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criteria and allowing, for example, obese patients, or patients with
sleep apnea, to be considered for elective outpatient procedures?
"The addition of video laryngoscopes has allowed for rescue or intu-
bation of marginal or newly recognized difficult airways," says James
DelloRusso, MD, a Huntington Beach, Calif., anesthesiologist. "But I
don't necessarily think that newer technology should mean allowing
more difficult-airway patients for freestanding outpatient centers."
Praise for supraglottic devices
Along with video, our panelists frequently cited LMAs and their cousin
Is the combination of new airway-management technology and business pressure having the
unintended consequence of putting patients in jeopardy?
William Landess, CRNA, MS, JD, a lawyer and a 30-year anesthesia veteran from South
Carolina, worries that the answer is yes. "Despite issues with obesity and other comorbidities,
you have physician-owners (in outpatient facilities) trying to push for the case," he says. "The
production pressure put on anesthesia providers is wholly and totally inappropriate and is open-
ing the door to legal consequences if a problem develops."
Mr. Landess says many anesthesia providers are in danger of becoming too cavalier, lulled into
a false sense of security by new technology. "People feel more comfortable, because they have
another technique," he says. "But everything has a failure rate. If they've never had an issue,
they become braver and braver and they don't know what they don't know.
"I can't tell you how many of these newer providers put people to sleep, give them the propo-
fol, give them the muscle relaxant and then start bagging them. I don't mind putting someone to
sleep, but I want to test the airway before I give them the muscle relaxant. If I can't ventilate
them, I have to intubate them, and if I can't do that, I have to go to the ASA algorithm, and I'm
starting behind the 8 ball." — Jim Burger
OVERCONFIDENCE?
Can New Devices Create
A False Sense of Security?
