blog.anesthesiology.jp » ambulatory surgery

デイサージャリー診療部でのremifentanil使用とPONV

bodyhacker — Sat, 09 Mar 2013 03:29:23 +0000

以前研修をしていて今は京都医療センターにいる原先生の論文がKorean Journal of anesthesiologyにアクセプトされました。

The impact of remifentanil on incidence and severity of postoperative nausea and vomiting in a university hospital-based ambulatory surgery center: a retrospective observation study

Abstract

Background: Ambulatory surgery, including short-stay surgery, has become a common choice of clinical practice. For the success of ambulatory surgery, perioperative care with safe and effective anesthesia and postoperative analgesia, which can reduce the occurrence of postoperative nausea and vomiting (PONV), is essential. The effect of remifentanil on the occurrence and severity of PONV has not been thoroughly examined, particularly, in an ambulatory surgery setting. We investigated whether remifentanil influenced the occurrence and severity of PONV in a university hospital-based ambulatory unit.

Methods: We retrospectively analyzed a total of 1765 cases of patients who had undergone general anesthesia at our ambulatory surgery unit. Parameters such as occurrence and severity of nausea, vomiting or retching, use of antiemetic drugs, amount of postoperative analgesic and patient satisfaction were extracted from the records and analyzed between the groups that was administered remifentanil (RF group) and that was not administered remifentanil (non RF group).

Results: Within 565 patients of the RF group, 39 patients (6.6%) experienced nausea, 7 patients (1.2%) experienced vomiting or retching, 10 patients (1.8%) were given antiemetic, and the maximum VAS value for nausea was 12.1mm. In 1200 patients of the non RF group, 102 patients (8.5%) experienced nausea, 19 patients (1.6%) experienced vomiting or retching, 34 patients (2.8%) were given antiemetic and the maximum VAS value was 13.2 mm. There were no statistically significant differences between the two groups.

Conclusions: Our results indicate that remifentanil did not increase the occurrence of PONV in patients in the ambulatory surgery unit.

Keywords: Ambulatory surgery, Post operative nausea and vomiting, Remifentanil

要するに鎮痛がしっかりしていれば術中にremifentanilを用いてもPONVの比率は上がらないし、術後の鎮痛剤の要求度も上がらないという研究です。 KJAは雑誌の掲載が遅いのでまだ読むことはできません。

ambulatory anesthesiaの総説

bodyhacker — Fri, 10 Jun 2011 13:55:36 +0000

雑誌Anaesthesiaにambulatory surgeryのとってもよい総説が出ています。
ambulatory surgeryに関わりが現時点ではない人も一読する価値があると思います。
要点は次の11項目によくまとまっていると思います。

Day surgery is a continually evolving speciality performed in a range of ways across different units.

In recent years, the complexity of procedures has increased with a wider range of patients now considered suitable for day surgery.

Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery.

Fitness for a procedure should relate to the patient’s health as determined at pre-operative preparation and not limited by arbitrary limits such as ASA status, age or body mass index.

Patients presenting with acute conditions requiring urgent surgery can be efficiently and effectively treated as day cases via a semi-elective pathway.

Central neuraxial blockade and a range of regional anaesthetic techniques, including brachial plexus and paravertebral blocks, can be used effectively for day surgery.

Each anaesthetist should develop techniques that permit the patient to undergo the surgical procedure with minimum stress and maximum comfort, and optimise his/her chance of early discharge.

Every day surgery unit must have a Clinical Lead with specific interest in day surgery and whose remit includes the development of local policies, guidelines and clinical governance.

Good quality advice leaflets, assessment forms and protocols are in use in many centres and are available to other units.

Effective audit is an essential component of good care in all aspects of day and short stay surgery.

Enhanced recovery is based on established day surgery principles and is aimed at improving the quality of recovery after inpatient surgery such that the patient is well enough to go home earlier and healthier.