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New discharge criteria decrease recovery room time after subarachnoid block.

C M Alexander1, L E Teller, J B Gross

  • 1Department of Anesthesia, University of Pennsylvania.

Anesthesiology
|April 1, 1989
PubMed
Summary
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Orthostatic testing can predict hemodynamic stability after subarachnoid block (SAB). Two successive orthostatic decreases of 10% or less in mean arterial pressure (MAP) indicate stability, potentially shortening recovery room (RR) stays.

Area of Science:

  • Anesthesiology
  • Cardiovascular Physiology

Background:

  • Subarachnoid block (SAB) can cause hemodynamic instability during recovery.
  • Current discharge criteria from the recovery room (RR) are empirical and may prolong patient stays.

Purpose of the Study:

  • To identify criteria predicting hemodynamic stability during recovery from SAB.
  • To evaluate the safety and efficacy of orthostatic testing for RR discharge.

Main Methods:

  • A two-phase study involving 52 patients undergoing SAB.
  • Monitoring of supine and sitting blood pressures at 30-minute intervals in the RR.
  • Retrospective and prospective analysis of orthostatic changes in mean arterial pressure (MAP).

Main Results:

  • Two successive orthostatic decreases in MAP of 10% or less predicted stability.

Related Experiment Videos

  • No orthostatic challenges resulted in >15% MAP decrease when this criterion was met.
  • Patients meeting this criterion could be discharged significantly sooner (76 ± 6 min).

    • Conclusions:

    • Orthostatic testing is a reliable predictor of hemodynamic stability post-SAB.
    • Hemodynamic stability may precede sensory and motor function recovery.
    • Implementing orthostatic testing can safely reduce RR length of stay.