Volume 7, Issue 5 S A M B A T A L K S - PAGE 2 October, 2007

JOIN THE DISCUSSION - TOP

Need advice about a problem case in ambulatory anesthesia? Suggestions about a difficult situation in your ambulatory surgery center? A reply to questions others have raised about ambulatory anesthesia issues?

If you answered "yes" to any of these questions, or would like to share with other professionals a comment or opinion on a topic related to ambulatory anesthesia then please "Join the Discussion".

Your question, reply or comment will be published in the next available issue of SAMBA TALKS. Include your name (or initials), email address, city, and state, if you would like these published. Please note that because of the high volume of questions we receive, there is often a delay of 1 to 2 months before publication.

SAMBA Talks will include all discussion questions we receive considered of interest to the membership at large. We will endeavor to publish a response to at least one of these questions. The response will be from experts in the field, and from those willing to express a view on a particular topic, backed by experience and/or published evidence. Where email addresses are published, those individuals have indicated their interest in discussing the published questions.

Questions and responses from previous months are now available at the eNewsletter Discussion Archive. If you have any comments regarding the previous questions, please submit them to SAMBA Discussion, and they will be published here next month.

Please note: The information presented in the replies below does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

?? - LAST MONTH'S QUESTION WITH REPLIES - ?? - TOP

I have a question about using stimulants for ADHD and other conditions and their place in anesthesia.  Recently we have seen an increase in the use of stimulants such as dextroamphetamine or modafinil for adult ADHD and for treatment of narcolepsy, sleep apnea, chronic pain, etc.  Should we be administering these preoperatively to our patients prior to surgery just as we do a beta blocker?  I have had conflicting advice since our pediatric colleagues feel that they make the operative experience better for children.  In adults, I am not so sure and I would appreciate advice on this topic.  Thanks.

-- From: Dana N Wiener, M.D. Durham, NC (WIENE003@mc.duke.edu)

Reply 1

Even though many children are "off" of these drugs during the summer time, we continue them if a child is currently taking them. I can't say whether it makes the operative experience better... but children are usually on them for behavioral issues and the inability to focus; so stopping them may have a negative impact. Additionally, I would not favor the discontinuation of these drugs on patients that are chronically taking them for management of narcolepsy, OSA, or chronic pain.

-- From: Julie Niezgoda, MD Cleveland, OH

Reply 2

In terms of empiric usage for anesthesia recovery, there is only one small study (34 patients) that has been published and another that is being reviewed that evaluates the effect of modafinil. The reference is as follows: Larijani et al. Anesth Analg 2004;98:976 –81. Having said that, more studies need to be done before recommending its empiric usage.

For patients chronically taking these medications I  see no reason to stop modafinil but I am not sure if there's any theoretical reason w/ dextroamphetamine.

-- From: Lucy Everett, MD and Peter Glass, MD Boston, MA and Stony Brook, NY

In addition to the above article by Larijani et al, there are two articles, one of a single case report and the other of a series of 8 case reports (Fischer et al  Anesth Analg 2006;103:203–6) of patients on chronic amphetamine treatment having uneventful surgery. Despite the lack of hard science, my feeling is that when used for appropriate medical indications that it is probably safe to continue the medication.  However, when used in an uncontrolled fashion as a recreational drug, it must be viewed as a serious risk and a reason to cancel an elective surgery.

-- From: Robert Helfand, MD Cleveland, OH

?? -- THIS MONTH'S QUESTION -- ?? - TOP

I have a question regarding equipping a multi-specialty (ortho, ENT, plastics, endo, ophthalmology) ASC. If the budget allows for only one difficult airway device, would it be appropriate to obtain a Glidescope rather than a fiberoptic bronchoscope? Assuming the ASC has LMAs, bougies and a Glidescope; can one make an argument that a fiberoptic bronchoscope is unnecessary? What are the medico-legal implications of this decision?

-- From: David Cohen (djco@comcast.net)

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