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

BMC Anesthesiology

Research Article

Bradly J Narr¹  Juraj Sprung¹  Toby N Weingarten¹  Darrell R Schroeder²  Tammy S Bergan³ 

[1] Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, USA;Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;Division of Surgical Services, Department of Nursing, Mayo Clinic, Rochester, MN, USA;

关键词: Anesthesia General;    Anesthesia Recovery Period;    Anesthesia inhalation;    Postoperative nausea and vomiting;    Hypoventilation;   

DOI  :  10.1186/s12871-015-0040-x

 received in 2014-12-17, accepted in 2015-04-17,  发布年份 2015

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Weingarten et al.; licensee BioMed Central. 2015