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

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138 Appendix 4 TABLE 66 contd Summary of adult clinical outcomes studies Study Investigations and subjects Outcome Results Conclusions and measures grade of evidence Wetchler et al., Study 1 Study 1 Study 1 Grade I 1992, 136 USA (1) Propofol TIVA (n = 20) (a) PONV (a): (1) 18, (2) 68, (3) 96; (Patton severity p < 0.001 Method of randomisation RCT (2) Propofol, isoflurane (n = 20) score) not reported (b): (1) 32.9, (2) 39.8, (3) Thiopentone, isoflurane (n = 20) (b) Time (3) 49.1 min; p < 0.01 Not blind to sitting N 2O: given independently (c):Values not reported; Very few details of the p < 0.01 trial were reported Premedication: none (c) Tolerance of clear fluids (d): No significant difference Analgesia: fentanyl (d) Trieger (e): No significant difference Procedures; laparoscopy Dot Test Study 2 Age: not reported (e) Aldrete (a): (1) 10%, (2) 42%; p < 0.002 score Study 2 (b): (1) 3%, (2) 29%; p < 0.02 (1) Propofol TIVA (n = 50) Study 2 (a) Nausea (2) Thiopentone, isoflurane (n = 50) (b) Vomiting N 2O: given Analgesia: fentanyl Premedication: none Procedures: not reported Age: not reported Wrigley et al., (1) Propofol/desflurane N 2O (n = 15) (a) Open eyes (a): (1) 8, (2) 8, (3) 9, Grade I 1991, 137 England (4) 6 min; NS (2) Propofol TIVA, N 2O (n = 15) (b) Obey Method of randomisation RCT command (b): (1) 10, (2) 9, (3) 9, not reported (3) Desflurane, desflurane, N 2O (n = 15) (4) 6 min; NS (c) Orientation Blind (4) Desflurane, desflurane, no N 2O (c): (1) 13, (2) 12, (3) 11, (n = 15) (d) Sit/stand (4) 8 min; NS N 2O: given in groups 1–3 (e) Discharge (d): (1) 111, (2) 108, (3) 106, (4) 82 min; NS Premedication: none (f) P-deletion test (e): No difference Procedures: orthopaedic surgery (g) DSST (f): Raw data not given Age: 18–70 years (h) PONV (g): Group 2 worst, group 4 best (h): Desflurane group worse then propofol group (raw data not given) CFFT, critical flicker fusion test; NNT, numbers needed to treat; PACU, postanaesthesia care unit; TCI, target controlled infusion
TABLE 67 Summary of paediatric clinical outcomes studies © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Appendix 5 Health Technology Assessment 2002; Vol. 6: No. 30 Paediatric clinical outcomes studies Study Investigations and subjects Outcome Results Conclusions and measures grade of evidence Ariffin et al., (1) Sevoflurane (n = 40) (a) Loss of (a): (1) 89, (2) 127; p < 0.05 Grade I 1997, 138 UK eyelash reflex (2) Halothane (n = 40) (b): (1) 125, (2) 146; p < 0.05 No details of RCT (b) Loss of randomisation Induction and maintenance jaw tone (c): (1) 167, (2) 102; p < 0.05 Gender and ASA data N 2O: given (c) Eye opening (d): (1) 3, (2) 10; p < 0.05 not given Procedures: dental extractions (d) Nausea Discharge time/intraoperative after discharge and recovery complications: Age: 5–12 years NS Cheng et al., (1) Propofol/ketamine (n = 32) Number of (a): (1) 12/32, (2) 2/28 Grade II–1a 1998, 139 Taiwan patients with: (2) Thiopentone/halothane (n = 28) (b): 1 No details on RCT (a) pain on randomisation N 2O: not given injection (c): 2 No differences were Procedures: herniorrhaphy, (b) apnoea (d): (1) 0, (2) 6; p < 0.05 statistically significant, hydrocelectomy apart from vomiting (c) phlebitis (e): (1) 4, (2) 3 Age: 2–7 years (d) vomiting (e) involuntary movement Crawford et al., (1) Propofol (n = 18) Time (min) to: (a): (1) 6.3, (2) 5.4, (3) 5.4; Grade I 1998, 140 Canada NS (2) Propofol/N 2O (n = 17) (a) extubation No details on RCT (b): (1) 11, (2) 11, (3) 18; randomisation (3) Halothane/N 2O (n = 19) (b) eye opening p < 0.05 vs group 3 Maintenance only (c) obey (c): (1) 13, (2) 12, (3) 21; command p < 0.05 vs group 3 Procedures: minor orthopaedic, urological, general surgical (d) fully awake (d): (1) 21,(2) 21, (3) 35; p < 0.05 vs group 3 Age: 3–12 years (e) discharge (e): (1) 50, (2) 45, (3) 9; NS (f) vomiting in unit (f): (1) 0, (2) 2, (3) 2; NS (g) vomiting (g): (1) 3, (2) 7, (3) 10; after discharge p < 0.05 vs group 1 continued 139
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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
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The mean CVs for avoidance of PONV
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1.80 The new variable cost and tota
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100 90 80 70 60 50 40 30 20 10 0 Su
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The structure and content of this d
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nurses to have an in-depth knowledg
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agent used (see appendix 18). It wa
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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
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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
Page 191 and 192: Hall JE, Stewart JIM, Harmer M. Sin
Page 193: Struys M, Versichelen L, Thas O, He
Page 196 and 197: 182 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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