ASA Meeting Features Sessions on Safety

John H. Eichhorn, M.D.

Issues and topics concerned with anesthesia patient safety will be featured prominently at the American Society of Anesthesiologists (ASA) Annual Meeting in San Francisco October 26-30.

In the Refresher Course Lectures, on Saturday, October 26, Dr. Isaac Azar will speak on “Quality Assurance and Peer Review.” Also on that day will be presentations by Dr. Robert Caplan on “Adverse Outcome in Anesthetic Practice: What Do We Know?” and by Dr. Ian Ehrenwerth on “Electrical Safety in the Operating Room:’ Sunday, October 27 will have a Refresher Course on “Standards in Anesthesia Practice” by Dr. John Eichhorn.

Among the panel discussions, on Tuesday, October 29, 2:00 5:00 p.m., there will be a panel on “Practice Standards, Quality of Care and Physician Reimbursement.”

Forty-nine Scientific Papers will be presented in three sessions in the Patient Safety and Education Annual Meeting Section.

Poster Session VI on Monday, October 28, 2:00 – 5:00 p.m. (Moscone Room D, will be the first patient safety-oriented scientific session. Among the presentations concerning safety will be a study presented by Dr. J.J. Andrews demonstrating the significant hazards of filling contemporary vaporizers with desflurane by mistake. In such a circumstance, its vapor pressure and consequent characteristics can lead to an extreme overdose of agent and an hypoxic gas mixture. Recommendations for safety features of equipment that would be used with this new agent are made.

The safety of a new heat-resistant endotracheal tube for use in laser surgery cases was evaluated in a Japanese study to be presented by Dr. S. Kaseno. Two French teams will present: one headed by Dr. Y. Lambert on “Depression of swallowing reflex two hours after midazolam” and the other led by Dr. J. Auffray on “Thromboembolic risk of long-term radial artery cannulation: prospective comparison of two different cannulae.”‘

“Safety of inhalation anesthetic delivery during patient transport” will be presented by Dr. R. Friedhoff. Dr. K. Deepika will deliver new information on the perpetual question of the need for supplemental oxygen during transport from the operating room to the PACU. The data revealed that 16.2 percent of patients transported without extra oxygen (compared to 0 percent of patients with it) had PACU admission hemoglobin saturations more than 5 percent lower than the preanesthetic control.

Addressing another long-standing question, Dr. P. Popic will present a study of vaporizer contamination showing that over 0.5 percent of vaporizers tested at 22 hospitals contained some incorrect volatile agent, exactly evenly distributed between institutions with and without agent identifying monitors.

Dr. D. Melynk will present “End-tidal C02 monitoring in the recovery room after general anesthesia” and Dr. D. Handlin will present “Use of pulse oximetry as a predictor of post-anesthesia care unit duration in smokers and nonsmokers.”

In platform presentations in the morning sessions, Tuesday, October 29, 9:00 a.m. 12:00 noon (Moscone Room 308), Dr. N. Johannessen from Denmark will relate that 5.2 percent of over 20,000 patients from five hospitals suffered anesthesia complications with the greatest number discovered on the second postoperative day, followed closely in number by the first and third days following surgery.

The ASA Closed Claims Study makes another report, to be presented by Dr. W Gild, concerning eye injuries associated with anesthesia. A new technique applied to critical incident analysis will be explained by Dr. R. Cook.

One of the major emphases in patient safety research has been the question of the impact of many of the observations on patient outcome. One study specifically oriented to help address these points, “Pulse oximetry does not reduce postoperative complications; a prospective study of 20,802 patients,” will be recounted at the ASA by Dr. J. Moller of Denmark. Another type of investigation will be outlined by Dr. N. Sharrock in the paper “Perioperative mortality following total knee and hip arthroplasty the role of anesthesia care?” Further, Dr. D. Cullen will give a paper entitled, “ASA physical status and age predict morbidity following three surgical procedures,” considering total hip replacement, TURP, and cholecystectomy.

Dr. R. Moon will present a paper on “Spontaneous Generation of carbon monoxide within anesthetic circuits” considering the issue of the interaction of potent volatile anesthetic agents reacting with C02 absorbent to produce potentially dangerous amounts of carbon monoxide. Dir. 1. Brooks considers “Anesthesia machine contamination” in a study involving culturing anesthesia breathing systems (25 percent positive) and anesthesia ventilators (44 percent positive) for bacteria.

The second platform presentation session will take place Tuesday, October 29, 2:00 5:00 p.m. (Moscone 308). It focuses largely on educational issues in anesthesia training. Among the presentations are two regarding substance abuse among physicians training in or practicing anesthesia (see the APSF Newsletter, Spring 1991).

In addition to the formal sessions, the Exhibits, both Technical and Scientific, will feature products and topics related in various degrees to patient safety. ASA meeting attendees often find the time touring and viewing the exhibits also significantly educational regarding anesthesia patient safety.

Dr. Eichhorn, University of Mississippi, is Editor of the APSF Newsletter.