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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
https://snomed.zoom.us/j/86213859447?pwd=bURwUkV4VDBGY2hSQjJLZWVLdW55UT09
Or Telephone:
+1 646 518 9805 (US Toll)
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International numbers available: https://snomed.zoom.us/u/avs0qL3Fx

Item Description Owner Notes
1 Introductions and Apologies
Andrew Marchant Patrick McCormick
No apologies were presented.
2
Matters arising from the previous meeting notes
2022-11-22 Anesthesia CRG Meeting
Andrew Marchant Patrick McCormick
Previous meetings were noted. Continuing to work on the previous topics. The potential for the group to add value to other areas was discussed.
3 SNOMED Update
Jane Millar Monica Harry Toni Morrison
SNOMED F2F will be in April: April 2023 - SNOMED International Business Meetings

4 Ventilation Related Terms
Steven Dain
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)
5 Restructuring of Local Anaesthetic Hierarchy.
Steven Dain
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 :
https://rapm.bmj.com/content/46/7/571
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:
https://jira.ihtsdotools.org/browse/IHTSDO-376
https://jira.ihtsdotools.org/browse/IHTSDO-661
Monica Harry will update one or the other ticket.
CRS ticket to be made for radioablation, identified by Steven Dain as missing.

6 Intubation of the Trachea Monica Harry Several concepts seem to relate to endotracheal intubation. After discussion, the existing terms were not considered totally synonymous and no change was recommended.
7 Intensive Care Clinical Data
Steven Dain
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.
8
Dates of next meeting:
Tuesday, March 28, 2023
Patrick McCormick Andrew Marchant
2023-03-28 Anesthesia CRG Meeting

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Key

Item	Description	Owner	Notes
1	Introductions and Apologies	Andrew Marchant Patrick McCormick	No apologies were presented.
2	Matters arising from the previous meeting notes 2022-11-22 Anesthesia CRG Meeting	Andrew Marchant Patrick McCormick	Previous meetings were noted. Continuing to work on the previous topics. The potential for the group to add value to other areas was discussed.
3	SNOMED Update	Jane Millar Monica Harry Toni Morrison	SNOMED F2F will be in April: April 2023 - SNOMED International Business Meetings
4	Ventilation Related Terms	Steven Dain	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)
5	Restructuring of Local Anaesthetic Hierarchy.	Steven Dain	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 : https://rapm.bmj.com/content/46/7/571 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: https://jira.ihtsdotools.org/browse/IHTSDO-376 https://jira.ihtsdotools.org/browse/IHTSDO-661 Monica Harry will update one or the other ticket. CRS ticket to be made for radioablation, identified by Steven Dain as missing.
6	Intubation of the Trachea	Monica Harry	Several concepts seem to relate to endotracheal intubation. After discussion, the existing terms were not considered totally synonymous and no change was recommended.
7	Intensive Care Clinical Data	Steven Dain	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.
8	Dates of next meeting: Tuesday, March 28, 2023	Patrick McCormick Andrew Marchant	2023-03-28 Anesthesia CRG Meeting