Circulation 60,475 • Volume 13, No. 3 • Fall 1998

ASA Meeting Features Patient Safety

Visit the Safety Booth at ASA!

Anesthesia patient safety will be a prominent theme of the Annual Meeting of the American Society of Anesthesiologists this year in Orlando, October 17-21, as has been consistently the case for the past several years.

Among the Refresher Courses and Clinical Update Program, certain presentations stand out as specifically safety related. “Complications of anesthesia delivery systems” will be discussed by James Eisenkraft, MD, Sunday morning. “The ASA Closed Claims Project: lessons learned” is to be presented earlier Sunday morning by Robert Caplan, MD. “NPO and aspiration: new perspectives” is the topic of Robert Stoelting, MD, who is also President of the APSF, first thing Saturday morning. Also, several lectures deal with airway management issues, including approaches to both adult and pediatric difficult airways.

A panel presentation Monday, October 19, 9-11 a.m., entitled “What Price Glory? The Cost of Improving Outcomes” has important and intriguing, albeit possibly indirect, patient safety implications. Dr. D. Mangano will present “Estimating the current cost of adverse outcomes,” Dr. L. Fleisher’s topic is “When are costly improvements worth the price? Quality-adjusted life years and third-party payers,” and Dr. P. Barash will present “Cost and impact of physician report cards on patient outcomes.” The audience likely will be confronted with a popular and profound concept in this era of rigidly managed care: is expending effort and money trying to make care even safer really worth it-at least in actuarial terms? The degree to which human terms enter this equation is a relevant related topic.

In four scientific sessions, 74 abstracts addressing aspects of patient safety will be presented.

The poster session Monday afternoon includes several diverse topics: adding phenylephrine to the irrigant used during TURP to try to decrease absorption, by Dr. G. Korula; venous emboli during total hip surgery, by Dr. M. Hayakawa; use of acute normovolemic hemodilution, by Dr. P Loubser; use of a new type of NG tube to occlude the esophagus and prevent regurgitation, by Dr. K. Ellinger; a study of supine position ulnar nerve conduction during general anesthesia, by Dr. D. Rusy; possible air emboli from a fluid warmer, by Dr. S. Woon; remotely supervised and televised tracheal intubation, by Dr. C. MacKenzie; radiofrequency transmission in the OR to various devices (Dr. J. Welsh) and to pulmonary artery catheters (Dr. B. Kline; and the persistence of patients’ cognitive dysfunction 1-2 years following major noncardiac surgery, by Dr. H. Mikkelsen.

Tuesday morning’s poster-discussion session includes consideration by Dr. H. Devitt of the use of simulators to assess anesthesiologists; by Dr. C. Kingsley of factors affecting the Mallampati score; and by Dr. P Langevin of the transmission of the tuberculosis bacillus through anesthesia breathing circuits.

Throughout the morning Tuesday, a large poster session will have many relevant presentations: the basic (and poorly answered) question of defining anesthesia-related mortality, by Dr. R. Lagasse; use of a closed-loop feedback system to control infusion of propofol based on analysis of bispectral index and hemodynamics, by Dr. B Guignard; the effect of identifying and registering patients with difficult airways on their subsequent management, by Dr. L Foley; intrusiveness of audio alarms during airway management, by Dr. Y Xiao; predictors of hypothermia during spinal anesthesia, by Dr. S. Frank; meaning and interpretation of the statistic of “no adverse events” in a given number of cases, by Dr. R. Bartkowski; medication errors in anesthesia practice, by Dr. G. Blike; behavioral evidence of provider fatigue during simulator anesthesia care, by Dr. S. Howard; “making the impossible airway possible…,” by Dr. T. McDonald; and reducing pressure on the ulnar nerve at the elbow by Dr. R. Morell (funded by an APSF research grant).

Finally, the Tuesday afternoon poster-discussion session includes discussion of increasing CO production in dry soda lime with low minute volumes, by Dr. T. Kurki; of propofol’s effects on membrane oxygenators, by Dr. N Nader-Djalal; of use of anesthesia simulators to evaluate response time (Dr. M. Kurrek) and to evaluate effects of fatigue on clinical performance (Dr. C. Herndon); and of the question “Do nurse anesthetists need medical direction by anesthesiologists?” by Dr. J. Silber.