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.
Having a young child with any type of health problem or illness can be very stressful for parents and family members that are required to make important decisions on the behalf of the child. As if the stress of the health condition is not enough, parents also worry that a procedure requiring their child to be put under anesthesia can have negative effects on them later in life. People often worry anesthesia can cause developmental problems that will affect their child’s readiness for school and cognitive problems. A recent study, however, may prove that anesthesia in young children is not linked to developmental problems The study, performed in Canada, examined research on 11,000 pairs of siblings, 370 of which both siblings had been exposed to general anesthesia at a young age, and about 2,350 pairs of which only one sibling had ever been exposed to general anesthesia. The most common procedures that the children had had were related to ears, mouth, and throat or the musculoskeletal system. Researchers for the study examined data collected from teachers that accessed the development of the children before they started school at the age of five or six. The study did not show a link between developmental problems and children that were exposed to anesthesia. Young children that had been under anesthesia due to a procedure, were no more likely than their sibling to experience any issues, developmentally. Some children that were exposed to anesthesia did have a slightly higher risk of developing health problems and other issues compared to their siblings, but the difference were so small, researchers could not say this was due to chance. “This study adds to the increasing data that for the vast majority of cases anesthesia does not have an impact on school readiness and this should be added to the fact that we increasingly think in the majority of cases it does not have an impact on cognition and many other aspects of neurodevelopment,” said Dr. Andrew Davidson of Royal Children’s Hospital and the Murdoch Children’s Research Institute in Melbourne, Australia. “The findings of the current study should reassure parents of young children who require anesthesia for surgical procedures,” said lead author Dr. James D. O’Leary. Knowing that anesthesia in young children is not linked to developmental problems should give parents and family members some peace of mind when making decisions regarding the health of their children. The pros of surgery under anesthesia outweigh the cons. If someone you know is looking to learn more about anesthesia and how to prepare for a surgery, visit our website at www.steelcityanesthesia.com.
Without the advancements and developments in anesthesia since its first use in 1846, many modern procedures and surgeries would not be possible. By eliminating pain, surgeons are able to perform otherwise extremely painful surgeries on patients in need. Although anesthesia is extremely common and necessary for many surgeries, patients are still sometimes apprehensive about “going under”. By explaining the three types of anesthesia, we hope to ease the minds of patients who may be preparing to undergo a surgery that requires some type of anesthesia. Local Anesthesia Local anesthesia is typically used for minor procedures where the physician does not need the patient to be unconscious for the surgery. It is used to block the nerves in one specific part of the body without affecting any other area. For example, if someone was receiving certain types of dental surgery, a local anesthetic would be used just to numb that area of the mouth, but would not affect the rest of the body. Local anesthesia can be administered in the form of an injection, or topically with a spray or ointment. This type of anesthesia usually starts to work within a few minutes and wears off after a few hours. While the patient will not feel pain during the procedure, they may feel slight pressure in the area. Regional Anesthesia Regional anesthesia is used to numb larger parts of the body during more invasive procedures, but the patient is still not unconscious. It is most commonly used for surgeries on the lower body, such as cesarean sections or surgery on the legs. Different types of regional anesthesia include spinal anesthesia, epidural anesthesia, and nerve blocks. Regional anesthesia may be administered with a needle or a catheter line which allows anesthetics and other medications can be administered throughout the procedure. This type of anesthesia is typically used when long term pain relief is needed. General Anesthesia General anesthesia is the type where the patient is put completely to sleep. This allows the surgeon to operate without any interruption, and keeps the patient from feeling any pain or having any memory of the procedure. This is used for surgeries that cannot be done with the patient being conscious. General anesthesia is typically inhaled through a breathing mask or given intravenously. During the procedure, patients are closely monitored by their anesthesiologist to make sure heart rate, blood pressure, and blood oxygen levels are regulated. The anesthesiologist also carefully controls and adjusts the amount of anesthesia given throughout the surgery. The three types of anesthesia are extremely helpful in successfully operating on patients undergoing surgeries of all kinds. By understanding each type, patients can have peace of mind knowing which type of anesthesia they are receiving and why. If you or a loved one is preparing for a procedure that requires anesthesia, visit our page that discusses anesthesia information for surgery patients.
For over 170 years, doctors have been using many different forms of anesthesia to make patients unconscious when it is necessary for surgery. Millions of Americans receive anesthesia every year, and it is now a very common part of surgery. While it is a very common practice, many people still wonder about the effects of anesthesia on the mind and body. The truth is, all of the details of exactly how the process works is unknown, but more is being discovered about the effects of anesthesia on the mind and body with each new study. In an article from Business Insider, Anesthesiologist Jill Fong explains how anesthesia interrupts the brain’s neural pathways so patients don’t feel pain during a procedure. She discusses how for anesthesia to work correctly, you need amnesia so the patient does not remember anything from the surgery and analgesia so the patient has pain relief. Depending on the type of surgery and the operating conditions, some patients may also be given muscle relaxers to keep their body relaxed, while others may be given medication to suppress excitatory neurons or enhance inhibitory neurons. The article explains “Excitatory neurons, for example, get excited and send signals to other neurons to fire. Depressing them means less signals telling your brain you’re in pain. Inhibitory neurons do the opposite. They make it harder for neurons to generate these electrical signals. In either case this means fewer active neurons overall which is important because when your body is being poked and prodded, neurons would typically fire to tell your brain you’re in pain. If those neurons aren’t firing, your brain doesn’t know that your body is, well, being cut open.” The pathways and communication between your neural networks are interrupted, which leaves the body unconscious, and unable to feel or remember a surgery. Identifying the effects of anesthesia on the mind and body is sometimes tough to determine, considering all of the advancements which have been made since its first use in 1846. Without the advancements in anesthesia, we would not have the advancements in surgery. Countless studies and immense research is helping us understand exactly how anesthesia works, and if necessary how it can be improved. For more information on anesthesia, visit our website at www.steelcityanesthesia.com.
Although anesthesia is an extremely common and crucial part of the world of medicine today, there are still many unanswered questions about how it actually works. Many aspects of anesthesia are constantly being researched and explored, and new discoveries are constantly being made. One question that is often asked by patients and physicians alike, is are you partly conscious under anesthesia? A new study performed by the research group of Adjunct Professor of Pharmacology and Anaesthesiologist Harry Scheinin studying anaesthesia mechanisms, and the research group of Professor of Psychology Antti Revonsuo studying human consciousness and brain from the point of view of philosophy and psychology, aims to answer this common question. The first part of this study involved healthy adults who were anesthetized with dexmedetomidine or propofol, while being monitored with an electroencephalogram (EEG) and a positron emission tomography (PET). The drugs were given to the subjects until they had just almost lost responsiveness. They could then be woken up with loud talking or a light shake. As soon as the person regained responsiveness, they were asked if they experienced anything during their time under anesthesia. Nearly all the participants said they experienced something similar to a dream. The subjects also were played sentences, half which ended normally and half that ended in a strange way. One unexpected sentence, for example, was “The night sky was filled with shimmering tomatoes”. If the subject heard the strange sentence when they were awake, a reaction would show on the EEG. However, when they were under anesthesia, their brains could not tell the difference between the normal and strange sentences. The activity on the EEG did show, however, the brain was trying to interpret the meaning of the words. When the patients woke up from the anesthesia, they had no memory of the sentences. The subjects in this study were lastly played very unpleasant sounds while they were under anesthesia. When they woke up, they were played these sounds, along with others that had not been played before. The participants reacted quicker to the sounds that had already been played. So can we answer the common question are you partly conscious under anesthesia? The results of this study has lead researchers to believe that consciousness is not completely lost when a patient is put under anesthesia, even though the person is not reacting to what is happening around them. The brain may try to understand words and register speech while under anesthesia, but they will not remember when they are woken up and regain full consciousness. “The state of consciousness induced by anaesthetics can be similar to natural sleep. While sleeping, people dream and the brain observes the occurrences and stimuli in their environment subconsciously” summarises Professor Revonsuo. “Anaesthesia could resemble normal sleep more than we have previously thought” adds Dr. Scheinin. While this topic will continue to be researched, these findings are extremely helpful to doctors and patients hoping to understand anesthesia a bit more.
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