Patient Safety Continues as Significant Theme in ASA Exhibits
By John H. Eichhorn, M.D.
Regarding patient safety issues the exhibits at the ASA Annual Meeting in October contained many predictable variations on established themes as well as a few potentially promising surprises.
The Technical Exhibits featuring manufacturers displaying and selling their products [as always, specific brand-name references and endorsements are excluded from this publication] reflected many popular aspects of current practice. There were many computerized information management systems that all purported to enhance overall safety by making data access and trend-spotting easier. Patient warming devices continue to proliferate in number and shape. Most of the manufacturers and sellers made reference to recent publications suggesting that even moderate intraoperative hypothermia may predispose to less favorable patient outcomes. Latex-free devices and equipment also was more prominent this year as the publicity increased regarding the rare but dramatic potential allergic reactions to latex by certain patients.
Airway tools continue to be extremely popular. One patient mouthguard looked quite similar to those used by football players. New types of stylettes, including flexible lighted ones were shown. A new design LMA was displayed, as was a new "cuffed oropharyngeal airway" for use during spontaneous ventilation which has a large inflatable balloon-like "cuff" intended to fill virtually the entire pharynx when inflated. A new "visualized endotracheal tube" that has fiberoptic illumination and imaging actually in the wall of the tube and that can be used with a handset eyepiece, a videoscreen display, or a head-mounted virtual reality-type goggle display for the operator was shown. In addition to advantages in overcoming difficult intubations and verifying correct tube placements, the system is intended for diagnosis of tracheal pathology also. Two new devices intended to facilitate very rapid emergency crycothyrotomies were displayed.
Several hand-held capnographs were prominently offered. One was extremely compact and had a minimal "draw rate" of gas, potentially making it useful for infants as well as larger patients. There was a new generation of continuous intraarterial blood gas monitoring devices unveiled, again with the assertion that the surface is nonthrombogenic, allowing extended function (hundreds of hours). A new type of noninvasive blood pressure monitor claiming "direct" arterial pressure measurements via a cutaneous transducer was shown. Another new type of monitor exhibited was a device to asses tension in facial muscles via electromyographic electrodes that "separates the unconsciousness component from the analgesic component in determining the adequacy of anesthesia." It is intended to be used functionally as a monitor of level of consciousness in a manner similar to what is being successfully done with bispectral algorithm-processed EEG.
It was interesting to note that, while not necessarily specifically safety oriented, three new anesthesia machines were prominently displayed in the Technical exhibits. Each was purported to offer advantages over the familiar existing brands currently in widespread application in this country. Marketplace forces as well as formal product evaluations will determine over time whether this is so.
The ASA Scientific Exhibits (all summarized near the back of the ASA meeting program book) featured several presentations with patient safety implications. Probably the most dramatic involved a new difficult-airway tool. Dr. D. Gravenstein et al. From the University of Florida demonstrated their fiberoptic imaging stylette that has light and visual plastic fibers in a relatively stiff but flexible stylette. The video receiver and screen are quite compact, making them much easier to use than usual. This display received the APSF award for best safety-related scientific exhibit. Difficult airways were just as prominent as in the Technical Exhibits. Another presentation considered airway management in the ICU setting and, also, the Society for Airway Management had a booth.
Another scientific exhibit demonstrated a very compact hand-powered portable suction device intended for use during patient transport when traditional vacuum-powered suction is not available. One exhibit from SUNY Syracuse demonstrated in detail the dangers of accidental mixing of liquid volatile anesthetics in a vaporizer and techniques to detect and to avoid this problem. Finally, as has been the case for several years, there were many exhibits featuring computer applications intended to smooth, improve, and speed anesthesia practice, some of which touted specific patient safety advantages.
Dr. Eichhorn, Professor and Chairman of Anesthesia at the University of Mississippi, is Editor of theAPSF Newsletter