Neobook — clinical reference

The following tables have been taken from the International Standards for the Practice of Safe Anaesthesia. Please note that facilities in South Africa where anaesthesia is delivered should comply with Hospital Level 2–3 standards in these tables. Please note that international levels of care do not exactly correlate to South African levels of care. This table should be merely used as a guideline.

Table 1: Characteristics and clinical practice recommendations for Level 1 facilities

Level 1 hospital	Required standards	*Peri-anaesthetic care and monitoring standards – highly* recommended**
Rural hospital or a health centre with a small number of beds; sparsely equipped operating room (OR) for “minor” procedures	All that are highly recommended	Continuous, direct presence in the anaesthetising location of a vigilant anaesthesia professional.
		Appropriate “pre-check” of the anaesthesia system, facilities, equipment, and supplies.
		Use of the relevant components of the WHO Safe Surgery Checklist (Appendix I).
		Supplemental oxygen administered to all patients undergoing general anaesthesia.
		Continuous use of pulse oximetry.
		Continuous monitoring of airway and ventilation by observing the bag and with a stethoscope.
		Confirmation of the correct placement of an endotracheal tube by auscultation.
		Continuous monitoring of the pulse by clinical examination and with a pulse oximeter.
		Availability of a defibrillator.
		Continuous monitoring of tissue perfusion by clinical examination and with a pulse oximeter.
		Monitoring of non-invasive arterial blood pressure at appropriate intervals.
		Use of a disconnect alarm if mechanical ventilation is employed.
		Audible signals, e.g. pulse oximeter, and alarms activated at all times.
		All patients should remain where anaesthetised until recovered or be transported safely to a specifically designated recovery location.
		Immediate availability of oxygen, suction, and a means of ventilation in recovery.
		Continuous use of pulse oximetry until recovery of consciousness.
		Adequate pain relief, including narcotics when needed.

Table 2: Characteristics and clinical practice recommendations for Level 2 facilities

Level 2 hospital	Required standards	*Peri-anaesthetic care and monitoring standards – highly* recommended plus recommended**
District or provincial hospital, e.g. with 100–300 beds, with adequately equipped major and minor operating rooms	All highly recommended (Level 1) plus these recommended items	Monitoring of inspired oxygen concentration with an instrument fitted with a low oxygen concentration alarm.
		Use of a device protecting against the delivery of a hypoxic gas mixture.
		Use of capnography to verify the correct placement of the endotracheal tube or other airway device and the adequacy of ventilation.
		Use of a continuous electrocardiograph.
		Continual measurement of temperature.
		Use of a peripheral neuromuscular transmission monitor when neuromuscular blocking drugs are given.
		Sufficient trained staff in the postanaesthesia recovery area to manage patients recovering from anaesthesia and surgery.

Table 3: Characteristics and clinical practice recommendations for Level 3 facilities

Level 3 hospital	Required standards	*Peri-anaesthetic care and monitoring standards – highly* recommended plus recommended plus suggested**
A referral hospital of 300–1000 or more beds with basic intensive care facilities	All highly recommended (Level 1) plus recommended (Level 2) plus these items	Continuous measurement of the inspiratory and/or expired gas volumes, and of the concentration of volatile agents.
		Continuous measurement and display of arterial pressure in appropriate cases.
		Use of continuous electronic temperature measurement.
		Monitoring of urine output during prolonged procedures or when significant administration of intravenous fluids is anticipated.

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South African Society of Anaesthesiologists (SASA) Practice Guidelines_2022_To be Reviewed in 2026