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

  • Adrian W. Gelb
  • Wayne W. Morriss
  • Walter Johnson
  • Alan F. Merry
  • the International Standards for a Safe Practice of Anesthesia Workgroup
Special Article


The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a non-profit 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.

Normes internationales pour une pratique sécuritaire de l’anesthésie de l’Organisation mondiale de la santé et de la Fédération mondiale des sociétés d’anesthésiologie (OMS-FMSA)


Les Normes internationales pour une pratique sécuritaire de l’anesthésie ont été élaborées pour le compte de la Fédération mondiale des sociétés d’anesthésiologie (FMSA), un organisme sans but lucratif représentant des anesthésiologistes de 150 pays, et l’Organisation mondiale de la santé (OMS). Les recommandations ont été approuvées par l’OMS et les membres de la FMSA. Ces normes s’appliquent à tous les prestataires d’anesthésie dans le monde entier. Ils ont pour but de fournir des conseils et d’aider les prestataires d’anesthésie, leurs organisations professionnelles, les hôpitaux et les administrateurs des établissements, ainsi que les gouvernements à maintenir et améliorer la qualité et la sécurité des soins anesthésiques. Les normes couvrent les aspects professionnels, les établissements et l’équipement, les médicaments et solutés intraveineux, la surveillance et le déroulement d’une anesthésie. Les normes TRÈS FORTEMENT RECOMMANDÉES, en pratique l’équivalent de normes obligatoires, incluent, entre autres choses : la présence continue d’un prestataire d’anesthésie formé et vigilant, la surveillance constante de l’oxygénation et de la perfusion des tissus par l’observation clinique et un oxymètre de pouls, la mesure intermittente de la pression artérielle, la confirmation du placement correct du tube endotrachéal (si utilisé) par l’auscultation et la détection de dioxyde de carbone, l’utilisation de la liste de vérification d’une chirurgie sécuritaire de l’OMS, et un système de transfert des soins à la fin d’une anesthésie. Les normes internationales représentent des normes minimales et l’objectif devrait toujours être une pratique selon les normes les plus élevées possible, de préférence allant au-delà de celles qui sont soulignées dans ce document.



The current workgroup wishes to acknowledge the previous efforts of Drs. AF Merry, JB Cooper, O Soyannwo, Wilson IH, and JH Eichhorn. They were the workgroup who developed the 2010 version that has served as a template and inspiration for the current workgroup.

WHO-WFSA International Standards Workgroup. Chair: Adrian W. Gelb (USA) Deputy Chairs: Alan F. Merry (New Zealand) and Wayne Morriss (New Zealand) Anuja Abayadeera (Sri Lanka), Natalia Belîi (Moldova), Sorin J. Brull (USA), Aline Chibana (Brazil), Faye Evans (USA), Cyril Goddia (Malawi), Carolina Haylock-Loor (Honduras), Fauzia Khan (Pakistan), Sandra Leal (El Salvador), Nan Lin (China), Richard Merchant (Canada), Mark W. Newton (USA), Jackie S. Rowles (USA), Arinola Sanusi (Nigeria), Iain Wilson (UK) WHO: Adriana Velazquez Berumen (Mexico) and Walter Johnston (USA)

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Adrian W. Gelb, Wayne Morriss, and Alan Merry contributed substantially to all aspects of this manuscript, including conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Walter Johnson contributed to the analysis of data and contributed substantially to the interpretation of data. All the other members of the Working Group contributed to the analysis and interpretation of data.


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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  • Adrian W. Gelb
    • 1
  • Wayne W. Morriss
    • 2
  • Walter Johnson
    • 3
  • Alan F. Merry
    • 4
    • 5
  • the International Standards for a Safe Practice of Anesthesia Workgroup
  1. 1.Department of Anesthesia & Perioperative CareUniversity of California San Francisco, San FranciscoSan FranciscoUSA
  2. 2.Department of AnaesthesiaUniversity of Otago, Christchurch HospitalChristchurchNew Zealand
  3. 3.Services Organization and Clinical Interventions Unit (SCI), Service Delivery and Safety Department (SDS), Health Systems and Innovation (HIS)World Health OrganizationGenevaSwitzerland
  4. 4.Department of AnaesthesiologyUniversity of AucklandAucklandNew Zealand
  5. 5.Department of AnaesthesiaAuckland City HospitalAucklandNew Zealand

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