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Accurately Assessing Pain Levels with New Device

  • Accurately assessing pain levels of a patient is always a challenge, and when the person is unable to communicate to describe the pain they are in, the challenge becomes even greater. Medasense Biometrics, Ltd. recently announced they have developed a pain monitoring device, the PMD200. This new device was created to help physicians in assessing pain levels of an individual when the patient is unable to communicate. This will assist anesthesia teams in providing the correct amount of pain-relief medicine based on accurately assessing pain levels of the patient. This device is based on the NOL technology, which quantifies an individual’s psychological response to pain. The PMD200 is a very easy to use system, which includes a finger probe that records psychological signals from four different sensors. The device also records dozens of pain-related psychological parameters. The data is then analyzed and converted into the Nociception Level index. In this index, 0 = no pain and 100 = extreme pain. This system will allow physicians to better manage pain treatments and help them avoid using too much or too little pain medicine. Too much pain medicine during a procedure can cause a patient to suffer from nausea, vomiting, respiratory depression, constipation, and hyperalgesia once they regain consciousness. Professor Albert Dahan, MD. PhD. from the Department of Anaesthesiology at Leiden University Medical Center in the Netherlands said, “We have been studying the PMD device for a number of years now, and I believe that the NOL index may allow for more balanced anesthesia, as for the first time we are able to titrate analgesic medication to patients’ needs. In the upcoming weeks, the LUMC will be adding PMD200 devices into the operating rooms. In the future, I hope to see the NOL index integrated into other monitors as it provides significant decision support information and can potentially positively impact patient outcomes.” The device is currently being distributed throughout Europe for use in operating rooms and in critical care units. The company also hopes to broaden the use of the NOL index and is currently researching other forms of pain such as chronic back pain. This device is a breakthrough in accurately assessing pain levels of a patient and can be a great asset to anesthesia teams in the future.

    14 Feb
    14 Feb
  • The thought of heading to the doctor for a procedure that requires local anesthesia probably doesn’t seem like that big of a deal. However, imagine if you were going to feel everything that was happening during the procedure. Well for some, this horrible nightmare is a reality. In very rare cases, some individuals have a resistance to local anesthesia, and no matter the amount received, they can still feel pain. In a report from the BBC, a woman named Lori Lemon, discusses how since she was young she has always had to go to the dentist and other doctors expecting to endure pain. Even after crying out during dental procedures, doctors never took Lori seriously. She describes a visit to the dentist as a young child when her condition first became apparent, “They started working on me and I, being obedient, I just raised my hand and let ’em know, ‘I can feel this’,” she says. Another injection still proved that she had a resistance to local anesthesia. “Finally I just kind of screamed and was in tears the whole time.” When she recently visited the Mayo Clinic in Jacksonville for a procedure to remove a lipoma from her elbow, an anesthesiologist noticed that none of their methods were working and knew something had to be wrong. Dr. Steven Clendenen, the anesthesiologist at the clinic, said “The nerves were flooded with local anaesthetic and at the time it didn’t work.” Clendenen decided to research this issue further and found that while there were other cases of this same problem, there was hardly any answers as to why patients had a resistance to local anesthesia. After finding out Lemon’s mother and maternal half-sister also suffer from a similar type of resistance to local anesthesia, he decided to do a genetic study on the family. Doctors discovered a genetic defect which was directly related to a specific sodium channel in the body, sodium 1.5. “We looked at the genetics of that and went, ‘wow’ – [her mother] had the same gene defect,” explains Clendenen. This genetic mutation is significant due to the theory that local anesthetics are successful due to the disruption of sodium channels. Since sodium 1.5 channels have mostly been studied in heart tissue, not the peripheral nerves where local anaesthetic is applied, there is still a lot of research that needs to be done. “This is really important to get that out there,” said Clendenen. “People don’t believe [these patients] and it’s very frustrating. Even some of my colleagues that I’ve talked to say, ‘I don’t believe it’.” For patients like Lori Lemon, however, this has put light on the issue and gives them some relief knowing there is work being done to figure out this problem. If you or a loved one is preparing for a procedure, click here to visit our anesthesia information page to learn more.  

    13 Jan
    13 Jan
  • There is often still concern about the later effects anesthesia may have on a person, especially anesthesia on toddlers. There have been numerous small studies done analyzing the effects, if any, that may appear later in a patient’s life. Results of a recent study in Sweden, the largest of its kind, suggest anesthesia on toddlers carries no long term risks.  Patients who have anesthesia before age 4 show little risks later in life, especially for intelligence. Overview of Anesthesia on Toddlers Study The results of this study were based on research done on 200,000 Swedish teenagers. 33,500 of these teenagers had been exposed to anesthesia before the age of 4 and nearly 160,000 of the teenagers had never been exposed to anesthesia. The school grades of the teenagers at age 16 were on average less than a half a percent lower in teenagers who had undergone a childhood surgery than the teens who had not had surgery. Among teenagers that had two or more surgeries, grades were less than two percent lower. IQ tests were also given to boys in the study who were 18 years of age. IQ scores were nearly the same among all tested. The leader of this study, Dr. Pia Glatz from Sweden’s Karolinska Institute, as well as other researches mentioned that other factors, a Mother’s education level for example, pose more of a risk on intelligence than administering anesthesia on toddlers. Among those studied, the most common surgeries the teenagers had received as children were hernia repairs, abdominal procedures, and ear, nose, or throat operations. These surgeries likely caused the children to be under anesthesia for about an hour or less. Researchers involved in the study as well as other physicians find the results of this study reassuring, and believe parents need to consider the harm of postponing surgery more than future risks for intelligence and academics later in life.  A journal editorial says the study is  “reassuring for children, parents and caregivers and puts the issue of anesthetic-related neurotoxicity and the developing brain into perspective.” While this study is still ongoing, it can put parents and caregivers at ease knowing that this study shows anesthesia on toddlers carries no long term risks. If you or someone you know wants to learn more about anesthesia before a procedure, take a look at our surgery patient FAQ page.

    19 Dec
    19 Dec
  • It is pretty fair to say that no one really enjoys getting a cavity filled or going under anesthesia because of a painful surgery, it’s just something we have to do. Although it isn’t fun for anyone, redheads may dread a trip to the dentist’s office a bit more than the average person, and for good reason. Over the years, many have said that a patient’s natural hair color may have an impact on anesthesia efforts. But do redheads really require more anesthesia? Recent studies have been done that show people with naturally red hair often require a higher dosage of anesthesia, and are sometimes resistant to pain blockers, such as novocaine, than their brunette or blonde counterparts. Making up only 1-2% of the population worldwide, the genetics of a redhead are what makes them such a rarity. Researchers believe a mutation of the gene that causes people to have red hair and fair skin, also has an effect on a person’s sensitivity to pain. The Mc1R gene, which affects hair color, produces melanin in people with blond, black, or brown hair, but a mutation causes it to produce pheomelanin in redheads. This gene is a part of a family of receptors in the brain that include pain receptors, which may be why it affects a redheads tolerance of pain. Dr. Daniel I. Sessler, an anesthesiologist and chairman of the department of outcomes research at the Cleveland Clinic, said he started studying hair color after hearing many colleagues discuss redheads needing more anesthesia than patients with different hair colors. “The reason we studied redheads in the beginning, it was essentially an urban legend in the anesthesia community saying redheads were difficult to anesthetize,” Dr. Sessler said. “This was so intriguing we went ahead and studied it. Redheads really do require more anesthesia, and by a clinically important amount.” Researchers believe patients with red hair require about 20% more general anesthesia than the average person, which proves that redheads being harder to anesthetize was not just a myth in the medical community. Another study in 2005, proved that redheads are more resistant to the effects of local anesthesia, such as the numbing drugs that are often used by dentists. It is possible that people with dark skin, eyes, and hair may produce more melanin than normal and in turn will also require more anesthesia. So the next time you hear your redheaded friend complaining about a routine trip to the dentist, you’ll know why!

    15 Oct
    15 Oct
  • Each year, millions of Americans safely and successfully undergo procedures while under a form of anesthesia. While it is extremely common to require anesthesia for a surgery, most patients don’t really know much about the anesthetic itself. As we approach the 170th anniversary of the first successful use of a form of anesthesia, here are four interesting facts about anesthesia you may not have known. Before Anesthesia, Patients were Told to “Bite the bullet.” This popular phrase has meaning that dates back to a time before there was anesthesia. A wounded patient, often a soldier, would be told to “bite the bullet” while enduring painful surgery without anesthetic. Aside from bullets, patients were often given sticks, leather straps, and other objects to clench between their jaw during painful procedures. As you can imagine, this was not a very good alternative to anesthesia, and we are very thankful so much has changed! Anesthesia Causes Temporary Amnesia Anesthesia activates memory-loss receptors in the brain, which ensures the patient has no memory of the surgery. Some look at the effects of anesthesia as just being “put to sleep”, but this really is not the case considering if it was just sleep, the patient would be awakened by the extreme pain their body is experiencing. The effects of anesthesia can be more closely related to a reversible coma than to a deep sleep. Smokers May Need Higher Doses of Anesthesia than Nonsmokers Smokers, as well as people who are regularly exposed to secondhand smoke, may require more anesthesia than the average non-smoker. A study monitored a group of women all undergoing the same surgery. The results of the study showed the women who were smokers required 33% more anesthesia, and women exposed to secondhand smoke required 20% more. John Reynolds, MD, an associate professor at Wake Forest University, says smokers have irritated airways, and as a result, they may need higher doses of pain medication to improve their tolerance with the breathing tubes. Redheads May Sometimes Require More Anesthesia Due to a gene that causes their red hair, redheads sometimes require 20% more anesthesia than the average patient. This gene is known as the melanocortin-1 receptor (MC1R) and responsible for the bodies pigment. The MC1R gene is also connected to hormones that stimulate pain receptors in the brain. The gene can sometimes overproduce a pain-related hormone, which may make redheads more sensitive to pain, in turn causing them to require more anesthesia. While anesthesia has been around for some time and has become extremely common in the world of medicine, there is still a lot of interesting facts about anesthesia that many people do not know. We hope you enjoyed learning some interesting facts about anesthesia and, if it peaked your curiosity in learning more about anesthesia, CLICK HERE for some Frequently Asked Questions and Answers from Steel City Anesthesia.  

    20 Sep
    20 Sep
  • Viral videos are constantly popping up, and it seems like every week there is a new video circulating the internet. Many times, anesthesia is the source of the hilarity in these viral sensations. We’ve all seen videos of patients waking up after a procedure, saying outlandish things while their family members get it all on film. Who can forget the girl who took a ride on a unicorn? One of the first, with 1.3 million views on YouTube, is the little boy who became known as “David After the Dentist”. The adorable little boy keeps asking “Is this real life?”, and telling his Father “I feel funny!”. While it is obviously the anesthesia that makes the stars of these videos say some interesting things, many people wonder what exactly the anesthesia does to put patients in this confused state of mind. Anesthesia affects all patients differently, and often times it causes them to say strange things and act differently than they normally would. The word anesthesia is derived from greek and actually means “loss of sensation”. It is administered to patients to relieve pain, paralyze muscles, and encourage amnesia so the patient undergoing the surgery has no memory of the procedure. Anesthesia temporarily disrupts normal brain function, which may be why many patients wake up feeling scared, anxious, or saying funny things they would not normally say. The effects are often compared to a very deep sleep, however, the effects of anesthesia are more closely related to a reversible coma. The dosage of anesthesia given to a person is very carefully controlled. The process is closely monitored by highly skilled professionals like the medical professionals at Steel City Anesthesia. We can confidently say the patients will be in great hands during the procedure, but if they wake up saying hilarious things, we can’t guarantee their family and loved ones won’t have their cameras ready! For more information or questions about what you or a loved one might experience with anesthesia, CLICK HERE for some Frequently Asked Questions and Answers from Steel City Anesthesia.  

    29 Jul
    29 Jul
  • New laws and changes in legislature are common and affect many different things, including the world of healthcare. Medical professionals are required to make changes and adapt as needed to make sure they are following the laws and guidelines. Recently, a new law in Utah has passed that is causing conflict between medical professionals and the government. The bill, recently signed, is the first of its kind.  This new law requires anesthesia for abortions past 20 weeks to be administered by doctors to patients to eliminate pain for the fetus. Whether or not a fetus can feel pain at that state remains to be a controversial topic, and many doctors and medical professionals have varying opinions. “If a child can experience pain, we have an obligation to protect that child,” said Republican state Sen. Curt Bramble, who sponsored the law. Bramble originally hoped to ban all abortions after 20 weeks but abandoned the idea after legislative attorneys warned him it would likely be unconstitutional. Many agree that the fetus will feel some degree of pain and hope that this law will change that while protecting the fetus. While many support this law, many doctors disagree and are fighting back. Doctors are uniting across the country and are concerned if a law requires anesthesia for abortions, the use of anesthesia or painkillers may increase health risks for women by giving them heavy sedation. Some believe it is unnecessary and not healthy for the woman. Dr. Leah Torres, a Salt Lake City obstetrician-gynecologist claims to be confused by the law and says “I have no choice but to cross my fingers and hope that what I’m doing already is in compliance, because I don’t know what they’re talking about,” With the subject of fetal pain still being a very controversial topic, people can argue which side is right and wrong. Regardless of what a doctor or medical professional may believe, the bill passed and changes will now have to be made as this law requires anesthesia for abortions. With further research and tests, hopefully more information will be available on this controversial and important topic.

    25 May
    25 May
  • In a previous blog post, the idea of machines taking over the job of an anesthesiologist was discussed. Although we believed this was far off, a few new machines were beginning to gain popularity in the medical world. Just recently, however, sales of the Sedasy machine, made by Johnson & Johnson, have been stopped. Johnson & Johnson says halted sales are due to poor sales and cost cuts within the company which means the concept of facilities using machines over anesthesiologists is still far off. To refresh your memory, the most popular of these devices is called Sedasys, an open-loop system that can administer the initial dose of anesthesia a patient needs, favoring machines over anesthesiologists. The machine was developed to be used for patients undergoing endoscopies and colonoscopies. The dosage of medicine is predetermined by the patient’s weight and age, and the machine can reduce or stop drug delivery depending on the patient’s condition. The machine, however, cannot decide alone how much anesthesia the patient needs, and the dosage can only be increased by the doctor or nurse that is monitoring in case of emergencies. This more conservative approach is what offered comfort to regulators and helped win the approval of the FDA. Johnson & Johnson believed, at first, that the Sedasys system would be a cost efficient way to administer anesthesia, but the machine was quickly fought against by many medical professionals, especially anesthesiologists. Many were concerned that choosing machines over anesthesiologists would begin a less humanistic approach, which many people did not like. Safety concerns were also an issue. “While the Sedasys System can safely administer sedation for healthy patients undergoing the procedures mentioned, emergencies can and do occur, even during the simplest procedures and with the healthiest patients,” Jeffrey Apfelbaum, co-chair of the ASA committee on the Sedasys machine, said in a 2015 interview with Medscape. “Additionally, many have concerns for the safety of patients if device operators do not remain in strict compliance with the limitations imposed by the FDA on the use of the device.” While choosing the Sedasys machine over anesthesiologists is no longer an option as they are no longer being produced or sold, there are still others on the market, and new machines may begin to pop up. However, it still seems that something like this will never be accepted universally by medical professionals. As the fastest growing Anesthesia Management Solution in the midwest, Steel City Anesthesia offers more than just anesthesia services. We strive to provide exceptional patient satisfaction and meet anesthesia needs with a personal touch that will never be able to be replaced by a machine.

    22 Apr
    22 Apr
  • While surgery is very common, patients sometimes fear that they will experience some type of future impairment because of an operation. Many elderly patients may even opt out of having a procedure that will give them a better quality of life because they are worried having surgery that requires anesthesia may lead to cognition impairment. A new study, however, hopes to prove just the opposite. Cognitive Test Results of Twins The University of Southern Denmark has recently released results from their study that examined a total of 8503 twins. Of these twins, 4299 were under the age of 70 and the remaining 4204 were over the age of 70. Cognitive tests of twins that had undergone surgery requiring anesthesia within the past 18-24 years were compared to test results of twins who had not had any type of surgical procedure. Results showed that twins who had undergone surgery in recent years had slightly lower scores on cognitive tests, however, researchers stated that the differences were not statistically significant. Unni Dokkedal, from The University of Southern Denmark, said, “Our use of twins in the study provides a powerful approach to detect subtle effects of surgery and anesthesia on cognitive functioning by minimizing the risk that the true effects of surgery and anesthesia are mixed up with other environmental and genetic factors. We found no significant cognitive effects related to surgery and anesthesia in these patients, suggesting that other factors, such as preoperative cognitive levels and underlying diseases, are more important to cognitive functioning in aging patients following surgery.” All Part of the Postoperative Puzzle Postoperative cognitive dysfunction is normal for a short time after a surgery, but this study shows receiving anesthesia alone does not cause cognitive impairment. This leads researchers to focus on other factors that may play a role in postoperative cognitive impairment. A researcher from the study said, “This research has the potential to become a key piece of this very complex research puzzle.” Researchers believe this information will especially help older patients when faced with the decision of having an operation with anesthesia. Although there may be other factors that cause a person to have some cognitive issues after an operation, patients can have some peace of mind knowing it will not be caused by anesthesia.

    09 Mar
    09 Mar
  • Although the development of anesthesia took place in the 1840’s, surgery was still not regularly performed due to fear of infection and other complications. That was until the Civil War started in 1861, which caused the number of necessary operations to drastically increase. According to an article in the newsletter of the American Society of Anesthesiologists by Maurice S. Albin, M.D., “The sheer magnitude of battlefield injuries during the conflict played a major role in establishing the regular use of anesthesia.” The need for surgery was greater than ever before, which gave physicians no choice but to use anesthesia to operate. Methods Prior to Anesthesia Prior to the the war, patients may have been given something to bite on, alcohol, opioid drugs, or put in physical restraints to keep them under control during surgery. According to Albin, “It was thought to be unmanly for a male to undergo surgery with an anesthetic, which was usually reserved for women and children. There was even a belief that the use of ‘cold steel’ had a beneficial effect, and it would not cause the depression thought to occur with the use of anesthesia.” “Real Men” Don’t Need Anesthesia The idea of anesthesia being “unmanly”, quickly shifted as the war progressed and the number of injuries rapidly increased. It became a necessity in battlefield hospitals, and is believed that there were around 120,000 uses of anesthetic agents by surgeons on both sides during the battle. Anesthesia on the Fly At the time of the Civil War, many surgeons and physicians had little no experience with using an anesthetic during operations. They were forced to rely on manuals which gave them instructions on how to properly use anesthetics such as ether and chloroform. Although many doctors lacked experience with these agents, mortality rates associated with the use of an anesthetic were surprisingly low. Albin stated, “After the termination of this horrendous conflict, these doctors would return to their practices, hospitals and medical schools, all the richer for being exposed to this unique American contribution to the life-easing quality of mercy — the discovery of anesthesia.” Physicians benefited from learning firsthand the techniques and uses of anesthetics, and many lives of wounded soldiers were saved as a result. Today, millions of people undergo anesthesia each year in the United States alone, and it has become extremely common. Although anesthesia has developed and changed over the years, its regular use was established during the time of the Civil War.

    26 Feb
    26 Feb
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