Anesthesia is a critical aspect of medical practice and is especially important in ensuring patient comfort and safety during surgical procedures. However, it comes with inherent risks. In recent use, the concept of harm reduction, which was originally developed within substance use and public health, has become relevant and important in the field of anesthesia and healthcare in general (Hawk et al., 2017). In this article, we will discuss how harm reduction principles can be applied in the context of anesthesia.
As a concept, harm reduction focuses on minimizing the negative consequences of certain activities without necessarily eliminating the activity itself (Hawk et al., 2017). For example, a harm reduction program in substance use may focus on reducing overdose without directly reducing substance use. In the context of anesthesia, harm reduction includes identifying potential risks and mitigating them to enhance patient safety and optimize healthcare outcomes (Ladak, et al., 2021).
A key aspect of harm reduction in anesthesia includes conducting thorough patient-specific risk assessments. Individuals care plans are vital and must include patient history, comorbidities and medication regimens when creating treatment approaches (Ladak, et al., 2021). With this approach, anesthesiologists can tailor their interventions to the specific needs of each patient, therefore reducing the risk of adverse events.
The choice of anesthetic agents and their dosages significantly influences patient outcomes. For example, benzodiazepines were previously used often in anesthesia but are associated with many adverse effects including cognitive and psychomotor impairment. At higher doses, benzodiazepines can lead to paradoxical excitement in the elderly as older patients are more sensitive to benzodiazepines (Lader, 2014). The current prevailing viewpoint is to avoid them when possible in patients with a risk of experiencing adverse effects.
A case report on harm reduction for a surgical patient consuming fentanyl recreationally also demonstrated that a cornerstone of harm reduction in anesthesia is effective communication. Discussing strategies for harm reduction among clinicians and the patient led to an unconventional, personalized pain management approach that nonetheless reduced risk from self-administered illicit opioids. It is vital to establish clear lines of communication among all members of the healthcare team and that information is relayed promptly and in a streamlined manner (Ladak, et al., 2021).
Harm reduction in anesthesia extends beyond the operating room to postoperative care. Postoperative monitoring and follow-up is essential to identifying complications of surgery and or anesthesia and addressing them in a timely manner. This approach aligns with harm reduction principles by addressing potential risks during the perioperative period, minimizing the impact of adverse events on patient outcomes (Ladak, et al., 2021).
One large area of discussion in this arena is opioid analgesia. Opioids are used to treat many conditions that cause pain, but these medications carry a significant risk of adverse health effects. Harm reduction strategies to address opioid misuse have been studied in the emergency department, hospital floor, and intensive care units. Some examples of strategies include medication review on admission and discharge, presence of a pharmacist during rounds, education for the healthcare team on appropriate opioid dosing and use, and education on drug withdrawal symptoms (Deschamps et al., 2018). Notably, the American Society of Anesthesiologists was involved in the approval of naloxone hydrochloride nasal spray for over-the-counter, non-prescription use (“FDA Approves OTC Naloxone Consistent with Longstanding Asa Recommendations”, 2023).
In conclusion, harm reduction principles can be successfully applied to anesthesia practice and contribute to improved patient safety and outcomes. Through patient specific risk assessments, optimized drug selection, enhanced monitoring technologies, effective communication, and comprehensive postoperative care, anesthesiologists can mitigate potential risks associated with anesthesia administration. As the medical and scientific community continues to evolve, integrating harm reduction strategies into anesthesia protocols represents a potential and exciting approach to enhancing the quality of care provided to patients.
References
Deschamps, Jean et al. “Association between harm reduction strategies and healthcare utilization in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a protocol for a systematic review and meta-analysis.” Systematic reviews vol. 8,1 88. 5 Apr. 2019, doi:10.1186/s13643-019-0997-5
“FDA Approves OTC Naloxone Consistent with Longstanding Asa Recommendations.” American Society of Anesthesiologists (ASA), 29 Mar. 2023, www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2023/03/fda-approves-otc-naloxone-consistent-with-longstanding-asa-recommendations.
Hawk, Mary et al. “Harm reduction principles for healthcare settings.” Harm reduction journal vol. 14,1 70. 24 Oct. 2017, doi:10.1186/s12954-017-0196-4
Ladak, Salima S., et al. “The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report.” Canadian Journal of Pain, vol. 5, no. 1, 2021, pp. 166–171, doi:10.1080/24740527.2021.1952066.
Lader, Malcolm. “Benzodiazepine harm: how can it be reduced?.” British journal of clinical pharmacology vol. 77,2 (2014): 295-301. doi:10.1111/j.1365-2125.2012.04418.x
