April 2011

National Institutes of Health • Department of Health and Human Services • newsinhealth.nih.gov

Inside News: 3 Reflux or GERD?... 4 Barbers Help Beat High Blood Pressure... Stay Healthy and Fit... Smokefree.gov

Waking Up to doses and continuously monitors Learn More Before You Go Under your vital signs—such as heart rate, body temperature, blood pressure When you face surgery, you might and breathing. have many concerns. One common “When patients are going worry is about going under anesthe- under, they experience a series sia. Will you lose ? How of deficits,” says Dr. Howard Nash, will you feel afterward? Is it safe? a scientist at NIH’s National Every day about 60,000 people Institute of Mental Health. nationwide have surgery under “The first is an inability to general anesthesia. It’s a combina- remember things. A tion of drugs that’s made surgery patient may be able to more bearable for patients and repeat words you say, doctors alike. General anesthesia but can’t them dampens pain, knocks you after waking up.” unconscious and keeps you Next, patients lose from moving during the the ability to respond. operation. “They won’t squeeze “Prior to general anesthe- your fingers or give their sia, the best ideas for killing name when asked,” Nash pain during surgery were biting says. “Finally they go into on a stick or taking a swig of deep .” whiskey,” says Dr. Emery Brown, an Although doctors often say that anesthesiologist at Massachusetts you’ll be asleep during surgery, General Hospital in Boston. Things research has shown that going under improved more than 150 years ago, everything below the waist—for a anesthesia is nothing like . “Even when a dentist in Massachusetts few hours. Most people are awake in the deepest stages of sleep, with publicly demonstrated that the during operations with local or prodding and poking we can wake drug ether could block regional anesthesia. But general you up,” says Brown. “But that’s not pain during surgery. Within just a few anesthesia is used for major surgery the case with general anesthesia. months, anesthesia was being used and when it’s important that you be General anesthesia looks more like a in Australia, Europe and then around unconscious during a procedure. coma—a reversible coma.” You lose the world. General anesthesia has 3 main awareness and the ability to feel pain, “General anesthesia changed stages: going under (induction), form and move. medicine practically overnight,” says staying under (maintenance) and Once you’ve become unconscious, Brown. Life-saving procedures like recovery (emergence). NIH-funded the anesthesiologist uses monitors open-heart surgery, brain surgery or scientists are working to improve the and to keep you that organ transplantation would be im- safety and effectiveness of all 3. way. In rare cases, though, something possible without general anesthesia. The drugs that help you go under General anesthesia affects your are either breathed in as a gas or continued on page 2 entire body. Other types of anes- delivered directly into your blood- thesia affect specific regions. Local stream. Most of these drugs act anesthesia—such as a shot of novo- quickly and disappear rapidly from @ caine from the dentist—numbs only your system, so they need to be given Subscribe a small part of your body for a short throughout the surgery. A specially period of time. Regional anesthesia trained anesthesiologist or nurse newsinhealth.nih.gov numbs a larger area—such as anesthetist gives you the proper 2 April 2011 http://newsinhealth.nih.gov/issue/Apr2011 continued from page 1 Scientists have developed strat- can go wrong. About once in every egies to identify and prevent an- Web Links 1,000 to 2,000 surgeries, patients esthesia awareness. Small studies suggested that brain monitors might may gain some awareness when For more information about help. But in 2008, Evers and his col- they should be unconscious. They anesthesia, see our links online: may hear the doctors talking and re- leagues reported the results of the member it afterward. Worse yet, they largest study to compare different http://newsinhealth.nih.gov/issue/Apr2011/Feature1 may feel pain but be unable to move techniques. Brain did no or tell the doctors. better than standard monitoring in fly’s genome, it affects the insect’s “It’s a real problem, although it’s preventing anesthesia awareness. response to anesthesia. Copy number quite rare,” says Dr. Alex Evers, an Addiction to or drugs in- variations are known to affect hu- anesthesiologist at Washington creases the risk for anesthesia aware- man responses to other drugs. Nash University in St. Louis. “Anesthesia ness, but doctors can’t accurately pre- suspects that these gene segments awareness can lead to post-traumat- dict who will be affected. A research may also affect how patients react ic stress disorder,” a severe team in Canada identified variations to anesthesia. “As researchers learn disorder that can arise after a terrify- in a gene that may allow animals to more, I expect genetic screening will ing ordeal. form memories while under anes- become more common in the clinic,” thesia. Ongoing studies are explor- says Nash. ing whether this gene plays a role in After surgery, when anesthesia Wise Choices anesthesia awareness in people. wears off, you may feel some pain When You Go Other researchers are searching for and discomfort. How quickly you Under genes that may affect how anesthetic recover will depend on the medica- drugs are processed, or metabolized, tions you received and other factors General anesthesia has 5 major by the body. Genetic differences like your age. About 40% of elderly effects on your body. Researchers might affect the proper dosage or the patients and up to one-third of chil- are working to develop drugs that selection of drugs for each patient. dren have lingering confusion and target each of these characteristics: Nash and his colleagues have thinking problems for several days after surgery and anesthesia. n Lack of Consciousness. Keeps found that studies of the common fruit fly may offer clues to how genes Right now, the best cure for these you from being aware of your side effects is time. Brown and his surroundings. affect anesthesia. When certain re- peating segments—called copy num- colleagues are working to develop n Analgesia. Blocks your ability to ber variations—are snipped from the drugs to help patients more quickly feel pain. emerge and recover from general n Amnesia. Prevents formation anesthesia. of memories. Definitions Anesthesia is generally considered quite safe for most patients. “Anes- n Loss of Movement. Relaxes your thetics have gotten much safer over muscles and keeps you still Gene the years in terms of the things we’re during surgery. A stretch of DNA, a substance you inherit from your parents, most worried about, like the patient n Stable Body Functions. Stabilizes dying or having dangerously low your heart rate, blood pressure, that defines characteristics such as eye color, your risk for disease blood pressure,” Evers says. By some temperature, breathing and estimates, the death rate from gen- kidney function. and your likely response to different medications. eral anesthesia is about 1 in 250,000 patients. Side effects have become less common and are usually not as NIH News in Health (ISSN 1556-3898) serious as they once were. National Institutes of Health Editor Harrison Wein, Ph.D. Don’t delay important surgery Office of Communications Assistant Editor Vicki Contie because of fear of anesthesia. If & Public Liaison Contributors Vicki Contie, Alan Defibaugh (illustrations), you have concerns, talk with your Building 31, Room 5B64 Bryan Ewsichek (design), Belle Waring and Harrison Wein doctor. It might help to meet in Bethesda, MD 20892-2094 [email protected] advance with the person who will Tel: 301-435-7489 Fax: 301-496-0019 newsinhealth.nih.gov give you anesthesia. Ask what kind of anesthesia you will have. Ask Attention Editors Reprint our articles and about possible risks and side illustrations in your own publication. Our material For more health information from NIH, visit is not copyrighted. Please acknowledge NIH News effects. Knowing more might in Health as the source and send us a copy. http://health.nih.gov help you feel less concerned about going under. n http://newsinhealth.nih.gov/issue/Apr2011 April 2011 3 Reflux or GERD? When Heartburn Spells Trouble Most of us get heartburn from time esophagus and lead to bleeding and to time. It may come as a burning scarring. In adults, GERD can raise sensation in the chest, or a bitter the risk of cancer of the esophagus. taste in the back of the throat. And if you have asthma, GERD can Heartburn is one word people make it worse. use to describe reflux. It happens As for babies, reflux is common when stomach contents come in healthy infants. Most babies back upwards. Reflux is sometimes outgrow reflux by 13 months, painless: You may have trouble but if they don’t, they too may swallowing or get a dry cough, have GERD. perhaps some wheezing. GERD can harm a child’s Occasional reflux episodes are ability to feed and grow. It normal. Like millions of Americans, can also increase the risk for you can manage reflux by avoiding inhaling stomach contents foods that don’t agree with you— into the lungs. This can be things that are fatty, spicy or acidic— life-threatening. or by eating smaller meals. If reflux People of any age can occurs less than once a week, you have GERD. Available can usually cope by making lifestyle medications, whether changes or using over-the-counter over-the-counter or medications. prescription, can make the “We all have a little reflux when acid in the esophagus less intense. If you have reflux twice or more we burp or belch,” says Dr. John But medications don’t prevent per week, talk to your health care Pandolfino of Northwestern Univer- GERD. Surgery can be an option if provider. It’s best to start treatment sity. But of the 20 million or more symptoms are severe and medicine early to prevent GERD from leading Americans with reflux, about 5% and lifestyle changes don’t seem to more serious health problems. n have significant episodes 2 or 3 times to help. per day. When severe events occur Dr. Michael Raymond Ruggieri, Sr., this often, it’s not ordinary reflux. It of Temple University is researching may be gastroesophageal reflux the root causes of GERD. The Wise Choices disease (GERD). You may need pre- problem isn’t that the stomach How To Steer scription medications to control it. makes too much acid. In GERD, the Clear of Reflux GERD should be taken seriously. special set of muscles between Stomach (gastric) contents contain the esophagus and the stomach is n Maintain a healthy weight. acid needed to digest food. In reflux, weakened. n Eat smaller meals. these contents wash upward into the “The stomach muscle fibers are n esophagus, a slender tube connect- not doing their job, and we’re trying Avoid triggering foods, ing the mouth and the stomach. to understand why they’re not,” says including alcohol. Because the lining of the esophagus Dr. Ruggieri. His team is among the n Don’t lie down for 3 hours isn’t meant to touch gastric acid, first to look at how nerves receive after a meal. the acid can irritate the lining of the and send messages to these muscle n Raise the head of your bed 6 fibers. Their goal is to develop drugs to 8 inches by putting wood that prevent GERD altogether. blocks under the bedposts. Definitions n For an infant, try burping frequently during feeding. Reflux Web Links Keep the infant upright for 30 When stomach contents rise up minutes after feeding. into the esophagus For more about heartburn, reflux and n If you have reflux twice or GERD, see our links online: Gastroesophageal more per week, see your Related to the stomach and the http://newsinhealth.nih.gov/issue/Apr2011/Feature2 health care provider. esophagus. 4 April 2011 http://newsinhealth.nih.gov/issue/Apr2011

For links to more information, see these stories online: Health Capsules http://newsinhealth.nih.gov/issue/Apr2011/Capsule1 Barbers Help Beat High Blood Pressure In a new study, barbers helped to American men beat hypertension. ment in the shops that just handed fight high blood pressure in African- The study evaluated about 1,300 out pamphlets. American men. The findings suggest black men who had hypertension “The barbers were the heroes that trusted members of the com- and were patrons of 17 African- of this story. They really stepped munity can deliver important health American-owned barbershops in forward and made it part of their messages to those who need them. Texas. In 9 of the shops, barbers barber practice,” says researcher About 1 in 3 adults nationwide has offered blood pressure checks with Dr. Robert Haley of the University high blood pressure, or hypertension. haircuts and encouraged patrons to of Texas Southwestern Medical African Americans are at especially follow up with physicians. Patrons Center. “They helped us show that high risk. Left untreated, high blood of the 8 comparison shops received social settings can be an integral pressure can damage the heart, blood pressure pamphlets written part of health care in the black blood vessels and kidneys. especially for African Americans. male population.” n Your genes, diet and other lifestyle After 10 months, both groups factors can affect your chances of had improved rates of hypertension getting high blood pressure. The control. But the shops that offered low rate of preventive care among blood pressure checks showed Featured Web Site African-American men is one factor greater improvement. In these Smokefree.gov that can lead to poor blood pressure shops, the percentage of participants control. An NIH-funded research whose blood pressure dropped to http://smokefree.gov/ team set out to see if barbershop- recommended levels improved by based outreach might help African- 20%, compared to an 11% improve- Ready to quit smoking? Just starting to think about it? This website can help. A step-by-step guide offers tips as you Booklet Offers Tips for Staying Fit prepare to quit and supports you in the days and weeks afterward. Download Spring is here—a perfect time to get nutrition, try adding canned or frozen a Smokefree QuitGuide app for your outside and get moving. You don’t vegetables to any pasta or rice dish. smartphone. Or choose from a variety need fancy equipment or a gym Set healthy goals and keep track of of other tools and resources that fit membership to get fit. A new NIH your progress. These activities might your needs. booklet shows how you can use what help you maintain a healthy weight you already have, or can easily get, to and prevent or delay certain health improve your health. problems, such as diabetes. The 8-page publication, The World The World Around You is available Around You: Use What You Have to online at www.win.niddk.nih.gov/publications/ Stay Healthy and Fit, has realistic way.htm. Or you can order a free copy suggestions for eating better and by contacting NIH’s Weight-control getting active. Try different activities Information Network, 1 WIN Way, to see what works best for you. Bethesda, MD 20892-3665. Call toll- You might enjoy walking with free at 1-877-946-4627 or email “exercise buddies” around a track [email protected]. n at the local school. For better

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