The Comparison of Propofol, Isoflurane and Enflurane Anesthesia on Recovery in Day Surgery / 대한마취과학회지

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is expected to provide fast and comfortable recovery, plus an early return to normal daily activities. This study was carried out to compare the characteristics of recovery after VATS in patients anesthetized with isoflurane, enflurane or propofol. METHODS: Sixty patients undergoing VATS were allocated randomly to receive propofol-N2O, isoflurane-N2O or enflurane-N2O anesthesia. The time between the end of anesthesia and extubation were compared. The orientation, cooperation and degree of sedation in Numeric Rating Scale (NRS) were recorded 5, 10, 30 and 60 min after anesthesia. Recovery was also evaluated by the P-deletion test (PDT) and Digit Symbol Substitution test (DSST) 30, 60 and 120 min after anesthesia for the comparison of the recovery of cognitive and psychomotor function. RESULTS: Early recovery was significantly (P < 0.05) faster in the propofol group (orientation, cooperation and degree of sedation in 10 min) when compared to the isoflurane and enflurane groups, but there was no significant difference in the other parameters of recovery. CONCLUSIONS: The authors concluded that although propofol was associated with faster emergence from anesthesia than enflurane and isoflurane after VATS, recovery of cognitive and psychomotor function were similar in the three anesthetic groups.

Comparison of Propofol and Propofol-Isoflurane Anesthesia for Outpatient Surgery / 대한마취과학회지

BACKGROUND: Outpatient surgery has recently grown at a substantial rate. The development and use of short acting anesthetic and analgesic agents have played a major role in the growth of outpatient surgery. This study was designed to evaluate the intraoperative hemodynamic responses and recovery characteristics, using propofol or isoflurane to maintain the anesthesia. METHODS: A total number of 30, ASA physical status I-II patients scheduled for outpatient surgery, all of whom were to undergo excision of breast mass. The patients were randomly allocated to receive either total intravenous anesthesia with propofol, or inhalation anesthesia with isoflurane after induction of anesthesia with propofol. All patients were ventilated via a laryngeal mask airway (LMA) using a mixture of oxygen and air so that the FiO2 would be 0.4. RESULTS: There were no significant differences in hemodynamic changes during anesthesia in recovery time, or in complications between the two groups. CONCLUSIONS: We conclude that both methods provide reasonably rapid and reliable recovery from anesthesia and are equally acceptable to the patients.

Effect of Midazolam Premedication on Postanesthetic Recovery and Postanesthetic Recovery Room Discharge Time for Outpatient Surgery / 대한마취과학회지

BACKGROUND: Midazolam is often used as an anxiolytic premedication before surgery. But preoperatively administered midazolam may contribute to postopertive sedation and delayed recovery from general anesthesia. This study was undertaken to evaluate the effect of midazolam premedication on postoperative recovery and discharge-readiness after brief outpatient surgery. METHODS: Sixty healthy ASA physical status I women scheduled for outpatient diagnostic laparoscopic surgery were considered for the study. They were randomly allocated to one of two groups. Group one received normal saline (N/S) 5 ml intravenously (IV), while group two received IV midazolam 0.04 mg/kg. The study drug was prepared in 5 ml of saline and administered 10 minutes before the induction of general anesthesia. General anesthesia was induced with fentanyl, propofol and vecuronium and was maintained with N2O and enflurane. Postanesthetic recovery (PAR) scores were recorded after the arrival of the patients in the postanesthetic recovery room. Sedation was quantified before and after premedication and 60, 120 minutes after arriving in the postanesthetic recovery room, using the symbol-digit-modalities test (SDMT) and trail-making test (TMT). RESULTS: There were no significant differences between the two groups with respect to age, weight and anesthesia time. There were no significant differences in PAR scores or PAR-stay time between two groups. SDMT and TMT scores were significantly different 5 minutes after the study's drug administration, and 60 minutes after arrival in the postanesthetic recovery room between the two groups. The incidence of side effects was similar in both groups. CONCLUSIONS: Midazolam premedication proved effective in sedation and anxiolysis without prolonging postanesthetic recovery and discharge times for outpatient general anesthesia.

Postanesthetic Complications of Outpatient Surgery / 대한마취과학회지

BACKGROUND: Outpatient surgery has grown in many hospitals. This rapid recently been on the increase in ambulatory surgery would not have been possible without the changing role of the anesthesiolosist and the development of new and short-acting anesthetic drugs. Specific care and knowledge are required for outpatient anesthesia. The aim of this study was to review the clinical experiences of postanesthetic patients at the Oneday Surgery Center (OSC). METHODS: We reviewed the 720 records of the recovery unit in OSC and the 620 records of telephone interviewers? after discharge from January to December 1997. The PACU Record contained Aldrete scores and discharge summaies (about such things as vital signs, alertness and orientation, dizziness, nausea and vomiting, pain, the state of the neurovascular system, the ability to ambulate or dress, voiding, oral intake, etc). Records of telephone interviewers? after discharge contained questionnaires about wound status, limitations a activity and other abnormal symptoms relating to feeding, nausea and vomiting, pain, and medications. RESULTS: The most largest percentages of parameters of patients were below 10 years of age; They had undergone general anesthesia in method, and Herniorraphies. All the patients achieved Alderete score of 7 10 on arrival at the First recovery unit (1st RU) in OSC and achieved 10 points within an hour, when they were transfered to the Second recovery unit (Comfortable room). 41 (5.4%) patients suffered from nausea or vomiting in the Recovery unit. One (0.1%) patient had nausea or vomiting and 5 (0.7%) patients had pain at discharge. The mean durations of stay at the 1st RU and Comfortable room were 90 min and 240 min respectively. Records of telephone visits after discharge showed that 30 (4.8%) patients had nausea or vomiting and 27 (4.3%) patients had postoperative pain after discharge. 20 patients (3.2%) had abnormal symptoms (e.g., fever, coughing, dysuria, epistaxis). There were no limitations in activities or feeding. CONCLUSIONS: For the assurance of a rapid and complication-free recovery in the increasings needed ambulatory surgery, much effort is reguired to increase its quality and safety.

Postanesthetic Complications of Outpatient Surgery / 대한마취과학회지

BACKGROUND: Outpatient surgery has grown in many hospitals. This rapid recently been on the increase in ambulatory surgery would not have been possible without the changing role of the anesthesiolosist and the development of new and short-acting anesthetic drugs. Specific care and knowledge are required for outpatient anesthesia. The aim of this study was to review the clinical experiences of postanesthetic patients at the Oneday Surgery Center (OSC). METHODS: We reviewed the 720 records of the recovery unit in OSC and the 620 records of telephone interviewers? after discharge from January to December 1997. The PACU Record contained Aldrete scores and discharge summaies (about such things as vital signs, alertness and orientation, dizziness, nausea and vomiting, pain, the state of the neurovascular system, the ability to ambulate or dress, voiding, oral intake, etc). Records of telephone interviewers? after discharge contained questionnaires about wound status, limitations a activity and other abnormal symptoms relating to feeding, nausea and vomiting, pain, and medications. RESULTS: The most largest percentages of parameters of patients were below 10 years of age; They had undergone general anesthesia in method, and Herniorraphies. All the patients achieved Alderete score of 7 10 on arrival at the First recovery unit (1st RU) in OSC and achieved 10 points within an hour, when they were transfered to the Second recovery unit (Comfortable room). 41 (5.4%) patients suffered from nausea or vomiting in the Recovery unit. One (0.1%) patient had nausea or vomiting and 5 (0.7%) patients had pain at discharge. The mean durations of stay at the 1st RU and Comfortable room were 90 min and 240 min respectively. Records of telephone visits after discharge showed that 30 (4.8%) patients had nausea or vomiting and 27 (4.3%) patients had postoperative pain after discharge. 20 patients (3.2%) had abnormal symptoms (e.g., fever, coughing, dysuria, epistaxis). There were no limitations in activities or feeding. CONCLUSIONS: For the assurance of a rapid and complication-free recovery in the increasings needed ambulatory surgery, much effort is reguired to increase its quality and safety.

Anesthesia for Day Surgery in Pediatric Outpatients / 대한마취과학회지

BACKGROUND: Day surgery is increasing recently because of various benefits such as cost-saving, reduced emotional disturbance, and risk of infection. Children are ideal patients for day surgery. Developments in surgical, anesthetic technique, and pharmacology made day surgery to be increased without major complications. METHODS: This retrospective study includes our experience about outpatient anesthesia for pediatric general surgery in 219 children including both sexes up the age of 15 years over two years from jan. 1. 1994 to dec. 31. 1995. RESULTS: In 183 patients(83.5%), general anesthesia was done with mask inhalation. In 165 patients (75%), herniorrhaphy was done. Mean duration of operation, anesthesia and stay in recovery room were 25, 30 and 25 minutes respectively. There was no patient who needs admission and treatment due to complications. CONCLUSIONS: If we considered selection of patients, anesthetic techniques, and prevention and treatment of complications in day surgery, it is safe and desirable in modern anesthesia for us to do day surgery in pediatric outpatients.

Hospital Admissions of Ambulatory Surgical Patients / 대한마취과학회지

BACKGROUND: The purpose of ambulatory facilities is to relieve the pressure on hospital beds and to make the process of surgery more convenient for the patient. One way of assessing the success of a ambulatory unit is to look at the number of patients requiring admission to hospital. Thus the author investigated the rate, distribution, and cause of admission cases to get help to reduce the admission rates. METHODS: Total ambulatory surgeries were 15,512 cases for the period from March 1995 to January 1998. The medical records were reviewed and the patients admitted to hospital instead of being discharged home were analyzed retrospectively. RESULTS: The overall mean rates of admissions for the period was 0.76 percent. The principal reasons for admissions were requestion by surgeon (0.53%), wish of patients (0.12%), surgery related admissions (0.08%) and anesthesia related admissions (0.03%), respectively. CONCLUSIONS: With proper assessment and selection of patients and surgical procedures, the admission rates of ambulatory surgery will be reduced acceptably low. Thus the efficiency of ambulatory unit will be increased. But it will reduce the use rate of ambulatory unit. For increasing the use rate of ambulatory unit, our hospital is broadening the patients' selection criteria.

Usefulness of PAR Score and Modified PADSS as Patient Discharge Criteria in Ambulatory Surgery / 대한마취과학회지

Background: Although an ambulatory surgical practice continues to increase, there is a few data exist about patient discharge criteria. This study was undertaken to evaluate the usefulness and safety of Aldrete PAR (postanesthetic recovery) score and modified PADSS (modified postaneathesia discharge scoring system) on ambulatory surgery patients for recovery in Korea. Methods: Demographic, anesthetic data, Aldrete PAR score and modified PADSS on 279 patients were recorded. The time to dicharge, from recovery room and postoperative complications were evaluated, also. Results: PAR score and modified PADSS are correlated to length of stay in ambulatory surgery center. 24hr after discharge, 16% patients complained postoperative complications. Pain was most frequent postoperative complication. The PAR score was correlated with the occurrence of the complication. Conclusion: PAR score and modified PADSS are useful scoring systems to evaluate patients and make a decision to discharge the patients from ambulatory surgery center in safe.

Comparison of Propofol-N2O and Propofol-fentanyl Anesthesia for Outpatient Surgery / 대한마취과학회지

BACKGROUND: The choice of anesthetic agents and adjuvants during outpatient surgery is of critical importance. Propofol is widely used for the induction and maintenance of outpatient anesthesia. Because propofol lacks analgesic properties, very high concentrations may be required when propofol is used as the sole anesthetic drug. Propofol is used with adjuvants such as nitrous oxide or opioid. This study was designed to evaluate the intraoperative hemodynamic response, recovery characteristics and side effects of propofol-fentanyl anesthesia compared with propofol-N2O anesthesia for outpatient surgery. METHODS: Twenty six healthy and unpremedicated patients scheduled for outpatient surgery were randomly allocated to receive either propofol-N2O anesthesia (N-group) or propofol-fentanyl anesthsia (F-group). The patients in N-group were ventilated with nitrous oxide 60~70% in oxygen and the patients in F-group were ventilated with oxygen 40% in nitrogen via laryngeal mask airway (LMA). RESULTS: There was no significant difference in blood pressure during anesthesia, recovery time and side effects between two group. There was significant decrease of heart rate in F-group. CONCLUSION: We concluded that nitrous oxide and fentanyl are reasonable adjuvants of propofol anesthesia in outpatient anesthesia.

An Experience in Anesthesia for Ambulatory Surgery / 대한마취과학회지

BACKGROUND: Ambulatory surgery has the advantages of reduced demand for postoperative medications, faster recuperation, less disruption to personal life and reduced hospital costs. At present, 60-70% of surgery in North America is performed on an ambulatory basis. DSC (day-surgery center) was opened on March 1995 in our hospital. We want to introduce an experience in anesthesia for ambulatory surgery. METHODS: Ambulatory surgeries were reviewed from March 1995 to July 1996. Total ambulatory surgeries were 5,593 cases. The medical records of 1,816 patients who were anethetized by anesthesiologists for ambulatory surgery were an alyzed retrospectively (3,777 patients who were operated under local anesthesia were excluded). RESULTS: The rate of utility was 14.1% on March 1995 and 27.7% on January 1996. The mean rate of utility was 22.2% per month in DSC. The overall mean rate of delayed discharge for the period was 2.9% and the overall mean rate of admission for the period was 1.9%. The principal reasons for the both were requestion by surgeons without surgery and anesthesia-related complications. CONCLUSIONS: The increase of demands of patients for ambulatory surgeries, new technological developements for surgery and anesthesia and increased experiences of surgeons will stimulate the utility of day surgery center.

Current Status of Outpatient Anesthesia in University Hospitals in Korea / 대한마취과학회지

BACKGROUND: Outpatient procedures account for more than half the operations performed in the United States, but the status of outpatient anesthesia in Korea has not been documented yet. The present study was designed to evaluate the current status of outpatient anesthesia in university hospitals in Korea. METHODS: Thirty-nine university hospitals were surveyed by questionnaire in February 1997. Objects were patients underwent outpatient operations under general, intravenous or regional anesthesia except local anesthesia by surgeon from January 1996 to December 1996. RESULTS: One university hospital started outpatient anesthesia in 1980 and now ten of 39 universities (25.6 %) provide the procedures. In 1995 one of 10 university hospitals has opened day- surgery center having 7 operating rooms and the capability of 24 hours overnight stays. The other 9 hospitals use one of in-patient operating rooms for outpatient procedures. The utility rate per year was 3.06 +/- 1.59 % and 11.49 % in 9 university hospitals and day-surgery center respectively during 1996. Outpatients were mainly classified as physical status 1 and 2 by American Society of Anesthesiologists, and 54.0 38.3 % to 70 % of patients were distributed under 15 years of age. Surgical procedures were relatively simple and 10 surgical departments were participated into the field of outpatient anesthesia. Inhalation techniques and intravenous anesthesia were used predominantly. Complications were sore throat, nausea and vomiting, delayed recovery of consciousness, bleeding at the operative site, fever and so on. CONCLUSIONS: I think that outpatient anesthesia in Korea has grown at very slow rate over the last 4 decades and that it is very low utility rate per year compared to United States. So we have to try to get more interests and supports about the outpatient anesthesia setting.