Patient Safety Featured at Oct. 9-13 ASA Meeting

John H. Eichhorn, M.D.

Patient safety once again will he prominently featured in the program presented at the Annual Meeting of the American Society of Anesthesiologists (ASA) in Washington, D.C., October 9-13.

Among the ASA Refresher Courses on Saturday, October 9, is a presentation by Dr. J. Ehrenwerth on electrical safety in the operating room. Sunday’s presentations include a lead-off presentation by Dr. R. Caplan, one of the lead investigators of the ASA Closed Claims Study, entitled “Adverse outcomes in anesthetic practice: what are the data? Can outcomes be improved?’ Later that day is a lecture by Dr. P. Kapur on the recognition and management of complications of ambulatory anesthesia.

In the Clinical Update Program at midday on Tuesday, October 12, Dr. R. Stoelting will give a presentation discussing changing perspectives on NPO status and aspiration pneumonitis. Immediately following will be Dr. D. Cook lecturing on the safe induction and emergence of the pediatric patient. At the same hour, Dr. J. Eichhom will present a safety-oriented discussion of risk management in anesthesia practice. The following day, Dr. J. Benumof will lecture on the management of the difficult airway with emphasis on the ASA algorithm developed by an ASA task force he headed.

Also on Tuesday morning, October 12, will be a three-hour panel discussion entitled ‘Obstetrical anesthesia: how safe is it?’

Within the ASA meeting section on patient safety, epidemiology, education and history, there will be six scientific sessions containing 83 papers. On Monday, October 11, in the morning, there will be a poster-discussion session focused primarily on measurement of clinical performance, application of computers and use of simulators. Monday afternoon, a poster session on various clinical practice issues is scheduled. Tuesday, October 12, there will be an oral presentation session in the morning dealing with the history of anesthesia practice and related issues. That afternoon, another oral presentation session will contain papers addressing resident education and clinical teaching issues. Wednesday morning, October 13, there will be an oral presentation session focused primarily on airway management and related safety points. Finally, Wednesday afternoon, there will be a major poster session (one of the strongest of the meeting) with the theme of patient safety risks and outcomes.

Among the many safety-related topics that will be covered in the presentations will be several on the use of anesthesia simulators. Whether experience on these devices leads to improved clinical performance will be examined as well as aspects of their utility as teaching modalities.

Human factors contributing to anesthesia accidents will also be considered. For example, a study was conducted regarding the role of fixation of an anesthetist s attention in preventing the recognition of a potentially dangerous anesthetic overdose. Videotape analysis of practice characteristics was used in another study.

Another study evaluates the use of stethoscopes as continuous monitors, as suggested by the ASA monitoring standards. Several new and, it is hoped, better ways to evaluate and deal with patients’ airways will again be offered among the presentations, as will several discussions of the effectiveness and safety of laryngeal mask airways.

Capnogram recognition by attendees at last year’s ASA meeting was studied and the results will be presented. The source of latex allergens as a potential source of reactions will be discussed.

Attitudes of anesthesiologists about OR ‘production pressure’ (the demand for the maximal amount of service in the minimal possible time, even if safety corners must be cut) were studied and the possibly surprising results will be presented. Also, the new idea of incorporating anesthesia risk factors into OR scheduling parameters will be revealed and discussed.

The hypothesis that continuous non-invasive blood pressure monitoring may help reduce risk will be presented and tested. Cases in which ‘too much drug” was given were analyzed and the causes will be presented. In another area, further work into the cause of the now-recognized syndrome of sudden cardiac arrest during spinal anesthesia is the subject of a paper. Also, the relationship of end-tidal carbon dioxide to arterial in sedated awake patients with blocks for cataract procedures, a topic directly related to a flurry of letters in recent issues of the APSF Newsletter, will be discussed.

Current attitudes toward NPO orders is the subject of a scientific paper, as is also the incidence of mortality associated with pediatric liver transplantation and the outcome of pancreas transplants. Differing risks for different CVP catheterization sites is also the subject of a presentation.

A new cement for total hip arthroplasty was examined for safety and efficacy and the results will be revealed. Factors involving potential laryngoscope contamination in differing settings were studied as well as a survey of methods used to clean laryngoscopes both will be presented. Further, there will be a follow-up presentation regarding the potential mechanism of infection in propofol liquid.

In all, the recent tradition of significant emphasis on patient safety at the ASA meeting clearly will continue this year.

Dr. Eichhorn, APSF Newsletter editor, is chairman of anesthesiology at the University of Mississippi, Jackson, MS.