Process analysis in outpatient knee surgery : Effects of regional and general anesthesia on anesthesia-controlled time

• Published in: Anesthesiology (Philadelphia) Vol. 93; no. 2; pp. 529 - 538
• Main Authors: WILLIAMS, B. A, KENTOR, M. L, FU, F. H, WILLIAMS, J. P, FIGALLO, C. M, SIGL, J. C, ANDERS, J. W, BEAR, T. C, TULLOCK, W. C, BENNETT, C. H, HARNER, C. D
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.08.2000
• Subjects: Adult; Ambulatory Surgical Procedures; Analysis of Variance; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, Conduction - methods; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anterior Cruciate Ligament - surgery; Biological and medical sciences; Critical Pathways; Databases, Factual; Female; Humans; Male; Medical sciences; Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics; Patient Care Team; Postoperative Nausea and Vomiting; Process Assessment (Health Care); Time Factors; Knee; Human; Endoscopic surgery; Regional anesthesia; Arthroscopy; Orthopedic surgery; Diseases of the osteoarticular system; General anesthesia; Ambulatory; Comparative study
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-200008000-00033

The performance of anesthetic procedures before operating room entry (e.g., with either general or regional anesthesia [RA] induction rooms) should decrease anesthesia-controlled time in the operating room. The authors retrospectively studied the associations between anesthesia techniques and anesthesia-controlled time, evaluating one surgeon performing a single procedure over a 3-yr period. The authors hypothesized that, using the anesthesia care team model, RA would be associated with reduced anesthesia-controlled time compared with general anesthesia (GA) alone or combined general-regional anesthesia (GA-RA). The authors queried an institutional database for 369 consecutive patients undergoing the same procedure (anterior cruciate ligament reconstruction) performed by one surgeon over a 3-yr period (July 1995 through June 1998). Throughout the period of study, anesthesia staffing consisted of an attending anesthesiologist medically directing two nurse anesthetists in two operating rooms. Anesthesia-controlled time values were compared based on anesthesia techniques (GA, RA, or GA-RA) using one-way analysis of variance, general linear modeling using time-series and seasonal adjustments, and chi-square tests when appropriate. P < 0. 05 was considered significant. RA was associated with the lowest anesthesia-controlled time (11.4 +/- 1.3 min, mean +/- 2 SEM). GA-RA (15.7 +/- 1.0 min) was associated with lower anesthesia-controlled time than GA used alone (20.3 +/- 1.2 min). When compared with GA without an induction room for outpatients undergoing anterior cruciate ligament reconstruction, RA with an induction room was associated with the lowest anesthesia- controlled time. Managers must weigh the costs and time required for anesthesiologists and additional personnel to place nerve blocks or induce GA preoperatively in such a staffing model.