International Anesthesia Research Society Research Articles

Abstracts of Posters Accepted to the International Anesthesia Research Society 2020 Annual Meeting

Abstracts of Posters Accepted to the International Anesthesia Research Society 2020 Annual Meeting

A Guide for Submitting a Manuscript That Is Aligned With the Mission of A&A Practice.

Anesthesia & Analgesia (A&A) Practice is a journal for clinicians worldwide. It is aligned with the educational mission of its parent organization, the International Anesthesia Research Society. A&A Practice is an online-only companion journal of A&A. A&A Practice seeks to publish short yet informative, peer-reviewed, PubMed indexed articles that offer a solution to a perioperative care or patient safety conundrum or a health management issue, which is communicated as one of the several manuscript types. We herein provide authors with a guide to assist them toward a successfully published manuscript in A&A Practice.

Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries.

Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.

Abstracts of Posters presented at the International Anesthesia Research Society 2019 Annual Meeting and International Science Symposium

Abstracts of Posters presented at the International Anesthesia Research Society 2019 Annual Meeting and International Science Symposium

Editorial introductions

Editorial introductions

Michigan Medicine: The University of Michigan Head and Neck Anesthesiology and Advanced Airway Management Fellowship

Michigan Medicine: The University of Michigan Head and Neck Anesthesiology and Advanced Airway Management Fellowship

Anesthetic Exposure and Neurodevelopmental Outcomes in the Neonate

With ongoing advances in cardiorespiratory monitoring and improved anesthetic techniques, preterm and full-term infants routinely undergo successful surgical procedures under general anesthesia to repair congenital defects that were considered lethal in the past. Recent studies in immature animals exposed to anesthetics and sedative agents, however, have demonstrated clear evidence of neurotoxicity and deficits in learning that do not occur in older animals with the same exposure. Initial epidemiologic studies in humans also raised concern when it was found that children exposed to multiple anesthetics before age 4 years were more likely to demonstrate subsequent behavioral and learning deficits. Moreover, several recent case reports have highlighted concerns about the potential negative effects of intraoperative hypotension and hypocapnia on neonates undergoing anesthesia. Since 2009, the US Food and Drug Administration has been working collaboratively with the International Anesthesia Research Society in a public-private partnership called SmartTots to design and fund research to investigate these concerns. This review outlines the most recent evidence from both animal and human studies about the effects of anesthetic and sedative drugs and anesthetic-related hemodynamic changes on the developing newborn brain.

Progress to publication of survey research presented at anesthesiology society meetings.

Understanding how survey methodology and quality measures are associated with progress from abstract presentation to manuscript publication can help optimize the design of survey research in anesthesiology, and enhance respondents' confidence in the value of survey participation. The aim of this study was to determine if adherence to survey method recommendations and attainment of high response rates are associated with faster progress to publication among abstracts initially presented at anesthesiology society meetings. Abstracts from the American Society of Anesthesiologists' (ASA) Annual Meeting, Association of Anaesthetists of Great Britain and Ireland (AAGBI) Annual Congress, and the International Anesthesia Research Society (IARS) Annual Meeting from 2011-2014 were reviewed. Abstracts reporting original survey data collection were included in a systematic search for resulting publications in peer-reviewed academic journals. Cox proportional hazards regression was used to analyze progress to publication. Ninety-nine ASA, 76 AAGBI, and 30 IARS abstracts met inclusion criteria. Among these abstracts, 43 (43%) from ASA, none from AAGBI, and 7 (23%) from IARS have been published as original research articles or brief reports. Surveying patients or caregivers, as opposed to medical professionals, was associated with increased likelihood of publication (hazard ratio [HR] = 4.4, 95% confidence interval [CI]: 1.6, 12.4, P=0.005) as was a larger sample size (eg, >500 vs <100; HR = 12.9, 95% CI: 3.8, 43.6, P<0.001). While abstract presentation facilitates rapid dissemination of survey research findings, the impact and utility of such studies may be limited until a full manuscript is published. In our review, 25% of abstracts presenting survey data at major anesthesiology meetings were eventually published. Larger sample sizes and a target population of patients or caregivers increased the likelihood of survey research being published in full form.

SmartTots Update Regarding Anesthetic Neurotoxicity in the Developing Brain.

SmartTots (http://smarttots.org/) represents a public-private partnership between the International Anesthesia Research Society and the US Food and Drug Administration. Over the past 7 years, SmartTots has worked in collaboration with various stakeholders to determine whether anesthetic drugs have detrimental effects on the developing brain. SmartTots has funded clinical and preclinical studies, organized meetings, served as a repository of peer-reviewed information, and facilitated the development of consensus-based statements. Here, we report advances in the field of anesthetic neurotoxicity and provide an update on SmartTots' activities. Clinical studies have provided some reassurance that a brief exposure to anesthetic drugs does not cause overt, persistent cognitive deficits. New recommendations aim to increase the reproducibility and "clinical relevance" of data from studies of laboratory animals. Overall, the field has advanced substantially; however, it remains paramount to definitively resolve whether anesthetic drugs are neurotoxic to the immature brain. The results of SmartTots efforts will either ally unwarranted fears or substantially change pediatric anesthetic practice and prompt studies to identify neuroprotective strategies.

The Role of the WFSA in Reaching the Goals of the Lancet Commission on Global Surgery.

The Role of the WFSA in Reaching the Goals of the Lancet Commission on Global Surgery.

Abstracts of Posters presented at the International Anesthesia Research Society 2018 Annual Meeting and International Science Symposium

Abstracts of Posters presented at the International Anesthesia Research Society 2018 Annual Meeting and International Science Symposium

Editorial introductions

Editorial introductions

The FDA Warning on Anesthesia Drugs.

The FDA Warning on Anesthesia Drugs.

Abstracts of Posters Presented at the 2017 International Anesthesia Research Society Annual Meeting and International Science Symposium, May 6-9, 2017

Abstracts of Posters Presented at the 2017 International Anesthesia Research Society Annual Meeting and International Science Symposium, May 6-9, 2017

Dexmedetomidine and propofol differentially alter human immune cell metabolism

IntroductionProlonged treatment with sedatives such as dexmedetomidine or propofol is common in the critically ill patient, yet their differential impact on immune cell metabolism, specifically, on mitochondrial function, remains to be elucidated. Here we hypothesize that propofol and dexmedetomidine differentially impact human immune cell mitochondrial function.Material and MethodsBlood was drawn from healthy male and female human donors and peripheral blood mononuclear cells (PBMCs) were isolated and treated with dexmedetomidine and propofol at concentrations achieved in human plasma. Intralipid was used as the control for propofol. Metabolic function (mitochondrial stress and glycolysis) was assessed using the Seahorse XF analyzer.ResultsCells treated with dexmedetomidine showed decreased maximal respiration, reserve capacity, increased non‐mitochondrial respiration, and overall decreased mitochondrial health as determined by an overall decreased respiratory control ratio (RCR) compared to buffer control in a dose dependent manner. Propofol decreased basal respiration, ATP‐linked respiration, reserve capacity, and non‐mitochondrial respiration dose dependently when compared to intralipid control. Glycolysis assay revealed that propofol treated cells had an increased glycolytic rate with glucose treatment compared to intralipid control and this rate could not be further increased upon addition of Oligomycin A, suggesting a potential glycolytic compensation.ConclusionHuman immune cell mitochondrial function is significantly and differentially altered by commonly used clinical sedatives. The phenomenon of “immune cell paralysis” has been shown to be associated with increased mortality in septic patients that are commonly treated with sedatives. Mitochondrial function has been tied to immune cell fate and our finding may therefore pose a relevant consideration when treating patients in the intensive care unit.Support or Funding InformationAngela Meier is supported by the Mentored Research Award of the International Anesthesia Research Society. Furthermore this research was supported by funds from the UCSD Department of Anesthesiology.

Case reports: Should we do away with them?

Study objectiveThere has been a gradual decline in the number of case reports published in leading medical journals in recent years. Since case reports are not highly cited they have an adverse effect on the journal impact factor. On the other hand sharing new experiences, challenges, or discoveries with colleagues is essential for medical community. Should case reports be eliminated from the journals or published only in journals devoted to case reports? DesignObservational study. SettingWeb of Science database was searched, between 2005 and 2009, with terms: “anesthesia”, “anesthesiology” and “case report” yielding 25 969, 9532, and 661 publications, respectively. Since some reports contained large number of cases, only those involving up to three cases (n = 425) were evaluated by the authors with respect to their type, contribution to knowledge and/or practice (Likert scale) and times they were cited. Main resultsDistribution of answers to the statement “Case has added to my knowledge and/or improved my practice” was; 3% (strongly disagree), 10.5% (disagree), 33.2% (neither agree nor disagree), 39.3% (agree) and 13.7% (strongly agree). Average citations per item was 4.43 (1883/425), 7.32 (4838/661), and 7.82 (74 529/9532). As to the types of the reports; 50% unexpected event in the course of anesthesia, 31% unusual and instructive cases, 9.6% novel/unique anesthetic techniques, 6% novel use of equipment, 1.6% new information on diseases of importance to anesthesiology and 1% scientific observations. ConclusionCase reports have been an important source of clinical guidance and scientific insight, and play an important role in medical education. They can be published quickly, providing publication opportunity for juniors and for clinicians who may not have the time or finance to conduct large-scale research. On the other hand some argue, that case reports are irrelevant in current medical practice and education, being at the bottom of the hierarchical ladder of medical evidence. We conclude that case reports should not be done away with but be published in websites and journals like the venue to be launched in 2013 by the International Anesthesia Research Society, devoted entirely to them to meet the need for the publication of interesting cases.

Avoid extended anesthesia if possible in young children and pregnant women

Janet Woodcock, director of the Food and Drug Administration's Center for Drug Evaluation and Research, has issued new safety information on anesthesia use in young children and pregnant women. On Dec. 14, 2016, she issued a Drug Safety Communication (http://www.fda.gov/Drugs/DrugSafety/ucm532356.htm) to inform health care providers, parents, and caregivers of children younger than three years, and pregnant women in their third trimester, that the repeated or lengthy (more than three hours) use of general anesthetic and sedation drugs may adversely affect children's developing brains. Woodcock wrote, “To better inform the public of the risks, we are requiring warnings to be added to the labels of these drugs. We recognize that in many cases these exposures may be medically necessary and these new data regarding the potential harms must be carefully weighed against the risk of not performing a specific medical procedure. In 2010, the FDA formed a partnership with the International Anesthesia Research Society (IARS) called SmartTots (Strategies for Mitigating Anesthesia‐Related neuroToxicity in Tots) (http://smarttots.org) to fund additional research to better understand the safe use of these drugs in young children and pregnant women.”

Abstracts of Posters presented at the 2016 Annual Meeting of the International Anesthesia Research Society San Francisco, California May 21-24, 2016

BACKGROUND: Prior data from the isolated forearm technique (IFT) following noxious stimuli suggest that the incidence of response to command may approach 40% under anesthesia 1,2 . We conducted an international, multicenter, pragmatic study of the IFT to establish the incidence of responsiveness following intubation in current practice (NCT02248623). Methods: Following IRB approval at six sites, 260 adult patients were recruited from six centers into a prospective observational cohort study of the IFT during induction of anesthesia . Univariate comparisons were made with Student’s t­test assuming equal variances, and Pearson’s χ2 test. Bivariate models were constructed using logistic regression . RESULTS: The incidence of IFT responsiveness following intubation was 4 .6% (12/260). Responders were younger than nonresponders ([mean±standard deviation] 39±17 vs . 51±16 years old; p=0 .009) and had a higher incidence of observer rated signs of distress (50% vs . 2 .4%; p=0 .027) with 5 out of 12 responders reporting pain through a second hand squeeze . No subject reported explicit recall of intraoperative events when questioned after surgery (n=253) . Depth of anesthesia monitoring values showed a wide range in both groups; however mean values were higher for responders before (53±19 vs . 42±14; p=0 .032) and after (55±24 vs . 43±16; p=0 .032) intubation . In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics prior to intubation reduced the odds of responding (OR 0 .2 (0 .1 - 0 .8); p=0 .022) following adjustment for age . CONCLUSIONS: An incidence rate of 4 .6% suggests that intraoperative connected consciousness may occur frequently but this rate is lower than predicted from previous studies . Larger studies are required to identify risk factors for, and long-term consequences of, IFT responsiveness. REFERENCES: 1 . Sanders RD, Tononi G, Laureys S, Sleigh JW . Unresponsiveness ≠ Unconsciousness Anesthesiology. 2012;116:946­959. 2 . Schneider G, Wagner K, Reeker W, Hanel F, Werner C, Kochs E. Bispectral Index (BIS) may not predict awareness reaction to intubation in surgical patients . J Neurosurg Anesthesiol . Jan 2002;14(1):7-11

Helium induces Caveolin Secretion and decreases Permeability in Human Umbilical Vein Endothelial Cells

Caveolins are structural proteins essential for the formation of caveolae, small lipid enriched membrane invaginations. Caveolins have been shown to be involved in anesthetic‐induced cardioprotection and play an important role in signal transduction in various cell types. The noble gas helium, a potent cardioprotectant, leads to decreased protein levels of caveolin‐1 and caveolin‐3 in mice hearts, whereas higher levels of these caveolins were found in the serum of mice. These data suggest that caveolins are secreted into the bloodstream after helium inhalation. As actin filaments are an integral part of the cytoskeleton and are located in close connection to caveolins in the plasma membrane we hypothesized that helium might affect the cytoskeleton and thereby induce secretion of caveolins. To investigate this hypothesis we used human umbilical vein endothelial cells (HUVEC), as the endothelium is considered the first target organ that gets in contact with circulating blood.HUVEC were isolated from fresh umbilical cords, pooled and grown upon a confluent monolayer in passage 3–5. Cells were exposed for 20 minutes to either helium (5% CO2, 25% O2, 70% He) or control gas (5% CO2, 25% O2, 70% N2) in a specialized gas chamber. Cells and supernatant were collected after 0 minutes, 2, 4, 6, 12 and 24 hours for Western blot analysis, RT‐PCR, immunofluorescence staining and permeability measurements.In the helium group, protein analysis showed a significantly lower expression of caveolin‐1 at 6 hours in cell lysate (13.35±1.30 in controls vs. 8.02±1.29 in helium treated cells, average light intensity (AVI), p&lt;0.05) and a higher expression in supernatant starting at 6h (1.42±0.25 in controls vs. 8.26±4.5 in helium treated cells, AVI, p&lt;0.05) Actin staining demonstrated a significant increase of the border/inner ratio of the filaments at 12 hours after helium exposure. Cell permeability measurement revealed a significantly lower flow‐through of FITC‐BSA at 6 (p&lt;0.05) and 12 hours (p&lt;0.05) in the helium group. RT‐PCR of Cav‐1 did not show significant differences.These findings suggest that caveolin‐1 is secreted after helium exposure in vitro and that the actin cytoskeleton filaments are regulated by helium. This mechanism might finally lead to a decreased permeability of the endothelium after helium inhalation.Support or Funding InformationThis project was in part funded by the IARS (International Anesthesia Research Society) and the SCA (Society of Cardiovascular Anesthesiologists).

Editorial introductions

Editorial introductions