Archive Anesthesia 2017

The Quest for Patient-Pleasing Anesthesia

10 ways your anesthesia providers can boost patient satisfaction.

Michael Reines, MD

Michael Reines, MD AMBASSADOR? In the battle for high scores on patient satisfaction surveys, your anesthesia providers can play a key role, says anesthesiologist Michael Reines, MD.

With the possible exception of the PACU nurse who serves the apple juice, your anesthesia providers can make or break a patient's surgical experience more so than anyone else dressed in scrubs. Are you overlooking the ways your anesthetists can improve patient satisfaction, including decreasing delays, speeding recovery, reducing post-op nausea and controlling pain with fewer opioids? Here are 4 ways they can deliver outpatient anesthetics with outstanding results.

1. Reduce PONV. Except for pain, there's nothing patients dread more than being nauseous or vomiting after surgery. The best ways to avoid PONV?

Bookending propofol. My "bookending" technique (osmag.net/WS3Yuy) uses propofol for induction and again at the end of cases when the general anesthetic is discontinued.

Hydration. A well-hydrated patient is less likely to be nauseous. I'm pretty aggressive with IV fluids and won't hesitate to give up to a liter of fluid over an hour to a healthy adult patient.

Regional blocks. Your anesthetist should be willing and able to provide regional nerve blocks. I wouldn't be serving my patient well if I didn't offer a regional block that can significantly relieve post-op pain. To optimize patient satisfaction, you should be able to place blocks, including an interscalene or femoral block, as part of an anesthetic.

Prophylaxis. I proactively treat nausea by adding 8 mg of low-cost Decadron in the IV bag. It's fairly benign and effective. I save Zofran for when I need it post-operatively, unless the patient has a history of PONV. If so, I give it pre-operatively.

No nitrous oxide. I avoid nitrous oxide, especially in cases lasting longer than 2 hours. Nitrous oxide displaces air in closed spaces such as the bowel, which can cause distention and potentially nausea and vomiting.

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