Liem E, Lin C, Suleman M et al. Anesthetic requirement is increased in redheads. Anesthesiology. 2004;101(2):279-283.
This study is a randomized controlled trial that was conducted with the approval of the University of Louisville Human Studies Committee. The trial was supported by grants from the National Institutes of Health, the Joseph Drown Foundation, and the Commonwealth of Kentucky Research Challenge Trust Fund. No conflicts of interest were apparent, nor did the authors have any financial connection to the products used during testing. The purpose of this study was to determine if the amount of desflurane, an inhalational anesthetic, required to maintain a state of anesthesia is greater in redheads than in those with dark hair.
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After a laryngeal mask airway was inserted, sevoflurane was discontinued and anesthesia was maintained using desflurane. The initial desflurane concentration was randomly assigned and ranged between 4.5 and 7.5 end-tidal volume %. Following an equilibration period of 45 minutes, noxious electrical stimulation testing began. Intradermal needles inserted bilaterally into the anterior thighs were used to deliver electrical stimulation for 10 seconds at a time at an intensity of 100 Hz, 60-70 mA. This level of stimulation is not tolerated by unanesthetized patients, but is undetected by those under general anesthesia. Response to the stimulation was evaluated by an independent investigator who was chosen randomly out of a group of four investigators for each session. Investigators were brought into the room just before the stimulation commenced. A response was considered positive if a gross purposeful movement of the arms or legs occurred within the first minute after stimulation. While the investigators were not blinded to the hair color or skin complexion of the volunteers, they were blinded to both the initial desflurane concentration as well as the desflurane concentrations for the duration of the study. Depending on if the volunteer moved or did not move in response to the electrical stimulation, desflurane was increased or decreased by 0.5 …show more content…
Dual testing via spectrophotometry and single nucleotide polymorphism analysis ensured that the two hair colors were being accurately represented. Other patient characteristics were not of statistical significance and therefore did not limit the validity of the study. Subjects were recruited from Greater Louisville, Kentucky, an area with a population of over 1,000,000. This indicates a large pool of potential subjects and, therefore, a significant degree of genetic diversity. Unfortunately, however, using volunteers may have created some bias due to the personality type of those who are willing to volunteer for such an experiment. The effort taken to blind the independent investigators was an additional strength of the study. Because investigators were chosen randomly out of a group of 4 for each session and the desflurane concentrations were unknown throughout the study, there was little room for bias. Last, the equilibration periods and movement of the stimulation needle indicated strong study design. Equilibration periods allowed for the desflurane to take it’s full effect before beginning electrical stimulation testing, while moving the needles prevented sensitization of the skin being stimulated. Both measures were critical to ensure that the data recorded was
Inadvertent perioperative hypothermia is a common anesthesia-related complication with reported prevalence ranging from 50% to 90%.(ref 3,4 of 4) The clinical consequences of perioperative hypothermia include tripling the risk of morbid myocardial outcomes and surgical wound infections, increased blood loss and transfusion requirements, and prolonged recovery and hospitalization.(ref 5)
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
It is not uncommon for a patient to experience pain and anxiety before or after a major procedure or breathing treatment. Imagining the myriad of complications that might occur during an operation can send one into multiple panic attacks. Coping with the loss of mobility and independence joined by the pain that accompanies recovery are only a few examples of the complex and traumatic experiences awaiting pre/post-operation patients. Fortunately, a medication was synthesized by Armin Walser and Rodney I. Fryer in 1975 to aid patients by easing anxiety and promoting sleepiness before an operation. An added benefit was that the events experienced during the operation were also forgotten while the medication was still in effect.
Breathing is the most important AL (Roper et al, 1998). A detailed assessment of her airway would be performed because protection of the airway throughout anaesthesia is essential (Yates, 2000). This does not just include recording of respiration rate and oxygen saturation (SpO2) but also noting any use of accessory muscles, shortness of breath, auscultation of chest and lungs areas for wheezes/crackles and asking patient about history of any respiratory illness/smoking (McArthur-Rouse, 2007).
The gene mutation responsible for ginger hair was discovered in 1995, but this research did not leave any significant impact and future research based on this discovery was dedicated to exploring other differences in genetic constitution between redheads and people with other hair colour (Johansen, 2005). For example, it is established that red hair is the first phenotype linked to pain tolerance (Knight, 2002). Research by Edwin Liem, Teresa Joiner, Kentaro Tsueda, and Daniel Sessler (2005) proved that redheads are more sensitive to thermal pain than women with dark hair, and the results have confirmed previous studies regarding redhead resistance to anaesthetics. There were several limitations to this study, including possible bias from the investigators and subjective responses from participants, but Liem, Joiner, Tsueda, and Sessler (2005) have reached the desired conclusion because they did not consider these limita...
...ure anesthesia, auricular needling is often used. By stimulating sensory receptors at auricular points, signals inputted into the body are transmitted through the trigeminal lemniscuses instead of the spinal cord. There were studies demonstrated anterior and posterior portions of the nucleus of spinal tract of trigeminal nerve had similar feedback effects to the gate system in the posterior horn of spinal cord, which could be used to modulate transmissions of pain impulses. This might be able to explain why auricular acupuncture has analgesia effects on surgical or painful irritation on the head and face. However, anesthesia effects of auricular acupuncture during thoracic and abdominal surgeries cannot be explained by any hypotheses about the gate control occurring at either posterior horns of the spinal cord or the nucleus of spinal tract of trigeminal nerve [27].
Volles, D. F. (2011, April 11). University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures. Retrieved May 12, 2011, from University of Virgina Health System: University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures
Race can be used as a way to link a person to their ancestry, which can lead doctors to critical information that can give their patient the best treatment they can. With all of the advances in medicine there is still no way to determine a patient’s specific genetics and be able to treat each person with respect to their unique genes. Doctors narrow down possible risk factors and medication interactions by categorizing patients, by gender, age, and race. Race is a general way f...
The gold standard for a clinical trial design is the inclusion of a control. A control could be a placebo, active or no treatment. Clinicians use controls in order to give more power for their studies. A placebo control is a vehicle without the active ingredient. The main purpose of using a placebo in clinical trials is to differentiate the background noise from the actual effect of the treatment drug. Regulatory agencies prefer or favor trials that use controls such as placebo since the data obtained will be clear and non-ambiguous [1].
2) “It’s difficult to determine who provides anesthesia care in the studies and the number of cases that actually involved a physician anesthesiologist (p. 11)” the ASA is claiming that the data collected and used in this review, are difficult to determine who did what and when. In other words it is unclear as to who was performing and providing care in these studies and very well could be, the care provided by an anesthesiologist. They say also that the data provided and used by the study has limiting factors to determine whether an anesthesiologist was available as needed, for rescue or advice by a patient being treated by a nurse anesthetist if they were to experience complications under the
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
Another very important woman in history for Certified Registered Nurse Anesthetists was Alice Magaw. Her achievements opened the doors to nurse anesthetists. She paved the road for innovation and helped evolve the nurse’s role in anesthesia. Although she had many achievements, her chief accomplishment was her mastery of the open-drop inhalation anesthesia technique that used chloroform and ether as the sedative. For this great achievement she was given th...
Reinarman, Craig and Peter D. A. Cohen and Hendrien L. Kaal. “The Limited Relevance of Drug
There are some key distinctions between Randomized Controlled Trials (RCT) in a psychotherapeutic context and a medical context. There are key differences between the design of an RCT to evaluate a new drug and an RCT to evaluate a new form of couples’ therapy. However, it is important to begin by defining and understanding the importance of RCT in research (O'Brien, 2013).
...rocess and is cost effective for many patients. It has also generated a positive impact on patient’s comfort and convenience. Yet still, the selection of an optimal modality remains amongst the scientific and medical communities. Further research and clinical trials to support these positive effects on wound healing may help generate that consensus and help ES therapy gain full support in the US. In reviewing the above studies the evidence of the numerous beneficial effects ES therapy has are clear, however, the evidence that the lack of consensus on standardization of parameters to devise systematic protocols for its use and the lack of uniformity in reports on ES dosages, application modes and waveforms is also clear. Further research trials are needed in order to prove the effectiveness and benefits of electrical stimulation therapy as it relates to wound healing