An observational study of practice during transfer of patients from anaesthetic room to operating theatre*

Abstract

SummaryWe observed practice during transfer of 80 patients from anaesthetic room to operating theatre, to determine the duration of apnoea and the time without monitoring during the transfer process. Median (IQR [range]) time from disconnection of the breathing system in the anaesthetic room to the first breath in theatre was 54 (44-65 [27-196]) s, and from disconnection of the pulse oximetry probe to the first reading in theatre was 90 (74-103 [44-182]) s. In four patients (5%) arterial oxygen saturation fell to 94%, with the greatest desaturation observed 11%. The transfer process may represent a window of opportunity for the occurrence of harm or the first step in a chain of events leading to harm, and is difficult to justify on patient safety grounds. In the United Kingdom it is common practice to anaesthetise patients in the anaesthetic room before transfer to the operating theatre. During transfer, patients tend to be neither monitored nor their lungs ventilated. This practice contrasts with other countries including the United States of America, Canada and Australia, where anaesthesia is routinely induced in the operating theatre. This issue has been discussed in the literature in general correspondence and editorials [1-3], but we are not aware of any studies measuring anaesthetic transfer times or adverse incidents relating to transfer. Our aims were to determine how long patients are unmonitored and apnoeic during transfer from the anaesthetic room to the operating theatre, and to record any adverse outcomes during this period. MethodsLocal Research Ethics Committee approval was obtained to observe routine staff practice during transfer of patients from anaesthetic room to operating theatre. We collected data for 80 cases, over a 4-month period. All cases were adult inpatients, of ASA physical status 1-3, undergoing induction of general anaesthesia in the anaesthetic room. After induction, patients were disconnected from monitoring and the breathing system, wheeled into theatre on a trolley, and transferred by slide to the operating table. Patients were followed from the anaesthetic room until fully monitored and their lungs ventilated in theatre. Principal measurements were the time from disconnection of the breathing system until the first breath in theatre, and the time from disconnection of the pulse oximetry probe until the first reading in theatre. We also noted the extent of pre-oxygenation (formal: ‡ 3 min via a tight fitting facemask or ‡ 4 vital capacity breaths; informal: any attempt at pre-oxygenation not fulfilling formal criteria; or none), whether the patient was on the trolley or the operating table when the first breath in theatre was given, and whether the patients' airways were managed using laryngeal mask airways or tracheal tubes. The theatre staff were unaware of the nature of the study. We asked permission to be present in the anaesthetic room and observe the beginning of each case and then leave, explaining that the nature of the study precluded revealing exactly what we were ob...

A comparison of inhalational inductions for children in the operating room vs the induction room

“…have examined the oxygenation of anesthetized patients during transport from the IR to the OR and reported a decrease in oxygen saturation during this time. Although their study population included patients who were apneic with an endotracheal tube or a laryngeal mask airway during transfer to the OR from the IR, they did not observe any desaturation to <90% (25). In our study, spontaneous respiration was maintained after inhalational induction and upon transfer to the OR where intubation was then performed if required.…”

Transfer of patients from anaesthetic room to operating theatre

“…In Broom and colleagues' study [1], the median time between circuit disconnection in the anaesthetic room and reconnection in theatre was 44-65 s, and the median time to the first pulse oximetry recording was 90 s. Transfer of a morbidly obese patient may take considerably longer, and as mentioned by the authors, all that is needed is for a few unforeseen problems to occur during transfer, and desaturation will occur in at-risk patients who are unmonitored.…”

“…This would be easy to reproduce as it uses a single agent and a single regimen, whereas there is still no consensus on the optimum timing, agent or dose of beta-blockers. We read with interest the study by Broom, Slater and Ure [1]. The merits and disadvantages of using anaesthetic rooms have been much debated.…”

“…These concerns should certainly be considered in any discussion about the place of anaesthetic rooms in our practice. We read with interest the study on transferring patients from anaesthetic room to operating theatre [1]. This showed that patient transfer without monitoring may be prolonged.…”

A reply

“…We read with interest the study on transferring patients from anaesthetic room to operating theatre [1]. This showed that patient transfer without monitoring may be prolonged.…”