March 2002
Volume 66 |
Number 3
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| Practice
Parameters Update |
James
F. Arens, M.D., Chair
Committee on Practice Parameters
The ASA House of Delegates approved three practice parameters
in October 2001. They were the “Practice Advisory on Preanesthetic
Evaluation,” the “Practice Guidelines for Postanesthetic
Care” and an updated version of “Practice Guidelines
for Sedation and Analgesia by Nonanesthesiologists.”
The Committee on Practice Parameters is planning a new guideline
or advisory on pediatric anesthesia. The chair and other task
force members will be appointed in the near future. Three guidelines
are undergoing revision:
1. “Practice Guidelines for Management of the Difficult
Airway” is undergoing revision, and an open forum will
be held this spring. Robert A. Caplan, M.D., chairs the task force,
and the guideline is expected to be presented to the House of
Delegates in October 2002.
2. The revision of the “Practice Guidelines for Pulmonary
Artery Catheterization” is nearly complete. Open forums
have already been held at the International Anesthesia Research
Society and the Society for Cardiovascular Anesthesiologists.
Michael F. Roizen, M.D., chairs this task force, and the document
will be presented to the House of Delegates in October 2002.
3. Revisions of the “Practice Guidelines for Acute Pain
in the Perioperative Setting” have just begun. Michael
A. Ashburn, M.D., is serving as chair of this task force. The
revision will likely be ready for the House of Delegates in 2003.
There are now three different levels of practice parameters in
existence. Practice parameters are developed to provide guidance
or direction for the diagnosis, management and treatment of specific
clinical problems. Practice parameters may refer to standards,
guidelines or advisories.
Practice standards are authoritative statements or rules
of minimum requirements for clinical practice. For example, “Standards
for Basic Intraoperative Monitoring” are the guiding principles
in pulse oximetry. A standard may be modified only under unusual
circumstances, such as extreme emergencies.
Practice guidelines are systematically developed recommendations
for patient care that describe a basic management strategy or
a range of basic management strategies. Guideline recommendations
are supported by analysis of the current literature and by a synthesis
of expert opinion, open forum commentary, clinical feasibility
data and consensus surveys. Guidelines are not intended as standards
or absolute requirements. They may be adopted, modified or rejected
according to clinical needs and constraints.
Practice advisories are systemically developed reports
that are intended to assist decision-making in areas of patient
care where scientific evidence is insufficient. Advisories provide
a synthesis and analysis of expert opinion, clinical feasibility
data, open forum commentary and consensus surveys. Advisories
are not intended as standards or guidelines. They may be adopted,
modified or rejected according to clinical needs and constraints.
Approved parameters are published in Anesthesiology and are available
at <www.asadev.org/publicationsServices.htm>.
The Committee on Practice Parameters gratefully acknowledges the
volunteer spirit of our ASA members and thanks the task force
chairs, task force members, consultants and other ASA members
who have participated in the development of practice parameters.
Concerns that parameters may cause increased litigation have
not proven to be valid. In fact, in many cases, parameters have
been helpful to the anesthesiologist who is being sued. Many of
us have been amazed to find little or no evidence to support long-standing
dictums when evidence-based guidelines are being formulated.
The American College of Cardiology and the American Heart Association
recently published their “Updated Guideline on Perioperative
Cardiovascular Evaluation for Noncardiac Surgery.” Of special
interest to anesthesiologists is Section VIII of that guideline,
which deals with “Anesthetic Considerations and Intraoperative
Management”; a portion of Section VII, which addresses issues
related to implanted pacemakers and ICDs; and Section IX, which
deals with perioperative surveillance.
Since these areas are integral portions of our practice, awareness
of these guidelines is important; they are available at <www.acc.org>
or <www.americanheart.org>.
This is for your information only; the Committee on Practice Parameters
advocates no specific position on this document.
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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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