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Background: Hypotension, characterized by abnormally low blood pressure, is a frequently observed adverse event in sedated gastrointestinal endoscopy procedures. Although the examination time is typically short, hypotension during and after gastroscopy procedures is frequently overlooked or remains undetected. This study aimed to construct a risk nomogram for post-anesthesia care unit (PACU) hypotension in elderly patients undergoing sedated gastrointestinal endoscopy. Methods: This study involved 2919 elderly patients who underwent sedated gastrointestinal endoscopy. A preoperative questionnaire was used to collect data on patient characteristics; intraoperative medication use and adverse events were also recorded. The primary objective of the study was to evaluate the risk of PACU hypotension in these patients. To achieve this, the least absolute shrinkage and selection operator (LASSO) regression analysis method was used to optimize variable selection, involving cyclic coordinate descent with tenfold cross-validation. Subsequently, multivariable logistic regression analysis was applied to build a predictive model using the selected predictors from the LASSO regression. A nomogram was visually developed based on these variables. To validate the model, a calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used. Additionally, external validation was conducted to further assess the model's performance. Results: The LASSO regression analysis identified predictors associated with an increased risk of adverse events during surgery: age, duration of preoperative water abstinence, intraoperative mean arterial pressure (MAP) <65 mmHg, decreased systolic blood pressure (SBP), and use of norepinephrine (NE). The constructed model based on these predictors demonstrated moderate predictive ability, with an area under the ROC curve of 0.710 in the training set and 0.778 in the validation set. The DCA indicated that the nomogram had clinical applicability when the risk threshold ranged between 20 and 82%, which was subsequently confirmed in the external validation with a range of 18–92%. Conclusion: Incorporating factors such as age, duration of preoperative water abstinence, intraoperative MAP <65 mmHg, decreased SBP, and use of NE in the risk nomogram increased its usefulness for predicting PACU hypotension risk in elderly patient undergoing sedated gastrointestinal endoscopy. [ABSTRACT FROM AUTHOR]

This study reviewed existing literature on parental presence in cases of pediatric patients after general anesthesia and explored its effect on emergence delirium (ED) in the postanesthesia care unit (PACU). Systematic review and meta-analysis. After protocol registration, we searched the PubMed, EMBASE, CINHAL, Web of Science, SCOPUS, and CENTRAL databases. Two authors independently searched and selected the relevant studies, assessed their risk of bias, and abstracted the data. The primary outcome was ED, and the additional outcome was pain. We provided the narrative synthesis and meta-analysis results. Of the 296 articles retrieved, 6 were included in the narrative synthesis, and 5 were used for the meta-analysis. Four studies were randomized controlled trials, and two studies were nonrandomized controlled trials. There were 348 pediatric patients in the parental presence group and 314 pediatric patients in the usual care group. Parental presence effectively reduced the ED score (mean difference, −0.58; 95% confidence interval [CI], −0.84 to −0.31; P <.001). The ED incidence rate (log odds ratio, −0.58; 95% CI, −1.24 to 0.09; P =.090) and pain score (standardized mean difference, −0.24; 95% CI, −0.57 to 0.10; P =.163) were lower in the parental presence group than in the usual care group. However, the differences were not statistically significant. The presence of parents in the PACU can reduce ED in pediatric patients. Therefore, parental presence may be a useful intervention in the PACU. [ABSTRACT FROM AUTHOR]

The purpose of thisstudy was to evaluate the clinical impact of the Recovery Room (RR) in an Enhanced Recovery After Surgery (ERAS) pathway in colorectal surgery. Single-center retrospective study. From November 2019 until September 2021, a total of 149 consecutive patients that underwent to colon-rectal surgery were enrolled. The patients were divided into two study groups: RR Group if admitted to RR after surgery, and no-Recovery Room (NRR) Group if monitored directly on the ward, bypassing the RR. The postoperative ERAS items adherence was assessed in the two study groups. Final analysis included 119 patients in the RR Group and 30 patients in NRR Group. Patients that started clear liquid oral intake within two hours postoperatively were 118 in the RR group and 19 in the NRR group (99.1% vs 63.3%, P <.001). A total of 98 patients and 18 patients were mobilized on day 0 in the RR group and in NRR group, respectively (84.4% vs 15.5%, P <.05). In the RR group, postoperative adherence to the ERAS protocol components was higher in comparison with the NRR group (P <.003); adherence to the all protocol components was also higher (P <.004). Among patients undergoing colorectal surgery admitted to RR after surgery, the RR nurse guaranteed effective patient assistance and ensured appropriate compliance to the postoperative ERAS items. [ABSTRACT FROM AUTHOR]

Background: The subject of post-anesthetic complications in the recovery room and their prevention has continued to generate interest in the last decade. Unfortunately, there is a paucity of published data regarding this subject in Tanzania and Bugando Medical Centre (BMC) in particular. This study sought to describe the patterns of immediate post-anesthetic complications and associated factors among patients admitted to the operating theatre recovery room following major surgery at BMC. Methods: This was a cross-sectional study of patients aged 18 years and above admitted to the operating theatre recovery room following major surgery at BMC from March 2019 to May 2019. Results: A total of 430 patients (M: F ratio = 1: 1.7) were studied. The median age at presentation was 35 [interquartile range, 27-52] years. A total of 294(68.4%) patients developed immediate post-anesthetic complications. Of these, postoperative nausea and vomiting were the most common post-anesthetic complication accounting for 43.5% of cases. American Association of Anesthesiologists (ASA) II (p = 0.017), general anesthesia (p = 0.011), and abdominal surgery (p = 0.023) were found to be statistically significantly associated with post-anesthetic complications on multivariate logistic regression analysis. Conclusion: This study has demonstrated that the incidence of immediate post-anesthetic complications among patients admitted to the operating theatre recovery room following major surgery at BMC is unacceptably high despite recent advances in anesthetic techniques and the introduction of newer anesthetic drugs. We recommend that factors responsible for an increased incidence of immediate postanesthetic complications at BMC should be addressed to reduce the occurrence of these complications. [ABSTRACT FROM AUTHOR]

Background: The subject of post-anesthetic complications in the recovery room and their prevention has continued to generate interest in the last decade. Unfortunately, there is a paucity of published data regarding this subject in Tanzania and Bugando Medical Centre (BMC) in particular. This study sought to describe the patterns of immediate post-anesthetic complications and associated factors among patients admitted to the operating theatre recovery room following major surgery at BMC. Methods: This was a cross-sectional study of patients aged 18 years and above admitted to the operating theatre recovery room following major surgery at BMC from March 2019 to May 2019. Results: A total of 430 patients (M:F ratio = 1: 1.7) were studied. The median age at presentation was 35 [interquartile range, 27-52] years. A total of 294(68.4%) patients developed immediate postanesthetic complications. Of these, postoperative nausea and vomiting were the most common post-anesthetic complication accounting for 43.5% of cases. American Association of Anesthesiologists (ASA) II (p = 0.017), general anesthesia (p = 0.011), and abdominal surgery (p = 0.023) were found to be statistically significantly associated with post-anesthetic complications on multivariate logistic regression analysis. Conclusion: This study has demonstrated that the incidence of immediate post-anesthetic complications among patients admitted to the operating theatre recovery room following major surgery at BMC is unacceptably high despite recent advances in anesthetic techniques and the introduction of newer anesthetic drugs. We recommend that factors responsible for an increased incidence of immediate post-anesthetic complications at BMC should be addressed to reduce the occurrence of these complications. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory complications remain an important cause of morbidity and mortality in the post-anaesthetic period. This study aimed to describe the knowledge of postoperative airway emergencies of recovery room nurses attending two separate anaesthetic symposia held in Cape Town and Johannesburg. Methods: A cross-sectional research design was followed by means of an anonymous, self-administered, previously described questionnaire using a convenience sampling method. Results: A total of 309 nurses took part in the study, 116 (37.5%) and 193 (62.5%) in Cape Town and Johannesburg, respectively. Of the nurses, 279 (90.3%) were female, had a mean (SD) age of 44.6 (10.4) years (n = 198) and had 11.5 (9.2) years of operating room experience (n = 304). One hundred and fifty (50.8%) were registered nurses and 196 (62.5%) worked in the private sector. The overall mean score obtained by the nurses was 40.4% (SD 17.9), with a range of 0-88%. This is 30% below the predetermined competency score of ≥ 70%, which was achieved by only 24 (7.8%) nurses. The lowest median (IQR) scores, 16.7% (0-33.3) and 16.7% (0-50) were obtained in the clinical signs and treatment sections of the questionnaire, respectively. Conclusion: This study showed that the nurses sampled had poor knowledge of postoperative airway emergencies in the recovery room. Legal action in the healthcare environment is a reality in South Africa. The anaesthetist remains accountable for ongoing patient care in the recovery room until discharge. Therefore, it is of the utmost importance that anaesthetists know how knowledgeable the recovery room nurses whom they entrust their patients to are regarding postoperative airway emergencies. [ABSTRACT FROM AUTHOR]

To determine the spectrum of critical incidents in postanesthesia care unit (PACU) and the possible prediction and prevention of the worse scenario–associated critical incidents. A retrospective observational study. The critical incidents in PACU comprising 92,136 patients were recorded. The incidents included the following disorders: delayed recovery, pain, bleeding, hypothermia, unplanned transfer to intensive care unit, shivering, agitation, nausea and vomiting, and respiratory or cardiovascular-related critical incidents. We then performed descriptive analyses and t test or χ2 test on the collected data. A total of 1,760 critical incidents were recorded in 1,417 patients among 92,136 patients. Most critical incidents were associated with the patients after general anesthesia and general or gynecologic surgery. The most common critical incidents noted in the present study were pain, followed by cardiovascular-related and respiratory-related incidents. The average length of stay in PACU was 61.50 ± 44.40 minutes for the patients with critical incidents and 28.50 ± 19.40 minutes for the patients without critical incidents. Critical incidents lead to longer length of stay in the PACU. Regular inspection and immediate response for critical incidents in the PACU is essential for the maintenance of the quality of the immediate postoperative care. [ABSTRACT FROM AUTHOR]

Purpose To examine the practice of nebulizer cool mist blow-by oxygen administered to spontaneously breathing postanesthesia care unit (PACU) pediatric patients during Phase one recovery. Design Existing evidence was evaluated. Informal benchmarking documented practices in peer organizations. An in vitro study was then conducted to simulate clinical practice and determine depth and amount of airway humidity delivery with blow-by oxygen. Methods Informal benchmarking information was obtained by telephone interview. Using a three-dimensional printed simulation model of the head connected to a breathing lung simulator, depth and amount of moisture delivery in the respiratory tree were measured. Findings Evidence specific to PACU administration of cool mist blow-by oxygen was limited. Informal benchmarking revealed that routine cool mist oxygenated blow-by administration was not widely practiced. The laboratory experiment revealed minimal moisture reaching the mid-tracheal area of the simulated airway model. Conclusions Routine use of oxygenated cool mist in spontaneously breathing pediatric PACU patients is not supported. [ABSTRACT FROM AUTHOR]

Background: Strategies aimed at favouring functional recovery after surgery for hip fracture may be of clinical importance.Aims: To test the clinical utility of a recovery room (RR) in terms of postoperative walking performance in an elderly population submitted to hip fracture surgery.Methods: Postoperative walking performance at rollator was assessed in 242 consecutive orthogeriatric patients able to follow the institutional physiotherapy protocol starting on day 1 after hip surgery. Group 1 (n = 186, age 86.0 ± 9.3 years, 24.7% male) was admitted to the RR for postoperative monitoring, whereas Group 2 (n = 56, age 85.2 ± 5.7 years, 23.2% male) was directly admitted to the ward. The best performance observed during the first three postoperative days was considered.Results: Group 1 showed a better walking performance than Group 2, with a 50% lower probability of walking < 5 m (relative risk 0.51, p = 0.0005) and a two-fold higher probability of walking > 10 m (relative risk 2.10, p = 0.0005). Multivariable analysis confirmed a favourable independent effect of the RR stay on walking performance (β = 0.205, p = 0.005).Discussion: Admission to the RR in elderly patients submitted to hip fracture surgery could have an independent beneficial effect on postoperative walking functional recovery. This beneficial effect could probably depend on the possibility of ensuring a more rapid management of postoperative issuesConclusions: These findings support the clinical utility of a RR implementation in facilities where hip surgery in elderly subjects is routinely performed. [ABSTRACT FROM AUTHOR]

Purpose: To describe patients' perceptions of informational privacy and factors promoting it in the recovery room. Design: A descriptive semistructured qualitative interview study. Methods: The study was conducted in 2013, and the data were analyzed with inductive content analysis. Adidt surgical recovery room patients (n = 17) were recruited with purposive sampling at the Department of Ear, Nose and Throat diseases in a university hospital in Finland. Findings: Informational privacy was described as control of patients' health information maintained by the health care professionals and the patients. Informational privacy was especially important in relation to other patients. Health care professionals and patients' attitude, behavior, and knowledge of informational privacy, barriers of hearing and seeing, societal rules, and the electronic patient data system promoted informational privacy. Conclusions: Informational privacy in relation to other patients could be improved in the recovery room, for example, by developing patient health information transmission and architectural solutions. [ABSTRACT FROM AUTHOR]

It is evident that immediate skin-to-skin care after birth has the potential to improve breastfeeding outcomes and maternal satisfaction after a caesarean section; hence partners and infants should be present on the postoperative ward. Objective To investigate the intensive care nurses’ experiences of having the infant and partner present on the postoperative ward after emergency caesarean sections. Design Interviews with semi-structured interviews were conducted and analysed using qualitative content analysis. Setting The interviews were conducted at a hospital in Stockholm, Sweden; where close to 10,000 births occur each year. After a caesarean section the mother is treated on a postoperative ward for at least two hours. Eight intensive care nurses participated in the study. Result The analysis yields the theme ‘ The challenges of caring for infants on a postoperative unit ’ covering the following categories; collision between the intensive care nurse and midwife, responsibility versus knowledge and organisational issues. The study concluded that improved routines and increased continuity between involved clinics could improve care. There is also a need for education for staff involved in caesarean section regarding the benefits of early skin-to-skin care between the mother and her infant. [ABSTRACT FROM AUTHOR]

Background A number of different treatment regimens have been described for post-operative pain management for pediatric tonsillectomy following the widespread discontinuation of the use of codeine due to safety concerns. However, the literature is lacking with regard to the relative efficacy of the treatment regimens. This study is designed to determine the effectiveness of an intraoperative dose of intravenous acetaminophen for pediatric tonsillectomy pain management. Methods Records were reviewed for pediatric patients undergoing tonsillectomy with a single surgeon between 2012 and 2014. Pain scores, need for narcotic analgesics, and recovery times were reviewed for up to 24 postoperative hours. Patients were grouped based on whether they received an intraoperative dose of intravenous acetaminophen (Group 1) or did not receive it (Group 2). The primary outcome measure was pain score during the 24-h post-operative period. Secondary outcome measures include need for narcotic medications for breakthrough pain in the recovery room and time spent in the recovery room and hospital. Results 350 patients were included, of which 116 received an intraoperative dose of intravenous acetaminophen. Patients in Group 1 had lower pain scores during the second postoperative hour (1.27 vs. 2.06, p = 0.008). No significant differences were noted for pain scores during postoperative hours 1 or 3–24. Patients in Group 1 spent less time in the Recovery Room (59.08 min vs. 69.5 min, p = 0.016) but more time in the hospital (24.54 h vs. 19.66 h, p = 0.030). There was no difference between the groups based on whether the patients received narcotics for breakthrough pain in the recovery room (79.3% vs. 70.9%, p = 0.094). Conclusion Intraoperative intravenous acetaminophen may lead to improved pain scores in the early postoperative period and decreased time in the recovery room, but this group also had a longer hospital stay. This information should instigate randomized controlled trials of this intervention. [ABSTRACT FROM AUTHOR]

To identify the validated instruments used for screening and detecting postoperative delirium (POD) during Post Anesthesia Recovery (PAR) period, and the incidence and associated risk factors with POD. A scoping review. The study search occurred in May 2021 in the PubMed, Embase, Scopus, CINAHL, Web of Science and LILACS databases. Primary studies that used validated instruments for screening and detecting POD in the PAR period were included. A total of 38 articles were included. The most used instruments were CAM-ICU, Nu-DESC, and RASS. The instruments that screened and detected delirium earliest were the Nu-DESC and CAM-ICU. POD incidence was up to 20% in more than half of the included studies. Cardiovascular comorbidities, chronic kidney disease, low functional reserve, chronic obstructive pulmonary disease and postoperative pain were among the primary risk factors. The instrumentsshowing the greatest accuracy for screening and detecting POD in the PAR period were the Nu-DESC and CAM-ICU. [ABSTRACT FROM AUTHOR]

Copyright of Colombian Journal of Anesthesiology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Eletrônica de Enfermagem is the property of Revista Eletronica de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: In Europe, standardized criteria for recovery room (RR) requirements have not been established. The purpose of this study was to examine the clinical utility of an undersized nurse-operated RR in an Italian community hospital. Design: Single-center observational study. Methods: A total of 1,945 consecutive surgical patients admitted to the RR at the study institution between September 31, 2009, and August 31, 2011, were included in the study. A control group of surgical patients not admitted to the RR, matched for age, gender, American Society of Anesthesiologists score, and type of surgery were also considered. The prevalence of early adverse events occurring within 3 hours of the end of surgery was compared between the two groups. Findings: Patients admitted to the RR (mean age, 73.6 ± 14.2 years; 42.2% male; and 76.3% having major surgery) showed lower prevalences of hypotension (P < .0001), hypertensive response (P < .0001), new arrhythmias requiring intervention (P = .0036), and oxygen desaturation (P < .0001) in comparison with the control group. No differences in the proportions of patients experiencing postoperative nausea and vomiting, shivering, bleeding, and respiratory events were found. The Numeric Rating Scale for pain was also significantly lower at 2 hours in the study group as compared to the control group (1 [0 to 5] vs 3 [1 to 7]; P < .0001). Conclusion: In this Italian community setting, an undersized nurse-operated RR contributed to a reduced prevalence of adverse postoperative events. [Copyright &y& Elsevier]

Discharge of patients from the postanesthesia care unit (PACU) is often delayed for nonclinical reasons. This includes organizational issues such as patient transport, times of heavy workload for the ward and PACU nursing staff, surgical wards being unable to admit the patient, and clerical or administrative delays. We undertook a prospective study to evaluate PACU patient flow and the incidence and reasons behind delayed PACU discharge for nonclinical reasons in a tertiary referral hospital. Over a 4-month period, 2,783 patients were admitted postoperatively to our PACU. Delayed discharge because of nonclinical reasons was common, occurring in 421 (15%) patients. The median time of delayed discharge was 70 minutes (range, 25 to 420 minutes). The most common reasons for delayed discharge of the patient to the ward were no bed in the designated postoperative ward for admittance (52%), ward nurses too busy to accept the patient (32%), and ward nurses'' meal breaks (10%). Delayed PACU discharge for nonclinical reasons is common and occurs predominantly because of discharge planning and organizational and staffing issues in postoperative surgical wards. Improved discharge planning, restructured staffing, and alterations in operating room scheduling may minimize these nonclinical discharge delays. [Copyright &y& Elsevier]

Abstract: Routine inpatient radiographs after total hip arthroplasty can be taken in the recovery room immediately after surgery or in the radiology suite later in the hospital stay. In a review of 632 consecutive recovery room series, we found that 17% of series were inadequate to detect technical issues. We identified technical issues on 12 series (1.9%) and technical issues that impacted inpatient management on 2 series (0.3%). One of these 2 was a dislocation that was detected clinically before imaging. The other was a medial penetration of an acetabular screw that probably did not require the immediate revision that it received. Findings suggest that the single routine inpatient series should be taken in the radiology suite, rather than in the recovery room. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to test whether pre-operative visual information and parental presence had positive effects on anxiety, delirium, and pain in pediatric patients who awoke from general anesthesia in a post-surgical stage. Methods: This study used a non equivalent control-group post test design (n=76). Independent variables were provision of pre-operative visual information and parental presence for post-surgical pediatric patients in PACU (post anesthesia care unit). Dependent variables were anxiety, delirium, and pain in the pediatric patients measured three times at 10 minute intervals after extubation in the PACU. Measurements included Numerical Rating Scale for assessing state anxiety, Pediatric Anesthesia Emergence Delirium Scale by Sikich & Lerman (2004) for delirium, and Objective Pain Scale by Broadman, Rice & Hannallah (1988) for pain. Results: Experimental group showed significantly decreased state anxiety at time points-10, 20, and 30 minutes after extubation. Delirium was significantly lower at 10 minutes and 30 minutes after extubation in the experimental group. Pain was significantly lower at 10 minutes after extubation in the experimental group. Conclusion: The results of this study suggest that this intervention can be a safe pre-operative nursing intervention for post-surgical pediatric patients at PACU. [ABSTRACT FROM AUTHOR]

Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objectives: Most patients are managed on the intensive care unit (ICU) after elective open aortic surgery. We preoperatively identify patients suitable for extubation in theatre with overnight management in theatre recovery before discharge back to the ward (overnight intensive recovery (OIR)). The safety of this was investigated. Design: Retrospective case note analysis of all patients who underwent EOAS from 1998 to 2002, recording in-hospital morbidity and mortality. Physiological and operative severity score for the enUmeration of mortality and morbidity (POSSUM) data were collected prospectively. Methods: Patients were divided into those selected for OIR and those booked for elective ICU admission. Observed morbidity and mortality data were compared with predicted outcomes generated by Portsmouth-POSSUM and POSSUM equations. Results: Hundred and fifty-two out of 178 patients used OIR; 155 patients had abdominal aortic aneurysm (AAA) repair. The elective ICU group had significantly higher anaesthetic risk scores (ASA grade), larger AAA, greater intraoperative blood loss and longer operations. In the OIR group, ten patients (7%) needed ICU admission within 48h postoperatively. Complications occurred in 85/152, with two deaths. There was no excess morbidity or mortality in the OIR group (predicted 95% CI 83–105 and 5–17, respectively). Conclusion: Most patients having elective open aortic surgery can be managed safely using OIR. [Copyright &y& Elsevier]

Purpose Preoperative anxiety in children is associated with postoperative distress in recovery. Both are predictors of long-term maladaptive behavior. Remedies have been suggested to modify individual risk factors, but overall strategy is lacking. Design An approach to anxiety reduction coordinated throughout the hospital experience has been developed in our day-stay pediatric surgical unit. Methods There is a preadmission familiarization visit. On admission, time is spent in a playroom with other children. Anxiety is recorded using the modified Yale Preoperative Anxiety Scale. Children are distracted with an activity book during propofol induction. They are allowed to wake naturally, and emergence state is scored. Finding The incidence of emergence distress is low in our study. Of 68 children, only one exhibited emergence delirium and three had inconsolable crying. Conclusions Important elements in reducing emergence distress are preadmission visit, use of a playroom, effective analgesia, anesthetic maintenance without short-acting volatiles, and undisturbed recovery with a parent present for reassurance. [ABSTRACT FROM AUTHOR]