Some "noxious" general anesthetics excite sensory neurons that cause peripheral pain in patients once they wake from surgery, researchers say.

In a study published in the June 24 issue of Proceedings of the National Academy of Sciences, researchers at Georgetown University in Washington, D.C., have confirmed what anesthesia providers have known anecdotally for many years.

The more noxious general anesthetics activate a protein called TRPA1, known as the mustard-oil receptor, which is a principal receptor in the pain pathway. In nature, plants that produce chemicals such as mustard oil and capsaicin to prevent animals from eating them act upon the same receptor, says co-author Gerard Ahern, PhD, an assistant professor of pharmacology at Georgetown University Medical Center, in a press release.

The results of the study, which was performed on mice and rats, may explain why many surgery patients experience burning or inflammation in airways or at IV injection sites. Some anesthetics seem to cause a stronger reaction than others. "The choice of anesthetic appears to be an important determinant of post-operative pain," says Dr. Ahern. Sevoflurane, for example, seems to cause less swelling than isoflurane, according to the authors.

Kent Steinriede

The World Health Organization and the Harvard University School of Public Health have created a new perioperative checklist for surgical team members to use as a guideline for improving patient safety and preventing surgical errors.

The checklist outlines steps to follow during three phases of surgery: before anesthesia is administered ("sign in"), before the first incision ("time out") and before the patient leaves the OR ("sign out").

Items on the checklist include confirming the patient's name and the surgical site, administering antibiotics, ensuring a safe airway for anesthesia and counting sponges and needles before closing. During each phase, WHO recommends that a designated coordinator confirm that each item has been completed before the team proceeds.

The checklist is part of the "Safe Surgery Saves Lives" initiative, a joint effort by WHO and Harvard. Researchers led by Atul Gawande, MD, associate professor of health policy and management at the university, have found that use of the checklist boosted compliance with surgical safety standards from 36 percent to 68 percent in eight pilot sites around the world, reports WHO.

Nearly 250 health organizations, including the American College of Surgeons and AORN, endorsed the checklist at its unveiling in Washington, D.C., last week.

Irene Tsikitas

It's no secret that some leading orthopedic surgeons receive six- and seven-figure payments annually from the makers of artificial hips and knees. But could these payments, which vendors commonly distribute to surgeons in exchange for consulting, development assistance and speaking engagements, create a conflict of interest by affecting the way that doctors choose to treat their patients? That's the subject of a investigation appearing in the June 29 issue of the Philadelphia Inquirer.

On June 26, the New York Times examined another potentially controversial practice: doctors who are incentivizing their Botox, breast augmentation and LASIK patients with rebates and discounts in exchange for posting footage of their surgeries and personal testimonials on such online video sites as YouTube. While doctors and patients have taken to the new media with gusto, the article states, other industry observers question the ethics of the situation.

Dan O'Connor