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

emetic, and these responses were weighted
accordingly. Ondansetron or cyclizine were
the most popular prophylactic anti-emetics
(Table 12).
Local anaesthetics
Respondents were asked to name just one local
anaesthetic they used routinely, but some respondents
(3% for urology, 4% for orthopaedics, 4%
for paediatrics) named two agents. Combinations
of local anaesthetic agents included bupivacaine
and lignocaine or ropivacaine. Local anaesthetics
can be mixed to modify the overall drug mixture
profile, to give rapid onset of action with improved
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Health Technology Assessment 2002; Vol. 6: No. 30
TABLE 11 Oxygen and N 2O flow rates for induction and maintenance anaesthesia in the three specified clinical areas
Fresh gas Mean flow rate (95% CI; n) (l/min)
Urology Orthopaedics Paediatrics
Induction oxygen 3.9 (3.58 to 4.23; 170) 4.0 (3.64 to 4.26; 180) 3.6 (3.30 to 3.87; 162)
Induction N2O 3.0 (2.66 to 3.32; 170) 3.0 (2.72 to 3.36; 178) 3.0 (2.68 to 3.31; 163)
Maintenance oxygen 1.3 (1.13 to 1.46; 170) 1.2 (1.10 to 1.37; 178) 1.9 (1.68 to 2.13; 162)
Maintenance N2O 1.5 (1.34 to 1.75; 170) 1.5 (1.30 to 1.69; 181) 2.3 (2.01 to 2.55; 158)
duration of action. Topical lignocaine may also
be used in combination with a parenteral form
of local anaesthetic.
The use of local anaesthetics varied between the
three types of day surgery named in the survey,
and local anaesthetic use is likely to be specific to
the named example of procedure for the type of
day surgery (Table 13). Bupivacaine was the most
popular choice of local anaesthetic, and respondents
said they were likely to use concentrations
of 0.5% (17% urology, 59% orthopaedics,
23% paediatrics) or 0.25% (7% urology, 14%
orthopaedics, 45% paediatrics) for day surgery.
TABLE 12 Named prophylactic anti-emetic agents used routinely for day surgery in the three specified clinical areas
Anti-emetic agent Respondents (%)
Urology Orthopaedics Paediatrics
No agent given 55 46 76
Ondansetron 13 18 18
Cyclizine 12 12 5
Droperidol 11 12 5
Metoclopramide 6 9 1
Beta/dexamethasone 1 1 1
Granisetron 2 2 0
Prochlorperazine 0.6 0 0
TABLE 13 Named local anaesthetic agents used routinely for day surgery in the three specified clinical areas
Local anaesthetic agent Respondents (%)
Urology Orthopaedics Paediatrics
Not given 57 5 2
Bupivacaine 30 85 93
Lignocaine 6 0.5 2
Bupivacaine with adrenaline 2 8 0.5
Lignocaine gel 5 0 0
Lignocaine with adrenaline 0 1 0
Ropivacaine 0 0 0.5
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