Guidelines to the Practice of Anesthesia Revised Edition 2011

- Appendix 2: American Society of Anesthesiologists classification of physical status Appendix 3: Pre-anesthetic checklist Appendix 4: Guidelines, standards, and other official statements available on the internet Appendix 5: Position Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society Appendix 6: Position Paper on Procedural Sedation: An Official Position Paper of the Canadian Anesthesiologists Society Table des matie`res Preambule Principes de base Organisation des services danesthesie Responsabilites du chef du departement danesthesie Privile`ges dexercice en anesthesie Residents Personnel de soutien E quipement et installations La periode preanesthesique La periode anesthesique Dossiers Monitorage du patient La periode postanesthesique La salle de reveil Conge des patients apre`s chirurgie dun jour Lignes directrices pour lanalgesie regionale en obstetrique E lements requis pour lutilisation de lanalgesie regionale en obstetrique Maintien de lanalgesie regionale pendant le travail Absorption orale pendant le travail Lignes directrices pour la prise en charge de la douleur aigue a` laide de lanalgesie neuraxiale Politiques administratives et educatives Politiques en matie`re dadministration de medicaments Monitorage des patients et prise en charge des evenements indesirables Lignes directrices pour lexercice de lanesthesie hors du milieu hospitalier Selection des patients Considerations preoperatoires Conduite de lanesthesie Annexe 1 : Normes de lAssociation canadienne de normalisation (CSA) au sujet de lequipement Annexe 2 : Classification de letat de sante des patients, selon lAmerican Society of Anesthesiologists Annexe 3 : Liste de verification preanesthesique Annexe 4 : Lignes directrices, normes et autres enonces officiels disponibles sur linternet Guidelines to the Practice of Anesthesia Revised Edition 2011 Richard Merchant, MD Craig Bosenberg, MBChB Karen Brown, MD Daniel Chartrand, MD Steven Dain, MD Joy Dobson, MD Matthias Kurrek, MD Kenneth LeDez, MBChB Pamela Morgan, MD Monica Penner, MD Romesh Shukla, MBBS Overview The Guidelines to the Practice of Anesthesia Revised Edition 2011 (the guidelines) were prepared by the Canadian Anesthesiologists Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. Whereas previous versions of the guidelines appeared as special supplements to the Canadian Journal of Anesthesia (the Journal), this edition of the guidelines is published within the Journal. This allows for improved archiving and online access to complement the printed versiona new offering for CAS members and Journal subscribers. The Guidelines to the Practice of Anesthesia Revised Edition 2011 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the society cannot guarantee any specific patient outcome. Each anesthesiologist should exercise his or her own professional judgement in determining the proper course of action for any patients circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia. Electronic supplementary material The online version of this article (doi:10.1007/s12630-010-9416-z) contains supplementary material, which is available to authorized users. R. Merchant, MD (&) C. Bosenberg, MBChB K. Brown, MD D. Chartrand, MD S. Dain, MD J. Dobson, MD M. Kurrek, MD K. LeDez, MBChB P. Morgan, MD M. Penner, MD R. Shukla, MBBS Canadian Anesthesiologists Society, 1 Eglinton Avenue East, Suite 208, Toronto, ON M4P 3A1, Canada e-mail: ; Anesthesia is a dynamic specialty of medicine. Continuous progress is being made to improve anesthetic care for patients undergoing surgical and obstetric procedures in Canada. To reflect this progress in the delivery of anesthetic services, this document is reviewed annually and revised periodically. The following recommendations are aimed at providing basic guidelines to anesthetic practice. They are intended to provide a framework for reasonable and acceptable patient care and should be so interpreted, allowing for some degree of flexibility in different circumstances. Each section of these guidelines is subject to revision as warranted by the evolution of technology and practice. In this document, the term anesthesiologist is used to designate all licensed medical practitioners with privileges to administer anesthetics. An anesthetic is any procedure that is deliberately performed to render a patient temporarily insensitive to pain or the external environment so that a diagnostic or therapeutic procedure can be performed. The independent practice of anesthesia is a specialized field of medicine. As such, it should be practised by physicians with appropriate training in anesthesia. The only route to specialist recognition in anesthesia in Canada is through the certification process of the Royal College of Physicians and Surgeons of Canada. The Canadian Anesthesiologists Society (CAS) acknowledges the fact that remote communities often lack the population base to support a specialist anesthetic practice. In these communities, appropriately trained family physicians may be required to provide anesthesia services. All anesthesiologists should continue their education in the practice of anesthesia, pain management, perioperative care, and resuscitation. These guidelines are intended to apply to all anesthesiologists in Canada. Organization of Anesthetic Services The department of anesthesia should be properly organized, directed, and integrated with other departments in the organization or facility, and it should include all facility staff members who provide anesthetic services to patients for surgical, obstetric, diagnostic, and therapeutic purposes. The department should be staffed appropriately, bearing in mind the scope and nature of the services provided, and it should strive to ensure that these services are available as required by the health care facility. The chief of the department should be a physician who has obtained certification or appropriate training in anesthesia. This individual should be appointed in the same manner as other chiefs of clinical departments and should be a member of the senior medical administrative bodies for the facility. Responsibilities of the Chief of Anesthesia 1. To be aware of the current CAS Guidelines to the Practice of Anesthesia, the requirements of the Canadian Council on Health Services Accreditation, and the requirements of the provincial licensing authority as they relate to anesthesia; 2. To ensure that written policies with respect to the practice of anesthesia are established and enforced; 3. To (...truncated)