2017-04-23 Anesthesia SIG Face to Face Meeting

Introduction for James Palmer

Introduction to Anesthesia SIG: history, objectives, current activity

Future as a VCG

DDTF page at APSF

IOTA page at APSF

AN gave a summary of the development of coding systems including development of Read, CTV3, SNOMED and SNOMED CT and the history of the Anesthesia SIG from the time of the DDTF (Data Dictionary Task Force) - see links above. Discussion agreed that SNOMED CT remains the best way to move forward with structured recording of anesthesia data, especially complications and morbidity in anesthesia, but a renewed effort is needed at least in the UK to engage with the Royal College and Association of Anaesthetists - possibly these bodies should nominate representatives to the Anesthesia SIG

RCOA National Audit Projects - UK-wide initiative to capture rates of awareness, airway management complications, and other issues

Future as a VCG. The group did not anticipate major changes in current ways of working but needs increased emphasis on seeking support of anesthesia related items on SNOMED International workplans. Current meeting schedule to continue. Issues to be raised and clarified at HPCG meeting on Tuesday 25th April

Outlined coding issue with awareness under anesthesia in ICD 10 (could only be added as a subcode of T85) arising from the NAP 5 audit project in the UK (awareness under anesthesia). Has reviewed existing SNOMED CT concepts and in discussion with UK terminology centre has considered possibilities of examining observable values for agent concentrations in patients in whom awareness is recorded.

Concepts to consider adding:

• Minimum alveolar concentration (MAC)
• End-tidal Minimum alveolar concentration (etMAC)
• Age-adjusted Minimum alveolar concentration (aaMAC)
• Age-adjusted End-tidal Minimum alveolar concentration (aaetMAC)

Synonyms of "Awareness under anesthesia" to remove (since they conflict with child term)

• GA - Depth of anaesthesia

• GA - Depth of anesthesia

Proposed child for "Awareness under general anesthesia":

• Accidental awareness under general anesthesia (AAGA)
  • Accidental awareness under general anesthesia during induction and/or intubation
  • Accidental awareness under general anesthesia during maintenance of anesthesia

Currently has "398204001 | Bispectral index (assessment scale) " - however this is a trademarked term.

• Depth of anesthesia (observable entity)

Retire:

• Light anesthesia (finding)

Hypothermia in anesthesia with ref. to planned /unplanned

procedures

Following issues raised at SIG meeting

28th March 2017

Conclude discussion from SIG meeting on

28th March 2017

Anethesia Quality Institute Outcome (AQI) terms

Review progress, discussion of new concepts

(Possibly during Modelling Advisory Group session

on Monday morning)