Patient safety retains its prominent place on the program of the American Society of Anesthesiologists (ASA) Annual Meeting this year in New Orleans.

In the ASA Refresher Courses on Saturday, October 17, there are three particularly pertinent presentations: J.L. Benumof, M.D. will speak on ‘Management of the Difficult Airway: The ASA Algorithm;’ R.A. Caplan, M.D., one of the principal investigators of the ASA Closed Claims Study, will present ‘Adverse Outcomes in Anesthetic Practice: What Are the Data? Can Outcome Be Improved?” and J. Ehrenwerth, M.D. will lecture on ‘Electrical Safety in the Operating Room.”

On Tuesday morning, October 20, there will be a panel discussion entitled “ASA Closed Claims Project: Impact on the Practice of Anesthesiology.’ Among the distinguished speakers will be F.W. Cheney, M.D., who is chairman of the ASA Committee on Professional Liability and the main organizer of the study. Also, Dr. J.B. Cooper will speak on the methodology of dosed claims analysis and E.C. Pierce, Jr., M.D., President of the APSF, will discuss ‘The Impact on Patient Safety.’ Integral to this significant session will be the opportunity for questions, discussion, and observation from ASA members. It is anticipated that this will be an extremely interesting panel.

Also on Tuesday will be a Clinical Update Program titled “Risk Management in Anesthesia” given by J.H. Eichhorn, M.D. in which patient safety and quality assurance issues will be related to medical-legal concerns.

Another panel discussion, this one on Wednesday morning, October 21, concerns airway fires. In addition to presentation of information about ignition and combustion, there will be discussion of clinical experience with airway fires and suggestions for anesthesia techniques in dangerous situations.

A substantive discussion of a subject that is receiving a great deal of attention as human factors are considered more and more in regard to anesthesia care is expected during a panel discussion Tuesday afternoon, October 20, entitled ‘Vigilance: Euphemism or Science?’ Audience members will be able to contemplate the potential impact on safety of presentations regarding neuropsychological, environmental, and task-related factors which might affect an anesthesiologists’ vigilance in the O.R. Automation in the O.R. and the mechanism of decision making will also be considered.

Among the scientific presentations in the section “Patient Safety, Epidemiology, and Education,” there are three oral paper presentations, two poster sessions, and one poster-discussion session with a total of 89 individual presentations in the six sessions.

Several papers will deal with problems of unintentional hypothermia in anesthetized patients and its consequences. One study examines the likelihood of central vascular perforation based on the type of tip on a CVP catheter. The complications associated with axillary block are discussed in a poster presenting a review of 17,750 of these block procedures. Another poster likely to attract considerable attention is entitled “Adverse Experiences of Recovering Physician Addicts /Alcoholics in the Perioperative Period”

Complications of epidural analgesia when instituted specifically by residents will be covered in a poster. Another paper examines the epidemiology of intraoperative bradycardia in infants. Hypoxemia during ‘conscious sedation” with midazolam and diazepam will be examined in an oral paper presentation. Another presentation will examine using transesophageal echocardiography to look for pulmonary embolization associated with the use of limb tourniquets for orthopedic surgery.

Safety Potpourri

Analysis of adverse events by two raters for 26,841 patients in a multicenter study will be the subject of a Monday afternoon poster. The diagnosis of patient latex allergy will also be discussed. Additional new methods intended to improve the prediction 4f malignant hyperthermia susceptibility are covered in several presentations. Factors predisposing to abscess formation after epidural block will be covered in another paper. Following up on past presentations, there will be a paper on exactly how carbon monoxide can be produced in an anesthesia breathing circuit.

Studies regarding the use of laryngeal masks in airway management will be among the first presented in this country while several other papers deal with various aspects of intubation and techniques for confirming correct endotracheal tube placement. (Also, papers in the Equipment, Monitoring, and Engineering Technology section deal with using capnography as an aid to blind nasal intubation and with a new device to detect esophageal intubation.)

A presentation in the poster-discussion session is titled simply, ‘Fire in the Operating Room!’ Also, a frequent question will be reexamined by a study looking at lower extremity nerve injury associated with the Lithotomy position.

A potentially significant paper related to the recent major interest in anesthesia simulators is entitled “Can Simulation Accelerate the Learning of Basic Anesthesia Skills by Beginning Anesthesia Residents?’ In the Equipment section, there will be a poster on the hearing acuity of anesthesiologists as it relates to alarm detection. Also in that section will be two papers on the use of artificial neural networks to analyze the effects of anesthetics.

In all, the recent tradition of significant emphasis on patient safety at the ASA meeting dearly will continue this year.

Dr. Eichhorn, APSF Newsletter Editor, is chairman of anesthesiology at the University of Mississippi Medical Center, Jackson MS.