Patient Safety Featured in ASA Meeting Exhibits

John H. Eichhorn, MD

Patient safety issues and related equipment designed to address them again were found throughout the Exhibit Hall, among both the Scientific and Technical Exhibits at the 2000 ASA Annual Meeting in San Francisco in October.

Among the Scientific Exhibits, the APSF’s E.C. Pierce Award for the best exhibit with a patient-safety related theme was given to a team from the University of Pittsburgh headed by John J. Shaefer, III, MD that presented the exhibit: " Simulation based training in applying the ASA Difficult Airway Algorithm." (See photo, page 47.) The simulator displayed had the ability to perform dynamic exercises involving difficult airways and possible methods of securing them. It seemed to attract significant attention from exhibit viewers.

As has been the case for several consecutive years, airway management and airway tools were prominent topics among the Scientific Exhibits. A team from UCLA and the University of Rochester displayed "A flexible video intubating scope as an important teaching aid for the difficult airway management." The flexible scope has a miniature video camera built into the handle and the miniature TV monitor is placed on the patient’s chest so the teacher standing behind the trainee sees on TV exactly what the trainee sees via direct laryngoscopy. Oxygen can be insufflated through the scope to allow more time for laryngoscopy. The airway management learning curves of the trainees were faster with use of this device. In another scientific exhibit, an educational presentation from the American Sleep Apnea Association highlighted such ideas as having patients bring their own CPAP masks to the OR and PACU and also presented a new Association statement about patients with documented sleep apnea having same-day surgery.

In the Technical Exhibits, airway management recurred this year as a very popular topic. Multiple fiberoptic intubation guides and devices were shown. Otherwise, there were new permutations and combinations of airway tools intended to offer newer approaches to what still seems to be a dominant if not the single main safety issue highlighted in the Technical Exhibits. Varieties and variations of the laryngeal mask airway devices and its siblings were prominently displayed. Temperature management seemed slightly less prominent this year but, nonetheless, there were many devices offered that were variations on the forced air blankets or products that revived the use of heated circulating liquids in what was claimed to the more convenient and/or efficient configurations.

Products intended to enhance monitoring capabilities were widely displayed. One very small, portable, real-time capnograph has the new feature of a very small sample draw and little dead space, so that it is intended for awake or sedated patients as well as anesthetized patients. Several-other hand-held three-in-one monitors were being advertised as ideal for patient transport or use in office-based anesthetizing locations. One cardiac function monitor is intended to give real-time continuous estimates of intravascular volume as a guide to intraoperative physiologic management. A new non-invasive blood pressure monitor fits on the wrist and updates the digital pressure readout every 15 beats. It is entirely self-contained, with batteries, but also can be connected to a waveform display. Infusion pumps for fluids and medications were prominently displayed. Several advertised that they minimized dead space and had improved safeguards against accidental infusion of air.

Finally, several of the major manufacturers showed new anesthesia "workstations" that combined an anesthesia machine, all monitors, and even related equipment such as pumps, on a single platform with only one central display and alarm. The projected cost of these integrated systems was quite formidable and appeared to be as much of a topic for questions from exhibit attendees as the benefits of an integrated display of all parameters and alarms in one place.

Dr. Eichhorn, Chairman of Anesthesiology at the University of Mississippi, is Editor of the APSF Newsletter.