Page tree

Versions Compared


  • This line was added.
  • This line was removed.
  • Formatting was changed.



2017-04-23 to 2017-04-24

GoToMeeting Details

Anesthesia SIG
Sun, Apr 23, 2017 9:00 AM - 5:00 PM BST

Anesthesia SIG Monday
Mon, Apr 24, 2017 1:30 PM - 5:30 PM BST

You can also dial in using your phone.

United States: +1 (646) 749-3117

Access Code: 503-348-413

More phone numbers
Australia: +61 2 8355 1038
Austria: +43 1 2530 22500
Belgium: +32 28 93 7002
Canada: +1 (647) 497-9373
Denmark: +45 32 72 03 69
Germany: +49 69 5880 7802 72
Netherlands: +31 207 941 375
New Zealand: +64 9 913 2226
Spain: +34 912 71 8488
Sweden: +46 853 527 818
Switzerland: +41 225 4599 60
United Kingdom: +44 20 3713 5011

Sunday Morning Agenda

1WelcomePatrick McCormick

Introduction for James Palmer

2Approval of minutes from last meetingPatrick McCormickReviewed minutes
3Matters arising from the MinutesPatrick McCormick


Discussed history of outcome definitions and mapping

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

 < coffee break >  
5Awareness under Anesthesia

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)


  • Light anesthesia (finding)




6Adoption of SNOMED CT in AnesthesiaFollowing discussion under item 4, James Martin and Andrew Norton would seek to engage with Councils of the Royal College and Association of Anaesthetists to seek support for further adoption of SNOMED CT in UK Anaesthesia. Many US Anesthesia Information Management Systems currently installed or in implementation (eg EPIC) will support the use of SNOMED CT, but there is often a considerable amount of local configuration required
7Anesthesia machine / workstation failure

Need to add two terms:

    • Anesthesia machine failure
    • Anesthesia workstation failure
      It was noted that much of the world uses basic anesthesia machines (ie a gas and volatile agent delivery system) rather than the sophisticated integrated workstations prevalent in more developed nations.


Sunday Afternoon Agenda




Hypothermia in anesthesia with ref. to planned /unplanned procedures

Following issues raised at SIG meeting

28th March 2017


Anesthesia Quality Institute Outcome (AQI) terms

Review progress, discussion of new concepts

Acute Kidney Injury:

  • Comorbidity concept "Acute Renal Impairment (disorder)" 236423003
  • Also see "Acute Non-traumatic Kidney Injury" and unreleased concept 726541005 (Acute Kidney Injury due to Trauma)
  • Has "acute kidney injury" been renamed to "acute renal failure"? PMID 18084974.
  • Monica Harry to look into who to contact re new renal terms in SNOMED (likely from European Renal Society work)
  • Andrew Norton to email Monica to confirm change above
  • Possible best match: Postoperative renal failure (disorder)
    • However, this concept doesn't have same parents as the above concepts, which should be fixed

Case Cancelled:

  • Three new concepts with definitions will be requested

Injury to Artery during Central Line Placement Procedure: (bruce to test that)

  • Will look into new concept specific to central lines and arteries. May have difficulty because we are generic for central line vessel and generic for injury vessel.

Are AQI definitions used outside US? Some in Canada, possibly in NZ.


New concept:


Infection following percutaneous neuraxial procedure

  • Superficial soft tissue infection following percutaneous neuraxial procedure
  • Epidural abscess following percutaneous neuraxial procedure
  • Meningitis following percutaneous neuraxial procedure
  • Sepsis following percutaneous neuraxial procedure

Infection associated with percutaneous peripheral nerve procedure

Superficial soft tissue infection associated with percutaneous peripheral nerve procedure

Deep tissue infection associated with percutaneous peripheral nerve procedure

Sepsis associated with percutaneous peripheral nerve procedure

Procedure site indirect: peripheral nerve structure

Pathological process: superficial ST infection, deep T infection, sepsis
Associated Morphology: abscess, septicemia, ?
Associated process: peripheral nerve procedure

IV infiltration vs extravasation. (Local UK slang: "Tissued") Consider adding "intravenous infiltration" as a disorder.

Perioperative Visual Loss: Will look into new concept

Consider new concept: "Peripheral neurological deficit associated with percutaneous peripheral nerve procedure"


New concept "Postoperative cognitive dysfunction" - no longer be synonym of postoperative delirium

"Emergence delirium" should get new concept because it is transient, not the same as postoperative delirium


Create new concept "Post-discharge nausea or vomiting" as child PONV

Includes inpatients and outpatients


Consider "Neuraxial hematoma associated with percutaneous neuraxial procedure"

Will look into new concept for unticipated transfusion


Unplanned conversion to general anesthesia



Monday Afternoon Agenda



2Issues from recent terminology requests

ECG: anterior and posterior hemiblock - some issues with general structure of pattern findings. Hopefully classifier would model as ECG; presence findings. Screen shots from Protege model would be helpful.

Issues discussed around higher levels of nerve block anesthesia and classification. Direct substance is anaesthetic - in view of

  •  "Absence of EKG finding" is child of "EKG finding", should be remodeled
    • Patrick suggested concept be done away with, but Bruce mentioned that some EMRs require postiive/negative response for each finding, and AndrewM noted that many people likely expect this concept to be present
  • Local anesthesic procedure hierarchy restructuring
    • "Nerve block anesthesia" has child "Local anesthetic nerve block" - while this seems to be a synonym, problem is which substance is attached to concept, "local anesthetic" or "anesthetic"? The "anesthetic" substance includes general anesthetic agents as well as local anesthetics.
    • AndrewN: we attempted to rebuild nerve block hierarchy with CAP, not much progress made
  • Patient positioning
    • mostly resolved, will email group with questions
  • (Return of the) Gum elastic bougie
3Update on drug and substance remodellingToni Morrison


Presentation to follow

One problem: how to handle numeric values within SNOMED (e.g. how to code "60 mg"?) - Created new

Numeric hierarchy

concepts in Number hierarchy; this will allow transformation to concrete domains.

View file

 <coffee break>  
4Modelling complications associated with devicesBruce Goldberg

New concepts modeled with new temporal attributes:

  • Peri-operative complication
  • Intraoperative complication

(Postoperative complication already existed)

Device Complications (presentation to follow)

Proposing that Complication Associated With Device hierarchy will go away, concepts to be moved to Complication of Device or elsewhere


Infection of central venous catheter (disorder) SCTID: 408866006 vs Central venous catheter associated bloodstream infection (disorder) SCTID: 473441009


Consider remodeling or offering new terms for common findings that occur in the postoperative or intraoperative.

5VCG's and clinical engagementIan Green

Presentation on informal structure of VCG's moderated through pages on Confluence. Users would need to be logged on to participate in discussion, but the structure is informal with no chairs, formal agenda, regular meeting structure as it was felt that an enlarged formal "SIG" model is not sustainable for IHTSDO

Representation to IHTSDO would be through a clinical coordination froup but no specific membership from the VCG. However CCG would be responsible for championing a VCG project and securing the appropriate resources.

Members of the group raised concern about the lack of structure that could be detrimental to efforts to engage clinicians who would need some rationale to seek funding, allocate time and resource and justify participation (professionally and regulation - eg appraisal)

6Modelling of assessment scalesAndrew NortonAndrew Norton raised questions about modelling guidance for assessment scales and components. Monica and Toni noted that many scales are proprietary and would require expensive licensing. However there are a number of open source scales that would be useful to include and guidance on modelling would be helpful