The additional time required to awaken a patient is one of the main reasons for not extubating him or her in the operating room (OR). Conversely, transferring an intubated patient to recovery room (RR), prolonging the duration of anesthesia and intubation, in a limited environment in human resources, may lead to increased complications' rates. Little is known about those time lengths and complications rates.
The additional time required to awaken a patient is one of the main reasons for not extubating him or her in the operating room (OR). Conversely, transferring an intubated patient to recovery room (RR), prolonging the duration of anesthesia and intubation, in a limited environment in human resources, may lead to increased complications' rates. Little is known about those time lengths and complications rates. The primary objective was to evaluate the additional OR occupancy time associated with awakening and extubation. Secondary objectives were to assess the rate of post-extubation complications and the need for ventilatory support. This was a prospective multicenter observational study involving intubated patients who underwent surgeries in the operating theatres of the Montpellier and Clermont-Ferrand university hospitals. Anesthesia teams were asked to complete a form including data related to the patient, surgical procedure, anesthesia procedure (induction and recovery) and the occurrence of any complications during the procedure. A multivariate analysis was conducted on the full cohort, using a propensity score (IPTW, inverse probability of treatment weighting) to account for imbalances between groups.
Study Type
OBSERVATIONAL
Enrollment
756
Extubation takes place in operative room
Extubation takes place in post anesthesia care unit
Clermont-Ferrand University Hospital
Clermont-Ferrand, France
Additional operative room occupancy time associated with awakening and extubation
Time between dressing application (or end of procedure if there was no cutaneous effraction) and discharge from the OR
Time frame: From end of procedure until extubation, assessed up to 2 hours
Time from the end of the surgical procedure (closure of surgical site and dressing placement) to extubation
Time from the end of the surgical procedure (closure of surgical site and dressing placement) to extubation
Time frame: From end of procedure until extubation, assessed up to 2 hours
Time from the end of anaesthesia drug administration to extubation
Time from the end of anaesthesia drug administration to extubation
Time frame: From end of anesthesia drug administration until extubation, assessed up to 2 hours
Time from the end of the surgical procedure to patient able to be transferred to the ward (as defined by an Aldrete score above 10)
Time from the end of the surgical procedure to patient able to be transferred to the ward (as defined by an Aldrete score above or equal to 10). Aldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the post-anesthesia care unit (PACU), generally to an hospital ward, or home. Modified Aldrete score ranges from 0 to 12.
Time frame: From end of procedure until discharge to surgical ward, assessed up to 6 hours
Impact of sequencing of operating programme in the room concerned on extubation location
Impact of sequencing of operating programme in the room concerned on extubation location
Time frame: From end of procedure until next procedure in the same room, assessed up to one day
Incidence of oxygen support requirement_Day-1
Oxygen support requirement on the first day post-extubation
Time frame: First postoperative day
Reported post-operative pulmonary complications_Day7
Reported post-operative pulmonary complications within the first 7 days after extubation (as defined as acute respiratory failure, atelectasis, pneumonia, bronchospasm, pulmonary embolism or cardiorespiratory arrest)
Time frame: Seven first postoperative days
Oxygen therapy_PACU
Use of any rescue oxygen therapy after extubation in post-anesthesia care unit
Time frame: From end of procedure until discharge to surgical ward, assessed up to 6 hours
Hypotension_PACU
Hypotension occurrence (as defined by a systolic blood pressure below 90 mmHg and/or a mean arterial pressure below 65 mmHg)
Time frame: From end of procedure until discharge to surgical ward, assessed up to 6 hours
Bradycardia_PACU
Bradycardia occurrence (as defined as a drop of cardiac frequency below 50 beats.min-1)
Time frame: From end of procedure until discharge to surgical ward, assessed up to 6 hours
Hypoxemia_PACU
Desaturation occurrence defined as a drop of SpO2 below 96% (15), either early (within 5 min post-extubation) or delayed
Time frame: From end of procedure until discharge to surgical ward, assessed up to 6 hours
NMBA_PACU
Presence of residual neuromuscular blockade as illustrated by train of four below 90%
Time frame: From end of procedure until discharge to surgical ward, assessed up to 6 hours
Reversal_NMBA
Incidence of pharmacologic reversal of neuromuscular blocking agents
Time frame: From end of anesthesia until extubation, assessed up to 2 hours
Loco-regional anaesthetic technique
Use of any loco-regional anaesthetic technique
Time frame: Perioperative
Drugs_neuromuscular blocking agents
Use of neuromuscular blocking agents during anesthesia
Time frame: Perioperative
Drugs_opioids
Use of opioids during anesthesia
Time frame: Perioperative
Drugs_hypnotics
Use of hypnotics during anesthesia
Time frame: Perioperative
Drugs_adjuvant analgesics
Use of adjuvant analgesics during anesthesia
Time frame: Perioperative
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