Ambulatory Surgery最新文献

{"title":"Oral or rectal diclofenac for laparoscopic sterilization","authors":"A. Corner ,&nbsp;R. Lightfoot ,&nbsp;D. James","doi":"10.1016/j.ambsur.2005.10.002","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.10.002","url":null,"abstract":"<div><p><span>In the UK, perioperative non-steroidal anti-inflammatory drugs are commonly administered via the rectal route even though suppositories are unpopular with patients. This prospective, randomised, double-blind study compares the analgesic effectiveness of diclofenac 100</span> <span>mg given either orally or rectally to 42 ASA<span> grades 1 and 2 patients scheduled to undergo day-case laparoscopic sterilization by the application of Filshie clips. General anaesthesia<span> was induced with fentanyl 2</span></span></span> <!-->μg kg⁻¹<span><span> and propofol<span> and maintained with isoflurane and </span></span>nitrous oxide<span> in oxygen. No difference was observed between the two groups in postoperative pain scores, morphine requirement, nausea and vomiting rates and time to achievement of street fitness. One patient in the rectal group and none in the oral group required in-patient admission. We conclude that oral and rectal diclofenac are of equal effectiveness in this approach to day-case laparoscopic sterilization.</span></span></p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 3","pages":"Pages 139-142"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137391642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Give the patients the choice—The ‘walk in walk out’ hernia clinic","authors":"Daniel R. Leff ,&nbsp;Rajinder P. Bhutiani","doi":"10.1016/j.ambsur.2005.09.004","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Patients referred with symptomatic inguinal hernias traditionally make at least three visits to the hospital and wait on average 41–53 weeks for their operation. Approximately, 10–15% of patients either do not attend (DNA) their clinic appointment, attend on the day of operation or are cancelled by the hospital due to bed shortage, lack of theatre space or associated co-morbidities. This results in a significant psychological strain on the patients and a financial drain on NHS resources.</p></div><div><h3>Aims</h3><p>To set up a hernia service within the confines of the NHS and give patients the choice of having their hernia repaired under local anaesthetic with only one visit to the hospital, on a date of their choosing, as in private hernia centres but without incurring the cost.</p></div><div><h3>Patients and Methods</h3><p>An e-mail containing two detailed proformas, “suitability criteria” and “instructions for patients” was sent to each general practitioner (GP) referring hernia patients to the North West London Hospitals NHS Trust (Northwick Park and Central Middlesex Hospitals). The GP gave each suitable and willing patient the instructions booklet and faxed a referral letter to the consultant's (RPB) scheduler. Patients were advised to read the instruction booklet and, when ready, ring the scheduler to make an appointment for a date of their convenience for the consultation and operation at the same visit.</p></div><div><h3>Results</h3><p>Ninety patients have been referred to the ‘walk in walk out’ (WIWO) clinic in the last 6 months. Ninety one percent of these patients have had successful ‘tension free’ open mesh repair under local anaesthetic. There were five (6%) inappropriate referrals (recurrent or bilateral hernias), and three patients (3%) did not attend their appointment due to ill health or family bereavement.</p></div><div><h3>Conclusion</h3><p>Patients with unilateral primary reducible inguinal hernias, regardless of their ASA status can safely have open ‘tension free’ mesh repair under local anaesthetic on a date of their choosing by making just one visit to the hospital. In just 6 months this ‘WIWO’ hernia clinic has shown a high level of patient satisfaction, significant reduction in ‘did not attend’/cancellation rates and financial savings for the Trust. Similar clinics set up across the nation would multiply the benefits we have shown.</p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 3","pages":"Pages 125-129"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.09.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137392480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancellations in day-case ENT surgery","authors":"G. Carter Singh ,&nbsp;Riaz Agha ,&nbsp;David R. Roberts","doi":"10.1016/j.ambsur.2005.05.002","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.05.002","url":null,"abstract":"<div><h3>Introduction:</h3><p>In excess of two million operations are performed in a day-case/ambulatory setting in the United Kingdom each year. Cancellations in elective surgery cost the National Health Service (NHS) over £265 million per year.</p></div><div><h3>Methodology:</h3><p>This is a retrospective study in which the total number of elective ENT operations performed at The Guy's &amp; St. Thomas’ NHS Trust in a 6-month period were investigated for a range of demographic factors including, age, gender and ethnicity with regards to their relationship to operative cancellation rates.</p></div><div><h3>Results:</h3><p>The overall cancellation rate was 19.9% (21.7% for females and 18.5% for males—this was statistically significant (<em>p</em> <!-->&lt;<!--> <!-->0.001)). There was a statistically significant difference between the three age groups (<em>p</em> <!-->&lt;<!--> <!-->0.001). There was a significant difference between the two commonest reasons for cancellation—“patient failed to arrive” and “patient unfit”. The cancellation rate for day-case operations was 11.4% and this was significantly lower than that for elective operations at 21.6% with (<em>p</em> <!-->&lt;<!--> <!-->0.001). The cancellation rates were 16.0% for Caucasians, 23.7% for blacks and 22.6% for Asians. There was a significant increase in cancellations during the winter months.</p></div><div><h3>Discussion/recommendations:</h3><p>Attention should be paid to subgroups at higher risk of operative cancellation (0 to 20-year olds, ethnic minorities, non-day case) especially in the winter months. The reason(s) for cancellation should be clearly recorded in the patient's notes. Medical staff at all levels should be given appropriate training as to the clinical significance of good note-keeping and its enforcement. The coding system for the classification of operative cancellations should be extensive and descriptive so as to include a broad range of categories.</p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 2","pages":"Pages 57-60"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.05.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137330764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bispectral Index® and the incidence of apnea during monitored anesthesia care","authors":"Roy G. Soto ,&nbsp;Eugene S. Fu ,&nbsp;Robert A. Smith ,&nbsp;Rafael V. Miguel","doi":"10.1016/j.ambsur.2005.08.001","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.08.001","url":null,"abstract":"<div><h3>Purpose:</h3><p>The Bispectral Index (BIS) provides an estimate of depth of consciousness during sedation. If apnea can be shown to correlate with BIS, then a potential improvement in safety during MAC/sedation may be achieved.</p></div><div><h3>Scope:</h3><p><span>Ninety-nine patients undergoing MAC anesthesia were monitored with BIS for level of consciousness, and capnography for apnea detection. The anesthesia provider was blinded to BIS and capnography data. Forty-nine percent of subjects experienced apnea independent of medical history, procedure, or medication. BIS immediately preceding apneic episodes (55</span> <!-->±<!--> <!-->18) was frequently lower than that recommended for an upper limit during general anesthetics (&lt;60). The incidence increased as depth of consciousness decreased with a 50% likelihood of developing apnea at a BIS of 56.</p></div><div><h3>Conclusions:</h3><p>The incidence of apnea during MAC is high, and incidence increases as BIS decreases.</p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 2","pages":"Pages 81-84"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137330741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery time and patient satisfaction in ambulatory knee arthroscopy","authors":"M.A. Martín ,&nbsp;G. Ollé ,&nbsp;F. Oferil ,&nbsp;Ll Opisso ,&nbsp;M. Serra-Prat ,&nbsp;L. Hidalgo","doi":"10.1016/j.ambsur.2005.06.005","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.06.005","url":null,"abstract":"<div><p><span><span>The aim of this study was to compare recovery time and satisfaction of patients operated under two anaesthetic techniques. A randomised-controlled trial that enrolled ASA<span> I–II patients submitted to ambulatory knee arthroscopy<span> was designed. Patients included were randomly assigned to one of the three study groups: general intravenous anaesthesia (TIVA), </span></span></span>spinal anaesthesia<span><span> with lidocaine (LIDO), and spinal anaesthesia with prilocaine (PRILO). Spinal groups did not receive supplementary sedation. Major outcome measures considered were both the time to discharge from the post-anaesthesia care unit (PACU) and from the day-case surgical unit (DSU), the incidence of adverse events, postoperative need for </span>analgesics and patients satisfaction. One hundred and twenty patients were enrolled. Mean time from the patients comes into operating room to discharge from PACU was 125</span></span> <!-->±<!--> <!-->27<!--> <!-->min for the PRILO group, 109<!--> <!-->±<!--> <!-->24<!--> <!-->min for the LIDO group and 106<!--> <!-->±<!--> <!-->34<!--> <!-->min for the TIVA group (<em>P</em> <!-->&lt;<!--> <!-->0.01). Time to discharge from the ASU was 279<!--> <!-->±<!--> <!-->37<!--> <!-->min for the PRILO group, 261<!--> <!-->±<!--> <!-->53<!--> <!-->min for the TIVA group and 241<!--> <!-->±<!--> <!-->36<!--> <!-->min for the LIDO group (<em>P</em> <!-->&lt;<!--> <!-->0.001). No significant differences were observed in the appearance of adverse events, the need for postoperative analgesics and the degree of patient satisfaction among the study groups. A shorter recuperation time was observed in the LIDO group, but more TIVA patients preferred to have the same anesthetic again. All three anaesthetic methods are useful for ambulatory knee arthroscopy.</p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 2","pages":"Pages 75-79"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.06.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137330927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr. Domingos Marques","authors":"Paulo Lemos","doi":"10.1016/j.ambsur.2005.04.001","DOIUrl":"10.1016/j.ambsur.2005.04.001","url":null,"abstract":"","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 2","pages":"Page 51"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"109562603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing patient disposition after ambulatory herniorrhaphy","authors":"Stavros G. Memtsoudis ,&nbsp;Melanie C. Besculides ,&nbsp;Cephas P. Swamidoss","doi":"10.1016/j.ambsur.2005.06.004","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.06.004","url":null,"abstract":"<div><h3>Purpose:</h3><p>To determine factors associated with patient disposition status other than discharge to their customary residence (DCR) after elective, ambulatory inguinal hernia repair (IHR).</p></div><div><h3>Materials and methods:</h3><p><em>N</em> <!-->=<!--> <span>7953 patients who underwent IHR were identified in the National Survey of Ambulatory Surgery<span> (NSAS). Disposition status was examined by age, sex, race, type of anesthetic, anesthesia provider, expected source of payment, laterality of the procedure, facility type and US region. Logistic regression was used to examine independent risk factors for such disposition status.</span></span></p></div><div><h3>Results:</h3><p>Independent risk factors for disposition status other than DCR included anesthesia type, anesthesia provider, increasing age of the patient, and bi- versus unilaterality of the procedure. Differences in disposition status were also found by facility type and US region in which the procedure was performed.</p></div><div><h3>Discussion:</h3><p>The increased cost associated with a disposition status other than DCR requires identification of factors that independently contribute to such an outcome. In this study a number of anesthesia related and unrelated factors were identified that may impact on the disposition of patients undergoing ambulatory inguinal hernia repair. In light of limitations inherent to analysis of large databases our results should be interpreted with caution and prospective trials are needed for validation of our findings. The value of our results may lie particularly in the hypothesis generation for such trials.</p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 2","pages":"Pages 67-73"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137330766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postdischarge nausea and vomiting: A review of current literature","authors":"Jan Odom-Forren ,&nbsp;Debra K. Moser","doi":"10.1016/j.ambsur.2005.08.003","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.08.003","url":null,"abstract":"<div><p><span>Postoperative nausea and vomiting continues to occur in approximately one-third of patients who have surgery despite newer medications and emerging guidelines for care. There is a paucity of literature that relates to patients who experience postdischarge nausea and vomiting after </span>outpatient surgery. The purpose of this article is to review the current knowledge in the area of postdischarge nausea and vomiting. The findings were that the problems with postdischarge nausea and vomiting (PDNV) have not been as thoroughly assessed and evaluated as nausea and vomiting immediately postsurgery. More research needs to be conducted in this population, as the rate of surgeries performed in this setting will only increase.</p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 2","pages":"Pages 99-105"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.08.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137330762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder function after ambulatory surgery","authors":"K.J. Souter,&nbsp;D.J. Pavlin","doi":"10.1016/j.ambsur.2005.08.002","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.08.002","url":null,"abstract":"<div><p><span>Micturition is a complex process under both involuntary and voluntary control. A variety of pathological conditions, as well as certain surgical and anesthetic procedures cause urinary retention, which may have long lasting consequences. Patients undergoing </span>ambulatory surgery<span><span><span> have traditionally been required to void prior to discharge; however, this practice is increasingly being questioned. Ultrasound scanning of the </span>bladder is an accurate method of measuring urine volume in postoperative patients. It may be useful as a non-invasive method of monitoring </span>bladder volume<span>, thus avoiding unnecessary bladder catheterization whilst at the same time preventing prolonged overdistension. We present an algorithm for managing ambulatory patients in both low and high-risk groups for postoperative urinary retention.</span></span></p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 2","pages":"Pages 89-97"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137330763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory treatment of haemorrhoids with the infrared coagulator","authors":"Michael E.C. McFarlane","doi":"10.1016/j.ambsur.2005.03.002","DOIUrl":"https://doi.org/10.1016/j.ambsur.2005.03.002","url":null,"abstract":"<div><p>The objective of the study was to demonstrate the effectiveness of infrared photocoagulation<span> (IRC) for the outpatient treatment of internal haemorrhoids.</span></p><p>One hundred and seven consecutive patients were prospectively studied during a 2-year period in a general surgery ambulatory practice using a Redfield infrared coagulation system without anaesthesia or sedation.</p><p>There was improvement in 73% of patients. Fifty-nine percent of patients became asymptomatic and 14% of patients had partial improvement with reduction in bleeding and prolapse. No response was seen in 15%.</p><p>Infrared coagulation should be considered as a simple trouble-free option in the outpatient management of haemorrhoids.</p></div>","PeriodicalId":38794,"journal":{"name":"Ambulatory Surgery","volume":"12 2","pages":"Pages 53-55"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ambsur.2005.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137330928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}