Mark Warner |
An increase in high-risk obstetric and pediatric surgical procedures associated with a predicted spurt in immigration, together with stepped-up demand for surgical care from aging baby boomers, point to a dramatic rise in surgeries requiring general anesthesia in the years ahead. But technologies on the horizon may dramatically reduce the number of procedures that otherwise would require anesthesia services, as well as reduce patient trauma and perioperative complications, according to Mark A. Warner, MD. Warner, an anesthesiology professor at the Mayo Clinic College of Medicine, dean of the Mayo School of Graduate Medical Education and chair of the American Society of Anesthesiologists' Section on Education and Research, presented an overview of technologies that hold the potential of dramatically affecting perioperative practice during the Executive Symposium on Surgical Patient Safety July 15-17 in Beaver Creek, Colo.
Current projections point toward a more than doubling of the number of surgical procedures requiring anesthesia by the year 2040, Warner said—a level of demand growth that can't possibly be met with current perioperative processes. Warner sees an array of advances in minimally invasive or noninvasive treatment procedures and deployment of new technologies coming to the rescue of the U.S. healthcare system.
They include:
- The use of nanocrystals and "nanocontainers" that theoretically could trap and retain heat, oxygen or carbon dioxide and transport them without harm through a patient's vascular system, releasing them when and where needed. Such nanotransport containers also might be used to transport drugs that can be released in response to specific biochemical signals, such as from tumors or coronary disease-associated inflammatory markers, Warner noted.
- Procedural improvements, including patient-tailored therapies, that will reduce tissue trauma and analgesia requirements, boost the effectiveness of medications and enable surgeons and perioperative staff to anticipate complications before they arise. As examples, Warned noted that advances in ongoing clinical trials eventually could enable identification of patients who metabolize the pain reliever codeine poorly or metabolize it and break it down into morphine far faster than average. Similarly, identifying patients whose responses to anticoagulants, antiemetics and other medications fall outside the normal range would reduce harmful complications dramatically.
- Improved perioperative monitoring systems, providing complete continuous assessments of patients' breathing, oxygenation and hemodynamics, will enable identification of trends and early recognition of such complications as sepsis, acute respiratory distress syndrome and pulmonary embolisms.
- As electronic medical record systems are fully implemented, it will pave the way for advanced bed-side electronic systems that will provide practitioners with pertinent treatment algorithms, identify expertise resources and point them to educational references.
- Improved imaging/tracking and radiation technologies, such as proton-radiation therapy, intensity-modulated radiation therapy and, on the horizon, heavy particle radiation, will enable clinicians to hit tumor tissue with concentrated radiation doses that don't leak outside to cause collateral damage to healthy tissues.
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