Anesthesiologist Staffing Considerations Consequent to the Temporal Distribution of Hypoxemic Episodes in the Postanesthesia Care Unit

作者：Epstein Richard H^*; Dexter Franklin; Lopez Marcos G; Ehrenfeld Jesse M

来源：Anesthesia and Analgesia, 2014, 119(6): 1322-1333.

DOI：10.1213/ANE.0000000000000410

BACKGROUND: Hypoxemia, as measured by pulse oximetry (Spo(2)), is common in postanesthesia care unit (PACU) patients. The temporal distribution of desaturation has managerial implications because treatment may necessitate the presence of an anesthesiologist. %26lt;br%26gt;METHODS: We retrieved Spo(2) values recorded electronically every 30 to 60 seconds from 137,757 PACU patients over n = 80 four-week periods at an academic medical center. Batch mean methods of analysis were used. Onset times of hypoxemic episodes (defined, on the basis of previous studies, as Spo(2) %26lt;90% lasting at least 2 minutes) were determined and resolution at 3, 5, and 10 minutes was assessed. Episodes beginning %26lt;30 minutes and %26gt;= 30 minutes after PACU admission were compared. Patients undergoing intubation in the PACU were identified by doing a free text search of electronically recorded nursing notes for phrases suggesting intubation, followed by a confirmatory manual chart review. Intervals from PACU admission to intubation were determined. %26lt;br%26gt;RESULTS: Fewer than half (31.2%+/- 0.05%) of episodes of PACU hypoxemia lasting %26gt;= 2 minutes occurred %26lt;30 minutes after PACU admission. Most (i.e., %26gt;50%) occurred %26gt;= 30 minutes after admission (P %26lt; 0.0001). Few (%26lt;1%) anesthesia providers transporting patients to the PACU were still present in the PACU %26gt;= 30 minutes after arrival in the PACU. Fewer than half (37%; 95% confidence interval, 27.4% to 48.8%) of PACU intubations occurred %26lt;30 minutes after PACU admission. Most (i.e., %26gt;50%) occurred 30 minutes after admission (P = 0.029). Hypoxemic episodes in the PACU resolved more slowly than episodes in operating rooms (P %26lt; 0.0001). After 3 minutes, 40.9%+/- 0.6% were unresolved in the PACU versus 23% (99% upper confidence limit) in operating rooms, and 32.6%+/- 0.5% vs 9% (99% upper confidence limit) after 5 minutes. %26lt;br%26gt;CONCLUSIONS: Because most (68.8%) hypoxemic episodes in the PACU occur 30 minutes after admission, a time by which the anesthesia provider who transported the patient usually would no longer be present (%26gt;99% of cases), the PACU needs to be considered when anesthesiologist operating room staffing and assignment decisions are made.

• 出版日期2014-12