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Digital Issues

Can You Inherit PONV?

A study appearing in the July issue of the journal Anesthesiology suggests that patients can inherit post-operative nausea and vomiting.

Previous studies had established family history as a risk factor, but this study is among the first to analyze a possible connection between PONV and such genetic factors as a family history of the condition, as well as motion sickness, migraine headaches and other adverse side effects of anesthesia.

Researchers from Penn State College of Medicine gathered DNA samples from and interviewed 122 patients who'd suffered PONV on at least 3 separate occasions following surgery.

Their findings revealed 41 genetic markers, known as single nucleotide polymorphisms (SNP), that may contribute to a patient's predisposition to PONV. Additionally, researchers discovered at least one SNP common to the patients with severe PONV.

The study's authors hope their research leads to the development of pre-operative tests for patients showing PONV risks, and a possible drug therapy for the complication.

Dan O'Connor

Bilateral Knee Replacement Risky for Older Patients

Elderly patients with lung and heart conditions are at greater risk for adverse outcomes following bilateral total knee replacement, according to researchers at the Hospital for Special Surgery in New York City.

Major in-hospital complications and mortalities occurred in 9.5% of the more than 200,000 bilateral total knee procedures performed between 1998 and 2007, according to the study, which appears online in the journal Anesthesia & Analgesia.

Serious complications were 5.5 times more likely to occur in patients with congestive heart failure and 4 times more likely in patients with pulmonary hypertension, notes the report. Patients 75 years of age or older were twice as likely to experience post-op complications than patients younger than 65 years.

The researchers point out that bilateral knee replacement lowers hospital costs, decreases hospitalization times for patients and lets them return to an active lifestyle more quickly. However, they say, the research clearly shows patients with congestive heart failure and pulmonary hypertension are less than ideal candidates for the procedure.

During any orthopedic procedure bone particles and marrow can enter the bloodstream, lodge in the pulmonary vasculature and negatively impact blood flow, says anesthesiologist Stavros Memtsoudis, MD, PhD, the study's lead author. That's ordinarily not an issue in healthy patients, he adds, but individuals with pre-existing heart and lung problems are "already at a disadvantage."

The researchers call for the development of national guidelines to help guide the providers who perform the approximately 600,000 knee replacements each year, a rate that's expected to increase as baby boomers interested in maintaining active lifestyles continue to age.

"Clinicians need to adopt an approach when doing this surgery that reconciles the benefits of bilateral knee replacement surgery and concerns for safety," says Dr. Memtsoudis. "In order to do that, they will need to use evidence-based criteria of who should and who shouldn't be considered an appropriate candidate. What we are providing with this study is the first step towards an evidence-based approach to risk stratifying patients."

Daniel Cook

Kentucky Eye Surgeons Object to Proposed Regulations

Kentucky ophthalmologists are urging state lawmakers to reconsider recently passed and proposed legislation that allows optometrists to perform various eye surgery procedures.

A bill passed and signed earlier this year authorizes optometrists to utilize scalpels, needles, lasers, tissue burning and freezing technologies and other surgical tools in their practices, and gives them the ability to inject a range of drugs (but not Schedule 1 and 2 controlled substances).

A set of currently proposed industry regulations requires optometrists to undergo a course of training before they're able to undertake these surgical maneuvers, but the Kentucky Academy of Eye Physicians and Surgeons points out that it's vague on details, which leaves patients at potential risk.

"On nearly every level, these regulations fail to ensure that Kentuckians will receive the highest standard of eye care," says Woody Van Meter, the academy's president. "The proposed regulations have little substance, do not specify details of training nor qualifications of teachers, and conceivably allow optometrists to start performing surgical procedures after a weekend course. This current draft should be withdrawn and the process should be started anew to ensure that patients are protected."

The Kentucky Board of Optometric Examiners held hearings to gather public comment on their proposed regulations last month.

David Bernard

InstaPoll: How Satisfied Are You With Your Job?

Managing a surgical facility is a pressure-cooker of a job. Tell us in this week's InstaPoll how satisfied you are with your job. Check back here next week for the results.

About one-third (31%) of the 86 respondents to last week's InstaPoll pay their anesthesia providers a subsidy and about two-thirds (69%) do not financially support their providers to guarantee anesthesia coverage.

Dan O'Connor

News & Notes

  • AAAHC seeking comment on standards The Accreditation Association for Ambulatory Health Care has posted its revised accreditation standards for 2012 and is seeking public comment on the proposals. Interested parties can review and respond at the association's website until Aug. 31.

  • OR integration help Hospital administrators interested in planning and implementing an integrated OR can refer to a new white paper issued by the ECRI Institute, a non-profit, independent research organization in Plymouth Meeting, Pa. The paper outlines ways to modernize a general OR, build a state-of-the-art integrated OR for educational purposes and integrate a specialty OR. In addition, the paper discusses vendors, installation-cost-reducing strategies and returns on investment.

  • Building a biological spinal discEngineers from Cornell University and physicians from the Weill Cornell Medical College in New York City have collaborated to create a biologically based spinal implant which, inserted to replace damaged discs, could serve as an alternative to discectomy. The disc, manufactured from collagen and the hydrogel alginate, shares the structure and behavior of real discs. It is also enriched with cells that regenerate tissue, so it doesn't degrade but improves over time. The researchers findings, tested on animal subjects, have been published online by the Proceedings of the National Academy of Sciences.

  • Tip of the week"If you don't have a process lined up for efficiency, you won't have efficient processes," says Andrea Cromer, BSN, MT, CIC, of the Duke University Infection Control Outreach Network in Durham, N.C., who recommends placing hands-free wastebaskets near your scrub areas - and keeping their lids unobstructed - in order to eliminate the potential infection hazard of scrub kit waste discarded in the sinks.
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