[Infection hazards in the hospital. I. Hygienic measures in the intensive care units and recovery room].
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Antisepsis↗
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[The operating suite and recovery room: a world to discover ... with urgency!].
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Humans↗
Reflections on hospital lighting. 6. The operating theater and recovery room.
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Hospitals↗
A microprocessor-based arrhythmia monitor/recorder for the operating and recovery rooms.
A microprocessor-based cardiac arrhythmia monitor/recorder was designed to detect and document arrhythmias that occur during general anesthesia. A Holter tape recorder controlled by the monitor records arrhythmias and associated annotation. These condensed records are later manually scanned for final classification. The project was undertaken to build a database of arrhythmias correlated with various inhalation anesthetic agents, while simultaneously evaluating-time rhythm analysis algorithms.
Anesthesia, Inhalation↗
Anaesthetic complications in the recovery room.
INTRODUCTION: The immediate post-operative period in the recovery room is a known period of high risk for anaesthetic complications to occur. AIMS: We wanted to know the incidence and nature of our recovery room patients in the main-theatre complex of Hospital Kuala Lumpur. METHOD: A prospective study was conducted over a two-month period on all patients receiving either regional and/or general anaesthesia by an anaesthetic doctor admitted to this recovery room. Complications were documented according to predefined criteria. RESULTS: Out of a total of 1,995 patients, 50(2.5%) had some form of anaesthetic complication. Fifteen patients had more than one complication. The most common was pain (23 patients) followed closely by nausea and vomiting (21 patients). There were 32 patients with CNS problems (including the 23 with pain), 21 with GIT, 10 with CVS, 2 with respiratory and 3 with other problems. CONCLUSION: Our recovery room complication rate is acceptably low. Knowing the type and frequency of problems (in this case, mainly pain and nausea and vomiting) can further improve the figure. The role of anaesthesiologists has expanded as they are not only expected to ascertain the safety but also the comfort of patients post-operatively.
Adult↗
Recurarization in the recovery room.
A case of recurarization in the recovery room is reported. Accumulation of atracurium in the intravenous line led to recurarization after flushing the line in the recovery room. A respiratory arrest with severe desaturation and bradycardia occurred. Circumstances leading to this event and the mechanisms enabling a neuromuscular blockade to occur, following the administration of a small dose of relaxant, are discussed.
Adult↗
Recovery room care of the surgical patient.
The recovery room provides short-term intensive care to a wide variety of patients, better assuring their smooth, uncomplicated, rapid postoperative course. Many disorders (of all organ systems) occur acutely but, with proper recognition and treatment, they may be resolved very rapidly. The key to optimal postoperative management is anticipation, recognition, and immediate action along with close observation and monitoring of both the therapy and the process derived from therapy. The recovery room will justify its existence by limiting the number of postoperative complications and enhancing the postanesthetic, postsurgical recovery.
Anesthesia↗
An audit of airway problems in the recovery room.
It has recently been suggested that recovery rooms should have dedicated anaesthetic cover during working hours to deal with serious life-threatening problems. This audit was undertaken to determine the incidence and severity of airway problems that occurred in the recovery room at a District General Hospital. One thousand consecutive patients who received a general anaesthetic were assessed. If an airway problem was identified, the patient's notes were examined to document the type of surgery and any predisposing factors which may have contributed. The incidence of airway problems in this study was found to be 2.8%, which was in agreement with previous studies and appears too low to warrant a full-time anaesthetic presence.
Adolescent↗
Concentration and elimination of anaesthetic gases in recovery rooms.
The investigation includes measurement of the N2O-concentration in the recovery rooms of three hospitals with different room ventilation systems. The amount of ventilation determines the elimination of the gas exhaled by the patients and, therefore, is related to the number of patients in the recovery rooms. The investigation has shown that non-recirculating room ventilation of 500 m3/pt./hour in recovery rooms gives personnel the same protection against inhalation of anaesthetic gases as is afforded to personnel in operating theatres with scavening equipment.
Air Pollutants↗
Continuous monitoring of arterial oxygen saturation with pulse oximetry during transfer to the recovery room.
The incidence of hypoxemia in the immediate postoperative period was determined using a pulse oximeter for continuous monitoring of arterial oxygen saturation (SaO2) in 95 ASA class I or II adult patients breathing room air during their transfer from the operating room to the recovery room. Hypoxemia was defined as 90% SaO2 (arterial oxygen partial pressure (PaO2) approximately equal to 58 mm Hg). Severe hypoxemia was defined as 85% SaO2 (PaO2 approximately equal to 50 mm Hg). Hypoxemia occurred in 33 (35%) patients; severe hypoxemia occurred in 11 (12%). Postoperative hypoxemia did not correlate significantly with anesthetic agent, age, duration of anesthesia, or level of consciousness. There was a statistically significant correlation (P less than 0.05) between hypoxemia and obesity. All three patients with a history of mild asthma became severely hypoxemic even though none had perioperative evidence of obstructive disease, also a statistically significant (P less than 0.003) finding.
Adult↗
Postoperative recovery rooms. Staffing and facilities in three regions in the United Kingdom.
Postoperative recovery rooms have been used in the United Kingdom for just over 30 years. Anaesthetic and surgical practices have improved during this time but the clinical problems encountered are unchanged essentially. Several surveys have reviewed complications that occur; the most common causes of postoperative morbidity and mortality are still cardiovascular and respiratory problems, the latter particularly of the upper airway. In contrast there are no data available on the standard of staff and equipment in recovery rooms. The results of a survey of this aspect of postoperative recovery rooms in hospitals in Wessex, North West Thames and Yorkshire Regional Health Authorities are reported. Particular effort was made to define the facilities available. The results indicate that 70% of hospitals do not provide staffing levels and facilities which meet recommendations of the Association of Anaesthetists of Great Britain and Ireland. The implications of these findings with regard to anaesthetic morbidity and mortality are discussed.
England↗
Anaesthetic-related recovery room complications.
A prospective survey was conducted over a one-month period in all surgical patients admitted to the recovery room of a university-affiliated teaching hospital. Complications arising in the recovery room were documented by the nursing staff according to predefined criteria and were critically evaluated. A total of 443 patients were admitted to the recovery room and in 133 (30%) of these, some form of complication was noted. There were 86 patients with complications referable to the central nervous system, 68 with abnormal cardiovascular parameters, 24 with nausea and/or vomiting and 10 with abnormalities referable to the respiratory system. Many patients had more than one complication. The results are discussed, with emphasis on their relevance to current anaesthetic practice. It is concluded that many patients exhibit recovery room complications when they are specifically sought. The recovery period remains a time of great potential danger to patients.
Adult↗
[Exposure of recovery room personnel to inhalation anesthetics].
Both desflurane and sevoflurane have a favourable blood/gas distribution coefficient. There is concern, however, that environmental contamination is higher when these agents are employed since they must be used in relatively high concentrations. Our study seeks to determine the degree of exposure of recovery room staff to trace amounts of these two agents. Two hundred and seven surgical patients were included in the study. The recovery room studied had a volume of 243 cubic metres. The hourly fresh air supply for this room was 1,845 cubic metres, which results in 7.6 air exchanges per hour without air return. Measurements of trace concentrations of the inhalational agents were taken for 12 days. Concentrations of these anaesthetics were assessed in the recovery room with a real-time infrared spectrometer every 90 seconds. Mean exposure to nitrous oxide in the recovery room was 11.5 +/- 3.97 ppm and to isoflurane 1.4 +/- 0.31 ppm. All measured values were below the standard German threshold values. Trace concentrations of desflurane were 2.8 +/- 0.84 ppm and of sevoflurane 3.2 +/- 0.62 ppm. We conclude that the exposure to the inhalational anaesthetics in the climatised recovery room was low. The threshold values of 100 ppm for nitrous oxide and 10 ppm for isoflurane recommended by German law were not exceeded. When the new volatile anaesthetics are used, exposure of recovery room staff to trace concentrations of these agents is higher, but the concentrations do not exceed the levels allowed applicable German health regulations.
Air Pollutants, Occupational↗
The Australian Incident Monitoring Study. Recovery room incidents in the first 2000 incident reports.
Of the first 2000 incidents reported to the Australian Incident Monitoring Study 120 (6%) occurred in the recovery room after general, regional or local anaesthesia. Over two thirds (69%) of these involved the respiratory system, 19% were cardiovascular, 3% involved the central nervous system and 9% were miscellaneous in nature. These recovery room incidents were associated with significantly more adverse outcomes (56%) than incidents in the operating theatre (24%). The types and relative frequencies of these recovery room incidents were similar to those of serious recovery complications in a recent analysis of closed malpractice claims; this suggests that incident monitoring may be useful in the study and prevention of recovery room complications. Over three quarters (77%) of all recovery incidents (and 88% of respiratory incidents) were detected clinically; the remainder were first detected by a monitor. A theoretical analysis showed that over 95% of respiratory events, had they been allowed to evolve, would have been detected by pulse oximetry before organ damage occurred, emphasising the potential importance of pulse oximetry in reducing adverse outcome from any complication in the recovery ward which might be "missed" by clinical observation. The findings of this study underline the importance of having an adequate number of trained recovery nursing staff supported by the availability of a pulse oximeter for each patient at least until the return of protective reflexes and the ability to maintain adequate arterial saturation has been established.
Accidents↗
Intraoperative and recovery room outcome.
OBJECTIVES: To identify and quantitate anaesthesia related complications in the intraoperative period and in the post anaesthesia recovery room. DESIGN: A prospective study. SETTING: University of Benin Teaching Hospital; a University-affiliated tertiary centre. SUBJECTS: Patients scheduled for elective and emergency surgery under anaesthesia. Obstetric patients were excluded. RESULTS: Out of the 700 patients studied, intraoperative and postoperative complications were recorded in 221 (31.6%) patients. Data showed a higher incidence of postoperative complications. P = 0.0001, X2 = 19.343, Odds Ratio (OR) = 0.5116, 95% CI: 0.3800-0.6886. The differences were statistically significant. The incidence of cardiovascular, central nervous system and respiratory complications were also higher in the postoperative period than intraoperative period. There were two cases of cardiac arrest both in the intraoperative period and in the recovery room. A higher incidence of both intraoperative and recovery room complications was observed in females than in males. P = <0.0001; X2 = 16.951 (with Yate's correction); OR = 2.066; 95% CI: 1.468-2.908. The difference was considered extremely significant. There was one case of mortality intraoperatively and one postoperatively. P = 1.000; OR = 1.772; 95% CI: 0.1093-28.743. CONCLUSION: Our study showed a high incidence of complications both in the intraoperative period and in the recovery room. Complication rate was higher in females than males. The incidence of complications was also higher in the elderly patients.
Adolescent↗
Prostatectomy patients' postoperative pain assessment in the recovery room.
AIM: This paper reports a study to assess the usability and use of different pain assessment tools and to compare patients' and nurses' pain assessments in the recovery room after prostatectomy. BACKGROUND: Pain assessment is the first step towards providing adequate pain relief but poses problems because of the subjective nature of the pain experience and the lack of quantifiable measurements. Pain tools have been tested in several clinical settings, but not in the recovery room. METHODS: Data were collected in the recovery room from 45 consecutive patients who had undergone prostatectomy by asking them to evaluate their pain intensity using visual analogue scale, numeric rating scale and verbal expressions. One of two research nurses measured patients' pain at regular intervals and at the same time as the patients. Physiological parameters were also evaluated. Data were analysed as frequencies and percentages. Sum variables were formed and results were analysed using Spearman's rank correlation, Pearson's correlation and with multiple regression analysis. RESULTS: Patients varied in their ability to assess the intensity of their pain using different tools, but assessments were correlated with each other and with nurses' estimations. Nurses and patients obtained similar assessments, but nurses both underestimated and overestimated patients' pain. Patients' verbal assessments varied widely. Patients' and nurses' pain assessments showed no association with patients' pulse or mean arterial blood pressure. CONCLUSIONS: According to our results, it is not totally clear whether pain tools are usable in the recovery room. This issue calls for further research.
Aged↗
Reduction of laparoscopic-induced hypothermia, postoperative pain and recovery room length of stay by pre-conditioning gas with the Insuflow device: a prospective randomized controlled multi-center study.
OBJECTIVE: To assess the efficacy and safety of Insuflow (Georgia BioMedical, Inc.) filter heater hydrator device in reducing the incidence, severity and extent of hypothermia, length of recovery room stay and postoperative pain at the time of laparoscopy. DESIGN: Prospective, randomized, blinded, controlled multi-center study. Patients underwent gynecologic procedures via laparoscopy; surgeons, anesthesiologists and recovery room personnel assessed the results. SETTING: Seven North American institutions. PATIENTS: Seventy-two women for safety evaluation and efficacy studies. INTERVENTIONS: Intraoperative pre-conditioning of laparoscopic gas with the Insuflow device (treatment) or standard raw gas (control) during laparoscopic surgery and postoperatively. MAIN OUTCOME MEASURES: Incidence, severity and extent of hypothermia, postoperative pain perception and length of recovery room stay. RESULTS: The Insuflow group had significantly less intraoperative hypothermia, reduced length of recovery room stay and reduced postoperative pain. Pre-conditioning of laparoscopic gas by filtering heating and hydrating was well tolerated with no adverse effects. The safety profile of the Insuflow pre-conditioned gas showed significant benefits compared to currently used raw gas. CONCLUSIONS: Pre-conditioning laparoscopic gas by filtering heating and hydrating with the Insuflow device was significantly more effective than the currently used standard raw gas and was safe in reducing or eliminating laparoscopic-induced hypothermia, shortening recovery room length of stay and reducing postoperative pain.
Adolescent↗
Residual curarization in the recovery room: atracurium versus gallamine.
Residual curarization in the recovery room was evaluated in 19 patients randomly allocated to two groups with nine and ten patients in each group, respectively. In one group atracurium was used for relaxation, and gallamine was used in the other. Anaesthesia was achieved with thiopental, diazepam, fentanyl and nitrous oxide in oxygen. Mean train-of-four (TOF) ratio in the gallamine and atracurium group was 0.63 and 0.91, respectively. Fifty per cent of the patients in the gallamine group had TOF ratios below 0.70, and none of these patients were able to sustain a head lift for 5 s. All patients in the atracurium group had TOF ratios above 0.70, and all of them were able to lift their head for 5 s. All patients were fully awake when they were evaluated, and no patient had any sign of respiratory difficulty. We conclude that residual curarization in the recovery room remains a problem and that this problem seems to be reduced when muscle relaxants of intermediate duration of action are used for relaxation during operation.
Adult↗