February 2001
Volume 65 |
Number 2
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WHAT'S NEW IN...
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| ...Practice
Parameters |
James
F. Arens, M.D., Chair
Committee on Practice Parameters
Activity in practice parameter development by ASA remains vigorous.
In the April 2000 issue of Anesthesiology, the Practice Advisory
for the Prevention of Perioperative Peripheral Neuropathies: A
Report by the American Society of Anesthesiologists Task Force
on Prevention of Peripheral Neuropathies was published under that
task force, chaired by Mark A. Warner, M.D., of the Mayo Clinic.
This is the first practice advisory developed by ASA. A practice
advisory is a systematically developed report intended to assist
decision-making in areas of patient care where strong scientific
evidence is currently lacking. An advisory provides a rigorous
synthesis and analysis of expert and practitioner opinion, clinical
feasibility data and open-forum commentary. Advisories are not
intended as standards or guidelines; they may be adopted, modified
or rejected according to clinical needs and constraints. A practice
advisory is an attempt to provide guidance for practice in the
absence of sufficient scientific evidence.
There are three additional practice advisories under development.
An advisory on Preanesthesia Evaluation is being prepared for
presentation at the House of Delegates meeting in 2001. The task
force has been reconvened under the leadership of L. Reuven Pasternak,
M.D. One open forum was held last October at the ASA Annual Meeting
in San Francisco, California, and another was held at the December
Postgraduate Assembly meeting in New York City. At the same time,
the Health Care Financing Administration (HCFA) has become interested
in the issue of perioperative testing. Michael F. Roizen, M.D.,
and Patricia A. Kapur, M.D., prepared a draft letter for the Committee
on Economics to use as a response to HCFA.
An advisory on Recovery from Anesthesia is being developed. Jeffrey
H. Silverstein, M.D., chairs this task force. An open forum will
be held on May 5, 2001, at the Society for Ambulatory Anesthesia
meeting (see page 35). This practice advisory will be presented
to the 2001 House of Delegates for approval.
As a follow-up to the advisory on Prevention of Perioperative
Peripheral Neuropathies, a practice advisory is being developed
on the Prevention of Perioperative Blindness. The number of cases
of postoperative blindness due to ischemic optic neuropathy continues
to increase. Therefore, there is a need to get information to
the membership on this devastating postoperative complication.
A practice advisory is being developed on the Basic Expectations
for Anesthesia Practice. This task force is being chaired by Carl
C. Hug, Jr., M.D., Ph.D., and is scheduled to be presented to
the 2002 House of Delegates.
Three current guidelines are in the process of being updated
for presentation to the 2001 House of Delegates.
Practice Guidelines for Management of the Difficult Airway is
being updated by a task force under the leadership of Robert A.
Caplan, M.D.
Practice Guidelines for Pulmonary Artery Catheterization is
being revised under a task force chaired by Michael F. Roizen,
M.D.
Practice Guidelines for Sedation and Analgesia by Nonanesthesiologists
is being updated under the leadership of Jeffrey B. Gross, M.D.
This update is very timely in view of the renewed emphasis on
sedation by the Joint Commission on Accreditation of Healthcare
Organizations in recent surveys.
The Committee on Practice Parameters will recommend that a parameter
be developed on prevention of drug errors. This will be presented
to the March 2001 Board of Directors. However, the committee feels
that outside funding will be required for a thorough study of
the issue. Currently, we are attempting to identify likely outside
funding agencies.
ASA continues to manage this process in-house with Richard T.
Connis, Ph.D., and David G. Nickinovich, Ph.D., serving as the
methodologists. Dr. Caplan provides ongoing guidance to the methodologists,
who are located in Seattle, Washington. The task forces and their
chairs developed these documents on a completely volunteer basis;
all committee work in ASA is on a volunteer basis. ASA remains
strong because of the volunteer spirit of our members.
Approved parameters are published in Anesthesiology, and reprints
are available from the ASA Executive Office. Practice
parameters are also available for inspection and downloading
from the ASA Web site.
The Committee on Practice Parameters gratefully acknowledges
the valuable contributions of task force chairs, task force members,
consultants and other members of ASA who have participated in
the development of evidence-based guidelines. The committee welcomes
suggestions for new parameter topics and for ways to improve the
development process.
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James
F. Arens, M.D., is Dr. R. Lee Clark Professor and Chair, Department
of Anesthesiology, Division on Anesthesiology and Critical
Care, University of Texas M.D. Anderson Cancer Center, Houston,
Texas. He was ASA President in 1989. |
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