New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete's scoring system.

T he modified Aldrete’s scoring system (1) is commonly used for determining when patients can be safely discharged from the postanesthesia care unit (PACU) to either the postsurgical ward or to the second stage (Phase II) recovery area. Recently, these discharge criteria have also been used in the operating room (OR) to determine the fast-track eligibility of outpatients undergoing ambulatory surgery (2,3). Because fast-tracking in the ambulatory setting implies taking a patient from the OR directly to the less extensively monitored Phase II step-down unit, this scoring system may not be adequate after ambulatory procedures requiring general anesthesia because it fails to consider common side effects that have traditionally been treated in the PACU (e.g., pain, nausea, and vomiting). Therefore, a new fasttrack scoring system that incorporates the essential elements of the modified Aldrete system, as well as an assessment of pain and emesis, has been proposed (4). We hypothesized that using this new scoring system to determine a patient’s fast-track eligibility would reduce the need for nursing interventions to administer parenteral medications in the Phase II recovery area. The times to fast-track eligibility were compared using the modified Aldrete and new fasttrack criteria in outpatients undergoing laparoscopic surgery with one of three standardized general anesthetic techniques. Methods