Here are eight recent studies related to anesthesia.
1. Electronic reminders improve accuracy of anesthesia billing. Electronic reminders in information management systems can boost billing accuracy and profitability, according to a University of Michigan study. Researchers found that sending electronic reminders through their facility's anesthesia information management system tripled clinicians' compliance with proper documentation of anesthesia start times and boosted annual reimbursement by more than $450,000.
2. Alpha-2 agonists reduce opioid use among post-surgical patients. Researchers at Geneva University Hospital in Geneva, Switzerland, found that the use of alpha-2 agonists with opioids in surgical patients decreased post-surgical opioid use by 25 to 30 percent. The decrease in opioids use did not deprive patients of pain relief — to the contrary, researchers found that the patients reported slightly less pain after surgery. Lead study author Grégoire Blaudszun, MD, said that further research on alpha-2 agonists is needed before they can be recommended for regular use by anesthesiologists.
3. Ohio State cuts ventilation time for coronary artery bypass graft patients. The university's strategy for reducing patients' mechanical ventilation times after coronary artery bypass graft surgery suggests that departments can significantly reduce ventilation times without sacrificing patient outcomes. Colleagues at Ohio State University Medical Center decided to start the protocol after noticing the median time on mechanical ventilation for CABG patients in the first quarter of 2010 was 12.8 hours. After initiating the protocol, Ohio State's median time on mechanical ventilation following CABG surgery fell to 7.2 hours a year later.
4. Animal studies raise concerns over effect of pediatric anesthesia. A study published in the Journal of Neuroscience found that exposure of seven-day-old rats to commonly used anesthetic agents resulted in widespread neurodegeneration and learning deficits. The rats received one dose of midazolam and were exposed for six hours to oxygen, nitrous oxide, and isoflurane. The negative side effects were not observed in older rats that received the same anesthetic. Thus far, similar studies on humans have been inconclusive. However, a higher incidence of learning disabilities has been found in children under age four who have had multiple anesthetics.
5. Local anesthesia is sufficient for transcatheter aortic valve implantation. A study published in JACC: Cardiovascular Interventions found that only 3.3 percent of "high surgical risk" patients undergoing TAVI under local anesthesia had to be converted to general anesthesia. The conversions were due to complications with the valve procedure rather than with IV sedation or because of an uncooperative patient, said study author Hélène Eltchaninoff, MD. The simplified percutaneous approach using local anesthesia has become more popular because it offers multiple advantages in an elderly and fragile population, the report said.
6. Anesthesia personnel overestimate blood loss during spine procedures. Estimates of blood loss during surgery by anesthesia personnel may lead to excess transfusion, according to a recent study. Researchers found that the estimated blood loss exceeded measured blood loss by more than 40 percent during spine procedures. "Interpretation of intermittent measurements of hemoglobin levels is often complicated by fluid shifts, intravenous volume infusions and transfusions," said John Stover, MSN, a nurse practitioner at Duke University Medical Center who helped conduct the study.
7. Use and cost of anesthesia during GI procedures on the rise. A recent Journal of the American Medical Association study found that the use and cost of anesthesia services in gastroenterology procedures is increasing. In both the Medicare and privately insured populations, the proportion of procedures using anesthesia services increased from about 14 percent in 2003 to more than 30 percent in 2009. Regional variation was significant, with anesthesia services used least frequently in the West (around 13 percent) and most frequently in the Northeast (59 percent). The expense of anesthesia services rose with the frequency of the procedure, the study found.
8. Ninety percent of surgery centers experience a drug shortage at least weekly. According to an ASC Association drug shortage survey, more than 80 percent of respondents were never given advanced notice of the shortage. The survey found that half of respondents had to use an alternative level of sedation or alternative medications because of a drug shortage, which many respondents said led to an increase in patient nausea and vomiting. More than 10 percent of responding facilities had to reschedule a procedure due to a drug shortage.
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1. Electronic reminders improve accuracy of anesthesia billing. Electronic reminders in information management systems can boost billing accuracy and profitability, according to a University of Michigan study. Researchers found that sending electronic reminders through their facility's anesthesia information management system tripled clinicians' compliance with proper documentation of anesthesia start times and boosted annual reimbursement by more than $450,000.
2. Alpha-2 agonists reduce opioid use among post-surgical patients. Researchers at Geneva University Hospital in Geneva, Switzerland, found that the use of alpha-2 agonists with opioids in surgical patients decreased post-surgical opioid use by 25 to 30 percent. The decrease in opioids use did not deprive patients of pain relief — to the contrary, researchers found that the patients reported slightly less pain after surgery. Lead study author Grégoire Blaudszun, MD, said that further research on alpha-2 agonists is needed before they can be recommended for regular use by anesthesiologists.
3. Ohio State cuts ventilation time for coronary artery bypass graft patients. The university's strategy for reducing patients' mechanical ventilation times after coronary artery bypass graft surgery suggests that departments can significantly reduce ventilation times without sacrificing patient outcomes. Colleagues at Ohio State University Medical Center decided to start the protocol after noticing the median time on mechanical ventilation for CABG patients in the first quarter of 2010 was 12.8 hours. After initiating the protocol, Ohio State's median time on mechanical ventilation following CABG surgery fell to 7.2 hours a year later.
4. Animal studies raise concerns over effect of pediatric anesthesia. A study published in the Journal of Neuroscience found that exposure of seven-day-old rats to commonly used anesthetic agents resulted in widespread neurodegeneration and learning deficits. The rats received one dose of midazolam and were exposed for six hours to oxygen, nitrous oxide, and isoflurane. The negative side effects were not observed in older rats that received the same anesthetic. Thus far, similar studies on humans have been inconclusive. However, a higher incidence of learning disabilities has been found in children under age four who have had multiple anesthetics.
5. Local anesthesia is sufficient for transcatheter aortic valve implantation. A study published in JACC: Cardiovascular Interventions found that only 3.3 percent of "high surgical risk" patients undergoing TAVI under local anesthesia had to be converted to general anesthesia. The conversions were due to complications with the valve procedure rather than with IV sedation or because of an uncooperative patient, said study author Hélène Eltchaninoff, MD. The simplified percutaneous approach using local anesthesia has become more popular because it offers multiple advantages in an elderly and fragile population, the report said.
6. Anesthesia personnel overestimate blood loss during spine procedures. Estimates of blood loss during surgery by anesthesia personnel may lead to excess transfusion, according to a recent study. Researchers found that the estimated blood loss exceeded measured blood loss by more than 40 percent during spine procedures. "Interpretation of intermittent measurements of hemoglobin levels is often complicated by fluid shifts, intravenous volume infusions and transfusions," said John Stover, MSN, a nurse practitioner at Duke University Medical Center who helped conduct the study.
7. Use and cost of anesthesia during GI procedures on the rise. A recent Journal of the American Medical Association study found that the use and cost of anesthesia services in gastroenterology procedures is increasing. In both the Medicare and privately insured populations, the proportion of procedures using anesthesia services increased from about 14 percent in 2003 to more than 30 percent in 2009. Regional variation was significant, with anesthesia services used least frequently in the West (around 13 percent) and most frequently in the Northeast (59 percent). The expense of anesthesia services rose with the frequency of the procedure, the study found.
8. Ninety percent of surgery centers experience a drug shortage at least weekly. According to an ASC Association drug shortage survey, more than 80 percent of respondents were never given advanced notice of the shortage. The survey found that half of respondents had to use an alternative level of sedation or alternative medications because of a drug shortage, which many respondents said led to an increase in patient nausea and vomiting. More than 10 percent of responding facilities had to reschedule a procedure due to a drug shortage.
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