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PubMedDate not supplied

Cost analysis of propofol versus thiopental induction anesthesia in outpatient laparoscopic gynecologic surgery.

This study investigated the cost of propofol versus thiopental anesthesia in 243 patients who underwent outpatient laparoscopic gynecologic surgery. Patients records were analyzed for medication use, duration of surgery, anesthesia, recovery room stay, and associated costs. Despite the higher drug cost for propofol, the total mean cost was $273.00 less per patient for patients receiving propofol induction anesthesia. Extension of these data translates into cost savings of approximately $7900.00 if propofol had been used for all patients. Although the duration of surgery for the propofol group was shorter by nearly 12 minutes, the anesthesia duration and recovery room stay were both longer for the thiopental group, reflecting the longer duration of action of thiopental. Although the realized cost savings of drugs, surgery, anesthesia, and recovery time when propofol versus thiopental is used for outpatient laparoscopic gynecologic surgery are relatively small on an individual patient basis, cost savings may become more significant if larger patient populations are studied.

Adult↗
PubMed1993

Blood loss following tonsillectomy in children. A blind comparison of diclofenac and papaveretum.

One hundred and ninety-eight children, aged 3 to 12 years, who were scheduled for tonsillectomy were randomly allocated to receive either diclofenac 1.0 mg.kg-1 or papaveretum 0.2 mg.kg-1 by intramuscular injection after induction of anaesthesia. There were no significant differences between the treatment groups in operating theatre blood loss, the frequency of bleeding on the ward, or the need for operative haemostasis. However, the incidence of above average bleeding in the recovery room was significantly higher in the diclofenac group (p < 0.05). Similarly, marked restlessness in the recovery room was more frequent in the diclofenac group (p < 0.01). In both treatment groups there was an association between bleeding and restlessness during recovery so the increased bleeding in the diclofenac group may not be a direct effect.

Akathisia, Drug-Induced↗
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↗
PubMed1996

[Computerized anesthesia record. How far have we gone?].

There are more and more computerized anaesthetic records becoming available from various constructors. However, the setting up and operation of such a product depends on the development of concepts in computing. The second technological breakthrough, currently underway, is challenging principles which had seemed accepted up until now. The technical development concerns computer processing units, RAM or ROM. The development in software influences the operation of networks, multiple task and object programming. The graphic interface becomes the centre of this second revolution. All of these developments should be included in the proposed computerized anaesthetic records. Three factors determine the realisation of such a product: control of the data collecting process, the man-machine interface and the utilisation of storing data. The computerized anaesthetic record should be of open conception, allowing communication with all of the data bases and providing an interface with all the monitors and ventilators used in operating and recovery rooms. Now is the time to install the infrastructure network in operating and recovery rooms and to be thinking of acquiring the new generations of computerized anaesthetic records.

Anesthesiology↗
PubMed2000

[Practical realization of a patient-accompanying concept in anesthesia and intensive care].

UNLABELLED: Our current concept of stationary workplaces results in an interruption in patient monitoring and treatment. Because transfers are invariably associated with a reduction or interruption in the monitoring and treatment chain, an endangerment to critically-ill patients, as well as a significant increase in the mortality rates, can result. DESIGN: In the new construction of the Cardiac Clinic, the previous concept of immobile anesthesia and intensive care workstations has been completely abandoned. The complete treatment workstation, including monitoring and fluid management, is set up on a bedside cart which accompanies the patients uninterruptedly--from anesthesia administration, to the operating room, to the ICU or recovery room, as well as during elective or emergency interventions outside the ICU. Transport times and complications from 995 transports (ASA III and IV) were analysed and compared with 880 transports with the conventional system. RESULTS: During all intrahospital transfers with the mobile workplace, there were no complications resulting from faulty operation or accidental adjustment of the perfusors, or from disconnecting the monitoring,-, respiration-, or infusion lines. On the whole, there were fewer cases of circulatory instability during transport, since infusion treatment and medication could be administered without interruption. All hemodynamic parameters were recorded during transport, as were cardiac minute output and right- and left-atrial filling pressures. The mobile workplace system allows for the shortest possible transport and exchange times--13.5 min, as compared to 42.5 min with the conventional system. The reconnection of monitoring equipment with zeroing, adjustment of the alarm limits, as well as exchanging perfusors and infusomats before and after transport is eliminated entirely. CONCLUSION: This mobile workplace, in which all components of the anesthesiological and intensive care workstations are integrated, guarantees the highest possible level of patient safety, since nothing has to be disconnected until the patient is transferred to a normal-care ward. In addition to the improved ergonomic design of the nurse's and doctor's workplace, substantial savings can also be made.

Anesthesia↗
PubMed1998

Post operative nausea and vomiting in Nigerians.

A retrospective survey of postoperative nausea and vomiting (PONV) in the recovery room over a five year period was conducted, followed by a prospective study of 200 adult patients to estimate the incidence and predisposing factors to nausea and vomiting during the first 24 hours after anaesthesia and surgery in Nigerians. In the retrospective study only records of 61 patients (0.79%) out of the 7714 post anaesthetic recovery room charts reviewed revealed documentation of vomiting. These were 20 males (32.8%) and 41 females (67.2%). In the prospective study, the incidence of post operative nausea and vomiting within twenty four hours of surgery was 41.6% and 19.6%, respectively. But only two out of 39 patients (one per cent) vomited within the first three hours in postoperative period. The frequency of vomiting varied from one to 15 times and women had significantly more emetic symptoms than men (p < 0.05). Preoperative administration of pethidine and morphine was associated with postoperative nausea and vomiting. It is suggested that Nigerian women should be considered for prophylactic anti-emetic therapy, especially when narcotic analgesic are to be employed in their anaesthetic management.

Adult↗
PubMed2005

Reduction of anesthesia process times after the introduction of an internal transfer pricing system for anesthesia services.

To improve operating room workflow, an internal transfer pricing system (ITPS) for anesthesia services was introduced in our hospital in 2001. The basic principle of the ITPS is that the department of anesthesia receives reimbursement only for the surgically controlled time, not for anesthesia-controlled time (ACT). A reduction in anesthesia process times is therefore beneficial for the anesthesia department. In this study, we analyzed the ACT (with its parts: preparation before induction, induction, extubation, and recovery room transfer) for 3 yr before and 3 yr after the introduction of the ITPS in 55,776 cases. Furthermore, the anesthesia cases were subsegmented into 10 different anesthesia techniques, and the process times were studied. The average total ACT was reduced from 40.4 +/- 23.5 min in 1998 to 34.3 +/- 21.7 min in 2003. The main effect came from reductions in anesthesia preparation time and recovery room transfer time, whereas induction and extubation time changed little. A significant reduction in average ACT was seen in 7 of 10 analyzed anesthesia techniques, ranging from 4 to 18 min. We conclude that transfer pricing of anesthesia services based on the surgically controlled time can be a successful approach to reduce anesthesia process times.

Anesthesia↗
PubMed1979

Reduction of nitrous oxide contamination in a paediatric hospital.

Ambient nitrous oxide concentrations were recorded in an operating room during delivery of the gas at low and medium flow-rates, with and without the application of simple scavenging devices. Residual background levels of nitrous oxide were still present more than one hour after disconnection of the flowmeters and use of the room. Scavenging reduced concentrations ten-fold. Adjacent corridors and the post-anaesthetic recovery room were contaminated with nitrous oxide from the operating rooms and from patients. A vigorous programme of checking for leaks and repairing and maintaining equipment, coupled with the use of suction scavenging, can reduce atmospheric contamination with nitrous oxide below 30 p.p.m., which is well within the limit suggested by the U.S. National Institute for Occupational Safety and Health.

Air Pollution↗
PubMed2004

Anaesthesia for carotid endarterectomy: comparison of hypnotic- and opioid-based techniques.

BACKGROUND: Although the synergistic interaction between hypnotics and opioids for total i.v. anaesthesia has been repeatedly demonstrated, questions about different dose combinations of hypnotics and opioids remain. The optimal combination would be based on maximal synergy, using the lowest dose of both drugs and having the lowest incidence of side-effects. METHODS: The major goal of this prospective randomized study was to compare two different dose combinations of propofol and remifentanil (both administered by target controlled infusion (TCI)) in respect of haemodynamics during surgery and recovery, and the need for cardiovascular treatment in the recovery room. A secondary goal was to compare pain scores (VAS) and morphine consumption in the recovery room. Anaesthesia was induced in both groups using TCI propofol, adjusted to obtain a bispectral index score (BIS) value between 40 and 60. TCI for remifentanil commenced at an initial effect-site concentration of 0.5 ng ml(-1), and was adjusted according to haemodynamics. Patients were divided into one of two groups during anaesthesia: (i). Group H, hypnotic anaesthesia (n=23), propofol effect-site concentration maintained at 2.4 microg x ml(-1); and (ii). Group O, opioid anaesthesia (n=23), propofol effect-site concentration maintained at 1.2 microg x ml(-1). In both groups, remifentanil effect-site concentration was adjusted according to haemodynamics and changes in BIS value. RESULTS: In Group O, more episodes of intraoperative hypotension (P<0.02) and hypertension (P<0.01), and fewer episodes of tachycardia were observed. More patients in Group O required nicardipine administration for postoperative hypertension (8 patients in Group H vs 15 patients in Group O, P<0.04). During recovery, morphine titration was necessary in approximately 50% of patients. No significant difference between groups was observed concerning pain scores or requirement for morphine titration. CONCLUSIONS: Maintenance of anaesthesia predominantly with propofol and a low dose of remifentanil, both administered using TCI, is associated with greater stability in perioperative haemodynamics than anaesthesia predominantly with remifentanil alone. Postoperative pain was identical in both groups of patients who underwent relatively short duration, and relatively painless surgery.

Aged↗
PubMed2006

Financial and operational impact of a direct-from-PACU discharge pathway for laparoscopic cholecystectomy patients.

BACKGROUND: We assessed the operational and financial impact of discharging laparoscopic cholecystectomy (LC) patients directly from the postanesthetic care unit (PACU) in comparison with post-transfer discharge from a hospital bed in a busy academic hospital. METHODS: We retrospectively compared 6 months of performance (bed utilization; recovery room and hospital length of stay; complications; readmissions; hospital costs, revenue, and margin) after implementation of PACU discharges (case patients) to the corresponding 6 months in the prior year (control patients). RESULTS: After implementation, 66% of LC case patients were discharged on the day of surgery, compared with 29% in the control group (P < .05). Eighty percent of the day-of-surgery discharges were directly from the PACU. Shifting to PACU discharge saved 1 in-hospital bed transfer and 1 bed-day for each PACU discharge. Recovery room length of stay for PACU discharge patients was 26% longer than for hospital discharge patients (P = NS). Average hospital length of stay for all patients discharged on the day of surgery was 3.2 hours shorter (P < .05) for case patients (80% PACU discharge) than for control patients. There were no readmissions in the PACU discharge group and no difference in complications. While costs, revenue, and net margin for PACU discharge patients were reduced by 40% to 50% (P < .02) relative to floor discharge patients, the hospital's net margin for the combined case patient group was preserved relative to the control group. CONCLUSIONS: PACU discharge of LC patients significantly reduces bed utilization, decreases in-hospital transfers, and allows congested hospitals to better accommodate patient care needs and generate additional revenue.

Adult↗
PubMed2005

Heating and humidifying of carbon dioxide during pneumoperitoneum is not indicated: a prospective randomized trial.

BACKGROUND: Carbon dioxide (CO2) pneumoperitoneum usually is created by a compressed gas source. This exposes the patient to cool dry gas delivered at room temperature (21 degrees C) with 0% relative humidity. Various delivery methods are available for humidifying and heating CO2 gas. This study was designed to determine the effects of heating and humidifying gas for the intraabdominal environment. METHODS: For this study, 44 patients undergoing laparoscopic Roux-en-Y gastric bypass were randomly assigned to one of four arms in a prospective, randomized, single-blinded fashion: raw CO2 (group 1), heated CO2 (group 2), humidified CO2 (group 3), and heated and humidified CO2 (group 4). A commercially available CO2 heater-humidifier was used. Core temperatures, intraabdominal humidity, perioperative data, and postoperative outcomes were monitored. Peritoneal biopsies were taken in each group at the beginning and end of the case. Biopsies were subjected staining protocols designed to identify structural damage and macrophage activity. Postoperative narcotic use, pain scale scores, recovery room time, and length of hospital stay were recorded. One-way analysis of variance (ANOVA) and the nonparametric Kruskal-Wallis test were used to compare the groups. RESULTS: Demographics, volume of CO2 used, intraabdominal humidity, bladder temperatures, lens fogging, and operative times were not significantly different between the groups. Core temperatures were stable, and intraabdominal humidity measurements approached 100% for all the patients over the entire procedure. Total narcotic dosage and pain scale scores were not statistically different. Recovery room times and length of hospital stay were similar in all the groups. Only one biopsy in the heated-humidified group showed an increase in macrophage activity. CONCLUSIONS: The intraabdominal environment in terms of temperature and humidity was similar in all the groups. There was no significant difference in the intraoperative body temperatures or the postoperative variable measured. No histologic changes were identified. Heating or humidifying of CO2 is not justified for patients undergoing laparoscopic bariatric surgery.

Abdomen↗
PubMed2006

Total intravenous anaesthesia with propofol and remifentanil for elective neurosurgical procedures: an audit of early postoperative complications.

BACKGROUND AND OBJECTIVES: This was a prospective audit to assess the incidence and characteristics of early postoperative complications in the recovery room in extubated patients after elective neurosurgical procedures using propofol and remifentanil-based total intravenous anaesthesia. METHODS: Vital signs (temperature, conscious level, respiratory rate, oxygen saturation, pulse and blood pressure) and postoperative complications (shivering, nausea, vomiting and cardiorespiratory) were analysed in 145 adult patients over a 1-yr period. RESULTS: The overall shivering, postoperative nausea and vomiting and postoperative hypertension (systolic blood pressure more than 25% of the preoperative value) incidences were 30.3%, 16.6% and 35.2%, respectively. Fifty-one percent of the patients had at least one of the above complications. The complication rates were found to be widely different among various types of neurosurgery. The surgical procedures were divided into five groups: supratentorial craniotomy, posterior fossa craniotomy, intracranial vascular procedures, transphenoidal hypophysectomy and extracranial procedures. Median extubation time was similar in all groups and patients were fully conscious with no hypoxia in the recovery room. The intracranial vascular group had the highest shivering and postoperative nausea and vomiting rates (58.8% and 29.4%, respectively). In the supratentorial craniotomy group, 46% of the patients had hypertension. The overall complication rate (presence of any complications) was highest in the supratentfial craniotomy (55.4%), posterior fossa craniotomy (75%) and intracranial vascular (76.5%) groups. Shivering and overall complication rate was significantly related to the anaesthetic time (P<or=0.001 and 0.02, respectively). CONCLUSIONS: Despite the potential advantages of total intravenous anaesthesia in titratability, rapid return of consciousness and reduced respiratory complications, making it suitable for planned extubation at the end of neurosurgery, the postoperative complications of shivering, postoperative nausea and vomiting and hypertension were still high.

Anesthesia, Intravenous↗
PubMedDate not supplied

Ketorolac analgesia for inguinal hernia repair is not improved by peripheral administration.

PURPOSE: It has been suggested that ketorolac, a non-steroidal anti-inflammatory drug (NSAID) available for parenteral use, may result in prolonged (24 hr) postoperative analgesia through a peripheral mechanism when added to local anesthetic infiltration. Our objective was to assess this effect by controlling for systemic absorption of the drug. METHODS: This randomized, double-blind trial studied 40 men undergoing elective inguinal hernia repair under spinal anesthesia. All patients received 19 mL of lidocaine 1% infiltrated in the operative field before incision. Patients were randomized into two groups of 20. The surgical site group received ketorolac 30 mg added to the lidocaine infiltration. In the control group, ketorolac 30 mg was injected subcutaneously in the contralateral abdominal wall. Numeric rating scores (0-10) of pain at rest and with movement were recorded at the time of discharge from the recovery room and at 24 hr postoperatively. Time to first analgesia, postoperative iv morphine use, total time in the recovery room, and total oral analgesic use in the first 24 hr were also compared. RESULTS: There were no significant differences between groups with respect to any of the measured variables. In both groups, pain scores were low at rest (1.9 +/- 1.4 vs 2.2 +/- 1.8, surgical site and systemic groups, respectively) and moderate with movement (5.3 +/- 2.2, 5.0 +/- 1.8) after anesthetic recovery. Pain scores were similar at 24 hr (1.1 +/- 1.3, 1.9 +/- 1.6 at rest; 5.7 +/- 2.0, 6.2 +/- 2.2 with movement). CONCLUSION: Adding ketorolac to lidocaine infiltration for hernia repair does not improve or prolong postoperative analgesia compared to systemic administration.

Adult↗
PubMed2005

Does pancuronium or cisatracurium delay the rate of arousal following remifentanil-based anesthesia?

STUDY OBJECTIVE: The present report investigates the rate of arousal following remifentanil-based anesthesia associated with the coadministration of pancuronium, which inhibits butyrylcholinesterase, or cisatracurium, which is partially metabolized by nonspecific esterases, versus vecuronium that is eliminated independently of ester hydrolysis. DESIGN, SETTING AND PATIENTS: Sixty patients, ASA I-II, scheduled for elective abdominal surgeries were enrolled in a double-blinded prospective study. In fact, patients were equally divided into three Groups with each Group receiving remifentanil and either one of the following three muscle relaxants: pancuronium, vecuronium or cisatracurium. MEASUREMENTS: The rate of arousal following discontinuation of anesthesia was assessed by Modified Aldrete Score. Time to eye opening on verbal command, tracheal extubation, Modified Aldrete Score >9, and time to discharge from the recovery room were recorded. MAIN RESULTS: Time to eye opening on verbal command, tracheal extubation, Modified Aldrete Score >9, and time to discharge from the recovery room were not significantly different between the three groups. CONCLUSION: The results suggest that recovery following remifentanil-based anesthesia is not delayed by the coadministration of pancuronium, cisatracurium versus vecuronium; and by the use of neostigmine for reversal of neuromuscular blockade.

Abdomen↗
PubMed1989

A comparison of oxymorphone and fentanyl as narcotic supplements in general anesthesia.

The safety and efficacy of two potent opiate analgesics, fentanyl and oxymorphone, used as adjuncts in general anesthesia, were studied in 39 patients undergoing elective gynecologic surgery of at least 2 hours duration. Based on a potency ratio of 10:1, patients received either fentanyl 6.5 micrograms/kg or oxymorphone 65 micrograms/kg prior to a thiopental 2 to 3 mg/kg succinylcholine induction and endotracheal intubation. Additional maintenance narcotic and isoflurane were administered as required by the "blinded" anesthesiologist in response to hemodynamic alterations 15% above a presurgical baseline. Overall analysis included hemodynamic response at preset intraoperative intervals, total anesthetic requirements, and stability of vital signs in the recovery room. Blood pressure and heart rate were reliably controlled with either agent; however, less narcotic (ml) and recovery room analgesics were required in the oxymorphone-treated group (p less than 0.05). Decreased naloxone requirements (p less than 0.05) and a more rapid emergence suggested that fentanyl was a safer agent when administered in relatively unrestricted fashion.

Anesthesia, General↗
PubMed2000

Reduction of postoperative nausea and vomiting by dimenhydrinate suppositories after strabismus surgery in children.

UNLABELLED: Although dimenhydrinate has been used for treatment and prevention of postoperative nausea and vomiting (PONV) since the fifties, there have been few controlled studies about its efficacy. We performed a double-blinded study of 301 children aged 4 to 10 yr who underwent strabismus surgery. Preanesthetic medication with midazolam (0.5 mg/kg) as well as application of either dimenhydrinate suppositories or a placebo preparation was performed 30 min before the induction of anesthesia. Anesthesia was induced with thiopentone (5-10 mg/kg) and vecuronium (0.1 mg/kg) and maintained with halothane (1%-2%) in N(2)O/O(2) (65%/35%). The incidence of PONV, requirements for rescue dimenhydrinate, and time to recovery were recorded. The overall incidence of PONV was 60.1% in the placebo group and 30.7% in the dimenhydrinate group. In the dimenhydrinate group, children had to be observed in the recovery room significantly longer than those in the placebo group. Children having received dimenhydrinate were discharged from the recovery room with lower arousal scores. We conclude that the rectal administration of dimenhydrinate is effective for the prevention of PONV, although the sedative effect may require longer postoperative monitoring. IMPLICATIONS: We performed a double-blinded, randomized study to investigate the effects of prophylactic rectal dimenhydrinate application on postoperative nausea and vomiting in children undergoing strabismus surgery. In comparison with placebo, dimenhydrinate reduced the incidence of postoperative vomiting from 60.1% to 30.7%.

Anesthesia, Inhalation↗
PubMed2005

Total shoulder arthroplasty as an outpatient procedure using ambulatory perineural local anesthetic infusion: a pilot feasibility study.

We investigated the feasibility of converting total shoulder arthroplasty (TSA) into an outpatient procedure using ambulatory interscalene perineural ropivacaine infusion. Of the patients of the first phase (n = 8) who were required to remain hospitalized for at least 1 postoperative night, 5 met discharge criteria in the recovery room. Of the subsequent patients of the second phase (n = 6), all met discharge criteria in the recovery room after surgery, and 5 were discharged directly home. For all patients, postoperative pain was well controlled, oral opioid requirements and sleep disturbances were minimal, range-of-motion consistently reached or exceeded the surgeon's expectations, and patient satisfaction was high. These results suggest that TSA may be performed on an outpatient basis using perineural local anesthetic infusion. Additional research is required to define the appropriate subset of patients and assess the incidence of complications associated with this practice before its mainstream use.

Adult↗
PubMed2006

Multimodal analgesia without routine parenteral narcotics for total hip arthroplasty.

Methods for managing pain after a total hip replacement have changed substantially in the past 5 years. We documented the outcome of patients treated with a multimodal pain program designed to avoid parenteral narcotics. Avoidance of parenteral narcotics can essentially eliminate the complications of respiratory depression, ileus, and narcotic-induced hypotension. It can minimize nausea and vomiting which cause dissatisfaction with an operation. Twenty-one of 140 patients (15%) needed parenteral narcotics postoperatively with only nine patients (6.4%) using parenteral narcotics after the day of surgery. Mean pain scores were below 3 of 10 on all postoperative days. There were no patients with respiratory depression or ileus, and four (2.9%) with urinary retention. Nausea occurred with 35 patients (25%) in the recovery room and in 28 patients (20%) thereafter. Emesis occurred in five patients (3.6%) with two incidences in the recovery room. One hundred and thirty-eight patients (98.6%) were discharged home at a mean of 2.7 seven days postoperatively with 98 (70%) on a single assistive device. The multimodal pain management program, which avoided parenteral narcotics, was effective in providing pain relief, nearly eliminating emesis, and eliminating the severe complications of respiratory depression, urinary tract infection and ileus, as well as accelerating function.

Adult↗