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Abstracts of Posters; Presented at the International Anesthesia Research Society; 73rd Clinical and Scientific Congress; Los Angeles, CA; March 12-16, 1999: Ambulatory Anesthesia

A NEW SCORING SYSTEM FOR DETERMINING FAST-TRACK ELIGIBILITY AFTER AMBULATORY ANESTHESIA

White, P.F. PhD, MD; Song, D. MD, PhD

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doi: 10.1097/00000539-199902001-00034
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Abstract S34

INTRODUCTION: In an effort to improve efficiency and facilitate the recovery process after ambulatory surgery, anesthesiologists are examining the possibility of transferring patients from the operating room (OR) directly to the phase II (step-down) recovery area after general anesthesia [1]. The process of "bypassing" the postanesthesia care unit (PACU) has been termed fast-tracking in ambulatory anesthesia [2]. We have evaluated fast-track eligibility after outpatient laparoscopic surgery under general anesthesia using the standard PACU discharge criteria as described by Aldrete [3] and a new fast-track scoring system which also includes an assessment of acute postoperative pain and emesis.

METHODS: After obtaining IRB-approval, 138 healthy, consenting women undergoing laparoscopic tubal ligation procedures under general anesthesia with one of three standardized anesthetic anesthetics were studied. All patients received midazolam 2 mg iv for premedication and anesthesia was induced with propofol 1.5-2 mg[center dot]kg-1 and remifentanil 0.5-1 [micro sign]g[center dot]kg-1. Maintenance of anesthesia consisted of propofol (75-150 [micro sign]g[center dot]kg (-1) [center dot]min-1), sevoflurane (0.75 - 1.5%) or desflurane (2-4%) in combination with nitrous oxide 67% in oxygen. All patients received the same adjunctive drugs as well as prophylactic antiemetics (droperidol 0.625 mg and ondansetron 4 mg) and analgesics (acetaminophen 1.2 g, ketorolac 30 mg and bupivacaine 0.25%). Fast-track eligibility was assessed on arrival in the recovery area using both the 5 item 10-point modified Aldrete scoring system [3] and a new 7 item 14-point version which also considers the severity of pain and emesis upon emergence from anesthesia (with 0=severe, 1=moderate and 2=minimal or none). To be considered fast-track eligible, patients had to achieve: (1) a modified Aldrete score of 9 or 10, or (2) a score of >or=to 12 (with no score less than 1 in any individual category) using the new scoring system.

RESULTS: All three anesthetic treatment groups were similar demographically. Compared to propofol, maintenance of anesthesia with desflurane or sevoflurane was associated with a higher percentage of fast-track eligible patients using both scoring systems (Figure 1). However, the overall percentage of fast-track eligible patients was decreased by 15% when the new criteria were used as an alternative to the standard PACU discharge criteria [3].

F1-34
Figure 1

DISCUSSION: To minimize the risk of complications when "bypassing" the PACU, both pain and emesis should be adequately controlled during the early recovery period. When prophylactic antiemetics and analgesics were administered as part of the anesthetic technique, these data suggests that 48% of the patients undergoing gynecologic laparoscopic surgery with general anesthesia and tracheal intubation were eligible for fast-tracking.

REFERENCES

1. Anesth Analg 1998;86:267-73.
2. J Clin Anesth 1996;8:70-2S.
3. J Clin Anesth 1995;7:89-91.
© 1999 International Anesthesia Research Society