The desire to minimize costs, eliminate the use of pain-inducing methods and rising awareness of opioid addiction are some of the factors driving new technologies for anesthesia services.
“One of the agents that’s helped transform opioid-sparing efforts is administering acetaminophen intravenously,” said Garry Brydges, chief nurse anesthetist at Anderson Cancer Center in Houston, Texas. “We've only had it in the U.S. for about the last three to five years but it's been in use in Europe for well over a decade.”
Because opioid-sparing anesthesia is more costly, however, hospitals are reluctant to incorporate newer methods or agents that can add $30 to $100 per dose to a hospital budget.
"The direct cost of a drug or piece of equipment is completely the wrong way to look at anesthesia care,” Brydges said. “Instead, we need to be translating cost into outcomes.”
Although acetaminophen administered intravenously is more effective than opioids, it has been limited to hospital access with administration by pharmacies within the hospital because it's perceived as too expensive. “We must look at the cost of outcomes like post-operative nausea and vomiting, urinary retention, shortened length of stays and 30-day readmission rates,” said Brydges who is also president elect with the American Association of Nurse Anesthetists. “These have economic consequences that far exceed 2 or 3 doses of intravenous acetaminophen.”
One significant development since the pulse oximeter, which measures oxygen saturation in the blood, is cerebral oximetry.
“[The cerebral oximetry] is a pulse oximeter for measuring oxygenation of the brain, which is non-invasive and important for tracking post-operative cognitive dysfunction,” Brydges said.
Post-operative cognitive dysfunction has been on the rise over the past ten years and providers of anesthesia are not sure why it’s occurring in such record rates in certain segments of the patient population.
The concern has resulted in the development of goal direct therapy, which targets optimizing a patient’s fluid status.
“Because newer technologies are more dynamic, we’re able to look at trends over time,” said Brydges. “One of those areas is as basic as fluid management because there are consequences when over-administering fluid.”
LIDCO is one of the newer non-invasive technologies that practitioners are employing along with Enhanced Recovery After Surgery (ERAS).
“We're starting to see the industry consolidate their products into a one-device for the end-user anesthesia provider,” Brydges said. “We are being pushed to do a better job at lowering pain, which means higher quality medical care at a lower cost of healthcare delivery.”
Another emerging technology replacing opioid anesthesia is ultrasound for regional anesthesia and regional anesthesia using ultrasound.
"Regional anesthesia is transforming our industry from a practice perspective because opioids create profound inflammation, which is what we're trying to avoid or minimize with any anesthetic and surgical intervention," said Brydges.
The latest models of ultrasound machines allow medical professionals to place newer forms of regional anesthesia in targeted areas now more than ever.
“Ultrasound machines offer extreme clarity and precision,” Brydges said. “Patients are enabled to get up and walk earlier, which minimizes their length of stay in the hospital.”
Although artificial intelligence (AI) isn’t expected to replace anesthesia providers, it is a rising component of anesthesia services that will augment the tracking of medical records, such as prescriptions, how they interact and patient adverse responses.
“There are some medications that shouldn't be administered with anesthesia and AI will be helpful in screening out those cases, providing us with an enhanced safety net,” Brydges said.
AI will likely be incorporated in the near future in the areas of electronic health records, treatment protocol and in monitoring equipment, such as brain wave monitoring.
“AI is useful for evaluating algorithms and giving anesthesia professionals more information so that we can provide individualized care to the patient as to how they're specifically responding,” said Brydges. “We're already seeing AI technology in hemodynamic monitors for goal-directed fluid therapy. AI will give us better real-time analytics of the trends, and guidance in clinical decision making.”
Discoveries in the future are expected to optimize anesthesia delivery capability so that it’s safer, more cost effective, and less invasive.
“The less sticking, poking and prodding on the patient we can do, the better because it avoids the risk associated with more invasive devices such as threading catheters into the heart,” Brydges said.