To the Editor:--It was most interesting and encouraging to read the letter to the editor by Atkins regarding a method of tracking patients with difficult or failed tracheal intubation. With the cooperation of our private practice group, we also initiated a local registry for patients in whom difficult or failed tracheal intubation has occurred. Our staff anesthesiologists address the issue with the patient by verbal and/or written explanation postoperatively, and the patient is enrolled in our local database, where demographics, problems encountered, surgery, and outcome are listed.
Both a letter and wallet card are extremely important, but, in addition, a bracelet or necklace are recommended in the event of unanticipated surgery or trauma, when the patient may be unconscious or incoherent. We initiate the enrollment process into the Medic Alert Foundation and find the necessary funding to cover the costs of the bracelet for those patients who require financial assistance.
We integrated our automated anesthesia information system, CompuRecord(R) Anesthesia Information System (Anesthesia Recording, Pittsburgh, PA), into all aspects of our perioperative care during the past 6 yr. Currently, the system prompts the anesthesiologist to indicate whether tracheal intubation was easy or difficult. We are in the process of using this information to provide a warning message that will appear on the screen once the patient's medical record number has been entered, informing the anesthesia team of this potentially lethal condition (Figure 1). In the future, this system will provide warnings of other critical conditions, including histories of malignant hyperthermia, pseudocholinesterase deficiency, and drug allergies. It is our hope that the automated anesthesia information system, combined with the patient letter, local registry, and Medic Alert bracelet, will reduce the incidence of adverse sequelae for this challenging situation.
Roberta T. Pasqual, Ph.D.; Christopher A. Troianos, M.D.; Chester A. Phillips III, M.D.; Department of Anesthesiology; The Mercy Hospital of Pittsburgh; 1400 Locust Street; Pittsburgh, Pennsylvania 15219
(Accepted for publication March 29, 1996.)