Entries in Anesthesia (9)


General Anesthesia Linked to Increased Risk of Dementia in Elderly

Pixland/Thinkstock(NEW YORK) -- A new study shows that senior citizens who go under general anesthesia during medical procedures may experience an increased rate of dementia.

General anesthesia is used to make a patient unconscious and unable to feel pain or discomfort during medical procedures. Often, anesthesia is delivered through intravenous drugs or inhaled gases.

Elderly patients frequently develop a conditioned known as post-operative cognitive dysfunction (POCD) after major surgeries. Experts believe that POCD may be a precursor to lasting dementia.

In a study, researchers in France followed over 7,000 patients who did not suffer from dementia and analyzed data taken from those patients over a span of ten years.

Over 22 percent of those who had a medical history including general anesthesia developed dementia. That rate is 35 percent higher than in patients without a history of general anesthesia, 18.7 percent of whom developed dementia.

It is possible that other health conditions contributed to a higher rate of dementia, as senior citizens who undergo procedures requiring general anesthesia may be less healthy than those who did not require those procedures.

Copyright 2013 ABC News Radio


Anesthesia Drug Shortages Linked to Patient Deaths?

Pixland/Thinkstock(PARK RIDGE, Ill.) -- Seven U.S. anesthesiologists have reported that drug shortages resulted in deaths of their patients, according to a new survey from the American Society of Anesthesiologists.

Although the online survey completed by 3,063 of the organization's 28,000 practicing anesthesiologists cannot be considered scientific, it opens a window to the growing shortage of anesthetics and painkillers used before, during and after surgery, and the potentially fatal consequences when those are unavailable.

Seven doctors responded to the question, "How has a drug shortage impacted your patients?" by checking the option, "Has resulted in death of a patient," according to survey results exclusively obtained by ABC News.

"We have a warning here.  We are bound to trace this warning down and find out the extent of it," American Society of Anesthesiologists President Dr. Jerry A. Cohen said in an interview.  "Are these the canary in the mine?  I don't know.  I worry that they are."

Because the survey was anonymous, Cohen said he couldn't determine where the reported deaths occurred, how the patients died, or be sure all seven reports were reliable.  "Six we're absolutely sure were reported," Cohen said.

ASA had questions about "data points" in one responder's answers that cast doubts on one of the death reports, he explained.  "It's unusual to have anybody report a death due to a drug shortage," Cohen said.

Responses to a similar ASA survey in 2011 included two reports of patient deaths, but those weren't made public, Katherine Looze, an ASA spokeswoman, revealed in response to a question from the ABC News Medical Unit.

Going forward with surgeries when they're short of needed drugs can put anesthesiologists in a legal bind, Cohen said.

"We are at risk," he added.  "If I proceed, if I don't have the drug I need -- and know I don't have the drug I need -- and I have a bad outcome, I'm responsible."

Among survey respondents -- 3,033 Americans and 30 from abroad -- 97.6 percent reported being currently short of at least one drug and 96 percent said shortages forced them to use substitutes for particular patients and procedures.  When they used alternatives to their top-choice drugs, some of their patients experienced nausea and vomiting, spent longer in surgery or took longer to recover from sedation or anesthesia, the survey revealed.

The drugs survey respondents most often couldn't get were the workhorses of local and general anesthesia, such as propofol, a milky white intravenous sedative and anesthetic that works in just 40 seconds.  It's best known as the drug that led to the death of pop superstar Michael Jackson.  Another is succinylcholine, a quick-acting paralytic agent frequently given to help insert a breathing tube into a patient's airway.  There's also fentanyl, a powerful synthetic opioid used to knock patients out and to treat operative and post-op pain.

Anesthesiologists also reported problems getting thiopental, also known as sodium penthothal, an ultra-short acting barbiturate that's used less frequently today in hospitals, but remains in demand for the lethal cocktail many states use in executions.  The shortage has left some prisoners longer on death row.

Copyright 2012 ABC News Radio


Study Finds Possible Link Between Anesthesia and ADHD

Jupiterimages/Thinkstock(ROCHESTER, Minn.) -- Young children who undergo multiple procedures requiring anesthesia could be at higher risk for developing attention-deficit hyperactivity disorder (ADHD) later on, according to a new study published in the current issue of the journal Mayo Clinic Proceedings.

Researchers from the Mayo Clinic in Rochester, Minn., and Children's Hospital in Boston analyzed the medical records of more than 5,300 children previously enrolled in other studies.  They found that children younger than two years old who underwent more than one procedure that called for anesthesia were more likely to develop ADHD.

But Dr. David Warner, a co-author and professor of anesthesiology at the Mayo Clinic, stressed that the study only found an association between the procedures performed on the children in the study and ADHD.

"We need to do more work to confirm whether this is really a problem in children or not," he said.  "We can't exclude there is a problem, but we also haven't determined there is a problem."

The potential effects on the developing brain also remain unknown, he said.  Previous studies on young rodents found a link between anesthesia exposure and problems with learning and memory.  But while researchers are able to separate out the effects of anesthesia on animals by exposing them only to anesthesia, they cannot do the same in children, making it difficult to determine whether ADHD is related to the anesthetic drugs, to the specific procedures, or to other medical conditions.

"It's not normal for a one-year-old to have two surgeries before the age of two, so maybe there are some underlying conditions that leads them to have surgery," said Dr. Rod Eckenhoff, vice chair of research in the Department of Anesthesia and Critical Care at the University of Pennsylvania in Philadelphia.  Eckenhoff was not involved with the Mayo Clinic research.

Prior research on children has also linked surgical procedures to learning disabilities, autism spectrum disorders in children and the risk of deteriorating brain function in the elderly.

Copyright 2012 ABC News Radio


Study: Anesthesia Exposure before Age 2 Could Disrupt Development

Photodisc/Thinkstock(ROCHESTER, Minn.) -- Infants who are put under for surgery more than once before the age of 2 may be at increased risk of learning disabilities later in life, according to research from the Mayo Clinic in Rochester, Minn.

The use of general anesthesia in infants undergoing surgery is currently considered very safe, but mounting evidence -- first in animals and more recently in humans -- suggests that repeated exposure to anesthetics in the first few years of life could cause brain damage if carried out during certain key developmental periods.

The Mayo Clinic study, published Monday in the journal Pediatrics, tracked the medical and school records of a thousand children born between 1976 and 1982 in Rochester, Minn., 350 of which were given general anesthesia at least once in the first two years of life.

Among infants who had had more than one surgery during those years, almost 37 percent experienced a learning disability later in life, compared with only 21 percent in the children who did not undergo surgery.  Even for those children who had only one surgery during infanthood, the rate of learning disability was slightly higher, at 24 percent.

Learning disabilities seemed to center on speech and language difficulties, says Dr. Randall Flick, Mayo Clinic pediatric anesthesiologist and lead author of the study.

Researchers controlled for characteristics that might also affect development later in life such as birth weight, gestational age and maternal education level, by matching each of the 350 study subjects to two control children in the same population who shared similar characteristics.

"Kids who were exposed were three times as likely to later need a special education program to address speech and language difficulties than kids who weren't exposed to anesthesia," he says.

The research is preliminary, and shouldn't change surgical protocol at this time, the authors say.  But even the possibility that anesthesia is damaging to infants' brains is disquieting for physicians and parents, especially because infant surgery is so seldom elective -- surgery in infants is almost always medically necessary.

Copyright 2011 ABC News Radio


Five Year Old Dies from Lethal Dose of Local Anesthesia

Pixland/Thinkstock(ATLANTA) -- Five-year-old Kensley Kirby was taken to an Atlanta urgent care center to get treated for a broken arm, but died from a lethal dose of local anesthesia given to her at the clinic, an Atlanta coroner confirmed.

In June, Kensley's parents brought her to Family Medical Clinic in Atlanta, Ga. after she fell. When doctors administered the local anesthesia lidocaine while setting Kensley's arm, her parents "went from picking the color of the cast with their daughter to basically being with her as she died," explained Pete Law, the Kirby family's attorney.

A hospital spokesperson refused to comment on the case, and the family's attorney did not return several requests for comment.

"Dying from a local anesthesia is extremely rare," said Dr. Elliot Krane, professor of pediatrics and anesthesia at Stanford University. "But there is a maximum allowable dose of lidocaine, and as with any drug, it has toxicity associations with it."

Lidocaine is a common local anesthesia used topically to relieve itching and burning from skin irritations; it is injected during dental work and other minor surgeries. The drug blocks nerves and in turn, numbs pain, during surgical procedures.

Allergic reactions to the drug are rare, but excessive doses of the anesthesia can cause unconsciousness, seizures, low blood pressure and even cardiac arrest. Drug dosage is determined by a patient's weight and whether it will be injected into tissue mass or directly into the bloodstream.
It is unclear which way Kensley received the anesthesia after breaking her arm.

"It's possible that the doctor might have been accustomed to taking care of adults all the time, which would have been a larger dose than necessary," said Krane, who was quick to note that he did not know the details of the case. "And with broken bones, there's an opening of vascular channels, so it's possible that it absorbed very rapidly into the bloodstream."

If parents are concerned, Dr. Mark Singleton, chair of the committee of pediatric anesthesia at the American Society of Anesthesiologists, encouraged them to speak with their child's anesthesiologist prior to surgery.

Copyright 2011 ABC News Radio


Hypnosis Minimizing Need for Anesthesia and Painkillers

Hemera Technologies/Photos[dot]com(NEW YORK) -- The effects of hypnosis on reducing preoperative anxiety are well-documented. But increasingly, studies also support a role for hypnosis in reducing pain during and after surgery.

The technique, which starts with relaxation, can change a willing participant's mindset though softly spoken suggestions such as "You're doing this for your health," and "You're going to be fine."
The latest research, presented at the European Anesthesiology Congress in June, found that patients who were hypnotized before breast cancer surgery done under local anesthetic fared better than patients who were put under general anesthetic without hypnosis. Those who underwent hypnosis with a local anesthetic experienced a faster recovery, a shorter hospital stay, and had need for fewer painkillers.

Similarly, a 2007 study published in the Journal of the National Cancer Institute found that patients who were hypnotized briefly before breast cancer surgery needed less anesthetic and had less pain, nausea, and fatigue after the procedure. The benefits even extended to the health care system, with a cost savings of $772.71 per patient, mainly due to reduced surgical time.

Dr. Michael Schmitz, director of pediatric pain medicine at Arkansas Children's Hospital in Little Rock, Ark., described the state of anesthesia as consisting of four basic conditions: amnesia or loss of memory, analgesia or pain relief, sedation, and relaxation.

"Hypnosis is used to assist with the other parts of anesthesia not covered by the local anesthetic," said Schmitz, explaining that it can help patients enter a calm, relaxed state, during which discomfort is tolerable and quickly forgotten.

Not everyone is hypnotizable, however. Dr. Elliot Krane, director of pediatric pain management at Lucille Packard Children’s Hospital adds that children are harder to hypnotize, and some faiths preclude followers from entering the trance-like state required for hypnotic suggestion. Even if the patient is a good candidate, the hospital may not be.

Hypnosis takes time, skill with hypnosis, and patience, as well as a quiet location," said Krane, "and these three elements are not commonly found in a busy operating room in most hospitals."
But Guy Montgemery, director of Mount Sinai School of Medicine's Integrative Behavioral Medicine Program and the author of the 2007 study hopes more research by him and others will encourage more hospitals to offer the service.

Even anesthesiologists like Krane and Schmidt said they'd give it a try.

Copyright 2011 ABC News Radio


Hypnosis to Replace Anesthesia During Surgery?

Jupiterimages/Thinkstock(BRUSSELS, Belgium) -- Partial mastectomy, biopsy and removal of lymph nodes, removal of the thyroid -- would you be willing to undergo these surgical procedures without general anesthesia? One Belgium hospital reportedly performs a third of their thyroid surgeries and a quarter of all breast cancer surgeries with only local anesthetic and hypnosis.

A study conducted by the Saint-Luc University Hospital has found that women who underwent the removal of their thyroids using only local anesthesia and hypnosis had lower use of opioids pain killers, shorter hospital stay, and greater satisfaction compared to women who opted for general anesthesia.

The findings were presented at a European Anaesthesiology Congress meeting, and researchers say the approach may be broadened to other surgeries including hernias, gynecological surgeries, plastic surgery procedures, and even some heart surgeries, thereby also providing benefits for healthcare systems by reducing costs involved in longer hospital stays.

Copyright 2011 ABC News Radio


FDA to Hold Meeting on Anesthesia's Link to Learning Disabilities in Kids

Pixland/Thinkstock(WASHINGTON) -- Advisers to the U.S. Food and Drug Administration will hold a panel meeting Thursday to explore whether or not anesthesia use in children can cause learning disabilities.

Studies in the past have shown a possible link between anesthesia exposure in young rats and monkeys and the death of their brain cells.  However, that link has not yet been made clear in humans.  But a 2009 study reported in Anesthesiology, found that children who were exposed to anesthesia twice before the age of four were 59 percent more likely to be diagnosed with learning disabilities than those who weren't.

"We need to definitively answer the questions of whether anesthetic use in children poses a risk to their development and, if so, under what circumstances," Bob Rappaport, MD, the head of the FDA's anesthesia and analgesia products and his colleagues wrote in an article published Wednesday in the New England Journal of Medicine.

Copyright 2011 ABC News Radio


'Am I Going to Wake Up?' Scientists Continue to Analyze the Effects of Anesthesia

Photo Courtesy - Getty Images(CAMBRIDGE, Mass.) -- Modern medical advancements could put patients more at ease when going under anesthesia, but scientists are only now researching the effects of the drug on the brain.

A patient’s fear of waking up while under the knife could be calmed by modern developments such as brain monitors that can gauge levels of consciousness. Such developments, however, underscore the complex science of keeping patients free from consciousness and pain without killing them.

The use of general anesthesia is a routine part of surgical operations at hospitals and medical facilities around the world, but the precise biological mechanisms of the drug's effects on the brain are only now being analyzed.

In a review article published this week in the New England Journal of Medicine, scientists have for the first time used a range of disciplines, including neuroscience and sleep medicine, to lay the groundwork for better understanding of how anesthesia actually works.

Armed with the new information, doctors can speak more frankly and knowledgeably to patients.

"The biggest concern among patients is, "Am I going to wake up?" said lead study author Dr. Emery Brown, an anesthesiologist at Massachusetts General Hospital and professor at Massachusetts Institute of Technology. "That happens extremely rarely but it's a fear everyone has. I think the way to assuage the fear is to know what we are doing. But we can't continue to comfort people if it's a black box and I assure you it's not going to go wrong."

Among the most common misconceptions given by doctors to patients regarding anesthesia is the idea that they are being put to sleep. General anesthesia, however, is a reversible coma. Brown said doctors often tell their patients they are putting them to sleep in hopes of scaring them less.

Copyright 2010 ABC News Radio

ABC News Radio