future advancements?

[ALTorGT]

hi
following on from the "some queries" message below - torn btw anes and rads, a lot of people talk about the super modern imaging and scope for interventional radiology to really grow and become an exciting field in the future.

However, in my conversation with an anesthesiologist in the OR one day, he said that there wasn't much development or research happening in this field because most of it is driven by the need to cut costs. AND as anesthetics is pretty mature and safe compared to 30 years ago, theres nothing bang busters on the horizon....well 10-15 year horizon. Might just get better biometrics (eg anesthetic systems that self regulate etc) or better engineered patient monitors that will decrease human error rates..that was his opinion...

any thoughts on this - I mean IM promises to be revolutionised by genetics, Surgery by robotics and breakthrough treatments. all this excting stuff happening elsewhere but anesthetics doesnt seem like something that would be spoken of in that regard....

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[BassDominator]

I got this same vibe from one of my mentors... this is the explanation he gave me:

"Think about the things that kill people: heart disease, cancer, etc. Those are the things the NIH and the public want to throw money at. Sure, we still don't know precisely how anesthetics work, but unless you are killing people en mass, it's hard to get the same kind of research dollars"

So, are we victims of our own success? Maybe. I still think there are a lot of unanswered questions in anesthesia. There are many things we do without good evidence and many things we could do better. I think it's just gotten harder recently to get the research dollars now that anesthesia is relatively safer.

 

[2ndyear]

Critical care will continue to increase in research and anesthesiologist interest. That's just my opinion, but consider that patients today are sicker than ever before. The need for critical care is growing, few ICU's are adequately staffed outside of university settings. The cost of caring for these patients is huge compared to a regular patient, so cost containment will continue to be an issue. Also so much of what is done is not yet backed up by evidence based research. Look into any area of critical care and it is just booming with research ideas. 42% of the time a patient spends on a vent is weaning off of it. Different pressors aren't well studied against each other. There's no good consensus on feeding these people. How much can you save by not using a propofol drip, really? All of this stuff carries into anesthesiology as well even if you don't dig critical care. Really sick people still need surgery and MD's are the ones to do those cases. Those gastric bypass trainwrecks, the necrotizing pancreatic tumor patients, the ruptured AAA's. I would predict that that's where the field is going, with the CRNA's doing the lap choles and ortho stuff. So yeah, anesthesiology has a bright future with lots of research to be done still. Will it be 'super-modern' stuff like IR? Who knows.

 

[Gator05]

Don't forget about post-operative cognitive function, and other under-the-radar morbidities associated with anesthetics.

Heck, this is fun. Why is it that some patients "need to stay intubated" overnight because they're "real sick"? What's the role of anesthetic-based cerebral protection in stroke?

Why do some people get a buzz off oxycodone, and others experience a total failure of it to relieve pain? Do we have any PO meds which cleanly prevent, rather than merely alter in a clumsy way, the perception of pain?

Can we develop a semi-permanent TEE probe, one which could be left in the patient for days-weeks in the way a PA cath is? Can we head-off sepsis intraoperatively when a patient suffers a perf and/or other insult?

There is still no perfect monitor of sedation, nor fluid-status monitor for that reason.

How about a propofol-type anesthetic which can be used long-term for kids without the dreaded lactic acidosis? Or a true neonatal pain/sedation monitor?

With fetal surgery, is the fetus experiencing pain? How much, if any? Do anesthetics administered to mom really cover the kiddo in such a circumstance?

Can anesthetics prevent premature labor?

There has to be a better way to utilize and realize the full potential of regional anesthesia.

Do anesthetics adversely affect neurological development of kids? Adults???

Crystalloid or colloid?

I'd say the list could go on and on; there is no shortage of possible projects out there. It's one reason I love this specialty.