Postoperative Sedation in General Care Wards: A Retrospective Cohort Study.

Autor:	Weingarten TN; From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota., Deljou A; From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota., Friedman KE; Nurse Anesthetist Program, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Lindhart ML; Nurse Anesthetist Program, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Schulz AN; Nurse Anesthetist Program, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Lau S; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Schroeder DR; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota., Sprung J; From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2024 Dec 01; Vol. 139 (6), pp. 1317-1324. Date of Electronic Publication: 2024 Jul 22.
DOI:	10.1213/ANE.0000000000007012
Abstrakt:	Background: We hypothesized that deeper sedation in the postanesthesia care unit (PACU) increases the risk of subsequent sedation in general care wards (ward sedation) and that patients with ward sedation have more postoperative adverse events than those without ward sedation. Methods: We reviewed the health records of adult patients who underwent procedures with general anesthesia at Mayo Clinic from May 5, 2018, through December 31, 2020, and were discharged from the PACU to the general care ward. Patient groups were dichotomized as with ward sedation (Richmond Agitation-Sedation Scale [RASS], ≤-2) and without ward sedation (RASS, ≥-1) within the first 24 hours after PACU discharge. Multivariable logistic regression was used to assess the association between clinical variables and ward sedation. Results: A total of 23,766 patients were included in our analysis, of whom 1131 had ward sedation (incidence, 4.8 [Poisson 95% confidence interval, CI, 4.5-5.0]) per 100 patients after general anesthesia. Half of the ward sedation episodes occurred within 32 minutes after PACU discharge. The risk of ward sedation increased with the depth of PACU sedation. The odds ratios (95% CI) of ward sedation for patients with a PACU RASS score of -1 was 0.98 (0.75-1.27); -2, 1.87 (1.44-2.43); -3, 2.98 (2.26-3.93); and ≤-4, 3.97 (2.91-5.42). Adverse events requiring an emergency intervention occurred more often for patients with ward sedation (n = 92, 8.1%) than for those without ward sedation (n = 326, 1.4%; P < .001). Conclusions: Among patients who met our criteria for PACU discharge, deeper sedation during anesthesia recovery was associated with an increased risk of ward sedation. Patients who had ward sedation had worse outcomes than those without ward sedation. Competing Interests: Conflicts of Interest: See Disclosures at the end of the article. (Copyright © 2024 International Anesthesia Research Society.)
Databáze:	MEDLINE
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