Society of Cardiovascular Anesthesiologists

ASA Standards Regarding Presence of Qualified Personnel during Cardiopulmonary Bypass

The ASA Committee on Standards of Care has clarified its first Standard, "Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics and monitored anesthesia care." According to the Annual Report of the Committee on Standards of Care, questions are asked from time to time about the propriety of leaving a patient for a relatively extended period while the patient is on cardiopulmonary bypass and the ventilator is off. They state in their report, ".because the anesthetic is still under way during cardiopulmonary bypass, no exception exists at that time."

The Standards of the ASA may be found in Section 4 of the ASA Directory of Members. To quote further from the explanation of Standard I:

"In the event that an emergency requires the temporary absence of the person primarily responsible for the anesthetic, the best judgment of the anesthesiologist will be exercised in comparing the emergency with the anesthetized patient's condition and in the selection of the person left responsible for the anesthetic during the temporary absence." The other possible reason given for not being present with an anesthetized patient is because of direct hazard to anesthesia personnel such as radiation. In that case a provision must be made for remote observation and monitoring.

Certainly a need for a coffee break does not constitute either an emergency or a danger to anesthesia personnel. The issue of anesthesiologists not being present and not having a qualified anesthesia provider such as a nurse anesthetist or resident present during bypass was noted with horror by our former President, Dr Davis. With this further clarification from the ASA, it is obvious that anyone who leaves an anesthetized patient, even a very stable patient on cardiac bypass, without providing a qualified care provider and in a situation where there is no emergency or danger requiring him/her to leave, is practicing outside of ASA guidelines.

Rosemarie Maddi, MD
Chair, Ethics Committee

Rose Christopherson, MD, PhD
Chair, Newsletter Committee