Recovery and Discharge for Procedures Conducted Outside of the Operating Room

2018 ◽  
Author(s):  
Hairil R. Abdullah ◽  
Frances Chung
Keyword(s):  
Operating Room ◽  
Recovery Period ◽  
Scoring Systems ◽  
Nausea And Vomiting ◽  
Postanesthesia Care Unit ◽  
Significant Pain ◽  
Assessment And Monitoring ◽  
Standards And Guidelines ◽  
Recovery Assessment

This chapter provides contemporary perspectives on the issues of recovery assessment and monitoring, as well as an overview of the criteria-related discharge following anesthesia outside the operating room. The need for appropriate monitoring in the recovery period is argued based on data from an outcomes and claims registry. Discharge scoring systems are also discussed together with pertinent postanesthesia issues that may delay discharge from the postanesthesia care unit, such as nausea and vomiting, significant pain, as well as the need for mandatory patient escort. The standards and guidelines mentioned in this chapter apply not only to the anesthesiologists, but also to other physicians who supervise the recovery of patients in different units.

The Post-Anesthesia Care Unit

2018 ◽  
Author(s):  
Evan R Bohnenblust
Keyword(s):  
Neuromuscular Blockade ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Scoring Systems ◽  
Nausea And Vomiting ◽  
Postanesthesia Care Unit ◽  
Emergence Delirium ◽  
Residual Neuromuscular Blockade ◽  
Hemodynamic Compromise ◽  
Standards And Guidelines

physiologic changes caused by both recent administration of anesthesia as well as the preceding surgical intervention. This general overview of the postanesthesia care unit (PACU) summarizes the most current standards and guidelines for patient care and monitoring. It also details the causes and treatment of the most common complications observed in PACU, such as postoperative nausea and vomiting, hemodynamic compromise, and respiratory insufficiency. Other relevant topics such as residual neuromuscular blockade and emergence delirium are also addressed. Finally, this chapter concludes with a discussion of the development of commonly used discharge scoring systems, including a discussion of the differences between the ambulatory and inpatient surgery populations. Each of these sections discusses current trends in management as supported by the latest literature and guidelines.   This review contains 1 figure, 6 tables, and 50 references Key Words: Aldrete scoring, delayed awakening, emergence delirium, postanesthesia care unit, postanesthesia care unit discharge criteria, postoperative nausea and vomiting, postoperative respiratory failure, residual neuromuscular blockade, sugammadex

Alfentanil Causes Less Postoperative Nausea and Vomiting than Equipotent Doses of Fentanyl or Sufentanil in Outpatients 

1999 ◽  
Vol 91 (6) ◽  
pp. 1666-1666 ◽  
Author(s):  
Stephan Langevin ◽  
Martin R. Lessard ◽  
Claude A. Trépanier ◽  
Jean-Pierre Baribault
Keyword(s):  
Postoperative Nausea ◽  
Randomized Study ◽  
Recovery Period ◽  
Plasma Concentrations ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Oxygen Mixture ◽  
Postanesthesia Care Unit ◽  
Outpatient Basis ◽  
Opioid Administration

Background The relative potencies of alfentanil, fentanyl, and sufentanil as a risk factor for postoperative nausea and vomiting have not been determined. They were compared in a randomized study designed to obtain equipotent plasma concentrations of these three opioids at the beginning of the recovery period. Methods The study included 274 patients treated on an outpatient basis. The steady state opioid plasma concentration providing a predicted 50% reduction of the minimum alveolar concentration of isoflurane was used to determine the relative potency of the opioids. The opioids were prepared in equal volumes at concentrations of alfentanil 150 microg/ml, fentanyl 50 microg/ml, and sufentanil 5 microg/ml and were administered in vol/kg. Anesthesia was induced in a blinded fashion with a bolus of the study opioid (0.05 ml/kg) and 4-6 mg/kg thiopental and was maintained with isoflurane (0.6-1%) in a nitrous oxide-oxygen mixture with a continuous infusion of the study opioid (0.06 ml x kg(-1) x h(-1)). If necessary, up to five additional boluses of opioid (0.02 ml/kg) could be given. This opioid administration protocol was tested by pharmacokinetic simulations. Results The incidence of postoperative nausea and vomiting was not different in the postanesthesia care unit, but in the ambulatory surgery unit it was significantly lower for alfentanil compared with fentanyl and sufentanil (12, 34, and 35%, respectively P < 0.005). Pharmacokinetic modeling showed that the end-anesthesia opioid plasma concentrations were approximately equipotent in the three groups. However, modeling does not support that the difference between groups in the postoperative period can be explained by a more rapid disappearance of alfentanil from the plasma. Conclusions Alfentanil, compared with approximately equipotent doses of fentanyl and sufentanil, is associated with a lower incidence of postoperative nausea and vomiting in outpatients.

scholarly journals Early versus delayed postoperative oral hydration in children following general anesthesia: a prospective randomized trial

2019 ◽  
Author(s):  
Xiaorong Yin ◽  
Xiaoqi Zeng ◽  
Ting Wang ◽  
Bibbin Dong ◽  
Menghang Wu ◽  
...  
Keyword(s):  
Drinking Water ◽  
General Anesthesia ◽  
Recovery Period ◽  
Vital Signs ◽  
Nausea And Vomiting ◽  
Patient Comfort ◽  
Postanesthesia Care Unit ◽  
Oral Hydration ◽  
Relative Safety ◽  
Swallowing Reflex

Abstract Background: oral hydration has typically not been administered for between 4 and 6 hours postoperative for children’s safety. But children are more likely to suffer from apnea, crying and agitation, wound bleeding, and other complications during the post-anesthesia recovery period because of thirsty and fear. This Prospective, randomized study sought to assess the compare the early and late oral hydration (EOH and DOH, respectively) in children following general anesthesia, with the goal of assessing relative safety and tolerability and thereby improving patient comfort. Methods : A total of 2,000 children corresponding to the American Society of Anesthesiology (ASA) I-III were randomized into an EOH group (n=1000) and a DOH group (n=1000). For the former group, children were administered a small amount of drinking water following recovery of the swallowing reflex, and children's vital signs were monitored for 20 minutes in a postanesthesia care unit (PACU). DOH group patients received water at 4 h following general anesthesia). All patients underwent monitoring to assess their thirst, satisfaction, oropharyngeal discomfort, nausea, and vomiting. Results: Complete data were collected from a total of 1770 patients (EOH=832, DOH=938) and was compared via chi-squared and t-tests as appropriate. There was no hypoxemia in either group, nor did the incidence of nausea and vomiting differ between the two groups (P>0.05). The thirst score of the EOH group was significantly decreased relative to the DOH group in the children over 5 years old after drinking for 10 to 20 minutes (P<0.05). Conclusions: For children undergoing general anesthesia, a small amount of drinking water in the early stages of recovery will not increase the incidence of nausea, vomiting, or hypoxemia, but will decrease thirst and improve satisfaction. It is important, however, that medical staff carefully monitor the swallowing reflex and vital signs of all children.

Solid Organ Biopsies

2018 ◽  
pp. 246-249
Author(s):  
Jennifer Biber ◽  
Jenna Wheeler
Keyword(s):  
Adverse Events ◽  
General Anesthesia ◽  
Operating Room ◽  
Local Anesthesia ◽  
Deep Sedation ◽  
Recovery Period ◽  
Contingency Planning ◽  
Solid Organ ◽  
Sedation And Analgesia ◽  
Pediatric Sedation

While solid organ biopsies are routinely done on adults with only local anesthesia or minimal sedation, children frequently require deep sedation or general anesthesia to achieve acceptable conditions (stillness, anxiolysis, analgesia) to facilitate these procedures. This is more frequently being done with pediatric sedation/anesthesia outside the operating room. Issues unique to sedation for these procedures are pain, the need for relative patient immobility (both during the procedure and following it), and the nonstandard positioning required during the procedure. Regardless of the medications chosen, adequate monitoring should occur during the procedure as well as during the recovery period. With a good sedation plan for both sedation and analgesia, adequate monitoring, and contingency planning for adverse events, this can safely be performed in institutions with highly motivated and organized sedation services.

Recovery and Discharge for Procedures Conducted Outside of the Operating Room

2011 ◽  
pp. 37-41
Author(s):  
Lianfeng Zhang ◽  
Frances F. Chung
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Regional Anesthesia ◽  
Postoperative Care ◽  
Postoperative Recovery ◽  
Therapeutic Interventions ◽  
Postanesthesia Care Unit ◽  
Discharge Process ◽  
Step Down

Continued advances in procedural techniques, anesthetic pharmacology, and regional anesthesia allow more prolonged diagnostic and therapeutic interventions to be conducted at an increasing variety of locations outside of the operating room (OOOR). However, recovery and discharge process may vary according to the patient’s condition and the specifics of the procedure. Generally, most patients are sent to the postanesthesia care unit (PACU) and ambulatory surgery unit (ASU) or a medical post-procedure recovery unit not staffed by an anesthesiologist, while some patients receive special postoperative care in a step-down or intensive care unit. Therefore, ensuring rapid postoperative recovery and safe discharge are important components following these OOOR procedures.

Ondansetron Versus Droperidol or Placebo to Prevent Nausea and Vomiting after Otologic Surgery

1998 ◽  
Vol 118 (6) ◽  
pp. 785-789 ◽  
Author(s):  
W. SCOTT JELLISH ◽  
JOHN P. LEONETTI ◽  
ELAINE FLUDER ◽  
ZUHAIR THALJI
Keyword(s):  
Saline Solution ◽  
Nausea And Vomiting ◽  
Postanesthesia Care Unit ◽  
Anesthetic Induction ◽  
Otologic Surgery ◽  
Preoperative Administration ◽  
To Receive ◽  
Head Neck ◽  
Rescue Antiemetic ◽  
Better Than

This study compares the preoperative administration of ondansetron with that of droperidol or saline solution for the prevention of nausea and vomiting in otologic surgery patients. A total of 120 otherwise healthy individuals were randomly assigned to receive either saline solution, ondansetron (4 mg intravenously), or droperidol (25 μg/kg intravenously) before anesthetic induction. Intraoperative and postanesthesia care unit times were recorded along with incidence of nausea, vomiting, pain, nausea and recovery scores, and the administration of rescue antiemetics. Similar assessments were made during the next 24 hours. Demographics were similar, but more males received ondansetron. Anesthetic recovery scores were lower after administration of droperidol than after ondansetron. Incidence of nausea was similar between groups, but severity was greater with placebo and droperidol than with ondansetron. More vomiting occurred with placebo than with ondansetron or droperidol. No intergroup differences in rescue antiemetic administration were noted, however. Twenty-four hours later, more patients receiving placebo had nausea or vomited than patients receiving droperidol or ondansetron. Fewer women in the ondansetron group vomited than in the other two groups. Ondansetron 4 mg intravenously is as effective as droperidol and better than saline solution in preventing nausea and vomiting in patients undergoing otologic surgery. No cost advantage as determined by lower use of rescue antiemetics or shorter postanesthesia care unit times was noted after ondansetron therapy. (Otolaryngol Head Neck Surg 1998;118:785–9.)

scholarly journals Comparison Between Sevoflurane and Propofol With Remifentanil Anesthesia Avoid Neuromuscular Blocking Agent After Intubation in Thyroid Operation

2021 ◽  
Author(s):  
Chunyao Yang ◽  
Jing Sun ◽  
Xihua Lu ◽  
Chen Yang
Keyword(s):  
Sore Throat ◽  
Recovery Period ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Nausea And Vomiting ◽  
Thyroid Operation ◽  
Recovery Profile ◽  
Extubation Time ◽  
Significant Difference

Abstract Background: The goal of the study is to compare sevoflurane and propofol with remifentanil anesthesia avoid neuromuscular blocking agent after intubation in thyroid operation with intra-operative neuromonitoring.Methods: 80 patients scheduled to receive thyroid operation were randomly assigned to sevofluraneor propofol anesthesia maintained group. The time of rocuronium recovery profile were monitored. Adverse events such as sinus bradycardia, tachycardia, hypertension, hypotension and movement were recorded. Analyze the time from anesthetic stop to the extubation time and operation time. Record the incidence rate of sore throat, drowsiness, agitation, nausea and vomiting after extubation. Record the first neuromonitoring time and the number of successful neuromonitoring.Results: There were significant differences in the recovery profile of rocuronium between sevoflurane and propofol group(P<0.05). The incidence of hypotension was similar between sevoflurane and propofol group. There was no significant difference of sinus braducardia between the two groups. The incidence of movement was less in sevoflurane compared to propofol(12.% vs. 47.5%, P=0.002). The propofol group had longer extubation time than sevoflurane group(13.10±1.52 vs. 8.07±1.07 min, P=0.001).The incidence of sore throat, drowsiness, agitation, nausea and vomiting in the two groups was similar during the recovery period, and the difference was not statistically significant. There was no significant difference of neuromonitoring between the two groups.Conclusion: Sevoflurane has advantage with less movement adverse effects in thyroid surgery with intra-operative neuromonitoring compared to propofol when associated with remifentanil 0.1μg/kg/min in general anesthesia.Trial registration: Chinese Clinical Trial Registry (ChiCTR1800017166, 15 July 2018)

Inventory Cost Reduction in the Perioperative Setting

2001 ◽  
Vol 36 (5) ◽  
pp. 514-517
Author(s):  
Toni Elkach
Keyword(s):  
Operating Room ◽  
Inventory Control ◽  
Cost Reduction ◽  
Postanesthesia Care Unit ◽  
Intravenous Fluids ◽  
Inventory Cost ◽  
Anesthesia Department ◽  
Neuromuscular Blockers ◽  
Inventory Turnover ◽  
Near Future

An inventory cost-reduction project for our operating room was undertaken to reduce excess inventory, increase inventory turnover, and eliminate unusable items. The operating area consisted of three departments with different inventory control potentials. In the anesthesia department, the targeted areas with corresponding results in inventory savings were: anesthesiologists' trays stock, $2344; refrigerated neuromuscular blockers, $2025; intravenous fluids and miscellaneous items, $2817; reduction of midazolam waste, $5907. Inventory reductions in the postanesthesia care unit and the operating room (the second and third departments) totaled $565 and $496, respectively. In addition, a yearly report run by the pharmacy and its purposes were discussed. These simple interventions led to inventory savings of $14,154. Projects now underway should lead to more impressive results in the near future.

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