The effect of intraoperative dexmedetomidine administration on length of stay in the post-anesthesia care unit in ambulatory surgery: A hospital registry study

Circumcision is one of the most common urologic procedures performed at pediatric ambulatory centers. Emerging data on the short- and long-term effects of perioperative opioid administration has highlighted the importance of an opioid-free anesthetic regimen. We sought to evaluate the effectiveness of an opioid-free anesthetic in pediatric circumcision and its correlation with ambulatory surgery center efficiency. Patients, 3 years of age and younger, who underwent circumcision or circumcision revision by two surgeons pre and post introduction of an opioid-free anesthetic fast-track regimen at an outpatient surgical center were included. There were 100 patients included in this analysis, with 50 patients in each cohort. On univariate analysis, fast-tracking was associated with a decrease in median combined in-room and post-anesthesia care unit times (102.5 vs. 129.0 min, p-value < 0.001). This difference continued after multivariable analysis with an adjusted median combined in-room and post-anesthesia care unit time difference of −15.6 min (95% CI −34.2 to −12.7 min, p-value 0.018). In addition, the fast-track cohort received less intraoperative morphine equivalents without an increase in post-operative analgesic administration or change in postoperative questionnaire score. This demonstrates that opioid-free anesthesia may be used effectively in pediatric circumcision while also allowing for significant time savings for surgical centers.

Download Full-text

The effects of intraoperative brain activity monitoring on post-anesthesia care unit length of stay: A systematic review

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-201008341-00017 ◽

2010 ◽

Vol 8 (Supplement) ◽

pp. 1-10

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Brain Activity ◽

Unit Length ◽

Activity Monitoring ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Download Full-text

01: Post-anesthesia care unit length of stay and complications among same-day discharged laparoscopic hysterectomy patients

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.01.030 ◽

2019 ◽

Vol 220 (3) ◽

pp. S702

Author(s):

A. Rosenbaum ◽

K. Voltzke ◽

M. Louie ◽

L. Schiff ◽

E. Carey

Keyword(s):

Length Of Stay ◽

Unit Length ◽

Laparoscopic Hysterectomy ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Download Full-text

The effect of systemic lidocaine on post-operative opioid consumption in ambulatory surgical patients: a meta-analysis of randomized controlled trials

Perioperative Medicine ◽

10.1186/s13741-021-00181-9 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Danielle Lovett-Carter ◽

Mark C. Kendall ◽

James Park ◽

Anas Ibrahim-Hamdan ◽

Susannah Crepet ◽

...

Keyword(s):

Ambulatory Surgery ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Controlled Trials ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Weighted Mean ◽

Randomized Controlled ◽

Opioid Sparing ◽

Sparing Effect

Abstract Background Ambulatory surgical procedures continue to grow in relevance to perioperative medicine. Clinical studies have examined the use of systemic lidocaine as a component of multimodal analgesia in various surgeries with mixed results. A quantitative review of the opioid-sparing effects of systemic lidocaine in ambulatory surgery has not been investigated. The primary objective of this study was to systematically review the effectiveness of systemic lidocaine on postoperative analgesic outcomes in patients undergoing ambulatory surgery. Methods We performed a quantitative systematic review of randomized controlled trials in electronic databases (Cochrane Library, Embase, PubMed, and Google Scholar) from their inception through February 2019. Included trials investigated the effects of intraoperative systemic lidocaine on postoperative analgesic outcomes, time to hospital discharge, and adverse events. Methodological quality was evaluated using Cochrane Collaboration’s tool and the level of evidence was assessed using GRADE criteria. Data was combined in a meta-analysis using random-effects models. Results Five trials evaluating 297 patients were included in the analysis. The pooled effect of systemic lidocaine on postoperative opioid consumption at post-anesthesia care unit revealed a significant effect, weighted mean difference (95% CI) of − 4.23 (− 7.3 to 1.2, P = 0.007), and, at 24 h, weighted mean difference (95% CI) of − 1.91 (− 3.80 to − 0.03, P = 0.04) mg intravenous morphine equivalents. Postoperative pain control during both time intervals, postoperative nausea and vomiting reported at post anesthesia care unit, and time to hospital discharge were not different between groups. The incidence rate of self-limiting adverse events of the included studies is 0.007 (2/297). Conclusion Our results suggest that intraoperative systemic lidocaine as treatment for postoperative pain has a moderate opioid-sparing effect in post anesthesia care unit with limited effect at 24 h after ambulatory surgery. Moreover, the opioid-sparing effect did not impact the analgesia or the presence of nausea and vomiting immediately or 24 h after surgery. Clinical trials with larger sample sizes are necessary to further confirm the short-term analgesic benefit of systemic lidocaine following ambulatory surgery. Trial registration PROSPERO (CRD42019142229)

Download Full-text

Holding some postoperative patients overnight in the post-anesthesia care unit as a tactic to deal with hospital congestion is associated with increased resource length of stay

Perioperative Care and Operating Room Management ◽

10.1016/j.pcorm.2020.100111 ◽

2020 ◽

Vol 21 ◽

pp. 100111 ◽

Cited By ~ 1

Author(s):

Sara E. Nelson ◽

Warren S. Sandberg ◽

Jacob C. Clifton ◽

Yu Cui ◽

Matthew S. Shotwell ◽

...

Keyword(s):

Length Of Stay ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Download Full-text

Factors Affecting Post-Anesthesia Care Unit Length of Stay in Pediatric Patients after an Adenotonsillectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420931557 ◽

2020 ◽

Vol 129 (11) ◽

pp. 1071-1077

Author(s):

Dhivyaa Anandan ◽

Shilin Zhao ◽

Amy S. Whigham

Keyword(s):

Length Of Stay ◽

Pediatric Patients ◽

Statistical Significance ◽

Unit Length ◽

Medication Administration ◽

Dopamine Antagonists ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Family Presence ◽

Postoperative Administration

Objectives: (1) To identify clinical factors and perioperative practices that correlate with longer length of stay (LOS) in the post-anesthesia care unit (PACU) after adenotonsillectomy (T&A) in pediatric populations. (2) To understand the relationship between family presence and PACU LOS for pediatric patients after T&A. Methods: Pediatric patients (ages 3-17) who underwent T&A between February 2016 and December 2016 were retrospectively reviewed. Factors assessed for impact on PACU LOS included BMI, preoperative medications, intraoperative medications/narcotics, postoperative medications/narcotics, method of postoperative medication administration, and family presence in the PACU. Kruskal–Wallis and Spearman tests were used to assess correlations. Statistical significance was set a priori at P < .05. Results: Our cohort included 500 patients. Patients were in the PACU for an average of 135.4 minutes (±65.8). Subset analyses of the type of medications administered intra-operatively and in the PACU show that the intraoperative administration of sedatives is associated with increased LOS ( P = .014). Postoperative administration of any medications ( P < .001), and specifically, postoperative administration of narcotics ( P < .001), analgesics ( P = .043), antihistamines ( P < .001), and dopamine antagonists ( P = .011), are associated with increased LOS. Administration of PACU medications by IV was also correlated with shorter LOS compared to oral administration of PACU medications ( P = .016). A comparison of patients who received PACU medications to those who did not demonstrated that intraoperative administration of acetaminophen was associated with a reduced need for PACU medication administration ( P = .012). Shorter waiting times for family arrival in the PACU was also associated with shorter LOS ( P < .001). Conclusion: Our results suggest that postoperative medication administration and time until family arrival in the PACU are associated with significant differences in LOS. We also find that intraoperative administration of acetaminophen is correlated with reduced need for postoperative medication administration. Standardizing postoperative practices to minimize PACU LOS could result in a more efficient recovery for pediatric patients undergoing T&A.

Download Full-text