How do Singapore patients view post-anaesthesia adverse outcomes? A single-centre willingness-to-pay study

<p><b>INTRODUCTION</b>Knowing how patients value the quality of anaesthesia helps anaesthesiologists to customise their service. However, generalising findings from Western population-based willingness-to-pay studies across different cultures and societies might result in the oversight of some contextualised perspectives of the anaesthesia experience. This study aimed to capture the Singapore perspective of undesired post-anaesthesia outcomes.</p><p><b>METHODS</b>132 patients recruited in a pre-anaesthetic evaluation clinic were given questionnaires describing ten possible post-anaesthetic outcomes. Outcomes were ranked for undesirability and assigned relative value through the hypothetical proportioning of SGD 100 to avoid their occurrence. Data was analysed with reference to patients' background and anaesthetic history.</p><p><b>RESULTS</b>A response rate of 69.1% (n = 132/191) was achieved. Outcomes from the most to least undesirable were pain; vomiting; nausea; shivering; orodental trauma; sore throat; abrasions; somnolence; and thirst. Relative values allocated, in descending order, were pain; vomiting; nausea; orodental trauma; abrasions; sore throat; shivering; somnolence; and thirst.</p><p><b>CONCLUSION</b>Similar to previous studies in Western populations, pain, vomiting and nausea were the top three adverse outcomes that Singapore patients wished to avoid. However, discrepancies with Western patients were seen in spending attitudes, possibly accounted for by differences in healthcare socioeconomics. This study provided a better understanding of Singapore patients' perspectives on post-anaesthesia adverse outcomes and could help to improve treatment strategy and resource management.</p>

Retrospective review of critical incidents in the post-anaesthesia care unit at a major tertiary hospital

<p><b>INTRODUCTION</b>We reviewed patients with critical incidents that occurred in the post-anaesthesia care unit (PACU) at a major tertiary hospital, and assessed the effect of these incidents on PACU length of stay and discharge disposition.</p><p><b>METHODS</b>A retrospective review was conducted of patients in the PACU over a two-year period from 24 June 2011 to 23 August 2013. Data on critical incidents was recorded in the administrative database using a standardised data form.</p><p><b>RESULTS</b>There were 701 incidents involving 364 patients; 203 (55.8%) patients had American Society of Anesthesiologists (ASA) physical status I or II. The most common critical incidents were cardiovascular-related (n = 293, 41.8%), respiratory (n = 155, 22.1%), neurological (n = 52, 7.4%), surgical (n = 47, 6.7%) and airway-related (n = 34, 4.9%). There were two incidents of cardiac arrest and 25 incidents of unexpected reintubations. Many patients (n = 186, 51.2%) stayed for over four hours in the PACU due to critical incidents and 184 (50.5%) patients required a higher level of care postoperatively than initially planned. Some patients (n = 34, 9.3%) returned to the operation theatre for further management. A proportion of patients (n = 64, 17.6%) had unplanned intensive care unit admissions due to adverse events in the PACU.</p><p><b>CONCLUSION</b>A wide spectrum of critical incidents occur in the PACU, many of which are related to the cardiovascular and respiratory systems. Critical incidents have a major impact on healthcare utilisation and result in prolonged PACU stays and higher levels of postoperative care than initially anticipated.</p>

Perceived needs of patients undergoing coronary artery bypass graft surgery during perioperative period

Introduction: Perioperative care is nursing care provided by perioperative nurses to surgical patients during the perioperative period. Its role is important as patients especially those who had undergone coronary artery bypass graft (CABG) surgery encounter high levels of psychological and physical stress. Objective: To determine the needs of CABG patients throughout the perioperative period and how well those needs were met. Methods: This is a cross sectional descriptive survey. A total of 88 patients who had undergone coronary artery bypass graft were recruited through census sampling. The instrument which was adapted and used with permission for this study was “Survey of Patient Needs and Experiences during the Perioperative Period’ questionnaire (Davis et al., 2014). Results: The patients perceived the perioperative needs in the post-anaesthesia care unit area to be the most important (M = 2.89, SD = 0.06). Perioperative needs which were rated the highest for each of the four time periods were “Having information about the surgical procedure itself”, “Having your family member or significant other with you in the pre-surgical area complications”, “Being treated with respect and with dignity by hospital personnel” and “Having your family member or significant other visit you in the recovery room”. Overall, patients perceived their needs during perioperative period to be partly met (M = 2.73, SD = 0.07) with post-anaesthesia care unit area being rated the highest (M = 2.81, SD = 0.06). Conclusion: The results of this study highlighted the perceived needs of patients undergoing coronary artery bypass graft surgery throughout their perioperative period. In order to improve the quality of perioperative care for patients, nurses need to take into consideration the important needs identified by the patients and address the items which were not meeting the needs of the patients.

Negative pressure pulmonary oedema after routine elective surgery.

Negative Pressure Pulmonary Oedema (NPPE) is known to occur in healthy subjects in the early post anaesthesia period, in the absence of fluid overload or left ventricular dysfunction. This type of non cardiogenic pulmonary oedema is also reported in literature following upper airway obstruction. We report two such cases of negative pressure pulmonary edema. Both the patients developed NPPE during postanaesthesia period due to persistent laryngospasm leading to upper airway obstruction. Both the patients were treated with diuretics, bronchodilators & antibiotics in intensive care unit. Within 24 hours the coarse crepitations disappeared and the patients were weaned off the ventilator. Awareness, early recognition and prompt treatment of negative pressure pulmonary oedema could be life saving.