Newer monitors that precisely gauge a patient's sedation level could help improve safety, says Dr. Michael Lew, chairman of anesthesiology at City of Hope National Medical Center in Duarte. Accounts of patients waking up during surgery had spurred the development of the sophisticated monitors, but even with the monitors, doctors face a balancing act.
"What has evolved is a feeling that maybe, at times, anesthesia is not deep enough and that we need better monitors to look at the depth of anesthesia," Lew says. "On the other hand, Monk's study is saying if you run them too deep, you increase mortality."
Doctors also say that giving patients certain drugs before surgery can offset the risks of death later. For example, beta-blockers, drugs that control hypertension, are recommended for many patients before non-cardiac surgery to reduce the risk of postoperative death. Beta blockers can relieve stress on the heart during surgery. A 2004 study, however, showed that only about 40% of the suitable candidates for the prevention measure received it.
Two recent studies, Meiler says, show that statins given to patients undergoing major vascular surgery could protect against death after surgery by improving the patient's cholesterol levels and stabilizing plaque in the arteries' walls to avoid rupture.
Preoperative visits between the patient and anesthesiologist increasingly may include discussions about minimizing the long-term risks of surgery. Certain patients may be safer with a particular type of anesthesia, for example.
With continuing research, Meiler says, "The preoperative visit is going to reach a new level of sophistication."