Volume 5, No. 4 • Winter 1990

Reporters Ask Safety Questions During ASA ‘Media Tour’

Richard H. Stein, M.D.

Anesthesia patient safety was the main topic of interest to reporters from the print and broadcast media at the American Society of Anesthesiologists’ Annual Meeting in Las Vegas in October. Thirty-two representatives of the media, the largest group in the history of the ASA, attended the very well received President’s Media Tour. Because of the obvious interest to readers, listeners, and viewers and because of past public education efforts of the ASA, many of the questioners gathering information or conducting interviews inquired about the safety of the anesthetic experience

Outgoing ASA President Richard Stein, M.D. appeared on the local ABC-TV and CBS-TV affiliates. There were two major newspaper stories, in the L-is Vegas Sun and the Reno Gazette journal. Dr. Stein was also interviewed on radio by the local CBS station and had a 20-minute interview with the News Director of the National Public Radio station serving the area. Also, Dr. Stein appeared for one hour on the “Las Vegas Profile” radio program and gave a 30-minute live studio call-in interview on the “People Talk” show. AU these activities illustrate the breadth and depth of the media and public interest in the practice of anesthesiology, particularly the saw aspects.

The main theme and principle concern of the reporters was, “Why is it safer today to receive an anesthetic ever before?” Three main reasons were offered as the fire level of response to these questions. First, there is the routine use of the pulse oximeter, providing continuous monitoring of hemoglobin saturation and thus giving the anesthesiologist very early warning signs of declining blood oxygen. Prior to 1 9 84, estimated risk of anesthesia-related deaths was I in 10,000. These may be excellent odds if you are in Las Vegas, but are totally unacceptable if that one person was a member of your family or your patient. The safety and well-being of our patients is the anesthesiologists’ chief concern. Also with the principles outlined in the ASA Monitoring Standards, having pulse oximetry routinely and with the addition of the routine use of capnography during general endotracheal anesthesia, the risk of anesthesia caused death has fallen to at least I in 30,000 and probably much lower. This is a dramatic drop in presentable complications and we now see concomitant relief in the significant cuts in malpractice premiums for anesthesiologists.

The second reason why it is safe-r to receive an anesthetic today is our newer anesthetic agents, e.,$ the most recent inhalation agents, beta blockers, short acting muscle relaxants, and intravenous infusion anesthetics. Our knowledge of the pharmacokinetics and pharmacodynamics of our new agents and safer techniques with improved delivery system allows us to safely administer anesthetics to a much wider range of risks among our anesthetic patients. Our modem anesthesia machines with built-in safety features and alarms are helping to decrease preventable equipment related and judgment-related mishaps.

The third, and probably the strongest reason for increased patient safety is the high caliber of the anesthesiologist delivering care. We truly have the brightest and best of young physicians being graduated from our residency programs. Further, our practicing anesthesiologists are dedicated to continuing education to stay current in their knowledge and skills and thus become better clinicians. The modem anesthesiologist is the key ingredient in recognizing the monitors’ early warnings and generating the proper timely response with our newer agents and techniques. Anesthesiolosists have proven to be the leaders and pioneers in medical practice quality assurance and peer review.

Several reporters inquired about our ASA Standards and their role in improved cam Thanks to the APSF ,Greater and all the publicity the Standards attracted, we are now seeing publicized the benefits of safer anesthetic administration: fewer catastrophies associated with anesthesia. The practicing clinician is better off today because of the educational efforts of the Anesthesia Patient Safety Foundation. It is only proper that our ASA House of Delegates placed APSF formally within our Society’s Dues Structure, guaranteeing support from our entire membership.

ASA Standards Cited

Questions were asked concerning a key issue in patient safety, the fear of not waking up, and even regarding “How does a patient successfully sue you.?” The responses always reflected the positive advances we are making in patient safety and the fact that patients are in excellent hands when being put to sleep by an anesthesiologist.

Four new noninvasive cardiovascular techniques were presented at the Las Vegas ASA Annual Meeting. Automated ST segment analysis uses a computer that continuously watches the electrocardioscope for signs of inadequate circulation to a patient’s heart. New noninvasive techniques to monitor continuously blood pressure wave forms will supplement the intermittent blood pressure monitoring technique currently used. Thoracic electrical bioimpedance monitors reveal changes in the electrical conductivity of the chest and thus estimate the quantity of blood being pumped from the heart, providing an early warning of the decrease in cardiac output that may precede changes in blood pressure. Finally, transesophageal Doppler echocardiography using high-frequency sound to evaluate the fine details of cardiac function can provide the earliest possible warning signs of intraoperative myocardial ischemia. All these new techniques are advances that will help improve safety for the patient receiving anesthesia.

Dr. Stein, Vincennes, N, is ASA Immediate Past President.