Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

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126 Appendix 4 TABLE 66 contd Summary of adult clinical outcomes studies Study Investigations and subjects Outcome Results Conclusions and measures grade of evidence Marshall et al., (1) Propofol, isoflurane (n = 32) (a) Awakening (a): (1) 6.9, (2) 6.2, (3) 4.9, Grade I 1992, 93 England (4) 3.9 min; NS (2) Propofol TIVA + alfentanil + N 2O (b) Orientation Method of randomisation RCT (n = 32) (b): (1) 8.0, (2) 7.3, (3) 6.1, not reported (c) Picture (4) 5.1 min; NS (3) Propofol, isoflurane (n = 25) memory Blind (c–f): No difference (4) Propofol TIVA + N 2O, no alfentanil (d) Simple (n = 26) reaction time N 2O: given in groups 2 and 4 (e) Computer dot tracker Premedication: none (f) PONV Procedures: gynaecological laparoscopy Maitikainen et al., (1) Spinal lidocaine (n = 55: 30 women, (a) Time to (a): (1) NA, (2) 11, (3) 12, Grade I 1998, 94 Finland 25 men) eye opening (4) 8 min; NS Method of randomisation RCT (2) Propofol TIVA (n = 32: 20 women, (b) Time to (b): (1) NA, (2) 13, (3) 13, not reported 12 men) orientation (4) 9 min; NS Not blind (3) Propofol/isoflurane (n = 38: (c) Pain (c): Figures but no data values 14 women, 24 men) reported (less pain p < 0.001 (d) Alertness for group 1) (4) Propofol/desflurane (n = 48: 18 women, 30 men) (e) Nausea (d): Figures but no data values reported (more sedated N 2O: not given (f) Time to p < 0.001 for groups 1 and 4) discharge Premedication: alfentanil (e): NS (no data reported) Procedures: knee arthroscopy (f): (1) 168, (2) 55, (3) 56, (4) 46: p < 0.001 for group 1 Age: 18–65 years Martikainen et al., (1) Spinal (n = 55) (a) PONV No significant difference Grade I 2000, 95 Finland (2) Propofol/propofol TIVA (n = 32) (b) Pain Method of randomisation RCT not reported (3) Propofol/isoflurane (n = 38) (c) Satisfaction (subjective) Not blind (4) Propofol/desflurane (n = 48) N 2O: not given Premedication: none Procedures: arthroscopic knee surgery Gender: 50% women Age: 16–65 years Martikainen et al., Same patient group as Martikainen Street fit No difference between Grade I 2000, 95 Finland et al.(2000a) groups 2, 3 and 4 Method of randomisation RCT Group 1 longer; p < 0.01 not reported Not blind Not much detail Poorly reported study continued
TABLE 66 contd Summary of adult clinical outcomes studies © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 Study Investigations and subjects Outcome Results Conclusions and measures grade of evidence Melnick and (1) Isoflurane, no N 2O (n = 30) (a) Drowsiness (a): NS Grade I Johnson, 1987, 96 USA (2) Isoflurane + N 2O (n = 30) (b) PONV (b): (1) 1%, (2) 8%; p < 0.05 Method of randomisation not reported RCT N 2O: given in group 2 Blind Premedication: none Procedures: minor gynaecology Moffat and Cullen, (1) Propofol TIVA,TCI, spontaneous (a) Mini Mental (a): No change Grade II–1a 1995, 97 Scotland ventilation (n = 20) State Examination (MMSE) (b): (1) 15, (2) 8 min Method of randomisation RCT (2) Etomidate, isoflurane, IPPV (n = 20) not reported (b) Time to (c): (1) 17, (2) 11 min; N 2O: given spontaneous p < 0.01 Questionable compareye opening ability of techniques Premedication: none (c) Time to give Opioid: fentanyl on induction correct date of birth Procedures: cataracts Gender: not reported Age: > 60 years Naidu-Sjosvaad (1) Propofol, desflurane (n = 25) (a) Open eyes (a): (1) 504, (2) 744 s; Grade I et al., 1998, 98 p < 0.001 Sweden (2) Propofol, sevoflurane (n = 25) (b) Orientation (b): (1) 526, (2) 818 s; Method of randomisation RCT N2O: not given (c) Sit unaided p < 0.001 not reported Premedication: none (d) DSST (c): (1) 24, (2) 76 min; NS Blind Procedures: videoarthroscopy (knee) (e) Simple (d): No difference reaction time (graph data only) Gender: 22% women (f) Perceptive (e): No difference Age:18–45 years accuracy (graph data only) (f): Group 2 more at 15 and 45 min; p < 0.01 (graph data only) Nathan et al., (1) Alfentanil, sevoflurane, sevoflurane, (a) Subjective (a): Cannot be summarised Grade I 1998, 99 France N 2O (n = 26) views of patients (b) NS Method of randomisation: RCT (2) Alfentanil, propofol, propofol, N 2O ‘sealed envelopes’ (n = 26) (b) PONV Not blind N 2O: given Premedication: lorazepam Procedures: elective termination of pregnancy continued 127
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Which anaesthetic agents are costef
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Which anaesthetic agents are costef
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NHS R&D HTA Programme The NHS R&D H
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Contents Appendix 6 Adult patient-b
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Background The aim of the project w
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• The incidence of PONV was low d
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2 Introduction dizziness or disorie
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4 Introduction a reduced incidence
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6 Introduction willingness to pay f
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8 Literature review included in the
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10 Literature review TABLE 1 Compar
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12 Literature review intermediate a
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18 Literature review Patient-based
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20 Literature review TABLE 5 contd
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22 Literature review No studies fol
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24 Literature review (30%) and meth
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26 Literature review • There are
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28 National survey of anaesthetic p
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36 Economic evaluation methods (inc
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38 Economic evaluation methods The
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40 Economic evaluation methods Tabl
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42 Economic evaluation methods simi
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44 Economic evaluation methods Prob
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Recruitment to the CESA RCT The stu
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Clinical outcome data PONV by anaes
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The findings from the logistic regr
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TABLE 29 The length of stay and pri
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140 120 100 80 60 40 20 0 No. of pa
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250 200 150 100 50 0 No. of patient
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TABLE 37 Deterministic sensitivity
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20 15 10 5 0 -5 Difference in varia
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Patient admitted for day surgery an
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500 400 300 200 100 0 -100 -200 -30
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Recruitment to the CESA RCT The stu
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TABLE 49 The occurrence of any PONV
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60 50 40 30 20 10 0 No. of patients
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a scale effect for scenario A, but
Page 89 and 90: The mean CVs for avoidance of PONV
Page 91 and 92: 1.80 The new variable cost and tota
Page 93 and 94: 100 90 80 70 60 50 40 30 20 10 0 Su
Page 95 and 96: The structure and content of this d
Page 97 and 98: nurses to have an in-depth knowledg
Page 99 and 100: agent used (see appendix 18). It wa
Page 101 and 102: Furthermore, anaesthetists operate
Page 103 and 104: The CESA project was designed to as
Page 105: practice, such as the use of midazo
Page 109 and 110: 1. Royal College of Surgeons of Eng
Page 111 and 112: 60. Cheng KI, Chu KS, Fang YR, Su K
Page 113 and 114: 112. Raeder J, Gupta A, Pedersen FM
Page 115 and 116: 162. Viitanen H, Baer G, Annila P.
Page 117 and 118: 220. Rosenberg KM, Bridge P, Brown
Page 119 and 120: The range of databases interrogated
Page 121: 24. preferen$.mp. [mp=title, abstra
Page 124 and 125: 110 Appendix 2 TABLE 65 contd Summa
Page 126 and 127: 112 Appendix 3 Quality assessment o
Page 173 and 174: TABLE 69 Summary of paediatric pati
Page 175 and 176: TABLE 69 contd Summary of paediatri
Page 177 and 178: TABLE 70 Characteristics of cost or
Page 179 and 180: TABLE 71 Quality of cost or economi
Page 181 and 182: TABLE 71 contd Quality of cost or e
Page 189 and 190: Abbott J, Abbott P. Psychological a
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Hall JE, Stewart JIM, Harmer M. Sin
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Struys M, Versichelen L, Thas O, He
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182 Appendix 11
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184 Appendix 11
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186 Appendix 11
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188 Appendix 11
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The aim of this study was to develo
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anaesthetics in day surgery, using
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© Queen’s Printer and Controller
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Background The empirical study quan
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Satisfaction with care Nearly all (
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TABLE 76 Reason given for preferenc
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TABLE 79 Comparisons with previous
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TABLE 80 Reason given for preferenc
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TABLE 81 Reason given for willingne
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Background Variable costs account f
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TABLE 85 Unit costs for the purchas
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Background The empirical study requ
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Ethical approval This was covered b
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20 15 10 5 0 -5 -10 -15 True weight
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15 10 5 0 -5 -10 True weight - Dion
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224 Appendix 19 • patients aged o
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All staff unit costs were for the y
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Background Fixed costs account for
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232 Appendix 22 March, Tuesday 15 A
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234 Appendix 23 TABLE 96 Reasons fo
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Patients were coded using the OPCS
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Q03.4 punch biopsy of cervix Q03.5
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This section displays the associati
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given in Table 103 confirm the age
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TABLE 107 Occurrence of PONV by dur
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248 Appendix 27 TABLE 113 Frequency
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This section displays the associati
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The adverse events observed in the
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262 Health Technology Assessment Pr
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264 Health Technology Assessment Pr
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