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

More documents

Recommendations

Info

20 Literature review TABLE 5 contd Summary of outcome measures in the reviewed literature Outcome measure Description Studies Objective pain score A pain score based on observations of behaviour Wilson and Doyle, 1996 210 and features of facial expression such as crying, movement, agitation, posture and verbal. Following observation, a score of 0–2 is given Four-point numerical A pain score based on a four-point self Likert Wilson and Doyle, 1996 210 pain scale scale, where 0 = no pain, 1 = mild pain, 2 = moderate pain and 3 = severe pain Trieger Dot Test The subject joins together a dotted line, which is Gupta et al., 1995 78 represented in the form of a figure.The test is performed preoperatively and at 30 and 60 min after the end of anaesthesia.The score is the number of dots missed Preoperative anxiety A 100 mm non-graduated VAS graded from not Brandner et al., 1997 170 score (VAS) anxious at all (0 mm) to very anxious (100 mm) Anxiety State–Trait Anxiety Inventory. This study used the Winwood, 1993 198 state form only.The questionnaire contained 20 statements, evenly divided between anxietypresent and anxiety-absent items Hall and van der Castle Any of the following feelings present: angry, Brandner et al., 1997 170 Emotions Scale apprehensive, happy, sad and confused (with ‘sexual feelings’ added by authors) Bodily and biological Experienced any of the following: sick, hungry, Brandner et al., 1997 170 states high, sedated, dizzy, light-hearted (with ‘headache’ added by authors) Aldrete recovery score A postanaesthesia recovery score looking at: Philip et al., 1996 108 activity, respiration, circulation, consciousness and colour. A rating of 0, 1 or 2 is given to each sign, with a score of 10 indicating a patient in the best possible position Postoperative clinical Simple descriptions of clinical outcomes: nausea; Macario et al., 1999 186 anaesthesia outcomes recall without pain; gagging on endotracheal tube; shivering; vomiting; residual weakness; somnolence; sore throat; normal; pain Quality of recovery A 40-item quality of recovery score; identified to Myles et al., 2000 187 score (QoR-40) represent aspects of good-quality recovery after anaesthesia and surgery. Evaluated at: emotional stage; physical comfort; psychological support; physical independence; pain Contingent valuation The degree of preference for one alternative Hawksworth, 1996; 21 Elliott et al., 2000 33 healthcare intervention is valued using willingness to pay.This equates to the maximum amount of money that must be taken from an individual to equalise a utility change Short Form with A generic quality of life questionnaire with Baker et al., 1995 167 36 items (SF-36) eight domains
16 years of age. The study validated this questionnaire and the initial results suggested that patient satisfaction is most affected by age, gender and type of surgical procedure. During 1991–92 the questionnaire was used in 1741 day-surgery patients undergoing day surgery at 11 hospitals in England. Issues relating to anaesthesia included in the questionnaire were: satisfaction with 17 specific aspects of care (not detailed), pain during the first 24 hours, time taken convalescing, impact on activities of daily living, effect of the operation on day-to-day life, speed of recovery, readmission, and use of ambulatory and domiciliary services. Response rates ranged from 33% to 90% (mean 60%). The procedures carried out were: dilatation and curettage (D&C) (12.4%); removal of skin growth (9.4%); cystoscopy (7.9%); dental extraction (7.6%); laparoscopy (7.4%); and varicose vein surgery (6.6%). Eighty-four per cent of patients would recommend day surgery in similar circumstances, reflecting the generally high levels of satisfaction in this area. The use of satisfaction as an outcome in clinical or economic evaluations is problematic due to the range of methods available to measure it, but more specifically because an ‘index’ of satisfaction is required for analysis. There is little evidence of the development of this type of measure in anaesthesia in general. One descriptive study was found that developed a CV method in the form of a willingness-to-pay tool. 21 The tool had been developed in anaesthetic staff rather than patients, because it was rejected by three ethics committees as too politically sensitive. A further study looked at 80 patients’ valuations to reduce the incidence of PONV to zero. 176 The willingness-to-pay values were found to be in the range US $56–100. The study did not explore any of the methodological issues associated with the development of valid CV instruments. Elliott and co-workers 33 explored the methodological development of a CV tool to elicit patients’ preferences and willingness to pay for alternative anaesthetic agents in day surgery. The willingness-to-pay values for induction agents were a mean of £208 for propofol and £105 for sevoflurane. The mean willingness-to-pay value for maintenance with propofol was £157. In another descriptive study, Macario and coworkers 186 undertook a survey to try and quantify patients’ preferences for postoperative anaesthesia outcomes by asking them to rank ten possible postoperative outcomes. Patients rated the most undesirable as being vomiting, gagging on the tracheal tube and incisional pain. The © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 authors felt that patient validation of different outcomes was necessary for economic studies in anaesthesia. Baker and co-workers 167 used the Short Form with 36 items (SF-36) to measure health status in varicose vein day surgery. The SF-36 scores indicated that the operation caused increased pain and reduced role function at 1 month. At 6 months all dimensions except social function and health perception were improved. No other studies were found that evaluated the use of utility measures, such as QALYs. However, this is not surprising, as patient-based differences between anaesthetic techniques are transient and ‘process-orientated’. Therefore, outcome-oriented measures such as QALYs will not be sensitive to these differences. Qualitative studies are often useful in providing an in-depth analysis of patient satisfaction. One such study, using a grounded theory methodology, explored patients’ experiences and views of day surgery which would lead to improving the quality of this service. This study highlighted the need for adequate preparation and provision of information for patients attending for day surgery. 191 In summary, in the small number of studies found, a wide range of methods was used, but reported in little detail. They were mostly unvalidated, apart from the CFQ and the Aldrete recovery score, and were used in small groups of patients. Further work is required to satisfy the criteria for the evaluation of outcomes measures suggested by Fitzpatrick and co-workers. 49 Results of studies High levels of satisfaction with the day surgery process overall were reported by patients. Two studies reported a higher incidence of ‘dreams’ with propofol, 164,180 although one of these studies 180 also used ketamine. Brandner and co-workers 170 reported that patients ‘felt happier’ with TIVA than with thiopentone induction or isoflurane maintenance (p = 0.0038). Gupta and co-workers 78 reported no mood difference between patients maintained with propofol or isoflurane. Larsen and co-workers 89 reported quicker psychomotor recovery with isoflurane than with propofol (p < 0.05), as did Nelskyla and co-workers 189 (p < 0.05). Philip and co-workers 108 reported faster cognitive recovery with sevoflurane than with isoflurane (p < 0.001). 21
Page 1 and 2: Which anaesthetic agents are costef
Page 3: Which anaesthetic agents are costef
Page 6 and 7: NHS R&D HTA Programme The NHS R&D H
Page 8 and 9: Contents Appendix 6 Adult patient-b
Page 11 and 12: Background The aim of the project w
Page 13: • The incidence of PONV was low d
Page 16 and 17: 2 Introduction dizziness or disorie
Page 18 and 19: 4 Introduction a reduced incidence
Page 20 and 21: 6 Introduction willingness to pay f
Page 22 and 23: 8 Literature review included in the
Page 24 and 25: 10 Literature review TABLE 1 Compar
Page 26 and 27: 12 Literature review intermediate a
Page 32 and 33: 18 Literature review Patient-based
Page 36 and 37: 22 Literature review No studies fol
Page 38 and 39: 24 Literature review (30%) and meth
Page 40 and 41: 26 Literature review • There are
Page 42 and 43: 28 National survey of anaesthetic p
Page 50 and 51: 36 Economic evaluation methods (inc
Page 52 and 53: 38 Economic evaluation methods The
Page 54 and 55: 40 Economic evaluation methods Tabl
Page 56 and 57: 42 Economic evaluation methods simi
Page 58 and 59: 44 Economic evaluation methods Prob
Page 61 and 62: Recruitment to the CESA RCT The stu
Page 63 and 64: Clinical outcome data PONV by anaes
Page 65 and 66: The findings from the logistic regr
Page 67 and 68: TABLE 29 The length of stay and pri
Page 69 and 70: 140 120 100 80 60 40 20 0 No. of pa
Page 71 and 72: 250 200 150 100 50 0 No. of patient
Page 73 and 74: TABLE 37 Deterministic sensitivity
Page 75 and 76: 20 15 10 5 0 -5 Difference in varia
Page 77 and 78: Patient admitted for day surgery an
Page 79 and 80: 500 400 300 200 100 0 -100 -200 -30
Page 81 and 82: Recruitment to the CESA RCT The stu
Page 83 and 84: TABLE 49 The occurrence of any PONV
Page 85 and 86:
60 50 40 30 20 10 0 No. of patients
Page 87 and 88:
a scale effect for scenario A, but
Page 89 and 90:
The mean CVs for avoidance of PONV
Page 91 and 92:
1.80 The new variable cost and tota
Page 93 and 94:
100 90 80 70 60 50 40 30 20 10 0 Su
Page 95 and 96:
The structure and content of this d
Page 97 and 98:
nurses to have an in-depth knowledg
Page 99 and 100:
agent used (see appendix 18). It wa
Page 101 and 102:
Furthermore, anaesthetists operate
Page 103 and 104:
The CESA project was designed to as
Page 105:
practice, such as the use of midazo
Page 109 and 110:
1. Royal College of Surgeons of Eng
Page 111 and 112:
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
Page 121:
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 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 170 and 171:
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 183 and 184:
Page 185 and 186:
Page 187 and 188:
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 198 and 199:
184 Appendix 11
Page 200 and 201:
186 Appendix 11
Page 202 and 203:
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
Page 235:
15 10 5 0 -5 -10 True weight - Dion
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
Page 246 and 247:
232 Appendix 22 March, Tuesday 15 A
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
Page 255 and 256:
This section displays the associati
Page 257 and 258:
given in Table 103 confirm the age
Page 259:
TABLE 107 Occurrence of PONV by dur
Page 262 and 263:
248 Appendix 27 TABLE 113 Frequency
Page 265 and 266:
This section displays the associati
Page 267 and 268:
The adverse events observed in the
Page 269 and 270:
262 Health Technology Assessment Pr
Page 271:
264 Health Technology Assessment Pr
show all

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

Create successful ePaper yourself

Delete template?

Save as template?