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

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160 Appendix 7 TABLE 69 contd Summary of paediatric patient-based outcomes studies Study Investigations Outcome Results Conclusions and Reviewers’ comments and subjects measures grade of evidence (grade of evidence and checklist criteria) Kotiniemi et al., Intravenous PHBQ: parents Problematic changes Children who received Grade I 1996, 201 Finland thiopentone evaluated were detected in 17 halothane behaved (29 patients) changes in their (59%) children receiving more calmly, but had Small numbers; problematic RCT child’s behaviour thiopentone, 14 (50%) significantly more changes not significant Inhalational at 1 day, 1 week children receiving negative memories halothane and 1 month halothane and 17 (58%) of the induction of (28 patients) children receiving anaesthesia (halothane methohexitone (NS) group, 6 children; Rectal thiopentone group, methohexitone There were no statistically 2; methohexitone (29 patients) significant differences group, 1) between the groups in the proportion of children who showed postoperative behavioural problems Kotiniemi et al., Evaluation Preoperative There were no problems Age of child, pain at Grade IV 1997, 202 Finland of type and questionnaire in cooperation in 423 home and previous occurrence of was adapted (81%) subjects during difficult experience Descriptive survey; not a Descriptive changes in from the PHBQ premedication and in 323 of healthcare were randomised comparison, study children’s (61%) during anaesthetic predictors of so no conclusions can be behaviour PHBQ carried induction.There were problematic behavioural drawn about different during the first out post- more problematic changes changes at home. anaesthetic techniques 4 weeks after operatively; at day 0 (p < 0.001), while Gender and previous day surgery behaviour the difference at week 4 operations did not have Behaviour changes are seen assessed using was not significant a significant effect on in children who have mild a 4-point scale (p = 0.9). Pain was the incidence of changes. pain at home and severe only postoperative The results emphasise pain plus a previous bad symptom mentioned in the importance of the experience of healthcare the questionnaire that effective prevention of which has adversely affected significantly affected the postoperative pain. It the attitude of the child occurrence of behaviour is important to avoid towards doctors or nurses changes unpleasant experiences in all contacts that children have with healthcare Payne et al., Oral A posthospital Changes in behaviour Midazolam Grade I 1992, 203 trimeprazine, behaviour reported in 78% of premedication via the South Africa methadone questionnaire subjects. Use of oral or i.m. routes RCT, single blind and droperidol (not the PHBQ) premedication showed provides benefit to RCT (31 patients) on two little benefit. General a child in that some No indication of how publications. anxiety – night crying behavioural changes behaviour changes were Oral midazolam Assesses was seen in 10 children on returning home are assessed; difficult to assess (30 patients) behaviour receiving i.m. midazolam decreased in frequency whether the medication had changes in (p < 0.05), 39 receiving and severity. Pharma- an effect on a child’s Intramuscular six categories oral midazolam (p < 0.05), cological premedication behaviour midazolam 20 controls and 16 alone is poor (31 patients) receiving trimeprazine, protection against a methadone and child’s behavioural Controls droperidol problems caused by (31 patients) a theatre experience continued
TABLE 69 contd Summary of paediatric 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 (grade of evidence and checklist criteria) Scaife and Day patients Five-point scale There were few significant The results show Grade I Campbell, (34) vs using various differences in the magni- trends in favour of 1988, 204 UK inpatients (27) descriptors, tude or direction of day procedures; the RCT, no blinding derived from a change between the day- argument is made that RCT Children’s standardised patient and inpatient day procedures should No significant changes in behaviour behaviour groups; no significant be the preferred option behaviour between day screening device. differences were found for minor surgery in patients and inpatients. Parents rated between day patients and young children Difficult to draw a their own inpatients on the post- conclusion subjective discharge ratings or at anxiety about 3 months follow-up different aspects Selby et al., 266 children PONV, sore PONV 53%, sore throat Personal interviews Unrepresentative sample, 1996, 205 UK (aged 5 years throat, visual 31%, visual disturbance with children revealed as only 10% of the sample and over) were disturbance, 25%, headache 19%, a higher incidence of agreed to be interviewed. Descriptive interviewed by headache, shivering 13%, bad minor morbidity However, the results survey an anaesthetist shivering, dreams 4% following day surgery were significant about minor bad dreams than had been sequelae after previously reported day surgery. 10% of patients were interviewed Sikich et al., Evaluation Postal Extreme concern 5% of parents expected Grade IV 1997, 206 Canada of parental questionnaire expressed for pain (45.5%). their child to be active perceptions, 28.7% had postoperative and alert in the first Survey design Survey expectations vomiting. Pain vs sleepi- 24 h after surgery; and preferences ness, p < 0.0001; pain vs 22.8% preferred Unclear what questions for post- vomiting, p < 0.02 quicker postanaesthetic were asked in the anaesthetic recovery; speed of questionnaire recovery of discharge was not a children priority for parents; parents were concerned about postoperative pain and postoperative vomiting Tarbell et al., Evaluation of TPPPS and a Scores on the TPPPS were The TPPPS was found Grade IV 1992, 207 USA the reliability VAS scale in the range 0–7. The to have satisfactory and validity of variability in the TPPPS internal reliability.The Observational study Observational the TPPPS scores appears acceptable inter-rater reliability study in spite of the negative was good, with κ values Further study is indicated skew, given that the for pain behaviour to specifically control for surgical procedures evalu- items ranging from analgesic factors that may ated were not the most 0.53 to 0.78 have complicated the painful procedures that interpretation of the TPPPS a young child may undergo. scores (e.g. the sedative Inter-rater reliability checks properties of analgesic were conducted for 38% medications) of children continued 161
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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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The range of databases interrogated
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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: TABLE 69 Summary of paediatric pati
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
Page 209: © Queen’s Printer and Controller
Page 213 and 214: Background The empirical study quan
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Page 217 and 218: TABLE 76 Reason given for preferenc
Page 219 and 220: TABLE 79 Comparisons with previous
Page 221 and 222: TABLE 80 Reason given for preferenc
Page 223 and 224: 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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