Patient safety was a significant component of one section of the scientific presentations at the March 7-11 Annual Meeting of the International Anesthesia Research Society in Orlando. Summarized briefly here are a few of those abstracts.
Drs. S. Barnes and A. Sikavitsas presented survey results concerning application of appropriate guidelines for the administration of IV sedation by nonanesthetists in emergency room settings. While printed guidelines seem to be widely available, it appeared that there was relatively low compliance with them, particularly with pediatric and also critical patients. Suggestions for more efforts to insure safe sedation practices in ER were made.
Dr. B. Bryssine and colleagues from France studied 110 patients and noted that absorption of large amounts of glycine with consequent adverse effects (hyponatremia, including one patient down to 94 mmol/L, and hyperammonemia, including one with encephalopathy) is a definite risk of intrauterine endoscopic surgery involving facilitating glycine infusions. The TURP syndrome may need to be renamed.
Dr. M. Contreras and associates questioned whether anatomic differences between the genders may contribute to the incidence of ulnar neuropathy and concluded that the anatomy of men as compared to women is such that it does, in fact, predispose to the compromise of the ulnar nerve in the ulnar groove at the elbow, which would explain the comparatively higher incidence of perioperative ulnar neuropathy in males.
Possibly surprisingly, Drs. R. Gaiser and A. Castro reported that the incidence of dental damage from laryngoscopy does not correlate with the level of training of anesthesia residents involved. Dental injuries (overall rate when residents are involved was about 1 in 1000) were just as likely to occur with a senior resident as with a new trainee.
A study was presented in which 11 volunteers were anesthetized with sevoflurane in sufficient quantities and circumstances to produce Compound A through interaction with the CO2 absorbant. Dr. M Goldberg and coinvestigators reported that Compound A does cause nephrotoxicity (demonstrated by urinary glucose and protein increases) and that the degree of effect observed correlates directly with the extent of uptake of Compound A in the affected subjects.
Dr. A. Rosenberg and associates presented data from 538 patients who were reinfused with unwashed shed blood from orthopedic surgical procedures which was found “not associated with any complications in our study.” In another paper, Dr. M. Rosenblatt and colleagues report reinfusing salvaged blood washed and passed through a special filter during surgery on spine malignancies. There appeared no decreased long-term survival and the authors concluded that malignancy need not be an absolute contraindication to salvage and reinfusion of blood in selected cases.
Reducing the apnea time associated with anesthesiology residents learning fiberoptic-guided intubation techniques was the goal of Dr. J. Smith and associates who found that use of a concomitant in-situ LMA allowed longer efforts for intubations but that the apnea interval during those times was reduced.
Dr. Y. Sowb and two colleagues gave a presentation entitled “Competence analysis of intraoperative critical events.” Briefly, they examined ventilation-related intraoperative critical incidents and constructed an elaborate model of all the 15 factors potentially involved. Six variables can be observed directly, two must be calculated, and seven involve hypothesis testing (such as whether there may be a gas supply failure occurring). A “competence model” of the gas delivery system was presented and it was noted that the nuclear power industry has used this technique to study operations with the intent of improving both training and operations to decrease the likelihood of accidents involving human error. Suggestions that the same concepts can be applied to anesthesia critical incidents, such as these ventilation related events, were offered by the authors.