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.
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.
Focusing on CQI Meeting the anesthesia requirements of an increasing number of surgical as well as office-based procedures can sometimes compromise the quality of healthcare provided. Maintaining high standards means implementing a Continuous Quality Improvement (CQI) program to evaluate performance and identify areas in need of attention. CQI for medical services, often referred to as managed care, is based on evaluation of a product or the outcome(s) of a process. It involves a clear understanding of the needs and expectations of the consumers of these products or processes. Photo Source The greatest value of CQI is in identifying areas of change while planning improvements. A successful program depends on documentation, accountability and assessment. For anesthesia services this involves tracking complications and unexpected outcomes as well as anesthetist competency. 10 things an Anesthesia Services CQI program must include A detailed clinical assessment of the facilities you are working with to ensure they are in compliance with approved standards of health care Examining credentials of your anesthetists and CRNAs to minimize liabilities and implement best practices Having a well-documented plan for benchmarking your anesthesia services and evaluating anesthetists (like peer reviews) Implementing a proper anesthesia delivery process that conforms to required standards and minimizes error Online technology to facilitate communication between anesthetists, the anesthesia consulting firm and medical centers they service. Should also have an online mechanism for dissemination of information and education for staff. Regular reporting by anesthetists/CRNAs, patient satisfaction surveys, staff and/or client meetings to record and discuss cases (especially those with complications and unexpected outcomes) Routine checks on equipment and anesthesia providers to ensure compliance and maintain quality Assigning local staff familiar with the medical center/office-based physician’s modus operandi to improve patient outcomes Strategies for risk management as well as securing anesthetist and CRNA buy-in to change Process to measure results and effectiveness Share with us your CQI strategies for improving anesthesia services.
Is there a difference between Sedation and Monitored Anesthesia Care (MAC)? No matter what the procedure, every patient’s main concern is pain level, speed of recovery and quality of healthcare services. The debate over methods of sedation is an ongoing one. BUT, Monitored Anesthesia Care (MAC) has proven to be clinically safe, improve patient comfort and aid faster recovery. The biggest difference between Sedation and MAC is continuous monitoring. With Sedation, anesthesia levels in a patient’s system are not as heavily monitored and it often becomes a guessing game. With MAC on the other hand, a dedicated resource is watching patient vitals and monitoring status throughout the procedure from pre to post-op. At any point, there is full knowledge of exactly how much of the anesthetic drug is in a patient’s system. This rules out the chances of less than a required dosage or an overdose on anesthesia. Key benefits of Monitored Anesthesia Care or MAC: Only a licensed anesthetist or CRNA assesses and manages the patient’s condition throughout the procedure. Continuous monitoring increases patient safety and comfort. MAC provides cost-effective pain relief. Even small doses of sedation medication can cause adverse physiological response. MAC requires a qualified CRNA or anesthetist who is trained to deal with any medical problems or complications that may arise during the procedure. The healthcare professional delivering MAC monitors the patient’s condition throughout the procedure and eliminates the need for additional medical staff during sedation or recovery. Improves efficiency, quality of medical procedures and number of patients a facility can serve. Hospitals, surgery/ambulatory centers and office-based physicians can better manage patient volumes by using MAC. While disturbing to know, it’s a fact that in some medical centers propofol sedation is not administered or monitored by a qualified anesthesia provider. Outsourcing your anesthesia services to an established provider like Steel City Anesthesia LLC increases patient safety and reduces your liabilities — a win-win situation for your healthcare facility and the patient. MAC can mean the difference between safe, top quality healthcare and increased risks of complications or even death from overdose. Remember what happened to Michael Jackson? Would you like to share your thoughts or observations about sedation vs. MAC? We’d love to hear from you on our blog.
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