The Influence Factors Of Delay The PACU Postoperatively In Patients With General Anesthesia

Objective:through retrospective analysis of patients with delayed PACU after general anesthesia in our hospital,the influencing factors of delayed PACU were discussed,so as to provide theoretical basis for improving the quality of preoperative evaluation and intraoperative management of anesthesiologists,the quality of safe resuscitation of patients,and the efficiency of anesthesia recovery room.Methods:in this study,electronic medical records,anesthesia records and resuscitation records of all patients admitted to PACU in the operating room of the east hospital of the first affiliated hospital of guangxi medical university from 2015 to 2017 were selected.Exclusion conditions:incomplete data（such as intraoperative failure to monitor the data type required in this study,incomplete medical records）,patients undergoing neurosurgery,and cases under local anesthesia were excluded.A total of 60,761 cases were finally included.Patients who stay in PACU for more than 3 hours are referred to as PACU roll-out delay^[1].Retrospective analysis and other statistical treatment were used to explore the related factors affecting delayed PACU in patients after general anesthesia.Results:During the statistical period,a total of 60,761 patients were admitted to PACU for resuscitation,and 791 patients spent more than 3 hours in PACU.The overall incidence was 1.30%.Among patients with delayed PACU,there were 328 in 2015,239 in 2016 and 224 in 2017.In 2015,2016 and 2017,the incidence of delayed PACU was 1.57%,1.00%and 0.89%,respectively.Among the 791 patients with delayed PACU,107 patients aged 0 to 1 years old had the highest incidence,which was 8.64%.There were 57 patients older than75 years old,with an incidence of 3.62%.The incidence rates of each age group were compared,and the differences were statistically significant（P<0.05）.Among the 791 patients with delayed PACU,hepatobiliary surgery had the highest incidence rate,which was 3.37%.The incidence rate of patients with delayed PACU in each department was compared,and the difference was statistically significant（P<0.05）.There were 78 unscheduled ICU transfers for patients with delayed exit from PACU.Among them,the incidence of cerebrovascular accident was the highest when patients were transferred to the ICU unplanned,and the difference was statistically significant（P<0.05）.Patients with delayed onset of PACU were the most likely to report respiratory complications,with 289 cases（36.55%）,followed by 147 cases with delayed onset of consciousness（18.58%）.Among them,the number of patients with hypoxemia in respiratory complications was the highest,with a total of 222cases.Analysis of the causes of hypoxemia in patients without intraoperative hypoxemia before extubation showed that the hypoxemia caused by residual muscle relaxations and anesthetic residues in patients aged 0¹4 years before extubation was significantly higher than that in the group aged 14⁶5 years and the group aged over 65 years（P<0.01,the difference was statistically significant）.However,the postoperative wound pain induced by hypoxemia in patients aged 14⁶5 years before extubation was significantly higher than that in the group aged 0¹4 years and over 65 years（P<0.01 or P<0.05）,and the difference was statistically significant.The causes of hypoxemia after extubation were analyzed as follows:upper respiratory tract obstruction in patients aged0¹4 years was significantly higher than that in the group aged 14⁶5 years and the group aged over 65 years（P<0.05,the difference was statistically significant）.The respiratory frequency and amplitude of patients aged 14⁶5years were normal,and the hypoxemia caused by the use of sedative and analgesic drugs was significantly higher than that of the group aged 0¹4 years and over 65 years（P<0.05,the difference was statistically significant）.There was no statistically significant difference in postoperative hypoxemia caused by various causes in each age group among the patients without blood gas,P>0.05.Conclusions:1.The number of patients with delayed PACU showed a decreasing trend from 2015 to 2017.2.The incidence of delayed PACU in hepatobiliary surgery and spinal bone disease surgery is significantly higher than that in other departments.3.Patients aged 0 to 1 years old account for a large proportion of patients with delayed PACU.4.Respiratory complications accounted for the largest proportion in patients with delayed PACU.Hypoxemia is the most common respiratory complication.5.For patients with postoperative hypoxemia retention in PACU,the residual muscle relaxant,anesthetic residue and upper respiratory tract obstruction should be highly valued,and postoperative analgesia should be strengthened.6.The lack of beds in the ICU leads to prolonged retention in the PACU for patients who are not scheduled to be transferred to the ICU.