30, and 60 minutes postoperatively, narcotic requirements in the postanesthesia care unit (PACU), patient satisfaction with pain control, as well as time to discharge from the PACU. There were no significant differences in narcotic requirements and recovery room discharge times between the two groups. Postoperative lavender oil aromatherapy did not significantly affect pain scores. However, patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group (P = 0.0001).

A double-blind prospective comparison of rofecoxib vs ketorolac in reducing postoperative pain after arthroscopic knee surgery.

STUDY OBJECTIVE: The aim of this study was to compare the analgesic efficacy of premedication with rofecoxib vs intravenous (IV) ketorolac in reducing postoperative pain after arthroscopic knee surgery. STUDY DESIGN: This is a prospective, randomized, double-blinded study. SETTING: This study was set at a university hospital. SUBJECTS: The subjects include 54 patients with American Society of Anesthesiologists physical statuses I, II, and III undergoing knee arthroscopy. INTERVENTIONS: Group 1 received 50 mg oral rofecoxib preoperatively with IV placebo injection, which was administered 20 minutes before the end of the operation. Group 2 received a preoperative placebo and 30 mg IV ketorolac 20 minutes before the end of surgery. MEASUREMENTS: The primary outcome measure was the proportion of patients reporting pain in the postoperative anesthesia care unit, 6 hours and 24 hours after discharge. Additional end points included the use of 5:325 mg oxycodone-acetaminophen (O/A) tablets, pain scores, patient's satisfaction survey, and comparison of side effects. Data were analyzed using independent samples t tests for continuous variables or chi2 tests for categorical variables. P < .05 was considered significant. RESULTS: The 2 groups were comparable with regard to patient characteristics, intraoperative medication use, and duration of surgery. There was no difference either in pain scores or O/A use in the postoperative anesthesia care unit. At 24 hours after discharge, significantly more patients in the ketorolac group (91%) reported pain than the rofecoxib group (63%) (P = .02). Sixty-one percent of patients in the ketorolac group used O/A during the first 24 hours vs 38% in the rofecoxib group. The difference, however, was not statistically significant. CONCLUSION: Preoperative rofecoxib is as effective as ketorolac for the treatment of pain after knee arthroscopy. Higher frequency of pain reporting at 24 hours by patients in ketorolac group is explained by the longer analgesic effect of rofecoxib. Future studies should directly compare gastrointestinal injury of these drugs, as well as cost-effectiveness of rofecoxib vs ketorolac.