This phenotype returns the date and time using the defined process and concepts below. 

Step 1. Is case determined a Labor Epidural by the Obstetric Anesthesia Type (value code 3 or 6)?. If yes, exclude. If no, then  proceed to step 1B.

Step 1B. Is case determined a labor epidural converted to cesarean section by the Obstetric Anesthesia Type (value code 1)? If no, proceed to step 2. If yes, then

Obstetrics Case: Conversion (Labor Epidural and Cesarean Delivery combined) 

1. Earliest documentation between 'Labor continued as C-section' (50596) (else Patient In Room) and Procedure End (else Anesthesia End)

• Propofol bolus (10377)
• ETCO2 > 10 (3235, 3256)
• Halogenated Gas or Nitrous Oxide

2. If none, then use 50596. (else Data Capture Start, else Patient In Room)

Step 2. Does case return Anesthesia Technique: General? (value code > 0)  If yes, proceed to Step 2A. If no, Proceed to Step 2B.

General Anesthesia Cases (A)

1. Earliest Documentation of the following concepts between Patient in Room. (else, Anesthesia Start) and Procedure Start (else, Anesthesia End):
   • Induction Start (50004)
   • Pre-induction verification (50301)
   • Propofol bolus (10377)
   • Halogenated Gas or Nitrous Oxide
2. If none, then earliest documentation of the following, between Patient in Room. (else, Anesthesia Start) and Procedure Start (else, Anesthesia End):

• ETCO2 > 10 (3235, 3256)
• Data Capture Start. If none, then
• Patient in Room. If none, then
• Anesthesia Start

Sedation Cases (B)

1. Induction Start (50004). If none, then

2. Earliest Documentation of Regional/Neuraxial block placement (see concept subset below*) . If none, then

• Must follow Patient in Room (if not then, Anesthesia Start) and precede Procedure Start

3. Earliest documentation of Sedation medication following Patient In Room (if not then, Anesthesia Start) and before Procedure Start. If none, then

• ETCO2 > 10 (3235, 3256)

• Sedation Medications (see list below)

4. Data Capture Start. If none, then

5. Patient in Room. If none, then

6. Anesthesia Start. If none, then

Sedation Medication

10020   ALFENTANIL
10149   DEXMEDETOMIDINE
10154   DIAZEPAM
10183   ETOMIDATE
10186   FENTANYL
10187   FENTANYL/MIDAZOLAM 40 MCG/ML / 200MCG/ML
10238   KETAMINE
10272   LORAZEPAM
10290   METHADONE
10292   METHOHEXITAL
10377   PROPOFOL
10390   REMIFENTANIL
10414   SUFENTANIL
10427   THIOPENTAL
10453   PROPOFOL W/ KETAMINE 10 MG/ML + 1 MG/ML
10700   CLONAZEPAM

* Regional/Neuraxial Concept Subset

• 50065  Regional - Cervical Plexus Block

• 50081  Regional - Adductor Canal Block Performed

• 50383  Regional - Supraclavicular Block

• 50384  Regional - Interscalene Block

• 50385  Regional - Infraclavicular Block

• 50386  Regional - Axillary Block

• 50387  Regional - Femoral Nerve Block

• 50388  Regional - Popliteal Block

• 50389  Regional - Sciatic Block

• 50390  Regional - Ankle Block

• 50391  Regional - Bier Block

• 50398  Regional - Lumbar Plexus Block

• 50629  Regional - Retrobulbar Block by surgeon

• 50724  Regional - Superior Laryngeal Block

• 50765  Regional - Saphenous Nerve Block

• 50798  Regional - Inguinal Field Block

• 50808  Regional - Transversus Abdominis Plane (TAP) Block

• 50243  Regional - Quadratus Lumborum Block

• 50624  Regional - Infiltration between Popliteal Artery and Capsule of Knee (IPACK) Block

• 50021  Regional- Peripheral Nerve Catheter Placed

• 50356  Regional- Block Performed

• 50690  Categorized Note- Regional Anesthesia

• 50665  Procedures - Other unlisted procedure

• 50254  Categorized note: Regional or neuraxial note

• 50614  Neuraxial technique- combined spinal/epidural technique note

• 50154  Epidural anesthesia catheter placement note

• 50643  Neuraxial - Epidural placed for postoperative pain control

• 50020  Neuraxial Approach

• 50635  Regional - Caudal block performed

• 50691  Categorized note - Neuraxial anesthesia

• 50148  Neuraxial- Spinal needle approach

• 50680  Neuraxial – spinal or epidural performed