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PubMed1959

Operating room deaths; an analysis of mortality in a Veterans Administration hospital over a ten-year period.

A study of operating room and recovery room deaths which occurred during a ten-year period from 1948 through 1957 at one hospital revealed that there were 59 deaths associated with 57,132 surgical procedures. Factors which directly influenced the rate of operating room and recovery room death were the age of the patient and the length of operating time. Seventy-five per cent of the deaths occurred in cases in which the operation took longer than one hour. Combined anesthesia techniques may have indirectly contributed to death in some cases. Complications of operation requiring another surgical procedure sometimes occur. In this series, reoperation proved to be more hazardous in terms of mortality rate than did single operations. This is not surprising for most complications occur in the poorer risk patients. The operating room death rate steadily increased during the ten-year period studied. This increasing death rate can largely be attributed to the more intricate operations which are being done on poorer risk patients. The use of the curariform drugs had no influence on the increasing death rate.

Anesthesia↗
PubMedDate not supplied

Continuous 2-chloroprocaine infusion versus intermittent bolus injections of bupivacaine or 2-chloroprocaine for epidural anesthesia in cesarean delivery.

A continuous infusion of 2-chloroprocaine (Group C) was compared with intermittent bolus injections of bupivacaine (Group B) or 2-chloroprocaine (Group N) for epidural anesthesia in cesarean delivery. Sixty-six patients scheduled for elective cesarean delivery were studied retrospectively during a three-month period. Maternal and neonatal demographics; cord pH; Apgar scores; duration of surgery, including times from induction, incision and end of the case; fluid requirements in the operating room and recovery room; amount of ephedrine used; blood pressures; duration of analgesia, and meperidine use via patient-controlled analgesia (PCA) up to 48 hours postpartum were recorded. Group B experienced a significantly longer time from loading dose to incision and a longer duration of analgesia, but twice the duration of recovery room care than either of the 2-chloroprocaine (2CP) groups. In the first six hours after surgery, Group N patients required significantly more PCA injections than patients in either Group B or Group C. Although statistically significant changes were detected in blood pressure values at three intervals, no clinical importance was appreciated. Fluid requirements were also greater for patients in Group B, both intraoperatively and in the post-anesthesia care unit. Epidural anesthesia using continuous 2CP infusion appears to combine the beneficial effects of bolus injections of both bupivacaine and 2CP by reducing recovery room stay and PCA requirements without troublesome side effects.

Adult↗
PubMed2001

Unsedated small-caliber esophagogastroduodenoscopy (EGD): less expensive and less time-consuming than conventional EGD.

BACKGROUND: A significant portion of the costs and complications of esophagogastroduodenoscopy (EGD) are related to the use of sedation. The feasibility and tolerability of small-caliber EGD (scEGD) without sedation has been evaluated; however, there is limited data concerning times and costs associated with this procedure as compared with conventional EGD (cEGD) with sedation. STUDY: Sixteen patients underwent scEGD with the Pentax EG-1840 (outside diameter, 6 mm) without sedation. A control group of 16 patients was matched for age, sex, day, and indication of procedure. The time of procedure, time in procedure room, time in recovery room, and procedure costs were determined in both the study and control groups. After the procedure, scEGD patients completed surveys consisting of visual-analogue scales to assess tolerance and preference regarding sedation for future procedures. RESULTS: Procedure time, procedure room time, and recovery room time was 5.2, 16.3, and 9 minutes for scEGD and 13.5, 34.9, and 41.3 minutes for cEGD, respectively (p < 0.001 for all comparisons). The mean cost of scEGD, excluding physician fees, was $462.00, which was significantly lower than the $587.00 for cEGD (p < 0.001). Survey results revealed good tolerance for the unsedated procedure. CONCLUSIONS: Unsedated scEGD was well tolerated and resulted in a shorter time of procedure, less time spent in procedure room, reduced recovery room time, and lower costs as compared with cEGD with sedation.

Case-Control Studies↗
PubMed1987

Oxygen saturation during transfer from operating room to recovery after anaesthesia.

Transcutaneous oxygen saturation of haemoglobin was measured in 101 patients en route from the operating room to the recovery room. Twenty-nine became significantly hypoxaemic during the journey. The incidence of hypoxaemia was not found to relate to age, weight, duration or type of surgery, type of anaesthesia or pre-existing disease. Duration of the interval between cessation of oxygen in the operating room and arrival in recovery room was the only significant finding in patients who became hypoxaemic.

Adolescent↗
PubMed1987

Effects of information feedback and pulse oximetry on the incidence of anesthesia complications.

No standard outcome measures exist to evaluate the effect of interventions intended to improve the quality of anesthesia care. The authors established a clinically practical definition of outcome, and used it to assess the effect of feedback of information about complications and the effect of pulse oximetry on the rate and severity of important anesthesia-related problems encountered in the operating room (OR) and recovery room (RR). On admission to the RR, the patient's anesthetist documented Recovery-Room-Impact Events (RRIE), defined as an "unanticipated, undesirable, possibly anesthesia-related effect that required intervention, was pertinent to recovery-room care, and did or could cause at least moderate morbidity." Following a control period with no feedback of data, intense feedback of grouped (anonymous) RRIE rates was provided. Later, pulse oximeters were introduced to all anesthetizing locations. Among 12,088 patients (71% of all RR admissions), 18% had at least one RRIE in the OR or RR. The most common RRIEs were hypotension (4.4%), arrhythmia (3.9%), hypertension (1.5%), intubation difficulties (0.8%), hypoventilation (0.8%), and hypovolemia (0.6%). Feedback of information produced no demonstrable change in the rate of RRIEs. Although significantly fewer patients experienced RRIEs (15.6% vs. 12.4%, P less than 0.0001), hypotensive RRIEs (5.2% vs. 3.8%, P = 0.0003), and hypovolemic RRIEs (0.88% vs. 0.42%, P = 0.0017) following the introduction of pulse oximetry in the OR, confounding factors prevent establishment of a cause-and-effect relationship. Quality assurance may require more direct intervention and individual feedback to be effective. Still, the RRIE measure requires minimal effort at low cost and encourages improved transmission of information at the time of admission to recovery-room care.

Anesthesia↗
PubMed2006

The Universal Oxygen Connector.

The purpose of this article is to describe the benefits of using the Universal Oxygen Connector. Until now, an oxygen hose was only able to connect to a 22-mm fitting, such as those found on humidifiers used in the recovery room, and oxygen tubing was only able to connect to a Christmas tree type adapter. The Universal Oxygen Connector, manufactured and sold by International Medical, Inc (Burnsville, Minn), was developed to allow the practitioner to attach either a 22-mm oxygen hose, oxygen tubing, or a 15-mm oxygen adapter to the same connector. Patients benefit from the administration of supplemental oxygen in the perioperative period. Supplemental oxygen has been shown to decrease postoperative hypoxemia, infection, and in some cases, nausea and vomiting. As such, oxygen should be administered during transport from the operating room to the recovery room, in the recovery room, and at times during transport to the patient room and in the patient room. Oxygen also should be administered whenever a patient receiving oxygen is transported. Use of the Universal Oxygen Connector decreases material waste, decreases hospital costs, saves time and effort and, most importantly, promotes patient safety by providing a versatile system for oxygen delivery.

Cost-Benefit Analysis↗
PubMed1993

[ST trend analysis. Monitoring of risk patients?].

ST-segment monitoring has been proved to be an effective tool in detecting silent myocardial ischaemia, which is an important factor for perioperative cardiac morbidity. The case of a 72-year-old patient with peripheral vascular disease who underwent iliaco-femoral bypass surgery due to acute occlusion of a existing femoropopliteal bypass is reported. As part of a study the patient had perioperative ST-segment holter monitoring which showed pre-, peri- and postoperative severe episodes of silent myocardial ischaemia. No episode was accompanied by anginal symptoms. Post-operatively, a long-lasting episode of severe ST-segment deviation with complex arrhythmias occurred, resulting in cardiac failure and lung oedema. This ST-segment deviation began when the surgical procedure had been concluded and the patient extubated. The peak of the deviation occurred during transport from the operating room the recovery room. The existing ECG changes and the raised heart rate, from the beginning of the time in the recovery room to arrival on the normal ward, were not adequately recognized. The lack of clinical symptoms was misinterpreted. Many hours before, ST deviations and higher heart rate could be seen as precursors of a severe cardiac event. This demonstrates the importance of silent ischaemia in the perioperative period and shows the usefulness of ECG monitoring, especially of the ST segment, in detecting silent ischaemia and enabling early treatment.

Aged↗
PubMed2001

Timing of postcarotid complications: a guide to safe discharge planning.

OBJECTIVES: Currently, our standard of practice is that patients undergoing carotid endarterectomy (CEA) may be safely discharged on the first postoperative day. Because many patients do not appear to require overnight observation, we wanted to determine the safety and feasibility of same-evening discharge by establishing the timing of postoperative complications, which may potentially require operative intervention. METHODS: A total of 835 consecutive patients undergoing CEA were retrospectively reviewed. Sixty-two patients had a postoperative wound hematoma or neurologic deficit (ND) (transient ischemic attack or stroke) within 24 hours of their operation, complications potentially requiring a second operation. Excluded were 64 patients not eligible for same-day discharge because of other reasons (eg, heparinization, CEA with coronary artery bypass grafting). RESULTS: Sixty-two patients (8.0%) had ND (26 [3.4%]) or neck hematoma (NH) (36 [4.7%]) within 24 hours of their CEA. Nineteen (73%) of the NDs were diagnosed in the operating room or recovery room, 5 (19%) within 8 hours of the operation, and 2 (7.7%) after 8 hours but in less than 24 hours. Of the NHs, 23 (66%) were diagnosed in the recovery room, 11 (31%) within 8 hours, and 1 (2.7%) after 8 hours. Of the outliers, one patient experienced a blowout of the vein graft occurring on postoperative day 1, one patient had a delayed ipsilateral stroke, and one had a vertebrobasilar stroke. Overall, only three of 773 (0.4%) patients undergoing CEA had a complication occurring more than 8 hours after operation. CONCLUSION: NDs and NHs in post-CEA patients occurred within 8 hours of operation in 95% of those patients experiencing these complications or 99.6% of all CEA patients. These data indicate that same-evening discharge may be safely performed without increasing the adverse effects of stroke or hematoma. This plan has cautiously been initiated at this institution.

Endarterectomy, Carotid↗
PubMedDate not supplied

Low-dose droperidol versus standard-dose droperidol for prevention of postoperative vomiting after pediatric strabismus surgery.

STUDY OBJECTIVE: To determine whether a low dose of droperidol is as effective as a high dose in preventing vomiting after pediatric strabismus surgery. DESIGN: Randomized, double-blind study. SETTING: Operating room and recovery room at a university medical center. PATIENTS: One hundred children undergoing strabismus procedures. INTERVENTIONS: Patients were divided randomly into three groups and received either droperidol 75 microgram/kg, droperidol 20 microgram/kg, or saline. MEASUREMENTS AND MAIN RESULTS: Vomiting was assessed in all groups, as was time to discharge and ability to perform a satisfactory postoperative eye examination. Children who received droperidol vomited less frequently than those who did not (p = 0.0521). There was no difference in the frequency of vomiting between the two groups that received droperidol. CONCLUSION: Droperidol 20 microgram/kg is as effective as droperidol 75 microgram/kg in preventing vomiting after pediatric strabismus surgery. Because higher doses of droperidol may sedate some patients, the lowest effective dose should be used. In this study, however, there was no statistically significant difference with regard to length of recovery room stay.

Adolescent↗
PubMed2000

Living liver donor surgery: report of initial anesthesia experience.

The charts and anesthetic records of 12 patients who donated the left lateral segment of their liver to a related infant or child to treat liver failure were retrospectively reviewed. Blood loss, need for transfusion, fluids administered, surgical length, and perioperative complications were investigated. The records also were examined to determine the hemodynamic stability of patients undergoing donor hepatectomy to assess their need for invasive monitoring. There were no episodes of hypotension or hemodynamic instability. The average operating time was 9.6 +/- 1.1 hours. The blood loss was 562 +/- 244 mL (range 300 to 1100 mL). Four patients received their own cell saver blood (200 mL, 220 mL, 300 mL, 475 mL), and one patient received 1 U (350 mL) of predonated autologous blood. The average hemoglobin decreased significantly (p = 0.001) from a preoperative value of 14.1 +/- 1.2 to 12.3 +/- 1.8 g/dL in the recovery room. All patients were extubated in the operating room or recovery room. Patients were discharged home in 6.9 +/- 1.3 days (range 5 to 9 days). Living-related liver resection can be performed with noninvasive monitoring and without the need for heterologous blood products.

Adult↗
PubMed2000

Patients' perception of sound levels in the surgical suite.

STUDY OBJECTIVES: To measure sound levels that our patients are exposed to in the surgical suite and their perception of these sound levels. DESIGN: Sound levels experienced by 100 patients undergoing general anesthesia for elective surgery during three phases: induction and maintenance of anesthesia in the operating room (OR), and recovery from anesthesia in the recovery room, were measured using a Type 4436 Noise Dose Meter. The equivalent continuous sound levels (Leq), maximum sound levels (Lmax), and the sources of sounds were noted. Patients were interviewed 24 hours after anesthesia about their perception of the sound levels they had experienced in the OR and recovery rooms. MEASUREMENTS AND MAIN RESULTS: The Leq during the induction, maintenance, and recovery phases were 70.3 +/- 16.8 dB(A), 66.2 +/- 4.1 dB(A) and 71.8 +/- 6.1 dB(A), respectively. These sound levels are much higher than international recommendations for hospital acute care areas and exceed the thresholds to produce noise-induced cardiovascular and endocrine effects. Sound levels were significantly higher during the induction and recovery phases compared to the maintenance phase. Thirty-two patients found the induction phase noisy and 33 patients found the recovery phase noisy. The sound levels distressed 16 patients and 52 patients would have preferred a quieter environment. There was no difference in the sound levels experienced by those who expressed dissatisfaction with the sound levels and those who did not. Much of the noise, particularly staff conversations, unnecessary alarms, and preparation of equipment, could have been prevented by simple measures. CONCLUSION: Noise prevention in the OR and recovery room needs more attention and should be a routine part of patient care.

Anesthesia↗
PubMed2006

Factors affecting recovery and discharge following ambulatory surgery.

PURPOSE: Recovery and discharge following ambulatory surgery are important components of the ambulatory surgery experience. This review provides contemporary perspectives on the issues of discharge criteria, fast-tracking, patient escort requirements, and driving after ambulatory anesthesia. SOURCE: A search was performed in the Cochrane Central Register for Controlled Trials, MEDLINE(R), EMBASE(R), CINAHL, and PsycINFO, to review factors delaying discharge following ambulatory surgery. The following subject headings were used: "ambulatory surgery, discharge, recovery, car driving, escort, transport, fast tracking, patient discharge, recovery, transportation of patients, hospital discharge, recovery room, patient transport, hospital discharge, recovery room, anesthetic recovery, patient transport, ambulatory surgical procedures, patient discharge, recovery of function, automobile driving, patient escort service, recovery room". Using the same search engines, the following keywords were used: "fast tracking, recovery, and discharge". PRINCIPAL FINDINGS: The current literature supports that discharge scoring systems may be useful to guide discharge following ambulatory surgery. While fast-tracking has become common in some centres, further studies are required to justify more routine implementation of this practice in the management of patients undergoing ambulatory surgery. Patients at low risk for urinary retention can be discharged home without voiding. Patients should not drive until at least 24 hr postoperatively. CONCLUSIONS: Ensuring rapid postoperative recovery and safe discharge following ambulatory surgery are important components of the ambulatory surgical program. A clearly defined process should be established for each ambulatory surgical unit to ensure the safe and timely discharge of patients after anesthesia, in accordance with current best evidence.

Ambulatory Surgical Procedures↗
PubMed1991

[Pulse oximetry monitoring of postanesthetic transportation of ophthalmic surgery patients: risk of hypoxemia despite pre-oxygenation].

40 adult patients, ASA class I-III, were studied with regard to their arterial oxygen saturation during transportation from the operating room to the recovery room, following ophthalmic surgery under general anaesthesia. Before transportation the patients were breathing oxygen spontaneously for 6 min.; during transportation they were breathing air. The time for the transport from the operating room to the recovery room was between two and eight minutes. Hypoxaemia (SaO2 85-90%) was observed in 18 cases, severe hypoxaemia (SaO2 less than or equal to 85%) in 5 cases.

Aged↗
PubMed2003

Pulse oximetry for perioperative monitoring: systematic review of randomized, controlled trials.

Monitoring with pulse oximetry might improve patient outcome by enabling an early diagnosis and, consequently, correction of perioperative events that might otherwise cause postoperative complications or even death. The aim of the study was to clarify the effect of perioperative monitoring with pulse oximetry and to identify the adverse outcomes that might be prevented or improved by its use. Trials were identified by computerized searches of the Cochrane Library, MEDLINE, EMBASE, and by checking the reference lists of trials and review articles. All controlled trials that randomized patients to either pulse oximetry or no pulse oximetry during the perioperative period, including in the operating and recovery room, were included in the study. The search identified six reports. Of these 6 reports, 4 studies with data from 21,773 patients were considered eligible for analysis. Two studies specifically addressed the outcomes in question; both found no effect on the rate of postoperative complications using perioperative pulse oximetry. Hypoxemia was reduced in the pulse oximetry group both in the operating room and in the recovery room. During observation in the recovery room, the incidence of hypoxemia in the pulse oximetry group was 1.5-3 times less. There were postoperative complications in 10% of the patients in the oximetry group and in 9.4% in the control group. The duration of hospital stay was a median of 5 days in both groups, and an equal number of in-hospital deaths was registered in both groups. The studies confirmed that pulse oximetry could detect hypoxemia and related events. However, given the relatively small number of patients studied and the rare events being sought, the studies were not able to show an improvement in various outcomes.

Blood Gas Analysis↗
PubMed1989

Postoperative blood salvage using the Cell Saver after total joint arthroplasty.

The purpose of this study was to investigate whether the salvage in the recovery room of blood from the drainage tubes of patients who had total joint arthroplasty was both feasible and efficacious. The cases of seventy-four patients who had seventy-six consecutive total hip or knee arthroplasties were studied prospectively. Intraoperative salvage of blood was performed using the Cell Saver. After closure of the fascial layer or joint capsule, the drainage tubes were connected to the Cell Saver in the operating room and remained connected in the recovery room for a mean of 2.9 hours. Blood that was collected in the recovery room was then processed and transfused back to the patient. The average amount of blood that was salvaged after different types of arthroplasty varied. The addition of bone cement to the acetabular side during primary total hip replacement decreased the amount of postoperative bleeding and of salvaged blood (p = 0.018), whereas cementing the femoral component had no statistically significant effect. Revision total hip replacement also resulted in more bleeding and in the collection of more blood in the recovery room than did primary total hip replacement (p = 0.03), especially if cement was not used (p less than 0.001). There were no statistical differences in the amount of blood that was collected in the recovery room after unilateral, bilateral, primary, or revision total knee replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion, Autologous↗
PubMed1987

Effects of 100% oxygen and a mixture of oxygen and air on oxygen saturation in the immediate postoperative period in children.

Arterial oxygen saturation during transportation of children from the operating room to the recovery room and in the recovery room was monitored in two groups of patients, one given 100% oxygen at the end of anesthesia, the other given a 50:50 mixture of oxygen and air. The oxygen-air group had a statistically significantly higher incidence of hypoxemic episodes. Preoxygenation with 100% oxygen before transfer from the operating room reduces the incidence of hypoxemia in children.

Adolescent↗