Reliability and validity of the Anaesthesiological Questionnaire for electively operated patients

OBJECTIVE: The Anaesthesiological Questionnaire (ANP) is a self-rating method for the assessment of postoperative complaints and patient satisfaction. The questionnaire consists of two parts.Part 1 assesses the intensity of symptoms regarding the postoperative period in the "recovery-room and the first hours on the ward" (19 items) and the "current state" (17 items). Part 2 assesses patient satisfaction with the anaesthetic care as well as the unspecific perioperative care and postoperative convalescence. The questionnaire was designed to fulfill the criteria of reliability and validity and to serve as a practicable means of auditing the quality of routine clinical practice. METHODS: A total of 1,112 patients older than 18 years completed the questionnaire after an elective operation. Additionally data concerning the type of anaesthesia were recorded from the anaesthesia chart. To determine retest-reliability, 94 patients competed the ANP twice postoperatively. RESULTS: The participants of the survey represented 74.6% of the total collective. Out of 19 items 16 had a retest-reliability of r(tt)>0.70, the 3 other items had a reliability of r(tt)>0.50. Reliability (Cronbach's Alpha) of the patient satisfaction scales was between r(tt)=0.76 and r(tt)=0.91. In relation to the period immediately after anaesthesia,women reported more postoperative complaints than men but no differences were found between male and female patients with regard to satisfaction with perioperative care. Younger patients (18-49 years old) described more postoperative complaints than older patients and a lesser degree of satisfaction with perioperative care. There were plausible differences in postoperative complaints between patients who received general vs. regional anaesthesia. Patients reported less postoperative complaints after TIVA than after volatile anaesthetics. The configuration of patient characteristics and anaesthesia gives indications to "risk groups" who predominantly suffer after anaesthesia. CONCLUSIONS: The Anaesthesiological Questionnaire (ANP) is a reliable and valid method for the assessment of postoperative complaints and patient satisfaction.     

Der Anästhesiologische Nachbefragungsbogen für Patienten in der Herzanästhesie

OBJECTIVE: The Anaesthesiological Questionnaire (ANP) is a self-rating method for the assessment of postoperative complaints and patient satisfaction. The questionnaire was adapted for use in cardiac anaesthesia (ANP-KA). The study was conducted to show the value of ANP-KA as a practicable means of assessing the patient's state after cardiac anaesthesia and for its use in quality assurance. METHODS: A total of 1,688 patients from 19 clinics were included who had exclusively received heart valve surgery, CABG surgery or both operations. They completed the ANP-KA between days 1 and 8 postoperatively. RESULTS: The ANP-KA was completed by 79.1% of the patients without any assistance. The highest incidence rates were reported for a dry mouth/thirst (85.1%) and for pain in the area of surgery (60.2%). Plausible and significant differences in patients' symptoms between the grading for the immediate postoperative period and the current state at filling in the questionnaire were found. Women reported more postoperative complaints than men but no differences were found between male and female patients with regard to satisfaction with anaesthesiological care and convalescence. More complaints were reported after heart valve surgery than after CABG and satisfaction with convalescence was significantly lower after heart valve surgery. The clinics differed with respect to the reported somatic complaints and satisfaction scales. CONCLUSION: The results demonstrate the practicability and validity of the ANP-KA for the assessment of postoperative complaints and patient satisfaction after cardiac surgery.     

The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%

BACKGROUND: The incidence of TNS after spinal anaesthesia is a problem. Especially the use of hyperbaric lidocaine in patients placed in the lithotomy position during surgery has been associated with a high incidence of TNS. The present study was performed to investigate whether TNS is present more frequently in patients undergoing surgery in the supine position with use of hyperbaric lidocaine compared with hyperbaric bupivacaine. METHOD: Seventy patients were included and randomised to receive either hyperbaric lidocaine or hyperbaric bupivacaine. All patients were contacted on the first and third postoperative days by an anaesthesiologist blinded to the local anaesthetic used. The patients were asked about symptoms of TNS, pain not associated with the operation area, and asked to grade the complaints after a verbal analogue score from 0 to 10. RESULTS: We found a total of ten patients who showed signs of TNS. There were nine patients in the lidocaine group (26%) who showed signs of TNS compared to only one patient in the bupivacaine group (3%) (P<0.01). The average score of TNS complaints was 3.5. A total of 13 patients (19%) complained of back pain. There were no significant differences with regard to which local anaesthetic was used. The average score of back pain was 3.3. CONCLUSION: TNS is a significant problem in patients having spinal anaesthesia with hyperbaric lidocaine compared to hyperbaric bupivacaine, both in the supine position. For day-case surgery, TNS would start after dismissal from hospital. The use of hyperbaric lidocaine is therefore questionable, even though these problems are of an order that the majority of patients would still choose spinal anaesthesia for future operations.     

Recollections of general anaesthesia: a survey of anaesthesiological practice

In order to identify the factors to which patients attach importance when undergoing general anaesthesia, 678 patients were retrospectively asked about their recollections of previous anaesthetics during routine preoperative screening over a period of 14 months. The most frequently mentioned recollections concerned the post-anaesthetic period, followed by recollections of the induction of anaesthesia. From the post-anaesthetic period, nausea/vomiting and drowsiness were most often cited. The number of anaesthetics previously undergone had no influence on the reports of the two most frequently mentioned complaints. The rate of nausea/vomiting in this series was 21.0%. The number of patients reporting nausea/vomiting following an anaesthetic has not changed over the years. The last 250 patients were asked to assess the quality of their anaesthetics on a 5-point scale. More than a quarter of the patients were not satisfied with the anaesthesia. No correlation was found between the assessment of the anaesthesia and complaints about nausea/vomiting and drowsiness. The possible role of psychological factors in the origin of complaints about anaesthesia is discussed.     

Anaesthesia in an Australian private hospital: the consumer's view

A survey of the patients' view of anaesthesia was carried out in a medium-sized metropolitan private hospital. The study was performed using a postoperative questionnaire. A two-week period was investigated, and data was obtained from 121 of 124 patients anaesthetised during that period. The results showed a very high degree of satisfaction with the anaesthetic services provided, although specific questioning revealed many minor complaints. The results are compared with previous studies done in public hospitals and show that from the patients' perspective, there were fewer complaints than have been noted in the other studies.     

Complaints of sore throat after tracheal intubation: a prospective evaluation

BACKGROUND AND OBJECTIVE: Sore throat and hoarseness rank, besides pain and nausea, among the most frequent subjective complaints after tracheal intubation for general anaesthesia. Our intention was to determine the incidence of postoperative sore throat from a large sample of patients and thus to identify the most important associated factors. METHODS: We prospectively followed up 809 adult patients who underwent elective surgical interventions and examined their history, the applied anaesthetic techniques, perioperative course and the occurrence, intensity and duration of postoperative throat complaints. The assignment and professional experience of the involved intubators were also assessed. The influence of a multitude of variables on postoperative throat complaints was statistically analysed. RESULTS: Postoperative sore throat was present in 40% overall being significantly higher in female than in male (44% vs. 33%; P = 0.001). The mean pain intensity in the affected patients (n = 323) was 28+/-12 mm on a visual analogue scale where 0 = no pain and 100 = extreme pain. The average duration was 16+/-11 h. Main factors associated with throat complaints were female sex; history of smoking or lung disease, duration of anaesthesia, postoperative nausea, bloodstain on the endotracheal tube and natural teeth. We could find no influence on the occurrence or intensity of throat complaints by the professional assignment or the length of professional experience of the personnel involved. CONCLUSIONS: Postoperative throat complaints frequently arise after tracheal intubation for general anaesthesia in the first 2 postoperative days, but they are of limited intensity and duration.     

Studies in postoperative sequelae. Nausea and vomiting—still a problem

We collected data on postoperative nausea and vomiting from 3850 patients aged 11–91 years. Thirty-seven percent of the 3244 patients who received a general anaesthetic reported nausea and 23.2% vomited. Twenty percent of the 606 patients who received a local anaesthetic reported nausea and 11.4% vomited. Of the general anaesthetic patients reporting nausea, 72.2% were women, and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 74.0% were women and again the mean age was lower (p < 0.001). Of the local anaesthetic patients reporting nausea, 62.0% were women and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 68.1% were women and again the mean age was lower (p < 0.001). Anxiety before general, but not local, anaesthesia was associated with postoperative nausea (p < 0.001) but not vomiting. Patients from the gynaecological, orthopaedic, ENT and general surgical wards had higher incidences of postoperative nausea and vomiting. Linear visual analogue pain scores were higher in patients with postoperative nausea and vomiting in both general and local anaesthesia groups (p < 0.001).     

The nature of pre-operative anxiety

In a study of 247 patients who had general anaesthesia for dental procedures, the incidence of individual anxieties was noted using a questionnaire completed by the patient. The most common anxieties related to the period before transfer to the operating theatre, intra-operative awareness and postoperative pain. These anxieties were present in over half the patients questioned. The follow-up questionnaire was completed by 207 patients in order to indicate which anxieties they would expect to have if they needed anaesthesia in the future. All anxieties were less frequent than found before operation.     

SPINAL ANAESTHESIA IN YOUNG PATIENTS USING A 29-GAUGE NEEDLE: TECHNICAL CONSIDERATIONS AND AN EVALUATION OF POSTOPERATIVE COMPLAINTS COMPARED WITH GENERAL ANAESTHESIA

One hundred patients aged 18–49 yr, undergoing electivearthroscopy of the knee joint, were allocated randomly to eitherspinal anaesthesia using a 29-gauge spinal needle or generalanaesthesia. Dural puncture was considered difficult in 18%of the patients receiving spinal anaesthesia. In three patients(6%) it was necessary to supplement the spinal anaesthetic withgeneral anaesthesia. Spinal and general anaesthesia were otherwiseuneventful in all patients. The incidence of postoperative headachewas similar in the two groups. One patient developed post duralpuncture headache following spinal anaesthesia. This headachewas of short duration and disappeared without treatment. Spinalanaesthesia caused more backache than general anaesthesia, otherwisethe frequency of postoperative complaints was the same or lower.Ninety-six percent of the patients receiving spinal anaesthesiawould prefer the same anaesthetic for a similar procedure inthe future ^*Department of Anaesthesiology, Hvidovre University Hospital,DK-2650 Hvidovre, Copenhagen, Denmark     

Outpatient laparoscopic sterilization: is local anaesthesia better?

A prospective, randomized study comprised 125 outpatient laparoscopic sterilization patients who had received either general anaesthesia or local anaesthesia together with intravenous sedation. The patients who had received local anaesthesia suffered significantly less postoperative pain and sore throat. Recovery and discharge were similar in the two groups, but those given a general anaesthetic were more drowsy in the evening on the day of operation. The time spent in the operating theatre was significantly shorter for the group given local anaesthesia, and the costs were lower. The majority of patients from both groups would prefer local anaesthesia for a similar procedure in the future. We conclude that local anaesthesia together with intravenous sedation is the method of choice for laparoscopic sterilization.     

Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network*

The aim of this audit was to investigate process, personnel and anaesthetic factors in relation to mortality among patients with proximal femoral fractures. A questionnaire was used to record standardised data about 1195 patients with proximal femoral fracture admitted to 22 hospitals contributing to the Hip Fracture Anaesthesia Network over a 2‐month winter period. Patients were demographically similar between hospitals (mean age 81 years, 73% female, median ASA grade 3). However, there was wide variation in time from admission to operation (24–108 h) and 30‐day postoperative mortality (2–25%). Fifty percent of hospitals had a mean admission to operation time < 48 h. Forty‐two percent of operations were delayed: 51% for organisational; 44% for medical; and 4% for ‘anaesthetic’ reasons. Regional anaesthesia was administered to 49% of patients (by hospital, range = 0–82%), 51% received general anaesthesia and 19% of patients received peripheral nerve blockade. Consultants administered 61% of anaesthetics (17–100%). Wide national variations in current management of patients sustaining proximal femoral fracture reflect a lack of research evidence on which to base best practice guidance. Collaborative audits such as this provide a robust method of collecting such evidence.     

Arterial hypertension associated with the use of a tourniquet with either general or regional anaesthesia

A hypertensive patient with left cardiac enlargement developed marked hypertension under general anaesthesia, during which time a tourniquet was applied around his thigh. When the tourniquet was released, severe hypotension ensued which responded to therapy. The patient, however, died 16 h later of a myocardial infarction. Because of this incident, the anaesthetic and haemodynamic data of 699 patients who underwent limb surgery with a pneumatic tourniquet inflated for at least an hour were retrospectively examined using multivariate analysis. A 30% increase in systolic and/or diastolic arterial blood pressure occurred in 27% of the total patient material and in 67% of those who had had a general anaesthetic. There was a higher frequency of the occurrence of "tourniquet hypertension" with older age, longer operations and the operation site being the lower rather than the upper limb. Tourniquet hypertension rarely occurred in patients with spinal anaesthesia (2.7%) and brachial plexus blockade (2.5%), while those with intravenous regional anesthesia had a higher incidence (19%) of hypertension.     

Haemorrhoidectomy without tears.

A study of 50 patients undergoing haemorrhoidectomy under general anaesthesia in Reading was undertaken. Half the patients received, in addition, a caudal anaesthetic given by the surgeon at the beginning of the operation with the patient in the lithotomy position. The rest of the patients had no form of local anaesthetic. The amount of analgesia needed, general comfort after the operation, and the number of days after surgery of the first bowel movement were recorded. The use of caudal anaesthesia resulted in a 79% reduction in the number of doses of papaveretum needed by the patients after the operation and a reduction by half in the period of postoperative constipation. Possible reasons for the latter finding are discussed. The possible risks of caudal anaesthesia are considered, but it is concluded that they are far outweighed by the benefits obtained.     

Randomized clinical trial of haemorrhoidectomy under a mixture of local anaesthesia versus general anaesthesia

BACKGROUND: Application of a topical anaesthetic agent may facilitate infiltration of local anaesthetic at haemorrhoidectomy. METHODS: A randomized clinical trial of 53 consecutive patients requiring elective haemorrhoidectomy was carried out. One group underwent haemorrhoidectomy under general anaesthesia, while the second group had topical anaesthetic cream (containing lignocaine and prilocaine) applied followed by local anaesthetic infiltration for surgical anaesthesia. RESULTS: There were no differences between the two groups in terms of operating time, postoperative pain, nausea or vomiting, pain-free interval after operation, analgesic requirements or patients' satisfaction with the method of anaesthesia. Postoperative oxygen saturation and pulse rate were similar in the two groups. CONCLUSION: Topical anaesthetic and local anaesthesia can be used effectively for haemorrhoidectomy and provide an alternative to general anaesthesia.     

Postural post-dural puncture headache after spinal and epidural anaesthesia. A randomised, double-blind study

Background : This study was conducted in order to investigate the effect of patient expectation in the developement of postural post-dural puncture headache (PPDPH).
Methods : 224 patients less than 55 years scheduled for minor non-obstetric surgery were randomised to receive single-injection spinal (SA) or epidural (EA) anaesthesia. A 27-g Quinke needle was used for SA and a 18-g Tuohy needle for EA. Patients, operating team and postoperative ward personnel were all blinded to the anaesthetic given and so was an independent observer responsible for follow-up after 5–7 days. The occurrence of headache, backache and other complaints was recorded. Headache was classified as PPDPH or non-PPDPH, and duration and intensity of the headache was registered. The quality of anaesthesia was directly evaluated by the surgeon using a VAS scale from 1(excellent) to 10 (very poor) and indirectly by the supplemental use of opioid analgesia and general anaesthesia in the two groups.
Results : 212 patients, 103 SA and 109 EA, with a mean age of 36.7 years, could be fully evaluated. The groups were comparable with regards to age, sex and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 16 patients (15.5%) in the SA group and 2 (1.8%) in the EA group (P=0.0014). Non-PPDPH occurred in 13 patients in each group. PPDPH had significantly greater mean intensity and duration than non-PPDPH. More patients in the EA group had postoperative backache (31.2%) than in the SA group (22.3%), but this difference was not statistically significant. More patients in the EA received general anaesthesia and opioid analgesia than in the SA group, and the surgeon's rating was on average 1.3 in the SA group compared to 2.5 in the EA group (P=0.0003).
Conclusions : SA gave more headache but superior quality of surgical anaesthesia compared with EA. Dural puncture, and not expectation, is the major cause of PPDPH.     

Patients’ reported experiences and outcomes following surgical excision of lower limb osteomyelitis and microvascular free tissue reconstruction under ‘awake’ epidural anaesthesia and sedation

BackgroundOrthoplastic operations for lower limb osteomyelitis (LLOM) involving microvascular free tissue reconstructions (“free-flaps”) are usually performed under general anaesthesia (GA), with or without epidural anaesthesia (EA) due to concerns about the discomfort associated with prolonged surgery. However, our clinical experience supports “awake” epidural anaesthesia with sedation (EA + Sed) rather than EA + GA as a technique of choice for this type of surgery.MethodsWe used a standardised postoperative questionnaire to formally assess the experiences and outcomes for 50 patients who underwent free-flaps for LLOM under EA + Sed.FindingsThe mean duration of surgery was 522 min (8.7 h), range 240–875 min. There were no ITU admissions or flap failures. Postoperatively, fifty patients completed a standardised questionnaire about their experiences before the operation, in the anaesthetic room and theatre. 80% were aware of the procedure at least “some of the time”. 72.5% patients and 75% respectively, did not have any concerns in the anaesthetic room and theatre. Concerns expressed by the remaining patients were manageable. 97.5% of those patients who recalled their operation reported their overall experience as “comfortable” or “very comfortable”. 92% of respondents had undergone previous lower limb surgery under GA ± EA. In this subgroup, 91.3% reported the recovery after EA + Sed as “quicker” than GA, and 89.4% reported their experience with EA + Sed as “better”. All fifty patients (100%) were “satisfied” or “very satisfied” with their experience and all but one (98%) would recommend this technique to others.ConclusionsOur study showed that despite prolonged duration, the patients' reported experiences and outcomes were excellent when EA + Sed was used for orthoplastic operations involving free-flaps for LLOM. We recommend EA + Sed as the anaesthetic technique of choice for such patients.     

Outpatient procedures on the glans and anterior urethra under a new local anaesthesia: intracorpus spongiosum anaesthesia

OBJECTIVE: To determine the efficacy of intracorpus spongiosum anaesthesia during minor procedures on the glans and anterior urethra in the outpatient clinic. METHODS: Sixty-nine consecutive male patients underwent various procedures on the glans penis or anterior urethra under intracorpus spongiosum anaesthesia, which was performed by injection of 3 mL of 1% lidocaine into the glans penis. The effect of this anaesthetic technique was assessed by questionnaire using a pain scale. RESULTS: Following injection of lidocaine, the anaesthetic effect was immediate and very satisfactory. The minor procedures, varying from 8 to 68 minutes in duration, were successfully completed under the new local anaesthesia. Of the 69 patients, 63 (91.3%) felt no pain and six (8.7%) reported either minor or moderate discomfort that was tolerable and could be ignored. There were no serious complications with this anaesthetic technique except for three patients (4.3%) who had instantaneous trance during lidocaine injection. CONCLUSION: Intracorpus spongiosum anaesthesia is an effective, simple, safe anaesthetic technique for minor procedures on the glans and anterior urethra in an outpatient setting. With this new local anaesthesia, the total cost of many procedures on the glans and anterior urethra can be markedly reduced.     

局麻和硬膜外麻醉下腹股沟疝无张力修补手术的比较分析

目的探讨腹股沟疝无张力修补更适宜的麻醉方式。方法将我院2002年3月至2005年3月收治的单侧腹股沟疝病例422例按随机数字表法分为局麻组和硬膜外麻醉组，手术方法均采用充填式无张力疝修补，设定观察指标，记录相关数据（包括手术时间、下地时间、进食时间、住院时间、恢复日常生活时间、伤口并发症、术后麻醉并发症、辅助药物使用率、麻醉满意率及住院费用），填写问卷调查表并进行随访。结果局麻组和硬膜外麻醉组的辅助药物使用率、伤口并发症发生率、手术时间及恢复日常生活时间比较，差异均无统计学意义（P〉0、05）；在对麻醉满意率方面两组均为总体满意。局麻组下地时间、进食时间、住院时间、术后麻醉并发症（恶心／呕吐、尿潴留）发生率及住院全部费用均明显低于硬膜外麻醉组，两组差异有统计学意义（P〈0．05）。随访期间，两组患者均无复发。结论大多数腹股沟疝无张力修补均可在局麻下完成，局部麻醉可成为腹股沟疝无张力修补的常规麻醉方式。     

Postoperative recovery after general anaesthesia with and without retrobulbar block in retinal detachment surgery

This study was to determine whether general anaesthesia plus retrobulbar block would be a better anaesthetic technique than general anaesthesia alone in retinal detachment surgery. Twenty-eight patients were allocated randomly to either general anaesthesia with retrobulbar block or general anaesthesia alone. The anaesthetist involved was blinded as to whether a retrobulbar block was performed or not. Significantly fewer patients in the general anaesthesia plus block group complained of postoperative pain than patients in the general anaesthesia group (21.4% as compared with 64.3%, p less than 0.05). Those who received general anaesthesia plus block recovered significantly more rapidly than those receiving general anaesthesia alone. The time to opening of eyes on command (p less than 0.05), telling the correct date of birth (p less than 0.01), reaching a full recovery score (p less than 0.005) and performing a simple motor task (p less than 0.025) was shorter in patients with general anaesthesia plus block. Thus general anaesthesia plus retrobulbar block was superior to general anaesthesia alone in terms of pain and recovery after operation.     

Postoperative nausea and vomiting. A comparison between intravenous and inhalation anaesthesia in breast surgery

Nausea and vomiting during the first 24 postoperative hours after breast surgery were studied. Ninety patients scheduled for elective breast surgery were randomly assigned to one of three anaesthetic methods: total intravenous anaesthesia with propofol, or propofol or thiopental for induction followed by isoflurane anaesthesia. All three groups received fentanyl for peroperative analgesia. A total of 46 (51%) patients experienced emetic sequelae: 19 (21%) complained about nausea and another 27 (30%) vomited once or more during the postoperative course. More than 50% of the patients with nausea and 70% with vomiting first suffered from these symptoms in the surgical wards after leaving the postoperative unit. Nausea and vomiting were seen in 18 (60%), 13 (43%) and 15 (50%) for the groups propofol–propofol, propofol–isoflurane and thiopental–isoflurane, respectively. In conclusion, every second patient experienced nausea or vomiting after breast surgery, the majority of these emetic symptoms occurring after leaving the postoperative unit. Propofol for induction or as a main anaesthetic did not make any major difference with regard to postoperative nausea or vomiting.