To the Editor
I respond to Dr. Priano’s letter in the APSF Newsletter (Vol. 5, No 4, page 45) concerning his objections to pulse oximetry as a standard of care in the P.A.C.U. (and ostensibly in anesthesia). As an anesthetist and former P.A.C.U. nurse, I contend that in spite of any supposed shortage of conclusive, “uncontestable” confirming the efficacy of pulse oximetry for patient saw, empirical evidence supporting its indispensability abounds.
I assume that Dr. Priano accepts electrocardiography, blood pressure monitoring, and temperature monitoring as reasonable basic standards of care. Given the often indirect relationship between the information provided by these monitors and the problems that this information helps us to detect (most of which are not immediately life-threatening), it is hard to imagine not embracing a device that alerts us to one of the most rapidly life-threatening events in anesthesia. Even with its artifactual potential, the pulse oximeter’s information is valid and reliable enough to warrant mandating N use as an adjunct to observing, listening to, and touching the patients under our care.
Regarding the allegations that mandating its use camouflages anesthesia caregivers’ incompetencies and propagates incompetence through monitor dependency, I can only wonder if that fine of reasoning would be carried through to eliminating all other monitors that provide objective patient information simply because that information could be obtained by direct clinical methods. The obvious point is that though clinical correlation is necessary, the simultaneous gathering of multiple data and immediate recognition of abnormalities through electronic monitoring devices is a fundamental aspect of modem anesthesia practice. If monitor dependency is a result of monitor availability, it seems clear that the issue to be addressed is not that of the equipment.
The gravity of designating something as a “Standard of Care’ is clear and it is certainly incumbent upon those that make such designations to insure validity first. Given that consideration, the cam and safety of patients with compromised respiratory function is still dearly enhanced by proper adjuctive use of the pulse oximeter vis-a-vis other methods alone. Considering the myriad of other costly and frequently invasive equipment we readily incorporate into our patient management, the pulse oximeter would seem welcomed by all whose patient care involves respiratory function monitoring. I respectfully submit to Dr. Priano that the ASA House of Delegates made a good call on this issue
Darryl M. Lodato C.R.N.A., Education Coordinator Parish Anesthesia Associates
East Jefferson General Hospital Metairie, Louisiana