ASA Exhibits Continue Safety Theme

John H. Eichhorn, M.D.

Scientific and technical exhibits at the American Society of Anesthesiologists Annual Meeting in Atlanta October 22-25 featured many safety-related topics.

In the Scientific Exhibits, 13 presentations involved computer demonstrations or operational programs (such as those for automated preop evaluation). Many were teaching tools or tutorials, including a virtual reality presentation of the epidural space intended to educate practitioners on what their needles and catheters are really doing under the skin. There was a comprehensive tutorial on anesthesia equipment preop checkout. Another type of program provided real-time Internet access to clinicians actually in the OR.

Latex allergy among patients with the associated risks was the subject of two scientific exhibits. A shuttle on which critically ill children can be transported back and forth between ICU and OR with maximal monitoring and safety was demonstrated. There was a new variant of the previous exhibit demonstrating the use of an ultrasensitive capnograph as a guide for blind intubations of difficult airways. Related was an endotracheal tube changer that incorporated both an inflating bulb and a CO2 indicator. An elegant fluoroscopic study of unstable cervical spines in children had great visual impact. Finally, ventilation problems associated with laparoscopic cholecystectomies were featured in one scientific exhibit.

Data on Exhibit Highway

In the Technical Exhibits, airway tools and patient warming devices again were very prominently featured. For the first time, however, patient and anesthesia information management systems (of many various shapes and descriptions) were the most prominent single display type. Each system was touted by its manufacturer as having several patient safety advantages, both in the real time of the OR and in QA or CQI data management to help study outcomes and identify patient care problems that need attention.

Exhibited again was a device with a relatively simple concept of creating a location within the anesthesia environment, a plastic platform clamping on to an IV pole, which would have all medication syringes in clearly marked and characterized (and consistent) spots to help minimize the chance of IV medication errors during anesthetics.

The CD-ROM formats of many of the computer data bases and presentations may help speed PC upgrades for individuals and departments seeking this type of tool. One prepackaged anesthesia QA system does come on floppy disk, however. Clear plastic covers, whether for IV and arterial catheter sites, the patients’ eyes, or other areas benefiting from continual visual inspection, seemed more common in the technical exhibits this year.

New EEG Analysis Monitors Hypnotic Effect

Monitoring devices offered no major breakthrough, although a new technology of “bispectral analysis” of a 4-channel EEG shows the hypnotic effect of anesthetic medications, which appears to correlate with “anesthetic depth” and, thus, offers a new monitoring modality. One endotracheal tube is now constructed so that the cuff pressure is continuously monitored electronically and the intrathoracic sounds are captured, amplified, and wired to earphones for the anesthetist, allegedly providing unprecedented clarity of heart tones and breath sounds. Finally, a palm-sized hand-held capnometer was offered as a means to verify intubation and monitor ventilation in situations where conventional technology is awkward or even impractical.

Dr. Eichhorn, Professor and Chairman of Anesthesiology at the University of Mississippi, is Editor of the APSF Newsletter.