Foreign Correspondence: Anesthesia Safety at the VII AACA

Ross Holland

The 7th Asian and Australasian Congress of Anaesthesiologists was held in Hong Kong from 20-25 September. Present were more than 400 delegates from over 20 countries. The meeting was particularly strongly supported by anaesthesiologists from Japan, Australia, and the UK. Major contributions came from Hong Kong and the People’s Republic of China.

Amongst the many seminars and panels of the five day program were several which took safety and monitoring as their theme. In Ross Holland’s session, John Williamson (Australia) and John Gibbs (New Zealand) both challenged the traditional role of the EKG monitor intraoperatively. It was pointed out that in the ASA Class I or 11 patient, by the time the EKG gives warning of a hypoxic episode, the brain is already seriously injured, and indeed may have suffered irreversible damage.

On the other hand, once a crisis has occurred, the EKG may give invaluable information on the progress of resuscitation, Ode the use of drugs and other measures, and confirm the presence of sinus rhythm when circumstances make other methods less reliable.

From the New South Wales mortality committee’s records, Dr. Holland presented data showing that almost exactly half of 624 deaths could have been prevented by the application of modern monitoring principles and practices. The other half could not have been so prevented, and the solution to these tragedies lies in education and training.

This paper triggered lively discussion, and brought Jeff Cooper, Ph.D. to the microphone to enlighten the meeting on the recently published mandatory minimal monitoring standards for the Harvard group of Hospitals.

Dr. Cooper pointed out that the differences in environment of anesthesia practice may modify the approaches taken to enhance safety, especially if anaesthesia is more often in the hands of untrained or partly trained practitioners.

At another session, on Quality Assurance, chaired by Bill Crosby (Geelong, Australia), delegates were advised of a number of strategies aimed at detecting departures from “normal” or satisfactory anaesthesia outcomes and methods for correction. The dependence of quality of care evaluation on adequate record-keeping was emphasized, as was the value of feed-back from recovery room nursing staff.

Discussion on the “accident-prone” individual as anaesthetist, and how to keep that person (if he costs) out of the anaesthesia work-force, stimulated great interest. Although the desirability of such exclusion was acknowledged, it was agreed that previous attempts at obje6vely assessing suitability prior to entry have not been validated.

Discussion from the sessions continued at an informal breakfast meeting. Dr. Cooper reported on the recent meeting of the International Committee for Prevention of Anaesthesia Mortality and Morbidity in Vienna (see report on page 23). Dr. John Zorab described progress in the major study of perioperative mortality ongoing in the UK (CEPOO). Professor Crul brought news of the minimum monitoring standard now accepted in the Netherlands. This has effectively applied pressure on hospital authorities to provide appropriate equipment. Dr. Williamson reported that an expanded critical incident study is being organized in Queensland. The same type of study is also being planned in the UK using a “prospective” questionnaire.

The East and West contingents will be meeting together in 1988 at the World Congress of Anesthesiology.