Anästhesiesimulation und Patientensicherheit - von der Innovation zum Standard

In the past, early recognition of new trends, looking for innovations and facing additional challenges have all been attributes of the anesthesiologic development. Broadly known examples include quality management and documentation, intensive care medicine as well as the development of modern emergency medicine and pain treatment. In modern clinics these tasks are often carried out by anesthetists. Today, once again, a new opportunity is given to anaesthesiology to be pioneer.

The rapid progress in development of simulation techniques is obvious in many fields of technology and now is appearing in medicine on a regular basis. In medical education, simulation offers many advances for specific needs, especially for the improvement of quality of treatment and patient security.

Until now, many of us have only considered simulation in anaesthesiology on a PC-screen of varying quality that provides just a glimpse into the practical aspects of anesthesia. The comparison to recreational videogames come easily to mind and useful simulation could be misunderstood as just ”playing around”.

Rising expectations of the public in reference to security in medicine and our own expectations in the improvement of quality of treatment are reasons to reconsider our present standard procedures and search for new optimal anesthesiologic therapies. Relevant personal attributes of an anesthetist and their impact on efficacy and quality of results are often misunderstood. Without special methods, observing these conditions cannot be included during daily clinical routine.

Modern simulation units resemble a realistic conduction of a narcosis at a complete anesthesiologic workstation that include a surgeon and nurses as well as many other details. Simulation units have been available for a few years now [1] and the opportunities given by this development need to be closely considered.

Complex simulations resembling realistic conditions influenced by human, technical and situative factors have been introduced to several applications and are leading to broad changes of already established procedures. A well known example is the ”crew resource management training” as part of pilot training. Since the introduction of this special kind of practice, the rate of mistakes of pilot crews has been markedly reduced.

For clinical anesthesia, development and implementation of similar concepts in training and specialization of medical staff are just beginning [2] [3]. Results seem to be promising.

In December 2002 the ”Catalogue of requirement for the realisation of simulator-based training” was published as a society announcement of the DGAI [4]. For the first time, formal criteria for the general use of simulation in the training and specialization of anesthetists were defined. Furthermore, simulation elicits opportunities to modify the ergonomy of the anesthesiologic equipment, the workstation, process and team management in operative medicine. Taking this into account, the integration of simulation into anaesthesiology will be an important step in patient security. Consequently, at the German Anesthesia Congress 2002 (Deutscher Anaesthesie Kongress) a main session titled ”Anesthesia simulation and patients security” took place. The given presentations clearly illustrated the aims and opportunities of simulations. In response, the editors were able to then present a mini-symposium of this topic of increasing interest in this edition of AINS.

Literatur

• 1 Gaba D M, DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training.  Anesthesiology. 1988;  69 387-394
• 2 Holzman R S, Cooper J B, Gaba D M, Philip J H, Small S D, Feinstein D. Anesthesia crisis resource management: real-life simulation training in operating room crises.  Clin Anesth. 1995;  7 675-687
• 3 Kuhnigk H, Kuhnigk R, Roewer N. Simulatorkurse - Freiwillige Qualitätssicherung oder Instrument der Rezertifizierung?.  Anästhesiologie und Intensivmedizin. 2003;  44 539-542
• 4 Verbandsmitteilung der  DGAI. Anforderungskatalog zur Durchführung von Simulatorkursen.  Anästhesiologie und Intensivmedizin. 2002;  43 828-830