Recovery Room : Evaluation of Efficacy and Safety in a Cancer Center after 13 Years of Activity

The aim of this study was to assess the characteristics of patients admitted to a recovery room [RR] in an oncological department. The secondary outcomes were to evaluate how RR was able to prevent immediate postoperative complications and which are the principal factors influencing RR stay. A consecutive sample of cancer patients who were admitted in RR was surveyed. Patients who received some form of anesthesia by specialized staff were included. Patients were discharged to their ward when they achieved a safety score and adequate symptom control. The patient’s level of consciousness, respiration, hemodynamics, mobility of the extremities, oxygen saturation [SO2] were recorded, on a scale from 0 to 2 [modified Aldrete score], as well as pain intensity, vomiting, shivering, and drugs administered in RR. Patients, who were expected to need respiratory support for the subsequent 24-48 hours after evaluation in RR, were discharged to continue non-invasive ventilatory support [NIV] in a sub-acute unit, according to local policy. 1185 patients were surveyed. The mean age was 59.4 yrs [SD 14]. At RR admission, the mean SO2 was 98.1 [SD 2.2], with 10[0.8%] patients having a SO2 of less than 90%. The level of consciousness was normal in 847 patients, patients were sedated [score 1] in 246 cases, and 8 patients had more profound level of unconsciousness [score 2]. (NOTE: this does not make sense – do you mean unconsciousness? ). On admission to RR, 1079 patients were spontaneously breathing, one patient was intubated and breathing spontaneously, three patients had a laryngeal mask airway, 87 were intubated and manually ventilated a but extubated shortly after arriving to RR. Seven patients were intubated on arrival to the RR and received CPAP.One patient underwent controlled ventilation. Two patients had to be re-intubated in RR, and one patient needed alaryngeal mask airway to be inserted. The mean duration of RR stay was 61.3 minutes [SD 54]. Using an univariate analysis, the duration of RR stay was correlated to age, duration of surgery, ASA, gender [male], obesity, cardiovascular disease, renal disease, and abdominal surgery. Significant correlation was found only with gender, ASA, obesity, cardiovascular disease, and duration of surgery. In order to maintain respiratory support mainly through non-invasive ventilation [NIV], 51 patients [4.3%] were discharged from RR to a sub-intensive Care unit for a median duration of 1 day. RR is of paramount importance for the management of cancer patients undergoing different types of surgery. Patients can be monitored and stabilized after an appropriate treatment until the best balance is achieved.Thus, admission to RR improves patient safety and efficacy of treatment. Central Mercadante et al. (2014) Email: terapiadeldolore@lamaddalenanet.it Int J Clin Anesthesiol 2(1): 1018 (2014) 2/5 monitoring is guaranteed in a minority of patients due to infrastructure problems, as many hospitals were built in the sixties-seventies [6]. The aim of this study was to assess the characteristics of patients admitted to RR, in an oncological department. The secondary outcomes were to evaluate how RR was able to prevent immediate postoperative complications and what are the principal factors influencing RR stay. PATIENTS AND METHODS Data from a consecutive sample of cancer patients who were admitted to RR at La Maddalena Cancer Center after surgery ereover was collected for a period of 9 months. Patients who received some form of anesthesia by specialized staff were included, while patients who received local anesthetics only, were excluded. La Maddalena Cancer Center is an oncological department with 75 beds with medical oncology units, radiotherapy, pain and supportive care, and different surgical specialties, including an abdominal-general surgery unit, a breast unit, a gynecological unit, a thoracic-endoscopic procedure unit, and occasionally other interventions requiring external consultants. In 1999 La Maddalena Cancer Center followed the recommendations of SIAARTI and constructed a RR that is located close to the operating theatres [4]. After operation, patients are admitted to a four bed RR, where they are monitored until full recover from anesthesia is achieved. Anesthesiologists accompany the patient during transportation from the operating theatre to RR, and provide handover information to the nurse accepting the patient. They also provide instructions to the RR nurse including the need to ventilate, inotropic infusion, pain killers, and so on. Patients who are unable to be extubated in the OR are transferred to RR intubated and ventilated. Although there is a central nursing station where it is possible to concentrate all data deriving from the single monitors on one single screen, all patients are under the supervision of one trained nurse. Assisted by auxiliary staff. A special form is used to record the principal parameters during the patient’s stay in RR. The patient’s level of consciousness, respiration, hemodynamics, level of activity of extremities, oxygen saturation [O2] [on a scale from 0 to 2], according a modified scale of Aldrete and Froulik [7], were recorded Pain intensity, vomiting, shivering, drugs administered in RR are also recorded. Patients with a pain intensity of ≥ 4/10 [on a numerical scale of 0-10] [NOTE: Is this based on pain intensity? – you need to clearly define] receive intravenous opioid dose titration, generally with morphine. The successful doses are used to calculate the dose for the next 24 hours [8]. In particular the effective dose is multiplied by four and the same dose is prescribed as needed. Analgesia of patients with epidural catheter is re-assessed and infusion rate of local anesthetics changed according to the clinical need and hemodynamics. Changes of treatment [extubation, intubation, or starting ventilation], are performed according to the clinical need during RR stay according to the evaluation of the anesthesiologist responsible for the case. Warming is provided by blankets and meperidine is used for shivering. Despite formal handovers, informal communication and friendly environment between anesthesiologists and nurses are common. Anesthesiologists are available in the operatory rooms for any question, and occasionally a supervisor is present in RR for specific cases. Patients are discharged to their ward when they achieve a safety score and adequate symptom control [pain intensity less than 4/10, no shivering etc] NOTE: Again please define what is adequate]. Nurses and physicians sign a form to allow the discharge and a postoperative prescription for the first 24 hours is provided for the ward. Alternately, patients who are expected to need respiratory support for the subsequent 24-48 hours after evaluation in RR, are discharged to continue non-invasive ventilatory support [NIV] to a sub-acute unit, according to local policy.