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Day Surgery (day + surgery)
Selected AbstractsDay surgery in Finland: a prospective cohort study of 14 day-surgery unitsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009K. MATTILA Background: Day surgery is an established practice for elective operative care, and is considered safe and cost-effective in several procedures and for several patients. At present, day-surgery accounts for approximately 50% of elective surgery in Finland. The aim of this study was to prospectively describe the present situation at Finnish day-surgery units, focusing on the quality of care. Methods: Fourteen large- to medium-sized day surgery and short-stay units were recruited, and all patient cases performed during a 2-month study period were registered and analyzed. Quality of care was assessed by analyzing the rates and reasons for overnight admission, readmission, reoperation, and cancellations. Satisfaction of care was inquired from day- surgery patients during a 2-week period. Head anesthesiologists were interviewed about functional policies. Results: Of 7915 reported cases, 84% were day surgery. Typically, several specialties were represented at the units, with orthopedics accounting for nearly 30% of all day-surgery procedures. Patient selection criteria were in line with the present-day recommendations, although the proportion of older patients and the ASA physical status 3 patients were still relatively low. The rate of unplanned overnight admissions was 5.9%. Return hospital visits were reported in 3.7% and readmissions in 0.7% of patients 1,28 days post-operatively. Patient satisfaction was high. Conclusion: Along with the growing demand for day surgery, Finnish public hospitals have succeeded in providing good-quality care, and there still seems to be potential to increase the share of day surgery. Easily accessible benchmarking tools are needed for quality control and learning from peers. [source] Dexamethasone decreases oxycodone consumption following osteotomy of the first metatarsal bone: a randomized controlled trial in day surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010K. MATTILA Background: Dexamethasone may improve multimodal pain management following painful orthopedic day surgery procedures, and decrease the need for post-operative opioids. We hypothesized that dexamethasone would reduce the need for oxycodone after surgical correction of hallux valgus. Methods: Sixty patients planned to undergo unilateral osteotomy of the first metatarsal as a day surgery procedure were randomized to receive pre-operatively and 24 h afterwards, orally either dexamethasone 9 mg or placebo. For pain medication, paracetamol and oxycodone capsules for rescue medication were given. The study ended on the evening of the third post-operative day (POD). The primary endpoint was the cumulative oxycodone consumption. Secondary endpoints were maximal pain scores before oxycodone intake and daily oxycodone doses. In addition, adverse effects were documented. Results: Twenty-five patients in both groups completed the study. The total median (range) oxycodone consumption during the study period was 45 (0,165) mg in the dexamethasone group and 78 (15,175) mg in the placebo group (P=0.049). The major differences in oxycodone consumption were seen on PODs 0,1. In the dexamethasone group, patients reported significantly lower pain scores on PODs 0,1, and significantly less nausea on POD 1. On PODs 2,3 no differences were seen. However, at 2 weeks post-operatively, patient satisfaction to drug therapy did not differ , in both groups 81% would have chosen the same medication again. Conclusion: Oral dexamethasone combined with paracetamol significantly reduced total oxycodone consumption following surgical correction of hallux valgus. [source] Use of perioperative dialogues with children undergoing day surgeryJOURNAL OF ADVANCED NURSING, Issue 1 2008Berith Wennström Abstract Title.,Use of perioperative dialogues with children undergoing day surgery Aim., This paper is a report of a study to explore what it means for children to attend hospital for day surgery. Background., Hospitalization is a major stressor for children. Fear of separation, unfamiliar routines, anaesthetic/operation expectations/experiences and pain and needles are sources of children's negative reactions. Method., A grounded theory study was carried out during 2005,2006 with 15 boys and five girls (aged 6,9 years) scheduled for elective day surgery. Data were collected using tape-recorded interviews that included a perioperative dialogue, participant observations and pre- and postoperative drawings. Findings., A conceptual model was generated on the basis of the core category ,enduring inflicted hospital distress', showing that the main problem for children having day surgery is that they are forced into an unpredictable and distressful situation. Pre-operatively, the children do not know what to expect, as described in the category ,facing an unknown reality'. Additional categories show that they perceive a ,breaking away from daily routines' and that they are ,trying to gain control' over the situation. During the perioperative period, the categories ,losing control' and ,co-operating despite fear and pain' are present and intertwined. Post-operatively, the categories ,breathing a sigh of relief' and ,regaining normality in life' emerged. Conclusion., The perioperative dialogue used in our study, if translated into clinical practice, might therefore minimize distress and prepare children for the ,unknown' stressor that hospital care often presents. Further research is needed to compare anxiety and stress levels in children undergoing day surgery involving the perioperative dialogue and those having ,traditional' anaesthetic care. [source] Music and its effect on anxiety in short waiting periods: a critical appraisalJOURNAL OF CLINICAL NURSING, Issue 2 2005Marie Cooke PhD Aims and objectives., This paper undertakes a critical appraisal of the methodological issues associated with studies that have investigated the extent to which music decreased the anxiety experienced by patients in short-term waiting periods such as day surgery. Background., Investigations and surgery undertaken on a day basis have significantly increased in number over the last decade. Music has been evaluated as an appropriate nursing intervention in relation to pain, discomfort and anxiety in a number of clinical settings but its usefulness for decreasing anxiety in short-term waiting periods such as day surgery is only beginning to be understood. Conclusion., A number of methodological limitations are identified by this critical review, particularly in relation to the design of research studies. Recommendations to strengthen research in this area are suggested and include (i) describing methods clearly and with detail to allow assessment of the validity and rigour of study results; (ii) using permuted block randomization; (iii) recruiting from a variety of surgical procedures and cultural groups; and (iv) standardizing the health care provided during waiting period. Relevance to clinical practice., Music as a simple and cost-effective intervention to reduce the anxiety experienced in limited time periods will have enormous impact on clinical practice where patients wait and undergo invasive investigations, procedures or surgery. However, the evidence of its utility in these unique environments is only beginning to emerge and this critical review provides a basis for considerations for future research. [source] Assessment of recovery after day surgery using a modified version of quality of recovery-40ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009E. IDVALL First page of article [source] Day surgery in Finland: a prospective cohort study of 14 day-surgery unitsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009K. MATTILA Background: Day surgery is an established practice for elective operative care, and is considered safe and cost-effective in several procedures and for several patients. At present, day-surgery accounts for approximately 50% of elective surgery in Finland. The aim of this study was to prospectively describe the present situation at Finnish day-surgery units, focusing on the quality of care. Methods: Fourteen large- to medium-sized day surgery and short-stay units were recruited, and all patient cases performed during a 2-month study period were registered and analyzed. Quality of care was assessed by analyzing the rates and reasons for overnight admission, readmission, reoperation, and cancellations. Satisfaction of care was inquired from day- surgery patients during a 2-week period. Head anesthesiologists were interviewed about functional policies. Results: Of 7915 reported cases, 84% were day surgery. Typically, several specialties were represented at the units, with orthopedics accounting for nearly 30% of all day-surgery procedures. Patient selection criteria were in line with the present-day recommendations, although the proportion of older patients and the ASA physical status 3 patients were still relatively low. The rate of unplanned overnight admissions was 5.9%. Return hospital visits were reported in 3.7% and readmissions in 0.7% of patients 1,28 days post-operatively. Patient satisfaction was high. Conclusion: Along with the growing demand for day surgery, Finnish public hospitals have succeeded in providing good-quality care, and there still seems to be potential to increase the share of day surgery. Easily accessible benchmarking tools are needed for quality control and learning from peers. [source] Children's day surgery: a challenge for the working teamACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009M. Astuto No abstract is available for this article. [source] Early bioavailability of paracetamol after oral or intravenous administrationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2004P. Holmér Pettersson Background:, Paracetamol is a peripherally acting analgesic commonly used in multimodal post-operative pain management to reduce the need for more potent analgesics with their unwanted side-effects. The dose and optimal galenical form for achieving analgesic concentrations is not well defined. The primary aim of this pilot project was to study the early bioavailability for two fixed doses of orally administrated paracetamol and one dose of intravenous propacetamol, all of which were given after minor surgery. Methods:, Thirty-five patients undergoing day surgery were divided into five groups, seven patients each. Groups received either 1 g of an ordinary paracetamol tablet, 2 g of an ordinary paracetamol tablet, 1 g of a bicarbonate paracetamol tablet, 2 g of a bicarbonate paracetamol tablet or 2 g intravenously of prodrug propacetamol. We studied the plasma concentration of paracetamol during the first 80 min after administration. Results:, Within 40 min, intravenous propacetamol gave a median plasma paracetamol concentration of 85 µmol/l (range 65,161) and decreased thereafter. After oral administration, median plasma paracetamol concentration increased with increasing dose and time, but there were huge inter-individual differences at all time points studied. At 80 min after oral paracetamol the median plasma concentrations were 36 and 129 µmol/l for the 1- and 2-g groups, respectively, with an overall range between 0 and 306 µmol/l. Conclusion:, Oral administration of paracetamol as part of multimodal pain management immediately post-operatively resulted in a huge and unpredictable variation in plasma concentration compared with the intravenous administration. [source] Parents should be given better information to manage their child's pain after day surgeryPEDIATRIC ANESTHESIA, Issue 5 2006Isabeau Walker FRCA No abstract is available for this article. [source] Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesiaPEDIATRIC ANESTHESIA, Issue 5 2002JENNIFER W. COLE MD Background: Children display a variety of behaviour during anaesthetic recovery. The purpose of this study was to study the frequency and duration of emergence behaviour in children following anaesthesia and the factors that alter the incidence of various emergence behaviour following anaesthesia. Methods: A prospective study of children who required outpatient lower abdominal surgery was designed to determine an incidence and duration of emergence agitation. We developed a 5-point scoring scale to study the postanaesthetic behaviour in these children. The scale included behaviour from asleep (score=1) to disorientation and severe restlessness (score=5). Children were scored by a blinded observer every 10 min during the first hour of recovery or until discharge from same day surgery. Results: We found 27 of 260 children experienced a period of severe restlessness and disorientation (score 5) during anaesthesia emergence. Thirty percent of the children (79/260) experienced a period of inconsolable crying or severe restlessness (score 4 or 5) following anaesthesia. The frequency of this behaviour was greatest on arrival in the recovery room, but many children who arrived asleep in the recovery room later experienced a period of agitation or inconsolable crying. Conclusions: Repeated assessments of behaviour following anaesthetic recovery are required to define an incidence and duration of emergence agitation. Emergence agitation occurs most frequently in the initial 10 min of recovery, but many children who arrive asleep experience agitation later during recovery. [source] The effect of grade of anaesthetist on outcome after day surgery,ANAESTHESIA, Issue 2 2009J. Hanousek Summary We conducted a retrospective survey to investigate if the grade of anaesthetist was a significant factor in determining outcome after day surgery in a district general hospital. All day surgery procedures performed between 1996 and 2006 were included except those under surgically administered local anaesthetic. The outcome measures assessed were unplanned admissions and symptoms reported after discharge. The overall admission rate was 2.6%, the admission rate for anaesthetic-related reasons was 1.5%, and 49% of patients reported some symptoms after discharge. Over the period studied the admission rate fell from 4.2% to 2.0%, admissions for anaesthetic-related reasons fell from 3.0% to 0.7% and reported symptoms fell from 67% to 37%. Consultants anaesthetists were associated with the lowest unplanned admission rate (consultants 2.3%, staff grade and associate specialists 3.1%, and trainees 3.3%), the lowest admission rate for anaesthetic reasons (consultants 1.2%, staff and associate specialists 2.0%, and trainees 1.8%), lower than expected specialty-weighted admissions and the lowest number of reported symptoms (consultants 47.3%, staff grade and associate specialists 52.6%, trainees 49.0%) (p < 0.001). We conclude that there was an improvement in outcome over the period of study and that the grade of anaesthetist is associated with outcome after day surgery. [source] | ||||||||||||||||||||||