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Considering the importance of environmental design as behavioral context, a trial assessment was made in a postpartum recovery room, using systematic observation. Staff-patient and patient-patient interactions were also considered. Results indicate that alterations in some of the physical and programmatic environmental variables may contribute to improve patient assistance.
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BACKGROUND: The objective of our study is to present the analysis of the organizational and clinical work carried out in the first year of activity of the Recovery Room (RR) at the Azienda Ospedaliera Santa Maria degli Angeli of Pordenone and to compare personal experience with what is stated in the literature. METHODS: The RR is located at the center of the operating block (composed of 10 operating rooms), the number of bed is 6, 3 of which are equipped with ventilators. There is a central nursing station where it is possible to concentrate all data deriving from the single monitors on one single screen. The RR operates from Monday to Friday from 8.00 to 20.00. An Anesthetist is on duty for the 12 hours and has the clinical, therapeutic and decision-making responsibility regarding the discharge of patients, while nursing assistance is provided by 2 qualified professional nurses for shift, assisted by an auxiliary. In the first year of activity of the RR, a total of 11,626 surgical operations were carried out; of these 1,047 patients, equal to 9%, were assisted in the RR. The age of 51% of the patients was between 61 and 80 years; 53.3% belonged to the ASA 2 group and only 0.48% to the ASA 4 group. The operations were sub-divided as follows: 56.8% general, thoracic and vascular surgery, 15.3% urological, 10% orthopedic, 7.7% obstetrical and gynecological, 6.1% ENS, 3% stomatological, 1% others. 56.8% off the patients underwent general anesthesia, 30.5% combined anesthesia and 12.6% local-regional anesthesia. The time spent by the patients in RR was between 1 hour 30 minutes and 10 hours 45 minutes, with an average time of 3 hours 49 minutes. RESULTS: Of the 1,047 patients studied no case of cardio-respiratory arrest or death was recorded, while the complications encountered were: 13.15% cardio-circulatory, 3.62% respiratory, 3.62% PONV, 2.1% oliguria, 1.24% hypothermia, 0.48% disoriented patients, 0.38% hyperthermia and 0.38% shivering. In the area of cardio-circulatory complications encountered, the most important was arterial hypertension (5.6%), followed by cardiac arrhythmia, such as bradycardia (2.5%) and tachycardia (2.6%). CONCLUSIONS: The conclusion is drawn that correct administration in the early postoperative period is decisive for the final outcome of surgery and that the presence of RR contributes significantly to a reduction in the postoperative morbidity rate. Our case-series leads us, however, to reflect on an excellent organization of the opening hours of RR.
PURPOSE: To evaluate the effectiveness of short-acting anesthetic drugs and techniques to achieve recovery room bypass criteria after minor surgery in a community hospital environment. METHODS: After agreement by a multidisciplinary committee, a pilot project was undertaken to assess the usefulness of ultra- short acting anesthetic drugs and pre-emptive analgesia to facilitate rapid recovery from general anesthesia. A cohort of 100 ASA I-II patients aged 18-65 yr undergoing simple knee arthroscopy or minor peripheral orthopedic procedures was compared to a similar cohort treated in the three months prior to the study period. Outcomes of interest included patient morbidity, success in achieving post-anesthesia care unit (PACU) bypass criteria, impact upon nursing resources, duration of operating room (OR) and hospital stay, and pharmaceutical costs before and after implementation. RESULTS: No patient morbidity was demonstrated prior to discharge home, and successful PACU bypass occurred in 83% of cases. Achievement of PACU discharge criteria while in the OR did not prolong the OR time, and discharge from hospital occurred earlier in the patients who did not require PACU care (P=0.0006 all "fast-track cases" vs all "controls"). Nursing complaints were more numerous when the day surgery personnel did not normally participate in PACU care. The cost of anesthetic care was significantly more using ultra-short acting drugs (CDN $14.17 vs CDN $20.57), but closer adherence to protocol could reduce this differential (CDN $18.84). CONCLUSION: Not all patients who receive a general anesthetic require admission to a phase I recovery facility. However, the justification for use of more expensive pharmaceuticals to achieve PACU bypass requires extensive changes in operating systems and voluntary professional behaviours.
In a prospective, randomized study, we have investigated the effects of two arbitrary pulse oximeter lower alarm limit (LAL) settings (90% = group 90, n = 320 and 85% = group 85, n = 327) on the incidence of hypoxaemia in the recovery room. In group 90, we calculated the theoretical effect of elimination of transient episodes of low pulse oximeter oxyhaemoglobin saturation (SpO2) by introducing a time delay between the onset of the alarm condition and triggering of the alarm. When only hypoxaemic episodes lasting more than 1 min were included, SpO2 < or = 90% occurred in 11% of patients in group 90 and in 20% in group 85 (relative risk (RR) 1.84, confidence interval (CI) 1.26-2.69; P < 0.01). Hypoxaemia < or = 85% occurred in 2% of patients in group 90 and in 6% in group 85 (RR 3.10, CI 1.32-7.28; P < 0.01). In group 90, 1007 alarms (33% false) occurred, whereas in group 85, 395 alarms (28% false) occurred. Introducing a theoretical delay of 15 s in group 90 between crossing the alarm threshold and triggering the alarm would have reduced the number of alarms by 60%. The results of the study suggest that decreasing the alarm limit in an attempt to reduce frequent false alarms may lead to an increase in more relevant episodes of hypoxaemia and setting the LAL at 85% cannot be recommended routinely. Introducing a 15 s delay in group 90 would reduce the number of alarms by the same amount as changing the LAL from 90% to 85%.
UNLABELLED: According to Section 4 of the German maternity law (MuSchG), pregnant and nursing women are not allowed to work in places where they may be exposed to hazardous gases. Due to MuSchG these women are often effered work in the recovery room (RR) and the surgical intensive-care unit (ICU). The present study examined the occupational exposure in the RR and the ICU to nitrous oxide, isoflurane and the new volatile agents desflurane and sevoflurane in accordance with the German work place safety and maternity laws. METHODS: Trace concentrations of inhalational agents which 10 (ICU) and 207 (RR) patients exhaled after anaesthesia were measured in the RR air and the rooms of the ICU. Measurements were effected with a real-time infrared spectrometer continuously every 90 seconds for period of 6 (ICU) and 14.5 (RR) hours. RESULTS: The mean concentrations exceeded both in RR and ICU the legal limits of workplace concentrations prescribed by the German maternity law. Concentrations for both desflurane and seroflurane were up to more than twice as high as those of isoflurane. Exposition levels at the ICU and in the RR exceeded those measured in the operating theatre. The ICU personnel had a higher exposure to anaesthetic gases than those working in the RR. CONCLUSION: To reduce the working-place concentrations below the legal threshold it is necessary to use local scavenging devices in addition to appropriate ventilation systems. According to our data, pregnant and nursing women should not be allowed to work in the RR or to nurse mechanically ventilated patients after surgery in the ICU.
The article describes the nurse's role in the recovery room about assistance, educational, administrative and research areas. Those areas explored in our country to improve the assistance in perioperative period.
To establish whether continuous transcutaneous O2 and CO2 measurement in the recovery room is suitable for non-invasive monitoring of spontaneous respiration in patients newly operated upon, comparative transcutaneous and arterial pO2 and pCO2 investigations were carried out on 35 adults. There was a correlation coefficient of 0.66 between paO2 and tcpO2. The transcutaneous pO2 values measured were 45.3 mm Hg under the arterial values. When the transcutaneous CO2 values were compared with the arterial values, the correlation coefficient was 0.906. The mean transcutaneous pCO2 values measured lay around 0.7 mm Hg above the arterial values. On the basis of this slight deviation in CO2 values, the method appears to be suitable for continuous non-invasive determination of pCO2. The very large deviations in the O2 values indicate that transcutaneous measurement of oxygen partial pressure in this specific examination situation is not sufficiently reliable, which makes questionable the practice of using one piece of equipment for both measurements. In the clinical setting presented, transcutaneous O2 monitoring does not represent an alternative to close clinical observation and pulse oximetry.
Humidification, unlike nebulization, does not produce water droplets in the process of producing desiccated gases, and therefore is considered low risk in terms of potential infection sources. However, direct inoculation of bacteria into these units has been shown to produce contaminated effluents. Therefore, the present study was designed to determine if the airborne route of contamination was a potential source of bacterial inoculum for these units and to determine the maximum number of days units remained free of bacterial contamination. Disposable humidifiers were placed in both high and low volume patient areas of the recovery room. Units were used on multiple patients with only the cannula replaced between patients. Our results showed that these units do have the potential for becoming inoculated through the airborne route, but did not produce contaminated effluents greater than background air. Units remained sterile during the entire time in use in both high and low volume areas. In conclusion, our data suggests that each institution should evaluate the usage of disposable humidifiers based on patient parameters and environment rather than manufacturer's guidelines.
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To determine the impact of pulse oximeter monitoring on the incidence, severity and duration of hypoxaemia in the operating theatre (OT) and in the recovery room (RR), we investigated 200 patients in a randomized study. The extent of hypoxaemia in the OT was compared with that in the RR. Adult inpatients were allocated randomly to two groups: group I, pulse oximeter data and alarms "available"; group II, these data "unavailable" to the anaesthesia team and RR staff. Hypoxaemia was graded into four values of oxyhaemoglobin saturation (SpO2). The incidence of hypoxaemia was reduced significantly in group I in both OT and RR. In the OT, five patients in group II suffered SpO2 less than 76% compared with none in group I (P less than 0.02). In group II in the RR, seven patients suffered SpO2 less than 81%; three of these had SpO2 less than 76%. No patients in group I exhibited such small values of saturation. The smallest recorded SpO2 in the OT and the RR was significantly greater in group I. The cumulative duration of hypoxaemia was significantly less in group I in the RR, but not in the OT. The incidence and severity of hypoxaemia in the OT and in the RR were comparable, whereas the cumulative duration of hypoxaemia was significantly greater in the RR than in the OT. The occurrence of hypoxaemia in an individual patient in the OT significantly increased this patient's risk of suffering hypoxaemia in the RR. We conclude that the extent of hypoxaemia, especially in the RR, may be reduced significantly by pulse oximeter monitoring, but even with the information provided, some patients still develop hypoxaemia.
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Explore the source record for details and available documents.