Every year, millions of Americans are able to experience a painless surgery with the help of anesthesia, even though most don’t really know how anesthesia works. Each day, Steel City Anesthesia helps administer anesthesia to Ambulatory Surgery Centers, and hospitals and doctors’ offices across Pennsylvania, Ohio, and West Virginia. Although it is extremely common and vital to the world of medicine, there is constant research to find out exactly how anesthesia works. The most common theory is that anesthetics block neural function by disrupting fat molecules in the cell membranes. However, new research from a study done by Weill Cornell Medicine may have debunked a century-old theory of how anesthesia works. Co-researcher Dr. Hugh Hemmings, chair of the Department of Anesthesiology at Weill Cornell Medicine, discusses the new findings saying they have debunked a century-old theory of how anesthesia works and, “Finally have proof that these anesthetics must have a direct effect on integral membrane proteins – and not an indirect effect on proteins through the lipid bilayer – to put patients in a coma-like state, allowing them to undergo painful procedures with no memory or pain.” This new evidence supports the idea that anesthesia does not affect the lipid bilayer, which is the part of the cell membrane that is made up of fat. The new findings show rather than interacting indirectly through the membrane itself, anesthetics interact directly with membrane proteins, which inhibit electrical communications between neurons, which triggers unconsciousness. Researchers in this study reconstructed a model cell surrounded by thin membrane in order to determine the biological mechanism behind anesthesia. Thirteen different anesthetic agents were tested using a technique developed by by Dr. Olaf Andersen, a professor of physiology and biophysics at Weill Cornell Medicine, and Dr. Helgi Ingólfsson, Ph.D. The results showed that none of the anesthetics tested affected the lipid bilayer properties. “That was a very surprising result,” said Dr. Andersen. “When we started conducting the experiments I was convinced we would see some effect on the bilayer. The fact that the results are as clean as they are was to me really amazing.” While there is still more research to be done on this topic, these results are groundbreaking in the world of anesthesia. Researchers are always hoping to learn more, and this study may have just “debunked” a century old theory of how anesthesia works. As we focus on patient care and achieving industry leading satisfaction ratings, having a better understanding of the mechanisms behind anesthesia can lead to the development of new anesthetic agents with less undesirable side effects.
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.
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.
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!
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.
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.
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.
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.
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.
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