It's been a fun fall here at National Anesthesia - one crisp, sunny day this month we all visited our local cider mill for some delicious fresh-made donuts and newly pressed apple cider. As you can see, we had our photographs taken with a giant pumpkin, which soon got us all in the Halloween mood. Although we're not dressing in costumes for Halloween, we did enjoy a little dress-up time recently in preparation for Christmas - watch for the results in future newsletters!

Earlier this month, Jill, Christi and Ryan attended the ASA Anesthesiology 2011 Annual Meeting in Chicago. They spent a busy weekend in the Windy City catching up with anesthesiologist friends, old and new.

As the days become shorter, we're all missing the bright sunlight we enjoyed just a few weeks ago. From the article we bring you this month, we were fascinated to learn about the effects of the blue light from energy-efficient light bulbs and electronic devices on melatonin production and the body's natural clock. If you happen to be reading the article on your electronic device late at night, we do hope that you'll continue reading our newsletter to the end, and that we're not responsible for any sleep problems!

This month's second article tells how a widely used ADHD drug may help speed recovery and reduce complications from general anesthesia. Although research has thus far been confined to animal subjects, the authors of the study predict significant reductions in complications - and health care costs - if the results can be replicated in humans.

Finally, for our "fun facts" this month, we bring you a selection of sinister and spooky Halloween trivia. Again, we hope not to cause any sleepless nights!

As always, we're bringing you a selection of our hot jobs - just a small sampler of the many exciting opportunities we have available through the end of the year and into 2012. Check out our website at www.nationalanesthesia.com for more details.

Stephen Read, President
National Anesthesia Services, Inc. and National Physician Staffing, Inc.

"This is the aging process worth celebrating. Chronological age marks how long you've lived, but emotional age reflects what you've done with the time."

---- Judith Sills

*Long-term contract at Lackland AFB in Texas starting January 2012 - Contact Christi for details!

Connect with us today at 1-800-642-1999!

Freshly squeezed cider, warm cinnamon donuts, carmel apples... All sound delicious, doesn't it? Well, on Thursday, October 6th the NAS gang headed out to enjoy all of those wonderful treats! One of the greatest things about Fall here in Michigan is our cider mills and National is lucky enough to have one just a few miles down the street from our office! It was the perfect day to break out our fall boots, throw on some jeans and enjoy an afternoon outing. While there, we did have time to stop for a photo with a 1,500 pound pumpkin - see above! Next up on our social calendar: National's Christmas Party! Stay tuned to National News or our Facebook (www.facebook.com/nationalanesthesia) for details and photos!

On October 14-17 Jill Binder, Christi Adamson and Ryan Read traveled to Chicago's McCormick Place Convention Center for the ASA's annual meeting. We met so many anesthesiologists that were new to our company and also had time to visit with a few we've known for years. Thank you to everyone who stopped by our booth and a special congratulations to Dr. Dean Connors who was the winner of our G-Shock watch! We look forward to seeing you all next year in Washington D.C.

Just as the ear has two purposes - hearing and telling you which way is up - so does the eye. It receives the input necessary for vision, but the retina also houses a network of sensors that detect the rise and fall of daylight. With light, the body sets its internal clock to a 24-hour cycle regulating an estimated 10 percent of our genes.

The workhorse of this system is the light-sensitive hormone melatonin, which is produced by the body every evening and during the night. Melatonin promotes sleep and alerts a variety of biological processes to the approximate hour of the day.

Light hitting the retina suppresses the production of melatonin - and there lies the rub. In this modern world, our eyes are flooded with light well after dusk, contrary to our evolutionary programming. Scientists are just beginning to understand the potential health consequences. The disruption of circadian cycles may not just be shortchanging our sleep, they have found, but also contributing to a host of diseases.

"Light works as if it's a drug, except it's not a drug at all," said George Brainard, a neurologist at Thomas Jefferson University in Philadelphia and one of the first researchers to study light's effects on the body's hormones and circadian rhythms.

Any sort of light can suppress melatonin, but recent experiments have raised novel questions about one type in particular: the blue wavelengths produced by many kinds of energy-efficient light bulbs and electronic gadgets.

Dr. Brainard and other researchers have found that light composed of blue wavelengths slows the release of melatonin with particular effectiveness. Until recently, though, few studies had directly examined how blue-emitting electronics might affect the brain.

So scientists at the University of Basel in Switzerland tried a simple experiment: They asked 13 men to sit before a computer each evening for two weeks before going to bed.

During one week, for five hours every night, the volunteers sat before an old-style fluorescent monitor emitting light composed of several colors from the visible spectrum, though very little blue. Another week, the men sat at screens backlighted by light-emitting diodes, or LEDs. This screen was twice as blue.

"To our surprise, we saw huge differences," said Christian Cajochen, who heads the Center for Chronobiology at the University of Basel. Melatonin levels in volunteers watching the LED screens took longer to rise at night, compared with when the participants were watching the fluorescent screens, and the deficit persisted throughout the evening.

The subjects also scored higher on tests of memory and cognition after exposure to blue light, Dr. Cajochen and his team reported in the May issue of The Journal of Applied Physiology. While men were able to recall pairs of words flashed across the fluorescent screen about half the time, some scores rose to almost 70 percent when they stared at the LED monitors.

The finding adds to a series of others suggesting, though certainly not proving, that exposure to blue light may keep us more awake and alert, partly by suppressing production of melatonin. An LED screen bright enough and big enough "could be giving you an alert stimulus at a time that will frustrate your body's ability to go to sleep later," said Dr. Brainard. "When you turn it off, it doesn't mean that instantly the alerting effects go away. There's an underlying biology that's stimulated."

Still, nobody is suggesting that we all turn off the lights at dusk and sit in the dark; research into this area is in its infancy. "We are only beginning to understand what really happens under natural conditions," said Mark Rea of the Lighting Research Center at Rensselaer Polytechnic Institute in New York.

Artificial light has been around for more than 120 years. But the light emitted by older sources, like incandescent bulbs, contains more red wavelengths. The problem now, Dr. Brainard and other researchers fear, is that our world is increasingly illuminated in blue. By one estimate, 1.6 billion new computers, televisions and cellphones were sold last year alone, and incandescent lights are being replaced by more energy-efficient, and often bluer, bulbs.

In January in the journal PLoS One, the University of Basel team also compared the effects of incandescent bulbs to fluorescents modified to emit more blue light. Men exposed to the fluorescent lights produced 40 percent less melatonin than when they were exposed to incandescent bulbs, and they reported feeling more awake an hour after the lights went off.

In addition, the quantity of light necessary to affect melatonin may be much smaller than once thought. In research published in March in The Journal of Clinical Endocrinology and Metabolism, a team at the Harvard Medical School reported that ordinary indoor lighting before bedtime suppressed melatonin in the brain, even delaying production of the hormone for 90 minutes after the lights were off, compared with people exposed to only dim light.

What do these findings mean to everyday life? Some experts believe that any kind of light too late into the evening could have broad health effects, independent of any effect on sleep. For example, a report published last year in the journal PNAS found that mice exposed to light at night gained more weight than those housed in normal light, even though both groups consumed the same number of calories.

Light at night has been examined as a contributor to breast cancer for two decades. While there is still no consensus, enough laboratory and epidemiological studies have supported the idea that in 2007, the World Health Organization declared shift work a probable carcinogen. Body clock disruptions "can alter sleep-activity patterns, suppress melatonin production and disregulate genes involved in tumor development," the agency concluded.

Blue light's effects might be particularly pronounced for shift workers and others who get little natural daylight, some researchers say. Consider one small trial that appears the June issue of The Journal of the American Medical Directors Association. Among 28 elderly nursing home residents, those exposed to just 30 minutes of blue light on weekdays for four weeks showed improvement in cognitive abilities, compared with patients exposed only to red.

Researchers like Dr. Brainard hope the science may lead to a new generation of lights and screens designed with wavelengths that adjust according to the hour of the day.

Among those interested are officials at NASA, who have approached the neurologist about designing light on the International Space Station in a way that promotes alertness during waking hours and encourages sleep during times of rest.

"I think we're on the verge of a lighting revolution," said Dr. Brainard. If the hormone-sparing lights can be made to work during spaceflight, he said, "people will use it here on the ground."

---Laura Beil
www.nytimes.com

A recent study finds that a drug used to treat attention deficit hyperactivity disorder may prove to speed patients' recovery from general anesthesia, reduce post-anesthesia complications and ultimately cut down on the time patients spend in the OR.

Researchers at Massachusetts General Hospital used adult rats to test the effect of methylphenidate (Ritalin) - a stimulant widely used to treat ADHD - on time to emergence from general anesthesia. They also performed experiments to test the effects of methylphenidate on sedation and respiratory depression by general anesthesia. The study was designed to see whether methylphenidate could stimulate arousal in rats receiving the anesthetic drug isoflurane, according to MGH.

The first experiments showed that animals receiving intravenous methylphenidate 5 minutes before discontinuation of isoflurane recovered significantly faster than rats receiving a saline injection. Another experiment showed that methylphenidate induced signs of arousal, such as movement and standing, in animals continuing to receive isoflurane at a dose that would have been sufficient to maintain unconsciousness. EEG readings taken during that experiment showed that brain rhythms associated with arousal returned within 30 seconds of methylphenidate administration.

"Our results tell us that, even though we don't yet know the precise mechanisms underlying general anesthesia, we can overcome its effects by activating arousal pathways," says Ken Solt, MD, of MGH's department of anesthesia, critical care and pain medicine and the study's lead author, in a statement.

Dr. Solt adds that further testing will be performed at MGH, gauging the actions of methylphenidate with other anesthetic agents to see if these effects are broadly applicable. If these findings can be replicated in humans, the study's authors note, post-anesthesia complications such as delirium and cognitive dysfunction could potentially be reduced in pediatric and elderly patients as well.

"We also found that methylphenidate increased respiration in anesthetized animals, which could help rescue patients who receive too much sedation for simple procedures," says study co-author Emery Brown, MD, PhD. "And the ability to safely reduce the time patients spend in the operating room - which can cost between $1,000 and $1,500 an hour - could translate into significant savings in health costs."

---Mark McGraw
www.outpatientsurgery.net

General Disclaimer: The materials have been compiled by National Anesthesia Services. Inc. from internal and external sources. However, while we have attempted to provide accurate information in this publication, no representation is made or warranty given as to the completeness or accuracy of the Materials. In particular, you should be aware that the Materials may be incomplete, may contain errors, or may have become out of date. You should therefore verify information obtained from this publication before you take any action upon it.