Postoperative Delirium, Cognitive Changes Theme of ASA 2016

Alicia Ault

October 21, 2016

CHICAGO — The role of anesthesia in postoperative delirium, and whether or not it contributes to long-term cognitive dysfunction, will be a primary focus here at the upcoming Anesthesiology 2016 meeting.

"We don't know the complexities of how anesthesia works," said Brenda Gentz, MD, from the Banner University Medical Center in Tucson, Arizona, who is chair of the American Society of Anesthesiologists (ASA) committee on annual meeting oversight.

Whether multiple exposures to anesthetics cause problems with the proteins inside our brains or affect the ability to maintain cognitive function will be explored during the meeting.

Information from the Brain Health Summit, held in September, will be reported by Lee Fleisher, MD, from the University of Pennsylvania in Philadelphia, who is chair of the ASA ad hoc committee on brain health initiative.

Delirium and cognitive function will also be discussed during at least one session in every educational track, Dr Gentz told Medscape Medical News.

New analyses of data from some high-profile clinical trials will be presented, including an update by the SIRS investigators on whether steroids can improve the quality of recovery and reduce delirium in cardiac surgery ( Lancet. 2015;386:1243-1253).

In addition, the effect of withholding or continuing angiotensin converting inhibitors or angiotensin II receptor blockers before noncardiac surgery will be addressed in a presentation of data from the VISION Prospective Cohort ( Open Med. 2011;5:e193-e200).

There will also be multiple sessions on opioids.

New Review of Opioid Guideline

Asokumar Buvanandran, MD, from the Rush University Medical Center in Chicago, Illinois, will oversee a review of the guideline on opioid use for chronic pain, issued in March by the Centers for Disease Control and Prevention ( MMWR Recomm Rep. 2016;65:1-49), as well as recent classwide safety labeling changes for opioids required by the US Food and Drug Administration.

The opioid sessions will dovetail nicely with the focus on patient safety, said Jeffrey Jacobs, MD, from Cleveland Clinic Florida in Weston, who is the ASA alternate director from Florida.

Physicians should be doing everything they can to minimize abuse, addiction, and accidental overdose, but "there's a better way to control pain than writing a prescription every month," Dr Jacobs told Medscape Medical News.

The specialty has been moving toward regional pain management, which Dr Gentz said she expects to "be a real push in the upcoming year."

There's a better way to control pain than writing a prescription every month. Dr Jeffrey Jacobs

One procedure that might be the first to benefit from a new approach to pain management is total knee replacement. Sessions on same-day surgery for knees and the enhanced recovery pathway for total knee replacement will likely be very popular, Dr Gentz pointed out.

Dr Jacobs said he is excited about the opening keynote talk, which will be delivered by renowned economist Michael Porter, PhD, who founded the Institute for Strategy and Competitiveness at Harvard Business School in Boston, Massachusetts.

"This could be a game-changer, this kind of lecture," said Dr Jacobs. "It's going to be well worth my time." Dr Porter practically invented the idea of value-based healthcare, he explained.

Dr Gentz said she agrees. "This is going to be huge," she told Medscape Medical News.

Issues related to professional practice and policy will also be addressed during the meeting. Dr Jacobs will be involved in a multispeaker panel on malpractice, and there will be discussions on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The final rule for MACRA, which creates a new payment system to replace the Sustainable Growth Rate, was released last week. The House of Delegates will likely discuss how to mesh the National Anesthesia Clinical Outcomes Registry with MACRA requirements, Dr Gentz said.

Best of Abstracts

More than 1200 abstracts and ePosters will also be presented during the meeting. Separate sessions will highlight the "best of the best" basic science and clinical abstracts, said Evan Kharasch, MD, PhD, from Washington University in St. Louis, Missouri, who is editor-in-chief of Anesthesiology.

One clinical science abstract — "Early Surgery Confers One-Year Mortality Benefit in Hip-Fracture Patients" — might not be practice-changing, but "it does inform on the timing of repair," Dr Kharasch told Medscape Medical News.

A symposium on coagulation will look at new data and therapeutic approaches related to clot formation for hemostasis; the management of perioperative anticoagulation, especially for regional anesthesia; and specific antidotes for the novel anticoagulants. In addition, there will be a look at whether tranexamic acid can reduce blood loss or transfusion requirements, Dr Kharasch added.

Dr Gentz, Dr Jacobs, and Dr Kharasch have disclosed no relevant financial relationships.

Anesthesiology 2016 from the American Society of Anesthesiologists.


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