Journal articles on the topic 'Postanaesthetic care unit (PACU)'
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Son, Ilsoon, Chung-Sik Oh, Jae Won Choi, and Seong-Hyop Kim. "The Effect of Sufentanil Administration on Remifentanil-Based Anaesthesia during Laparoscopic Gynaecological Surgery: A Double-Blind Randomized Controlled Trial." Scientific World Journal 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/701329.
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This study assessed the effect of sufentanil administered before conclusion of remifentanil-based anaesthesia on postoperative hyperalgesia and haemodynamic stability in patients undergoing laparoscopic gynaecological surgery. The patients were randomly allocated to a sufentanil administration group (S group) or a normal saline administration group (C group). Anaesthesia was induced and maintained with controlled administration of remifentanil at 10 ng·mL−1and propofol under bispectral index guidance. Once the surgical specimen was procured, sufentanil or normal saline was administered at 0.15 ng·mL−1and maintained until extubation. The haemodynamic status during anaesthetic emergence was evaluated. The pain and postoperative nausea and vomiting (PONV) were assessed for 72 h following postanaesthetic care unit (PACU) discharge. The S group had significantly lower mean systemic arterial blood pressure and heart rate changes between the start of drug administration and extubation. Postoperative pain was significantly lower in the S group until 24 h following PACU discharge. There were no significant differences in PONV incidence and severity 72 h after PACU discharge between the two groups. Sufentanil administration before concluding remifentanil-based anaesthesia improved postoperative hyperalgesia and achieved haemodynamic stability at extubation without delaying recovery or increasing PONV during laparoscopic gynaecological surgery. Clinical trial registration is found atKCT0000785.
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Kang, Joo-Eun, Chung-Sik Oh, Jae Won Choi, Il Soon Son, and Seong-Hyop Kim. "Postoperative Pharyngolaryngeal Adverse Events with Laryngeal Mask Airway (LMA Supreme) in Laparoscopic Surgical Procedures with Cuff Pressure Limiting 25 cmH2O: Prospective, Blind, and Randomised Study." Scientific World Journal 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/709801.
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To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60 cmH2O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25 cmH2O, L group) and high (at 60 cmH2O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25 cmH2O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered withKCT0000334.
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Keller, Niklas, Götz Bosse, Belinda Memmert, Sascha Treskatsch, and Claudia Spies. "Improving quality of care in less than 1 min: a prospective intervention study on postoperative handovers to the ICU/PACU." BMJ Open Quality 9, no. 2 (June 2020): e000668. http://dx.doi.org/10.1136/bmjoq-2019-000668.
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PurposeStandardisation of the postoperative handover process via checklists, trainings or procedural changes has shown to be effective in reducing information loss. The clinical friction of implementing these measures has received little attention. We developed and evaluated a visual aid (VA) and >1 min in situ training intervention to improve the quality of postoperative handovers to the intensive care unit (ICU) and postoperative care unit.Materials and methodsThe VA was constructed and implemented via a brief (<1 min) training of anaesthesiologic staff during the operation. Ease of implementation was measured by amount of information transferred, handover duration and handover structure. 50 handovers were audio recorded before intervention and 50 after intervention. External validity was evaluated by blinded assessment of the recordings by experienced anaesthesiologists (n=10) on 10-point scales.ResultsThe brief intervention resulted in increased information transfer (9.0–14.8 items, t(98)=7.44, p<0.0001, Cohen’s d=1.59) and increased handover duration (81.3–192.8 s, t(98)=6.642, p=0.013, Cohen’s d=1.33) with no loss in structure (1.60–1.56, t(98)=0.173, p=0.43). Blinded assessment on 10-point scales by experienced anaesthesiologists showed improved overall handover quality from 7.1 to 7.8 (t(98)=1.89, p=0.031, Cohen’s d=0.21) and improved completeness of information (t(98)=2.42, p=0.009, Cohen’s d=0.28) from 7.3 to 8.3.ConclusionsAn intervention consisting of a simple VA and <1 min instructions significantly increased overall quality and amount of information transferred during ICU/postanaesthetic care unit handovers.
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Randmaa, Maria, Maria Engström, Christine Leo Swenne, and Gunilla Mårtensson. "The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses." BMJ Open 7, no. 8 (August 2017): e015038. http://dx.doi.org/10.1136/bmjopen-2016-015038.
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ObjectivesTo investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover.DesignA focus group interview study with a descriptive design using qualitative content analysis of transcripts.SettingOne anaesthetic clinic at two hospitals in Sweden.ParticipantsSix focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).ResultsPatterns and five categories emerged: (1) having different temporal foci during handover, (2) insecurity when information is transferred from one team to another, (3) striving to ensure quality of the handover, (4) weighing the advantages and disadvantages of the bedside handover and (5) having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient but also that it could threaten the patient's privacy and that frequent interruptions could be disturbing.ConclusionsThe present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimise the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision makers need to pay attention to the environment and infrastructure in postanaesthesia care.
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Stavrou, George, Stavros Panidis, John Tsouskas, Georgia Tsaousi, and Katerina Kotzampassi. "An Audit of Operating Room Time Utilization in a Teaching Hospital: Is There a Place for Improvement?" ISRN Surgery 2014 (March 13, 2014): 1–6. http://dx.doi.org/10.1155/2014/431740.
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Aim. To perform a thorough and step-by-step assessment of operating room (OR) time utilization, with a view to assess the efficacy of our practice and to identify areas of further improvement. Materials and Methods. We retrospectively analyzed the most ordinary general surgery procedures, in terms of five intervals of OR time utilization: anaesthesia induction, surgery preparation, duration of operation, recovery from anaesthesia, and transfer to postanaesthesia care unit (PACU) or intensive care unit (ICU). According to their surgical impact, the procedures were defined as minor, moderate, and major. Results. A total of 548 operations were analyzed. The mean (SD) time in minutes for anaesthesia induction was 19 (9), for surgery preparation 13 (8), for surgery 115 (64), for recovery from anaesthesia 12 (8), and for transfer to PACU/ICU 12 (9). The time spent in each step presented an ascending escalation pattern proportional to the surgical impact P=0.000, which was less pronounced in the transfer to PACU/ICU P=0.006. Conclusions. Albeit, our study was conducted in a teaching hospital, the recorded time estimates ranged within acceptable limits. Efficient OR time usage and outliers elimination could be accomplished by a better organized transfer personnel service, greater availability of anaesthesia providers, and interdisciplinary collaboration.
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Wu, Huanghui, Fei Yang, Ran Zhang, Haiyan Xue, Yongyong Yang, Ruizhe Liao, Min Li, et al. "Study protocol for a randomised controlled clinical trial comparing desflurane-based versus propofol-based anaesthesia on postanaesthesia respiratory depression in patients with obstructive sleep apnoea after major abdominal surgery." BMJ Open 11, no. 10 (October 2021): e051892. http://dx.doi.org/10.1136/bmjopen-2021-051892.
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IntroductionPatients with obstructive sleep apnoea (OSA) are more sensitive to postanaesthesia respiratory depression. Whether different anaesthetic regimens (intravenous-based or inhalational-based general anaesthesia) affect the postanaesthesia respiratory depression is controversial. Although desflurane has been reported that presents favourable rapid recovery profile in special patients including whom with OSA, the strong clinical evidence of the benefit on postanaesthesia respiratory depression is far from being revealed. This study aims to fill this knowledge gap by investigating the postanaesthesia respiratory depression in postanaesthesia care unit (PACU) in patients with OSA after major abdominal surgery, followed by desflurane-based anaesthesia compared with propofol-based anaesthesia.Methods and analysisEight hundred and fifty-four patients with OSA scheduled for elective major abdominal surgery will be randomly 1:1 assigned to desflurane-based (n=427) or propofol-based anaesthesia (n=427) using a computer-generated randomisation scheme with permuted block size maintained by a centralised randomisation centre. Patients will be assessed before and a consecutive 3 days after their surgery according to the standardised tasks. Demographic data as well as surgical and anaesthesia information will be collected for the duration of the procedure. Incidence of postanaesthesia respiratory depression in PACU as well as anaesthesia recovery, emergence delirium, postoperative nausea and vomiting, rescue analgesia, duration of PACU and hospital stay, and any other adverse events will be assessed at the given study time point. Investigators performing postoperative follow-up are not involved in both anaesthesia implementation and postoperative care.Ethics and disseminationThis study protocol has been approved by the ethics board at Xiang’an Hospital of Xiamen University (XAHLL2019003). The results of this study will be published in a peer-review journal and presented at national conferences as poster or oral presentations. Participants wishing to know the results of this study will be contacted directly on data publication.Trial registration numberChiCTR2000031087.
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Darvall, Jai, Britta Sylvia von Ungern-Sternberg, Sabine Braat, David Story, Andrew Davidson, Megan Allen, An Tran-Duy, Dana Middleton, and Kate Leslie. "Chewing gum to treat postoperative nausea and emesis in female patients (CHEWY): rationale and design for a multicentre randomised trial." BMJ Open 9, no. 6 (June 2019): e027505. http://dx.doi.org/10.1136/bmjopen-2018-027505.
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IntroductionPostoperative nausea, retching and vomiting (PONV) remains one of the most common side effects of general anaesthesia, contributing significantly to patient dissatisfaction, cost and complications. Chewing gum has potential as a novel, drug-free alternative treatment. We aim to conduct a large, definitive randomised controlled trial of the efficacy and safety of peppermint-flavoured chewing gum to treat PONV in the postanaesthesia care unit (PACU). If chewing gum is shown to be as effective as ondansetron, this trial has the potential to significantly improve outcomes for tens of millions of surgical patients around the world each year.Methods and analysisThis is a prospective, multicentre, randomised controlled non-inferiority trial. 272 female patients aged ≥12 years having volatile anaesthetic-based general anaesthesia for breast or laparoscopic surgery will be randomised. Patients experiencing nausea, retching or vomiting in PACU will be randomised to 15 min of chewing gum or 4 mg intravenous ondansetron. The primary outcome (complete response) is cessation of PONV within 2 hours of administration, with no recurrence nor rescue medication requirement for 2 hours after administration.Ethics and disseminationThe Chewy Trial has been approved by the Human Research Ethics Committees at all sites. Dissemination will be via international and national anaesthesia conferences, and publication in the peer-reviewed literature.Trial registration numberACTRN12618000429257; Pre-results.
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Olmos, Andrea V., Sasha Steen, Christy K. Boscardin, Joyce M. Chang, Genevieve Manahan, Anthony R. Little, Man-Cheung Lee, and Linda L. Liu. "Increasing the use of multimodal analgesia during adult surgery in a tertiary academic anaesthesia department." BMJ Open Quality 10, no. 3 (July 2021): e001320. http://dx.doi.org/10.1136/bmjoq-2020-001320.
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ObjectiveMultimodal analgesia pathways have been shown to reduce opioid use and side effects in surgical patients. A quality improvement initiative was implemented to increase the use of multimodal analgesia in adult patients presenting for general anaesthesia at an academic tertiary care centre. The aim of this study was to increase adoption of a perioperative multimodal analgesia protocol across a broad population of surgical patients. The use of multimodal analgesia was tracked as a process metric. Our primary outcome was opioid use normalised to oral morphine equivalents (OME) intraoperatively, in the postanaesthesia care unit (PACU), and 48 hours postoperatively. Pain scores and use of antiemetics were measured as balancing metrics.MethodsWe conducted a quality improvement study of a multimodal analgesia protocol implemented for adult (≥18 and≤70) non-transplant patients undergoing general anaesthesia (≥180 min). Components of multimodal analgesia were defined as (1) preoperative analgesic medication (acetaminophen, celecoxib, diclofenac, gabapentin), (2) regional anaesthesia (peripheral nerve block or catheter, epidural catheter or spinal) or (3) intraoperative analgesic medication (ketamine, ketorolac, lidocaine infusion, magnesium, acetaminophen, dexamethasone ≥8 mg, dexmedetomidine). We compared opioid use, pain scores and antiemetic use for patients 1 year before (baseline group—1 July 2018 to 30 June 2019) and 1 year after (implementation group—1 July 2019 to 30 June 2020) project implementation.ResultsUse of multimodal analgesia improved from 53.9% in the baseline group to 67.5% in the implementation group (p<0.001). There was no significant difference in intraoperative OME use before and after implementation (β0=44.0, β2=0.52, p=0.875). OME decreased after the project implementation in the PACU (β0=34.4, β2=−3.88, p<0.001) and 48 hours postoperatively (β0=184.9, β2=−22.59, p<0.001), while pain scores during those time points were similar.ConclusionA perioperative pragmatic multimodal analgesic intervention was associated with reduced OME use in the PACU and 48 hours postoperatively.
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Wang, Wei, Wan-You Yu, Jie Lv, Lian-Hua Chen, and Zhong Li. "Effect of creatine phosphate sodium on bispectral index and recovery quality during the general anaesthesia emergence period in elderly patients: A randomized, double-blind, placebo-controlled trial." Journal of International Medical Research 46, no. 3 (January 14, 2018): 1063–72. http://dx.doi.org/10.1177/0300060517744957.
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Objective To evaluate the effect of creatine phosphate sodium on bispectral index (BIS) and recovery quality during the general anaesthesia emergence period in elderly patients. Methods This randomized, double-blind, placebo-controlled study enrolled patients undergoing transabdominal cholecystectomy under general anaesthesia. Patients were randomly assigned to receive either creatine phosphate sodium (1.0 g/100 ml 0.9% saline; group P) or 100 ml 0.9% saline (group C) over 30 minutes during surgical incision. The BIS values were recorded at anaesthesia induction (T0), skin incision (T1), cutting the gallbladder (T2), suturing the peritoneum (T3), skin closure (T4), sputum suction (T5), extubation (T6) and 1 min (T7), 5 min (T8), 10 min (T9), and 15 min (T10) after extubation. The anaesthesia duration, operation time, waking time, extubation time, consciousness recovery time, time in the postanaesthesia care unit (PACU), and the Steward recovery scores at T7, T8, T9 and T10 were recorded. Results A total of 120 elderly patients were randomized equally to the two groups. Compared with group C, the BIS values were significantly higher in group P at T5, T6, T7 and T8; and the Steward recovery scores at T7 and T8 were significantly higher in group P. The waking time, extubation time, consciousness recovery time and time in the PACU were significantly shorter in group P compared with group C. Conclusion Creatine phosphate sodium administered during transabdominal cholecystectomy can improve BIS values and recovery following general anaesthesia in elderly patients.
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Huang, Congcong, Xiaoguang Zhang, Chaoxuan Dong, Chunwei Lian, Jun Li, and Lingzhi Yu. "Postoperative analgesic effects of the quadratus lumborum block III and transversalis fascia plane block in paediatric patients with developmental dysplasia of the hip undergoing open reduction surgeries: a double-blinded randomised controlled trial." BMJ Open 11, no. 2 (February 2021): e038992. http://dx.doi.org/10.1136/bmjopen-2020-038992.
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Objective To evaluate the analgesic effectiveness of two novel regional nerve blocks in paediatric patients with developmental dysplasia of the hip (DDH) after open reduction surgeries. Design Prospective, double-blinded, randomised controlled trial. Setting 2 tertiary teaching hospitals in China between August 2017 and July 2018. Participants 110 paediatric patients aged 2–10 years with DDH undergoing open reduction surgeries were recruited, 95 were randomised and 90 were included in the final analysis. Interventions Random assignment to quadratus lumborum block III (QLB III) group, transversalis fascia plane block (TFPB) group and the control (no region nerve block) group. Primary and secondary outcome measures The primary outcome was the Face, Legs, Activity, Cry and Consolability (FLACC) Scale Scores. Secondary outcomes included perioperative opioid consumption, the time until first press of nurse-controlled analgesia/patient-controlled analgesia (NCA/PCA) pump and the total counts number of pressing, length of postanaesthesia care unit (PACU) stay, length of hospital stay, parental satisfaction with pain management and adverse events. Results Mean FLACC Scores were significantly lower in QLB III group and TFPB group while in the PACU and for 48 hours postoperatively, compared with control group (p<0.0001, p<0.0001, respectively). No differences were found for FLACC Scores between QLB III group and TFPB group, neither at rest (p=0.0402) nor while posture changing (p=0.0306). TFPB prolonged the first-time request for NCA/PCA analgesia, and decreased the total number of pressing counts, compared with QLB III (22.5 (16.2 to 28.7) vs 11.7 (6.6 to 16.8), p<0.0001; 2.4 (1.3 to 3.6) vs 3.8 (2.8 to 4.8), p=0.0111, respectively). No patient experienced any adverse events. Conclusions We suggested that both ultrasound-guided QLB III and TFPB should be considered as an option for perioperative analgesia in children with DDH undergoing open reduction surgeries. TFPB was superior to the QLB III because it prolonged the first-time request for NCA/PCA analgesia and decreased the total counts number of pressing. Trial registration number NCT03189966/2017.
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Epp, Katharina, Uli Przybylski, Carla Luz, Marc Kriege, Eva Wittenmeier, Irene Schmidtmann, and Nina Pirlich. "Evaluation of gender differences in postoperative sore throat and hoarseness following the use of Ambu AuraGain laryngeal mask: the randomised controlled LadyLAMA trial study protocol." BMJ Open 12, no. 1 (January 2022): e056465. http://dx.doi.org/10.1136/bmjopen-2021-056465.
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IntroductionPostoperative sore throat (POST) is a comparatively minor but very common side effect of general anaesthesia with a supraglottic airway device. The patient considers these side effects a mirror of the quality of anaesthesia. The aims of this study are to evaluate gender-specific differences in the incidence of POST and to assess whether the effects of known risk factors vary between genders.Methods and analysisThe LadyLAMA trial is a single-centre, patient-blinded, randomised controlled trial. Consecutive patients requiring ophthalmological surgery under general anaesthesia with a second generation Ambu AuraGain laryngeal mask are randomly allocated to either cuff pressure of 45 cmH2O or cuff pressure of 60 cmH2O. We estimate the difference in POST between the genders at 20% and we hypothesised that a reduction of cuff pressure would reduce POST by 10%. A total of 800 patients will be recruited, with each subgroup including 200 patients to achieve 80% power for detecting a difference at the 5% significance level. Primary endpoints are gender differences in the incidence of POST within 24 hours postoperatively, as well as comparison of cuff pressure 45 cmH2O to 60 cmH2O with respect to POST. The main secondary objective is the effect of cuff pressure on POST stratified by gender. Further secondary endpoints are gender-specific differences in POST and hoarseness in postanaesthesia care unit (PACU) at 48 and 72 hours (or until freedom of discomfort). The parameter cuff pressure serves as key-secondary endpoint.Ethics and disseminationThe project is approved by the local ethics committee of the Medical Association of the Rhineland Palatine state (Nr. 2021-15835). The results of this study will be made available in the form of manuscripts for publication and presentations at national and international meetings.Trial registration numberNCT04915534.
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Cohen, Sheila E., Catherine L. Hamilton, Edward T. Riley, Dean S. Walker, Alex Macario, and Jerry W. Halpern. "Obstetric Postanesthesia Care Unit Stays." Anesthesiology 89, no. 6 (December 1, 1998): 1559–65. http://dx.doi.org/10.1097/00000542-199812000-00036.
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Background Obstetric patients may have long postanesthesia care unit (OB-PACU) stays after surgery because of residual regional block or other conditions. This study evaluated whether modified discharge criteria might allow for earlier discharge without compromising patient safety. Methods Data were prospectively collected for 6 months for all patients (N=358) who underwent cesarean section or tubal ligation and recovered in the OB-PACU. Regional anesthesia was used in 94% of patients. The duration of anesthesia and PACU stays, the presence and treatment of events in the PACU, and the regression of neural blockade were recorded. Discharge from the OB-PACU required a 60-min minimum stay, stable vital signs, adequate analgesia, and ability to flex the knees. After completion of prospective data collection, events that kept patients in the PACU after 60 min were reevaluated as to whether patients needed to stay in the PACU for medical reasons. "Needed to stay" events included bleeding, cardiorespiratory problems, sedation, dizziness, and pain. "Safe to leave" conditions included pruritus, nausea, and residual neural blockade. The cumulative duration of OB-PACU stays not clearly justifiable for medical reasons was calculated. Results Residual block and spinal opioid side effects accounted for the majority of "unnecessary" stays. Annually, 429 h of PACU time could have been saved using the revised criteria. Complications did not develop subsequently in any patient deemed "safe to leave." Conclusions In many obstetric patients, the duration of PACU stays could safely be shortened by continuing observation in a lower-acuity setting. This may result in greater flexibility and more efficient use of nursing personnel.
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Rose, D. Keith, Marsha M. Cohen, and Donald P. DeBoer. "Cardiovascular Events in the Postanesthesia Care Unit." Anesthesiology 84, no. 4 (April 1, 1996): 772–81. http://dx.doi.org/10.1097/00000542-199604000-00003.
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Background The purpose of this study was to determine the relationship of four postanesthesia care unit (PACU) cardiovascular events to long-term outcomes (unplanned critical care admission or mortality) and to evaluate the contribution of anesthetic management compared with other perioperative factors in predicting these events. Methods For patients admitted to the PACU after receiving general anesthesia (n = 18,380), the risk of long-term outcomes was examined for patients in the PACU with hypertension, tachycardia, bradycardia, or hypotension. Using logistic regression (P < 0.05), risk factors (grouped as patients, surgical, anesthetic, operating room observations, and other PACU observations) for each cardiovascular event were determined. For each factor grouping, the relative contributions to each cardiovascular event were compared using maximum likelihood chi-square analysis. Results Patients in the PACU with hypertension or tachycardia had more unplanned critical care admissions (2.6% and 4.0% vs. 0.2% for patients with no events) and greater mortality (1.9% and 2.3% vs. 0.3% and 0.4%) (P < 0.01). For PACU hypertension (rate 2.0%), age, smoking, renal disease, female gender, and angina were significant risk factors. For PACU tachycardia (0.9%), intraoperative tachycardia and dysrhythmia were the major contributors. Patient factors also increased the risk of bradycardia (2.5%); namely age, ASA physical status 1 or 2, and preoperative beta blocker therapy. For hypotension (2.2%), duration of surgery > 2 h, completion after 6 PM, and gynecologic intraabdominal procedures were significant risk factors. Compared to patient, surgical, intraoperative, or PACU observations, anesthetic factors studied (premedication, induction agent, ventilation, use of opioids) provided only a small contribution in predicting these events. Conclusions Hypertension and tachycardia in the PACU, although infrequent, are associated with increased risk of unplanned critical care admission and mortality. Patient, surgical, intraoperative, or PACU observations contribute more to cardiovascular events in the PACU than do differences in anesthetic management identified in this study.
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McNeillis, Melissa. "Care of the Neurosurgical Patient in the Post Anesthetic Care Unit." British Journal of Anaesthetic and Recovery Nursing 2, no. 3-4 (August 2001): 14–21. http://dx.doi.org/10.1017/s1742645600000656.
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In this care study I will explain the care that SVB received following his admission to the Post Anaesthetic Care unit (PACU) and summarise his discharge to the Intensive Care Unit (ICU). The limitations that this case report presents are that often the care received in the PACU can be quite short in terms of total length of stay in hospital. It is not uncommon that High Dependency patients are received for initial care into the PACU following surgery and to be further discharged and nursed in either a dedicated High Dependency Unit or to the Intensive Care Unit.
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Dexter, Franklin, and John H. Tinker. "Analysis of Strategies to Decrease Postanesthesia Care Unit Costs." Anesthesiology 82, no. 1 (January 1, 1995): 94–101. http://dx.doi.org/10.1097/00000542-199501000-00013.
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Background The goal of this study was to identify interventions that anesthesiologists can make to decrease total costs of a postanesthesia care unit (PACU). Methods Data were collected retrospectively from patients who underwent ambulatory surgery at our tertiary care center. Results Supplies and medications accounted for only 2% of PACU charges. Personnel costs, which depend on the peak number of patients in the PACU, accounted for almost all PACU costs. If nausea and vomiting could have been eliminated in each patient who suffered this complication, without causing sedation, the total time to discharge for all patients would have been decreased by less than 4.8% (95% confidence interval < 7.3%). Arrival rates to and times to discharge from the PACU followed triangular and log-normal distributions, respectively. Computer simulations, using published times to discharge for drugs with "faster recovery," such as propofol, showed that the use of these drugs would only decrease PACU costs if operating rooms were consistently scheduled to run later each day. Such earlier discharge also might be beneficial if used at night, but only if the PACU could close after a single patient leaves. However, reasonably achievable decreases in the times to discharge for all patients undergoing general anesthesia are unlikely to substantively decrease PACU costs. In contrast, arranging an operating room schedule to optimize admission rates would greatly affect the number of PACU nurses needed. Conclusions Anesthesiologists have little control over PACU economics via choice of anesthetic drugs. The major determinant of PACU costs is the distribution of admissions.
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Mendoza, Minerva R., Kristina Salcedo, and Kevin Motley. "Post Anesthesia Care Unit (PACU) Clock." Journal of PeriAnesthesia Nursing 29, no. 5 (October 2014): e27-e28. http://dx.doi.org/10.1016/j.jopan.2014.08.093.
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Odom-Forren, Jan. "The PACU as critical care unit." Journal of PeriAnesthesia Nursing 18, no. 6 (December 2003): 431–33. http://dx.doi.org/10.1016/j.jopan.2003.10.001.
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Macas, Andrius, Lina Andriuškevičiūtė, Jūratė Paltanavičiūtė, and Ieva Slauzgalvytė. "Sedation in the post-anaesthesia care unit." Acta medica Lituanica 19, no. 3 (October 1, 2012): 195–200. http://dx.doi.org/10.6001/actamedica.v19i3.2448.
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Background. Post-anaesthetic sedation is a common practice as it pro vides greater comfort and psychological stability for patients. Some spe cialists claim that sedation in the post-anaesthetic care unit (PACU) is applied too seldom due to several reasons. The goal of this study is to evaluate sedation in PACU in several aspects. Materials and methods. A total of 299 patients admitted to the PACU after general, orthopedic-traumatologic or urologic surgical procedures were enrolled in this prospective study. The patients evaluated their qual ity of sleep and the worst intensity of pain experienced in PACU, which was assessed using the Numerical Rating Scale. Nurses evaluated sedation using the Motor Activity Assessment Scale and filled in the questionnaire about the importance of sedation. Results. Statistically significant difference was observed in the quality of sleep between the patients sedated using benzodiazepines and opioids together and non-sedated patients (p = 0.025). There is no considerable difference in the statistics concerning the behavior of the patients. The patients prescribed only with opioids IV or IM, as well as the patients prescribed with opioids together with benzodiazepines, feel less intense pain compared to the non-sedated patients (p = 0.016, p = 0.03). Accord ing to the personnel, sedation is necessary in PACU. Half of them think that patients prescribed with opioids need additional sedation. Conclusions. Sedation is necessary in PACU. This fact is evident in the statistically significant difference of comfort factors among the patients as well as in the opinion of the nursing personnel that spend most of the time communicating and caring about the comfort of the patients.
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Sonneborn, Olivia, and Gill Robers. "Nurse-led extubation in the post-anaesthesia care unit." Journal of Perioperative Practice 28, no. 12 (July 31, 2018): 362–65. http://dx.doi.org/10.1177/1750458918793366.
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Weaning of mechanical ventilation occurs in intensive care units by nurses, which stimulates the prospect of nurse-led extubation extending into the PACU environment for improved patient outcomes and reduced demand of hospital resources. Nurse-led patient extubation in the PACU, would involve specially trained nurses weaning mechanical ventilation via an established protocol for a specific patient group, prior to the patient being extubated by an anaesthetist or intensivist.
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Yan, Yongxiang, Jianwei Luo, Liuming Pei, Jianfeng Zeng, Wenchan Yan, Dongni Xu, Shaoman Lin, Xiangbo Wu, Haixuan Zhao, and Sihua Liang. "Effect of a Care Bundle Combined with Continuous Positive Airway Pressure in the Postanesthesia Care Unit on Rapid Recovery after Pulmonary Tumor Resection." Journal of Healthcare Engineering 2021 (October 25, 2021): 1–7. http://dx.doi.org/10.1155/2021/5906855.
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Objective. To study the effect of a care bundle combined with continuous positive airway pressure (CPAP) in the postanesthesia care unit (PACU) on rapid recovery after pulmonary tumor resection. Methods. A total of 135 patients requiring anesthesia resuscitation after pulmonary tumor resection in our hospital from June 2020 to February 2021 were selected. They were randomly divided into three groups: the PACU experimental group, PACU control group, and operating room resuscitation (OR) group. Subsequently, their intraoperative clinical symptoms, parameters in monitoring postoperative respiratory status, and follow-up results were compared among the three groups. Results. The PACU experimental group had the highest number of right lesions, while the OR group had the highest intraoperative blood transfusion volume, urine volume, intraoperative colloid volume, intrapulmonary shunt, and intraoperative physician handover rate ( P < 0.05 ). Before surgery, serum potassium (K) in the PACU experimental group was significantly higher than that in the OR group but lower than that in the PACU control group ( P < 0.01 ). During the time in the PACU, blood partial pressure of oxygen (PO2) and oxygen index (OI) levels in the PACU experimental group were significantly higher than those in the other groups ( P < 0.01 ). After surgery, total PACU stay time, time from PACU to extubation, and stay after extubation were markedly reduced in the PACU experimental group ( P < 0.05 ). The highest number of patients with drainage was found in the PACU experimental group, while the highest number of patients without drainage was found in the PACU control group. Conclusion. A care bundle combined with CPAP in the PACU can improve the monitoring time of respiratory status and improve blood gas parameters, thus accelerating the postoperative rehabilitation process of patients undergoing pulmonary tumor resection.
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Curtis, William, Rajesh Sethi, and Thavarajah Visvanathan. "Airway obstruction in the postanaesthetic care unit of a tertiary care centre." European Journal of Anaesthesiology 32, no. 6 (June 2015): 444–46. http://dx.doi.org/10.1097/eja.0000000000000227.
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Anandan, Dhivyaa, Shilin Zhao, and Amy S. Whigham. "Factors Affecting Post-Anesthesia Care Unit Length of Stay in Pediatric Patients after an Adenotonsillectomy." Annals of Otology, Rhinology & Laryngology 129, no. 11 (June 2, 2020): 1071–77. http://dx.doi.org/10.1177/0003489420931557.
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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.
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Preston, Nick, and Maggie Gregory. "Patient recovery and post-anaesthesia care unit (PACU)." Anaesthesia & Intensive Care Medicine 13, no. 12 (December 2012): 591–93. http://dx.doi.org/10.1016/j.mpaic.2012.09.009.
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Cohen, Marsha M., Linda L. O'Brien-Pallas, Christine Copplestone, Ronald Wall, Joan Porter, and Keith D. Rose. "Nursing Workload Associated with Adverse Events in the Postanesthesia Care Unit." Anesthesiology 91, no. 6 (December 1, 1999): 1882. http://dx.doi.org/10.1097/00000542-199912000-00043.
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Background The authors used a nursing task inventory system to assess nursing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU). Methods Over 3 months, 2,031 patients were observed, and each task/activity related to direct patient care was recorded and assigned points according to the Project Research in Nursing (PRN) workload system. PRN values for each patient were merged with data from an anesthesia database containing demographics, anesthesia technique, and postoperative adverse events. Mean and median PRN points were determined by age, sex, duration of procedure, and mode of anesthesia for patients with and without adverse events in the PACU. Three theoretical models were developed to determine the effect of differing rates of adverse events on the requirements for nurses in the PACU. Results The median workload (PRN points) per patient was 31.0 (25th-75th percentile, 25-46). Median workload was 26 points for patients with no postoperative events and 155 for > or = six adverse events. Workload varied by type of postoperative event (e.g., unanticipated admission to the intensive care unit, median workload = 95; critical respiratory event = 54; and nausea/vomiting = 33). Monitored anesthesia care or general anesthesia with spontaneous ventilation used less resources compared with general anesthesia with mechanical ventilation. Modeling various scenarios (controlling for types of patients) showed that adverse events increased the number of nursing personnel required in the PACU. Conclusions Nursing care documentation based on requirements for individual patients demonstrates that the rate of postoperative adverse events affects the amount of nursing resources needed in the PACU.
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Smedley, Pat. "BARNA National Audit on Staffing in the Post Anaesthetic Care Unit – Results." British Journal of Anaesthetic and Recovery Nursing 13, no. 3-4 (August 2012): 48–57. http://dx.doi.org/10.1017/s1742645612000411.
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AbstractThis general audit on staffing the Post Anaesthetic Care Unit (PACU) was commissioned as a result of discussions around staffing held at two British Anaesthetic and Recovery Nurses Association (BARNA) Talks seminars in November 2009 and March 2010. Audit forms were sent to all BARNA members and made available on its website. One hundred audit forms were returned. The audit results clearly indicated that many problems exist in ensuring safe and appropriate staffing in the PACU at all times. The audit results highlighted the need for BARNA to take a lead in promoting information to inform PACU staff planning and to make this information freely available on its website.
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Ke, Yuhe, Sophia Chew, Edwin Seet, Wan Yi Wong, Vera Lim, Nelson Chua, Jinbin Zhang, et al. "Incidence and risk factors of delirium in post-anaesthesia care unit." Annals of the Academy of Medicine, Singapore 51, no. 2 (February 23, 2022): 87–95. http://dx.doi.org/10.47102/annals-acadmedsg.2021297.
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Introduction: Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery. Methods: Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30–60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC). Results: Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, P=0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, P=0.019), had estimated glomerular filtration rate (eGFR) of <60mL/min/1.73m2 (36.4% vs 10.6%, P=0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, P=0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, P=0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4–18] vs 4 days [range 2–8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis. Conclusion: PACU delirium is common in elderly patients with risks factors presenting for major surgery. Keywords: Geriatrics, major non-cardiac surgery, postoperative delirium
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Williams, Brian A., Michael L. Kentor, John P. Williams, Molly T. Vogt, Stacey V. DaPos, Christopher D. Harner, and Freddie H. Fu. "PACU Bypass after Outpatient Knee Surgery Is Associated with Fewer Unplanned Hospital Admissions but More Phase II Nursing Interventions." Anesthesiology 97, no. 4 (October 1, 2002): 981–88. http://dx.doi.org/10.1097/00000542-200210000-00034.
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Background The authors recently proposed a recovery scoring system for outpatients receiving regional anesthesia (RA) or general anesthesia (GA). This scoring system was designed to allow qualifying patients to be directly routed to the phase II (step-down) recovery unit instead of the traditional postanesthesia care unit (PACU). We report PACU bypass rates using these criteria, and the extent to which PACU bypass was associated with (1) required nursing interventions in the step-down recovery unit, and (2) successful same-day discharge. Methods Day-of-surgery outcomes were studied for 894 outpatients undergoing outpatient sports medicine surgery on the lower extremity. We determined PACU-bypass rates, nursing interventions in the step-down recovery unit for common symptoms, and unplanned hospital admissions. Using logistic regression, we analyzed step-down nursing interventions based on PACU requirement versus PACU bypass, and anesthesia techniques used (GA vs. not, peripheral nerve blocks vs. not). Results Eighty-seven percent (778/894) of all patients bypassed PACU. Of PACU-bypass patients, 241/778 (31%) required step-down nursing interventions. Of patients requiring PACU, only 19/116 (16%) required additional interventions in step-down (P < 0.001). PACU-bypass patients were almost three times more likely (odds ratio 2.9,P < 0.001) to require at least one nursing intervention in the step-down unit, when compared with patients requiring PACU. Fewer unplanned admissions were required by patients who bypassed PACU (odds ratio = 0.3,P = 0.007). Conclusions For outpatient lower extremity surgery, applying our PACU-bypass criteria led to an 87% PACU bypass rate with no reportable adverse events.
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Elsharydah, Ahmad, Daren R. Walters, Alwin Somasundaram, Trenton D. Bryson, Abu Minhajuddin, Rodney A. Gabriel, and Gaganpreet K. Grewal. "A preoperative predictive model for prolonged post-anaesthesia care unit stay after outpatient surgeries." Journal of Perioperative Practice 30, no. 4 (May 28, 2019): 91–96. http://dx.doi.org/10.1177/1750458919850377.
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Study objective To create a preoperative predictive model for prolonged post-anaesthesia care unit (PACU) stay for outpatient surgery and compare with an existing (University of California-San Diego, UCSD) model. Design Retrospective observational study. Setting Post-anaesthesia care unit. Patients: Outpatient surgical patients discharged on the same day in a large academic institution. Preoperative data were collected. The study period was three months in 2016. Measurements: Prolonged PACU stay defined as a length of stay longer than the third quartile. We utilized multivariate regression analyses and bootstrapping statistical techniques to create a predictive model for prolonged PACU stay. Main results: Four strong predictors for prolonged PACU stay: general anaesthesia, obstructive sleep apnoea, surgical specialty and scheduled case duration. Our model had an excellent discrimination performance and a good calibration. Conclusion We developed a predictive model for prolonged PACU stay in our institution. This model is different from the UCSD model probably secondary to local and regional differences in outpatient surgery practice. Therefore, individual practice study outcomes may not apply to other practices without careful consideration of these differences.
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Nagdeve, N., and Venkata K. Kada. "Quality of handover of patients to the postanaesthetic care unit staff." European Journal of Anaesthesiology 28 (June 2011): 214. http://dx.doi.org/10.1097/00003643-201106001-00692.
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Eskander, Jonathan P., Yury Rapoport, Elyse Cornett, Sonja Gennuso, Michael Franklin, Alan D. Kaye, and Charles J. Fox. "Does promethazine shorten the length of stay in the post anesthesia care unit?" Journal of Perioperative Practice 28, no. 7-8 (May 8, 2018): 194–98. http://dx.doi.org/10.1177/1750458918776548.
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The combination of promethazine and opioids is known to have an opioid-sparing effect, thereby facilitating a reduction in total patient opioid consumption. In recent years, this practice has fallen out of favor in many healthcare facilities, except primarily in the post anesthesia care unit (PACU). The goal of this study was to highlight the potential of promethazine as a direct or indirect adjuvant medication in acute pain management. The present investigation was undertaken with a case series of adult female patients who underwent open total abdominal hysterectomies. Data from the PACU was reviewed with patients being separated into two groups. Group 1 received only intravenous opioids for acute pain management. Group 2 received a combination of intravenous opioids for acute pain management and intravenous promethazine for nausea and/or vomiting. Patients were discharged from the PACU with a modified Aldrete score of 9 or 10. The study showed that patients who received promethazine in addition to opioids were discharged from the PACU an average of 19.2 minutes earlier than those patients who received only opioids (p=0.003). The time to achieve modified Aldrete score of 9 or higher was more quickly achieved when open abdominal hysterectomy patients received promethazine in addition to opioids in the PACU. The study concluded that promethazine, in combination with opioids, could potentially decrease PACU stay postoperatively. Based on the present investigation, the prospect of using promethazine in other facets of pain management are intriguing and warrant future studies. Specifically, it may be worth investigating whether promethazine is truly an adjunct in combination with opioids and to determine if there are any other antihistamines or neuroleptics which may have similar clinical effects to promethazine.
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Lara, Elena, Bonnie Shope, Zenaida Rodriguez, Bridgette Frison, and Rebecca Griffiths. "Creating an Extended Stay Unit Within the Perianesthesia Care Unit (PACU)." Journal of PeriAnesthesia Nursing 31, no. 4 (August 2016): e18. http://dx.doi.org/10.1016/j.jopan.2016.04.042.
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Schaub, Diane, and Elizabeth Rebello. "Value of phase II pathway in the ambulatory care setting." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 115. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.115.
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115 Background: The aim of the project was to decrease PACU (Post Anesthesia Care Unit) time by implementing a Phase II pathway for patients undergoing port-a-cath placement under Monitored Anesthesia Care in the Ambulatory Setting. Methods: The process improvement interventions were centered on eliminating unnecessary patient care processes and increasing patient flow and consisted of: patient and healthcare provider education, phase II unit utilizing existing bed space, revised charting template in the PACU. Queries of our AIMS database for port-a-cath cases performed between January 1, 2012 and February 28, 2013 (pre-intervention) and then between May 1, 2013 and May31, 2014 (post-intervention) were obtained. March 1, 2013 to May 1, 2013 was a transition period used to implement the process. Only cases performed under monitored anesthesia care were included. Cases with a PACU length of stay greater than 200 minutes were excluded from the study as these patients were no longer fast track. Descriptive statistics were used to summarize PACU length of stay pre/post-intervention. Scatter plots were used to show the variability in PACU length of stay and to illustrate the average trajectory of PACU length of stay over each time frame. A t-test was used to compare the average length of stay in the PACU, pre/post-intervention. Results: There were 917 pre-intervention cases and 362 post intervention cases. Trend of minutes spent in the PACU over time is illustrated (Figure 1). The average number of minutes in the PACU during the pre-intervention was 86.8. During the post-intervention, it was 67 minutes (Difference = 19.6 minutes; p-value < 0.001). Conclusions: As a result of implementing a phase II pathway for patients undergoing port-a-cath placement, there was a significant decrease in average time spent in the PACU. In addition, there was a decrease in the variation associated with PACU length of stay. The phase II pathway allowed a significant subgroup of this patient population to be less sedated after surgery and proceed directly to chemotherapy or their next scheduled appointment in the institution. Time and cost savings to the patient and the institution were additional benefits.
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Preston, Nick, and Maggie Gregory. "Patient recovery and the post-anaesthesia care unit (PACU)." Anaesthesia & Intensive Care Medicine 16, no. 9 (September 2015): 443–45. http://dx.doi.org/10.1016/j.mpaic.2015.06.015.
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Davidson, Marie, and Kerry Litchfield. "Patient recovery and the post-anaesthesia care unit (PACU)." Anaesthesia & Intensive Care Medicine 19, no. 9 (September 2018): 457–60. http://dx.doi.org/10.1016/j.mpaic.2018.06.002.
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Theuerkauf, Nils, Ulf Guenther, and Christian Putensen. "Postoperative delirium in the PACU and intensive care unit." Trends in Anaesthesia and Critical Care 2, no. 4 (August 2012): 148–55. http://dx.doi.org/10.1016/j.tacc.2012.03.002.
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Ramsingh, Davinder, Sumit Singh, Cecilia Canales, Elyse Guran, Zach Taylor, Zarah Antongiorgi, Maxime Cannesson, and Robert Martin. "The Evaluation Point-of-Care Ultrasound in the Post-Anesthesia Unit–A Multicenter Prospective Observational Study." Journal of Clinical Medicine 10, no. 11 (May 28, 2021): 2389. http://dx.doi.org/10.3390/jcm10112389.
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Introduction: Point-of-care ultrasound (POCUS) is the most rapidly growing imaging modality for acute care. Despite increased use, there is still wide variability and less evidence regarding its clinical utility for the perioperative setting compared to other acute care settings. This study sought to demonstrate the impact of POCUS examinations for acute hypoxia and hypotension occurring in the post-anesthesia care unit (PACU) versus traditional bedside examinations. Methods: This study was designed as a multi-center prospective observational study. Adult patients who experienced a reduced mean arterial blood pressure (MAP < 60mmHG) and/or a reduced oxygen saturation (SpO2 < 88%) in the PACU from 7AM to 4PM were targeted. POCUS was available or not for patient assessment based on PACU team training. All providers who performed POCUS exams received standardized training on cardiac and pulmonary POCUS. All POCUS exam findings were recorded on a standardized form and the number of suspected mechanisms to trigger the acute event were captured before and after the POCUS exam. PACU length of stay (minutes) across groups was the primary outcome. Results: In total, 128 patients were included in the study, with 92 patients receiving a POCUS exam. Comparison of PACU time between the POCUS group (median = 96.5 min) and no-POCUS groups (median = 120.5 min) demonstrated a reduction for the POCUS group, p = 0.019. Hospital length of stay and 30-day hospital readmission did not show a significant difference between groups. Finally, there was a reduction in the number of suspected diagnoses from before to after the POCUS examination for both pulmonary and cardiac exams, p-values < 0.001. Conclusions: Implementation of POCUS for assessment of acute hypotension and hypoxia in the PACU setting is associated with a reduced PACU length of stay and a reduction in suspected number of diagnoses.
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Murphy, Glenn S., Joseph W. Szokol, Jesse H. Marymont, Steven B. Greenberg, Michael J. Avram, Jeffery S. Vender, and Margarita Nisman. "Intraoperative Acceleromyographic Monitoring Reduces the Risk of Residual Meeting Abstracts and Adverse Respiratory Events in the Postanesthesia Care Unit." Anesthesiology 109, no. 3 (September 1, 2008): 389–98. http://dx.doi.org/10.1097/aln.0b013e318182af3b.
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Background Incomplete recovery from neuromuscular blockade in the postanesthesia care unit (PACU) may contribute to adverse postoperative respiratory events. This study determined the incidence and degree of residual neuromuscular blockade in patients randomized to conventional qualitative train-of-four (TOF) monitoring or quantitative acceleromyographic monitoring. The incidence of adverse respiratory events in the PACU was also evaluated. Methods One hundred eighty-five patients were randomized to intraoperative acceleromyographic monitoring (acceleromyography group) or qualitative TOF monitoring (TOF group). Anesthetic management was standardized. TOF patients were extubated when standard criteria were met and no fade was observed during TOF stimulation. Acceleromyography patients had a TOF ratio of greater than 0.80 as an additional extubation criterion. Upon arrival in the PACU, TOF ratios of both groups were measured with acceleromyography. Adverse respiratory events during transport to the PACU and during the first 30 min of PACU admission were also recorded. Results A lower frequency of residual neuromuscular blockade in the PACU (TOF ratio < or = 0.9) was observed in the acceleromyography group (4.5%) compared with the conventional TOF group (30.0%; P < 0.0001). During transport to the PACU, fewer acceleromyography patients developed arterial oxygen saturation values, measured by pulse oximetry, of less than 90% (0%) or airway obstruction (0%) compared with TOF patients (21.1% and 11.1%, respectively; P < 0.002). The incidence, severity, and duration of hypoxemic events during the first 30 min of PACU admission were less in the acceleromyography group (all P < 0.0001). Conclusions Incomplete neuromuscular recovery can be minimized with acceleromyographic monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intraoperative acceleromyography use.
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Hiller, Kenneth N., Alfonso V. Altamirano, Chunyan Cai, Stephanie F. Tran, and George W. Williams. "Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone." Anesthesiology Research and Practice 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/354184.
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Potential health hazards from waste anesthetic gases (WAGs) have been a concern since the introduction of inhalational anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaled WAG from the patient breathing zone was measured 8 inches from the patient’s mouth in the PACU. Maximum sevoflurane WAG levels in the patient breathing zone exceeded National Institute for Occupational Safety and Health (NIOSH) RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of anesthetic exposure. This study demonstrated that clinically relevant inhalational anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure.
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Stocki, Daniel, Conor McDonnell, Gail Wong, Gloria Kotzer, Kelly Shackell, and Fiona Campbell. "Knowledge translation and process improvement interventions increased pain assessment documentation in a large quaternary paediatric post-anaesthesia care unit." BMJ Open Quality 7, no. 3 (August 2018): e000319. http://dx.doi.org/10.1136/bmjoq-2018-000319.
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BackgroundDue to inadequate pain assessment documentation in our paediatric post-anaesthetic care unit (PACU), we were unable to monitor pain intensity, and target factors contributing to moderate and severe postoperative pain in children. The purpose of this study was to improve pain assessment documentation in PACU through a process improvement intervention and knowledge translation (KT) strategy. The study was set in a PACU within a large university affiliated paediatric hospital. Participants included PACU and Acute Pain Service nursing staff, administrative staff and anaesthesiologists.MethodsThe Plan–Do–Study-Act method of quality improvement was used. Benchmark data were obtained by chart review of 99 patient medical records prior to interventions. Data included pain assessment documentation (pain intensity score, use of validated pain intensity measure) during PACU stay. Repeat chart audit took place at 4, 5 and 6 months after the intervention.InterventionKey informant interviews were conducted to identify barriers to pain assessment documentation. A process improvement was implemented whereby the PACU flowsheets were modified to facilitate pain assessment documentation. KT strategy was implemented to increase awareness of pain assessment documentation and to provide the knowledge, skill and judgement to support this practice. The KT strategy was directed at PACU nursing staff and comprised education outreach (educational meetings for PACU nurses, discussions at daily huddles), reminders (screensavers, bedside posters, email reminders) and feedback of audit results.ResultsThe proportion of charts that included at least one documented pain assessment was 69%. After intervention, pain assessment documentation increased to >90% at 4 and 5 months, respectively, and to 100% after 6 months.ConclusionAfter implementing process improvement and KT interventions, pain assessment documentation improved. Additional work is needed in several key areas, specifically monitoring moderate to severe pain, in order to target factors contributing to significant postoperative pain in children.
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Aasvang, Eske Kvanner, Christoffer Calov Jørgensen, Mogens Berg Laursen, Jacob Madsen, Søren Solgaard, Mogens Krøigaard, Per Kjærsgaard-Andersen, et al. "Safety Aspects of Postanesthesia Care Unit Discharge without Motor Function Assessment after Spinal Anesthesia." Anesthesiology 126, no. 6 (June 1, 2017): 1043–52. http://dx.doi.org/10.1097/aln.0000000000001629.
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Abstract Background Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to significantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations. Methods A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. The primary outcome was frequency of a successful fast-track course (length of stay 4 days or less and no 30-day readmission). Noninferiority would be declared if the odds ratio (OR) for a successful fast-track course was no worse for those patients receiving no motor function assessment versus those patients receiving motor function assessment by OR = 0.68. Results A total of 1,359 patients (98.8% follow-up) were available for analysis (93% American Society of Anesthesiologists class 1 to 2). The primary outcome occurred in 92.2% and 92.0%, corresponding to no motor function assessment being noninferior to motor function assessment with OR 0.97 (95% CI, 0.70 to 1.35). Adverse events in the ward during the first 24 h occurred in 5.8% versus 7.4% with or without motor function assessment, respectively (OR, 0.77; 95% CI, 0.5 to 1.19, P = 0.24). Conclusions PACU discharge without assessment of lower limb motor function after spinal anesthesia for total hip or knee arthroplasty was noninferior to motor function assessment in achieving length of stay 4 days or less or 30-day readmissions. Because a nonsignificant tendency toward increased adverse events during the first 24 h in the ward was discovered, further safety data are needed in patients without assessment of lower limb motor function before PACU discharge.
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Kampan, Somphorn. "Air Quality and Employee Hygiene-related Behavior in a Post Anesthesia Care Unit in Thailand." Open Nursing Journal 13, no. 1 (April 30, 2019): 100–107. http://dx.doi.org/10.2174/1874434601913010100.
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Background: Airborne contaminants in Postanesthesia Care Units (PACUs) such as bacteria, fungi, and waste anesthetic gases pose serious, and sometimes fatal, risks to both patients and PACU workers. Numerous studies have linked long-term exposure to nitrous oxide and halogenated agents to, among other things, reproductive problems in PACU nurses and anesthesiologists. Microorganism contamination can result in a post-surgical complication, to which patients with diabetes and other respiratory diseases are especially vulnerable. Various researchers and governmental agencies have recommended hospitals take steps to reduce levels of airborne contaminants in PACUs. In particular, hazard communication programs are recommended to inform and train staff on relevant occupational health and safety procedures. Additionally, and perhaps more importantly, experts recommend hospitals install specialized ventilation systems to maintain low levels of airborne pollutants. Objective: This study has two main parts: (1) measurement of airborne contaminants in the PACU at Rajavithi Hospital in Bangkok, Thailand; and (2) assessment of PACU workers’ perceived level of importance regarding occupational health and safety protocols, via self-reporting survey. The study also has two main objectives: (1) to determine whether, and to what extent, a new ventilation system helps reduce airborne contaminants in the PACU; and (2) to discover whether an informational campaign increases perceived importance of health and safety procedures among PACU workers (i.e. handwashing, changing shoes, wearing proper facemasks). Methods: Surveys and air quality measurements were collected two times – in July 2016 and April 2017 – before and after Rajavithi Hospital implemented a hazard communication program consisting of training, posters, brochures, and informational media. Survey participants included all 64 PACU workers – 61 nurses and 3 anesthetists. Air sampling measured levels of bacteria, fungi, nitrous oxide, and desflurane. Results: Initial levels of airborne microorganisms were very high (1307CFU/m3 for bacteria and 70.4 CFU/m3 for fungi) and on the high end of normal for nitrous oxide (21.86ppm). Following the informational campaign and installation of the ventilation system, levels of bacterial contamination fell to 182 CFU/m3, and fungi fell to 35.8 CFU/m3. Simultaneously, workers’ levels of perceived importance for health and safety procedures increased. Conclusion: Both aspects of the study were successful, however, concentration of airborne microorganisms still exceeded recommended limits at the end of the study. Hospital administration and staff are encouraged to continue training and informing workers while assessing ventilation system until contamination levels fall to within internationally acceptable ranges.
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Budelier, Thaddeus P., Christopher Ryan King, Shreya Goswami, Anchal Bansal, Stephen H. Gregory, Troy S. Wildes, Joanna Abraham, et al. "Protocol for a proof-of-concept observational study evaluating the potential utility and acceptability of a telemedicine solution for the post-anesthesia care unit." F1000Research 9 (October 20, 2020): 1261. http://dx.doi.org/10.12688/f1000research.26794.1.
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Introduction: The post-anesthesia care unit (PACU) is a clinical area designated for patients recovering from invasive procedures. There are typically several geographically dispersed PACUs within hospitals. Patients in the PACU can be unstable and at risk for complications. However, clinician coverage and patient monitoring in PACUs is not well regulated and might be sub-optimal. We hypothesize that a telemedicine center for the PACU can improve key PACU functions. Objectives: The objective of this study is to demonstrate the potential utility and acceptability of a telemedicine center to complement the key functions of the PACU. These include participation in hand-off activities to and from the PACU, detection of physiological derangements, identification of symptoms requiring treatment, recognition of situations requiring emergency medical intervention, and determination of patient readiness for PACU discharge. Methods and analysis: This will be a single center prospective before-and-after proof-of-concept study. Adults (18 years and older) undergoing elective surgery and recovering in two selected PACU bays will be enrolled. During the initial three-month observation phase, clinicians in the telemedicine center will not communicate with clinicians in the PACU, unless there is a specific patient safety concern. During the subsequent three-month interaction phase, clinicians in the telemedicine center will provide structured decision support to PACU clinicians. The primary outcome will be time to PACU discharge readiness determination in the two study phases. The attitudes of key stakeholders towards the telemedicine center will be assessed. Other outcomes will include detection of physiological derangements, complications, adverse symptoms requiring treatments, and emergencies requiring medical intervention. Registration: This trial is registered on clinicaltrials.gov, NCT04020887 (16th July 2019).
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Braz, José Reinaldo Cerqueira, Lais Helena Camacho Navarro, Ieda Harumi Takata, and Paulo Nascimento Júnior. "Endotracheal tube cuff pressure: need for precise measurement." Sao Paulo Medical Journal 117, no. 6 (November 4, 1999): 243–47. http://dx.doi.org/10.1590/s1516-31801999000600004.
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CONTEXT: High compliance endotracheal tubes cuffs are used to prevent gas leak and also pulmonary aspiration in mechanically ventilated patients. However, the use of the usual cuff inflation volumes may cause tracheal damage. OBJECTIVE: We tested the hypothesis that endotracheal tube cuff pressures are routinely high (above 40 cmH2O) in the Post Anesthesia Care Unit (PACU) or Intensive Care Units (ICU). DESIGN: Cross-sectional study. SETTING: Post anesthesia care unit and intensive care unit. PARTICIPANTS: We measured endotracheal tubes cuff pressure in 85 adult patients, as follows: G1 (n = 31) patients from the ICU; G2 (n = 32) patients from the PACU, after anesthesia with nitrous oxide; G3 (n = 22) patients from the PACU, after anesthesia without nitrous oxide. Intracuff pressure was measured using a manometer (Mallinckrodt, USA). Gas was removed as necessary to adjust cuff pressure to 30 cmH2O. MAIN MEASUREMENTS: Endotracheal tube cuff pressure. RESULTS: High cuff pressure (> 40 cmH2O) was observed in 90.6% patients of G2, 54.8% of G1 and 45.4% of G3 (P < 0.001). The volume removed from the cuff in G2 was higher than G3 (P < 0.05). CONCLUSION: Endotracheal tubes cuff pressures in ICU and PACU are routinely high and significant higher when nitrous oxide is used. Endotracheal tubes cuff pressure should be routinely measured to minimize tracheal trauma.
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Yeung, Karin, Jonas Peter Eiberg, Henrik Kehlet, and Eske Kvanner Aasvang. "Acute complications in the post-anaesthesia care unit after infrainguinal surgery for lower limb ischaemia – a prospective observational cohort study." Vasa 48, no. 1 (January 1, 2019): 89–97. http://dx.doi.org/10.1024/0301-1526/a000745.
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Abstract. Background: Arterial surgery for lower limb ischaemia is a frequently performed procedure in patients with severe cardio-pulmonary comorbidities, making them high-risk patients for acute postoperative complications with a need for prolonged stay in the post-anaesthesia care unit (PACU). However, detailed information on complications during the PACU stay is limited, hindering mechanism-based interventions for early enhanced recovery. Thus, we aimed to systematically describe acute complications and related risk factors in the immediate postoperative phase after infrainguinal arterial surgery. Patients and methods: Patients transferred to the PACU after infrainguinal arterial surgery due to chronic or acute lower limb ischaemia were consecutively included in a six-month observational cohort study. Pre- and intraoperative data included comorbidities as well as surgical and anaesthetic technique. Data on complications and treatments in the PACU were collected every 15 minutes using a standardised assessment tool. The primary endpoint was occurrence of predefined moderate or severe complications occurring during PACU stay. Results: In total, 155 patients were included for analysis. Eighty (52 %) patients experienced episodes with oxygen desaturation (< 85 %) and moderate or severe pain occurred in 72 patients (47 %); however, circulatory complications (hypotension, tachycardia) were rare. Preoperative opioid use was a significant risk factor for moderate or severe pain in PACU (59 vs. 38 % chronic vs. opioid naïve patients (P = 0.01). Conclusions: Complications in the PACU after infrainguinal arterial surgery relates to saturation and pain, suggesting that future efforts should focus on anaesthesia and analgesic techniques including opioid sparing regimes to enhance early postoperative recovery.
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Thomas, Lini, Joey Yap, Shirley Sabarre, and Dawn Sullivan. "Eliminating Specimen Labeling Errors in Post Anesthesia Care Unit (PACU)." Journal of PeriAnesthesia Nursing 32, no. 4 (August 2017): e53. http://dx.doi.org/10.1016/j.jopan.2017.06.032.
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DeWitt, Lori A., and Nancy M. Albert. "Preferences for Visitation in the Post Anesthesia Care Unit (PACU)." Journal of PeriAnesthesia Nursing 24, no. 3 (June 2009): e1. http://dx.doi.org/10.1016/j.jopan.2009.05.005.
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DeWitt, Lori A., and Nancy M. Albert. "Preferences for Visitation in the Post Anesthesia Care Unit (PACU)." Journal of PeriAnesthesia Nursing 24, no. 3 (June 2009): e12. http://dx.doi.org/10.1016/j.jopan.2009.05.048.
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Dee, Jonathan F. "Case Study of a Patient with Acute on Chronic Pain Following Total Abdominal Hysterectomy." British Journal of Anaesthetic and Recovery Nursing 12, no. 3-4 (August 2011): 57–63. http://dx.doi.org/10.1017/s1742645612000125.
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AbstractThe aim of this case study is to critically explore the holistic care of a patient who requires pain management in the Post Anaesthetic Care Unit (PACU). The development of chronic pain can have a significant psychological impact as well as a debilitating physical effect. The article examines pain assessment tools used in the PACU as well as barriers to their implementation. Finally, both pharmacological and non-pharmacological holistic care interventions are examined.
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Aldwikat, Rami K., Elizabeth Manias, Alex Holmes, Emily Tomlinson, and Patricia Nicholson. "Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study." International Journal of Environmental Research and Public Health 19, no. 23 (November 30, 2022): 16020. http://dx.doi.org/10.3390/ijerph192316020.
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(1) Background: Delirium is a common complication among surgical patients after major surgery, but it is often underdiagnosed in the post-anaesthetic care unit (PACU). Valid and reliable tools are required for improving diagnoses of delirium. The objective of this study was to evaluate the diagnostic test accuracy of the Three-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and the 4A’s Test (4AT) as screening tools for detection of delirium in older people in the PACU. (2) Methods: A prospective diagnostic test accuracy study was conducted in the PACU and surgical wards of a university-affiliated tertiary care hospital in Victoria, Australia. A consecutive prospective cohort of elective and emergency patients (aged 65 years or older) admitted to the PACU were recruited between July 2021 and December 2021 following a surgical procedure performed under general anaesthesia and expected to stay in the hospital for at least 24 h following surgery. The outcome measures were sensitivity, specificity positive predictive value and negative predictive value for 3D-CAM and 4AT. (3) Results: A total of 271 patients were recruited: 16.2% (44/271) had definite delirium. For a diagnosis of definite delirium, the 3D-CAM (area under curve (AUC) = 0.96) had a sensitivity of 100% (95% CI 92.0 to 100.0) in the PACU and during the first 5 days post-operatively. Specificity ranged from 93% (95% CI 87.8 to 95.2) to 91% (95% CI 85.9 to 95.2) in the PACU and during the first 5 days post-operatively. The 4AT (AUC = 0.92) had a sensitivity of 93% (95% CI 81.7 to 98.6) in the PACU and during the first 5 days post-operatively, and specificity ranged from 89% (95% CI 84.6 to 93.1) to 87% (95%CI 80.9 to 91.8) in the PACU and during the first 5 days post-operatively. (4) Conclusions: The 3D-CAM and the 4AT are sensitive and specific screening tools that can be used to detect delirium in older people in the PACU. Screening with either tool could have an important clinical impact by improving the accuracy of delirium detection in the PACU and hence preventing adverse outcomes associated with delirium.
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Peskett, M. J. "Clinical indicators and other complications in the recovery room or postanaesthetic care unit." Anaesthesia 54, no. 12 (December 1999): 1143–49. http://dx.doi.org/10.1046/j.1365-2044.1999.01077.x.
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