Abstract
Purpose
To evaluate the effectiveness of short-acting anesthetic drugs and techniques to achieve recovery room bypass criteria after minor surgery in a community hospital environment.
Methods
After agreement by a multidisciplinary committee, a pilot project was undertaken to assess the usefulness of ultrashort acting anesthetic drugs and pre-emptive analgesia to facilitate rapid recovery from general anesthesia. A cohort of 100 ASA I–II patients aged 18–65 yr undergoing simple knee arthroscopy or minor peripheral orthopedic procedures was compared to a similar cohort treated in the three months prior to the study period. Outcomes of interest included patient morbidity, success in achieving post-anesthesia care unit (PACU) bypass criteria, impact upon nursing resources, duration of operating room (OR) and hospital stay, and pharmaceutical costs before and after implementation.
Results
No patient morbidity was demonstrated prior to discharge home, and successful PACU bypass occurred in 83% of cases. Achievement of PACU discharge criteria while in the OR did not prolong the OR time, and discharge from hospital occurred earlier in the patients who did not require PACU care (P=0.0006 all “fast-track cases” vs all “controls”). Nursing complaints were more numerous when the day surgery personnel did not normally participate in PACU care. The cost of anesthetic care was significantly more using ultra-short acting drugs (CDN $14.17 vs CDN $20.57), but closer adherence to protocol could reduce this differential (CDN $18.84).
Conclusion
Not all patients who receive a general anesthetic require admission to a phase I recovery facility. However, the justification for use of more expensive pharmaceuticals to achieve PACU bypass requires extensive changes in operating systems and voluntary professional behaviours.
Résumé
Objectif
Évaluer l’efficacité d’anesthésiques et de techniques à action brève permettant d’éviter le séjour en salle de réveil (SR) après une intervention mineure dans un hôpital communautaire.
Méthode
Ayant reçu l’accord d’un comité multidisciplinaire, on a mené un projet pilote pour évaluer l’utilité d’anesthésiques à action très brève et d’analgésie préventive pour faciliter une récupération rapide de l’anesthésie générale. Une cohorte de 100 patients d’état physique I–II, de 18–65 ans, devant subir une arthroscopie simple du genou ou une intervention orthopédique périphérique mineure, a été comparée à une cohorte semblable traitée pendant les trois mois qui ont précédé l’étude. Les paramètres étudiés comprennent la morbidité, la possibilité de satisfaire aux critères permettant d’éviter la salle de réveil, les conséquences sur les effectifs infirmiers, la durée du séjour en salle d’opération (SO) et à l’hôpital et la différence de coût des médicaments avant et après l’application du protocole.
Résultats
Aucune morbidité n’a été démontrée avant le départ du patient de l’hôpital et le fait d’éviter la SR a été possible dans 83 % des cas. L’atteinte des critères permettant d’accorder le congé de la SR alors même que le patient est encore en SO n’a pas entraîné de prolongation du temps en SO et la sortie de l’hôpital a été plus hâtive chez les patients qui n’ont pas eu besoin de soins de SR (P= 0,0006 —tous les cas sous “protocole accéléré” vs tous les “témoins”). Les plaintes du personnel infrmier ont été plus nombreuses lorsque le personnel de chirurgie de jour ne participait pas normalement aux soins de la SR Le coût des anesthésiques a été un peu plus élevé avec l’emploi de médicaments à action très brève (14, 17 $ CAN vs 20,57 $ CAN), mais une adhésion plus ferme au protocole pouvait réduire cette différence (18,84 $ CAN).
Conclusion
Nul n’est besoin d’admettre, dans une unité de réveil de phase I, tous les patients ayant subi une anesthésie générale. Cependant, la justification de l’usage de médicaments plus chers qui permettent d’éviter la SR nécessite des changements importants d’organisation des interventions et de la collaboration professionnelle volontaire.
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Acknowledgement: This study was supported in part by an unrestricted grant from Baxter Pharmaceuticals (Canada)
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Duncan, P.G., Shandro, J., Pharma, R.B. et al. A pilot study of recovery room bypass (“fast-track protocol”) in a community hospital. Can J Anesth 48, 630–636 (2001). https://doi.org/10.1007/BF03016195
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DOI: https://doi.org/10.1007/BF03016195