Purpose:We tested the hypothesis that digital insertion of the ProSeal TM laryngeal mask airway (ProSeal TM LMA) is more successful when using a suction catheter (SC) as a guide. Methods: Two hundred and forty-three patients (ASA physical status I-III; aged 18-84 yr) were randomly allocated for the digital or SC-guided technique. The digital technique was performed according to the manufacturer's instructions. The SC technique involved priming the drain tube with the SC so that it protruded by 15 cm, blindly inserting the SC into the pharynx to a depth of 15 cm, followed by the digital technique. Failed insertion was defined by any of the following criteria: 1) failed passage into the pharynx; 2) malposition; and 3) ineffective ventilation. Any airway trauma, and visible or occult blood was noted. Sore throat, dysphonia and dysphagia were assessed 16 to 24 hr postoperatively. Results: Fewer insertion attempts were required with the SC-guided technique (P = 0.02), but first attempt and overall success were similar. The time taken to provide an effective airway was shorter for the SC-guided technique (36 ± 24 sec vs 44 ± 28 sec, P = 0.02). A lateral approach was required less frequently with the SC-guided technique (0% vs 4%, P = 0.0004). There were no adverse events. Mouth trauma was more frequent with the digital technique (P = 0.04), but overall trauma was similar. There were no differences in the frequency of visible or occult blood. There were no differences in postoperative airway morbidity. Conclusions: The SC-guided technique is more frequently successful than the digital technique and is associated with less mouth trauma during insertion of the ProSeal TM LMA. We suggest that the SC technique may be a useful alternative when the digital technique fails. Objectif
A system based on mobile phones with built-in cameras has been developed for the postoperative management of patients sent home after day surgery. The system allows patients to send pictures and pulse oximetry measurements to a hospital server in a few seconds. Health professionals can then see what patients are describing and make a more objective estimate of the patients' status. Over a five-month period, a total of 49 patients used the system. A total of 222 images were sent, the average image delivery time being 29 s (SD 11). In nine cases (18%), the availability of images modified the treatment, and a visit to an emergency unit was avoided in eight of them who had blood-stained dressings and normal haematomas. The patients who had their treatment modified sent more images (an average of 5.4/patient) than those for whom images confirmed the correct treatment (3.1/patient). Each telephone call lasted for a mean duration of 18 min (range 8-34). The patient satisfaction data showed that all the aspects studied were evaluated in a very positive way, with 96% of the patients completely satisfied with the attention received by the mobile health application.
The correct implementation of Ambulatory Surgery must be accompanied by an accurate monitoring of the patient post-discharge state. We fit different statistical models to predict the first hours postoperative status of a discharged patient. We will also be able to predict, for any discharged patient, the probability of needing a closer follow-up, or of having a normal progress at home.BackgroundThe status of a discharged patient is predicted during the first 48 hours after discharge by using variables routinely used in Ambulatory Surgery. The models fitted will provide the physician with an insight into the post-discharge progress. These models will provide valuable information to assist in educating the patient and their carers about what to expect after discharge as well as to improve their overall level of satisfaction.MethodsA total of 922 patients from the Ambulatory Surgery Unit of the Dr. Peset University Hospital (Valencia, Spain) were selected for this study. Their post-discharge status was evaluated through a phone questionnaire. We pretend to predict four variables which were self-reported via phone interviews with the discharged patient: sleep, pain, oral tolerance of fluid/food and bleeding status. A fifth variable called phone score will be built as the sum of these four ordinal variables. The number of phone interviews varies between patients, depending on the evolution. The proportional odds model was used. The predictors were age, sex, ASA status, surgical time, discharge time, type of anaesthesia, surgical specialty and ambulatory surgical incapacity (ASI). This last variable reflects, before the operation, the state of incapacity and severity of symptoms in the discharged patient.ResultsAge, ambulatory surgical incapacity and the surgical specialty are significant to explain the level of pain at the first call. For the first two phone calls, ambulatory surgical incapacity is significant as a predictor for all responses except for sleep at the first call.ConclusionsThe variable ambulatory surgical incapacity proved to be a good predictor of the patient's status at home. These predictions could be used to assist in educating patients and their carers about what to expect after discharge, as well as to improve their overall level of satisfaction.
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Background Mentally disabled patients commonly offer little or no cooperation in dental treatments, and general anesthesia may become necessary in such cases. The present study was to identify the most relevant factors in dental treatment under general anesthesia in disabled patients based on a Major Ambulatory Surgery (MAS) model. The study analyzes anesthetic variables and type of dental procedures carried out for disabled patients compared with controls. Material and Methods A case-control study was carried out with 574 patients (263 cases and 311 controls) subjected to dental treatment under general anesthesia in the Day Surgery Unit of Dr. Peset University Hospital (Valencia, Spain). Epidemiological, anthropometric and preoperative data (ASA score, Mallampati classification) were collected. Results Males and obesity were more prevalent among disabled patients than controls. Significant associations were found between longer surgery time, underwent thoot extraction, tartrectomy, fillings and disabled patients treated under general anesthesia. The preoperative risk scores were likewise higher in disabled patients (ASA III-IV). The duration of surgery increased with the ASA score but didn´t influence postoperative stay. Patient condition in the first 24 hours of late postoperative recovery was good in both groups. Conclusions Dental treatment based on the MAS in mentally disabled patients is effective and safe, even in individuals with a certain prior risk (ASA III). Key words: Disabled patients, ambulatory surgery, dental treatment, special needs, Major Ambulatory Surgery by general anesthesia.
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