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Anesthesia: A medical mainstay re-examined

Rating

4 Star

Anesthesia: A medical mainstay re-examined

Our Review Summary

This was a story about how some doctors are taking a new look at anesthesia, the consequences associated with its use, and possible options for minimizing anesthesia exposure.  The story pointed out that anesthesia use is an important addition to medical care, but that there are certain possible risks that merit further evaluation.

The story was somewhat alarmist, citing 'suggestions' that anestheisa might weaken the body's ability to kill tumor cells  thereby making cancer recurrence more likely or that it might trigger an inflammatory response leading to atherosclerosis and other serious conditions. Mostly animal studies are cited to raise alarm about anesthesia.  There are relevant human studies and they should have cited those and the rates of adverse effects.

Although one of the anesthesiologists interviewed for this story talked about 'increasing evidence', the story itself did not contain evidence or even traceable references to evidence on the topic.  Instead, it quoted a number of experts about their 'suggestions', 'fears', and 'hopes' when it comes to the effects that anesthesia had on function.

While the story did mention rats taking longer to run a maze as adults when subjected to prolonged anesthesia when young, there was no quantitative estimate for the size of the effect anesthesia had been demonstrated to play. Even when data were given (1998 Lancet study showing 10% of elderly surgery patients have worse scores on cognition tests post surgery) we get no information on the magnitude of the effect (is it clinically important?) or on the research design (and therefore, the likely validity of any findings).

There were clear attempts to inject balance into the story. The story stated, "Many clinical anesthesiologists question the relevance of the animal studies."  One source said, "Human babies are not large rat pups."  It is also stated, "Most anesthesiologists and surgeons, citing the millions of people the world over who live long, healthy lives after surgery, say there is no call for worry."

 

 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable

There was no discussion of costs but we acknowledge that costs would be difficult to discuss in this story. They might have discussed the comparative costs of general vs. spinal vs. regional anesthesia or the potential downstream costs of anesthesia adverse effects. 

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The benefits associated with the use of anesthesia were not presented other than the introduction explaining that anesthesia allows a patient to 'wake……as if from a deep slumber' having made it possible for surgery to take place.

However there was no quantification of benefit from anesthesia in terms of how surgical risks are decreased in an anesthetized as opposed to unanesthetized patient.  The story could also have addressed the comparative benefits between different forms of anesthesia.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

Possible harms associated with anesthesia were discussed in the article, though there was no information about how often these harms occur or how severe the effects might be.

There were clear attempts to balance the information.  The story stated, "Many clinical anesthesiologists question the relevance of the animal studies."  One source said, "Human babies are not large rat pups." 

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

Although one of the anesthesiologists interviewed for this story talked about 'increasing evidence', the story itself did not contain evidence or even traceable references to evidence on the topic.  Instead, it quoted a number of experts about their 'suggestions', 'fears', and 'hopes' when it comes to the effects that anesthesia had on function.

While the story did mention rats taking longer to run a maze as adults when subjected to prolonged anesthesia when young, there was no quantitative estimate for the size of the effect anesthesia had been demonstrated to play. Even when data were given (1998 Lancet study showing 10% of elderly surgery patients have worse scores on cognition tests post surgery) we get no information on the magnitude of the effect (is it clinically important?) or on the research design (and therefore, the likely validity of any findings).

Does the story commit disease-mongering?

Satisfactory

The story was somewhat alarmist, citing 'suggestions' that anesthesia might weaken the body's ability to kill tumor cells  thereby making cancer recurrence more likely or that it might trigger an inflammatory response leading to atherosclerosis and other serious conditions. Mostly animal studies are cited to raise alarm about anesthesia.  There are relevant human studies and they should have cited those and the rates of adverse effects.  However, we'll give the story the benefit of the doubt because there were clear attempts to inject balance, with lines such as, "Most anesthesiologists and surgeons, citing the millions of people the world over who live long, healthy lives after surgery, say there is no call for worry."

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Several professors were interviewed for this story including at least one who was not associated with a department of anesthesia. 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Although outlining reasons why anesthesia might present some increased risk of bodily harm, the story did not provide any guidance for determining whether a patient has any options in regards to anesthesia type, dose, and duration or anything about categories of procedures where options were more likely. Various anesthesia options were mentioned (regional/spinal/local) as was the fact that studies are underway to test hypotheses about particular advantages.  However, the story didn't discuss any of the known advantages/disadvantages of these alternatives.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The use of anesthesia is widely utilized in the surgical management of medical conditions, which is clear in the story.

Does the story establish the true novelty of the approach?

Satisfactory

The story was clear that anesthesia is not new but explained that what is a more recent wrinkle is a focused examination of the long term impact of exposure to anesthesia

Does the story appear to rely solely or largely on a news release?

Satisfactory

Does not appear to rely on a press release.

Total Score: 6 of 9 Satisfactory

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