Robert D. Dripps, M.D.

Reader Would Like to Comply But Can’t Find the Time

hank you for the article “Antibiotics Within One Hour: The Clock is Ticking” in the May 2007 ASA NEWSLETTER.

Unfortunately the detailed definition of time envisioned in the PQRI measure “on-time administration of prophylactic antibiotics within 60 minutes prior to incision” is never stated in the article.

From the red referral box on page 25, I went to the tan box on page 33 “30. ...for whom administration of prophylactic antibiotic has been initiated within one hour ....” I am a part-time anesthesiologist in several nearby facilities and would like to help each comply with this PQRI measure. I ask each director of pharmacy how to interpret the measure: a) initiate the I.V. infusion during the 60 minutes immediately preceding the incision, b) complete the I.V. infusion during the 60 minutes immediately preceding the incision, c) initiate and complete the I.V. infusion during the 60 minutes immediately preceding the incision, and then I ask d) what about fluoroquinolone, vancomycin and other slow infusion antibiotics? I get a different response from each, and on return visits, the response changes.

The evidence on which this measure of care is based proved that the infusion should be administered and completed so the peak tissue level is present at incision. This occurs 30 to 60 minutes after infusion completion, depending on the antibiotic.

It is very hard to comply when there is no detailed statement for exactly what “time” is being measured.

Wallace H. Good, Jr, M.D.
St. Albans, Vermont

Misleading Title Is One for the Ages

ight years ago I retired from clinical anesthesia, and since then I have been lost in “The Wilderness of Not Being Needed.” It’s true, I’m still a member of ASA, the Massachusetts Society of Anesthesiologists and the American History Association and similar upper-case groupings. Even though vital and important, these organizations offer little in particular to the retiree.

Imagine my joy when in the May 2007 ASA NEWSLETTER, I read the title of the article by Deborah J. Culley, M.D., and Frederick E. Sieber, M.D.¹ They had founded a Society for “Aging” Anesthesiologists. They looked a bit young to be running such an organization, but I knew the editorial office of the NEWSLETTER had a large collection of portraits taken in the 1980s.

I would join immediately, and at the first meeting find colleagues who started practice in the 1960s and 1970s. We actually used Schimmelbusch masks. We would hide our ignorance of transesophageal echocardiography. All 5,000 of us would join.²

United, we would become a storehouse of knowledge and experience and a resource to the specialty. We could write to Congress on your behalf. We could write history as we experienced it. We could mentor and befriend residents. Those of us who can still hear could help departments by conducting preoperative interviews. We would look back and help you look into the future. We could give advice to ASA’s leaders. We would meet regionally, sit in deep leather armchairs and quaff low-salt brandy; we would exchange “war stories,” i.e., gossip about surgeons. Most of all, we would have a collegial identity and feel useful.

Then I read the text of Drs. Culley and Siebers’ article. That is also quite important. It’s about taking care of us when the time comes for hip replacements.

I hope the mistitling of this article will lead to something great for those of us no longer giving safe anesthesia in the operating room.

Gerald L. Zeitlin, M.D.
Chestnut Hill, Massachusetts

References:
1. Culley DJ, Sieber FE. SAGA: A society for ‘aging’ anesthesiologists. ASA Newsl. 2007; 71(5):40.
2. ASA at a glance. ASA Newsl. 2007; 70(6):17.

Wood Library-Museum (WLM) at Work

read with great interest “WLM: A Treasure Trove of Anesthesiology History” (May 2007) written by Shiva Birdi, M.D., Corry J. Kucik, M.D., D.M.C.C., and Alexander Wolfson, M.D., three WLM Board resident representatives for 2007. They wrote, “As anesthesiologists and residents, we cannot address many of the challenges facing our specialty today without the benefit of knowing our past.” The importance of this statement for the future of our specialty cannot be overemphasized!

To promote knowledge and understanding of fundamental concepts of anesthesia through a historical perspective, the chair of the department would bring to the residents antiquated pieces of anesthesia equipment. The chair would inquire about the name of the object, its use, clinical correlation and connection to modern-day equipment. The individual who wrote the most concise paper, connecting the historical significance to modern equipment, would receive a stipend. Through this intellectual “walk through time,” the knowledge gained and understanding achieved would be immeasurable.
Visit the WLM Web site, learn the history of your specialty, and make every effort to pass along all the knowledge you gain.

Thomas E. Schulte, M.D.
Omaha, Nebraska

Reader Tips His Hattox to 1980 President

was pleased to see the emphasis on ASA’s ongoing political efforts in the July NEWSLETTER (2007 Governmental Affairs: All Hands on Deck).

However, I was disappointed that the article by Timothy J. Quill, M.D., “A Brief History of ASA Involvement in Governmental Affairs,” did not mention the immense contributions by John S. Hattox, M.D., to ASA’s efforts.

ASA has had so many incredibly talented presidents and others who have advanced anesthesiology’s cause in Washington. Dr. Hattox truly needs to be recognized as an important organizer and leader of most of the early ASA Legislative Conferences. As ASA President in 1980 and chair of the Committee on Governmental Affairs for many years, John was truly out in front, blazing the trail for many of us to follow.

Thanks for the opportunity to comment!

Steven R. Young, M.D.
Indianapolis, Indiana

The views and opinions expressed in the “Letters to the Editor” are those of the authors and do not necessarily reflect the views of ASA or the NEWSLETTER Editorial Board. Letters submitted for consideration should not exceed 300 words in length. The Editor has the authority to accept or reject any letter submitted for publication. Personal correspondence to the Editor by letter or e-mail must be clearly indicated as “Not for Publication” by the sender. Letters must be signed (although name may be withheld on request) and are subject to editing and abridgment.