Reduction of Nonoperative Time Using the Induction Room, Parallel Processing, and Sugammadex: A Randomized Clinical Trial

Roland Kaddoum, Said Tarraf, Fadia M Shebbo, Arwa Bou Ali, Cynthia Karam, Carol Abi Shadid, Joanna Bouez, Marie T Aouad, Roland Kaddoum, Said Tarraf, Fadia M Shebbo, Arwa Bou Ali, Cynthia Karam, Carol Abi Shadid, Joanna Bouez, Marie T Aouad

Abstract

Background: An important variable in the operating room is the nonoperative time (NOT), the time between skin closure on a previous case and skin incision on the following case. Mismanagement of NOT can result in significant financial losses and delays in the operating room (OR) schedule, which can negatively impact efficiency and patient, surgeon, and staff satisfaction. NOT includes general anesthesia induction time (IT), emergence time (ET), and turnover time (TOT), and can be calculated by adding the 3 components. OR efficiency can be increased by applying parallel processing for general anesthesia induction and OR cleaning and reversal of neuromuscular blockade with sugammadex to reduce the 3 components of NOT without compromising patient safety.

Methods: This is a prospective, randomized study of 111 patients 18 to 75 years of age, American Society of Anesthesiologists (ASA) I-III, undergoing surgery requiring general anesthesia and muscle relaxation. Patients were randomly assigned to the control group (traditional linear processing for induction of anesthesia and OR cleaning and neuromuscular blockade reversal with neostigmine/glycopyrrolate) and the active group (parallel processing for induction of anesthesia and OR cleaning and neuromuscular blockade reversal with sugammadex). The primary outcome measured is the difference in the NOT. The secondary outcomes are surgeon and patient satisfaction.

Results: NOT was significantly shorter in patients who underwent the parallel processing strategy and received sugammadex compared to the patients in the control group (25.0 [18.0-44.0] vs 48.0 [40.0-64.5] minutes; Cliff' delta = 0.57; P < .001). After excluding the cases in the experimental group that were put into sleep in the OR (ie, the first case of the room), IT, ET, TOT, and NOT were further reduced and remained statistically significantly lower than the control group. Satisfaction scores from surgeons were significantly higher in the active group than in the control group (P < .001). There was no significant difference in the satisfaction scores of patients between the 2 groups.

Conclusions: Our study showed that interventions, such as parallel processing during induction of anesthesia and room cleaning instead of linear processing and the use of the faster-acting sugammadex instead of the combination of neostigmine and glycopyrrolate for the reversal of rocuronium-induced neuromuscular blockade, resulted in shorter IT, ET, TOT, and therefore NOT, in addition to higher surgeon's satisfaction.

Trial registration: ClinicalTrials.gov NCT01937247.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society.

Figures

Figure 1.
Figure 1.
Patient’s surgical flow in the 2 study groups.
Figure 2.
Figure 2.
CONSORT flow diagram of the patients’ enrollment. CONSORT indicates Consolidated Standards of Reporting Trials.

References

    1. Kynes JM, Schildcrout JS, Hickson GB, et al. . An analysis of risk factors for patient complaints about ambulatory anesthesiology care. Anesth Analg. 2013;116:1325–1332.
    1. Tiwari V, Queenan C, St. Jacques P. Impact of waiting and provider behavior on surgical outpatients’ perception of care. Perioper Care Oper Room Manag. 2017;7:7–11..
    1. Arakelian E, Gunningberg L, Larsson J. How operating room efficiency is understood in a surgical team: a qualitative study. Int J Qual Health Care. 2011;23:100–106.
    1. Bromhead HJ, Jones NA. The use of anaesthetic rooms for induction of anaesthesia: a postal survey of current practice and attitudes in Great Britain and Northern Ireland. Anaesthesia. 2002;57:850–854.
    1. Cendán JC, Good M. Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for additional caseload. Arch Surg. 2006;141:65–69..
    1. Dexter F. Deciding whether your hospital can apply clinical trial results of strategies to increase productivity by reducing anesthesia and turnover times. Anesthesiology. 2005;103:225–228.
    1. Shippert RD. A study of time-dependent operating room fees and how to save $100 000 by using time-saving products. Am J Cosmet Surg. 2005;22:25–34..
    1. Adams R, Warner P, Hubbard B, Goulding T. Decreasing turnaround time between general surgery cases: a six sigma initiative. J Nurs Adm. 2004;34:140–148.
    1. Macario A. Are your hospital operating rooms “efficient”? A scoring system with eight performance indicators. Anesthesiology. 2006;105:237–240.
    1. Chandrasekhar K, Togioka BM, Jeffers JL. Sugammadex. StatPearls. StatPearls Publishing LLC; 2021.
    1. Geldner G, Niskanen M, Laurila P, et al. . A randomised controlled trial comparing sugammadex and neostigmine at different depths of neuromuscular blockade in patients undergoing laparoscopic surgery. Anaesthesia. 2012;67:991–998.
    1. Luo J, Chen S, Min S, Peng L. Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade. Ther Clin Risk Manag. 2018;14:2397–2406.
    1. Sokolovic E, Biro P, Wyss P, et al. . Impact of the reduction of anaesthesia turnover time on operating room efficiency. Eur J Anaesthesiol. 2002;19:560–563.
    1. Kodali BS, Kim D, Bleday R, Flanagan H, Urman RD. Successful strategies for the reduction of operating room turnover times in a tertiary care academic medical center. J Surg Res. 2014;187:403–411.
    1. Flockton EA, Mastronardi P, Hunter JM, et al. . Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. Br J Anaesth. 2008;100:622–630.
    1. Sacan O, White PF, Tufanogullari B, Klein K. Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine. Anesth Analg. 2007;104:569–574.
    1. Putz L, Dransart C, Jamart J, Marotta ML, Delnooz G, Dubois PE. Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial. J Clin Anesth. 2016;35:107–113.
    1. Brueckmann B, Sasaki N, Grobara P, et al. . Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth. 2015;115:743–751.
    1. Hanss R, Buttgereit B, Tonner PH, et al. . Overlapping induction of anesthesia: an analysis of benefits and costs. Anesthesiology. 2005;103:391–400.
    1. Sandberg WS, Daily B, Egan M, et al. . Deliberate perioperative systems design improves operating room throughput. Anesthesiology. 2005;103:406–418.
    1. Torkki PM, Marjamaa RA, Torkki MI, Kallio PE, Kirvelä OA. Use of anesthesia induction rooms can increase the number of urgent orthopedic cases completed within 7 hours. Anesthesiology. 2005;103:401–405.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe