Two "magic weapons" of surgery: deep muscle relaxation and active antagonism

Surgery and anesthesiology are like inseparable working partners. They are inseparable and support each other. It is most appropriate to describe the relationship between anesthesia and surgery as "interdependent, complementary, and cooperative".

After years of development, anesthesia has become a comprehensive discipline that studies anesthesia-analgesia, emergency resuscitation and critical care medicine. In addition to providing good surgical conditions and painlessness, it also pays more attention to the regulation and maintenance of the patient's physiological functions.

So, how do anesthesiologists and surgeons reach a consensus and build a deep fighting friendship in the fight against the disease? Who has the most say in the quality of surgical operations? How to achieve the "unity of contradictions" between deep muscle relaxation and residual muscle relaxation? What challenges will the direction of national medical reform bring to the use of innovative drugs and hospital management? Faced with many questions, Professor Wang Dongxin, chief physician of the Department of Anesthesiology of Peking University First Hospital, and Professor Yang Yinmo, chief physician of the Department of Surgery of Peking University First Hospital, recently gave their respective answers.

The true meaning of friendship between anesthesiologists and surgeons: sharing the same ideals and keeping pace with the times

Question 1: People often say that when plates and bowls are bound to bump into each other, how can the "heart-to-heart" anesthesiology and surgery become tacit partners and trusted partners? Professor Wang Dongxin: The tacit understanding between the two disciplines is inseparable from close communication and exchanges. For example, the "China Accelerated Recovery Surgery Clinical Practice Guidelines (2021)" (hereinafter referred to as the "Guidelines") jointly issued by the Surgery Branch and the Anesthesiology Branch of the Chinese Medical Association last year involves multiple professional disciplines. We will continue to discuss during the formulation of the "Guidelines", and everyone will form a consistent point of view through these discussions, including preoperative preparation, fasting and drinking time, intraoperative anesthesia management, postoperative analgesia, etc. Only by reaching a consensus on the concept can we ensure tacit cooperation. As an anesthesiologist, I can have such a tacit understanding with Professor Yang Yinmo, a surgeon, at work. One of the important reasons is "consistent concepts."

Question 2: How do anesthesiology and surgery interact and understand each other? Who is most qualified to evaluate whether a surgical operation is successful?

Professor Yang Yinmo: Professor Wang Dongxin and I often discuss hot topics in anesthesia, muscle relaxation, ERAS (Enhanced Recovery After Surgery), etc., and I have benefited a lot from it. I remember a patient who had pancreatic surgery - also a friend of mine, who recovered very well after the surgery. But when he was discharged from the hospital, he took out the hospital bill and expressed doubts about the expenses during the period of entering and leaving the operating room, thinking that the proportion of the total hospitalization expenses was too high. The patient asked me at the time: "Isn't it just going in to sleep? Why is it so expensive?" I half-jokingly said to him: "It's easy to fall asleep, it's not expensive; but it's more difficult to make you wake up safely at any time without any side effects." After listening, he immediately expressed his understanding. This case also fully illustrates the escort role of anesthesia for surgical operations and patients. Therefore, anesthesiologists have the most say in evaluating the quality of a surgical operation.

Direction of medical reform: DRG is the future and innovation is the continuous driving force

Question 3: As the medical reform process continues to advance, how is the use and development of innovative drugs? What is the continuous driving force behind the development of medicine?

Professor Wang Dongxin: Under the current medical reform environment, the country is mainly promoting the DRG (Disease Diagnosis Related Group) pilot, which is based on disease payment. There is a fixed payment for specific diseases, which will encourage medical institutions to reduce medical expenses as much as possible.

When I visited and studied in the United States a few years ago, I saw that American anesthesiologists used sodium thiopental, fentanyl, and vecuronium for anesthesia during heart surgery, and the prices of these drugs are very cheap and common. In this case, many people are worried that this move will have a certain impact on the use of innovative drugs. But I don’t think this means that drugs do not need innovation. For example, we see that in the United States, innovative drugs represented by sugammadex are widely used in antagonizing muscle relaxation. The reason is that the use of such drugs can bring greater help in saving comprehensive medical expenses. Therefore, in the current medical reform environment, we must encourage innovations that can improve clinical outcomes under existing medical conditions. This will bring real benefits to patients and will also be an important direction for future medical innovation.

Innovation is what we need and will be the driving force for the continued development of medicine. In any case, innovation is necessary if we want to develop.

Deep muscle relaxation and active antagonism of sugammadex provide anesthesia and surgeons with more options

Question 4: Deep muscle relaxation can provide surgeons with a better surgical field of view, but residual muscle relaxation may affect the patient's postoperative recovery and even cause more serious postoperative complications. In the implementation of surgical operations, how to scientifically deal with the contradiction between the two and make a more reasonable choice? Professor Yang Yinmo: As a surgeon, whether it is open or laparoscopic surgery, I always hope that the anesthesiologist will maintain a deeper muscle relaxation of the patient to ensure the surgical field of view. But from the perspective of the anesthesiology department, deep muscle relaxation will delay the patient's awakening, easily lead to residual muscle relaxation, and pose a safety hazard, so both of us particularly need antagonistic drugs that can antagonize accurately, have fewer side effects, and can improve the quality of awakening.
Professor Wang Dongxin: Take the application of Sugammadex in antagonizing muscle relaxation as an example. The reason for its wide application is that many studies have shown that it has advantages in the speed and thoroughness of antagonizing muscle relaxation, which helps to reduce residual muscle relaxation and speed up awakening, thereby shortening the patient's stay in the operating room, reducing the occurrence of postoperative complications, and correspondingly shortening the length of hospital stay. I believe that new drugs and equipment will continue to emerge in the future to help us continuously improve the quality and efficiency of medical services and improve the safety and comfort of medical care.