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

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156 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 Ratcliff et al, Incidence of Duration of Incidence of emetic Changes in anaesthetic Audit 1994, 192 UK PONV, pain anaesthesia symptoms: 4.2% had practice would seem levels, overnight PONV at more than one to make day-case No significant differences Audit admission, Time to eye assessment while in the laparoscopy a more between groups after patient satis- opening; time day unit. No significant acceptable procedure discharge faction with to discharge differences between than previously day surgery groups for nausea, reported Nausea, nausea and (laparoscopy Postal vomiting or administration vomiting and pain scores or sterilisation) questionnaire of antiemetics. Morbidity: were lower than reported (72 patients) 70% of patients were still in other studies not feeling normal after Self-assessment 2 days. 7.7% would prefer pain-intensity to stay overnight scale Rhodes, Determine Surgical Mean pain scores for Day-care cataract Grade IV 1991, 193 UK current outcome and insertion of local extraction is acceptable anaesthetic frequency of anaesthetic blocks: no to patients. Morbidity Survey design Audit practice for follow-up; significant difference in 47%: minor and selfcataract day questionnaire; between day patients treated. No significant Authors give a summary patients; assess VAS pain score or inpatient groups; difference from the of the questionnaire used. extent of mor- during insertion 47% patients reported inpatient group in Day-care cataract bidity experi- of local intraoperative discomfort either anaesthetic or extraction was acceptable enced by anaesthetic on operating table. surgical complications. to patients. Half of patients patients at home block and Overnight complications: No clear advantage experienced complications intraoperatively 47% day patients; 37.5% between local at home overnight inpatients. No significant anaesthesia alone or difference between groups additional sedation was demonstrated Rudkin et al., Review of the Preoperative Longer patient waiting Impact of different day- Pilot study only: reviewed 1996, 194 influence of waiting time; time in hospital-integrated surgery facility types 3 types of day facility; Australia differently time in recovery facilities using inpatient on efficiency in day- shown to have differing organised room; compli- mixed recovery room surgery care delivered effects on management Pilot study: facilities on cations; follow-up care (144.9 min; median efficiencies and patient prospective patient outcome; information on 125); dedicated day 5% patients reported satisfaction study common trends patient satis- recovery 102.8 min that information given and differences faction (median 95); free-standing about anaesthesia was in eight 72.5 min (median 60.5) poor; 99% patients Australian day- reported that they had surgery facilities received good or satisfactory information Tong et al., Hypothesised Postanaesthesia 5228 patients studied. Dissatisfaction with Grade IV 1997, 196 Canada that satisfaction discharge Telephone interviews with anaesthesia is a with anaesthesia scoring system 52%. Global dissatisfaction: predictor of global Survey Prospective was a predictor 2.5% would decline to dissatisfaction with survey of global satis- Preoperative return to the same unit; ambulatory surgery. The predictors from this faction with data presence of postoperative An increased number study need to be validated ambulatory symptoms, increased of symptoms 24 h after by a second data set from surgery and dissatisfaction.Variables operation is a predictor another centre. However, that 24 h post- associated with global of dissatisfaction with the validity of the questions operative dissatisfaction (68/2730): anaesthesia.The rate, was established in a symptoms were 18 had personal pref- however, is low previous study a predictor of erence for inpatient care; satisfaction with 3 had adverse outcomes; The rate of global anaesthesia 6 had postoperative dissatisfaction and symptoms dissatisfaction with anaesthesia was found to be low 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 Tzabar et al., General Cognitive failure Mean preanaesthetic Cognitive failure Grade IV 1996, 197 UK anaesthesia questionnaires: score: general anaesthesia, questionnaire. In a (54 patients) 25 questions 35.2 (p < 0.01); local 3-day period after Duration of impairment Comparative vs local about lapses anaesthesia, 33 discharge, patients could not be assessed; study anaesthesia 3 days before undergoing general procedures were not (30 patients) admission and Mean postanaesthetic anaesthesia experienced equal between general 3 days after score: general anaesthesia, a significant increase anaesthesia and local discharge 38.6; local anaesthesia, in cognitive failures anaesthesia; bias of non 31 (NS) relating to preoperative responders baseline scores and to patients who underwent local anaesthesia Winwood, Propofol Anxiety assessed Preoperative STAI: Propofol produced Grade 1. Single blind. 1993, 198 UK induction 1 h before propofol, 36.64; statistically lower levels Small numbers (25 patients) induction and thiopentone, 37.56 (NS) of anxiety when RCT at 30 min and compared with Thiopentone 1,2 and 4 h Postoperative 30 min STAI: thiopentone induction postoperatively propofol, 28.68; (25 patients) on STAI thiopentone, 36.88 (p < 0.0002) Postoperative 1 h STAI: propofol, 25.44; thiopentone, 36.44 (p < 0.0001) Postoperative 2 h STAI: propofol, 25.40; thiopentone, 34.40 (p < 0.0006) Postoperative 4 h STAI: propofol, 26.40; thiopentone, 34.72 (p < 0.0007) IQR, interquartile range; ODU, operating department assistant; PACU, postanaesthesia care unit; SHO, senior house officer; SpR, specialist registrar 157
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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
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112. Raeder J, Gupta A, Pedersen FM
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162. Viitanen H, Baer G, Annila P.
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220. Rosenberg KM, Bridge P, Brown
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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
Page 215 and 216: Satisfaction with care Nearly all (
Page 217 and 218: TABLE 76 Reason given for preferenc
Page 219 and 220: 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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