Iowa Satisfaction With Anesthesia Scale Research Articles

P-494 Empowering women’s comfort! Sedation experts provide enhanced oocyte retrieval experiences with deep sedation

Abstract Study question What are the patient-reported-outcomes (PROs) and patient-reported-experiences (PREs) of deep sedation performed by sedation practitioners during oocyte retrievals compared to light-sedation by the fertility nurse? Summary answer Women undergoing oocyte retrievals with deep sedation by a sedation practitioner had a better experience and classified sedation the preferred method compared to light-sedation. What is known already Vaginal oocyte retrieval is a key step in modern IVF. The procedure is painfull, requiring systemic analgesics and anxiolytics which is called sedation. Light sedation is still the norm in the Netherlands although women prefer stronger analgesia, less anxiety, and less side effects such as nausea and vomiting from the opiods. From a safety point of view, the ministry of health (IGJ) recommends to perform sedation in an out-patient setting only by sedation professionals. It is known dat deep sedation delivered by trained sedation practitioners in an outpatient clinic is feasible in the Netherlands in other fields (gastroenterology etc). Study design, size, duration Prospective cohort study. In September 2021, moderate-to-deep sedation was introduced for oocytes retrievals for 5 days per week. In weekends, light sedation by the fertility nurse remained the standard. This enabled us to study PROs, defined as the view of participating women of their healthcare status, and PREs, defined as the perception of the received care, in both sedation strategies. PROs were assessed with the validated EuroQol-5D-5L questionnaire and PREs with the Iowa-Satisfaction-with Anesthesia-Scale (ISAS). Participants/materials, setting, methods All women who were scheduled for oocyte retrieval were asked to participate in PRO and PRE assessment. We assessed PROs at three time points: (i) day of trigger, (ii) 6-8 hours after discharge, (iii) 24-32 hours after oocyte retrieval. PREs were assessed 24-32 hours after oocyte retrieval. We intended to include 400 consecutive women. We performed mixed-model-analysis for between-group comparison of treatment and time effects (PROs) and a multivariate regression analysis (PRE). Main results and the role of chance A total of 460 women were scheduled for oocyte retrieval. Moderate-to deep sedation was offered 361 women and 352 (98%) received this. Light sedation was offered 83 women and 76 (92%) received this. Women with less than 3 follicles usually received analgesia only; their data were not used. Concerning the PROs, complete baseline questionnaires were available for 404/440 (93%) of women We found a significant time effect on “anxiety/sadness symptoms” which where high at (i) day of trigger in both groups and lowered at (ii) 6-8 hours after discharge; and a significant time effect in “pain” at (ii) 6-8 hours after discharge. We found no treatment effect of moderate-to-deep sedation versus light sedation for the PROs (p = 0.62). Concerning the PREs, the ISAS was scored for 398/440 (90%) of women. The maximum ISAS score is 3 points. The mean ISAS score was significantly higher in the moderate-to-deep sedation group compared to light sedation, indicating a better experience (1.8 ± 0.7 vs 0.9 ± 0.9, p = <0.001). Moderate-to-deep sedation was rewarded higher compared to light sedation because of less pain during the procedure (4 points better), more satisfaction (1 point better) and preference for same sedation in the future (1,5 points better). Limitations, reasons for caution The results are only applicable to the patient population of a tertiary out patient care setting. Wider implications of the findings Measurement of PREs (ISAS) should be standard-of-care to measure experiences of ambulant sedation. Our interpretation is that gynaecologists should abandon light sedation by non-anaesthesiologists and we suggest to provide deep sedation by the sedation professionals only. Trial registration number not applicable

Cross-cultural adaptation and validation of the Iowa Satisfaction with Anesthesia Scale for use in Brazil: a cross-sectional study

BackgroundThe Iowa Satisfaction with Anesthesia Scale (ISAS) was developed to assess the satisfaction of patients undergoing sedation with monitored anesthesia care. This study aimed to cross-culturally adapt the ISAS instrument and evaluate the acceptability, validity, and reliability of the proposed Brazilian version (ISAS-Br). MethodsThe cross-cultural adaptation process involved translation, synthesis, back-translation, expert committee review, pre-testing, and final review of the ISAS-Br. A cross-sectional study was conducted, involving 127 adult individuals undergoing ambulatory surgeries with moderate/deep sedation. The acceptability, reliability, and construct validity of the scale were assessed. ResultsThe cross-cultural adaptation process did not require significant changes to the final version of the scale. The ISAS-Br demonstrated excellent acceptability, with a completion rate of 99% and an average completion time of 4.6 minutes. Exploratory factor analysis revealed three factors: emotional well-being, physical comfort, and anxiety relief, with respective composite reliability coefficient values of 0.874, 0.580, and 0.428. The test-retest reliability of the ISAS-Br, measured by the intraclass correlation coefficient, was 0.67 (95% confidence interval [95% CI] 0.42 to 0.83), and the Bland-Altman plot showed satisfactory agreement between the measurements. ConclusionThe proposed Brazilian version of the ISAS underwent successful cross-cultural adaptation according to international standards. It demonstrated good acceptability and reliability, regarding the assessment of temporal stability. However, the ISAS-Br exhibited low internal consistency for some factors, indicating that this instrument lacks sensitivity to assess the satisfaction of deeply sedated patients. Further studies are necessary to explore the hypotheses raised based on the knowledge of its psychometric properties.

Patient tolerance in office-based blue laser therapy for lesions of the vocal folds: Correlation with patients' characteristics, disease type and procedure-related factors.

To report patient tolerance in office-based blue laser therapy for vocal fold lesions. A retrospective review of the medical records of patients who underwent office-based blue laser therapy for lesions of the vocal folds between November 2021 and February 2023 was conducted. A total of 48 patients were included. Patient tolerance was assessed using the Iowa Satisfaction with Anesthesia Scale (IOWA). Patient tolerance was analyzed in relation to patients' demographic characteristics, disease type and severity, and procedure-related factors. The mean tolerance score of the study group was 1.51 ± 1.1. There was a significant difference in the mean tolerance score between smokers and non-smokers (p = .038). Patients with vocal fold cyst (n = 3) had the highest mean tolerance score followed by patients with vocal fold polyps (n = 15). There was a nonsignificant difference in the mean tolerance score between benign lesions of the vocal folds and leukoplakia. Patients with lesions extending to more than half the vocal fold had less tolerance than those with lesions limited to less than half the vocal fold (1.91 vs. 1.27, p value .041). There was a moderate and significant negative correlation between vocal fold movement VAS, swallowing VAS, and tolerance score. The mean total duration of the procedures was 10.38 ± 4.8 min. There was a mild negative correlation between the duration of the procedure and tolerance. Office-based blue laser therapy for vocal fold lesions is a well-tolerated procedure. Patient should be instructed how to breathe quietly and avoid swallows to improve tolerance to surgery. 4.

Psychometric properties of Iowa Anesthesia Satisfaction Scale Turkish version.

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a valid and reliable measurement tool developed to evaluate patient satisfaction with anesthesia care during different surgical interventions. It is adapted to various languages and used in many studies. Considering the satisfaction of the patient with anesthesia applied in surgical procedures, the presence of such a measurement tool is crucial. From this point of view, the study aimed to evaluate psychometric properties of the ISAS by adapting it to Turkish culture. In this study, a descriptive, methodological and cross-sectional design was used. A total of 210 patients who underwent surgery under general or regional anesthesia were in the study. ISAS Turkish version (ISAS-T) shows good reliability which is obvious with a Cronbach's alpha value of 0.80. The correlation levels of the items with the ISAS total score were calculated between .45 and .73. Test-retest reliability was calculated as 0.83. CFA analysis was applied to the one-dimensional 11-item final version of ISAS. The uni-dimensionality of the 11-item scale was confirmed on a Turkish patient sample. The fit indices for the model obtained were calculated as χ2/sd = 2.342, RMSEA = .80, SRMR = .04, CFI = .90, GFI = .92. The fit indices of the model have good and acceptable fit values. Based on the psychometric evaluation, ISAS-T is a valid and reliable measurement tool for measuring patient satisfaction with anesthesia applied during different surgical procedures.

P038Ketamine versus fentanyl for surgical abortions: A randomized noninferiority trial

<h3>Objectives</h3> To compare patient satisfaction with anesthesia after first-trimester surgical abortions among patients receiving intravenous ketamine vs. IV fentanyl for procedural sedation. <h3>Methods</h3> This was a randomized noninferiority trial comparing IV ketamine to IV fentanyl for surgical abortions up to 13 6/7 weeks' gestation. Patients were randomized to receive midazolam 2 mg IV and either ketamine 200–500 mcg/kg IV over two minutes, repeated every five minutes until appropriate analgesia was achieved, or fentanyl 0.5–1 mcg/kg IV over two minutes, repeated every five minutes until appropriate analgesia was achieved. The primary outcome, patient satisfaction, was measured using the Iowa Satisfaction with Anesthesia Scale (ISAS) immediately post-procedure. Secondary outcomes included postoperative pain and additional pain medication given. We calculated a sample size of 84 with a noninferiority margin of 0.6 on the ISAS scale with 80% power, one-sided type 1 error of 0.025, and further increased this number to 110 to account for potential dropout. <h3>Results</h3> From April to October 2021, 184 patients were screened and 110 were randomized (57 to ketamine and 53 to fentanyl). Demographics were similar between groups. The primary outcome, patient satisfaction with anesthesia, was noninferior in the ketamine group (mean score, 2.4; SD, 0.8) compared with the fentanyl group (mean score, 2.2; SD, 0.9) with a risk difference of 0.20 (95% CI, 0.11–0.52). Secondary outcomes were similar between the groups. <h3>Conclusions</h3> Compared with IV fentanyl, IV ketamine is noninferior for patient satisfaction with anesthesia when used for procedural sedation for first-trimester surgical abortions.

Transcultural validation of a French version of the Iowa Satisfaction with Anesthesia Scale (ISAS-F).

We sought to validate a French translation of the Iowa Satisfaction with Anesthesia Scale (ISAS), a tool to assess the patient's satisfaction with monitored anesthesia care for surgery. The ISAS tool is particularly pertinent as surgery with monitored anesthesia care is increasingly used in ambulatory surgery settings. We studied content validity, internal consistency, convergent validity (vs physician-estimated satisfaction), and test-retest reliability of the French version of the ISAS (ISAS-F) in 122 adult patients undergoing a brief outpatient invasive procedure under conscious sedation. The ISAS-F was answered twice by the patient, once in the postanesthesia care unit and once before discharge from the ambulatory care unit. The median [interquartile range (IQR)] time of completion at the first assessment was 2 [2-4] min. The total median [IQR] ISAS-F scorewas 2.3 [1.8-2.7]. Internal consistency of the ISAS-F was foundto be good (Cronbach's α = 0.68). Test-retest reliability was significant, with an intra-class correlation coefficient at 0.74 (95% confidence interval [CI], 0.63 to 0.85). The ISAS-F scorecorrelated with the physician-estimated satisfaction score, with an intra-class correlation coefficient of 0.28 (95% CI, 0.12 to 0.44; P = 0.01). This validated version of the ISAS can now be used by French-speaking researchers and physicians to assess patient satisfaction with the anesthesia technique.

Comparative Effect of Local Anesthesia with Lidocaine 2% Versus Topical Anesthesia on Cognitive Function in Ophthalmic Surgery.

BackgroundMultiple clinical trials targeted the assessment of cognitive function following local versus general anesthesia in patients undergoing ophthalmic surgery, but no previous clinical trials have focused on the effect of topical anesthesia on cognitive function.ObjectivesThis study aimed to compare the effect of local anesthesia with lidocaine 2% versus topical anesthesia with Oxybuprocaine (benoxinate hydrochloride 0.4%) on cognitive function in patients undergoing elective cataract surgery.MethodsThis is a prospective randomized clinical trial carried out on 60 patients undergoing elective cataract surgery by phacoemulsification. Thirty patients received local anesthesia with lidocaine 2% and thirty patients received topical anesthesia with Oxybuprocaine (benoxinate hydrochloride 0.4%). Patients’ satisfaction was assessed postoperatively using the Iowa satisfaction with anesthesia scale (ISAS). Cognitive assessment for all patients was done preoperatively and 1 week postoperatively using paired-associate learning test (PALT) and category verbal fluency (VF) test (animal category).ResultsThere was no statistically significant difference between local and topical anesthesia groups in the mean of responses to the 11 statements of ISAS (P = 0.071). Regarding cognitive assessment, there was a statistically significant postoperative decline in the local anesthesia group in both PALT scores (P = 0.005) and VF scores (P = 0.01). In the topical anesthesia group, there was no statistically significant difference between pre- and postoperative PALT scores (P = 0.326) or VF scores (P = 0.199).ConclusionsPostoperative cognitive dysfunction following elective cataract surgeries under local anesthesia can be attributed to the effect of local anesthesia rather than the effect of surgery.

Evaluation of the Validity and Reliability of the Persian Version of Iowa Satisfaction with Anesthesia Scale in Iran

Introduction: The interaction between the doctor and the patient achieved when the physician is able to communicate effectively with the patient. Iowa Satisfaction with Anesthesia Scale is a tool for this purpose. Given that ISAS is originally in English and understudy in Iran, we decided to translate this scale into Persian and evaluate its validity and reliability.Purpose: Our aim in this study is translating, validity and reliability of ISAS.Methods: This study is an observational study with a correlational design that adopts an analytical approach. The population consisted of all patients undergoing surgery at Imam Reza Hospital out of whom 162 patients met the inclusion criteria, i.e. aged 18 years and above, transferred from the OP to ICU, exposed to general anesthesia and signed the consent form.Results: Patients completed the questionnaire in 5 minutes. The mean (maximum-minimum) age of the patients was 57.39 (18-87). As for gender, 102 (63%) of patients were male and 56 (34.6%) were female. About 4 (2.5%) of the data went missing. Cronbach's Alpha was 0.85. The correlation analysis showed that Iowa scale was significantly correlated with RP (P = 0.007), BP (P = 0.002), RE (P = 0.007) and GH (P = 0.012). The PSQ questionnaire had a significant correlation with the LOWA questionnaire (p < 0.001).Conclusion: Validity and reliability of the Persian version of Iowa Satisfaction with Anesthesia Scale (ISAS) in Iran are excellent.

Assessment of a Lateral Nasal Wall Block Technique for Endoscopic Sinus Surgery Under Local Anesthesia.

Introduction With increasingly limited operative resources and patient desires for minimally invasive procedures, there is a trend toward local endoscopic procedures being performed in the outpatient clinic setting. However, there remain limited data supporting a technique to adequately anesthetize the lateral nasal wall and provide patient comfort during these procedures. The objective of this study is to assess the efficacy of a novel lateral nasal wall block for use in office-based endoscopic sinus surgery. Methods A prospective cohort study assessing consecutive patients undergoing office-based endoscopic sinus surgery using our described lateral nasal wall block anesthesia technique. Procedural patient comfort was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS), completed by participants immediately following an office-based endoscopic procedure and prior to discharge from clinic. Postoperative analgesic use was assessed at the first postoperative visit. Results Thirty-five consecutive patients undergoing office-based outpatient endoscopic sinus surgery for chronic rhinosinusitis (with and without polyps) were assessed. The mean ISAS score was 2.83 (95% confidence interval: [2.69, 2.97]). All participants (100%) agree or strongly agree that they were satisfied with their anesthesia care and would want the same anesthetic again. No participant required narcotic analgesia, and 80% used no oral analgesia following the procedure. Conclusions Recent advances in office-based endonasal surgical procedures must be accompanied by the assessment and validation of local anesthetic techniques. The described novel lateral nasal wall block is well tolerated, provides patient satisfaction, and allows for limited use of postprocedure oral analgesics.

Validation to Spanish of the Iowa Satisfaction with Anesthesia Scale (ISAS) for monitored anesthesia care in ophthalmic surgery

The Iowa Satisfaction with Anesthesia Scale (ISAS) was rigorously developed and has been shown to be valid and reliable for evaluating patient satisfaction with monitored anesthesia care (MAC) in several scenarios. Such an instrument is important given the success that MAC is enjoying in the field. ObjectiveValidate the ISAS in Spanish and establish indicators of validity and reliability in patients undergoing ophthalmic surgeries with MAC. MethodsA translation and back-translation of the scale, face validity and pilot tests for adjustments were completed. The final instrument was applied to 117 subjects over 18 years of age, ASA I–III, in two healthcare institutions in Villavicencio (Meta Department, Colombia) in order to measure the concurrent criterion validity between the patients and the anesthesiologist of the case. The internal consistency of the scale was established in its first application to the subjects and later applied for the second and third times to verify the test–retest reliability. ResultsA Pearson anesthesiologist/patient concurrent criterion validity 0.85 CI 95% (0.79–0.89), intra-class 0.82 CI 95% (0.77–0.88), was confirmed. Internal consistency was measured with a Cronbach's alpha of 0.71. Test–retest reliability (40–65min) was measured with Pearson and intra-class 0.95 CI 95% (0.93–0.96) and, (12–36h) Pearson 0.65 CI 95% (0.52–0.75), intra-class 0.64 CI 95% (0.53–0.76). ConclusionsThe validation of the ISAS in Spanish allows for the use of a valid and reliable instrument to objectively measure the satisfaction of the patient in ophthalmic surgery under MAC.

Validación al español de la escala «The Iowa satisfaction with anesthesia scale (ISAS)» para cuidado anestésico monitorizado en cirugía de oftalmología

The Iowa Satisfaction with Anesthesia Scale (ISAS) was rigorously developed and has been shown to be valid and reliable for evaluating patient satisfaction with monitored anesthesia care (MAC) in several scenarios. Such an instrument is important given the success that MAC is enjoying in the field. ObjectiveValidate the ISAS in Spanish and establish indicators of validity and reliability in patients undergoing ophthalmic surgeries with MAC. MethodsA translation and back-translation of the scale, face validity and pilot tests for adjustments were completed. The final instrument was applied to 117 subjects over18 years of age, ASA I–III, in two healthcare institutions in Villavicencio (Meta Department, Colombia) in order to measure the concurrent criterion validity between the patients and the anesthesiologist of the case. The internal consistency of the scale was established in its first application to the subjects and later applied for the second and third times to verify the test–retest reliability. ResultsA Pearson anesthesiologist/patient concurrent criterion validity 0.85 CI 95% (0.79–0.89), intra-class 0.82 CI 95% (0.77–0.88), was confirmed. Internal consistency was measured with a Cronbach's alpha of 0.71. Test–retest reliability (40–65 min) was measured with Pearson and intra-class 0.95 CI 95% (0.93–0.96) and, (12–36 h) Pearson 0.65 CI 95% (0.52–0.75), intra-class 0.64 CI 95% (0.53–0.76). ConclusionsThe validation of the ISAS in Spanish allows for the use of a valid and reliable instrument to objectively measure the satisfaction of the patient in ophthalmic surgery under MAC.

Étude de satisfaction et de sécurité d’un protocole d’anesthésie simplifié pour la chirurgie de cataracte sous anesthésie topique

The purpose of our study was to assess safety and efficacy of cataract surgery (CS) under topical anesthesia alone, i.e. without pre-anesthetic evaluation and without direct presence of an anesthesiologist. To this end we assessed the incidence of patients' preoperative anxiety, perioperative adverse events and patients' and surgeons' satisfaction. Patients undergoing CS under topical anesthesia over a one-month period were included. An anesthesiologist and nurse anesthetist were present in the area and could intervene in case of an adverse event. Patients' anxiety was scored using the Amsterdam Preoperative Anxiety & Information Scale (APAIS), and their satisfaction with the Iowa Satisfaction with Anesthesia Scale (ISAS). Surgeons' satisfaction was scored with a VAS from 0 to 10 (0: surgery not possible & 10: excellent surgical conditions). One hundred and twenty-four consecutive patients were included; mean age was 71 (±9.4) years. Mean APAIS I was 6.4/20 (±3.7). Mean APAIS II was 3.1 (±1.8). Mean ISAS score was 5.5/6 (±0.6), indicating high patient satisfaction. Surgeon satisfaction score was 8.9/10 (±1.7). Twenty-three adverse events occurred of which 16 required interventions by the anaesthesiologist or surgeon: 5 supplemental local or regional anaesthesia, 6 iv-analgesia, 5 management of hypertension. These preliminary data suggest that a simplified topical anesthesia protocol for ambulatory CS appears to be feasible and safe, as long as an anesthesia team is present in the area to intervene if needed.

Validation to Spanish of the Iowa Satisfaction with Anesthesia Scale (ISAS) for monitored anesthesia care in ophthalmic surgery☆

Validation to Spanish of the Iowa Satisfaction with Anesthesia Scale (ISAS) for monitored anesthesia care in ophthalmic surgery☆

Assessing patient satisfaction with cataract surgery under topical anesthesia supplemented by intracameral lidocaine combined with sedation

Ocular akinesia, the use of anticoagulants, and patient collaboration are some of the factors that must be taken into consideration when choosing the appropriate anesthesia for phacoemulsification cataract surgery. The satisfaction of patients with the use of topical anesthesia and conscious sedation for this procedure has not been enough described in Brazil. Conscious sedation allows patient walk and answer a voice command. To assess the satisfaction, pain, and perioperative hemodynamic alterations of patients subjected to phacoemulsification under conscious sedation and topical anesthesia supplemented with intracameral lidocaine. Prospective cohort non-controlled study that included patients treated by the same surgical team over a 70-day period. Sedation was performed with midazolam at a total dose of 3 mg and topical anesthesia with 0.5% proxymetacaine chlorhydrate and 2% lidocaine gel combined with 2% lidocaine by intracameral route. The intraoperative vital parameters, scores based on the Iowa Satisfaction with Anesthesia Scale (ISAS), and the pain visual analog scale (VAS) were recorded at several time points after surgery. A total of 106 patients were enrolled in study (73.6% female), the mean age was 65.9 years. The surgical procedures lasted 11.2 minutes on average. The hemodynamic parameters did not exhibit significant changes at any of the investigated time points. The average ISAS score was 2.67 immediately after surgery and 2.99 eight hours after the surgery; this increase was statistically significant (p<0.0001). More than two-thirds (68.9%) of the participants (73 patients) did not report any pain in the transoperative period, and 98.1% of patients denied the occurrence of pain after surgery. Patients that received topical anesthesia supplemented by intracameral lidocaine combined with sedation for phacoemulsification cataract surgery reported adequate level of satisfaction with the anesthetic choice. Furthermore, the patients exhibited hemodynamic parameter stability and pain control.

Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification

Background:Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future.Methods:Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS). The Student's t-test was used to determine the significance of IOWA score in both groups. P<0.05 was considered significant.Results:Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively). In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively). Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant.Conclusion:Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

Multicenter Assessment of the Iowa Satisfaction with Anesthesia Scale, an Instrument that Measures Patient Satisfaction with Monitored Anesthesia Care

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a questionnaire that measures patient satisfaction with monitored anesthesia care. Previous assessments of the reliability and validity of this tool have been conducted in 2 separate single-center studies. Recently, the questionnaire was used in a 24-center, 315-patient, placebo-controlled trial of dexmedetomidine. We analyzed the data from these patients to provide anesthesiologists and statisticians designing multicenter clinical trials the information needed to use the ISAS as a primary study end point. Trial variables were ISAS score, treatment group, center, time of administration of the instrument, and potential covariates of age, race, gender, type of surgery, and ASA physical status. The ISAS could be scored for 98% of patients (95% confidence interval [CI], >97%). Whereas 73% of patients responded with the minimum of -3 or the maximum of +3 for the single question "I was satisfied with my anesthetic care," only 14% did so for the ISAS (i.e., the instrument differentiated among patients). The internal consistency (Cronbach α) equaled 0.84 (95% CI, 0.79-0.87). Because there was no correlation between the ISAS score and time of completion of the questionnaire the next day (Kendall τ(b), 0.01; 95% CI, -0.06 to 0.09), the ISAS likely is valid when administered by telephone the next day, not only when administered in person upon discharge as shown in its original development. Effect sizes of 0.48 have been detected in several trials, suggesting that typically appropriate sample sizes are 70 to 93 patients per group. There was significant heterogeneity in ISAS scores among study centers (P < 0.0001), making stratification by center very important, and planned analysis with center as a covariate reasonable. Type of surgery might be an additional appropriate covariate depending on the study. The ISAS is reliable, valid, and useful over the conditions suitable for use as a primary study end point in multicenter clinical trials.

Dexmedetomidine is effective for monitored anesthesia care in outpatients undergoing cataract surgery

BackgroundDexmedetomidine has a sedative analgesic property without respiratory depression. This study evaluated the efficacy of dexmedetomidine as an appropriate sedative drug for monitored anesthesia care (MAC) in outpatients undergoing cataract surgery on both eyes compared with combination of propofol and alfentanil.MethodsThirty-one eligible patients were randomly divided into two groups on the first operation day. Dexmedetomidine was administered in group D at 0.6 µg/kg/h, and propofol and alfentanil was infused concomitantly in group P at a rate of 2 mg/kg/h and 20 µg/kg/h, respectively. Sedation was titrated at Ramsay sedation score 3. Iowa satisfaction with anesthesia scale (ISAS) of the patients was evaluated postoperatively. Systolic blood pressure (SBP), heart rate (HR), respiration rate (RR), and peripheral oxygen saturation (SpO2) were recorded throughout the surgery. For the second operation, the group assignments were exchanged.ResultsPostoperative ISAS was 50.3 (6.2) in group D and 42.7 (8.7) in group P, which was statistically significant (P < 0.001). SBP was significantly lower in group D compared with group P from the beginning of the operation. HR, RR, and SpO2 were comparable between the two groups. There were 8 cases (25.8%) of hypertension in group P, and 1 case (3.2%) in group D (P < 0.05). In contrast, 1 case (3.2%) of hypotension and 1 case (3.2%) of bradycardia occurred in group D.ConclusionsCompared with the combined use of propofol and alfentanil, dexmedetomidine could be used appropriately for MAC in cataract surgery with better satisfaction from the patients and a more stable cardiovascular state.

Remifentanil plus low-dose midazolam for outpatient sedation in transesophageal echocardiography

Background The search for optimal sedation for transesophageal echocardiography (TEE) continues. We hypothesized that the ultra-short acting opioid remifentanil combined with very low-dose midazolam would provide a better sedation and recovery profile compared to midazolam alone. Methods 41 consecutive outpatients scheduled for TEE received either IV midazolam (group M, 2.5 mg bolus plus 1 mg increments repeated as needed, n = 18) or a combination of a low-dose IV bolus of midazolam (0.5 mg) plus an infusion of remifentanil (group RM, 0.1 mcg/kg/min, reduced to 0.08 mcg/kg/min after probe insertion, n = 23). All patients received topical pharyngeal anesthesia with 2 puffs of lidocaine 4% spray. We recorded BP, SpO 2, HR, time-to-discharge (modified Aldrete score of 13), duration of procedure, resource utilization, complications, ease of probe introduction, ease and quality of the procedure. Patients' satisfaction with sedation was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS). Results Mean dose of midazolam in group M was 3.7 ± 1.3 mg. Median time-to-discharge was significantly reduced in the RM group compared with the M group (5 (5–10) vs. 30 (5–240) min, p < 0.0001), with 22 of the 23 group RM patients ready for “street discharge” within 5 min of removal of the TEE probe. Ease of probe insertion ( p = 0.001), resource utilization ( p = 0.0001), patient satisfaction ( p = 0.03) and overall ease and quality of the procedure ( p = 0.0001) were significantly better in the RM group than in the M group. No episodes of desaturation were observed. Conclusions This is the first report of the use of an ultra-short acting opioid, remifentanil, combined with a low-dose of midazolam, as a sedative technique for outpatient TEE. In this pilot, non-randomized prospective study, remifentanil plus low-dose midazolam provided better sedation than our current practice of higher bolus doses of midazolam alone. This novel approach is associated with improved procedure tolerance, faster recovery and minimal resource utilization. A randomized, controlled study is under way to verify our preliminary results.

Topical Anesthesia versus Sub-Tenon Block for Cataract Surgery: Surgical Conditions and Patient Satisfaction

To compare the surgical conditions and complications and patient and surgeon satisfaction in cataract surgery by phacoemulsification under topical anesthesia (TA) versus sub-Tenon block (STB). Prospective randomized comparative blind study, without placebo control. Patient satisfaction evaluated by the Iowa Satisfaction with Anesthesia Scale (ISAS). The authors prospectively enrolled 59 patients (61% female) in the study, who were randomized into groups: 26 in the TA group and 33 in the STB. There was no statistically significant difference between the groups in terms of age, sex, waiting time for surgery, ASA (American Society of Anesthesiologists) state, eye laterality, cataract density, pupillary dilation, or surgery duration, but patient collaboration was better in the STB group. We found a mean 2.2 mmHg post-anesthetic rise in intraocular pressure in the STB group, with normalization at 24 hours, and no rise in the TA group. Subconjunctival hemorrhage and chemosis were more prevalent in the STB group, and the improvement of visual acuity was similar in both groups. Subjective satisfaction with the anesthetic technique, both for the surgeon and for the patient, was more elevated in the STB group. The final ISAS scores were 1.87 in the TA group and 2.71 in the STB (p<0.005). The data indicate that more significant anesthesia and analgesia was achieved with the STB, leading to more favorable surgical conditions and enhanced patient and surgeon satisfaction.

What Determines Patient Satisfaction with Cataract Care Under Topical Local Anesthesia and Monitored Sedation in a Community Hospital Setting?

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a reliable and valid tool to measure patient satisfaction with monitored anesthesia care. We used the ISAS to discover determinants of patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a small community hospital. The ISAS (scored 1 to 6) was administered to 306 patients immediately after cataract surgery. All patients received topical local anesthesia and IV sedation administered by an anesthesiologist. Patient satisfaction was high: mean ISAS was 5.6 (sd 0.46; range: 3.3-6.0). The incidence of intraoperative and postoperative pain was 13% and 37%; other adverse events were infrequent (<5%). In multivariable logistic regression, significant predictors of satisfaction were postoperative pain (odds ratio [OR]: 4.84; 99% confidence interval [CI]: 2.21, 10.60), surgeon (OR: 0.21; 99% CI: 0.05, 0.91), and preoperative anxiety (OR: 1.17; 99% CI: 1.03, 1.34). ISAS mean scores (OR = 0.28; 99% CI: 0.13, 0.59) and preoperative anxiety (OR = 1.12; 99% CI: 0.99, 1.28) emerged as significant predictors of low rating of quality of experience. Our results indicate that the ISAS can be used to track patient satisfaction with monitored cataract care. Pain during and after cataract surgery is common and is a major reason for lower patient satisfaction with their cataract care.