Waking Up After Anesthesia
Derek Sakata, M.D., Director of Anesthesia at the John A. Moran Eye Hospital at the University of Utah in Salt Lake City, talks about a new device that makes anesthesia safer and more tolerable for patients.
What is the QED device?
Dr. Derek Sakata: The QED device came about because of the need to actually actively remove or reverse inhaled anesthetics. We found in our populations that coming out of the anesthesia was a big issue and that patients just were not feeling well -- they were groggy, they had tendencies not to breathe very well coming out of anesthesia. The ability to actually change the way we practice anesthesiology by actively removing inhaled anesthetics and countering those effects so that patients can do better out of anesthesia was the main premise to do this.
How does the QED device work?
Dr. Sakata: The nice thing about this device is it's a very simple device, but it intrinsically changes the way our inhaled anesthetics that keep patients asleep work. It is basically a filter that takes the anesthetic out. There's also a re-breathing hose so that a patient can actually re-breathe their oxygen and carbon dioxide to augment that drive to breathe and also augment the washout of the anesthetics out of the brain.
Do patients then exhale the anesthesia more quickly?
Dr. Sakata: That's correct. We can actually actively do that at the end of a case, whereas before we were not really able to do that just because of some of the physiologic parameters that we weren't able to do.
How widely used is the device?
Dr. Sakata: More than a hundred hospitals are using it. They're finding advantages for this for patients, especially for obstructive sleep apnea where patients aren't able to breathe as well coming out of anesthesia. That's been really the primary focus for most hospitals across the country to use this, is to be able to actually get this anesthetic out of patients who don't breathe very well after anesthesia.
Is there a reason a hospital would not use something like this?
Dr. Sakata: I think that's the case any time anything is introduced into the marketplace or there are questions about whether is really works. It's a very simple device so sometimes people don't believe that it can actually work very well for the patients. Sometimes there's a little bit of hesitation because of the way we've always practiced, the way we've always done things, and I think that can also be a hesitation to a lot of clinicians -- to actually try something new.
Is the cost a deterrent for a hospital?
Dr. Sakata: No, I don't believe so. There are quite a few things that go into a surgical cost for a patient, and in terms of cost, this is a really sort of small amount to be able to have your patients do well after a surgical case. It's actually a safety issue for patients to be able to get rid of the inhaled anesthetics, so if you compare it to safety, it's definitely not an issue.
Is it something that you use at the hospital for all patients?
Dr. Sakata: I would definitely say that it should be used with a majority of the patients coming out of anesthesia, because even if you don't have some of the issues associated with obstructive sleep apnea or any of the other medical problems, just to feel well coming out of the anesthesia means that you have to get that anesthesia out of your system. Although the anesthetics are needed to keep you asleep and comfortable during surgery, after surgery there isn't any good reason to have those anesthetics onboard.
Does the device then lessen the typical effects of anesthesia, such as feeling groggy?
Dr. Sakata: Exactly. It's a big issue coming out of anesthesia. I think if you've seen your relatives go through anesthesia or if you've done it yourself, the process of coming out of anesthesia is not always very fun, especially for those of us who are a little more sensitive to anesthetics like I think I am.
How does re-breathing the CO2 make the QED work?
Dr. Sakata: Inhaled anesthetics are gases that you breathe in, that go into your lungs, into your blood, and from your blood to your brain, and actually keep you asleep during surgery. Those anesthetics, interestingly enough, aren't broken down by the body, which is both a good thing and a bad thing. The good thing is since it's not broken down in your body, there are no byproducts that cause any sort of side effects like most drugs can if they're introduced into your system. The bad thing, however, is that the only way those anesthetics can get out of your body is by you breathing -- you need the anesthetics to go from the brain to the blood and from the blood to the lungs and back out. What you need to do is breathe a lot to get that anesthetic out, and when you breathe a lot to get the anesthetic out, your carbon dioxide level drops. For most of us who have ever hyperventilated, that lightheaded feeling that you get is because your carbon dioxide level drops and the blood flow to your brain slows down. If you want to get the anesthetics out of your system, of course, you want to breathe it out, but you also want to get it out of your brain, so you need the blood flow to your brain to increase. In order to do that, we need to conserve that carbon dioxide that everyone wants to get rid of and maintain that during your emergence from anesthesia. With this device, the patient can re-breathe their carbon dioxide and their oxygen, but the anesthetic gets trapped in the device as we increase the ventilation of the patient at the end of the case, so we actually actively try to pull the anesthetic out of the patient's brain and lungs at the same time.
Does the CO2 make them breathe harder?
Dr. Sakata: The CO2 makes them breathe more, as well. That's another issue. Not only do we want to augment the brain's capability to get rid of the anesthetic, but the CO2 makes them want to breathe. It's very important to maintain that after the surgical procedure is over when you go to recovery because that's how you continue to recover from anesthesia. To maintain that drive is very critical.
How important is this device for sleep apnea patients?
Dr. Sakata: Obstructive sleep apnea is a huge issue. Studies have shown that 24 percent of men and nine percent of women have it. The other issue is that 80 to 90 percent of these cases are not diagnosed, so we don't know when these patients come into the hospital if they have it or not. They can be very thin, they can be young, they can be old, they can be obese. Of course, patients who are more obese and elderly are going to have more of this, but obstructive sleep apnea -- in other words, not being able to breathe very well after anesthesia -- is definitely an issue for both safety, because if you don't breathe you're not getting oxygen, and also for your recovery coming out of anesthesia. At the University of Utah, we love to use the device, and I think the University of Utah is a very forefront thinker in that we want our patients to do well coming out of anesthesia and we've adopted Anecare's device because we've seen the extreme potential benefits for our patients coming out of anesthesia and I'd like to say that we continue to give very good care to our patients here.
What are the concerns of doctors who aren't using the procedure?
Dr. Sakata: I think one of the things is -- as clinicians we go through a considerable amount of training. We are physicians, we are anesthesiologists, we go through four years of medical school and then four years of residency to do this type of practice. Going through eight years of practice after college, I think engrains in our mind that, we are good, we do look after patients, we want them to be safe, and we are essentially the guardians of the operating room. With that comes a sort of issue that we practice an art -- it's the practice of anesthesiology, and we know we're good at it. To introduce new schemes into that practice of anesthesia can actually make us think that maybe we aren't practicing the best that we should or maybe our art may need to change, and change in human nature is very difficult for any of us, whether you're a physician or not. I think that's the greatest obstacle. Also, I think we don't realize that the population in the United States has a growing number of the elderly and obese that have issues that can lead to obstructive sleep apnea. That's a huge issue, and we may not be as aware of that as we should be.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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