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

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140 Appendix 5 TABLE 67 contd Summary of paediatric clinical outcomes studies Study Investigations and subjects Outcome Results Conclusions and measures grade of evidence Davis et al., (1) Desflurane (n = 22) Time (min) to: (a): (1) 21, (2) 29; NS Grade I 1994, 142 USA (2) Halothane (n = 23) (a) discharge (b): (1) 76, (2) 68; NS Small numbers RCT recovery Maintenance only (c): (1) 50, (2) 21; p = 0.09 No differences were (b) discharge statistically significant N 2O: given home (d): (1) 13.6, (2) 13; NS Procedures: inguinal hernia repair, % Patients with: (e): (1) 0, (2) 4.3; NS orchidopexy, circumcision (c) delirium Mean ± SD age: 3 ± 2 years (d) PONV (e) airway problems Davis et al., (1) Remifentanil (n = 62) Time (min) to: (a): (1) 10, (2) 10, (3) 10, Grade I 1997, 141 USA (4) 11.5; NS and Canada (2) Alfentanil (n = 19) (a) extubation PONV was not (b): (1) 10, (2) 6, (3) 9, statistically significantly RCT multicentre (3) Isoflurane (n = 22) (b) first (4) 11.5; NS different for the four movement groups, but the PONV (4) Propofol (n = 20) (c): (1) 139, (2) 140, (3) 141, rate was high overall, due (c) discharge (4) 123; NS to the surgical procedure N 2O: given home (d): (1) 31, (2) 26, (3) 32, Procedures: strabismus surgery % Patients with: (4) 30; NS Age: 2–12 years (d) vomiting (e): (1) 12, (2) 0, (3) 5, (4) 0; NS (e) bradycardia (f): (1) 0, (2) 21, (3) 0, (4) 0; (f) postoperative p < 0.05 hypoxaemia Group 1 compared with group 2 Greenspun et al., (1) Sevoflurane (n = 21) Time (min) to: (a): (1) 1, (2) 1.4; p < 0.0002 Grade I 1995, 143 USA (2) Halothane (n = 18) (a) induction (b): (1) 7.1, (2) 9.6; p < 0.04 Small numbers RCT N 2O: given (b) emergence (c): (1) 19.9, (2) 31.1; p < 0.0003 Procedures: ENT (c) recovery (d): (1) 143.7, (2) 134.7; NS Age: 1–12 years (d) discharge (e): (1) 33, (2) 38; NS (e) PONV (%) Gurkan et al., (1) Propofol (n = 20) (a) Vomit (a): (1) 5, (2) 13; p < 0.05 Grade I 1999, 144 Turkey (2) Sevoflurane (n = 20) (b) Total vomit (b): (1) 0.3, (2) 1.7; p < 0.01 Discharge times and RCT admission rates not N 2O: given (c) Anti-emetic (c): (1) 1, (2) 9; p < 0.05 measured Tx Procedures: strabismus surgery (d): (1) 2, (2) 1; p < 0.05 (d) Oculocardiac Age: 3–15 years continued
TABLE 67 contd Summary of paediatric 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 Hamunen et al., (1) Thiopentone/isoflurane (n = 30) (a) Vomiting (%) (a): (1) 37, (2) 29, (3) 33; NS Grade I 1997, 145 Finland (2) Propofol 5 mg/kg (n = 29) (b) Time to first (b): (1) 427, (2) 393, (3) 434; Patients stayed overnight RCT emesis (min) NS after surgery (3) Propofol 10 mg/kg (n = 31) N 2O: given Procedures: strabismus surgery Age: 5–14 years Hannallah et al., (1) Propofol/propofol (n = 25) Time (min) to: (a): (1) 9, (2) 7, (3) 11, Grade I 1994, 146 USA (4) 11;NS (2) Propofol/halothane (n = 25) (a) extubation No details on RCT (b): (1) 22, (2) 29, (3) 36, randomisation (3) Thiopentone/halothane (n = 25) (b) recovery (4) 31;NS (4) Halothane/halothane (n = 25) (c) discharge (c): (1) 101, (2) 133, (3) 127, (4) 144; p < 0.05 (group 1 N 2O: given (d) PONV compared with groups 2, (hospital) (%) 3 and 4) Procedures: eye, plastic, dental, urology (e) PONV (d): (1) 4, (2) 24, (3) 24, Age: 3–12 years (home) (%) (4) 48; p < 0.05 (group 1 compared with groups 2, 3 and 4) (e): (1) 4, (2) 9, (3) 17, (4) 0; p < 0.05 (group 4 compared with groups 1,2 and 3) Johannesson et al., (1) Halothane (n = 18) Time (min) to: (a): (1) 8.8, (2) 6.8; p < 0.001 Grade I 1995, 147 Sweden (2) Sevoflurane (n = 22) (a) intubation (b): (1) 17, (2) 12; NS Difference in excitement RCT reported, patients N 2O: given (b) response (c): (1) 89, (2) 86; NS receiving sevoflurane post- had higher levels of Procedures: ENT operatively (d): (1) 25, (2) 9; NS excitement Age: 1.1–7.5 years (c) discharge (d) PONV (%) Kotiniemi and Comparison of induction methods: Time (min) (a): (1) 6.3, (2) 7.8, (3) 14.8; Grade II–1a Ryhanen, 1996, 148 from: p < 0.001 Finland (1) Intravenous (thiopentone) (n = 29) (See also appendix 7) (a) arrival to (b): (1) 1.7, (2) 3.8, (3) 9.0; RCT (2) Inhalational (halothane) (n = 28) surgery p < 0.001 No differences found (3) Rectal (methohexitone) (n = 29) (b) induction to (c): (1) 3.5, (2) 3.6, (3) 5.1; surgery p = 0.012 N 2O: given with halothane maintenance (c) emergence PONV in hospital: 15% Procedures: ENT to recovery room discharge PONV postdischarge: 27% Mean ± SD age: 4 ± 1.2 years Mild pain at home on day of operation: 52% Pain lasting > 24 h: 18% Sleepy on day of operation: 69%; no differences between groups continued 141
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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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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
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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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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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