2017-10-16 to 2017-10-17 Anesthesia CRG F2F Meeting

Monica Harry

2017-09-26 Anesthesia CRG Call

Updated list of ASA Definitions ready for discussion.  For review later.

Spreadsheet of perioperative drugs reviewed. Acceptable list of current perioperative drugs, as it stands it is not too specific for anaesthesia.

Group leadership, editing rights for Anesthesia

CRG pages

See #5.

Discussion of pre-coordinated terms and the problem of combinatorial explosion was discussed.  Toni Morrison notes that other groups have encountered similar questions  Ian Green notes that a concept model for devices is not currently pursued.  A CRG is to look at Medical Devices and will have thoughts on this area.

If the CRG has a need to contextualise its work, IG and JM are suitable contacts, and can involve the clinical engagement teams.

Please publicise the work you're doing as a CRG (e.g. SNOMED newsletter, work with RCoA). It helps build reputation and momentum.

Patrick McCormick's work with AQI was discussed.

Formulary BNF aligned 091017.xlsx

Ongoing review of this document may best proceed to include the various blood component products.

Brand names are deprecated for the International edition although national editions of SNOMED may include them.

Review will include preparations such as Tetracaine/ Oxymetazoline

A brief discussion with Toni Morrison noted that drugs, including iv fluids, will use a remodelled set of concepts and be clearer over the course of 2018.

Endotracheal tubes - descriptive attributes and

Compositional grammar

Endotracheal tube properties

Although there are many attributes to consider for an ETT, we could follow the situation in orthopaedics and use a set of compositional terms.  On examination of THR terms, this doesn't entirely answer the problem.

Updates from GMDN are noted, e.g. single use endotracheal tubes

19223 Out for ballot 31st October 2017. Ballot closes December 31st. Hoped that it will pass ballot and be implemented in 2018 if passes

4135: Due to start revision this Autumn. Paul Dixon is the secretary for this project

Steven Dain succeeds Julian Goldman as Chair of ISO TC121 in January 2018

SD also questioned relationship between LOINC and SNOMED. AN reported there was a collaboration agreement and a number of documents detailing progress are present on www.snomed.org

Communication with DAS highlights that SNOMED will replace READ codes. We should be able to expressdifficult airway situations, e.g.:

1 Difficult / failed mask ventilation

2 Difficult/ failed tracheal intubation

3 Emergency  FONA (Front of neck access)

1. Difficult / Failed FMV (Face mask ventilation)

2. Difficult / Failed SAD(supraglottic airway device) ventilation

3. Difficult tracheal intubation

4. Failed tracheal intubation

5. Emergency FONA

Anesthesia adverse events and outcomes - outstanding requests and review for any additions

Finalise requests for anesthesia outcomes for ASA Ad Hoc

Data Definitions Committee.

item 4

2017-09-26 Anesthesia CRG Call

AN's current list of adverse event concepts reviewed and discussed.

Local anesthetic toxicity added to SCT and made preferred term. Suggest additional relationships of the complications of anesthesia during labour and delivery to local anesthetic toxicity

Post operative aspiration - request will be non speciifc in definition - will merely note that material was aspirated

Add definition of difficult venous access, adapted from ref.

Procedural times - discussion took place on the scenarios and significance of cancellation before anesthesia start time, after anesthesia start time and after anesthesia induction time. Influences other than anesthesia are possible,

To use the AQI definitions as published, but may need some scenario expansion in the requests

Review procedural times definitions (AACD) for completeness in SNOMED as some included and some not

Agreed new concept requests for pleural injury after catheter and CVC line insertion

Difficult venous access - definition found from CHOP in literature - will be used in the request submission (number > 3 attempts) Difficult venous access (DVA) is a clinical condition in which multiple attempts (> 3) and/or special interventions are anticipated or required to achieve and maintain peripheral venous access¹. Adapted from: Rauch, D., Dowd, D. Eldridge, D. Mace, S. Schears, G., and Yen, K. Difficult Peripheral Venous Access in Children Clinical Pediatrics / Vol. 48, No. 9, November 2009

Confusion, POCD, delirium

Following discussion consensus was that definitions between these concepts is insufficiently clear to us - agreed we would review references and seek advice from Terri Monk

Definition for POCD:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959222/

POCD article from Terri Monk

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882015/pdf/nihms363159.pdf

Hyotensive episode - advise AQI to use existing SCT concept

Infection following neuraxial and peripheral nerve block

Event - condition - episode will now accept term requests that would meet this requirement. Epidural, spinal etc will grouped at level of neuraxial block. Some of the definition detail is problematical, implying sepsis when this may not exist. Omitting constraints in the definitions should resolve the problem and align more fully with CDC surgical site infection concepts

IV infiltration/Extravasation

Group agreed that extravasation is the preferred term. Using infiltration would be misleading as it has a specific meaning with SNOMED.

Communication with DAS highlights that SNOMED will replace READ codes. We should be able to expressdifficult airway situations, e.g.:

1 Difficult / failed mask ventilation

2 Difficult/ failed tracheal intubation

3 Emergency  FONA

1. Difficult / Failed FMV

2. Difficult / Failed SAD ventilation

3. Difficult tracheal intubation

4. Failed tracheal intubation

5. Emergency FONA

Reference: "Surgical intervention during a Can't intubate Can't Oxygenate (CICO) Event: Emergency Front-of-neck Airway (FONA)? "

https://academic.oup.com/bja/article/117/4/426/2410540/Surgical-intervention-during-a-Can-t-intubate-Can

Resolved:

1) submit request for difficult mask ventilation

2) submit for failure of mask ventilation

3) same pattern of terms for supraglottic airway ventilation

4) will need to review supraglottic airway device terms at some stage for any new types/patterns requiring additional terms

5) add CICO and CICV acronyms to cannot intubate cannot oxygenate

Emergency front of neck access.

This is now accepted terminology in international literature. will meed to encompass emergency tracheostomy and cricothyroidotomy. Noted emergency cricothyrotomy term in SNOMED is erroneously categorised - should be retired and replaced with new term to encompass cricothyroidtomy and thyrotomy which are synonymous. Will need to include emergency FONA acronym

Agreed no need for additional terms to distinguish scalpel and cannula cricothyroidotomy.

New content in July 2017 release

Content in authoring for next release

next scheduled call 28th November 2017