Practice Parameters

ASA practice parameters provide guidance in the form of requirements, recommendations, or other information intended to improve decision-making and promote beneficial outcomes for the practice of anesthesiology. The use of practice parameters cannot guarantee any specific outcome. Practice parameters are subject to periodic revision as warranted by the evolution of medical knowledge, technology and practice. Variance from practice parameters may be acceptable, based upon the judgment of the responsible anesthesiologist.

See also: Clinical Information


Practice Guidelines for Central Venous Access

These guidelines, published in Anesthesiology in March 2012, focus on the prevention of central venous catheter-related blood stream infections.  Additionally, the guideline addresses the prevention and management of major arterial vascular injury that may occur during attempted central venous catheter placement.

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Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists

Recognizing the growing impact that non-anesthesiologists have on the specialty, the Task Force on Sedation and Analgesia by Non-Anesthesiologists offers these revised practice guidelines, which were published in the April 2002 issue of Anesthesiology.  The guidelines allow clinicians to provide their patients with the benefits of sedation/analgesia while minimizing the associated risks.

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Click here for more information on the newly updated Sedation and Analgesia by Non-Anesthesiologists resources.


Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging

As healthcare technology continues to advance, physicians in medical specialties are taking necessary steps to ensure that all patients are provided safe care throughout procedures for diagnosis and treatment. Recognizing the magnetic resonance imaging (MRI) suite as a potentially hazardous location that may pose challenges for anesthetic administration and patient care decisions, the American Society of Anesthesiologists has developed a new "Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging," that can also be found in the March 2009 journal Anesthesiology.

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Practice Advisory for Intraoperative Awareness and Brain Function Monitoring

Intraoperative awareness under general anesthesia is a rare occurrence, with a reported incidence of 0.1-0.2 percent. The purposes of this advisory are to identify risk factors, provide decision tools and stimulate the pursuit and evaluation of strategies that may prevent or reduce the frequency of unintended intraoperative awareness, and provide guidance for the intraoperative use of brain-function monitors as they relate to intraoperative awareness.

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Practice Advisory for the Perioperative Management of Patients with Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter-Defibrillators

The 2004 version of this practice advisory was written by a task force consisting of anesthesiologists and cardiologists in private and academic practices from various geographic areas of the United States, and two methodologists from the ASA Committee on Practice Parameters. It was adopted by the ASA House of Delegates in October 2004, and revised in October 2010.  The purposes of this Advisory are to facilitate safe and effective perioperative management of the patient with a CRMD, and reduce the incidence of adverse outcomes.

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Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery

The purposes of this advisory are to enhance awareness of permanent impairment or total loss of sight associated with a spine procedure during which general anesthesia is administered and to reduce its frequency. The conditions addressed in this advisory are posterior ischemic optic neuropathy (PION), anterior ischemic optic neuropathy (AION) and central retinal artery occlusion (CRAO).

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Practice Advisory for the Prevention and Management of Operating Room Fires

This practice advisory was written by the ASA Task Force on Operating Room Fires and was approved by the House of Delegates on October 17, 2007. The purposes of this advisory are to identify the situations conductive to fire, prevent the occurrence of OR fires, reduce adverse outcomes associated with OR fires and identify the elements of a fire response protocol. This updated advisory was published in Anesthesiology in February 2013.

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Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques

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Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies

Written by a special task force of ASA and adopted by the ASA House of Delegates in October 1999 and revised in October 2010, this practice advisory was developed to reduce the frequency or minimize the severity of peripheral neuropathies that may be related to perioperative positioning of patients. This document specifically focuses on the use of protective padding and avoidance of contact with surfaces; it does not focus on compartment syndromes or neuropathies associated with anesthetic techniques or blocks.

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Practice Advisory for Preanesthesia Evaluation

This practice advisory was written by the ASA Task Force on Preanesthesia Evaluation and was approved by the House of Delegates on October 17, 2001, and amended on October 19, 2011. This advisory assesses currently available evidence pertaining to health care benefits of preanesthesia evaluation, offers a reference framework for the conduct of preanesthesia evaluation by anesthesiologists and stimulates research strategies that can assess health care benefits of preanesthetic evaluation.

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Practice Alert for the Perioperative Management of Patients with Coronary Artery Stents

This Practice Alert reviews published recommendations that address the perioperative management of surgical patients with recently implanted coronary artery stents. The intent of the Alert is to provide the anesthesiologist with the information about the increased risk of perioperative myocardial infarction and death in these patients and the relation between antiplatelet therapy and acute perioperative stent thrombosis. This alert was originally published in Anesthesiology in January 2009.

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Practice Guidelines for Acute Pain Management in the Perioperative Setting

The purpose of these guidelines, which were published in the journal Anesthesiology in April 1995 and amended by the House of Delegates on October 19, 2011, is to facilitate the efficacy and safety of acute pain management in the perioperative setting and to reduce the risk of adverse outcomes.

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Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies

The purposes of these guidelines is to improve the perioperative management of blood transfusion and adjuvant therapies and to reduce the risk of adverse outcomes associated with transfusions, bleeding or anemia. In addition, these guidelines provide an update on the relative risks that cause morbidity and mortality associated with blood transfusion and adjuvant therapies in inpatient or outpatient surgical settings and other locations (e.g., interventional radiology, critical care units)

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Practice Guidelines for Cancer Pain Management

Published in Anesthesiology in May 1996, these guidelines provide evidence-based information to optimize pain control; minimize side effects, adverse outcomes and costs; enhance functional abilities, physical and psychological well-being; and enhance the quality of life for cancer patients.

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Practice Guidelines for Chronic Pain Management 

These guidelines, published in April 2010 in Anesthesiology, focus on the knowledge base, skills and range of interventions that are the essential elements of effective management of chronic pain and pain-related problems.

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Practice Guidelines for Management of the Difficult Airway

The purpose of these guidelines, which were first published in Anesthesiology in March 1993 and revised in 2012, is to facilitate the management of the difficult airway and to reduce the likelihood of adverse outcomes. Included is a difficult airway management algorithm. The revised guidelines were published in the February 2013 issue of Anesthesiology.

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Practice Guidelines for Obstetric Anesthesia

First approved in October 1998, the newly revised guidelines address the latest evidence-based recommendations for perianesthetic evaluation, fasting in the obstetric patient, anesthetic choices for labor, removal of retained placenta, anesthetic choices for cesarean delivery, postpartum tubal ligation and management of complications.  In press, Anesthesiology, 2006.

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Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a syndrome characterized by periodic, partial or complete obstruction of the upper airway during sleep that may cause episodic sleep-associated oxygen desaturation, episodic hypercarbia and cardiovascular dysfunction. The purpose of these guidelines is to improve the perioperative care and reduce the risk of adverse outcomes in patients with OSA who receive sedation, analgesia or anesthesia for diagnostic or therapeutic procedures under the care of an anesthesiologist. This revised version appears in the January 2013 issue of Anesthesiology.

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Practice Guidelines for Perioperative Transesophageal Echocardiography

These recommendations address indications, the clinical settings in which transesophageal echocardiography should be considered, and the cognitive and technical skills and proficiency expected of anesthesiologists who perform transesophageal echocardiography. These guidelines appear in the May 2010 issue of Anesthesiology.

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Practice Guidelines for Preoperative Fasting

The 1999 version of these guidelines were the culmination of a two-year task force project to synthesize the available evidence with emphasis on a streamlined and cost-effective approach to management. The guidelines specifically focus on preoperative fasting recommendations for the healthy patient undergoing elective procedures. Also included are recommendations regarding the use of pharmacologic agents to reduce the risk of pulmonary aspiration. It was approved by the ASA House of Delegates in October 1999 and revised in October 2010.

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Practice Guidelines for the Prevention, Detection and Management of Respiratory Depression Associated with Neuraxial Opioid Administration

This document updates the Practice Guidelines for the Prevention, Detection and Management of Respiratory Depression Associated with Neuraxial Opioid Administration adopted by the ASA in 2007 and posted online at asahq.org. This updated report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids includes new survey data and recommendations pertaining to monitoring for respiratory depression.

This updated Practice Guideline was published in Anesthesiology February 2009.

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Practice Guidelines for Pulmonary Artery Catheterization

Developed by a special task force of ASA, this document was first published in Anesthesiology in February 1993 and revised in 2002. The report summarizes the task force’s recommendations on pulmonary artery catheterization and its rationale, based on scientific evidence and expert opinion. The revised guidelines were for published in Anesthesiology in 2003.

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Practice Guidelines for Postanesthetic Care

These guidelines seek to improve postanesthesia care outcomes for patients who have just had anesthesia or sedation and analgesia care. They focus on the perioperative management of patients with the goal of improving postanesthesia quality of life, reducing postoperative adverse events, providing a uniform assessment of recovery, and streamlining postoperative care and discharge criteria. The guidelines were published in the February 2013 issue of Anesthesiology.

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