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Practice Guidelines For Postanesthetic Care
Practice Guidelines For Postanesthetic Care
RACTICE Guidelines are systematically developed recommendations that assist the practitioner and patient
in making decisions about health care. These recommendations may be adopted, modified, or rejected according
to clinical needs and constraints, and are not intended to
replace local institutional policies. In addition, Practice
Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute
requirements, and their use cannot guarantee any specific
outcome. Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology,
and practice. They provide basic recommendations that are
supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.
This document updates the Practice Guidelines for Postanesthetic Care: A Report by the American Society of Anesthesiologists Task Force on Postanesthetic Care, adopted by
the ASA in 2001 and published in 2002.*
Methodology
A. Definition of Postanesthetic Care
A standard definition for postanesthetic care cannot be identified in the available literature. For these Practice Guidelines, postanesthetic care refers to those activities undertaken
to manage the patient after completion of a surgical procedure and the concomitant primary anesthetic.
Updated by the Committee on Standards and Practice Parameters: Jeffrey L. Apfelbaum, M.D. (Chair), Chicago, Illinois; and
the Task Force on Postanesthetic Care: Jeffrey H. Silverstein, M.D.
(Task Force Chair), New York, New York; Frances F. Chung, M.D.,
Toronto, Ontario; Richard T. Connis, Ph.D., Woodinville, Washington; Ralph B. Fillmore, M.D., Dothan, Alabama; Sean E. Hunt,
M.D., Manchester, New Hampshire; David G. Nickinovich, Ph.D.,
Bellevue, Washington; and Mark S. Schreiner, M.D., Philadelphia,
The original Guidelines were developed by the American Society of
Anesthesiologists Task Force on Postanesthetic Care: Jeffrey H. Silverstein, M.D. (Chair), New York, New York; Jeffrey L. Apfelbaum,
M.D., Northbrook, Illinois; Jared C. Barlow, M.D., Grand Island,
New York; Frances F. Chung, M.D., Toronto, Ontario; Richard T.
Connis, Ph.D., Woodinville, Washington; Ralph B. Fillmore, M.D.,
Dothan, Alabama; Sean E. Hunt, M.D., Manchester, New Hampshire; Thomas A. Joas, M.D., San Diego, California; David G. Nickinovich, Ph.D., Bellevue, Washington; and Mark S. Schreiner, M.D.,
Philadelphia, Pennsylvania. Pennsylvania.
Received from American Society of Anesthesiologists, Park
Ridge, Illinois. Submitted for publication October 18, 2012.
Accepted for publication October 18, 2012. Supported by the
American Society of Anesthesiologists and developed under the
direction of the Committee on Standards and Practice Parameters,
Jeffrey L. Apfelbaum, M.D. (Chair). Approved by the ASA House of
Delegates on October 17, 2012. A complete bibliography that was
used to develop these updated Guidelines, arranged alphabetically
by author, is available as Supplemental Digital Content 1, http://
links.lww.com/ALN/A906.
Address reprint requests to the American Society of Anesthesiologists: 520 North Northwest Highway, Park Ridge, Illinois 60068.
These Practice Guidelines, as well as all ASA Practice Parameters,
may be obtained at no cost through the Journal Web site, www.
anesthesiology.org.
* American Society of Anesthesiologists: Practice guidelines for
postanesthetic care. Anesthesiology 2002; 96:742752.
Anesthesiology, V 118 No 2
February 2013
Practice Guidelines
patients receiving infiltration local anesthesia without sedation, patients receiving minimal sedation (anxiolysis), or
patients receiving intensive care.
D. Application
The Guidelines are intended for use by anesthesiologists and
may also serve as a resource for other physicians and healthcare professionals who direct anesthesia or sedation and analgesia care. General medical supervision and coordination of
patient care in the postanesthesia care unit should be the
responsibility of an anesthesiologist.
E. Task Force Members and Consultants
The original Guidelines were developed by an ASA appointed
Task Force of ten members, consisting of anesthesiologists
in private and academic practices from various geographic
areas of the United States, and two consulting methodologists from the ASA Committee on Standards and Practice
Parameters.
The Task Force developed the original Guidelines by
means of a seven-step process. First, they reached consensus on the criteria for evidence. Second, original published
research studies from peer-reviewed journals relevant to postanesthetic care were reviewed and evaluated. Third, expert
consultants were asked to: (1) participate in opinion surveys
on the effectiveness of various postanesthetic care-management recommendations and (2) review and comment on a
draft of the Guidelines. Fourth, opinions about the Guideline recommendations were solicited from a sample of active
members of the ASA. Fifth, opinion-based information
obtained during an open forum for the original Guidelines,
held at a major national meeting, was evaluated. Sixth, the
consultants were surveyed to assess their opinions on the feasibility of implementing the Guidelines. Seventh, all available information was used to build consensus to finalize the
Guidelines. In 2011, the ASA Committee on Standards and
Practice Parameters requested the updating of the scientific
evidence for this Guideline. This update consists of an evaluation of literature published after completion of the original
Guidelines. A summary of recommendations is provided in
appendix 1.
Category A
RCTs report comparative findings between clinical
interventions for specified outcomes. Statistically significant
(P < 0.01) outcomes are designated as either beneficial (B)
or harmful (H) for the patient; statistically nonsignificant
findings are designated as equivocal (E).
Level 1: The literature contains a sufficient number of RCTs
to conduct meta-analysis, and meta-analytic findings
from these aggregated studies are reported as evidence.
Level 2: The literature contains multiple RCTs, but the
number of RCTs is not sufficient to conduct a viable
meta-analysis for the purpose of these Guidelines. Findings from these RCTs are reported as evidence.
Level 3: The literature contains a single RCT, and findings
from this study are reported as evidence.
Category B
Observational studies or RCTs without pertinent comparison groups may permit inference of beneficial or harmful
relationships among clinical interventions and outcomes.
Inferred findings are given a directional designation of beneficial (B), harmful (H) or equivocal (E). For studies that
report statistical findings, the threshold for significance is
P < 0.01.
Scientific Evidence
Scientific evidence used in the development of these Guidelines
is based on findings from literature published in peer-reviewed
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Level 3: The literature contains noncomparative observational studies with descriptive statistics (e.g., frequencies, percentages).
Level 4: The literature contains case reports.
Insufficient Evidence
The lack of sufficient scientific evidence in the literature may
occur when the evidence is either unavailable (i.e., no pertinent studies found) or inadequate. Inadequate literature
cannot be used to assess relationships among clinical interventions and outcomes, since such literature does not permit
a clear interpretation of findings due to methodological concerns (e.g., confounding in study design or implementation)
or does not meet the criteria for content as defined in the
Focus of the Guidelines.
Guidelines
Opinion-based Evidence
The original Guidelines contained formal survey information collected from expert consultants and a random sample of active members of the ASA. Additional information
was obtained from open-forum presentations and other
invited and public sources. All opinion-based evidence
relevant to each topic (e.g., survey data, open-forum testimony, internet-based comments, letters, and editorials)
was considered in the development of the original Guidelines. However, only the findings obtained from formal
surveys are reported.
Survey responses from the consultants and ASA
members obtained during development of the original
Guidelines are summarized in the text of this update and
reported in appendix 2. No new surveys were conducted
for this update.
Category A: Expert Opinion
Survey responses from Task Forceappointed expert consultants are reported in summary form in the text, with a
complete listing of consultant survey responses reported in
appendix 2.
Category B: Membership Opinion
Survey responses from a random sample of active ASA members are reported in summary form in the text, with a complete listing of ASA member survey responses reported in
appendix 2.
Survey responses from expert and membership sources
are recorded using a three-point scale and summarized based
on weighted values. The following terms describe survey
responses for any specified issue. Responses are assigned a
numeric value of agree = +1, undecided = 0, or disagree = 1.
The average weighted response represents the mean value for
each survey item.
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Practice Guidelines
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# Documentation of postoperative patient temperature is a performance measure by the Centers for Medicare and Medicaid
Services and the Joint Commission: NQF-endorsed voluntary
consensus standards for hospital care SCIP-Inf-105; in Specifications Manual for National Hospital Inpatient Quality Measures,
version 3.2: http://www.jointcommission.org/assets/1/6/HIQR_
SpecsManual_1.1.13_v.4.2.1_EXE.zip. Accessed December 5, 2012.
Anesthesiology 2013; 118:XX-XX
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As part of a recovery room discharge protocol, all patients should be required to have a responsible individual accompany them home.
Patients should be observed until they are no longer at
increased risk for cardiorespiratory depression.
A mandatory minimum stay should not be required.
Discharge criteria should be designed to minimize
the risk of central nervous system or cardiorespiratory depression after discharge.
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a fail-safe n value was calculated. No search for unpublished studies was conducted, and no reliability tests for
locating research results were done. When available, odds
ratio and combined-test findings must all agree for them to
be considered significant.
Meta-analysis of new literature reported significant
odds ratios for the prevention of nausea and vomiting
for the following interventions: dolasetron, granisetron,
ondansetron, and dexamethasone (8mg); findings for
metoclopramide and dexamethasone (45mg only) were
equivocal. No new combined tests were conducted due
to an insufficient number of studies with continuous or
interval level data.
In the original Guidelines, interobserver agreement
among Task Force members and two methodologists was
established by interrater reliability testing. Agreement
levels using a kappa () statistic for two-rater agreement
pairs were as follows: type of study design, = 0.801.00;
(2) type of analysis, = 0.551.00; (3) evidence linkage
assignment, = 0.911.00; and (4) literature inclusion
for database, = 0.781.00. Three-rater chance-corrected
agreement values were as follows: (1) study design, Sav =
0.86, Var (Sav) = 0.011; (2) type of analysis, Sav = 0.65,
Var (Sav) = 0.026; (3) linkage assignment, Sav = 0.81, Var
(Sav) = 0.005; and (4) literature database inclusion, Sav =
0.84, Var (Sav) = 0.045. These values represent moderate to
high levels of agreement. For the updated Guidelines, the
same two methodologists involved in the original Guidelines conducted the literature review.
B. Consensus-Based Evidence
The original Guidelines obtained consensus from multiple
sources, including: (1) survey opinion from consultants who
were selected based on their knowledge or expertise in difficult airway management, (2) survey opinions solicited from
active members of the ASA, (3) testimony for the previous
update from attendees of a publicly held open forum at a
major national anesthesia meeting, (4) internet commentary, and (5) task force opinion and interpretation. The rate of
return was 50% (n = 56/112) for the consultants and 21% (n
= 211/1,000) for the membership (table 3). Consultants and
ASA members were supportive of all of the interventions, with
the following exceptions: (1) routine assessment of urinary
output and voiding, (2) routine pharmacologic prophylaxis
of nausea and vomiting, (3) nonpharmacologic treatment
of nausea and vomiting, (4) supplemental oxygen during
transport or in the postanesthesia care unit, (5) routine use of
flumazenil and naloxone, (6) requiring that patients urinate
before discharge, (7) requiring that patients drink water before
discharge, and (8) requiring a minimum stay in recovery. The
original Guidelines also included an additional survey sent to
the expert consultants asking them to indicate which, if any,
of the evidence linkages would change their clinical practices
if the Guideline update was instituted. The rate of return was
35% (N = 39/112). The percent of responding Consultants
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No.
Studies
Fisher
Chi-square
P Value
Weighted
Stouffer Zc
P Value
Effect
Size
Mantel-Haenszel
Chi-Square
P Value
6
8
0.31
7.78
56.03
5
5
6
11
5
5
8
5
19.81
0.94
9
12
7
6
5
7
6
26.64
< 0.01
5
6
10
10
5
Odds
Ratio
Heterogeneity
Significance
Effect Size
0.86
1.77
< 0.001
2.56
< 0.001
27.60
38.29
< 0.001
< 0.001
3.97
4.88
0.05
13.83
75.18
3.90
3.51
0.01
< 0.001
< 0.001
> 0.02 (NS)
> 0.05 (NS)
> 0.90 (NS)
1.61
2.04
0.77
1.27
1.01
5.80
1.46
0.07
0.01
52.68
61.77
8.41
15.45
1.09
6.96
< 0.001
< 0.001
< 0.01
< 0.001
> 0.20 (NS)
< 0.01
2.02
2.95
1.44
0.40
1.17
0.73
0.81
4.15
0.78
1.58
35.46
< 0.001
3.18
< 0.001
0.22
14.43
11.86
< 0.001
< 0.001
1.79
1.67
21.14
< 0.001
2.36
6
11
8.00
25.59
< 0.01
< 0.001
1.88
2.46
10
12
7
5
15.87
7.87
0.00
0.04
< 0.001
< 0.01
> 0.50 (NS)
> 0.90 (NS)
2.17
1.69
1.00
1.08
174.83
< 0.001
5.66
< 0.01
46.77
< 0.001
6.18
8
5
107.43
< 0.001
17.67
< 0.001
0.99
14.11
< 0.001
3.75
< 0.001
< 0.001
> 0.70 (NS)
8
5
107.56
22.00
< 0.001
< 0.001
10.17
4.47
50.17
< 0.001
2.94
< 0.002
0.32
6
5
6
5
7
30.98
78.62
< 0.010
< 0.001
2.22
5.51
< 0.001
0.24
0.54
0.48
0.42
2.64
0.82
0.85
0.56
< 0.001
73.24
< 0.001
8.50
< 0.001
0.99
< 0.001
5
10
115.26
< 0.001
9.72
< 0.001
0.79
9.40
Nausea/vomiting
prophylaxis
Antihistamines
Nausea
Vomiting
5-HT3 Antiemetics
Dolasetron
Vomiting
Granisetron
Nausea*
Vomiting*
Ondansetron
Nausea
Vomiting
Headache
Dizziness
Drowsiness
Time to discharge
Tropisetron
Vomiting
Droperidol
Nausea
Vomiting
Headache
Agitation and restlessness
Dizziness
Drowsiness
Time to discharge
Prochlorperazine
Nausea
Vomiting
Metoclopramide
Nausea
Vomiting
Time to discharge
Scopolamine
Vomiting
Dexamethasone
Nausea
Vomiting
Multiple antiemetics
Nausea
Vomiting
Headache*
Drowsiness*
Nausea/vomiting treatment
Ondansetron
Vomiting
Supplemental oxygen
Hypoxemia
Forced-air warming
Temperature
Shivering
Meperidine for shivering
vs. placebo for shivering
vs. opioids for shivering
Reversal agents
Flumazenil (general anesthesia)
Recovery time
Flumazenil (sedation)
Nausea
Blood pressure
Dizziness
Drowsiness
Recovery time
Edrophonium
Recovery time
Neostigmine
Vomiting
Recovery time
< 0.01
0.44
< 0.001
CI = 99% confidence interval; N = number of studies; NS = not statistically significant, P < 0.01.
* Caution: Same authors for > 50% of studies; Inclusion criteria include an N over 100, study date 1995 and later; no abstracts;
Inclusion criteria include study date 1995 and later; no abstracts; DerSimonian-Laird random-effects odds ratio. CI = 99% confidence interval; N = number of studies; NS = not
statistically significant, P < 0.01.
10
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Odds Ratio
CI
Heterogeneity
(Effect Size)
0.27
0.160.48
0.993
5
5
0.58
0.34
0.291.13
0.180.68
0.954
0.255
7
12
10
14
7
11
0.73
0.68*
0.29
0.33
0.53
0.36
0.451.19
0.301.34
0.180.46
0.230.49
0.300.94
0.230.56
0.084
0.002
0.924
0.111
0.074
0.033
6
6
0.31
0.27
0.180.52
0.160.45
0.303
0.790
5
6
5
0.60
0.62
0.41
0.470.76
0.460.84
0.260.63
0.246
0.445
0.747
6
5
0.63
0.57
0.361.08
0.291.14
0.998
0.481
5
6
9
5
8
5
10
7
6
0.47
0.42
0.51
0.37
0.37
0.32
0.40
0.28
0.50
0.221.00
0.220.82
0.320.80
0.170.81
0.210.64
0.180.58
0.260.62
0.160.49
0.300.84
0.836
0.279
0.179
0.979
0.721
0.980
0.645
0.858
0.089
administration of supplemental oxygen100%; normalizing patient temperature100%; forced-air warming systems85%; meperidine for shivering92%; flumazenil for
reversal of general anesthesia95%; flumazenil for reversal
of sedation97%; naloxone for opioid reversal100%;
edrophonium for reversal of neuromuscular blockade97%;
neostigmine for reversal of neuromuscular blockade100%;
not requiring that patients urinate before discharge92%;
not requiring patients to drink water without vomiting before
discharge85%; requiring that patients have a responsible
individual accompany them home95%; and not requiring a mandatory minimum stay in recovery85%. Eightytwo percent of the respondents indicated that the Guidelines
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Outcome
Agree Disagree
(%)
(%)
Dont
Know (%)
Agree
(%)
Disagree
Dont
(%)
Know (%)
55
55
98.2
98.2
1.8
1.8
0.0
0.0
211
211
100.0
98.1
0.0
0.0
0.0
1.9
55
87.3
1.8
10.9
211
92.4
1.0
6.7
56
56
100.0
94.6
0.0
0.0
0.0
5.4
211
211
100.0
90.5
0.0
4.8
0.0
4.8
56
76.8
1.8
21.4
211
77.1
2.9
20.0
55
55
70.9
83.6
27.3
9.1
1.8
7.3
211
211
89.5
82.9
7.6
6.7
2.9
10.5
55
47.3
16.4
36.4
211
64.8
8.6
26.7
55
55
70.9
63.6
20.0
21.8
9.1
14.5
211
211
78.1
69.5
16.2
12.4
5.7
18.1
55
54.5
14.5
30.9
211
59.0
12.4
28.6
56
56
96.4
75.0
3.6
12.5
0.0
12.5
211
209
98.1
81.0
1.9
4.8
0.0
14.3
56
62.5
5.4
32.1
209
65.7
8.6
25.7
55
55
74.5
60.0
18.2
20.0
7.3
20.0
211
211
86.7
58.1
10.5
21.9
2.9
20.0
55
49.1
16.4
34.5
211
58.1
18.1
23.8
56
55
98.2
69.1
0.0
18.2
1.8
12.7
211
211
98.1
67.9
0.0
20.8
1.9
11.3
55
61.8
14.5
23.6
211
71.7
10.4
17.9
56
56
89.3
57.1
5.4
33.9
5.4
8.9
211
211
84.8
55.2
10.5
23.8
4.8
21.0
56
51.8
26.8
21.4
211
53.3
21.0
25.7
55
81.8
3.6
14.5
211
88.7
2.8
8.5
55
65.5
12.7
21.8
211
75.5
5.7
18.9
56
56
54
1.8
98.2
72.2
96.4
1.8
9.3
1.8
0.0
18.5
211
211
210
5.7
94.3
68.9
91.5
4.7
10.4
2.8
0.9
20.8
54
55.6
13.0
31.5
210
54.7
14.2
31.1
(continued)
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Table 3. (Continued)
Consultants Percentage Response
Intervention or
Linkage
Outcome
Agree Disagree
(%)
(%)
Dont
Know (%)
Agree
(%)
Disagree
Dont
(%)
Know (%)
56
56
55
12.5
66.1
52.7
83.9
26.8
20.0
3.6
7.1
27.3
211
211
209
21.7
67.0
48.1
72.6
25.5
18.9
5.7
7.5
33.0
55
43.6
20.0
36.4
209
43.4
20.8
35.8
56
56
100.0
100.0
0.0
0.0
0.0
0.0
211
211
99.1
96.2
0.9
1.9
0.0
1.9
56
89.3
0.0
10.7
211
87.7
3.8
8.5
56
55
56
8.9
89.1
80.4
85.7
10.9
7.1
5.4
0.0
12.5
211
211
210
16.0
84.0
85.8
79.2
12.3
5.7
4.7
3.8
8.5
56
66.1
14.3
19.6
210
64.2
13.2
22.6
56
56
100.0
96.4
0.0
1.8
0.0
1.8
211
211
100.0
98.1
0.0
0.0
0.0
1.9
56
71.4
10.7
17.9
211
76.4
2.8
20.8
56
56
50.0
37.5
21.4
21.4
28.6
41.1
210
210
44.3
38.7
14.2
13.2
41.5
48.1
56
26.8
26.8
46.4
210
27.4
14.2
58.5
53
52.8
37.7
9.4
210
57.1
30.5
12.4
53
54.7
34.0
11.3
210
53.3
33.3
13.3
55
60.0
32.7
7.3
209
55.7
30.2
14.2
55
56.4
27.3
16.4
209
55.7
29.2
15.1
56
55
48.2
29.1
46.4
27.3
5.4
43.6
210
210
38.7
28.3
53.8
36.8
7.5
34.9
56
55
50.0
36.4
46.4
23.6
3.6
40.0
211
211
57.5
41.5
37.7
28.3
4.7
30.2
56
82.1
7.1
10.7
211
85.8
3.8
10.4
56
56
83.9
98.2
3.6
0.0
12.5
1.8
211
211
79.2
92.5
8.5
0.0
12.3
7.5
56
55.4
8.9
35.7
211
68.9
6.6
24.5
56
71.4
5.4
23.2
211
77.4
2.8
19.8
56
85.7
3.6
10.7
211
84.9
0.9
14.2
(continued)
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Table 3. (Continued)
Consultants Percentage Response
Intervention or
Linkage
Meperidine vs. no
treatment
Outcome
Reduces adverse
outcomes
Reduces shivering
Improves comfort/
satisfaction
Meperidine vs. other Reduces adverse
opioid agonists
outcomes
Reduces shivering
Improves comfort/
satisfaction
Routine use of
Reduces adverse
flumazenil and
outcomes
naloxone
Improves comfort/
satisfaction
Regimens for
Reduces adverse
avoiding
outcomes
neuromuscular
Improves comfort/
blockade reversal
satisfaction
Requiring urination
Reduces adverse
before discharge
outcomes
Increases recovery
stay
Increases comfort/
satisfaction
Mandatory for all
day surgery
Mandatory for
select day surg
Reduces adverse
Requiring drinking
outcomes
before
discharge
Increases recovery
stay
Increases comfort/
satisfaction
Mandatory for all
day surgery
Mandatory for
select day surg
Responsible
Should be
individual for escort mandatory
Reduces adverse
outcomes
Increases comfort/
satisfaction
Responsible
Should be
mandatory
individual to stay
for 24 h
Reduces adverse
outcomes
Increases comfort/
satisfaction
Early discharge for
Improves comfort/
regional extremity satisfaction
block patients
Is acceptable
clinical practice
Agree Disagree
(%)
(%)
Dont
Know (%)
Agree
(%)
Disagree
Dont
(%)
Know (%)
56
23.2
17.9
58.9
211
26.4
23.6
50.0
56
56
92.9
82.1
0.0
3.6
7.1
14.3
211
211
88.7
82.1
4.7
5.7
6.6
12.3
56
17.9
21.4
60.7
211
25.5
25.5
49.1
56
56
75.0
62.5
0.0
3.6
25.0
33.9
211
211
78.3
67.9
6.6
7.5
15.1
24.5
56
3.6
80.4
16.1
211
5.7
77.4
17.0
56
1.8
80.4
17.9
211
4.7
80.2
15.1
56
32.1
32.1
35.7
211
40.6
33.0
26.4
56
30.4
35.7
33.9
211
40.6
31.1
28.3
56
14.3
58.9
26.8
210
13.2
56.6
30.2
56
94.6
3.6
1.8
210
91.5
5.7
2.8
56
10.7
71.4
17.9
210
11.3
64.2
24.5
56
3.6
89.3
7.1
210
9.4
83.0
7.5
56
76.8
16.1
7.1
210
71.7
19.8
8.5
56
10.7
67.9
21.4
211
19.0
51.4
29.5
56
76.8
14.3
8.9
211
60.0
26.7
13.3
56
17.9
67.9
14.3
211
34.3
40.0
25.7
56
12.5
78.7
8.9
211
24.8
64.8
10.5
54
25.9
64.8
9.3
211
29.8
52.9
17.3
56
98.2
1.8
0.0
211
98.1
1.9
0.0
56
76.8
1.8
21.4
211
69.8
2.8
27.4
56
50.0
17.9
32.1
211
54.7
10.4
34.9
56
30.4
44.6
25.0
211
36.8
46.2
17.0
56
28.6
19.6
51.8
211
33.0
21.7
45.3
56
32.1
21.4
46.4
211
33.0
23.6
43.4
55
61.8
14.5
23.6
210
52.8
18.9
28.3
55
83.6
9.1
7.3
210
69.8
25.5
4.7
(continued)
Practice Guidelines
Copyright by the American Society of Anesthesiologists. Unauthorized reproduction of this article is prohibited.
Special Articles
Table 3. (Continued)
Consultants Percentage Response
Intervention or
Linkage
Early discharge for
spinal or epidural
patients
Minimum stay after
intravenous
narcotic
Minimum stay after
vasoactive agents
Minimum stay in
recovery facility
Requiring separate
phase 1 and 2
facilities
Agree Disagree
(%)
(%)
Agree
(%)
32.1
210
50.9
18.9
30.2
10.7
10.7
210
73.6
17.9
8.5
73.2
46.4
23.2
12.5
3.6
41.1
211
211
72.6
48.1
22.6
20.8
4.7
31.1
56
56
80.4
53.6
12.5
8.9
7.1
37.5
211
211
89.6
58.5
10.4
7.5
0.0
34.0
56
55
30.4
25.5
67.9
52.7
1.8
21.8
210
209
38.7
32.1
54.7
38.7
6.6
29.2
55
16.4
61.8
21.8
209
25.5
42.5
32.1
56
21.4
64.3
14.3
210
19.8
55.7
24.5
56
10.7
53.6
35.7
210
10.4
47.2
42.5
56
41.1
33.9
25.0
210
23.6
41.5
34.9
Outcome
Improves comfort/
satisfaction
Is acceptable
clinical practice
Should be required
Reduces adverse
outcomes
Should be required
Reduces adverse
outcomes
Should be required
Reduces adverse
outcomes
Improves comfort/
satisfaction
Should be required
56
51.8
16.1
56
78.6
56
56
Reduces adverse
outcomes
Improves comfort/
satisfaction
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17
Practice Guidelines
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