A comparison of recovery after sevoflurane or desflurane in ambulatory anesthesia.

STUDY OBJECTIVE: To determine if there is a difference between sevoflurane and desflurane when used as part of a balanced anesthetic technique in terms of time to discharge from an ambulatory surgery unit. DESIGN: Randomized, double blind study. SETTING: Ambulatory surgery unit of a large, metropolitan teaching hospital. PATIENTS: 60 ASA physical status I and II adult women undergoing laparoscopic tubal ligation on an outpatient basis. INTERVENTIONS: Patients were randomized to receive either sevoflurane or desflurane as a component of a balanced anesthetic technique. Visual analog scores (VAS) for discomfort, nausea, and wakefulness, and digit-symbol substitution tests (DSST) were completed preoperatively and at specified intervals after extubation. MEASUREMENTS AND MAIN RESULTS: Time to eye opening, command response, orientation, sitting in bed, sitting with legs dangling, standing, walking, discharge, and departure were measured for all patients. VAS and DSST scores were compared with preoperative baseline scores. CONCLUSIONS: Recovery indices and psychomotor function are marginally but not significantly better with sevoflurane than desflurane.

Friendliness of OR staff is top determinant of patient satisfaction with outpatient surgery.

Two hundred patients (151 women) undergoing outpatient surgery at a university hospital were asked to complete a questionnaire at the time of discharge. Listing 12 factors related to preoperative intraoperative, and postoperative care, the questionnaire asked each respondent to rank the five most important factors from 1 to 5. The most important factor, ranked among the top five by 67% of the patients, was friendliness of the operating room staff. The other four (and, parenthetically, the percentage of patients ranking the factor among the top five) were as follows: surgeons's postoperative visit (63%); management of postoperative pain (62%); starting i.v. smoothly (53%); and avoidance of delays (45%).

Sulindac-associated hepatic injury: analysis of 91 cases reported to the Food and Drug Administration.

BACKGROUND: Recent emphasis on nonsteroidal anti-inflammatory drug (NSAID)-associated hepatic injury blurs differences between NSAIDs. Accordingly, examination of hepatic injury by individual NSAIDs seemed warranted. Sulindac-associated hepatic injury was selected. METHODS: From 338 reports submitted to the Food and Drug Administration, 247 were considered inadequate or unconvincing for sulindac toxicity. The remaining 91 cases of reactions to the drug were analyzed. In 15 there was histological material available. RESULTS: There were four deaths, three attributed to severe hypersensitivity and one to fulminant hepatic failure. Two thirds of the cases had clinical hallmarks of hypersensitivity. The ratio of females to males was 3.5:1; 69% of the patients were over 50 years of age. Jaundice was recorded in 67% of the patients. The pattern was cholestatic in 43%, hepatocellular in 25%, mixed in 12%, and indeterminate in 20% of the patients. Eosinophilia was significantly more frequent in patients with cholestatic injury (40%) than in those with hepatocellular injury (0). CONCLUSION: Sulindac injury involves females more than males. It can lead to cholestatic or hepatocellular injury, most often because of immunological idiosyncrasy. In some patients, metabolic idiosyncrasy may be the mechanism. This study illustrates the utility of analysis of adverse reaction reports in characterizing drug-induced injury.