Is postanesthesia care unit length of stay: increased in hypothermic patients?

AORN Journal,  Feb, 2005  by Kiekkas Panagiotis,  Poulopoulou Maria,  Papahatzi Argiri,  Souleles Panagiotis

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AIM OF THE STUDY

The aim of the present study was twofold. The study sought to

* determine whether the actual and appropriate LOS in the PACU differs between hypothermic and normothermic patients and

* identify differences between subgroups of patients according to age, gender, and type of anesthesia.

MATERIALS AND METHODS

This study was conducted in the PACU of General University Hospital of Patras, Greece, from Sept 1, 2003, to Nov 30, 2003. General University Hospital of Patras is a 700-bed, tertiary care academic hospital with 12 ORs and a phase one PACU that receives 35 to 45 postoperative patients daily. Postanesthesia care unit patients are discharged to the ward or the intensive care unit because a phase two PACU is not available.

STUDY SAMPLE. The study sample consisted of patients admitted for an elective orthopedic procedure. The inclusion criteria were

* age of 18 years or older,

* ASA physical status of 1 to 3,

* a preoperative core temperature value within the normal range of 36[degrees] C to 37.5[degrees]C (96.8[degrees]F to 99.5[degrees]F)--a criterion that was established to measure the real proportion of previously normothermic patients whose hypothermia was a result of the surgical procedure; and

* extubation before leaving the OR.

STUDY DESIGN AND DATA COLLECTION. Core temperature threshold for hypothermia was set at 36[degrees]C (96.8[degrees]F). Temperature was measured at the tympanic membrane using an infrared thermometer. This method allows an acceptable assessment of core body temperature and, as opposed to use of an esophageal thermometer, is noninvasive and well tolerated by extubated patients. Core temperature measurements were conducted just before patients entered the OR and on PACU arrival. Heart rate, arterial blood pressure, and oxygen saturation were monitored continually during surgery and PACU stay. Patient and procedure characteristics, including age, gender, ASA status, type of anesthesia, duration of surgery, and OR temperature, were recorded.

In patients undergoing general anesthesia, IV administration of midazolam hydrochloride, propofol, fentanyl, and cisatracurium besylate or rocuronium bromide was used for induction. Anesthesia was maintained by 50% to 60% nitrous oxide in oxygen, sevoflurane or desflurane, and remifentanil. In patients undergoing regional anesthesia, IV administration of midazolam and spinal administration of levobupivacaine 5%, 10 to 15 mg, were used. An epidural catheter was used only for postoperative analgesia. Medication dosage and total volume of intraoperatively administered crystalloids were adjusted according to age, gender, body weight, and physical status of each patient, as well as duration of anesthesia.

After patients arrived in the PACU, oxygen was administered to them via a simple oxygen mask or a Venturi mask. Postoperative pain and shivering were treated with IV administration of morphine or pethidine, depending on the characteristics of the patient. Nausea and emesis were treated with IV administration of metoclopramide hydrochloride. In all patients who arrived hypothermic to the PACU, a forced-air warming system was applied and set on high (ie, 43[degrees]C [109.4[degrees]F]). Ambient PACU temperature was kept stable at between 27[degrees]C and 29[degrees]C (80.6[degrees]F and 84.2[degrees]F).