title: Effects of changes in intraoperative management on recovery from anesthesia: a review of practice improvement initiative.
abstract: BACKGROUND
  Our anesthetic practice was hindered by inadequate postanesthesia care unit space resulting in operating room inefficiencies. In response, an anesthetic protocol designed to reduce the duration of postanesthesia stay by decreasing residual anesthetic sedation and postoperative nausea and vomiting (PONV) was introduced. Here the impact of this practice change is analyzed.
  
  
  METHODS
  The protocol encouraged desflurane use instead of isoflurane, triple antiemetic prophylaxis, and discouraged midazolam. Records of patients undergoing general anesthesia from calendar-matched epochs were reviewed. Epoch I included a 6-month period prior to implementation of the practice change (October 1, 2009, to March 31, 2010) and Epoch II included 6 months following the practice change (October 1, 2010, to March 31, 2011).
  
  
  RESULTS
  General anesthesia was administered to 2,936 and 3,137 patients during Epochs I and II, respectively. Midazolam decreased from 57.4% to 24.0%, isoflurane from 50.8% to 5.7%, desflurane increased from 25.6% to 77.0%, and antiemetic prophylaxis from 6.5% to 50.8%. Median [IQR] recovery time decreased from 72 [50, 102] to 62 [44, 90] minutes, P <0.001. Supplemental analyses found antiemetic prophylaxis was associated with PONV reduction (OR = 0.47, 95% CI 0.38 -0.58, P < 0.001). When compared to isoflurane, desflurane was associated with a decreased rate of respiratory depression (OR = 0.72, 95% CI 0.55-0.93, P = 0.013). Patients administered midazolam trended towards higher rate of respiratory depression (OR = 1.27, 95% CI 1.00-1.60, P = 0.050).
  
  
  CONCLUSIONS
  Introduction of an anesthetic protocol that was designed to attenuate adverse anesthetic effects was associated with a reduction of anesthetic recovery time.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, USA. weingarten.toby@mayo.edu.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Division of Surgical Services, Department of Nursing, Mayo Clinic, Rochester, MN, USA. bergan.tammy@mayo.edu.
authors.forename: Tammy S
authors.initials: TS
authors.lastname: Bergan
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, USA. narr.bradly@mayo.edu.
authors.forename: Bradly J
authors.initials: BJ
authors.lastname: Narr
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. schroedd@mayo.edu.
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, USA. sprung.juraj@mayo.edu.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D000932:Antiemetics / Q000008:administration & dosage*; D000077335:Desflurane; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D018685:Anesthetics, Inhalation; D000932:Antiemetics; D000077335:Desflurane; D007530:Isoflurane; D008874:Midazolam