First Ever Guidelines Issued in Japan

To maintain and encourage the safety of the patient undergoing anesthetic care, the Japan Society of Anesthesiology (JSA) has adopted the following minimal guidelines that apply for the administration of general, epidural and spinal anesthesia:

Guidelines for Minimal Monitoring.

1. The physician in charge of each anesthetic shall always be present to watch the patient continuously to provide appropriate anesthesia care.

2. Monitoring by pulse oximetry shall be employed. To ensure adequate oxygenation of the patient, the patient’s skin, mucous membranes and blood color shall be assessed.

3. To ensure adequate ventilation of the patient, clinical signs such as observation of chest excursions, observation of the reservoir breathing bag and auscultation of breath sounds shall be assessed. Monitoring end-tidal C02 with capnographic waveform is highly recommended; and monitoring of expired gas volumes is recommended when it is clinically indicated.

4. To ensure adequacy of the patient’s circulatory function, every patient should be evaluated by at least one of the following: auscultation of heart sounds, palpation of arterial pulses, monitoring of intra-arterial pressure tracing or pulse plethysmography. Every patient shall have the electrocardiogram continuously displayed, and their blood pressure and heart rate shall be measured and evaluated at least every 5 minutes. Where it is clinically indicated, invasive arterial blood pressure monitoring should be available to those patients indicated.

5. To control the patient s temperature appropriately, the patient’s temperature shall be continuously monitored.

6. Adequacy of muscle relaxation shall be monitored when it is clinically indicated.

Note: The anesthesia machine and equipment shall be tested according to the anesthetic apparatus pre-operative check-list and maintenance manual previously established by the Japan Society of Anesthesiology (1990).