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.
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.
Photo Source The 2 new Rs of anesthesia patient safety: Right Indication and Right Documentation Medical practitioners are familiar with the 5 Rs of patient safety viz. Right patient Right drug Right dose Right concentration Right time However the rise of medication errors during procedures has necessitated the addition of 2 more… Right indication, and Right documentation You can never be too careful in the operating room or even during an office-based procedure. A small mistake can lead to disastrous consequences. As errors in the preparation and administration of medication seem to be on the rise, the need for the “double check” has become supremely important. And anesthesia service providers are not exempt. Here are some guidelines that will help reduce medication errors: Proper process: Implement a proper process including efficient double check techniques and equipment that facilitates right indication and documentation. Easy-to-read labeling: New and improved, easier-to-read standardized labeling, color and bar coding reduces chances of error significantly. Bar coding is also extremely helpful in improving documentation and billing. Diligent reporting: Regular communication among anesthesia providers about medication used, techniques and procedures increases awareness of issues as well as vigilance. Constant monitoring: There is no substitute for constant monitoring of a patient’s vitals and well-being for the slightest changes, to prevent small issues from assuming monumental proportions. Medical Director – Quality and Staff Anesthesiologist at Virginia Mason Medical Center in Seattle, Robert Caplan’s analysis of The American Society of Anesthesiologist (ASA) Closed Claims Projects revealed that of the 80 medication-error claims studied, 44% were the result of anesthesia administered at the wrong dose. Furthermore, a study published by the Canadian Journal of Anesthesia also found that anesthetists experienced more than one drug error in their practice with syringe swap being the most prevalent category. The standard and goals for reducing medication errors set by regulatory agencies like the Institute for Healthcare Improvement, Centers for Medicaid and Medicare Services, Institute for Safe Medication Practices (ISMP) and Joint Commission should form the basis of the process all anesthetists follow. Any deviation could increase your liability giving rise to serious malpractice issues. We welcome your ideas on processes that improve anesthesia services. Leave a comment on our blog below.
In our previous blog posts we’ve mentioned how a CRNA (Certified Registered Nurse Anesthetist) improves the quality of healthcare services offered. Let’s discuss why having a CRNA is more of a necessity than an option if you want to increase patient safety, positive outcomes and revenue. What is a CRNA? A CRNA is an advanced practice registered nurse (APRN) who has acquired graduate-level education in anesthesia overseen by the American Association of Nurse Anesthetist’s (AANA) Council on Accreditation of Nurse Anesthesia Educational Programs (COA). What this really means is that… Anesthesia providers are considered specialists and CRNAs are qualified to do the job. You know that it is illegal to have anesthesia administered by anyone who is not certified. CRNAs are independent licensed professionals who follow best practices and maintain high standards. They are accountable should anything go wrong. The liability is theirs… not yours. Their education is overseen by the AANA which provides all the necessary training to build a sound and safe practice. Having a CRNA means increased patient safety. A recent study on the “Cost Effectiveness Analysis of Anesthesia Providers,” published in the May/June 2010 issue of the Journal of Nursing Economics examined different anesthesia delivery models. The study included CRNAs, physician anesthesiologists acting solo, and a single anesthesiologist supervising one to six CRNAs. The findings were conclusive. AANA President James Walker said, “The data confirms that CRNAs deliver anesthesia safely and cost-effectively. With growing demands on the healthcare system nationwide, we must do all we can to make sure the nation’s healthcare professionals are used as effectively and efficiently as possible.” This reiterates what we’ve been saying, that CRNAs drive cost-efficiency and increase safety, improving your bottom line significantly. An established anesthesia management company like Steel City Anesthesia enhances productivity and patient flow by assigning local CRNAs on a routine basis. Your physicians get to know the person they are working with and our CRNAs understand your processes. Developing a complementary working style speeds up procedures and patient recovery. Plus we are very particular about who we hire. Our CRNAs are dedicated to delivering quality care to enhance your reputation and your practice. Do you have CRNAs on your medical team? Share your experience with us.
New evidence confirms the quality and safety of Certified Registered Nurse Anesthetists and the anesthesia care they deliver! This is the conclusion reached by Jerry Cromwell, PhD and Brian Dulisse, PhD while researching the quality and safety of care provided by CRNAs in states that opted out of the physician supervision rule by Medicaid (“No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians”). The study concludes that there is no difference in the outcome experienced by the patient whether the anesthetic was administered by the physician anesthesiologist, the supervised Certified Registered Nurse Anesthetist, or the unsupervised CRNA. RTI International, where the study was conducted, confirmed what has been known for years by the community of nurse anesthetists; CRNA-only care is high quality and safe. As of right now, the Center’s for Medicare and Medicaid Services (CMS) restricts or in some cases prohibits reimbursements to hospitals and ambulatory surgery centers where there is no physician supervision of the CRNA. However, states began opting out of that rule in 2001. California is the most recent of the 15 states to have opted out. The RTI findings illustrate that physician supervision of Certified Registered Nurse Anesthetist is outdated and unnecessary. The study compared states where physician supervision is mandatory versus 14 states where it is not and found that the patient outcomes did not differ. As a result, the authors of the study are recommending that CMS repeal the “supervision rule.” Paul Santoro, CRNA, MS and president of the American Association of Nurse Anesthetist’s (AANA) states, “this study should encourage other states to think critically about their healthcare needs and how nurse anesthetists can expand access to anesthesia services.” In a recent article published in May by RTI, they found that the CRNA-only anesthesia care to be the most cost-effective anesthesia delivery model. This study obtained coverage in such notable media sources such as: The Wall Street Journal, Reuters, The Bureau of National Affairs, and Modern Healthcare. For further information on this topic visit the AANA website or contact Steel City Anesthesia.
The adverse events rate is low when Propofol is administered by a trained professional such as a CRNA. In a recent article published in Clinical Gastroenterology and Hepatology, a study was performed with patients undergoing a variety of endoscopic procedures with sedative dosing administered by a CRNA. This article stated, “… this is the first paper to report the frequency of airway modification associated with the use of propofol in endoscopy.” The article continued to highlight the importance and need for trained personnel, such as CRNA’s, to monitor patients during sedation with propofol. The conclusion by Sreenivasa Jonnalagadda M.D., the lead author of the article, confirmed ” … Highest-risk patients should be managed by nurse anesthetists trained in advanced airway interventions…” . For further reference and information please see the April 2010 Clinical Gastroenterology and Hepatology Journal.
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