Postoperative Sedation in General Care Wards: A Retrospective Cohort Study

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Patient Safety

Background:

• Postanesthesia care unit (PACU) sedation depth may influence subsequent sedation on general care wards.
• Sedation on general care wards is associated with increased postoperative adverse events.

Purpose of the Study:

• To investigate the association between deeper sedation in the PACU and the risk of subsequent ward sedation.
• To determine if ward sedation is linked to more postoperative adverse events.

Main Methods:

• Retrospective review of adult patients receiving general anesthesia from May 2018 to December 2020.
• Dichotomization of patients into ward sedation (Richmond Agitation-Sedation Scale [RASS] ≤-2) and no ward sedation (RASS ≥-1) groups within 24 hours of PACU discharge.
• Multivariable logistic regression analysis to identify predictors of ward sedation.

Main Results:

• 4.8% of patients (1131/23,766) experienced ward sedation, with half occurring within 32 minutes of PACU discharge.
• Increased PACU sedation depth significantly correlated with higher odds of ward sedation (e.g., RASS ≤-4 had an odds ratio of 3.97).
• Patients with ward sedation had a higher incidence of adverse events requiring emergency intervention (8.1% vs. 1.4%, P < .001).

Conclusions:

• Deeper sedation during anesthesia recovery in the PACU is a significant risk factor for subsequent ward sedation.
• Ward sedation is associated with poorer patient outcomes, including a higher likelihood of adverse events requiring emergency intervention.