10 Recent Anesthesia Findings and Breakthroughs

Here are 10 recent findings impacting the anesthesia community, according to reports from various anesthesia journals, conferences and societies.

1. Type of anesthetic does not affect long-term post-operative cognitive dysfunction.
Post-operative cognitive dysfunction at three months after surgery is independent of the type of procedure or anesthetic, according to a report published in Anesthesia & Analgesia. The study sample consisted of subjects involved in three separate clinical trials: coronary angiography under sedation, major non-cardiac surgery under general anesthesia and coronary artery bypass graft surgery under general anesthesia. The incidence of POCD in elderly patients seven days after surgery was higher after CABG surgery than THJR surgery, but after three months, there was no difference when comparing the three surgical groups.

2. Brief anesthetic exposure in infancy does not affect adolescent test scores. Researchers found no evidence that a single, relatively brief anesthetic exposure connected to hernia repair in infancy reduced academic performance during adolescence, according to a report published in Anesthesiology. The study used Danish birth cohorts from 1986-1990 and compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched population sample. The researchers found nothing suggesting that the anesthetic exposure related to hernia repair reduced academic performance at 15 or 16 years old.

3. Non-infiltrative anesthetics can treat transrectal prostate biopsy pain. Non-infiltrative anesthetics are safe and effective in treating pain from transrectal prostate biopsy, according to research from the Department of Urology and Renal Transplantation at the University of Foggia in Italy. According to the study, periprostatic nerve block is the standard anesthesia for ultrasound-guided transrectal prostate biopsy, but periprostatic infiltration creates a major source of discomfort for patients. The researchers aimed to determine the effectiveness and safety of perianal-interrectal lidocaine gel, lidocaine-ketorolac gel and lidocaine-prilocaine cream in relieving pain. The study found that lidocaine-prilocaine cream was most effective on probe-related pain, whereas lidocaine-ketorolac gel was most effective on sampling-related pain.

4. Fentanyl provides alternative to anesthesia for ROP laser therapy. Data suggests fentanyl used during laser therapy for retinopathy of prematurity is a safe and effective alternative to anesthesia, according to a poster presentation at the American Association for Pediatric Ophthalmology and Strabismus meeting. The study examined consecutive preterm neonates undergoing laser treatment of ROP in the neonatal intensive care unit. Twenty-two patients received morphine and 13 received fentanyl, and midazolam was also used when necessary. A change in ventilation status was observed in 45.46 percent of morphine patients and 15.39 percent of fentanyl patients, according to the report. Apneic events were more common in the morphine group. The data suggests that continuous infusion with fentanyl is safer than morphine for preterm infants undergoing ROP laser therapy in the neonatal ICU.

5. Capnography could reduce airway complications in obese anesthesia patients.
The use of capnography in ICUs could significantly reduce deaths and brain damage from airway complications in obese anesthesia patients, according to a British study published in the British Journal of Anaesthesia. The study found that the absence of a breathing monitor, or capnograph, contributed to 74 percent of airway-related deaths reported from ICUs in the United Kingdom from 2008-2009. The capnograph detects exhaled carbon dioxide and is used almost universally in anesthesia but only occasionally in ICUs. The researchers concluded if the monitor had been used in the ICUs, it would have identified problems at an earlier stage and thus could have prevented some deaths.

6. Anesthesia groups' average administrative service contracts outrank other specialties. Anesthesia is the highest-paid hospital-based physician specialty, with a median annual administrative service contract of $773,309, according to MD Ranger's 2010/2011 Physician Contract Benchmarks Report. The numbers reported in the 2010/2011 Physician Contract Benchmarks Report do not represent the median annual salary of anesthesiologists, but rather, the average administrative service contract. In addition, group size and other factors are not adjusted. According to an October 2010 CNN Money report, anesthesiologists make an average salary of $290,000 each year. Twenty-one percent of contracts only pay medical directorship fees, and another 34 percent only pay for coverage services. Anesthesia and hospitalist contracts are more likely to have an incentive component, which exist in approximately seven percent of all contracts.

7. Obese patients are twice as likely to develop airway problems. Obese patients were shown to be twice as likely to develop serious airway problems during a general anesthetic compared to non-obese patients, in a study titled "4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society: Major complications of airway management in the United Kingdom." Severely obese patients were four times as likely to develop airway complications. Obese patients were also more likely than non-obese patients to die if they had airway complications in the intensive care unit. The study examined patients who had major airway complications due to anesthesia from 2008-2009.

8. Hemoglobin monitors could help monitor blood hemoglobin levels noninvasively.
A spectrophotometric hemoglobin sensor may help providers monitor blood hemoglobin levels noninvasively during surgery, according to a report published in the April 2011 issue of Anesthesia & Analgesia. The SpHb technology could reduce facilities' reliance on invasive monitoring or the need for blood transfusion during surgery. The study, led by Ronald D. Miller, MD, of the University of California in San Francisco, evaluated SpHb for continuous monitoring of blood hemoglobin levels in 20 patients undergoing spine surgery with general anesthesia. Results found that the SpHb monitor was fairly accurate compared to the standard lab test.  

9. Orphan drug could make morphine safter and more effective. A discovery by researchers at the Indiana University School of Medicine could make morphine a safer and more effective drug, according to a report in the March 25 issue of Brain, Behavior and Immunity. Morphine, which is used throughout the country to control moderate to severe pain, can cause reduced respiration, constipation, itching and addiction. What's more, patients develop a tolerance to morphine over time, meaning doses must be increased for the drug to be effective. Morphine increases molecular communication to and from the nerves by a protein known as CXCR4. The boost in CXCR4 signaling results in a neuroinflammatory response that causes increased sensitivity and pain. In the study, researchers gave rats AMD3100, an orphan drug that blocks the response. The drug was effective in interrupting the neuroinflammatory response.

10. Researchers discover accurate predictor of pediatric lumbar plexus depth.
The distance from the posterior superior iliac spine (PSIS) to the intercristal line can be an accurate predictor of lumbar plexus depth in children, according to a study published in Anesthesia & Analgesia. Researchers studied patients aged one to 24 undergoing lower extremity surgery and lumbar plexus block. They found a strong linear relationship between lumbar plexus depth and PSIS-ICL distance. The predicted depth was within 10 mm of actual depth in 92 percent of patients. The authors suggest the PSIS-ICL distance can guide ultrasound location and needle length.

Read more on anesthesia:

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-Study: Dentist Anesthesiologists Contribute Much to Research

-ASA Responds to Study on Anesthesia Service Contract Compensation

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