Recovery following thiopentone or propofol anaesthesia assessed by computerized coordination measurements

Quantitative measurements of coordination ability and performance speed were carried out on 76 female day-case patients undergoing minor gynaecological operations. The women were assigned at random to the anaesthetic agent used, propofol 2.5 mg/kg or thiopentone 4 mg/kg. Spacing control, timing control and performance speed were recorded using a newly developed computerized coordination ability test system. The patients were tested once before the operation and 0.5, 1 and 2 h after awakening. Postoperatively the initial impairment and the subsequent regression towards preoperative test results were very similar whether the anaesthetic agent was propofol or thiopentone. Although the test apparatus was able to detect even minor differences, no postoperative test showed statistically significant differences between the two groups. We find it reasonable to conclude that there is no difference in recovery of coordination ability following propofol- or thiopentone-induced anaesthesia.     

Premedication with controlled-release oxycodone does not improve management of postoperative pain after day-case gynaecological laparoscopic surgery

BACKGROUND: Controlled-release (CR) oxycodone provides an option for theprevention of postoperative pain. We designed this randomizeddouble-blinded placebo controlled study to evaluate the controlof pain after premedication with CR oxycodone 15 mg inaddition to ibuprofen 800 mg orally in day-case gynaecologicallaparoscopic surgery. METHODS: Sixty consenting patients were anaesthetized in a standardizedfashion. Postoperative analgesia was provided by ibuprofen 800 mgtwice a day in combination with fentanyl i.v. in the recoveryroom and normal-release (NR) oxycodone orally after the recoveryroom. The visual analogue scale (VAS) scores for pain and side-effects,and the amounts of postoperative analgesics were recorded for24 h after discharge from the hospital. After a statisticalanalysis of the original study, we extended the study to investigateanother 10 patients, who received CR oxycodone 15 mg orallyin an open-labelled fashion 60 min before surgery. Theplasma concentrations of oxycodone were measured from samplesdrawn before and 2, 4, 6 and 8 h after premedication. RESULTS: The amounts of fentanyl [100 µg (0–330) inthe CR oxycodone group; 125 µg (0–330) in theplacebo group], NR oxycodone, or the VAS scores for pain duringthe first 24 h after the discharge from the hospital didnot differ after the premedication with CR oxycodone or placebo.In the extension study group, the peak plasma concentration(C_max) of oxycodone was 10.0 (4.6–14.7) ng ml^–1,indicating possibly a sub-therapeutic level. CONCLUSION: Oral premedication with CR oxycodone did not improve managementof postoperative pain after day-case gynaecological laparoscopicsurgery.     

Reducing admission times in the endoscopy unit

Pre-procedural admission of outpatients to a day-case endoscopy facility is time-consuming. Collecting and recording routine but necessary information distracts nurses from spending time that could be used to counsel patients. This study assessed whether patients can record some pre-procedural details and whether such self-recording quickens nurse admission times. A new admission document was devised and posted to patients. Patients completed personal/administrative details and information about drugs and allergies and brought the document with them when attending for outpatient endoscopy. Endoscopy nurses anonymously timed 100 admissions, 50 using the new admission form and 50 using the old admission form. Overall, the median (range) time to admit using the old form was 6 (3-15.5) min. Using the new form, the median time to admit was lower at 4 (0.5-10) min. No patient completing the new form reported any particular difficulties. An admission document that patients partially complete at home leads to a faster pre-procedural admission in the endoscopy unit. This allows more nursing time to discuss patients' anxieties and answer patient queries, helps to prevent delays and facilitates increased capacity in the endoscopy unit.     

Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy

Background. Acetaminophen and non-steroidal anti-inflammatorydrugs have different mechanisms of action. We investigated ifcombining rectal acetaminophen with ibuprofen would providebetter postoperative analgesia compared with either drug aloneafter adenoidectomy in children. Methods. 160 children, aged 1–6 yr, undergoing day-caseadenoidectomy, were randomized to receive either acetaminophen40 mg kg^–1, ibuprofen 15 mg kg^–1, their combination,or placebo rectally immediately after anaesthetic induction.A standard anaesthetic method was used and all children receivedalfentanil 10 µg kg^–1 i.v. during induction. Meperidine5–10 mg i.v. was used for rescue analgesia for a painscore (Objective Pain Scale) over 3. Recovery times, sedationscores and the need for rescue analgesia and adverse eventsduring the first 24 h after anaesthesia were recorded. Rescueanalgesic at home was ibuprofen 10 mg kg^–1. Results. Total meperidine requirements were significantly lessin the groups receiving acetaminophen, ibuprofen, or their combinationcompared with the group receiving placebo indicating an opioid-sparingeffect of 19–28% (P<0.05). Children given acetaminophenwere more sedated than those given ibuprofen (P<0.05). Dischargecriteria were fulfilled earlier in the ibuprofen group thanin all the other groups (P<0.05). At home, less children(49%) needed rescue analgesia in the combination group comparedwith the other groups (74–77%) (P<0.02). Conclusions. We conclude that prophylactically administeredrectal acetaminophen combined with ibuprofen does not improveanalgesia after adenoidectomy in the immediate postoperativeperiod compared with either drug alone but does decrease theneed for analgesia at home. Ibuprofen results in lesser sedationand faster discharge than when acetaminophen is used. Br J Anaesth 2003; 91: 363–7     

Analgesic efficacy of tramadol 2 mg kg(-1) for paediatric day-case adenoidectomy

We studied the analgesic efficacy of tramadol 2 mg kg^–1for post-operative analgesia after day-case adenoidectomy inchildren aged 1–3 yr. Eighty children were allocatedrandomly to receive tramadol 2 mg kg^–1 i.v.or placebo immediately after induction of anaesthesia. Anaesthesiawas induced with alfentanil 10 µg kg^–1and propofol 4 mg kg^–1 followed by mivacurium0.2 mg kg^–1 for tracheal intubation. Anaesthesiawas continued with sevoflurane in nitrous oxide and oxygen.All children were given ibuprofen rectally at approximately10 mg kg^–1 before the start of surgery. Post-operativepain and recovery assessments were performed by a nurse blindedto the analgesic treatment using the Aldrete recovery score,the pain/discomfort scale and measurement of recovery times.Rescue medication (pethidine in increments of 5 mg i.v.)was administered according to the pain scores. A post-operativequestionnaire was used to evaluate the need for analgesia athome up to 24 h after operation. Rescue analgesic at homewas rectal or oral ibuprofen 125 mg. Children in the tramadolgroup required fewer pethidine doses than those in the placebogroup (P=0.014). Forty-five per cent of children receiving tramadoldid not require post-operative analgesia at all compared with15% of children receiving placebo (P=0.003). Recovery timesand the incidence of adverse effects were similar in the twogroups in the recovery room and at home. The requirement forrectal ibuprofen at home did not differ between groups. Br J Anaesth 2001; 86: 572–5