Patient safety continues its prominent position as a presentation topic that has grown to a become a permanent fixture of the American Society of Anesthesiology Annual Meeting. This year’s assembly is in San Francisco from Saturday, October 14 through Wednesday, October 18.
Among the many relevant Saturday Refresher Course Lectures, Dr. B. Cullen will present “Drug Interactions for the Anesthesiologist” (# 161), Dr. C. Hagberg covers “Current concepts in the Management of the Difficult Airway” (# 163) and Dr. S. Hall presents his classic “The Child with a Difficult Airway: Recognition and Management” (# 165). On Sunday, notable among many germane topics, Dr. M. Bishop will speak on “Bronchospasm: Successful Management” (# 272). Also, Dr. Stephen Small of the University of Chicago introduces an important new topic to the Refresher Course series with his lecture, “Reframing the Question of Human Error: Tools to Navigate the Next Era in Anesthesia Safety” (# 263). After the lunch break, the same lecture hall hosts a sequence of three safety-related presentations: Dr. M. Warner on “Perioperative Neuropathies: Current Thoughts on Etiology and Prevention” (# 264), Dr. R. Caplan on “The ASA Closed Claims Project: Lessons Learned” (# 265), and Dr. J. Eichhorn on “Risk Management in Anesthesia” (# 266).
In the Clinical Update Program lunchtime lecture series, Dr. R. Stoelting speaks about “‘NPO’ and Aspiration: New Perspectives” (# 432) on Tuesday at 12:40 p.m.; Dr. J. Eisenkraft covers “Problems with Anesthesia Gas Delivery Systems” (# 511) Wednesday at 11:30 a.m.; and Dr. G. Levinson presents “Obstetric Standards: What’s Old? What’s New?” (# 522) Wednesday at 12:40 p.m.
Among the numerous interesting Panel Presentations, one on Tuesday afternoon is especially relevant. Dr. L. Fleisher will host a panel entitled “Risk of Anesthesia: Can We Detect and Prevent Rare Outcomes?” (2-4 p.m., Moscone Room 131). It includes Dr. F. Cheney on the “ASA Closed Claims Project,” Dr. J. Morray on “Pediatric Perioperative Cardiac Arrest Registry,” Dr. J. Silber on “Failure to Rescue,” and Dr. Fleisher on “Outpatient Location of Care: Analysis of Medicare Claims.” Also, on Wednesday afternoon, as part of the panel “Anesthesia for Office-Based Surgery: The Surgery May Be Cosmetic but the Anesthesia Runs Deep,” Dr. T. Joas will present “Public Safety – How and Why Did Politicians get involved in OBA?”
Hands on for Safety
The Workshop series, always an extremely popular component of the ASA meeting because of the “hands-on” experiences offered to participants, contains many skill topics directly related to patient safety, such as fiberoptic-guided intubation (adult and pediatric), difficult airways in general (also adult and pediatric), and detecting and troubleshooting malfunctions in anesthesia delivery systems.
The section of the Scientific Papers presentations focusing on safety is “Practice Management & Patient Safety” and features four sessions during the meeting which incorporate 76 individual scientific papers.
A poster-discussion session Monday morning has been devoted to two topics receiving increasing recent interest: renal effects of inhalation anesthetics and also carbon dioxide absorbers. Potential deleterious impact of low-flow inhalation anesthesia with sevoflurane is the subject of four papers. Likewise, production of Compound A or carbon monoxide due to interactions with CO2 absorbent also will have four abstracts presented and discussed by both moderators and the audience.
Also Monday morning is a regular poster session that includes such varied topics as: the physiologic changes among morbidly obese patients having laparoscopic surgery, LMA use in known difficult airways and in resuscitations, risk factors for postoperative neuropathy and also the point that males seem more susceptible that females, mechanism of brain damage in anesthesia-related adverse events, ethics in cost-containment research, inadequate reporting of a patient’s difficult airway experience or even cardiac arrest causing preventable future problems, lack of oxygen use in postop transport, variations in “the real anesthesia mortality rate,” comparison of perioperative morbidity in third-world vs. industrialized country statistics, embolism during total hip surgery, a new analysis of dental injuries associated with anesthesia, an analysis of visual loss associated with surgery, and stability studies of various propofol emulsions.
The other large regular poster session is Tuesday afternoon. Again, among the wide variety of topics covered are: safety of immediate extubation after AAA surgery, the safety of pediatric sedation services, a safety analysis of over a million elderly outpatient cases comparing hospital vs. non-hospital locations, confirmation that ASA physical status classification is predictive of adverse outcome rate and severity, the timetable for practice re-entry for chemically dependent anesthesiologists, efficacy of air-elimination devices in rapid high-volume fluid infusers, and, finally, an assessment of patients’ preoperative spiritual needs based on the observation that the majority of patients desire to pray before anesthesia for surgery.
The final poster-discussion session is Wednesday afternoon and includes five papers on preoperative testing, including one on using diagonal earlobe creases as a sign of ischemic heart disease and one on more classic preop cardiac stress testing. The other topic is blood product usage and papers cover the issues of safely reducing transfusion in vascular surgery, preoperative prediction of transfusion needs, and reduction of transfusion associated with the new endoluminal AAA treatments.
These previews highlight merely some of the safety-related presentations at the ASA meeting and a full schedule can be found in the Annual Meeting Program.