Trends in Randomized Controlled Trials in Anesthesia

By November 9, 2018Uncategorized

The primary objective of an anesthesiologist is to ensure that the patient undergoes a safe, effective procedure with an optimized post-operative recovery time. In order to effectively deliver on this, it is essential for anesthesia providers to be cognizant of changes in the field, whether that be in the form of new iterations of delivery methods or novel medications used in the operating room (OR). Randomized controlled trials (RCTs) are utilized to compare the efficacy of medical technologies and to assess their practical applications in the clinical setting. In the field of anesthesia management, administrators and physicians alike should remain informed about relevant research developments.

At the Joint World Congress on Regional Anesthesia held in April 2018, a team of anesthesiologist-researchers presented an analysis of the field’s scientific literature spanning over a century[1]. Utilizing a series of standardized metrics, the research team sought to measure bias, reliability, and access in anesthesiology-related RCT literature over time. They found that the summarized risk of bias decreased over time while the sample size of patients included in these trials effectively remained the same. These findings suggest that while the strategic underpinnings of anesthesia trials are becoming quantitatively less biased, the access to patient participants has remained the same despite the recent increase in clinical trials conducted globally[2]. This is an important consideration for healthcare management, particularly those in the service delivery lines as they consider introducing novel medications and delivery mechanisms to the existing hospital framework. Healthcare administrators should further explore the implications of research on new technologies and assess whether existing RCTs offer strong enough support for adopting these technologies in clinical settings.

In addition to assessing the applicability of RCTs, anesthesia providers should also analyze trial results for the presence and frequency of adverse events in their patient populations[3]. As providers, anesthesiologists and certified registered nurse anesthetists (CRNAs) are directly implicated in the patient’s pain management, both during and immediately following surgery. Knowing the possible side effects and adverse events of any novel agent is thus critical for understanding its application in the context of individual patients. Certain subpopulations, such as young children and the elderly population may also be more susceptible to adverse events compared to the overall population[4]. By performing a thorough analysis of trial results, including side effects and adverse events, anesthesia providers can better determine which novel technologies and agents are most suited to their practice.

Anesthesia management can benefit from increased exposure to and knowledge of clinical trials. This extra awareness can help equip providers with the relevant information for forecasting future medical management for their patients. As lifelong learners, anesthesia clinicians should also utilize research resources to understand how their field is evolving by staying up-to-date on new medications, innovations in the OR, and interventions for pain management and patient recovery. As new medications and technologies enter hospitals and the OR, anesthesiologists and certified registered nurse anesthetists (CRNAs) can serve as leaders in progressing anesthesia healthcare delivery.

[1] Karlsen, A. P. H., et al. “Evolution of Bias and Sample Size in Postoperative Pain Management Trials after Hip and Knee Arthroplasty.” Acta Anaesthesiologica Scandinavica, vol. 62, no. 5, 2018, pp. 666–676., doi:10.1111/aas.13072.

[2] Pagel, P. S., & Hudetz, J. A. (2012). Recent trends in publication of basic science and clinical research by United States investigators in anesthesia journals. BMC Anesthesiology, 12, 5. doi:10.1186/1471-2253-12-5

[3] Michael M. Todd; Clinical Research Manuscripts in Anesthesiology. Anesthesiology. 2001;95(5):1051-1053.

[4] Luo, J., Eldredge, C., Cho, C. C., & Cisler, R. A. (2016). Population Analysis of Adverse Events in Different Age Groups Using Big Clinical Trials Data. JMIR medical informatics, 4(4), e30. doi:10.2196/medinform.6437