The annual meeting of the American Society of Anesthesiologists -- Anesthesiology 2010 -- took place Oct. 16 to 20 in San Diego and attracted approximately 15,000 participants from around the world and included more than 1,500 abstract presentations. The conference highlighted advances in pain medicine, with presentations focused on the prevention and treatment of acute and chronic pain as well as surgical outcomes associated with anesthesia approaches.
In a retrospective study, Gerhard Brodner, M.D., of the Fachklinik Hornheide in Münster, Germany, and colleagues found that patients with malignant melanoma who underwent inguinal lymph node dissection with regional anesthesia as compared to general anesthesia experienced better prognostic outcomes. The investigators evaluated 273 patients who underwent inguinal lymph node dissection after primary malignant melanoma of the leg either with spinal anesthesia or general anesthesia between 1998 and 2005.
After adjustment for gender, American Society of Anesthesiologists class, tumor size, and type of surgery, the investigators found a trend toward a significantly better cumulative survival rate over 10 years after spinal anesthesia as compared to general anesthesia.
"We evaluated an anesthesia approach that might protect immunity and provide better survival with the technique. We performed a retrospective review and, while we found that this technique provided better outcomes over a 10-year period, long-term randomized prospective studies evaluating prognosis need to be conducted to determine whether we can recommend this technique," Brodner said.
In another study, Glenn S. Murphy, M.D., of the NorthShore University HealthSystem in Evanston, Ill., and colleagues found that administration of dexamethasone prior to laparoscopic cholecystectomy improves quality-of-life measures after hospital discharge. The investigators administered a 40-question survey to 120 patients who received either dexamethasone (8 mg) or saline (control group). The survey included questions regarding physical comfort, emotional state, physical independence, psychological support, and pain.
"We found that overall quality of recovery was enhanced with a single dose of dexamethasone. Patients administered the single dose of steroid felt better during the first 24 hours after discharge, with patients citing improvements in patient comfort, pain, and emotional state," Murphy said. "In addition, we saw benefits among patients who were administered a single 8-mg dose of dexamethasone before surgery, including less nausea, vomiting, and pain as well as less use of pain medications and less fatigue, finding patients being discharged 70 minutes earlier than those who received a single shot of saline."
The investigators found no additional adverse effects associated with dexamethasone administration prior to surgery.
"Despite significant improvements in the safety of surgical procedures over the past several decades, many patients may suffer from the adverse effects of anesthesia and surgery after discharge from the hospital. Our findings demonstrate that we can significantly enhance how patients feel after they leave the hospital when a single small dose of steroids is administered," Murphy added.
In a retrospective review presented by Alparslan Turan, M.D., of the Cleveland Clinic, the investigators found that smokers experience significantly more complications after surgery compared to nonsmokers.
"As compared to nonsmokers, smokers had a 38-percent increase in risk of mortality and 40 percent increased risk of any major complication as well as double the risk of pneumonia," Turan said. "Smokers had 87 percent increased chance of an additional tube after surgery and a 53 percent increased risk of being on a ventilator 48 hours after surgery, as compared to nonsmokers. Smokers also had a 73 percent increased risk of stroke as compared to nonsmokers as well as a 53 percent increased risk of cardiac arrest and 87 percent increased risk of myocardial infarction. In addition, smokers had a higher risk of infections including wound infection and sepsis."
The investigators evaluated 635,265 patients from the American College of Surgeons National Surgical Quality Improvement Program database to assess post-surgery risks associated with smoking.
"Future clinical practice of anesthesiologists will focus more on smoking cessation prior to surgery to prevent serious complications from happening," Turan added.
ASA: Pre-Op Screen for Obstructive Sleep Apnea Feasible
WEDNESDAY, Oct. 20 (HealthDay News) -- Physicians should screen patients for obstructive sleep apnea (OSA) prior to surgery to ensure proper management and prevent complications during and after procedures, according to two studies presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 16 to 20 in San Diego.
ASA: Pre-Surgical Aspirin Tied to Fewer Cardiocerebral Events
TUESDAY, Oct. 19 (HealthDay News) -- Administration of either aspirin or statin therapy prior to cardiac surgery appears to improve patient outcomes by reducing the risk of cardiocerebral complications and mortality rates, according to two studies presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 16 to 20 in San Diego.
ASA: Link Between Mortality and Pre-Op Glucose Studied
MONDAY, Oct. 18 (HealthDay News) -- Significant differences appear to exist between patients with diabetes and those without the condition regarding blood sugar levels prior to non-cardiac surgery and mortality within one year after surgery, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 16 to 20 in San Diego.
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