Aldrete Score Calculator

How does this Aldrete score calculator work?

This is a health tool designed to assess whether a patient can be discharged from the PACU which is the Post Anaesthesia Care Unit. It involves scoring criteria that evaluates the patients conditions and provides a score based on the answers. This score is then used to determine if the effect of the anesthetic iv or otherwise administrated has worn off.

The 5 variables taken into account by this Aldrete score calculator are discussed below. Each of them has three answer choices and each of the answers choices has their own number of points that will in turn contribute to the overall scoring:

■ State of consciousness – whether the patient is fully awake, arousable at different stimuli, mostly sound or not responding at all.

■ Mobility – checks whether the patient can move and how many extremities they can move on command.

■ Breathing – this part tests whether the patient can breath deeply, if dyspnea is in any way installed or if apnea is present.

■ Circulation – checks the systemic blood pressure against the preanesthetic level and assumes three different cases.

■ Color – assesses the patient’s skin aspect, whether the skin is normal, pale, jaundiced, blotchy or if cyanosis is present.

As a post anaesthetic discharge scoring criteria, Aldrete score results vary from 0 to 10 and the guidelines say that when a patient reaches a score of 9 or 10, they can be safely discharged from the PACU department if they have an escort to help them.

Beside the factors discussed above, there are many other variables taken into account when establishing a patient’s stay in the post anesthetic unit such as the drugs used, half life, nursing assessments and general status. Aldrete was one of the first to propose a system that would assess patient readiness for discharge and nowadays this is one of the most common systems used. There was created even a modified version that takes account of O₂ saturation.

However, there are still voices that say there should be more criteria that assesses general readiness and particular cases and that the model should be adapted to the modern version of medicine that often involves one day surgeries that should be treated differently in post op than classical surgeries.

Post anesthesia care

In the current clinical environment it is essential for all clinicians to understand the most common post anesthesia situations, the complications that might appear and the treatments that are available in these cases. It is also need for scoring systems to be understood and used efficiently in order to progress in the unit. Concepts like PACU are relatively recent and have been more recognized in the past decades as well as their need for specialized nursing. It is also important to make the distinction between these and ICUs.

The evaluation of one patient from another might vary widely and changes in anesthetics and the continuous evolution in this area should be monitored.

One of the primary PACU assessments include checking the airways and breathing, respiratory rate and rhythm and also the mental status. Surgical site should be checked and see whether there is need for dressing or drains. Vital signs are accounted for through non invasive or invasive procedures and intravenous fluids are to be checked and maintained at proper levels.

Recovery phases

Phase I is the immediate post op phase, it occurs at the intensive care level and the patient is hemodynamically unstable yet, somnolent and might require supplemental oxygen or pain intervention. During this phase the surgical site is still unstable.

Phase II occurs afterwards at a different amount of time, depending on situation and is the phase in which the clinician needs to ensure the patient can be discharged. The amount of pain and general discomfort is starting to diminish and requires less assistance and the patient is hemodynamically stable, awake and easily arousable while the surgical site is in good condition.

References

1) Aldrete JA. (1995) The post-anesthesia recovery score revisited. J Clin Anesth; 7(1):89-91.

2) Marshall SI, Chung F. (1999) Discharge criteria and complications after ambulatory surgery.  Anesth Analg. 88(3):508-17.

3) Trevisani L, Cifalà V,Gilli G, Matarese V, Zelante A, Sartori S. (2013) Post-Anaesthetic Discharge Scoring System to assess patient recovery and discharge after colonoscopy. World J Gastrointest Endosc. 2013 Oct 16; 5(10): 502–507.