Effects of changes in intraoperative management on recovery from anesthesia: a review of practice improvement initiative

Table 1 Discharge criteria for Phase I recovery following general anesthesia

Primary Discharge Criteria* [5]	Points
Primary Discharge Criteria* [5]	0	1	2
Motor activity	No motion	Weak motion	Active motion
Respiration	Required airway maintenance	Maintains airway without support	Coughs on command
Blood pressure	Systolic blood pressure ≥ ± 50 mmHg preanesthetic value	Systolic blood pressure ± 20–50 mmHg preanesthetic value	Systolic blood pressure ± 20 mmHg preanesthetic value
Consciousness	No response or absent protective reflexes	Responds to stimulus	Fully awake or easily aroused
Oxyhemoglobin saturation	<93% or preoperative value with supplemental oxygen	≥93% or preoperative value with supplemental oxygen	≥93% or preoperative value without supplemental oxygen
Respiratory Specific Events [ 7 , 8 ] ^†
Hypoventilation	3 episodes of < 8 respirations/minute
Apnea	Episode of apnea ≥ 10 seconds
Hypoxemia	3 episodes of oxyhemoglobin desaturations as measured by pulse oximetry (<90% with or without nasal cannula)
Pain/sedation mismatch	Richmond Agitation Sedation Score[6] = −3 to −5 and a numeric pain score > 5, from a scale 0 to 10
Additional Discharge Criteria
Numeric Pain Score	Score ≤ 4
Postoperative nausea	Mild to none

*To meet discharge criteria the composite score needs to be ≥ 8 with absence of 0 score in any of the 5 subcategories ^†Any patient who develops a respiratory specific event must have a subsequent 60-minute period free of further events in order to be transferred to a nonmonitored ward. Patients who had repeated respiratory specific events are discharged to an advanced monitored setting or continuously monitored for oxyhemoglobin desaturation via pulse oximetry.

ISSN: 1471-2253