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R J Saunders

Publications and source records attributed to R J Saunders.

14 recordsLinked to original sources
PubMed1990

Will we see automated record keeping systems in common use in anesthesia during our lifetime? The automated anesthetic record will not automatically solve problems in record keeping.

The proponents of automated anesthetic records list the ostensibly logical reasons for them and then claim that automated records will make everything better. The logic goes as follows: (1) It is good to have accurate records because accurate records (a) make clinical decision making more effective and improve patient safety, (b) provide better defense against frivolous lawsuits, and (c) enable more astute medical policy decisions based on improved retrospective case reviews; (2) automatic record-keeping systems will give more nearly accurate records; (3) therefore, quality of care will improve if we acquire automatic record-keeping systems. This logic fails on several counts, which are detailed in this essay. Having said all this, however, I do believe that automated record systems will be implemented and they will be extremely useful, both for the patient and for those who care for the patient. However, we must exercise great care in their design and implementation, lest they wind up doing more harm than good.

Anesthesia↗
PubMed1987

Public Health Laboratory Service enzyme linked immunosorbent assay for detecting Toxoplasma specific IgM antibody.

An enzyme linked immunosorbent assay (ELISA) based on the antibody class capture method for the detection of specific IgM against Toxoplasma gondii, using the microtitre plate format, was developed. Antigen binding was detected using a monoclonal antibody, CIE3, conjugated to horseradish peroxidase. Prior mixing of the conjugate and antigen improved the stability of these reagents as well as removing an incubation stage from the assay. The incubation time of less than four hours permits a rapid throughput of specimens. Using the assay, a total of 163 sera were examined in a three centre study and good agreement was found. Results were expressed as arbitrary enzyme immunoassay units (EIUs) against a freeze dried standard. Throughout the study the standard serum showed a coefficient of variation less than 10% across the microtitre plate. By measuring IgM titres in patients having toxoplasmic lymphadenopathy with a known date of onset, IgM class antibodies were shown to peak at two months, persisting for about six months. In addition, a case of laboratory acquired toxoplasmosis was monitored. Sera shown to contain rheumatoid factor and antinuclear factor did not give false positive results. This rapid, robust, and simplified assay is used by the Public Health Laboratory Service Toxoplasma Reference Units and will provide a standard with which other assays can be compared.

Animals↗
PubMed1984

Gas and vapor delivery.

Technology for gas and vapor delivery has not changed substantively in decades. Technology possessing greater precision and reliability has been in use by nonmedical industries to regulate gas flows and to vaporize liquids. Adaptation of existing technology to the needs of anesthesia delivery systems requires stimulus from the anesthesia community and commitment from the anesthesia device industry. No insurmountable problems are evident, but the perennial problem of inertia has prevented progress consistent with that seen in other fields of biomedical technology.

Anesthesia, Inhalation↗
PubMed1984

What do we do until the future gets here?

We have seen that there are serious design inadequacies in the basic anesthesia machines now in the marketplace. None of these meets criteria for technologic soundness or clinical utility elaborated in previous chapters. It is tempting to simply buy what is available and shrug one's shoulders over the situation. Those in desperate need of replacement equipment should go ahead and buy, because significant changes may be years away. However, those who are able and disposed to wait for real progress may accelerate the process by waiting not silently but loudly. Until the anesthesiologists on the firing line are consistently asking technically sophisticated questions related to safety and efficacy, expecting them to be answered, and letting their equipment budgets speak where words do not, we can expect consistent laissez-faire attitudes and actions from the anesthesia machine industry. Technology already available in other industries will continue to be overlooked or ignored, and our clinical needs will be unmet until industry is convinced that the majority of anesthetists want far-reaching substantive change in anesthesia delivery system design. We have no choice but to use what is currently available; but we can reward solid, thoughtful innovation with our capital equipment dollars, with our support of research in anesthesia technology, with our verbal and written requests to manufacturers, and with our individual time spent staying abreast of technologic issues. The ultimate beneficiaries are our patients; we cannot remain static--we must improve.

Anesthesiology↗
PubMed1984

Components of the system: future design requirements.

A few ideas about future design concepts have been outlined and highlighted. Whether anesthetists will accept it or not, automation is the direction of the future, and data processing is increasingly important. Anesthesiology and industry need to initiate total cooperative efforts for appropriate implementation of modern technology.

Anesthesiology↗
PubMed1983

ECG lead with the endotracheal tube.

We evaluated the potential of obtaining ECG signals from electrodes attached to an endotracheal tube. Tests during surgery using a 2-electrode system with 3 pediatric patients produced recordings suitable for rate monitoring and arrhythmia detection.

Electrocardiography↗
PubMed1982

Anesthesia and the geriatric patient.

The elderly patient presents a number of challenges to the anesthetist in otolaryngologic surgery, ranging from psychologic to physiologic to pharmacologic. Careful attention to the changes in physiology, with depressed or deranged function of many organ systems, requires closer monitoring of vital signs and the incremental administration of drugs. Preoperative evaluation may often be more thorough than a "minor" surgical procedure would seem to indicate, simply to ensure a good perioperative course. Balancing the necessity for perfusion of vital organs against the work load imposed on the heart involves a thorough understanding of the patient's medical condition, so that an anesthetic treatment plan may be tailored to the needs of the patient. Geriatric patients enjoy the benefits of many modern otolaryngologic procedures because of the joint efforts of the otolaryngologist and the anesthesiologist. We may expect more progress to come.

Aged↗
PubMedDate not supplied

System integration--the need in future anesthesia delivery systems.

Although current anesthesia delivery systems possess the virtues of familiarity, ruggedness, reliability, and longevity, problems inherent in their design require remedy. These systems consist of discrete subsystems that are unrelated physically, functionally, or by communications. Production of derived values, as opposed to raw data, is almost unheard of, although transformed data may be much more useful in the clinical environment. Future anesthesia delivery systems will use microprocessors to integrate data from multiple sensors with calculation, display, and control functions--without removing the anesthesiologist from the control loop. New ergonomic data will promote design of equipment that can be optimally manufactured, marketed, and used in clinical care. The proliferation of new equipment with advanced design and application features creates challenges for a society conscious of rising health-care costs. Creative alternatives to conventional financing, ownership, and early obsolescence of anesthesia systems must be sought in order to ensure that the quality of and capability for anesthetic care will continue to advance.

Anesthesia↗