41 260名小儿科手术患者的结局 无阿片类药物麻醉:一个中心的经验
Lynn D Martin1, Amber M Franz2, Sally E Rampersad2
1Department of Anesthesiology & Pain Medicine and Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA.
Paediatric anaesthesia
|June 10, 2023
概括
无阿片类药物麻醉 (OFA) 在儿科门诊和住院手术中成功减少了阿片类药物的使用. 这种增强的恢复途径减少了疼痛,恶心和吐,改善了患者的治疗结果和医院的效率.
科学领域:
- 麻醉学 麻醉学
- 改善外科手术的质量
- 疼痛管理 疼痛管理
背景情况:
- 在手术中使用阿片类药物存在重大风险和副作用.
- 增强的恢复途径强调区域麻醉和多模式策略,以尽量减少阿片类药物依赖.
- 无阿片类麻醉 (OFA) 协议旨在消除手术期间使用的阿片类药物,保留它们用于救援治疗.
研究的目的:
- 在儿科门诊和住院环境中实施和评估无阿片类麻醉 (OFA) 协议.
- 评估OFA对疼痛评分,阿片类药物救援率以及术后恶心和吐 (PONV) 的影响.
- 确定OFA在提高医院效率和患者结果方面的可行性和好处.
主要方法:
- 质量改进 (QI) 项目由多学科团队进行,以开发和实施OFA.
- 使用统计过程控制图表来跟踪结果措施并增加OFA采用率.
- 数据从2016年1月1日到2022年9月30日收集,涉及门诊外科中心 (ASC) 和医院住院患者.
主要成果:
- 在ASC,OFA的采用率从30%增加到98%;在医院,OFA的采用率从15%增加到60%.
- 同时观察到,麻醉后护理单位 (PACU) 的最大疼痛得分,阿片类药物救生率和PONV治疗的同时下降.
- OFA的实施带来了显著的医院节约,包括52个患者日用于腺切除术和>500个患者日/年用于腹腔镜尾切除术.
结论:
- 儿科的门诊和选择的住院手术适合OFA技术.
- 在没有加剧疼痛的情况下,OFA可能会减少PONV.
- 成功实施OFA可以提高患者康复和医院资源利用率.
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