Groundbreaking Anesthesia Research

[Yangkower]

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I'm really curious what new ground breaking research is being done in Anesthesia. When I read our journals (and other medical journals) it feels like there is a lot of fluff that gets published that is frankly not very interesting. I don't know how many times I've heard some one say "that would be an interesting study but it would never get IRB approval". Of course we shouldn't be experimenting on people who don't give informed consent or putting patients in unnecessary danger but it seems we have lost our edge and are just well paid technicians who practice ways to not get sued. In the interest of full disclosure I plan to slip into a comfortable PP job so I'm not any better.

 

[btbam]

Xenon?

 

[Noyac]

Green Lights in the OR

 

[doctor712]

Sniff. Sniff sniff.

 

[Gern Blansten]

Xenon?

It's been around for decades but has never caught on in the US. Probably $$ related and tough to get. I think it has been used more extensively elsewhere (Russia I think). I have not heard any buzz that it is gaining a foothold anywhere, so I don't really know the practicality fo it for routine use.

Perhaps the next big thing will be designer narcotics. I have been hearing that they are in development for years. It would take the guess work out of which drugs work for each patient by doing a quick genetic screen to see what receptors need blocked for each patients since each person can be a bit different.

I think Dr Weinberg's work with lipid emulsion is the biggest new innovation to occur in our field as far as treatments. I think we will continue to see advances of this idea into still more areas of toxic overdoses.

Of course, the less invasive hemodynamic monitoring systems are all over the place. Once one becomes the clear leader in this and maintains the top spot, there will probably be subtle improvements and better competition over time.

I have heard that suggamedex may be gaining some traction again for another push at FDA approval. We will see.

 

[cincincyreds]

Maybe someone could research why when right after we move a patient to the or bed they are in such a rush to get a warm blanket onto the patient.

 

[cchoukal]

I would like to see some research into why all my lines and cables get tangled without even touching them.

But in all seriousness, research in anesthesia covers an incredibly broad range of topics (particularly in light of, or perhaps as a result of, the fact that we don't have our own study section at the NIH).

From mechanisms and novel agents, to rat/bench stuff, to outcomes of various techniques, cardiac preconditioning, neuronal injury, hemodynamic monitoring, staffing/workflow modeling, and across the breadth of our subspecialties of pain, peds, and ICU.

Go to pubmed.org and enter the following search string:

("anesthesiology"[Journal]) OR "anesthesia and analgesia"[Journal]

and you'll see recent titles of publications from our two highest-impact-factor journals.

 

[dhb]

and you'll see recent titles of publications from our two highest-impact-factor journals.

And half the articles will be about pre-conditioning 😴

 

[cchoukal]

And half the articles will be about pre-conditioning 😴

admittedly, I find much of the basic science in Anesthesiology, specifically, to be a bit esoteric.

 

[Gern Blansten]

admittedly, I find much of the basic science in Anesthesiology, specifically, to be a bit esoteric.

Yeah, it usually is. However, I thought both journals for March had higher than average number of articles that captured my attention at least a little bit.

There was talk a while back of having a spinoff journal from Anesthesiology that would focus only on clinically relevant topics. Haven't heard it come up in a while. I wonder if it is a dead project.

 

[Yangkower]

I agree, the articles about giving volatiles via IV were interesting. I guess this isn't a new idea but the new carriers seem to have promise. If the delivery is perfected it seems that the the next task is to determine if there is really an advantage to this method. Just getting rid of vaporizers doesn't seem to be enough.

Faster on and off seems like a reasonable advantage. Use for neuraxial or regional anesthesia is intriguing.

 

[proman]

I'm working on something that I hope will be pretty big. Obviously I'm not going to talk about it until publication. But still, it'll be evolutionary at best, which is how the majority of medicine advances.

 

[Monty Python]

Maybe someone could research why when right after we move a patient to the or bed they are in such a rush to get a warm blanket onto the patient.

Unfortunately that intervention (which has nothing to do with the ABCs) is a JCAHO marker. My hospital by policy has to track the arrival temp in PACU, and God help us if a patient is below 96.5. Causes all sorts of incident reports, etc.

😡

Edit: Oh, my bad, you asked when moving to the OR table. That's because non-thinking reflex-action circulator RNs do things by checklist, even though it directly interferes with us applying EKG leads, BP cuff, etc. I'm all for patient comfort but Jesus give me a minute to get my monitors on before swaddling the patient in a blanket which I then have to immediately unswaddle.

 

[DScully]

I would like to see some research into why all my lines and cables get tangled without even touching them.

Cordless BP cuff / pulse ox / EKG leads would be amazing. I spent at least 5-10 mins each morning to untangle every single cord and then all the efforts are futile once you step out the room.

I don't understand why RNs constantly put on blankets before we move the pt to the OR table. And then take them away when pt starts to move himself. And then put the blankets back on again. Seriously. Please bring your brain to work - if you have one...which as it turns out, is a lot to ask.

 

[countingdays]

Maybe someone could research why when right after we move a patient to the or bed they are in such a rush to get a warm blanket onto the patient.

I would also like to know why everyone but me apparently thinks it is impossible for able-bodied people to scoot from one bed to another if the beds are more than about half and inch apart in height. I haven't done a blinded study, but my unpublished observational study indicates that most people can move from one bed to another even if those beds have up to a 4 inch difference in height. I may do a study of 8 inch bed height difference and scootability, but I might have to start consenting patients and sedating nurses at some point. Cause really, why should they stop and think for 2 seconds before asking me to lower the bed before a patient slides off that 1 inch cliff from the OR bed to the stretcher.

 

[sevoflurane]

I'm working on something that I hope will be pretty big. Obviously I'm not going to talk about it until publication. But still, it'll be evolutionary at best, which is how the majority of medicine advances.

Wacha doing over there proman? Something supah cool? 😎

I’m thinking this is pretty sweet... I hope it proves to be a viable option.

http://www.ncbi.nlm.nih.gov/pubmed/15927990

Conclusions― Stem-cell tissue-engineered heart valves can be created from mesenchymal stem cells in combination with a biodegradable scaffold and function satisfactorily in vivo for periods of >4 months. Furthermore, such valves undergo extensive remodeling in vivo to resemble native heart valves.

🙄

 

[imfrankie]

Nirs

 

[proman]

Wacha doing over there proman? Something supah cool? 😎

Depends if I get the (small) grant.

Nirs

The big thing with NIRS is determining the lower limit of autoregulation. Whether that translates to meaningful outcomes is a different story.

 

[imfrankie]

Depends if I get the (small) grant.



The big thing with NIRS is determining the lower limit of autoregulation. Whether that translates to meaningful outcomes is a different story.

I suspect NIRS has a bright future below the neck also.

 

[proman]

I suspect NIRS has a bright future below the neck also.

Peds cardiac typically has a somatic sensor over the liver. In adults we place them on the legs anytime there's a femoral arterial or venous cannula in. Maybe kidney would be another site, see if there's an association to renal failure with desaturations. Not really groundbreaking though.

 

[imfrankie]

Peds cardiac typically has a somatic sensor over the liver. In adults we place them on the legs anytime there's a femoral arterial or venous cannula in. Maybe kidney would be another site, see if there's an association to renal failure with desaturations. Not really groundbreaking though.

At my former institution we used two site NIRS on head and over kidney for sick neonates including all pedi cardiac and unit kids. Lots of info can be gleaned from that two site data stream including CO, sympathetic tone, Qp/Qs, Hg, anesthetic "depth" etc.

But I think we'll see a lot more utilization of NIRS and other spectroscopy for not only for diagnostic but also therapeutic, e.g. neuromodulatory, purposes.

 

[Ignatius J]

I would also like to know why everyone but me apparently thinks it is impossible for able-bodied people to scoot from one bed to another if the beds are more than about half and inch apart in height. I haven't done a blinded study, but my unpublished observational study indicates that most people can move from one bed to another even if those beds have up to a 4 inch difference in height. I may do a study of 8 inch bed height difference and scootability, but I might have to start consenting patients and sedating nurses at some point. Cause really, why should they stop and think for 2 seconds before asking me to lower the bed before a patient slides off that 1 inch cliff from the OR bed to the stretcher.

Haha, can't tell you how many MAC cases I do on ambulating and mobile folks where they want to log roll the patient over to the bed. God forbid the beds aren't even!

 

[epidural man]

I'm really curious what new ground breaking research is being done in Anesthesia. When I read our journals (and other medical journals) it feels like there is a lot of fluff that gets published that is frankly not very interesting. I don't know how many times I've heard some one say "that would be an interesting study but it would never get IRB approval". Of course we shouldn't be experimenting on people who don't give informed consent or putting patients in unnecessary danger but it seems we have lost our edge and are just well paid technicians who practice ways to not get sued. In the interest of full disclosure I plan to slip into a comfortable PP job so I'm not any better.

there isn't a journal produced without fluff, or very uninteresting articles. They all suck.

Cosmo is pretty cool. It made me really miss sex when I was in ass-crackistan.

 

[pgg]

I would also like to know why everyone but me apparently thinks it is impossible for able-bodied people to scoot from one bed to another if the beds are more than about half and inch apart in height. I haven't done a blinded study, but my unpublished observational study indicates that most people can move from one bed to another even if those beds have up to a 4 inch difference in height. I may do a study of 8 inch bed height difference and scootability, but I might have to start consenting patients and sedating nurses at some point. Cause really, why should they stop and think for 2 seconds before asking me to lower the bed before a patient slides off that 1 inch cliff from the OR bed to the stretcher.

You ought to submit that to the ABA for your MOCA project.

 

[cincincyreds]

You ought to submit that to the ABA for your MOCA project.

I've also noticed that the brakes on the gurney's in myh hospital don't work, so I always tell someone to hold the bed when moving the patient over.

 

[soorg]

It seems that the American anesthesia journals (i.e. Anesthesiology and Anesthesia & Analgesia) have very experimental/non-practical articles. Who cares about sevoflurane-induced ischemia in the rat testicle, or how trendelenburg position induces cellular apoptosis in the dorsal horn during laparoscopy in the Pickwickian patient?!

In my opinion, the Canadian Journal of Anesthesia is the best for useful, real-world studies that you can apply everyday. British Journal of Anesthesia is 2nd best. Just solid info that you can use.

 

[IlDestriero]

At my former institution we used two site NIRS on head and over kidney for sick neonates including all pedi cardiac and unit kids. Lots of info can be gleaned from that two site data stream including CO, sympathetic tone, Qp/Qs, Hg, anesthetic "depth" etc.

But I think we'll see a lot more utilization of NIRS and other spectroscopy for not only for diagnostic but also therapeutic, e.g. neuromodulatory, purposes.

When we used to do this and the numbers sucked and didn't respond to whatever treatment we thought appropriate, we just stopped writing the numbers down.

 

[sunnyINphilly]

Virtual reality pre-conditioning to decrease post-operative pain