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.
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.
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.
General anesthesia is very commonly used to induce unconsciousness in patients undergoing surgery. Each year millions of people in the United States are required to receive anesthesia, and there is no single right amount for every patient. Factors such as weight, age, gender, illness, and medications all play a role in determining just how much anesthesia each person needs. A patient’s heart rate and rhythm, breathing rate, blood pressure, and oxygen and carbon dioxide levels are also monitored so the amount of anesthesia can be adjusted as needed. A recent study from the University of Cambridge, published in PLOS Computational Biology, may have identified a better way to calculate the amount of anesthesia one may need. A group of 20 volunteers were involved in this study to discover how brainwaves can identify patient anesthesia needs. The Brain Signals and Anesthesia As different areas of the brain communicate with each other they give off signals that can indicate a person’s level of consciousness. In the study, researchers gave a steadily increasing dosage of propofol to the group of healthy volunteers (9 male, 11 female). Their brain activity was monitored using an electroencephalogram (EEG). While receiving the propofol, the individuals were asking to perform a simple task where they would hit one button after hearing a “ping” and a different button after hearing a “pong”. All of the people involved in this study had the same limited amount of propofol and once that limit was hit some were unconscious while others were still awake and able to continue performing the task. Researchers studied EEG results and found a very clear difference between that brain activity of those who were affected by that amount of anesthetic and those who were still able to perform the task. EEG readings showed that volunteers with more alpha wave activity prior to receiving the anesthesia required more propofol to put them under. Researchers said “These findings could lead to more accurate drug titration and brain state monitoring during anesthesia,”. Dr Tristan Bekinschtein, senior author from the Department of Psychology, adds: “EEG machines are commonplace in hospitals and relatively inexpensive. With some engineering and further testing, we expect they could be adapted to help doctors optimise the amount of drug an individual needs to receive to become unconscious without increasing their risk of complications.” Although this is a relatively new study, many agree that with more testing and research, monitoring brainwave activity prior to administering anesthesia may be a useful, non-invasive way of measuring the dosage needed for each unique patient.
Before the development of Ambulatory Surgery Centers, or ASCs, it was not uncommon for patients to wait several weeks or months to get an appointment for surgery, or to spend days or weeks in the hospital recovering. With hopes to change this by providing affordable and accessible outpatient surgery alternatives, two doctors, named Wallace Reed and John Ford, came up with the idea for freestanding ambulatory surgery centers. In 1970, this idea became a reality when they opened their first Ambulatory Surgery Center called, Surgicenter, in Phoenix, Arizona.
The effects of the use of anesthesia on infants and young children have been a concern for doctors and parents for many years. Each year, millions of patients are exposed to anesthesia during surgery, and about a half a million of those patients are children under the age of three. In the past, studies have been done on young monkeys and other animals that showed anesthetics may kill brain cells, affect memory, and cause behavioral problems. However, since these were animals and not children, these studies offered no definitive results.
As we approach the 170th anniversary of the first successful use of a form of anesthesia in a public procedure, it makes sense to think of how anesthesia has changed the world of medicine. Before surgical anesthesia services, surgery was extremely uncommon and only performed when absolutely necessary. Patients and physicians avoided operations due to the unbearable amount of pain that would come with the procedure.
It is no surprise that at a time where technology is rapidly changing and advancing, machines are sometimes being used to replace humans to perform certain jobs. Some believe that machines can perform tasks and make decisions more efficiently than humans. The world of healthcare and anesthesia service is not immune to these types of practices.
The last of this four part series striking down the myths behind the use of an anesthesia management solutions focuses on time. Many facilities are of the mindset that by having their own, in-house anesthesia team provides them with the most flexible option as it relates to availability and time. However, regional anesthesia management solutions actually have the ability to offer improved flexibility as it relates to anesthesia services.
In today’s world, every company is being asked to take on more responsibilities with the same or, unfortunately, sometimes even less resources. Finding cost efficiencies does not always mean going without something; it sometimes means absorbing the workload in another area. The world of healthcare, and anesthesia, is not immune to this practice.
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