Airline cancellations expose latent issues with electronic systems: A doctor’s perspective

After a hot summer in the Texas sun spent working as a camp counselor, the last thing a teenage boy would want is to be stuck in the student housing for another day. But, this is exactly what happened to my son due to a major outage on the Southwestern Airlines system. Over two days, more than 1,100 flights were cancelled  and hundreds more were delayed because of issues with their computer system.

Just this week, Delta suffered a similar outage that was described at a “System Outage Nationwide”. Fortunately, flights that were en route continued to operate normally, but this was no consolation for the thousands of people who were struggling to get where they were going. To add insult to injury, flight status systems in the airports continued to show flights as on time.

Just like with these massive flight systems, electronic anesthesia charting systems sometimes suffer outages. This can even occur during the middle of an anesthetic. An

Three myths about anesthesia

I recently received a thank-you note from a patient. While I may spend hours taking care of a patient, most barely remember me. I meet patients in the preoperative area for a few minutes while they are distracted by the litany of paperwork and a parade of well-intentioned personnel from the hospital. Shortly thereafter, a magical cocktail of drugs erases most of the rest of our interaction.

This patient was different, he was a colleague that I had known for many years. The comment on the note was short and to the point: “Thank you for keeping me alive.”

As shocked as I was by the directness of the letter, it brought to mind several key anesthesia myths.

New anesthesia drug sugammadex: Will it cause unintentional pregnancies?

FDA approval at last

After a lengthy consideration by the FDA, sugammadex (brand name: Bridion), a new agent in a novel drug class, received approval this December. As Merck makes plans to bring the drug to the US market in January 2016, physician anesthesiologists around the country are making their own plans on how this drug might play a role in their tool belt. As I reviewed information in the press release, an interesting statement made by Merck raised concerns about potential unintentional pregnancy in patients taking hormonal birth control after administration of the medication – more on that later.

Muscle Relaxants

To understand sugammadex, you have to know something about non-depolarizing muscle relaxants (NDMR). These aren’t the type muscle relaxants you take when you strain your back. NMDRs act at the synapse (connection) between nerve and muscle to prevent any signals from the nervous system from directing muscular activities. This type of action is similar to what occurs with exposure to the toxin released by the bacteria Clostridium botulinum. In severe cases, botulism results in total body paralysis and involves the muscles essential for breathing. This condition can be quickly fatal if not properly managed.

Complete body paralysis is catastrophic with botulism but is desirable for surgery. Muscle relaxation allows surgeons to manipulate tissues in a perfectly motionless environment. Without muscle relaxants, even a completely “asleep” patient could cough or move suddenly resulting in an unintentional puncture or laceration of vital organs.

When administered at normal doses, NDMRs act like the botulism-causing toxin, but in a more reliable manner. The whole body is relaxed, including the respiratory muscles. For this reason, the doctors who administer NMDRs must be trained in advanced airway management.

What you give up when you “Go Under”

When I meet a patient in the pre-operative area, they have already experienced a significant amount of indignity. They have accepted the procedural risks of their planned surgery and have shouldered the burden of how to pay for the procedure. A well-intentioned, but well-trained staff member – or three – has questioned their identity and banded them the same way a biologist tracks an animal. Clothing and jewelry, the basest identifiers of one’s persona, have been summarily stripped from them and stuffed into a plastic bag. Then, I enter their room as a veritable stranger and explain to them, as their anesthesiologist, what they will have to give up to receive general anesthesia.