SOAP Delivers: Options for Labor Pain.

To the Editor The article by Morey et al. 1 illustrates the fact that anesthesiologists are effectively being turned into glorified technicians and clerks, one step at a time. As an example, it is a New York State law requirement that a fluid warmer is to be used and documented while administering blood products to patients. However, it seems counterintuitive that the physician anesthesiologist administering the blood product should divert his or her attention from the hemorrhaging patient to document the serial number of the blood/fluid warmer used. Very soon, we will have to record the lot number and expiration date of every single vial of medication we use, the lot number of the laryngoscope and the endotracheal tube, etc. While we are busy with clerical tasks that have never been shown to improve outcomes, how can we be fully vigilant and provide the best patient care? Regarding the example given by the authors, the rules on saline bags should be supported by evidence: is bacterial growth detectable 1 hour after a sterile saline bag is spiked with a sterile set? If yes, let us try to determine what is the safe time interval, how we can decrease bacterial contamination, and why so few patients connected to an arterial blood pressure monitoring set develop an infection. If not, this bureaucratic rule, probably created with good intentions, should be purely and simply scrapped, because it is both impractical and actually dangerous if enforced in the setting of a busy trauma center requiring a functional operating room at all times. SOAP Delivers: Options for Labor Pain