The Impact of Routine Post-Anesthesia Care Unit Extubation for Pediatric Surgical Patients on Safety and Operating Room Efficiency

Author(s):  
Parisa Oviedo ◽  
Branden Engorn ◽  
Daniela Carvalho ◽  
Justin Hamrick ◽  
Brock Fisher ◽  
...  
BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
K. Sisa ◽  
S. Huoponen ◽  
O. Ettala ◽  
H. Antila ◽  
T. I. Saari ◽  
...  

Abstract Background Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols. Methods We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1–3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated. Results We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8–24) and 17 (8–25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups. Conclusion Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.


2017 ◽  
Vol 24 (7) ◽  
pp. S98
Author(s):  
J. Geynisman-Tan ◽  
O. Brown ◽  
K. Bochenska ◽  
A. Leader-Cramer ◽  
B. Dave ◽  
...  

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Mark Xiao ◽  
Alex Ciaramella ◽  
Jeremy Goldfarb ◽  
...  

Abstract Objective Deep extubation refers to endotracheal extubation performed while a patient is deeply anesthetized and without airway reflexes. After deep extubation, patients are sent to the post-anesthesia care unit (PACU) to recover, an area with notably different management and staffing than the operating room (OR). One of the most frequent and concerning complications to occur in the PACU is hypoxemia. As such, this study seeks to evaluate the incidence of desaturation, defined by SpO2 < 90% for longer than 10 s, in the PACU following deep extubation. Additionally, we hope to assess the consequence of desaturation on perioperative workflow by comparing PACU recovery times. Results Following deep extubation, 4.3% of patients (13/300) experienced desaturation in the PACU. Every episode was notably minor, with patients reverting to normal saturation levels within a minute. Of the 26 case factors assessed, 24 had no significant association desaturation in the PACU, including the amount of time spent in the PACU. History of asthma was the only statistically significant factor found to be positively associated with desaturation. We find that PACU desaturation episodes following deep extubation are rare. Our findings suggest that deep extubation is a viable and safe option for patients without significant respiratory tract pathology.


2013 ◽  
Vol 1 (2) ◽  
pp. 69-71
Author(s):  
Kelly T Peretich ◽  
Samir Saba ◽  
Heather Byrd

ABSTRACT This echo report describes a patient who developed cardiac temponade in the post-anesthesia care unit after laser lead extraction at electrophysiology laboratory. Diagnosis was readily established by transthoracic echocardiography and this lead to good outcome. Transthoracic ultrasound helps in preoperative evaluation of non-cardiac surgical patients and also postoperative care of hemodynamically unstable patients. This describes the importance of training and competence in transthoracic ultrasound for anesthesiologists. How to cite this article Peretich KT, Liu JC, Saba S, Byrd H, Subramaniam K. A Case of Delayed Cardiac Tamponade: Highlighting the Importance of Transthoracic Echocardiography Training for Anesthesiologists. J Perioper Echocardiogr 2013; 1(2):69-71.


2015 ◽  
Vol 31 (10) ◽  
pp. S217
Author(s):  
E.D. Percy ◽  
A.M. Yip ◽  
J.B. MacLeod ◽  
S. Lutchmedial ◽  
CD Brown ◽  
...  

2015 ◽  
Vol 30 (4) ◽  
pp. e3-e4
Author(s):  
Gloria Luu ◽  
Deborah Burgoon ◽  
Maria Caburnay ◽  
Alex Lozada ◽  
Sharlyn Navarro ◽  
...  

2020 ◽  
Author(s):  
Deepak Gupta ◽  
Matthew Ryan Tukel ◽  
Divya Mukhija ◽  
Edward Kaminski ◽  
Maria Markakis Zestos

Background: Some pediatric centers prefer to extubate their patients in the operating rooms (ORs) while others prefer post-anesthesia care units (PACUs) for the same. Objectives: To share our retrospective experience of 214 pediatric adenotonsillectomy (T&A) patients cohort extubated in our pediatric PACU during a seven-month retrospective study-period. Materials and Methods: After institutional board approval for retrospective chart review, institutional electronic surgical database was used to identify patients who underwent T&A and the peri-anesthetic records were obtained from patients electronic medical records and/or from hospital paper records. Results: Patients tracheas were extubated in average 11 minutes (standard deviation 8 minutes) after arrival to PACU care and only one patient required tracheal re-intubation. Patients were ready for discharge from PACU in average 56 minutes (standard deviation 20 minutes) thus averaging only 44 minutes (standard deviation 20 minutes) after their tracheas had been extubated. Conclusion: Summarily for re-validating or refuting our results, institutions can prospectively create PACU extubation quality improvement projects to discern if tracheal extubation in PACU of all or some pediatric surgical patients is beneficial when their rapid turnover surgeries warrant anesthesia providers to not attempt their tracheal extubation in ORs.


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