The American Society of Anesthesiologists has issued new recommendations for the safe use of propofol, including capnography during upper endoscopy procedures.

The society has also reiterated its stance that a physician trained in anesthesia and qualified to provide rescue techniques in the event the patient's airway fails or too much propofol is given should supervise the drug's administration.

At its annual meeting in New Orleans last week, the society approved guidelines calling for:

A Colorado Springs, Colo., surgery center says that DNA analysis of a patient who was thought to have contracted hepatitis C from surgical tech Kristen Parker has definitively rejected that possibility.

"Now that Audubon has completed testing, there is no evidence that any patient at Audubon was infected with hepatitis C from the former employee, and possibly none were ever actually exposed," says Audubon Surgery Center spokeswoman Amy Triandiflou in a published report.

In order to build their case against Ms. Parker, federal prosecutors had subpoenaed Audubon to disclose the identity of a patient who may have been infected by the surgical tech. The patient in question, however, refused to be identified unless DNA testing showed a positive link to Ms. Parker, and Audubon withheld the name from prosecutors, citing patient privacy rights.

Ms. Parker pleaded guilty in September to stealing fentanyl syringes from the operating rooms of Audubon and Rose Medical Center in Denver. She injected herself during lunch breaks or when she returned home and refilled the syringes with saline solution. Some of the syringes were then administered to surgery patients, according to the Colorado Department of Public Health and Environment. Ms. Parker, who will serve 20 years for her crimes, will be formally sentenced at a hearing on Dec. 11 in Denver's federal court.

Daniel Cook

Less than 6 months after Rhode Island's hospitals and surgery centers adopted a statewide safety protocol designed to prevent medical errors, Providence-based Rhode Island Hospital is under investigation for a wrong-site surgery, its fifth since 2007.

The state department of health's inquiry follows an Oct. 22 case in which a surgeon began operating on the wrong finger of a patient undergoing outpatient hand surgery. After the error was corrected, the procedure was completed and the patient discharged without further complication.

"We have begun a thorough analysis with hospital leadership, the physicians, and the team from the operating room," says hospital president Timothy J. Babineau, MD, in a published report. "Thus far, we have identified an ambiguity in the timeout process for hand surgery when more than one procedure is being performed which may have contributed to the error."

The statewide safety protocol implemented in June seeks to cut down on errors by encouraging and expanding routine communication between healthcare providers before, during and after surgeries.

This safety effort was sparked in large part by a series of wrong-site surgeries occurring at Rhode Island Hospital. On 3 occasions in 2007, surgeons drilled into the wrong sides of patients' skulls. In May 2009, a surgeon correcting a child's cleft palate at Hasbro Children's Hospital, the hospital's pediatric division, began operating on the wrong side of the mouth.

Additionally, in September 2008, a surgeon at Providence's Miriam Hospital - like RIH and Hasbro, a member of the Lifespan group of hospitals - performed arthroscopic surgery on the incorrect knee.

David Bernard

Surveys show that women between the ages of 35 and 45 are the fastest-growing population on the Internet's social networking sites. But how many surgical decisionmakers belong to Facebook or MySpace? Tell us in this week's InstaPoll. We'll report the results in this space next week.

Last week we asked you how you transport flashed instruments to the OR. A little more than one-fourth (27%) of our 130 respondents, who said they sterlilize and transport the instruments in open trays, are not in compliance with the latest guidance from CMS, which states that routine flashing is only acceptable for wrapped or contained loads.

The majority of respondents, however, would pass muster with CMS surveyors by flash-sterilizing and transporting instruments in closed containers (35%), flashing in open trays but covering them during transport (8%) or flashing in emergency situations only (30%).

Dan O'Connor