The effect of unanticipated perioperative death on anesthesiologists.

PURPOSE: Unanticipated perioperative death (UPD) is a significant event for the anesthesiologist that has not been widely studied. An anonymous questionnaire was used to obtain information about the frequency of UPD, anesthesiologists' most significant UPD, and their opinions regarding UPD. METHODS: A questionnaire was mailed to all anesthesiologists who were registered with the College of Physicians and Surgeons of Alberta in 2005 (n = 285). RESULTS: The study achieved a 63% response rate. Sixty-four percent of respondents had been in practice for more than ten years, and 53% of respondents had experienced at least one UPD. After the UPD, 46% of the respondents performed further elective cases the same day, although 62% of them indicated that this was not advisable. Personal consequences were reported. Twenty-five percent felt they were being blamed for the event, and 10% thought about the UPD on a daily basis for more than a year afterwards. Mortality and morbidity reviews were common, and disciplinary consequences occurred infrequently. Sixty-four percent of anesthesiologists' most significant UPDs were elective cases. The etiology of death was thought to be anesthesia-related in only 11% of the UPDs. Although most respondents agreed that supportive and educational activities in the aftermath were advisable, such activities occurred in a minority of cases. CONCLUSIONS: Alberta anesthesiologists are likely to experience UPD during their careers, and the experience can be associated with important personal consequences. Support for the anesthesiologist is inconsistent, and many continued to perform elective cases immediately following UPD. These conditions were not supported by the majority of respondents.

Prepared endotracheal tubes: are they a potential source for pathogenic microorganisms?

UNLABELLED: Prepared endotracheal tubes (PETTs) are frequently used for unanticipated difficult intubation, but their storage time is highly variable and institution-dependent. We sought to determine first, if open, unused PETTs are a potential source of pathogenic microorganisms, and second, if PETTs can provide a medium for bacterial survival after deliberate contamination. A stylet was inserted into a 7-mm ETT, and this system was ethylene oxide sterilized. The PETTs were placed in 20 different locations and sampled 8 times in a 4-wk period. Growth was determined after 48-h incubation, and the microorganism was identified. In Phase 2, the PETT (n = 40) was swabbed with a fresh suspension of H. influenzae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecium, or a negative control. Nonvirulent bacteria were cultured from 13 of 160 (8.1%) samples and from 15 of 320 (4.7%) samples in Phases 1 and 2, respectively. No PETT grew the same bacteria more than once. In Phase 2, after 24 h, only E. faecium was recovered. Based on this study, the pathogenic potential of PETTs is very small, and they can be safely used for up to 1 mo. This practice could translate to significant cost reduction for operating room budgets. IMPLICATIONS: Prepared endotracheal tubes (PETTs) are back-up airway equipment to be used in the case of a difficult intubation. A short PETT shelf life because of unknown safe storage time results in significant budget costs. This blinded, controlled study examined the pathogenic potential of PETTs in the operating room environment.