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For years anesthesiologist have refused technology to help with documentation, etc. With the growing public awareness of medical errors and pressure from groups like HIPPA, HCFA, and Leapfrog, do you think they will now start to rely more on technology? —bpanosian@docusys.net

Dr. David Lubarsky responds:

It is clear that the future of medical record keeping is electronic, and probably wireless. With the exploding amount of information, computer assisted decision-making, algorithm storage and guidance via computer, as well as preventing bad reactions and promoting optimal care by cross-checking medical records with proposed drugs to be administered, are all going to come about in the near future.

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Is it possible for anesthesia equipment to become contaminated by infectious agents, specifically viral agents, after employing it to practice anesthesia in an infected patient? Do you know of any clinical trials where this possibility has been studied? —Dr. Maria Laura Alonso

Dr. Kathryn McGoldrick responds:

We do know that a few of the more hardy infectious agents can be transmitted via contaminated anesthesia or surgical equipment. Obviously, however, this is not the type of problem that would lend itself to controlled "trials."

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What are the minimal lab and x-ray requirements for ambulatory patients receiving GA and MACs for endoscopy? —seasons4@midwest.net

Dr. Kathryn McGoldrick responds:

If the patient is perfectly healthy, only a history and physical examination are required. No laboratory tests or X-rays are indicated for that particular circumstance. IF the patient has medical problems, then tests should be ordered based on the patient's history and physical findings. The point is to not order tests ROUTINELY but rather to base the tests on the individual patient's medical history.

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Is there an approved (FDA or otherwise) electronic anesthesia record system? Are any of these systems (e.g., PICIS, CompuRecord) recommended by anindependent anesthesia organization?—rjohn12866@aol.com

Dr. David Lubarsky responds:

All intraoperative record keepers require FDA approval as a device "hooked up to a patient." (510K, I believe). None are recommended by an independent organization. The best advice is to speak with experts,visit/talk to a site where the version you are buying is actually in service, and make sure that it is of a comparable size to your planned deployment. At Duke University, we have Saturn (made by Drager) and are quite pleased with it, and are rolling out a PACU module to connect with our intraoperative piece. PICIS has a similarly large premier site at Mayo and has software for the ICU, and Compurecord has many installations (but not all of them necessarily the latest windows based version). All three seem to be popular products among users. The University of Michigan is developing a highly touted home-grown automated record with GE.

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Can you direct me to any literature that talks about estimating blood loss when "eyeballing" surgical sponges. —lanettegm@hotmail.com

Dr. David Lubarsky responds:

I do not know of any literature, however, I suggest using saline with red food dye. I measured this during my residency being the curious type. 2x4—pink 1cc, red 5cc, soaked about 10cc large lap pad—pink 10cc, red 25 cc, soaked 50cc

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Do you know of any new nerve stimulation or nerve imaging devices to aid in performing peripheral nerve blocks? —104472.1513@compuserve.com

Dr. Francine D’Ercole responds:

Presently, a B. Braun nerve stimulator with stimuplex needles is used at our large academic institution. There is literature documenting the attempt to employ ultrasound. However, the practicality is quite limited until technology improves. There maybe a needle for peripheral nerve blockade with ultrasound capability in the pipeline, however, this is not yet state-of-the art.Additionally, the literature does not adequately support this methodology as superior or cost effective.

Reference:

• Pusch F, et al. Sonographic measurement of needle insertion depth in paravertebral blocks in women. British Journal of Anaesthesia. 2000; 85(6):841-3.

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Is it not unusual for patient to awake during surgeries, due to the anesthesia now being used?
—Gary Ramae

Dr. Katherine Grichnik responds:

It is exceedingly unlikely and very, very infrequent for a patient to awaken during surgery done under general anesthesia with our currently used anesthetic techniques and monitors. An especially useful monitor is the BIS, a two channel EEG put on the patient's forehead. It converts the EEG signal to an analog scale which has been correlated with patient awareness (scale 1-100, higher numbers more likely to be awake/aware, lower numbers less likely to be awake/aware). Monitoring the BIS during surgery aids the anesthesiologist in determining the depth of anesthesia. Inhaled anesthestic agent analyzers can also help to guide depth of anesthesia. An experienced anesthesiologist should also be able to monitor a patient's vital signs and movements to also guide depth of anesthesia and prevent awareness during general anesthesia.

For surgeries done under local or regional techniques, the goal is to have an awake patient, who may be sedated to varying degrees for anxiolysis and comfort in the OR as necessary. You may be referring to a surgery done under local or regional anesthesia.

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I need information, web sites and links, and literature about a new device, similar to the combitube, but of silicon and usable for every age.
— Jorge Ivan Izaguirre

Dr. Peter D. Dwane responds:

The only information that I found was from an article in Anesthesia & Analgesia in May 2000 [1]. The maker of the laryngeal tube is VBM Medizintechnik GmbH, Sulz, Germany. The email of the author of the article is:
v.doerges@t-online.de.

Contacting the maker of the laryngeal tube or the author may help you to obtain this product.

Reference:

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Is it not unusual for patient to awake during surgeries, due to the anesthesia now being used?
—Gary Ramae

Dr. Katherine Grichnik responds:

It is exceedingly unlikely and very, very infrequent for a patient to awaken during surgery done under general anesthesia with our currently used anesthetic techniques and monitors. An especially useful monitor is the BIS, a two channel EEG put on the patient's forehead. It converts the EEG signal to an analog scale which has been correlated with patient awareness (scale 1-100, higher numbers more likely to be awake/aware, lower numbers less likely to be awake/aware). Monitoring the BIS during surgery aids the anesthesiologist in determining the depth of anesthesia. Inhaled anesthestic agent analyzers can also help to guide depth of anesthesia. An experienced anesthesiologist should also be able to monitor a patient's vital signs and movements to also guide depth of anesthesia and prevent awareness during general anesthesia.

For surgeries done under local or regional techniques, the goal is to have an awake patient, who may be sedated to varying degrees for anxiolysis and comfort in the OR as necessary. You may be referring to a surgery done under local or regional anesthesia.

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I need information, web sites and links, and literature about a new device, similar to the combitube, but of silicon and usable for every age.
— Jorge Ivan Izaguirre

Dr. Peter D. Dwane responds:

The only information that I found was from an article in Anesthesia & Analgesia in May 2000 [1]. The maker of the laryngeal tube is VBM Medizintechnik GmbH, Sulz, Germany. The email of the author of the article is:
v.doerges@t-online.de.

Contacting the maker of the laryngeal tube or the author may help you to obtain this product.

Reference: