Surgical Outpatient Care: Triage, Time and Test

Day care surgery is the standard of care for minor surgical procedures in developed countries and rapidly increasing in practice in developing countries. The main advantages of day care surgery are cost containment, early mobilization of the patient, less pain because of minimally invasive surgical techniques, early return of patient to their home and work. The downsides of day care surgery include the inability to treat all patients and perform all surgical procedures since surgical fitness for day care procedures is demanding, unforeseen readmission, the need for more operating rooms, and increasing expertise among health care workers. Considering day care surgery as systematic, scheduled and short duration stay in hospital, it is very important to select or sort out the cases which fit in the criteria according to all conventional definitions of triage. It is well organized within stipulated time frame and performed in fixed unit with proper assessment by anesthesia and nursing team in addition to core assessment of surgical team. Surgical option exercised and close follow up with ability to manage complications are integral components in working team. Delivery of more surgery in primary care has potential for enhancing patient-centred management by promoting the development of multi-specialty community providers and reducing length of hospital stay. The outpatient surgical centers provide many benefits and advantages for surgical patients with proper organizations, dedicated services, and meticulous procedures.

A prospective study of 100 cases of day care surgery in inguinal hernia

Background: Day care or ambulatory surgery is a concept familiar to surgeons since time immemorial more so now as world over it has been re-evolved into a specialty in the modern medical care scenario. The patients and the procedures are selected in such a way so as to cause minimal harm or disturbance to the patient and his life.Methods: Present prospective study was conducted on 100 patients at the department of surgery, PDU medical college, Rajkot, Gujarat for the duration of one and half years. Patient's history had been taken regarding duration of illness, complain, and physical examination was done. With local examination of each specific cases done and then post-operative follow up was taken.Results: None of the patients had major immediate complications out of 100 patients, 18% of patients had minor immediate post op. 2 out of 100 patients had stay for more than 23 hours, due to immediate post-operative complications and 4 patients had to be re admitted post discharge. 96% of inguinal hernia patients are satisfied with the concept of day care surgery that proves acceptance for day care surgery.Conclusions: Day care surgery is suitable for patients of all age groups as seen in our study for inguinal hernia management. Looking at the advantages of reduction of hospital stay, less post-operative pain and greater satisfaction, day care hernia should be promoted.

A Comparative Study between Day Care and Routine Care Inguinal Hernia Mesh Repair

Inguinal hernia is one of the oldest diseases known to mankind. If not treated on time, patient may land up with complications. The basic principle of hernia surgery is tension free repair. There are no guidelines regarding an ideal surgery or anaesthesia to be used for inguinal hernia repair. Around 10-12% patient visiting outpatient clinic suffer from inguinal hernia and occupy a significant space in the operative list. Day care surgery in which the patient is discharged within 24 hours of surgery is gradually becoming the norm. A lot of centres are performing exclusive day care surgery with a good patient acceptance, thus reducing the burden on the hospital. In this study conducted on 68 patients in a public tertiary care centre, we have compared day care versus routine care inguinal hernia surgery with 34 patients in each group. Lichtenstein hernia repair was done for all patients. The procedure was done under local anaesthesia for the day care surgery group whereas local/spinal/general anaesthesia was used for routine care group. Patients were admitted and discharged on the same day in day care group while patients in routine care group were admitted and discharged as per and norms of in-patient care. The feasibility of the procedure, recovery time, readmission for surgery related complications, and patient satisfaction was compared among the two groups. We concluded that day care surgery is a feasible option, with early recovery, short stay, early ambulation, minimal complications, and significant patient satisfaction. Day care procedures have an edge over routine care public tertiary care hospitals. Keywords: Inguinal hernia, day care surgery, Lichtenstein repair.

Day Care Surgery for Unilateral Alveolar Bone Grafting of Residual Clefts With Mandibular Symphyseal Bone—A Prospective Questionnaire Study

Objective: To evaluate patients’ experiences of shortened hospitalization in relation to bone grafting of unilateral alveolar clefts with mandibular symphyseal bone grafts. Design: Prospective cohort questionnaire study. Setting: Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark. Patients: Thirty-nine (male n = 26, female n = 13) patients with unilateral residual clefts after primary reconstruction, mean age 10.4 years. Interventions: All patients underwent a standardized procedure with closure of the alveolar defect using mandibular symphyseal bone grafts. Patients were discharged within a day after surgery. Within 24 hours after discharge from surgery, patients and their parents filled in a 14-item psychometric questionnaire assessing the quality of their recovery. For all questions, a visual analogue scale (VAS) (0-10) was used. Main Outcome Measure: Patients’ experience of shortened hospitalization in relation to secondary bone grafting of alveolar defects. Factors influencing the overall experience were measured using a VAS scale. Results: A significant correlation between “Information from the hospital” and feeling worried and anxious was found ( P = .04). Additionally, the ability to sleep correlated with pain ( P = .003) and with nausea ( P = .001). Conclusions: Although this study included a limited number of patients, the findings suggest that treatment of alveolar residual cleft with bone grafting from the mandibular symphyseal region in a day care surgery setting is characterized by very high patient satisfaction.

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

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

Intraocular pressure response to airway management: Comparison between LMA Supreme® and C-MAC® videolaryngoscope in day care surgery

Background: Airway maintenance procedures during anesthesia are usually associated with a rise in intraocular pressure (IOP). This is an important issue especially in vulnerable patients. In the present study we compared the rise in IOP with two different group of airway devices i.e. Laryngeal mask airway Supreme (LMA-S) and endotracheal intubation (ETT) using C-MAC® videolaryngoscope (VLS). Methodology: The present study was conducted on 100 adult patients of ages >18 yrs, of either sex, belonging to American Society of Anesthesiologist (ASA) I and II, scheduled to undergo non-ophthalmic elective surgery under general anesthesia. Patients were divided into two equal groups of 50 each, Group A and Group B. In group A (n = 50), lubricated appropriate sized LMA-S was inserted and in Group B (n=50), lubricated appropriate sized ETT was inserted by an anesthesiologist using VLS. IOP was measured in right eye just before insertion of device and subsequently at 1 min, 3 min, 5 min and 10 min after insertion of device. Hemodynamic parameters were recorded along with IOP measurement. Results: Both the groups were comparable regarding demographic data (p > 0.05), ASA grade (p = 0.069), and Mallampati grade (MPG) (p = 0.646). Airway establishment time (p = 0.011) was significantly less with C-MAC VLS. IOP were comparable at all measurement times, e.g., 1 min (p = 0.216), 3 min (p = 0.093), 5 min (p = 0.859) and 10 min (p = 0.060) after insertion of each device. Hemodynamic parameters measured were also comparable between two groups (p > 0.05). Conclusion: Both LMA Supreme and intubation using C-MAC® videolaryngoscope are safe regarding rise in intraocular pressure. Both methods can be safely used for airway management in suitable patients. Key words: Airway; Anesthesia; Intraocular pressure; LMA; Endotracheal intubation Citation: Kaur H, Singh G, Singh J, Kaur, Dhawan M, Singh A. Intraocular pressure response to airway management: Comparison between LMA Supreme and C-MAC® videolaryngoscope in day care surgery. Anaesth. pain intensive care 2020;24(6):__ Received: 27 January 2020, Revised: 12 May 2020, Reviewed: 25 October 2020, Accepted: 27 October 2020