Key result
An audit at 3 major London Teaching Hospitals revealed shortcomings in user compliance to national anesthetic equipment checklists and an alarming unawareness of anesthesiologist responsibility.
Highlights the importance of anesthesiologists taking final responsibility for equipment safety checks and advocates for mandatory simulation training for crisis management.
We would like to commend Prien et al1 on their excellent article, highlighting the latest cluster of avoidable anesthetic equipment-related deaths in Europe. As they have outlined, these incidents stress the importance of anesthesiologists checking their medical equipment. We agree that there should be a review of the design of the hoses and connection ports of the anesthetic circuit by the International Organization for Standardization. The importance of formal “pre-use checks” of anesthetic equipment is recognized worldwide and has been included in the World Health Organization’s Surgical Safety Checklist,2 in addition to many national checklists like the updated 2012 Association of Anaesthetists of Great Britain and Ireland (AAGBI) equipment checklist.3 Despite these long-existing checklists, adherence is often poor.4 Following our recent audit at 3 major London Teaching Hospitals, we also found similar shortcomings in user compliance to national anesthetic equipment checklists. More importantly, we found an alarming degree of unawareness that the final responsibility remains with the anesthesiologist, regardless of whether the operative assistant practitioner fails to do the safety check or has failed to spot a fault. Delegating the safety checks and sharing the responsibility might be part of the problem. In addition to the author’s suggested checklists and future technical solutions regarding new designs of connection ports, we should emphasize the “crisis management capability” of the individual anesthesiologist. Securing patient oxygenation despite malfunctioning anesthetic machines, wrongly assembled breathing circuits, blocked heat and moisture exchange filters (HME) filters, or misplaced endotracheal tubes must be a core competency of an anesthesiologist. We should stress the importance of lifelong learning with simulation training of anesthetic emergencies. The Civil Aviation Authority requires their pilots to spend a certain number of hours per year in the flight training simulator to keep their license. Our profession should consider a similar approach. Jan Schumacher, MD, PhD, FRCADepartment of AnaestheticsGuy’s and St Thomas NHS Foundation TrustLondon, United Kingdom[email protected] Sara Ko, MDDepartment of AnaestheticsLewisham and Greenwich NHS TrustLondon, United Kingdom Gamunu Ratnayake, MDDepartment of AnaestheticsKing’s College Hospital NHS Foundation TrustLondon, United Kingdom
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Schumacher et al. (2019) conducted a letter in Anesthetic equipment safety. Anesthetic equipment checklists and safety checks was evaluated. An audit at 3 major London Teaching Hospitals revealed shortcomings in user compliance to national anesthetic equipment checklists and an alarming unawareness of anesthesiologist responsibility.
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