estar planificada para no interferir con el programa quirúrgico
y la recuperación postoperatoria. La terapia electroconvulsiva
es, de alguna manera única, ya que requiere anestesia general
realizada por un anestesiólogo. Normalmente, estos procedi-
mientos cortos pueden realizarse antes que los casos quirúrgi-
cos rutinarios. Un programa de terapia electroconvulsiva exi
toso planifica el procedimiento a las 5.30 AM, con una propor
ción enfermera-paciente de 2:1 y una estancia estimada en la
URPA de 2 horas
168 .Resumen
La URPA es más que una unidad de observación postanestésica. Es
única en su capacidad de proporcionar cuidados a pacientes de
todas las edades y en todas las fases de la enfermedad. Desde sus
inicios hace más de 50 años, la URPA ha demostrado ser una
unidad que se adapta a todo y que está equipada para suplir las
necesidades de un sistema de cuidados de salud en desarrollo.
Bibliografía
1. Standards of the American Society of Anesthesio-
logists; Standards for Postanesthesia Care, Appro-
ved by the House of Delegates on Oct. 12, 1988 and
last amended on Oct. 27, 2004. Copyright © 1999.
American Society of Anesthesiologists.
2. Practice guidelines for postanesthetic care: A report
by the American Society of Anesthesiologists Task
Force on Postanesthetic Care. Anesthesiology
96:742-752, 2002.
3. Hines R, Barash PG, Watrous G, O’Connor T: Com-
plications occurring in the postanesthesia care unit:
A survey. Anesth Analg 74:503-509, 1992.
4. Zeitlin G: Recovery room mishaps in the ASA
closed claims study. ASA Newsletter 53(7),
1989.
5. Kluger MT, Bullock MF: Recovery room incidents:
A review of 419 reports from the Anaesthetic Inci-
dent Monitoring Study (AIMS). Anaesthesia
57:1060-1066, 2002.
6. Siddiqui N, Teresi J, Arzola C, Fox G: Hypoxemia on
arrival to PACU: An observational audit. Can J
Anesth 53(Suppl 1), 2006.
7. Mathes DD, Conaway MR, Ross WT: Ambulatory
surgery: Room air versus nasal cannula oxygen
during transport after general anesthesia. Anesth
Analg 93:917-921, 2001.
8. Benumof JL: Obstructive sleep apnea in the adult
obese patient: Implications for airway management.
J Clin Anesth 13:144-156, 2001.
9. Kopman AF, Yee PS, Neuman GG: Relationship of
the train-of-four fade ratio to clinical signs and
symptoms of residual paralysis in awake volunteers.
Anesthesiology 86:765-771, 1997.
10. Eriksson LI, Sundman E, Olsson R, et al: Functional
assessment of the pharynx at rest and during swa-
llowing in partially paralyzed humans: Simulta-
neous videomanometry and mechanomyography
of awake human volunteers. Anesthesiology
87:1035-1043, 1997.
11. Bevan DR: Neuromuscular blockade: Inadvertent
extubation of the partially paralyzed patient. Anes-
thesiol Clin North Am 19:913-922, 2001.
12. Shaha AR, Jaffe BM: Practical management of post-
thyroidectomy hematoma. J Surg Oncol 57:235-238,
1994.
13. Shen WT, Kebebew E, Duh QY, Clark OH: Predic-
tors of airway complications after thyroidectomy
for substernal goiter. Arch Surg 139:656-659, 2004;
discussion 659-660.
14. Self DD, Bryson GL, Sullivan PJ: Risk factors for
post-carotid endarterectomy hematoma formation.
Can J Anaesth 46:635-640, 1999.
15. Venna RRJ: A nine-year retrospective review of
postoperative airway related problems in patients
following multilevel anterior cervical corpectomy.
Anesthesiology 95:A1171, 2001.
16. Fisher MM, Raper RF: The “cuff-leak” test for extu-
bation. Anaesthesia 47:10-12, 1992.
17. Adderley RJ, Mullins GC: When to extubate the
croup patient: The “leak” test. Can J Anaesth 34:
304-306, 1987.
18. De Bast Y, De Backer D, Moraine JJ, et al: The cuff
leak test to predict failure of tracheal extubation for
laryngeal edema. Intensive Care Med 28:1267-1272,
2002.
19. Vidhani K, Langham BT: Obstructive sleep apnoea
syndrome: Is this an overlooked cause of desatura-
tion in the immediate postoperative period? Br J
Anaesth 78:442-443, 1997.
20. American Sleep Apnea Association: Sleep apnea
and BMI: The majority of OSA patients are not
obese. 2007. Available at
www.sleepapnea.org.
21. Hillman DR, Platt PR, Eastwood PR: The upper
airway during anaesthesia. Br J Anaesth 91:31-39,
2003.
22. Brodsky JB, Lemmens HJ, Brock-Utne JG, et al:
Morbid obesity and tracheal intubation. Anesth
Analg 94:732-736, 2002.
23. Siyam MA, Benhamou D: Difficult endotracheal
intubation in patients with sleep apnea syndrome.
Anesth Analg 95:1098-1102, 2002.
24. Loadsman JA, Hillman DR: Anaesthesia and sleep
apnoea. Br J Anaesth 86:254-266, 2001.
25. Cullen DJ: Obstructive sleep apnea and postopera-
tive analgesia—a potentially dangerous combina-
tion. J Clin Anesth 13:83-85, 2001.
26. Dhonneur G, Combes X, Leroux B, Duvaldestin P:
Postoperative obstructive apnea. Anesth Analg
89:762-767, 1999.
27. Gross JB, Bachenberg KL, Benumof JL, et al: Prac-
tice guidelines for the perioperative management of
patients with obstructive sleep apnea: A report by
the American Society of Anesthesiologists Task
Force on perioperative management of patients
with obstructive sleep apnea. Anesthesiology
104:1081-1093, 2006.
28. Lickteig C, Grigg P: Risks of OSA and anesthesia.
Sleep Rev, January-February, 2003.
29. Daley MD, Norman PH, Colmenares ME, Sandler
AN: Hypoxaemia in adults in the post-anaesthesia
care unit. Can J Anaesth 38:740-746, 1991.
30. Rock P, Rich PB: Postoperative pulmonary compli-
cations. Curr Opin Anaesthesiol 16:123-131, 2003.
31. Lumb A: Nunn’s Applied Respiratory Physiology,
6th ed. Philadelphia, Butterworth-Heinemann,
2005.
32. Herrick IA, Mahendran B, Penny FJ: Postobstruc-
tive pulmonary edema following anesthesia. J Clin
Anesth 2:116-120, 1990.
33. Silva PS, Monteiro Neto H, Andrade MM, Neves
CV: Negative-pressure pulmonary edema: A rare
complication of upper airway obstruction in chil-
dren. Pediatr Emerg Care 21:751-754, 2005.
34. Goldsmith WW, Pandharipande PP: Transfusion-
related acute lung injury—does the anesthesiologist
need to worry about this? J Clin Anesth 17:366-368,
2005.
35. Barrett NA, Kam PC: Transfusion-related acute
lung injury: A literature review. Anaesthesia 61:777-
785, 2006.
36. Silliman CC, McLaughlin NJ: Transfusion-related
acute lung injury. Blood Rev 20:139-159, 2006.
37. Curtis BR, McFarland JG: Mechanisms of transfu-
sion-related acute lung injury (TRALI): Anti-leu-
kocyte antibodies. Crit Care Med 34(5 Suppl)
S118-S123, 2006.
38. Moore SB: Transfusion-related acute lung injury
(TRALI): Clinical presentation, treatment, and
prognosis. Crit Care Med 34(5 Suppl)S114-S117,
2006.
39. Swanson K, Dwyre DM, Krochmal J, Raife TJ:
Transfusion-related acute lung injury (TRALI):
Current clinical and pathophysiologic considera-
tions. Lung 184:177-185, 2006.
40. Toy P, Popovsky MA, AbrahamE, et al: Transfusion-
related acute lung injury: Definition and review.
Crit Care Med 33:721-726, 2005.
41. DiBenedetto RJ, Gravenstein N: Against routine
postoperative oxygen administration in the PACU.
J Clin Monit 11:408-410, 1995.
42. DiBenedetto RJ, Graves SA, Gravenstein N,
Konicek C: Pulse oximetry monitoring can change
routine oxygen supplementation practices in the
postanesthesia care unit. Anesth Analg 78:365-368,
1994.
43. Johnstone RE: Studies of cost savings require cost
measurements. Anesth Analg 79:816-817, 1994.
44. Hopf H, Sessler DI: Routine postoperative oxygen
supplementation. Anesth Analg 79:615-616, 1994.
45. Russell GB, Graybeal JM: Hypoxemic episodes of
patients in a postanesthesia care unit. Chest
104:899-903, 1993.
46. Scuderi PE, Mims GR 3rd, Weeks DB, et al: Oxygen
administration during transport and recovery after
outpatient surgery does not prevent episodic arte-
rial desaturation. J Clin Anesth 8:294-300, 1996.
47. Gravenstein D: For routine postoperative oxygen
administration in the PACU. J Clin Monit 11:406-
408, 1995.
48. Greif R, Laciny S, Rapf B, et al: Supplemental oxygen
reduces the incidence of postoperative nausea and
vomiting. Anesthesiology 91:1246-1252, 1999.
49. Goll V, Akca O, Greif R, et al: Ondansetron is no
more effective than supplemental intraoperative
oxygen for prevention of postoperative nausea and
vomiting. Anesth Analg 92:112-117, 2001.
50. Donaldson AB: The effect of supplemental oxygen
on postoperative nausea and vomiting in children
undergoing dental work. Anaesth Intensive Care
33:744-748, 2005.
51. Joris JL, Poth NJ, Djamadar AM, et al: Supplemental
oxygen does not reduce postoperative nausea and
vomiting after thyroidectomy. Br J Anaesth 91:857-
861, 2003.
52. Treschan TA, Zimmer C, Nass C, et al: Inspired
oxygen fraction of 0.8 does not attenuate postope-
rative nausea and vomiting after strabismus surgery.
Anesthesiology 103:6-10, 2005.
53. Piper SN, Rohm KD, Boldt J, et al: Inspired oxygen
fraction of 0.8 compared with 0. 4 does not further
reduce postoperative nausea and vomiting in dola-
setron-treated patients undergoing laparoscopic
cholecystectomy. Br J Anaesth 97:647-653, 2006.
54. Kober A, Fleischackl R, Scheck T, et al: A randomi-
zed controlled trial of oxygen for reducing nausea
and vomiting during emergency transport of
patients older than 60 years with minor trauma.
Mayo Clin Proc 77:35-38, 2002.
55. Kabon B, Kurz A: Optimal perioperative oxygen
administration. Curr Opin Anaesthesiol Feb 19:11-
18, 2006.
56. Greif R, Akca O, Horn EP, et al: Supplemental perio-
perative oxygen to reduce the incidence of surgical-
wound infection. Outcomes Research Group.
N Engl J Med 342:161-167, 2002.
2492
Cuidados postoperatorios
VI