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    Study Sheds New Light on Anesthesia-Recovery Process

    By Nancy Deutsch, RN, contributor.      

    Waking from anesthesia may not be as simple and natural a process as many people think. New research suggests that there is more to anesthesia—and recovery from it—than previously considered.

    “Emergence from anesthesia may not be a passive process. There may be an active component to it,” said Max Kelz, M.D., an assistant professor in the University of Pennsylvania’s Department of Anesthesiology and Critical Care and the Mahoney Institute of Neurological Sciences.

    Researchers at the University of Pennsylvania recently conducted research on mice that found the cellular pathway for emerging from anesthesia is different from the one that puts patients to sleep during operations. The researchers looked at the orexin systems (also known as hypocretin, believed responsible for promoting wakefulness) in mice. Mice whose orexin systems had been genetically destroyed took much longer to wake from anesthesia than those who orexin systems were intact. However, the mice without functioning orexin systems did not fall asleep faster during anesthesia, suggesting that different processes are involved in how quickly a person reacts to anesthesia and how long it takes for them to recover from anesthesia.

    Kelz said he became particularly interested in this topic after having a patient with narcolepsy and cataplexy who took six hours to recover from anesthesia. In narcolepsy, the orexin system seems disturbed, so Kelz thought there might be a connection between the orexin system and how people recover from anesthesia.

    “It may be rare, but it gave us a window into the anesthetized brain’s workings,” he said.

    If researchers learn more how people with narcolepsy can be awakened, they make be able to make new anesthetic drugs that work better and are targeted for the person undergoing anesthesia, he said. If the orexin systems can be stimulated, people may recover faster. Similarly, if they can be blocked, there may be a slower emergence from anesthesia, which is useful in some cases, such as when a surgeon needs more time.

    It’s surprising to realize that in 160 years of using anesthetic drugs, “we don’t really understand how they work and why they work,” he said.  If we can find out more about the sleep and wake system, we can make better drugs for people undergoing anesthesia, he said.

    “It’s still a little early” to change the way or what we give as anesthesia based on this finding, Dr. Kelz noted, but nurse anesthetists should be aware that “there are probably more surprises to be had about how anesthesia works.”



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