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

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National survey of anaesthetic practice for paediatric and adult day surgery
Survey sample frame
In October 2000, consultant anaesthetists involved
in anaesthetising patients for day surgery in
NHS trusts in the UK were contacted via a list
of clinical directors of anaesthesia (n = 270).
This list had recently been used in a survey of
clinical directors. 230
Analysis
Frequency data and descriptive statistics were
produced for three main sections, which corresponded
with the three clinical areas: urology,
orthopaedics and paediatrics. SPSS version 9 ®
was the statistical software package used.
Answers were coded as ‘not appropriate’ if the
respondents indicated they were not involved in
treating day patients from one of the specified
clinical areas and then went on to leave the
relevant questions in the survey blank.
Respondents were asked to name the agent they
used routinely for each stage of the anaesthetic
process. In some cases respondents named more
than one agent. The purpose of the survey was to
determine the popularity of the available anaesthetic
techniques and so, if more than one agent
was named, the response was weighted by the
number of responses offered. The number of
responses for each named agent are therefore
presented and converted to a percentage of the
sample size.
Results
The results are presented in four main sections
relating to duration of day procedures, use of
premedication, general anaesthesia and
perioperative supplementary therapy.
Response rate
The overall response rate to the main survey
was 76% (n = 204). Five of the returned questionnaires
were not completed. A total of 199 (74%)
completed questionnaires were included in
the analysis.
The completed questionnaires were representative
of all UK NHS regions (including Northern
Ireland, Scotland and Wales). Respondents seemed
interested in the topic area and 68% of them
indicated that they would like a summary of the
results and wrote additional comments at the end
of the questionnaire describing their current
practice or making suggestions about the
implications of the study.
All respondents were consultant anaesthetists and
94% of them said that their base hospital had a
dedicated day-case ward or unit. Not everyone who
completed a questionnaire worked in all the three
areas of day surgery, 15% did not work with
urology or paediatric day-surgery patients and 9%
did not work with orthopaedic day-surgery patients.
As anticipated, most respondents who indicated
that they did not do any urology, orthopaedic or
paediatric day surgery did not complete the relevant
sections of the questionnaire. Some respondents
did complete the sections for urology and
orthopaedics (3% and 2%, respectively) even
though they stated they did not have any day
patients from these clinical areas. These
responses were included in the analysis.
Duration of day-case procedures
The mean duration of a day-case procedure
was reported to be 26 minutes (95% confidence
interval (CI), 21.7 to 30.2; n = 170) for urology,
41 minutes (95% CI, 37.2 to 45.7; n = 181) for
orthopaedics and 34 minutes (95% CI, 29.3 to
39.1; n = 167) for paediatrics. The standard
accepted maximum for a day-case operation
is 60 minutes, 3 but seven respondents reported
the remarkably long time of 240 minutes. It is
possible that these seven respondents may have
misunderstood the question and estimated the
total time a person having day surgery stays under
the care of the hospital rather than estimating the
length of time to complete the day-case procedure.
Use of premedication
The majority of respondents indicated that they
did not give premedication for urology (83%),
orthopaedics (81%) or paediatrics (67%). Respondents
were asked to indicate ‘In what percentage
of your day-case patients do you routinely use premedication?’.
Respondents said that premedication
would be used routinely in 6% (95% CI, 2.7 to 8.4;
n = 173) of their urology day-case patients, 12%
(95% CI, 7.8 to 16.1; n = 185) of their orthopaedic
day-case patients and 19% (95% CI, 13.6 to 23.9;
n = 167) of their paediatric day-case patients.
Table 7 summarises the named premedication
agents of choice used in day surgery.
General anaesthesia
Induction
Propofol was the most popular induction agent
used routinely for day surgery in all three clinical
areas (Table 8). Sevoflurane was a popular choice
for paediatric day surgery, but not for adult
urology or orthopaedic day surgery. Some of
the respondents (12% for urology, 14% for
orthopaedics, 35% for paediatrics) named more