James F. Arens, M.D., Chair
Committee on Practice Parameters

t the 2004 meeting of the ASA House of Delegates last October in Las Vegas, Nevada, the Practice Advisory for the Perioperative Management of Patients With Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter-Defibrillators was passed <www.ASAhq.org/PublicationsAndServices/CRMDAdvisory.pdf>. The task force that developed this advisory was chaired by James R. Zaidan, M.D. The advisory will be submitted to Anesthesiology for publication. It is important to be familiar with this document because many of us will need to change our practices. The publication also has been endorsed by the Heart Rhythm Society and the Society for Cardiovascular Anesthesiologists.

Practice advisories are systematically 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.

At the same meeting, an open forum was held to discuss the practice parameter related to intraoperative awareness and brain function monitoring. This task force is chaired by Jeffrey L. Apfelbaum, M.D. The task force plans to have a document ready for presentation at the 2005 ASA Annual Meeting. From the forum, the task force heard about 1) the need to make a clear distinction between awareness and recall and 2) that the task force should not address the question of cost-benefit analysis.

A practice parameter on obstructive sleep apnea is scheduled for presentation at the 2005 ASA Annual Meeting.

A parameter on the prevention of perioperative blindness is being developed and will likely be ready for presentation at the 2005 Annual Meeting as well.

The Practice Guidelines for Blood Component Therapy are being updated and are scheduled for presentation at the 2005 Annual Meeting.

A document on the Prevention of Operating Room Fires is being developed.

The Committee on Practice Parameters will recommend two new practice parameters on Neuraxial Anesthesia and Central Venous Pressure Insertion.

The committee also was asked to develop a parameter on Spinal Manipulation; however, several committees had already done extensive work on this subject. Therefore John C. Rowlingson, M.D., and I have written an article on this subject for this NEWSLETTER.

Appreciation is expressed to the members of the Committee on Practice Parameters. The task forces do yeoman’s work in the development of the parameters. Special thanks are given to Robert A. Caplan, M.D., and to the methodologists Richard T. Connis, Ph.D., and David Nickinovich, Ph.D., who staff the task forces but also do literature searches and establish the necessary methodology for evidence-based guidelines.

If you have a recommendation for a new guideline, please forward your suggestions to Dr. Caplan at <anerace@vmmc.org> or to me at <jarens@mdanderson.org>.

James F. Arens, M.D., is Professor, Department of Anesthesiology, M.D. Anderson Cancer Center, Houston, Texas. He was ASA President in 1989..