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

@article{Epstein2014AnesthesiologistSC,
  title={Anesthesiologist Staffing Considerations Consequent to the Temporal Distribution of Hypoxemic Episodes in the Postanesthesia Care Unit},
  author={Richard H. Epstein and Franklin Dexter and Marcos G Lopez and Jesse M. Ehrenfeld},
  journal={Anesthesia \& Analgesia},
  year={2014},
  volume={119},
  pages={1322–1333}
}
BACKGROUND:Hypoxemia, as measured by pulse oximetry (SpO2), 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. METHODS:We retrieved SpO2 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… 
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Anesthesiologist Staffing Considerations Consequent to the Temporal Distribution of Hypoxemic Episodes in the Postanesthesia Care Unit
TLDR
The PACU needs to be considered when anesthesiologist operating room staffing and assignment decisions are made, because most 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.
Post-anesthesia care unit desaturation in adult deep extubation patients
TLDR
The findings suggest that deep extubation is a viable and safe option for patients without significant respiratory tract pathology, and it is found that PACU desaturation episodes following deep Extubation are rare.
Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial
TLDR
Capnography and the Integrated Pulmonary Index™ algorithm (IPI) detected respiratory adverse events earlier than standard monitoring in 75% and 88% of cases, respectively, with an average early warning time of 8 ± 11 min.
Operational realities in the postanesthesia care unit: staffing and monitoring for safe postoperative care.
TLDR
This study portends similar studies analyzing large data sets, which should help elucidate the mysteries of the PACU and establish a generally accepted “low saturation” cutoff, or the temporal duration over which a desaturation event becomes “dangerous,”.
Differences in the incidence and timing of reintubation in the postanesthesia care unit among large teaching hospitals.
Time to recovery after general anesthesia at hospitals with and without a phase I post-anesthesia care unit: a historical cohort study
TLDR
This knowledge can be generally applied in situations at hospitals with regular PACU use when there are such large disruptions to PACU capacity that the anesthesiologist likely will need to recover the patient (i.e., when there will not be an available PACU bed and/or nurse).
Timing of postoperative respiratory emergencies: when do they really occur?
TLDR
Emerging evidence indicates that the first postsurgical day carries the highest risk of adverse respiratory events, and this risk is often associated with opioid administration, and resources for increased monitoring should be directed to these high-risk times.
Assessment of Staffing and Service Provision in the Post-Anesthesia Care Unit of Hospitals Found in Amhara Regional State, 2020
Background Post-anesthesia recovery is a continuous process which is considered to be complete after the patient returns to their preoperative physiological state. Although all patients who have had…
Bypass of an anesthesiologist-directed preoperative evaluation clinic results in greater first-case tardiness and turnover times.
Evaluation of respiratory volume monitoring (RVM) to detect respiratory compromise in advance of pulse oximetry and help minimize false desaturation alarms
TLDR
Respiratory volume monitoring can provide advanced warning of impending oxygen desaturation and potentially reduce the number of false SpO2 alarms, and may translate to the general care floor and prehospital and posthospital environments.
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References

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Anesthesiologist Staffing Considerations Consequent to the Temporal Distribution of Hypoxemic Episodes in the Postanesthesia Care Unit
TLDR
The PACU needs to be considered when anesthesiologist operating room staffing and assignment decisions are made, because most 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.
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TLDR
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TLDR
Hypoventilation can be detected reliably by pulse oximetry only when patients breathe room air, and in patients with spontaneous ventilation, supplemental oxygen often masked the ability to detect abnormalities in respiratory function in the PACU.
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