Have The ASA Guidelines For Sedation And Analgesia Affected The Practice Of Non Anesthesiologists?

Background: In 1996, ASA published Guidelines for Sedation and Analgesia by Non Anesthesiologists which include specific recommendations designed to improve patient safety. The goal of this study was to determine if sedation practices of non anesthesiologists have changed since the publication of the Guidelines. Methods: With IRB approval we mailed surveys (and a copy of the Guidelines) to 280 practitioners of specialties other than anesthesiology where sedation is commonly administered. We chose these individuals at random from directories of medical specialists, sending equal numbers to private and academic practitioners. We asked: (1) If the individuals were previously aware of the Guidelines; (2) Which of 21 Guideline recommendations they followed before their publication in 1996; and (3) Which of these 21 recommendations they follow now. We analyzed the data using one way ANOVA with post hoc binomial tests for proportions when overall significance was detected. P<0.05 indicated significance. Results: We received 34 evaluable responses. From 1996 to 2001, the mean number of recommendations followed increased from 16.6±3.4 to 18.2 ±2.8, ±SD, P<0.05). Fifty six percent of respondents were previously aware of the guidelines; this fraction did not differ between academic and private practitioners. Those who were aware of the guidelines had a slightly greater increase in the number of recommendations followed than those who were not (1.8 vs 1.1, P=NS). Overall, obtaining a pre procedure history and physical, contemporaneous recording of monitored parameters, use of pulse oximetry, and immediate availability of a defibrillator were significantly more common in 2001 than before the guidelines were published in 1996. Conclusions: Although the number of recommendations being followed has increased, we were unable to demonstrate that this was related to previous familiarity with the guidelines. It is particularly encouraging that the use of pulse oximetry has become almost universal, and that the availability of defibrillators has increased to over 90%.