Standardizing Post-Anesthesia Discharge Criteria in an Office Setting

Purpose:Although oral and maxillofacial surgeons (OMS) routinely perform ambulatory surgery under sedation in an office setting, there is paucity of literature detailing objective criteria for discharging patients.  The aim of this study was to evaluate the effectiveness of a standard protocol for discharging patients after ambulatory anesthesia and minor oral surgery in an office setting.

Materials and Methods: A retrospective chart review from January 2010 through December 2013 was performed on all patients who underwent minor oral surgical procedures under intravenous (IV) sedation using a combination of versed and fentanyl with or without ketamine, propofol, and brevital. All patients were discharged after anesthesia recovery using the modified Aldrete Score.  Patients were objectively evaluated at the 15 minute postoperative interval and assigned a scored of 0, 1, or 2 in each of the following categories: activity, respiration, circulation, consciousness, and oxygen saturation. These individual scores were combined for a total score and a minimum score of 8 or greater was deemed safe for discharge. Records were reviewed for patient age, type of anesthesia received and post-operative anesthetic complications.

Results: A total 1040 patients were included in the study of which, 101 (9.7%) were pediatric patients. Each pediatric patient scored a 10/10, and all adult patients received scores >9/10. In the adult patient category, all but four patients scored 10/10; each of the remaining four patients scored at least 9, and all of them scored a 1 in the circulation criteria. No differences were noted relative to type of anesthetic drugs used and none of the patients suffered from any post-discharge anesthesia-related complications. 

Conclusions: Use of the modified Aldrete Score in an ambulatory OMS office setting: 1) standardizes discharge criteria with objective evaluation, and, 2) ensures safe and efficient discharge, for patients who have undergone under IV sedation. With its use, the incidence of complications related to “premature discharge” has decreased significantly at our center.

References:

1. Aldrete, JA. Modifications to the Post-Anesthesia Score for Use ub Ambulatory Surgery. Journal of Peri - Anesth Nurs. Jun; 13(3):148-55.1998.
2. Chung, F. Are Discharge Criteria Changing? Journal of Clinical Anesthesia. Nov-Dec; 5 (6 Suppl 1):64S-68S. 1993.