World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia

Abstract

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

The global capnography gap: a call to action

“…The importance of propagating capnography is an important WFSA agenda item . The WHO does not use the word ‘mandatory’ and instead uses ‘highly recommended’ as the functional equivalent.…”

“…Many such efforts have focused on pulse oximetry (LifeBox, World Health Organization checklist) and for good reason . Pulse oximetry is relatively inexpensive, easy‐to‐use, low maintenance, versatile, instantaneous and considered essential by all existing national and international anaesthesia guidelines, including the recently published World Health Organization – World Federation of Societies of Anaesthesiologists (WHO‐WFSA) standards . Capnography is another important anaesthesia monitor that has received relatively less attention despite having many of these same characteristics.…”

Encouraging a bare minimum while striving for the gold standard: a response to the updated WHO–WFSA guidelines

“…We read with interest the recently published World Health Organization-World Federation of Societies of Anesthesia (WHO-WFSA) International Standards for the Practice of Safe Anesthesia. 1,2 We thank Dr. Gelb and his colleagues for their effort to provide ideal global safety guidelines for providers in every setting. These aspirational guidelines are undoubtedly the gold standard, but we argue that they are unrealistic for many providers.…”

In reply: Encouraging a bare minimum while striving for the gold standard: a response to the updated WHO-WFSA guidelines

“…Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia 2,3 reiterating their previously stated concern that such standards set the bar too high. 4 The WHO-WFSA workgroup was globally representative and was balanced for sex, geography, and high-, middle-, and low-income country membership.…”

“…If HIGHLY RECOMMENDED standards are not met, provision of anesthesia for elective surgical procedures is unsafe and unacceptable.'' 3 Standards are by definition ''A required or agreed level of quality or attainment; something used as a measure, norm, or model in comparative evaluations''. 5 They are not intended to ''imply'' what that level is-they state it explicitly.…”