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Clinical Tips Enhanced Recovery After Surgery Human Physiology and Pathophysiology Opioid Free Anesthesia Outpatient Anesthesia Pharmacology Wellness

#128 – The Power of Non-Pharmacologic Anxiolysis with Jonathan Harrington & Justin Rodriguez

My guests today are Jonathan Harrington & Justin Rodriguez, 3rd-year doctoral students from two different nurse anesthesia programs. Jonathan is attending the program accredited through the Integrated Anesthesia Associates of Hartford and Justin is attending the Yale New Haven Hospital program… both of which are affiliated with Central Connecticut State University.

They join me to talk about non-pharmacological interventions for anxiety in the preoperative setting. It’s a pretty interesting conversation and if you’re about to write this off as “yeah, but I have midazolam or dexmedetomidine or my dashing good looks and affable personality working for me”… hang in there. While your beautiful face and affable personality are technically non-pharmacological interventions and likely put many people at ease just by you showing up in the room, Jonathan and Justin walk us through actual techniques, grounded in the scientific literature with clinically significant effects, that you can readily deploy on your next shift.

Jonathan & Justin want to acknowledge their professors, Dr Stephanie Stewart and Dr Samantha Barbessi for their role in supporting and editing their doctoral scholarly project and what they’ve prepared to share on the podcast today.

As a quick primer on this show – I’m thrilled these guys have come to share what they’ve found in the literature with us. When I started my practice, every patient I met got 2mg of versed pretty much as soon as I could give it to them. I thought that’s how every anesthetic was supposed to start. That was followed by a heavy dose of intraoperative opioids for pain management. Over the last decade of my practice, my perspective has shifted dramatically on both of these fronts. I rarely pull midazolam for patients now but not because I don’t care about preoperative anxiety – I probably care more about it now than ever. I also care about how the rest of my patient’s day is going to go and how their post operative recovery will go.

Jonathan and Justin walk us through a handful of techniques we can readily deploy as anesthesia providers and anchor the power of these non-pharmacologic anxiolysis techniques in the literature so you can make an informed decision about how to change your practice.

And with that, let’s get to the show…

Here’s a link to the YouTube video referenced in the show:

References

  1. Agüero-Millan B, Abajas-Bustillo R, Ortego-Maté C. Efficacy of nonpharmacologic interventions in preoperative anxiety: a systematic review of systematic reviews. J Clin Nurs 2023;32(17-18):6229-6242. doi:10.1111/jocn.16755
  1. Anzalone K, Ohliger A, Tanios M, Mas D Alessandro NM, Hill H, Tollinche L. Anxiety assessment education for preoperative nurses. J Perianesth Nurs. 2025; 40(5):1140-1146. doi:10.1016/j.jopan.2025.01.006
  2. Honig AJ, Galassi MG, Ogungbe OO, Uranga T, Cuevas DK. Implementation of aromatherapy, a nonpharmacological intervention, to reduce anxiety during the preoperative period. J Perianesth Nurs. 2023; 38(2):206-2012. doi:10.1016/j.jopan.2022.06.011
  3. Reynaud D, Bouscaren N, Lenclume V, Boukerrou M. Comparing the effects of self-selected music versus predetermined music on patient anxiety prior to gynecological surgery: the muanx randomized controlled trial. BMC. 2021; 22:535. doi:10.1186/s13063-021-05511-2
  4. Law M, Karulkar N, Broadbent E. Evidence for the effects of viewing visual artworks on stress outcomes: a scoping review. BMJ Open. 2021;11(6). doi:10.1136/bmjopen-2020-043549
  5. Anamagh MA, Kouhpayeh MS, Khezri S, et al. The effect of guided imagery on perioperative anxiety in hospitalized adult patients: a systematic review of randomized controlled trials. Surg Pract Sci. 2024;18. doi:10.1016/j.sipas.2024.100255
  6. Álvarez-García C, Yaban ZS. The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: a meta-analysis. Complement Ther Clin Pract. 2020;38. doi:10.1016/j.ctcp.2019.101077
  7. Wang R, Huang X, Wang Y, Akbari M. Non-pharmacologic approaches in preoperative anxiety, a comprehensive review. Front Public Health. 2022;10. doi:10.3389/fpubh.2022.854673
  8. Lertkovit S, Siriussawakul A, Suraarunsumrit P, Lertpipopmetha W, Manomaiwong N, Wivatdechakul W, et al, eds. Polypharmacy in older adults undergoing major surgery: prevalence, association with postoperative cognitive dysfunction and potential associated anesthetic agents. Front. Med. 2022; 9:811954. doi: 10.3389/fmed.2022.811954
  9. Grondin F, Bourgault P, Bolduc N. Intervention focused on the patient and family for better postoperative pain relief. Pain Manag Nurs. 2012;15(1):76-86. doi:10.1016/j.pmn.2012.06.006
  10. Baek J, Kim C, Bissett K. Preoperative anxiety management for elderly patients undergoing cataract surgery: an integrative review. Geriatr. Nurs. 2024; 59:677-696. Accessed March 20, 2026.
  11. Wang Q, Ding G, Li Y. Preoperative anxiety and postoperative delirium: a mini review of the association, mechanisms, and preventive strategies. J. Multidiscip. Healthc. 2026;19:1-11. Accessed March 20, 2026.https://doi.org/10.2147/JMDH.S564668
  12. Tse WLW, Sin PY, Choi KC, Cheng HY. The effectiveness of non-pharmacological interventions on preoperative and postoperative anxiety among patients undergoing abdominal surgery: A systematic review and meta-analysis. Worldviews Evid Based Nurs. 2026;23(1):e70099. doi: 10.1111/wvn.70099
  13. Cardillo ER, Chatterjee A. Benefits of Nature Imagery and Visual Art in Healthcare Contexts: A View from Empirical Aesthetics. Buildings. 2025;15(7):1027. doi:10.3390/buildings15071027
  14. Yang K, Detroyer E, Grootven BV, et al. Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis. BMC Geriatr. 2023;23(198). doi: 10.1186/s12877-023-03923-0
  15. Giordano F, Giglio M, Sorrentino I, et al. Effects of preoperative music therapy versus intravenous midazolam on anxiety, sedation and stress in stomatology surgery: a randomized controlled study. J Clin Med. 2023;12(9):3215. doi:10.3390/jm12093215
  16. Giese A, Khanam R, Nghiem S, Rosemann T, Havranek MM. Patient-reported experience is associated with higher future revenue and lower  costs of hospitals. Eur. J. Health Econ. 2024;25:1031-1039. doi: 10.1007/s10198-023-01646-y
  17. Richter JP, Muhlestein DB. Patient experience and hospital profitability: is there a link? Health Care Manag. Rev. 2017;42(3):247-257. doi: 10.1097/HMR.0000000000000105
  18. Haradon-Chrisler D. Managing anxiety and unrealistic expectations before surgery. Nursing. 2025;55(12):41-45. doi:10.1097/NSG.0000000000000278

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Anesthesia Education Wellness

#4 – Front Line Heroes with M.J. Hiblen

Front Line Heroes by M.J. Hiblen

MJ Hiblen is an illustrator from Norwich, United Kingdom who’s first book of art titled, Front Line Heroes is available now from Eyewear Publishing. 

This book is incredibly powerful.  I’ve followed MJ’s work on Instagram since the early days of the COVID19 pandemic when he began drawing images depicting the coronavirus as a classic comic-book style menacing villain with healthcare workers squaring off as the front line heroes the world has come to know them as.  When I saw that this collection of art was coming together in a limited edition hardcover, I immediately put my order in.  The book went to print in August 2020 and over the last few weeks I’ve shared it with colleagues in my anesthesia department.  Their first glance at the artwork – during busy shifts at our level 1 trauma center – was often much like mine:  at first intrigued and then within pages, fighting back tears as we realize the beauty and power of what M.J. Hiblen has captured in his images.  His work is evocative & heart wrenching, at once it powerfully represents the human toll and suffering this virus has brought around the world while also casting healthcare workers as the defiant, battle-worn and ultimately triumphant care providers they are.

You owe it to yourself, after the year we’ve all experienced, to look M.J. Hiblen up on Instagram and get a copy of this book for yourself.  You can find it on Amazon or directly from the publisher at Eyewear Publishing.  Links to the book are in the show notes and if you hurry, you might still be able to get one only 1000 first edition hardcovers, signed by M.J. Hiblen.

Click here: M.J. Hiblen on Instagram

Order your copy of Front Line Heroes, art by M.J. Hiblen here.

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