Safety Issues Resonate through ASA Meeting Exhibits

John H. Eichhorn, M.D.

Patient safety issues and topics again could be found throughout the Exhibit Hall at the 1999 ASA Annual Meeting held in Dallas in October.

In the Scientific Exhibits, the APSF’s Pierce Award for the best patient safety related exhibit went to a team from the Long Beach, CA, VA hospital for an extensive exhibit about the cuffed oropharyngeal airway, its history, and, particularly, how it can be used to both facilitate and teach fiberoptic intubation (see photo, bottom of page).

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Coping with a difficult airway: Dr. Panchal demonstrates to an exhibit visitor how the COPA airway facilitates fiberoptic intubation and can be used to teach fiberoptic techniques under controlled circumstances in actual patients.

There were multiple computer applications displayed, several each for enhancement of clinical practice and for teaching applications. One from Boston University Medical Center was an Internet-based system for evaluating both residents and staff in an academic anesthesiology department. Another from Albert Einstein/Montefiore in New York uses both a LAN and the Internet for structured peer review of selected anesthetic cases. One example offered concerned the idea of using a "trial of extubation" at the end of cases with the intent to reintubate if needed. After net-based review, this practice was reevaluated and abandoned. Specifically helping to secure a complete preanesthetic history from a speaker of Spanish only by a non-Spanish speaking anesthesiologist is a "Spanish phrase CD-ROM for Anesthesia" exhibited by a team from Louisiana State University in Shreveport that allows specific yes/no questions to be selected by the history-taker and these are then spoken by the computer to the patient. Procedure descriptions and informed consent information spoken by the computer are also available.

A new type of monitor display based on sound was shown by Dr. R Loeb from the University of Arizona. Physiologic data from monitors (e.g. HR and RR) are converted to sounds simulating heart tones and breath sounds and then changes in blood pressure, saturation, end-tidal carbon dioxide, and tidal volume cause changes in the simulated sounds, providing continuous monitoring signals while anesthesia personnel can be looking at and doing other things.

A prototype version of a system that aromatically senses and records the type and amount of medication injected intravenously during an anesthetic was exhibited by Dr. R Evans and colleagues. Labels are scanned for medication identity and a special injection port holder measures volume injected, both of which can be automatically recorded on a computerized anesthesia record.

In the Technical Exhibits, there were many "new" variations of previously existing products and a few new products with safety implications.

"Thermal management" was arguably the most frequent topic among the multitude of displays. One product is intended to warm a hypothermic patient by using a vacuum to mechanically dilate blood vessels in a patient’s hand and then expose that increased circulation to a single-use chemical hot pack at 46°C, thus adding heat to the body. The manufacturer states that in a 70 kg person, the core temperature can be raised one degree C in 30 minutes.

Gastric tonometry of carbon dioxide is now available to be used as an early warning system of organ dysfunction. A silicone rubber balloon is part of an NG tube and equilibrates with gas tension in the gut with a 10-minute response time. Elevated CO2 indicates visceral ischemia before systemic acidosis appears and would invoke therapy intended to increase tissue oxygen delivery.

{short description of image} Award Winner: The E.C. Pierce Award from the APSF for the best patient-safety related scientific exhibit at the ASA Annual Meeting was won for 1999 by a team from the Long Beach (CA) Veterans Affairs Healthcare System with an exhibit entitled "The cuffed oropharyngeal airway (COPA) – a review and demonstration of its use in fiberoptic intubation" and presented by Drs. EC Behringer, RB Etrata, S Panchal, and RS Greenberg. Shown above are (from left), Dr. E.C. Pierce, Jr., APSF Executive Director, Dr. Sumedha Panchal, Dr. Elizabeth Behringer (holding award plaque), Dr. Robert Stoelting, APSF President, and Dr. Michael Good, Chairman of the APSF Committee on Education and Training.

Airway tools of all types but especially those with fiberoptic components, as always, were very prominent in the displays, again indicating that managing and securing the difficult airway persists as one of the central themes of anesthesia practice. Clinical trials of a product based on a past APSF Pierce Award-winning scientific display were emphasized at one commercial exhibit. The fiberoptic lightwand optical intubation aid for direct laryngoscopy involving an extremely small light source and camera on the stylet connected to an easily positioned 5-inch color TV monitor was prominently demonstrated as facilitating intubation in difficult airway situations. Also, a new type of disposable airway (on the theme of an LMA but different) was displayed that is placed using a relatively large metal "insertion blade" and involves a conventional inflatable balloon and, above that, a foam collar that fits snugly against the supraglottic region, generating what is claimed to be a better seal that is claimed adequate for positive pressure controlled ventilation with up to 40 cm H2O pressure. Also very common were permutations and combinations of IV equipment, particularly different types of injection ports. There were a great many computer applications, particularly comprehensive patient data management systems. Included with these could possibly also be considered the updated mannequin-based anesthesia simulators, which are becoming more and more realistic.

As before, there were more and more products touted as "latex free" or "MRI compatible," echoing patient safety themes from previous years. New brands of anesthesia machines previously not available in this country were touted as containing safety advances because they are compatible with the new International Standards Organization (ISO) standard F-1850. Their appearance and ergonomics will be unfamiliar to U.S. anesthesia personnel and, independent of any potentially perceived safety implications, it will be interesting to see how they are accepted in the American competitive market.

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