Attendees were welcomed by Andrew Norton and a brief summary of the growth of anaesthetic terminology was given, with specific reference to the work of the Anaesthesia CRG, formerly SIG, in SNOMED/ IHTSDO.

Monica Harry supports the CRG as a terminologist, and briefly introduced her role.

2018-03-27 Anesthesia CRG Call

The minutes of this meeting were reviewed and accepted as a suitable record.

Review of sections of SNOMED CT hierarchy:

• 128258000 Ventilation finding
• 250763003 Anesthetic finding
  
  

Include consideration of relevance of terms under anesthetic finding to other medical specialties

Discussion of terminology relating to Accidental Awareness under GA (AAGA, see the NAP5 audit) was used as an example of the group's work.  Terminology will develop to accommodate AAGA as a search term and definition.

A number of other terms are undergoing revision and have been submitted to the content request system.

The structure of Ventilation Finding and Anaesthetic Finding was considered; "grouper" terms such as "Anesthetic finding" should be removed where they do not add value.  Some groupers may be removed, some should be renamed.

Anesthetic finding

Potentially redundant terms for difficulty with airway management, inc. intubation, were reviewed. Monica Harry and the group will look at these with a view to the consequences should we amalgamate them all.  The group noted that the term "intubation" was previously used to primarily refer to "intubation of the trachea", but wider use is now normal (e.g. placing a gastroscope in the oesophagus).  We may have to modify "intubation" terms to explicitly specify "tracheal intubation".  Classification structure will stay the same at moment.

CICV was not found in the pending release of SNOMED, Monica Harry will review this and see if its inclusion can be expedited.

Distinction between "Anaesthesia Finding" and "Anesthetic Finding" was not clear - changes were not made.

"Ventilation finding" was reviewed.

Terms will be reviewed so that terms properly fit their concepts; so that a continuous measurement (e.g. minute volume, or minute volume) is an Observable Entity, and the diagnosis of Hypoventilation will be a Finding.

SNOMED definition of Observable Entity
SNOMED definition of Finding

Minute volume and Minute ventilation are currently distinct concepts. Consider making them synonyms, with the primary term being an observable entity.

Multiple terms are noted which relate to terms such as Minute Volume; Andrew Norton will review these. Alveolar Ventilation is represented, but a review of ventilatory parameters will be worthwhile. Terminology must: 1) be clearly defined; and 2) use words such as "Volume" and "Capacity" precisely.

4

Current thinking seems to be represented in:

Anaesthesia 2018; doi:10.1111/anae.14247. The Airway App: exploring the role of smartphone technology to capture emergency front-of-neck airway experiences internationally.

The article presents the following terms re cricothyroidotomy:

Cannula Cricothyroidotomy
Wire-guided Cricothyroidotomy
Open Cricothyroidotomy
Scalpel- Introducer procedure:

• Scalpel–bougie Cricothyroidotomy
• Scalpel-Hook Cricothyroidotomy

(may develop to include use of adjunctive tools, e.g. surgical hook)

It also presents these for Tracheostomy:

Open tracheostomy
Percutaneous Tracheostomy

Discussion

Emergency cricothyrotomy is correctly spelt and synonymous with cricothyroidotomy in the current version of SNOMED.  Cricothyroidotomy and cricithyrotomy are now considered synonymous.  Emergency cricothyrotomy has a new FSN 398142004.

Cricothyroidotomy will remain the parent term, with open/ percutaneous/ emergency variants.

Device terminology may need to extend to include terms for specifically designed cricithyroidotomy tubes. We will review the representation of cricothyroidotomy tubes.  Andrew Marchant to review the devices which are available and comment on a suitable classification.

Tracheostomy terms have been reviewed and some ambiguity removed.

Parent of emergency cricothyrotomy was formation of anastomosis - this was incorrect and the parent is now cricothyrotomy.

FONA (Front Of Neck Access) is a recent term which encompss a broad range of techniques designed to access the larynx and trachea for the purposes of ventilation and oxygenation.

BJA: 118: 649 "Critical airways, critical language" uses and defines the term "Emergency front-of neck airway"

A number of previous terms have been retired, new terms modelled.

Review new model and parent concepts