Volume 12, No. 3 • Fall 1997

Safety To Be Featured at ASA Meeting

John H. Eichhorn, M.D.

Anesthesia patient safety will once again be a central component of the scientific and educational sessions at the Annual Meeting of the American Society of Anesthesiologists in San Diego, October 18-22.

Safety-related scientific presentations are grouped in sessions at the meeting combined with practice management as well as history and education. The resulting meeting section this year will include 106 scientific presentations in five sessions. [See the adjacent article which includes information about an APSF-sponsored research study of residents’ attitudes regarding various safety related topics, one component of which will be reported as one of the 106 abstracts at the ASA meeting.]

This year, there will be a Refresher Course Lecture (# 242) Sunday, October 19 at 10:15 a.m. by Robert Caplan, M.D. of Seattle entitled “The ASA Closed Claims Project: Lessons Learned.” Traditionally, these reports have highlighted important established patient safety issues as well as frequently identifying new trends in adverse anesthesia events.

Other Refresher Course Lectures with safety-related themes include Saturday’s “NPO and Aspiration: New Perspectives” by R. Stoelting, M.D. (#111),”Inhalation Anesthetic Toxicity: Current Controversies” by E. Kharasch, M.D., Ph.D. (#122), “Transfusion Controversies and Management Alternatives” by K. Tremper, M.D. (#113), “Latex, Anaphylaxis and Other Allergic Responses” by J. Levy, M.D. (#123), “Anesthetic Management of Obstetrical Emergencies” by C. Gibbs, M.D. (#134), and “Management of the Traumatized Airway” by A. Gotta, M.D. On Sunday, J. Benumof, M.D. will present “The ASA Difficult Airway Algorithm: New Thought/Considerations” (#241), Dr. Caplan speaks on closed claims (see above), M. Bishop, M.D. will present “Bronchospasm: Successful Management” (#272), J. Eisenkraft, M.D. speaks on “Complications of the Anesthesia Delivery System” (#223) at the same time J. Eichhorn, M.D. presents “Risk Management in Anesthesia” (#233), D. Wedel, M.D. considers “Neurologic Complications of Spinal and Epidural Anesthesia” (#254), and G. Levinson, M.D. finishes the day with “Avoiding Obstetric Anesthesia Lawsuits: Relevant Guidelines and Standards.”

“Risky” Business

Tuesday, October 21, 2-5 p.m., there will be a special panel on “Anesthesia and Risk” which will include further review of closed claims by Dr. Caplan as well as a session presented by Dr. Jack Rosenberg of Ann Arbor about intraoperative cardiac arrests and other adverse events as studied by the QA process, a thought-provoking discussion by Dr. Matt Weinger from San Diego entitled “How Do We Teach Vigilance?” and, importantly, a final session by Dr. Jeff Cooper from the Massachusetts General on “How Do We Prevent Adverse Events?”

Scientific Sessions

Monday, October 20, in the morning, there will be a poster session including several presentations on the history of safety considerations in anesthesia practice, including summaries of the first anesthesia-related deaths in France, the first outcome analysis in anesthesia practice, anesthetic morbidity in the 25 years after the introduction of ether, and the first death associated with anesthesia. In the same session will be several posters dealing with anesthesia simulators and their use as teaching tools, including specifically ausculting important diagnostic sounds. In addition to the APSF grant-sponsored research on sleep and work schedules of anesthesiology residents (see associated article), there is a poster concerning the incidence of automobile accidents involving anesthesia residents at times after being on call. Simulator performance of well rested vs. highly fatigued residents will be presented by the Stanford team. The potential patient safety implications of all these studies can be discussed with the authors manning their posters during the session.

The Monday afternoon poster session will include a wide variety of topics. One study evaluates the potential benefits of actually administering an oral high carbohydrate drink to patients preoperatively. The impact of carboxyhemoglobin in the perioperative period will be presented by Marc Rozner, M.D. from Tampa. Carin Hagberg, M.D. of Houston will feature a poster suggesting that the routine elective awake intubation of morbidly obese patients is not indicated.

An Age-Old Question

“Age and Professional Liability: The National Practitioner Data Bank” is a poster in the Tuesday morning session to be presented by Ken Travis, M.D. from Dartmouth, which revives the debate on whether aging anesthesia practitioners present any patient safety risk. An abstract from Ann Arbor suggests that excessive pressure in endotracheal tube cuffs is common but not clinically important while another from France suggests it causes sore throat and hoarseness. Other posters will consider errors in continuous infusions of medications, preoperative prediction of susceptibility to malignant hyperthermia, and the misplacement of gastric feeding tubes into the tracheas of anesthetized patients.

One of the last sessions of the meeting will be a poster-discussion presentation that will include papers addressing the suggestion that acute smoking by patients increases myocardial ischemia, the need for an alarm to help assure the resumption of mechanical ventilation at the end of cardio-pulmonary bypass, a new aspect of the debate on the formation of carbon monoxide by dried out carbon dioxide absorbent, and, finally, a suggestion on the best position for the forearm to avoid ulnar nerve injury.

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