Safety Highlighted At ASA in Atlanta

Bradly J. Narr, M.D.; James H. Philip, M.D.

The October American Society of Anesthesiologists annual meeting in Atlanta included several scientific and poster sessions on patient safety and epidemiology. A brief summary of selected papers concerning patient safety is given here. More details are available in the abstracts, published as a supplement to Anesthesiology.

Dr. I.B. Cooper from Massachusetts General Hospital presented data on the effect of two interventions, pulse oximetry and intensive feedback of information from self-reporting, on the rate of operating room and recovery room anesthesia related problems. No reduction in recovery room impact events was associated with feedback of complications information. However, pulse oximetry did appear to lower the rate of unanticipated effects that were possibly anesthesia-related. The design of the study precluded the author’s speculation on specific reasons for the results.

Dr. D.M. Gaba from Stanford presented his model for using structured mishap analysis as a way to greater patient safety. A detailed summary of this work appeared in the September APSF Newsletter (2:24-25). A. DeAnda, working with Dr. Gaba, also presented a system for anesthesia simulation in an operating room. It uses actual operating room monitors and equipment to realistically simulate clinical situations faced by anesthesiologists. The system is employed to investigate problem solving by anesthetists during simulated anesthesia administration.

Information from the ASA Committee on Professional Liability on closed insurance claims dealing with respiratory mishaps was presented by Dr. R.A. Caplan from the University of Washington School. Although the results were preliminary, the data presented suggested that respiratory-related mishaps are a major source of risk and financial loss in anesthesiology. Close analysis of the cases indicated that capnography and pulse oximetry might have prevented the majority of respiratory related complications. Dr. Caplan reiterated that the findings must be interpreted cautiously, and continued investigation is underway.

Dr. R. Hines from Yale presented a prospective analysis of 3,244 consecutive admissions to postanesthesia recover (PAR) room. A significant finding was the high incidence of PAR complications in patients who developed intraoperative hypertension. The study verifies the necessity for vigilant monitoring of recently anesthetized patients into the PAR period.

Dr. K. Hogan of the University of Wisconsin presented convincing evidence that inhalations in diabetics are significantly more difficult than in matched controls and suggested that this may be a manifestation of “Stiff joint Syndrome”, comprising insulin-dependent diabetes, short stature, limited joint mobility, and rapidly progressive microvascular disease.

Dr. E.A. Ernst of the of the University of Alabama

showed that there was no significant difference in safety between open circuit and dosed circuit anesthesia when administered by an anesthesiologist skilled in both techniques.

Mr. L. Perlstein and Dr. P.G. Barash of Yale showed that patients’ perception of anesthetic care can be assessed by postcard inquiry.

Dr. H. de Sousa of the University of Pittsburgh presented data and analysis attempting to show that peritoneal insulating gas is not absorbed to a hazardous degree during laparoscopy.

Dr. R.L. Bernstein of the Orthopedic Institute of New York demonstrated that perdonation of two units of autologous blood prior to major orthopedic surgery significantly reduces the patient’s chance of receiving homologous transfusion.

Dr. R.R. Papenburg from Montreal General Hospital presented data and analysis which demonstrated that warmed crystalloid is not effective in warming already-cold patients.

Dr. A.C. Pinchak from Case Western Reserve attempted to demonstrate that 27 gauge needles are satisfactory for drawing blood for potassium measurement. Their experiments utilized dogs, however, which have equal intra and extracellular potassium levels and, thus, hemolysis would have no effect on measured serum potassium in that species.

Dr. A. Buschman from Brigham and Women’s

Hospital and Harvard, reported that the prevalence of hypoxemia among inpatients recovering from anesthesia in the recovery room is 14% and that hypoxemia exists even in patients without predisposing conditions or procedures.

Dr. I.P. Koch from the University of Toronto

presented data suggesting that ASA physical status classification is adequate to predict mortality in blunt trauma victims. They admitted, however, that to show this relationship, healthy patients who appeared badly injured were all classified as 4E or 5E.

Overall, the well-attended presentations reflected

a growing interest in a wide spectrum of safety related topics.

Dr. Narr, Mayo Clinic, and Dr. Philip, Brigham and Women’s, Boston, were moderators of the sessions on safety at the ASA meeting.