Patient Safety Emphasized at ASA Meeting: Exhibits

John H. Eichhorn, M.D.

Patient safety was again a prominent theme of the technical and scientific exhibits at the San Francisco 1988 American Society of Anesthesiologists (ASA) annual meeting.

Among the products displayed by manufacturers of supplies and equipment, there were few genuinely new ideas. Rather, the emphasis was on new variations and combinations of established technology, especially oximetry and capnography.

Thirty-one manufacturers exhibited pulse oximeters for sale in one form or another. Size, shape, and features varied widely, but the function was universal in its application. There were several versions of “data management systems” that organize patient and monitoring information in a manner believed to facilitate interpretation and faster response to clinical developments.

Among the new products seen was a calorimetric C02 detector intended to verify the correct placement of an endotracheal tube by showing a color change when the device is attached to a newly inserted tube through which expired gas flows. Intended only for single-patient use, these are relatively expensive at about $15.00 each and seem to be primarily intended for non-OR use in places where capnography would not be available (such as in an ambulance).

Also displayed was an intracardiac Doppler device intended to give a continuous reading of cardiac output and a waveform of ventricular contractility. This complemented several other ultrasound-based cardiac output devices.

Two manufacturers offered instruments to determine hemoglobin, hematocrit, or both in the operating room using a simple system utilizing a drop of patient blood. Such measurements by anesthesia personnel are likely to be easy and very rapid.

One anesthesia machine manufacturer offered for the first time a “vigilance audit” preventive maintenance program in which the anesthesia machines covered would be certified annually as functioning correctly and in compliance with standards.

Automated anesthesia record keeping devices continue to advance, with new programs for trending, analysis, and review of captured data.

Among the scientific exhibits were several presentations of automated/computerized anesthesia quality assurance programs. One focused specifically on the PACU. There was an illustration of the application of telemetered pulse oximetry for a hospital general medical ward. One display concerned non-invasive cerebral oxygenation monitoring and another demonstrated an endotracheal tube introducer that simultaneously insufflates oxygen while measuring exhaled carbon dioxide. One major display dealt with a computer simulation of clinical anesthesia situations and featured new graphic animations and a system to analyze errors in judgment by the subject training on the simulator.

Dr. Eichhorn, Harvard Medical School, is Editor of the APSF Newsletter.