Pulse
Warmer Welcome
Your patient will thank you for warming up that local anesthetic before injecting it. Why? The injection will hurt less. So concluded researchers from the University of Toronto, who recently studied the issue.
The researchers looked at 18 studies involving more than 800 patients and found warming an anesthetic prior to injecting it consistently reduced patients’ pain, regardless of whether the anesthetic had been buffered or not, whether the shot was administered subcutaneously or intradermally, or whether the amount of anesthetic was large or small.
The authors did not recommend the best way to warm an anesthetic. But they listed using a baby food warmer, a warming tray, and water baths among the methods used in the studies they analyzed. The study was published in the February 11, 2011, issue of the Annals of Emergency Medicine.
Doctors Only
A 1996 survey published in the American Association of Nurse Anesthetists Journal found that nurses administer anesthesia in 107 countries around the world, including the United States. The United Kingdom is an exception. That’s because case law from the 19th century established that only physicians could administer anesthesia there. The other Commonwealth jurisdictions followed this precedent. Thus, in Canada, Australia, New Zealand, and Hong Kong, anesthetics are administered only by physicians. Japan follows a similar practice.
Sources: McAuliffe MS, Henry B. Countries where anesthesia is administered by nurses, AANA J. 1996;64(5):469-79.
The Next Little Thing
The pulse oximeter is a standard tool for anesthesiologists in wealthy countries. But it’s a rarity in other parts of the world. An article last year in The Lancet called attention to the fact that between 60 and 70 percent of operating rooms in Sub-Saharan Africa do not have the devices, which are credited with dramatically reducing anesthesia mortality. In the United States and England, for example, the rate is now one in 185,000; it remains as high as one in 133 in the world’s poorest countries.
An effort known as the Lifebox project is attempting to make pulse oximeters more widely available. Its organizers, including noted writer and surgeon Atul Gawande, M.D., challenged manufacturers to come up with a pulse oximeter that was cheap (less than $250), met International Organization for Standardization requirements, and could be used in settings with few resources. A Taiwan company’s model was selected, and 2,000 of its pulse oximeters have been purchased for delivery to various countries this year. The group’s ultimate goal is to deliver 70,000.
Anesthesia Contributes to Climate Change
Anesthesia has an effect on the earth’s atmosphere each year similar to that of CO2 emissions from a coal plant or a million cars, according to research published in the online version of the British Journal of Anaesthesia last October.
Researchers detailed properties of gases commonly used in anesthesia to calculate their effect on global warming. Three—isoflurane, desflurane, and sevoflurane—were found to have climate-changing potential.
The worst offender was desflurane, which is used in inhaled general anesthesia. The effect of each pound that enters the atmosphere is equal to that of 1,620 lbs. of carbon dioxide. The other two gases had much less impact.
Source: Sulbaek Andersen MP, Sander SP, Nielsen OJ, Wagner DS, Sanford TJ, Wallington TJ. Inhalation anaesethics and climate change. British J Anaesthesia. Published online October 8, 2010.