Weingarten Toby N, Bergan Tammy S, Narr Bradly J, Schroeder Darrell R, Sprung Juraj
Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, USA.
Division of Surgical Services, Department of Nursing, Mayo Clinic, Rochester, MN, USA.
BMC Anesthesiol. 2015 Apr 23;15:54. doi: 10.1186/s12871-015-0040-x.
Our anesthetic practice was hindered by inadequate postanesthesia care unit space resulting in operating room inefficiencies. In response, an anesthetic protocol designed to reduce the duration of postanesthesia stay by decreasing residual anesthetic sedation and postoperative nausea and vomiting (PONV) was introduced. Here the impact of this practice change is analyzed.
The protocol encouraged desflurane use instead of isoflurane, triple antiemetic prophylaxis, and discouraged midazolam. Records of patients undergoing general anesthesia from calendar-matched epochs were reviewed. Epoch I included a 6-month period prior to implementation of the practice change (October 1, 2009, to March 31, 2010) and Epoch II included 6 months following the practice change (October 1, 2010, to March 31, 2011).
General anesthesia was administered to 2,936 and 3,137 patients during Epochs I and II, respectively. Midazolam decreased from 57.4% to 24.0%, isoflurane from 50.8% to 5.7%, desflurane increased from 25.6% to 77.0%, and antiemetic prophylaxis from 6.5% to 50.8%. Median [IQR] recovery time decreased from 72 [50, 102] to 62 [44, 90] minutes, P <0.001. Supplemental analyses found antiemetic prophylaxis was associated with PONV reduction (OR = 0.47, 95% CI 0.38 -0.58, P < 0.001). When compared to isoflurane, desflurane was associated with a decreased rate of respiratory depression (OR = 0.72, 95% CI 0.55-0.93, P = 0.013). Patients administered midazolam trended towards higher rate of respiratory depression (OR = 1.27, 95% CI 1.00-1.60, P = 0.050).
Introduction of an anesthetic protocol that was designed to attenuate adverse anesthetic effects was associated with a reduction of anesthetic recovery time.
我们的麻醉工作因麻醉后护理单元空间不足而受到阻碍，导致手术室效率低下。作为应对措施，引入了一项麻醉方案，旨在通过减少残余麻醉镇静作用以及术后恶心和呕吐（PONV）来缩短麻醉后停留时间。在此分析这一实践变革的影响。
该方案鼓励使用地氟烷而非异氟烷，采用三联抗呕吐预防措施，并减少咪达唑仑的使用。回顾了与日历匹配时期接受全身麻醉患者的记录。时期I包括实践变革实施前的6个月（2009年10月1日至2010年3月31日），时期II包括实践变革后的6个月（2010年10月1日至2011年3月31日）。
时期I和时期II分别有2936例和3137例患者接受全身麻醉。咪达唑仑的使用从57.4%降至24.0%，异氟烷从50.8%降至5.7%，地氟烷从25.6%增至77.0%，抗呕吐预防措施从6.5%增至50.8%。中位[四分位间距]恢复时间从72[50,102]分钟降至62[44,90]分钟，P<0.001。补充分析发现抗呕吐预防措施与PONV减少相关（比值比=0.47，95%置信区间0.38 - 0.58，P<0.001）。与异氟烷相比，地氟烷与呼吸抑制发生率降低相关（比值比=0.72，95%置信区间0.55 - 0.93，P=0.013）。接受咪达唑仑的患者呼吸抑制发生率有升高趋势（比值比=1.27，95%置信区间1.00 - 1.60，P=0.050）。
引入旨在减轻不良麻醉效应的麻醉方案与麻醉恢复时间缩短相关。
