Fewer Patients Receiving Opioids Alone Following Hip or Knee Replacement

MedicalResearch.com Interview with:
Philipp Gerner

MD Candidate – Class of 2018
University of Massachusetts Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids.

As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients.

Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain.

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Virtual Cartoon Technology Can Ease Pediatric Anxiety in OR Before Anesthesia

MedicalResearch.com Interview with:
Dr. Sunghee Han
Professor
Seoul National Unversity College of Medicine
Seoul National University Hospital
Department of Anesthesia and Pain Medicin

What is the background for this new technology and study? What are the main findings?

Response: The time from patient arrival in the operating theatre to induction of general anesthesia is one of the most stressful moments for children undergoing surgery. Various strategies such as ‘pre-operative guided operating room tour’ or ‘therapeutic play intervention’ have been developed in order to reduce children’s pre-operative anxiety. Although these existing simulation-based approaches may be effective, they have not been widely used in real clinical settings with limited budget and resources such as manpower and space.

Virtual Reality(VR), a relatively new technology in the field of healthcare, can allow the user to experience an immersive environment. In this study, using VR technology, we provided the children with a realistic trip to the operating theatre accompanied by ‘My best friend’ Pororo. “Pororo, The Little Penguin” is a very famous cartoon character in Korea and Asia. Most children in Korea watch Pororo in TV, play with Pororo toys since early yeas and perceive Pororo as a ‘close friend’. In the VR content used in this study, Pororo acts as a patient and is subjected to anesthesia and surgery himself. Pororo kindly brings his friend(the viewer; paediatric patient) to the theatre and shows all that is going on in there.

Intervention with the VR content was able to reduce the level of anxiety in paediatric patients and promote collaborative behavior and acceptance of the invasive procedures, especially general anesthesia. Parental satisfaction level was also relatively higher in the VR group.

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Large Trial Evaluates Inhaled Nitric oxide on Survival Without Pulmonary Dysplasia in Preterm Infants

MedicalResearch.com Interview with:

Shabih U. Hasan, MD, DCH, FRCPC Professor and Staff Neonatologist, Alberta Health Services Department of Pediatrics, Cumming School of Medicine University of Calgary

Dr. Hasan

Shabih U. Hasan, MD, DCH, FRCPC
Professor and Staff Neonatologist, Alberta Health Services
Department of Pediatrics, Cumming School of Medicine
University of Calgary

MedicalResearch.com: What is the background for this study?

Response: Approximately 8% of all infants are born prematurely (preterm birth <37 weeks postmenstrual age). Preterm infants have many challenges including establishment of adequate pulmonary gas exchange. Due to not yet fully developed lungs, preterm infants require respiratory support consisting of respirators and other forms of non-invasive ventilation modalities and supplemental oxygen.  Bronchopulmonary dysplasia (BPD) is the commonest morbidity among very low birth weight infants as 40% of survivors at postmenstrual age <30 weeks develop BPD. This is a serious condition as it can lead to short- and long-term pulmonary complications, increased hospital visits and neurodevelopmental impairment. BPD is defined where preterm infants require respiratory support and/or supplemental oxygen at 36 weeks postmenstrual age.

A number of therapeutic and non-therapeutic modalities have been used to prevent BPD including inhaled nitric oxide (iNO).  In 2006, the NO CLD trial demonstrated that iNO prevented BPD (Relative benefit 1.81; CI 1.27-2.59, P = 0.006) if used according to the NO CLD Protocol (Ballard et al., New England Journal of Medicine, 355:343-353, 2006). Our study (NEWNO; Newborns treated with Nitric Oxide) was designed to replicate the NO CLD study.
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Risk Factors for Adverse Events in Emergency Procedural Pediatric Sedation

MedicalResearch.com Interview with:

Maala Bhatt MD, MSc., FRCPC Director, Pediatric Emergency Research Staff Physician, Emergency Medicine  Children's Hospital of Eastern Ontario

Dr. Bhatt

Maala Bhatt MD, MSc., FRCPC
Director, Pediatric Emergency Research
Staff Physician, Emergency Medicine
Children’s Hospital of Eastern Ontario 

MedicalResearch.com: What is the background for this study?

Response: Procedural sedation, defined as the administration of medications to minimize pain and awareness, has become standard practice in pediatric emergency departments worldwide to facilitate short, painful procedures such as orthopedic reduction and complex laceration repairs. Although emergency department sedation is regarded as safe, serious adverse events have been reported. The incidence of these events has been difficult to determine due to the infrequency of their occurrence and lack of large, multi-center surveillance studies focused on systematic detection of adverse events. Previous studies of emergency department sedation have been limited by single-center design and small sample sizes. These studies have not been able to reliably predict sedation-related adverse events, their severity or impact on patients.

To improve understanding of the safety and comparative effectiveness of ED procedural sedation, we conducted a large multi-center cohort study using standardized outcome measures that are valid and relevant to clinical practice. Our primary objective was to determine which practices lead to the best outcomes in children undergoing emergency department procedural sedation.

MedicalResearch.com: What are the main findings?

Response: We enrolled 6,295 patients undergoing parenteral procedural sedation for a painful procedure in one of six Canadian pediatric emergency departments from July 2010 to February 2015.

The overall incidence of adverse events in our population was 11.7%. Oxygen desaturation (5.6%) and vomiting (5.2%) were the most common events. Serious adverse events and significant interventions in response to an adverse event were rare occurring in only 1.1% and 1.4% of patients respectively.

We found that choice of sedation medication had the biggest impact on the incidence of adverse events and need for significant interventions in response to those events. The incidence of serious adverse events and significant interventions was lowest among patients sedated with ketamine-alone and highest among patients sedated with combination drugs ketamine+propofol and ketamine+fentanyl. We also found that pre-procedural opioid administration was strongly associated with increased odds of oxygen desaturation, vomiting and need for significant interventions, regardless of sedation medication.

Higher doses of ketamine were associated with increased odds of oxygen desaturation and vomiting. These findings are in opposition to the common belief that ketamine does not exhibit a dose-response relationship.

We also found that pre-procedural anti-emetics were associated with a 50% reduction in the odds of vomiting. However, based on published evidence, use in children under five years may not be as advantageous as their baseline risk is much lower.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Procedural sedation for children provided by Emergency Physicians in these tertiary care pediatric emergency departments is safe and effective with low rates of serious adverse events (1.1%) and significant interventions (1.4%). Ketamine, Ketamine and Propofol and Propofol alone are all effective and safe in the hands of competent/experienced providers, however using ketamine alone is associated with fewer serious adverse events and significant interventions.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our finding that administering opioids prior to sedation increases the odds of oxygen desaturation, vomiting and the need for significant interventions is interesting. Future work could focus on the timing of opioid administration and the incidence of adverse events. We are also interesting in understanding the longer term effects of sedation medications, controlling for age.

Disclosures: This study was supported by a Canadian Institutes of Health Research Team Grant in Pediatric Emergency Medicine.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Bhatt M, Johnson DW, Chan J, Taljaard M, Barrowman N, Farion KJ, Ali S, Beno S, Dixon A, McTimoney CM, Dubrovsky AS, Sourial N, Roback MG, for the Sedation Safety Study Group of Pediatric Emergency Research Canada (PERC). Risk Factors for Adverse Events in Emergency Department Procedural Sedation for Children. JAMA Pediatr. Published online August 21, 2017. doi:10.1001/jamapediatrics.2017.2135

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

 

Combination Opioids and Benzodiazepines Raises Risk of Overdose

MedicalResearch.com Interview with:

Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA

Dr. Eric Sun

Eric C Sun MD PhD, assistant professor
Department of Anesthesiology
Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%.

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New Scoring System Guides Surgical Risks During Pregnancy

MedicalResearch.com Interview with:
Adam Sachs MD

Assistant Professor of Anesthesiology
University of Connecticut School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: When women undergo appendectomy or cholecystectomy during pregnancy they are obviously concerned about the well being of their fetus. Unfortunately, the majority of the data available to council pregnant women is outdated and medical practice has significantly changed since their publication.

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Over 1/3 of Anesthesia Now Delivered Outside of Traditional Operating Rooms

MedicalResearch.com Interview with:
Dr. Richard Dutton, MD

Chief quality officer
U.S. Anesthesia Partners
Dallas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to document the change in national anesthesia practice over the past 5 years, specifically the increase in non-operating room anesthesia NORA. We found that non-operating room anesthesia now accounts for more than 1/3 of all anesthetics. The proportion continues to rise as minimally invasive procedures are developed in gastroenterology, cardiology, radiology and other non-surgical disciplines. These procedures are often performed in complex patients, and require anesthesia involvement to facilitate.

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Liposomal Bupivacaine Infiltration Reduced Costs and Opioid Use in TKA Surgery

MedicalResearch.com Interview with:
Bryan Sakamoto MD, PhD
Department of Anesthesia
Richard L. Roudebush, Veterans Affairs Medical Center
Department of Anesthesia
Indiana University School of Medicine
Indianapolis, Indiana

MedicalResearch.com: What is the background for this study?

Response: Liposomal bupivacaine is a novel extended-duration anesthetic that has recently become a popular option in total knee arthroplasty (TKA) for post-operative pain management. Although liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. The main purpose of this medication use study was to evaluate the cost verses benefit of using this agent in our veteran patient population.

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Repeat Urine Drug Testing Can Improve Compliance of Patients on Opioid Medications

MedicalResearch.com Interview with:

N. Nick Knezevic, MD, PhD Vice Chair for Research and Education Associate Professor of Anesthesiology and Surgery at University of Illinois Advocate Illinois Masonic Medical Center Department of Anesthesiology Chicago, IL 60657

Dr. N. Nick Knezevic

N. Nick Knezevic, MD, PhD
Vice Chair for Research and Education
Associate Professor of Anesthesiology and Surgery at University of Illinois
Advocate Illinois Masonic Medical Center
Department of Anesthesiology
Chicago, IL 60657

MedicalResearch.com: What is the background for this study?

Response: Even though serious efforts have been undertaken by different medical societies to reduce opioid use for treating chronic non-cancer pain, still many Americans seek pain relief through opioid consumption. The purpose of this study was to accurately assess compliance of chronic opioid consuming patients in an outpatient setting and evaluate if utilizing repeated urine drug testing could improve compliance.

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Persistent Postpartum Pain Linked To Higher Risk of Depression

MedicalResearch.com Interview with:
MS WEI DU, First author
Third Year Medical Student
DUKE-NUS Medical School and
DR BAN LEONG SNG, Senior Author
Senior Consultant Department of Women’s Anesthesia KK
Women’s and Children’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

MS WEI DU: We performed a cohort study involving 200 healthy women who received epidural pain relief during the deliveries of their firstborns to investigate the relationship between persistent childbirth pain, psychological and pain vulnerability with postnatal depression. Postnatal depression was evaluated using the Edinburgh Postnatal Depression Score (EPDS).

Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

DR BAN LEONG SNG: Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

MedicalResearch.com: What should readers take away from your report?

MS WEI DU: We concluded that greater pain vulnerability and stress during intrapartum period, and presence of persistent pain or higher anxiety during postpartum period are positively associated with higher scores on postnatal depression tests.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

DR BAN LEONG SNG: The research findings support the need to address pain comprehensively to lessen the risk of developing postnatal depression. We are currently conducting a larger study to evaluate the impact of pain and postnatal depression in pregnant women.

MedicalResearch.com: Is there anything else you would like to add?

DR BAN LEONG SNG: Postnatal evaluation and management of childbirth pain and postnatal depression is important in our care of mothers and their newborns.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

World Congress of Anaesthesiologists abstract discussing:

Persistent childbirth pain increases risk of postnatal depression

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Opportunities for Improvement in Pediatric Resuscitation Across US EDs

MedicalResearch.com Interview with:
Marc Auerbach, MD, FAAP, MSc
Associate Professor of Pediatrics (Emergency Medicine) and of Emergency Medicine
Co-chair INSPIRE (International Network for Simulation Based Pediatric Innovation Research and Education)
Director, Pediatric Simulation
Yale Center for Medical Simulation;

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Severely ill infants and children present to any of over 5000 United States Emergency Departments every day. A direct comparison of the quality of resuscitative care across EDs is challenging due to the low frequency of these high stakes events in individual EDs. This study utilized in-situ simulation-based measurement to compare the quality of resuscitative care delivered to two infants and one child by 58 distinct interprofessional teams across 30 EDs. Composite quality scores correlated with annual pediatric patient volume, with higher volume departments demonstrating higher scores.

The pediatric readiness score measures compliance with guidelines created by the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association. The pediatric readiness score correlated with composite quality scores measured by simulation.

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New Drug Class May Prevent Learning Deficits In Infants Exposed To Repeated Anesthesia

MedicalResearch.com Interview with:

Guang Yang, Ph.D. Assistant Professor NYU Langone School of Medicine Alexandria Center for Life Sciences New York, NY 10016

Dr. Guang Yang

Guang Yang, Ph.D.
Assistant Professor
NYU Langone School of Medicine
Alexandria Center for Life Sciences
New York, NY 10016

MedicalResearch.com: What is the background for this study? How common is the problem of long-lasting behavioral deficits after repeated anesthesia exposure in neonates?

Response: Each year, in the United States alone, more than 1 million children under 4 years of age undergo surgical procedures that require anesthesia. Many lines of evidence from animal studies have shown that prolonged or repeated exposure to general anesthesia during critical stages of brain development leads to long-lasting behavioral deficits later in life. The results from human studies are less clear, although some studies suggest a higher incidence of learning disabilities and attention-deficit and hyperactivity disorders in children repeatedly exposed to procedures requiring general anesthesia. To date, there has been no effective treatment to mitigate the potential neurotoxic effects of general anesthesia.

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Limited Anesthesia in Young Children Not Link To Later Cognitive Impairment

MedicalResearch.com Interview with:

Lena S. Sun, MD E. M. Papper Professor of Pediatric Anesthesiology Professor of Anesthesiology and Pediatrics Executive Vice Chairman, Department of Anesthesiology Chief, Division of Pediatric Anesthesiology Columbia University Medical Center New York, New York 10032

Dr. Lena S. Sun

Lena S. Sun, MD
E. M. Papper Professor of Pediatric Anesthesiology
Professor of Anesthesiology and Pediatrics
Executive Vice Chairman, Department of Anesthesiology
Chief, Division of Pediatric Anesthesiology
Columbia University Medical Center
New York, New York 10032

MedicalResearch.com: What is the background for this study?

Dr. Sun: The background for the study is as follow: There is robust evidence in both rodent and non-human primate studies that exposure of the developing brain leads to impairment in cognitive function and behavior later in life. The evidence from human studies derives mostly from retrospective studies and the results have been mixed. Some have demonstrated anesthesia in early childhood was associated with impaired neurocognitive function, while others have found no such association. Our study is the first to specifically designed to address the question of effects of general anesthesia exposure on cognitive function, comparing exposure with no exposure.

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Listening To Music Reduces Anxiety During Awake Eye Surgery

MedicalResearch.com Interview with:
Dr Gilles Guerrier
Cochin University Hospital
Paris, France

MedicalResearch.com: What is the background for this study?

Dr. Guerrier: Awake eye surgery is particularly stressful for patients. Music has long been known to reduce anxiety, minimise the need for sedatives, and make patients feel more at ease. The purpose of this pilot study was to evaluate the effect of music on anxiety in outpatients undergoing elective eye surgery under topical (local) anaesthesia. The music played was specifically composed to ease anxiety following strict criteria, including instrumental pieces only using a decreasing tempo and a progressive decrease in the number of instruments playing. Each patient was able to choose from a panel of 16 recorded music styles according to their own preferences, and listened through high quality headphones. There were various styles available, including jazz, flamenco, Cuban, classical and piano. The music was provided by MUSIC CARE, a Paris-based company that produces music aimed at preventing and managing pain, anxiety and depression.

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Opioid-Free Approach To Breast Cancer Surgery Explored

MedicalResearch.com Interview with:
Dr. Sarah Saxena
Université Libre de Bruxelles

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Saxena: Opioids are well known analgesics, but like every drug, they do not come without side-effects. Recently, certain studies have been published about an opioid-free approach in bariatric patients. An opioid free approach is possible combining ketamine, lidocaine and clonidine.

We studied this type of approach in breast cancer patients and looked at several factors such as patient comfort pain quality after an opioid free approach vs after an opioid approach. The study showed patients requiring less analgesics after an opioid free approach.

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Noise Pollution Endemic in Intensive Care Units

MedicalResearch.com Interview with:
Dr. Eveline Claes
Jessa Ziekenhuis Hospital
Hasselt, Belgium

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background of this study was the presence of noise in our ICU, and patients complaining about it. We wanted to look into the problem. The main findings were that there is indeed too much noise in our ICU compared to the WHO recommendations, but the measured sound levels were comparable with other ICU’s.

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Study of Cognitive Functioning after Surgery Has Reassuring Findings

MedicalResearch.com Interview with:

Unni Dokkedal, M.P.H. Unit of Epidemiology, Biostatistics, and Biodemography University of Southern Denmark

Unni Dokkedal

Unni Dokkedal, M.P.H.
Unit of Epidemiology, Biostatistics, and Biodemography
University of Southern Denmark

MedicalResearch: What is the background for this study? 

Response: Early (seven days) postoperative cognitive impairment is common in adult surgical patients of all ages, but elderly patients are at higher risk for this complication. Previous studies have shown that these impairments are detectable up to three months after surgery in patients older than 60 years. Furthermore, the condition may persist for longer than six months in some patients with potential long-term implications of the surgery leading to impaired quality of life and increased mortality risk. We wanted to investigate the contribution of surgery, anesthesia, preexisting conditions and other factors on the postoperative cognitive functioning of elderly patients.

MedicalResearch:  What are the main findings?

Response: For a sample of 4,299 middle-aged twins younger than 70 years and 4,204 elderly twins over 70 years, all of whom were residents of Denmark, medical records were reviewed from 1977 and until the accomplishment of cognitive tests in the period from 1995 to 2001. Results from five cognitive tests were compared in twins exposed to surgery, classified as major, minor, hip and knee replacement, or other, with those of a reference group without surgery. A statistically significant lower composite cognitive score was found in twins with at least one major surgery compared with the reference group (mean difference, −0.27; 95% CI, −0.48 to −0.06), which is a negligible effect size. None of the other groups differed from the reference group except the knee and hip replacement group that tended to have higher cognitive scores (mean difference, 0.35; 95% CI, −0.18 to 0.87).To consider genetic and shared environmental confounding and to take preoperative cognition into account, intrapair analyses were performed in same-sexed pairs in whom one had a history of major surgery and the other no surgery. No difference was found in the intra-pair analysis. The results suggest that preoperative cognitive functioning and underlying diseases were more important for cognitive functioning in mid- and late life than surgery and anesthesia.
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Acute Respiratory Distress Syndrome Often Underrecognized, Has High Mortality

MedicalResearch.com Interview with:

John G. Laffey MD Chief, Department of Anesthesia; Co-Director, Critical illness and Injury Research Centre; Scientist, Keenan Research Centre for Biomedical Science ‑ St. Michael's Hospital Professor, Anesthesia, Critical Care, and Physiology ‑ University of Toronto

Dr. John Laffey

John G. Laffey MD
Chief, Department of Anesthesia; Co-Director, Critical illness and Injury Research Centre; Scientist, Keenan Research Centre for Biomedical Science ‑ St. Michael’s Hospital
Professor, Anesthesia, Critical Care, and Physiology ‑ University of Toronto

Medical Research: What is the background for this study?

Dr. Laffey: Acute respiratory distress syndrome is the commonest cause of severe acute respiratory failure in the critically ill. ARDS is a major cause of death and disability in the critically ill worldwide. Second, there is no treatment for ARDS, and our present management approaches are limited to supporting organ function while treating the underlying causes

We performed the LUNG SAFE study to address several clinically important questions regarding ARDS.

First, the current incidence in a large international cohort was not known. Large regional differences had been suggested: for example, the incidence of ARDS in the US was reported to be ten times greater of that in Europe_ENREF_4.

Second, we wanted to understand how we manage patients with  Acute respiratory distress syndrome in the ‘real world’ situation. Specifically, it was not clear to what extent newer approaches to artificial ventilation, such as reducing the size of the breaths (lower tidal volumes) and keeping the lung pressure positive at all times to minimize collapse (PEEP) were used. The impact of studies showing promise for other measures to improve gas exchange such as turning patients prone during mechanical ventilation, or using neuromuscular blockade, on routine clinical practice in the broader international context was not known.

Third, there were some concerns over the extent of clinician recognition of ARDS. This was an important issue because implementation of the effective therapies may be limited by lack of recognition of ARDS by clinicians. A better understanding the factors associated with ARDS recognition and how this recognition influenced patient management could lead to effective interventions to improve care.

Lastly we wanted to determine the outcome from  Acute respiratory distress syndrome in a global cohort of patients.

Medical Research: What are the main findings?

Dr. Laffey: We found that ARDS continues to represent an important public health problem globally, with 10% of ICU patients meeting clinical criteria for ARDS. While there appeared to be some geographic variation, this did not seem as great as previously thought.

An important finding was the under-recognition of  Acute respiratory distress syndrome by clinicians, with 40% of all cases not being recognized.

In addition, over one third of patients did not receive protective lung ventilation strategies. The use of other measures to aid gas exchange during artificial ventilation, such as turning the patient into the prone position, or the use of neuromuscular blockade was also quite low.

Of most concern, ARDS continues to have a very high mortality of approximately 40% of patients dying in hospital.

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Meditation May Improve Experience with Imaging-Guided Needle Breast Biopsy

MedicalResearch.com Interview with:

Mary Scott Soo, M.D. FACR Associate professor of Radiology Duke Cancer Institute

Dr. Mary Scott Soo

Mary Scott Soo, M.D. FACR
Associate professor of Radiology
Duke Cancer Institute

Medical Research: What is the background for this study?

Dr. Soo: Imaging-guided needle breast biopsies for diagnosing suspicious breast lesions have been performed for many years and have definite advantages as a diagnostic tool over surgical biopsies. These biopsies are performed in outpatient settings, which decrease costs and reduce delays, and are highly accurate and less invasive than surgical procedures, requiring only local anesthesia. However, performing biopsies in this outpatient setting limits the use of intravenous sedation and pain medication that could address commonly experienced patient anxiety and occasional associated pain. Anxiety and pain can negatively impact the patient’s experience and could possibly affect the biopsy outcome due to patient movement, and could potentially even alter patients’ adherence to follow-up recommendations. Prior studies have explored methods to reduce anxiety, using interventions such as music, hypnosis and anxiolytics. Although hypnosis and anxiolytics are effective, these are a little more complicated to implement due to training costs for administering hypnotherapy, and costs, potential side effects, and need for an adult driver to take the patients home when anxiolytics are used. Other research has shown that meditation-based interventions can lead to positive psychological and physical outcomes, and may be helpful for decreasing anxiety, pain and fatigue.

Loving-kindness mediation is a type of mediation that focuses on relaxation and developing positive emotions, by silently repeating phrases encouraging compassion and goodwill towards oneself and others, while also reducing negative emotions. Previous studies have shown that even a 7-minute loving-kindness meditation can be effective for increasing positive emotions, so my co-authors Rebecca Shelby PhD, a clinical psychologist at Duke’s Pain Prevention and Treatment Research Program,clinical psychologist Anava Wrenn PhDwho has used loving-kindness meditation in a different practice setting, and breast imaging radiologist Jennifer Jarosz MD and I put together a team to study whether an audio-recorded, lovingkindness meditation could reduce anxiety, fatigue and pain during the imaging-guided breast biopsy time frame.  We consulted with Mary Brantley, MA, LMFT, who teaches loving-kindness meditation at Duke’s Integrative Medicine, to develop an audio-recorded loving-kindness mediation used specifically in the breast biopsy setting, and compared this to using music during biopsies or standard care (supportive dialogue) from the technologist and radiologist performing the biopsy.

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Frail Patients Much More Likely To Die After Surgery

More on Frailty on MedicalResearch.com
MedicalResearch.com Interview with:

Dr. Daniel I McIsaac

Dr. Daniel McIsaac

Dr. Daniel I McIsaac, MD, MPH, FRCPC
Assistant Professor of Anesthesiology
Department of Anesthesiology
The Ottawa Hospital, Civic Campus
Ottawa, ON

Medical Research: What is the background for this study?

Dr. McIsaac: Older age is a well-known risk factor for adverse outcomes after surgery, however, many older patients have positive surgical outcomes. Frailty is a syndrome that encompasses the negative health attributes and comorbidities that accumulate across the lifespan, and is a strong discriminating factor between high- and low-risk older surgical patients.  By definition, frail patients are “sicker” than non-frail patients, so their higher rates of morbidity and mortality after surgery aren’t surprising. However, frailty increases in prevalence with increasing age, so as our population ages we expect to see more frail people presenting for surgery.  Our goal was to evaluate the impact of frailty on postoperative mortality at a population-level, and over the first year after surgery to provide insights that aren’t available in the current literature, which largely consists of single center studies limited to in-hospital and 30-day outcome windows.

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Brain-Based Signatures May Help Optimize Anesthesia Dose

Srivas Chennu, PhD Senior Research Associate Clinical Neurosciences, University of Cambridge Visiting Scientist, MRC Cognition and Brain Sciences Unit College Research Associate, Homerton College

Dr. Srivas Chennu

More on Anesthesiology on MedicalResearch.com
MedicalResearch.com Interview with:
Srivas Chennu, PhD
Senior Research Associate
Clinical Neurosciences, University of Cambridge
Visiting Scientist, MRC Cognition and Brain Sciences Unit
College Research Associate, Homerton College

Medical Research: What is the background for this study?

Dr. Chennu:  Scientific understanding of how brain networks generate consciousness has seen rapid advances in recent years, but the application of this knowledge to accurately track transitions to unconsciousness during general anaesthesia has proven difficult. Crucially, one reason for this is the considerable individual variability in susceptibility to anaesthetic dosage. 

To better understand the factors underlying this variability, we measured interconnected, oscillatory brain activity (‘brain networks’), using non-invasive, high-density electroencephalography (EEG) from healthy volunteers while they were sedated with the common anaesthetic propofol. Alongside, we measured their behavioural responsiveness, and the actual concentration of the drug in their blood plasma.  Continue reading

ER Trial of Inhaling Isopropyl Alcohol From Pads Reduced Nausea

Michael D. April, MD, DPhil Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium San Antonio, TX

Dr. April

MedicalResearch.com Interview with:
Michael D. April, MD, DPhil
Department of Emergency Medicine
San Antonio Uniformed Services Health Education Consortium
San Antonio, TX 

Medical Research: What is the background for this study? What are the main findings?

Dr. April: Anesthesia research studies have found that nasal inhalation of isopropyl
alcohol has efficacy in treating nausea among post-operative patients. We
sought to study this agent among Emergency Department patients with nausea or
vomiting. We found that patients randomized to inhale isopropyl alcohol had
improved self-reported nausea scores compared to patients randomized to inhale
saline (placebo).

MedicalEditor’s note:  Do Not Do This Without Medical Supervision!

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Soothing Words Do More Than Pills To Decrease Patient Anxiety

Dr Emmanuel Boselli, MD, PhD Anesthesiology and Intensive Care University Claude Bernard Lyon I University of Lyon Lyon, France

Dr. Boselli

MedicalResearch.com Interview with:
Dr Emmanuel Boselli, MD, PhD
Anesthesiology and Intensive Care
University Claude Bernard Lyon I
University of Lyon
Lyon, France

Medical Research: What is the background for this study? What are the main findings?

Dr. Boselli: We hypothesized that the use of conversational hypnosis in patients undergoing regional anesthesia procedures for ambulatory upper limb surgery might provide better comfort than the use of oral premedication during the regional anesthesia procedure. We assessed the subjective effect of conversational hypnosis on a patient self-reported comfort scale ranging from 0 (no comfort) to 10 (maximal comfort), and the objective effect was assessed using the Analgesia/Nociception Index (ANI), a 0-100 index derived from heart rate variability reflecting the relative parasympathetic tone. In our study of 100 patients undergoing hand surgery in two different centers, 50 had conversational hypnosis while being given regional anesthesia (Saint-Grégoire hospital), and 50 were given of oral hydroxyzine 30 minutes to an hour before the regional anesthesia procedure (Lyon hospital). Patients having hypnosis measured an average ANI of 51 before and 78 after hypnosis, whereas those who had premedication averaged 63 before and 70 after. The average comfort scale of those who had received hypnosis was 6.7 before and 9.3 after, while patients who had medication averaged 7.8 before and 8.3 after. The main finding of this study is that conversational hypnosis induced greater increase in comfort scales and ANI values than oral premedication.

Medical Research: What is conversational hypnosis? What does it consist of?

Dr. Boselli: Conversational hypnosis consists of matching the patient’s behavioral communication patterns, reflective listening, avoiding any negative suggestion (e.g. “Keep calm and quiet” instead of “Please don’t move!”) and focalizing the patient’s attention on something else than the regional anesthesia procedure, such as the ultrasound machine screen.

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Medicaid Patients, Minorities Less Likely To Receive Regional Anesthesia

Jashvant Poeran MD PhD Assistant Professor Dept. of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York, NY

Dr. Jashvant Poeran

MedicalResearch.com Interview with:
Jashvant Poeran MD PhD
Assistant Professor
Dept. of Population Health Science & Policy
Icahn School of Medicine at Mount Sinai
New York, NY

Medical Research: What is the background for this study?

Dr. Poeran: Neuraxial anesthesia and peripheral nerve blocks  are two techniques for regional anesthesia for hip and knee replacements. Compared to general anesthesia, these two regional anesthesia techniques are increasingly seen as ‘higher quality care’ as a growing number of studies show that patients have better outcomes after surgery when regional anesthesia is used. However, less is known about the factors that influence the process of anesthetic care. This is important information because the choice for regional anesthesia might affect outcomes after hip and knee replacement surgery. We therefore used a large national database of health claims of hip and knee replacement procedures to study if specific patient subgroups were less likely to receive regional anesthesia.

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Veterans with PTSD Require More Sedatives in Critical Care Units

Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo

Dr. Jad Kebbe

MedicalResearch.com Interview with:
Jad Kebbe, MD
Jacobs School of Medicine and Biomedical Sciences
Department of Medicine
University of Buffalo

Medical Research: What is the background for this study? What are the main findings?

Dr. Kebbe: This study proceeded after sensing that post-traumatic stress disorder (PTSD) was a major contributor to ill outcomes in Veterans who are hospitalized in general, and mechanically ventilated in the intensive care unit (ICU) in particular. There is plenty of data depicting the comorbid roles PTSD plays in other medical conditions, leading to an increase in the use of medical services. Furthermore, PTSD affects a Veteran’s adherence to both medical and psychiatric therapies. Having said this, the ICU course could itself negatively affect a pre-existing PTSD, or even lead to the inception of such a condition de novo. However, to date, there has been no study looking at the effect a pre-existing PTSD diagnosis may have on the ICU hospitalization and thereafter.

Our study confirmed that PTSD led to an increase in sedative requirements (opiates and benzodiazepines) for Veterans who were mechanically ventilated for more than 24h between 2003 and 2013, and revealed a trend towards an increase in mortality when compared to Veterans not suffering from PTSD.

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Universal TXA During Hip/Knee Replacement Reduced Transfusions 40%

Dr. Gregory M.T. Hare MD PhD Department of Anesthesia St. Michael's HospitaMedicalResearch.com Interview with:
Dr. Gregory M.T. Hare MD PhD
Department of Anesthesia
St. Michael’s Hospital

Medical Research: What is the background for this study? What are the main findings?

Dr. Hare: While many randomized trials had demonstrated that tranexamic acid (TXA therapy) was effective at reducing surgical blood loss and red blood cell transfusion in patients undergoing hip and knee replacement surgery, our hospital and many other centers in Ontario were not fully utilizing this therapy. Part of the reason was a concern about drug safety and potential side effects. While no serious adverse events had been reported using TXA, we set out to assess the impact of a protocol designed to ensure that we administered TXA (20 mg/kg iv preoperatively) to all eligible patients undergoing hip and knee replacement and determining the effect on our red blood cell transfusion rate and adverse effects including blood clot, stroke, heart attack, kidney injury and death. We excluded patients at high risk of any thrombotic complication.

After implementing our protocol, we increased utilization of the drug from 46% to 95% of eligible patients. With this increase in TXA use, we observed a 40% reduction in red blood cell transfusion. The impact was greater in patients with pre-operative anemia, but was also effective in non-anemic patients. The threshold for transfusion was not different after initiating our protocol and patients were discharged with higher red blood cell counts. Length of hospital stay remained constant and the incidence of adverse events did not increase.

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Music Therapy Reduced Anxiety During Ambulatory Breast Cancer Surgery

Jaclyn Bradley Palmer, MM, MT-BC University Hospitals Of Cleveland Cleveland, OHMedicalResearch.com Interview with:
Jaclyn Bradley Palmer, MM, MT-BC
University Hospitals Of Cleveland
Cleveland, OH

 Medical Research: What is the background for this study? What are the main findings?

Response: Patients awaiting breast cancer surgery may be understandably anxious. While pharmacologic intervention may reduce anxiety, higher doses of preoperative drugs can depress circulation and respiration, making alternative measures a particular interest. Music therapy is the clinical use of music interventions to accomplish individualized goals within a therapeutic relationship by a board-certified music therapist. While music in surgery has been researched under the label of “music therapy”, many of the studied investigations illicit recorded music provided by non-music therapy staff, making it truly “music medicine” practices instead. In this investigation, the effect of both live and recorded music therapy on anxiety, anesthesia requirements, recovery time and patient satisfaction were studied perioperatively. Breast cancer surgery patients were engaged in a brief music therapy session which consisted of one live or recorded preferred song choice, followed by discussion and processing of emotions. Compared to usual care, both live and recorded music therapy groups experienced significantly greater reductions in anxiety (p<.001) with point reductions of 27.5 (42.5%) and 26.7 (41.2%), respectively. During surgery, both music groups listened to music-therapist selected recorded, instrumental harp music, chosen for it’s evidence-based therapeutic value of smooth lines, consistent volumes and stable melodies. In measuring the amount of interoperative drug (propofol) needed to reach moderate sedation, the intraoperative music was not found to have an effect in this trial. Patient satisfaction was universally high in all three study groups. Those who received live music preoperatively were discharged an average of 12.5 minutes sooner than those who received recorded music preoperatively, although neither music group was dischanged significantly sooner than the control group. Subjective reactions to the music interventions relayed that music therapy in surgery was an enjoyable addition.

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Arrhythmia Risk Increased By Post-Operative Antinausea-Steroid Combination

Dr. Andrea Tricco Ph.D Dalla Lana School of Public Health University of TorontoMedicalResearch.com Interview with:
Dr. Andrea Tricco Ph.D
Dalla Lana School of Public Health
University of Toronto

Medical Research: What is the background for this study? What are the main findings?

Dr. Tricco: We were commissioned by Health Canada to assess the safety and effectiveness of serotonin (5-HT3) receptor antagonists in patients undergoing surgery. In order to examine this research question, we conducted a systematic review and network meta-analysis including >450 studies.

We found that more patients receiving granisetron plus dexamethasone experienced arrhythmia compared to all other interventions and placebo. No differences were observed regarding mortality and QT prolongation in meta‐analysis; no studies reported on PR prolongation or sudden cardiac death. Granisetron plus dexamethasone was often the most effective antiemetic, with the number needed to treat ranging from two to nine. We found that ondansetron plus droperidol intravenous (IV) was also a highly effective antiemetic for decreasing the risk of vomiting and post-operative nausea and vomiting (PONV). Continue reading

Erythomycin Allows Gastric Emptying To Prevent Aspiration In ER Patients

MedicalResearch.com Interview with:
Christoph Czarnetzki MD, MBA
Division of Anesthesiology
Geneva University Hospitals
Geneva, Switzerland

Medical Research: What is the background for this study? What are the main findings?

Dr. Czarnetzki: In the US, about 40 million patients undergo a general anesthetic each year, and approximately 12,000 broncho-aspirate. Broncho-aspiration of gastric juice may lead to acute respiratory distress syndrome, carrying a 40% mortality rate. The risk is increased 10-fold in patients undergoing emergency surgery. Trauma patients may have ingested food before their accident, or have swallowed blood from oral or nasal injuries. Also, gastric emptying is delayed due to head injury, stress, pain, and opioid medication. Non-trauma patients may have delayed gastric emptying due to paralytic ileus and critical illness, leading to significant residual stomach content even after long fasting periods. Erythromycin, a macrolide antibiotic, and motilin receptor agonist induces antral contractions, and increases the lower esophageal sphincter tone, which is an important barrier against gastro-esophageal reflux. Although gastric emptying properties of erythromycin are well known, its efficacy in patients undergoing emergency surgery has never been investigated before to our knowledge.

In our study we included 132 patients undergoing general anesthesia for emergency procedures and we could show that erythromycin increased the proportion of clear stomach and decreased acidity of residual gastric liquid. Dependent of the definition of empty stomach (less than 40 ml and absence of solid food or completely empty stomach) the absolute risk reduction ranged from 17% to 24%, equivalent to a number needed to treat of four to six patients to produce one completely cleared stomach. Erythromycin was particularly efficacious in non-trauma patients. Adverse effects were minor.

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Pre-Operative Low Blood Pressure Linked To Increased Mortality After Surgery and Anesthesia

Prof. Dr. Robert Sanders MD Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION) Department of Anesthesiology University of Wisconsin, Madison, WIMedicalResearch.com Interview with:
Prof. Dr. Robert Sanders MD
Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION)
Department of Anesthesiology
University of Wisconsin, Madison, WI

Medical Research: What is the background for this study? What are the main findings?

Dr. Sanders: While it is known that chronic raised blood pressure exerts important effects on long term health outcomes, it is unclear how pre-operative blood pressure levels effect risk from surgery. In this study we show that after adjustment for other diseases, high blood pressure does not increase perioperative risk. Rather low blood pressure is associated with an increase in risk of death following surgery and anesthesia.
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Anesthesia Drug and Deep Sleep Use Same Neural Circuits In Brain

Nick Franks FSB, FRCA, FMedSci, FRS Professor of Biophysics and Anaesthetics, Professor William Wisden, Chair in Molecular NeuroscienceMedicalResearch.com Interview
Professor Nick Franks 

Professor of Biophysics and Anaesthetics

Professor William Wisden,
Chair in Molecular Neuroscience
Department of Life sciences
Wolfson Laboratories, Imperial College, South Kensington London

Medical Research: What is the background for this study? What are the main findings?

Profs. Franks and Wisden: We were interested in finding out how a particular type of sedative drug, dexmedetomidine, works in the brain. This drug is increasingly used during intensive care for sedation of patients, but unlike other powerful sedatives, it induces a state whereby the patient can be temporarily woken up. This is a highly useful property because it means patients can be both sedated and responsive during procedures. The drugged sedative state induced by dexmedetomidine struck us as being highly similar to the deep sleep that we all need to have if we have been extensively sleep deprived. If people and animals are kept awake for extended periods of time, they have to sleep. Most people know this from common experience – catching up on lost sleep. But how and why we need to sleep after sleep deprivation is not known. We found that dexmedetomidine-induced sedation and this recovery sleep used the same brain circuits, in a tiny area at the base of the brain called the preoptic hypothalamus. To do this we used a new genetic technique in mice that allowed us to mark or “tag” which neurons in the mouse’s brain were active during sedation or recovery sleep after sleep deprivation. The beauty of this technique is that we could then specifically reactivate these same neurons several days later with a special molecule that only binds to the tagged neurons. This reactivation caused the mice to go into a deep sleep. We concluded that the sedative drug dexmedetomidine copies or hijacks the mechanism used by the brain to respond to sleep deprivation and trigger deep sleep.

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Study Links Intraoperative Hypothermia and Transfusion Requirements

Daniel Sessler, M.D. Michael Cudahy Professor and Chair of the Department of Outcomes Research Cleveland ClinicMedicalResearch.com Interview with:
Daniel Sessler, M.D.
Michael Cudahy Professor and Chair of the Department of Outcomes Research
Cleveland Clinic

Medical Research: What is the background for this study? What are the main findings?

Dr. Sessler: That intraoperative hypothermia is well established. However, temperature patterns during surgery are not. We thus evaluated core temperature in more tan 50,000 surgical patients, all of whom were actively warmed with forced air.

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Bacterial Biofilms Make Joint Infections Resistant to Antibiotics

MedicalResearch.com Interview with:
Sana Dastgheyb
National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, MDDepartment of Orthopedic Surgery,
Thomas Jefferson University, Philadelphia, PA and

Dr. Noreen Hickok
Department of Orthopedic Surgery
Thomas Jefferson University, Philadelphia, PA

Medical Research: What are the main findings of the study?

Response: Physicians have long been resigned to the fact that staphylococcal joint infections are among the most challenging to treat. Our study points towards a definitive mechanism whereby bacteria become insensitive to antibiotics in the human joint environment. We added MRSA to synovial fluid and observed dense, biofilm-like aggregates, as well as a relative insensitivity to antibiotics as compared to ideal medium. Our findings suggest that serum/extracellular matrix proteins within synovial fluid contribute greatly to staphylococcal antibiotic insensitivity in synovial fluid. Furthermore, pre-treatment of synovial fluid with the enzyme plasmin, which degrades extracellular matrix proteins, significantly inhibits aggregate formation, and restores normal antibiotic sensitivity to MRSA.

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Should Antidepressants Be Use For Post-Surgical Pain?

Ian Gilron, MD, MSc, FRCPC Director of Clinical Pain Research Professor of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, and Center for Neuroscience Studies Queen's University Kingston General Hospital, Kingston, Ontario, CanadaMedicalResearch.com Interview with:
Ian Gilron, MD, MSc, FRCPC
Director of Clinical Pain Research
Professor of Anesthesiology & Perioperative Medicine,
Biomedical & Molecular Sciences, and
Center for Neuroscience Studies Queen’s University
Kingston General Hospital, Kingston, Ontario, Canada

Medical Research: What are the main findings of the study?

Dr. Gilron: Pain is the most common symptom which prevents recovery from surgery. Even with the best available treatments today, many patients still suffer from moderate to severe pain after surgery.

Antidepressants – drugs used to treat depression – are also proven effective for treating chronic pain due to nerve disease and fibromyalgia. However, there has been much less research on the effects of antidepressant drugs on pain after surgery.

Our group conducted a systematic review of all published clinical trials of antidepressant for post surgical pain.

Slightly more than half of these studies suggested some benefit of these drugs but the details of this review led us to conclude that there is not yet enough evidence to recommend these medications for post surgical pain treatment.

Given the possibility that these medications could be useful treatments for pain after surgery, we believe that future studies of higher scientific quality and which involve larger numbers of patients should be carried out in the hopes of finding safer and more effective treatments for pain after surgery.
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Mercury Contamination In Chilean Sea Bass Complicated By Seafood Substitution

Prof. Peter B. Marko Department of Biology University of Hawaii at Mānoa, Honolulu, HawaiiMedicalResearch.com Interview with:
Prof. Peter B. Marko
Department of Biology
University of Hawaii at Mānoa,
Honolulu, Hawaii


Medical Research: What are the main findings of the study

Prof. Marko: The main finding of the study was that species substitutions and fishery stock substitutions together obscure a complex pattern of mercury contamination in Chilean sea bass (or Patagonian toothfish) that can put consumers unknowingly at risk of ingesting greater levels of mercury than the labeling would suggest.  Although it is well appreciated that mercury levels vary dramatically among different species of fish, and that species substitutions have the potential to expose consumers to unwanted mercury, our study shows that for Chilean sea bass, fish mislabeled as to their country or region of origin (but labeled as the correct species) have a high potential to expose consumers to unexpectedly high levels of mercury.
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More Attention To Cognitive Effects of Anesthesia May Be Needed

MedicalResearch.com Interview with:
Jan G. Jakobsson
Institution for Clinical Science
Karolinska Institutet, Danderyds Hospital
Stockholm, Sweden

Medical Research: What are the main findings of the study?

Dr. Jakobsson:  We found that anaesthesiologists and nurse anaesthetists were concerned about the risk for neurocognitive side effects, but there routines and practice for preoperative identification of patients at risk, intraoperative management to minimise risk and assessment and management of patients showing signs and/or symptoms of neurocognitive side effects after anaesthesia was rarely at place.
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How Safe Is Ketamine For Sedation in the ER?

MedicalResearch.com Interview with:
Lindsay Cohen MD
Department of Emergency Medicine
University of British Columbia

Medical Research: What are the main findings of the study?

Dr. Cohen: In our systematic review of the literature, we sought to synthesize the available evidence on the effect of ketamine on clinical outcomes as compared to other sedative agents in intubated patients. Our outcomes of interest included intracranial and cerebral perfusion pressures, neurologic outcomes, ICU length of stay, and mortality. We included only randomized controlled trials and prospective controlled studies, and identified a total of ten studies that met our inclusion criteria. Due to the lack of homogeneity in the studies, data was analyzed in a qualitative manner. None of the studies reported significant differences between ketamine and other sedative agents for any of our outcomes of interest.

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Hot Flashes: Study of Local Anesthetic Nerve Block

MedicalResearch.com Interview with:
David Walega, MD Chief of the Division of Pain Medicine Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine.David Walega, MD
Chief of the Division of Pain Medicine
Northwestern Memorial Hospital and
Northwestern University Feinberg School of Medicine.

MedicalResearch.com: What are the main findings of the study?

Dr. Walega: Patients who underwent a single stellate ganglion injection with a local anesthetic had a 50% decrease in moderate -to- very severe hot flashes and this effect appeared to last thru the 6 month duration of the study; the placebo or “sham control” group had injections of saline and they did not demonstrate long-term improvements in hot flash symptoms

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Experimental Fish Oil DHA Extract Prevented Injury Induced Neuropathic Pain

Ru-Rong Ji, PhD Professor, Chief of Pain Research Department of Anesthesiology and Neurobiology Duke University Medical Center Durham, NC 27710MedicalResearch.com Interview with:
Ru-Rong Ji, PhD
Professor, Chief of Pain Research
Department of Anesthesiology and Neurobiology
Duke University Medical Center
Durham, NC 27710

Neuroprotectin/Protectin D1 protects neuropathic pain in mice after nerve trauma

MedicalResearch.com: What are the main findings of the study?

Answer: We found the pro-resolution lipid mediator protectin D1 (PD1), derived from the fish oil DHA, can effectively prevent nerve injury-induced neuropathic pain. This treatment can also prevent nerve injury-induced neuroinflammation in the spinal cord (such as glial activation and expression of cytokines and chemokines, e.g., IL-1b, CCL2). These cytokines and chemokines are known to elicit pain.
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Predictors of Survival from Perioperative Cardiopulmonary Arrests: A Retrospective Analysis of 2,524 Events from the Get With The Guidelines-Resuscitation Registry

Satya Krishna Ramachandran MD FRCA Director, Quality Assurance Department of Anesthesiology University of MichiganMedicalResearch.com eInterview with
Satya Krishna Ramachandran MD FRCA
Director, Quality Assurance
Department of Anesthesiology
University of Michigan

MedicalResearch.com: What are the main findings of the study?

Answer:

  • Background: A cardiac arrest is a life-threatening condition where the heart has stopped beating. This remains one of the biggest fears of patients undergoing anesthesia and surgery. This is a rare complication around anesthesia, with only seven arrests per 10,000 patients undergoing surgeries unrelated to the heart. Although this is a rare complication nowadays, previous research has provided limited understanding of risk factors and outcomes.  Cardiac arrests that happen during or soon after anesthesia and surgery may present themselves in different ways and have differences in survival or further complications. By studying these arrests in a large national database of cardiac arrests called the “Get With The Guidelines – Resuscitation” registry, we were able to identify over 2,500 instances of cardiac arrest occurring during or soon after anesthesia. This database is supported by the American Heart Association and has specific information on patient conditions, life-saving treatments and recovery from the arrests.
  • Findings: Cardiac arrests that happen during or immediately after anesthesia are rare events. But we have found that recovery from these events is much better than previous reports of arrests from other hospital locations. We have also found that life-saving treatment is given extremely rapidly in the operating room and the post-anesthesia care unit. These are two locations that anesthesiologists and peri-anesthesia nurses closely monitor patients for complications. We believe that the better recovery seen in these places is because of the immediate availability of these trained caregivers.

MedicalResearch.com: Were any of the findings unexpected?

Answer:

  • Specifically, recovery from asystole (a type of cardiac arrest where the electrical activity of the heart completely stops) in the operating room is at least three times better than previous reports from other hospital locations. We also found that life-saving treatment was given much faster in these locations. We think this improved survival is mainly because of the presence of trained anesthesiologists and nurse providers who directly monitor and respond quickly to any cardiac arrest situation.
  • Patients developing arrests during or immediately after anesthesia (in the post-anesthesia care unit) were more likely to survive with good brain function than other hospital locations.  We believe that the presence of trained anesthesiologists in both locations improve chances of good recovery due to careful monitoring and immediate responses to these uncommon events.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer:

  • We found that one out of every three patients who develop a perioperative cardiac arrest survives to hospital discharge. We also found that two out of every three patients who survived had no signs of brain damage after the arrest.
  • We also identified several risk-conditions during hospital admission that reduce the chance of successful recovery from a perioperative cardiac arrest. These include major trauma, heart failure, low blood pressure, electrolyte disturbances, kidney failure, late stage cancer, major infection of the blood, and breathing difficulties. Patients with older age and longer arrest times had reduced chance of successful recovery.
  • The following conditions improved chances of successful recovery from arrests: presence of a heart rhythm abnormality, ventricular fibrillation arrest, and difficulty in keeping open the breathing passage. We showed that patients recover better from cardiac arrests that happen during or immediately after anesthesia, compared to other hospital locations. However, we also found that arrests that happen during weekends and at night have worse outcomes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer:

  • Research into the role of monitoring in preventing postoperative complications including cardiac arrests is essential. There are concerns about inadequate monitoring of postoperative patients in US hospitals. On the other hand, there are concerns that increasing the level of monitoring also increases nursing fatigue to alarms, similar to a “cry-wolf” situation. As most monitoring strategies are potentially associated with immense healthcare benefits, costs and risks, good quality research into the value and effectiveness of monitoring postoperative patients is essential.
  • We also found that patients who had signs of brain damage at the time of hospital admission had the lowest chance of surviving the arrest and recovering their brain function. In these patients, the chance of good recovery was low, even if they did not have any other major risk-conditions listed above. On the other hand, patients who had good brain function at the time of hospital admission had a good chance of recovery even if they had many risk-conditions listed above.  Future research into do-not-resuscitate orders needs to incorporate this finding.

Citation:

Predictors of Survival from Perioperative Cardiopulmonary Arrests: A Retrospective Analysis of 2,524 Events from the Get With The Guidelines-Resuscitation Registry

Ramachandran, Satya Krishna; Mhyre, Jill; Kheterpal, Sachin; Christensen, Robert E.; Tallman, Kristen; Morris, Michelle; Chan, Paul S.; for the American Heart Association’s Get With The Guidelines-Resuscitation Investigators

Anesthesiology., POST AUTHOR CORRECTIONS, 30 April 2013
doi: 10.1097/ALN.0b013e318289bafe