(Excerpted from a report by ASA President Eugene
P. Sinclair)
I would like to report on a proposal that originated
with the Anesthesia Patient Safety Foundation (APSF)
and is under consideration by the Committee on Standards
of Care. Based on information regarding adverse anesthesia
related outcomes, APSF proposed that the wording of
the Standards for Basic Anesthetic Monitoring be amended
by adding the following language:
STANDARDS FOR BASIC ANESTHETIC MONITORING
( Approved by ASA House of Delegates
on October 21, 1986 and last amended on October 27,
2004)
STANDARD II
OXYGENATION
METHODS
2) Blood oxygenation: During all anesthetics, a quantitative
method of assessing oxygenation such as pulse oximetry
shall be employed.* When the
pulse oximeter is utilized, the variable pitch pulse
tone and the low threshold alarm must be audible .** Adequate illumination and
exposure of the patient are necessary to assess color.*
VENTILATION
METHODS
2) When an endotracheal tube or laryngeal mask is
inserted, its correct positioning must be verified
by clinical assessment and by identification of carbon
dioxide in the expired gas. Continual end-tidal carbon
dioxide analysis, in use from the time of endotracheal
tube/laryngeal mask placement, until extubation/removal
or initiating transfer to a postoperative care location,
shall be performed using a quantitative method such
as capnography, capnometry or mass spectroscopy.* When
capnography is utilized, the capnograph alarms must
be audible .**
**Under extenuating circumstances
the responsible anesthesiologist may waive the
requirements marked with an asterisk ( * ); it
is recommended that when this is done, it should
be so stated (including the reasons) in a
note in the patient's medical record.
The proposal is posted on the Members Only page of
the ASA web site with a request for comments at:
http://www.asawebapps.org/docs/audiblealarms.htm
The Committee on Standards of Care will consider
the APSF proposal and report its recommendations to
the Board of Directors and House of Delegates. The
House will make the final determination whether to
add the APSF suggested wording to the Basic Standards
for Anesthetic Monitoring.
The Executive Committee of ASA has carefully followed
the development of the APSF proposal and regards it
as a common sense action that will help avoid preventable
patient injury and is easily implemented. The Executive
Committee encourages all members to incorporate the
APSF proposal into their practices without waiting
for formal adoption of the standard.