Anesthesia providers are in a position to serve at the forefront of the evolution of patient care. The primary professional duty of an anesthesiologist is to ensure that every patient experiences a safe, accurate procedure with a palatable post-operative recovery time. In order to meet this objective, it is crucial for anesthesia providers to be knowledgeable about changes in the field, including improved iterations of drug delivery, new anesthesia medications, and operating room (OR) workflow optimization methods. Randomized controlled trials (RCTs) serve as the foundation of clinically-relevant research that may be applied to medical technologies. To remain leaders in the field, anesthesia administrators and physicians alike should be aware of several pertinent developments in the realm of research.
Of note, research presented at the most recent Joint World Congress on Regional Anesthesia in April 2018 described the conclusions of an analysis of anesthesia-specific literature over a century. The research presented is the most extensive study done on anesthesia RCTs to date[1]. By applying a series of standard scoring metrics to the data, anesthesia researchers aimed to measure bias, reliability, and access within anesthesia-centered RCTs over time. The research team concluded that while the total risk of bias in trials decreased over time, the sample size and composition of included patients essentially remained the same. In practice, this suggests that while anesthesia trial design may be improving, the inclusion of a large and varied number of patients in such trials has not[2]. Healthcare management administrators should be aware of this important finding. In particular, leaders in the anesthesia service delivery lines should pay careful attention in order to ensure that new policies are driven by strong and universally applicable research.
In addition to utilizing RCT results as a metric of patient access and applicability, anesthesia providers should also analyze RCT results for the prevalence of side effects and adverse events in patient populations[3]. As providers, anesthesiologists and certified registered nurse anesthetists (CRNAs) are responsible for guiding a patient’s pain management during and after an operation. It is essential for anesthesia providers to thoroughly understand the possible side effects and adverse events for any novel drug that they are prescribing, particularly when treating special subpopulations such as young children and the elderly[4]. By executing a comprehensive analysis of RCT results, including side effects and adverse events, anesthesiologists and CRNAs can be better informed when considering how new technologies and drug agents may fit into their practice.
Moving forward, anesthesia management and anesthesia providers will find it advantageous to stay up-to-date on ongoing anesthesia RCTs and trial results in order to better provide for their patients. Moreover, as part of their continuing medical education (CME), anesthesia clinicians have the ability to engage with research resources to actively learn about new developments in the field. These new developments can take the form of novel medications, OR workflow innovations, and pain management interventions. As new anesthesia agents and technologies begin to be used in hospitals and in the OR, anesthesiologists and CRNAs can serve as effective and engaged leaders for the anesthesia field.
[1] Karlsen, A. P. H., et al. “Evolution of Bias and Sample Size in Postoperative Pain Management Trials after Hip and Knee Arthroplasty.” Acta Anaesthesiologica Scandinavica, vol. 62, no. 5, 2018, pp. 666–676., doi:10.1111/aas.13072.
[2] Pagel, P. S., & Hudetz, J. A. (2012). Recent trends in publication of basic science and clinical research by United States investigators in anesthesia journals. BMC Anesthesiology, 12, 5. doi:10.1186/1471-2253-12-5
[3] Michael M. Todd; Clinical Research Manuscripts in Anesthesiology. Anesthesiology. 2001;95(5):1051-1053.
[4] Luo, J., Eldredge, C., Cho, C. C., & Cisler, R. A. (2016). Population Analysis of Adverse Events in Different Age Groups Using Big Clinical Trials Data. JMIR medical informatics, 4(4), e30. doi:10.2196/medinform.6437