Study: Dopamine Quickens Recovery From Anesthesia

A new study of mice by MIT researchers suggests dopamine, a neurotransmitter that helps control the brain's reward and pleasure centers, and shorten recovery time from general anesthesia.

The study, published in Proceedings of the National Academy of Sciences, found that the anesthetized mice quickly woke up and walked around when dopamine was released in the ventral tegmental area (VTA) of the brain. The lab mice were bred to have nerve cells in the VTA, which would only activate when a blue light shined on them, prompting the release of dopamine. This study is one of the first to show specifically how dopamine can waken patients from anesthesia — an important finding as researchers study ways to lessen recovery time from anesthesia and thereby reduce the health risks associated with it.

"The process of how the neural circuits come back online following anesthesia has not really been studied in depth," says senior author Ken Solt, MD, an anesthesiologist at Massachusetts General Hospital. "And this is something that interested us from a clinical standpoint, because we are investigating ways to rapidly reverse anesthesia."

Dr. Solt explained that dopamine neurons in the VTA are traditionally associated with reward, motivation and drug addiction, but that its impact on arousal is a developing concept. "We discovered that by activating dopamine neurons in this very specific area of the brain, we were able to reverse the state of general anesthesia and wake up the animals," says Dr. Solt.

"We want to get the patient's cognitive processes back to exactly where they were before they had anesthesia," says co-author Dr. Emery Brown, a fellow MIT researcher and anesthesiologist at Massachusetts General Hospital. "It's a given that a high fraction of older patients' brains in particular will not work as well after anesthesia."

Dan Dunkin

Medication Management Made Easy

Are your patients often unaware of which regularly prescribed medications they should continue to take and which they should temporarily stop before undergoing surgery? Putting the directives in writing will clear up any confusion they might have, according to a study presented at the recent annual meeting of the American Society of Anesthesiologists.

Researchers assessed 8 patients who were given verbal instructions and 57 patients who received medication instruction sheets during pre-op assessments before elective orthopedic surgery. Use of the instruction sheets, which nurses filled out along with patients during the assessments, increased medication compliance by 20%. Written instructions also reduced the number of patients who mistakenly stopped taking prescribed medications from 42% to 25% and the number of patients who took their medications incorrectly from 6% to 2%.

Medication instruction lists improve the likelihood that patients will take prescribed medications as needed before their scheduled procedures and are an inexpensive and effective intervention that can significantly improve patient safety and reduce case cancellations on the day of surgery, according to study lead author Andrew Grant, MB, ChB, of the Royal Alexandra Hospital in Scotland.

"While the approach seems simple, re-enforcement of delivered information in written format can increase patients' compliance with advice given at pre-assessment and actively engages them in their own health care," he says.

Daniel Cook

Perioperative Surgical Home Study Produces Strong Results

It shouldn't come as a surprise, but communication and coordination — as exemplified by the perioperative surgical home (PSH) model of health care — appear to promote efficiency, save money and increase patient satisfaction, a new study suggests.

The PSH model — in which the anesthesiologist is the focal point of a coordinated approach that includes primary care physicians, surgeons, and other specialists — is an acclimation to increased emphasis on improving quality and reducing costs.

In the study, which included 1,356 total joint patients, half of whom were cared for under the PSH model, and half of whom were cared for under the traditional — you might say, disjointed — model, the PSH patients fared better from start to end. They had 9% and 22% fewer imaging and laboratory tests, respectively, they required 87% fewer units of blood, and their length of stay was reduced by half a day. Not surprisingly, their satisfaction scores were higher, too, with patients reporting better pain management and better communication with physicians.

The study was carried out by TEAMHealth Anesthesia at Tampa (Fla.) General Hospital, and reported at the 2016 American Society of Anesthesiologists meeting last month in Chicago.

Jim Burger

InstaPoll: What Do You Call Your OR Housekeepers?

The name housekeeper doesn't seem a fitting title for the staff who perform such critical functions at a surgical facility as turning over rooms, restocking shelves and helping transport patients. What do you call these staff members — housekeepers, environmental services staff, turnover team, custodial staff, nursing assistants? Tell us in this week's InstaPoll.

More than one-third (35%) of the 281 respondents to last week's poll are happy in their current positions, but 16% are actively looking for a new job and 39% would be interested if the right opportunity came along. The results:

Are you job-hunting?

  • I'm actively looking for a new position. 16%
  • If something catches my eyes, I'd apply for it. 39%
  • I haven't updated my resume in years. 10%
  • I'm quite content where I am, thank you. 35%

Dan O'Connor

News & Notes
  • Better results with outpatient ankles Outpatient surgeries for ankle fractures are associated with fewer infections and other adverse events, compared with inpatient procedures, a new study reported in The Journal of Bone & Joint Surgery finds.
  • From nose to knees Swiss physicians have found a way to grow new cartilage in damaged knees by using cells from patients' noses.
  • Bariatric surgery benefits teens Weight-loss procedures performed on severely obese adolescents becomes a cost-effective treatment option that results in healthcare savings after 5 years, according to a study published in JAMA Surgery. More importantly, say the researchers, bariatric surgery can completely transform the lives of obese adolescents who might be subjected to ridicule and isolation from peers.