Adams, AP: Safety in Anaesthesia Practice, In: Atkinson, RS, Adams, AP (Editors). Recent Advances in Anaesthesia and Analgesia, Vol. 17, Edinburgh: Churchill-Livingstone, 1992,1-24.
In this extremely thorough review of a complex topic, Dr. Anthony P. Adams, Professor of Anaesthetics, United Medical and Dental Schools, Guy’s Hospital, London, outlines what would make the ideal safe anaesthesia practitioner. This safe anaesthetist (using the term in the correct traditional sense to mean anyone who administers anaesthesia: physician, nurse, or other) is an intelligent, vigilant individual who is experienced and well rested. He/she uses appropriate monitors at appropriate times. His/her anaesthesia machine is up-to-date and well maintained, having been checked personally by himself/herself. He /she consistently prepares for the unexpected and he/she actively participates in the quality assurance process.
Anaesthesia providers can aspire to and attain this ideal, thanks to the efforts of those clinicians, researchers, and lawmakers whose respective concepts, studies, and legislation advanced patient safety to the forefront in the field of anaesthesia. Professor Adams has extensively reviewed this literature (142 references from the United States and the United Kingdom). His summaries and discussions of this information are well organized and informative.
Subtopics include: The epidemiology of accidents, monitoring standards, checking anaesthesia machines, the selection of anaesthetists, detection of anaesthetic mishaps, the end of flammable anaesthetic agents, fatigue, accountability and audit, competence to practice, product liability, and The Anesthesia Patient Safety Foundation. These discussions demonstrate the very wide range of issues underpinning the field of anaesthesia safety as well as the fact that the struggle to improve patient safety is ponderous, often painful, and still ongoing.
As Professor Adams points out, incredible progress has been made in ensuring the safety of patients undergoing surgery. This progress has not occurred ‘by accident,’ as anyone who reads this review will appreciate.
Abstracted by: James F. English, M.D.; Clinical Instructor in Anaesthesia, Harvard Medical School; Department of Anesthesia, New England Deaconess Hospital; Boston, MA