Em relação à dor, a cada incremento de uma unidade na escala numérica (0 a . até a obtenção do escore, segundo a escala de Aldrete e Kroulik modificada, . Área quirúrgica pediátrica. CIRCUITO QUIRÚRGICO MONITORIZACIÓN La monitorización recomendada. A su llegada a la unidad la. puede ser modificado o adaptado según los requerimientos institucionales y .. Use an Aldrete type scale to assess every patient prior to discharge from the.
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Evidence-based clinical practice manual: Article info Article history: Received 10 October Accepted 19 October Post-anesthetic care reduces the anesthesia-related postoperative complications and mortality, shortens the length of stay at the postoperative care units and improves patient satisfaction. This is a process of “rapid” clinical practice guidelines adaptation, including systematic search.
The guideline selected to be adapted as the clinical practice handbook was Practice guidelines for post-anesthetic care of the American Society of Anesthesiologists. The manual was evaluated in terms of implementation ability, up-to-date information, relevancy, ethical considerations and patient safety by the group of anesthesiologists and epidemiologists based on Delphi. Aldgete manual kept the recommendations on evaluation and monitoring, pharmacological management of postoperative nausea and vomiting, antagonistic actions for sedatives and analgesics and neuromuscular block agents, emergency management and anesthesia recovery, as well alsrete the criteria for discharge from the unit.
Indications about the conditions and requirements of the unit and patient admission were also included.
This handbook comprises the basic guidelines for primary management of patients at the postoperative care unit. It may be amended or adapted according to the institutional requirements and for specific patient groups and is not intended to replace the existing protocols at the particular institution and does not define outcomes or prognosis.
Se incluyeron indicaciones sobre condiciones y requisitos de la unidad y el ingreso del paciente a esta. The practice of anesthesiology has made considerable progress in terms of patient safety. The drop in surgery, anesthesia and perioperative care-associated mortality has been possible trough mechanisms such as improved monitoring techniques, the development and dissemination of clinical practice guidelines alderte other systematic approaches aimed at reducing the number of errors.
A meta-analysis including 87 trials measuring mortality in over patients – out of The contribution of anesthesia to aldrste mortality prior to was 3. The least developed countries exhibit a 5. The registry trial of 1. Of these latter patients, 7. Only one case out of eighty was due to post-anesthesia care problems. Postoperative complications affect the survival of both major surgery patients and the elderly. An adequate postoperative approach results in a considerable increase in survival and reduces adverse events and unplanned ICU admissions.
This handbook includes the key aspects that should be kept in mind for such adequate approach. The implementation of post-anesthesia care protocols contributes to reduce the hospital stay, the complications, the mortality and unplanned critical care admissions. Postoperative or post-anesthesia care was defined as the care administered at a postoperative care unit. This care must be improved so that the patient begins to recover or for an adequate transfer to more complex care units.
Whenever complications arise, patients require timely intervention or the decision is made to transfer them to more complex care units. A key condition for improved efficacy is the balance between the care provided to those patients that need extra care and those that do not.
The handbook of Postsurgical Controls includes a set of recommendations based on the concepts of the American Society of Anesthesia, 14 trough a process of a,drete of clinical care guidelines. The second part of the handbook focuses on the prophylaxis or treatment for nausea and vomiting; treatment during emergency situations and the recovery from anesthesia, including the use of antagonists for sedatives, analgesics and neuromuscular block.
Finally, the procedures for discharge of the patient from the postoperative care unit are established. Actions undertaken to manage the patient following a surgical procedure that required anesthesia. Ee of time during which the effect of anesthesia slowly fades away following. The evaluation of recovery, depending on the type of anesthesia, determines the patient’s discharge from the postoperative care unit.
The area in the operating rooms with the infrastructure and necessary equipment and resources for the recovery of patients that received general or regional anesthesia, or sedation.
Post-anesthesia evaluation and monitoring. The process included four phases. Each phase used standardized techniques and procedures for the development of evidence-based guidelines and protocols. A team of expert anesthesiologists and epidemiologists was organized and entrusted with the task of defining the methodological guidelines for preparing the evidence-based handbook. The team members accepted to participate in the process and had no conflicts of interest to disclose.
A systematic review was performed to identify the clinical practice protocols and guidelines with indications or recommendations for anesthesiology management.
The analysis modiflcada on articles published in scientific journals or technical documents – gray literature – published sinceboth in English and Spanish. An electronic search strategy sensitive to documents meeting the established criteria was designed. The initial search was completed on August A second search included databases from protocol compilers and meta-browser agencies.
Additional searchers were undertaken for guidelines in websites of anesthesiology national and international modificad and of the top ten US hospitals in The sources of information are shown in Table 1.
Search strategies design and implementation For the initial search some keywords were identified natural languagecorresponding to the health condition or area of interest anesthesia, perioperative care, and clinical protocols. Then a baseline search strategy was developed using controlled terminology tMeSH, Emtree and DeCS and free language spelling variations, plurals, synonyms, acronyms and abbreviations. Using the baseline strategy, searchers were adapted to the various resources using extended terminology, field identifiers title and abstracttruncation, and Sldrete and proximity operators – when possible.
Searches were completed in depositories of clinical protocols, tracking keywords using the “search” tool in the Internet browser, in addition to a reproducible search in Google and Google Scholar, with no language or date of publications restrictions. For the second search the keywords were changed anesthesia, postoperative care, post-anesthesia care, clinical protocols, clinical care guidelinesmaintaining the comprehensive first search process.
A logbook or report was generated for each search to ensure reproducibility and transparency. The references were consolidated on a Microsoft Excel database.
As of the first phase of the search, references consistent with the objective of the handbook were identified, even if these were not clinical practice guidelines.
Twelve documents were identified as clinical practice guidelines on postoperative care during the clearance process of the two search phases. Two experts reviewed these twelve documents: The experts checked that the guidelines met the inclusion and exclusion criteria and were evidence-based. Four of the twelve documents met the criteria.
The information about the criteria used is shown in Table 3. The documents meeting the eligibility requirements as source documents for this Handbook were identified. Appendix A summarize this process. In accordance with the grading, the clinical practice guideline to be adopted corresponds to the American Society of Anesthesiology 14 that is an update of the Guidelines.
The baseline clinical practice guidelines considered both the scientific evidence and the opinion of experts. Table 4 is a summary of the rating of scientific evidence published in journals. The category of level of evidence refers to the strength and validity of the research design.
The levels refer to the strength and quality of the findings summarized in each trial for example: In accordance with the outcomes, the intervention was considered to be beneficial Bharmful Hor equivocal E when no statistically significant differences were identified. A modified Delphi method was used. Twenty-eight anesthesiologist and epidemiologists attended the meeting. After presenting the clinical contents of the handbook and following the experts’ discussion, the following characteristics were evaluated for compliance:.
Potential ease of use of the handbook by the various institutions. Whether the indications are consistent with the current evidence. Whether the indications are relevant to most of the surgical environments. Whether using this handbook was ethical. Whether the patient may be exposed to a high risk when using this handbook.
A numeric nine-category scale was used to score each one of the characteristics identified. Each indication suggested was rated as recommended appropriatecontraindicated inappropriateor uncertain. Preparation and drafting of the final document A final handbook model was designed, including the justification, the methodology, and the adaptation of the baseline clinical practice guidelines, according to the expert recommendations under the participative method.
The team that prepared the handbook developed the final document. All of the participants in the working group and in the expert consensus affirmed, completed, and signed the disclosures document. Consultations were made and authorizations secured for using and translating part of the contents of the guidelines to prepare the handbook.
Copyright belongs to the authors of the guidelines and protocols that are duly referenced in the document. The handbook focuses on the postoperative management of the patient, emphasizing the reduction in the number of adverse events through a standardized evaluation of the recovery process, leading to improved quality of life during the post-anesthesia phase and a rationalization of postoperative care and discharge criteria.
This handbook is applicable to patients receiving general or regional anesthesia, profound or moderate sedation and may be amended or a complementary protocol be designed to adapt it to the needs of a particular type of patients or populations such as children and the elderly.
It is not applicable to patients receiving local anesthesia without sedation, minimal sedation or patients admitted to the ICU. This handbook is not intended to replace individualized patient care or the particular protocols of the institution. Neither is it expected to predict patient outcomes.
The postoperative care unit shall preferably be located centrally to the operating rooms, allowing easy access and transit to and from the unit. Monitors, medicines, equipment and enough trained nursing staff shall all be available for managing patients during the postoperative phase and to deal with any complications.
An anesthesiologist in charge of the patients transferred to the postoperative care unit shall be available. The anesthesiologist in charge of the patient shall personally hand-off the patient to the postoperative care unit staff.
The anesthesiologist is required to give a verbal report of the patient’s pre-surgical and surgical medical record, including any adverse event that modificadaa have occurred in the course of the surgical procedure.
The anesthesiologist shall report on all the general indications for postoperative care in accordance with the medical record, the type of surgery and the anesthesia received by the patient. The team of practitioners and modifciada assistants in charge of the postoperative care unit are required to record every evaluation based on monitoring, clinical observation, reading of diagnostic follow-up tests, intervention, therapeutic or prophylactic prescription done during the emergency care and anesthesia recovery, including the prevention and treatment of complications.
The periodic evaluation and monitoring of the airway patency, the respiratory rate, and oxygen saturation SpO 2 shall be modifivada during anesthesia recovery to reduce the number of adverse outcomes Evidence A2-B. ASA experts 17 considered that blood pressure, pulse and EKG monitoring identify complications, reduce the number of adverse outcomes and shall be implemented during anesthesia recovery insufficient evidence.
They were of the opinion that EKG monitoring may be unnecessary in certain types of patients or moidficada on the anesthetic procedure. The evaluation of the neuromuscular function is deemed to reduce the number of adverse events and should be carried out during post-anesthesia recovery.