This Wednesday, Sept. 1, is your last chance to participate in Outpatient Surgery Magazine's OR Excellence 2010 Pre-Registration Contest. There's no time like the present to secure your spot at and lock in savings for the surgical conference of the year, while also entering the running for more than $10,000 in prizes.

Early registrants will receive a $100 discount on the conference's full registration fee, guarantee their reservation at the meeting - taking place from Oct. 27 to Oct. 29 in Ft. Lauderdale, Fla. - and secure discounted rooms at the Harbor Beach Marriott Resort and Spa, the center of conference activity.

In addition, all attendees who are paid in full by Sept. 1 will enter a drawing for prizes that include free sunset cruises and the grand prize, an upgrade to the Marriott's $2,000-a-night Vice-Presidential Suite during OR Excellence and for 2 extra nights - a $10,000 value.

For more information, visit the OR Excellence website, but don't delay. These special opportunities end Wednesday.

Steven Archibald

A recent analysis of the anesthesia labor market speculates that a current shortfall of providers across the surgical industry could widen in the next 10 years into a much larger shortage of anesthesiologists and a surplus of nurse anesthetists.

In its study, which was funded by Ethicon Endo-Surgery, the Rand Corporation calculated a nationwide personnel shortage of 3,800 anesthesiologists and 1,282 certified registered nurse anesthetists at present.

By the year 2020, however, the shortage of anesthesiologists could reach 4,500, while the ranks of CRNAs could swell to a surplus of about 8,000. The study's authors based this projection on a survey that examined anesthesia providers' employment details, compensation, demographics, use of technology and other factors, as well as on the assumption that the demand for anesthesia services would continue to grow at an annual rate of 1.6%, as it had between 1985 and 2004.

That's 1 scenario. If the demand for growth increases to 3 percent in response to the increasing medical needs of the baby boom generation, the shortage of anesthesiologists could reach 12,500, say the researchers, while an excess 15,000 CRNAs appear on the market.

In the anesthesiologists' view, American patients will "face a gap in anesthesiology services that is just as important to Americans' health as the projected physician gap for primary care services," says Mark A. Warner, MD, the president-elect of the American Society of Anesthesiologists. The study should spur the need for training in the field, he says.

In an e-mail, American Association of Nurse Anesthetists' President Paul Santoro, CRNA, MS, says his group finds the surplus predictions "overly optimistic," but adds that the potential increased access to anesthesia care is "a tremendous positive."

"Think about it: Thanks to health reform, a projected 30 million uninsured Americans will soon be entering the healthcare system," he writes. "Anesthesia services for surgical, obstetrical and trauma care will be in demand like never before. ... Americans can rest assured that CRNAs provide the safest, most cost-effective anesthesia care available."

While the 2 professional organizations collaborated with Rand on its survey of providers, they did not sponsor the study.

David Bernard

The brain works through different processes as it transitions between conscious and unconscious states, a finding that bucks commonly held assumptions about anesthesia's effects on the central nervous system, say researchers.

In the online journal PLoS ONE, physicians from the University of Pennsylvania School of Medicine note that the sedative effect of anesthesia is typically attributed to drug-induced modifications of the CNS, while emergence is commonly believed to occur as the anesthetic is gradually eliminated. Observing animal test subjects, however, they report a delay in the return to consciousness as the anesthetic concentration is reduced. Once the animal test subjects transition from wakefulness to anesthetic-induced unconsciousness, the researchers say, the subjects exhibit resistance when returning to a wakeful state.

"That a protective barrier exists is probably a good thing," says Max B. Kelz, MD, PhD, assistant professor of anesthesiology and critical care at Penn and the study's lead author. "Without it, we might see many more cases of anesthesia awareness."

He says the CNS might have a memory of whether or not it's aware, and seems to have an intrinsic resistance to transitioning between conscious and unconscious states.

Further understanding of how the resistance works in humans and how it can be manipulated could get sedated patients to cross back over to consciousness more quickly, which could potentially improve surgical efficiencies, says Dr. Kelz. "That's a ways off," he explains, "but we might discover a new class of drugs or new uses for existing ones that help providers get patients mentally crisp following anesthesia."

Daniel Cook

Who's anesthetizing patients at your facility? MDs only? CRNAs only? MDs supervising CRNAs? MDs and CRNAs working together? Let us know in our online poll, and check back next week to see the results.

Last week's InstaPoll asked where you or a family member would go for surgery. To no one's surprise, nearly 9 out of 10 (88%) of our 223 respondents said they'd rather have surgery at their own facilities. We can't help but wonder why the other 12% wouldn't feel comfortable undergoing surgery at the facilities under their management.

Dan O'Connor