Features  |   January 2017
Remembering Vigilance in the Age of Technology
Article Information
Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Patient Safety / Technology / Equipment / Monitoring / Features
Features   |   January 2017
Remembering Vigilance in the Age of Technology
ASA Monitor 01 2017, Vol.81, 18-20.
ASA Monitor 01 2017, Vol.81, 18-20.
No matter where we go or what we do, technology is an integral and ever-increasing part of our lives. This is true in our homes, our cars and certainly in our O.R. and non-O.R. procedural areas. Over the past 50 years, technology has flourished within the periprocedural world, significantly improving patient safety with real, measurable reductions in morbidity and mortality.1 
We have come a long way since the days of William Morton.2  Our first ether anesthetics, documented on paper records in 1895, contained little more than observations of pulse, respiration and temperature (Figure 1).3  Pulse oximetry, auto-cycling non-invasive blood pressure and disconnect alarms all evolved in the 1970s and 1980s, improving clinical workflow and patient safety.4,5  The late 1990s saw the advent of infusion pumps with drug libraries that are now the standard of care throughout the world.6  The early 2000s brought development of brain state monitoring7  and the past decade has seen the rise of cerebral oximetry.8  The next decade promises to bring improved brain state monitoring with real-time, target-controlled anesthesia.9 
1 Comment
January 7, 2017
Scott Springman
University of Wisconsin-Madison
Don't lose low-tech in high-tech medicine

I applaud the authors' warning about distractions. When I was learning to fly a small plane, my instructor would try to bombard me with distractions to prove a point and then say, "Stop! Just look out the window and fly the plane." 

I have a version of that I use when I teach anesthesia to residents and students. I also encourage them to not fixate on the monitors and devices. In fact, in an era of multiple electronic monitors, there remains tremendous value in actually viewing the patient in front of you (!) and, for example, listening to breath and heart sounds. Pre- and post-procedure, listening to what the patient says, rather than only talking at the patient, will improve both patient safety and satisfaction. 

I tend to be an early adopter of technology, but I also recognize that our brains can assimilate only so much at any one time. We need better clinical decision support in our devices and EHRs in order to overcome our human limitations. We also need to be sure we don't lose sight of the basics of care, while being inundated with data input from all around us.

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