Recent studies show that a common anesthetic, Ketamine, can be used to treat severe depression. This recent breakthrough has come from clinics in Denver where people are given very small doses to treat severe depression. All of the patients that were given a minuscule dose of Ketamine, had previously tried a number of other antidepressants that were not helpful. Since Ketamine has an addictive quality, none of the patients tested have had a history of addiction. Patients were closely monitored while being given the doses through an IV or a small nasal spray infusion. One patient was quoted saying “I thought the depression was going to kill me because I couldn’t live like that anymore. I had done everything” Another patient spoke of depression, saying “It tells you that you will be better off by not being here. There’s been numerous times when I felt that and almost acted on it”. For many of these patients, this was their last resort. Anyone who was given a dose of Ketamine was closely monitored through the entire process due to ongoing research that is being conducted on the healing effect Ketamine may have on the brain. Ketamine is FDA approved, but not for the use of an antidepressant. It is used off-label, which is a legal practice that is used often across the country. Each infusion costs about $350 and patients have to be cleared before being administered any of the drug. We don’t know what the future will hold for the relationship between Ketamine and severe depression. Will Ketamine be a long-term cure to severe depression? Will it have an addictive quality that is not safe for widespread consumption? Will it become cheaper and more widely available, and if so, how soon? With all of the constant testing and progress being made on this possible breakthrough the answers to these questions shouldn’t be too far away.
Whether you’re nine years old or fifty-nine years old, having surgery is always a pretty nerve-racking experience. When the procedure requires anesthesia, this can add even more apprehension before going under the knife. In the past, doctors have tried to find ways to entertain patients as they are preparing to go under anesthesia in hopes to distract them and calm their nerves. A fairly new technology, virtual reality, can distract and entertain patients going under anesthesia. A new program at Texas Children’s Hospital aims to calm pediatric patients before heading into surgery. The program is known as the CHARIOT program – Childhood Anxiety Reduction through Innovation and Technology – and it is designed to distract patients through virtual reality during the beginning stages of anesthesia. “The use of our various technologies has made it easier to focus our patients’ attention away from an experience that is new and different and possibly frightening to them and on to something that they’re much more comfortable with—and it helps them work through this experience to get surgical procedures that they very much need,” said Clint Fuller, M.D., a pediatric anesthesiologist at Texas Children’s Hospital. “It’s made it a much easier process both for them and for us.” Depending on the age and preference of the child, the suite of technology has different entertainment options the patients can choose from. Many will choose to watch their favorite Disney movie while another child may want to play an interactive game to pass the time. While the program originally started as a way to distract children before going under anesthesia, they are now using it for other procedures including IV placement, oral exams, scopes and more. “I think it was really helpful, definitely with the anxiety, because we’re doing these invasive procedures where we’re putting scopes in their noses and their mouths and it’s kind of intimidating and scary for them,” Julina Ongkasuwan, M.D., pediatric otolaryngologist and director of the Pediatric Voice Clinic at Texas Children’s said “This is definitely a change in our approach, and I think anything we can do to decrease the trauma is beneficial, especially for those kids who have to come repeatedly.” The CHARIOT program first began at Stanford Children’s Health in California and Texas Children’s is one of the first hospitals in the nation to start using an entertainment suite. While these programs are currently for children, it seems that they would be beneficial for adult patients experiencing anxiety before a procedure.
In the United States, 1 out of every 8 women will develop invasive breast cancer over the course of her lifetime, according to statistics from breastcancer.org. A cancer diagnosis is a life changing, and scary time for a patient and their family. Many women who are diagnosed with breast cancer will need surgery as part of their treatment. A recent study revealed that breast cancer recurrence is not linked to Anesthesia type that is used during surgery. In recent years, there had been concern that the type of anesthesia used on a patient needed a Surgical tumor resection may be connected to the recurrence of cancer later in a patient’s life. “The leading cause of death after cancer surgery is the recurrence of cancer,” said senior study author Jin-Tae Kim, MD, PhD, of the Department of Anesthesiology and Pain Medicine at Seoul National University Hospital, South Korea. “If there is a difference in cancer recurrence rate according to the type of anesthesia used, even a small difference would make a big difference for patients.” In this study, the long term outcomes of 5,331 patients with breast cancer were analyzed. The researchers used propensity score matching to ensure the IV and volatile anesthetic cohorts (1,766 in each group after matching) shared similar baseline characteristics. Patients in the IV group were treated with propofol and remifentanil, and those in the volatile group received enflurane, isoflurane, sevoflurane or desflurane. The primary endpoint was recurrence-free survival following surgery, and the secondary end point was overall survival. The results of the study concluded that there was no significant difference in the recurrence rate of the patients of either group that had been studied, meaning breast cancer recurrence is not linked to Anesthesia type that is used during surgery. Based on the study results, Dr. Kim said, “Both anesthetic techniques can be used for breast cancer surgery, and the choice of anesthetic agent should be made according to the characteristics of the individual patient. Selection of IV or volatile anesthesia should be based on factors other than cancer recurrence.” These findings should give patients suffering from breast cancer and that are in need of surgery peace of mind knowing the anesthesia given will not affect the recurrence of cancer in the future.
With marijuana being legalized for both medical and recreational use in many states throughout the United States, more people are now using the drug and the amount is increasing everyday. Ten states have legalized the recreational use of marijuana and twenty-one states have made the use of medical marijuana legal. Between 2007 and 2015, the use of marijuana increased 43% in the United States, where an estimated 13.5% of adults use marijuana, according to a United Nations report. The increasing marijuana use throughout the country is affecting medical care in different ways and is bringing about many questions and studies hoping for more answers. A new study aims to answer the question do regular marijuana users require more anesthesia? Researchers at Community Hospital in Grand Junction, Colorado performed a study where they collected data from 250 Colorado patients who had colonoscopies and other endoscopic procedures between January 1, 2016, and December 31, 2017, which was years after the state legalized recreational marijuana in 2012. The study, which was published in the Annals of the American Osteopathic Association, compared marijuana users and non-users to see if there was any difference in the amount of anesthesia needed during a procedure. Results showed that patients who reported using marijuana on a daily or weekly basis required 14% more fentanyl, 20% more midazolam and 220% more propofol to achieve optimum sedation for routine procedures. For example, it took 13.83 milligrams of propofol, on average, for 225 nonusers to be sedated, compared to an average of 44.81 milligrams that was needed by marijuana users. “Although marijuana use has been legalized for recreational and medical use in many states, it’s been a very poorly studied substance,” said the study’s lead author, Dr. Mark Twardowski, a specialist in internal medicine who is in private practice in Colorado. “So we can’t say it doesn’t have an effect on other medications and substances that patients might be using. Our study demonstrates that it seems to have an effect on at least the classes of medication used for sedation for simple endoscopic procedures.” Although this study offers some interesting insight, there is still a great amount of research that needs to be done on the topic. It does however, highlight the importance of patients telling their surgeons about marijuana use. Twardowski said “Knowing if someone is using marijuana regularly might affect how we do anesthesia.”
The American Psychiatric Association defines Posttraumatic Stress Disorder, or PTSD, as “a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.” In the past, it has often been associated with war and typically went by the names of “Shell Shock” or “Combat Fatigue”, however it is associated with many experiences other than combat. People who suffer from PTSD have disturbing thoughts or feelings that are somehow related to the traumatic experience they suffered, and they often relive the event through flashbacks or nightmares. There are many therapies and methods used to help treat PTSD, however, a new study poses the question: can anesthesia help take away painful memories of PTSD patients? The new study, which was published in the journal Science Advances, studied 50 volunteers who were preparing to have a gastroscopy or colonoscopy. The week before the procedure, each volunteer was asked to memorize two slide shows that involved scenarios that most would consider to be upsetting. A week later, right before their procedure, the volunteers were shown the first slide from the scenarios and asked questions about it. After the procedures, half of the group was interviewed immediately following the procedure and half was interviewed 24 hours later, once the anesthesia had worn off. The volunteers that were interviewed immediately following the procedure remembered the stories from the slide show well. The group that was interviewed 24 hours later had much less recollection of the stories from the slide show, especially the heavily emotional details. “The [brain] circuitry involved in emotional memory is probably quite sensitive to anaesthetics,” Bryan Strange, study author and a neuroscientist at the Technical University of Madrid, explains in New Scientist. “This is good for a potential treatment because you don’t want to remove information that isn’t dramatic or unwanted.” Researchers involved in the study hope these findings can be helpful in developing more treatments for patients suffering from PTSD. PTSD is a very complex disorder, however the results will hopefully lead to the development of treatments that can help people who suffer from this disorder each and everyday.
Postoperative delirium is a state of agitation or confusion in the days following a procedure involving anesthesia. It is most common in older patients, with nearly 25% of them experiencing this unpleasant event after surgery. In the past, researchers believed that very closely monitoring the brain of older patients during surgery, and reducing the amount of anesthesia used would prevent the confusion following a procedure. However, a new study suggests this is not the case and that less anesthesia during surgery does not prevent postoperative delirium. Researchers from Washington University School of Medicine, studied 1,200 older patients undergoing surgery at the Barnes-Jewish Hospital in St. Louis, Missouri. Half of the patients were randomly selected to receive normal care during their procedure while the other half received very close and meticulous monitoring of brain activity measured by a electroencephalogram. The results showed that 23% of the patients that received normal care and monitoring suffered from postoperative delirium, and 26% of the patients that were closely monitored also suffered from the same delirium in the days after their surgery. “The thought has been that at certain levels of anesthesia, brain activity is suppressed, and that is what mediates these problems,” said first author Troy S. Wildes, MD, an associate professor of anesthesiology. “But we found that preventing suppression by closely monitoring and then adjusting doses of anesthesia made delirium no less likely.” The study did find that there were fewer deaths in the month after surgery among those who had their brain activity closely monitored as compared to those who did not. In those that had been monitored, less than 1% passed away within a month, while in the other group, 3% of the patients passed away within 30 days of their surgery. The Principal investigator Michael S. Avidan, MBBCh, the Dr. Seymour and Rose T. Brown Professor of Anesthesiology said “I believe we should monitor the brain of every single patient during general anesthesia, just as we routinely monitor heart and lung function,” Avidan said. “Monitoring other organs during surgery has become the standard of care, but for some reason, even though the brain is the target of anesthesia drugs, this type of close monitoring and adjustment has never become routine.”While these findings show less anesthesia during surgery does not prevent postoperative delirium postoperative, it did discover other findings that will be further researched. For more information on anesthesia, visit our website www.steelcityanesthesia.com.