The Gould-Statham P23id transducer with disposable dome was tested for accuracy between 0 and 20 ... more The Gould-Statham P23id transducer with disposable dome was tested for accuracy between 0 and 20 mm Hg. With a criterion of +/- 2 mm Hg, 16 per cent of 74 systems failed. Inaccuracies were relatively large (SD, 6.02 mm Hg). The source of the unreliable measurements was poor sealing between the membrane of the disposable dome and the transducer diaphragm.
when the standard operative maximum wall suction might inadvertently be used to suction the neona... more when the standard operative maximum wall suction might inadvertently be used to suction the neonatal oropharynx and trauma might be induced. There is no easy way to know during sections if suction is causing esophageal trauma because of the usual bloodstained amniotic fluid at cesarean delivery. Careful intubation of the newborn by skilled personnel is fundamentally important. Routine use of the bulb syringe and use of regulated suction only when indicated, and always below 100 mm Hg, are also important to avoid traumatic esophageal perforation in neonates.
Two hundred patients (151 women) undergoing outpatient surgery at a university hospital were aske... more Two hundred patients (151 women) undergoing outpatient surgery at a university hospital were asked to complete a questionnaire at the time of discharge. Listing 12 factors related to preoperative intraoperative, and postoperative care, the questionnaire asked each respondent to rank the five most important factors from 1 to 5. The most important factor, ranked among the top five by 67% of the patients, was friendliness of the operating room staff. The other four (and, parenthetically, the percentage of patients ranking the factor among the top five) were as follows: surgeons's postoperative visit (63%); management of postoperative pain (62%); starting i.v. smoothly (53%); and avoidance of delays (45%).
The Appendix, which listed members of the Dolasetron Prophylaxis Study Group who participated in ... more The Appendix, which listed members of the Dolasetron Prophylaxis Study Group who participated in the study trials, should read as follows. The authors have made every effort to include all participants from each trial site and regret the inadvertent errors and omissions from the roster. Institution City State
Magnesium sulfate (MgSO4) is widely utilized in the treatment of preeclamptic hyperreflexia. Such... more Magnesium sulfate (MgSO4) is widely utilized in the treatment of preeclamptic hyperreflexia. Such therapy has important anesthetic implications because increases in plasma magnesium potentiate the activity of both depolarizing and nondepolarizing neuromuscular blocking agents (1). In a recent animal
We compared vital capacity inhaled induction (VC) with sevoflurane with i.v. induction with propo... more We compared vital capacity inhaled induction (VC) with sevoflurane with i.v. induction with propofol for adult ambulatory anesthesia. Patients were randomly assigned to receive either 8% sevoflurane in 75% N2O/O2 from a primed circuit (VC, 32 patients) or propofol 2-mg/kg bolus (i.v., 24 patients). Times to loss of consciousness (response to command) and induction side effects (airway, hemodynamic, motor) were assessed. Anesthesia was maintained with sevoflurane/N2O via a face mask for both groups. At the end of surgery, recovery times were measured and psychomotor function tests were performed. Patients were also asked to assess the quality of their anesthesia. Of the VC patients, 59% lost responsiveness in one breath, taking 39 +/- 3 s. All VC patients completed the induction, and all measures of induction time were significantly shorter for VC than for i.v. Induction side effects were different in the two groups (cough and hiccough for VC versus movement and blood pressure changes for i.v.), but overall incidences were similar. There were no significant differences in any index of early or intermediate recovery. Mild nausea occurred more often with VC, but no antiemetics were needed, and discharge was not delayed. Patients' assessments of the quality of induction or wake up were not significantly different between VC and i.v. Thus, VC induction with sevoflurane is an acceptable alternative to propofol i.v. induction of general anesthesia for adult ambulatory surgical patients. A vital capacity induction with sevoflurane produced a faster loss of consciousness and had side effects, recovery times, and patient satisfaction similar to that of a propofol induction in adults undergoing ambulatory surgery.
Ambulatory surgical procedures represent a large and increasing fraction of all surgery performed... more Ambulatory surgical procedures represent a large and increasing fraction of all surgery performed in the U.S.A. Between 1980 and 1990, ambulatory procedures increased from 13% to 51% of all surgery done in U.S.A. hospitals (1). This represents an increase from 3.2 million to 11.7 million operations per year. Also, in 1990 there were 1364 freestanding ambulatory surgery centers which performed an additional 2.3 million procedures. We are seeing the continuing shift of more complex patients and procedures from the inpatient hospital to the outpatient setting.
The IVAC Variable Pressure Volumetric Pump, Model 560, was evaluated for hydrostatic and central ... more The IVAC Variable Pressure Volumetric Pump, Model 560, was evaluated for hydrostatic and central venous pressure (CVP) measurement. In bench tests, 4 per cent of IVAC systems failed a +/- 2 mm Hg accuracy test. When measurements were inaccurate, errors were small (SD = 0.49 mm Hg). In simultaneous clinical measurements with a standard electronic transducer system, the correlation coefficient between the IVAC and transducer measurements was 0.95. A potential drawback of the IVAC 560 for CVP measurement is the lack of waveform display. The IVAC system is simple to operate and less expensive per use than the standard electronic system.
To obtain patients' assessments of ambulatory anesthesia and surgery using a return-mail ... more To obtain patients' assessments of ambulatory anesthesia and surgery using a return-mail questionnaire postcard. Return-mail questionnaire given to consecutive ambulatory surgery patients. Adult ambulatory surgery unit of a university hospital. The questionnaire was given to 3,722 patients. Responses were returned by 1,511 patients (41%). Among the respondents, 95% had gynecologic procedures and 5% had general surgical procedures. Eighty-six percent of respondents reported at least one minor sequela persisting after discharge. Laparoscopy patients experienced significantly more aches, drowsiness, dizziness, sore throat, nausea, and vomiting. For all patients, sequelae lasted 1 day for 59% of all patients, 2 days for 28%, and 3 or more days for 14%. Different sequelae had different durations. Thirty-eight percent of respondents were able to return to their usual activities the day after surgery; the remainder required 3.2 +/- 2.0 additional days. The main reasons for delayed recovery included general malaise (57%) and surgical discomfort (38%). Assessing their overall satisfaction, 97% would choose day surgery again. Return-mail questionnaires can be used for patient follow-up after ambulatory surgery, with limitations characteristic of unselected-patient methods. Patients' assessments of their anesthesia and surgery can identify common sequelae that ambulatory patients should realistically expect to experience.
Increasing numbers of ambulatory surgical procedures are being performed in hospitals, surgery ce... more Increasing numbers of ambulatory surgical procedures are being performed in hospitals, surgery centers, and doctor’s offices; many of these procedures can be advantageously performed under regional anesthesia. This review article will discuss supplemental medication for the adult patient having regional anesthesia for ambulatory surgery. The introduction will address the role of pharmacologic supplementation, the characteristics of drugs appropriate for ambulatory patients, and the use of verbal reassurance as sedation. This will be followed by a review of the pharmacology of selected suitable drugs, including dosage, duration of action, advantages, and adverse effects. Supplemental medication for ambulatory regional anesthesia serves two major functions. One is to provide chemically induced tranquility and relaxation during the surgical procedure. Supplemental sedation can thereby improve acceptance of regional techniques, particularly when a patient would rather not be fully awake in the operating room (76). The second function of supplemental medication is to provide additional analgesia that is useful even with a successful regional block. Patients may experience sensations of pressure, movement, or visceral traction that can be reduced with concomitantly administered analgesics. Supplemental analgesics can also ease the discomfort of having to lie still on a hard operating table. Supplemental ataractics and analgesics can greatly increase the ambulatory patient’s satisfaction with regional anesthetic techniques.
... Anesth Analg 1987;66:679-83. 2. Philip BK. ... Roberta Galford, MD Instructor in Anesthesia R... more ... Anesth Analg 1987;66:679-83. 2. Philip BK. ... Roberta Galford, MD Instructor in Anesthesia Roger L. Royster, MD Associate Professor in Anesthesia Wake Forest Medical Center The Bowman Gray School of Medicine Winston-Salem, NC 27203 ...
The Gould-Statham P23id transducer with disposable dome was tested for accuracy between 0 and 20 ... more The Gould-Statham P23id transducer with disposable dome was tested for accuracy between 0 and 20 mm Hg. With a criterion of +/- 2 mm Hg, 16 per cent of 74 systems failed. Inaccuracies were relatively large (SD, 6.02 mm Hg). The source of the unreliable measurements was poor sealing between the membrane of the disposable dome and the transducer diaphragm.
when the standard operative maximum wall suction might inadvertently be used to suction the neona... more when the standard operative maximum wall suction might inadvertently be used to suction the neonatal oropharynx and trauma might be induced. There is no easy way to know during sections if suction is causing esophageal trauma because of the usual bloodstained amniotic fluid at cesarean delivery. Careful intubation of the newborn by skilled personnel is fundamentally important. Routine use of the bulb syringe and use of regulated suction only when indicated, and always below 100 mm Hg, are also important to avoid traumatic esophageal perforation in neonates.
Two hundred patients (151 women) undergoing outpatient surgery at a university hospital were aske... more Two hundred patients (151 women) undergoing outpatient surgery at a university hospital were asked to complete a questionnaire at the time of discharge. Listing 12 factors related to preoperative intraoperative, and postoperative care, the questionnaire asked each respondent to rank the five most important factors from 1 to 5. The most important factor, ranked among the top five by 67% of the patients, was friendliness of the operating room staff. The other four (and, parenthetically, the percentage of patients ranking the factor among the top five) were as follows: surgeons's postoperative visit (63%); management of postoperative pain (62%); starting i.v. smoothly (53%); and avoidance of delays (45%).
The Appendix, which listed members of the Dolasetron Prophylaxis Study Group who participated in ... more The Appendix, which listed members of the Dolasetron Prophylaxis Study Group who participated in the study trials, should read as follows. The authors have made every effort to include all participants from each trial site and regret the inadvertent errors and omissions from the roster. Institution City State
Magnesium sulfate (MgSO4) is widely utilized in the treatment of preeclamptic hyperreflexia. Such... more Magnesium sulfate (MgSO4) is widely utilized in the treatment of preeclamptic hyperreflexia. Such therapy has important anesthetic implications because increases in plasma magnesium potentiate the activity of both depolarizing and nondepolarizing neuromuscular blocking agents (1). In a recent animal
We compared vital capacity inhaled induction (VC) with sevoflurane with i.v. induction with propo... more We compared vital capacity inhaled induction (VC) with sevoflurane with i.v. induction with propofol for adult ambulatory anesthesia. Patients were randomly assigned to receive either 8% sevoflurane in 75% N2O/O2 from a primed circuit (VC, 32 patients) or propofol 2-mg/kg bolus (i.v., 24 patients). Times to loss of consciousness (response to command) and induction side effects (airway, hemodynamic, motor) were assessed. Anesthesia was maintained with sevoflurane/N2O via a face mask for both groups. At the end of surgery, recovery times were measured and psychomotor function tests were performed. Patients were also asked to assess the quality of their anesthesia. Of the VC patients, 59% lost responsiveness in one breath, taking 39 +/- 3 s. All VC patients completed the induction, and all measures of induction time were significantly shorter for VC than for i.v. Induction side effects were different in the two groups (cough and hiccough for VC versus movement and blood pressure changes for i.v.), but overall incidences were similar. There were no significant differences in any index of early or intermediate recovery. Mild nausea occurred more often with VC, but no antiemetics were needed, and discharge was not delayed. Patients' assessments of the quality of induction or wake up were not significantly different between VC and i.v. Thus, VC induction with sevoflurane is an acceptable alternative to propofol i.v. induction of general anesthesia for adult ambulatory surgical patients. A vital capacity induction with sevoflurane produced a faster loss of consciousness and had side effects, recovery times, and patient satisfaction similar to that of a propofol induction in adults undergoing ambulatory surgery.
Ambulatory surgical procedures represent a large and increasing fraction of all surgery performed... more Ambulatory surgical procedures represent a large and increasing fraction of all surgery performed in the U.S.A. Between 1980 and 1990, ambulatory procedures increased from 13% to 51% of all surgery done in U.S.A. hospitals (1). This represents an increase from 3.2 million to 11.7 million operations per year. Also, in 1990 there were 1364 freestanding ambulatory surgery centers which performed an additional 2.3 million procedures. We are seeing the continuing shift of more complex patients and procedures from the inpatient hospital to the outpatient setting.
The IVAC Variable Pressure Volumetric Pump, Model 560, was evaluated for hydrostatic and central ... more The IVAC Variable Pressure Volumetric Pump, Model 560, was evaluated for hydrostatic and central venous pressure (CVP) measurement. In bench tests, 4 per cent of IVAC systems failed a +/- 2 mm Hg accuracy test. When measurements were inaccurate, errors were small (SD = 0.49 mm Hg). In simultaneous clinical measurements with a standard electronic transducer system, the correlation coefficient between the IVAC and transducer measurements was 0.95. A potential drawback of the IVAC 560 for CVP measurement is the lack of waveform display. The IVAC system is simple to operate and less expensive per use than the standard electronic system.
To obtain patients' assessments of ambulatory anesthesia and surgery using a return-mail ... more To obtain patients' assessments of ambulatory anesthesia and surgery using a return-mail questionnaire postcard. Return-mail questionnaire given to consecutive ambulatory surgery patients. Adult ambulatory surgery unit of a university hospital. The questionnaire was given to 3,722 patients. Responses were returned by 1,511 patients (41%). Among the respondents, 95% had gynecologic procedures and 5% had general surgical procedures. Eighty-six percent of respondents reported at least one minor sequela persisting after discharge. Laparoscopy patients experienced significantly more aches, drowsiness, dizziness, sore throat, nausea, and vomiting. For all patients, sequelae lasted 1 day for 59% of all patients, 2 days for 28%, and 3 or more days for 14%. Different sequelae had different durations. Thirty-eight percent of respondents were able to return to their usual activities the day after surgery; the remainder required 3.2 +/- 2.0 additional days. The main reasons for delayed recovery included general malaise (57%) and surgical discomfort (38%). Assessing their overall satisfaction, 97% would choose day surgery again. Return-mail questionnaires can be used for patient follow-up after ambulatory surgery, with limitations characteristic of unselected-patient methods. Patients' assessments of their anesthesia and surgery can identify common sequelae that ambulatory patients should realistically expect to experience.
Increasing numbers of ambulatory surgical procedures are being performed in hospitals, surgery ce... more Increasing numbers of ambulatory surgical procedures are being performed in hospitals, surgery centers, and doctor’s offices; many of these procedures can be advantageously performed under regional anesthesia. This review article will discuss supplemental medication for the adult patient having regional anesthesia for ambulatory surgery. The introduction will address the role of pharmacologic supplementation, the characteristics of drugs appropriate for ambulatory patients, and the use of verbal reassurance as sedation. This will be followed by a review of the pharmacology of selected suitable drugs, including dosage, duration of action, advantages, and adverse effects. Supplemental medication for ambulatory regional anesthesia serves two major functions. One is to provide chemically induced tranquility and relaxation during the surgical procedure. Supplemental sedation can thereby improve acceptance of regional techniques, particularly when a patient would rather not be fully awake in the operating room (76). The second function of supplemental medication is to provide additional analgesia that is useful even with a successful regional block. Patients may experience sensations of pressure, movement, or visceral traction that can be reduced with concomitantly administered analgesics. Supplemental analgesics can also ease the discomfort of having to lie still on a hard operating table. Supplemental ataractics and analgesics can greatly increase the ambulatory patient’s satisfaction with regional anesthetic techniques.
... Anesth Analg 1987;66:679-83. 2. Philip BK. ... Roberta Galford, MD Instructor in Anesthesia R... more ... Anesth Analg 1987;66:679-83. 2. Philip BK. ... Roberta Galford, MD Instructor in Anesthesia Roger L. Royster, MD Associate Professor in Anesthesia Wake Forest Medical Center The Bowman Gray School of Medicine Winston-Salem, NC 27203 ...
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