Sedation and analgesia are routinely used to improve patient tolerance for GI endoscopy.
|When Aldrete discharge criteria were met, the average psychomotor recovery was only 60% to 70% compared to baseline.|
However, current assessment of postprocedure recovery uses cardiovascular and respiratory parameters, but not psychomotor function.
This study, published in the December issue of Gastrointestinal Endoscopy, had 2 aims:
- To determine the degree of psychomotor recovery after conscious sedation for endoscopy when patients meet established discharge criteria.
- To identify a sensitive method of testing psychomotor recovery, and thereby provide meaningful predictions regarding the ability of patients to return to daily activities.
The research team recruited outpatients undergoing elective EGD. A total of 31 patients were enrolled in the study (12 men, 19 women, mean age 43 years).
They then used 4 psychometric tests to establish baseline psychomotor function before sedation and analgesia: Critical Tracking, Manual Dexterity, Multiple-Choice Reaction Time, and Letter Cancellation.
The researchers intravenously administered meperidine and midazolam, per standard nomogram.
The tests were repeated immediately after the procedure, and then at 15-minute intervals until patients were deemed ready for discharge by recovery room personnel.
Discharge criteria included an Aldrete discharge score of 10, and the ability to ambulate unhindered and carry on a simple conversation.
The recovery personnel were blinded to psychometric test results.
The team then compared psychomotor scores at discharge with the baseline scores to determine percent recovery.
The researchers found that when Aldrete discharge criteria were met, the average psychomotor recovery was only 60% to 70% compared with baseline.
Furthermore, at the time of discharge, the average psychomotor recovery was 87% of baseline.
The team discovered that the Letter Cancellation and Multiple-Choice Reaction Time had the highest sensitivity in detecting depression of psychomotor function versus baseline.
Dr Juliana Willey's team concluded, "Psychomotor function remains significantly impaired when patients reach an Aldrete discharge score of 10".
"The Letter Cancellation test was most sensitive in detecting psychomotor impairment and recovery."
"Incorporating psychometric tests with current discharge criteria may identify patients who are better able to resume normal daily activities without supervision."