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PubMed1990

[Aconite in homeopathic relief of post-operative pain and agitation in children].

Despite the use of modern analgesic methods and an improved use of narcotics, the combination pain-agitation sometimes persists in the recovery-room. Aconit seems to be an appropriate homeopathic treatment in this case. To prescribe it, the following conditions must be combined: violence and suddeness of the stress bringing about intense and anguish. The study included 50 children with such symptoms; it was carried out double-blind, the children being given either placebo or Aconit. Aconit proved to be effective for children's postoperative agitation with 95% good results. It is usually stated in such studies that the placebo effect is high and may reach rates higher than 30%. Aconit is an amazing cure when well prescribed, as much for the speediness of its action as for its efficiency. This remedy has a place in the recovery-room and should be in every physician's emergency case. The fundamental research could specify how the remedy works and may be discover other molecules effective for stress.

Aconitum↗
PubMed1995

[Exposure to anesthetic gases].

In recent years there has been a growing awareness of possible hazards caused by anaesthetic gases in operating theatres. Our study monitored ambient nitrous oxide (N2O) levels in the operating theatres and recovery rooms at the University Hospital in Tromsø. The results show that exposure to waste anaesthetic gases occurs because of leaks in the anaesthetic equipment. The three major sources of leaks are masks, high pressure fittings and exhalation valves. Prevention of leakage from equipment is very important, and a leakage testing programme should be an essential part of the daily control strategy. Good working practices and tracheal intubation results in low exposure to nitrous oxide in the breathing zone of the anesthetic personnel. During mask anaesthesia we have observed nitrous oxide concentrations above 1500 ppm, owing to mask leakage. A closely fitting scavenging mask and good working practices lead to in lower nitrous oxide concentrations. Nitrous oxide exhalation from the patient in the recovery room is only a minor problem.

Air Pollutants, Occupational↗
PubMed2026

A Triple-Blinded, Randomized, Controlled Trial Comparing Hydromorphone vs. Fentanyl for Children Undergoing Tonsillectomy.

BACKGROUND: Tonsillectomy is one of the most frequently performed pediatric surgeries; however, little evidence guides the choice of intraoperative opioids in a population at an elevated risk for perioperative respiratory complications. This study tested the hypothesis that fewer children who received hydromorphone during tonsillectomy would require postoperative "rescue" opioids compared to children who received fentanyl. METHODS: We conducted a triple-blind, randomized, controlled trial to compare intravenous hydromorphone versus fentanyl in pediatric patients undergoing tonsillectomy. Children aged 2-15 years undergoing bilateral tonsillectomy or adenotonsillectomy were assigned (1:1) to receive hydromorphone (10 mcg/kg) or fentanyl (1 mcg/kg) intraoperatively. The primary endpoint was the number of patients who required rescue intravenous opioid analgesia following endotracheal extubation. Secondary endpoints included pain scores, pulse oximetry saturations, postoperative nausea, time in the recovery room, morphine milligram equivalents in the post-anesthesia care unit, and adverse events. RESULTS: A total of 188 children underwent randomization, and 180 were analyzed (90 in each group). The median age was 5 years (interquartile range: 3-7 years). Rescue intravenous opioid was administered to 48 (53%) children who received intraoperative hydromorphone and 66 (73%) children who received intraoperative fentanyl (difference, 20.0 percentage points; 95% confidence interval, 6.2-33.8) (p = 0.005). Children who received hydromorphone also had lower mean pain scores for the first 15 min postoperatively and lower median morphine milligram equivalents. The incidence of adverse events was similar between the two groups. CONCLUSIONS: This study in children undergoing tonsillectomy found that intraoperative hydromorphone resulted in improved analgesia in the recovery room compared to fentanyl. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04230681.

Adolescent↗
PubMed1996

Selective use of the intensive care unit after nonaortic arterial surgery.

PURPOSE: The purpose of this study was to determine whether the institution of a clinical protocol combining 6 hours of recovery room observation and guidelines for intensive care unit (ICU) admission would allow selected patients to be safely transferred directly to a surgical floor after nonaortic arterial reconstruction. METHODS: After a clinical pathway was formed, 134 consecutive patients undergoing 154 nonaortic arterial operations were prospectively enrolled in this study. Patients requiring ICU care and the responsible factors were identified. Comparisons of risk factors and demographics were made between those patients who did and did not require ICU care. RESULTS: Twelve (7.8%) patients spent a total of 27 days in the ICU (range 1 to 11 days). As per our guidelines four patients were transferred to the ICU for invasive monitoring, and four were sent to the ICU because of refractory hemodynamic instability or arrhythmia in the postanesthetic recovery room. An additional four patients were transferred to the ICU after having been on the surgical floor for 24 to 72 hours because of the following perioperative complications: prolonged chest pain (one), pneumonia (one), heart failure (one), and graft occlusion requiring a urokinase infusion. Patients admitted to the ICU were more likely to have heart disease (p = 0.02) and to have had an operation other than carotid endarterectomy (p = 0.04) than those who were not. The 30-day mortality rate was 1.4%. CONCLUSIONS: The implementation of a clinical protocol similar to the one used in this study will allow many patients undergoing nonaortic vascular surgery to avoid the use of the ICU. This approach will conserve hospital and financial resources without adversely affecting patient morbidity and mortality rates.

Aged↗
PubMed1999

[The effect of low droperidol dosages on postoperative anxiety, internal tension, general mood and PONV].

BACKGROUND: Droperidol even in low doses such as 0.5 mg to 1.25 mg can increase postoperative anxiety and state of tension. The aim of this study was to determine whether these side effects occur frequently following low-dose droperidol and to see whether these are dose related. METHODS: 184 female in- and outpatients ASA grade 1 and 2 undergoing gynaecological laparoscopy were recruited to this prospective, double-blind study. General anaesthesia was standardized (induction with thiopentone, fentanyl 2 micrograms/kg and vecuronium 0.1 mg/kg, tracheal intubation, maintainance with enflurane in N2O/O2). Patients were randomly allocated to receive saline (n = 45), 0.625 mg (n = 46), 1.25 mg (n = 47) or 2.5 mg (n = 46) droperidol i.v. 10 minutes before the end of surgery. 1,3,6, and 24 hours postoperatively, the patients' anxiety, state of tension and overall mood was evaluated using two psychological questionnaires which had been tested for the perioperative period (Erlanger anxiety and tension-scale/BSKE-EWL-test). Sedation was evaluated by the staff of the recovery room. In addition, postoperative nausea and vomiting (PONV) was assessed using a 100 mm visual analogue scale and by counting the episodes of retching or vomiting. PONV was then rated over the whole observation period as none, mild, moderate or severe using a fixed scoring algorithm. Statistical analysis was performed using the ANOVA and the chi2-test. RESULTS: The patients did not differ with regard to biometric data, duration of surgery and anaesthesia. The postoperative scores for anxiety, state of tension and overall mood were not different between the groups at any observation time (Fig. 1: anxiety and tension: P = 0.5687; figure 2: overall mood: P = 0.0647). Quality of sleep in the first night after surgery was the same in all groups (Table 2 and 3). Sedation was not significantly different (Table 4; P = 0.0704). Furthermore, duration of stay in the recovery room did not differ (P = 0.4353). On the other hand, three patients from the 2.5 mg droperidol group had to stay unexpectedly on the ward overnight, because they had been too much sedated to be discharged at home. This was not the case with any patient from the other groups. Compared to placebo, PONV over the whole 24 h observation period was significantly reduced by droperidol (Fig. 3; P = 0.0338): completely free from PONV: placebo: 41.3%, 0.625 mg droperidol: 67.4%, 1.25 mg droperidol: 53.2%, 2.5 mg droperidol: 71.7%. Also the severity of PONV was reduced. CONCLUSION: In gynaecological laparoscopy under general anaesthesia with tracheal intubation, we recommend droperidol 0.625 mg in the prevention of PONV, as it reduces PONV as well as 2.5 mg with no severe sedation in this dosage. Psychological side effects did not occur more frequently after droperidol compared to placebo in any of the investigated dosages.

Adjuvants, Anesthesia↗
PubMed1997

Truncal rigidity as a result of epidural sufentanil--a case report.

It is well known that intravenous opioids may cause truncal rigidity. To the best of our knowledge truncal rigidity induced by epidural opioid has never been reported. Recently, we came across an accident of truncal rigidity following epidural sufentanil. The victim was a 65-year-old female who received cholecystectomy, choledochotomy, and cholangiography. For post-operative pain control, an epidural catheter was inserted cephalad [corrected] at L1-2 interspace with a length of 4 cm of the catheter retained in the epidural space. The epidural catheter was secured and tested for correct placement with 3 ml of 2% lidocaine with 1:200,000 epinephrine prior to induction of general anesthesia. No opioid was ever given in the operative course. When the patient was fully awake and complained of wound pain in the recovery room 50 mg of sufentanil in 10 ml normal saline was given via the epidural catheter after a negative evacuation test. About one minute after the epidural shot, she was found to lose consciousness without any slightest warning sign. Truncal rigidity and locked jaw that followed entailed respiratory arrest and rapid deterioration of oxygenation which evidenced a life-threatening airway emergency. It spite of our efforts we could not manage to ventilate her with ordinary means. It was not until the administration of 80 mg of succinylcholine and oral endotracheal intubation could an adequate ventilation be reestablished. She regained spontaneous breathing 15 min after the episode but for safety's sake she remained intubated for 6 h until the dissipation of analgesia. Another test dose was attempted, which reconfirmed that the epidural catheter was in proper position. She stayed in the recovery room for 24 h and returned to ward in satisfactory condition. The incidence disclosed that epidural sufentanil even with a dose as small as 50 micrograms could cause truncal rigidity. Thus when epidural sufentanil is applied for post-operative pain control constant vigilance is necessary in order to avoid accident.

Abdomen↗
PubMed2003

Postoperative management of patients after stereotactic biopsy: results of a survey of the AANS/CNS section on tumors and a single institution study.

As little consensus exists on the postoperative care of patients undergoing stereotactic biopsy, we sought to establish a new algorithm for their postoperative management. First, we surveyed active members of the AANS/CNS Section on Tumors to determine national practice patterns for patients after stereotactic biopsy. Second, we retrospectively reviewed 84 consecutive stereotactic biopsy procedures at our institution to assess the potential benefit of routine computed tomography (CT) scanning and intensive care unit (ICU) monitoring. Finally, we prospectively applied this new algorithm in 54 patients to assess its validity. Of 629 surgeons, 263 (42%) responded; they were experienced neurosurgeons (mean 15 years in practice) who performed more than 10 stereotactic biopsies per year. Most surgeons (59%) routinely ordered postoperative CT scans, and the remainder ordered scans based on specific indications. Patients were transferred from the recovery room to a special care unit (47%), regular room (47%), or home (6%). In our retrospective review, 81 patients underwent 84 stereotactic biopsy procedures; 79 underwent postoperative CT scanning and all 81 were monitored overnight in the ICU. Among five (6%) patients who experienced intraoperative hemorrhage, two (2%) underwent craniotomy to control arterial bleeding. Three (4%) patients developed new neurological deficits, which occurred within 2 h of surgery. In both groups, CT scans were helpful in excluding hemorrhage that would require re-operation. In the remaining patients (90%), findings on routine postoperative CT did not alter patient management and ICU monitoring appeared unnecessary because neurological complications occurred within 2 h postoperatively. We confirmed these results in the prospective study of 54 patients undergoing stereotactic biopsy without routine postoperative CT scanning or ICU monitoring. In contrast with national practice patterns reported, we recommend that CT scanning and ICU monitoring be reserved for patients who have intraoperative hemorrhage or new deficits after surgery. All other patients can be monitored for 2 h in the recovery room and transferred to a regular hospital room without a postoperative CT scan.

Adult↗
PubMed2002

Totally implanted venous access device removal in interventional radiology.

PURPOSE: To demonstrate that totally implanted venous access device (TIVAD) removal in the out-patient interventional radiology (IR) recovery room is safe and effective. MATERIALS AND METHODS: Fifty-seven TIVADs were removed in 56 patients using a standard cut-down technique. Forty-one devices (72%) in 40 patients without signs of pocket infection were closed with primary intention with sub-cuticular absorbable or simple non-absorbable sutures, depending on operator preference. All patients were followed up to assess for bleeding or infection. Sixteen devices (28%) in 16 patients with suspected pocket infection were allowed to heal by secondary intention. These patients were managed with antibiotics and dressing changes until healing was complete. Catheter tips were sent for culture and sensitivity. RESULTS: TIVADs were removed intact in all 57 cases. There were no cases of air embolism, uncontrolled hemorrhage, retained foreign body or catheter fragmentation. No bleeding or infectious complications were noted in those patients who were allowed to heal with primary intention. Wound closure was accomplished in all patients who were allowed to heal with primary or secondary intention. CONCLUSION: TIVAD removal in an out-patient recovery room by an interventional radiology team is safe and feasible, providing a possible alternative venue for this procedure.

Adult↗
PubMed2001

The quality of perioperative care: development of a tool for the perceptions of patients.

AIM OF THE STUDY: To find out how surgical hospital patients (n=874) perceived the quality of perioperative care they received in an operating department and in the recovery room. BACKGROUND: Patients' perceptions of the perioperative care have not been included systematically in the improvement of the care. Accordingly, there is no standardized, valid, and reliable instrument or system in common use that we could use for the evaluation. The nursing care in operating departments has an important role in modern health care, and therefore more research concerning perioperative care quality is needed urgently and the development of the measurement tool is urgent. METHOD: The data were collected using a structured questionnaire in five operating departments in southern Finland during 1998. RESULTS: Physical activities (such as pain management and temperature maintenance) were rated as excellent, as were staff characteristics and the physical and social environment. The most critical comments were made with regard to supporting patient initiative, encouragement and educational activities. Patients stated they would have liked more information and it was felt that they should have been encouraged to ask more questions about unclear matters. Some of the patients said they had only very limited influence over their own care. The patients were very pleased with their care in the recovery room. There were only minor differences between the views of patients from different departments. CONCLUSIONS: Overall the quality of care was considered extremely good, but comparisons of different quality categories did reveal some problems. Although it has already proved to be a useful tool, the questionnaire needs to be developed and tested further.

Adolescent↗
PubMed1994

Practical management of post-thyroidectomy hematoma.

Thyroid diseases and surgery for thyroid neoplasms are both very common. Several complications of thyroidectomy are well known. Some of these are quite disturbing, such as recurrent laryngeal nerve injury and permanent hypoparathyroidism. However, postoperative hematoma often in the recovery room may be fatal. Close observation and early intervention are of utmost necessity in the post-thyroidectomy period. In a series of 600 thyroidectomies performed over a period of 11 years, eight patients developed postoperative hematoma. Seven of them underwent re-exploration, while one patient was treated conservatively. Two patients had second re-exploration for hematoma reaccumulation. All patients recovered very well after re-exploration except one elderly patient who required ventilatory support due to poor pulmonary reserve; after a week of ventilatory support and a tracheostomy, she too recovered well. One patient had the hematoma re-explored as late as 24 hours after the operation, while the remainder were re-explored within 4-6 hours after the initial procedure. Because of the extent of edema of the larynx and pharyngeal wall, it is very important that a senior, experienced person perform intubation in these patients. It is also very important to recognize that when the patients lie down flat, they may develop acute airway distress; hence, one must be prepared to intubate them emergently. We recommend close recovery room observation after thyroidectomy and early exploration and evacuation of hematoma in all patients who develop postoperative hematoma. A conservative approach may be considered in selected patients with minimal hematoma and no progression. However, it generally takes a long time for the hematoma to resorb. A better understanding of the complications of thyroidectomy will minimize morbidity and make thyroidectomy a safer procedure and a surgical triumph.

Adolescent↗
PubMed1999

Comparison of subcutaneous hydromorphone with intramuscular meperidine for immediate postoperative analgesia.

Intramuscular (i.m.) injection with meperidine is the most common analgesic approach to treat postoperative pain in Taiwan. Hydromorphone (Dilaudid) can provide very potent and rapid analgesic effect through subcutaneous (s.c.) injection. Although hydromorphone is widely used in North America, no study has compared the analgesic efficacy, side effect profiles and patients' satisfaction with the method of injection of hydromorphone s.c. and meperidine i.m. for the immediate post-operative analgesia. In this randomized and double-blind study, 60 female patients scheduled for abdominal total hysterectomy were treated either with 1 mg hydromorphone s.c. (n = 30) or 50 mg meperidine i.m. (n = 30) when they regained consciousness and asked for analgesic treatment in the recovery room. Visual analogue score (VAS) of wound pain was obtained at 0, 10 and 30 min after injection by a blinded observer. The occurrence and severity of nausea, vomiting, dizziness, drowsiness, flatus passage and respiratory depression were recorded. Post-operative analgesia in the ward was maintained by patient-controlled analgesia (PCA) with intravenous morphine. Time to first PCA demand, the number of demands, delivery, delivery/demand ratio and 24 h morphine consumption were documented. We found that VAS was reduced at 10 min and, to a greater extent, at 30 min postinjection in both groups but with no significant difference between the two groups. The occurrence and severity of side effect profiles were similar in both groups except that dizziness was more frequently observed after meperidine injection. Delivery, demand, delivery/demand ratio and 24 hr morphine consumption by PCA were not significantly different between the two groups. Time to first PCA trigger was also similar. Patients receiving hydromorphone s.c. injection exhibited higher satisfactory score than those receiving meperidine i.m. injection. Hydromorphone 1 mg, injected subcutaneously, was as effective as intramuscular meperidine 50 mg while permitting more favorable injection technique and fewer side effects. We suggest that subcutaneous hydromorphone is a good alternative to intramuscular meperidine for postoperative analgesia in the recovery room.

Adult↗
PubMed2005

Cost comparison of laparoscopic versus radical retropubic prostatectomy.

OBJECTIVES: To determine the cost of laparoscopic radical prostatectomy (LRP) versus open radical retropubic prostatectomy (RRP) in an actual clinical setting, we analyzed the cost data from a single institution comparing LRP and RRP. LRP is increasing in prevalence, yet questions remain regarding its higher cost versus open RRP. METHODS: A chart and cost review was performed for consecutive patients undergoing LRP (n = 30) and RRP (n = 67) between May 2003 and August 2004. The clinical characteristics, operative techniques, and radiographic and pathologic information were recorded. Detailed cost information for room and board, laboratory, pharmacy, radiology, operating room, surgical supplies, anesthesia, recovery room, electrocardiography, and respiratory services were obtained. RESULTS: The total cost of the procedure was significantly more for LRP than for RRP (6,760 dollars versus 5,253 dollars, P < 0.001). Most of this difference was due to surgical supply (1,202 dollars LRP versus 145 dollars RRP, P < 0.001) and operating room costs (1,601 dollars LRP versus 1,141 dollars RRP, P < 0.001). The room and board and pharmacy costs were significantly lower for LRP than for RRP because of the shorter mean length of stay (1.73 days versus 2.37 days, P < 0.001). The laboratory/pathology and radiology costs were not significantly different. No significant difference was found in the Gleason score, preoperative prostate-specific antigen level, subject age, positive surgical margins, lymph node involvement, or seminal vesicle involvement between the two groups. CONCLUSIONS: At a single institution, the actual LRP costs were significantly greater than the costs for RRP, and this was predominantly due to the higher surgical supply and operating room costs.

Aged↗
PubMed1997

The effects of an outpatient practice guideline at a teaching hospital: a prospective pilot study.

Practice guidelines (PGs) are becoming increasingly important in modern medicine. To study the effects of a PG, we performed a pilot study at a large, urban, public teaching hospital according to a prospective, observational research design with both concurrent and historic controls. Specifically, we studied the effects of a multidisciplinary PG for pediatric outpatient tonsillectomy and adenoidectomy on the process of health-care delivery. Variables in the health-care process included patient compliance with clinic and surgery appointments, surgery time, operating room turnover, time in recovery room, unplanned admission rate, patient compliance with postoperative follow-up, provider compliance with guidelines, and hospital charges. Patients in the PG were found to have fewer preoperative laboratory tests, decreased duplication of services, and shorter operating room turnover times. Provider compliance with the PG varied by service and was intermittent at first but improved gradually. There was a trend toward improved compliance with postoperative follow-up in patients in the PG. Provider opinions concerning the guideline were positive. This pilot study demonstrates several advantages and disadvantages of the use of PGs in the outpatient setting and in a teaching hospital.

Adenoidectomy↗
PubMed2001

Interrater reliability of the Glasgow Coma Scale scoring among nurses in sub-specialties of critical care.

The Glasgow Coma Scale (GCS) is used as an assessment tool to measure the levels of consciousness and coma in patients. This research investigated the reliability of scoring the GCS among registered nurses (RNs) working in five different sub-specialty clinical areas of critical care; general intensive care, neurosurgical intensive care, coronary care, emergency room and post anaesthetic recovery room. Seven video recordings were made of six patients (one patient was recorded twice) having their level of neurological response assessed utilising the GCS. Seventy five RNs (15 from each sub-specialty) viewed each of the GCS assessments on the videotape and rated each patient on the scoring sheet provided. Analysis was performed for all RN subjects as a single group as well as separately for each of the five groups under investigation. The ratings for the first six videos were used to test interrater reliability and the scores from videotape four and seven (same patient) were used to calculate intrarater reliability. Based on comparison with expert scores, of the 75 participants, 38 responded correctly to eye opening responses; only 26 responded correctly to the motor response ratings. However, a better accuracy was achieved in the verbal response category with 67 participants responding correctly. Education qualifications and previous neurosurgical experience were statistically significant with regard to the nurses' accuracy of GCS assessment with p values of 0.004 and 0.043 respectively. The results were consistent with previously published studies demonstrating the motor response rating is most problematic in relation to rate accuracy.

Adult↗
PubMed2000

Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay, and costs in the management of primary hyperparathyroidism.

OBJECTIVE: To compare the first 20 patients who underwent minimally invasive radioguided parathyroidectomies (MIRPs) performed at the authors' institution with 20 similar patients who underwent a more conventional surgical approach for primary hyperparathyroidism. SUMMARY BACKGROUND DATA: The technique of parathyroidectomy has traditionally involved a bilateral exploration of the neck with the intent of visualizing four parathyroid glands and resecting enlarged parathyroid glands. Parathyroid scanning using radioisotopes has evolved and now can localize adenomas in 80% to 90% of patients. MIRP combines parathyroid scanning with a hand-held intraoperative detector that guides the surgeon to the adenoma. METHODS: Forty patients with documented primary hyperparathyroidism who underwent surgery by a single surgeon between January 1998 and May 1999 were included in this study. Twenty of these patients underwent MIRP. The technique involved injecting 20 mCi technetium-99m sestamibi 2 hours before surgery and performing a parathyroid scan. If the scan was considered positive for a single adenoma, patients were taken to the operating room and given the choice of either general anesthesia or intravenous sedation with local anesthesia. Using an incision of 4 cm or less, the dissection down to the adenoma was guided by the Navigator miniature hand-held probe. An additional 20 patients who underwent more conventional bilateral or unilateral neck exploration were chosen to match the MIRP patient population. Both groups included four patients undergoing repeat surgery for persistent or recurrent primary hyperparathyroidism and one patient with multiple endocrine neoplasia type 1 syndrome. Patient demographics, preoperative calcium and parathyroid hormone levels, operative time, total time in the operating room, time in the recovery room, complications, hospital charges for the operating room, and total hospital charges were analyzed. RESULTS: There were no differences in patient demographics, presenting symptoms, or preoperative calcium level between patients undergoing the standard procedure versus MIRP. Operative time, total time in the operating room, operative charges, and total hospital charges were significantly reduced in the MIRP group. All 40 patients were cured of primary hyperparathyroidism. There were no recurrent laryngeal nerve injures in either group. The mean length of stay in the standard group was 1. 35 days; in the MIRP group, 65% of patients were discharged within 5 hours after surgery. CONCLUSIONS: The MIRP technique resulted in excellent cure rates for primary hyperparathyroidism while simultaneously decreasing operative time and hospital stays. These resulted in significant cost reductions without compromising patient safety. The technique may significantly change the management of primary hyperparathyroidism.

Adenoma↗
PubMed1980

Close scavenging experimental and preliminary clinical studies of a method of reducing anaesthetic gas contamination.

Long-term exposure to low concentrations of anaesthetic gases is potentially hazardous. In spite of efforts to reduce the exposure of personnel by increased air conditioning, by scavenging of excess circuit gases and by improvements in anaesthetic equipment, high concentrations of gases have still been measured. Problems arise during mask induction, in paediatric anesthesia, and in certain situations with unavoidable leaks, especially in small rooms but also in recovery rooms. Experimental and preliminary clinical studies have shown that nitrous oxide pollution can be considerably reduced by using a separate close scavenging system in the area where high gas concentrations occur. The geometrical and flow dimensions of a close scavenging device used in paediatric anaesthesia are described.

Air Pollutants↗
PubMed2005

A cost comparison of nephron-sparing surgical techniques for renal tumour.

OBJECTIVE: To compare costs associated with open partial nephrectomy (OPN), laparoscopic PN (LPN) and percutaneous radiofrequency ablation (PRF) in consecutive patients undergoing nephron-sparing surgery. PATIENTS AND METHODS: The charts and costs were reviewed for all 46 patients undergoing nephron-sparing PN at our institution from March 2003 to March 2004. Clinical characteristics, operative techniques, radiographic and pathological information were recorded. Detailed cost information for room and board, laboratory, pharmacy, radiology, operating room, surgical supplies, anaesthesia, recovery room, electrocardiography and respiratory services were obtained from our institution. RESULTS: The hospital stay was significantly shorter for PRF (0.5 days) than either LPN (1.86) and OPN (4.94). PRF was statistically less costly than LPN and OPN, with mean (sd) costs of (US dollars) 4454 (938), 7013 (934) and 7767 (1605). There was no significant difference in cost between LPN and OPN. Surgical supply costs were significantly higher for LPN and PRF than OPN. LPN had less than a third of the room and board costs of OPN (P < 0.001). Decreases in room and board were also associated with lower pharmacy and laboratory costs. CONCLUSIONS: PRF is significantly less costly than LPN and OPN; LPN is cost-equivalent to OPN as the shorter stay compensates for significantly higher surgical supply costs. In those patients with tumours of appropriate size and location, minimally invasive approaches can decrease the morbidity, with cost benefits.

Aged↗
PubMed1998

Unexpected cardiac arrest during epidural anaesthesia.

We reported the case of sudden asystole requiring close chest cardiac massage in a 56-yrs-old health man receiving epidural anaesthesia for elective transurethral resection of bladder tumour (TURBT). The anaesthetic procedure was performed in a regional-block-room. Cardiac arrest developed few minutes after local anaesthetic injection, before the patient has been transferred to the operating room. The importance of patient monitoring during regional anaesthesia must be further on pointed out, especially when the anaesthetic procedure is performed out of the operating room (e.g. in the recovery room or in a "regional-block-room").

Adult↗