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

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National survey of anaesthetic practice for paediatric and adult day surgery
each area of day-case practice were calculated.
Estimates for the mean length of a day procedure
were also generated. These estimates were used to
inform the choice of variables and range of values
for the sensitivity analysis and modelling in the
empirical study. These findings were assumed to
reflect national practice and were used to set the
empirical study in context with current paediatric
and adult day-surgery anaesthesia.
Summary
The literature review (see chapter 2) reports
current practice patterns, variations and trends
for adult and paediatric anaesthetic practice.
The aim of this national survey was to inform
the investigators of the anaesthetic agents and
techniques used in common practice for
paediatric and adult day surgery in the UK.
Method
In January 1999, a preliminary survey of paediatric
anaesthetic practice was conducted to inform the
choice of alternative anaesthetic agents for the
arms of the paediatric empirical study. A national
postal survey, conducted in October 2000, used a
structured data-collection instrument comprising
closed questions about the key aspects of anaesthetising
a patient for day surgery. Information
was collected on premedication, induction, maintenance,
prophylactic and treatment anti-emetics,
analgesia, local anaesthesia and duration of
day procedures.
Results
One-hundred and ninety-nine questionnaires (74%
response rate), representing all UK health regions,
were analysed. Fifteen per cent of respondents did
not anaesthetise urology or paediatric day patients
and 9% did not anaesthetise orthopaedic daysurgery
patients.
The stated mean length of a day procedure was
26 minutes for urological procedures, 41 minutes
for orthopaedic procedures and 34 minutes for
paediatric general surgical procedures. Respondents
reported that premedication, such as a
benzodiazepine or a NSAID, would be used
routinely in 6% of their urology, 12% of their
orthopaedic and 19% of their paediatric day
patients. Propofol was the preferred induction
agent for 89% of respondents for urology,
86% for orthopaedics and 60% for paediatrics.
Isoflurane was the preferred maintenance
agent for 56% of respondents for urology, 58%
for orthopaedics and 54% for paediatrics. Low
flow rates of N 2O and oxygen were used, but
not always. Respondents estimated that a prophylactic
anti-emetic would be used in 32% of their
urology, 41% of their orthopaedic and 24% of
their paediatric day patients. Ondansetron was
the preferred choice of drug when a prophylactic
anti-emetic was given. The use of prophylactic
anti-emetics was not confined to those using
intraoperative opioids. Respondents reported
that a local anaesthetic, such as bupivacaine, was
used routinely in 26% of their urology, 77% of
their orthopaedic and 80% of their paediatric
day patients. A non-depolarising neuromuscular
blocking agent was used routinely by respondents
in 4% of their urology, 6% of their orthopaedic
and 6% of their paediatric day patients.
Suxamethonium was used routinely by respondents
in 0.7% of their urology and orthopaedic
and 2.5% of their paediatric day patients.
A laryngeal mask airway was used routinely
by respondents in 86% of their urology, 93%
of their orthopaedic and 85% of their paediatric
day patients. An intraoperative analgesic was not
used routinely by 5% of respondents for urology,
1% for orthopaedics and 6% for paediatrics. A
variety of analgesics for intraoperative use were
described, but fentanyl alone, or with a NSAID,
was the preferred choice. Cyclizine and ondansetron
were favourite choices as first- or second-line
treatment anti-emetics for urology and orthopaedic
day patients. Ondansetron was the first-line
treatment for paediatric day patients. Fifty-five per
cent of respondents did not indicate a second-line
anti-emetic for paediatric day patients.
Implications for the empirical study
The findings from this national survey were used
to create a national picture of paediatric and adult
day-surgery anaesthesia and inform the choice of
variables to be used in the sensitivity analysis and
modelling for the empirical study (CESA RCT).