The Use of Determinants of Length of Stay in the Post-anesthesia Care Unit (PACU) at the Philippine General Hospital among Postoperative Patients who Underwent Elective Surgeries to Create a Predictive Model for PACU Length of Stay

Background@#The aims of this study were to determine the average length of stay in the Post-anesthesia Care Unit (PACU LOS) in the Philippine General Hospital (PGH) and to create a model that will predict the PACU LOS based on the factors that significantly affect the LOS. Determination and prediction of PACU LOS is essential in resource utilization, and in cost containment and reduction. Addressing the modifiable variables that affect the PACU LOS may lead to an improvement in the LOS of patients in the PACU and, consequently, to better recovery room staffing and a reduced cost for the patients and the hospital.@*Methods@#A prospective chart review of 400 postoperative patients admitted in the PGH PACU was done. Summary statistics were presented. Using the set of variables found to be significant, a regression model was formulated to estimate the PACU LOS.@*Results@#The mean PACU LOS was 4.59 hours. There were significant differences in the mean PACU LOS based on the occurrence of complications. There were also significant differences in the median PACU LOS based on the type and duration of surgery, anesthetic technique, and duration of anesthesia. The multiple linear regression model that best predicted PACU LOS included ASA-PS classification, type of surgery, duration of surgery, anesthetic technique, and occurrence of intraoperative or postoperative complications. @*Conclusions@#The mean PACU LOS of the Philippine Genera Hospital is higher than that of published data. The factors included in the model that best predicts PACU LOS may be studied to improve the PACU LOS.@*@#

Emergence delirium following sevoflurane anesthesia in adults: prospective observational study / Delirium do despertar após anestesia com sevoflurano em adultos: estudo observacional prospectivo

Abstract Background and objectives: Emergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence. Design & methods: A prospective observational study was conducted in adult patients who had non-neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC). Results: The incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) (p = 0.04), emergency surgery (p = 0.04), African ethnicity (p = 0.01), longer duration of surgery (p = 0.007) and number of intubation attempts (p = 0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium. Conclusions: The incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.

Resumo Justificativa e objetivos: O delirium do despertar após a anestesia geral com sevoflurano não tem sido relatado com frequência em adultos como nas crianças. Este estudo teve como objetivo determinar a incidência de delirium do despertar em pacientes adultos submetidos à anestesia com sevoflurano como agente volátil e os prováveis fatores de risco associados à sua ocorrência. Desenho e métodos: Um estudo observacional prospectivo foi conduzido com pacientes adultos sem distúrbios neurológicos ou psiquiátricos submetidos à anestesia geral para procedimentos não neurológicos. Dados demográficos como idade, sexo, etnia e dados clínicos, inclusive estado físico ASA, estado cirúrgico, tentativas de intubação, tempo de cirurgia, hipotensão intraoperatória, drogas usadas, dor pós-operatória, analgesia de resgate e presença de cateteres, foram registrados. A intensidade do delirium do despertar foi medida com a Escala de Triagem de Delirium em Enfermagem (Nursing Delirium Scale - NuDESC). Resultados: A incidência de delirium do despertar foi de 11,8%. Os fatores significativamente associados ao delirium do despertar incluíram idade avançada (> 65) (p = 0,04), cirurgia de emergência (p = 0,04), descendência africana (p = 0,01), tempo maior de cirurgia (p = 0,007) e número de tentativas de intubação (p = 0,001). Fatores como sexo, uso de álcool e drogas ilícitas e especialidade cirúrgica não influenciaram a ocorrência de delirium do despertar. Conclusões: A incidência de delirium do despertar em adultos após a anestesia geral com sevoflurano é significativa e não tem sido relatada adequadamente. Fatores de risco modificáveis precisam ser abordados para reduzir ainda mais sua incidência.

Perioperative Factors Associated with Severe Pain in Post-Anesthesia Care Unit after Thoracolumbar Spine Surgery: A Retrospective Case-Control Study

STUDY DESIGN: A retrospective case-control study. PURPOSE: To evaluate the effect of nitrous oxide and anesthetic and operative factors associated with severe pain in the early postoperative period after thoracolumbar spine surgery. OVERVIEW OF LITERATURE: Thoracolumbar spine surgery is the most common procedure in spine surgery, and up to 50% of the patients suffer from moderate to severe pain. Nitrous oxide has analgesic, anxiolytic, and anesthetic effects; nevertheless, its benefits for early postoperative pain control and opioid consumption remain to be established. METHODS: The medical records of eligible participants who underwent thoracolumbar spine surgery between July 2016 and February 2017 were reviewed. Enrolment was performed consecutively until reaching 90 patients for the case (severe pain) group (patients with a pain score of >7 out of 10 at least once during the post-anesthesia care unit [PACU] admission), and 90 patients for the control (mild-to-moderate pain) group (patients with a pain score of <7 in every PACU assessment). The data collected comprised patient factors, anesthetic factors, surgical factors, PACU pain score, and PACU pain management. RESULTS: A total of 197 patients underwent thoracolumbar spine surgery with an incidence of early postoperative severe pain of 53.3%. The case-control study revealed no differences in the factors related to pain intensity. A subgroup analysis was performed for failed back surgery syndrome (FBSS), spinal stenosis, and spondylolisthesis. After multivariate analyses, only the age group of 19–65 years and the baseline Oswestry Disability Index (ODI) were found to be significant risk factors for early postoperative severe pain in the PACU (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.32–6.25; OR, 1.03; 95% CI, 1.01–1.05, respectively). CONCLUSIONS: Nitrous oxide, anesthetic agents, and surgical techniques did not affect the early postoperative pain severity. Age under 66 years and the baseline ODI were the significant risk factors for pain intensity during the early postoperative period of the FBSS, spinal stenosis, and spondylolisthesis subgroups.

Percepções acerca de um instrumento para avaliação e alta da sala recuperação pós-anestésica / Perceptions about an instrument used for patients' evaluation and discharge from post-anesthesia care units / Percepciones sobre un instrumento para evaluación y alta de la sala de recuperación postanestésica

Objetivo: Descrever as percepções de profissionais de enfermagem acerca de um instrumento para avaliação e alta da Sala de Recuperação Pós-anestésica. Método: pesquisa exploratório-descritiva, de abordagem qualitativa realizada em uma instituição hospitalar do Sul do Brasil. Os participantes foram oito técnicos de enfermagem e uma enfermeira. A coleta de dados ocorreu nos meses de fevereiro e março de 2016 por meio de entrevista semiestruturada e os dados foram submetidos à análise temática. Resultados: os resultados foram agrupados em três categorias: "O cotidiano de trabalho na Sala de Recuperação Pós-anestésica", "Critérios de avaliação e alta do paciente na Sala de Recuperação Pós-anestésica" e "Atuação do enfermeiro na Sala de Recuperação Pós-anestésica". Conclusões: os profissionais percebem a necessidade de estabelecer critérios de avaliação para a alta da Sala de Recuperação Pós-anestésica de forma documentada, destacando a importância do enfermeiro durante todo período de funcionamento da unidade a fim de prevenir possíveis complicações que envolvem o período pós-operatório imediato

Objetivo: Describir las percepciones de los profesionales de enfermería sobre un instrumento para evaluación y alta de la Sala de Recuperación Postanestésica. Método: la Investigación es exploratoria y descriptiva, de abordaje cualitativo realizada en una institución hospitalaria del Sul de Brasil. Los participantes fueron ocho técnicos de enfermería y una enfermera. La recolección de datos ocurrió en los meses de febrero y marzo de 2016 por medio de entrevista semiestructurada y los datos fueron sometidos al análisis temático. Resultados: los resultados fueron agrupados en tres categorías: "en el cotidiano del trabajo en la Sala de Recuperación Postanestésica", "Criterios de evaluación y alta del paciente en la Sala de Recuperación Postanestésica" y "Actuación del enfermero en la Sala de Recuperación Postanestésica". Conclusión: los profesionales perciben la necesidad de establecer criterios de evaluación para el alta de la Sala de Recuperación Postanestésica de forma documentada, destacando la importancia del enfermero durante todo el período de funcionamiento de la unidad con el fin de prevenir posibles complicaciones que envuelven el período postoperatorio inmediato

Objective: Herein, we have aimed to describe the nursing professionals' perceptions about an instrument for the evaluation and discharge of patients from Post-Anesthesia Care Units. Methods: This qualitative and exploratory-descriptive research was carried out in a hospital located in the South Region of Brazil. The participants were eight nursing technicians and one nurse. Data were collected by semi-structured interviews from February to March 2016 and then analyzed using Content Analysis. Results: Three categories appeared: "Daily work in post-anesthesia care units", "Evaluation Criteria and the patient's discharge from post-anesthesia care units", and "Nurses' performance in post-anesthesia care units". Conclusion: The professionals perceived the necessity of documented evaluation criteria for discharging patients from post-anesthesia care units to prevent complications

Complicações na sala de recuperação anestésica, fatores de riscos e intervenções de enfermagem: revisão integrativa / Complications in the post-anesthesia care unit, risk factors and nursing interventions: an integrative review / Complicaciones en la sala de recuperación anestésica, factores de riesgos y intervenciones de enfermado: revisión integrativa

Objetivos: Identificar as complicações e os riscos que os pacientes possam desenvolver no pós-operatório imediato e propor um instrumento que contenha as complicações, riscos e intervenções de enfermagem individualizadas. Método: Revisão integrativa da literatura realizada entre março e outubro de 2015 nas bases de dados PubMed (arquivo digital produzido pela National Library of Medicine) e Biblioteca Virtual em Saúde (BVS). Para o levantamento dos artigos foram utilizados os descritores: sala de recuperação, complicações e cuidados de enfermagem. Resultados: A estratégia de busca permitiu a análise de 15 artigos. As complicações, riscos e intervenções foram identificadas e assim categorizadas: hipotermia, hipoxemia, apneia; edema agudo de pulmão, tremores, náuseas e vômitos; retenção urinária, grau de dependência de cuidados; disritmias cardíacas, complicações gerais; complicações com idosos e posicionamento cirúrgico. Conclusão: As complicações e riscos levantados, assim como as intervenções, foram a base para a construção do instrumento.

Objectives: To identify complications and risks that patients can develop in the immediate postoperative period and to propose an instrument that addresses the complications, risks and individualized nursing interventions. Methods: We conducted an integrative review of the literature between March and October 2015 in PubMed databases (digital archive produced by the National Library of Medicine) and Virtual Health Library (Biblioteca Virtual em Saúde - BVS). We used the following descriptors in our search: recovery room/sala de recuperação/sala recuperación; postoperative complications/complicações pós-operatórias/complicaciones pós-operatórias; and nursing care/cuidados de enfermagem/atención de enfermeira. Results: The search strategy allowed the analysis of 15 articles. Complications, risks and interventions were identified and categorized as follows: hypothermia, hypoxemia and apnea; acute pulmonary edema, tremors, nausea and vomiting; urinary retention and degree of dependence on care; cardiac dysrhythmias and general complications; complications in the elderly and surgical positioning. Conclusion: The resulting complications, risks and interventions were the basis for the construction of our instrument.

Objetivos: Identificar las complicaciones y los riesgos que los pacientes pueden desarrollar en el período posoperatorio inmediato y proponer un instrumento que aborde las complicaciones, los riesgos y las intervenciones individualizadas de enfermería. Métodos: Realizamos una revisión integrativa de la literatura entre marzo y octubre de 2015 en las bases de datos de PubMed (archivo digital producido por la Biblioteca Nacional de Medicina) y la Biblioteca Virtual en Salud (BVS). Utilizamos los siguientes descriptores en nuestra búsqueda: recovery room/sala de recuperação/sala de recuperación; postoperative complications/complicações pós-operatórias/complicaciones pós-operatórias; y nursing care/cuidados de enfermagem/atención de enfermería. Resultados: La estrategia de búsqueda permitió el análisis de 15 artículos. Las complicaciones, los riesgos y las intervenciones se identificaron y categorizaron de la siguiente manera: hipotermia, hipoxemia y apnea; edema agudo de pulmón, temblores, náuseas y vómitos; retención urinaria y grado de dependencia de la atención; disrritmias cardíacas y complicaciones generales; complicaciones en ancianos y posicionamiento quirúrgico. Conclusión: Las complicaciones, riesgos e intervenciones resultantes fueron la base para la construcción de nuestro instrumento.

Application of healthcare failure modes and effects analysis before the transportation of postanesthesia care unit patients / 中国实用护理杂志

Objective To study the application effectiveness of healthcare failure modes and effects analysis before the secure transportation of post anesthesia care unit(PACU) patients. Methods A total of 689 general anesthesia post-operative patients who had been recovered in PACU and transported between January to December in 2015 by convenience sampling were divided into 2 groups to receive nursed by traditional method before transportation (contrast group, 346 cases) or nursed both with traditional way and healthcare failure modes and effects analysis method to analyze (observation group, 343 cases). The Medical Risk Priority Number (RPN), Status of Failure modes and satisfaction value of physicians and nurses were compared. Results The RPN value of observation group had been cut down from (229.00 ± 52.91) points to (57.14 ± 16.04) points, there was significant difference (t=7.58, P=0.01). The occurrence rate of failure mode of observation group was 2.62%(9/343), which was obviously lower than 19.36%(67/346) of contrast group, there was significant difference (χ2=49.19, P<0.01). The satisfaction rate of observation has improved significantly from 74.36%(58/78) to 93.59%(73/78), there was significant difference (χ2=10.72, P<0.01).Conclusions Healthcare failure modes and effects analysis management method could find out the failure mode of PACU patient before the secure transportation in time, could decrease the effect of failure mode and would continuously improve the quality of PACU nursing service .

Application of nursing flowchart in the post-anesthesia care unit / 现代临床护理

Objective To investigate effect of applying nursing flowchart in the post-anesthesia care unit(PACU).Method The nursing flowchart in PACU are as follous,including a ventilator connection,monitoring instrument connection,handover of pipeline and skin and training for PACU nurses.Results After application of the nursing flowchart,the nursing time for postoperative patients was reduced from 7.0 min to 4.0 min.No nursing risks and adverse events occurred.Conclusion Application of nursing flowchart in PACU can improve the quality of nursing and enhance patients safety.

Extrapyramidal side effects after metoclopramide administration in a post-anesthesia care unit: A case report / 대한마취과학회지

Although the incidence of extrapyramidal reactions associated with metoclopramide has been reported to be approximately 0.2%, such reactions are rare in the anesthetic field. Several anesthetic adjuvants, including ondansetron and pregabalin, have also been associated with extrapyramidal side effect. Here, the authors report the case of a 47-year-old patient, previously administered pregabalin and ondansetron, who developed extrapyramidal side effects after a single injection of metoclopramide (10 mg) in a post-anesthesia care unit.

Incidence of complications of patients in different age in post-anesthesia care unit / 中国康复理论与实践

@#ObjectiveTo analyze the distribution of complications of patients in different age in post-anesthesia care unit (PACU).Methods2679 patients in PACU were divided into three age group, and complications were observed and compared among each group.ResultsThere were statistics difference of recovery-time and incidence of complications among each group, except myopalmus.ConclusionIt is important to understand the difference of incidence of complications in different age, which may need different kind of nursing.