The effect of anaesthetic agents on induction, recovery and patient preferences in adult day case surgery
| Autor: | J. Kerr, Nigel J.N. Harper, Katherine Payne, Rachel Elliott, E. W. Moore, J.K Moore, A. S. St Leger, Brian J. Pollard |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male Methyl Ethers Adolescent Nausea Nitrous Oxide Sevoflurane law.invention Young Adult Randomized controlled trial law medicine Humans Postoperative Period Prospective Studies Prospective cohort study Propofol Aged Anesthetics Aged 80 and over Isoflurane business.industry Respiration Middle Aged Treatment Outcome Anesthesiology and Pain Medicine Ambulatory Surgical Procedures Anesthesia Vomiting Female medicine.symptom business Postoperative nausea and vomiting medicine.drug |
| Zdroj: | European Journal of Anaesthesiology. 25:876-883 |
| ISSN: | 0265-0215 |
| DOI: | 10.1017/s0265021507003493 |
| Popis: | SummaryBackground and objectiveTo compare induction, pre- and post-discharge recovery characteristics and patient preferences between four anaesthetic regimens in adult day-surgery. METHODS: Randomized controlled trial. In all, 1158 adults assigned to: propofol induction and maintenance, propofol induction with isoflurane/N2O, or sevoflurane/N2O maintenance, or sevoflurane/N2O alone. We prospectively recorded induction and pre-discharge recovery characteristics, collected 7-day post-discharge recovery characteristics using patient diaries and patient preferences by telephone follow-up. RESULTS: Recruitment rate was 73% - of the 425 refusals, 226 were not willing to risk a volatile induction. During induction, excitatory movements and breath holding were more common with sevoflurane only (P < 0.01). Injection pain and hiccup were more common with propofol induction (P < 0.01). In the recovery room and the postoperative ward, both nausea and vomiting were more common with sevoflurane only (P < 0.01). This difference disappeared within 48 h. There was no difference between groups in the mental state on awakening, recovery time, time to discharge or overnight admissions; then was also no difference in pain between the four groups for each of the seven postoperative days (P < 0.01), nor any differences in concentration or forgetfulness. Patients took 6.5 days (95% CI: 6.0-7.0, n = 693) to resume normal activities. Patients who received sevoflurane only were more likely to recall an unpleasant induction and least likely to want the same induction method again (P < 0.01).ConclusionDifferences in outcome between the four regimens are transient; sevoflurane is not an ideal sole agent for adult day case anaesthesia and, in this setting, patients base their preferences for future anaesthetics on the method of induction. |
| Databáze: | OpenAIRE |
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