Unbalancing the Concept of the Structured Alarm Systems for an Anesthesia Working Area

Abstract

To the Editor: Wisniewski et al. [1] describe a simple new technique to monitor the intravenous flow with pulse oximetry to assure uninterrupted administration of the short-acting opioid, remifentanil. There is one important consequence of this idea that we would like to point out: anesthesiologists are adjusted to different levels of alarm tones in the busy anesthesia working area, e.g., the disconnection alarm and low oxygen saturation alarms are urgent, whereas temperature or infusion rate alarms are less urgent and have a less busy alarm tone [2]. Adding a highly urgent alarm device on a less important position to the cacophony of alarms may fully confuse the attention of the resident anesthesiologist. Our experience from a clinic with approximately 110 residents is that too many alarms going off at the same time leads to uncontrolled overlooking of important alarms. Adding more alarms also increases the difficulty of distinguishing "high-urgency" alarms-e.g., disconnection, low SpO2-from "low-urgency" alarms-e.g., temperature alarm [3]. Acknowledging the importance of an uninterrupted delivery of remifentanil, we think that setting up a high-urgency alarm should not be misused as routine intravenous flow monitoring! Thomas Hartmann, MD Carsten Preis, MD Claudia M. Muller, MD Department of Anesthesiology and General Intensive Care; University of Vienna; 1090 Vienna, Austria