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Printable Version
A1195
October 24, 2005
9:00:00 AM - 11:00:00 AM
Hall C4
Anesthesia Machine Pre-Use Check Survey - Preliminary Results
Samsun Lampotang, Ph.D., Sungwook Moon, B.S., David E. Lizdas, B.S.M.E., Jeffrey M. Feldman, M.D., Rensheng Zhang, M.D., Ph.D.
Anesthesiology, University of Florida, Gainesville, Florida, United States
Introduction. Outright omission or improper performance of the anesthesia machine pre-use check has been reported in the past. A 1981 paper suggested failure to perform a pre-anesthetic check in at least a third of anesthetics [1]. A 1996 paper reported 40.9% of 22 anesthesia providers missing more than 50% of planted faults when using the 1993 Food and Drug Administration (FDA) Anesthesia Apparatus Checkout Recommendations [2]. We initiated a study to estimate current compliance and identify reasons that the pre-use check might be improperly performed or entirely omitted.

Methods. We conducted an anonymous survey via the web. Participants were required to answer 20 questions (via radio buttons, checkboxes and/or free text entry) before being given access to a free simulation of the anesthesia machine pre-use check. Answers are automatically entered into a mySQL database for subsequent analysis. The web survey is ongoing.

Results. 244 surveys were filled at the time of writing, with 138 US respondents (human and veterinary). The average age was 38.7 years with an average of 7.5 years providing anesthesia. Responders included 56 anesthesiologists, 47 CRNAs, 46 residents, 11 anesthesiology assistants and 49 non-anesthesia providers (anesthesia techs/biomedical engineers). 182 responders had anesthesia techs or biomedical engineers at their institution with 163 indicating that that the anesthesia techs or biomedical engineers did not perform the pre-use check for the anesthesia providers.

71 responders (29%) rated their competence in performing the 1993 FDA pre-use check as Poor (do not know what, how or why of each step), 81 (33%) as Satisfactory (know what to do), 64 (26%) as Good (know what to do and how to do each step) and 28 (12%) as excellent (know what, how and why of each step). The frequency of performing the pre-use check was: every case (48), every morning/first case of the day only (128), never (12), someone else does it for (21) and last time was in residency (1). The most often cited reasons for not performing a pre-use check were: insufficient time (75), takes too long to perform (73), I do not know how to perform a proper pre-use check (42), my anesthesia machine has an automated pre-use check and does it for me (37), production pressure from surgeon (33), was never taught during residency training (23), production pressure from administration (15), 1993 FDA pre-use check is obsolete and does not apply to my local environment (12) and do not have knowledge to adapt 1993 FDA pre-use check to local conditions (11). Participants responded that they would perform a pre-use check before every case if it took at most 4.9 minutes on average to perform.

Discussion. Our preliminary results indicate that the pre-use check continues to present an opportunity for improvement. The average age of 37.5 years is fairly young. Anesthesia providers who are not proficient with the pre-use check may be over-represented in the survey population, given that they were motivated to fill the survey as a means to access the pre-use check simulation and learn from it. The number of responders who indicated that they did not know or have not been taught in residency training how to properly perform a pre-use check is cause for concern and action.

References.

1. Anaesthesia 36:933-36, 1981

2. American Association of Nurse Anesthetists Journal 64(3):277-82, 1996

Anesthesiology 2005; 103: A1195