Lost research staff - unable to enroll until new research staff is hired.

The purpose of this research study is to test the safety, tolerability, and effectiveness of watching streamed videos through virtual reality (VR) goggles during surgery.

The results of this study will be used to evaluate whether video-streaming services on VR goggles are worthwhile additions to standard anesthesia care during total knee surgery.

Usual anesthetic care for total knee replacement involves intravenous sedation as well as spinal anesthesia. In this study, participants will receive usual care, and in addition, will be asked to wear VR goggles once they arrive in the operating room. Participants will choose from a selection of 10 shows and movies to watch for the duration of the surgery (approximately 2 hours).

Inclusion Criteria:

1. undergoing a primary elective total knee replacement by one of the orthopedic joint surgeons at Virginia Commonwealth University Medical Center
2. 18 years of age or older
3. eligible for spinal anesthesia
4. mentally capable of understanding instructions on how to request anesthesia medication

Exclusion Criteria:

1. identified as a member of regulated vulnerable population
2. ineligibility for spinal anesthesia
3. morbid obesity (body mass index greater than 40)
4. allergy to propofol or midazolam
5. pre-operative daily opioid consumption of more than 10 mg oxycodone every 6 hours (over 60 morphine miligram equivalents per day)
6. daily benzodiazepine consumption
7. history of alcohol or recreational drug abuse
8. hearing or visually impaired individuals