A study of modified Aldrete score and fast-track criteria for assessing recovery from general anaesthesia after laparoscopic surgery in Indian adults

Abstract

Study ObjectiveThe primary objective of the study was to compare and evaluate two of the recovery assessment tools, i.e. the Modified Aldrete score (MAS) and fast-track criteria (FTC), for assessing time to recovery from general anaesthesia after laparoscopic surgeries in Indian settings. As a secondary objective we explored the factors associated with time to recovery. DesignLongitudinal observational study. SettingOperative room, Post-op recovery area and general ward of SSK Hospital, New Delhi, India PatientsAfter a thorough pre-anesthetic evaluation, 100 consecutive subjects 18–65 years, ASA I/II, posted for laparoscopic surgery were included. MeasurementsBaseline and clinical parameters were noted. Post-extubation recovery scores were recorded every 5 min until 30 min and at 2, 6, 12 and 24 h in the post-operative period using both the criteria. Main ResultsMean time to recovery from anaesthesia was found to be 14.8 ± 3.8 and 13.0 ± 3.5 minutes when assessed by MAS (score ≥ 9) and FTC (score ≥ 12), respectively. At 2 and 6 h. post-extubation a dip in the FTC scores were observed in 7% and 3% of the subjects though the MAS scores remained unaffected. This corresponds to the incidence of severe post-op pain and nausea vomiting in the study subjects. Older age > 35 years, pre-operative medication with fentanyl and midazolam and duration of surgery are factors which were significantly associated with time to recovery. ConclusionFTC and MAS seem to be equally good in assessing recovery in immediate postoperative period from general anaesthesia after laparoscopic surgery. However, the former criterion is better for documenting adequate recovery for transfer of patients from post-anaesthesia-care-unit/high-dependency-unit (PACU / HDU) to the ward as it provides assessment of postoperative-nausea-vomiting (PONV) and pain.