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.
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.
Centers for Medicare and Medicaid Services (CMS) issued a statement that it no longer requires physician supervision of CRNA’s providing labor analgesia or moderate sedation in hospitals participating in Medicare. Along with this announcement was an additional statement that Medicare requires, during deep sedation with propofol, the involvement of an anesthesia provider such as a CRNA. This revision was to “ensure high quality, safe, and effective care provided by CRNA’s throughout the United States” as stated by James Walker president of AANA. In the article from the January AANA Journal, specific reference is made to the example of “deep sedation” for colonoscopy screening. It goes on to state most propofol use in this area is used to decrease patient movement and improve visualization in this invasive procedure. It continues, the reason that anesthesia personnel are needed is the potential for inadvertent progression to general anesthesia. Thus, the need for a highly qualified individual trained in anesthesia is a must. You can read more through the AANA website here, but you must register first. Additional resources on this topic can be found below: America Society of Anesthesiologists – Revised Interpretive guidelines Outpatient Surgery Magazine – CMS Substantially Alters Guidelines for Hospital Anesthesia Services Medical Society of Virginia – CMS revises interpretive guidelines for anesthesia services in hospitals The Health Law Partners – Anesthesia Guidelines Clarified: CMS Issues Transmittal on May 21, 2010
© 2014 Steel City Anesthesia, LLC. All rights reserved