Archive Hot Technology 2019

5 Key Advances in Anesthesia

The latest tools and techniques that enable safe and pain-free same-day discharge.

Jim Burger

Jim Burger, Senior Editor

BIO

COMMAND CENTRAL
Pamela Bevelhymer, RN, BSN, CNOR
COMMAND CENTRAL Anesthesia providers are tapping into technology to keep patients safe and limit their post-op discomfort.

Surgeons grab headlines for performing innovative procedures and nurses will always be the heart of health care, but it’s the anesthesia providers who ultimately green light the complex cases that are pushing outpatient surgery forward. Without their mastery of airway management and deft touch in controlling post-op pain, patients who undergo surgeries that used to require several overnight stays wouldn’t be ready or willing to walk out of your facility hours after they walked in. Look closely and you’ll notice there are plenty of exciting things happening at the head of the OR table, beginning with efforts to address a national crisis.

1. Opioid-sparing pain management

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Pamela Bevelhymer, RN, BSN, CNOR
PUSHING FORWARD New IV NSAIDs in the pipeline promise to give providers even more opioid-sparing options to manage post-op pain.

That opioids are a major concern isn’t big news. That in many ways they’re an even bigger problem than previously realized may be the more important recent revelation.

“We now know that the intraoperative use of opioids — particularly potent lipophilic ones like fentanyl, sufentanil and especially remifentanil — produce hyperalgesia intolerance,” says Eugene Viscusi, MD, a professor of anesthesiology and the chief of pain medicine at Thomas Jefferson University Hospital in Philadelphia, Pa. “In other words, they literally cause more pain and higher opioid requirements. It’s pretty alarming to realize that you’re giving what you think are pain drugs only to find out they actually increase pain and opioid use.”

By now you know that the opioid crisis has led to a spike in ongoing efforts to find analgesic combinations that serve as opioid alternatives (as well as a spike in the use of the word multimodal).

“We have a lot more tools available if we want to avoid opioids,” says Dr. Viscusi. “In fact, the data now strongly show that opioids are not the most powerful analgesic agent. There are a lot of drugs that are on par in terms of efficacy.”

The quest for perfect pain management, or something as close as possible to perfection, continues, fueled by the overlap of art and science.

“We’re still learning a lot about opioid-sparing techniques, because as a society we spent many decades using opioids as a crutch,” says Mohammad Piracha, MD, an anesthesiologist and pain management specialist at Weill Cornell and the Center for Comprehensive Spine Care in New York City. “We’ve forgotten about some other medications that are supremely effective. There are so many classes of medications that have gone by the wayside, because there was such a surge of opioid use. I think some people are starting to look back and say, you know what, this medication used to work great.”

Medications like these:

  • Ketamine, which was recently FDA-approved as a nasal spray to treat depression, is also showing considerable promise as an anesthetic agent.

“There’s a host of emerging data supporting ketamine as not only reducing tolerance and hyperalgesia, but also providing a lot of other benefits,” says Dr. Viscusi, “including cognitive preservation and ancillary anti-inflammatory effects. I think you’re going to see ketamine coming back as a background infusion drug in a lot of anesthesia.”

  • Intravenous lidocaine infusion is also promising. “There are a lot of data to support it,” adds Dr. Viscusi. “It’s a potent anti-inflammatory, and it appears to reduce the inflammatory response to surgery. It also seems to improve functional outcomes longer-term, even months after surgery.”
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