Circulation 36,825 • Volume 18, No. 3 • Fall 2003

2003 ASA Meeting Highlights Safety

As in prior years, patient safety will again play a major role at the upcoming Annual Meeting of the American Society of Anesthesiologists, which will be held in San Francisco, California, October 11-15, 2003. Refresher Course Lectures, Clinical Update Programs, Scientific Presentations, and Scientific Exhibits are replete with a host of safety-related topics.

Refresher Course Lectures Feature Many Safety Topics

The meeting begins Saturday morning with Refresher Course Lectures including Dr. Cottrell presenting Brain Protection in Neurosurgery (#113), Dr. Hata discussing Pulmonary Complications During the Perioperative Period (#162), and Dr. Ehrenwerth warning anesthesiologists about A Fire in the Operating Room: It Could Happen to You (#193). The afternoon session continues with Dr. Warner providing important information about Perioperative Neuropathies, Blindness and Positioning Problems (#115). Dr. Levy will expound on Anaphylaxis and Adverse Drug Reactions (#125), and Dr. Olympio will follow up on his article in the summer issue of the APSF Newsletter with Modern Anesthesia Machines: What You Should Know (#194).

Sunday morning begins with a Basic Science Review session that includes the timely topic of Current Concepts of the Inflammatory Response (#621) presented by Dr. Sherwood. This topic is also introduced in this issue of the APSF Newsletter and will be further explored in the winter issue. The Refresher Course Lectures continue Sunday with Dr. Brandon reviewing Malignant Hyperthermia—What is New in Detection and Treatment? (#261). Airway topics are also featured including Dr. Hall’s important lecture on the Child With a Difficult Airway: Recognition and Management (#213). Dr. Benumof reviews the troublesome problems presented by Obesity, Sleep Apnea, the Airway and Anesthesia (#234), Dr Rosenblatt helps us with Decision Making in Airway Management (#235), and Dr. Ferson presents LMA: What’s Old-What’s New: Patients with Difficult Airways (#236). Risk management and outcome topics are highlighted by Dr. Caplan’s ever popular lecture on The ASA Closed Claims Project: Lessons Learned (#224), Dr. Eichhorn’s informative review of Risk Management in Anesthesia (#226), and Dr. Stoelting’s expert discussion of Anesthesia Safety: Are There Predictable Risks? (#264). Should an adverse event occur, Dr. Berry’s discussion What to Do After a Bad Outcome (#265) would certainly prove useful. Dr. Eisenkraft and Dr. Andrews continue to enhance our knowledge of anesthesia machines with Problems With Anesthesia Gas Delivery Systems (#294) and Understanding Your Anesthesia Machines (#295), respectively. Other safety-related lectures include Dr. Hines providing an update on Substance Abuse in Anesthesia Providers (#245), Dr. Leak reviewing The Potential Hazards of Perioperative Herb and Supplement Use (#225), Dr. Drasner asking the question Is Lidocaine Safe for Spinal and Epidural Anesthesia? (#243) which relates closely to two Letters to the Editor in this issue. Finally, Dr. Reed will present the pervasive problem of Anesthesia for the Morbidly Obese Patient (#253).

The ASA Clinical Update Program runs from Monday through Wednesday, October 13-15, 2003, and includes several topics germane to patient safety. On Monday, Dr. Hagberg will review Current Concepts in the Management of the Difficult Airway (#311); on Tuesday Dr. Wedel will discuss Neurologic Complications of Spinal and Epidural Anesthesia (#411) and Dr. Neal will ponder Perioperative Outcome: Does Regional Anesthesia Make a Difference? (#431). Dr. Horlocker will complement Dr. Warner’s Refresher Course Lecture with a discussion of Peripheral Nerve Injury Following Regional Anesthesia: Diagnosis, Prognosis, and Prevention (#521).

Rovenstine Lecture Focuses on Postoperative Cognitive Function

On Monday, October 13, 2003, in room 134 of the Moscone Center, Dr. Terri Monk, Professor of Anesthesiology at the University of Florida College of Medicine, will present the annual E. A. Rovenstine Memorial Lecture, honoring Dr. Emery Andrew Rovenstine. Dr. Monk will discuss Postoperative Cognitive Dysfunction: The Next Challenge in Geriatric Anesthesia.

Five Scientific Sessions Focus on Safety

The Scientific Papers Poster Discussion portion of this year’s annual meeting includes 5 sessions related to Patient Safety, Education and Practice Management and one session on Patient Safety Outcomes and Improvement Opportunities, beginning on Monday, October 13, 2003, at 9:00 a.m. in rooms 224-226 of the Moscone Center. This session is to be moderated by Drs. Schubert and Furman and includes a presentation by Dr. Stahl and colleagues pertaining to A Living Laboratory: The Center for Integration of Medicine and Innovative Technology OR of the Future Project (A-1347). This presentation highlights a new OR design optimized for effectiveness and including an associated outcomes measurement mechanism. Also at 9:00 a.m., in Hall D, Area H, Drs. Mackey and Zerwas will moderate a session that includes several safety-related presentations. Dr. Keita and coworkers describe the Incidence and Predictive Factors of Urinary Retention at Discharge from PACU (A-1286), Dr. Girard and colleagues describe Mutation V2168M is Causative for Malignant Hyperthermia (A-1288), and a team led by Dr. Kolodzie examines Validation of the Clinical Grading Scale for Prediction of Malignant Hyperthermia (A-1292). A Japanese team under the direction of Dr. Irita will present ASA-PS Affects Human Factor-Induced Morbidity in the Operating Room and Its Outcome. Similarly, Dr. Masanori and colleagues analyze The Value of the ASA-Physical Status Classification for Anesthesiologists to Predict Perioperative Outcomes (A-1304). Dr. Curry and teammates present two abstracts (A-1306 and A-1312), which discuss a Comparison of Postoperative Hypoxemia in Abdominal and Peripheral Surgery Patients and a Comparison of Postoperative Hypoxemia in Major Peripheral Surgery Patients Treated with Intrathecal Morphine or ITMS with Narcotic PCA, respectively. Dr. Billard and colleagues also examine postoperative hypoxemia, in their session, entitled Which Risk Factors for Early Postoperative Hypoxemia Remain in 2003? (A-1302). Human factors are explored by Dr. Dru’s group, which will present Long Work Cycles in Physicians Working in Interventional Specialties: Effects of Overnight Duty on Physical Activity, Sleep, and Performance (A-1301).

Patient Safety Outcomes and Improvement Opportunities is the title of the Tuesday morning session, October 14, from 9-10:30 a.m. which will be held in rooms 220-222 of the Moscone Center. This session will be moderated by Drs. Johnstone and Cope and includes a presentation by Dr. Seiden and coworkers from the University of Chicago, which addresses Wrong-Sided Anesthetic and Surgical Procedures: Why Do They Continue to Happen? (A-1355). Liability Associated with Monitored Anesthesia Care: ASA Closed Claims Project (A-1356) will be presented by Dr. Bhananker and members of the Closed Claims team from the University of Washington. Dr. Bowdle and a team also from the University of Washington present a survey revealing information about Drug Administration Errors in a University Hospital (A-1358). A team from Israel led by Dr. Berkenstadt will present A Point-of-Care Information System Reduces the Incidence of Potentially Life Threatening Mistakes in Simulated Anesthesia Scenarios (A-1353). Also on Tuesday, a concurrent session (9-11 a.m.) will be held in Hall D, Area E and will be moderated by Drs. Bready and Curry. At this session, Dr. Samsun Lampotang from the University of Florida will lead his team in a presentation of The Virtual Anesthesia Machine: An Experiment in Sustainable Philanthropic Education Over the Web (A-1319). More information on the Virtual Anesthesia Machine (VAM) and the APSF’s involvement in this initiative can be obtained from the VAM website at In addition, Dr. Takla and Dr. Tetzlaff from the Cleveland Clinic will present an assessment of Cardiopulmonary Arrest Performance Evaluation of Anesthesiology Residents (A-1324).

Airway Management Continues to Raise Safety Concerns

Airway management is the focus of several scientific presentations at the Airway Management and Simulation session that will be held on Tuesday, October 14, from 9-11 a.m., in Hall D, Area G of the Moscone Center. Dr. Mackey and Dr. Liu will lend their expertise as moderators of this session. Presentations will include The Role of an Airway Simulator in Medical Student Teaching (A-1228) by Dr. Burkle and colleagues from the Mayo Clinic and an Assessment of Difficult Airway Management: Discrepancies Between Self Reported Knowledge and Actual Performance in an Advanced Full-Scale Airway Simulator (A-1231), which will be presented by Dr. Rosenstock and a team from Denmark. Dr. Oehlkern and coworkers from Auvergne, France, will present their answer to the question Is Cricoid Pressure Efficient? The First Clinical Evidence (A-1235). Airway management concerns in obese patients will be highlighted in presentations by Dr. Donohue’s team as they examine the question Do the ASA Guidelines Assist in the Emergency Airway Management of the Obese Patient (A-1250) and Dr. Shaw and colleagues, who will address The Risks of Emergency Intubation in the Obese: The Correlation Between Patients Based on the Body-Mass Index (A-1251). Similarly, Dr. Szmuk’s team from the University of Texas Medical School at Houston will enlighten attendees with Prediction of Difficult Laryngoscopy in Obese Patients by Ultrasound Quantification of Anterior Neck Soft Tissue (A-1256). The Closed Claims teams also weighs in on this session with Dr. Peterson leading the presentation Management of the Difficult Airway in Closed Malpractice Claims (A-1252). This session includes a number of other interesting and important presentations and is sure to be an area for lively discussion and exchange of information.

Wednesday, October 15, 2003, will be the date of the final Patient Safety and Practice Management Session, with a focus on Systematic Outcomes Reporting. This session will be moderated by Dr. Joan Christie and Dr. Susan Vesallo, and will be held at the Moscone Center, Rooms 224-226, from 10:30 a.m. until 12 noon. Included will be a presentation by Dr. Monk reporting her groups observations that Intraoperative BIS™ Utilization Is Associated with Reduced One-Year, Postoperative Mortality (A-1361). Dr. Hector Vila and colleagues provide information on office-based safety concerns in their 2003 Update: Outcomes Analysis of Procedures Performed in Florida Physician Offices and Ambulatory Surgery Centers (A-1364). Dr. Posner also reports that Voluntary Self-Reports of Anesthesia Problems Capture Intraoperative Events (A-1360), while Dr. Bowdle’s group discusses Accuracy of Self-Reported Anesthesiology Quality Assurance Data (A-1365).

Many other panels, discussions, and presentations will address safety-related issues and important information that cannot be covered in this brief preview. For example, Dr. Lennmarken and colleagues confirm the Welden group’s prior finding of an association between low BIS™ value and one year of mortality. This will be presented Tuesday, October 14, 2003, in the Clinical and Neurosciences Session in Hall D, Area H, of the Moscone Center. This year’s ASA Annual Meeting will certainly provide a wealth of information, great food for thought, and stimulating ideas toward improving patient safety.