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Biomedical subjects

H Vaghadia

Publications and source records attributed to H Vaghadia.

At least 19 recordsLinked to original sources
PubMed1998

Readmission for bleeding after outpatient surgery.

PURPOSE: To examine the frequency of readmission due to surgical bleeding after ambulatory surgery. METHODS: A retrospective review of hospital records for patients readmitted to the same hospital after surgery in our Daycare centre was conducted for January 1984 to December 1992. The charts of all patients readmitted to hospital within 48 hr of surgery were examined. Readmissions for bleeding were studied with respect to demographics, time when bleeding occurred after arrival in PACU(latent interval) and treatment. Matched controls were identified and a case-control analysis performed to identify factors associated with an increased risk of readmission from bleeding. RESULTS: There were 172,710 outpatient procedures and 64 readmission for bleeding (0.04%). Gynaecological and urological surgery accounted for the highest number of bleeders (86%). Most patients who bled excessively in the OR continued to bleed in PACU. Those who bled in the PACU alone had a latent interval of 54 +/- 77 min. Those who bled both in the OR and PACU had a latent interval of 20 +/- 7 min. Those who bled mainly at home had a latent interval of 104 +/- 68 min. A majority of bleeders could have been identified if they had been observed for 30-45 min. Logistic regression of case-control matches did not identify any risk factor likely to increase the risk of readmission in bleeders. CONCLUSIONS: Bleeding after outpatient surgery is uncommon and discharge criteria need to be re-examined in order to take this into account and permit appropriate fast tracking of outpatients.

Adolescent↗
PubMed1998

Electrocardiographic monitoring in healthy young adult outpatients: mandatory or optional?

PURPOSE: To determine the incidence and duration of ECG abnormalities in healthy adults during short duration outpatient surgery and their relationship to important clinical events. METHOD: In 381, ASA Class I, day surgery patients undergoing short surgical procedures the ECG was monitored prospectively for evidence of abnormalities. The attending anaesthetist administered the anaesthetic and made all clinical decisions while relying on routine monitors (ECG, oximeter, BP, capnometer, oxygen analyser, low pressure alarm and anaesthetic gas monitors). Intra-operative events of clinical significance (e.g., light anaesthesia, regurgitation, coughing, hypotension, arterial desaturation, hiccoughs etc), ECG abnormalities and their duration were documented. RESULTS: Electrocardiographic abnormalities were detected in 21% of patients as follows: sinus tachycardia (11%), artifacts (7%), premature atrial contractions (1.6%), lead disconnects (1%), sinus bradycardia (0.5%) and premature ventricular contractions (0.3%). All abnormalities resolved spontaneously within three minutes. Intra-operative incidents of consequence occurred in only 2.6%: light anaesthesia (5), arterial desaturation > 5% (2), hypotension (1), hiccough (1) and regurgitation (1). All incidents were detected clinically and by pulse oximetry. The ECG did not detect any of the incidents and was normal during the events. CONCLUSION: Routine ECG monitoring did not detect intra-operative incidents in healthy adults during short outpatient procedures. Detected ECG abnormalities were benign and resolved spontaneously within three minutes. Firm conclusions as to the safety implications of withdrawing ECG monitoring cannot be drawn from this study. Guidelines may need to be reviewed to determine whether ECG monitoring in such cases should be optional rather than mandatory.

Adolescent↗
PubMed1997

EMLA patch for intravenous cannulation in adult surgical outpatients.

PURPOSE: The purpose of this study was to evaluate the effectiveness of a single-unit-dose package of the EMLA Patch for dermal analgesia during intravenous cannulation in adult, outpatients and in preventing vaso-vagal side effects. METHODS: After giving consent, 51 ASA I-III adult outpatients participated in a randomized, double-blind, placebo-controlled, parallel-group trial to receive either an EMLA or placebo patch applied to the intravenous cannula site for 60 to 90 min. Following cannula insertion, patients and investigators rated the pain using a 100 mm VAS ruler. The incidence and severity of vaso-vagal responses, local skin reactions, and willingness to pay for the patch were also evaluated. RESULTS: The median VAS pain score by patient assessment in the EMLA patch group was lower (8 mm; range: 0-92) than in the placebo group (25 mm; range: 0-98, P < 0.05). The median VAS pain score by investigator assessment was also lower in the EMLA patch group (15 mm; range 1-79) than in the placebo group (23 mm; range 3-81, P < 0.05). There was a notable difference in the number of vaso-vagal reactions (17 placebo vs 4 EMLA, P < 0.05). Eighty-eight percent of patients who received the EMLA patch would be willing to pay for the patch in the future compared with 69% of the placebo patch patients. CONCLUSION: This study showed that the EMLA patch, applied for 60-90 min before venous cannulation reduced the pain of venepuncture and vaso-vagal side effects in adult outpatients.

Adult↗
PubMed1997

Pharmacoeconomics of intravenous regional anaesthesia vs general anaesthesia for outpatient hand surgery.

PURPOSE: To compare the cost and effectiveness of intravenous regional anaesthesia (IVRA) with general anaesthesia (GA) for outpatient hand surgery. METHOD: A retrospective record analysis of 121 patients who received IVRA were compared with 64 patients who received GA in our Daycare centre. The costs of anaesthesia and recovery were calculated from an institutional perspective using 1995 Canadian Dollar values. Effectiveness was measured in terms of time for anaesthesia, recovery and discharge, % with unsatisfactory anaesthesia and complications. RESULTS: Both groups were well matched in terms of weight, sex and ASA class. Patients in the IVRA group were older (45 +/- 16 vs 38 +/- 13 yr) and had a lower frequency of two types of operation. The median total cost for the IVRA group of $24.60 (15.76-55.29) was less than that for the GA group of +f448.66 (35.59-73.11), (P < 0.00001). Anaesthesia was unsatisfactory in 11% of the IVRA group, but in none having GA,(P < 0.01). Recovery was faster in the IVRA group with a median time to discharge of 70 (35-180) min compared with 118 (45-320) min in the GA group, (P < 0.00001). Vomiting requiring treatment occurred in 5% of the GA group, but in none having IVRA, (P < 0.05). Dizziness which delayed discharged also occurred in 5% of the GA group, but in none having IVRA, (P < 0.05). CONCLUSION: The cost of anaesthesia and recovery using IVRA for outpatient hand surgery was half that of GA. intravenous regional anaesthesia was less effective than GA in achieving satisfactory anaesthesia, equally effective in time to administer anaesthesia, and more effective in speeding recovery and minimising postoperative complications.

Adult↗
PubMed1997

Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine.

A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mL by the addition of 1.5 mL 10% dextrose. All patients received 500 mL of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.

Adult↗
PubMed1997

Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. II. Optimal fentanyl dose.

We performed a double-blind, controlled trial to determine the optimal dose of intrathecal fentanyl in small-dose hypobaric lidocaine spinal anesthesia for outpatient laparoscopy. Sixty-four gynecological patients were randomized into three groups, receiving 0, 10, or 25 micrograms fentanyl added to 20 mg lidocaine and sterile water (total 3 mL). Administration was with 27-gauge Whitacre needles and patients sat upright until the block was > T-8. One patient in the 0-microgram fentanyl group required general anesthesia 40 min after the start of surgery, leaving 21 patients per group. Three patients in each of the 0-microgram and 10-microgram fentanyl groups had mild discomfort with trocar insertion, or return of some sensation and felt discomfort or sutures toward the end of surgery. Shoulder-tip pain was less frequent in the 25-microgram than 0-microgram fentanyl group, 28% vs 67% (P < 0.0166). Intraoperative supplementation with alfentanil (+/- propofol) was needed less often in the 25-microgram than 0-microgram fentanyl group, 43% vs 76% (P = 0.028). Recovery of sensation took longer in the 25-microgram than in the 0-microgram and 10-microgram fentanyl groups, 101 +/- 21 vs 84 +/- 20 and 87 +/- 18 min (P < 0.05), although motor recovery and discharge times were the same. Postoperative analgesia was needed earlier in the 0-microgram than in the 25-microgram fentanyl group, median 54 (13-120) vs 87 (65-132) min (P < 0.05). Pruritus was the only side effect that occurred more often in the 10-microgram and 25-microgram groups than in the 0-microgram fentanyl group, 62% and 67% vs 14% (P < 0.0166). One patient required an epidural blood patch for postdural puncture headache. Based on these results, we concluded that 25 micrograms intrathecal fentanyl is required when 20 mg lidocaine is used for hypobaric spinal anesthesia (SA) to ensure reliable, durable anesthesia, reduce shoulder-tip pain, and minimize the need for intraoperative supplementation. This dose provides longer postoperative analgesia and does not increase side effects apart from pruritus. SA with small-dose hypobaric lidocaine-fentanyl was found to be a satisfactory technique for outpatient laparoscopy, although postdural puncture headache can occur in some patients.

Adult↗
PubMed1996

Refractory dystonia during propofol anaesthesia in a patient with torticollis-dystonia disorder.

PURPOSE: To report a case of refractory dystonia under propofol anaesthesia in a patient with Torticollis-Dystonia disorder. CLINICAL FEATURES: A 38-yr-old man presented for an MRI scan for investigation of a Torticollis-Dystonia disorder. There was a biphasic response to propofol with complete amelioration of the torticollis and limb dystonia initially with subsequent recurrence under deep propofol anaesthesia. Coadministration of midazolam, diazepam, and thiopentone were not successful in abolishing the recurrent dystonia. CONCLUSIONS: Propofol should preferably be avoided in patients with torticollis and dystonias. Where complete control of movements is required, it may be necessary to consider general endotracheal anaesthesia with muscle relaxants.

Adult↗
PubMed1996

Ankylosing spondylitis and neuraxial anaesthesia--a 10 year review.

PURPOSE: Ankylosing Spondylitis (AS) patients present specific challenges to the anaesthetist. Both airway management and neuraxial access may prove to be difficult. The trend has been to deal with the airway challenge, and avoid neuraxial anaesthesia. In many cases this may lead to unnecessarily denying the patient neuraxial anesthesia (NA). We retrospectively reviewed the operative anaesthetic management of 51 consecutive AS patients who underwent 82 perineal or lower limb procedures and concurrent anaesthetic management at the Vancouver Hospital and Health Sciences Center from 1984 through 1994 (inclusive). SOURCE: Anaesthetic records were used to document the type of anaesthetic used, i.e., general or regional, and the degree of difficulty experienced with each. PRINCIPAL FINDINGS: Of the 82 procedures performed on AS patients 16 (19.5%) were planned as NA. General anaesthesia (GA) was planned for 65 (79.3%) of the procedures. One procedure involved monitored anaesthetic care (MAC). Neuraxial access consisted of 13 spinal and three epidural attempts. Spinal anaesthesia was possible in 10 (76.2%) of cases and failed in 3 (23.8%). Epidural anaesthesia was unsuccessful in each attempt. There was no difference in demographics or duration of disease between the successes and failures. CONCLUSIONS: These data suggest that spinal anaesthesia can be used as an alternative to general anaesthesia in AS patients undergoing perineal or lower limb surgery. There were no factors identified in this review that were predictive of success or failure in gaining neuraxial access.

Adolescent↗
PubMed1995

Lateral popliteal sciatic nerve block compared with ankle block for analgesia following foot surgery.

The purpose of this study was to compare postoperative analgesia after foot surgery in patients anaesthetised either with popliteal sciatic nerve block or ankle block. In a prospective study, 40 patients scheduled for foot surgery involving osteotomies were allocated randomly into one of two groups. Following induction of general anaesthesia, Group PS (n = 21) received a lateral popliteal sciatic nerve block and Group AB (n = 19) received an ankle block. Both groups received 20 ml bupivacaine 0.5% plain. In group PS 43% required morphine analgesia in the Post Anaesthetic Recovery Room (PAR) compared with 16% in group AB. Postoperative analgesia was assessed using VAS and a pain scale in the PAR and a questionnaire by telephone follow-up on the day after surgery. The ankle block appeared to be more reliable, providing more consistent analgesia in the PAR. Postoperative analgesia in Group PS lasted a median of 18.0 hr and in Group AB lasted 11.5 hr (P < 0.05). Both techniques provided effective analgesia after discharge home and high levels of patient satisfaction.

Adolescent↗
PubMed1995

Thiopentone pretreatment for propofol injection pain in ambulatory patients.

This study investigated propofol injection pain in patients undergoing ambulatory anaesthesia. In a randomized, double-blind trial, 90 women were allocated to receive one of three treatments prior to induction of anaesthesia with propofol. Patients in Group C received 2 ml normal saline, Group L, 2 ml, lidocaine 2% (40 mg) and Group T, 2 ml thiopentone 2.5% (50 mg). Venous discomfort was assessed with a visual analogue scale (VAS) 5-15 sec after commencing propofol administration using an infusion pump (rate 1000 micrograms.kg-1.min-1). Loss of consciousness occurred in 60-90 sec. Visual analogue scores (mean +/- SD) during induction were lower in Groups L (3.3 +/- 2.5) and T (4.1 +/- 2.7) than in Group C (5.6 +/- 2.3); P = 0.0031. The incidence of venous discomfort was lower in Group L (76.6%; P < 0.05) than in Group C (100%) but not different from Group T (90%). The VAS scores for recall of pain in the recovery room were correlated with the VAS scores during induction (r = 0.7045; P < 0.0001). Recovery room discharge times were similar: C (75.9 +/- 19.4 min); L 73.6 +/- 21.6 min); T (77.1 +/- 18.9 min). Assessing their overall satisfaction, 89.7% would choose propofol anaesthesia again. We conclude that lidocaine reduces the incidence and severity of propofol injection pain in ambulatory patients whereas thiopentone only reduces its severity.

Adolescent↗
PubMed1992

Continuous lumbosacral block using a Tuohy needle and catheter technique.

Three cases are reported where continuous lumbosacral block was performed using a catheter through an epidural needle technique. Good unilateral lower limb surgical anaesthesia was achieved in all three cases with successful blockade of the lumbar and sacral plexuses. A 17-gauge Tuohy needle was positioned between the transverse processes of L4 and L5 and an epidural catheter inserted into the space between the quadratus lumborum and psoas muscles. Forty to seventy millilitres of local anaesthetic were injected and resulted in good surgical anaesthesia within 12-20 min. Radiographic studies in these patients confirmed placement of the catheter in close proximity to the lumbosacral plexus. Experience in a further 12 cases is also reported. There were no side-effects. The technique is successful and is recommended when unilateral lower limb anaesthetic is required and when spinal and epidural anaesthesia are contraindicated.

Aged↗