Does Anesthesia Stunt Children's Development?

A panel of FDA physicians met last week to gauge anesthesia's impact on developing brains with the hope of directing future clinical research on and care guidelines for pediatric surgery patients.

The government's involvement stems in part from the fact that generating definitive data will most likely require numerous resources and animal and human studies spanning many years, which a single individual or organization would be hard-pressed to develop, according to a report by members of the FDA's panel in the March 9 issue of the New England Journal of Medicine.

Mounting evidence from animal studies implies that prolonged exposure to anesthesia drugs could adversely affect neurologic, cognitive and social development of neonates and young children, says their report.

While current research suggests a link between anesthesia and neurotoxicity in children, a lack of studies performed on humans has prevented a definitive analysis of the risk of exposing pediatric patients to sedative drugs, according to a joint statement by the American Society of Anesthesiologists, American Academy of Pediatrics and Society for Pediatric Anesthesia.

A partnership between the FDA and the International Anesthesia Research Society called Strategies for Mitigating Anesthesia-Related Neuro-Toxicity in Tots (SmartTots) aims to spur the scientific community forward, stimulate dialogue among anesthesia leaders and raise the funds needed for further research, notes the NEJM article.

It's an important first step, but not nearly enough to put this issue to rest, write the physicians. "We need to definitively answer the questions of whether anesthetic use in children poses a risk to their development and, if so, under what circumstances," they say. "Although withholding anesthesia from children who need surgery is unreasonable, obtaining more information about safe use is imperative."

Daniel Cook

Surgical Robot Purchases Boost Prostate Surgeries

When a hospital purchases a DaVinci surgical robot, the rate of prostate cancer surgery in the surrounding region subsequently increases, according to researchers at the New York University Langone Medical Center and the Yale School of Medicine.

Introduced in 2001, the robot's use has grown to the point that 85% of all prostatectomies in 2009 used the device. Researchers studying its use between 2001 and 2005 found that hospitals that purchased a robot saw higher increases in radical prostatectomies than hospitals that didn't, they report online in the journal Medical Care this month.

Author Danil V. Makarov, MD, of NYU speculates that either patients sought care from surgeons affiliated with hospitals that had purchased robotic technology, or that physicians affiliated with these hospitals were more likely to propose robotic surgery over such conservative approaches as surveillance and radiation.

"Patients should be aware that if they seek care at a hospital with a new piece of surgical technology, they may be more likely to have surgery," he says in a statement. "Hospital administrators should also consider that new technology may increase surgical volume, but this increase may not be sufficient to compensate for its cost," which can range from $1 million to $1.7 million.

Kent Steinriede

Colonoscopy Could Prevent Twice As Many Deaths

Generally regarded as the gold standard for colorectal cancer screening, colonoscopy has prevented as many as 12,000 U.S. deaths annually, but could have prevented twice that many with increased use, says a recent study.

For a study published in the March issue of the journal Gastrointestinal Endoscopy, researchers reviewed colorectal cancer mortality data in epidemiological studies to estimate the impact, and the potential impact, of colonoscopy against the disease.

According to their calculations, colonoscopy spared approximately 7,300 to 11,700 patients death by colorectal cancer in 2005 (the latest year that the data were available). But a total of 13,800 to 22,000 deaths could have been prevented, they say.

"Colonoscopy can be an effective tool to reduce mortality rates from this largely preventable disease," says Glenn M. Eisen, MD, MPH, FASGE, the journal's editor, "but we still have a long way to go in getting more people screened for colorectal cancer."

The March issue of GIE, which recognizes National Colorectal Cancer Awareness Month, also includes studies on repositioning patients during scope withdrawal to increase polyp and adenoma detection; on preventing endoscopist fatigue and declining detection rates with 3-hour shift schedules can prevent; on the effectiveness of retrograde scope views; the measurement and reporting of bleeding, perforation and other post-colonoscopy complications; and the accuracy of Medicare claims for identifying a case's findings.

David Bernard

InstaPoll: Can You Spot Drug-Seeking Patients?

In the "Cutting Remarks" column of April's Outpatient Surgery Magazine, orthopedic surgeon John Kelly IV, MD, takes a funny look at a not-so-funny problem: patients who go to great lengths (even undergoing surgery) just so they can score pain meds from you. Do you think you've got what it takes to spot drug-seeking behavior in patients? You're invited to register your opinion on this topic in this week's InstaPoll.

Nearly 4 out of 5 (78%) of the 100 readers who took last week's InstaPoll use single-use drapes and gowns. Ten percent use reusable textiles and 12% use a mixture of both. You can weigh in on this topic on our Second Opinions discussion board.

Dan O'Connor

News & Notes
  • Tip of the week If you're looking to truly test how prepared your staff is for an emergency situation, delegate the responsibility for safety and evacuation drills to members of your staff, not to managers, says Julie Adelchanow, CST. "This is a great way for staff to take ownership of safety procedures and to take it more seriously," she writes.

  • New accreditation handbooks available The Accreditation Association for Ambulatory Health Care has released 2 new handbooks: the 2011 Accreditation Handbook for Ambulatory Health Care and the Accreditation Handbook for Ambulatory Surgery Centers Seeking Medicare Deemed Status. Both feature user-friendly formats, glossaries, self-audit worksheets and guides for writing QI studies. The handbooks, which incorporate changes from the 2010 accreditation standards, are 3-hole punched, allowing users to keep the pages in a binder and add notes as needed.

  • Learning from snails Scientists are studying the wave-like muscle motions that propel snails in the hope of someday creating robots that move easily on mucus-covered surfaces, such as the intestinal tract. An endoscope with snail-like locomotion may cause less irritation than a traditional scope, say scientists.
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