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

he Committee on Standards and Practice Parameters has maintained a high level of activity over the course of the last year. In 2006, the committee was directed to review and revise the existing “Policy Statement on Practice Parameters” to provide clear definitions for all practice parameters. This revision was completed in 2007 and approved by the ASA House of Delegates at the Annual Meeting in October.

Also at the annual meeting, the House of Delegates approved two new practice parameters: “Practice Guidelines for Neuraxial Opioids Associated With Respiratory Depression” and “Practice Advisory for Prevention and Management of Operating Room Fires.” These practice parameters are scheduled for publication this year. When the “Practice Guidelines for Neuraxial Opioids Associated With Respiratory Depression” is published, there will be a footnote at the start of Section III (“Detection of Respiratory Depression after Neuraxial Opioids”). The footnote will read: “The Task Force will propose a revision to Section III in October 2008.” The proposed revision will be published on the ASA Web site following publication of the guideline in Anesthesiology. Comments on the proposed revision are welcomed by the Task Force for this important revision.

Presently, two new practice parameters are in progress: “Prevention, Diagnosis and Management of Infections and Bleeding Complications Associated with Neuraxial Blockade,” chaired by Terese T. Horlocker, M.D., and “Magnetic Resonance Imaging,” co-chaired by Jan Ehrenwerth, M.D., and Mark A. Singleton, M.D. Both of these practice parameters are scheduled for completion this year. In addition, two guideline updates are in progress: “Chronic Pain Management,” chaired by Timothy R. Deer, M.D., and “Transesophageal Echocardiography,” chaired by Daniel M. Thys, M.D. The TEE update is a joint effort funded by both the Committee on Standards and Practice Parameters and the Society of Cardiovascualar Anesthesiologists. These practice parameter updates are scheduled for completion this year.

The committee also discussed and considered potential future practice parameters. After discussion of several options, the committee elected to proceed with a practice parameter on monitoring of oxygenation and ventilation for patients receiving postoperative PCA opioids. Other topics for future practice parameters that were considered by the committee included: 1) medication safety, 2) obesity and bariatric surgery, 3) hypotensive anesthesia for shoulder surgery and 4) central venous catheter insertion. A guideline regarding central venous catheterization will be given serious consideration following articles pointing out medical errors and perioperative risks with this procedure.

Nineteen evidence-based practice parameters and six updates have been approved and published in Anesthesiology since 1992. Twelve have been reviewed and approved by the National Guideline Clearinghouse (NGC), and 11 are currently listed on the Web site www.guideline.gov. Much of the credit for the ASA efforts in practice parameter development goes to the volunteer members of our various task forces.

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