Anaesthetists play great role in society

By Nilma DOLE

In medical science, the role of an anaesthetist is much more than just putting a patient to sleep in preparation for an operation.

"An anaesthetist actually is involved in many aspects of medical care than just making a patient unconscious," said the President of the College of Anaesthesiologists of Sri Lanka and government medical consultant, Dr. Jayantha Jayasuriya.

CPR or cardio-pulmonary resuscitation

He said that more than just an anaesthetist, they also play a role as a peri-operative physician, an intensive care physician and a pain physician. Anaesthetists are highly specialised in the area of CPR or cardio-pulmonary resuscitation.

CPR involves BLS or Basic Life Support techniques and ALS or Advanced Life Support techniques.

"The public should be aware of BLS because it is a type of medical preparedness that can come in useful in an emergency. If a person is found collapsed, is unresponsive and not breathing, BLS can be started even by a member of the public who has been trained in BLS. It is important that BLS is started immediately because after three minutes the victim will suffer brain damage. One can come across such a person at the site of an accident, as a result of drowning or electrocution. Before approaching the patient to start BLS one must ensure that it is safe to approach the patient.

"At present, we conduct workshops and training for medical, para-medical, ambulance and fire service staff. Ideally this training should be provided to members of the public too because they would be the first on the scene in most situations," said Dr. Jayasuriya.

BLS encompasses the three golden rules of the ABCs' of emergency care. The 'A' is for 'Airway' which is the protection and maintenance of a clear passageway for oxygen. The 'B' stands for 'Breathing' . If the person is not breathing, mouth to mouth respiration or the "kiss of life" should be started. The 'C' is for 'Circulation' which is vital in ensuring that an adequate blood supply and oxygen supply to the body is maintained. This is done by cardiac or heart massage which should be done simultaneously.

A heart massage is an emergency procedure which is a rhythmic compression of the heart by pressing on the middle of the chest in a bid to maintain circulation during cardiac arrest.

Moreover, the role of an anaesthetist is often misunderstood and so people don't realise the value of their job and role in the medical profession.

"Anaesthetists or anesthesiologists are perioperative physicians ("peri-" meaning "all-around") who provide a total medical care solution to patients. This can be done before, during, and after surgical procedures.

Any medical problems the patient has is optimised before surgery to ensure that the patient is in the best possible condition to undergo the operation, the patient is looked after during surgery; pain and any other problems relating to breathing or fluids are managed after the surgery.

The anaesthetist is responsible for making sure that a patient is safe under anesthesia and that there are no complications. The vital signs like pulse rate, blood pressure, breathing, amount of oxygen in the blood, body temperature are closely monitored during the operation and afterwards until the patient has recovered from the effects of anaesthesia.

"This is why we ask patients before doing a surgery to tell us about their medical history, their past anaesthetic history, their family medical history and any allergies if they have, because it would be better to see if there are side effects that arise from administering anesthesia," said the doctor.

In addition to this, a preoperative medical evaluation of every patient before surgery is vital. and a proper consultation should be done with the surgical team.

Talking about some types of anaesthesia, Dr. Jayasuriya said, "Regional anaesthesia is an anaesthesia which affects only a part of the body, such as the part below the waist as in spinal or epidural anaesthesia or only a limb." The doctor said that local anaesthesia is anaesthesia of a small part of the body such as a tooth or an area of skin.

In operations such as Caesarian sections, spinal anaesthesia is administered and this is a form of regional anaesthesia involving injection of a local anaesthetic into the fluid surrounding the spinal cord.

In children where veins are difficult to find and in those who have needle-phobia, gas is used to make them go to sleep," he said.

Anaesthetists are also involved in the management of patients in intensive care units and in the management of acute and chronic pain.

In order to boost media awareness on BLS and becoming prepared to face medical emergencies better, the College of Anaesthesiologists will be having a stall at the MEDICARE 2011 where demonstrations on CPR will be shown.

The National Healthcare Exhibition will take place from March 4-6 at the BMICH.

Examined in medical journal:

Homicides using anaesthesia medications increase

A study published in March's issue of Anaesthesiology examines several homicides involving anaesthetic drugs and calls on anaesthesiologists to assist in the investigation and prosecution of criminals who divert and kill with these drugs.

The 2009 death of singer Michael Jackson from propofol, a widely used anaesthetic, along with the ruling that the death was a homicide, heightened the profile of this issue.

The article outlines the experiences of anesthesiologists in several investigations and prosecutions.

"The role of anaesthesiologist is that of a healer and defender of life", said Robert E. Johnstone, M.D., lead study investigator.

"Seeing the harm done to victims in these cases, several anesthesiologists have offered their expertise to help solve these crimes and bring the perpetrators to justice. This paper outlines the cases and these anaesthesiologists' experiences."

Dr. Johnstone also calls on anaesthesiologists to continue to work with healthcare providers and administrators to stop drug diversion.

About the study

The article reports on four homicides and one attempted homicide involving medications typically used during anesthesia such as rocuronium, succinylcholine, fentanyl, and pancuronium.

These are cases where anesthesiologists provided insight into the investigation and prosecutions.

"The person on trial in cases involving murder by muscle relaxants or anaesthetic drugs is often a healthcare worker, occasionally a physician," said Dr. Johnstone.

"The drugs used in four of the cases reported in this article came from hospitals. Drug diversion from operating rooms is a recognised problem, especially with the storage of such medications throughout hospitals, possibly making their diversion easier."

The Drug Enforcement Agency has not classified muscle relaxants or propofol as controlled substances, so they are not individually tracked in most hospitals.

(Source: American Society of Anesthesiologists)

Could compound used to block cholesterol also kill breast cancer?

A University of Missouri researcher believes there could be a new drug compound that could kill breast cancer cells. The compound might also help with controlling cholesterol.

Salman Hyder, the Zalk Endowed Professor in Tumor Angiogenesis and professor of biomedical sciences in the College of Veterinary Medicine and the Dalton Cardiovascular Research Centre, and his research team discovered that a small molecule, Ro 48-8071, initially developed for controlling cholesterol synthesis "dramatically destroys" human breast cancer cells. This development was discovered as Hyder's research team was investigating PRIMA-1, a drug that targets a common mutated gene in human breast cancer cells, and kills tumor cells.

During the course of the study, Xiaoquin Zou, an assistant professor in the MU Department of Physics and Astronomy, compared the chemistry of PRIMA-1 binding to thousands of proteins using a software program she developed called MDock. Hyder and Zou found that PRIMA-1 showed excellent binding properties to a protein called oxidosqualene cyclase, (OSC) that is known to be important for producing cholesterol. This led Hyder's team to investigate whether known OSC inhibitors, such as Ro 48-8071, developed to stop cholesterol production, also killed breast cancer cells.

"We had been working with PRIMA-1 for some time, and what we didn't quite understand is exactly how it killed tumor cells," Hyder said.

"With the current findings, we think it's possible that one mechanism utilized by PRIMA-1 to kill cancer cells may include shutting down cholesterol synthesis, but we still don't know for certain if that's the case. What we do know is that Ro 48-8071 does stop cholesterol synthesis, and it proved to be just as effective in destroying cancer cells as PRIMA-1, without harming other normal breast cells, which is a big advantage."

While there are still many studies to complete, including testing on humans, Hyder believes there are great possibilities in using Ro 48-8071 as a treatment for breast cancer.

Hyder gives equal credit to MU colleagues Xiaoquin Zou, Sam Grinter, graduate student in physics; Yayun Liang, assistant professor and Dalton researcher and Sheng-You Huang, research associate.

"This is a good example of interdisciplinary research, where colleagues with different expertise collaborated to find targets and verify their use for breast cancer therapy.

We couldn't have achieved this finding with each of us working on our own," Hyder said.

The study results are published in an article "An inverse docking approach for identifying new potential anti-cancer targets" in the February Journal of Molecular Graphics and Modelling.

(Source: Steven Adams University of Missouri-Columbia)

Steroids to treat asthma: how safe are they?

Children experiencing an asthma attack who are treated with a short burst of oral steroids may have a brief and transient depression of immune response according to a new study led by Universite de Montreal. These findings, published in this month's issue of Pediatric Allergy, Immunology and Pulmonology, have implications for asthmatic children who have flare-ups and who may be exposed to new contagious diseases.

"There is no question that the administration of corticosteroids reduces the risk and duration of hospital admission in children with acute asthma and remains the most effective treatment for moderate and severe asthma exacerbations," says first author Francine M. Ducharme, a Universite de Montreal professor and paediatrician and researcher at the Sainte-Justine University Hospital Research Centre. "However, the safety profile of these medications continues to raise concerns among parents and physicians. Concerns over their possible impact on the immune system stem from few rare reports linking or severe chickenpox infections linked with corticosteroid administration."

Ducharme and colleagues evaluated the immune response of children aged 3 to 17 years, who had arrived at the emergency department (ED) with an asthma attack.

All subjects were given immune triggers (known as antigens) and the immune response between those who received corticosteroids versus those who did not were compared.

"Several corticosteroid-treated children had a lower immune response, as measured by the amount of antibody produced, than non-treated kids," says Ducharme.

Reduced immunity only transient

Children enrolled in the study were revaccinated with the antigen five weeks following their initial ED visit.

Comparable immune responses were measured in children exposed to oral corticosteroids and not exposed to corticosteroids.

"These findings indicate there may be a very transient immune suppression only in some children exposed to a new antigen at the same time as a corticosteroid administration," says Ducharme.

"In summary, our findings suggest a very transient immune suppression occurs in some children who are concomitantly exposed to a new antigen and corticosteroids during an asthma attack, with a recovery within six weeks."

"Given the high frequency of use of these drugs over the past 20 years, the very rare occurrence of severe infectious disease is reassuring and would suggest that the window of risk is very small and only applies to exposure to a new antigen. However, before prescribing oral corticosteroids, it would appear prudent to systematically enquire about recent exposure to chickenpox in children who did not have chickenpox or the vaccine," adds Ducharme. Moreover, all children with asthma who have not had chickenpox should be vaccinated for this condition.

(Sources: Universite de Montreal, AlphaGalileo Foundation.)

Two drugs protect hearing better than one

Whether on a battlefield, in a factory or at a rock concert, noise-induced hearing loss is one of the most common hazards people face.

Researchers at Washington University School of Medicine in St. Louis have identified a low-dose, two-drug cocktail that reduces hearing loss in mice when given before they are exposed to loud noise. The drugs, already FDA-approved for other conditions, also treat hearing loss after noise exposure.

While both drugs are known to protect hearing on their own, this is the first study to test the two in combination.

"We found they have synergy," says Jianxin Bao, PhD, research associate professor of otolaryngology at the School of Medicine. "Two drugs at lower dosages can block more signaling pathways than one alone, improving results while reducing side effects. We got the idea from cancer and HIV studies that use multiple drugs at lower dosages."Bao presented the work Feb. 21 in Baltimore at a meeting of the Association for Research in Otolaryngology.

In earlier work, Bao's group found that anticonvulsant drugs for treating epilepsy helped protect hearing in mice after exposure to loud noise. And other groups had determined that glucocorticoids, anti-inflammatory drugs often used to treat allergies and asthma, were also protective.

The reasons these drugs reduce noise-induced hearing loss are not well understood. But anticonvulsants are known to block calcium channels in nerve cells, and Bao's group speculates that the drug helps protect neuronal connections between hair cells and auditory neurons. For this work, Bao and colleagues chose two drugs from the anti-epilepsy family and two from the glucocorticoid family.

"We picked drugs that have fewer side effects and that can be chronically used," says Bao, also associate professor of audiology and communication sciences.

Bao says their next step is to test the drugs in animals that model human hearing more closely.

Source: Washington University School of Medicine