Prolonged-Stay Patients in the PACU: A Review of the Literature

Lalani, Sharifa Bashir; Ali, Fauziya; Kanji, Zeenatkhanu

doi:10.1016/j.jopan.2012.06.009

Cited by 48 publications

(40 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The lynchpin of this system is the Postanesthesia Care Unit (PACU) where patients undergo immediate recovery from anesthesia (Phase I recovery) prior to discharge to ambulatory settings, postoperative wards, and advanced monitoring wards (Phase II recovery). When patient volume surpasses PACU capacity, a bottleneck of patient flow is created delaying discharge from the operating room [ 2 ]. Slow anesthetic emergence, excessive respiratory depression, and postoperative nausea and vomiting (PONV) can prolong PACU stays [ 2 - 4 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of changes in intraoperative management on recovery from anesthesia: a review of practice improvement initiative

et al. 2015

View full text Add to dashboard Cite

BackgroundOur anesthetic practice was hindered by inadequate postanesthesia care unit space resulting in operating room inefficiencies. In response, an anesthetic protocol designed to reduce the duration of postanesthesia stay by decreasing residual anesthetic sedation and postoperative nausea and vomiting (PONV) was introduced. Here the impact of this practice change is analyzed.MethodsThe protocol encouraged desflurane use instead of isoflurane, triple antiemetic prophylaxis, and discouraged midazolam. Records of patients undergoing general anesthesia from calendar-matched epochs were reviewed. Epoch I included a 6-month period prior to implementation of the practice change (October 1, 2009, to March 31, 2010) and Epoch II included 6 months following the practice change (October 1, 2010, to March 31, 2011).ResultsGeneral anesthesia was administered to 2,936 and 3,137 patients during Epochs I and II, respectively. Midazolam decreased from 57.4% to 24.0%, isoflurane from 50.8% to 5.7%, desflurane increased from 25.6% to 77.0%, and antiemetic prophylaxis from 6.5% to 50.8%. Median [IQR] recovery time decreased from 72 [50, 102] to 62 [44, 90] minutes, P <0.001. Supplemental analyses found antiemetic prophylaxis was associated with PONV reduction (OR = 0.47, 95% CI 0.38 –0.58, P < 0.001). When compared to isoflurane, desflurane was associated with a decreased rate of respiratory depression (OR = 0.72, 95% CI 0.55-0.93, P = 0.013). Patients administered midazolam trended towards higher rate of respiratory depression (OR = 1.27, 95% CI 1.00–1.60, P = 0.050).ConclusionsIntroduction of an anesthetic protocol that was designed to attenuate adverse anesthetic effects was associated with a reduction of anesthetic recovery time.

show abstract

Section: Introductionmentioning

confidence: 99%

Effects of changes in intraoperative management on recovery from anesthesia: a review of practice improvement initiative

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The second aim of the study was to determine if pain and PONV on arrival correlate with the length of stay in our PACU. It is important to early identify patients at risk for unplanned, prolonged PACU stay for optimal perioperative efficiency [ 5 ]. If the PACU becomes congested by these patients, the outflow of patients from the PACU to the ward is stopped and the unit cannot receive any further patients from the operating room (OR).…”

Section: Introductionmentioning

confidence: 99%

The length of stay in the post-anaesthesia care unit correlates with pain intensity, nausea and vomiting on arrival

et al. 2014

View full text Add to dashboard Cite

BackgroundThe benefit of the post-anaesthesia care unit (PACU) with respect to an early detection of postoperative complications is beyond dispute. From a patient perspective, prevention and optimal management of pain, nausea and vomiting (PONV) are also of utmost importance. The aims of the study were therefore to prospectively measure pain and PONV on arrival to the PACU and before discharge and to determine the relationship of pain and PONV to the length of stay in the PACU.MethodsPostoperative pain was assessed over 30 months using a numeric rating scale on admittance to the PACU and before discharge; in addition, PONV was recorded. Statistical analysis was done considering gender, age, American Society of Anesthesiologists (ASA) classification, surgical speciality, anaesthesia technique, duration of anaesthesia, intensity of nursing and length of stay.ResultsData of 12,179 patients were available for analysis. The average length of stay in the PACU was 5.7 ± 5.9 h, whereas regular PACU patients stayed for 3.2 ± 1.9 h and more complex IMC patients stayed for 15.1 ± 6.0 h. On admittance, 27% of patients were in pain and the number decreased to 13% before discharge; 3% experienced PONV. Risk factors for increased pain determined by multivariate analysis were female gender; higher ASA classification; general, cardiac and orthopaedic surgery and prolonged case duration. In more complex IMC patients, pain scores were higher on arrival but dropped to similar levels before discharge compared to regular PACU patients. Female gender and postoperative pain were risk factors for postoperative vomiting. Pain and PONV on arrival correlated with length of stay in the PACU. Pain- or PONV-free patients stayed almost half of the time in the PACU compared to patients with severe pain or vomiting on arrival.ConclusionsThe majority of PACU patients had good pain control, both on admittance and before discharge, and the overall incidence of PONV was low. Managing patients in the PACU could achieve a significant reduction of pain and PONV. The level of pain and presence of PONV on admittance to the PACU correlate with and act as predictors for increased length of PACU stay.

show abstract

“…It is known that stays longer than 2 hr in the PACU put a burden on the nursing staff, because the time of postoperative recovery is marked by intense evaluation in relation to various problems such as haemodynamic control and postoperative care actions related to the presence of nausea, vomiting, bleeding and pain, which require constant nursing attention (Lalani, Ali, & Kanji, ).…”

Section: Discussionmentioning

confidence: 99%

The effect of intraoperative hypothermia upon blood transfusion needs and length of stay among gastrointestinal system cancer surgery

Poveda

Nascimento

2017

Eur J Cancer Care

View full text Add to dashboard Cite

This cross-sectional study was performed to evaluate the relationship between intraoperative body temperature and the need for blood transfusion and length of stay in the post-anaesthetic care unit (PACU) or in the intensive care unit (ICU) among 79 patients undergoing elective oncology surgery of the digestive system. There was a statistically significant correlation between a lower temperature during surgery and medical diagnosis (p = .009), the use of bupivacaine anaesthesia (p = .016), anaesthesia time (p = .003) and anaesthesia type (p = .033), surgery time (p = .021) and surgery type (p = .002), volumes infused during the intraoperative period (p = .006), admission to the ICU (p = .032) and length of stay in PACU (p = .029). The lower the temperature when the patient is admitted to the operating room, the lower the temperature during the procedure (p ˂ .001). There was no association between the body temperature of patients and blood transfusion (p = .619). Hypothermia was associated with increased length of stay in the PACU, but was not associated with the need for blood transfusion during the intra- and postoperative periods. The use of preoperative passive warming methods allows patients to reach the operating room hypothermic.

show abstract

Prolonged-Stay Patients in the PACU: A Review of the Literature

Cited by 48 publications

References 15 publications

Effects of changes in intraoperative management on recovery from anesthesia: a review of practice improvement initiative

Effects of changes in intraoperative management on recovery from anesthesia: a review of practice improvement initiative

The length of stay in the post-anaesthesia care unit correlates with pain intensity, nausea and vomiting on arrival

The effect of intraoperative hypothermia upon blood transfusion needs and length of stay among gastrointestinal system cancer surgery

Contact Info

Product

Resources

About