Vigilance, Alarms, and Integrated Monitoring Systems

The administration of anesthesia is a complex monitoring task and, as such, requires sustained vigilance. Unfortunately, humans are not very good at monitoring because we are error-prone, and our vigilance is susceptible to degradation by a variety of human, environmental, and equipment factors. Designers of anesthetic equipment therefore have attempted to aid the anesthesiologist by incorporating devices and systems that augment vigilance and clinical performance. Alarms intended to notify the operator of potentially critical situations are effective only if properly designed and implemented. Although many modern anesthesia delivery devices are physically integrated and generally contain systems for gas delivery, monitoring, alarms, and sometimes record keeping, many of the promised benefits of full-scale integration (e.g., “smart” alarms, decision aids) are as of yet unfulfilled. The successful implementation of comprehensive integrated anesthesia workstations will require further technologic advances as well as a more complete understanding of the task of administering anesthesia and the factors that affect performance of the anesthesiologist in this complex human/machine environment. Research to elucidate these “performance-shaping factors” in anesthesia has been under way for a number of years and is beginning to bear fruit.