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Discussion about the usefulness and meaning of the term 1263452006 |Anesthesia and/or sedation procedure (procedure)|

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3 Comments

  1. Adding link to google sheet with subtypes for review. Either modelled with anesthetic or sedative.

    https://docs.google.com/spreadsheets/d/1qxPnkuxtJacpXTBHMOZhDUZwhRGBeoH95Zt5JumXR5w/edit?usp=sharing


    1263452006 |Anesthesia and/or sedation procedure (procedure)| is a GCI and direct subtype for 71388002 |Procedure (procedure)|. 

    The subhierarchy is split in two main groups: the grouper 410011004 |Administration of anesthesia AND/OR sedation (procedure)| and 16 "anesthesia and/or sedation related" procedures. eg. 241726007 |Application of cricoid pressure (procedure)|, 442944005 |Induction of amnesia (procedure)|, 88084009 |Resuscitation, anesthesia (procedure)|.

    • Is a good idea to split Anesthesia and/or sedation procedure (procedure) into Anesthesia procedure (procedure) and Sedation procedure (procedure)? This will create the need for a clear differentiation for each of the non grouper 16 concepts currently under Anesthesia and/or sedation procedure (procedure), which may be hard in some cases. e.g. 241727003 |Induced hypotension (procedure)|, 241729000 |Intraoperative wake-up test (procedure)|.
    • Administration of anesthesia AND/OR sedation (procedure) (GCI) can be inactivated given the existence of 399097000 |Administration of anesthesia (procedure)| and 72641008 |Administration of sedative (procedure)| with subtypes clearly identified.

    Discussed internally and think the anesthesia & sedation terms are grouped together because the concept was/is used as the domain of a medical speciality rather than a procedure.  399248000 |Procedure related to anesthesia and sedation (procedure)| was inactivated with a target to 1263452006 |Anesthesia and/or sedation procedure (procedure)|.  The question of what this means lingers. For example, does it include the following?

    • 182770003 |Pre-anesthetic assessment (procedure)|
    • 398272001 |Post-anesthesia assessment (procedure)|
    • 774088000 |Assessment using American Society of Anesthesiologists Physical Status Classification System (procedure)|
  2. This is very strange indeed.  It is mixing concepts together related to General anesthesia, regional anesthesia, topical anesthesia.  This is not really a domain or a medical specialty either, as all the topical local anesthesia are not really done by anesthesia professionals.


    I would split them as suggested into Anesthesia procedure (procedure) and Sedation procedure (procedure).  Anesthesia procedure then should be split into general anesthesia procedure, regional anesthesia procedure, local anesthesia procedure.

    The "anesthesia for procedures on xxx" are bad precoordinated terms as theoretically one would need a term for every body part and every approach!  Anesthesia for procedure on extremity includes upper extremity, but not lower extremity that has it's own term.  

    Regarding 

    • 182770003 |Pre-anesthetic assessment (procedure)|
    • 398272001 |Post-anesthesia assessment (procedure)|
    • 774088000 |Assessment using American Society of Anesthesiologists Physical Status Classification System (procedure)|

    are these not types of 11429006 Consultation (procedure) or 386053000 Evaluation procedure (procedure)?

    I'm afraid as usual I have created more questions than I answered (smile)

  3. I agree with Steven's comments. The grouping of Anesthesia AND/OR Sedation only makes sense if there is a use case for a procedure where we don't know in advance what the requirements are or what plan has been made with the patient. So it could (in theory) be used as part of a pre-assessment plan, with the expectation that agreement will be reached with the patient on whether the procedure can be done under an anesthetic (of any type) and if regional/topical/local, is sedation given.

    In the case where a procedure begins under local or regional and subsequently requires conversion to GA, this would be recorded in a sequential manner.

    Patrick also mentioned that there is a use case in the US where the conflation of Anesthesia and Sedation has implications for billing but I can't remember the details.

    Also, see:
    Anesthesia, sedation and analgesia procedures classification