Home Readiness Research Articles

Postoperative pain, recovery and discharge after robot-assisted laparoscopic prostatectomy: A multicentre, single blinded, randomised controlled trial.

General anaesthesia is standard of care for patients undergoing robot assisted laparoscopic prostatectomy (RALP). However, postoperative pain and bladder discomfort remains an issue, and optimising pain management could improve recovery and promote earlier home discharge. The main objective of this trial was to evaluate if patients receiving spinal anaesthesia are more frequently home ready at 8 pm on the same day compared with multimodal pain management following RALP under general anaesthesia. This pragmatic, randomised controlled, multicentre trial was performed between January 2019 to December 2021. Patients undergoing RALP under general anaesthesia were randomised to either multimodal analgesia using parecoxib and morphine intra-operatively (Group GM) or spinal anaesthesia with bupivacaine and sufentanil (Group GS). The primary aim, home readiness, was assessed using a post-anaesthesia discharge scoring system. Of 202 patients analysed, 27% patients reached home readiness criteria after 12 h, 46% after 24 h and 79% after 48 h, without differences between the groups. Urge to pass urine was greater in group GM than in group GS (p ⟨0.001) and lasted for a median of two hours in both groups. More patients expressed satisfaction with postoperative care in group GS (p ⟨0.001). No other significant differences were found between the groups. We found no difference in time to home readiness between the groups. Approximately one-fourth of the patients achieved home readiness the same day after surgery without difference between the groups. Fewer patients had urge, and patient satisfaction was greater in group GS.

Well-being and empowerment perceptions in a sudden shift to working from home

In the literature on the antecedents and mediators of employee well-being, there is little or no acknowledgement of sudden changes in the social and environmental context in which perceptions of well-being are formed. Contextual influences are rarely so impactful and unexpected as those associated with the COVID-19 pandemic. To continue operating within lockdown restrictions, many organizations, apart from those unable or unwilling to initiate such changes, abruptly adopted a work from home (WFH) or hybrid working pattern. These circumstances raise novel questions about the influence of impactful, unanticipated contextual factors on employee well-being outcomes. To address these questions in the context of a shift to WFH, we tested a model adapted from aspects of Event Systems Theory (EST) and the Psychology of Working Theory (PWT). Central to our theoretical adaptation was a unique perspective on PWT “decent work” perceptions based on principles of empowerment. In a study of 337 employees during the lockdown period, we applied a Bayesian multilevel model to investigate the contrast between in-lockdown perceptions relative to current pre-lockdown perceptions. Results suggested the contextual shift to WFH related negatively to relative perceptions of well-being, job satisfaction, and organizational commitment. Empowerment significantly mediated all well-being outcomes. Organizational support, neuroticism, and home readiness related directly to empowerment and indirectly to well-being outcomes via empowerment. We discuss how sudden contextual changes interacted with relationships observed in our model, and how our findings progress a context-responsive adaptation of EST and PWT in the new world of WFH.

Student-led activities of daily living group program in a hospital inpatient rehabilitation setting.

Occupational therapists have vital roles in inpatient rehabilitation to focus on independence in activities of daily living. Occupational therapy interventions are uniquely designed to address goals of service users and can be delivered individually or in group formats. Group interventions promote service users' mutual support and enable therapists to increase frequency and intensity of service provision. Student-led programs have become an attractive model, benefiting students while providing positive treatment outcomes for service users. There is an emerging body of literature that explores service users' and students' satisfaction with student-led group models of practice within inpatient rehabilitation and occupational performance outcomes of service users participating in student-led programs. This study aimed to explore the satisfaction of service users and students in addition to the self-reported occupational performance outcomes of a student-led activities of daily living group program in inpatient rehabilitation. Data from 33 service users and seven students were collected retrospectively. The intervention involved a student-led activities of daily living group program, consisting of three groups: breakfast, morning tea, and home readiness group. All service users and students completed unique satisfaction surveys at the conclusion of their participation in the student-led program. Service users completed a self-reported activities of daily living performance measure pre- and post-program. Findings were reported in descriptive statistics, and pre- and post-program data were compared with the Wilcoxon signed-rank test. All students were satisfied with the student-led program. Majority of service users were satisfied with all components of the student-led program. Median scores for self-reported performance increased significantly following the student-led program (P < 0.001). This study highlighted that service users and students were satisfied with the service delivery of a student-led activities of daily living group program. The program was effective in addressing self-reported performance for service users in inpatient rehabilitation. The findings from this study have potential to inform clinical practice on the implementation of student-led programs in occupational therapy settings.

A comparative study of awakening characteristics after propofol based total intravenous anaesthesia and sevoflurane based volatile induction and maintenance anaesthesia in short surgical procedure

To maintain hemodynamic parameters and rapid emergence is a challenge for anaesthesiologist in emerging era of early recovery. The aim of this study was to assess recovery characteristics of propofol and sevoflurane for induction as well as maintenance of anaesthesia in short surgical procedures. Sixty patients were assigned randomly into two groups. Group P patients were induced with 2mg/kg propofol intravenously followed by infusion of 12mg/kg/hr for 10mins, 10mg/kg/hr for 20 mins and 8mg/kg/hr till end of procedure. Group S patients were induced with 8% sevoflurane in 4L/min nitrous oxide and 2L/min oxygen mixture and maintained with 3.5% sevoflurane with spontaneous breathing. LMA was inserted in all patients. LMA insertion time and insertion attempt were observed. Time from end of procedure to first spontaneous movement, spontaneous eye opening, removal of LMA, followed verbal commands and became fully oriented to time and place, time to achieve Aldrete score ≥9 (phase I recovery) and time to achieve PADSS score ≥9(phase II recovery) were noted. Phase 1 recovery time was less in sevoflurane group as compared to propofol group. Phase 2 recovery time was less in propofol group as compared to sevoflurane group. They were statistically significant. Incidence of both nausea and vomiting was significantly higher in the sevoflurane group. We concluded that sevoflurane provides rapid induction with LMA insertion condition comparable with propofol. Sevoflurane provides early phase I recovery where as home readiness is early with propofol. Sevoflurane can be a suitable alternative to propofol for induction and maintenance.

Comparing intrathecal 1% 2-chloroprocaine and 0.5% bupivacaine for patients undergoing saddle block in daycare surgeries with respect to recovery and home readiness: A prospective double blind randomised study

Preservative free 2-chloroprocaine seems to be a better alternative to lidocaine and bupivacaine for day care procedures, because of its short duration of action. This study was designed to compare 2-chlorprocaine with low dose bupivacaine for saddle block in elective perineal surgeries on day care basis in terms of recovery and home readiness. To compare 1% 2- chloroprocaine with 0.5% bupivacaine with respect to time taken to obtain discharge criteria from post-anaesthesia care unit (PACU) to post-operative ward, from hospital to home and time taken for ambulation and micturition. This is a prospective, randomized, double blind, parallel group clinical study, conducted on ASA class I and II patients undergoing elective perineal surgeries on daycare basis in MIMS teaching hospital, Mandya. After obtaining approval from institutional ethical committee, a total of 100 patients were enrolled in this study. Saddle anaesthesia was achieved with 7.5 mg 0.5% hyperbaric bupivacaine (Group B, n = 49) or 1% 2- chloroprocaine 40 mg (Group C, n = 50). After completion of surgery, patients were monitored in PACU and postoperative ward using modified Aldrete’s score and PADSS. After discharging, patients were contacted at 24 hours and followed up for 7 days via telephone to assess potential complications of saddle block. Data analysis was done using IBM SPSS version 20. Chi-square test, Fisher’s exact test and independent t-test were used to compare the variables. P value of &amp;#60;0.05 is considered statistically significant. Mean time required to attain discharge eligibility from hospital in Group B was 296.24 min and Group C was 213.3 min with a difference of 83 mins (P &amp;#60; 0.001). Mean duration of time spent in PACU in Group B was 105.18 min and Group C was 27.22 min (P &amp;#60; 0.001). Time to unassisted ambulation and micturition was also significantly lower in Group C. None of the patient in both study groups required additional analgesia in the intraoperative period. However, 26% patients in Group C experienced more pain in the post-operative period compared to Group B (4%) (P = 0.04). Chloroprocaine provides satisfactory anaesthesia with advantage of faster regression of block, early ambulation and micturition, and thus early discharge from the hospital.

The predictive utility of functional status at discharge: a population-level cohort analysis

BackgroundFunctional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes.MethodsIn this population-based retrospective cohort study, Adults 65+ discharged from an acute hospitalization between 4 November 2008 and 18 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) re-presentation, hospital readmission, long term care facility (LTCF) admission or wait listing (‘LTCF readiness’), and death at 180 days from discharge.ResultsA total of 80 020 discharges were included. 38 928 (48.6%) re-presented to the ED, 24 222 (30.3%) were re-admitted, 5 037 (6.3%) were LTCF ready, and 9 047 (11.3%) died at 180 days. Beyond age, diminished functional status at discharge was the factor most associated with LTCF readiness (adjusted Odds Ratio [OR] 4.11 for those who are completely dependent for activities of daily living compared to those who are independent; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (p<0.01) but not ED re-presentation or hospital re-admission.ConclusionRoutinely collected functional status at discharge meaningfully improves the prediction of long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and planning for older adults.

Effect of intraperitoneal instillation of dexmedetomidine or fentanyl as adjuvants to bupivacaine on fast tracking discharge criteria in patients undergoing ambulatory laparoscopic cholecystectomy: a randomised double-blind control trial

BackgroundPostoperative analgesia in laparoscopic cholecystectomy significantly affects the ambulation and discharge of the patient. This study compares fentanyl and dexmedetomidine as adjuvants to bupivacaine in intraperitoneal instillation after LC, in terms of their impact on ambulation, analgesic efficacy and recovery profile. Ninety patients were randomised into three groups with thirty patients in each group; group BF was administered 20 ml of 2 μg/kg fentanyl + 0.25% bupivacaine, group BD received 20 ml of 1μg/kg dexmedetomidine + 0.25% bupivacaine and group B received 20 ml of 0.25% bupivacaine only. After 8 h, Post-Anaesthesia Discharge Scoring System (PADS) scored for determining home readiness. Analgesic profile was assessed using Verbal Rating Scale and rescue analgesia requirement seen. Sedation was scored using Ramsay sedation scoring.ResultsGroup B had significantly higher VRS and rescue analgesia requirements whilst groups BF and BD had a similar analgesic profile. Ramsay sedation scores were significantly higher in group BD when compared to groups BF and B. However, the PADS score remained comparable in all three groups (P = 0.113). The trial was retrospectively registered with the clinical trial registry of India CTRI/2019/07/020466.ConclusionIntraperitoneal instillation of bupivacaine in combination with dexmedetomidine or fentanyl significantly reduces postoperative pain scores in comparison to bupivacaine alone, in patients undergoing ambulatory laparoscopic cholecystectomy. However, fentanyl may be preferred over dexmedetomidine, because it causes less sedation and achieves a better PADS score.

Saddle Block for Transrectal Prostate Biopsy: A Comparison of the Analgesic Efficacy of 0.25% Bupivacaine and 0.375% Ropivacaine

Background: Prostate biopsy is a painful procedure, and the degree of pain is related to the number of core biopsies taken.&#x0D; Objective: To compare the analgesic properties of hyperbaric bupivacaine 0.25% with 0.375% ropivacaine for saddle block in transrectal prostate biopsy.&#x0D; Methods: This was a randomised double-blinded study. Eighty patients with indications for prostate biopsy presenting at the Day-Case Theatre in a Nigerian tertiary facility were randomised into two equal groups: B (Bupivacaine) and R (Ropivacaine). Group B received 1ml of 0.25% bupivacaine, while Group R received 1ml of 0.375% ropivacaine for saddle block, respectively. Pain assessment, home readiness, patients' satisfaction, and time to first analgesic request were assessed and compared between the two groups.&#x0D; Results: The Bupivacaine group had an earlier onset of sensory block (11.90±4.10 minutes vs 23.70±8.65 minutes, p = 0.000), slower sensory block regression (48.73±9.32 minutes vs 24.88±4.21 minutes, p = 0.000), but delayed home readiness (47.23±15.93 minutes vs 29.88±8.58 minutes, p = 0.000), than patients in the Ropivacaine group. The pain scores during, immediately after and 30 minutes post-biopsy were lower in the Bupivacaine group: p = 0.010, p = 0.028 and p = 0.023 respectively. The time to first analgesic request was also longer in the Bupivacaine group (48.73±9.33 minutes) than for those in the Ropivacaine group (24.88±4.21 minutes) with statistical significance (p = 0.000).&#x0D; Conclusion: Intraoperative analgesic properties were better in the Bupivacaine group than in the Ropivacaine group. However, home readiness was earlier in the Ropivacaine group.

PENGARUH PEMBERIAN EDUKASI MELALUI VIDEO TERHADAP KESIAPAN PULANG PASIEN DENGAN PENYAKIT JANTUNG KORONER DI RUMAH SAKIT DAERAH (RSD) MANGUSADA BADUNG

Health education is defined as the process by which health professionals provide information to patients that will change their health behavior or improve their health status. Properly targeted health education can lead to reduce hospitalizations. Educational interventions in heart care have been shown to increase physical activity and lead to healthy dietary habits and smoking cessation. One of the promotional methods that can be used to prepare home readiness of patients is audio visual media. This study aimed at determining the effect of video education on home readiness of patients with coronary heart disease in Mangusada Badung Regional Hospital. This study was a quasi-experimental study with a nonequivalent control group design. Home readiness of patients was analyzed using RHDS questionnaire. The control group (conventional lecture method) in this study was a group without video education, the treatment group had been given video education with 36 samples of each group using a systematic sampling method. Data analysis used t paired sample test and Man Whitney test. Based on Mann-Whitney U test with a confidence level of 95%, the results obtained P-value, = 0.000 with Z value = -7.215 therefore it can be concluded that providing video education media had a greater effect than providing lecture media education on home readiness of patients with coronary heart disease.

Assessment of Psychomotor Recovery after Etomidate and Propofol Induction: A Randomized Double-Blind Trial

Background: The very idea of faster recovery and early ambulation has prompted patients to opt for day care surgeries. The concept of ERAS (enhanced recovery after surgery) is the backbone to achieve this goal. We conducted this study with primary objective to compare the post-operative recovery with etomidate and propofol in terms of early recovery (awakening), intermediate recovery (psychomotor and cognitive recovery) and ambulation “home readiness” and secondary objective to study the adverse effects. Methods: 60 eligible patients scheduled for day care gynaecological procedures were randomised in two groups of 30 each. Group E received etomidate 0.2mg/kg and group P received propofol 2mg/kg. Early, intermediate and late postoperative recovery (ambulation) was studied in both groups. Results: Demography between the groups were comparable while hemodynamic fluctuations were more with propofol (p&gt;0.05), early recovery was faster with etomidate (p = 0.07), psychomotor tests revealed better alertness with etomidate (p= 0.1) and patient could ambulate earlier in etomidate group. Conclusion: Both propofol and Etomidate facilitate early recovery but etomidate provides hemodynamic stability with early awakening, more alert patients and better ambulation and was found to be superior for day care surgeries.

Setting Priorities to Inform Assessment of Care Homes' Readiness to Participate in Healthcare Innovation: A Systematic Mapping Review and Consensus Process.

Organisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. Review data were mapped against the Alberta Context Tool, which was designed to assess organizational context in care homes. The review included 56 papers. No studies involved a systematic assessment of organisational context prior to implementation, but many provided post hoc explanations of how organisational context affected the success or otherwise of the innovation. Factors identified to explain a lack of success included poor senior staff engagement, non-alignment with care home culture, limited staff capacity to engage, and low levels of participation from health professionals such as general practitioners (GPs). Thirty-five stakeholders participated in workshops to discuss findings and develop questions for assessing care home readiness to participate in innovations. Ten questions were developed to initiate conversations between innovators and care home staff to support research and implementation. This framework can help researchers initiate discussions about health-related innovation. This will begin to address the gap between implementation theory and practice.

Bispectral index (BIS) guided comparison of ketamine-propofol or fentanyl-propofol combinations when used in day care urological surgeries

Bispectral index (BIS) guided comparison of ketamine-propofol or fentanyl-propofol combinations when used in day care urological surgeries - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/2394-4994.2019.0008, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Influence of anxiolytic premedication on vasovagal reactions and home readiness following outpatient intrathecal anaesthesia-A retrospective analysis.

Vasovagal reactions during application of intrathecal anaesthesia (IA) are associated with high anxiety levels. A high percentage of patients undergoing outpatient surgery suffer from anxiety. Anxiolytic premedication in day-surgery is suspected to delay recovery and discharge and is, therefore, not routinely used. The aim of this retrospective analysis was to detect the influence of anxiolytic premedication on the incidence of vasovagal reactions and time until discharge home. Anaesthesia records of all patients undergoing outpatient surgery under low-dose IA from January 2008 to June 2017 were analysed. Incidences of vasovagal reactions with a decrease in blood pressure and/or heart rate and need for cardiovascular activating medications were documented. Patients were categorised as having received an anxiolytic premedication or not. The time from intrathecal injection of the local anaesthetic until readiness for discharge was recorded. The records of 2747 patients were analysed. One thousand two hundred and ninety-one of them received an anxiolytic premedication of 1-2mg midazolam intravenously. Three hundred and fourteen patients had vasovagal incidents during application of IA (no premedication n=217 [15.0%], premedication n=97 [7.5%], P<0.0001). Premedication did not prolong time to achieve readiness for discharge (mepivacaine: P=0.5886, chloroprocaine: P=0.1555). However, in the prilocaine group, premedication led to a significantly earlier achievement of readiness for discharge (P=0.0002). Anxiolytic premedication significantly reduces the incidence of vasovagal reactions during the application of IA and does not affect time until readiness for discharge.

Readiness for Discharge After F&amp;A Surgery Using Peripheral Nerve Blocks

Category: Other Introduction/Purpose: Neuraxial anesthesia is often viewed as superior to general anesthesia (GA), but there are concerns that it may prolong length of stay (LOS). Most studies comparing the two anesthesias were performed in the absence of peripheral nerve blocks (PNBs), which when used as an analgesic adjunct may overcome the associated negative side effects of GA and allow decreased LOS. We hypothesized that patients given PNBs and GA would be discharged sooner than patients given PNBs and spinal anesthesia plus sedation, without increased incidence of adverse side effects such as pain, opioid administration and nausea. Methods: A single-center triple-blinded randomized controlled trial of 36 consecutive patients receiving elective F&amp;A surgery predicted to take 1-3 hours under planned PNB with either spinal or GA was performed (see table 1. for demographics).The primary outcome was time to meet criteria for home discharge. The a priori clinically relevant difference with 80% power was determined to be 45 minutes. Patients were assessed after admission to the PACU and at 15-minute intervals thereafter. Once an Aldrete score=9 (scale signifying patient no longer needs intensive monitoring) was obtained, patients were transferred to Phase II and assessed until the post anesthesia discharge scoring system, a home readiness scale, was =9. Actual time to discharge was also recorded.Additional outcomes included a series of baseline characterizations which were assessed pre-and post-operatively, and again during Phase II.The primary outcome was compared using multivariable unconditional quantile regression. Various regressions were performed on secondary outcomes. Results: After adjustment for age and surgical duration, patients given GA plus PNB were ready for discharge from PACU 39 minutes prior to patients given neuraxial anesthesia plus PNB, but this difference did not reach the clinically relevant a priori selected difference of 45 minutes (Table 1). However, the adjusted median time to meet ambulation discharge criteria was 52 minutes fewer (p = 0.003) (Table 1). Patients met discharge criteria substantially sooner than their time until actual discharge which was not different between groups (Table 1). Pain scores at rest were higher among GA patients at 1 hour in the PACU (adjusted difference in means [95% CI]: 2.1 [1.0, 3.2], p &lt; 0.001). Subsequent pain scores and all other secondary outcomes were not different. Conclusion: GA with PNB patients were ready for discharge 39 minutes earlier, but that difference may not be clinically significant. Although patients met criteria for discharge sooner due to a significantly more rapid ability to ambulate, they were not discharged sooner because PACU staff was not acclimated to the earlier readiness and so did not push for earlier discharge. These findings suggest that GA plus PNB leads to earlier discharge with similar side effects as spinal plus PNB. Therefore, the use of GA with PNB for foot and ankle surgeries could save the hospital and the patient time and resources.

유아의 가정환경, 유치원 적응 및 학습준비도의 구조적 관계

유아의 가정환경, 유치원 적응 및 학습준비도의 구조적 관계

DEVELOPING A PROGRAMME THEORY OF HEALTH CARE IN UK CARE HOMES—REVIEWS, SURVEYS, AND INTERVIEWS

AbstractWe aimed to develop a programme theory of health care delivery to UK care homes. A review of 15 surveys of care home health services completed since 2008 found working relationships lacking in structure and purpose and wide variation in provision of healthcare services. 58 stakeholder interviews with health and social care managers, providers, commissioners and regulators identified 3 overlapping approaches to health care in care homes: investment in relational working to foster continuity; provision of age-appropriate clinical services; and governance arrangements using incentives. A realist literature review identified important contextual factors as: care home readiness to work with health care staff; availability of structured assessment and care plans; involvement of health care staff to support learning; organisational endorsement of collaborative working; financial remuneration; and staff incentives. These findings acted as the focus of case studies in phase 2 of the study.

Randomized Comparison of Isoflurane versus Sevoflurane and Desflurane for Maintenance of Ambulatory Anesthesia.

Background:Ambulatory surgeries demand safe anesthesia with faster recovery which makes it expensive due to the cost of inhalational anesthetic agents such as sevoflurane and desflurane. Isoflurane is inexpensive agent but can cause delayed recovery. The aim of this study was to evaluate cost-benefit ratio of all three agent with respect to recovery and safety profileMaterials and Methods:Patients posted for elective ambulatory surgeries were divided into three groups. Suitable size laryngeal mask airway was inserted following induction with propofol and vecuronium. Anesthesia was maintained on low-flow anesthesia with inhalational agent as isoflurane for Group I, sevoflurane for Group II and Group III received desflurane. Patients were monitored for recovery as per modified Aldrete score and as per postanesthesia discharge scoring system for discharge from hospital. Cost analysis was done by Dion's formula. Statistical analysis was done with analysis of variance for recovery profile, Chi-square test for safety profile and Kruskal Wallis test for cost comparison between groups.Results:Patient characteristics and duration of anesthesia were similar in all three groups. Time to eye-opening was significantly less with desflurane than sevoflurane and isoflurane (P = 0.001). Time to home readiness was similar in all three groups (P = 0.451). The incidence of airway irritation, pain, and nausea/vomiting was similar in all three groups. Cost of Group I was statistically lower than other two groups (P = 0.00).Conclusion:Home readiness and safety profile were comparable between agents; the cost involved was the least with isoflurane.

Application of Discharge Criteria for Home Readiness Using Bispectral and Supraglottic Airway Devices in Day-care Surgery without Using Muscle Relaxants.

Introduction:The availability of rapid and short-acting intravenous and volatile anesthetics has facilitated early recovery that is why nowadays ambulatory surgery is becoming more common. If the criteria used to discharge patients from the Postanesthesia Care Unit (PACU) are met in the operating room (OR), it would be appropriate to consider bypassing the PACU and transferring the patient directly to the step-down unit. This process is known as “fast-tracking” after ambulatory surgery.Aims:To compare hemodynamic characteristics and recovery profile as per fast-track criteria (FTC) of recovery and postanesthesia discharge scoring system (PADSS) between sevoflurane and desflurane.Materials and Methods:One hundred American Society of Anesthesiologists Class I–II patients aged 20–50 years were randomly divided into two groups. Following anesthesia induction with injection propofol and injection dexmedetomidine airway was secured with i-gel, Group D (n = 50) received desflurane + dexmedetomidine + O2 + N2O and Group S (n = 50) received sevoflurane in place of desflurane. Emergence time was noted and FTC was evaluated in the OR, Score >12 is considered as shifting criteria for ambulatory surgery unit (ASU). PADSS was noted in ASU at an interval of 15 min for 3 h and Score >9 is considered as ready to discharge home.Results:Response to pain, verbal commands, and spontaneous eye opening in Group D was shorter than that in Group S (P = 0.001). Mean time to achieve FTC score >12 was 15 min in both the groups. Eighty-six percent of patients were ready to go home between 60 and 90 min using PADSS.Conclusion:We concluded that early recovery is faster for desflurane, and there is no difference in ready to go home time between desflurane and sevoflurane.

Comparing the efficacy and safety between propofol and dexmedetomidine for sedation in claustrophobic adults undergoing magnetic resonance imaging (PADAM trial)

Study ObjectiveTo determine the efficacy of sedation with dexmedetomidine compared to propofol for claustrophobic adults undergoing magnetic resonance imaging (MRI) in our institution. DesignRandomized, prospective, double-blinded study. SettingUniversity-based tertiary referral center. PatientsThirty claustrophobic adults with American Society of Anesthesiologists physical status I and II who were planned for MRI. InterventionsPatients were randomly assigned to target-controlled infusion propofol or dexmedetomidine loading followed by maintenance dose for procedural sedation. Measurements and Main ResultsThe primary end point was adequate reduction in patient anxiety levels to allow successful completion of the MRI sequence. Both methods of sedation adequately reduced anxiety levels in visual analog scale scores and Spielberger Strait Test Anxiety Inventory (P<.001). Dexmedetomidine required a longer time to achieve anxiolysis, 7.36minutes (SD, 2.59), and required increasing maintenance dose to induce sleep compared to 10.71minutes (SD, 4.63) for propofol. In terms of image quality, 2 patients (16.67%) in the dexmedetomidine group were satisfactory, whereas all with propofol were graded as good to excellent. Adverse effects were seen in patients sedated with dexmedetomidine with number needed to harm 8 for hypotension and 15 for bradycardia compared to none recorded in the propofol arm. There was no significant difference in patient satisfaction scores or home readiness after the MRI. ConclusionsBoth dexmedetomidine and propofol can effectively reduce anxiety levels of claustrophobic adults undergoing MRI, but dexmedetomidine takes longer to achieve adequate anxiolysis and sleep and may have an effect on image quality. Hypotension and bradycardia are common adverse effects observed with dexmedetomidine.

Integrative Literature Review: Ascertaining Discharge Readiness for Pediatrics After Anesthesia.

Unplanned hospital readmissions after the administration of general anesthesia for ambulatory procedures may contribute to loss of reimbursement and assessment of financial penalties. Pediatric patients represent a unique anesthetic risk. The purpose of this integrative literature review was to ascertain specific criteria used to evaluate discharge readiness for pediatric patients after anesthesia. This study is an integrative review of literature. An integrative literature search was conducted and included literature sources dated January 2008 to November 2013. Key words included pediatric, anesthesia, discharge, criteria, standards, assessment, recovery, postoperative, postanesthesia, scale, score, outpatient, and ambulatory. Eleven literature sources that contributed significantly to the research question were identified. Levels of evidence included three systematic reviews, one randomized controlled trial, three cohort studies, two case series, and two expert opinions. This integrative literature review revealed evidence-based discharge criteria endorsing home readiness for postanesthesia pediatric patients should incorporate consideration for physiological baselines, professional judgment with regard to infant consciousness, and professional practice standards/guidelines. Additionally, identifying and ensuring discharge to a competent adult was considered imperative. Nurses should be aware that frequently used anesthesia scoring systems originated in the 1970s, and this review was unable to locate current literature examining the reliability and validity of their use in conjunction with modern anesthesia-related health care practices.