Evaluation of Graphic Cardiovascular Display in a High-Fidelity Simulator

• Published in: Anesthesia and analgesia Vol. 97; no. 5; pp. 1403 - 1413
• Main Authors: Agutter, James, Drews, Frank, Syroid, Noah, Westneskow, Dwayne, Albert, Rob, Strayer, David, Bermudez, Julio, Weinger, Matthew B
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.11.2003; Lippincott
• Subjects: Anaphylaxis - diagnosis; Anaphylaxis - physiopathology; Anaphylaxis - therapy; Anesthesia; Anesthesia - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology - education; Arthroplasty, Replacement, Hip; Biological and medical sciences; Blood Vessels - physiology; Central Venous Pressure - physiology; Computer Graphics; Computer Simulation; Data Display; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Hemodynamics - physiology; Humans; Intraoperative Complications - diagnosis; Intraoperative Complications - physiopathology; Medical sciences; Monitoring, Intraoperative; Myocardial Ischemia - diagnosis; Myocardial Ischemia - physiopathology; Myocardial Ischemia - therapy; Oxygen - blood; Prostatectomy; Human; Hypovolemia; Cardiovascular disease; General anesthesia; Coronary heart disease; Myocardial disease; Vascular disease; Graphics; Anaphylaxis; Treatment; Ischemia; Simulation; Myocardium; Complication; Diagnosis; Hemodynamics; Monitoring
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000085298.03143.CD

“Human error” in anesthesia can be attributed to misleading information from patient monitors or to the physician’s failure to recognize a pattern. A graphic representation of monitored data may provide better support for detection, diagnosis, and treatment. We designed a graphic display to show hemodynamic variables. Twenty anesthesiologists were asked to assume care of a simulated patient. Half the participants used the graphic cardiovascular display; the other half used a Datex As/3 monitor. One scenario was a total hip replacement with a transfusion reaction to mismatched blood. The second scenario was a radical prostatectomy with 1.5 L of blood loss and myocardial ischemia. Subjects who used the graphic display detected myocardial ischemia 2 min sooner than those who did not use the display. Treatment was initiated sooner (2.5 versus 4.9 min). There were no significant differences between groups in the hip replacement scenario. Systolic blood pressure deviated less from baseline, central venous pressure was closer to its baseline, and arterial oxygen saturation was higher at the end of the case when the graphic display was used. The study lends some support for the hypothesis that providing clinical information graphically in a display designed with emergent features and functional relationships can improve clinicians’ ability to detect, diagnose, manage, and treat critical cardiovascular events in a simulated environment.