Anaesthetic complications in surgical out-patients

Abstract

THE NUMBER OF OUT-PATIENTS receiving surgical treatment necessitating general anaesthesia has increased dramatically in the past ~ive years. Various psychological, economic, medical and social factors are behind this increase.Since all our patients are entitled to hospitalization for surgery, there is no economic motivation to stimulate such patients to undergo the discomfort of immediate post-operative travel and convalescence at home. In the group of patients presented here, the psychological advantages were certainly less important than in the case of children. The safety of out-patient surgery depends mainly on patient selection, the type of operation and the anaesthetic technique. We therefore thought it might be of some interest to evaluate anaesthetic sequelae and how these patients fared in the first five days following operation. METHODFive hundred female patients (ASA class I) were the subjects of this study. All underwent tubal electrocoagulation through a laparoscope as out-patients.After an interval varying from one week to four months post-operatively, each patient received a questionnaire designed to determine the incidence and severity of post-anaesthetic complications (headache, nausea, vomiting, muscular pains, sore throat, cough, expectorations, dizziness, orthostatic dizziness and inability to concentrate ) and the time needed for full recovery as indicated by the time before returning to work and that required for complete return to pre-operative status.The severity of any complication was defined by its duration and graded as:Mild -duration less than 48 hours Moderate -duration two-five days Severe -persisted longer than five daysThe criteria for recovery are of course subjective evaluations made by the patients. Patients were also asked to comment generally about the operation and to state whether or not they would be prepared to repeat the experience as an outpatient.ANAESTHETIC MANAGEMENT Several anaesthetic agents were used for induction and maintenance, although an attempt was made to adhere to certain principles of management.No premedieation was given unless the patient was very nervous. Consequently

Different clinical course of BPPV according to the medical conditions

“…Patients commonly experience dizziness after trauma or general anesthesia. Dizziness after general anesthesia is typically accompanied by nausea and lightheadedness and resolves within 2–5 days with conservative treatment 21 . In the case of post-traumatic dizziness, various manifestations ranging from central dizziness due to cerebral hemorrhage to malingering were noted 22 .…”

Anaesthesia for Day-care Surgery: A Review

“…Methods of testing recovery include reaction time, memory tests, flicker fusion, EEGs and cerebral function monitors, so recovery can be gauged by subjective accounts, clinical assessment, and psychological or physiological tests. Subjective accounts suggest that disturbances persist longer than is clinically apparent or detectable using psychomotor testing (Brindle & Soliman 1975).…”

“…Smith & Young (1976) concluded that dental surgery under general anaesthesia as a day Case is an unpleasant experience which only 63% of their patients would be prepared to repeat. Brindle & Soliman (1975) commented that 'since all our patients are entitled to hospitalization for surgery, there is no economic motivation to stimulate patients to undergo the discomfort of immediate postoperative travel and convalescence at home', although 81% of their patients said they would be prepared to repeat the experience. These figures are not really reassuring, with at least a fifth of the patients finding the experience so terrible that they would never like to repeat it.…”