Section Editor: Jerrold Lerman
A comparison of inhalational inductions for children in the operating room vs the induction room
Article first published online: 15 DEC 2011
© 2011 Blackwell Publishing Ltd
Volume 22, Issue 4, pages 327–334, April 2012
How to Cite
Varughese, A. M., Hagerman, N., Patino, M., Wittkugel, E., Schnell, B., Salisbury, S. and Kurth, D. (2012), A comparison of inhalational inductions for children in the operating room vs the induction room. Pediatric Anesthesia, 22: 327–334. doi: 10.1111/j.1460-9592.2011.03755.x
- Issue published online: 2 MAR 2012
- Article first published online: 15 DEC 2011
- Accepted 10 November 2011
- induction of anesthesia;
- adverse events;
- respiratory arrest
Background: There has been debate about the use of an induction room (IR) compared with an operating room (OR) for inhalational induction in children. The quality of the anesthesia induction between these two physical environments has not been studied previously. We sought to compare child distress, OR utilization and efficiency, and parental satisfaction and safety, between an IR and an OR.
Methods: In a prospective observational study, we studied 501 developmentally appropriate children ages 1–14 years, American Society of Anesthesiologists (ASA) physical status I–III, presenting for the inhalational induction of anesthesia, undergoing outpatient or outpatient-admit ENT surgery. Inductions were performed in an IR (IR group) or OR (OR group) with parent(s) present. Child behavioral compliance was assessed using the Induction Compliance Checklist (ICC), a validated observational scale from 0 to 10 consisting of 10 behaviors; an ICC score ≥4 was considered poor behavioral compliance. Times for transport, anesthesia start, ready for surgery, surgery finish, out of OR, and total case process times were recorded. OR utilization and OR efficiency was derived using these times. Data on number and experience of clinical providers were also collected. Parent satisfaction with the induction was measured using a satisfaction survey. Safety was measured by recording respiratory complications during induction. The chi-squared test was conducted to determine whether induction location was associated with level of behavioral compliance. A multivariable proportional odds model was used to control for risk factors. OR utilization and efficiency were analyzed using the Wilcoxon–Mann–Whitney test.
Results: There were no significant differences in ICC scores between the groups (P-value = 0.12). Anesthesia, nonoperative, and transport time were statistically less in the OR group when compared with the IR group, although total case process times were similar in both groups. While OR efficiency was significantly higher for the OR group (P-value = 0.0096), OR utilization did not differ between groups (P-value = 0.288). The OR group had a significantly higher number of anesthesia providers and a more experienced surgical team. Parents in the two groups were equally satisfied with their experience during induction, and none of the subjects had respiratory complications during the anesthesia induction.
Conclusions: We found no differences in child distress, parent satisfaction, and respiratory complications between inductions conducted in the IR vs the OR. Differences in utilization, efficiency, and turnover were minimal and not operationally significant. Capital equipment, space, and staffing strategies should be key drivers in considerations for the use of IRs, and in the design of ORs with IRs.