A prospective observational study comparing criteria-based discharge method with traditional time-based discharge method for discharging patients from post-anaesthesia care unit undergoing ambulatory or outpatient minor surgeries under general anaesthesia

Jain, Anuj; Muralidhar, V; Aneja, Sanjeev; Sharma, Anil Kumar

doi:10.4103/ija.ija_549_17

Cited by 17 publications

(22 citation statements)

References 19 publications

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“…Traditionally, time based discharge method has been used to discharge patients from post-anesthesia care unit. Which varies from institution to institution, whereas modi ed Alderte,s score method standardizes and objecti es the discharge criteria across the institutions (13).Our study showed that only 73.3 % patients were meet the audit standard. This nding was low compared with the standard as well as with the other studies.…”

Section: Discussionmentioning

confidence: 77%

Current Practice of Discharging Patients From Post Anesthesia Care Unit After Surgical Operations, 2018

Bizuneh

berhe

Ashagrie

et al. 2020

Preprint

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Background: Post-Anesthesia discharge criteria scoring systems have been used successfully to help discharge from the post anesthetic care unit for more than many years. They provide standardized documentation of a patient’s readiness for discharge. A formal checklist is highly recommended for the staff to decide discharge of patients either to the ward or not from post-anesthesia care unit. In our study area there is no any standardized discharging systems. So the aim of this study was to improve post-anesthesia care outcomes.Methods: Institutional based cross sectional study was conducted from January, 1- 15, 2018. All patients who were discharged from post anesthesia care unit to wards after operation were involved and a consecutive sampling method was done within the stud period. From the checklist form maximum score of subscales is two and minimal score is zero .The total scores should be greater than or equal to nine out of ten to transfer the patient from post anesthesia care unit to wards.Results: This study showed that only 73.3 % patients were meet the audit standard. From sub scales, patients awakens scored was 91.1%, however all the rest scales were scored less than the standard. Able to move four extremities was 73.3%,able to deep breath and cough freely was 80%, blood pressure ± 20 mmHg of pre-anesthetic level was 75.6% and able to maintain oxygen saturation > 92% on room air was 84.4%.Conclusion and recommendation: This finding was low compared with standard as well as with the other studies. Then the staffs who work in post anesthesia care unit should be given training and they must discharge patients based of the standard as well as r- auditing is important to achieve the standard.

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Section: Discussionmentioning

confidence: 77%

Current Practice of Discharging Patients From Post Anesthesia Care Unit After Surgical Operations, 2018

Bizuneh

berhe

Ashagrie

et al. 2020

Preprint

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“…reported the successful use of the LMA Protector™ in three patients scheduled for elective laparoscopic cholecystectomy. [ 13 ] In their assessment, the LMA Protector™ possessed oropharyngeal leak pressures and maximum minute ventilation of ranges 27-31 cm H 2 O and 15.1-21.8 l/min, respectively. These are above the thresholds of 25 cm H 2 O for oropharyngeal leak pressure and 12 l/min for maximum minute ventilation considered to reflect adequate clinical efficacy.…”

Section: Discussionmentioning

confidence: 99%

Laryngeal mask airway protector generates higher oropharyngeal leak pressures compared to the laryngeal mask airway supreme

Acx

Caelenberg

Baerdemaeker

et al. 2021

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: The Laryngeal Mask Airway (LMA) Protector™ is one of the latest introduced supraglottic airway devices. It provides access and functional separation of the respiratory and digestive tracts. Compared to the LMA Supreme™, it has two digestive ports, one to provide suction in the pharyngeal region and one for gastric tube insertion. High oropharyngeal leak pressure is a marker for safe ventilation when using LMA devices. We hypothesized that oropharyngeal leak pressure of the LMA Protector™ is 5 cm H 2 O higher than the oropharyngeal leak pressure of the LMA Supreme™ at various cuff volumes. Secondary outcome measures were ease of insertion of both masks, fiberoptic confirmation of correct positioning, failures of insertion, presence of blood staining, sore throat, presence of air leak and insertion time. Material and Methods: American Society of Anesthesiologists (ASA) I-III patients aged >18 years, scheduled for elective minor ambulatory surgery under general anesthesia with a LMA were included. Patients were randomized in the LMA Protector™ or LMA Supreme™ group based on a computer-generated random sequence table. After general anesthesia induction, oropharyngeal leak pressures were measured. Results: Oropharyngeal leak pressures were significantly higher ( P < 0.0001) for LMA Protector™ compared to LMA Supreme™ at different cuff volumes and a cuff pressure of 65 cm H 2 O. Insertion time was significantly higher for the LMA Protector™ (29 sec) [interquartile range (IQR) 23, 35] compared to the LMA Supreme™ (19 sec) (IQR 16, 22) ( P < 0.0001). There were no statistically significant differences in ease of insertion (number of attempts for succesful positioning), failures of insertion, presence of blood staining, sore throat or presence of air leak. Conclusion: Oropharyngeal leak pressures were consistently higher (>5 cm H 2 O) for LMA Protector™ compared to LMA Supreme™. LMA Protector™, therefore, allows effective ventilation at higher airway pressures than LMA Supreme™. Trial Registration: http://clinicaltrials.gov.NCT03462550 .

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“…At almost all PACUs (93.3%), the staff used predetermined discharge criteria. Recent studies have shown that the discharge criteria based on a predetermined physiological scoring system can reduce the length of stay in the PACU (Jain et al 2018, Street et al 2017, 2018 and is cost-effective (Street et al 2017). Furthermore, this method increases patient safety by identifying patients at a greater risk of adverse events, thereby decreasing the rate of clinical deterioration and cardiac events following discharge from the PACU (Nilsson et al 2020, Street et al 2017.…”

Section: Discussionmentioning

confidence: 99%

Clinical practice and procedures for postoperative care in Sweden: Results from a nationwide survey

Juhasz

Iversen

Samuelson³

et al. 2020

Journal of Perioperative Practice

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A nationwide survey describing Swedish post-anaesthesia care units (PACUs), n = 75 was undertaken. The patients most commonly cared for at PACUs were patients who had undergone laparoscopic surgery, 69.3%, followed by patients who had undergone minor orthopaedic surgery, 68%. At the majority of the PACUs, 86.7%, the staff cared for emergency surgery patients and 48% for day surgery patients. In 31% of the PACUs, a pain relief service was offered through a specific pain service team. During the daytime, the anaesthetist in charge most frequently worked in the operating room 42.7%, and on call in the intensive care unit, 37.3% of the time. In 88% of the PACUs, either all or most registered nurses had a specialist education at an advanced level. The most frequent ratio of registered nurses to patients was 1 to 4, 37.3%. However, Swedish PACUS are also staffed by assistant nurses and the most frequent ratio of registered nurse to assistant nurse was 1:1. Thirty-three (44%) of the PACUs had access to a physiotherapist during the daytime. Almost all PACUs (93.3%) had predetermined discharge criteria but in the majority of PACUs' high-risk patients (68%) were not followed up by an anaesthetist after discharge from the PACU.

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A prospective observational study comparing criteria-based discharge method with traditional time-based discharge method for discharging patients from post-anaesthesia care unit undergoing ambulatory or outpatient minor surgeries under general anaesthesia

Cited by 17 publications

References 19 publications

Current Practice of Discharging Patients From Post Anesthesia Care Unit After Surgical Operations, 2018

Current Practice of Discharging Patients From Post Anesthesia Care Unit After Surgical Operations, 2018

Laryngeal mask airway protector generates higher oropharyngeal leak pressures compared to the laryngeal mask airway supreme

Clinical practice and procedures for postoperative care in Sweden: Results from a nationwide survey

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