SPECTRAL ENTROPY FOR ASSESSING THE PATIENT RESPONSIVENESS DURING PROPOFOL/FENTANYL SEDATION IN DAY CARE SURGERIES

Background: For day care surgery under monitored anesthetic care, precise monitoring of sedation depth facilitates optimization of dosage and prevents adverse complications from over sedation. Conventionally subjective sedation scales, such as the Modified observer’s assessment of alertness/ sedation scale (MOAA/S) have been widely utilized for sedation monitoring. The newer monitoring called entropy is considered to be beneficial for objective assessment with combined use of opioids and hypnotics if applied. The primary objective is to determine measurement of entropy as a marker for measuring depth of anaesthesia. Methods: Two groups P and PF ( with 25 patients each) received either propofol 1mg/kg followed by maintenance infusion of 250 mic/ kg/hr whereas “PF”group received additional single dose of fentanyl 2 mic/kg respectively. The values of response entropy (RE) and state entropy (SE) corresponding to each MOAA/S (5 to 0) were determined. Results: The patient’s demographic profile and clinical characteristics were comparable in both the groups. No difference observed in duration of anaesthesia and surgery in both groups. No difference observed in MOAA/S in both groups. The results shows a highly significant differences in the observed means of SE, RE, MAP and HR with considerably higher mean values in group P (p<0.0001). However other parameter such as SPO2, ETCO2 and RR were almost comparable in both groups. Conclusion: The mean value of SE and RE in group P and PF indicates that deeper plane of anaesthesia is observed in PF group. It is concluded that in assessing the level of hypnosis during intra-operative sedation in MAC, entropy corresponds to MOAA/S and increases or decreases proportionately depending upon increase or decrease level of sedation. Hence from these results it is proposed that entropy monitoring is a reliable monitoring index of anaesthesia depth in MAC. Keywords: Entropy, Propofol, Sedation, Day care surgery, Observer’s assessment of alertness/ sedation scale, Monitored anaesthesia Care

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Intrathecal anesthesia for day-care surgery. A retrospective study of 160 cases using 25 and 26 gauge spinal needles

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199206000-00085 ◽

1992 ◽

Vol 89 (6) ◽

pp. 1193

Author(s):

V. J. Sarma ◽

David Wood

Keyword(s):

Retrospective Study ◽

Day Care ◽

Day Care Surgery ◽

Care Surgery

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Day-Care Surgery for Pilonidal Sinus

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x149255 ◽

2006 ◽

Vol 88 (7) ◽

pp. 656-658 ◽

Cited By ~ 16

Author(s):

AKM Abdul-Ghani ◽

AN Abdul-Ghani ◽

CL Ingham Clark

Keyword(s):

Pilonidal Sinus ◽

Day Care ◽

Day Surgery ◽

Complete Healing ◽

Sinus Surgery ◽

Potential Cost ◽

Day Care Surgery ◽

Ambulatory Treatment ◽

Wound Breakdown ◽

Care Surgery

INTRODUCTION The surgical approach to symptomatic pilonidal sinus is open to debate. Many techniques have been described and no single technique fulfils all the requirements of an ideal treatment. Ambulatory treatment with minimal morbidity and rapid return to activity is desirable. The aim of this work was to study the feasibility of day-care surgery for excision and primary asymmetric closure of symptomatic pilonidal sinus. PATIENTS AND METHODS All patients referred electively over 2 years were assessed in a single-consultant, colorectal clinic and booked for day-care surgery. All patients had excision and primary asymmetric closure under general anaesthesia in the left lateral position. Whenever possible, they were discharged on the same day according to the day-surgery protocol. Patients were subsequently seen in the out-patient clinic for removal of stitches and were followed up further if there was any wound breakdown. RESULTS Fifty-one patients were operated on electively for pilonidal sinus over the 2 years. Two patients were excluded as the final diagnosis was not pilonidal sinus. At 4 weeks following operation, 43 (88%) had complete healing and 6 (12%) had dehiscence of the wound. Recurrence rate was 8% (4 patients) for follow-up of 12–38 months. There was no admission from the day-surgery unit and no unplanned re-admissions. The cost for day-care pilonidal sinus surgery was estimated to be £672.00 per patient compared with in-patient cost of £2405.00. CONCLUSIONS Excision and primary asymmetric closure for pilonidal sinus is safe and feasible as day-care surgery and is associated with potential cost saving.

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Adult tonsillectomy and day care surgery

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-007-0097-z ◽

2007 ◽

Vol 59 (4) ◽

pp. 341-345 ◽

Cited By ~ 4

Author(s):

Ashok Verma ◽

Sharifa Al Nabhani ◽

Mazin Al-Khabori

Keyword(s):

Day Care ◽

Day Care Surgery ◽

Care Surgery ◽

Adult Tonsillectomy

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Effect of Pre-Anaesthetic Evaluation on Complication Free Outcome among Day-Care ENT Surgeries in a Tertiary Care Hospital

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/616 ◽

2020 ◽

Vol 7 (50) ◽

pp. 3016-3021

Author(s):

Jayachandran C.G ◽

Naiji S. James ◽

Ushakumari P.R

Keyword(s):

Health Care ◽

Postoperative Pain ◽

Day Care ◽

Health Care Personnel ◽

Pain Intensity Score ◽

Care Hospital ◽

Day Care Surgery ◽

Duration Of Surgery ◽

Associated Symptoms ◽

Care Surgery

BACKGROUND Day-care surgery in all the surgical specialities has become an accepted and popular method among the health care personnel and patients. Lesser demand for in-patient beds and lower cost of hospital stay are making this therapeutic modality more acceptable. Current concepts in anaesthesia, availability of newer anaesthetic drugs and surgical methods have helped in achieving progress of daycare surgeries. Pre-anaesthetic evaluation of patients determine their fitness for day-care anaesthesia and surgery, and at times guide the anaesthesiologist in formulating appropriate plans and strategies. We wanted to observe the demography of patients undergoing day-care surgery and estimate the proportion of complication free outcome among day-care ENT procedures following preanaesthetic evaluation. METHODS 96 patients aged between 18 and 60 years undergoing day-care ENT surgeries for which pre-anaesthetic evaluation was done were included. Demographic data was obtained, thorough pre-anaesthetic evaluation and detailed clinical ENT examination were done. Nature of anaesthesia given, duration of the surgery and severity of the postoperative pain were recorded. Analgesic protocol undertaken during recovery period and associated symptoms were recorded. RESULTS Out of 96 patients 55 (57.29) were males and 41 (42.70 %) were females with a male to female ratio of 1.4:1. The mean age was 31.50 ± 4.15 years. 32 / 96 (33.33 %) ear surgeries, 26 / 96 (27.08 %) nose surgeries, 22 / 96 (22.91 %) throat surgeries and 16 / 96 (16.66 %) head and neck surgeries were performed. The smallest mean duration of surgery was 13.30 ± 02.5 minutes for removal of foreign body in the ear and the largest mean duration of surgery was for cortical mastoidectomy, 91.65 ± 6.20 minutes. Postoperative pain was present in 93 / 96 (96.87 %) of the patients varying from class I to class V of Verbal Pain Intensity Score (VPIS). CONCLUSIONS To manage patients undergoing day-care surgeries, efficient pre-anaesthetic evaluation is essential. It should include proper selection of patients, assessing the nature of surgery, analysis of comorbid conditions, counselling patients regarding type of anaesthesia and postoperative pain management. The postoperative pain and associated symptoms should be assessed and monitored periodically and should be managed by trained health care personnel to avoid unplanned overnight stays. KEYWORDS ENT, Anaesthesia, Day-Care Surgery, Complications, Pre-Anaesthetic Medication and Post-Operative Outcome

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