Special announcement: Guidelines to the practice of anesthesia--revised edition 2010

The first Minimum Guidelines for the Standards of Practice of Anaesthesia (the Guidelines) was approved by the Council of the Canadian Anaesthetists’ Society (the Society) on January 17, 1975 and published in booklet form in 1977. Several concurrent events drove the formulation of the Guidelines. The development of standards on ‘‘Anesthesia Services’’ by the Canadian Council on Hospital Accreditation (now Accreditation Canada) was an initial cause of concern in anesthesia circles, since it was perceived as an encroachment on ‘‘areas of responsibility’’. At about the same time, there were two unfortunate deaths under anesthesia that prompted the Canadian Medical Protective Association to consult with the Society and to advise them to propose minimum standards of anesthesia practice. The Committee on Standards of Practice was directed to prepare such guidelines, and a final draft, much like the form we see today, was accepted by 1974 and published in 1975 as a policy of the Canadian Anaesthetists’ Society. Dr. J. Earl Wynands, the President of the Society at that time, stated that the committee had produced ‘‘a major and definitive report that will have an impact on the practice and delivery of anaesthetic care in this country’’. All this, incidentally, occurred several years before the Harvard Standards were proposed in 1986, so the Society can be regarded as an international leader in the field of standards development and patient safety. The Guidelines were received with enthusiasm, although not universal support at that time, since some expressed concern that the Society had ‘‘set a standard that now had to be followed.’’ However, a consensus evolved recognizing that the Guidelines were intended to represent the generally accepted standard of care and that they served as a ‘‘stimulus for improving the quality of anesthesia practice’’. The Guidelines were written in such a manner as to provide flexibility for modification as anesthesia practice evolves, as monitoring techniques become more sophisticated, and as new technologies become available. The Guidelines were modified periodically at irregular intervals until 1989 and annually since then. In an early revision of the Guidelines, the term ‘‘standards’’ was removed from the title of the document, emphasizing instead the term ‘‘guideline’’ to indicate that the document was intended to represent a ‘‘statement of principle rather than a standard or required level of conduct’’. A contentious issue for some time was the role of general practitioners in providing anesthesia care in addition to Royal College trained specialists. This concern came about in the context of the general recognition that a significant proportion of health care in Canada took place in communities too small to support a specialist anesthesia practice. The eventual compromise was to define the practice of anesthesia as a ‘‘specialized field of medicine’’ while explicitly recognizing that ‘‘appropriately trained family physicians may be required to provide anesthesia services’’ in some communities. The role of anesthesia assistants (AA) was a similarly contentious issue. The role of paramedical personnel was first raised by Dr. Graves in a report to Council in 1968. The discussion of their role continued for many years and culminated in 2006 in a ‘‘Position Paper on Anesthesia Assistants’’ published by the Canadian Anesthesiologists’ Society as Appendix 5 to the Guidelines. The Society remains involved in defining the curriculum for AA training in a joint working group R. N. Merchant, MD (&) Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 Columbia St. E., New Westminster, BC V3L 3W7, Canada e-mail: richard.merchant@ubc.ca