Safer anesthesia and sounder sleep: Going beyond 'not killing as many people'

September 27, 2013 by Jim Oldfield

Life before anesthesia was horrific. Operations were incredibly painful. Many patients facing surgery suffered anxiety worse than the condition their surgery was supposed to fix.

That's probably why a 2007 British Medical Journal poll named anesthetics one of the top three medical advances since the 1840s, along with sanitation and antibiotics.

But how these potent—yet dangerous—agents of bliss actually work is a mystery. Indeed, the science of how we dull sensation hasn't advanced much since anesthesia was invented.

"Anesthesia drugs today are just expensive cousins of ether," says Dr. Beverley Orser, a professor in the Departments of Anesthesia and Physiology at the University of Toronto who holds the Canada Research Chair in Anesthesia. "We need to move beyond 'not killing as many people as we once did,' to '.'"

The need for a new era in anesthesia is pressing. Deaths related to anesthesia are down to about one patient per 13,000 in . But in low-income countries like Togo, without highly trained anesthesiologists and newer, safer technologies, the death rate is about one in 150.

Mounting evidence suggests that are responsible for many post-surgery respiratory, memory and cognition problems. Some of these may be long-term or permanent or, in the case of , even lethal.

To develop drugs with fewer side effects and safety risks, Orser and other researchers have focused on individual elements of the anesthetized state. Their goal is specificity: without impaired memory, for example, or that doesn't shut down breathing.

Orser's lab has already identified and begun to manipulate a subtype of a neurotransmitter called GABA that plays a key role in memory disruption. More recently, Orser expanded her focus to an area historically outside anesthesia—.

Orser and Richard Horner, a professor in U of T's Departments of Medicine and Physiology, have begun to study how anesthesia and sleep overlap at the molecular level.

"Anesthetics and painkillers are a black box," says Horner, who is also the Canada Research Chair in Sleep and Respiratory Neurobiology. "But increasingly, it seems they tap into the same molecular circuits that put our brains to sleep."

Horner's lab recently located the spot in the brain that opioids activate, critically depressing breathing in sleep and anesthesia. Now, they are mapping the molecular pathways at work in this important class of painkillers.

Horner's research has also begun to explore the origins of obstructed breathing during sleep, which can be fatal if left untreated. Sleep apnea, a respiratory problem that affects about four per cent of the population, causes hypertension and doubles the chance of heart attack and stroke. It also leads to daytime drowsiness that lowers productivity at work and raises the risk of car accidents and other injuries.

Horner's lab has identified a target for one of the first molecular therapies for sleep apnea.

"The idea is to trick the cells that matter to keep the airway open, and this same thinking may keep patients breathing when they are asleep or anesthetized," says Horner, who with Orser, hopes to soon launch a unique anesthesia and sleep science research program at U of T.

"How does work, and what is the function of sleep?" says Orser. "As we probe both questions, answers in one area should provide insights to the other. Major advances come from looking at the sciences differently and bringing them together in novel programs."

Explore further: Better guidance urgently needed for 'epidemic' of sleep apnea in surgical patients

Related Stories

Anesthesia drugs really do put us to sleep

October 25, 2012

When patients are put under anesthesia, they are often told they will be "put to sleep," and now it appears that in some ways that's exactly what the drugs do to the brain. New evidence in mice reported online on October ...

Researchers pin down the genetics of going under

September 6, 2013

(Medical Xpress)—Falling asleep in your bed at night and being "put to sleep" under general anesthesia – as well as waking up in the morning or coming out of anesthesia – aren't quite the same thing, yet they share ...

Epidural during/Post spine surgery gives better outcomes

July 17, 2013

(HealthDay)—In patients undergoing reconstructive spine surgery, combined epidural and general anesthesia results in better pain control and other outcomes compared with general anesthesia plus narcotics, according to a ...

Recommended for you

3-D-printable implants may ease damaged knees

April 19, 2017

A cartilage-mimicking material created by researchers at Duke University may one day allow surgeons to 3-D print replacement knee parts that are custom-shaped to each patient's anatomy.

Stem cell innovation regrows rotator cuffs

April 3, 2017

Every time you throw a ball, swing a golf club, reach for a jar on a shelf, or cradle a baby, you can thank your rotator cuff. This nest of tendons connecting your arm bone to your shoulder socket is a functional marvel, ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.