Propofol reduces prolonged outpatient PACU stay. An analysis according to surgical procedure.

This study compared the effects of propofol anesthesia and nonpropofol general anesthetics on duration of stay in the postanesthesia care unit (PACU) for prolonged drowsiness or nausea and vomiting following various surgical procedures. A group of 512 patients undergoing general anesthesia for a variety of outpatient surgical procedures over a 6-month period received general anesthesia with nitrous oxide, with or without propofol. Data collected from PACU records included type of surgical procedure and duration in the PACU of more than 2 hours owing to drowsiness or nausea and vomiting. Overall, patients who received propofol with nitrous oxide experienced less frequent drowsiness, nausea, or vomiting compared with patients who received nonpropofol anesthetic agents (drowsiness 12% vs 31%; nausea/vomiting 3% vs 25%). For patients undergoing gynecologic surgery, propofol anesthesia yielded an 8% incidence of prolonged PACU stay, compared with 41% for nonpropofol techniques. Similar results occurred for orthopedic surgery (15% vs 35%); for ear, nose, or throat procedures (30% vs 75%); and for ophthalmic surgery (18% vs 71%), but not for oral surgery (44% vs 64%). Most same-day surgery patients benefit from administration of propofol for induction and maintenance of anesthesia. Advantages include a decreased likelihood of a prolonged stay in the PACU as a result of drowsiness or nausea and vomiting.

Lidocaine hydrochloride versus lidocaine bicarbonate for epidural anesthesia in outpatients undergoing arthroscopic surgery.

In a randomized, double-blind study, 24 patients undergoing outpatient arthroscopic knee surgery were divided into two groups. Group 1 received 2% lidocaine hydrochloride; group 2 received pH-adjusted 1.73% lidocaine made by adding 1 ml of NaHCO3 44.6 meq/L to 10 ml of 2% lidocaine hydrochloride. Epidural anesthesia was administered in the sitting position. Group 1 consisted of 12 males; group 2 consisted of 6 males and 6 females (p less than 0.01). Statistical analysis using the unpaired Student's t-test and the Mann-Whitney test found no significant differences between the two groups regarding time of onset of analgesia, degree of spread of analgesia, time to maximum motor blockade, degree of motor blockade, length of surgical procedure, total anesthesia time, regression of anesthesia, dosage of lidocaine used, and serum lidocaine levels. Intraoperative conditions were satisfactory in all cases. Postoperatively, all patients reported having experienced a satisfactory anesthetic without any complications. The authors conclude that epidural anesthesia is a satisfactory technique for outpatient arthroscopic surgery. There appears to be no advantage to adding bicarbonate to lidocaine anesthetic solutions for use in epidural anesthesia.