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Every year, millions of patients receive preoperative sedatives for reduction of anxiety before

surgery. As early as the 1950s it was proposed that lower levels of anxiety were associated with
improved postoperative clinical recovery, and the literature has borne out this theory. It has been
well established in the medical literature that preoperative anxiolytic administration was
associated with decreases in postoperative pain, analgesic consumption, and duration of hospital
stay. The mainstay of these preoperative anxiolytic therapies is midazolam given its rapid onset
and clearance; however in recent years numerous investigators have demonstrated the efficacy of
other preoperative interventions aimed at further reducing anxiety in an effort to improve
postoperative outcomes. These alternate therapies range from alternate medications to include
melatonin, ketamine, and gabapentin, to more psycho-social interventions to include audio/video
distraction during induction, increased face to face time with nursing staff, and acupuncture. To
date, numerous studies have demonstrated the efficacy of acupuncture, specifically auricular
acupuncture, as an anxiolytic therapy, and others have demonstrated auricular acupuncture as
improving postoperative outcomes to include decreased opiate consumption and decreased
postoperative nausea and vomiting. Despite these numerous studies, no prospective study to date
has examined the relationship between the effects of acupuncture on preoperative anxiety with
subsequent follow through into assessing the quality of postoperative recovery.
We will recruit and consent *** relatively healthy patients (ASA Class I-II and scheduled to
undergo elective general, orthopedic, or gynecologic surgeries). They will be consented to take
part in this prospective, double blind, randomized control trial. Each patient will be randomly
assigned to either the acupuncture or control group. At that time they will self-administer a StateTrait Anxiety Inventory (STAI) to determine baseline preoperative Anxiety. Patients in the
acupuncture group will have gold ASP needles inserted into bilateral Shenmen points, and have
these needles covered by bandages. Patients in the control group will simply have bandages
placed over the corresponding sites. Patients will not be informed as to their treatment group.
Prior to entrance to the OR, the patient will again self-administer an STAI to determine any
change in anxiety from baseline. In the PACU initial postoperative pain will be recorded on a
visual analogue scale, and initial nausea and vomiting will be assessed using a Johnson 10 scale
criteria. Time to first ambulation and time to hospital discharge will also be recorded. Patients
will be followed up at the 72 hour postoperative point to assess pain and any complications with
the acupuncture needles. Statistical analysis will be performed to determine what effect if any the
auricular acupuncture had on preoperative anxiety and the postoperative metrics mentioned
above.
Myotonic dystrophy type 1 (DM1) is the most common muscular dystrophy presenting in 1 in
8000 adults. It is characterized primarily by myotonia of the skeletal muscles, but also in
systemic manifestations that include respiratory compromise and cardiac involvement. DM1 is
an autosomal dominant disorder caused by an expanded trinucleotide repeat found on
chromosome 19 in a non-coding region of a serine-threonine protein kinase. It is well established
in the DM1 literature that myocardial fibrosis results in abnormal cardiac conduction, resulting in
both atrial and ventricular arrhythmias, myocardial disease, and increased risk of sudden death.
Cardiac dysrhythmia, primarily heart block, is the second leading cause of death in patients with
DM1 after respiratory failure, with some studies indicating a risk of sudden death at 1% annually
in all-comers with DM1. 65% of DM1 patients show a prolongation of the PR interval or QRS

duration. The disease process in DM1 patients in currently progressive and without effective
treatment at this time, so interventions are supportive and directed at delaying the effects of the
disease. Early placement of a pacemaker or implantable cardiac defibrillator has been shown to
decrease the risk of sudden death in DM1 patients, so early identification is vital of the disease is
vital in this patient population. An early diagnosis also aids physicians and caretakers when
treating a patient with DM1 as suspicion for other systemic manifestations of the disease will
obviously increase in an otherwise healthy patient except for mild muscle weakness.
The most common initial symptom in DM1 is myotonia that is more pronounced at rest and
improves with muscle activity. This typically involves characteristic muscle groups to include the
forearm, hand, tongue and jaw. By the time this diagnosis is made however, anywhere from 2540% of patients will have some evidence of conduction abnormality on a routine screening EKG,
normally a prolonged PR interval.
No studies to date have examined the use of routine EKG as a screening test for development of
DM1 or other muscular dystrophies. There is no data on the incidence of DM1 in patients who
had previously identified idiopathic heart block. This data could allow researchers to potentially
identify DM1 patients earlier, and begin prophylactic and supportive interventions earlier, and
potentially extend life and quality of life when compared to waiting for a myotonia to develop.
We will perform an incidence study within the Military Healthcare Record system looking for an
association between idiopathic first, second, and third degree heart block and increased incidence
of DM1 when compared with the general population. Patient will be identified according to
Coding