Circulation 60,475 • Volume 14, No. 4 • Winter 1999

APSF President Notes “State of the Foundation”

Robert K. Stoelting, M.D.

As President of the Anesthesia Patient Safety Foundation (APSF) it is my privilege to report annually on the activities of the APSF during the calendar year. In that regard, I am pleased to report that 1999 has been a busy and successful year for the APSF as we strive to fulfill our mission that every patient experience optimal anesthesia safety during the perioperative period.

I continue to believe that the APSF NEWSLETTER, under the able direction of its Editor, John H. Eichhorn, M.D. and his Editorial Board, is the most important source of current and important anesthesia patient safety information and issues, for all those who care for patients in the perioperative period as well as those who contribute to anesthesia care from the corporate sector. A world-wide circulation of more than 60,000 assures wide dissemination of important issues with minimal delay. Articles published during the last year have discussed a variety of current topics including latex allergy, "mega-dose" lidocaine administered during liposuction, detection and treatment of cerebral hypoxia, and issues relating to bisulfite sensitivity when this preservative is present in commercial preparations of drugs administered during anesthesia. Current and past Newsletter issues can be viewed on the APSF Web page ( The tireless efforts of Keith M. Ruskin, M.D. are reflected in the superb Web page created by and for APSF.

Sponsorship of patient safety research has always been a high priority for the APSF. In October 1999, the APSF Committee on Scientific Evaluation, chaired by Jeffrey B. Cooper, Ph.D. ultimately awarded two research grants with funding up to $65,000. The two grant recipients were Mary E. Warner, M.D. from the Mayo Clinic (Perioperative Vision Loss and Other Visual Changes), and Robert C. Morell, M.D. from Wake Forest University School of Medicine (Effect of Gender on Ulnar Nerve Dysfunction Induced by Stretch).

Survey Shows Issues In an effort to determine the "most important current anesthesia patient safety issues," the APSF developed a survey that was mailed to more than 1600 anesthesiologists in September, 1998. The results of this survey were reported in the Spring 1999 Newsletter. Based on the survey results, the 10 most important current anesthesia patient safety issues were: 1. difficult airway management; 2. cost-saving mandates (production pressures); 3. anesthesia delivery outside the operating room – remote sites; 4. anesthesia delivery outside the operating room – office-based anesthesia; 5. neurologic deficits attributed to the anesthetic technique; 6. coronary artery disease; 7. occupational stress; 8. fatigue; 9. medication errors; and 10. cost-saving mandates – time for preoperative evaluation. The results of this survey are being utilized in making decisions regarding future educational and investigative goals of the APSF.

OBA Safety Central The Board of Directors of APSF, at its annual meeting in October, 1999, identified "office-based anesthesia" as a high priority anesthesia patient safety issue that merited the attention of APSF. This decision is consistent with the same high priority given this issue by anesthesiologists completing the APSF survey. A future issue of the APSF Newsletter will be devoted entirely to "office-based anesthesia" and associated patient safety issues. Drs. J. S. Gravenstein and E. S. Siker will coordinate this special Newsletter effort that will contain articles on several related topics authored by individuals from both the anesthesia community and the related corporate community. It is hoped that APSF can once more become the forum for discussion of a vitally important issue and incorporate ideas and suggestions from a broad spectrum of "experts." Increased public awareness of the potential risks of office-based anesthesia and surgery is an important goal of this endeavor.

ASA Support Sustained Contributions from individuals, corporations, national and state societies are vital for the APSF to continue to sustain its mission. I am pleased that the American Society of Anesthesiologists (ASA), at its annual meeting in October, 1999, voted to continue to support APSF at its current funding level. There is no doubt that the success of APSF as a unique contribution to American medicine would not have been possible, or continue to be possible, without the generous financial support of the ASA.

I am pleased that efforts to increase the participation of Certified Registered Nurse Anesthetists (CRNAs) in the activities of the APSF during the past year have been very successful. Bette M. Wildgust, CRNA was elected to the Board of Directors during the past year. In addition, CRNAs have been appointed to the four standing APSF committees. At the conclusion of the APSF Board of Directors meeting in October, Richard C. Prielipp, M.D. succeeded Michael L. Good, M.D. as Chair of the APSF Committee on Education and Training. On behalf of the APSF Board of Directors I wish to publicly recognize and thank Dr. Good for his many and outstanding contributions to the APSF and its efforts over the years.

Ideas Welcome As in the last annual report, I wish again to reiterate the desire of the APSF Executive Committee to provide a broad based consensus on anesthesia patient safety issues. We welcome comments and suggestions from all those who participate in the common goal of making anesthesia a safe medical experience. We have accomplished a great deal but this should serve only as the foundation for future successes. With respect to past achievements, I urge you to read the article, "When Doctors Make Mistakes" in the February 1, 1999 issue of the New Yorker magazine, in which the author (Atul Gawande, M.D., a surgery resident and recipient of the 1999 ASA Media Award) recognizes the contributions of APSF to patient safety. In that regard, Ellison C. Pierce, Jr., M.D., Executive Director of APSF and founder of APSF, receives well-deserved recognition for his "vision and contributions" to anesthesia patient safety.

Best wishes to all for a safe and productive year 2000.

Robert K. Stoelting, M.D. President Anesthesia Patient Safety Foundation