Day Case Surgery Patients Research Articles

Factors influencing the fasting decisions of day-case surgery patients.

Patients admitted on the day of surgery are asked to arrive fasted, and they often fast for longer than necessary. Although pre-assessment supports patients to prepare for surgery, little is known about how they make fasting decisions. To explore factors influencing the fasting decisions of day-case patients and how to provide information pre-operatively. A qualitative descriptive study design was used. Semi-structured telephone interviews were carried out with 10 patients recruited from a single day-case unit. Data were analysed using thematic analysis. Three themes provided context for fasting decisions: the operation as a serious event; the patient as an active partner; and the patient as a rule follower. Length of fast is determined by fasting decisions and practicalities. Patients approach fasting decisions according to their knowledge and experience and their individual preferences for information. Pre-assessment nurses should tailor information to the patient and explain the rationale for fasting.

Clinical Study of Flumazenil Antagonizing Remimazolam on Nausea and Vomiting After Gynecologic Day Surgery.

To evaluate the effect of flumazenil antagonizing remimazolam on postoperative nausea and vomiting (PONV) after gynecologic day surgery. 141 cases of gynaecological daycase surgery patients in Weifang People's Hospital were selected, randomized into group F (flumazenil group, 71 cases) and group C (control group, 70 cases). Dexamethasone 5 mg, flurbiprofen axetil 50 mg, and droperidol 1 mg were given intravenously before induction of anesthesia in both groups. Anesthesia induction: Remimazolam 0.25mg / kg was injected within 1 minute. After the patient fell asleep, mivacurium chloride 0.2mg / kg was injected for 30 seconds and alfentanil 20ug / kg was injected for 30 seconds. Anesthesia maintenance: Remimazolam 1mg/kg/h and alfentanil 40ug/kg/h were continuously pumped by micro pump. Stopping the injection of remimazolam and alfentanil at the end of the operation. Flumazenil 0.2 mg was given to antagonize remimazolam in group F after 1 minute. Group C was given an equal volume of saline. The incidence of PONV in the postoperative PACU and over a 24-hour period, patient awakening time, and general patient information were recorded. The incidence of PONV in both groups within 24 hours was 50.70% in group F was significantly higher than 32.86% in group C. The difference was statistically significant (P < 0.05). The incidence of PONV in the PACU was 5.6% in group F and 8.6% in group C. The difference was not statistically significant (p > 0.05). Flumazenil antagonism of remimazolam increases the incidence of PONV within 24 hours in gynecologic day surgery patients and has no significant effect on the incidence of PONV in the PACU.

Perioperative sleep disorders in gynaecological daycase surgery patients and analysis of risk factors: protocol for a cross-sectional study

IntroductionSleep disorders are clinical syndromes of disturbed sleep-wake rhythms and abnormal sleep quality. They have various causes, but their main manifestations are difficulty falling asleep, sleep disruption and daytime fatigue....

The influence of different perioperative analgesia modes on postoperative nausea and vomiting in day-case surgery patients

The influence of perioperative analgesia modes on the prevalence of postoperative nausea and vomiting in day-case surgery patients is investigated in the article. The study involved 100 cases of unilateral phlebectomy under propofol and nitrous oxide anaesthesia, randomized by 4 groups with different perioperative analgesia modes of 25 patients each. In the first group fentanyl IV infusion was provided during surgery, in the second group it was amplified with ketoprofen 100 mg IV. In the third group sodium adenosintriphosphate IV infusion was provided for the whole surgery time, whereas the patients in the fourth group received 100 mg ketoprofen IV before it. Analgesic efficacy of all the four modes was equal, while ketoprofen administration aggravated and prolonged postoperative nausea and vomiting without influence on PONV morbidity.

Pain management in day-case surgery

### Key points Day-case surgery is defined as a planned surgical procedure for which selected patients are admitted to hospital and discharged home the same calendar day. The Department of Health in 2000 set a target that 75% of all elective surgery should be undertaken as day-case procedures and subsequently the British Association of Day Surgery now lists >200 different surgical procedures suitable for day-case and short-stay units. Additionally, there is an increasing political, managerial, and clinical drive to also admit patients presenting with acute conditions requiring urgent surgery as day cases. Indeed, the National Health Service (NHS) Modernisation Agency states inpatient care should be the exception rather than the rule.1 Planned changes to admission policies are expected to release nearly half a million in-patient bed days each year, generating large savings for the NHS, while at the same time responding to patients’ expectations of a modern, flexible healthcare service. Hence, day-case surgery is continually evolving with more extensive surgical procedures being offered to patients with an increased number of co-morbidities. Assisting in achieving those targets it is the role of the anaesthetist to plan anaesthetic techniques and pain relief suitable for day-case surgery patients. As postoperative pain is a common cause for extended hospital stay, unanticipated admission, and re-admission, the responsibilities of the anaesthetist encompass not only the immediate patient care but also the implementation and planning of day surgical lists. This paper will, in the context of day-case surgery, discuss the currently available options …

Lorazepam does not improve the quality of recovery in day-case surgery patients

In day-case surgery, the effects of the anxiolytic lorazepam as premedication on the quality of postoperative recovery are unknown. To evaluate whether lorazepam as a premedication beneficially affects quality of recovery (primary outcome) and psychological manifestations (secondary outcome) after day-case surgery. A randomised, double-blind, placebo-controlled clinical trial. Single tertiary centre. day-case surgery; age at least 18 years. insufficient knowledge of the Dutch language; intellectual disability; ophthalmology surgery; extracorporeal shock wave lithotripsy; endoscopy; botulinum toxin A treatment; abortion; chronic pain treatment; preceding use of psychopharmaceuticals; contraindication to lorazepam. Lorazepam (1 to 1.5 mg) intravenously vs. NaCl 0.9% as a premedication prior to surgery. Quality of Recovery-40 (QoR-40) score. State-Trait Anxiety Inventory (STAI-State/Trait); State-Trait Anger Scale (STAS-State/Trait); Multidimensional Fatigue Inventory (MFI); Hospital Anxiety and Depression Scale (HADS). Timing of evaluation: T0: preoperatively (all scales); T1: before discharge (STAI-State/Trait); T2: first postoperative working day (QoR-40); T3: 7th day after surgery (all scales). Robust regression analysis was applied. Statistical analyses were adjusted for the corresponding baseline value and sex. Four hundred patients were randomised; 398 patients were analysed. Postoperative mean QoR-40 scores were similar in both groups at T2 (174.5 vs. 176.4, P = 0.34) and T3 (172.8 vs.176.3, P = 0.38). Postoperative mean STAI-State/Trait scores decreased less in the group with lorazepam at T1 (32.3 vs. 29.3, P < 0.0001; 32.7 vs. 30.8, P = 0.0002). STAI-Trait and HADS-Anxiety decreased less in the group with lorazepam at T3 (31.1 vs. 30.0; P = 0.03, 3.3 vs. 2.5, P = 0.003). STAS-State increased in the group with lorazepam at T3 (10.8 vs. 10.3, P = 0.04). In day-case surgery, lorazepam as a premedication did not improve quality of recovery. Furthermore, this premedication may delay the decrease in postoperative anxiety and aggression. ClinicalTrials.gov identifier: NCT01441843.

The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

Background and objectivesEmergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. MethodsThis was a cross-sectional, observational study including pediatric patients aged 3–10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients’ level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. ResultsOne hundred and forty-five (145) children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7±10.8min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p=0.01, OR 3.3, 95% CI 1.2–8.6) and moderate and severe anxiety prior to induction (p<0.001, OR 5.6, 95% CI 2.3–13.0). Complications of emergence delirium included intravenous line removal (n=1), and surgical site bleeding (n=3). ConclusionChildren of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

Health-related quality of life of day-case surgery patients: a pre/posttest survey using the EuroQoL-5D

This paper describes and compares the perceived health-related quality of life (HRQoL) of day-case surgery patients before and after their procedures and examines some associated patient-related factors. A pre/posttest survey design was employed to collect data from Finnish adult day-case surgery patients using participant-completed EuroQoL 5-Dimensional Classification Component Scores (EQ-5D) questionnaires given 2 weeks presurgery (n = 131) and 2 weeks postsurgery (n = 131) in 2004. No noticeable change after minor surgery was found using the EQ-5D. Using the EQ-5D index, patients perceived their HRQoL as high before and after surgery. Almost one fifth (17%) reported no pain or discomfort before the procedure compared with 40% after it. As measured by the EuroQol visual analogue scale (EQ(VAS)), those patients who reported chronic illness before the operation had a lower perception of their HRQoL compared with those who did not. It was also found that self-care and usual activities were more disturbed after surgery. Although there were increases and decreases within items of the EQ-5D, overall, there was no improvement on EQ-5D scores. More research is needed to explore the sensitivity and responsiveness of the EQ-5D measure in day-case surgery patients.

At Your Convenience: Preoperative Assessment by Telephone

This article describes how practitioners in one trust have worked in partnership with colleagues at NHS Direct to develop a telephone preoperative assessment service for elective day case surgery patients. The service has improved theatre utilisation by reducing the numbers of 'did not attends' (DNAs) and ensures the safe preparation of appropriately selected patients for day case surgery. It has reduced the number of trips to hospital patients need to make and, more recently, the length of time spent there.

Day‐case surgery patients' health‐related quality of life

This study describes the health-related quality of life (HRQoL) of day-surgery patients and aims to identify factors associated with HRQoL. The cross-sectional questionnaire survey data were collected from day-surgery patients being discharged from hospitals in one Finnish hospital district in 2001 using the Nottingham Health Profile (NHP). The analysis was based on statistical methods. Day-case surgical patients had the best HRQoL in the social dimension and mobility. The NHP scores showed moderate distress in sleep and energy, and demonstrated pain. Older age and vocational education were associated with higher scores as measured with the NHP, indicating more problems in the measured variables. The patients who have been operated as day cases recovered satisfactorily and the operation did not weaken their perceived HRQoL. More emphasis should be put on evaluating day-case surgery patients' pain. Patient's age should be taken into account in planning type of surgery. The NHP is also a useful tool for the purposes of studying the HRQoL of day-case surgery patients.

Hyperbaric articaine for day-case spinal anaesthesia

Articaine and lidocaine are clinically very similar suggesting that articaine could be suitable for day-case spinal anaesthesia. A dose-response study with articaine in ambulatory spinal anaesthesia was therefore performed. In this randomized double-blind study, 90 day-case surgery patients received spinal anaesthesia with 60 mg (A60), 84 mg (A84) or 108 mg (A108) of hyperbaric articaine hydrochloride. Sensory block was tested with pinprick and motor block on a modified Bromage scale. A structured interview was performed on the first and seventh postoperative days. Sensory block reached the T10 dermatome in a median (range) of 5 (5-10) and was maintained at this level for 70 (35-145), 70 (15-115) and 85 (20-115) min in the A60, A84 and A108 groups, respectively. Six patients in the A108 group, two in the A84 group and one in the A60 group had maximum spread of analgesia to T(1) or higher (NS). Patients in the A108 group needed more medication for hypotension (P=0.018), had more often nausea and vomiting (P=0.027), took oral fluids later (P=0.031) and both sensory block recovery [median (range)] [2.5 (2-4.5) h] (P=0.017) and motor block recovery [2 (1.3-4) h] (P=0.009) were delayed. No patients in the A108 group needed opioid intraoperatively while fentanyl was needed in 5 (17%) and 2 (7%) patients in the A60 and A84 groups, respectively. Discharge criteria were attained in approximately 4.5 h after articaine injection (NS) and no drug-related sequelae were observed. Hyperbaric articaine 60 and 84 mg resulted in spinal anaesthesia allowing surgery of the lower extremities for about 1 h. Recovery was rapid. Use of 108 mg of articaine is not recommended because of frequent extensive cephalad spread of the block, accompanied by arterial hypotension and nausea.

Effects of Sensory Information on Preoperative Anxiety of Day-Case Surgery Patients

Background: Preoperative anxiety is described as an unpleasant state of uneasiness or tension that may adversely influence the quality of anesthesia and outcome of surgery. This study was designed to assess the effects of sensory information on preoperative anxiety of outpatients for day-case surgery. Methods: One hundred healthy patients scheduled for elective day-case surgery were randomly assigned to one of two groups. A leaflet consisting of sensory information describing what they could expect to feel during anesthesia, surgery, and recovery time was provided by a trained nurse to the patients in information group (n = 50) in the preparation room before the operation. However, no information was provided to the patients in control group (n = 50). All patients were requested to complete the Spielberger's State-Trait Anxiety Inventory on the day before the operation in the clinic, and at the conclusion of the sensory information or standard interview in the preparation room before the induction of anesthesia. Blood pressure, heart rate, and respiratory rate were recorded during the observational period. Results: Although no significant difference existed between the two groups on the pre and postintervention anxiety scores and vital signs, the question about feeling of objective anxiety in the information group was significantly higher than in the control group. Conclusions: Implications are presented for identifying the patients at risk for preoperative anxiety and coping styles and for designing effective interventions to enhance the patient's sense of control. (Korean J Anesthesiol 2001; 40: 435∼442) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Direct referral day case oral surgery for dental practitioners: a pilot investigation.

Direct referral of patients for day case surgery by general medical practitioners (without hospital assessment) has become widely accepted but few facilities exist for this form of referral from general dental practice. In order to evaluate whether direct access day surgery is applicable to dentistry, the quality of referral by GDPs and hospital consultant clinics was compared in a prospective study (1994-1997) involving 1581 patients.

Factors predisposing to postoperative intraocular inflammation.

This prospective study of 123 patients undergoing cataract extraction determined the preoperative and surgical factors predisposing to an exaggerated postoperative inflammatory response. It is important to identify the patients at increased risk of complications requiring additional prophylaxis or more intensive postoperative care, particularly when selecting patients for day case surgery. Previous intraocular inflammation or surgery was the factor most strongly associated with marked inflammation on the first postoperative day (p < 0.01, compared to uncomplicated patients). As a result, patients stayed in hospital an average of one day longer (p < 0.001) and required significantly more steroid drops (p < 0.001). Other factors of significance, but reducing importance were: difficult surgery, non-caucasian race and brown irides. Amongst uncomplicated patients, the difficulty of surgery was most significantly related to a high inflammation score (p < 0.01). Non-caucasian patients stayed in hospital significantly longer than their caucasian counterparts (p < 0.05), and required more steroid drops (p < 0.001). Of caucasian patients, those with brown irides were inpatients for significantly longer than those with blue or hazel (p < 0.05). No other factors studied significantly altered postoperative inflammation: neither the presence of diabetes, nor the technique of cataract extraction.

Prévention des nausées et vomissements postopératoires par l'ondansétron

This study was carried out to assess the efficacy of oral ondansetron, a new 5HT 3 receptor antagonist, in patients undergoing thyroid surgery. It included 60 patients, randomly assigned to two groups, and receiving orally, 1 h before induction of anaesthesia, either 8 mg of ondansetron (n = 29) or a placebo (n = 30). One patient was excluded. The same anaesthetic protocol, consisting of 3 to 5 μg · kg −1 of fentanyl, 4 to 6 mg · kg −1 of thiopentone, and 0,5 mg · kg −1 of atracurium, was used in all. Anaesthesia was maintained with 50 % nitrous oxide in oxygen with 0.8 to 1 % endtidal concentration of isoflurane and additional boluses of 0.1 mg of fentanyl as required. The incidence and intensity of nausea, graded mild, moderate or severe, and the incidence of vomiting were recorded postoperatively. During the first twelve hours after surgery, 40 % of patients in the placebo group had nausea (16.7 % mild, 20 % moderate and 6.7 % severe), and 50 % vomited. In the ondansetron group, nausea and vomiting occurred in 13.8 % and 20.4 % of patients respectively. The 4 patients in the latter group complained of major nausea. The differences between the groups were statistically significant : p = 0.025 for nausea and p = 0.042 for vomiting. It is concluded that oral ondansetron, 8 mg taken orally 1 h before surgery, significantly reduces the incidence of nausea and vomiting during the first twelve postoperative hours. As it is easy to use and has no side-effects, it might be of interest in day-case surgery patients, despite its high cost.