Inducing anaesthesia in the operating theatre: staff and patient opinions.

Abstract

Following recent correspondence regarding anaesthesia without induction rooms [1, 2], we would like to report our experience. The usual practice in our hospital is to induce anaesthesia in an anaesthetic room before transferring the patient to the operating theatre. We conducted a trial, over a 4-week period, of inducing anaesthesia in theatre and surveyed the opinions of surgeons, theatre staff and patients. A questionnaire distributed to all anaesthetists in the trust before the trial period demonstrated that the major reservations about the change in practice were that patients' anxiety would be increased, that there would be unnecessary time delays and that parents would be excluded from accompanying their children during induction of anaesthesia. For 4 weeks, two consultant anaesthetists induced all their cases in theatre. Extensive consultations with all the relevant parties involved, including surgeons, anaesthetic assistants and scrub staff, were conducted before embarking on the study. The anaesthetic room was used for establishing monitoring and intravenous access; if deemed necessary, small doses of midazolam were administered. The patient was then transferred to theatre for induction of anaesthesia. Twenty-one operating lists (seven surgical specialities) were included in the survey. We sought the opinions of the lead surgeon, anaesthetic assistant and scrub nurse at the end of each list by means of a questionnaire. We attempted to ascertain whether theatre workers felt this change had detrimental or beneficial effects on the efficient running of the list. Feedback from patients was sought postoperatively by means of an interview questionnaire. We found on 21 operating lists that on no occasion did the anaesthetic assistant or scrub nurse feel there was a delay to the list. The lead surgeon perceived a delay on one occasion out of 21. When asked about list efficiency, the lead surgeon reported an increase in efficiency of the running of the list on four of the 21 occasions, the anaesthetic assistant on nine occasions and the scrub nurse on five occasions. A reduction in efficiency was reported only once, which was by a lead surgeon. The mean (SD) time from one patient leaving theatre to the next arriving was 7 min (3 min) and mean time from patient arriving in theatre to time ready for surgery 12 min (5 min). Of the 35 patients questioned postoperatively, 13 did not recall the room they were in when they were anaesthetised; of those who did recall being in theatre, no patient reported being disturbed or upset by the theatre environment. Following consultation with representatives from infection control, it was agreed that parents could be allowed into theatre during induction of children if wearing theatre footwear and a sterile gown over their clothing. They were subsequently questioned about the experience. In eight of nine cases, parents reported not being distressed by the theatre environment. Several parents commented that it felt reassuring to know exactly where their child was, compared with previous experiences of leaving their children in the anaesthetic room. One parent was a ward staff nurse and felt that her presence in the operating theatre was inappropriate. Where possible the child was also questioned. On no occasion did the child report being upset by being anaesthetised in theatre. The commonest problem encountered was that of occasional noise in theatre caused by talking or the theatre phone ringing. There were no critical incidents attributable to the change in practice and trainee anaesthetists present during the surveyed lists did not feel under any undue extra pressure. Overall, our experience of abandoning the anaesthetic room and inducing anaesthesia in theatre was positive. The most obvious and important advantage was the continuity of monitoring, which has obvious implications for patient safety. In our view, there are also other less obvious advantages, such as improved understanding by other staff members of the conduct of anaesthesia, greater availability of help in the event of crisis and less equipment to check (and malfunction!). We also found it easier to maintain the patient's temperature. The few problems encountered, such as noise in theatre, are easily addressed with appropriate education and increased familiarity with this new approach. Perceived problems, such as increased patient distress, were not demonstrated by this small study. We feel that in the absence of purpose-built reception rooms, there is still an important role for the anaesthetic room as an anteroom to theatre for institution of monitoring, establishing venous access and storage of equipment. After conducting this survey, we feel that induction of anaesthesia performed in theatre does not have adverse effects on patient well-being or theatre efficiency. We feel that it could bring about a significant improvement in patient safety, and have thus changed our practice accordingly.