A variation on the general anesthetic etomide, currently under development by researchers, could prove to be a safer option for elderly and critically ill patients.

The drug, methoxycarbonyl-etomidate (MOC-etomidate), doesn't cause the sudden drop in blood pressure or suppression of adrenal gland activity that the conventional version does, according to a pre-clinical study performed on rats and tadpoles that was published in the August issue of the journal Anesthesiology.

The Massachusetts General Hospital researchers who conducted the study say they hope to administer the rapid onset and recovery drug to humans someday, if their limited animal trials continue to show success.

"We could give a large dose of MOC-etomidate to induce anesthesia and then run a continuous infusion to maintain anesthesia without reducing blood pressure in even very sick patients," says Douglas Raines, MD, the study's leader and a member of Mass. General's anesthesia department, in a press release.

Kent Steinriede

Giving children pre-op oral doses of melatonin significantly reduces the occurrence of emergence delirium, a frightening experience marked by crying, thrashing and perhaps the need for restraint, according to researchers at the University of California Irvine School of Medicine.

Emergence delirium affects up to 20% of children who undergo surgery and can lead to such developmental challenges as nightmares, bedwetting and separation anxiety, say researchers in a study published in the July issue of the journal Anesthesia.

The sedative midazolam is commonly used to combat pre-op anxiety in children, say the researchers, who explored the possibility that melatonin, a hormone secreted by the pineal gland, is a better treatment option. For the study, 148 patients between the ages of 2 and 8 who underwent outpatient surgery under general anesthesia were randomly administered midazolam or melatonin.

The incidence of emergence delirium was greatest in the midazolam group, with 25.6% of patients affected. In the melatonin group, where patients were given varying doses up to a maximum of 20mg, the incidence was found to be dose-related. The emergence delirium rate of patients who received 0.05mg/kg dose was 25%; of those receiving 0.2mg/kg, 8.3%; and of those receiving 0.4mg/kg, 5.4%.

While melatonin isn't as effective as midazolam in reducing pre-op anxiety levels in pediatric patients, the researchers conclude, it significantly reduces the risk of emergence delirium.

"Studies conducted in adults have revealed that oral administration of melatonin before surgery beneficially reduced anxiety levels, but relevant similar treatment data for children undergoing anesthesia and surgery are limited," says Zeev N. Kain, MD, MBA, the study's lead author, chair of the department of anesthesiology and associate dean for clinical research at UC Irvine. "As 3 million children undergo surgery in the U.S. each year, these findings reveal noteworthy health care and treatment implications."

Daniel Cook

The Florida Department of Health has withdrawn a complaint that cited a Fort Lauderdale anesthesiologist for his role in a pain management procedure that left a patient comatose and paralyzed.

In a letter issued earlier this month, the department said it had "determined that there is insufficient evidence of a violation" in the actions of Thomas J. Rodenberg, MD, who attended the December 2008 procedure at the Atlantic Surgical Center in Pompano Beach, according to the South Florida Sun-Sentinel.

The patient, 33-year-old Dale Whyte of Lauderdale Lakes, was sedated and undergoing a joint manipulation procedure when his brain's blood or oxygen supply was interrupted for several minutes.

A Feb. 5, 2009, investigation by Florida's Agency for Health Care Administration uncovered allegations of mismanagement and faulty equipment at the surgery center, which was ordered closed. (It was allowed to reopen on March 6 after correcting its violations.)

The investigation reports cited Dr. Rodenberg for failing to monitor Mr. Whyte's blood oxygen level and for lacking workable monitoring and oxygen equipment. In interviews with Outpatient Surgery Magazine last month, Dr. Rodenberg countered that his equipment was operational and his oxygen and monitoring actions were standard. He maintained that vagus nerve trauma suffered during the joint manipulations led to the patient's complications, and that state inspectors hadn't incorporated his procedure notes into their findings.

David Bernard

Have you ever discovered a member of your staff stealing controlled substances from your facility? Go to our Web site to let us know and to see real-time results. Then keep an eye out for our August issue, in which we'll report on the surgical tech who diverted fentanyl and infected patients with hepatitis C in the process.

Last week's InstaPoll asked whether your facility's lineup included any "deadwood docs" - physician-owners who still share in the facility's profits even though they perform hardly any procedures there. Of 69 respondents, 84% said yes and 16% said no.

Dan O'Connor