Office-based ambulatory anesthesia: Factors that influence patient satisfaction or dissatisfaction with deep sedation/general anesthesia

Abstract Background: The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia.Methods: This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. CRBD scores and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results: CRBD scores and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p<0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p<0.001). No diﬀerences were detected in Steward score out of PACU (p=0.213) and from the time of the end of operation to fully awake (p=0.417).Conclusion: Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia.Clinical Trial Registration: Chinese Clinical Trial Registry (No. ChiCTR1800016429), date of registration 1st June 2018

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Oral Health Care Delivery for Children During COVID-19 Pandemic—A Retrospective Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.637351 ◽

2021 ◽

Vol 9 ◽

Author(s):

Avia Fux-Noy ◽

Luna Mattar ◽

Aviv Shmueli ◽

Elinor Halperson ◽

Diana Ram ◽

...

Keyword(s):

General Anesthesia ◽

Behavior Management ◽

Deep Sedation ◽

Care Delivery ◽

Medical Center ◽

Pediatric Dentistry ◽

Control Measures ◽

Healthy Children ◽

Efficient Treatment ◽

Dental Staff

Aim: COVID-19 outbreak and the lockdown period following was a very challenging time for pediatric dentistry. We aimed to find whether the characteristics of dental care provided to children at the Department of Pediatric Dentistry at Hadassah medical center, Jerusalem, Israel, differed between the periods, before COVID-19 outbreak, during the lockdown period and during the period that followed it.Materials and Methods: We retrospectively reviewed computerized records of patients who visited the pediatric dental clinic at three different periods: pre-lockdown period, lockdown period, and post-lockdown period.Results: Nine-hundred and forty-nine children were included in the study; most of them were healthy children between 3 and 6 years old. During lockdown, all scheduled appointments except for treatments under general anesthesia and deep sedation were canceled due to the government's restrictions; the frequency of treatments with non-pharmacological behavior management, general anesthesia or deep sedation was higher than in the previous or subsequent periods and the use of inhaled/conscious sedation was significantly lower. During lockdown most of the children were diagnosed with dentoalveolar abscess (32.3%), compared to 14 and 21% at the previous or subsequent periods, respectively (P < 0.001). Treatments combination during lockdown included more extractions, pulpectomies and pulp extirpation and less permanent restorations (P < 0.001). None of the staff members was infected with COVID-19 at the clinic during these periods. We concluded that dentists should be updated about Covid-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols can help the dental staff to continue to provide efficient treatment and prevent Covid-19 contamination.

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Abstract 359: Unit-Specific Influences on Conscious Sedation Nursing Practices: Comparing Medication Utilization and Patient Outcomes

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.359 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Linda Parone ◽

Sahil Rawal ◽

Allison Ellis ◽

Bryant Peterson ◽

Lourdes Escalante ◽

...

Keyword(s):

Patient Satisfaction ◽

General Anesthesia ◽

Clinical Outcomes ◽

Median Time ◽

Conscious Sedation ◽

Adverse Outcomes ◽

P Value ◽

Medication Utilization ◽

American Society ◽

Cardiac Catherization

Background: Unit-Specific influences may determine the amount of sedation given to patients and lead to deviations in patient satisfaction and clinical outcomes due to vague guidelines (4). This study aims to compare medication utilization, clinical outcomes and patient satisfaction in order to determine safety and efficacy of nurse administrated conscious sedation. Methods: Data from outpatient procedures in Cardiac Catherization Lab (Cath Lab) and Interventional Radiology (IR) departments were collected including comorbidities, labs, procedural characteristics, clinical outcomes, and post-sedation questionnaires. Results: Mean age was 63 ± 14 years and 124 (54.9%) were males. Cath Lab n=132 and IR n=94. Procedure duration(min) was found to be longer in the Cath Lab 55 (37,81), than in IR 24 (16,45), p-value of <0.001. The American Society of Anesthesiologist (ASA) scores of Cath Lab 26(21%), IR 29(30.9%), p-value (0.1). Total amount of versed (mg) given in the Cath Lab 2 (1,2), significantly less than IR 3 (1,4.5) with a p-value of <0.01. Total amount of fentanyl (mcg) for Cath Lab 50(50,100), and IR 100 (50,100) with a p-value of <0.01. Median time between 1 st and 2 nd dose of versed in Cath Lab 0 (0,1), IR 9 (5, 16). Median time between 2 nd and 3 rd dose of versed for Cath Lab 0 (0,0), IR 6 (0,13.5) with a p-value <0.001. Median time between 1 st and 2 nd dose of fentanyl in Cath Lab 1 (0,14.8), IR 12.5 (6.8, 24) with a p-value <0.001. Median time between 2 nd and 3 rd dose of fentanyl for Cath Lab 0 (0,0), IR 0,(0,15), p-value <0.001. Median second dose of versed in Cath Lab 0 (0,1), IR 1 (1,1). Median second dose of fentanyl in Cath Lab 25 0 (0,25), IR 25 (25,50), p-value <0.001. Post-Sedation Questionnaire completed by 57 patients, Cath Lab n=30, IR n=27. Patients that felt uncomfortable during their procedure in Cath Lab 11(36.7%), compared to IR 1 (3.7%). The choice of sedation that patient would choose if undergoing a similar procedure again if under general anesthesia Cath Lab 6(20%), IR 0(0%), p-value 0.03. Patients stated that they would recommend conscious sedation to others based on their previous experience, Cath Lab 24 (80%), IR 27(100%). Conclusion: Patients receiving conscious sedation while undergoing procedures in both the Cath Lab and IR were found to have no adverse outcomes and were considered safe. The procedural duration of catheterization procedures was significantly longer than IR with no adverse outcomes, but patients in the Cath lab received less sedation medication and were found to be less satisfied with their procedure. Patients from Cath Lab received less initial sedation medication and rarely received an additional dose. Cath Lab patients were more likely to not recommended conscious sedation to others (20%), and 6 (20%) stated they would rather undergo a similar procedure under general anesthesia; 36.7% of Cath Lab patients stated that they were uncomfortable during the procedure.

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Solid Organ Biopsies

The Pediatric Procedural Sedation Handbook ◽

10.1093/med/9780190659110.003.0038 ◽

2018 ◽

pp. 246-249

Author(s):

Jennifer Biber ◽

Jenna Wheeler

Keyword(s):

Adverse Events ◽

General Anesthesia ◽

Operating Room ◽

Local Anesthesia ◽

Deep Sedation ◽

Recovery Period ◽

Contingency Planning ◽

Solid Organ ◽

Sedation And Analgesia ◽

Pediatric Sedation

While solid organ biopsies are routinely done on adults with only local anesthesia or minimal sedation, children frequently require deep sedation or general anesthesia to achieve acceptable conditions (stillness, anxiolysis, analgesia) to facilitate these procedures. This is more frequently being done with pediatric sedation/anesthesia outside the operating room. Issues unique to sedation for these procedures are pain, the need for relative patient immobility (both during the procedure and following it), and the nonstandard positioning required during the procedure. Regardless of the medications chosen, adequate monitoring should occur during the procedure as well as during the recovery period. With a good sedation plan for both sedation and analgesia, adequate monitoring, and contingency planning for adverse events, this can safely be performed in institutions with highly motivated and organized sedation services.

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Esophagogastroduodenoscopy Procedure in Sick Pediatric Patients: A Comparison between Deep Sedation and General Anesthesia Technique

Journal of Anesthesia & Clinical Research ◽

10.4172/2155-6148.1000185 ◽

2012 ◽

Vol 03 (01) ◽

Cited By ~ 2

Author(s):

Somchai Amornyotin ◽

Siriporn Kongphlay

Keyword(s):

General Anesthesia ◽

Pediatric Patients ◽

Deep Sedation ◽

Anesthesia Technique

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Recovery Profile and Patient Satisfaction After Ambulatory Anesthesia for Dental Treatment—A Crossover Comparison Between Propofol and Sevoflurane

Anesthesia Progress ◽

10.2344/15-00012.1 ◽

2016 ◽

Vol 63 (4) ◽

pp. 175-180 ◽

Cited By ~ 3

Author(s):

Keita Ohkushi ◽

Ken-ichi Fukuda ◽

Yoshihiko Koukita ◽

Yuzuru Kaneko ◽

Tatsuya Ichinohe

Keyword(s):

Patient Satisfaction ◽

Dental Treatment ◽

Recovery Phase ◽

Day Case ◽

Ambulatory Anesthesia ◽

Verbal Command ◽

Recovery Profile ◽

Eye Opening ◽

Emergence Phase ◽

Severe Anxiety

The purpose of this study was to determine which anesthetic was preferable for ambulatory anesthesia: propofol alone or sevoflurane alone. A crossover study was performed to compare the recovery profile and patient satisfaction after 2 anesthesia methods. Twenty healthy patients with severe anxiety toward dental treatment undergoing 2 sessions of day-case dental treatment received either propofol or sevoflurane anesthesia. The order of these methods was randomized. The depths of anesthesia were kept constant using bispectral index (BIS) monitoring. Observations on recovery profiles were performed in the emergence phase, in the recovery phase, and 24 hours after discharge. Patient satisfaction and preference were obtained by a questionnaire. Most of the recovery profiles in the emergence phase such as time to eye opening to respond to verbal command, time to BIS ≥ 75, and time to extubation were shorter in the sevoflurane group than in the propofol group. All recovery profiles in the recovery phase showed no differences between the 2 groups. Based on the subject's satisfaction and preference, propofol was evaluated as a better anesthetic for ambulatory anesthesia than sevoflurane. Higher patient satisfaction and a greater preference for future dental treatment were revealed for propofol anesthesia. Propofol may be more suitable for ambulatory anesthesia for dental treatment.

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