This modified Aldrete score calculator evaluates availability for discharge after anesthesia from the PACU by patient abilities and results. Discover the original and the modified version differences below the form.
How does the modified Aldrete score calculator work?
This is a health tool that evaluates the availability for discharge of a patient in the Post Anaesthesia Care Unit PACU. It is based on the modified Aldrete score and consists of 6 factors taken into account by the clinician that checks whether the patient can be released or not. There are 6 questions, each with 3 choices that are given different scores.
Once all the questions are completed, this modified Aldrete score calculator computes the overall score which is then used to assess the patient’s situation.
This model includes one more question than the original version and focuses on the following variables:
■ Consciousness – whether the patient is fully awake, arousable at different stimuli, mostly sound or not responding at all.
■ Mobility – assess if the patient is able to move all extremities on command and whether there are any impairments.
■ Breathing – evaluation of deep breath and any case of dyspnea or apnea.
■ Circulation – the difference between the preanesthetic level and the current level.
■ Color – refers to the skin aspect and the presence of any jaundice or cyanosis.
■ O2 saturation – evaluates whether the patient is able to maintain an above 90% saturation on room air, with or without supplementation of oxygen.
In regard to score interpretation, the score values range from 0 to 12, 0 being the condition in which the patient is closest to the anesthesia state, 9 being the guideline to begin discharge from and the closer the score gets to 12, the closest to all anesthetic, IV or different to have worn off from the system.
However, guidelines also say that the patients can be discharged if there is availability for someone to escort him and still continue the care, to different degrees, by considering their general state.
Post anesthesia discharge factors
There are several models that use the discharge factors to evaluate the readiness of the patient to either be discharged entirely from hospital or to be moved to a different unit. Amongst the factors involved there are different evaluations to be made, evaluation that consider the conscious state of the patient, their different motor and cognitive abilities.
The basic factors to follow are also the kind of surgery that has been performed, the anesthetic that has been used (in terms of half life, power, overall effect, contraindications, complications) and also the nursing assessment.
The first assessment done is that of the airways and checking whether breathing is in any way impaired. Then the mental status is evaluated. Surgical site is third in importance and is essential for it to be in good order, regardless of how invasive the procedure was. Any drains or dressings should be addressed immediately as well as intravenous fluids.
The Aldrete models are well renowned for their use in the PACU setting. The only criticism received by them is related to the fact that they only take general factors in consideration and that there is no room for adaptation like the type of surgery e.g. day or more invasive ones which many clinicians suggest should be treated differently. It is considered that evaluation differs widely from one patient to another and should also mind changes in technology, anesthetics and medical care.
Post anesthesia care instructions
Although concepts like the PACU have been introduced relatively recently, there was always need for instructions and a detailed and organized manner in which the discharge and then the after anesthesia care to be done.
Amongst the things that are always recommended to patients when they are discharged are in regard to keeping hydrated and drinking a lot of liquids, rest for the first 24h at least, care with smoking and with decisions or activities that involve hard machines. Then there are the particular cases, in which the surgical site possible problems and complications are addressed and the patient learns how to care for themselves.
Recovery phases after surgery
The following table presents the main characteristics of the two phases post op in terms of hemodynamic stability, oxygen requirements, pain intervention and other differences. The first phase focuses on gaining stability in functional organs and in most body constants while the second phase focuses more on integrating the patient and in assuring that he/she and their support know how to address the after surgery care.
| Characteristic | Phase 1 | Phase 2 |
| Hemodynamically | unstable | stable |
| Supplemental oxygen | yes | no |
| Pain intervention | yes | little |
| Surgical site | unstable | stable |
| Arousal | somnolent | awakened |
| Focused on | patient | after care |
| Discomfort | maximal | diminishing |
References
1) Aldrete JA. (1995) The post-anesthesia recovery score revisited. J Clin Anesth; 7(1):89-91.
2) 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; 5(10): 502–507.
3) Marshall SI, Chung F. (1999) Discharge Criteria and Complications After Ambulatory Surgery. Anesthesia & Analgesia; (88) 3 508-517
15 Aug, 2015