Volume 9, No. 4 • Winter 1994

Two New ASA Safety Videotapes Premiere

Ellison C. Pierce, Jr., M.D.

ASA Videotape 22, ‘Crisis Management in Anesthesia,’ was prepared in consultation with David Gaba, M.D., and his colleagues, including Dr. Stephen Howard. This production provides an overview of the key principles of crisis resource management and focuses on the mandate for the anesthesiologist to take charge when a life-threatening crisis develops during surgery.

Practical guidelines are offered on appropriate allocation of attention, management of all available resources, exercise of strong leadership, sensible distribution of the workload, and effective communication with the OR team.

Dr. Gaba’s colleagues from Stanford and the Palo Alto Veterans Affairs Medical Center play the staff roles during two engaging vignettes simulating evolving crises during anesthesia to allow the viewer to see the principles in practice. One is centered on a 20-year-old man having knee surgery under general anesthesia and the other a 72-year old patient with COPD undergoing splenectomy.

Both desirable and undesirable behaviors under stress are demonstrated and these behaviors are subsequently critiqued by Dr. Gaba and Dr. Howard.

The film provides a memorable learning experience for every anesthesiologist who lives with the pressure of a potential crisis case after case on a daily basis.

This videotape was shot on location at the Palo Alto Veterans Affairs Medical Center in California. In addition to the primary author, Dr. Gaba, contributions by the following are acknowledged: Steven K. Howard, M.D., Kevin J. Fish, M.D., Richard Botney, M.D., and Brendan Flanagan, M.D.

The production of ‘Crisis Management in Anesthesia’ was funded by the Burroughs Wellcome Company; and distribution was begun in the fall of 1994 by Burroughs Wellcome. The film was produced by GWF Associates, Holmdel, NJ.

ASA Videotape 23, ‘Memory and Awareness in Anesthesia,’ was prepared in consultation with Dr. Peter Sebel, Dr. Charles McLeskey and Dr. Robert Caplan. This film alerts the anesthesiologist to the problem of patient awareness during anesthesia, a serious issue considering the potential consequences. Since about 70% of awareness episodes may result from the choice of anesthesia technique, it is imperative that anesthesiologists are mindful of contributory factors. Reported incidence figures may represent just the ‘tip of the iceberg.’

During this film, which describes conditions that contribute to intraoperative awareness, the consultants provide specific recommendations for avoiding the occurrence of unintended and undesirable patient awareness during anesthesia. In addition, Dr. Caplan points out techniques for a postoperative patient interview by the anesthesiologist to determine whether awareness might have occurred. The responsibilities of the anesthesiologist, if an awareness episode has occurred, are then explained.

The importance of vigilance in preventing patient awareness is underscored by the testimonial of Ms. Andrea Thaler, a patient who states her episode of awareness was traumatic, with longterm negative sequelae.

Dr. Sebel concludes that intraoperative patient awareness can be prevented by adherence to definitive recommendations combined with careful monitoring of both patient and equipment.

The ASA funded the production of ‘Memory and Awareness in Anesthesia,’ and Burroughs Wellcome Company will distribute it in the Winter

of 1994-5. The film was produced by GWF Associates, Holmdel, NJ.

Dr. Pierce is president of APSF and executive producer of the ASA Patient Safety Videotape Series.