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

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150 Appendix 6 TABLE 68 contd Summary of adult patient-based outcomes studies Study Investigations Outcome Results Conclusions and Reviewers’ comments and subjects measures grade of evidence Ghosh and Patient Self-administered Patient satisfaction: 52% Patients are satisfied Grade IV. Higher response Sallam, 1994, 178 satisfaction questionnaire were impressed by first with their treatment; rate; difficult to assess UK following day (rating: area for class service at their contact with GP due questionnaire, as it is not surgery concern; outpatient visit; 6% were to problems with stated how the questions Descriptive (953/557 borderline; concerned; 62% felt that pain management. were asked survey (58.4%)) reserved the information given was Day surgery provides satisfaction; first class compared with satisfaction for the first class) 8% who were concerned. majority of patients; 2.5% contacted the does not produce hospital 24 h after their undue extra demands operation; 4.3% contacted on community services their GP Gnanalingham Hernia repair Interview either 91% of patients fit for A small minority of Grade IV and Budhoo, under local at hospital or local or general anaesthesia patients preferred day 1998, 179 UK vs general by telephone preferred day surgery; 20% case hernia surgery; Patients interviewed anaesthesia had no preference for there was a greater preferred general Questionnaire type of anaesthesia; 33% preference for general anaesthesia (47%). 91% of survey Patients’ had a strong preference anaesthesia as the patients preferred day-case willingness to for local anaesthesia; 47% mode of anaesthesia. hernia repair. Patients were have day-case had a strong preference Authors felt that local young in comparison to hernia repairs for general anaesthesia. anaesthesia is desirable those opting for inpatient under local Preference for general and anxiety of patients surgery (p < 0.05) or general anaesthesia associated regarding local anaes- anaesthesia with previous adverse thesia should be experiences with local reduced for a anaesthesia and an greater acceptability ‘assumed feeling of anxiety’ if awake during surgery Gupta et al., Arthroscopy (1) Trieger Surgery was longer the in P-deletion test not Grade I 1995, 78 Sweden Dot Test propofol group than the sensitive enough;Trieger (1) Propofol isoflurane group (p < 0.05); Dot Test was sensitive, Double-blind; the two RCT (24 patients) (2) P-deletion no significant difference but interpretation was outcome measures test (modified between groups in the subjective.There was (P-deletion test and Trieger (2) Isoflurane in version, Sweden, six variables studied or no difference in early Dot Test) were not suitable. O 2 (26 patients) found not to be in total mood score. recovery following Due to surgery being sensitive enough) Incidence of nausea and anaesthesia with longer in the propofol vomiting was 15% in propofol or isoflurane. group, the dose of alfentanil (3) Mood isoflurane group and Psychomotor recovery administered was greater. (MACL) 4% in propofol group was quicker following No difference in early isoflurane anaesthesia. recovery following (4) VAS pain Discharge times were anaesthesia with propofol scores similar in the two or isoflurane groups Gupta et al., (1) Propofol (1) Finger Mood: calmness p < 0.05 Desflurane is a useful Grade I 1996, 79 Sweden induction; Tapping Test isoflurane vs desflurane; alternative to isoflurane, maintained with Finger Tapping Test, no but offers no clear Unblinded; small groups; no RCT desflurane in (2) Perception changes in baseline values advantage when used difference in psychomotor O 2 and N 2O (PAT) in desflurane group; in for maintenance of recovery using PAT and (25 patients) isoflurane group there anaesthesia for Finger Tapping Test.The VAS (3) Mood was significant impairment operations of for mood was not validated (2) Propofol (MACL) at 30 and 60 min short duration (translated from English induction; to Swedish) maintained with isoflurane in O 2 and N 2O (25 patients) continued
TABLE 68 contd Summary of adult patient-based outcomes studies © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 Study Investigations Outcome Results Conclusions and Reviewers’ comments and subjects measures grade of evidence Harju, 1991, 180 Examination of Postal survey; Before treatment: Day surgery has had Grade IV Finland patient type of questions patient satisfaction 74%, a positive effect on satisfaction with asked unclear indifferent 4%, negative surgical patient Survey Postal survey hospital services 6%, 16% did not answer satisfaction; an among patients question. Satisfaction important improvement Availability of surgery treated in improved among those was increased surgical influenced patient day surgery patients who had negative/ availability satisfaction; preferred indifferent or no opinion waiting time 8–10 weeks. at all before treatment Unclear; 3 months prior to surgery, but must have surveyed patients after operation Hawksworth, Pilot study: Willingness No definite difference Pilot study.Authors felt Grade IV 1996, 21 UK (18 anaes- to pay could be shown in that it would be feasible thetists, willingness-to-pay to do a similar study Pilot study only Descriptive 9 ODAs; valuations of the benefits on day-surgery patients. study 8 recovery described, except in those Three ethics Willingness-to-pay values nurses) participants who had not committees rejected are arbitrary had a general anaesthetic. the study on the Anaesthetists and ODAs grounds that the placed a higher value on willingness-to-pay effective anti-emesis, while technique was too recovery nurses did not sensitive politically Hunter et al., Incidence of Self-administered Enflurane: increase in Minor morbidity after Grade IV 1998, 181 UK problems such questionnaire nausea and vomiting day surgery is common; as pain, head- and pain (p < 0.01). 40% developed pain Descriptive survey, showing Descriptive ache, nausea and Droperidol: increase after discharge, which scope for improvement in study or vomiting. in pain (p < 0.05) reflects the short-acting area of anti-emesis and Effectiveness of nature of opioid postoperative analgesia self-medication 52.3% experienced analgesics. Scope for in day patients symptoms relating to the improvement in area 24 h after operation; 33.3% self- of anti-emesis and anaesthesia administered simple postoperative analgesia (553/635 analgesics; 80.9% felt this patients (87%)) was adequate; 5.6% who were concerned following day surgery sought GP advice; 2.2% visited their GP. 47% of respondents judged their immediate postoperative care to be worse than expected, 8% judged it to be better continued 151
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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
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1. Royal College of Surgeons of Eng
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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
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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Page 213 and 214: 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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