The APSF Committee on Scientific Evaluation has once again awarded research grants for patient safety-related studies. Four of 15 grant applications were approved for funding of a total of $155,658. These studies represent different aspects of patient safety: study of a factor affecting human performance, validation of a new measurement for studying human performance, mechanisms of a specific event and examination of a new monitoring concept.
Sleepiness and Fatigue in Anesthesiologists in Training
Dr. Steven Howard will lead a unique collaboration between researchers at the Stanford University Department of Anesthesiology and Stanford Sleep Disorders Center to evaluate acute and chronic fatigue in anesthesiology residents.
A variety of experimental methods will be used to (1) quantify the level of sleepiness during .rested’ and sleep-deprived states; (2) examine whether or not brief mental lapses (microsleeps) are occurring in residents while on duty; (3) examine sleep, work and recreational habits of anesthesia residents; (4) evaluate a computer-based instrument that measures performance on medically relevant tasks. The latter instrument is modified from the .synthetic work environment’ program (SYNWORK) used for examining performance in the US Army.
This study is expected to produce new information about the physiological sleepiness of anesthesia residents, determine for the first time if microsleeps occur and validate a new test of performance. The investigators believe that their techniques and experimental design will avoid flaws in previous studies that hampered objective interpretation of the results.
A Search for Mechanisms of Intraoperative Carbon Monoxide Poisoning
Dr. Richard Moon and colleagues at the Duke University Medical Center will expand their efforts to identify the cause(s) of suspected CO poisoning that has been identified intraoperatively in some cases. Interaction with carbon dioxide absorbent in breathing systems is the primary suspect mechanism. To test as many as six hypotheses, a battery of experiments will be performed using several analytical techniques employing various radiolabelled species. Depending upon the results, two prevention strategies may be examined.
Identifying a Cerebral Ischemic Threshold
A measure of the adequacy of brain oxygen levels is much sought after, but elusive. Transcranial near-infrared spectrometry has been examined as a possible technique. This study, to be undertaken by Dr. Warren Levy at the University of Pennsylvania, has the primary objective of determining the saturation of hemoglobin in the cerebral vasculature that is associated with electroencephalographic evidence of cerebral ischemia. Continuous phase-modulated near-infrared spectrophotometric measurement of changes in hemoglobin saturation and EEG recordings will be performed in patients undergoing implantation of an internal cardioverting defibrillator, a procedure that frequently produces EEG evidence of cerebral ischemia. It is expected that definition of the ‘ischemic threshold” could make measurement of cerebral oxygenation possible in situations where alternative monitoring is not successful or practical.
Creating a Measure of Intraoperative Vigilance
Despite the great interest in the concept of vigilance in anesthesia, the few studies of the subject have lacked an objective measure of intraoperative monitoring performance. Dr. Robert Loeb of the University of California Davis Medical Center will lead a study to validate a measure of intraoperative vigilance during the conduct of a routine case. The artificial talk (an extra display mounted on a non invasive blood pressure monitor) was tested in a pilot study (Loeb RG:A measure of intraoperative attention to monitor displays, Anesth Analg, 1993, in press) and its validity will now be examined versus a real task in which the loss of real patient data (a blanked non invasive blood pressure display) must be recognized. The question to be answered is if performance in the simulated vigilance task differs from performance of the real vigilance task. If the simulated task proves valid, Dr. Loeb plans to use it in other studies of factors affecting intraoperative vigilance.
Those considering applying for a grant to begin in January 1994 should contact the APSF Executive Office for instructions for submission. The maximum award will continue to be $50,000.
Dr. Cooper of the Massachusetts General Hospital, Boston, is the Chairman of the APSF Committee on Scientific Evaluation and a member of the APSF Executive Committee.