Archive for month: August, 2020

People who suffer from a rare illness, the Mal de Debarquement Syndrome (MdDS), now have a chance for full recovery thanks to treatment developed by researchers at the Icahn School of Medicine at Mount Sinai. 

People often feel a sensation of movement, called Mal de Debarquement, after they have finished boating, surfing or a sea voyage. The symptoms usually disappear within hours, but in some people, and more frequently in women, symptoms can continue for months or years, causing fatigue, insomnia, headaches, poor coordination, anxiety, depression and an inability to work. Known as the Mal de Debarquement Syndrome (MdDS), the rare condition is marked by continuous feelings of swaying, rocking or bobbing.

Antidepressants are known to provide effective pain relief for various chronic pain conditions; however, the jury is still out on their use in treating the millions of patients who suffer from acute or chronic pain following surgery.  A first-of-its-kind literature review suggests although a majority of studies report positive outcomes, there is currently insufficient evidence to support the clinical use of antidepressants for the treatment of postoperative pain.

MIT chemical engineers have devised a new implantable tissue scaffold coated with bone growth factors that are released slowly over a few weeks. When applied to bone injuries or defects, this coated scaffold induces the body to rapidly form new bone that looks and behaves just like the original tissue.

This type of coated scaffold could offer a dramatic improvement over the current standard for treating bone injuries, which involves transplanting bone from another part of the patient

Postsurgical cognitive side effects can have major implications for the level of care, length of hospital stay, and the patient’s perceived quality of care, especially in elderly and fragile patients. A nationwide survey of Swedish anaesthesiologists and nurse anaesthetists has found there is low awareness of the risks of cognitive side effects following surgery. Furthermore, only around half of the respondents used depth-of-anaesthesia monitors.

Patients generally expect to make a rapid recovery from anaesthesia with a minimum of side effects. The main focus by anaesthesia personnel centres around how to minimize cardiovascular and pulmonary risks and on the management of postoperative pain, nausea, and vomiting. According to the survey results, less attention is being paid to cognitive side effects following surgery, yet these complications can have major implications for the patient.

‘We found that Swedish anaesthesia personnel viewed risk assessment, prevention, and handling of postoperative delirium and postoperative cognitive dysfunction of rather low importance. Protocol and/or standardized routines were only rarely implemented,’ observes senior investigator Professor Jan G. Jakobsson, MD, PhD, of the Department of Anesthesia & Intensive Care, Institute for Physical Science, Karolinska Institute, Stockholm, Sweden.

Postoperative cognitive impairments may arise early on after surgery, such as the short-lasting, but still distressful postoperative emergence agitation (EA). Postoperative delirium (POD) usually makes its debut one or two days after surgery, sometimes giving rise to major concerns. The more subtle but longer lasting postoperative cognitive dysfunction (POCD) generally starts during the first week after surgery, but may last for a month. Although these side effects are of major concern for both hospitals and patients, they have received less attention from anaesthesia personnel.

To gain insight regarding routines and practice for risk assessment, diagnosis, and management of postoperative cognitive side effects, and the use of EEG-based depth-of-anaesthesia monitoring (DOA), investigators sent a web-based validated questionnaire to over 2,500 Swedish anaesthesiologists and nurse anaesthetists. The questionnaire consisted of three sections covering subjective preferences, routines, and practices related to the perioperative handling of EA, POD, POCD, and awareness. The response rate was 52%.

In general the respondents considered the risk for neurocognitive side effects to be the least important during the preoperative assessment, while the risk of awareness with recall (when patients are able to recall the surgery) as well as traditional cardiac and pulmonary risk was considered of high importance.

It has been suggested that the use of EEG-based DOA monitoring to fine-tune and tailor anaesthetic delivery can reduce the risk of postoperative cognitive side effects. Previous surveys of anaesthetic practice in Sweden showed a high degree of standardization and that structured protocols for the perioperative management are in place. However, the results of this survey were more diverse. EEG-based DOA monitors were used in half of all departments, but the frequency and indication for their use varied.

‘Respondents were overall quite skeptical about the value of EEG-based DOA monitors, however their use in patients at risk for awareness was more positive among the nurse anaesthetists than the anaesthesiologists,’ notes Professor Jakobsson. ‘This attitude to DOA monitoring may be due to the rather negative stance of the Swedish Council on Health Technology Assessment regarding these devices. This is in contrast to the national guidelines in the UK, which support the use of DOA monitoring in at-risk patients.’

‘The results show there is a need to improve the knowledge of anaesthesia personnel about risk factors, prevention and management of postoperative cognitive side effects,’ concludes Professor Jakobsson. EurekAlert

For the first time, a minimally invasive transcatheter valve – tested by Baylor Research Institute in Dallas (BRI) – has been shown to save more lives than open-heart surgery, according to new research revealed at the American College of Cardiology