Special announcement: Guidelines to the Practice of Anesthesia, Revised Edition 2014

Abstract

This issue of the Canadian Journal of Anesthesia (the Journal) continues its policy of publishing the yearly revised version of the Guidelines to the Practice of Anesthesia (the Guidelines) as developed by the Committee on Standards and approved by the Board of the Canadian Anesthesiologists’ Society (CAS). Initially developed in 1974 and published in 1975, the Guidelines are updated regularly and the revisions are published annually. This is now the fifth year in which the Guidelines are being published as a special article within the Journal. The Committee continuously reviews features of the Guidelines and responds to the changing practice of anesthesiology with updates to the recommendations. In 1988, the following view was expressed in an editorial in the Journal, ‘‘In developing the guidelines the society has attempted to achieve a consensus as to what is practical, realistic and acceptable by a broad sample of concerned physicians. The statements cannot be based upon facts or proof because there are none one can only go with the best information available. It is emphasized that guidelines can encourage high-quality patient care, but by no means do they guarantee any specific patient outcome.’’ The forgoing perspective remains largely true today, though we consider the strength of evidence to be stronger in 2014 than in 1988. This year, the Guidelines incorporate three significant recommendations regarding important areas of anesthesia practice in Canada. The first involves subspecialty areas of anesthesia practice. A broad review was undertaken in concert with representatives from the CAS Pediatric Anesthesia group to ensure the Guidelines include wording that provides appropriate guidance for pediatric anesthesia. The pediatric anesthesia population includes children ranging in age from the neonatal (perhaps even pre-natal) period to the ‘‘near-adult’’ age of 19 years. Within this population, there are specific groups of children at the extremes of the age range as well as those with special comorbidities undergoing procedures of variable complexity. We have identified areas where anesthesia departments must develop policies and procedures—while considering their members’ specific training and experience in pediatric anesthesia and the situations in which they practice—in order to care for such challenging patients in a safe and effective manner. The second significant recommendation relates to patient care perhaps at the other extreme of care: i.e., in adult hospitals where our practice involves patients near or at the very limit of life. In these patients, proposed intervention may lead to events culminating in management decisions that may not be in keeping with patients’ wishes and may be unbeknownst to their care providers. Respect for the principles of autonomy, informed consent, dignity, and prevention of suffering necessitate that discussions regarding ‘‘advance care planning’’, ‘‘living wills’’, or ‘‘do not resuscitate status’’ should be considered prior to embarking on an intervention. Without such thoughtful discussion, we miss the opportunity to honour these fundamental principles. As consultants, anesthesiologists share in the ‘‘most responsible physician’’ role in perioperative care; it is not reasonable to leave such assessments solely to the vagaries of surgical care. Anesthesiologists must be proactive in ensuring that the proposed care is in accordance with the wishes of the patient. Wording to this effect is added in the ‘‘Preoperative Care’’ section of the Guidelines. R. N. Merchant, MD (&) M. M. Kurrek, MD Committee on Standards, Canadian Anesthesiologists’ Society, 1 Eglinton Avenue East, Suite 208, Toronto, ON M4P 3A1, Canada e-mail: richard.merchant@ubc.ca