Anaesthetists lead the way in patient comfort

Chocolate and chewing gum: anaesthetists lead the way in patient comfort

A chocolate-flavoured sedative for children and the use of chewing gum to stop nausea after an anaesthetic are two novel research projects that have just received funding by the Australian and New Zealand College of Anaesthetists.

The chocolate mini-tablet to replace the bitter taste of a sedative given to young children before they have an anaesthetic has been developed by a leading anaesthetist and researcher and her team.

Professor Britta Regli-von Ungern-Sternberg, a paediatric anaesthetist and researcher from The University of Western Australia, has been trialling a specially-designed and formulated chocolate tablet form of the commonly-used drug midazolam.

Midazolam is a short-acting benzodiazepine with sedative, amnesic and anti-anxiety effects and is often administered to young children before they are given an anaesthetic but it is often poorly tolerated because of its extremely bitter taste.

Professor Regli-von Ungern-Sternberg said taking midazolam can be a distressing experience due to its bad taste for some children who were already highly stressed in the hospital environment.

“While taking midazolam leads to a smoother and more comfortable experience at the induction of anaesthesia, many children hate to take it and that leads to more grief for children and their caregivers – and when it is spat out we can’t know of its effectiveness.”

She said it was also noted that with a bad experience with the pre-medication, there was less chance a child would accept other oral medicines like pain relief or antibiotics after their operation.

In a world-first, Professor Regli-von Ungern-Sternberg and her team in collaboration with Professor Lee-Yong Lim, a pharmacologist from the University of Western Australia, have developed a prototype of the chocolate mini-tablet, which she says in early studies has been tolerated very well by young patients.

The research received funding from the Anaesthesia and Pain Medicine Foundation of the Australian and New Zealand College of Anaesthetists and the Princess Margaret Hospital Foundation.

She hopes the outcomes of her study will lead to the scaled-up manufacture of chocolate-based midazolam tablets for use in paediatric hospital wards, and the adaptation of the chocolate base for the formulation of other bitter drugs, for example, antibiotics.

In another novel research project, also supported by the Anaesthesia and Pain Medicine Foundation, Melbourne anaesthetist and researcher Dr Jai Darvall is investigating the effectiveness and safety of chewing gum compared with ondansetron, a commonly-used anti-nausea drug, in treating post-operative nausea and vomiting after an anaesthetic.

Dr Darvall said post-operative nausea and vomiting was a significant complication of general anaesthesia.

“In addition to patient discomfort, there are cost burdens associated with post-operative nausea and vomiting and patient discharge is delayed,” Dr Darvall said.

“Chewing gum, if effective, is a cheap alternative therapy to medication.”

Nausea and vomiting after anaesthesia is more common in female patients, and the study will include 100 women aged 18 or over undergoing keyhole or breast surgery who will randomly be given ondansetron or chewing gum.

The Anaesthesia and Pain Medicine Foundation of ANZCA supports research projects across the fields of anaesthesia and pain medicine. ANZCA established the Anaesthesia and Pain Medicine Foundation in 2007 to support medical research and education.

ENDS

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