A comparative study of the post anesthesia care Practice between Kenyatta national hospital and Kenyan provincial hospitals

Abstract

Introduction: The Post Anesthesia Care Unit is a specialized area where the patients coming out of anesthesia undergo intensive monitoring before being discharged to the ward. Authors have found an overall complication rate of 18- 30%, with varied levels of monitoring and staffing. However the nature of our local practice and prevalence of immediate post operative complications has not been established. The objective of this study was to evaluate the post anesthesia care practice at KNH and compare it with the provinces. Patients and Methods: The study was conducted in KNH and the seven provincial PACUs. It was a cross sectional descriptive study where staff were interviewed together with physical enumeration of equipment and emergency drugs. In KNH, 280 consecutive, adults patients post general anesthesia were observed in the PACU starting from 15 minutes after admission to the time of discharge. 40 patients were similarly followed up in each of the seven provinces (total 280). Complications referable to each of the different organ systems were identified and recorded in a questionnaire. Results: The study showed an overall adequate recovery bed space throughout the country. The theatre table: recovery bed ratio was 1.5:1 in KNH and a mean of 1.15:1 in the provinces. There was an overall poor staff: patient ratio in the country i.e. 1:2.7 in KNH compared to a mean of 1:1.96 in the provinces during peak PACU activity. In KNH 100% of the patients were on continuous ECG, SP02 and automated NIBP monitoring with adequate oxygen supplementation. 100%, 57.1% and 57.1% of the provinces had manual NIBP; SP02 and ECG monitoring, and adequate oxygen therapy respectively. The resuscitation cart was 100% complete in KNH and only 73.5% complete on average in the provinces. The overall frequency of PACU complications was 69.4% in KNH compared to 77.5% in the provinces. Post operative pain was commonest complication occurring in 58.6% of the patients in KNH compared to 55.2% in the provinces. Hypoxemia was the least observed complication in the country; KNH (1.1%) and 0% in 57.1% of the provinces. The other provinces did not monitor SP02. Conclusions: There was adequate PACU bed space, inadequate staffing throughout the country. Monitoring and emergency drug availability was poor in the provinces. The overall complication rate was much higher than observed in literature, and higher in the provinces compared to KNH. Pain was the commonest in both settings.