Past Annual Meetings

2011 Annual Meeting

Annual Mtg Onsite Materials:

Speaker Handouts:




Name Author(s) 
Introduction: The aim of this project was to determine the performance of an hybrid closed loop sedation system ('HSS') which integrates a decision support system (DSS) for controlled sedation of patients undergoing knee or hip arthroplasty with spinal anesthesia and conscious sedation.
Thomas Hemmerling, MSc, MD
Introduction: The SEDASYS System is an investigational computer-assisted personalized sedation system that is designed to facilitate the administration of minimal-to-moderate sedation with propofol. The system was designed using the ASA Practice Guidelines for Sedation and the FDA approved propofol labeling. The system provides many safety elements proposed by the anesthesia medical community based on decades of study and experience.
Paul Niklewski, BS
Recall of intra-operative events occurs in approximately 0.1% of all general anesthetics. Many of these patients experience devastating psychological consequences such as post traumatic stress disorder, and despite awareness monitors, malpractice claims citing recall have remained relatively constant. One frequent and avoidable cause of anesthetic recall is an undetected empty vaporizer. It has been recognized in the anesthesia safety literature that the lack of an "empty" alarm on non-powered vaporizers is a glaring deficiency. We now present the first such alarm, which is completely self contained, rechargeable, safe, effective and completely retrofittable.
Allan Shang, MD, MSE
Introduction: Polysomnography (PSG) is the standard procedure for the diagnosis of sleep related breathing disorders (SRBD) and patients are typically referred for overnight studies when they are identified as being at risk by a clinician. various tools are in use today to identify patients at risk for SRBD and refer them subsequently for studies. The ASA (American Society of Anesthesiologists) and other professional bodies have published guidelines calling for the recognition of patients suffering from SRBD during perioperative care.
David Lain, PhD
Background: General anesthesia includes initial drug injections that induce unconsciousness and paralysis, causing a patient to stop breathing on their own. The ensuing moments are critical, as a failure to provide oxygen will result in cardiac arrest, brain damage, and ultimately, brain death. Anesthesiologists utilize a multitude of tubes, connectors, and adapters to provide oxygen to the patient during these critical times and throughout the duration of anesthesia. This abstract describes a novel universal airway connector (The TibbleCap (TM) - ActMD Inc., San Diego, CA) that ensures continuous delivery of life-sustaining oxygen.
Adam Tibble, MD
Introduction: Ensuring that a patient always receives the correct blood product is known to be very difficult and reducing transfusion error is a national patient safety goal. In recent years, the standard mechanism has used the Typenex system where a wrist band with identification code is placed on the patient and peel-off labels with the same code are placed on the blood-sample tube and the blood-product requisition. The blood bank then sends the blood product to the operating room along with the code. Prior to transfusion, 2 people verify that the code on the patient's wrist matches the codes on the bag and chart copy. This system is known to be unreliable as the 2-person check is subject to lapses and bypassing without the ability to audit the check. We have instituted a comprehensive computerized barcode scanning system to decrease the probability of misadministration of a blood product.
Franklin L Scamman, MD
Microstream capnography is applied to spontaneously breathing, assisted and fully supported breathing during resuscitation. It has also been used effectively with noninvasive mask ventilation and CPAP. This analysis examines capnographic monitoring at two sites during simulated resuscitation with a bag-value-mask (BVM) apparatus in normal subjects.
Richard Wales, BS, RRT
Introduction: Anesthetic ventilators are vital to the safe administration of inhalational anesthetics. There are different models of ventilators with unique features which may be important for optimizing mechanical ventilation in pediatric and adult surgical patients with obstructive or restrictive lung disease while preventing hypoxemia, hypercarbia, and/or barotrauma. This study contrasts two types of anesthesia machine ventilators: The Apollo and Fabius GS. The relative position of the anesthesia bag in the circle system of the Apollo lowers the airway resistance compared with the Fabius (1). Two lung models were used with each machine for comparison. The first lunch model (A), an anesthesia bag, represented an ordinary lung. The second lung model (R), an anesthesia bag with resistance, represented an obstructed an/or restrictive lunch pattern.
Marc Bloom, MD, PhD
Introduction: Evaluation of care provided by physicians is an important part of pay for performance (P4P) and ongoing professional practice evaluation (OPPE). An optimal care score is an "all or none: summary score which combines several recommended treatment components. Optimal care scores are calculated at the level of the individual patient or patient encounter and then summarized at the physician, service or hospital level. Optimal care protocols have been developed for diseases such as diabetes and heart failure management. We report the development of an optimal care score anesthesia related care delivered to surgical patients.
Paul St. Jacques, MD
Introduction: The increasing number of parameters being monitored in the operating room has consequently increased the number of alarms. With the introduction of intelligent clinical decision support systems such as iAssist [1], false alarms are even more likely. The knowledge rules within iAssist were designed for use in the stable phase of anesthesia, but the system lacked this context and fired rules throughout a case. In addition, clinicians have multiple tasks to perform at the start and end of a clinical case and do not have time to initiate the system between cases. To facilitate the automated detection of the phases of anesthesia we have developed a set of phase rules, which deactivate or activate the knowledge rules as appropriate.
Dustin Dunsmuir, BSc
Introduction: The use of procedural sedation and analgesia (PSA) has increase in frequency and scope, including emergent settings inside and outside of the hospital. Although end-tidal CO2 (EtCO2) monitoring is routinely used during general anesthesia to monitor ventilatory status, this is not the case for PSA. Pulse oximetry and visual inspection, both with inherent limitations; represent the current standards of care for monitoring ventilatory status during PSA. EtCO2 monitoring may be a preferable method for detecting alveolar hypoventilation and preventing hypoxemia during PSA but is not widely used in this setting. Our study objective was to determine if capnography in addition to standard monitoring improved detection of respiratory events compared to standard monitoring alone.
Yulia Khodneva, MD
Background: Capturing vital signs for research activities, such as measuring heart rate variability [1], obtaining data to design, or testing novel medical displays [2] or alarm algorithms [3] is traditionally done by directly connecting a data capture device to the patient monitor. A novel method and device that allow researchers to retrospectively analyze data for all patients admitted to an intensive care unit (ICU) is presented.
Matthias Go?rges, PhD
Background: Dynamic predictors of fluid responsiveness like pulse pressure variation have made automated management of fluid resuscitation feasible. We present simulation data for a novel closed-loop fluid-management algorithm using pulse pressure variation (PPV) as the input variable. The performance of the closed loop was compared to the performance of anesthesiologists in managing a simulated hemorrhage.
Joseph Rinehart, MD
Introduction: Closed-loop management has been successfully demonstrated for many clinical applications but has been limited in fluid resuscitation due to the absence of reliable predictors of fluid responsiveness. We present simulation data for a novel closed-loop fluid-management algorithm using pulse pressure variation (PPV) as the input variable.
Joseph Rinehart, MD
Introduction: Alarm settings on capnography monitors are important and have the potential to prevent untoward events and even deaths by alerting caregivers to dangerous situations such as apnea and significant changes in CO2 levels. However, excessive alarms including clinically-irrelevant alarms ('nuisance alarms' or false-positive alarms created by artifact) have been shown to desensitize caregivers to clinically-significant alarms and become a threat to patient safety. In addition, they are a source of aggravation to patients and family members, potentially reducing compliance with monitoring. Recently, algorithms have been developed which have been shown to significantly reduce such clinically insignificant alarms. Our goal was a secondary analysis of data from an alarm survey of experienced users of capnography to compare capnography alarm settings commonly used between multiple care environments. Due to differing monitoring needs in each environment, alarm settings used may differ and such information may be useful to new users in developing their own alarm limit protocols or defaults for each care environment.
Greg Spratt, BS, RRT, CPFT
Introduction: Anesthesia records are different from other medical records because many data are recorded in a brief period by an individual who is engaged in vital tasks other than data entry. An especially demanding task is the recording of administered intravenous medications. The electronic anesthesia record should be designed and configured to facilitate the accurate and prompt recording of 6-10 drugs administered coincidentally. To help us choose between options implementable in EPIC, we performed multiple systematic searches for experimental and observational studies of impact of display format for medication entry rate and found none. We therefore did a Quality Improvement project within our department. Clinicians completed a task of selecting medications form a simulated environmental similar to EPIC's Anesthesia Intraop module.
Frank Scamman, MD
Background: The ability to measure hemoglobin continuously and noninvasively during surgery may allow for a more rapid assessment of a patient's condition and more appropriate blood management. This study evaluates the accuracy of noninvasive hemoglobin measurement via Pulse CO-Oximetry (SpHb) during complex spine surgeries compared to values obtained from laboratory CO-Oximetry (tHb).
Lauren Berkow, MD
Introduction: Prone position in patients undergoing spine surgery causes important cardiovascular and pulmonary disturbances. The aim of the present study was to determine incidence and magnitude of the decrease in cerebral oxygen saturation (SctO2) in patients undergoing spine surgery in prone position.
Thomas Hemmerling, MSc, MD
Introduction: Large scale data mining and analysis is becoming critical to achieving the next level of safety and quality in anesthesia. For the past four years we have been developing our own single-institution data warehouse, with an emphasis on the use of open source tools and software.
Matthew A. Levin, MD
Introduction: Current generation intra-operative monitoring and decision support technology remains primitive in comparison to other information-intensive fields. We hypothesized that open source tools and platforms could be used to build a next-generation intra-operative monitoring platform with near real-time decision support capability at low cost and with excellent interoperability, extensibility, and performance characteristics.
Patrick J. McCormick, MD