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The effect of anaesthetic agents on induction, recovery and patient preferences in adult day case surgery: a 7-day follow-up randomized controlled trial

Published online by Cambridge University Press:  01 November 2008

J. K. Moore ,
R. A. Elliott ,
K. Payne ,
E. W. Moore ,
A. S. St Leger ,
N. J. N. Harper ,
B. J. Pollard  and
J. Kerr
J. K. Moore*
Affiliation:
Wirral Hospital Trust, Cheshire, Manchester, UK
R. A. Elliott
Affiliation:
University of Manchester, School of Pharmacy and Pharmaceutical Sciences, Manchester, UK
K. Payne
Affiliation:
University of Manchester, School of Pharmacy and Pharmaceutical Sciences, Manchester, UK
E. W. Moore
Affiliation:
Wirral Hospital Trust, Cheshire, Manchester, UK
A. S. St Leger
Affiliation:
University of Manchester, School of Epidemiology and Health Sciences, Biostatistics Group, Manchester, UK
N. J. N. Harper
Affiliation:
Central Manchester & Manchester Children’s University Hospitals NHS Trust, Department of Anaesthesia, Manchester, UK
B. J. Pollard
Affiliation:
Central Manchester & Manchester Children’s University Hospitals NHS Trust, Department of Anaesthesia, Manchester, UK
J. Kerr
Affiliation:
Wirral Hospital Trust, Cheshire, Manchester, UK
*
Wirral Hospital Trust, Cheshire CH49 5PE, UK. E-mail: julia.moore@whnt.nhs.uk; Tel: +44 151 604 7156; Fax: +44 151 604 7126
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Summary

Background and objective

To compare induction, pre- and post-discharge recovery characteristics and patient preferences between four anaesthetic regimens in adult day-surgery.

Methods

Randomized controlled trial. In all, 1158 adults assigned to: propofol induction and maintenance, propofol induction with isoflurane/N2O, or sevoflurane/N2O maintenance, or sevoflurane/N2O alone. We prospectively recorded induction and pre-discharge recovery characteristics, collected 7-day post-discharge recovery characteristics using patient diaries and patient preferences by telephone follow-up.

Results

Recruitment rate was 73% – of the 425 refusals, 226 were not willing to risk a volatile induction. During induction, excitatory movements and breath holding were more common with sevoflurane only (P < 0.01). Injection pain and hiccup were more common with propofol induction (P < 0.01). In the recovery room and the postoperative ward, both nausea and vomiting were more common with sevoflurane only (P < 0.01). This difference disappeared within 48 h. There was no difference between groups in the mental state on awakening, recovery time, time to discharge or overnight admissions; then was also no difference in pain between the four groups for each of the seven postoperative days (P < 0.01), nor any differences in concentration or forgetfulness. Patients took 6.5 days (95% CI: 6.0–7.0, n = 693) to resume normal activities. Patients who received sevoflurane only were more likely to recall an unpleasant induction and least likely to want the same induction method again (P < 0.01).

Conclusion

Differences in outcome between the four regimens are transient; sevoflurane is not an ideal sole agent for adult day case anaesthesia and, in this setting, patients base their preferences for future anaesthetics on the method of induction.

Keywords

AMBULATORY (DAY STAY)ANAESTHESIA, generalINHALATION ANAESTHESIAINTRAVENOUS ANAESTHESIATCI/TIVAPOSTOPERATIVE CARE/RECOVERYPOSTOPERATIVE NAUSEA AND VOMITINGPATIENT PREFERENCES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 11 , November 2008 , pp. 876 - 883
Copyright
Copyright © European Society of Anaesthesiology 2008

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