American Society of Anesthesiologists, Oct. 18-22, 2008

American Society of Anesthesiologists 2008 Annual Meeting

The American Society of Anesthesiologists 2008 Annual Meeting took place Oct. 18 to 22 in Orlando, Fla., and attracted about 12,000 attendees, including sizable contingents from Europe and Asia. The meeting featured 600 sessions, 1,770 abstracts and nearly 300 exhibits addressing recent developments in basic and clinical science.

"We presented the best experts in clinical anesthesiology," said Patricia Kapur, M.D., of the University of California Los Angeles, who chaired the annual meeting. "They addressed advances in technology, pharmacology, the understanding of disease processes and anesthesia for new types of surgery, including increasingly popular minimally invasive procedures performed outside the operating room."

According to Kapur, potentially practice-changing research included a study presented by researchers from Rush Medical College in Chicago that showed the administration of pregabalin before and after total knee replacement surgery significantly reduced the risk of chronic pain while improving patient mobility.

In that study, Asokumar Buvanendran, M.D., and colleagues randomly assigned 240 patients to receive either 300 milligrams of pregabalin two hours before surgery and 150 milligrams of pregabalin twice a day for 14 days after surgery or placebo. They found that no one in the pregabalin group experienced chronic neuropathic pain, but 5.3 percent of patients in the placebo group did. They also found that the pregabalin group had a greater knee range of motion and improved ability to perform tasks such as climbing stairs.

"This is the first large prospective clinical trial examining the incidence of chronic pain after total knee replacement and defining strategy to prevent the development of this debilitating chronic pain syndrome," Buvanendran said in a statement. "With the promising treatment of pregabalin, patients may no longer delay needed orthopedic surgery for fear of pain after surgery and delayed rehabilitation."


Another potentially practice-changing study was presented by researchers from the Mater Misericordiae University Hospital in Dublin, Ireland. It compared the immune effects of nerve block and general anesthesia in patients undergoing primary breast cancer surgery. "This study received a lot of attention because it reported less immune suppression with nerve block therapy, which raised the possibility it may help protect against recurrent cancer," Kapur said. "This is something that's going to deserve a lot more study."

In the study, Catherine A. Deegan and colleagues randomly assigned 32 patients to receive either propofol/paravertebral anesthesia or sevoflurane/opioid anesthesia. They found that propofol/paravertebral anesthesia was associated with significantly reduced levels of the tumorigenic cytokines interleukin-1-beta and interleukin-8 and significantly increased levels of the anti-tumorigenic cytokine interleukin-10. It "appears to better preserve host immune defenses, thereby potentially resisting tumor progression, metastasis, and recurrence," Deegan and colleagues concluded.


Other highlights included a symposium related to obstructive sleep apnea and the obesity epidemic. "The anesthesia community is greatly interested in the effects of these lifestyle-mediated breathing disorders," Kapur said.

Five abstracts presented at the symposium received "best of session" honors. Among them was a study presented by Frances Chung that showed a high rate of postoperative complications in patients with obstructive sleep apnea.

In that study, Chung and colleagues compared 275 charts of patients with obstructive sleep apnea who underwent surgeries other than uvulopalatopharyngoplasty with charts of matched controls. They found that the incidence of postoperative complications was significantly higher in the obstructive sleep apnea group (44 percent versus 28 percent) and that the major cause was an increased incidence of respiratory complications (33 percent versus 22 percent) that required prolonged oxygen therapy and additional monitoring.


The other "best of session" abstracts were: "High Resolution Pulse Oximetry (HRPO) Detects Airway Obstruction -- Screening Implications for OSAS," "Postoperative Events in Patients at Risk for Obstructive Sleep Apnea Undergoing Elective Surgery," "Derivation of a Simple Preoperative Sleep Apnea Prediction Score (P-SAP Score)" and "Boussignac CPAP Immediately Following Extubation Improves Lung Mechanics in Morbidly Obese Patients."


A new feature at the meeting was human patient simulator sessions, which took place over two and a half days. "It's like simulator training for pilots and was very popular with attendees," Kapur said. "We can take the mannequin to the brink of cardiac or pulmonary disease, shock or heart attack, and the practitioner can have the experience of solving the problem with expert guidance."

ASA: Pediatric Anesthesia Studies Show Mixed Results

TUESDAY, Oct. 21 (HealthDay News) -- Young children who undergo general anesthesia may have an increased risk of developmental and behavioral disorders compared to other children. But older children who undergo general anesthesia and experience awareness may not have an increased risk of psychological distress compared with children who do not experience awareness, according to research presented at the annual meeting of the American Society of Anesthesiologists, held Oct. 18 to 22 in Orlando, Fla.

ASA: Anesthesia Awareness Leads to Mental Symptoms

MONDAY, Oct. 20 (HealthDay News) -- Surgical patients who experience anesthesia awareness may be at increased risk of long-term psychological symptoms, but use of a Bispectral index guided protocol -- which is developed from a processed electroencephalogram -- does not appear to decrease this risk, according to research presented at the annual meeting of the American Society of Anesthesiologists held Oct. 18 to 22 in Orlando, Fla.

ASA: Simple Assessment May Predict Postoperative Delirium

MONDAY, Oct. 20 (HealthDay News) -- In older adults undergoing non-cardiac surgery with general anesthesia, preoperative depression and executive function may predict the development of postoperative delirium, according to research presented at the American Society of Anesthesiologists annual meeting held Oct. 18 to 22 in Orlando, Fla.

ASA: Early Postsurgical Food Intake Beneficial to Children

MONDAY, Oct. 20 (HealthDay News) -- In children who undergo surgery, early postoperative oral intake of food and drink is associated with improved recovery, according to research presented at the American Society of Anesthesiologists annual meeting held Oct. 18 to 22 in Orlando, Fla.

ASA: Intra-Operative Hypotension Linked to Stroke

MONDAY, Oct. 20 (HealthDay News) -- In patients who undergo procedures other than cardiac, neuro or carotid surgery, those who have an intra-operative systolic blood pressure below 80 mm Hg or a history of stroke may have an increased risk of postoperative stroke, according to research presented at the American Society of Anesthesiologists annual meeting held Oct. 18 to 22 in Orlando, Fla.

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