News In Brief
Patients having operations in Leeds will be better prepared thanks to a new pre-admission unit.
The facility at St James’s Hospital means patients can be assessed for their operation in an improved environment, including individual examination rooms providing greater privacy and dignity.
Consultant anaesthetist Dr Hamish McLure said, “Patients will meet one of our specialist pre-assessment unit nurses, who will assess their fitness to undergo anaesthesia and surgery.
“They will be able to ask questions and get information leaflets about the various procedures that they might need to undergo. There will also be a resident consultant anaesthetist, so if there are anaesthetic issues that need to be discussed then patients don’t have to come back at another time.”
A recent study showed that the incident reporting database at the National Patient Safety Agency was interrogated on the nature, frequency and severity of incidents related to anaesthesia. Of 12 606 reports over a 2-year period, 2842 (22.5%) resulted in little harm or a moderate degree of harm, and 269 (2.1%) resulted in severe harm or death, with procedure or treatment problems generating the highest risk. One thousand and thirty-five incidents (8%) related to pre-operative assessment, with harm occurring in 275 (26.6%), and 552 (4.4%) related to epidural anaesthesia, with harm reported in 198 (35.9%). Fifty-eight occurrences of anaesthetic awareness were also examined. This preliminary analysis is not authoritative enough to warrant widespread changes of practice, but justifies future collaborative approaches to reduce the potential for harm and improve the submission, collection and analysis of incident reports. Practitioners, departments and professional bodies should consider how the information can be used to promote patient safety and their own defensibility.
Patients with intermittent claudication are less likely to experience pain in their legs when walking if they take the vasodilatory drug naftidrofuryl, according to the findings of a Cochrane Review.
Cochrane researchers studied data from seven clinical trials that compared naftidrofuryl with placebos.
They found that patients who took 200mg of the drug - three times a day for at least three months - had 37% more pain-free walking than those taking a placebo.
In 55% of patients taking naftidrofuryl the condition also improved, compared to only 30% of those on a placebo, the reviewers added.
Lead researcher Tine de Backer, from the Heymans Institiute of Pharmacology in Gent, Belgium, said: “It would make sense to give naftidrofuryl alongside recommending lifestyle changes such as stopping smoking, physical exercise and also prescribing anti-platelet drugs and statins.”
A hypnotist from West Sussex underwent surgery on his right hand without a general anaesthetic.
Alex Lenkei, 61, from Worthing, chose to sedate himself by hypnosis before undergoing the 83-minute operation.
He said he was fully aware of everything going on around him during the procedure but was free from pain.
The operation at Worthing Hospital involved removing some bone in the base of the thumb and fusing some joints in an attempt to improve his arthritis.
Consultant orthopaedic surgeon David Llewellyn-Clark said he was happy in agreeing to the unusual sedation on Mr Lenkei, a registered hypnotist who has been practising since the age of 16.
Mr Lenkei said Wednesday’s surgery “went amazingly well”.
“It took between 30 seconds to a minute for me to place myself under hypnosis, and from that point I felt a very deep relaxation.
“I was aware of everything around me, but I felt no pain.”
Throughout the operation, an anaesthetist was on standby to administer an anaesthetic if necessary.
Mr Llewellyn-Clark said he had been confident that Mr Lenkei was a skilled hypnotist and was “delighted all went well”.
Source: BBC News
Following its recent meeting, the Joint Medical Consultative Council (JMCC) has issued the following statement endorsing the BMA Consultants Committee campaign for an immediate, focused and planned expansion of consultant numbers where the evidence and need exists.
The statement reads, “At its recent meeting, the Joint Medical Consultative Council (JMCC) formally welcomed the launch of the CCSC campaign for a targeted increase in consultant numbers.
“In the NHS Plan, the Department of Health made a commitment to draw on national service frameworks to ensure that 'workforce plans will match the new standards of care with the numbers of staff required to implement them’ and that ‘NHS trusts will be performance managed against these standards.’ The Council therefore endorsed the need for an immediate, focussed and planned expansion of consultant numbers where the evidence and need exists.
In recognising the mounting need to increase consultant numbers, Dr Alan Russell, Chairman of the JMCC, said, ‘Consultants are highly skilled specialists in their field and are valued by patients. They are also cost effective in providing all patients with the highest standards of care. In order to maintain and indeed improve this high quality care, the JMCC believes that a targeted expansion in consultant numbers is essential now. Further to this, proper workforce planning with strong local input is needed and national oversight in the medium to long-term to ensure that we will be better able to produce the number of doctors we need.’”
NICE have now issued guidance for ‘Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome’.
To downloaded the document visit:
www.rcoa.ac.uk/index.asp?PageID=64&NewsID=611
NICE have issued new guidelines entitled, “Perioperative hypothermia (inadvertent)”. This guidance covers the care and treatment of people who are having an operation in hospital, in the NHS in England and Wales, to reduce their risk of getting cold before, during or after their operation.
To view the document please visit:
www.nice.org.uk/guidance/index.jsp?action=byID&o=11962
A study in America has published a randomized, double-blind study in the latest issue of Pediatrics, that has shown that a “needle-free powder lidocaine delivery system was well tolerated and produced significant analgesia within 1 to 3 minutes,” in pediatric patients scheduled to undergo venipuncture or cannulation. The system used in the study was Zingo™ lidocaine powder intradermal injector from Anesiva, Inc. The system, that uses compressed gas to accelerate the lidocaine particles under the skin, was approved by the FDA in August 2007, “ to reduce the pain associated with peripheral IV insertions or blood draws in children three to 18 years of age.”
To learn more about Zingo™, log on to
www.anesiva.com.
News Items
Chloroform Provides Clue To The Enigma Of General Anaesthesia
One of the earliest general anaesthetics to be used by the medical profession, chloroform, has shed light on a mystery that’s puzzled doctors for more than 150 years – how such anaesthetics actually work.
A discovery described as “true serendipity” made by Leeds University PhD student Dr Yahya Bahnasi, has provided a clue that may unravel the enigma of general anaesthesia – and offer the opportunity to design new generations of anaesthetics without harmful side effects.
“We take general anaesthesia for granted nowadays, but it’s still true to say that we don’t know exactly how it works on a molecular level,” says Dr Bahnasi, a qualified medical doctor on an Egyptian Ministry of Higher Education Scholarship at the University’s Faculty of Biological Sciences.
“However, I was examining the relationship between lipids and atherosclerosis and it just so happened that the lipids I was using were supplied already dissolved in chloroform. I noticed that the chloroform inhibited, or blocked, the calcium ion channel TRPC5 – it was quite a striking effect.”
Ion channels are pathways that allow electrically charged atoms to pass across cell membranes to carry out various functions such as pain transmission and the timing of the heart beat. TRPC5 calcium ion channels are found in many tissues around the body but are predominant in the brain.
“We know that this ion channel plays a signalling role in the central nervous system, which regulates the conscious and unconscious states, so I was left wondering whether inhibiting this calcium ion channel was one mechanism by which anaesthesia works,” says Dr Bahnasi.
Dr Bahnasi then carried out further experiments with several other modern anaesthetic compounds, both intravenous and inhaled, and found that the blocking effect on the TRPC5 ion channel was the same.
He says that the discovery opens up the opportunity to design and develop new generations of anaesthetics which directly target TRPC5, but with minimised side effects.
“Of course there are multi-molecular events that work together in anaesthesia, and inhibiting the TRPC5 ion channel may just be one of them. But it’s a great start in piecing together the underlying mechanisms and providing a novel molecular target for new drug design,” he says. “And it’s particularly fitting that this evidence was revealed by chloroform, the ‘grandfather’ of modern anaesthetics.”
Source: University of Leeds
Robot Anaesthetist Is Developed In France
A prototype robot that can induce a general anaesthetic for operations has been developed in France using American equipment and has been tested on some 200 patients, the project team leader has announced.
“The automatic pilot system relieves the anaesthetist of one of his tasks so that he can devote himself to the extremely important job of monitoring the patient’s state,” said Professor Marc Fischler, head of anaesthetics of the Foch Hospital in Suresnes, who developed the system with two other specialists.
The anaesthetist’s task would otherwise include administering anaesthetic drugs and pain-killers, as well as overseeing the patient’s condition during the course of the operation.
The French system has been tested on more than 200 patients in ten French hospitals, as well as one in Belgium and one in Germany.
“We have been fine-tuning our version for the last four years,” said Fischler, speaking in April.
“In the short term it’s still a research tool, but I can imagine that in the longer term it will become an instrument in everyday use,” he commented.
“We didn’t actually invent the system, but we developed it further and we’re still the only team in the world so far to have actually induced a general anaesthetic by means of the system, as well as using it during the operation,” he added.
“Furthermore, we can handle patients regardless of how serious their condition and even for long operations (up to 14 hours),” said Fischler.
“Our added value is the software.”
The system includes a bispectral monitor developed in the United States some years ago which can analyse the depth of the anaesthetic by recording brain activity. An electrode on the patient’s brow enables the monitor to situate the depth of anaesthesia somewhere between zero and 100, depending on the bispectral index.
Data is fed into a computer which controls the supply of morphine and hypnotising drugs, with the entire process constantly monitored by anaesthetists.
The bispectral index (BIS) can calculate the patient’s brain state and signal any major malaise occurring.
A bispectral index is a neurophysiological monitoring device which continually analyses a patient’s electroencephalograms during general anaesthesia to assess the level of the patient’s consciousness.
Source: Google news
Where Patients Don’t Complain: Simulated Hospital Part Of New Centre For Clinical Research
Talk about the perfect patient. Mr Ang has had at least three heart attacks in the last hour, but does not complain as student doctors and nurses resuscitate him yet again. Best of all, he feels no pain.
That’s because ‘Mr Ang’ is a state-of-the-art medical mannequin: He blinks, breathes, twitches, has a pulse and can simulate different medical scenarios, such as a stroke or asthma attack, and respond to medical intervention, such as cardio-pulmonary resuscitation.
As part of a new Simulated Hospital, ‘Mr Ang’ and similar mannequins, along with simulators for a range of medical procedures, will allow student doctors and nurses to attain higher levels of medical competency in a risk-free environment, said Assoc Prof Chen Fun Gee.
Dr Chen, who heads the department of anaesthesia at the Yong Loo Lin School of Medicine, coordinated the design of the Simulated Hospital.
With a fully-equipped operating theatre, an intensive care unit and four clinical skills laboratories, the Simulated Hospital is believed to be the only one of its kind in the region.
The two-storey set-up will be housed within the new Centre for Translational Medicine (CeTM) — the flagship building of the National University Health System (Nuhs).
The CeTM is another step driving Singapore’s excellence in clinical research, Prime Minister Lee Hsien Loong said at the ceremony earlier this year.
Mr Lee noted how Singapore has moved beyond merely adopting research from elsewhere to conducting more of its own clinical research, thereby narrowing the gap between basic research and cure.
“To derive full value from the researchers’ efforts, we need to follow through the basic research and development,” he said. "Insights gained at the laboratory bench have to be translated into better treatment protocols, therapies, diagnostic kits, or even drugs and devices to benefit patients.”
And the first step to realise this has been taken with the integration of the Yong Loo Lin School of Medicine, the Faculty of Dentistry and the National University Hospital (NUH) to form the Nuhs this January, he said.
But while organisational changes such as the Nuhs and infrastructure such as the CeTM are important in Singapore’s efforts to boost clinical research, more needs to be done, said Mr Lee.
“One major challenge is to promote collaboration and integration on a national scale. This is important because left on their own, organisations form silos naturally.”
Instead, he said: “We should promote collaboration to gain synergy, and enable our research institutions to undertake large-scale clinical trials and projects which each could not do on its own.”
He hoped the CeTM would lay the foundation for such synergies.
The $180 million flagship building, expected to be completed in mid-2010, will be home to more than 500 researchers and will bring together the new National University of Singapore (NUS) Research Centre of Excellence in Cancer, the world-class Clinical Imaging Research Centre and a top-notch infectious diseases laboratory.
It will also have a new medical library, research facilities, lecture halls and seminar rooms. According to Nuhs’ chief executive, Prof Tan Chorh Chuan, the “much-needed” research space CeTM affords will be “absolutely critical” to its vision.
Located at the site of the former NUS medical library and next to the NUH, the CeTM will be a hotbed of research for students, researchers and clinicians.
Prof John Wong, dean of Yong Loo Lin School of Medicine said, “The CeTM would create a more cohesive environment where students, clinicians and researchers can come together to share ideas and work on diseases that are highly important and relevant to Singapore.”
Source: todayonline.com
Anaesthetic May Help Treat Sleep Disorders And Improve Sleep Medications
Researchers at the University of Alberta in Canada have identified sleep patterns in a type of anaesthesia that are the closest ever to a natural, non-groggy snooze.
According to researchers, the anaesthetic, known as ethyl carbamate or urethane, provides a tool to more thoroughly investigate ways of treating sleep disorders and improving existing sleep medications.
Most general anaesthetics used for surgery and available medications used to treat sleeplessness promote what is called slow-wave sleep at the expense of the other main stage of sleep known as rapid eye movement or REM sleep so people tend to wake up groggy, said Clayton Dickson, an associate professor of psychology, physiology and neuroscience at the University of Alberta.
He added, “Our findings suggest that this type of anaesthesia can induce the full spectrum of the stages you would see during natural sleep, which will allow researchers to fine-tune sleep medications and anaesthetics, benefiting patients.”
During the study, researchers compared the brainwaves of rats under the anaesthetic to those occurring with natural sleep.
They discovered cyclic changes of brain states that were almost identical to those seen during the natural sleep cycle.
They also found changes in muscle tone; respiration rates and heartbeat were also similar.
Dickson said that the ethyl carbamate is not suitable for use in human consumption because of the high chemical dosage required, but findings of the study could be used by neuroscientists, physiologists and others in the field to unravel the mysteries of sleep.
He said that the long-term implications for this discovery will benefit researchers by allowing them to study sleep pattern anomalies, including the puzzling paradox of why brain activity is similar in wakefulness as it is during REM sleep, despite a complete lack of awareness and responsiveness.
Source: Thaindian News
Use Of The Bispectral Index Does Not Reduce Anaesthesia Awareness
Patients experiencing awareness during anaesthesia have potential long-term psychological consequences. Use of the bispectral index (BIS) has been found to decrease the incidence of this phenomenon when the BIS is maintained below 60. In a recent article in the N Engl J Med, Avidan et al., at the Washington University School of Medicine, describe a study they carried out to elucidate whether a BIS-based protocol has advantages over measurement of end-tidal anaesthetic gas (ETAG) for decreasing anaesthesia awareness.
They randomly assigned 967 patients to BIS-guided anaesthesia and 974 patients to ETAG-guided anaesthesia, and assessed patients at 0-24 hours, 24-72 hours and at 30 days postoperatively.
The authors found two cases of definite anaesthesia awareness in both groups (absolute difference 0%; 95% confidence interval -0.56 to 0.57%). The BIS value exceeded 60 in one of these cases, and the ETAG concentrations were less than 0.7 MAC in three cases.
The authors conclude that they were unable to reproduce the results of previous studies that reported a lower incidence of anaesthesia awareness with BIS monitoring, and that the use of the BIS protocol was not associated with reduced administration of volatile anaesthetic gases. They stated:
“Our study was unable to demonstrate superiority of a BIS-guided protocol over an ETAG-guided protocol for preventing anesthesia awareness and does not provide support for the additional cost of BIS monitoring as part of standard practice.”
Source: Anaesthesia UK
Canadian Scientists Develop Automated Anaesthetic System
Researchers from McGill University and the McGill University Health Centre (MUHC) in Canada have developed an automated machine, nicknamed ‘McSleepy’, that administers Anaesthesia without any sort of manual intervention.
The Device administers drugs for general anaesthesia and also does a second job of monitoring the separate effects in a fully automated way. The system first measures three separate parameters through an Integrated Monitor of Anaesthesia (IMA) which analyses depth of hypnosis via EEG analysis, judges pain with a new pain score, called Analgoscore, and does muscle relaxation through a phonomyography, all developed by ITAG. The System then administers the appropriate drugs using conventional infusion pumps, which is managed by a laptop computer where ‘McSleepy’ is installed.
“We have been working on closed-loop systems, where drugs are administered, their effects continuously monitored, and the doses are adjusted accordingly, for the last five years,” said Dr. Thomas M. Hemmerling of McGill’s Department of Anaesthesia and the Montreal General Hospital, who heads ITAG (Intelligent Technology in Anaesthesia research group), a team of anaesthetists, biomedical scientists and engineers.
“Think of ‘McSleepy’ as a sort of humanoid anaesthetist that thinks like an anaesthetist, analyses biological information and constantly adapts its own behaviour, even recognizing monitoring malfunction,” he added.
The device claims to be much more accurate and precise and it can even be much more efficient than a human. To add in mobility to the device, the McSleepy communicates with personal digital assistants (PDAs) which allow distant monitoring and anaesthetic control. The system has already been tested; however the researchers say that it will take approximately five years to get the system under the commercial spotlight.
Source: www.techshout.com
Issue: June 2008
