Technical and scientific exhibits offered at the ASA meeting in October contained many patient safety-related ideas and products.
Among the scientific exhibits, definitely the most dramatic was entitled ‘Beyond the Walls’ (see photos on Pages 45, 48, and 52) which displayed the hazards discovered in investigations of problems with medical gas and vacuum systems within the walls of medical facilities. Real-life, very frightening examples of contamination, obstruction, and misconnection of pipelines, often oxygen pipelines, were displayed. Even a dead bird in a medical air system inlet (the cause of a foul odor in the compressed air) was exhibited in a glass case. The elaborate, comprehensive, thought-provoking exhibit was prepared by Dr. Ervin Moss, Chairman of the APSF Subcommittee on Medical Gas and Vacuum Systems, Dr. Joseph Pepper of Ohmeda, Mr. Fred Evans, President of Medical Gas Management of Bethany, Oklahoma, Dr. Todd Peterson of University of Arizona, Mr. Tom Nagle of Ohmeda, and Mr. Pete Winboume of Medical Gas Management. AU who viewed this exhibit gained new insight into the often incredible substances and problems that can plague medical gas pipeline systems and, thus, often create very serious anesthesia patient safety problems that are obscure and difficult to identify because they are “beyond the walls.’
Several exhibits were similar to prior presentations. Notable among these was display of a device that helps guide an endotracheal tube into the trachea blindly through the use of multiple capnographic samples. A new scientific exhibit this year offered information about an instrument that does sound wave confirmation of correct intubation of the trachea.
Airway issues were prominently featured in the scientific displays. There was an excellent presentation of the history and historical perspective of airway management (see photo on Page 48). Several displays dealt with the teaching of airway techniques, including a description of the ‘airway rotation’ for residents at the University of California, San Diego. Also featured was an ‘interactive hypermedia approach” to the teaching of the ASA difficult airway algorithm from Wilford Hall Medical Center in Texas. Further, the department at Rush Presbyterian in Chicago outlined its integrated program in airway management and displayed the instructional material used to teach fiberoptic intubation techniques.
Other scientific displays with specific safety implications included demonstration of a new device used as an epidural needle introducer intended to make it easier to find the epidural space while reducing the likelihood of unintended events and also a presentation based on the need to correctly diagnose the rare but devastating event of failure of the oxygen supply to the cardiopulmonary bypass machine during cardiac surgery.
Among the technical exhibits, there were the standard, expected displays of multiple possible mix-and-match configurations of what are now traditional electronic monitors for various physiologic and anesthetic parameters.
As with the scientific displays, airway equipment, devices, and techniques appeared very prominently in the exhibit hall. There were multiple new devices to aid in the manipulation and negotiation of difficult airways. Several inventive and even radical variants of the traditional laryngoscope were displayed, by both new and established manufacturers. New blade configurations for traditional laryngoscopes were touted as significant advances. A new directional stylette to assist in tube placement seemed to offer novel ways to direct a tube in unusual ways. Once the tube has been successfully passed, several manufacturers offered ‘improved” ways to secure the tube in place and ensure safety from this aspect.
Parenthetically, there were several exhibits offering reportedly better ways (some involving tapes and hooks) to secure catheters of various, types in place for the desired interval.
Patient temperature maintenance again figured strongly in the technical exhibits. Combinations of traditional devices were offered, but there seemed to be no startling new advances in technology. Adding humidity to breathing systems was the main theme of six displays.
Several information management systems were prominently displayed among the exhibits. Teaching programs, patient information retrieval, and literally mountains of information on CD-ROM were offered as new advantages of these systems.
While possibly more provider-safety oriented than directly impacting patient safety, needleless injection systems were stressed heavily among the exhibits. There were at least ten different displays in place.
Overall, again this year, there were probably not any profound breakthroughs equivalent to “the next pulse oximeter’ displayed at the meeting. There were, however, several innovative and creative ideas and products shown that eventually may or even likely will have incremental positive effects on anesthesia patient safety.
Dr. Eichhorn, Professor W Chairman of Anesthesiology at the University of Mississippi, is an APSF Director and Editor of the Newsletter.