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.
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.
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.
Did you realize that 20% of Americans still smoke? That is an amazing number considering that cigarette smoke has some 6000 identifiable constituents! Some of the constituents include: ammonia, arsenic, benzene, formaldehyde, toluene, and vinyl chloride. I don’t know about you, but that sounds appetizing! But what does this mean for the anesthetist working in the clinical setting? For starters, smoking increases the likeliness of an irritable airway and a greater potential for hypoxia. There are a few steps you can take to try and mitigate the effects smoking can bring to the table. A thorough pulmonary examination is a great start. Listen to the lungs and ask if there is a history of wheezing, coughing, and expectoration. Observe their passive breathing and note if there is clubbing of the nails. Are they short of breath just sitting in the pre-op area? This can be an indication of pulmonary disease and prompt the need for further evaluation. As a side note, if they have pulmonary disease it is very likely that they cardio-vascular disease as well. While doing your H&P, don’t hesitate to focus on this area as well. Next, take a look at the medications they are on. If they use inhalers, ask them about the last time they used them and how frequently they use them. This is another good indicator for potential problems during the procedure. Have them use their inhaler before the procedure. It never hurts to have the airways as open as possible prior to a procedure. Chuck Biddle, CRNA, has a great list of considerations for the smoker that include, abstinence for 24 hours if possible, bronchodilators, nicotine patch if possible, pre-oxygenate, and there may be a need for increased analgesia during the procedure. Also be aware that their FRC (functional residual capacity) may be diminished. This may lead to a state of hypoxia sooner than normally expected in a non-smoker. Be prepared! And finally, as anesthesia providers we have a unique opportunity to educate our patients about the deleterious effects of smoking. For a brief period of time the patient is a captive audience, don’t hesitate to seize this opportunity for education.
A recent article brought about some very important and simple symptoms that patients can use to evaluate their susceptibility to sleep apnea. In an article by Dr. Orly Avitzur M.D., she describes the need for medical evaluation of loud snoring. She stated up to 1 in 10 women and 1 in 4 men might have undiagnosed sleep apnea and the first symptom to look at is loud snoring . She further states that less than 15% know they have sleep apnea and most physicians don’t routinely inquire about it during office visits. Other symptoms that warrant further professional evaluation include, but are not limited to: High blood pressure Frequent morning headaches Day time drowsiness Frequent wake-ups Frequent morning sore throats Wake-ups with choking or gasping for breath Wake-ups in a sweat Overweight Loud snoring Sleep apnea increases a persons chance of high blood pressure , stroke and type 2 diabetes, but the most terrifying statistic Dr. Avitzur stated is there is an increased risk of death that is associated with having sleep apnea. Anesthesia providers especially need to be aware of any of the symptoms listed above prior to administration of any anesthetic, so please inform them before any surgery. Additional protocols may be implemented in the pre and post-op areas and drug regimes may be modified if the symptoms are present in a patient. Avoid anesthesia complications with sleep apnea by speaking with your physician. Check out this article on sleep apnea and same-day surgery for more information. As sleep apnea affects such a high number of people, we would appreciate any personal experiences with sleep apnea you could share on this blog.
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