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Anesthesia Clinical Reference Group

Time: Tuesday, January 24, 2023 20:00 - 21:00 UTC / 20:00 - 21:00 UK / 15:00 - 16:00 ET

Or Telephone:

+1 646 518 9805 (US Toll)
+44 203 481 5237 (GB Toll)
+1 587 328 1099 (CA Toll)

International numbers available:


1Introductions and Apologies

No apologies were presented.


Matters arising from the previous meeting notes

2022-11-22 Anesthesia CRG Meeting

Previous meetings were noted. Continuing to work on the previous topics. The potential for the group to add value to other areas was discussed.
3SNOMED Update

4Ventilation Related Terms

Recent specification ISO 19223 and IEEE 11073-10101 (still in press) has several terms that need to be addressed in SNOMED.

See attached Word document for outline. Steven Dain will review this and we will proceed further at next meeting.

(postponed to next meeting)

5Restructuring of Local Anaesthetic Hierarchy.

Structuring Local Anaesthesia as per discussions in IHTSDO Content Tracker. No consistent approach exists in SNOMED at the moment. Previous discussions address phenol, alcohol and Botulinum Toxin and note that these are not defined as medicinal products. The group agreed that the distinction between medicinal and non-medicinal substances was not constructive in this case.

Many agents and modalities can be used for therapeutic nerve effect/ damage, it needs to be possible to accept all - e.g. Chemical, Cryotherapy, drug, Radio Frequency Ablation. General Concept Inclusion (GCI) would allow several different modalities to be combined. Monica Harry will discuss this @Krista. Steven Dain will request that Radio-Frequency Ablation be made an option.

Regional anesthesia should not be under local anesthesia (one of many observations leading to proposal for a hierarchy rework) 

ESRA Consensus document on this issue was found by Steven Dain :

Should we reach out to a group such as ESRA and/or the American Society of Regional Anesthesia ASRA to see whether they would be willing to suggest a classification?  Patrick McCormick will discuss with ESRA will reach out to ASRA.

See these tickets for more information: 

Monica Harry will update one or the other ticket.

CRS ticket to be made for radioablation, identified by Steven Dain as missing.

6Intubation of the TracheaMonica Harry Several concepts seem to relate to endotracheal intubation. After discussion, the existing terms were not considered totally synonymous and no change was recommended.
7Intensive Care Clinical Data

Steven Dain suggested the area of representing the contents of a daily ICU "Flow Chart", estimating that perhaps 50 new concepts might be needed in order to do this.

One prominent difficulty is the representation of scales which contain copyrighted information. Scales discussed include the VIP scale for monitoring peripheral cannulae (widely used, we might hope to get permission to use this), the FLACC scale (Pediatric Pain) and the Braden Scale. Some terms in the Braden Scale were thought to be quite subjective, this is not uncommon in scales used in practice. The Waterlow Scale is already modelled in SNOMED (UK) and this was noted to express comparable information to the Braden Scale. Steven Dain will explore the possibilities of using some of these scales.

There was general discussion about using published and copyrighted clinical assessment scales. It was agreed that the best course of action was for the CRG to approach the scale owner to explain the mutual value in expressing the scale within SNOMED, noting that SNOMED would be asking to use the scale, and not take ownership of it.


Dates of next meeting:

Tuesday, March 28, 2023