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

he Committee on Standards and Practice Parameters has, hopefully, continued to provide high-quality products for ASA. Seventeen evidence-based practice parameters and six updates have been approved and published since 1992. Eleven have been reviewed and approved by the National Guidelines Clearinghouse (NGC) and are currently listed on its Web site at www.guideline.gov.

Over the course of the last year, many positive comments were received for the two practice guidelines (“Practice Guidelines for the Perioperative Management of Patients With Obstructive Sleep Apnea” and the “Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies” update) and two practice advisories (“Practice Advisory for Intraoperative Awareness and Brain Function Monitoring” and “Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery”) approved in 2005. In October of last year, the House of Delegates approved an update for the “Practice Guidelines for Obstetric Anesthesia.”

Presently two new practice parameters are in progress: “Respiratory Depression Associated with Neuraxial Opioid Administration,” chaired by Terese T. Horlocker, M.D., and “Prevention of Operating Room Fires,” chaired by Robert A. Caplan, M.D. Both of these practice parameters are scheduled for completion this year. In addition two guideline updates are in progress: “Practice Guidelines for Chronic Pain Management,” chaired by Timothy R. Deer, M.D., and “Practice Guidelines for Perioperative Transesophageal Echocardiography,” chaired by Daniel M. Thys, M.D. The transesophageal echocardiography update will be a joint effort funded by both the Committee on Standards and Practice Parameters and the Society of Cardiovascular Anesthesiologists. These practice parameter updates are scheduled for completion in 2008.

The committee also discussed and considered potential future practice parameters, including: 1) magnetic resonance imaging (MRI); 2) central venous catheter insertion; 3) prevention, diagnosis and management of infections and bleeding complications associated with neuraxial blockade; 4) malignant hyperthermia; 5) medication safety and environmental management; and 6) updates of the “Practice Guidelines for Cancer Pain Management” and “Practice Guidelines for Preoperative Fasting.”

The task force for anesthesia for MRIs is currently being formed.

A proposal for a joint effort with the Committee on Performance and Outcomes Measurement (CPOM) is currently being considered by the committee. CPOM is working with the American Medical Association as part of a physician-based consortium for performance improvement to develop quality-incentive measures. The committee believes that such measures can best be developed using its evidence-based process for guideline development.

The Committee on Standards and Practice Parameters also has been directed to review the current “ASA Standards, Guidelines and Statements” with regard to the appropriateness of titles and categorizations of the documents it contains and to provide clear definitions for all practice parameters. A task force has been appointed to undertake and complete this review by June 2007.

Although serious complications have decreased since the introduction of “Standards for Basic Anesthetic Monitoring” and “Practice Guidelines for Management of the Difficult Airway,” studies have been unable to directly link the outcome to the practice parameters. Perhaps this basically reflects the adage that studying a problem will decrease its incidence.

James F. Arens, M.D., is Professor and Chair, Department of Anesthesiology, University of Texas Medical School at Houston. He was ASA President in 1989.