Background and Objectives : The obese patients undergoing general anesthesia are risk for complications such as hypoxemia or airway obstruction during intra- and post-anesthesia. This study aimed to develop the clinical nursing practice guideline (CNPG) for obese patients undergoing general anesthesia and to evaluate the outcomes of the implemented CNPG .
Methods: This Development Research has developed a CNPG based on the principles and guidelines from the National Health and Medical Research Council of Australia. The contents of the CNPG were validated and approved by five experts. The clinical outcomes and satisfaction were evaluated from the nurse anesthetists who implemented the CNPG in 35 patients. The tools for data collection include the operative care records collected at preoperative evaluation, intraoperative, and postoperative anesthesia care, and the satisfaction questionnaire from the nurse anesthetists as a CNPG user. Data were then analyzed by the descriptive statistics.
Results: The CNPG developed for the obese patients who were undergoing general anesthesia for surgery consisted of three stages: preoperative evaluation, intraoperative, and postoperative anesthesia care. The evaluation of the CNPG implementation from the nurse anesthetists showed the satisfaction level at 8.29 (from 0 to 10 scale). According to the clinical outcomes, only one patient developed, hypoxemia, in the postoperative anesthesia care unit, which was solved by giving oxygen. Oxygen was then given continuously to the patient at the ward. No incidence of airway obstruction was found in every patient during intraoperativeand postoperative anesthesia care, during transfer tothe recovery room, or in the recovery room. Most of obese patients had obstructive sleep apnea (OSA) and used CPAP before having the surgery. At the ward after surgery, 25.7% of the patients was found with OSA at night and used CPAP.
Conclusion: The CPNG was clear and easy for implementation. The guideline covered all three stages of the anesthesia including preoperative evaluation, intraoperative, and postoperative anesthesia care. This provided the same standard for every patient and improved the quality in nursing. Nurse anesthetists's suggest for improving the CNPG by adding a part of CPAP in the preoperative information.