Cohen S E, Hamilton C L, Riley E T, Walker D S, Macario A, Halpern J W
Department of Anesthesia, Stanford University School of Medicine, California 94305-5640, USA.
Anesthesiology. 1998 Dec;89(6):1559-65. doi: 10.1097/00000542-199812000-00036.
Obstetric patients may have long postanesthesia care unit (OB-PACU) stays after surgery because of residual regional block or other conditions. This study evaluated whether modified discharge criteria might allow for earlier discharge without compromising patient safety.
Data were prospectively collected for 6 months for all patients (N=358) who underwent cesarean section or tubal ligation and recovered in the OB-PACU. Regional anesthesia was used in 94% of patients. The duration of anesthesia and PACU stays, the presence and treatment of events in the PACU, and the regression of neural blockade were recorded. Discharge from the OB-PACU required a 60-min minimum stay, stable vital signs, adequate analgesia, and ability to flex the knees. After completion of prospective data collection, events that kept patients in the PACU after 60 min were reevaluated as to whether patients needed to stay in the PACU for medical reasons. "Needed to stay" events included bleeding, cardiorespiratory problems, sedation, dizziness, and pain. "Safe to leave" conditions included pruritus, nausea, and residual neural blockade. The cumulative duration of OB-PACU stays not clearly justifiable for medical reasons was calculated.
Residual block and spinal opioid side effects accounted for the majority of "unnecessary" stays. Annually, 429 h of PACU time could have been saved using the revised criteria. Complications did not develop subsequently in any patient deemed "safe to leave."
In many obstetric patients, the duration of PACU stays could safely be shortened by continuing observation in a lower-acuity setting. This may result in greater flexibility and more efficient use of nursing personnel.
产科患者术后可能因区域阻滞残留或其他情况而在麻醉后恢复室（OB - PACU）停留较长时间。本研究评估了修改后的出院标准是否能在不影响患者安全的情况下实现更早出院。
前瞻性收集了6个月内所有在OB - PACU接受剖宫产或输卵管结扎手术并恢复的患者（N = 358）的数据。94%的患者使用了区域麻醉。记录麻醉和PACU停留时间、PACU中事件的发生及处理情况以及神经阻滞的消退情况。从OB - PACU出院要求至少停留60分钟、生命体征稳定、镇痛充分且能屈膝。在前瞻性数据收集完成后，重新评估60分钟后仍使患者留在PACU的事件，判断患者是否因医疗原因需要留在PACU。“需要停留”的事件包括出血、心肺问题、镇静、头晕和疼痛。“可以离开”的情况包括瘙痒、恶心和残留神经阻滞。计算了因医疗原因无明确合理依据的OB - PACU停留累计时间。
阻滞残留和脊髓阿片类药物副作用占“不必要”停留的大部分。使用修订标准每年可节省429小时的PACU时间。在任何被认为“可以离开”的患者中随后均未出现并发症。
在许多产科患者中，通过在较低 acuity 设置下持续观察，可以安全地缩短PACU停留时间。这可能会带来更大的灵活性并更有效地利用护理人员。
