Pain in Patients Evaluated in Outpatient Orthopaedic Clinics

PURPOSE: We performed this study to assess pain in patients seen in member outpatient orthopaedic clinics of the Korean Knee Society (KKS). MATERIALS AND METHODS: We organized a committee for the study of knee joint pain. The committee designed a questionnaire form consisting of 11 items related to pain. One hundred thirty-five regular members of the KKS asked all patients visiting their respective outpatient clinics during May 2007 to complete the questionnaire form. Although 12,418 patients agreed to fill out the questionnaire form, we only analyzed the questionnaire forms of 9,578 patients who answered completely. RESULTS: 1. Approximately 85% of patients visiting outpatient orthopaedic clinics complained of pain. 2. The average degree of pain was more than moderate, and 72% of patients simply desired to be free of pain. 3. Seventeen percent of patients thought their physicians underestimated their pain. 4. Regarding agreement in the assessment of pain between physicians and patients, there was low level of agreement by numeric rating scale, but a high level of agreement based on a mild/moderate/severe grading scale. 5. Approximately one-third (36.2%) of patients had used additional treatments for pain relief on top of their prescribed medications. CONCLUSION: Eighty-five percent of patients complained of pain, and two-thirds of them were primarily focused on its relief in their visit to the outpatient clinic. Hence, we should heed pain management itself as an important goal in treating orthopaedic patients.

Comparison of Intravenous Propofol and Midazolam Anesthesia for Outpatient Cystoscopy / 대한마취과학회지

BACKGROUND: Ambulatory surgery has become popular because patients believe it allows them greater control over their business and personal lives and because third party payers find it reduces cost. This study was designed to compare the characteristics of induction and recovery as well as the safety of propofol with those of midazolam used for intravenous anesthesia in outpatient cystoscopy. METHODS: 56 healthy consenting outpatients were randomly assigned to receive either bolus of propofol (2 mg/kg, n=29) or midazolam (0.1 mg/kg, n=27) for anesthesia in outpatients cystoscopic procedure. All patients also received bolus of fentanyl 1ug/kg before induction and N-M blocking agent was not injected for maintenance of spontaneous respiration. Mean arterial pressure, HR and SpO2 were recorded and induction time (time to spontaneous eye closure), recovery time (time to response, time to orientation, time to ambulation) and adverse effects were evaluated. RESULTS: The results were as follows; 1) Both propofol and midazolam produced smooth induction, but caused significant respiratory depression. 2) The time of induction and postoperative recovery (time to ambulation) was faster in propofol than in midazolam. 3) There were less postoperative side effects (nausea, vomiting, dizziness) in propofol than in midazolam. 4) There were more cardiovascular depression in propofol than in midazolam. CONCLUSION: These results suggest 1) that propofol has significant advantage over midazolam in outpatient surgery, where early ambulation and discharge is desirable and 2) that both propofol and midazolam should be administered by expert anesthesiologist only when ventilatory assistant device with oxygen is immediately available.

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.