ASA Scientific Exhibits Continue Safety Themes

John H. Eichhorn, MD

Presentations among the Scientific Exhibits at the ASA Annual Meeting included several with patient safety-related themes, mostly dealing with familiar topic areas.

The recent widespread emphasis on risks to patients with obstructive sleep apnea prompted an exhibit from the American Sleep Apnea Association emphasizing both materials for patient education and also for anesthesia providers. This information is intended to heighten their awareness of the types and degree of risk as well as specific focus on sleep apnea patients having same-day surgery.

Another organized group presenting an exhibit was the Society for the Advancement of Geriatric Anesthesiology. Several patient safety issues, such as particular risks of ambulatory surgery in the very old, were included. There was particular emphasis on the continuing issue of postoperative cognitive dysfunction in the elderly and the need for anesthesiologists to incorporate awareness and concern for this into their care of aged patients.

Concerning technologic issues, one exhibit presented a current “hot topic” that has been cited in governmental reports as an apparent source of preventable patient morbidity: central venous cannulation. The exhibit emphasized the ease of use of real-time ultrasound guidance devices to aid in central venous cannulation with the clear implication that use of this technology should decrease complications and morbidity.

Promoting awareness of an uncommon (or possibly just under appreciated) issue was the purpose of an exhibit on “the dangers of putting the wrong anesthetic into a vaporizer.” Methods to prevent, detect, and manage this type of error were the subject of a computer video and techniques to avoid this mistake were highlighted in the exhibit.

As has been the case for many years, by far the most common topics of safety-related scientific exhibits involved airway management and problems. The Society for Airway Management provided an exhibit displaying many varieties of current airway management techniques. Another exhibit presented various “newly developed” versions of algorithms for airway management, particularly emphasizing correct tube placement into the trachea, at the correct depth. Also, training videos for pediatric difficult airway management were the highlight of a third exhibit that also included an airway model intended for use in teaching fiberoptic bronchoscopy skills in managing small children.

One novel exhibit suggested improvement on the traditional standing position of the anesthesia provider during endotracheal intubation. Material was presented to support the concept that the head of the person doing the intubation should be at roughly the same level as the head of the patient. Thus, the anesthesia provider should actually sit or kneel at the head of the OR table during intubation to achieve the resulting improved angle for viewing the patient’s larynx. Data suggesting an improved success rate for intubation using this method were included in the exhibit.

A “novel” device for use during extended airway manipulation was the subject of another exhibit. A single cannula with three internal lumens is intended for placement into the airway to facilitate the delivery of supplemental oxygen, the sampling of exhaled breath for CO2 analysis, and airway suctioning during approaches to managing a difficult airway.

Finally, the technology of acoustic reflectometry as potentially applied to airway management was the subject of an elaborate exhibit which incorporated several demonstration models. This technique, which might be considered a cousin to ultrasound, can show an image of the subglottic airway, distinguish between tracheal and esophageal lumens, aid in correct positioning of a tube in the trachea, and detect obstructions or encroachments on the airway, all in real time. As was the case in past years with variations of the video-assisted intubation devices, it will be intriguing to watch for potential commercial development of this new technology into a practical device to assist in managing difficult airways.

Overall, it is interesting to note the definite trend of the organization of highly focused and specialized groups devoted to specific subspecialty areas of anesthesia care. Further, the long-term recurrent emphasis, still true this year, on airway tools and management of difficult airways demonstrates that this remains one of the most vexing and problematic components of clinical anesthesia practice as well as a major patient safety issue. Perhaps next year’s ASA Meeting Scientific Exhibits may feature breakthrough technology and/or protocols to address this on-going safety concern.

Dr. Eichhorn serves on the Board of Directors and the Editoral Board of the APSF.