ASA: New research on epidural anesthesia in the OR, reducing SSIs, decreasing overinflation of breathing tubes

Editor's Note

On July 14 and 15, the American Society of Anesthesiologists (ASA) hosted a virtual event, the Anesthesia Quality and Patient Safety Meeting, which brought to light new research on when to administer epidural anesthesia in the OR, an anesthesiologist-led infection prevention program reducing rates of surgical site infections (SSIs), and preventing overinflation of breathing tubes to reduce airway complications after a surgical procedure.

According to three ASA press releases, here are the highlights on each of the above findings that were presented at the meeting: 

Epidural anesthesia

A research-led project that began in December 2022, when “very few epidural infusions were started in the OR,” showed that starting a patient-controlled epidural anesthesia infusion in the OR instead of the recovery room can speed up pain relief for patients. The project focused on streamlining the process for epidurals placed for major abdominal, chest, urologic, and gynecological procedures, or “other surgeries where postoperative pain is expected to be substantial.” Two months after launching the project, 90% of epidural infusions were started in the OR. The research team surveyed 16 anesthesiologists and 13 nurses about the new workflow and found that:

• 56% of the anesthesiologists and 79% of the nurses said patients were more comfortable when they arrived in the PACU
• 56% of anesthesiologists and 79% of nurses said patients required fewer IV or oral opioids
• 50% of anesthesiologists and 79% of nurses said they were more satisfied with the new workflow.

Surgical site infections

An anesthesiologist-led infection prevention program successfully reduced the number of SSIs in colorectal patients by 50%, the number of hospital bed days by 578 days (46%), and led to an estimated $540,000 in cost savings between 2021 and 2022, compared to 2020. Prior to the intervention, the infection ratio at UT Southwestern had increased from .74 in 2018 to 3.08 in 2020. In partnership with the facility’s ERAS program, the infection prevention initiative implemented a number of interventions to achieve the above outcomes, including but not limited to:

• Giving oral antibiotics with the patient’s mechanical bowel preparation
• Using chlorhexidine baths prior to the procedure and wipes to the abdomen immediately prior to entering the OR
• Requiring the surgical team to change their gowns and gloves when the procedure was completed and they were about to close the wound,
• Actively warming patients both prior to and during the procedure.

Overinflation of breathing tubes

“A measurement tool [manometers] should be used to reduce overinflation of a device, located on breathing tubes, that protects the patient’s airway during general anesthesia to help prevent [airway] complications such as sore throat,” another quality improvement initiative found. In summary:

• Before the quality initiative, the researchers collected data from 75 “consecutive patients” and determined cuff overinflation occurred 59% of the time, and 60% of patients had a sore throat after the procedure.
• After implementation of the initiative, the researchers collected inflation and complication data over 10 weeks from 200 patients and found 82% compliance with the initiative. They determined that overinflation occurred 27% of the time (a 54% decrease), and 32% of patients had a sore throat (a 47% decrease).