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Task analysis of the preincision period in a pediatric operating suite: an independent observer-based study of 656
Haleh Saadat1, Alejandro Escobar, Elizabeth A Davis
1Department of Anesthesiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut 06520-8051, USA.
Insights
Anesthesia release time (ART) in pediatric surgery varies significantly. Factors like surgical service, child's age, and ASA physical status impact ART, crucial for surgical scheduling.
Area of Science:
- Pediatric Anesthesiology
- Surgical Workflow Optimization
Background:
- Anesthesia release time (ART) and surgical preparation time are critical components of the pediatric surgical workflow.
- Variability in these times can impact operating room efficiency and patient scheduling.
Purpose of the Study:
- To assess the anesthesia release time (ART) and surgical preparation time in a large cohort of pediatric surgical patients.
- To identify factors influencing the variability of ART in children undergoing anesthesia and surgery.
Main Methods:
- A cross-sectional study involving 656 children undergoing anesthesia and surgery.
- Data collected by independent observers included patient demographics, anesthetic techniques, and invasive monitoring.
- Statistical analysis, including analysis of variance, was used to identify significant factors affecting ART.
Main Results:
- Mean ART was 11.0 ± 9.7 minutes, and mean surgical preparation time was 11.1 ± 10.0 minutes.
- ART showed wide variability, ranging from 7 ± 7 minutes (mask anesthesia) to 52 ± 18 minutes (general anesthesia with invasive monitoring).
- Significant variability in ART was associated with surgical service, ASA physical status, and age, with younger children having longer ART.
Conclusions:
- Anesthesia release time in pediatric surgery is highly variable.
- Surgical service, patient age, and ASA physical status are key determinants of ART.
- These factors must be considered for effective surgical case scheduling in pediatric patients.
Abstract:
We designed this cross-sectional investigation to assess anesthesia release time (ART = patient-on-table until release for surgical preparation) and surgical preparation time (start of surgical preparation to incision) of children undergoing anesthesia and surgery (n = 656). Data collected by trained independent observers included variables such as age, ASA physical status, anesthetic technique, and placement of invasive monitoring. We found that mean ART was 11.0 +/- 9.7 min and the mean surgical preparation time was 11.1 +/- 10.0 min. Also, ART ranged from 7 +/- 7 min (for mask anesthesia) to 52 +/- 18 min (general anesthesia/endotracheal tube and invasive hemodynamic monitoring). The percentage of ART of the total case length was 15% +/- 7%, with a wide variability depending on the total case length. We also found that there is a significant variability in ART as a function of the surgical service involved (analysis of variance; P = 0.0001), ASA physical status (P = 0.0001), and age. For example, younger children had a significantly longer ART as compared with older children (P = 0.001). Room coverage ratio by the attending anesthesiologist and training level of the anesthesia resident did not impact ART (P = not significant). We conclude that ART in children undergoing surgery is highly variable and is a function of factors such as the surgical service involved, age of the child, and ASA physical status of the child. These factors should be considered when scheduling a surgical case.