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Lack of recall after sedation for cataract surgery and its effect on validity of measuring patient satisfaction.

Abstract

Background

We evaluated the validity of assessing patient satisfaction with the sedation regimen among patients being discharged 45 minutes after receiving midazolam. If most patients do not have recall, then the sedation cannot be considered complete at the time of evaluation.

Methods

In this prospective cohort study, 20 patients underwent cataract surgery with nurse-administered midazolam and fentanyl. The 11-item Iowa Satisfaction with Anesthesia Scale was administered ≅30 minutes after sedation in the recovery room. Recalled items were evaluated next morning.

Results

11 patients recalled 0 themes, 4 recalled 1, 4 recalled 2, and 1 recalled 3 themes. Thus, 15/20 patients (75%) recalled 0 or 1 of the 11 themes (P = 0.021 versus half the patients). The 95% one-sided lower confidence limit for 0, 1, or 2 themes was 80% of patients (P < 0.0001 versus half). Patients who received less midazolam recalled more themes (Kendall's Ʈb = 0.43, P = 0.039).

Conclusions

Evaluating patient satisfaction with sedation shortly after admission to post-anesthesia care unit is invalid because of a lack of recall; the sedation/amnesia is ongoing. Patient comfort may be assessed, but comfort is not synonymous with satisfaction; "satisfaction" implies presence of recall. Because we studied sedation with low doses of midazolam and fentanyl, the same conclusion reliably would apply to larger doses of anxiolytics administered intraoperatively. The results match previous findings that when patients receive preoperative midazolam prior to meeting the anesthesiologist, even if the patient fully answers questions, they may have negligible recall of having met the anesthesiologist.

Authors+Show Affiliations

Mayo Clinic, Department of Anesthesiology and Perioperative Medicine, Jacksonville, Florida.University of Iowa, Department of Anesthesia, Iowa City, Iowa.Mayo Clinic, Department of Anesthesiology and Perioperative Medicine, Jacksonville, Florida.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31612692

Citation

Chadha, Ryan M., et al. "Lack of Recall After Sedation for Cataract Surgery and Its Effect On Validity of Measuring Patient Satisfaction." Korean Journal of Anesthesiology, 2019.
Chadha RM, Dexter F, Brull SJ. Lack of recall after sedation for cataract surgery and its effect on validity of measuring patient satisfaction. Korean J Anesthesiol. 2019.
Chadha, R. M., Dexter, F., & Brull, S. J. (2019). Lack of recall after sedation for cataract surgery and its effect on validity of measuring patient satisfaction. Korean Journal of Anesthesiology, doi:10.4097/kja.19314.
Chadha RM, Dexter F, Brull SJ. Lack of Recall After Sedation for Cataract Surgery and Its Effect On Validity of Measuring Patient Satisfaction. Korean J Anesthesiol. 2019 Oct 15; PubMed PMID: 31612692.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lack of recall after sedation for cataract surgery and its effect on validity of measuring patient satisfaction. AU - Chadha,Ryan M, AU - Dexter,Franklin, AU - Brull,Sorin J, Y1 - 2019/10/15/ PY - 2019/07/18/received PY - 2019/10/14/accepted PY - 2019/10/16/entrez KW - Iowa Satisfaction with Anesthesia Scale KW - cataract surgery KW - midazolam KW - patient satisfaction JF - Korean journal of anesthesiology JO - Korean J Anesthesiol N2 - Background: We evaluated the validity of assessing patient satisfaction with the sedation regimen among patients being discharged 45 minutes after receiving midazolam. If most patients do not have recall, then the sedation cannot be considered complete at the time of evaluation. Methods: In this prospective cohort study, 20 patients underwent cataract surgery with nurse-administered midazolam and fentanyl. The 11-item Iowa Satisfaction with Anesthesia Scale was administered ≅30 minutes after sedation in the recovery room. Recalled items were evaluated next morning. Results: 11 patients recalled 0 themes, 4 recalled 1, 4 recalled 2, and 1 recalled 3 themes. Thus, 15/20 patients (75%) recalled 0 or 1 of the 11 themes (P = 0.021 versus half the patients). The 95% one-sided lower confidence limit for 0, 1, or 2 themes was 80% of patients (P < 0.0001 versus half). Patients who received less midazolam recalled more themes (Kendall's Ʈb = 0.43, P = 0.039). Conclusions: Evaluating patient satisfaction with sedation shortly after admission to post-anesthesia care unit is invalid because of a lack of recall; the sedation/amnesia is ongoing. Patient comfort may be assessed, but comfort is not synonymous with satisfaction; "satisfaction" implies presence of recall. Because we studied sedation with low doses of midazolam and fentanyl, the same conclusion reliably would apply to larger doses of anxiolytics administered intraoperatively. The results match previous findings that when patients receive preoperative midazolam prior to meeting the anesthesiologist, even if the patient fully answers questions, they may have negligible recall of having met the anesthesiologist. SN - 2005-7563 UR - https://www.unboundmedicine.com/medline/citation/31612692/Lack_of_recall_after_sedation_for_cataract_surgery_and_its_effect_on_validity_of_measuring_patient_satisfaction L2 - https://ekja.org/journal/view.php?doi=10.4097/kja.19314 DB - PRIME DP - Unbound Medicine ER -