NAP5--death knell for the anaesthetic room?

Abstract

Anaesthetic rooms originated in the days of ether and chloroform, when a quiet place was required for the patient to experience all the phases of anaesthesia without undue stimulation or excitement. Minimal equipment was available, beyond a Boyle's machine and a vigilant anesthetist. However, I believe the time has come to review the ongoing need for specific anaesthetic rooms. Modern induction agents produce rapid anaesthesia, and elaborate anaesthetic machines and monitoring equipment are expensive to duplicate and occupy space. Furthermore, clinical experience in Australia, from obstetric practice 1 and when managing high-risk emergency patients, indicates that patient safety is not compromised by not using anaesthetic rooms. Indeed, given that increasing proportions of surgical patients are elderly, obese and unwell, it might even be safer for patients to position themselves before anaesthesia, without exposure to either personnel risks associated with manual handling or patient risks associated with transfer between the anaesthetic room and operating theatre 2. Crucially, the 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia identified that half of all reports of awareness occurred during induction of anaesthesia, with the interruption in anaesthetic delivery when transferring the patient from anaesthetic room to theatre (the ‘gap’) a contributory factor. Rather than introduce yet another checklist to mitigate this avoidable risk, as suggested by the authors 3, we should grasp the opportunity to overhaul our traditional but archaic professional attachment to anaesthetic rooms and move towards routinely inducing anaesthesia in theatre.