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Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 12/2018

12.09.2018 | Reports of Original Investigations

Time to recovery after general anesthesia at hospitals with and without a phase I post-anesthesia care unit: a historical cohort study

verfasst von: Kokila N. Thenuwara, MD, MBBS, MME, MHCDS, Tatsuya Yoshimura, MD, MBA, Yoshinori Nakata, MD, MBA, Franklin Dexter, MD, PhD, FASA

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2018

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Abstract

Purpose

There is little knowledge about how hospitals can best handle disruptions that reduce post-anesthesia care unit (PACU) capacity. Few hospitals in Japan have any PACU beds and instead have the anesthesiologists recover their patients in the operating room. We compared postoperative recovery times between a hospital with (University of Iowa) and without (Shin-yurigaoka General Hospital) a PACU.

Methods

This historical cohort study included 16 successive patients undergoing laparoscopic gynecologic surgery with endotracheal intubation for general anesthesia, at each of the hospitals, and with the hours from OR entrance until the last surgical dressing applied ≥ two hours. Postoperative recovery times, defined as the end of surgery until leaving for the surgical ward, were compared between the hospitals.

Results

The median [interquartile range] of recovery times was 112 [94-140] min at the University of Iowa and 22 [18-29] min at the Shin-yurigaoka General Hospital. Every studied patient at the University of Iowa had a longer recovery time than every such patient at Shin-yurigaoka General Hospital (Wilcoxon-Mann-Whitney, P < 0.001). The ratio of the mean recovery times was 4.90 (95% confidence interval [CI], 4.05 to 5.91; P < 0.001) and remained comparable after controlling for surgical duration (5.33; 95% CI, 3.66 to 7.76; P < 0.001). The anesthetics used in the Iowa hospital were a volatile agent, hydromorphone, ketorolac, and neostigmine compared with the Japanese hospital where bispectral index monitoring and target-controlled infusions of propofol, remifentanil, acetaminophen, and sugammadex were used.

Conclusions

This knowledge can be generally applied in situations at hospitals with regular PACU use when there are such large disruptions to PACU capacity that it is known before a case begins that the anesthesiologist likely will need to recover the patient (i.e., when there will not be an available PACU bed and/or nurse). The Japanese anesthesiologists have no PACU labour costs but likely greater anesthesia drug/monitor costs.
Fußnoten
1
For the current paper, we consider patients discharged to ward. Generally, patients may be discharged from the phase I postanesthesia care unit (PACU) to the phase II PACU, a ward, or intensive care unit.
 
2
As reported by the Chief gynecologic nurse, each ward nurse at Shin-yurigaoka General Hospital cares for an average of seven gynecologic patients, more than the five or six at the University of Iowa.
 
3
At the University of Iowa, the postanesthesia care unit (PACU) discharge policy has three criteria in addition to those of the modified Aldrete score:23 normothermia, no indication of urinary retention or oliguria, and a minimum PACU time of 30 min. The latter had no influence on results as every patient had a PACU time > 30 min (PACU minimum 36 min and recovery time minimum 58 min). At Shin-yurigaoka General Hospital, discharge to the ward was left to the judgment of the anesthesiologist; the electronic anesthesia chart has a built-in checklist, which is the same as the modified Aldrete score.23
 
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Metadaten
Titel
Time to recovery after general anesthesia at hospitals with and without a phase I post-anesthesia care unit: a historical cohort study
verfasst von
Kokila N. Thenuwara, MD, MBBS, MME, MHCDS
Tatsuya Yoshimura, MD, MBA
Yoshinori Nakata, MD, MBA
Franklin Dexter, MD, PhD, FASA
Publikationsdatum
12.09.2018
Verlag
Springer US
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 12/2018
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-018-1220-1

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