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

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144 Appendix 5 TABLE 67 contd Summary of paediatric clinical outcomes studies Study Investigations and subjects Outcome Results Conclusions and measures grade of evidence Splinter et al., (1) Halothane/N 2O (n = 158) Vomiting in 13% in both groups Grade I 1995, 158 Canada first 24 h after (2) Halothane/no N 2O (n = 162) surgery RCT Procedures: myringotomy and tube insertion Age: 0.5–13 years Sury et al., (1) Sevoflurane (n = 20) Time (min) to: (a): (1) 7, (2) 15; p = 0.002 Grade I 1996, 13 UK (2) Halothane (n = 20) (a) emergence (b): (1) 12, (2) 19; p < 0.01 RCT N 2O: given (b) discharge (c): (1) 129, (2) 124; NS from recovery Procedures: general, urological, (d): (1) 2, (2) 2; NS plastic, orthopaedic (c) discharge home (e): (1) 1, (2) 0; NS Age: 6 months to 6 years No. of patients (f): Higher in sevoflurane with: group; p < 0.01 (d) vomiting (e) nausea (f) Incidence of pain and need for pain relief Uezono et al., (1) Propofol (n = 8) (a) Extubation (a): (1) 16, (2) 13; NS Grade II–2a 2000, 159 Japan (2) Sevoflurane (n = 8) (b) Eye opening (b): (1) 32, (2) 19; p < 0.05 Small numbers of a Crossover design non-painful procedure Maintenance only (c) PACU (c): (1) 43, (2) 29; p < 0.01 Clearly more rapid N 2O: not given (d) Agitation (d): (1) 0, (2) 6; p < 0.05 emergence with sevoflurane Procedures: eye examination (e) Vomiting (e): (1) 0, (2) 2; NS under anaesthetic (f) Patient (f): (1) 5, (2) 4; p < 0.05 Age: 1–5 years satisfaction score Ved et al., (1) Halothane/halothane (n = 20) (a) Extubation (a): (1) 74, (2) 60, (3) 73, Group I 1996, 160 USA (4) 68; p < 0.2 (2) Propofol/propofol (n = 20) (b) Eye opening Explain concept of true RCT (b): (1) 12, (2) 6, (3) 10, endpoints (= discharge (3) Halothane/propofol (n = 20) (c) PACU (4) 12; p < 0.0002 times or admission rate). No group differences (4) Propofol/halothane (n = 20) (d) Vomiting (c): (1) 15, (2) 7, (3) 12, in these < 6 h (4) 15; p < 0.0001 N 2O: given No details on (e) Vomiting (d): (1) 9, (2) 2, (3) 3, (4) 5; randomisation Procedures: tonsillectomy/ > 6 h p < 0.05 adenoidectomy (e): (1) 4, (2) 3, (3) 4, (4) 4; Age: 3–10 years p = 0.97 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 Viitanen et al., (1) Propofol/sevoflurane (n = 26) Time (min) to: (a): (1) 17, (2) 11; p < 0.0002 Grade I 1999, 161 Finland (2) Sevoflurane/sevoflurane (n = 26) (a) extubation (b): (1) 64, (2) 41; p < 0.05 RCT N 2O: given (b) drinking (c): (1) 75, (2) 70; NS Procedures: adenoidectomy (c) discharge (d): (1) 8, (2) 15; NS Age: 1–3 years Patients with: (e): (1) 19, (2) 38; NS (d) vomiting in (f): Higher in group 2; hospital (%) p = 0.04 (e) delirium (g): (1) 4, (2) 7; NS in hospital (f) pain discomfort scale (g) vomiting postdischarge Viitanen et al., (1) Halothane/sevoflurane (n = 40) (a) Emergence (a): (1) 23, (2) 14; p < 0.0001 Grade I 2000, 162 Finland (2) Induction and maintenance (n = 40) (b) Aldrete (b): (1) 23, (2) 13; p < 0.001 More postoperative RCT score > 10 excitement with N 2O: given (c): (1) 35, (2) 23; p < 0.001 sevoflurane, but difference (c) Interaction not statistically significant Procedures: adenoidectomy (d): (1) 12, (2) 5; p < 0.05 (d) Vomiting Age: 1–3 years (e): No difference (e) Delirium Watcha et al., Induction with N 2O and halothane Time (min) to: (a): (1) 14.7, (2) 9.4, (3) 9.5, Grade I 1991, 163 USA then maintained with: (4) 9.6; p < 0.05 vs group 1 (a) extubation No details on RCT (1) Halothane, N 2O, droperidol (n = 30) (b): (1) 38.4, (2) 25.7, randomisation (b) eye opening (3) 33.4, (4) 25.9; NS (2) Propofol/propofol (n = 30) (c) following (c): (1) 84, (2) 54, (3) 48, (3) Propofol/propofol, N 2O (n = 30) commands (4) 57; p < 0.05, group 3 vs group 1 (4) Propofol/propofol, N 2O, droperidol (d) oral intake (n = 30) (d): (1) 220, (2) 135, (3) 131, (e) ambulation (4) 199; p < 0.05, groups 2 N 2O: given in groups 1,3 and 4 and 3 vs group 1 (f) discharge Procedures: strabismus surgery (e): (1) 247, (2) 175, (3) 190, (4) 218; p < 0.05, group 2 Age: 6 months to 12 years vs group 1 (f): (1) 357, (2) 279, (3) 313, (4) 342; p < 0.05, group 2 vs group 1, and group 2 vs group 4 continued 145
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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
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The CESA project was designed to as
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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
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
Page 205 and 206: The aim of this study was to develo
Page 207 and 208: 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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