ASA Exhibits Promote More Safety Strategies

John H. Eichhorn, MD

Both the scientific and the commercial technical exhibits at the 2003 Annual Meeting of the American Society of Anesthesiologists included several patient safety related presentations that offered attempted improvements on familiar safety strategies. As was the case the previous year, airway management and anesthesia information systems were the two most common subject areas within the patient safety realm.

Among the Scientific and Educational Exhibits, more than a dozen organized societies or issue-focused groups offered information and programs. Prime among them was the American Sleep Apnea Association with a presentation intended to disseminate information aimed at enhancing safety for sleep apnea patients requiring anesthesia care. Featured was the NIH publication “Sleep Apnea: Is Your Patient at Risk?” which highlights pre-surgery screening and, particularly, postoperative monitoring. The group’s own statement, “Sleep Apnea and Same-Day Surgery,” was an additional feature of the exhibit.

Also prominent in this section of the exhibits was the Society for Airway Management which displayed its activities to date and sought input regarding future projects. A separate exhibit by a Texas group discussed “SLAM (Street Level Airway Management)” via dissemination of their four component flow chart comprised of difficult intubation, rapid sequence intubation, rescue ventilation airway devices, and cricothyrotomy techniques (with a simulator for practicing). A separate key emphasis was on confirming correct tracheal intubation in the field. Another exhibit presented “Algorithms in Emergency Airway Management” as an expansion upon previously published guidelines. These enhanced protocols emphasized airway management in trauma patients such as those with compromised airways, verification of tracheal tube position and depth in emergency or ICU settings, management of tubes with leaks or exchange, alternate airway devices, laryngospasm, and airway techniques for patients with gut obstructions. Approaching airway teaching from a different aspect was a sophisticated “virtual reality” 3-D computer program developed in France that teaches fiberoptic-assisted intubation on screen with individual prompts and real-time feedback (see 3-D Fiberoptic Model on page 48). Likewise, but for teaching with real patients, there was an exhibit displaying a new video system that both records the performance of anesthesia personnel managing a patient’s airway while at the same time a camera lens on the laryngoscope blade shows on the same screen exactly what is being seen in the airway. Correlation of the practitioner’s approach and manipulations with the resulting success or failure of airway visualization provides a new and powerful teaching tool for intubation and airway safety. Another exhibit not only featured airway models but showed the latest examples of strikingly realistic simulation devices for practicing IV starts, central line placements, arterial cannulae insertions, and even administration of spinal anesthetics.

Another type of advanced simulator was exhibited as an adjunct to teaching brachial plexus block techniques with obvious positive safety implications for anesthesiology training programs. A remarkably sophisticated anatomically correct plastic upper body mannequin simulator contains electronic sensors wired into a computer, and a monitor screen shows the resulting hand and arm responses as the nerve-stimulator guided needle is advanced. Errant needle placements (intravascular or intrathoracic) are also sensed and signaled. A separate exhibit featured the use of ultrasound images to guide correct placement of peripheral nerve blocks.

A different type of exhibit with clear safety implications was “What to Do When Your Patient Does Not Speak English.” Relevant legal and regulatory requirements were featured as well as strategies for coping with this issue. Research into improving communication in such situations was described. Also different was “Herbal Medicines: What Your Patients Don’t Know,” which highlighted the commonly used herbal preparations that may have an impact on anesthetic pharmacology and management, points often poorly understood by patient and practitioner alike.

In recognition that the FDA prescribed pre-use anesthesia machine checkout protocol is viewed as cumbersome by some practitioners, and that it may also be relatively outdated as far as applicability to the most current models of anesthesia machines, an exhibit by a Milwaukee group offered a new sleeker and more efficient (less than 7 minutes) version of the functional checkout of an anesthesia machine. One of the presenters noted that a manuscript describing the new protocol had been submitted for publication with the hope that this new algorithm might become widely adopted.

Several of the remaining Scientific Exhibits concerned anesthesia information management systems in one way or another. A “do-it-yourself” automated record keeper was displayed that featured computer system drivers to mesh certain of the older monitoring systems with a recording computer. An electronic anesthesia outcome database fueled by PDA input from the bedside during the postoperative visit was presented. Other exhibits showed computer programs for collecting and analyzing quality improvement information.

As has been the case before, the commercial Technical Exhibits trumpeted many new bells and whistles for traditional types of equipment and supplies. Little was displayed in the way of genuinely new technology or products. Airway management tools and ideas were very prominent, as usual (demonstrating yet again that the airway may well be the one area of anesthesia practice and patient safety concern that has advanced the least over the now nearly 20 years of the modern anesthesia patient safety movement). One company offered an entire catalogue of “Products for the Difficult Airway,” which not only focused on devices for a transtracheal approach (including retrograde wires), but also promoted catheters and cannulae for laryngeal access. In addition to a panoply of laryngoscope species, a new version of the video laryngoscope, this one with a sharply curved blade connected to a dedicated small screen on a stand, was displayed. Variations of alternative airway devices (such as “the perilaryngeal airway”) were also shown. Anesthesia information management systems, many touting patient safety advantages, were widely exhibited. Enhanced features included such things as voice-recognition software that is intended to chart text entries automatically once the operator’s voice is learned by the computer. As with so many of the “advances,” the real-world practicality and applicability as well as the potentially significant costs involved will eventually determine whether this and many of the displayed products will survive to be shown in the 2004 and subsequent ASA Annual Meeting Exhibits.

Dr. Eichhorn, Professor of Anesthesiology at the University of Kentucky College of Medicine, was the founding Editor of this publication and now serves on the APSF Executive Committee as well as the APSF Newsletter Editorial Board.