Purpose

Maximizing operating room (OR) efficiency is essential for hospital cost containment and effective patient throughput. Little data is available regarding the safety and efficacy of extubation of children in the post-anesthesia care unit (PACU) by a nurse rather than in the OR. We sought to evaluate the impact of a long-standing practice of PACU extubation upon airway complications and OR efficiency.

Methods

The records of 1930 children who underwent inguinal hernia repair, laparoscopic appendectomy or pyloromyotomy at a children's hospital between July, 2018 and June, 2020 were reviewed. Extubations were performed in the OR only when the PACU was inadequately staffed or during the early months of the Covid-19 pandemic. Cases in which there was a deep extubation, a PACU hold was in effect or a patient went directly to an inpatient unit from the OR were excluded. Intra- and post-operative time metrics were recorded and emergency airway interventions were assessed.

Results

1747 operations were evaluated. Time from the end of the procedure to leaving the OR ranged from 4.1 to 4.8 min when extubation was done in the PACU and was 6–9 min less than with OR extubation. (see table). There were 23 airway events (1.5% of all cases) after PACU extubation that necessitated only brief bag-mask ventilation. There were no cases of re-intubation.

Conclusions

In a large population of children undergoing diverse surgical procedures, post-anesthesia care unit extubation was safe and resulted in rapid transfer of patients from the operating room after completion of their operation. Time saved because of shorter operating room times reduces hospital costs and can allow for increased throughput. Extubation in the post-anesthesia care unit may not only be as safe as operating room extubation, but may result in fewer serious airway events as patients may be less likely to have their endotracheal tube removed prematurely.

Level of evidence

Treatment Study, Level III

中文翻译：

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小儿外科患者常规麻醉后监护室拔管对安全性和手术室效率的影响

目的

最大限度地提高手术室 (OR) 的效率对于控制医院成本和有效的患者吞吐量至关重要。关于在麻醉后护理病房 (PACU) 中由护士而不是在手术室为儿童拔管的安全性和有效性的数据很少。我们试图评估长期实施 PACU 拔管对气道并发症和手术室效率的影响。

方法

回顾了 2018 年 7 月至 2020 年 6 月期间在儿童医院接受腹股沟疝修补术、腹腔镜阑尾切除术或幽门肌切开术的 1930 名儿童的记录。仅当 PACU 人员不足或在 Covid-19 大流行的最初几个月期间，才在手术室进行拔管。排除了深度拔管、PACU 保持有效或患者从手术室直接进入住院病房的病例。记录术中和术后时间指标并评估紧急气道干预。

结果

评估了 1747 项操作。在 PACU 中拔管时，从手术结束到离开手术室的时间为 4.1 至 4.8 分钟，比手术室拔管时少 6 至 9 分钟。（见表）。PACU 拔管后发生了 23 次气道事件（占所有病例的 1.5%），仅需要短暂的气囊面罩通气。没有再插管的病例。

结论

在接受不同外科手术的大量儿童中，麻醉后护理单元拔管是安全的，并导致患者在完成手术后迅速从手术室转移。由于手术室时间缩短而节省的时间降低了医院成本，并且可以提高吞吐量。在麻醉后护理病房中拔管不仅可能与手术室拔管一样安全，而且可能会减少严重的气道事件，因为患者可能不太可能过早拔除气管插管。

证据级别

治疗研究，III 级