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The purpose of this study is to determine whether treatment with intranasal nicotine on
emergence from anesthesia will decrease postoperative pain and improve memory and alertness.
Studies in rats, mice and humans have shown that the low concentrations of volatile
anesthetics increase pain sensitivity. This effect persists for more than 1 hour.

In our studies in mice, treatment with nicotine prevented the increase in pain sensitivity
caused by these same low concentrations of isoflurane. Volatile anesthetics also cause
amnesia at low anesthetic concentrations. We think that treatment with intranasal nicotine
prior to emergence from a volatile anesthetic may reduce pain and improve alertness after
surgery. Intranasal nicotine is commonly used as treatment for smoking cessation. While it
can cause an increase in blood pressure and heart rate, at the dose that we will use (3 mg
intranasally), studies have shown that the maximum increase in systolic blood pressure was
only 7 mM of mercury. Heart rate and diastolic blood pressure did not change.

Eighty adult women who plan to undergo hysterectomy or myomectomy will be recruited at NYPH.
Only women will be enrolled because our animal studies suggest that females are more
profoundly affected by volatile anesthetics in this way than males. The subjects will be
recruited by telephone prior to their surgery or in person after agreeing with their
gynecologist to discuss the project. They will be called by either Dr. Flood or her study
coordinator who will describe the study. If they are interested in participating they will
sign the consent form on the day of surgery. The patient will have one of 2 standard
anesthetics for their surgery. We will compare the effectiveness of nicotine between
patients given the 2 different anesthetics because one (isoflurane) is thought to increase
pain sensitivity and the other (propofol) is not. A BIS monitor (a noninvasive monitor that
measures brain waves) will be used to assure adequate and equivalent anesthesia. Five
minutes before anticipated emergence from anesthesia, the subject will be given either 3 mg
nicotine via a nasal spray or saline placebo. The patient will be given a standard, usual
amount of narcotic prior to emergence from anesthesia and will be given additional narcotic
on demand by their anesthesiologist until their pain is controlled.

In the recovery room, pain will be controlled with patient controlled analgesia (PCA) as is
common for these procedures. To test memory, the patient will be told 10 random words, 10
minutes after emergence from anesthesia and tested for how many they remember at 1 hour and
24 hours. The investigator will ask them how much pain they have using the visual analog
score (VAS) method every 5 minutes during the first hour, once at the 2nd hour and once
after 24 hours. VAS is a standard method for assessing pain. The patient is presented a 10
cm line numbered 1 to 10 and asked if 0 is no pain and 10 is the worst that they can
imagine, to rate their pain. This technique will be introduced to the patient
preoperatively.