American Society of Anesthesiologists, Oct. 15-19, 2011
The annual meeting of the American Society of Anesthesiologists was held from Oct. 15 to 19 in Chicago, 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, Jaime L. Baratta, M.D., of the Thomas Jefferson University Hospital in Philadelphia, and colleagues found that multimodal analgesia use was not yet standard practice pre- and post-surgery, despite the benefits of reduced opioid use, enhanced patient satisfaction, and recommendation by the American Society of Anesthesiologists.
"We evaluated how providers, specifically anesthesiologists, use pain medication pre- and post-surgery with regards to multimodal analgesia in the treatment of pain perioperatively," Baratta said. "We found that the majority of providers utilized multimodal analgesia preoperatively less than 25 percent of the time, and only about 25 percent of providers used a multimodal approach postoperatively on a consistent basis."
The investigators also evaluated the types of pain medications being used by providers.
"We found that, when providers used a multimodal approach, they used nonsteroidal anti-inflammatory drugs 92 percent of the time and local anesthetics 72 percent of the time. What surprised us was that only 51 percent of the time providers were using acetaminophen, which is considered one of the safest pain medications available," Baratta said.
The investigators also found that most providers did not have a multimodal analgesia protocol in place.
"Although the majority of providers believe that the decision to utilize a multimodal approach to pain management perioperatively lies with the anesthesiologist, all clinicians and nursing staff should be aware of the benefits of multimodal analgesia and the need to more consistently employ it as well as continue to educate their patients with regards to pain management during surgery," Baratta said.
In another study, Terri G. Monk, M.D., of the Duke University Health System in Durham, N.C., and colleagues found that a patient's baseline medical and cognitive status, not the anesthetic type, was associated with the risk of developing postoperative delirium. The investigators enrolled approximately 200 patients, aged 65 years or older, and randomized them to either inhaled isoflurane or total intravenous anesthesia (TIVA) for anesthetic maintenance during major orthopedic surgery.
"Surprisingly, we did not find any difference in postoperative delirium between those who received inhaled isoflurane versus those who received TIVA. The incidence of delirium was approximately 13 percent in both groups," Monk said. "However, elderly patients with more comorbidities and poorer cognitive function prior to surgery were more likely to develop postoperative delirium."
Jessica L. Booth, M.D., of Wake Forest University in Winston Salem, N.C., and colleagues evaluated whether using a higher-dose regimen of pain medication for certain patients, and not treating all patients the same, would improve pain after cesarean delivery.
"To identify women at risk for severe pain after surgery, we administered a questionnaire that evaluated her level of anxiety prior to surgery, how much pain she expected after surgery, and how much pain medication she expected to take after surgery," Booth said. "Sixty patients were randomly selected to receive either a higher dose of spinal morphine and oral acetaminophen over a 24 hour period or our standard spinal morphine dose. We compared the pain scores between the two groups at 24 hours, evaluating the patient's pain on average, at rest, upon movement, and the worst pain they felt within the 24 hour period."
The investigators found that patients who received larger doses of spinal morphine plus oral acetaminophen had significantly lower pain scores at 24 hours than those who received the standard dosing.
"We believe the findings will help other anesthesiologists tailor a postoperative pain treatment plan for these at-risk women, using simple methods to improve the amount of pain in the days following this major abdominal surgery," Booth added.
ASA: Blood Type Affects Bleeding, Death After Heart Surgery
MONDAY, Oct. 17 (HealthDay News) -- The risk of death or complications after heart surgery is affected by blood type, with patients with AB blood type having the lowest risk of death and bleeding, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 15 to 19 in Chicago.
ASA: Obesity Ups Peri-Op Peds Respiratory Complications
MONDAY, Oct. 17 (HealthDay News) -- Obese children, with or without asthma, are more likely to have at least one perioperative respiratory complication; and, the effective dose of propofol for loss of consciousness in 95 percent (ED95) of children is lower for obese than nonobese children, according to two studies presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 15 to 19 in Chicago.