Volume 3, No. 3 • Fall 1988

Safety To Be Featured at October ASA

Patient safety in anesthesia will once again be a major component of the presentations at the American Society of Anesthesiologists’ annual meeting in San Francisco, October 812. Various types of presentations will cover different aspects of the field.

Among the refresher course lectures on Sunday, October 9, will be a presentation “Anesthetic disasters: Causes, incidence and preventability” given by Dr. R.L. Keenan. Also in the morning, Dr. J.H. Eichhorn will discuss quality assurance in anesthesia. Later in the same day, Dir. J.A. Katz will present a refresher course on “management of intraoperative ventilatory emergencies:’

Among the workshops is one at 9 AM on Tuesday, October 11 on “needed research in patient safety.” On the following day, there will be a workshop on “quality assurance’ from 9 AM to 12 noon, and a workshop on “anesthesia machine obsolescence” from 2 to 4 PM.

Several of the formal presentations, both scientific paper and scientific poster, will deal with topics related to patient safety. In the sessions on patient safety and epidemiology will be presented a paper on the effect of obesity on the safe duration of apnea in patients, particularly during laryn8oscopy. ALSO, a paper generated from the ASA Closed claim Study concerning the impact of the severity of an injury on the way the mishap causing the injury is reviewed by various anesthesiologists will be presented. A discussion of the nasal insulation of oxygen as a way to prevent hypoxemia in apneic patients, such as during laryngoscopy, will be discussed. Findings regarding tracheal injury from the pressure of endotracheal tube cuffs and ways to prevent it will be presented. Finally, as an example of application of new research techniques, a paper will he given on “meta-analysis” as a new graphical and statistical technique to amalgamate the findings of many different research studies with the goal of attempting to help prevent adverse outcome from anesthesia.

Several papers in the sessions on monitoring relate to patient safety in anesthesia. There will be a paper on differentiating esophageal from tracheal capno8rams. Another paper will discuss the cascade of monitoring detection of anesthesia disaster. This work discusses accidents, such as circuit disconnects and failure of the oxygen supply, deliberately created in instrumented animals under general anesthesia. The sensitivity and specificity of various monitoring modalities was then studied over the course of evolution of events subsequent to these deliberate “accidents:’

Also, in the sessions on monitoring will be a paper on malignant hyperthermia and the clean anesthesia machine as well as a presentation on a simple pulse monitor for use during magnetic resonance imaging. Another paper will discuss an approach to “smart alarms” in anesthesia monitoring with the intention of suggesting that “rule-based” expert systems can potentially minimize unnecessary alarm events, consolidate alarm information, and suggest potential diagnoses in the course of adverse events. A different type of discussion will take place in a paper regarding the reproducibility of capnographic measurements in sedated patient receiving supplemental oxygen by nasal cannula while having exhaled carbon dioxide measured from the nose at the same time.

This list of presentations at the annual meeting is only a sampling of the multiple activities related to patient safety that will be available to anesthesiologists attending the annual meeting. Further details on these and other related presentations will be available in the meeting materials.