Volume 8, Issue 1 S A M B A T A L K S - PAGE 3 June, 2008

FROM THE LITERATURE: - TOP


ANESTHESIA AND ANALGESIA - TOP

A Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Anesthesia: A Double-Blinded Randomized Controlled Trial
Yuen, Vivian M. MBBS, FANZCA, FHKCA, FHKAM; Hui, Theresa W. MBBS, FANZCA, FHKCA, FHKAM; Irwin, Michael G. MBChB, MD, FRCA, FHKCA, FHKAM; Yuen, Man K. MBBS, FANZCA, FHKCA, FHKAM
Anesthesia & Analgesia. 106(6):1715-1721, June 2008

BACKGROUND: Midazolam is the most commonly used premedication in children. It has been shown to be more effective than parental presence or placebo in reducing anxiety and improving compliance at induction of anesthesia. Clonidine, an [alpha]2 agonist, has been suggested as an alternative. Dexmedetomidine is a more [alpha]2 selective drug with more favorable pharmacokinetic properties than clonidine. We designed this prospective, randomized, double-blind, controlled trial to evaluate whether intranasal dexmedetomidine is as effective as oral midazolam for premedication in children.
METHODS: Ninety-six children of ASA physical status I or II scheduled for elective minor surgery were randomly assigned to one of three groups. Group M received midazolam 0.5 mg/kg in acetaminophen syrup and intranasal placebo. Group D0.5 and Group D1 received intranasal dexmedetomidine 0.5 or 1 [mu]g/kg, respectively, and acetaminophen syrup. Patients' sedation status, behavior scores, blood pressure, heart rate, and oxygen saturation were recorded by an observer until induction of anesthesia. Recovery characteristics were also recorded.
RESULTS: There were no significant differences in parental separation acceptance, behavior score at induction and wake-up behavior score. When compared with group M, patients in group D0.5 and D1 were significantly more sedated when they were separated from their parents (P < 0.001). Patients from group D1 were significantly more sedated at induction of anesthesia when compared with group M (P = 0.016).
CONCLUSIONS: Intranasal dexmedetomidine produces more sedation than oral midazolam, but with similar and acceptable cooperation.

(C) 2008 by International Anesthesia Research Society.

Preoperative Oral Passiflora Incarnata Reduces Anxiety in Ambulatory Surgery Patients: A Double-Blind, Placebo-Controlled Study
Movafegh, Ali MD *; Alizadeh, Reza MD +; Hajimohamadi, Fatimah MD ++; Esfehani, Fatimah MD +; Nejatfar, Mohmad MD +
Anesthesia & Analgesia. 106(6):1728-1732, June 2008

BACKGROUND: Many patients have preoperative anxiety; therefore, the development of a strong anxiolytic with minimal psychomotor impairment for premedication may be desirable.
METHODS: In this study, 60 patients were randomized into two groups to receive either oral Passiflora incarnata (500 mg, Passipy(TM) IranDarouk) (n = 30) or placebo (n = 30) as premedication, 90 min before surgery. A numerical rating scale (NRS) was used for each patient to assess anxiety and sedation before, and 10, 30, 60, and 90 min after premedication. Psychomotor function was assessed with the Trieger Dot Test and the Digit-Symbol Substitution Test at arrival in the operating room, 30 and 90 min after tracheal extubation. The time interval between arrival in the postanesthesia care unit and discharge to home (discharge time) was recorded for each patient.
RESULTS: The demographic characteristics of patients, ASA physical status, duration of surgery, basal NRS score, sedation at the preset time intervals, and discharge time were similar in the two groups. The NRS anxiety scores were significantly lower in the passiflora group than in the control group (P < 0.001). There were no significant differences in psychological variables in the postanesthesia care unit and recovery of psychomotor function was comparable in both groups.
CONCLUSIONS: In outpatient surgery, administration of oral Passiflora incarnata as a premedication reduces anxiety without inducing sedation.

(C) 2008 by International Anesthesia Research Society.

Does Supplemental Oxygen Reduce Postoperative Nausea and Vomiting? A Meta-Analysis of Randomized Controlled Trials
Orhan-Sungur, Mukadder MD *+; Kranke, Peter MD, MBA, PhD ++; Sessler, Daniel MD [S]; Apfel, Christian C. MD, PhD *[//]
Anesthesia & Analgesia. 106(6):1733-1738, June 2008

BACKGROUND: Studies on the ability of supplemental oxygen to decrease the incidence of postoperative nausea and vomiting (PONV) are inconsistent, with initial studies suggesting benefit while subsequent trials demonstrate no decrease in PONV.
METHODS: To clarify whether supplemental oxygen is an effective and reliable method to reduce PONV, we performed a systematic review (MEDLINE, Cochrane Library, hand searching and bibliographies, with no language restriction, through March 2006) of randomized, controlled trials comparing perioperative 80% versus 30%-40% Fio2 on the incidence of PONV. For this systematic review, PONV was defined as any nausea, retching, and/or vomiting in the first 24 h after surgery. The end-points were early PONV (0-6 h), late PONV (6-24 h), and overall PONV (0-24 h). Data from 10 trials with 1729 patients were included in our meta-analysis: 860 received 80% Fio2 and 869 received 30%-40% Fio2.
RESULTS: In patients who received 80% Fio2,the relative risk (95% confidence intervals) of experiencing early PONV was 0.91 [0.71-1.16]; late PONV, 0.88 [0.69-1.11]; and overall PONV, 0.91 [0.77-1.06]. Results were similar for early, late, and overall nausea and vomiting.
CONCLUSIONS: The positive results of two initial studies reducing the risk for PONV in patients given 80% Fio2 were not confirmed by any of the subsequent trials. Considering all available evidence, 80% Fio2 should no longer be considered an effective or reliable method to reduce overall PONV.

(C) 2008 by International Anesthesia Research Society.

Preoperative Gabapentin Prevents Intrathecal Morphine-Induced Pruritus After Orthopedic Surgery.
Sheen, Michael, Ho, Shung-Tai, MD, MS, Lee, Chian-Her, Tsung, Yu-Chi, Chang, Fang-Lin
Anesthesia & Analgesia. 106(6):1868-1872, June 2008

BACKGROUND: Pruritus is the most common side effect of intrathecal morphine. Gabapentin is an anticonvulsant and had been reported to be effective in some chronic pruritus conditions. Its effect in intrathecal morphine-induced pruritus has not yet undergone an evaluation.
METHODS: We randomly allocated 86 patients scheduled for lower limb surgery under spinal anesthesia into two equal groups that received either gabapentin 1200 mg or placebo 2 h before operation in a prospective, double-blind manner. All patients received an intrathecal injection of 15 mg of 0.5% isobaric bupivacaine and 0.2 mg preservative-free morphine. Pruritus was evaluated at 3, 6, 9, 12, and 24 h after intrathecal morphine administration.
RESULTS: The incidence of pruritus was significantly more frequent in the placebo group compared with the gabapentin group (77.5% vs 47.5%; P = 0.01). The onset time of pruritus in the gabapentin group (6.2 +/- 1.8 h) was significantly delayed compared with that in the placebo group (3.1 +/- 0.8 h) (P < 0.0001). The severity of pruritus was significantly more in the placebo group compared with the gabapentin group at 3 and 6 h after intrathecal morphine injection.
CONCLUSION: Preoperative gabapentin prevents pruritus induced by intrathecal morphine in patients undergoing lower limb surgery with spinal anesthesia.

Nasal Ventilation Is More Effective than Combined Oral-Nasal Ventilation during Induction of General Anesthesia in Adult Subjects.
Liang, Yafen M.D. ; Kimball, William R. M.D., Ph.D. ; Kacmarek, Robert M. Ph.D. ; Zapol, Warren M. M.D. ; Jiang, Yandong M.D., Ph.D.
Anesthesiology. 108(6):998-1003, June 2008.

Clinical Investigations
 
Abstract:
Background: The authors hypothesized that nasal mask ventilation may be more effective than combined oral-nasal mask ventilation during induction of general anesthesia. They tested this hypothesis by comparing the volume of carbon dioxide removed per breath with nasal versus combined oral-nasal mask ventilation in nonparalyzed, apneic, adult subjects during induction of general anesthesia.
Methods: Fifteen adult subjects receiving general anesthesia were ventilated first with a combined oral-nasal mask and then with only a nasal mask. The patient's head was maintained in a neutral position, without head extension or lower jaw thrust. Respiratory parameters were recorded simultaneously from both the nasal and oral masks regardless of ventilation approach.
Results: The volume of carbon dioxide removed per breath during nasal mask ventilation (median, 5.0 ml; interquartile range, 3.4-8.8 ml) was significantly larger than that during combined oral-nasal mask ventilation (median, 0.0 ml; interquartile range, 0.0-0.4 ml; P = 0.001); even the peak inspiratory airway pressure during nasal ventilation (16.7 +/- 2.7 cm H2O) was lower than that during combined oral-nasal ventilation (24.5 +/- 4.7 cm H2O; P = 0.002). The expiratory tidal volume during nasal ventilation (259.8 +/- 134.2 ml) was also larger than that during combined oral-nasal ventilation (98.9 +/- 103.4 ml; P = 0.003).
Conclusions: Nasal mask ventilation was more effective than combined oral-nasal mask ventilation in apneic, nonparalyzed, adult subjects during induction of general anesthesia. The authors suggest that nasal mask ventilation, rather than full facemask ventilation, be considered during induction of anesthesia.

Anatomical Balance of the Upper Airway and Obstructive Sleep Apnea.
Tsuiki, Satoru D.D.S. ; Isono, Shiroh M.D. ; Ishikawa, Teruhiko M.D. ; Yamashiro, Yoshihiro M.D. ; Tatsumi, Koichiro M.D. ; Nishino, Takashi M.D. 
Anesthesiology. 108(6):1009-1015, June 2008.

Clinical Investigations

Abstract:
Background: Obesity and craniofacial abnormalities such as small maxilla and mandible are common features of patients with obstructive sleep apnea (OSA). The authors hypothesized that anatomical imbalance between the upper airway soft-tissue volume and the craniofacial size (rather than each alone) may result in pharyngeal airway obstruction during sleep, and therefore development of OSA.
Methods: Blind measurements of tongue cross-sectional area and craniofacial dimensions were performed through lateral cephalograms in 50 adult male patients with OSA and 55 adult male non-OSA subjects with various craniofacial dimensions.
Results: Maxillomandibular dimensions were matched between OSA and non-OSA groups. While the tongue was significantly larger in subjects with larger maxillomandible dimensions, OSA patients had a significantly larger tongue for a given maxillomandible size than non-OSA subjects. The hypothesis was also supported in subgroups matched for both body mass index and maxillomandible dimensions.
Conclusions: Upper airway anatomical imbalance is involved in the pathogenesis of OSA.

ACTA ANAESTHESIOLOGICA SCANDINAVICA - TOP

Ultrasound-guided peripheral nerve blocks: What are the benefits? (REVIEW)
Z. J. KOSCIELNIAK-NIELSEN
Acta Anaesthesiologica Scandinavica 2008; 52 (6): 727–737

Background: Use of ultrasound by anaesthesiologists performing regional blocks is rapidly gaining popularity. The aims of this review were to summarize and update accumulating evidence on ultrasound-guided nerve blocks, with an emphasis on the clinical relevance of the results and to critically appraise changing standards in regional anaesthesia.
Methods: A search of MEDLINE and EMBASE (1966 to 31 December 2007) was conducted using the following free terms: ‘ultrasound and regional anesthesia’, ‘ultrasound and peripheral block’ and ‘ultrasound and nerve and block’. These were combined with the MESH terms ‘nerve block’ and ‘ultrasonography’. The following limits were applied: studies with abstracts, only in humans, published in core clinical journals. Trial type: meta-analysis, randomized-controlled trial and clinical trial.
Results: When peripheral nerves are adequately imaged by ultrasound, the concomitant use of nerve stimulation offers no further advantage. However, several studies reported problems with obtaining satisfactory images in some patients. Ultrasound guidance significantly shortened the block performance time and/or reduced the number of needle passes to reach the target in all comparative studies. The occurrence of paraesthesia during block performance was also reduced, but not the incidence of short-lasting post-operative neuropraxia. The frequency of accidental vascular punctures may be lower, but the data are contradictory. Block onset time was significantly shortened. Block duration was longer in children, but not in adults. Ultrasound also allowed dose reduction of the local anaesthetic (LA).
Conclusions: Ultrasound guidance shortens the block performance time, reduces the number of needle passes and shortens the block onset time. Blocks may be performed using lower LA doses.

Intraoperative dreams reported after general anaesthesia are not early interpretations of delayed awareness
P. SAMUELSSON, L. BRUDIN, R. H. SANDIN
Acta Anaesthesiologica Scandinavica 2008; 52 (6): 805–809

Background: Dreams are more frequently reported than awareness after surgery. We define awareness as explicit recall of real intraoperative events during anaesthesia. The importance of intraoperative dreaming is poorly understood. This study was performed to evaluate whether intraoperative dreams can be associated with, or precede, awareness. We also studied whether dreams can be related to case-specific parameters.
Methods: A cohort of 6991 prospectively included patients given inhalational anaesthesia were interviewed for dreams and awareness at three occasions; before they left the post-anaesthesia care unit, days 1–3 and days 7–14 after the operation. Uni- and multivariate statistical relations between dreams, awareness and case-specific parameters were assessed.
Results: Two hundred and thirty-two of 6991 patients (3.3%) reported a dream. Four of those also reported awareness and remembered real events that were distinguishable from their dream. Awareness was 19 times more common among patients who after surgery reported a dream [1.7% vs. 0.09%; odds ratio (OR) 18.7; P=0.000007], but memories of dreams did not precede memories of awareness in any of the 232 patients reporting a dream. Unpleasant dreams were significantly more common when thiopentone was used compared with propofol (OR 2.22; P=0.005). Neutral or pleasant dreams were related to lower body mass index, female gender and shorter duration of anaesthesia.
Conclusions: We found a statistically significant association between dreams reported after general anaesthesia and awareness, although intraoperative dreams were not an early interpretation of delayed awareness in any case. A typical dreamer in this study is a lean female having a short procedure.

BIS does not predict dreams reported after anaesthesia
P. SAMUELSSON, L. BRUDIN, R. H. SANDIN
Acta Anaesthesiologica Scandinavica 2008; 52 (6): 810–814

Background: In earlier studies, between 1% and 57% of patients have been reported to dream during anaesthesia. Thus, dreaming is much more common than definite memories of real events. We wanted to examine whether dreaming during anaesthesia is related to insufficient hypnotic action, as indicated by BIS levels and, thus, may constitute a risk for awareness.
Methods: After IRB approval, 2653 consecutive surgical patients were included. BIS registrations were recorded continuously during the anaesthetic procedure. The patients were interviewed on three occasions after anaesthesia. Standard questions, according to Brice, to evaluate awareness and dreaming during anaesthesia were asked. The dreams were categorized as either pleasant/neutral or unpleasant without any further evaluation of the dream content. Episodes with a mean BIS below 40, above 60 and above 70 were identified and subdivided according to duration (1, 2, 4 and 6 min, respectively). The total time as well as number and duration of episodes for the three BIS-levels were used to analyze any relation to reported dreaming. The mean BIS was also analyzed.
Results: Dreaming during anaesthesia was reported by 211 of patients (8.0%) on at least one of the post-operative interviews. BIS data did not show any significant correlation with dreaming, and neither did any of the tested case-specific parameters (gender, age, ASA group, BMI, use of relaxants, induction agent, maintenance agent, length of procedure, omitting N2O and concomitant regional anaesthesia).
Conclusion: Dreaming during anaesthesia seems to be a separate phenomenon, not in general related to insufficient anaesthesia as indicated by high BIS levels.

Children in day surgery: clinical practice and routines. The results from a nation-wide survey
M. SEGERDAHL, M. WARRÉN-STOMBERG, N. RAWAL, M. BRATTWALL, J. JAKOBSSON
Acta Anaesthesiologica Scandinavica2008; 52 (6): 821–828

Background: Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking.
Methods: We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail.
Results: The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1–6-year-olds, and in 7–16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1–6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1–3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy.
Conclusions: In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.

BRITISH JOURNAL OF ANAESTHESIA - TOP

Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery
R. Jokela, J. Ahonen, M. Tallgren, M. Haanpää and K. Korttila
British Journal of Anaesthesia 2008 100(6):834-840

Background: Multimodal pain management has been suggested to improve postoperative analgesia. In this study, we evaluated the quality of analgesia in women undergoing day-case gynaecological laparoscopic surgery, after premedication with pregabalin 75 mg (P75) or 150 mg (P150), compared with diazepam 5 mg (D5). All patients were given ibuprofen 800 mg orally.
Methods: Altogether 90 consenting women were anaesthetized in a standardized fashion. Postoperative analgesia was provided by ibuprofen 800 mg twice a day with fentanyl i.v. on request in the recovery room (RR), and combination tablets with acetaminophen and codeine after the RR. The visual analogue scale (VAS) scores for pain and side-effects and the amounts of postoperative analgesics were recorded for 24 h after surgery. The areas under the curves (AUC) were calculated for the VAS scores for pain at rest, pain in motion, and pain at cough 1–8 and 1–24 h after surgery.
Results: The median AUC values for VAS scores for pain at rest (P=0.048) and in motion (P=0.046) 1–8 h after surgery were lower in the P150 group than that in the D5 group. The amounts of rescue analgesics or the degree of drowsiness did not differ in the three study groups.
Conclusions: Analgesia was better after premedication with pregabalin 150 mg than after diazepam 5 mg, both with ibuprofen 800 mg, during the early recovery after day-case gynaecological laparoscopic surgery. Pregabalin 150 mg did not reduce the amount of postoperative analgesics required.

CANADIAN JOURNAL OF ANESTHESIA - TOP

Total intravenous anesthesia with propofol augments the potency of mivacurium
Thomas M. Hemmerling, MD DEAA, Nhien Le, Patrick Decarie, Julie Cousineau and David Bracco, MD
Canadian Journal of Anesthesia 55:351-357 (2008)

Background: Little is known about the potentiating effect of propofol on neuromuscular blocking drugs. However, some animal studies indicate a dose-dependent increase of the potency of neuromuscular blocking drugs by propofol. This study compared mivacurium potency after five minutes and after 20 min of total intravenous anesthesia with propofol (TIVA propofol).
Methods: Twenty-eight patients were randomized into two groups, after approval of the Ethics Committee and written consent. Anesthesia was induced, in all patients, using remifentanil 0.5 µg·kg–1·min–1 for two minutes, after which: 3 mg·kg–1 of propofol was injected; a laryngeal mask airway was inserted; and intermittent, positive pressure ventilation was initiated. Anesthesia was maintained using TIVA propofol (titrated using bispectral index monitoring to 40–45). Neuromuscular monitoring consisted of phonomyography at the adductor pollicis muscle. In Groups 5 min and 20 min, a tetanic stimulation of the ulnar nerve commenced after four minutes and after 19 min of TIVA, respectively, followed by controlled, single twitch stimulation at 1 Hz for one minute. Boli of 60, 30, 30, and 30 µg·kg–1 mivacurium, respectively, were administered (each drug increment was administered after the effect of the previous dose had caused a stable response), and single twitch stimulation continued at 0.1 Hz. The dose-response curve was determined for both groups; potency was calculated using log-probit analysis. Data were presented as mean (SD) and were compared using two-sided analysis of variance, P < 0.05.
Results: Patient characteristics were similar in the two groups. The correspondingED50 and ED95 values were greater, at 76.7 ± 12.4 µg·kg–1 and 146.6 ± 27.6 µg·kg–1 for Group 5 min, vs 46.7 ± 12.2 µg·kg–1 and 101.1 ± 20.2 µg·kg–1 for Group 20 min, respectively.
Conclusions: After 20 min of TIVA propofol, the potency of mivacurium is approximately 50% greater than after five minutes of TIVA propofol. For clinical purposes, it is important, therefore, to consider the duration of TIVA propofol before determining the dose of neuromuscular blocking drug.

PUB MED - TOP



Propofol-based sedation regimen for infants and children undergoing ambulatory magnetic resonance imaging.
Machata AM, Willschke H, Kabon B, Kettner SC, Marhofer P.
Br J Anaesth.2008 Jun 4. [Epub ahead of print]

Department of Anaesthesia, General Intensive Care and Pain Therapy, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

BACKGROUND: Propofol is widely used for infants and children requiring sedation for magnetic resonance imaging. However, increased doses of propofol may quickly lead to an unintended deep sedation and respiratory depression. Thus, an appropriate low dosage, which nevertheless ensures sufficient sleep for successful magnetic resonance imaging (MRI) completion, would probably minimize respiratory adverse events. We investigated the safety and efficacy of a low-dose propofol-based sedation regimen in a broad age range of children.
METHODS: We investigated 500 infants and children, prospectively. Premedication consisted of i.v. midazolam 0.1 mg kg(-1). Sedation was induced with i.v. nalbuphine 0.1 mg kg(-1) and propofol 1 mg kg(-1), and maintained with propofol 5 mg kg(-1) h(-1). Outcome measures were induction time, sedation time, recovery time, need for additional sedation, respiratory events, cardiovascular events, paradoxical reactions, and sedation failure. RESULTS: Data were obtained from 53 infants and 447 children. Median (IQR) age was 5.3 (4.5, 6.1) yr and body weight was 19.3 (16.5, 24.7) kg. The induction time was 2 (1, 2) min, sedation time 55 (45, 65) min, and recovery time 8 (8, 9) min. Additional sedation was necessary in 11 patients (2.2%), mild respiratory events occurred in five patients (1%). All MRI examinations could be completed without paradoxical reaction or sedation failure. CONCLUSION: This sedation regimen provides the shortest induction time so far described, a rare demand for additional sedation, a low incidence of respiratory events, and a rapid recovery.

Nausea and vomiting in the ambulatory surgical setting.
Gundzik K.
Orthop Nurs. 2008 May-Jun;27(3):182-8

Katherine Gundzik, RN, MSN, CCRN, Clinical Nurse Specialist, 2901 Mt. Ventus Road, Manchester, MD 21102.

Postoperative nausea and vomiting (PONV) is a significant problem in the ambulatory surgical setting. PONV results in delayed discharge, increased cost, and decreased patient satisfaction. Treating patients at risk for PONV preemptively before surgery can minimize these negative outcomes. Nurses play a key role in preventing PONV by first identifying patients at risk. Administering medication and fluids, providing comfort measures, and assessing the patient throughout the postoperative course are crucial nursing functions in the treatment of PONV. However, successful patient outcomes require a multidisciplinary approach. There have been great advances in the treatment of this common postoperative complication with improved anesthesia techniques and newer antiemetic drugs. Future research is needed to determine optimal combinations and timing of medications. Effective prevention and treatment of PONV improve patient outcomes and provide a more pleasant postoperative experience for the patient.

PMID: 18521034 [PubMed - in process]

Endometrial ablation in the office setting.
Fothergill RE.
Obstet Gynecol Clin North Am. 2008 Jun;35(2):317-30

Division of Ambulatory Care, Department of Obstetrics and Gynecology, Texas A&M University Health Science Center, Scott & White Hospital, 2401 South 31st Street, Temple, TX 76508, USA.

The introduction of global endometrial ablation technology during the past decade has revolutionized the treatment of abnormal uterine bleeding. These minimally invasive treatment options have fewer risks than traditional procedures, are faster, and have shorter recovery times for patients. As technology has advanced, so has the shift away from performing ablations in the operating room. With proper patient selection, equipment, and anesthesia techniques, endometrial ablation can be performed safely and effectively in the office setting.

PMID: 18486844 [PubMed - in process]

Paediatric day-case surgery: an audit of unplanned hospital admission Royal Hospital for Sick Children, Glasgow.
Blacoe DA, Cunning E, Bell G.
Anaesthesia. 2008 Jun;63(6):610-5

West of Scotland School of Anaesthesia, Anaesthetic Department, Gartnavel General Hospital, Glasgow, G12 OYN, UK. dablacoe@yahoo.co.uk

Audit of unplanned hospital admission provides information to guide quality improvement measures and is a crude indicator of quality of care in ambulatory surgery. Our objectives were to re-audit factors relating to this outcome. Previous audit conducted in this unit revealed an unplanned admission rate of 3.7%. Data were collected between April 2000-March 2004. Of 13 592 day surgery patients, 238 (1.8%) unplanned admissions occurred. The admission rate displayed a falling trend and represented a significant improvement over the previous audit (p < 0.001). Unplanned admissions were most commonly caused by nausea/vomiting 23.5% (n = 56), postoperative bleeding 13.9% (n = 34), and unexpected extent/difficulty of procedure 11.8% (n = 28). Of all admissions, 18.5% (n = 44) were following orchidopexy, 16.4% (n = 39) following circumcision, and 12.6% (n = 30) following dental extraction. This audit shows that the unplanned admission rate is low and falling, and compares favourably with other units. Measures have been implemented targeting patients at high risk of admission.

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