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

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242 Appendix 26 TABLE 98 Occurrence of any PONV by randomisation group and gender in the adult study No. of patients Propofol/ Propofol/ Propofol/ Sevoflurane/ Total propofol isoflurane sevoflurane sevoflurane Men Total 66 (100%) 72 (100%) 70 (100%) 61 (100%) 269 (100%) Nausea or vomiting – no 65 (98.5%) 72 (100%) 68 (97.1%) 54 (88.5%) 259 (96.3%) Nausea or vomiting – yes 1 (1.5%) 0 (0%) 2 (2.9%) 7 (11.5%) 10 (3.7%) Women Total 201 (100%) 197 (100%) 207 (100%) 187 (100%) 792 (100%) Nausea or vomiting – no 165 (82.1%) 148 (75.1%) 163 (78.7%) 119 (63.6%) 595 (75.1%) Nausea or vomiting – yes 36 (17.9%) 49 (24.9%) 44 (21.3%) 68 (36.4%) 197 (24.9%) χ 2 :men,p < 0.004; women, p < 0.001 TABLE 99 Occurrence of PONV by age quartile in the adult study No. of patients Quartile 1 Quartile 2 Quartile 3 Quartile 4 Total Total 264 (100%) 266 (100%) 266 (100%) 265 (100%) 1061 (100%) Nausea or vomiting – no 180 (68.2%) 200 (75.2%) 225 (84.6%) 249 (94.0%) 854 (80.5%) Nausea or vomiting – yes 84 (31.8%) 66 (24.8%) 41 (15.4%) 16 (6%) 207 (19.5%) TABLE 100 Occurrence of PONV by age quartile (total study population) and gender in the adult study No. of patients Quartile 1 Quartile 2 Quartile 3 Quartile 4 Total Men Total 50 (100%) 53 (100%) 50 (100%) 116 (100%) 269 (100%) Nausea or vomiting – no 46 (92.0%) 52 (98.1%) 47 (94.0%) 114 (98.3%) 259 (96.3%) Nausea or vomiting – yes 4 (8.0%) 1 (1.9%) 3 (6.0%) 2 (1.7%) 10 (3.7%) Women Total 214 (100%) 213 (100%) 216 (100%) 149 (100%) 792 (100%) Nausea or vomiting – no 134 (62.6%) 148 (69.5%) 178 (82.4%) 135 (90.6%) 595 (75.1%) Nausea or vomiting – yes 80 (37.4%) 65 (30.5%) 38 (17.6%) 14 (9.4%) 197 (24.9%) χ 2 :men,p > 0.1 (linear trend); women,p > 0.001 (linear trend) TABLE 101 Occurrence of PONV by broad surgical procedure categories and gender in the adult study No. of patients Women, Men, Women, Women, Men, Total general general gynaecology orthopaedic orthopaedic Total 77 (100%) 184 (100%) 684 (100%) 31 (100%) 85 (100%) 1061 (100%) Nausea or vomiting – no 65 (84.4%) 178 (96.7%) 506 (74.0%) 24 (77.4%) 81 (95.3%) 854 (80.5%) Nausea or vomiting – yes 12 (15.6%) 6 (3.3%) 178 (26.0%) 7 (22.6%) 4 (4.7%) 207 (19.5%) χ 2 : p < 0.001
given in Table 103 confirm the age trends within general surgery and gynaecology. The number of women undergoing orthopaedic surgery was too small to characterise any trend, should one be present. The numbers in the various categories become too small to discern any clear pattern for two or more episodes of vomiting. Recovery of awareness Table 104 shows that patients deemed to be agitated on recovering awareness after anaesthesia were much more likely to suffer PONV (43%) than those who were alert (14%) or drowsy (25%). A similar pattern occurs when one or more episodes of vomiting is considered, but the heterogeneity is compatible with being a chance effect (p > 0.5). © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 TABLE 102 Occurrence of one or more episodes of vomiting by broad surgical procedure categories and gender in the adult study No. of patients Women, Men, Women, Women, Men, Total general general gynaecology orthopaedic orthopaedic Total 77 (100%) 184 (100%) 684 (100%) 31 (100%) 85 (100%) 1061 (100%) One or more episodes of vomiting – no 72 (93.5%) 183 (99.5%) 640 (93.6%) 27 (87.1%) 84 (98.8%) 1006 (94.8%) One or more episodes of vomiting – yes 5 (6.5%) 1 (0.5%) 44 (6.4%) 4 (12.9%) 1 (1.2%) 55 (5.2%) χ 2 : p < 0.001 ASA grade Consideration of the ASA grade (Table 105) shows increased occurrence of PONV among patients in ASA grade 1. There is no discernible pattern when one or more episodes of vomiting is considered. For one or more episodes of vomiting there is no discernible pattern. Previous anaesthetic experience Patients reported a mean of 3.2 previous anaesthetic experiences (median, 2.0; SD, 3.8; range, 0–41). There was no difference between randomised groups. Table 106 shows that the occurrence of PONV was not strongly enough associated with the number of previous anaesthetics received by the patients to yield a TABLE 103 Occurrence of PONV among women by surgical procedure and age quartile in the adult study No. of patients Quartile 1 Quartile 12 Quartile 13 Quartile 14 Total General Total 16 (100%) 8 (100%) 19 (100%) 34 (100%) 77 (100%) Nausea or vomiting – no 12 (75.0%) 6 (75.0%) 15 (78.9%) 32 (94.1%) 65 (84.4%) Nausea or vomiting – yes 4 (25.0%) 2 (25.0%) 4 (21.1%) 2 (5.9%) 12 (15.6%) Gynaecology Total 193 (100%) 197 (100%) 188 (100%) 106 (100%) 684 (100%) Nausea or vomiting – no 117 (60.6%) 137 (69.5%) 155 (82.4%) 97 (91.5%) 506 (74.0%) Nausea or vomiting – yes 76 (39.4%) 60 (30.5%) 33 (17.6%) 9 (8.5%) 178 (26.0%) Orthopaedics Total 5 (100%) 8 (100%) 9 (100%) 9 (100%) 31 (100%) Nausea or vomiting – no 5 (100%) 5 (62.5%) 8 (88.9%) 6 (66.7%) 24 (77.4%) Nausea or vomiting – yes 0 (0%) 3 (37.5%) 1 (11.1%) 3 (33.3%) 7 (22.6%) Tests for linear trend by age: general,p < 0.07; gynaecology,p < 0.001;orthopaedics,p > 0.6 243
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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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112 Appendix 3 Quality assessment o
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TABLE 69 Summary of paediatric pati
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TABLE 69 contd Summary of paediatri
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TABLE 70 Characteristics of cost or
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TABLE 71 Quality of cost or economi
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TABLE 71 contd Quality of cost or e
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Abbott J, Abbott P. Psychological a
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Hall JE, Stewart JIM, Harmer M. Sin
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Struys M, Versichelen L, Thas O, He
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182 Appendix 11
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184 Appendix 11
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186 Appendix 11
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188 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
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
Page 221 and 222: TABLE 80 Reason given for preferenc
Page 223 and 224: TABLE 81 Reason given for willingne
Page 225 and 226: Background Variable costs account f
Page 227 and 228: TABLE 85 Unit costs for the purchas
Page 229 and 230: Background The empirical study requ
Page 231 and 232: Ethical approval This was covered b
Page 233 and 234: 20 15 10 5 0 -5 -10 -15 True weight
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Page 238 and 239: 224 Appendix 19 • patients aged o
Page 241 and 242: All staff unit costs were for the y
Page 243: Background Fixed costs account for
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Page 248 and 249: 234 Appendix 23 TABLE 96 Reasons fo
Page 251 and 252: Patients were coded using the OPCS
Page 253 and 254: Q03.4 punch biopsy of cervix Q03.5
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Page 262 and 263: 248 Appendix 27 TABLE 113 Frequency
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Page 267 and 268: The adverse events observed in the
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