The last two decades could be considered the golden age for advances in anesthesiology, capped in October when the Anesthesia Quality Institute started the first nationwide system for the collection of data that includes individual problems from anesthesia in real cases.
Executive director and anesthesiologist Dr. Richard Dutton calls it an "early warning system" that will be especially useful when new devices or drugs are introduced. Despite dramatic improvements, the National Institute of General Medical Sciences says general anesthetics are still "among the most dangerous drugs used by doctors, particularly for elderly patients and those with certain chronic diseases."
Factors that can increase your risk of problems under general anesthesia include sleep apnea, smoking, obesity, high blood pressure, use of aspirin and other nonsteroidal anti-inflammatory drugs that can interfere with blood clotting, and some herbs that can cause bleeding, changes in blood pressure and affect anesthesia drugs.
That said, anesthesia-related deaths have decreased over the last 25 years from two per 10,000 anesthetics administered to one per 200,000 to 300,000. The American Society of Anesthesiologists says a person is more likely to be struck by lightning than die from anesthesia-related complications.
The reasons? Today, anesthesiologists use different intravenous drugs to achieve sedation, unconsciousness, pain prevention and amnesia, and carefully control them to meet each patient's needs, which increases safety. Modern drugs also result in fewer side effects such as nausea. The dosage is dependent on age, sex, weight and the health of the patient, Dutton says. In some complicated cases, a drug will paralyze the patient to prevent movement because even small twitches can cause surgical errors. To maintain the anesthesia, there may be a continuous infusion of an intravenous drug or an inhaled gas.
"We have much-shorter-acting inhalation agents today," says Dr. W. Scott Jellish, chairman of anesthesiology at Loyola University Medical Center in Maywood. "Once turned off, they dissipate very quickly, so wake-up time is much better. And there are now very short-acting narcotics."
In addition, new devices and digital technology enable continuous monitoring of vital signs such as blood pressure, blood oxygen levels, heart rate and breathing patterns, adds Timothy R. Lubenow, an anesthesiologist at Rush University Medical Center. "We can monitor and measure vital signs almost on a beat-by-beat basis," he says, "and so, are ready to take measures that are necessary to control a problem. Another big advance is the use of nerve blocks before anesthesia to control postoperative pain."
This is good news for Andrea Liedtke, of Wheaton, who says she was "scared witless," before being put under for the first time 20 years ago. "I was more scared about the anesthesia than I was about the procedure. You think you're going to go under and die." Education has made her much more comfortable with the idea of general anesthesia.
Lack of knowledge about anesthesia and the subsequent fear leads to 1 in 4 patients to put off surgery, according to an ASA report.
The lethal potential of general anesthetics grabbed headlines late last year when Dr. Conrad Murray received the maximum four-year sentence for involuntary manslaughter in Michael Jackson's 2009 overdose from propofol. He was convicted of injecting Jackson with propofol, a general anesthetic that should never be used outside a surgical setting, and then left him unattended at home.
Damian Newberger, of Glenview, has been put under nine times for operations that included a lung transplant 14 years ago that saved his life and a kidney transplant last October. Informed and curious, he studied what would happen step by step. When he had a question or a "demand," he spoke to his anesthesiologist at length until he had an answer, which eased any anxiety he had.
"Every surgery has its risks, and anesthesia may be the least of them." he says.
Ironically, with all the advances in anesthetic effectiveness and safety, researchers still don't know how they work. The prevailing theory is that the drugs target certain molecules in nerve cells, interfering with brain signals. Researchers also believe the different drugs target different molecules.
"To me, it's less important how they work and more important that they work and are safe," Liedtke says.Copyright © 2014, The Baltimore Sun