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Background: The perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported. Case presentation: A 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms. Conclusions: This case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key. [ABSTRACT FROM AUTHOR]

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]

Abstract Background The perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported. Case presentation A 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms. Conclusions This case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key.

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]

Background: Total joint arthroplasty (TJA) performed in the ambulatory surgical center (ASC) has been shown to be safe and cost-effective for an expanding cohort of patients. As criteria for TJA in the ASC become less restrictive, data guiding the efficient use of ASC resources are crucial. Purpose: We sought to identify factors associated with length of stay in the recovery room after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed in the ASC. Methods: We conducted a retrospective review of 411 patients who underwent primary THA or TKA at our institution's ASC between November 2020 and March 2022. We collected patient demographics, perioperative factors, success of same-day discharge (SDD), and length of time in the recovery room. Results: Of 411 patients, 100% had successful SDD. The average length of time spent in recovery was 207 minutes (SD: 73.9 minutes). Predictors of longer time in recovery were increased age, male sex, and operative start time before 9:59 am. Body mass index, preoperative opioid use, Charlson Comorbidity Index, type of surgery (THA vs TKA), urinary retention risk, and type of anesthesia (spinal vs general) were not significant predictors of length of time in the recovery room. Conclusion: In this retrospective study, factors associated with increased length of time in the recovery room included older age, male sex, and operative start time before 9:59 am. Such factors may guide surgeons in determining the optimal order of cases for each day at the ASC, but further prospective studies should seek to confirm these observations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Days before surgery, add-ons may be scheduled to fill unused surgical block time at an outpatient surgery center. At times, outpatient surgery centers have time limitations for end of block time and discharge from the postanesthesia care unit (PACU). The objective of our study was to develop machine learning models that predicted the following composite outcome: (1) surgery finished by end of operating room block time and (2) patient was discharged by end of recovery room nursing shift. We compared various machine learning models to logistic regression. By evaluating various performance metrics, including F1 scores, we hypothesized that models using ensemble learning will be superior to logistic regression. METHODS: Data were collected from patients at an ambulatory surgery center. The primary outcome measurement was determined to have a value of 1 (versus 0) if they met both criteria: (1) surgery ends by 5 pm and (2) patient is discharged from the recovery room by 7 pm. We developed models to determine if a procedure would meet both criteria if it were scheduled at 1 pm, 2 pm, 3 pm, or 4 pm. We implemented regression, random forest, balanced random forest, balanced bagging, neural network, and support vector classifier, and included the following features: surgery, surgeon, service line, American Society of Anesthesiologists score, age, sex, weight, and scheduled case duration. We evaluated model performance with Synthetic Minority Oversampling Technique (SMOTE). We compared the following performance metrics: F1 score, area under the receiver operating characteristic curve (AUC), specificity, sensitivity, precision, recall, and Matthews correlation coefficient. RESULTS: Among 13,447 surgical procedures, the median total perioperative time (actual case duration and PACU length stay) was 165 minutes. When SMOTE was not used, when predicting whether surgery will end by 5 pm and patient will be discharged by 7 pm, the average F1 scores were best with random forest, balanced bagging, and balanced random forest classifiers. When SMOTE was used, these models had improved F1 scores compared to no SMOTE. The balanced bagging classifier performed best with F1 score of 0.78, 0.80, 0.82, and 0.82 when predicting our outcome if cases were to start at 1 pm, 2 pm, 3 pm, or 4 pm, respectively. CONCLUSIONS: We demonstrated improvement in predicting the outcome at a range of start times when using ensemble learning versus regression techniques. Machine learning may be adapted by operating room management to allow for a better determination whether an add-on case at an outpatient surgery center could be appropriately booked.

Safe transfer of patients who have undergone anesthesia and surgery is a basic principle to maintain stability, and avoid side effects and preventable errors. Specific scoring systems or criteria may be used to assess and decide whether patients are sufficiently recovered to be safely transferred to another ward or discharged home. This study aims to answer the question, what criteria are appropriate for patient evaluation and discharge in the post-anesthesia care unit? designed. To find documents related to writing a review article on various scoring systems for patients after anesthesia in Google Scholar, PubMed, Scopus, and ScienceDirect databases and using English keywords post-anesthesia care unit, PACU, recovery room, discharge, scoring system, Assessment was searched. A total of 168 articles were found by searching the databases. After removing duplicates, 77 articles were evaluated. Finally, 17 articles were selected and included in the study. The included studies included a variety of tools and criteria for evaluating and discharging patients in the post-anesthesia care unit. This article separately describes each of the tools and criteria for the evaluation and discharge of patients in the post-anesthesia care unit along with the method of scoring, advantages and disadvantages of each. A safe scoring system for discharge from PACU should evaluate important parameters after anesthesia, including alertness, blood pressure, heart rate, ventilation, oxygen saturation, and surgical site bleeding, which can cause serious complications. Considering that one of the goals of PACU is to relieve patients’ pain in the post-surgery phase, the evaluation and control of pain and postoperative nausea and vomiting is effective in the satisfaction and safety of patients.

Objective: To assess the factors associated with ineffective thoracic epidural analgesia (iTEA) in the post-anesthesia care unit (PACU) among patients requiring TEA. Material and Methods: This prospective cohort was conducted on 146 patients requiring post-operative TEA. The verbal numeric rating scale (VNRS) was employed to assess TEA effectiveness on PACU arrival at 10, 20, and 30 minutes after surgery; iTEA was determined if the VNRS score was more than 3 and 4 at rest and during activity, respectively. The patient characteristics, and intra- and post-operative epidural management were collected. The risk factors of iTEA were evaluated using mixed-effects models. Moreover, factors associated with severe pain at PACU discharge were evaluated using logistic regression analyses. Results: The incidence of iTEA on PACU arrival, and at 10, 20, and 30 minutes after PACU arrival were 53.4%, 51.4%, 50.7%, and 36.3%, respectively. Intra-operative intravenous morphine supplementation and the cumulative fentanyl equivalent dose (every 10 mcg) were significantly associated with preventing the risk of iTEA on PACU arrival (OR 0.27; 95% CI=0.07-0.92) and during PACU stay (OR 0.87; 95% CI=0.77-0.97) compared to those who did not receive opioids. Moreover, iTEA on PACU arrival was a significant risk for severe pain at 30 minutes (adjusted OR 4.77; 95% CI=1.57-18.10). Conclusion: This study demonstrates a high incidence of iTEA immediately after surgery, and that intravenous opioid supplementation during and after surgery reduces the risk of iTEA. Lastly, iTEA on PACU arrival is a strong predictor of severe pain at discharge from PACU.

Background: Diagnostic criteria for emergence agitation are sensitive but not specific; they misclassify patients who are angry or upset as having emergence delirium. Aims: The aim of this three‐phase study was to determine expert agreement on the behaviors that differentiate children with emergence delirium from those without. Methods: In the first phase of this observational study, pediatric dental patients were video recorded while awakening from anesthesia. In the second phase, salient 10 s segments of the recordings showing patient activity were shown to an expert audience of pediatric dentists, anesthesiologists and Post Anesthetic Care nurses, who scored the recordings as showing or not showing "true emergence delirium." In phase 3, the video segments were assessed by three research assistants using a behavior checklist for features that discriminate between those scored "true emergence delirium" and those scored "NOT true emergence delirium" by the experts. Results: One hundred and fifty‐four pediatric dental patients were included. Subsequently, an expert audience consisting of 10 anesthesiologists, 12 anesthesiology residents, 3 pediatric dentists, and 4 experienced Post Anesthesia Care Unit nurses rated each 10‐second video segment. This resulted in three groups of patients: a group for whom all experts agreed was "True emergence delirium" (n = 33; CI 21 to 45), a group for whom all agreed was "Not True emergence delirium" (n = 120; CI 107 to 133), and a group where experts disagreed (n = 11; CI 4 to 18). Three research assistants then completed a behavior checklist for each of the 33 "True emergence delirium" video segments and matched "Not True" controls. Twenty‐four behaviors were identified as significantly different between videos scored True emergence delirium and those scored Not True emergence delirium. Research assistants reached almost perfect agreement (0.81–1.00) on one behavior, and substantial agreement (0.61–0.80) on seven behaviors that characterized "True emergence delirium." Conclusions: Eight behaviors that differentiate pediatric dental patients with emergence delirium from those without were found. These discriminators may be used to develop a scale that will lead to better diagnosis and treatment of emergence delirium. [ABSTRACT FROM AUTHOR]

A recovery room is a necessary unit of hospital nursing that should be continued in the operating room. The goal of recovery is to provide high-quality care for patients undergoing post-surgical recovery, in contrast to the effects of anesthetic drugs, such as sudden movements of the hands and legs, standing, or falling from the bed that may occur instantaneously. Due to the shortage of nurses in the recovery room that these units face, the need to use remote monitoring systems for patients is increasing to somehow compensate for the lack of service personnel and that assist staff in better monitoring of patients. In this study, using a combination of geometric features and depth data, a patient's actions are recognized. Then, the actions that are at risk for patients in the recovery room will be identified and notified to the nursing unit before its occurrence to take necessary measures. For this purpose, RGB-D data is collected and analyzed. The proposed methodology steps in this study generally include recording video images using Kinect sensors (457 videos with 640 × 480 resolution), extracting features from video frames (color separation-based approach), training the Hidden Markov Model to classify the indicator vectors, and finally evaluation and validation of the model. Experimental results indicate that the proposed identification method can accurately detect moments that the patient is exposed to danger due to their changes in the hospital bed. The recognition rate for this approach is 91.36%. [ABSTRACT FROM AUTHOR]

Background/Aims Data on the incidence of adverse respiratory events during recovery from gastrointestinal endoscopy are limited. The aim of this study was to investigate the incidence of these complications. Methods In this retrospective cohort study, data were obtained from the electronic records of 657 consecutive patients, who underwent gastroenterological procedures under sedation. Results Pulse oximetry oxygen saturation (SpO2) 60 seconds occurred in 79 patients (12.0%) and in 14 patients (2.1%), and SpO2

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/Aims: Data on the incidence of adverse respiratory events during recovery from gastrointestinal endoscopy are limited. The aim of this study was to investigate the incidence of these complications. Methods: In this retrospective cohort study, data were obtained from the electronic records of 657 consecutive patients, who underwent gastroenterological procedures under sedation. Results: Pulse oximetry oxygen saturation (SpO2) <90% for <60 seconds occurred in 82 patients (12.5%), and in 11 patients (1.7%), SpO2 of <90% for >60 seconds occurred in 79 patients (12.0%) and in 14 patients (2.1%), and SpO2 <75% occurred in four patients (0.6%) and in no patients during the procedure and recovery period, respectively. No major complications were noted. The occurrence of desaturation during recovery was correlated with desaturation during the procedure (p<0.001). Higher American Society of Anesthesiologists score (odds ratio [OR], 1.867; 95% confidence interval [CI], 1.008-3.458), ischemic heart disease (OR, 1.815; 95% CI, 0.649-5.080), hypertension (OR, 1.289; 95% CI, 0.472-3.516), and diabetes mellitus (OR, 2.406; 95% CI, 0.950-6.095) increased the occurrence of desaturation during recovery. Conclusions: We found no major complications during recovery after balanced propofol-based sedation administered by a gastroenterologist-nurse team. Patients with the identified risk predictors must be monitored carefully. [ABSTRACT FROM AUTHOR]

Background: Hypothermia occurs when the core body temperature of an organism is <36°C, commonly affecting up to 70% of surgical patients perioperatively. Body temperature performs vital role in maintaining normal human activities. However, factors like, the use of anesthetic drugs, cold operating theater, skin antisepsis and cold irrigation of a patient with the body uncovered and the use of intravenous solutions during surgery can leads to a low body temperature. Objective: objective of this study was effect of sociodemographicals on the post operative hypothermia. Method: a hospital based descriptive observational study was undertaken. All the postoperative patients (N=250) that underwent anaesthesia were included. The body temperature was measured after immediately after surgery at the arrival of recovery room or Preanesthetic care unit in post operative period. Analysis was done using the software SPSS version 26.00. Results: Total 250 post operative patients were included in the study. Among them 185 (74%) patients had post operative hypothermia. Mean of age of hypothermia patients were 45.74 years. the maximum cases had hypothermia 173 (93.5%) were having Hindu religion. the majority of patients 63 (34.1%) had hypothermia patients were having no education. 84 (45.4%) had hypothermia they were having farmers. 79 (42.7%) had hypothermia were having monthly income between 11000-19999. 96 (51.9%) had hypothermia they were in rural residency. Therefore while considering p value <0.05 significant, there is no any significant association of hypothermia with socio demographical variables found. Conclusion: The majority of samples 50% were having age between the 19 to 40 years. There no any significant association was found between hypothermia and socio demographical variables. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the intensity and discomfort caused by thirst in patients in the immediate postoperative period. Method: exploratory-descriptive study developed with patients hospitalized in the post-anesthetic recovery room of a public hospital in Paraná. Individuals over 18 years of age, of both sexes, with preserved cognitive function, hospitalized from June 2021 to January 2022, were evaluated. Thirst intensity and discomfort were measured by specific scales. Results: 150 patients were evaluated, with a mean of 43.9 years. Most were male (65.3%), without comorbidities (68.7%), underwent spinal anesthesia (58%) and orthopedic surgery (59.3%), with ongoing serotherapy (92.7%). The mean surgery time was 1.5 hours and 14.6 hours of fasting; 72.7% of the sample verbalized thirst, and 37.6% complained spontaneously. Conclusion: the research participants presented moderate intensity (6.6) and discomfort (7.6) of thirst in the postoperative period, making it necessary to discuss institutional intervention protocols to reduce such event. [ABSTRACT FROM AUTHOR]

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BackgroundChildren who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain.MethodsIn Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically-based intervention which was then evaluated by experienced nurses (N = 8) and parents (N = 9) during focus groups. After revising the intervention based on focus group feedback, it was tested in Phase 2 using a pre-post study design. Nurses (N = 23) who worked in the recovery room were recruited to be part of both pre- and post-intervention data collection periods. Parents were recruited to be part of either the pre- (N = 52) or post-intervention (N = 60) data collection periods. Nurses and parent-child dyads were recorded in the post anesthesia care unit and videos were coded for the desired (ie, behaviors that may decrease child pain) and non-desired (ie, behaviors that may increase child pain) behaviors. Pain data was collected from the children's medical records to assess pain after surgery. The intervention was given to the nurses and parents in the post-intervention data collection period.ResultsNurses significantly increased their rate of desired behaviors by 231% (P = 0.001; Somer's D = 1) and significantly decreased their rate of non-desired behaviors by 62% (P = 0.004, Somer's D = -0.88, 95% CI [-1.74, -0.03]). Parents significantly increased their rate of desired behaviors by 124% (P = 0.033). Moreover, the intervention significantly decreased child pain in the post anesthesia care unit (b = -2.19, SE = 0.63, z = -3.46, P = 0.001, 95%CI [-3.43, -0.95]).ConclusionThe intervention was effective in changing nurse and parent behaviors as well as child pain after surgery.

Background: The postoperative care transition from the postanesthetic recovery room (PACU) to the common ward or even home discharge represents a critical step of the surgical patients’ handover. Although some systems have been proposed to measure the ability to discharge after an anesthetic-surgical procedure effectively, there is no consensus defining which variables should necessarily be evaluated by these instruments. The instruments routinely used do not evaluate important domains for discharge and are laborious to fill, which compromises the professionals’ adhesion. The objectives are to describe the creation of a new recovery room discharge tool (SAMPE checklist) and determine the degree of agreement of the new tool with two classical scales. Methods: In a cross-sectional observational study, 997 patients were selected from the general population undergoing a wide range of surgical procedures in a quaternary care hospital. At 90 minutes after leaving the operating room (OR), patients were evaluated and information was collected to fill out the new SAMPE checklist and two other scores (Aldrete and White) to examine the degree of agreement between them. Results: SAMPE checklist has presented a satisfactory agreement with the White score and lower agreement with Aldrete modified score. Conclusion: This new instrument, as demonstrated in this study with nearly 1000 patients from different contexts, is easy to apply, has high adhesion potential, and can be considered a new option to formalize the discharge from the recovery room.

Junhui Ji,1,&ast; Xiafang Gu,2,&ast; Chengjiao Xiao1 1Anesthesiology Department, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Anesthesiology Department, The No.2 People’s Hospital of Suzhou Xiangcheng District, Suzhou, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chengjiao XiaoAnesthesiology Department, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, People’s Republic of ChinaTel +86-13962100544Email xiaocj1646@126.comBackground: Whether intraoperative temperature management can help patients recover quickly in the postanesthesia care unit (PACU) still remains to be investigated. This study aimed to investigate the effect of intraoperative temperature management on the quality of postoperative recovery of patients who underwent pulmonary lobectomy in the PACU.Methods: Totally, 98 patients aged 45– 60 years with a body mass index of 20– 25 kg/m2 who underwent elective thoracoscopic lobectomy were enrolled. Patients were categorized into two groups using a random number table: the conventional group received routine intervention to maintain normothermia (Group C, n = 49) and the aggressive group received integrated interventions (Group A, n = 49). In Group C, normothermic fluid was infused intravenously, the heating blanket was turned on when the intraoperative temperature was < 35.0 °C, and the warming was stopped when the temperature reached 36.5 °C. In Group A, the fluid heated to 37 °C was infused intravenously, and the heating blanket was used intraoperatively. When the body temperature was > 37 °C, the heating blanket was turned off, and when the body temperature was < 36.5 °C, the heating blanket was turned on to continue heating.Results: Steward awakening scores at 1 min and 5 min after extubation and PaO2 levels at 15 min after extubation were higher in Group A than in Group C (P < 0.05); incidence of chills, nausea, and vomiting in the PACU was lower in Group A than in Group C (P < 0.05); and length of stay in the PACU was shorter in Group A than in Group C (P < 0.05).Conclusion: Aggressive intraoperative temperature management of patients undergoing thoracoscopic lobectomy can improve the quality of postoperative recovery in the PACU through a safe and smooth transition compared with routine insulation measures.Keywords: hypothermia, recovery room, thoracoscopy, thoracic surgery

Stefan Schad,1 Hendrik Booke,2 Serge C Thal,3 Alexander H Bentley,3 Michael Booke1 1Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Kliniken-MTK, Academic Hospital of the Goethe-University Frankfurt, Frankfurt, Germany; 2Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; 3Department of Anesthesiology, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, GermanyCorrespondence: Stefan Schad Email sschad@kliniken-mtk.deAbstract: The anesthesiologist, who traditionally was solely responsible for the intra- and postoperative care of patients, has undergone a transformation over the last decades and has emerged as a specialist for perioperative medicine. This includes preoperative assessment, preoperative stabilization of emergent cases, pre- or postoperative initiation of regional blocks, postoperative recovery and if needed postoperative intensive care outside the intensive care unit. A traditional recovery room, designated to take care of patients emerging from anesthesia only, no longer matches the modern anesthesiologist’s demands. However, a traditional recovery room can easily be transformed into a vibrant multi-purpose perioperative care unit. Especially in smaller hospitals, this serves to match the anesthesiologist’s demands without the financial burden of separate units for each task. On the contrary, it allows to transform the recovery room from a mandatory, but costly postoperative unit into a highly productive and demanding perioperative unit, allowing for extra revenues without corresponding costs. Worldwide, operating rooms are linked to an adjacent recovery room allowing patients to emerge from anesthesia until they fulfill the criteria to be transferred either to the regular ward or, in case of outpatient surgery, to be discharged home. Running these recovery rooms, however, is expensive due to the required technical equipment and the monthly costs of highly qualified anesthesia personnel. Despite these financial burdens, such recovery rooms are still mandatory to ensure full recovery after anesthesia and surgery. In most countries, there is no (full) reimbursement for providing recovery rooms, turning them into fiscally deficient units in most hospitals. However, recovery rooms can be further developed allowing hospitals to improve their caseloads, reduce turnover times in the operating room, and even help to manage a shortage of beds in the intensive care unit. In this paper, we describe the potential transformation from a traditional recovery room to a multi-purpose perioperative high-tech unit.Keywords: recovery room, postanesthesia care unit, perioperative medicine, turnover time, reimbursement, same-day admission, holding area

With electrical impedance tomography (EIT) recruitment and de-recruitment phenomena can be quantified and monitored at bedside. The aim was to examine the feasibility of EIT with respect to monitor atelectasis formation and resolution in the post anesthesia care unit (PACU). In this observational study, 107 postoperative patients were investigated regarding the presence and recovery of atelectasis described by the EIT-derived parameters Global Inhomogeneity Index (GI Index), tidal impedance variation (TIV), and the changes in end-expiratory lung impedance (ΔEELI). We examined whether the presence of obesity (ADP group) has an influence on pulmonary recovery compared to normal weight patients (NWP group). During the stay at PACU, measurements were taken every 15 min. GI Index, TIV, and ΔEELI were calculated for each time point. 107 patients were monitored and EIT-data of 16 patients were excluded for various reasons. EIT-data of 91 patients were analyzed off-line. Their length of stay averaged 80 min (25th and 75th quartile 52–112). The ADP group demonstrated a significantly higher GI Index at PACU arrival (p < 0.001). This finding disappeared during their stay at the PACU. Additionally, the ADP group showed a significant increase in ΔEELI between PACU arrival and discharge (p = 0.025). Furthermore, TIV showed a significantly lower value during the first 90 min of PACU stay as compared to the time period thereafter (p = 0.036). Our findings demonstrate that obesity has an influence on intraoperative atelectasis formation and de-recruitment during PACU stay. The application of EIT in spontaneously breathing PACU patients seems meaningful in monitoring pulmonary recovery. [ABSTRACT FROM AUTHOR]

This study aimed to investigate whether there was an association between an unanticipated prolonged post-anaesthesia care unit (PACU) length of stay and early postoperative deterioration, as defined as the need for a rapid response team activation, within the first seven days of surgery. We conducted a single-centre retrospective cohort study of adult surgical patients, who stayed at least one night in hospital, and were not admitted to critical care immediately postoperatively, between 1 July 2017 and 30 June 2019. A total of 11,885 cases were analysed. PACU length of stay was significantly associated with rapid response team activation on both univariate (odds ratio (OR) per increment 1.57, 95% confidence intervals (CI) 1.45 to 1.69, P < 0.001) and multivariate analysis (OR per increment 1.41, 95% CI 1.28 to 1.55, P < 0.001). Patients who stayed less than one hour were at low risk of deterioration (absolute risk 3.7%). In patients staying longer than one hour, the absolute increase in risk was small but observable within six hours of PACU discharge. Compar\ed to a one-hour length of stay, a five-hour stay had a relative risk of 4.9 (95% CI 3.7 to 6.1). Other factors associated with rapid response team activation included non-elective surgery (OR 1.78, P < 0.001) and theatre length of stay (OR per increment 1.61, P < 0.001). PACU length of stay was also independently associated with predefined complications and unplanned intensive care unit admission postoperatively. In our cohort, an unanticipated prolonged PACU length of stay of over one hour was associated with an increased incidence of rapid response team activation in the first seven days postoperatively. [ABSTRACT FROM AUTHOR]

The reasons for the lag of the indicators of the leading Russian coal mines engaged in the longwall mining of the flat-lying coal seams from similar foreign mines are considered. The analysis of the efficiency of the longwall face move operations at the JSC SUEK-Kuzbass mines was carried out. A significant excess of the planned deadlines for the longwall face move during the thick flat-lying seams mining, the reasons for the low efficiency of disassembling operations and the main directions for improving the technology of disassembling operations are revealed. The directions of ensuring the operational condition of the recovery room formed by the longwall face are considered. The recommended scheme of converged coal seams mining and a three-dimensional model of a rock mass to justify its parameters are presented. Numerical studies using the finite element method are performed. The results of modeling the stress-strain state of a rock mass in the vicinity of a recovery room formed under conditions of increased stresses from the boundary part of a previously mined overlying seam are shown. The main factors determining the possibility of ensuring the operational condition of the recovery rooms are established. It is shown that it is necessary to take into account the influence of the increased stresses zone when choosing timbering standards and organizing disassembling operations at a interbed thickness of 60 m or less. A sufficient distance from the gob of above- or undermined seams was determined to ensure the operational condition of the recovery room of 50 m, for the set-up room – 30 m. Recommendations are given for improving technology and organization of the longwall face move operations at the mines applied longwall mining of flat-lying coal seams with the formation of a recovery room by the longwall face.

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]

Purpose: This study is a prospective observational study that analyzes the factors affecting and the incidence of postoperative delirium in elderly patients under general anesthesia. Methods: The study enrolled 193 elderly patients who entered the recovery room after surgery under general anesthesia in a certified tertiary hospital. Data were measured twice-first, before surgery and, second, 30 minutes after the patient entered the recovery room-using the Korean Nursing Delirium Screening Scale. The data were analyzed using x2 tests, the independent t-test, and logistic regression from SPSS 22.0. Results: The incidence of delirium in elderly patients after surgery under general anesthesia was 13.0% (25 of 193 patients). The incidence of delirium was a significant in the following cases: elderly patient, patients who performed physical activity with assistance at pre-operation, those with lower body mass index, those with lower body weight, those with long operative times, and those with high preoperative pain scores. The occurrence of delirium was 16.57 times higher in the presence of comorbidities, 5.74 times higher when hospitalization occurred through the emergency room, and 3.99 times higher when the number of catheters was high. Conclusion: Screening for early delirium in the recovery room is important, and it can provide basic data for early nursing intervention in patients suffering from postoperative delirium. [ABSTRACT FROM AUTHOR]

Introduction: Most post-operative patients do not feel well because of very severe pain level during the first 24 hours after surgery, pain can be managed and reduced by means of evidence-based practices. Objectives: To develop Clinical Practice Guidelines (CPG) for pain management in the recovery room. To assess the effectiveness of the clinical practice. Developmental research procedures: Phase 1: This phase is the analysis step of the causes of problems regarding post-operative pain management in the recovery room. Phase 2: Guidelines for post-operative pain management were developed. Phase 3: The CPG for post-operative pain management in the recovery room were used as a standard in practice by the staff of the anesthesiology department. The outcomes of the developed methods were assessed. Descriptive statistics and inferential statistics were used. Results: The development of CPG. The Clinical Practice Guidelines for post-operative pain management in the recovery room follow the practice following the CPG for post-operative pain management in the recovery room increased from 76.4% to 93.3% and 99.2%, respectively. The development periods were associated with the practices of nurse anesthetists following the Clinical Practice Guidelines in the recovery room with statistical significance (p<0.001). Comparing the means of pain scores before leaving the recovery room, it was found that the means of pain scores of the pre-development period and the during-development period were 2.99 and 2.59, respectively. The mean in the post-development period decreased to 1.86. The overall rating of nurse anesthetists and patients satisfaction in the use of the Clinical Practice Guidelines for pain management in the recovery room was good (mean 4.34, 4.37) respectively. The CPG were appropriate and they were satisfied with the implementation. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the application of cost-effectiveness modeling to redesign of perioperative care pathways, from a hospital perspective.Methods: A Markov cost-effectiveness model of patient transition between care locations, each with different characteristics and cost, was developed. Inputs were derived from clinical trials piloting a preoperative call center and a postoperative medium-acuity care unit. The effect chosen was days at home (DAH) after surgery, reflecting quality of in-hospital care, acknowledged financially by fundholders, and relevant to consumers. Cost was from the hospital's perspective. A model cycle time of 4 hours for 30 days reflected relevant timelines and costs.Results: A Markov model was successfully created, accounting for the care locations in the 2 pathways as model states and accounting for consequences and costs. Cost-effectiveness analysis allowed the calculation of an incremental cost-effectiveness ratio comparing these pathways, providing a mean incremental cost-effectiveness ratio of -$427 per additional DAH, where incremental costs and DAH were -$644 and +1.51, respectively. Probabilistic sensitivity analysis suggested the new pathway had a 61% probability of reduced costs and a 74% probability of increased DAH and a 58% probability this pathway was dominant. Tornado analysis revealed the major contributor to increased costs as intensive care unit stay and the major contributor to decreased costs as ward stay. For the new pathway, the probability of transfer from ward to home and the probability of staying at home had the greatest impact on DAH.Conclusions: These data suggest Markov modeling may be a useful tool for the cost-effectiveness analysis of initiatives in perioperative care. [ABSTRACT FROM AUTHOR]

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Background: Dexmedetomidine is a useful anesthetic adjunct, increasingly popular during pediatric surgery and procedural sedation. Its half‐life of 2–3 hours might prolong recovery and discharge times when compared with an un‐supplemented propofol anesthetic. This may create an additional burden in a busy post‐anesthetic care unit (PACU). Aim: To investigate whether intraoperative adjuvant dexmedetomidine delays PACU discharge in patients undergoing propofol anesthesia for day surgery or procedural investigations with minimal anticipated post‐procedural pain. Methods: We conducted a retrospective review of outpatient procedures performed during a six‐month period including pediatric patients, ASA physical status I‐III, who underwent intravenous anesthesia with propofol and remifentanil for magnetic resonance imaging (MRI), strabismus repair, upper gastrointestinal endoscopy, or combined upper/lower gastrointestinal endoscopy. Patients receiving a sedative premedication, long‐acting opioids, or volatile anesthetics for maintenance of anesthesia, were excluded. Duration of PACU stay was compared for patients who did or did not receive intraoperative dexmedetomidine in the four procedure groups. Results: Charts were reviewed for 359 patients; 130 (36%) received dexmedetomidine. Median differences in duration of PACU stay for dexmedetomidine versus non‐dexmedetomidine cases were: 5 minutes (95%CI 0 to 10, p=0.037) for MRI; 5 minutes (95%CI −3 to 15, p=0.258) for strabismus surgery; 7 minutes (95%CI 3 to 10, p<0.001) for upper endoscopy; and 5 minutes (95%CI 1 to 12, p=0.021) for combined upper/lower endoscopy. Linear regression (F=61.1, adjusted R2=0.40) indicated a significant relationship between dexmedetomidine dose (estimate 14.6 minutes per μg/kg, 95%CI 8.2 to 21.1, p<0.001) and duration of PACU stay. Conclusion: We found evidence for a small association of intraoperative dexmedetomidine with duration of recovery from propofol anesthesia for a set of common outpatient procedures, with a potential dose relationship equivalent to approximately 15 minutes delay per μg/kg dexmedetomidine administered. Future research into the benefits of dexmedetomidine in pediatric anesthesia should further evaluate this relationship. [ABSTRACT FROM AUTHOR]

Perform a systematic review to investigate the use of the Aldrete and Kroulik Index in the Post Anesthetic Recovery Room (PACU).Systematic review conducted in June 2018, with the DeCS / MeSH descriptors selected from their definitions, are as follows: Anesthesia recovery period; Recovery room; Nursing care; Patient discharge. The databases consulted were MEDLINE, LILACS, BDENF and SCIELO. The selection criteria were published between 2008 to 2017; main subject: anesthesia recovery period, PACU and patient discharge; Languages: Portuguese, English and Spanish.Seven articles were found within the established criteria. They reported the use of IAK associated with other scales such as pain, nausea, temperature and delusions. They pointed out deficiencies in the evaluation, such as absence of temperature and pain measurement. The benefits of using IAK were identified, besides raising a discussion about its limitations.

Background: To date, there is no instrument to adequately assess self-reported quality of recovery (QoR) in the post-anesthesia care unit (PACU). We previously developed the QoR-PACU, a 13-item questionnaire specifically applicable to the PACU. The feasibility, acceptance, and validity of the QoR-PACU were promising. However, measures of reliability were slightly lower than expected., Methods: We modified the QoR-PACU and evaluated its psychometric properties in a cohort of adult patients scheduled for non-cardiac surgery with general anesthesia. The modified QoR-PACU (termed QoR-PACU 2 ) was administered before surgery and postoperatively in the PACU at the time of the decision to discharge., Results: A total of 307 patients were included in the final analysis. Postoperative QoR-PACU 2 sum scores differed across categories of sex, perioperative and surgical risk, and modes of airway management. The duration of anesthesia and surgery, maximum pain intensity and analgesic requirement in the PACU, and length of PACU stay were all inversely correlated with QoR in the PACU. Cronbach's alpha was 0.70 (95%CI: 0.66-0.75). The intra-class correlation coefficient was 0.86 (95%CI: 0.70-0.94, p < 0.001) for intra-rater reliability (n = 24) and 0.94 (95%CI 0.90 to 0.97, p < 0.001) for inter-rater reliability (n = 31). Cohen's effect size was 0.68 and the standardized response mean was 0.57., Conclusion: The QoR-PACU 2 assesses self-reported QoR after surgery in the PACU. Measures of feasibility, validity, and reliability were consistently high. Measures of responsiveness were moderate, which might be attributable to the heterogeneity of the study population. Future studies should include aspects of ethnicity and cross-cultural applicability., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

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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]

Postoperative delirium is associated with worse outcome. The aim of this study was to understand present strategies for delirium screening and therapy in German Post-Anesthesia-Caring-Units (PACU). We designed a German-wide web-based questionnaire which was sent to 922 chairmen of anesthesiologic departments and to 726 anesthetists working in ambulatory surgery. The response rate was 30% for hospital anesthesiologists. 10% (95%-confidence interval: 8-12) of the anesthesiologists applied a standardised screening for delirium. Even though not on a regular basis, in 44% (41-47) of the hospitals, a recommended and validated screening was used, the Nursing Delirium Screening Scale (NuDesc) or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). If delirium was likely to occur, 46% (43-50) of the patients were examined using a delirium tool. 20% (17-23) of the patients were screened in intensive care units. For the treatment of delirium, alpha-2-agonists (83%, 80-85) were used most frequently for vegetative symptoms, benzodiazepines for anxiety in 71% (68-74), typical neuroleptics in 77% (71-82%) of patients with psychotic symptoms and in 20% (15-25) in patients with hypoactive delirium. 45% (39-51) of the respondents suggested no therapy for this entity. Monitoring of delirium is not established as a standard procedure in German PACUs. However, symptom-oriented therapy for postoperative delirium corresponds with current guidelines. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of hypothermia after general anesthesia and analyze its influencing factors. Methods: 110 patients with general anesthesia in our hospital from May 2020 to October 2020 were selected as the research objects, and methods retrospective analysis was used to sort out the patient's medical records. The incidence of hypothermia in the wake-up room of patients after general anesthesia was observed. Patients with hypothermia were classified as hypothermia group and those without hypothermia were classified as normal body temperature group. Logistic regression was used to analyze the related factors of hypothermia. Results: There were 15 patients with hypothermia after general anesthesia. The incidence of hypothermia was 13.64% (15/110). Univariate analysis showed that the incidence of postoperative hypothermia in patients after general anesthesia was related to age, anesthesia time, operation time, American Society of Anesthesiologists (ASA) classification, recovery delay and intraoperative infusion volume (P<0.05), but not with gender, body mass index, intraoperative ambient temperature and preoperative hemoglobin (P>0. 05). Multivariate Logistic regression analysis showed that operation time > 4h, ASA grade Ⅲ ~ Ⅳ, intraoperative infusion volume > 1300 mL, age > 60 years old were the influencing factors of the occurrence of postoperative hypothermia in patients after general anesthesia (P<0.05). Conclusions: The occurrence of hypothermia in the wake-up room of patients after general anesthesia is inevitable, and it is affected by many factors. It is necessary to shorten the operation time as far as possible, do a good job in heat preservation of input liquid, especially for elderly patients, so as to reduce the risk of hypothermia. [ABSTRACT FROM AUTHOR]

Summary: Postoperative complications are common and may be under‐recognised. It has been suggested that enhanced postoperative care in the recovery room may reduce in‐hospital complications in moderate‐ and high‐risk surgical patients. We investigated the feasibility of providing advanced recovery room care for 12–18 h postoperatively in the post‐anaesthesia care unit. The primary hypothesis was that a clinical trial of advanced recovery room care was feasible. The secondary hypothesis was that this model may have a sustained impact on postoperative in‐hospital and post‐discharge events. This was a multicentre, prospective, feasibility before‐and‐after trial of moderate‐risk patients (predicted 30‐day mortality of 1–4%) undergoing non‐cardiac surgery and who were scheduled for postoperative ward care. Patients were managed using defined assessment checklists and goals of care in an advanced recovery room care setting in the immediate postoperative period. This utilised existing post‐anaesthesia care unit infrastructure and staffing, but extended care until the morning of the first postoperative day. The advanced recovery room care trial was deemed feasible, as defined by the recruitment and per protocol management of > 120 patients. However, in a specialised cancer centre, recruitment was slow due to low rates of eligibility according to narrow inclusion criteria. At a rural site, advanced recovery room care could not be commenced due to logistical issues in establishing a new model of care. A definitive randomised controlled trial of advanced recovery room care appears feasible and, based on the indicative data on outcomes, we believe this is warranted. [ABSTRACT FROM AUTHOR]

Vomiting is a common side effect of surgery. Thus, timely prevention could improve the quality of patient care in the recovery room. The incidence rate of patient vomiting in the recovery room from April 13, 2018 to May 12, 2018 was found to be 3.86%. This may be attributed to the side effects of postsurgical use of narcotic analgesics, inconsistency in patients turnover operations and skills, and a lack of training on transporting patients. A special project was conducted from June 1, 2018 to September 30, 2018 in which measures to improve patient vomiting were devised. These measured were communicating with physicians to prescribe preventive anti-emetics before administering narcotic analgesics; breathing training using mint aroma; relieving wound swelling and pain using ice packs; administering painkiller injections; organizing patient turn over training camps and hands-on practice; and organizing bed transporting hands-on practice and training. The patient vomiting rate in the recovery room decreased from 3.86% to 1.65% after the project was implemented [ABSTRACT FROM AUTHOR]

We assessed the prognostic meaning of very early (

Abstract Background Respiratory adverse events are not uncommon in the post-anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15-year-old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation The 15-year-old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 min in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally, she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol. Conclusion Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such cases in the PACU.

Copyright of Turkiye Klinikleri Journal of Anesthesiology Reanimation is the property of Turkiye Klinikleri 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.)

Background: Postoperative radiographs may be performed on different timelines after shoulder arthroplasty. Radiographs obtained in the post-operative recovery unit (PACU) are often of poorer quality. The purpose of the current study was to explore and compare the quality of PACU radiographs and radiographs performed in the radiology suite on post-operative Day 1 (POD1), as well as determine their impact on changes in post-operative management., Methods: Our series included 50 consecutive anatomic total shoulder arthroplasties (TSA) for which post-operative radiographs were obtained in the PACU and 50 consecutive TSA for which post-operative radiographs were obtained in the radiology suite on POD 1. TSA radiographs were blinded and reviewed by 3 authors and graded on their quality using criteria described using previously published methods. The weighted kappa was used to describe the intra-rater agreement and inter-rater agreement between two raters., Results: There was no difference in age, sex, BMI, and comorbidities between cohorts. Intra-observer reliability was moderate to substantial with weighted kappa values of 0.65±0.07 (p<0.001), 0.58±0.09 (p<0.001), and 0.67±0.07 (p<0.001). Inter-observer reliability was moderate to substantial with weighted kappa values of 0.605±0.07 (p<0.001), 0.66±0.07 (p<0.001), and 0.65±0.08 (p<0.001). When assessing quality of radiographs, 30% of radiographs obtained in PACU were deemed quality while 57% of radiographs obtained in the radiology suite were deemed quality (p<0.001)., Conclusion: Post-operative radiographs in the PACU do not alter patient management and are often inadequate to serve as baseline radiographs. Conversely, radiographs obtained in the radiology suite are of higher quality and can serve as a superior baseline radiograph. Level of Evidence: IV ., Competing Interests: Disclosures: Brendan M. Patterson: This author is a paid consultant for Stryker Orthopedics., (Copyright © The Iowa Orthopaedic Journal 2024.)

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]

Objective: to elaborate, validate and evaluate the reliability of the Safety Protocol for Pediatric Thirst Management in the immediate postoperative period. Method: methodological quantitative research, based on the assumptions on measurement instrument development. The protocol was elaborated after literature review, interview with specialists and observation of the child’s anesthetic recovery. The judges performed theoretical validation through apparent, semantic and content analysis. Content Validity Index was calculated for content validation, whose minimum established concordance was 0.80. Protocol’s reliability was evaluated in children between three and 12 years old in the Post Anesthesia Care Unit. Results: in its final version, the protocol consisted of five evaluation criteria: level of consciousness, movement, airway protection, breathing pattern and nausea and vomiting. It presented easy comprehension and relevant content, and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses applied the protocol 116 times to 58 children, resulting in a high reliability index (kappa general = 0.98) Conclusion: the unprecedented protocol developed is valid and is a useful tool for use in anesthetic recovery, aiming to assess safety for reducing the thirst of infant patients.