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American Society of Anesthesiologists, Oct. 19-23

ANESTHESIOLOGY 2019

The annual meeting of the American Society of Anesthesiologists was held from Oct. 19 to 23 in Orlando, Florida, and attracted approximately 15,000 participants from around the world, including anesthesiologists and other health care professionals. The conference featured presentations focusing on the latest advances in the relief of pain and total care of surgical patients prior to, during, and after surgery.

In one study, Ghislaine Echevarria, M.D., of the New York University School of Medicine in New York City, and colleagues emphasized the importance of screening women for iron deficiency early in their pregnancy so that treatment may be started before the delivery date. The investigators found that this early screening would result in fewer postpartum blood transfusions in women undergoing cesarean sections and improve patient outcomes and hospital experiences. There would also be a cost-saving benefit for health care systems.

“We know that in the United States, from 1999 to 2006, iron deficiency was present in 25 percent of pregnant women. Following the United States Preventive Services Task Force, most institutions, including ours, only screened for iron deficiency in patients at a high risk for developing anemia (i.e., diabetics, vegetarians, inflammatory bowel disease, etc.) or patients identified as anemic at their first prenatal visit,” Echevarria said. “Based on published evidence and our own results, perhaps we should screen all pregnant women for iron deficiency at their first prenatal visit. In this way, we would be able to prescribe iron replacement, a safe treatment that is potentially beneficial to both the mother and the fetus.”

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In another study, Mark Zakowski, M.D., of Cedars-Sinai Medical Center in Los Angeles, and colleagues found that 30 percent of women in California have a positive attitude toward cannabidiol (CBD) use in pregnancy, making them more likely to use it.

“However, only 9 percent of women thought alcohol was safe to use during pregnancy,” Zakowski said. “This positive attitude toward CBD use in pregnancy in California may stem from the legalization or decriminalization of marijuana in the United States.”

The investigators surveyed physician anesthesiologists, women of child bearing age, doulas, and midwives about CBD, alcohol, and marijuana use during pregnancy.

“Among those surveyed, 30 percent of women have a positive attitude toward the use of CBD for the treatment of nausea, pain and/or anxiety during pregnancy and labor. The problem is that over-the-counter CBD products have little governmental regulation. The product may say a certain strength and may have more or less CBD and it may have tetrahydrocannabinol in it or other harmful contaminants like pesticides,” Zakowski said. “There is not enough hard science for marijuana due to its classification from the U.S. Food and Drug Administration. We need to learn more about marijuana, and CBD specifically, to determine whether it really works for anxiety, pain and/or nausea. There are studies starting to come out. Just using CBD without scientific studies to support it [is risky, as] no one really understands the impact on a pregnant woman and their fetus in the short or long term.”

Zakowski added that it is important for anesthesiologists to ask about CBD use, and patients should mention that they use CBD products and other herbal supplements.

“A lot of people skip citing the herbal supplements they are taking and some herbals may have an anticoagulant effect or interact with other medications, including anesthetics,” Zakowski said.

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Mario Moric, of the Rush University Medical Center in Chicago, and colleagues found that it is not only the quantity of the painful stimulus that is important with blood draws but more so the courtesy with which the patient is handled.

“The relationship between pain and number of blood draws was significant but not particularly strong, but when we included the courtesy question, we saw a very large effect for courtesy and lesser effect for number of blood draws. For courtesy, there was a 390 percent increase in pain control satisfaction for those patients who rate the blood draw staff as most courteous,” Moric said. “I feel that this once again speaks to the importance of bedside manner. Clinical staff performing route procedures may become depersonalized to their interactions and we need to be reminded that courtesy and kindness matter.”

In addition, Moric said that the Centers for Medicare & Medicaid Services has reimbursement incentives based on the Hospital Consumer Assessment of Healthcare Providers and Systems scores, so this may be another avenue through which improvements can be made.

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In another study, Moric and colleagues found that medical marijuana is an important tool in the reduction of opioid use and pain control for some, but it may be ineffective or even detrimental among certain patients.

The investigators found that overall, medical marijuana reduced both opioid use and opioid abuse as well as the perception of pain.

“Certain patient populations may see no reduction in opioid use and actually an increase in pain perception. It is possible these are patients with higher comorbidities and greater psychological and pain coping issues,” Moric said. “Additionally, side effects and quality control of medical marijuana are issues that need to be resolved. Further research is needed before a clear recommendation can be given.”

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ASA: Enhanced Recovery Program Cuts Opioid Use After Colorectal Surgery

TUESDAY, Oct. 22, 2019 — Colorectal surgery patients treated as part of an enhanced recovery after surgery (ERAS) program have less pain and use nearly half as many opioids as pre-ERAS patients, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 19 to 23 in Orlando, Florida.

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ASA: Opioid-Free Pediatric Tonsillectomy Feasible

TUESDAY, Oct. 22, 2019 — One-third of children undergoing tonsillectomies can do so without using opioids to manage pain, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 19 to 23 in Orlando, Florida.

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ASA: Unnecessary Opioids Often Prescribed After C-Section

MONDAY, Oct. 21, 2019 — Opioids are commonly not needed but are overprescribed at discharge among women who undergo cesarean deliveries (CDs), and provider education and new order sets can reduce use of oxycodone for post-CD pain management, according to two studies presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 19 to 23 in Orlando, Florida.

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Posted: October 2019


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