The 2004 American Society of Anesthesiologists meeting will be held October 23-27 in Las Vegas, Nevada. Safety will again play a key role at this meeting in the venues of Refresher Course Lectures, Clinical Update Programs, Scientific Presentations, and Scientific Exhibits. The 2004 ASA Annual Meeting Program provides detailed information—in addition, a synopsis is presented in this article as a preview and guide to patient safety at the 2004 ASA.
Refresher Course Lectures Feature Diverse Safety Topics
The 55th Annual Refresher Course Lectures begin on Saturday morning, October 23, and feature Dr. Neligan presenting Bariatric Medicine: Clinical Implications of Morbid Obesity (#121), Dr. Ehrenwerth’s hot topic of A Fire in the Operating Room: It Could Happen to You (#133), Dr. Cottrell discussing Brain Protection in Neurosurgery (#145), and Dr. Steve Hall reviewing The Child With a Difficult Airway: Recognition and Management (#150). The afternoon session continues with the sequential lectures of Dr. Hagberg presenting Current Concepts in the Management of the Difficult Airway (#116), Dr. Mark Warner tackling Perioperative Neuropathies, Blindness and Positioning Problems (#117), and Dr. Robert Caplan enlightening us with The ASA Closed Claims Project: Lessons Learned (#118). Also in the afternoon Dr. Leak will review The Potential Hazards of Perioperative Herb and Dietary Supplement Use (#146), Dr. Klock will review Drug Interactions for the Anesthesiologist (#147), and Dr. Berry will be informing us as to What to Do after a Bad Outcome (#148). Refresher Course Lectures continue Sunday morning with Dr. Gross awakening attendees with Less Jolts from Your Volts—Electrical Safety in the Operating Room (#207). Dr. John Eichhorn follows with Risk Management in Anesthesia Practice (#208), and Dr. Barash discusses Sequential Monitoring of Myocardial Ischemia in the Perioperative Period (#238). The final morning lecture is Dr. Gilbert providing highlights of Complications and Controversies in Regional Anesthesia (#245). The Sunday afternoon session includes Dr. Hogue reviewing ACLS for the Anesthesiologist (#205), while Dr. Schwartz will provide the parallel Update on Pediatric Advanced Cardiac Life Support (#234). Two lectures, Dr. Andrews helping us in Understanding your Anesthesia Machine (#211) and Dr. Eisenkraft presenting Problems with Anesthesia Gas Delivery Systems (#212), will highlight equipment safety, specifically enhancing our working knowledge of anesthesia machines. Dr. Roccaforte will also discuss the timely topic of Weapons of Mass Destruction: What We Need to Know (#206). Airway management will again be highlighted by Dr. Rosenblatt assisting our Decision Making In Airway Management (#217). In addition, Dr. Jeff Vender will pose an interesting question as he asks, Is Pulmonary Artery Catheterization Still Necessary (#204)?
Refresher courses continue Monday, October 25, through Wednesday, October 27. Safety based lectures include Dr. Olympio discussing safety features of Modern Anesthesia Machines, What You Should Know (#501), and Dr. Morray reviewing Unexpected Cardiac Arrest in Pediatric Anesthesia: Causes and Preventions (#309). Regional anesthesia safety is highlighted in 3 presentations: Dr. Wedel reviewing Neurologic Complications of Spinal and Epidural Anesthesia (#312); Dr. Horlocker teaching us about Peripheral Nerve Injury Following Regional Anesthesia: Diagnosis, Prognosis, Prevention (#414); and Dr. Drasner asking Is Lidocaine Safe for Spinal and Epidural Anesthesia (#413)? Finally, Dr. Barach will call our attention to Nuclear, Chemical, and Biological Hazards: Are You Prepared (#408)?
Scientific Papers Focus on Patient Safety
The Scientific Papers Poster portion of this ASA Meeting includes 6 sessions encompassing presentations that directly focus on patient safety. The first session will be held on Monday, October 25, at 9 a.m. in Hall C2, Area 6 of the Las Vegas Convention Center. Drs. David Mackey and John Tetzlaff will moderate this session. Dr. Lubenow and colleagues open this session with Safety of Magnetic Resonance Imaging (MRI) in Patients with Implanted Neurostimulators (A-1362). Dr. Shibata and coworkers from Nagasaki, Japan, will also discuss Comparative Effects of Disinfectants on the Epidural Needle/Catheter Contamination with Indigenous Skin Bacterial Flora (A-1363). Also on Monday an afternoon session will be held beginning at 2 p.m., in Hall C2, Area N. Drs. David Murray and Susan Tebich will facilitate this group of papers. Simulation is a major focus of this group, and Dr. Devitt et al., from Dalhousie University, Nova Scotia, Canada, will ask the question, Can the Number of Unplanned Errors Predict Performance on a Simulator-Based Evaluation Process (A-1243)? Another Canadian team, led by Dr. Morgan, from Ontario, will present Global Ratings to Assess Undergraduate Team Performances (A-1244). Dr. Deborah Whelan and her team from Wake Forest University ask, Does Training Affect the Definition of a Difficult Intubation (A-1247)? The subsequent presentation is that of Dr. Melanie Wright, PhD, a former recipient of an APSF Research Award, and her group from Duke University. Her presentation explores The Role of Simulation in the Development of Clinical Research Protocols (A-1248). Drs. Harrison, Howard, and Gaba from the VA Palo Alto Health Care System-Stanford University discuss The Use of Cognitive Aids in Simulated Anesthetic Crises (A-1250). An Israeli team led by Dr. Haim Berkenstadt also use simulation to explore Simulation-Based Evaluation of a Point-of-Care Information System for Anesthesiologists While Managing Pediatric Cardiac Dysrhythmias (A-1252).
Airway Issues Remain Important
In this same session, using a review of 1096 emergency intubations, Dr. Steven Flurry and colleagues present Airway Rescue with the Bougie in Emergency Airway Management (A-1251). Airway issues are also presented in paper A-1254, Lateral Neck Radiography and Prediction of Difficult Intubation: A Double-Blind, Randomized Trial, which comes from Dr. Kamali’s group from the University of Medical Sciences in Fars, Iran. Dr. Kipnis and coworkers from Lille, France, report on the Development of a Difficult Intubation Risk Assessment and Management Algorithm (A-1259); Dr. Sengupta and a team from The University of Louisville use Ultrasound Evaluation of Anterior Neck Soft Tissue Thickness as a Predictor of Difficult Laryngoscopy in Obese Patients (A-1260); Drs. Wolsczak and Mort from Hartford Hospital discuss The Role of the Combitube for In Hospital Emergency Airway Management (A-1261); and Dr. Romeo and colleagues from the University of Pittsburgh will report on Difficult Airway Management Using Human Dynamic Macrosimulation: Practicing Anesthesiologists Do Not Follow the ASA Difficult Airway Guidelines (A-1262). A German team lead by Dr. Berthold Bein also presents Tracheal Intubation Using the Bonfils Intubation Fiberscope after Failed Direct Laryngoscopy (A-1263). Complications from intubation and airway management are also discussed at this session in papers by Dr. Qureshi’s group from Louisville who present Factors Associated with Dental Injuries Associated with Anesthesia at University of Louisville Hospital (A-1253); Drs. Tolan and Westerfield who discuss Dental Injuries in Anesthesia: Frequency, Causes and Preventive Strategies (A-1256); and Dr. Yamanaka’s team from Osaka, Japan, who report on Hoarseness Following Endotracheal Intubation (A-1257).
Also on Monday afternoon, but in Hall C2, Area O, Drs. Calmes and Bacon will be the moderators of a session that includes a presentation by Dr. Candiotti and colleagues from the University of Miami, who explore Biological and Chemical Terrorism Preparedness—A Survey of Anesthesia Training Programs in the United States (A-1316). Occupational and environment safety are the focus of 3 presentations in this forum. Dr. Gold’s team from the University of Florida call attention to Addiction: An Occupational Hazard for Anesthesiologists (A-1323); Dr. Katz from Yale expounds on Radiation Exposure to Anesthesia Personnel (A-1324); and Dr. Akito Ohmura, from Teikyo University School of Medicine in Kanagawa, Japan, asks the question: Are We Polluting the Hospital Environment with Anesthetic Gases (A-1329)?
Medical Errors and Adverse Outcomes Explored
On Tuesday morning, October 26, in Hall C2, Area F, Drs. William Johnston and Bobbie Sweitzer will moderate a Scientific Papers Poster Session that begins with Dr. Glenn Murphy and colleagues from Northwestern University and Evanston Northwestern Healthcare describing Retrograde Air Embolization During Radial Artery Catheter Flushing: An Ultrasound Study (A-1273). Dr. Kimberly Kressin and members of the ASA Closed Claims Database team review the problem of Burn Injury in the OR: A Closed Claims Analysis (A-1282). Another hot issue involves the question Does the Use of Bair Huggers Increase the Likelihood of Operating Room Fires (A-1298), brought to light by Dr. Deborah Williams’ team from Stanford University. Medical errors are the subject of a number of presentations in this session including Discharge Analgesic Prescription Errors in Pediatrics: A Preliminary Study of 105 Patients (A-1280), presented by Dr. Lee and coworkers from Johns Hopkins Medical Institutions; Wrong Sided Anesthetic and Surgical Procedures: Are They Preventable? (A-1283), presented by Dr. Barach and Sam Seiden from the University of Miami; and Adverse Events Associated with Anesthesia (A-1297), discussed by Dr. Myrna Newland and her team from the University of Nebraska. Drs. Dulitz and Wong from Northwestern University illuminate the devastating complication of Postoperative Visual Loss: A Retrospective Chart Review (A-1286). Dr. Ping-Wing Liu and colleagues from Chang Gung Memorial Hospital-Linkou in Taoyuan, Taiwan, via their poster A Continuous Quality Improvement Program Reduced Perioperative Adverse Outcomes in a Large Hospital in Taiwan (A-1278), demonstrate Taiwanese progress in patient safety. Japan is also well represented by Dr. Irita’s group from the Japanese Society of Anesthesiologists with their presentation Cardiac Arrest in the Operating Theater Due to Problems in Administration of Anesthesia-Related Drugs: An Analysis of 3,855,384 Anesthetics over a 4-Year Period in Japanese Society of Anesthesiologists-Certified Training Hospitals (A-1277).
Information Systems Provide Important Methodology
On Tuesday afternoon, October 26, at 3:30 p.m. in Hall C2, Area 5, Drs. Keith Ruskin and Brian Parker will facilitate a session that has a number of presentations that utilize information systems in patient safety. Dr. Vigoda and colleagues from the University of Miami present both Anesthesia Information System Helps Identify Missed Opportunities for Perioperative Beta-Blockade (A-1378) and Anesthesia Information System Demonstrates Inadequacy of Perioperative Beta-Blocker Therapy (A-1381). Dr. Thomas Powell from Jackson Memorial Hospital in Miami, Florida has 2 presentations in this session: Merging Man and Machine in Anesthesia Quality Assurance (A-1379), and A Classification System for Electronically Extracted Adverse Events in Anesthesia (A-1382). Dr. Michael O’Reilly’s team from the University of Michigan demonstrates Using an Anesthesia Information System to Implement Practice Guidelines (A-1380). Florida is again represented by Kanzki-Armand and colleagues from Jackson Memorial Hospital in Miami with the presentation Health Information Technology: A State-Wide Approach to Improving Quality and Reducing Medical Errors in Florida (A-1384). Also on Tuesday afternoon, beginning at 2 p.m. in Hall C2, Area O, Drs. Michael O’Connor and Lois Bready will facilitate and moderate scientific papers that include a discussion of the Impact and Literature Consensus on Implementing a Patient Safety Curriculum (A-1346), presented by Dr. Tracy Jackson and teammates from The University of North Carolina at Chapel Hill. A group from Penn State in Hershey, Pennsylvania, led by Dr. Murray will discuss Using a Simulated Environment to Enhance the Safety of Ventilator Use by Improved Understanding of the Interaction Between Ventilators and Patient Pulmonary Physiology (A-1350). Dr. Murray’s group will also present Models for Providing Simulation Experience to Large Groups (A-1356).
Finally, on Wednesday morning, October 27, in Hall C2, Area 4, Drs. Joan Christie and Jean Pierre Yared will facilitate scientific papers that lead off with Dr. Powell and colleagues, again from Jackson Memorial Hospital in Miami, Florida. Dr. Powell will present Adverse Event Reporting Failures, Fear May Not Be the Barrier (A-1386). Dr. Paul Barach and coworkers, yet again from Miami, present A-1392, Modeling Techniques to Reduce Errors in Patient Hand-Offs.
It is clear that patient safety is the subject of an increasing number of important research investigations. The APSF wishes to commend these researchers and the many other clinicians and scientists who are dedicating their efforts to making anesthesia and the perioperative period safer than ever. Thank you.
Dr. Morell is Editor of the APSF Newsletter and a member of the Executive Committee. He is currently a Clinical Associate Professor of Anesthesiology at Wake Forest University and is in private practive in Fort Walton Beach, Florida.