Simulation has been extensively used in military and aviation training. In 2003, the Louisiana State University Health Sciences Center developed and successfully implemented a required simulation curriculum, one of the first of its kind in the United States. Since then, this practice has been widely accepted by many other medical schools, both in the United States and abroad. Simulation has been used for teaching medical students and residents, nursing students and practicing nurses, as well as clinical physicians in many fields of patient care. Simulation is one of the tools that can be effectively used to teach sedation to both anesthesiologists and non-anesthesiologists.

Modern dentistry has made much progress in pain control and in providing a patient-friendly service, which has expanded the dentist’s ability to perform a wide range of treatments in a pain-free environment. Nevertheless, despite revolutionary new dental techniques, it is well recognized in the dental literature that substantial fear exists concerning seeking dental care. This fear can be so extensive that people from all races and socioeconomic categories can be affected by it in some form.

Intravenous pharmacologic sedation is often chosen for surgical and nonsurgical procedures and is administered by an anesthesiologist, nurse anesthetist, or other trained professional. Sedation is described as a continuum, encompassing minimal, moderate, and deep sedation that can be categorized according to the patient’s level of consciousness (Figure 12.1). This categorization is subjective and the different levels of sedation can be achieved through changes in medication choice and dosage. There exist overlapping zones between levels of sedation. In clinical practice, deep sedation and general anesthesia share many of the same features in terms of patient awareness, lack of responsiveness, and risk of airway compromise.

Certain patient populations requiring sedation for procedures present the clinician with challenging decisions regarding their care and management. Some underlying medical disease states, airway abnormalities, or extremes of age require cautious pre-procedural assessment and planning when sedation is required to minimize the incidence of morbidity or mortality. It should be noted that some of these higher-risk patients should only be sedated by trained anesthesia providers. The following commonly encountered conditions are considered high risk and are associated with a higher rate of complications: old age, obesity, chronic obstructive pulmonary disease, coronary artery disease, and chronic renal failure. This chapter discusses important features of these higher-risk patients and practice management when sedation is required. In all cases, appropriate monitoring, prudent selection and dosing of sedative agents, and careful assessment are important to ensure the best outcome for these higher-risk patients.

Osteoarthritis (OA) of the hip is a common source of pain and disability associated with aging. Radiographic evidence of hip OA is present in approximately 24.7% of males and 13.6% of females over 50 years old, with symptoms seen in 5.2% of males and 3.0% of females. “Wear and tear” damage to hip joint leading to dysfunctional ECM reorganization leads to chronic onset of pain that is worse with use and associated with decreased hip mobility. Years of conservative treatment with exercise, weight loss, and oral anti-inflammatories can mitigate the disease progression, but severe cases may require intraarticular injections or hip arthroplasty. Some promising injections hope to better manage chronic symptoms by reversing the course of the disease; however, total hip arthroplasty remains a gold standard treatment of severe hip OA.

Oral medication has been the mainstay of therapy; however, the use of topical formulation for chronic pain can reduce serious systemic side effects caused by oral medications. Topical administration of medication via patches, gels, creams, ointments, and solutions can provide local anesthesia and bypass major organ system. Lidocaine is an amide-type local anesthetic agent stabilizing the neuronal membranes by inhibiting the ionic fluxes required for initiation and conduction of impulses. Capsaicin is a selective agonist for TRPV1 receptor expressed in afferent neuronal C fibers and Ad fibers resulting in loss of receptor functionality causing impaired local nociception.Diclofenac works via inhibition of prostaglandin synthesis by blocking COX-1 and COX-2.

Cognitive Behavioral Therapy (CBT)

Although anesthesiology and endocrinology are two distinct branches of medicine, some recent breakthrough treatments have brought together both medical specialties, particularly those concerned with surgical sciences and critical care. Related to the use of various traditional surgical techniques, the lack of newer and safer drugs, the lack of monitoring tools, and the scarcity of critical care services in the past, managing patients with various endocrine disorders has always been perceived as being more difficult by practicing anesthesiologists.

Pediatric anesthesiology is a distinct subspecialty of anesthesia. It focuses on the perioperative care of preterm and term neonates, infants, children, and teenagers. The pediatric population is vastly different from adults, as the clinician must recognize variations in anatomy, physiology, pharmacodynamics, and pharmacokinetics. For example, infants and children under 3 years old have a greater rate of morbidity and mortality associated with anesthesia than adults [1, 2]. The American Society of Anesthesiologists Closed Claims Project reports almost half of malpractice litigation involving pediatric injuries have been related to adverse respiratory events associated with improper oxygenation and/or ventilation. It is important for anesthesiologists caring for children to have a detailed knowledge of the distinctions between pediatric and adult patients. This chapter will discuss anatomic, physiologic, and pharmacologic distinctions, as well as infection prevention and anesthetic considerations, in the pediatric population.

The anesthesia workstation, commonly referred to as the “anesthesia machine,” is a complex and very specialized piece of equipment that is relatively unique in medical practice. It is, in essence, a device to control the delivery of medical gases to patients, including oxygen, air, nitrous oxide, and volatile anesthetics, along with a specialized ventilator adapted to operating room conditions. The safe use of the anesthesia workstation requires proper training, preuse checkout, and continuous monitoring of its function. The medical literature is replete with examples of patient harm from inappropriate use of the anesthesia workstation and from mechanical or electrical failure of its components. Additionally, volatile anesthetics, while valuable in medical practice, have a very low therapeutic index and manifest severe, and even fatal, side effects when administered improperly. Finally, many patients under general anesthesia are paralyzed for surgery and ventilated through an endotracheal tube. Their safety is completely dependent on the anesthesia professional’s use of the anesthesia workstation to deliver breathing gases, remove carbon dioxide from exhaled gas, and precise administration of volatile anesthetics.