Day Care Surgery Research Articles

Preparation, validation, and evaluation of an information leaflet for patients undergoing day-care surgeries under general anesthesia at a busy tertiary care hospital.

Background and Aims:It is essential that patients posted for day-care surgeries are adequately prepared preoperatively. Verbal information alone may not be always effective. This study aimed to prepare, validate, and evaluate the efficacy of a patient information leaflet (PIL) for patients undergoing day-care surgeries under general anesthesia (GA).Material and Methods:After approval from the hospital ethics committee a PIL was prepared in English. Readability and design of the leaflet were checked using standard tests: Flesch readability ease test (FRE), Flesch Kincaid grade level (FKGL), and Baker Able leaflet design (BALD). It was translated into three regional languages. The PIL was tested among patients using a questionnaire. Seventy-nine adult patients posted for elective day-care procedures were included while emergency surgeries were excluded. Patient knowledge pre and post-PIL was compared using paired 't' test. The influence of age, gender, and education level on the usefulness of PIL were analyzed using the Chi-square test and knowledge was compared using ANOVA.Results:The English leaflet had an FRE Score of 63.9 and FKGL of 6.4, which is “standard“. The BALD score for all leaflets was 25 (“above standard“). The overall knowledge scores significantly improved from 52.6% (preintervention) to 70.7% (postintervention), P < 0.001. Knowledge improvement was seen with the use of PIL in all four languages. Sixty eight percent of patients strongly recommended the PIL while 31% were willing to recommend it to others.Conclusion:The PILs developed in this study have standard readability, good design and validated for efficacy.

Low-Dose Dexmedetomidine Reduces Median Effective Concentration (EC 50) of Propofol More than Fentanyl in Unparalysed Anaesthetised Patients for I-gel Insertion: a Randomised Controlled Trial

BackgroundLiterature shows fentanyl reduces the median effective concentration (EC50) of propofol when used for various noxious stimuli. However, fentanyl combined with propofol has a depressive effect on haemodynamics. We hypothesise that low dose dexmedetomidine will reduce the propofol requirement for induction with better haemodynamic profile compared with fentanyl. Material and methods120 ASA I/II adult patients, of age group 20 to 60 years, scheduled for elective day-care surgeries under general anaesthesia were randomised to three equally distributed groups as group D, group F and group S (control) of 40 patients each. They received infusions of dexmedetomidine 0.5 mcg/kg, fentanyl 1.5 mcg/kg and normal saline (control) respectively over 5 min prior to induction with propofol TCI (Marsh model). EC50 of propofol (primary objective) for I-gel insertion in each group was determined from the estimated effect site concentration (Ce), using Dixon's up-and-down method . Secondary objectives were propofol dose requirement and percentage change in haemodynamics during induction. ResultsOur study demonstrates that low-dose dexmedetomidine premedication achieves more reduction in the EC50 (2.4 µg/ml, IQR 2.4 – 2.6 µg/ml, 95% CI 2.40 - 2.55 µg/ml) and dose of propofol (1.14 ± 0.28 mg/kg, 95% CI 1.05 - 1.23 mg/kg), for I-gel insertion, than that can be achieved by the use of fentanyl with propofol (EC50 of 3.0 µg/ml IQR 3.0 – 3.05 µg/ml, 95% CI 2.94 - 3.11 µg/ml; propofol dose 1.89 ± 0.55 mg/kg, 95% CI 1.72 - 2.07 mg/kg ) without any significant change in the haemodynamics. ConclusionLow-dose dexmedetomidine when compared with fentanyl significantly reduce the EC50 and dose of propofol required for I-gel insertion with propofol TCI, without much change in the haemodynamic profile.Clinical trial registration number: CTRI/2019/03/018003.

Effect of perioperative intravenous lignocaine infusion on postoperative pain in laparoscopic cholecystectomy

Background and Aims: Postoperative pain delays recovery after laparoscopic cholecystectomy which is done as a daycare surgery. Opioid analgesia carries adverse effects like nausea, vomiting and respiratory depression which can affect postoperative recovery. Our aim was to compare lignocaine infusion with saline infusion as perioperative ERAS measure for postoperative analgesia in laparoscopic cholecystectomy. Method: After obtaining ethical clearance, 40 patients undergoing laparoscopic cholecystectomy were randomised by computer generated codes in to two groups A and B. In group B two subjects were moved out of study, so two in group A were also excluded to make the two groups equal. Group A received saline and group B received 2mg/kg/h lignocaine infusion intravenously which were stopped at the end of the surgery. Postoperative pain was assessed by NRS score at definite time intervals 0 (admission to postoperative anesthesia care unit), 2nd, 4th, 6th, 8th, 10th, 12th and 24th hours. Time at which first rescue analgesia was requested, total analgesic requirements, mean NRS score and side effects were noted. Results: At every time interval, patients in lignocaine group had delayed time to request for rescue analgesia, less analgesic requirements and mean NRS. (P value &lt;0.05). No side effects or signs of toxicity were noted in lignocaine group. Conclusion: Perioperative lignocaine infusion is an efficient, safe and cost-effective armamentarium in implementing ERAS in laparoscopic cholecystectomy.

Safety and efficacy of mini-percutaneous nephrolithotomy as daycare procedure: a prospective observational study

BackgroundTo evaluate the safety, feasibility of mini-percutaneous nephrolithotomy (mPCNL) being carried out as a daycare surgery and to study the re-admission, stone clearance rate and complication rates following mPCNL. We also sought to find out the rate of requirement of ancillary procedure, after mPCNL.MethodsIn this prospective observational study, easily accessible patients above 18 years of age with renal and/or upper ureteric calculi, who underwent mPCNL between September 2018 and February 2020, were included. Seventy patients were selected, as per statistical methods. Preoperative evaluation including history, blood and urine investigations and radiological images was collected. Intra-operative and post-operative events were analyzed. Written consent was obtained from the patients to participate in the study and to publish their data. Institutional Ethical and scientific committee clearance was obtained.ResultsOut of 70 patients who underwent mPCNL in the study, in the age group ranging from 24–68 years, most of the cases were partial staghorn with maximum size of stone up to about 3.5 cm. Inferior calyx was most frequently punctured. Six cases had multipuncture mPCNL, four patients had bilateral procedure, and two had supra-costal puncture. Eighteen patients had tubeless mPCNL, of which four were totally tubeless procedures. Four patients had hematuria, none requiring transfusion. Two patients had sepsis, managed with higher antibiotics. Limitation of the study was the sample size. To derive a sturdy conclusion, large scale studies are recommended.ConclusionsWe can conclude that mPCNL can be safely done as daycare or ambulatory surgery in properly selected patients. In centers with experienced urologists, bilateral and multipuncture mPCNL can be done as an ambulatory surgery. Thus, this addresses the stone disease as well as cost containment, without patient safety being compromised. Bed occupancy rate is reduced, helping effective utilization of hospital resources.

An Analysis of Safety and Efficacy of Day-care Surgery in Children in a Tertiary Care Hospital in India.

Background:Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice.Aims and Objectives:This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children.Materials and Methods:In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded.Results:Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent.Conclusions:DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.

An Audit of the Provisional Date of Elective Surgery Allotted to Pediatric Surgery Outpatients of a Tertiary care, Public-funded Teaching Hospital of North India.

Aim:The aim of this study was to review the compliance to the provisional date of elective surgery allotted to pediatric surgery outpatients at our center.Patients and Methods:This retrospective study was conducted in the department of pediatric surgery at our center. The children who were brought to the outpatient department with a previously allotted date of admission for elective surgery (DAES) and the final operation theater (OT) lists of elective surgery between July 2007 and September 2018 under one senior consultant (VB), were reviewed.Results:A total of 2409 cases were allotted a DAES during the study period. Out of these, 12% (288/2409) were defaulters with a male gender preponderance (82%). Most of the defaulters (>49%) belonged to the day-care surgery group, followed by simple reconstructive (32%), major reconstructive (18%), and infectious sequelae groups (<1%). The difference in the proportion of defaulters from both the reconstructive groups was statistically significant (P = 0.0001). On a further system-wise subcategorization of children in the day-care group, the genitourinary subgroup constituted the majority (80%). Children who had to undergo staged procedures showed a significantly better compliance (P < 0.0001) to provisional DAES as compared to those belonging to the single-stage group.Conclusions:Compliance to provisional DAES is poor among the children scheduled for day-care surgeries and those undergoing simple reconstructive surgeries in a single stage.

Outcome of Restricted Antibiotic Policy in a Tertiary-Level Paediatric Surgical Unit

Purpose:The purpose was to evaluate the effect of a more restrictive antibiotic policy on infective complications, mainly surgical-site infection (SSI) in clean and clean contaminated surgeries in children. Materials and Methods:The study included children who underwent clean or clean contaminated surgeries over a period of 18 months with a no-antibiotic or single dose of pre-operative antibiotic protocol, respectively. These were compared to historical controls in previous 18 months where the antibiotic policy was to continue the course for 3–5 days. The outcome looked for was presence of SSI or infection related to the operated organ.Results:A total of 933 (study group) patients were compared to 676 historic controls (control group). In the study group, 661 of 933 were clean surgeries and 272 were clean contaminated surgeries. In the study group, 490 of the 676 were clean surgeries and 186 were clean contaminated surgeries. Clean contaminated surgeries included urological surgeries, gastrointestinal tract surgeries and neurosurgeries, whereas clean surgeries were typically day-care surgeries. Comparing the infective outcomes in each type of surgery, there was no statistical difference between cases or controls in either subgroup.Conclusion:Antibiotic prophylaxis (AP) is not required for clean surgeries. For clean contaminated surgeries, just one dose of pre-operative AP is effective in preventing SSI.

Comparing palonosetron and lignocaine pretreatment with venous occlusion on reducing rocuronium associated withdrawal movements. A double blinded randomized control trial

Introduction: Use of rocuronium has been associated with withdrawal movements of injected arm during its administration. Our study is to compare the effectiveness of palonosetron vs. lignocaine pretreatment with venous occlusion on reducing withdrawal movements associated with rocuronium injection. Materials and Methods: This prospective randomized double blind trial includes 150 patients aged between 18 and 65 years undergoing elective day-care surgeries. Patients were randomly divided into 3 groups of 50 patients each with assistance from computer generated random number table. Group P received palonosetron 075mg, Group L received Lignocaine 30 mg and Group S received Normal saline as pretreatment. The degree of withdrawal of limb was graded on four-point scale. Haemodynamic changes namely HR and MAP following administration of study drugs and complications following administration of the study drugs like urticaria, wheal and rash were also monitored. Results: Overall incidence of rocuronium induced withdrawal movements was significantly more in-group S (84%) than other study groups (p Conclusion: Study demonstrated that palonosetron pretreatment and venous occlusion has reduced rocuronium induced withdrawal movements more effectively than lignocaine. Keywords: Palanosetron, Rocuronium, Withdrawal movements, Lignocaine.

English

BACKGROUND Day-care surgery in all the surgical specialities has become an accepted and popular method among the health care personnel and patients. Lesser demand for in-patient beds and lower cost of hospital stay are making this therapeutic modality more acceptable. Current concepts in anaesthesia, availability of newer anaesthetic drugs and surgical methods have helped in achieving progress of daycare surgeries. Pre-anaesthetic evaluation of patients determine their fitness for day-care anaesthesia and surgery, and at times guide the anaesthesiologist in formulating appropriate plans and strategies. We wanted to observe the demography of patients undergoing day-care surgery and estimate the proportion of complication free outcome among day-care ENT procedures following preanaesthetic evaluation. METHODS 96 patients aged between 18 and 60 years undergoing day-care ENT surgeries for which pre-anaesthetic evaluation was done were included. Demographic data was obtained, thorough pre-anaesthetic evaluation and detailed clinical ENT examination were done. Nature of anaesthesia given, duration of the surgery and severity of the postoperative pain were recorded. Analgesic protocol undertaken during recovery period and associated symptoms were recorded. RESULTS Out of 96 patients 55 (57.29) were males and 41 (42.70 %) were females with a male to female ratio of 1.4:1. The mean age was 31.50 ± 4.15 years. 32 / 96 (33.33 %) ear surgeries, 26 / 96 (27.08 %) nose surgeries, 22 / 96 (22.91 %) throat surgeries and 16 / 96 (16.66 %) head and neck surgeries were performed. The smallest mean duration of surgery was 13.30 ± 02.5 minutes for removal of foreign body in the ear and the largest mean duration of surgery was for cortical mastoidectomy, 91.65 ± 6.20 minutes. Postoperative pain was present in 93 / 96 (96.87 %) of the patients varying from class I to class V of Verbal Pain Intensity Score (VPIS). CONCLUSIONS To manage patients undergoing day-care surgeries, efficient pre-anaesthetic evaluation is essential. It should include proper selection of patients, assessing the nature of surgery, analysis of comorbid conditions, counselling patients regarding type of anaesthesia and postoperative pain management. The postoperative pain and associated symptoms should be assessed and monitored periodically and should be managed by trained health care personnel to avoid unplanned overnight stays. KEYWORDS ENT, Anaesthesia, Day-Care Surgery, Complications, Pre-Anaesthetic Medication and Post-Operative Outcome

English

BACKGROUND Day-care procedures have become accepted and popular among the surgeons and anaesthesiologists all over the world in recent times especially for ENT surgeries. The economic and financial implications are making them acceptable among the general population also. Alleviating acute pain during immediate postoperative period plays a crucial role in deciding the fitness for discharge of the patient. We wanted to evaluate the pain intensity and observe the role of analgesia in its alleviation in postoperative period following day-care ENT surgeries. METHODS 96 adult patients undergoing various types of day-care surgeries in the department of ENT were included in this study. The pain scores were measured using Verbal Pain Intensity Score (VPIS) at frequent two hourly intervals. Opioids, and Paracetamol were used as analgesics. Antiemetic Ondansetron was used to combat nausea and vomiting. The effect of analgesics was assessed using mean values and Friedman test for repeated measures. RESULTS Out of 96 patients 55 (57.29 %) were males and 41 (42.70 %) were females with a male to female ratio of 1.4:1. The mean age was 31.50 ± 4.15 years. 32 / 96 (33.33 %) ear surgeries, 26 / 96 (27.08 %) nose surgeries, 22 / 96 (22.91 %) throat surgeries and 16 / 96 (16.66 %) head and neck surgeries were performed. Moderate to extremely intense grade pain was noticed in 75 / 93 (80.64 %) patients. CONCLUSIONS The prevalence of moderate to extremely intense acute postoperative pain in 75 / 93 (80.64 %) patients was high. But the analgesics prescribed were effective to control the pain and the mean pain intensity was less than 2 in 14 hours, hence 85 / 96 (88.54 %) patients could be discharged in time. The associated symptoms were managed with supportive care and required no additional medications and these patients were discharged after overnight stay. KEYWORDS Day-Care Surgery, Analgesia, Opioids, VPIS, Associated Symptoms, Postoperative Pain

Efficient techniques for postoperative analgesia in laparoscopic cholecystectomy

Today, in a generation of technological improvements, Laparoscopic cholecystectomy (L.C.) is the selection for the treatment of symptomatic illnesses of gallbladder like cholecystitis and cholelithiasis. Legitimate pain control is essential for advancing scientific outcomes and previous ambulation after surgery. Results aren't suitable for daycare surgeries. It is minimally invasive with much less postoperative ache, rapid recuperation, lesser health facility live and return to everyday interest on the earliest1. Though laparoscopic cholecystectomy is a slightly invasive surgical procedure with more secondary perioperative pain scores assessment to open procedures, it is present with enormous ranges of postoperative ache. The present prospective, unmarried blinded, randomized manipulate study protected sixty patients scheduled for laparoscopic cholecystectomy and aimed to compare the postoperative analgesia between the posterior transversus abdominis plane block and subcostal transversus abdominis aircraft block. The patients were randomly allotted to 2 businesses- Group 1 consisted of patients who received posterior T.A.P. block with zero. 2% Ropivacaine with Dexmedetomidine 1mcg/kg and Group 2 consisted of patients who obtained subcostal T.A.P. block with zero.2% Ropivacaine with Dexmedetomidine 1mcg/kg. All patients underwent laparoscopic cholecystectomy under general anaesthesia. At the quit of the surgical operation earlier than extubation, both one of the blocks were executed on the affected person underneath ultrasound steering by the identical anaesthesiologist. The objectives of the study were to compare the postoperative pain relief based on VAS at rest and VAS at deep breathing, to compare the time taken for the administration of rescue analgesia (duration of analgesia) and to compare the time taken to perform the block.

Assessment of Level of Patient Satisfaction with Day-Care Surgery: An Observational Study.

To assess the level of patient satisfaction with day-care surgery at a tertiary care centre and to find out the different determinants that influence the patient satisfaction. Observational study; Tertiary care hospital in Western India; Patients undergoing Day-care surgery at Dept of ENT from Feb 2018 to Aug 2018; All patients who underwent day-care surgery were given a questionnaire to determine level of satisfaction.On analysis of data according to questions the average score was in the range of 3.5 to 4.22 out of a maximum score of 5. On analysis of data according to domains of patient care the scores ranged from 3.61 to 4.19.Although patients were generally satisfied with the level of care being provided to them there is still scope of improvement.

A Comparative Evaluation of the Characteristics of Recovery from Anesthesia with Isoflurane and Halothane in Day-Care Surgery

A Comparative Evaluation of the Characteristics of Recovery from Anesthesia with Isoflurane and Halothane in Day-Care Surgery

Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival

In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children.

Current practice of pre-anaesthesia preparation and perioperative parental satisfaction during paediatric ambulatory procedures in a developing country — An observational study

ObjectiveTo assess the extent of preoperative information provided to patients’ parents, their expressed need for more information and its effect on paediatric anxiety and parental satisfaction with the perioperative care provided. DesignProspective observational study. SettingPublic university hospital. Participants100 children, 2–12 years scheduled to undergo elective day-care surgery under general anaesthesia. Outcomes measuredThe parents were interviewed preoperatively with a questionnaire, which included a list of items about preoperative preparation likely to contribute to patients’ satisfaction with the health care services. The baseline anxiety level in the participant children and its possible predictors were recorded. Before discharge, the parents were asked a questionnaire for satisfaction scoring. ResultsEighty-five (85%) parents were aware of the surgical procedure whereas 5 (5%) were aware of anaesthesia. Seventy-five (79%) families were not keen to know about anaesthesia. Amongst all the parents surveyed, 16 (16%) reported that receiving more information on anaesthesia would increase their anxiety while 84 (84%) reckoned that although more information would not increase their anxiety, it was unnecessary. Preoperative baseline anxiety was identified in 71 (71%) of children with a median mYPAS of 46.4 (95%CI: 41.4, 48.64). Amongst the potential predictors of anxiety analysed, low paternal education level was associated with high preoperative anxiety in children (adjusted OR: 3.67; 95%CI: 1.35, 9.99; P=0.01). Ninety-four (94%) and 57 (57%) parents expressed satisfaction with the obtained information from the surgeon and anaesthesiologist, respectively. ConclusionThe present study revealed the high incidence of preoperative anxiety in children and highlighted the expectations of parents regarding preoperative preparation suggesting the need to evolve the existing preparatory program in the context of a developing world setting.

Recovery characteristics in patients undergoing short Gynaecological day care procedures under sedation with Dexmedetomidine vs Propofol infusion : Double blind Randomized controlled trial

Background and Aims: Postoperative psychomotor dysfunction is one of the deciding factors for discharge after daycare surgeries. Sedation for daycare procedures is commonly done using propofol and dexmedetomidine. Hence, we decided to study the recovery characteristics of dexmedetomidine and propofol in patients undergoing short gynaecological day care procedures. Methods: After getting informed consent, 40 patients aged between 18 to 65 years and ASA physical status 1 and 2 undergoing short gynaecological procedures were included for this double-blind prospective randomized controlled trial. All patients were educated about psychomotor tests preoperatively. Patients were randomized into two groups, Group P (propofol) and Group D (dexmedetomidine). Sedation was given using propofol or dexmedetomidine according to the group and titrated to achieve observer's assessment of alertness/sedation (OAA/S) scale 2-3. Recovery characteristics were assessed by modified Aldrete score, time to sit without support, finger tapping test and visual-spatial capacity memory test. Results: Demographic variables, baseline finger tapping test and visual-spatial capacity memory test, duration and type of surgery were comparable. All forty patients tolerated the procedure with no signs of respiratory depression.Time to achieve modified Aldrete score 9- 10 was significantly more in Group P compared to Group D ( 5.6±1.4min vs 4.0±1.4min; P=0.002), while time to sit without support was significantly less in Group P ( 5.6±1.4min vs 4.0±1.4min; P=0.002). Psychomotor tests during recovery and patient satisfaction score were comparable between the groups. Conclusion: Dexmedetomidine and propofol have been found to have comparable recovery characteristics in daycare short gynaecological surgeries.

Comparison of clinical performance of i-gel with LMA-proseal in elective surgeries: A prospective randomized study

Background: Day-care surgery that is, the patient being discharged from the hospital on the same day of surgical procedure, has become immensely popular modality of treatment throughout the globe. Supraglottic airway devices are used commonly as an alternative to endotracheal intubation for delivering general anaesthesia in Day Care Surgery. I-gel is a type of Supraglottic device possessing a soft gel like, cuffless supraglottic airway made of thermoplastic elastomer. The Proseal LMA (PLMA), another supraglottic device was designed in late 1990’s especially for use with positive pressure ventilation at high pressures. The present study work is to record the time taken for successful insertion, number of insertion attempts, the quality of ventilation during anaesthesia, hemodynamic parameters (heart rate & Blood Pressure) and change in SpO2 and incidence of airway trauma and gastric distension with I-gel and Proseal LMA. Material and Methods: Sixty patients undergoing elective surgery under general anaesthesia were divided into two groups of 30 each. Group I in which anaesthesia was delivered using I-gel and in Group P, anaesthesia was delivered using Proseal LMA. Time taken for successful placement, number of insertion attempts, the quality of ventilation, hemodynamic parameters and incidence of airway trauma and gastric distension are recorded. Results: PLMA takes longer to insert with less hemodynamic stability than I-gel however the quality of airway seal achieved is comparable to that of I-gel. Conclusion: The present study showed that I-gel could be an effective and better alternative than Proseal LMA as a supraglottic airway device.

Day surgery for inguinal hernia

Day surgery for inguinal hernia Abstract. Hernia surgery has experienced a very positive development in the past 30 years: better meshes, better understanding of the anatomy and the nerves, improved skills-training, minimally invasive and more precise operations (e. g. also with the robot), just to name a few. This directly results in fewer recurrences, less chronic pain and better quality of life. In the current article, the growing importance day-care surgery of inguinal hernias is discussed - not least because of the statutory AVOS regulation that came into effect in Switzerland on 01.01.2019. This article reviews the indication and the most important surgical procedures for day-care groin hernia repair. There is no single standard procedure (no one-fits-all), since according to today's knowledge every patient is an individual case and must have access to an individually tailored procedure. For day-surgery inguinal hernia repair with mesh, both conventional and minimally invasive procedures are suitable. When planning outpatient hernia repairs, it must also be taken into account that acute postoperative pain is of negative prognostic significance, which is why optimal postoperative pain therapy should be well coordinated with the general practitioner in the first days after the operation. With all the positive aspects of AVOS, it is still not clear how the further training of the young generation will take place under the current conditions, as it is no longer provided for in the structural and reimbursement regulations. There is an urgent need for improvement here.

A pilot study of the effectiveness of a serious game CliniPup® on perioperative anxiety and pain in children

Introduction/AimChildren experience important anxiety before surgery. Anxiety and pain are positively correlated. Serious gaming is a non-pharmacological intervention to prepare children and parents for an operation. We aimed to evaluate the effectiveness of the serious game CliniPup® on anxiety and pain in children undergoing ambulatory surgery. MethodA prospective randomized controlled pilot trial in 72 children aged 5 to 11 years old scheduled for day-care surgery (general surgery, dentistry, otorhinolaryngology, urology) was performed. Participants were randomly assigned into 3 groups: A (CliniPup®), B (“Empty game” without educational information), or C (no game, oral information at the outpatient clinic, current standard of care). Anxiety, pain, and behaviour were evaluated by validated instruments at six time-points: T0: baseline, T1: 1 week preoperatively, T2: at hospital admission, T3: before discharge, T4: 1 week postoperatively, T5: 1 month postoperatively. ResultsAfter playing the game (T1), the estimated mean anxiety score (VASa) was lower in Group A (1.9 units) versus Group B (2.7 units). The estimated mean VASa at T1 for Group A was 2.6 units lower compared to Group C (p = 0.003). For Group B, VASa levels were 1.8 units lower than in Group C (p = 0.045). After correction for “surgery type”, Group A continued to show a significantly lower VASa compared to Group C (p = 0.044). On the other time points, no difference in anxiety and pain were observed, nor in post-hospitalization behaviour. ConclusionChildren that played the CliniPup® game one week before surgery had a significant reduction in preoperative anxiety after playing the game, but not on the other time points. No differences on peri-operative pain were observed during the different time points. Type of StudyRandomized Trial. Level of EvidenceLevel II.

Comparative evaluation of low-dose levobupivacaine and ropivacaine in patients undergoing inguinal herniorrhaphy under walking spinal anaesthesia as daycare surgery

Comparative evaluation of low-dose levobupivacaine and ropivacaine in patients undergoing inguinal herniorrhaphy under walking spinal anaesthesia as daycare surgery