Archive for July, 2011

Panel Studies Potential Health Risks of Anesthesia Use in Young Children

17 Jul

Few months back, an FDA advisory panel met regarding a very important topic: whether or not anesthesia poses cognitive and learning disability risks when used in young children. Since this involves millions of medical procedures, the importance of this topic is pretty obvious.

There have been a number of animal studies on the subject which have led to this meeting. According to Dr. Bob Rappaport, the Food and Drug Administration’s director of the division of anesthesia and analgesia products, these studies have suggested that there may be a correlation between anesthesia exposure and brain cell death or learning problems.

The FDA panel will evaluate this research, consider what further research may be needed, and decide what if anything parents should be presented if their children will be going into surgery.

“How do we communicate what we do know at this point without causing undue concern in parents and in physicians?", asked Dr. Rappaport.

Taking a look at the animal studies more closely, rodents and monkeys that were exposed to anesthesia at an age that is roughly equivalent to children under the age of four experienced brain cell death. An additional study, one done by the FDA, found that exposing newborn rhesus monkeys to 24 hours of anesthesia resulted in poorer tests performances for memory, attention and learning.
"We don’t know what this means for children at this time," said Dr. Rappaport. "That's exactly why it’s so critical that we get all of the necessary information."

It’s difficult to do similar controlled studies with children, so when examining humans, experts look to children who have learning disabilities and trace back to see if they had anesthesia when they were younger. However, this method is not considered very reliable.

In the absence of absolutely certain evidence, ultimately the dilemma is this: most young children who are being given anesthesia absolutely need the surgery performed on them. So, what do you do?

“What we know is that not giving anesthesia and appropriate medication to manage a child’s pain during surgery does have long-term adverse affects on a child – physical as well as emotional,” said Dr. Jayant Deshpande, another committee member, pediatrician and anesthesiologist who is a senior vice president at Arkansas Children’s Hospital. “So because the child needs surgery today, we are going to use the best information that we have and use the anesthetics.”

Most of the studies so far the studies have involved the common anesthetic, ketamine. Some of the questions experts still have involve dose, age or length of exposure, and how each may relate to the risks.


Electronic Prescriptions on the Rise

05 Jul

An electronic prescription is any sent by computer to the pharmacy of choice. Federal programs offer incentives to physicians to file prescriptions electronically. So why is it that only 36 percent of doctors do so?

Sometimes progress can be slow, but there is and upward trend. That move upwards is being attributed to incentives offered by two federal programs that give physicians rewards for using the technology.

According to an annual report by Surescripts, which operates the nation's largest e-prescription network, about 50 percent of the physicians who take advantage of prescribing medications electronically are cardiovascular specialists, family physicians, or internists.

By the end of 2010, 190,000 physicians were e-prescribing medications. But if you include nurse practitioners and physician assistants that number jumps to 234,000, which is up from 156,000 in the previous year.

While it's estimated that only 36 percent of all doctors do electronic prescriptions it is promising to note that from 2009 to 2010 it increased by nearly 70 percent. One reason the increase isn't even higher is that controlled substances were not allowed to be transmitted electronically until the middle of 2010.

Rewards and Penalties

The federal government is offering incentives for doctors to switch over to the e-prescription model because it has cost-saving benefits similar to any electronic health records. They are more efficient, reduce healthcare costs, and increase patient safety through more accurate transcriptions and communications.

These incentives appear to be working and are in part responsible for the significant increase in e-prescriptions. Under the Medicare Improvements for Patients and Providers Act, a law passed in 2009, doctors can receive a two percent Medicare bonus in 2010 if they e-prescribed using approved software. That bonus decreases by one percent in the next two years (2011 and 2012) then drops to 0.5 percent in 2013 and then no longer exists by 2014.

There are potential penalties as well. For 2012, doctors who do not report at least 10 electronic prescriptions in the first six months of 2011 on their Medicare claims, will receive a one percent pay cut.

Another significant incentive was introduced in the 2009 the legislation entitled the American Recovery and Reinvestment Act. It authorizes up to $44,000 under Medicare over five years and nearly $64,000 under Medicare over six years for physicians who show “meaningful use” of an electronic health record system, which includes using e-prescriptions.


Less Anesthesia Needed Through Catheter

05 Jul

According to a study presented at the 2011 annual meeting of the Society of Obstetric Anesthesia and Perinatology, women who undergo a cesarean section  may only need half of the anesthesia dosage that is currently being administered if they are given and intrathecal catheter instead of a single spinal injection.

Among the sample of 10 patients who were given an intrathecal catheter, on average they only needed 0.6 and 1.1 mL of 0.75% hyperbaric bupivacaine to experience a T4 to T6 block, an amount which is 25-50 percent less than the published notices the same medication delivered in a single spinal injection.

The study's author J. Sudharma Ranasinghe, MD, associate professor of anesthesiology at the University of Miami Miller School of Medicine, recommended that clinicians opting for intrathecal catheters use slow, incremental dosing to ensure patients don't receive excessive anesthesia.

"If an adequate block can be achieved with less local anesthetic, bolus injection of a spinal medication that was intended for single-shot spinal through a spinal catheter may lead to high spinal block with respiratory difficulty, aspiration risk and severe hypotension," said Dr. Ranasinghe.

David Wlody, MD, professor of clinical anesthesiology at the State University of New York-Downstate Medical Center, in New York City thinks that it's a good idea look further into these findings, but cautions that such a small sample size and the lack of the control group makes its premature to jump to any conclusions.