American Society of Anesthesiologists, Oct. 13-17, 2012
The annual meeting of the American Society of Anesthesiologists was held from Oct. 13 to 17 in Washington, D.C., and attracted approximately 15,000 participants from around the world, including anesthesiologists and other health care professionals. The conference featured presentations focusing on the latest advances in the relief of pain as well as the total care of surgical patients prior to, during, and after surgery.
In one study, Elizabeth Vogel, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues found that exposure to cigarette smoking early in life increases the risk of respiratory disease later in life.
"The key result of the study was that cigarette smoke exposure has a negative impact on the development of immature airway smooth muscle. These negative effects include alterations in cell proliferation and cell death and increased constriction or reactivity. The increased smooth muscle cell reactivity implies that exposure to cigarette smoke may lead to the development of asthma or other airway diseases later in life," Vogel said. "Clinical practitioners should emphasize that secondhand cigarette smoke exposure can have detrimental effects early in life as well as implications for disease development later in life. Clinical practitioners should recommend smoking cessation among those exposed to premature babies and infants, as even cigarette particles on clothing can have a negative impact on the health of babies and infants."
In another study, Jesse Ehrenfeld, M.D., M.P.H., of the Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues evaluated the efficacy of adding intraoperative glucose monitoring during surgery for patients with diabetes.
"We found that point-of-care monitoring decreased dangerous out-of-range sugar levels, postoperative surgical site infections, and length of hospital stays," Ehrenfeld said.
Patients with diabetes tend to have a higher likelihood of undergoing surgery and experiencing adverse reactions during and after surgery. Therefore, Ehrenfeld suggests that intraoperative glucose monitoring may help improve the care of patients with diabetes during and after surgery.
"The results of this study are likely to change the standard of care for the thousands of diabetes patients who undergo surgical procedures every day," Ehrenfeld added. "While this study was conducted at two large academic medical centers, we have enough confidence in these results, and there was enough improvement in patient care and outcomes, that we believe an adoption of a similar strategy across the nation and across the world can positively impact millions of patients every year."
Melissa Bauer, D.O., of the University of Michigan in Ann Arbor, and colleagues evaluated whether there was an increased rate of maternal sepsis, severe sepsis, and sepsis-related death during hospitalization for delivery.
"We found that sepsis did not increase over the study period, between 1998 and 2008. However, severe sepsis and sepsis-related death doubled over the study period," Bauer said. "We also found that certain factors, specifically comorbidities or medical issues, were associated with an increased risk of severe sepsis, including congestive heart failure, chronic liver disease, chronic kidney disease, lupus, and HIV."
Over the 11-year period, the investigators found that the overall incidence was one in 3,000 deliveries for sepsis; one in 10,000 deliveries for severe sepsis; and one in 100,000 deliveries for sepsis-related death. If the increase over the 11-year study period was taken into account, the rate of severe sepsis increased from one in 15,000 to one in 7,000, while sepsis-related death rose from one in 140,000 to one in 60,000.
"Clinical practitioners should watch for severe sepsis especially in patients with factors that put them at a higher risk of severe sepsis," Bauer added. "Practitioners should watch patients' vital signs more closely, including variations in temperature, heart rate, respiratory rate, and also blood pressure, watching for any signs of severe sepsis."
Melody Ritter, M.D., of the Ochsner Health System in New Orleans, and colleagues evaluated the use of an anesthesiologist-directed patient triage process in advance of surgery to learn whether costs associated with testing prior to surgery could be reduced.
The investigators assessed 219 total knee or hip replacement patients who went through the triage program over 14 months, beginning in 2010, and compared their results to 1,132 patients not triaged in the program, dating back to 2008, until the same end point in 2011. For each patient in the study, the investigators looked back one month prior to surgery and evaluated the tests ordered and associated costs to the patients of seven common tests: complete blood count; basic metabolic panel; comprehensive metabolic panel; prothrombin time/international normalized ratio; partial thromboplastin time; electrocardiogram; and chest X-ray. Patients within each group were divided into ASA2 patients (patients with mild comorbid disease) and ASA3 patients (patients with more moderate-to-severe disease).
"Looking just at the seven common preoperative tests, we found that the triage program saved $18,187 for every 100 ASA2 patients and $20,664 for every 100 ASA3 patients, compared to the non-triaged group," Ritter said. "We plan further study to see if these favorable trends in cost containment can be extended to other surgery types as well as other tests, while preserving favorable outcome measures."
ASA: Gene Variants Impact Pain After Traffic Accidents
TUESDAY, Oct. 16 (HealthDay News) -- Genetic polymorphisms correlate with pain following motor vehicle collisions (MVCs), according to two studies presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 13 to 17 in Washington, D.C.
ASA: Ocular Injuries Up With Robotic-Assisted Prostatectomy
TUESDAY, Oct. 16 (HealthDay News) -- For patients undergoing radical prostatectomy, perioperative visual injury (POVI) increased from 2000 to 2009, with significantly increased rates for robotic-assisted versus an open approach procedure, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 13 to 17 in Washington, D.C.
ASA: Illicit Drug Abuse Down, Prescription Drug Abuse Up
TUESDAY, Oct. 16 (HealthDay News) -- Emergency room data from 2007 to 2009 indicate that illicit drug abuse is decreasing, while prescription drug abuse is increasing, according to research presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 13 to 17 in Washington, D.C.
ASA: Spanish Speakers Less Likely to Use Epidural in Labor
MONDAY, Oct. 15 (HealthDay News) -- Among Hispanic women, Spanish speakers are less likely than English speakers to request and receive epidural analgesia for labor pain, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 13 to 17 in Washington, D.C.
ASA: Botox Injections Treat Myofascial Pain Syndrome
MONDAY, Oct. 15 (HealthDay News) -- Botulinum toxin type A (BoNT-A) injections are associated with a significant improvement in myofascial pain syndrome, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 13 to 17 in Washington, D.C.