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

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162 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) Vernon et al., General anxiety Posthospital Age, duration of The combination of Grade IV 1966, 208 USA and regression; behaviour hospitalisation and illness and hospitalis- separation questionnaire: occupational status were ation is a psycho- Descriptive study Descriptive anxiety; anxiety parents significantly related to logically upsetting study about sleep; compared their one or more types of experience for children Satisfactory data. Looked at eating disturb- child’s typical responses. Gender, in general, resulting in the hypothesis that children ance; aggression behaviour previous hospitalisation, increased separation aged 6 months and 4 years towards before degree of pain experi- anxiety, increased sleep are most likely to be upset authority; hospitalisation enced during hospital- anxiety and increased following hospitalisation. apathy– with their isation and birth order aggression toward Significant findings were withdrawal behaviour were unrelated to any authority associated with length of during the first type of response by hospitalisation. High rate 387/800 (48%) week after any analysis of non-responders (52%) of questionnaires hospitalisation were returned and useable Westerling, Evaluation of The TAS Children understood the The TAS is easy to Grade IV 1999, 209 USA whether it is consists of nine principle of the TAS; five explain to children and possible to bright red children could not rate is easy to use. Ratings Further validation is needed Prospective quantitate wooden balls either nausea or pain at ranging from light of this tool for assessing study postoperative their first attempt discomfort to severe postoperative pain and the pain and nausea Postoperative postoperatively, due to pain were made by efficacy of given treatments by using the TAS pain and nausea distress or restlessness 49 children; one child in 50 children were evaluated had no pain aged 4–12 years by means of the who were TAS every hour, undergoing 3–4 times ophthalmic before discharge surgery Wilson and Assessment of Pain scores: (1) Objective pain scores, Study showed a high Grade IV Doyle, 1996, 210 the suitability of objective pain range 0 to 8; numerical degree of correlation Canada use by parents score; (2) VAS; scale scores, range 0–3; between the assess- Parents are able to carry of three pain (3) four-point VAS scores, range 0–99. ments performed out pain assessments.Two Descriptive assessment numerical scale Correlation coefficients simultaneously by types of surgical procedure study scores com- for parental and medical an observer and were chosen: one where a monly used pain scores in recovery: the parent regional block was used (i.e. in paediatric objective pain scores, where pain is minimal); one anaesthesia 0.77; four-point numerical where a regional technique (40 children) scores, 0.70;VAS scores, is unsuitable.Teaching of 0.69. Correlation co- parents how to carry out efficients 1 h after leaving recovery area: objective pain assessments pain scores, 0.81;four-point numerical scores, 0.80; VAS scores, 0.73 (p < 0.01). In 80 simultaneous observations of each kind made by an observer and the parents, 44 (55%) of the objective pain scores, 49 (61%) of the four-point numerical scores, and 42 (52.5%) of the VAS-scores were identical within 10 min
TABLE 70 Characteristics of cost or economic comparisons of anaesthetic agents © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Appendix 8 Health Technology Assessment 2002; Vol. 6: No. 30 Characteristics of cost or economic comparisons of anaesthetic agents Authors Year of Country of Type of Alternatives compared No. of publication study study * subjects Alhashemi et al. 29 1997 Canada Economic Thiopentone/isoflurane 31 Propofol/alfentanil 31 Propofol/propofol 31 Churnside et al. 23 1996 UK Audit Surgical procedures 175 Dexter and Tinker 40 1995 USA Cost Cost impact of reducing adverse anaesthetic outcomes 1884 Enlund et al. 174 1996 Sweden Economic Thiopentone 19 Propofol 20 Fleischmann et al. 212 1999 Austria Cost– Sevoflurane, re-breathing bag 20 consequences Sevoflurane, circle system 20 Propofol, i.v. bolus 20 Thiopentone, i.v. bolus 20 Halberg et al. 213 1996 USA Cost Propofol 84 Isoflurane 23 Desflurane 43 Heidvall et al. 28 2000 Sweden Economic Propofol/sevoflurane 25 Propofol/propofol + alfentanil 25 Propofol/propofol + remifentanil 25 Hsu and 1995 Canada Economic Thiopentone 22 Shalansky 214 Propofol 52 Jakobsson et al. 84 1997 Sweden Economic Propofol maintenance 40 Desflurane maintenance 40 Kain et al. 215 1994 USA Cost– Propofol ? consequences Thiopentone/pentobarbitone ? Killian et al. 86 1992 Canada Economic Propofol TIVA 33 Thiopentone/isoflurane 30 Kurpiers et al. 216 1996 USA Cost Desflurane 27 Propofol 26 Meyer-McCright 1998 USA Cost Thiopentone/isoflurane 13 et al. 217 Propofol/isoflurane 126 Propofol/desflurane 55 Nathan et al. 99 1998 Canada Economic Sevoflurane 26 Propofol 26 Patel et al. 218 1996 USA Effectiveness Anaesthetic procedures, addition of desflurane to formulary 1568 Reis et al. 219 1999 Canada Cost– Isoflurane 20 consequences Sevoflurane 20 Rosenberg et al. 220 1994 USA Cost Propofol 25 Desflurane 25 Smith and 1999 UK Cost– Sevoflurane 30 Thwaites 125 consequences Propofol 31 continued 163
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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
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110 Appendix 2 TABLE 65 contd Summa
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Page 173 and 174: TABLE 69 Summary of paediatric pati
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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
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Page 223 and 224: TABLE 81 Reason given for willingne
Page 225 and 226: 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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