The Xchart Blog

I recently made a mistake. Quite honestly, I am still very upset at myself for it and certainly not proud of it. In the name of education and supporting each other, I’m sharing it with you.

As I write this, I can already imagine some of you rolling your eyes for what I'm sharing here. I get it. For many of us, it is easy to get into a routine where not only do we not calculate our anesthetic, but we don't necessarily even slow down to think about how much or when we have given it. And I get it as well, that by in large most of our patients are old enough and large enough and procedures small enough that we can get away with not calculating how much local anesthetic we have administered. I want to challenge you a little today. Before you scroll on and skip over this please think about this for a second.

I’m going to date myself a bit here. For my childhood, there were two players that I admired: “The Ryan Express” Nolan Ryan and “The Mailman” Karl Malone. And no, I’m not referencing when Nolan locked Robin Ventura in a headlock after he rushed the mound and started pounding on him (although sometimes we may feel we need to do that for our patients 😊). One of the elements that made these two greats stand out was their rituals.

In our world of sedation, anesthesia, and pain management, some drugs have a long and complicated legacy, while others offer a glimpse into the future. This month's spotlight features two agents worth your attention: meperidine, a familiar name with evolving relevance, and suzetrigine, a novel non-opioid analgesic that could change the game.

Meperidine: Old Friend, Narrow Path

Inattentional blindness is a fascinating psychological phenomenon that highlights how our focus on one task can make us blind to unexpected occurrences. This concept was introduced by cognitive psychologist Dr. Daniel Simons, whose groundbreaking research has profound implications across various fields, including medicine. One of the most famous demonstrations of this phenomenon is his YouTube video, often referred to as the "invisible gorilla experiment." In this video, viewers concentrating on counting basketball passes frequently fail to notice a person in a gorilla suit walking through the scene.

As providers, we know that precision and accuracy aren’t just virtues—they’re necessities. One seemingly simple tool that transforms our approach to patient safety and procedural success is the checklist. In The Checklist Manifesto, Atul Gawande illuminates how structured checklists improve outcomes across high-stakes fields, from aviation to medicine. For us, the significance of a checklist in sedation and anesthesia is immense, and I'd like to explore why.

The Power of a Checklist

In recent months, the topic of GLP-1 receptor agonists, such as Ozempic (semaglutide), has sparked significant discussion in the anesthesia community. With the growing popularity of these medications for diabetes and weight loss, anesthesia professionals need to be aware of the potential impacts these drugs can have on sedation and anesthesia. In this month's discussion, I’ll focus on the current understanding of how GLP-1 agonists influence anesthesia care, referencing the recent article from the American Society of Anesthesiologists (ASA), the Anesthesia Patient Safety Foundation (APSF), and the American Association of Nurse Anesthesiology (AANA).

What are GLP-1 Agonists?

I get asked quite a bit why I always suggest capnography to every provider regardless of the level or type of sedation they perform. It’s a valid question. Some states still don’t require capnography for even IV sedation much less minimal sedation. So, if it’s not a state regulation, why use it? Me personally, I consider state regulation requirements to be a minimum when it comes to patient monitoring and I am not going to limit the quality of care I offer to patients just because a state regulation says I don’t need to. I get it. That’s just my opinion. Here’s some more information for you to consider.

We all know that technology plays a pivotal role in enhancing patient care and safety. The key question is whether a tech item is truly useful or just a fun gadget. A prime example of this technological advancement is the utilization of Bispectral Index (BIS) monitoring. Xchart does not currently have the capability to automatically capture and report BIS monitoring data, but we are intrigued. Besides sharing with each of you things that are cutting edge, we also are interested in discovering the need that exists for us to incorporate BIS monitoring into the Xchart platform.

We are grateful for the trust you place in us when you input patient data into Xchart.

We take this trust very seriously. Historically, our challenge has been to find ways to confirm not only to potential customers but also to ourselves that we are living up to our security and privacy ideals.