全身麻醉技术缩短了满足第一阶段麻醉后护理单元出院标准的时间:随机临床试验和研究单元旁路的队列研究的叙述性回顾,并辅以计算机模拟

Franklin Dexter , Richard H. Epstein , Anil A. Marian
{"title":"全身麻醉技术缩短了满足第一阶段麻醉后护理单元出院标准的时间:随机临床试验和研究单元旁路的队列研究的叙述性回顾,并辅以计算机模拟","authors":"Franklin Dexter ,&nbsp;Richard H. Epstein ,&nbsp;Anil A. Marian","doi":"10.1016/j.pcorm.2023.100358","DOIUrl":null,"url":null,"abstract":"<div><p><span>We performed a narrative review of bypass of the phase I post-anesthesia care unit (PACU) following general anesthesia to gain insight into ways to reduce the time until patients are ready for PACU discharge following general anesthesia. Web of Science and PubMed literature searches were performed. Publications’ references and citations were examined. The Scale for the Assessment of Narrative Review Articles’ six components were satisfied. The 14 articles included 17 studies, with nearly all patients being adults. Most studies’ patients underwent </span>outpatient surgery<span><span> with an average surgical duration of less than 100 min . The studies applied several different, but similar, criteria to choose if patients bypass the PACU. Notably, 13 of 17 studies and all five with the largest observed bypass rates used some version of the White-Song fast-track bypass criteria. Propofol was used uniformly for induction of general anesthesia. Most studies included at least one </span>antiemetic<span><span><span><span> prophylactically, a local anesthetic administered by the surgeon, and a non-opioid analgesic. The six studies with the largest observed bypass rates used </span>remifentanil or restricted use of intraoperative opioids. We then considered economics. While achievable PACU bypass rates are insufficient to reduce healthcare costs, reducing mean PACU time markedly can lower the nursing labor costs, the total time until the last patient exits the PACU, and the incidence of patients recovering in operating rooms because of unavailable PACU nurses or beds. We examined probability distributions of brief patient recovery times by using Gas Man, an uptake and distribution software program, simulating times until reaching constant incremental reductions (0.1  %) in vessel-rich concentrations of </span>desflurane<span> and sevoflurane<span><span> once the vaporizer was set to zero. Results showed that simulated recovery from </span>volatile anesthetics can have recovery times appearing log-normal, as seen empirically. Thus, patients already meeting discharge criteria upon PACU arrival can be the far-left fraction of one population of patients. The implication is that the narrative review results for PACU bypass provide insight into how to have more patients with very brief times to recovery. Therefore, future studies should quantify the effectiveness and economic benefits of anesthesia practitioners aiming not for PACU bypass, per se, but rather that the patients meet PACU discharge criteria by the 5–10 min after unit arrival when the practitioner has completed PACU handoff and finished documentation in the </span></span></span>anesthesia record.</span></span></p></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"33 ","pages":"Article 100358"},"PeriodicalIF":0.0000,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"General anesthesia techniques reducing the time to satisfy phase I post-anesthesia care unit discharge criteria: Narrative review of randomized clinical trials and cohort studies studying unit bypass, supplemented with computer simulation\",\"authors\":\"Franklin Dexter ,&nbsp;Richard H. Epstein ,&nbsp;Anil A. Marian\",\"doi\":\"10.1016/j.pcorm.2023.100358\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p><span>We performed a narrative review of bypass of the phase I post-anesthesia care unit (PACU) following general anesthesia to gain insight into ways to reduce the time until patients are ready for PACU discharge following general anesthesia. Web of Science and PubMed literature searches were performed. Publications’ references and citations were examined. The Scale for the Assessment of Narrative Review Articles’ six components were satisfied. The 14 articles included 17 studies, with nearly all patients being adults. Most studies’ patients underwent </span>outpatient surgery<span><span> with an average surgical duration of less than 100 min . The studies applied several different, but similar, criteria to choose if patients bypass the PACU. Notably, 13 of 17 studies and all five with the largest observed bypass rates used some version of the White-Song fast-track bypass criteria. Propofol was used uniformly for induction of general anesthesia. Most studies included at least one </span>antiemetic<span><span><span><span> prophylactically, a local anesthetic administered by the surgeon, and a non-opioid analgesic. The six studies with the largest observed bypass rates used </span>remifentanil or restricted use of intraoperative opioids. We then considered economics. While achievable PACU bypass rates are insufficient to reduce healthcare costs, reducing mean PACU time markedly can lower the nursing labor costs, the total time until the last patient exits the PACU, and the incidence of patients recovering in operating rooms because of unavailable PACU nurses or beds. We examined probability distributions of brief patient recovery times by using Gas Man, an uptake and distribution software program, simulating times until reaching constant incremental reductions (0.1  %) in vessel-rich concentrations of </span>desflurane<span> and sevoflurane<span><span> once the vaporizer was set to zero. Results showed that simulated recovery from </span>volatile anesthetics can have recovery times appearing log-normal, as seen empirically. Thus, patients already meeting discharge criteria upon PACU arrival can be the far-left fraction of one population of patients. The implication is that the narrative review results for PACU bypass provide insight into how to have more patients with very brief times to recovery. Therefore, future studies should quantify the effectiveness and economic benefits of anesthesia practitioners aiming not for PACU bypass, per se, but rather that the patients meet PACU discharge criteria by the 5–10 min after unit arrival when the practitioner has completed PACU handoff and finished documentation in the </span></span></span>anesthesia record.</span></span></p></div>\",\"PeriodicalId\":53468,\"journal\":{\"name\":\"Perioperative Care and Operating Room Management\",\"volume\":\"33 \",\"pages\":\"Article 100358\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-10-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Perioperative Care and Operating Room Management\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2405603023000535\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Nursing\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perioperative Care and Operating Room Management","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405603023000535","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Nursing","Score":null,"Total":0}
引用次数: 0

摘要

我们对全身麻醉后I期麻醉后护理病房(PACU)的旁路手术进行了叙述性回顾,以深入了解如何缩短患者在全身麻醉后准备PACU出院的时间。进行了Web of Science和PubMed文献检索。审查了出版物的参考文献和引用。叙事评论文章评价量表的六个组成部分均满足要求。这14篇文章包括17项研究,几乎所有的患者都是成年人。大多数研究的患者接受门诊手术,平均手术时间小于100分钟。这些研究采用了几种不同但相似的标准来选择患者是否绕过PACU。值得注意的是,17项研究中的13项和所有5项观察到的最大搭桥率都使用了某种版本的White-Song快速通道搭桥标准。异丙酚均匀用于全麻诱导。大多数研究包括至少一种预防性止吐药、一种由外科医生实施的局部麻醉剂和一种非阿片类镇痛药。六项观察到搭桥率最高的研究使用瑞芬太尼或限制使用术中阿片类药物。然后我们考虑了经济学。虽然可实现的PACU旁路率不足以降低医疗成本,但显著减少平均PACU时间可以降低护理人工成本、到最后一位患者离开PACU的总时间,以及由于没有PACU护士或床位而导致患者在手术室康复的发生率。我们通过使用Gas Man(一种吸收和分配软件程序)来检测患者短暂恢复时间的概率分布,模拟时间,直到在汽化器设置为零后,血管富集的地氟醚和七氟醚浓度达到恒定的增量减少(0.1%)。结果表明,从经验上看,挥发性麻醉药的模拟恢复可以使恢复时间呈现对数正态。因此,在PACU到达时已经达到出院标准的患者可能是一个患者群体的极左部分。这意味着PACU搭桥的叙述性回顾结果为如何让更多的患者在很短的时间内恢复提供了见解。因此,未来的研究应量化麻醉从业人员的有效性和经济效益,而不是针对PACU旁路本身,而是在到达单位后5-10分钟,当从业人员完成PACU交接并完成麻醉记录时,患者符合PACU出院标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
General anesthesia techniques reducing the time to satisfy phase I post-anesthesia care unit discharge criteria: Narrative review of randomized clinical trials and cohort studies studying unit bypass, supplemented with computer simulation

We performed a narrative review of bypass of the phase I post-anesthesia care unit (PACU) following general anesthesia to gain insight into ways to reduce the time until patients are ready for PACU discharge following general anesthesia. Web of Science and PubMed literature searches were performed. Publications’ references and citations were examined. The Scale for the Assessment of Narrative Review Articles’ six components were satisfied. The 14 articles included 17 studies, with nearly all patients being adults. Most studies’ patients underwent outpatient surgery with an average surgical duration of less than 100 min . The studies applied several different, but similar, criteria to choose if patients bypass the PACU. Notably, 13 of 17 studies and all five with the largest observed bypass rates used some version of the White-Song fast-track bypass criteria. Propofol was used uniformly for induction of general anesthesia. Most studies included at least one antiemetic prophylactically, a local anesthetic administered by the surgeon, and a non-opioid analgesic. The six studies with the largest observed bypass rates used remifentanil or restricted use of intraoperative opioids. We then considered economics. While achievable PACU bypass rates are insufficient to reduce healthcare costs, reducing mean PACU time markedly can lower the nursing labor costs, the total time until the last patient exits the PACU, and the incidence of patients recovering in operating rooms because of unavailable PACU nurses or beds. We examined probability distributions of brief patient recovery times by using Gas Man, an uptake and distribution software program, simulating times until reaching constant incremental reductions (0.1  %) in vessel-rich concentrations of desflurane and sevoflurane once the vaporizer was set to zero. Results showed that simulated recovery from volatile anesthetics can have recovery times appearing log-normal, as seen empirically. Thus, patients already meeting discharge criteria upon PACU arrival can be the far-left fraction of one population of patients. The implication is that the narrative review results for PACU bypass provide insight into how to have more patients with very brief times to recovery. Therefore, future studies should quantify the effectiveness and economic benefits of anesthesia practitioners aiming not for PACU bypass, per se, but rather that the patients meet PACU discharge criteria by the 5–10 min after unit arrival when the practitioner has completed PACU handoff and finished documentation in the anesthesia record.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Perioperative Care and Operating Room Management
Perioperative Care and Operating Room Management Nursing-Medical and Surgical Nursing
CiteScore
1.30
自引率
0.00%
发文量
52
审稿时长
56 days
期刊介绍: The objective of this new online journal is to serve as a multidisciplinary, peer-reviewed source of information related to the administrative, economic, operational, safety, and quality aspects of the ambulatory and in-patient operating room and interventional procedural processes. The journal will provide high-quality information and research findings on operational and system-based approaches to ensure safe, coordinated, and high-value periprocedural care. With the current focus on value in health care it is essential that there is a venue for researchers to publish articles on quality improvement process initiatives, process flow modeling, information management, efficient design, cost improvement, use of novel technologies, and management.
期刊最新文献
A study of the relationship between professional autonomy and professional quality of life among operating room personnel: A cross-sectional study Postoperative mechanical ventilation after corrective Tetralogy of Fallot surgery in infants: Assessment of perioperative factors and radiographic severity scores Compliance evaluation in post-anesthesia care units at teaching hospitals in Alborz Province, Iran Anaesthetic management of caesarean section in a primigravida with pre-eclampsia, pleural effusion, consolidation, and lung collapse – a case report The effect of surgical smoke on operating room workers, attitudes towards risks, and the implementation of preventive measures
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1