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Abstract Background Emergence delirium (ED) is a mental disturbance in children during recovery from general anaesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) scale is the only validated scale that assesses ED in paediatric patients undergoing general anaesthesia. The aim of this study was the translation and cross-cultural adaptation of the PAED scale into Spanish (Chile). Methods A five-stage translation and cross-cultural adaptation process was carried out. The reliability of the Spanish version of the PAED scale was evaluated in paediatric patients independently by a set of two raters (anaesthesiologists or postanaesthesia care unit nurses) in the postanaesthetic period after major outpatient surgery. ED was defined by a cut-off level of ≥ 10 points on the PAED scale. Results The PAED scale was evaluated in 353 consecutive children. Patients had a mean age of 7.4 ± 3.22 years. The preoperative ASA Physical Status class was 62%, 37%, and 1% (ASA class I, II and III, respectively). The distribution of patients by service was as follows: 45% of patients underwent paediatric surgery; 33% underwent otorhinolaryngological surgery; 11% underwent orthopaedic surgery; 10% underwent ophthalmological surgery; and 1% underwent other types of surgery. The interrater agreement ranged from 96.9% to 97.9%, with Kappa values ranging from 0.59 to 0.79. The Cronbach’s alpha value was 0.91. The ED global incidence was 9.1% and was higher in the younger age groups (3–10 years). Conclusions The translated and cross-culturally adapted Spanish version of the PAED scale is a reliable instrument to measure ED in the postanaesthetic period in Chilean children.

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Background: Emergence delirium (ED) is a mental disturbance in children during recovery from general anaesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) scale is the only validated scale that assesses ED in paediatric patients undergoing general anaesthesia. The aim of this study was the translation and cross-cultural adaptation of the PAED scale into Spanish (Chile). Methods: A five-stage translation and cross-cultural adaptation process was carried out. The reliability of the Spanish version of the PAED scale was evaluated in paediatric patients independently by a set of two raters (anaesthesiologists or postanaesthesia care unit nurses) in the postanaesthetic period after major outpatient surgery. ED was defined by a cut-off level of ≥ 10 points on the PAED scale. Results: The PAED scale was evaluated in 353 consecutive children. Patients had a mean age of 7.4 ± 3.22 years. The preoperative ASA Physical Status class was 62%, 37%, and 1% (ASA class I, II and III, respectively). The distribution of patients by service was as follows: 45% of patients underwent paediatric surgery; 33% underwent otorhinolaryngological surgery; 11% underwent orthopaedic surgery; 10% underwent ophthalmological surgery; and 1% underwent other types of surgery. The interrater agreement ranged from 96.9% to 97.9%, with Kappa values ranging from 0.59 to 0.79. The Cronbach's alpha value was 0.91. The ED global incidence was 9.1% and was higher in the younger age groups (3–10 years). Conclusions: The translated and cross-culturally adapted Spanish version of the PAED scale is a reliable instrument to measure ED in the postanaesthetic period in Chilean children. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Incomplete recovery from residual neuromuscular block agent (NMBA) after anesthesia is a serious adverse event in the post-anesthesia care unit. Acetylcholinesterase neostigmine is usually used to reverse residual neuromuscular blockade and facilitate spontaneous breathing and endotracheal extubation. Case Report: A 40-year-old woman received general anesthesia for strabismus correction surgery. At the end of surgery, repeated doses of neostigmine up to 85 µg/kg failed to reverse the residual neuromuscular blockade (train-offour [TOF] ratio below 21%). Sugammadex (200 mg) provided immediate reversal, with the TOF ratio up to 100%. The patient regained spontaneous breathing, and the endotracheal tube was removed. After surgery, myasthenia gravis was diagnosed. Conclusions: When unexpected prolonged neuromuscular blockade presents, the TOF ratio should be used to detect its depth and guide a reasonable dose of reversal agents. Anticholinesterase has a ceiling effect; once acetylcholinesterase activity is fully inhibited, administration of additional anticholinesterase can result in no further recovery. Furthermore, excessive acetylcholine can cause muscle weakness. In contrast, sugammadex is a selective reversal agent for steroidal NMBA, which works by encapsulation via tight water-soluble complexes with amino steroids (eg, rocuronium) rather than increasing acetylcholine at the neuromuscular junction. In this case, the recovery from moderate neuromuscular blockade by sugammadex was more effective and rapid than that by neostigmine. When refractory and prolonged residual neuromuscular blockade presents after repeated doses of anticholinesterase, sugammadex should be considered as an effective reversal agent. Particularly in cases of myasthenia gravis, sugammadex is superior to neostigmine for reversing rocuronium-induced NMBA in patients undergoing surgery. [ABSTRACT FROM AUTHOR]

Introduction: the classification systems with standardized languages are established in a set of structured knowledge, concepts founded in a logical and coherent way, based on their similarities. In this sense, identifying a profile with the populations can cooperate for a better definition and situational understanding for that unit and/or patients. Objectives: to perform cross-mapping between the nursing diagnoses of NANDA-I with the manual nursing records in the post-anesthetic recovery room; and, to propose interventions and outcomes, according to standardized language. Method: exploratory, descriptive and retrospective analysis of the nursing records of 187 patients hospitalized from June to July 2018, in the post-anesthetic recovery room of an oncology hospital. Cross-mapping was carried out in three stages: identification of diagnostic indicators; proposition of interventions and activities; and outcomes indicators. The data were analyzed and described in absolute and relative frequencies. Results: of the 13 NANDA-I domains, five were highlighted; were identified five risk diagnoses and 11 focused on the problem; 100% frequency was observed for the diagnoses of: Aspiration, infection and falling risk; Impaired transfer capacity; Impaired bed mobility; Impaired skin/tissue integrity and impaired comfort. Conclusions: from the 16 nursing diagnoses mapped, were selected 22 interventions and 58 activities; 23 results and 48 outcomes indicators.

To explore the experiences of uncertainty in the clinical reasoning of nurses in the postanesthesia care unit (PACU). A phenomenological descriptive design, following Colaizzi's analysis. Semistructured interviews were conducted with 14 nurses from a PACU on their experience of uncertainty in clinical reasoning. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed seven phases: (re)reading the transcripts, extracting significant statements, formulating meanings from significant statements, aggregating formulated meanings into themes, developing a description of the phenomenon's essential structure, generating of the fundamental structure of the phenomenon, validating of the findings through participant feedback. The process employed MAXQDA analytics Pro 2022 software. Consolidated Criteria for Reporting A Qualitative Research checklist was used for reporting. From uncertainty experiences in nurses' clinical reasoning, 10 themes emerged: ambiguity and decision latitude, communication, work ethic, difficulty interpreting and predicting outcomes, cognitive performance impairment, incivility, core competence vagueness of postanesthesia nurses, high-tech care, (in)security and risk, and occupational stress. The experiences of uncertainty in clinical reasoning of nurses in postanesthesia care units are highly focused on patient safety. Exploring these experiences has made uncertainty more tangible and explicit, which will enable nurses in postanesthesia care units to prepare for adaptive responses to deal with uncertainty when it occurs in clinical practice. [ABSTRACT FROM AUTHOR]

PurposeTo identify perioperative predictors of immediate pain after ureteroscopy, specifically evaluating the impact of hydrodistention from irrigation on pain.Materials and methodsWe retrospectively identified patients who underwent ureteroscopy for the treatment of calculi. Data recorded for these patients included their maximum pain score in the post-anesthesia care unit (PACU), average flow rate of irrigant used during the procedure, patient and stone characteristics, operative procedure, and details of patients' immediate, post-operative course. Spearman's rho was used to determine the relationship between non-parametric, continuous variables. Then, a linear regression was performed to assess which variables could predict the peak pain score.ResultsA total of 131 patients were included in the study. A non-parametric correlation analysis revealed that maximum pain score was negatively correlated with being male (r = -0.18, p=0.04), age (r = -0.34, p

The purpose of this study was to investigate the effect of protective face mask usage during the postoperative period on carbon dioxide retention in children during the COVID-19 pandemic. This study was designed as a prospective, randomized trial including 40 ASA I–II patients aged 3 to 10 years who were scheduled for elective surgery. Patients were randomly allocated to two groups. The first group (group 1) received O 2 treatment over the protective face mask. In the second group (group 2), the protective face mask was worn over the O 2 delivery system. Heart rate, oxygen saturation (SPO 2) level, end-tidal carbon dioxide (EtCO 2) level, and respiratory rate were measured using a patient monitor at 0, 5, 10, 15, 30, and 45 minutes and recorded. The primary outcome of the study was the determination of the EtCO 2 levels, which were used to assess the safety of the mask in terms of potential carbon dioxide retention. None of the participants' SPO 2 levels fell below 92% while wearing masks. There was no statistically significant difference between the groups in terms of EtCO 2 , heart rate, SPO 2 , and respiratory rate (P >.05). During the COVID-19 pandemic, protective surgical face masks can be used safely in the postoperative period for pediatric patients aged 3 to 10 years. [ABSTRACT FROM AUTHOR]

Background: Nurse-reported missed care (NRMC) is considered as any significant delay or omission in provision of nursing care., Aim: (i) Evaluate the frequency, types, and reasons for NRMC in the Post-anesthesia Care Unit (PACU). (ii) Evaluate associations between nurse demographic and workload factors with NRMC. (iii) Explore nurses' perception of NRMC in the PACU., Methods: A cross-sectional study was conducted in the PACU in a tertiary acute care hospital over 3 months. Full-time PACU nurses were conveniently sampled to complete an anonymous survey after their daily shift over different shifts. It contained three sections: (i) nurse demographics; (ii) elements of NRMC; and (iii) reasons for NRMC. Qualitative interviews employed a semi-structured guide to explore perceptions and experiences of NRMC. Descriptive, inferential statistics, and thematic analyses were applied., Results: Sixty-six survey responses were collected. 48.5% of respondents indicated at least one NRMC activity. Activities more clinically sensitive were less missed. Eight nurses were interviewed. Four main themes were identified: (i) communication with patients; (ii) communication and teamwork with colleagues; (iii) dual role of documentation; and (iv) staffing inadequacy. Language barriers made communication challenging. Staff shortage exacerbates workload but effective teamwork and documentation facilitates nursing care., Conclusion: Communication and staffing concerns aggravate NRMC. Teamwork and personal contentment were satisfactory. Nurses' turnover intention may worsen staffing., Clinical Relevance: Timeliness and quality of nursing care is impacted by elements such as manpower, allocation of resources, work processes, and workplace environmental or interpersonal factors such as culture and language fit. Re-evaluation of nursing resources and work processes may assist post-anesthesia care unit nurses in fulfilling their role, decreasing the prevalence of nurse-reported missed care., (© 2024 Sigma Theta Tau International.)

Purpose: To determine if postanesthesia forced-air warming as a nonpharmacologic intervention for emergence delirium (ED)/emergence agitation (EA) decreased the incidence and severity of ED in children aged 18 months to 6 years old., Design: Prospective nonrandomized controlled trial., Methods: Participants included children aged 18 months to 6 years old receiving general anesthesia within a radiation oncology setting. Status of ED/EA was based on the participants' Pediatric Anesthesia Emergence Delirium (PAED) scale score (two consecutive scores greater than 10 out of 20) or inconsolable agitation behaviors post computed tomography simulation (day 0). Interrater reliability was conducted among the center's perianesthesia care nurses. Participants who scored positive for ED/EA received a forced-air warming blanket for the remainder of treatment with data collection 1 to 14 days postanesthesia. Non-ED/EA participants were followed for 14 days and provided forced-air warming if ED/EA occurred. Data consisted of daily PAED scores and self- or parent-report on the anxiety scale. If the participants received forced-air warming, nurses' clinical observations and parent satisfaction surveys were collected 3 times during the 14-day study period., Findings: A total of 59 participants completed the study (mean age 3.43 years; 60% male; 63% non-Hispanic White); 16 were identified with ED or EA (mean age 3.56 years; 50% male; 69% non-Hispanic White) with an incidence rate of 28%. For the 16 participants with ED/EA, the primary diagnosis consisted of solid tumors and an American Society of Anesthesia Classification III to IV. Prior to the forced-air warming intervention, all 16 participants exhibited inconsolable ED/EA behaviors, including 8 who had PAED scores greater than 10. ED/EA behaviors expressed included inconsolability, confusion, thrashing, and combativeness. Within the 14-day period, 3 participants received forced-air warming on day 1, while the other 13 received an average of 4.23 days of treatment (range 1 to 11 days; mode 1 day; median 4 days). Comparison of PAED scores pre (mean 4.4) and post (mean 1.8) indicated that the use of forced-air warming was statistically significant (P = .001). ED/EA behaviors and PAED scores after the forced-air warming period decreased in all but one participant. Some agitation behaviors were not captured within the PAED score., Conclusions: Forced-air warming impacted PAED scores and agitation behaviors for studied participants, offering a safe, nonpharmacological nursing intervention that may be an effective tool for helping to manage this baffling condition., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Recovery units are typically open-plan rooms where all patients can be seen at all times; however, a new hospital has been built with 4- to 6-bed perioperative bays. The purpose of the study was to establish expert consensus regarding problems, benefits, and suggested solutions for the new design across four domains: patient safety, staff satisfaction, organizational efficiency, and maintenance of professional standards. We conducted a Delphi study to inform the development of a model of care for this new design. A two-round Delphi study involved 71 recovery unit nurses from 13 countries. Problems, solutions, and any potential benefits of the new design were collected in round 1 and ranked in round 2. The highest ranked problems were mixing conscious and unconscious patients and need for safe skilled staffing levels. The highest ranked solutions were division of patients, increased safe skilled staffing, and staff education. Participants identified clear risks and mitigation strategies. Implementing these strategies should allow for a safer environment for both patients and staff. A model of care to ensure safety and quality in 4- to 6-bedded bay postanesthetic recovery units should address mixing of patients, staffing levels and staff education. [ABSTRACT FROM AUTHOR]

This study aimed to compare a mentholated popsicle with usual care (absolute fasting) in the change in thirst intensity and discomfort in elderly patients in the immediate postoperative period (IPP). A randomized controlled trial. The sample consisted of 50 elderly patients (60 years or older) in the IPP who were randomly assigned to two groups: experimental group (20 mL mentholated popsicle) and control group (usual care). The outcomes, thirst intensity and discomfort, were assessed at baseline and 20 minutes after the intervention. The mentholated popsicle presented a statistically significant (P <.001) decrease in thirst intensity and discomfort by 5.0 in the median and a Cohen's r large effect size for both outcomes. There were no adverse events or side effects. The use of a mentholated popsicle decreased the intensity and discomfort of the elderly patient's thirst in the IPP. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate intraoperative and postoperative factors tend to decrease in oxygen saturation in postanesthesia care unit (PACU). Methods: In this observational study, body temperature, systolic and diastolic blood pressure, mean arterial pressure, respiratory rate, pulse rate, O2 saturation, needs for using nitrous oxide (N2O), needs for positive end-expiratory pressure (PEEP), liquid volume used for each patients during surgery, mean patient's blood loss, type of blood products used during surgery, snoring, type of anesthetic medications, time duration of surgery, and site of operation in patient's body were recorded during and after operation. Patients were divided into two groups that experienced oxygen desaturation and those did not. All the variables were compared between the two groups. Findings: From 500 patients participated in this study, 50 participants (10%) experienced oxygen desaturation, while 445 cases (89%) did not, and 5 patients (1%) had uncertain condition for oxygen saturation. Significantly higher variables in the group with oxygen desaturation were as pulse rate during the surgery (P = 0.009), mean liquid volume (P = 0.029), pain and its severity (P = 0.001 for both), and snoring (P = 0.020). There was a significant relation between presence of oxygen desaturation and having operation on thorax (60%), upper abdomen (40%), and spine (39%) (P = 0.001). Conclusion: Pulse rate during the surgery, liquid volume used during surgery, using N2O, not using PEEP, pain and its severity, and snoring in PACU are associated with experiencing oxygen desaturation.

Aims and objectives: To evaluate the effectiveness of a psycho‐educational intervention for shoulder and breast day surgery patients in decreasing pain intensity and pain interference with function and strengthening adherence with the analgesic regimen; and further to identify factors that influence average pain intensity and pain interference with function. Background: Pain is one of the most prevalent symptoms after day surgery. However, pain management is left to the patients and family, and interventions to help patients are needed. Design: Randomised clinical trial with an intervention (n = 101) and a usual care group (n = 119) using multiple measurements during 6 months postoperatively. The CONSORT checklist is used. Methods: Patients in the intervention group received a booklet about pain and pain management and coaching by research nurses on postoperative days 2, 3 and 7. Differences between groups were identified using the chi‐squared analysis and t tests. Changes with time were identified using a linear mixed model with repeated measures. Results: After controlling for covariates, group differences at any time in average pain intensity and pain interference with function were not statistically significant. Changes over time within any one group in average pain intensity and pain interference with function were statistically significant and decreased with time. Higher levels of average pain intensity and pain interference over time were associated with shoulder surgery, female, younger, pain expectation, preoperative pain and poorer adherence. Conclusions: No group differences related to the intervention were revealed, and preoperative teaching together with a pain management booklet and coaching may help to strengthen the intervention's effects. Further research on interventions directed towards pain management is needed. Relevance to clinical practice: Day surgery patients' postoperative pain and pain management is not satisfactorily handled. To encourage and educate patients to use the prescribed analgesics in the immediate postoperative days may be necessary to enhance pain management. Clinical trial registration: ClinicalTrials.gov (NCT01595035). [ABSTRACT FROM AUTHOR]

This naturalistic, pre‐ and post‐design study explored the feasibility and acceptability of a brief patient safety intervention to introduce a tool to standardize interdisciplinary communication processes at patient handoff between anesthetists and postanesthesia nurses in the postanesthetic care unit. Observation and interview data were collected pre‐ and post‐intervention from a convenience sample of 27 nurses and 23 anesthetists in a large tertiary hospital in Melbourne, Australia. Following the intervention, significant improvement was observed in nurses' performance of several patient safety behaviors, but trends in nurses' interdisciplinary communication behaviors such as asking questions and escalation of care were nonsignificant. This research provides evidence that tools to standardize clinical handoff communication may empower nurses to perform desired patient safety behaviors during interprofessional handoff. It underpins future research to explore strategies to empower nurses to advocate for patient safety during interdisciplinary communication, and provides a foundation for patient handoff improvement, education, and further research. [ABSTRACT FROM AUTHOR]

Objective: To identify and analyze scientific articles describing the systematization of nursing care (SAE) in the Postanesthetic Care Units (PACU). Methodology: integrative review of the literature conducted in May 2019, through consultation of the databases and/or portals US National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Scopus, Web of Science and in the portals of the Virtual Health Library (VHL). Results: two articles composed the sample of this review, which proposed to identify SAE registration models in the PACU. Conclusion: There is a need for studies that propose instruments for SAE in the PACU. The evidence identified has elements that contribute to the nature of the categories of nursing diagnoses, which may represent the care needs of patients in PACU. [ABSTRACT FROM AUTHOR]

Nurse managers in charge of a post-anaesthesia care unit (PACU) face the task of optimising staffing levels and must be able to justify staffing needs to the wider operational team. The high variability in patient numbers and acuity that characterises the PACU, as well as the broader factors that affect patient flow to and from the PACU, make it challenging to quantify staffing requirements. Staffing models often fail to reflect accurately the needs of patients and therefore the needs of the unit and there is no recommended model for quantifying PACU staffing requirements. In this article, the author describes the challenges of quantifying PACU staffing requirements and the suitability of different types of data. The author also discusses factors to consider when developing model for quantifying PACU staffing requirements., Competing Interests: None declared, (©2023 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Competing Interests: Declaration of Competing Interest None to report.

To evaluate the differences in professional competence development between nursing students in routine clinical practice and those who experienced four additional in-situ simulations. The amount of clinical practice time available to nursing students is limited. Occasionally, clinical settings do not provide all of the content that nursing students are expected to acquire. In high-risk clinical scenarios, such as the postanesthesia care unit, clinical practice may not provide sufficient context for students to develop the professional competence. This was a non-blinded, non-randomized, quasi-experimental study. The study was conducted in the postanesthesia care unit of a tertiary hospital in China between April 2021 and December 2022. Nursing students' self-assessed professional competence development and faculty-assessed clinical judgment were used as indicators. A total of 30 final year undergraduate nursing students were divided into two groups according to the time they arrived at the unit for their clinical practice. Nursing students in the control group followed the routine teaching protocol of the unit. Students in the simulation group received four additional in-situ simulations during the second and third weeks of their practice in addition to the routine program. Nursing students self-assessed their postanesthesia care unit professional competence at the end of the first and fourth weeks. At the end of the fourth week, the nursing students were evaluated on their clinical judgment. Nursing students in both groups scored higher on the professional competence at the end of the fourth week than at the end of the first week and there was a trend of higher competence improvement in the simulation group than in the control group. For clinical judgment, nursing students in the simulation group scored higher than the control group. In-situ simulation contributes to the development of professional competence and clinical judgment of nursing students during their clinical practice in the postanesthesia care unit. [ABSTRACT FROM AUTHOR]

Purpose This article describes the development and psychometric testing of a new Postanesthesia Care Unit (PACU) Readiness for Discharge Assessment Tool (RDAT) that can be used in assessing patients' readiness for discharge from a phase 1 PACU. Design This study used an instrument development methodology described by Waltz and Strickland that included item development and testing for content and convergent validity and interrater reliability. Methods Items were developed from a review the literature, best practice exemplars, and input from an expert panel. Ten items were identified for patient assessment using a dichotomous response set (yes/no). Two nurses independently assessed the patients using the RDAT and Respiration, Energy, Alertness, Circulation, and Temperature, and comparing independent assessments using the RDAT. Finding The content validity index was determined to be a = .80, and interrater reliability index was a = 1.0. Conclusions The RDAT is a useful, safe tool to assess patients' readiness for discharge from the PACU. [ABSTRACT FROM AUTHOR]

Purpose : This study investigated the effects of active warming using a Warm Touch warming system or a cotton blanket in postoperative patients after general anesthesia for abdominal surgery. Methods : This quasi-experimental study utilized two experimental groups and one control group: a cotton-blanket group (n = 25) were warmed with a cotton blanket and a sheet; a forced-air warming group (n = 24) were warmed with a Warm Touch warming system, a cotton blanket, and a sheet; and a control group (n = 25) were warmed with a sheet. Measurement variables were postoperative pain, body temperature, and thermal discomfort. Data were analyzed using a one-way ANOVA,  -tests, Fisher’s exact test, and a repeated measures ANOVA. Results : The effects of active warming using a Warm Touch warming system and a cotton blanket on postoperative patients was significant in reducing pain (F = 13.91, p ＜ .001) and increasing body temperature (F = 12.49, p ＜ .001). Conclusion : Active warming made a significant difference in pain and body temperature changes. Active warming methods may help patients’ postoperative recovery and prevent complications. Further research is needed to explore the effects and side effects of active warming on recovering normothermia. [ABSTRACT FROM AUTHOR]

Same-day discharges after interventional and diagnostic radiological procedures occur in many health facilities. Evidence-based recovery protocols are essential to provide high-quality nursing care. The systemic review examines recovery protocols for three outpatient radiological procedures to look at variations in clinical practice. A systematic review of recovery protocols for liver biopsy, vertebroplasty, and peripheral angiography with titles and abstracts of articles were reviewed for relevance, followed by sourcing of the full text for relevant articles and data extraction. In total, 450 articles pertaining to liver biopsy, 930 articles pertaining to vertebroplasty, and 735 articles pertaining to peripheral angiography were identified; 17, 8, and 13 articles, respectively, were deemed relevant. For liver biopsy, there were 13 primary research articles with the remainder from secondary sources (i.e., protocols and guidelines). All vertebroplasty articles were secondary. There were 10 primary research articles for peripheral angiography. Overall, 13 of 38 articles were nursing authored. Marked variations in recovery management, particularly with timing of observations and mobility, were observed. In conclusion, there is varied practice with a limited evidence base to guide postprocedural recovery protocols for liver biopsy, vertebroplasty, and peripheral angiography. Evidence-based review of current practice to inform protocol refinement is recommended. [ABSTRACT FROM AUTHOR]

Background Pulse oximetry does not reliably recognize respiratory depression, particularly in the presence of supplemental oxygen. Capnography frequently detects hypoventilation and apnea among children recovering from anesthesia. Although children are routinely monitored with capnography during anesthesia, reducing the rate of adverse events, it is not routinely used in the postanesthesia care unit ( PACU), where patients remain at risk for respiratory depression. Aim We hypothesized that children monitored with capnography would have more frequent staff interventions and fewer adverse events than children monitored with pulse oximetry alone. Methods Otherwise healthy children of age 1-20 years undergoing general anesthesia for elective surgery were eligible for enrollment upon entering the pediatric PACU. Subjects were randomized as to whether PACU staff could view the capnography monitor (intervention group) or not (control group). All children received standard monitoring with pulse oximetry. Vital signs and patient interventions were recorded every 30 s by a portable monitor or a research associate. Results Data from 201 children were analyzed. The rates of hypopneic hypoventilation [5% (95% CI: 2-8%) per minute vs 1% (95% CI: −1% to 3%) per minute, difference 4% (95% CI: 0.2-8%) per minute; P = 0.04] and apnea [11% (95% CI: 8-14%) per minute vs 1.5% (95% CI: −2% to 5%) per minute, difference 9% (5-14%) per minute; P < 0.001] decreased significantly faster in our intervention group as compared to the control group. The rates of bradypnea decreased faster in our control group [5% (95% CI: 2-8%) per minute vs 1% (95% CI: 0-4%) per minute, difference 4% per minute, 95% CI: 0-9%; P = 0.05]. Rates of respiratory events over time between groups were affected by the presence or absence of interventions. There were no differences in rates of hypoxemia between groups over time. Conclusions Children monitored with capnography have different rates of adverse respiratory events over time than children monitored solely with pulse oximetry. The addition of capnography improved the efficacy of staff interventions, however did not impact rates of oxygen desaturation. [ABSTRACT FROM AUTHOR]

This study aimed to classify patients according to their degree of dependence on nursing care (Perroca Classification System) and correlate this with the anesthetic risk (American Society of Anesthesiologists - ASA classification) in a post-anesthesia care unit. A cross-sectional study was conducted, which included 402 patients, mean age 51.57 (±16.73) years, of which 216 (54%) were female. The results indicate that patients had a degree of dependence between intermediate and semi-intensive with an ASA classification of between two and three. There was a significant relationship between degree of dependence and ASA classification. The results indicate that the post-anesthesia care unit admits patients with semi-intensive care requirements and with moderate anesthetic risk.El estudio tuvo por objetivo clasificar los pacientes según el grado de dependencia de los cuidados de enfermería (Sistema de Clasificación de Perroca) y relacionarlo con el riesgo anestésico (Clasificación de la American Society of Anesthesiologists - ASA) en una unidad de recuperación postanestésica. Se realizó un estudio transversal con inclusión de 402 pacientes, con edad promedio de 51,57 (±16,73), siendo 216 (54%) del sexo femenino. Los resultados apuntan que los pacientes tienen un grado de dependencia entre intermedio y semi-intensivo con una Clasificación ASA entre dos y tres. Hubo relación significativa entre el grado de dependencia y la Clasificación ASA. Los resultados indican que la unidad de recuperación postanestésica admite pacientes con cuidados semi-intensivos con moderado riesgo anestésico.O estudo teve por objetivo classificar os pacientes, segundo o grau de dependência dos cuidados de enfermagem (Sistema de Classificação de Perroca), relacionando-o ao risco anestésico (Classificação da American Society of Anesthesiologists - ASA) em uma unidade de recuperação pós-anestésica. Realizou-se estudo transversal, com inclusão de 402 pacientes com idade média de 51,57 (±16,73), sendo 216 (54%) do sexo feminino. Os resultados apontam que os pacientes têm grau de dependência entre intermediário e semi-intensivo com Classificação ASA entre dois e três. Houve relação significativa entre grau de dependência e Classificação ASA. Os resultados indicam que a unidade de recuperação pós-anestésica admite pacientes com cuidados semi-intensivos com moderado risco anestésico.

O presente artigo tem por objetivo identificar a concepção de enfermeiros acerca do conteúdo de website sobre sala de recuperação pósanestésica (SRPA). Pesquisa de campo, descritiva, realizada durante o 8º Congresso Brasileiro de Enfermagem em Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização com docentes de enfermagem e enfermeiros. 95,65% dos enfermeiros consideraram importante um website com disponibilização de informações sobre SRPA e apresentou uma grande diversidade entre os assuntos que devem fazer parte do conteúdo do website, porém todos os aspectos devem ser abordados desde que sejam informações seguras e confiáveis. É importante saber a opinião e expecta tivas de enfermeiros relacionadas a um website que disponibilize informações sobre SRPA.El presente artículo pretende identificar el diseño de las enfermeras sobre el contenido del sitio web en la sala de recuperación postanestésica. Búsqueda de campo, descriptivo, celebrada durante el 8º Congreso Brasileño de Enfermería en la Sala de Operaciones, Anestesia y Centro de Recuperación de Materiales y Esterilización con los maestros, enfermeras y enfermería. El 95,65% de las enfermeras consideran importantes con un sitio web para proporcionar información SRPA y presentó una gran diversidad entre las cuestiones que deben que deben formar parte de los contenidos del sitio web, sino a todos los aspectos deben abordarse si son seguros y de la información fiable. Es importante escuchar la opinión de las enfermeras y expectivas en relación con un sitio web que proporciona información sobre SRPA.The present article has as its objective to identify the concept of the registered nurses in relation to the contents in a website about the post-anesthetic recovery room. The descriptive field research was done during the 8th Brazilian Nursing Congress in Surgical Nursing, Anesthetic Recovery and the Central Supply, Sterilization and Material Preparation room with nurses involved in the teaching field and also nurses working in these areas. 95.65% of the nurses considered a website important in relation to the availability of information about SRPA and these nurses presented a large diversity about the subjects that should make up the contents of the website, however all aspects should be presented only when the information is secure and correct. It is important to know the opinion and expectations of the nurses in relation to a website that contains information about SRPA.

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]

Purpose: The purpose of this study was to develop a performance appraisal tool (PAT) for postoperative anesthesia care unit (PACU) nurses. Methods: This study was a descriptive, non-experimental methodological study. The PAT was developed through a literature review and tests for validity and reliability. Results: Subsequent to a review of the literature on nursing performance of PACU nurse, a 63 item questionnaire was developed. Through factor analysis, 61 items in 3 domains with 8 factors were derived. Cronbach’s α coefficient of the final instrument was .99. Conclusion: This tool is an efficient PAT for PACU providing meaningful feedback for professional growth in PACU nurses. [ABSTRACT FROM AUTHOR]

Early postoperative patients are vulnerable. Poor communication between health care professionals may seriously damage patients' wellbeing. There is a risk of information loss when bedside handover is performed. To investigate whether the implementation of structured and relayed forms to shift-to-shift bedside handovers improve the frequency of appropriate handover elements and reduces the incidence of adverse events and postoperative length of stay for patients in a postanesthesia care unit. This quality improvement project was conducted in a postanesthesia care unit of a tertiary stomatological hospital in China. The study population was patients under surveillance in the postanesthesia care unit for >12 h. A pre- and post-implementation approach was employed. The pre-implementation of unstructured bedside handovers and the post-implementation of bedside handovers with structured and relayed forms were compared. The indicators measured were appropriate handover elements, adverse patient events, and postoperative hospital stay. There were 387 and 395 morning handovers observed pre- and post-implementation of bedside handovers with structured and relayed forms, respectively. Of the 21 elements that should be delivered, 17 elements were noted to be improved. No improvement was found in the incidence of adverse events and postoperative hospital stay. Bedside handovers with structured and relayed forms increased the incidence of appropriate handover elements. The use of structured and relayed forms did not affect on the incidence of adverse events and postoperative hospital stay. Individualized relayed handover forms may be developed and implemented according to the characteristics in which they are administered. • Poor communication in handovers may seriously damage patients' wellbeing. • Structured and relayed forms contributed to the quality improvement of handover. • Appropriate handover elements should be considered in handover research. [ABSTRACT FROM AUTHOR]