Safety is in the details
Safety in the ICU

A Review of Advances in the Field of Anesthesia

December 19, 2016

 

Anesthesia is one of the most important fields in medicine. Healthcare practices would not have the ability to safely perform a wide variety of procedures without it. However, many of the drugs and tools so commonly used in hospitals are still relatively new.


Advancements and innovations in anesthesia have vastly improved the quality of care provided to patients, as well as the safety and performance of CRNAs and anesthetists. In this article, we are going to discuss five innovations that have improved the field of anesthesia in a significant way.


Ultrasound in the Operating Room


Ultrasound is the most cost-effective form of imaging assisting with catheter placement, intravascular catheterization, and peripheral nerve blockade. Rather than sticking needles into the tissue of patients while searching for vascular access or paresthesias, physicians can see exactly what they’re doing.


In the past, ultrasound was primarily used by radiologists. Today, use of ultrasound in the operating room is increasingly common.


"It’s a technology that I think is going to expand in use," said Dr. Jay K. Harness, an early adopter of ultrasound in breast surgery and coauthor of the textbook "Ultrasound in Surgical Practice." "I started using it in the 1990s, and it’s like we’ve gone from analog TV to digital." [8]


Video Laryngoscopy devices


Video Laryngoscopy devices are innovative compared to standard Laryngoscopy devices. An observation was made in 121 obese patients undergoing Bariatric surgery where the use of video laryngoscopy devices benefitted in many ways compared to the use of standard laryngoscopy devices. The observation concluded that video laryngoscopy devices reduced the time needed to secure the airway and improved the glottic view when compared to standard direct laryngoscopy.


Video-Mac VL and Video McGrath VL were compared to standard laryngoscopy, and the results showed that along with the time reduction the Video-Mac and GlideScope required fewer intubation attempts. These devices also needed less frequent use of ancillary intubating devices [1]


A study comparing the effectiveness of the C-MAC Video Laryngoscope versus Direct Laryngoscopy in the setting of the predicted difficult airway included 300 patients. The results showed that skilled providers achieved higher success rates for tracheal intubation on the first attempt with C-MAC video laryngoscope (93%) than direct laryngoscopy (84%) [7].


Modified Nasal Trumpet for Airway Management


Double Nasopharyngeal airway is a more advanced version than the single Nasopharyngeal airway. A double Nasopharyngeal airway is beneficial in many ways, for example when the patient is restricted in a lateral position, prone position or sitting position; it is useful in craniotomy. A double modified nasopharyngeal airway connected to a breathing circuit can be a better rescue technique. This setup can provide continuous positive airway pressure, end-tidal carbon dioxide monitoring, allowing for unobstructed spontaneous ventilation and assisted ventilation. [2]


Insertion of a double modified nasopharyngeal airway is easier, faster, and less traumatic compared with that of tracheal intubation while providing a better seal than an oral airway with mask ventilation. In contrast to mask ventilation, the double modified airway technique prevents airway obstruction by the tongue, and therefore, obstructive sleep apnea.


Raman Spectroscopy in Epidural Needle Placement


It is important to know the precise anatomical markings in Epidural steroid injections and Neuraxial anesthesia to ensure safe and successful procedures. For this, clear spectroscopy results are key. In a study conducted in 2015, Raman spectroscopy was compared to fluorescence spectroscopy and reflectance spectroscopy. There were unique spectra for neuraxial, and paravertebral layers with Raman spectroscopy and the tissue layers were well distinguished. With other spectroscopies like fluorescence spectroscopy and reflectance spectroscopy, tissue layers are not distinct at some places. [3]


Automated delivery of Oxygen and Anesthetic drugs


Automated individual delivery of anesthetic drugs is far superior in results than manual delivery. It can reduce the consumption of anesthetic drugs, as it’s easy to reach the exact drug target level when using an automated delivery system, enabling hospital costs to be reduced by almost 50%. These systems are also environmentally friendly.


The Non-Injectable Arterial Connector


Dr Maryanne Mariyaselvam, a Clinical Research Fellow at the Queen Elizabeth Hospital, Kings Lynn at Cambridge University Hospital, Cambridge, has come with innovation in 2015 for which she was awarded AAGBI Prize for Innovation. The Non-Injectable Arterial Connector improves the safety of the patients in ICU and operation theaters who require arterial line. It helps in avoiding the wrong route of administration and helps prevent further complications related to it [6].


And what does the future of anesthesia hold?


The future trends of innovation in anesthesia follow two major directions, automation and analytics. The equipment and delivery of drugs can be completely automated to achieve various benefits when compared to manual delivery. Monitoring in ICU and ansthesia results in a large amount of data, but the data is mostly unused. Innovative analytic tools may enable actual use of this data to generate new insights, which might contribute to healthcare. Personalized use of data for returning patients and precision medicine is one of the options for using analytics in anesthesia and ICU.

 

Recommended reading:
7 medical innovations that changed healthcare forever 
A tribute to painless medicine and modern anesthesia 
The Challenges of pain management


References:
1. Jcafulltextonlinecom. 2016. Available at: http://www.jcafulltextonline.com/article/S0952-8180(16)00063-5/fulltext.
2. Weisman, H, Weis, TW, Elam, JO, Bethune, RM, Bauer, RO Use of double nasopharyngeal airways in anesthesia.. Anesth Analg. (1969). 48 356–61
3. Rathmell, JP, Benzon, HT, Dreyfuss, P, Huntoon, M, Wallace, M, Baker, R, Riew, KD, Rosenquist, RW, Aprill, C, Rost, NS, Buvanendran, A, Kreiner, DS, Bogduk, N, Fourney, DR, Fraifeld, E, Horn, S, Stone, J, Vorenkamp, K, Lawler, G, Summers, J, Kloth, D, O’Brien, DJr, Tutton, S Safeguards to prevent neurologic complications after epidural steroid injections: Consensus opinions from a multidisciplinary working group and national organizations.. ANESTHESIOLOGY. (2015). 122 974–84
4. De Santis VSinger M. Tissue oxygen tension monitoring of organ perfusion: rationale, methodologies, and literature review. British Journal of Anesthesia. 2015;115(3):357-365. doi:10.1093/bja/aev162.
5.Lucangelo et Al. End-tidal versus manually-controlled low-flow anaesthesia J Clin Monit Comput DOI 10.1007/s10877-013-9516-8.
6. https://www.england.nhs.uk/ourwork/innovation/nia/case-studies/maryanne-mariyaselvam/
7. http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2443424&resultclick=1
8. http://www.mdedge.com/ehospitalistnews/article/52520/imaging/use-ultrasound-expands-across-surgical-specialties
9. https://www.ncbi.nlm.nih.gov/pubmed/12464591
10. http://www.apicareonline.com/another-use-of-ultrasound-by-the-anesthetist/
11.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002788.pub3/abstract;jsessionid=04C3BED1767E166599F60556278A8D5D.f03t03
12. https://www.acep.org/Physician-Resources/Clinical/Thoracic-Respiratory/Rocuronium-vs--Succinylcholine--Which-Is-Best-/

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