Report From the Front Lines: Study Probes Anesthesia Providers’ Role

Report From the Front Lines: Study Probes Anesthesia Providers’ Role in Improving Combat-Related Outcomes

A study published in the July issue of the Journal Anesthesiology could be the impetus behind future prospective research exploring the hugely untapped potential of anesthesia providers (i.e., anesthesiologists and nurse anesthetists) to improve outcomes in wounded military personnel.

Specifically, it is one of the first studies to evaluate how anesthetic techniques influence the outcomes of those suffering traumatic brain injury (TBI) in combat.  

According to study author, LTC (P) Kurt W. Grathwohl, M.D., Program Director of Anesthesiology and Critical Care Medicine at Brooke Army Medical Center, the role that anesthesia providers play in the care of the combat-wounded has been largely unexplored and even misunderstood.

“The idea that anesthesia is just a necessary part of surgery to render someone unconscious and not feel pain doesn’t tell the whole story,” said Dr. Grathwohl.  “Maybe the anesthesia technique itself can result in improved outcomes.”

Few studies, however, have evaluated the role of anesthetic techniques as tools to improve outcomes by, for example, controlling the inflammatory process, altering circulation, affecting intracranial pressure, and protecting delicate brain tissue.

Dr. Grathwohl and his colleagues initially sought to evaluate whether total intravenous anesthesia (TIVA) was associated with better outcomes in TBI than the more frequently used volatile gas anesthetics (VGA).  

“Although our retrospective study concluded that TIVA seemed to offer no significant difference in neurological outcomes in patients with TBI, our results point to a need for further studies comparing TIVA and VGA and to increased efforts to discover superior anesthetics,” said Dr. Grathwohl.

In military personnel receiving combat wounds during recent military operations, TBI accounts for more than one-third of all deaths.  And survivors of TBI often suffer lingering consequences.

“Brain injury is the signature injury of this war,” said Dr. Grathwohl.  “The toll in quality of life and economics from TBI is huge, and any improvements are needed and welcomed.”

Dr. Grathwohl said that he and his fellow military anesthesiologists feel that they have been given a unique opportunity to report their experiences to the medical community for the sake of future studies.  

“We hope that clinicians use our data to design prospective studies that will more definitively conclude which anesthetics techniques work best and also how anesthesiologists can generally maximize their influence on the battlefield,” he said.

“Continued evaluation and follow up of military personnel over time will help physicians to understand how anesthetic care influences not only survival but also such phenomena as post-traumatic stress disorder and depression,” said Dr. Grathwohl.

Reviewed by Ramaz Mitaishvili, MD


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