anesthesia Archives - Xenon Health


Update on the Perioperative Surgical Home (PSH) Model

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A year ago, we wrote on the perioperative surgical home (PSH) model, a treatment paradigm that appoints the anesthesiologist as the main coordinator of care from the preoperative to perioperative phase. To summarize, the PSH model is utilized to increase efficiency and minimize cost throughout the care continuum.

Academic and research sites such as UC Irvine and University of Alabama were early adopters of the PSH model. In 2014, UC Irvine concluded a clinical study on the impact of PSH within primary joint replacement surgery practices. Researchers found that patients treated within the PSH model were associated with lowered readmission rates throughout 30 days post-surgery to statistical significance[1]. University of Alabama corroborated these results with their early stage study, finding that integration of PSH resulted in lower healthcare costs and increased efficiency in allocation of resources after the integration of PSH[2].

Given the positive results of early PSH studies, other academic institutions have sought to explore PSH in practical settings. For example, physician researchers at the Ochsner Health System in Louisiana recently developed a modified PSH model. In the Ochsner PSH model, anesthesiologists and orthopedic specialists worked in tandem as the main coordinators of care for patient subgroups[3]. To facilitate communication between each therapeutic side, specialists met weekly to discuss the patient pathway. By the end of treatment, Ochsner researchers found that the PSH treatment group was associated with improved outcomes and lowered costs, with an approximate savings of several hundred dollars per patient. Furthermore, patients in the PSH model did not present with worse clinical outcomes than control. In sum, the Ochsner study presents a strong case for the PSH model as a potential lever for increasing quality of care on a patient basis, while also pushing up value and driving costs down.

In multiple instances of the PSH model, anesthesiologists have served as physician leaders to great success. With expertise in multiple domains of the patient experience, anesthesiologists are strong candidates to remain at the forefront of the integration of the PSH model nationwide. As the healthcare field moves towards an emphasis on value-based care, anesthesiologists will prove to be essential leaders in PSH model applications as well as further optimized models of care.

Update: The American Academy of Physical Medicine and Rehabilitation officially endorsed the PSH model on October 12, 2017[4], further supporting the increased importance of PSH as a viable and efficient model for integration into healthcare institutions nationwide.

[1] http://www.anesthesiology.uci.edu/psh.shtml

[2] https://bmcanesthesiol.biomedcentral.com/articles/10.1186/1471-2253-13-6




Expanesthetics: Anesthesia Research Meets Venture Capitalism

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Expanesthetics is an expanding startup dedicated to an ambitious goal: to discover new inhalational anesthetic agents that have “improved qualities and a reduced side effect profile.” It aims no higher than to revolutionize the field of inhaled anesthetics, with potentially the same effect as the fluorinated hydrocarbons had in the 1940s when they largely eclipsed older anesthetics such as ether or chloroform. It’s an attractive and somewhat unique sales pitch, and the company claims to be the only one of its kind to be investing in research and development for the next generation of inhaled anesthetics.

How exactly Expanesthetics plans to accomplish this formidable goal is outlined in general terms on their website: to utilize a patent-pending screening platform to identify molecules with potential anesthetic and analgesic properties, and to test these molecules for potential utility as general anesthetics. It purports to have access to licensed and proprietary libraries of molecules from which to conduct the screens. The exact nature of the screening platform and its parameters for identifying promising molecules is not stated outright, which is understandable since it is the basis of their enterprise. The mechanism of action of modern inhaled anesthetics in general is one of the great unsolved questions of the past half century, and if Expanesthetics has indeed made a breakthrough into what makes them tick, the potential applications are not to be underestimated.

Expanesthetics is the brainchild of Dr. Robert Brosnan, a professor in the Department of Surgical and Radiological Sciences at the UC Davis School of Veterinary Sciences. According to Brosnan, his laboratory discovered a “plausible molecular mechanism of action” for current anesthetic agents, allowing him make predictions on novel agents and their interactions with specific receptors. A search of PubMed for Brosnan yields collection of anesthetic molecular and animal-based research, the most recent of which describes the anesthetic synergy between N-butane and n-pentane. It’s solid research, detailed, rigorous and transparent. Whether it has any relation to Brosnan’s discovery that prompted him to start Expanesthetics is unclear.

One challenge Expanesthetics has put forward is the question, “is what we have good enough?” In other words, why revolutionize a field that isn’t broken? In the arena of research and development, this question doesn’t really seem to have a place. Horses must have seemed just fine before the first cars came along, and what anesthesiologist has not lamented the vasodilatory properties of our current inhaled anesthetics when pushing pressors after induction? It remains to be seen what fruits will yield from this ambitious startup, but raising nearly $20 million in the name of anesthesia research is an impressive feat worth keeping an eye on.