Anesthesia Technique: General

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Description

This phenotype attempts to classify each case in terms of general anesthesia technique. This returns type of anesthetic used within the possibilities listed in the value types.

Limitation

This phenotype has several limitations. Tracheostomy is not considered. ETT and LMA single notes will return as general - unknown if there is only a single ETT or single LMA note in the case., meaning if there are no accompanying general, ETT, or LMA note. This phenotype also does not differentiate type of intubation (ex. fiberoptic or glidescope). Also, there is no differentiation of success, only if the type was documented as attempted. A negative return ("no") means there was either no general anesthetic attempted in the case (ex. a MAC / sedation case) or not enough documentation to determine a general anesthetic. Neuromuscular Blocker Only and Inhaled Anesthetic Only were used as distinct categories as they may convey meaning if isolated such as in pediatric mask induction cases or ECT cases in which succinylcholine was used. Only airway notes from 24 hours before anesthesia start through anesthesia end are considered.

Data quality is limited to individual site documentation accuracy, completeness, and variable mapping, which is performed by each site, independently. MPOG, as the coordinating center, reviews data quality at each data upload and monthly via Data Diagnostics and Case Validation tools. This review, while thorough, may not contain all data elements relevant to this phenotype and thus should be carefully reviewed by the user.

Value Type

Categorical

Enumeration

Value	Value Code	Definition

Return Columns

Column Name	Data Type

Granularity

Logic

This phenotype relies on six supporting phenotypes: ASA Class, Procedure Type: Intubation Only, Airway Type Notes, General Anesthesia Notes Present, Halogenated Gases Used, and Paralytics.

ASA Class = 6 will automatically return GA-ETT.
Procedure Type: Intubation Only = includes cases where the primary procedure performed was intubation alone - scheduled and emergent intubations included. Any case labeled as 'yes' (value code = 1) for the 'Procedure Type: Intubation Only' phenotype will automatically return as GA - ETT.
Airway Type Notes = ten generic airway concepts that are mapped in a separate collation to ETT, LMA, both ETT and LMA
General Notes = includes General - unknown, LMA, ETT and both ETT and LMA notes
Halogenated Gases Used = includes General - inhaled anesthetic only
- Volatile Gases documented between 'Anesthesia Start' and 'Anesthesia End' only will be considered by this phenotype
Paralytics Used All = includes General - neuromuscular blockers only
- Paralytics adminstered from 60 minutes before 'Anesthesia Start' through 'Anestheisa End' only will be considered by this phenotype

Airway Type and General Notes documented between 24 hours before 'Anesthesia Start' through 'Anesthesia End' are considered. Observed time is prioritized over entered time. If no observed time is available, entered time is considered

CASE RESULT

IMPORTANT: 'ETT' result takes precedence over all other results except 'ETT and LMA'

Here is the hierarchical order of return for this phenotype:

General - Both ETT and LMA: ETT and LMA notes both exist

If value returned is 'General - Both ETT and LMA' then, additional check will be to count the LMA notes and count the ETT notes.
- If there are greater than or equal to 2 LMA AND 2 ETT notes return General - both ETT and LMA
- If there are less than 2 LMA notes and greater than or equal to 2 ETT notes, return General - ETT
- If there are less than 2 ETT notes and greater than or equal to 2 LMA notes, return General - LMA
- All else return General - both ETT and LMA

General - ETT: ETT note with any other inhaled anesthetic, neuromuscular blocker or general unknown note

General - LMA: LMA note exists, without any ETT notes

General - inhaled anesthetic only: inhaled anesthetic documented without any ETT notes, LMA notes, general-unknown concepts, or paralytic notes

General - neuromuscular blocker only: Paralytic administered without inhaled anesthetic, ETT notes, LMA note, general unknown concepts, or inhaled anesthetic notes

General - unknown: There were both neuromuscular blockers and inhaled anesthetics associated with this case along with ambiguous general airway notes *(General-Unknown concept subset)

No : No general notes, sedative medications, inhaled anesthetics or paralytics associated with the case.

Invalid Value: Cases missing either 'Anesthesia Start' or 'Anesthesia End'

*General - Unknown Concept Subset:

50099 Intubation - Nasal approach note
50100 Intubation - Videolaryngoscopy View
50115 Intubation Laryngoscopy Blade Type and Size
50116 Intubation Laryngoscopy Cricoid Pressure or BURP Applied
50119 Intubation Direct Laryngoscopy View
50120 Intubation Bougie Introducer Used
50127 Intubation Extubated Awake or Deep
50129 Intubation Fiberoptic Asleep or Awake
50130 Intubation Fiberoptic Nasal or Oral
50131 Intubation Fiberoptic Topicalization Type
50132 Intubation Fiberoptic Transtracheal block
50133 Intubation Fiberoptic Number of Attempts
50134 Intubation Fiberoptic Existing Airway Device
50197 Intubation - atraumatic
50202 Emergence - patient extubated
50207 Intubation device and adjunct note
50311 Induction - GA Induction type (mask, iv, rapid)
50334 Intubation - cricoid pressure applied
50653 Intubation - Retrograde technique
50669 Airway - Cuff inflation volume
50670 Intubation - performed awake
50688 Intubation - comment
50695 Categorized note - Intubation

**Airway Type Notes:

50004 Airway Type
50117 Intubation – ETT placed
50208 Intubation view note
50118 Intubation number of attempts