Biomedical subjects

F Chung

Publications and source records attributed to F Chung.

At least 19 recordsLinked to original sources

PubMed2004

Fast-tracking (bypassing the PACU) does not reduce nursing workload after ambulatory surgery.

BACKGROUND: Postoperative day-case patients are usually allowed to recover from anaesthesia in a postanaesthesia care unit (PACU) before transfer back to the day surgical unit (DSU). Bypassing the PACU can decrease recovery time after day surgery. Cost savings may result from a reduced nursing workload associated with the decreased recovery time. This study was designed to evaluate the effects of bypassing the PACU on patient recovery time and nursing workload and costs. METHODS: Two hundred and seven consenting outpatients undergoing day surgery procedures were enrolled. Anaesthesia was induced and maintained with a standardized technique and the electroencephalographic bispectral index was monitored and maintained at 40-60 during anaesthetic maintenance. At the end of surgery, patients were randomly assigned to either a routine or fast-tracking (FT) group. Patients in the FT group were transferred from the operating room to the DSU (i.e. bypassing the PACU) if they achieved the FT criteria. All other patients were transferred to the PACU and then to the DSU. Nursing workload was evaluated using a patient care hour chart based on the type and frequency of nursing interventions in the PACU and DSU. A cost associated with the nursing workload was calculated. RESULTS: The overall time from end of anaesthesia to discharge home was significantly decreased in the fast-tracking group. However, overall patient care hours and costs were similar in the two recovery groups. CONCLUSION: Bypassing the PACU after these short outpatient procedures significantly decreases recovery time without compromising patient satisfaction. However, the overall nursing workload and the associated cost were not significantly affected.

Adolescent↗

PubMed2003

Indirect airway challenges.

Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle. Direct airway challenges have been used widely and are well standardised. They are highly sensitive, but not specific to asthma and can be used to exclude current asthma in a clinic population. Indirect bronchial stimuli, in particular exercise, hyperventilation, hypertonic aerosols, as well as adenosine, may reflect more directly the ongoing airway inflammation and are therefore more specific to identify active asthma. They are increasingly used to evaluate the prevalence of bronchial hyperresponsiveness and to assess specific problems in patients with known asthma, e.g. exercise-induced bronchoconstriction, evaluation before scuba diving. Direct bronchial responsiveness is only slowly and to a modest extent, influenced by repeated administration of inhaled steroids. Indirect challenges may reflect more closely acute changes in airway inflammation and a change in responsiveness to an indirect stimulus may be a clinically relevant marker to assess the clinical course of asthma. Moreover, some of the indirect challenges, e.g. hypertonic saline and mannitol, can be combined with the assessment of inflammatory cells by induction of sputum.

Asthma↗

PubMed2002

Assessing the burden of respiratory disease in the UK.

This review explores the health and social burden of some of the main respiratory diseases (asthma, chronic obstructive pulmonary disease, cryptogenic fibrosing alveolitis, cystic fibrosis, lung cancer, mesothelioma, obstructive sleep apnoea and tuberculosis) in order to increase awareness of these diseases and highlight areas where improvements in care are required. The overall impact of respiratory diseases in the U.K. in terms of prevalence, mortality, morbidity and economic costs, with particular reference to secondary care has been considered and comparisons made with the rest of Europe where data are available. Respiratory diseases are responsible for a significant proportion of serious morbidity and premature death among the population of the U.K. and they will continue to present a growing challenge; special support is needed to tackle this burden.

Adolescent↗

PubMed2002

Postoperative sore throat after ambulatory surgery.

BACKGROUND: Sore throat is a common complication of anaesthesia that affects patient satisfaction after surgery. METHODS: We studied 5264 ambulatory surgical patients prospectively to determine the patient, anaesthetic, and surgical factors associated with sore throat. RESULTS: In 5264 patients, 12.1% reported a sore throat. Patients with tracheal tube had the greatest incidence, 45.4%, followed by patients with laryngeal mask airway, 17.5%, while patients with a facemask had a lower incidence of sore throat, 3.3%. Female patients had more sore throats than male patients (13.4 vs 9.1%). Airway management had the strongest influence on the incidence of sore throat. Sore throat in ambulatory surgical patients was associated with female sex, younger patients, use of succinylcholine, and gynaecological surgery. CONCLUSION: Airway management, female sex, younger patients, surgery for gynaecological procedure, and succinylcholine predicts postoperative sore throat. Increased awareness of the predictive factors can help to avoid this combination and improve patient satisfaction.

Adolescent↗

PubMed2002

Evaluation of postural stability after low-dose droperidol in outpatients undergoing gynaecological dilatation and curettage procedure.

BACKGROUND: Low-dose droperidol is suggested to be cost-effective in preventing nausea and vomiting after ambulatory surgery. This clinical study evaluated patient postural stability using a computerized force platform after an i.v. dose of droperidol 0.625 mg in outpatients undergoing gynaecological dilatation and curettage procedures. METHODS: After institutional approval and informed consent, 120 females were randomly assigned to receive either 0.9% saline (placebo) or droperidol 0.625 mg i.v. before surgery. Anaesthesia was induced with propofol 2-2.5 mg kg-1 and fentanyl 50-100 micrograms, and was maintained with intermittent boluses of propofol 25-50 mg and fentanyl 25-50 micrograms i.v. After operation, the Post-Anaesthesia Discharge Score (PADS), patient self-assessment scores for pain, nausea, drowsiness and dizziness, and extrapyramidal symptoms were recorded. Body sway velocity was measured while the patient was standing on a firm surface with eyes open then closed vs standing on a foam surface with eyes open then closed, at the time of arrival in the operation holding area (baseline), on achieving a PADS of 9 after surgery and on discharge home. RESULTS: At the time of achieving a PADS of 9, body sway was significantly greater in the droperidol group than in the placebo group (overall 61% vs 33% above baseline). There were no differences between groups with respect to scores for pain, nausea, drowsiness and dizziness. Three patients (5%) in the droperidol group reported nervousness and restlessness postoperatively (not significant). CONCLUSION: Low-dose droperidol 0.625 mg i.v. for anti-emetic prophylaxis can cause balance disturbances in females after gynaecological dilatation and curettage procedures.

Adolescent↗

PubMed2001

Spinal anesthesia improves the early recovery profile of patients undergoing ambulatory knee arthroscopy.

PURPOSE: We compared the recovery profiles, postoperative complications, perioperative OR utilization times, and times to discharge of patients undergoing ambulatory knee arthroscopy under spinal anesthesia (SA) or general anesthesia (GA). METHODS: In this randomized, prospective study, 84 ASA I-II patients were randomized to receive either SA with 50 mg of 1% lidocaine, or a standardized GA. Postoperative pain, nausea and vomiting, sedation, OR utilization, postanesthesia care unit (PACU), and ambulatory surgical unit (ASU) recovery were compared. RESULTS: Patients in the GA group had more pain in the PACU than the SA group (61% vs 15%, P <0.01), and a higher incidence of PACU analgesic use (59% vs 7.5%, P <0.01). Patients in the SA group were able to drink and eat sooner than the GA group (83 +/- 23 vs 95 +/- 22 min, P <0.05 and 88 +/- 27 vs 105 +/- 29 min, P <0.01, respectively). The times to sit, walk, and void were similar. The length of PACU and ASU stay between the GA and SA groups were similar (67 +/- 17 vs 60 +/- 19 min, P >0.05 and 122 +/- 27 vs 127.9 +/- 31 min, P >0.05, respectively). The incidence of backache was higher in the SA group (35 vs 13.6%, P <0.05) than the GA group. However, the incidence of sore throat was higher in the GA compared to the SA group (25% vs 2.5%, P <0.01). CONCLUSIONS: SA with 50 mg of 1% lidocaine provides an improved recovery profile for ambulatory knee arthroscopy. Discharge times were similar, and with the exception of backache and sore throat, the incidence of complications was similar.

Adult↗

PubMed2001

When should diclofenac be given in ambulatory surgery: preoperatively or postoperatively?

STUDY OBJECTIVE: To determine the optimum time of administration of diclofenac in patients undergoing ambulatory knee arthroscopy: either preoperatively or postoperatively. DESIGN: Randomized, double-blind study. SETTING: Ambulatory surgical unit in a tertiary referral hospital. PATIENTS: 127 ASA physical status I and II patients undergoing ambulatory knee arthroscopy. INTERVENTIONS: Patients were randomized into three groups. The Preop group received 50 mg of potassium diclofenac orally 1 hour preoperatively and a placebo 30 minutes postoperatively. The Pre+postop group received 25 mg of potassium diclofenac 1 hour preoperatively and 25 mg diclofenac 30 minutes postoperatively. The Postop group received a placebo 1 hour before surgery and 50 mg of potassium diclofenac 30 minutes postoperatively. MEASUREMENTS AND MAIN RESULTS: The Postop group received a placebo 1 hour preoperatively and 50 mg of potassium diclofenac 30 min postoperatively. Postoperatively, patients used intravenous patient-controlled analgesia (PCA) with fentanyl. Total fentanyl consumption was recorded. During the recovery period, pain was assessed using a visual analog scale (VAS) at 30-minute intervals. Pain was assessed in both legs at rest, on flexion, and extension of the knee. There were no significant differences in pain scores either at rest or on movement of the operative knee among the Preop, Pre+postop, and Postop groups. The consumption of fentanyl via PCA showed no significant differences among the groups. CONCLUSIONS: There is no difference in pain relief whether diclofenac is given preoperatively or postoperatively in patients undergoing unilateral ambulatory knee arthroscopy. Preoperative and postoperative treatment with diclofenac potassium is equally effective.

Adult↗

PubMed2001

Multimodal analgesia for postoperative pain control.

Pain is one of the main postoperative adverse outcomes. Single analgesics, either opioid or nonsteroidal antiinflammatory drugs (NSAIDs), are not able to provide effective pain relief without side effects such as nausea, vomiting, sedation, or bleeding. A majority of double or single-blind studies investigating the use of NSAIDs and opioid analgesics with or without local anesthetic infiltration showed that patients experience lower pain scores, need fewer analgesics, and have a prolonged time to requiring analgesics after surgery. This review focuses on multimodal analgesia, which is currently recommended for effective postoperative pain control.

Analgesia, Epidural↗

PubMed2001

Compliance with postoperative instructions: a telephone survey of 750 day surgery patients.

Patients undergoing day surgical procedures are given postoperative instructions not to drink alcohol, drive vehicles or make important decisions for 24 h. They are also advised to have a responsible adult stay with them at home overnight. Seven hundred and fifty patients were telephoned at 24 h postoperatively to determine their compliance with these instructions. Four per cent of patients drove vehicles, 1.8% consumed alcohol, while one patient made an important decision. A higher proportion of patients (5%) drove after general anaesthesia than regional anaesthesia or intravenous sedation (2.4%). The percentage of patients consuming alcohol was similar in both groups (1.8% vs. 1.9%). Four per cent of patients had no one staying with them overnight despite being accompanied out of the hospital. Patient compliance with instructions to not drink alcohol, drive or make important decisions may be improved by physician reinforcement of instructions and patient education.

Aged↗

PubMed2001

Anti-inflammatory cytokines in asthma and allergy: interleukin-10, interleukin-12, interferon-gamma.

Interleukin-10 (IL-10) is a cytokine derived from CD4+ T-helper type 2 (T(H2)) cells identified as a suppressor of cytokines from T-helper type 1(T(H1)) cells. Interleukin-12 (IL-12) is produced by B cells, macrophages and dendritic cells, and primarily regulates T(H1) cell differentiation, while suppressing the expansion of T(H2) cell clones. Interferon-gamma (IFN-gamma) is a product of T(H1) cells and exerts inhibitory effects on T(H2) cell differentiation. These cytokines have been implicated in the pathogenesis of asthma and allergies. In this context, IL-12 and IFN-gamma production in asthma have been found to be decreased, and this may reduce their capacity to inhibit IgE synthesis and allergic inflammation. IL-10 is a potent inhibitor of monocyte/macrophage function, suppressing the production of many pro-inflammatory cytokines. A relative underproduction of IL-10 from alveolar macrophages of atopic asthmatics has been reported. Therapeutic modulation of T(H1)/T(H2) imbalance in asthma and allergy by mycobacterial vaccine, specific immunotherapy and cytoline-guanosine dinucleotide motif may lead to increases in IL-12 and IFN-gamma production. Stimulation of IL-10 production by antigen-specific T-cells during immunotherapy may lead to anergy through inhibition of CD28-costimulatory molecule signalling by IL-10s anti-inflammatory effect on basophils, mast cells and eosinophils.

Asthma↗

PubMed2001

Post-operative recovery: day surgery patients' preferences.

Due to the growing importance of quality assurance and cost containment in healthcare, eliciting patients' preferences for post-operative outcomes may be a more economical and reliable method of assessing quality. Three hundred and fifty-five day surgery patients completed a pre-operative written questionnaire to identify patients' preferences for avoiding 10 particular post-operative symptoms: pain, nausea, vomiting, disorientation, shivering, sore throat, drowsiness, gagging on the tracheal tube, thirst and a normal outcome. The two scoring methods used to evaluate preferences were priority ranking and relative value scores. The effects of age, gender, previous health status, type of surgery and previous experience of anaesthesia on patients' preferences were also examined. Avoiding post-operative pain, gagging on the tracheal tube and nausea and vomiting are major priorities for day-case patients. Anaesthetists should take patients' preferences into consideration when developing guidelines and planning anaesthetic care.

Adolescent↗

PubMed2001

Minimizing perioperative adverse events in the elderly.

Elderly patients still have the highest postoperative mortality and morbidity rate in the adult surgical population. Preoperative clinical assessment to detect patients at high risk of postoperative events, and specific intraoperative and postoperative anaesthesia management are important to minimize postoperative adverse events in the elderly.

Age Factors↗

PubMed2001

Awake craniotomy for removal of intracranial tumor: considerations for early discharge.

UNLABELLED: We retrospectively reviewed the anesthetic management, complications, and discharge time of 241 patients undergoing awake craniotomy for removal of intracranial tumor to determine the feasibility of early discharge. The results were analyzed by using univariate analysis of variance and multiple logistic regression. The median length of stay for inpatients was 4 days. Fifteen patients (6%) were discharged 6 h after surgery and 76 patients (31%) were discharged on the next day. Anesthesia was provided by using local infiltration supplemented with neurolept anesthesia consisting of midazolam, fentanyl, and propofol. There was no significant difference in the total amount of sedation required. Overall, anesthetic complications were minimal. One patient (0.4%) required conversion to general anesthesia and one patient developed a venous air embolus. Fifteen patients (6%) had self-limiting intraoperative seizures that were short-lived. Of the 16 patients scheduled for ambulatory surgery, there was one readmission and one unanticipated admission. It may be feasible to discharge patients on the same or the next day after awake craniotomy for removal of intracranial tumor. However, caution is advised and patient selection must be stringent with regards to the preoperative functional status of the patient, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission. IMPLICATIONS: It may be feasible to perform awake craniotomies for removal of intracranial tumor as an ambulatory procedure; however, caution is advised. Patient selection must be stringent with respect to the patient's preoperative functional status, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission.

Adolescent↗

PubMed2001

Pharyngolaryngeal morbidity with the laryngeal mask airway in spontaneously breathing patients: does size matter?

BACKGROUND: Currently, the manufacturer of the laryngeal mask airway (LMA; Laryngeal Mask Company, Ltd., Northfield End, Henley on Thames, Oxon, United Kingdom) recommends using as large a mask size as possible. The aim of this study was to compare the incidence of pharyngolaryngeal morbidity after the use of a large (size 5 in males and size 4 in females) or small (size 4 in males and size 3 in females) LMA in spontaneously breathing patients. METHODS: A total of 258 male and female patients were randomly assigned to insertion of a large or small LMA while breathing spontaneously during general anesthesia. After insertion of the LMA, a "just-seal" cuff pressure was obtained, and intracuff pressure was measured at 10-min intervals until just before removal of the LMA. The 2- and 24-h incidence of postoperative sore throat, pain, hoarseness, dysphagia, and nausea and vomiting was assessed. Complications after LMA removal, including body movement, coughing, retching, regurgitation, vomiting, biting on the LMA, bronchospasm, laryngospasm, or the presence of blood on the LMA, were recorded. RESULTS: The use of a large LMA was associated with a higher incidence of sore throat in both sexes (20% vs. 7% in men, 21% vs. 5% in women; P < 0.05) and a higher incidence of hoarseness in male patients at 2 h postoperatively (21% vs. 9%, P < 0.05). There was a higher incidence of sore throat in male patients at 24 h postoperatively with the use of a large LMA (26% vs. 12%, P < 0.05). There was no difference in the incidence of complications of LMA removal orother pharyngolaryngeal morbidity, such as difficulty swallowing, drinking, and eating, or nausea and vomiting, between male or female groups at any time period with the use of a large LMA. CONCLUSIONS: Selection of a small laryngeal mask airway (size 4) in spontaneously breathing male patients may be more appropriate to limit the occurrence of sore throat on the first postoperative day. All patients had a fourfold increased risk of developing sore throat when a large LMA was used.

Adult↗

PubMed2001

Effect of return hospital visits on economics of ambulatory surgery.

This review examines the effect of unanticipated admission, return hospital visits and readmission on the economics of ambulatory surgery. The overall rate of unanticipated admission was approximately 1% and the overall rate of readmission to hospital was approximately 1%. Ambulatory surgery allows total cost savings of 20-50% when compared with inpatient surgery. If 98% of ambulatory surgery patients experience uneventful recovery, the decrease in cost savings caused by unanticipated admission and return hospital visit is very small. Modifications of anesthesia and surgical technique can help to further reduce the incidence of unanticipated admission or readmission to hospital.

Journal Article↗

PubMed2001

Anaesthetic strategies towards developments in day care surgery.

Ambulatory surgery is growing worldwide. The challenge of providing anaesthesia for longer and more complex surgery in sicker and elderly patients is a reality. To maintain the safety and good outcomes of ambulatory anaesthesia, high-risk patients will need to be evaluated carefully. Anaesthetic techniques that use short-acting drugs and minimize postoperative morbidity and mortality should become the focus. Policies on management of postoperative pain, nausea, vomiting, voiding and discharge from hospital will maintain good outcome measures.

Ambulatory Surgical Procedures↗

PubMed2000

A comparison of midazolam, alfentanil and propofol for sedation in outpatient intraocular surgery.

PURPOSE: To determine the ideal sedative regimen for intraocular surgery under peribulbar or retrobulbar block. The addition of alfentanil and or propofol to midazolam was evaluated with regard to hemodynamic variables, respiratory rate, pain, anxiety, sedation, postoperative recovery and patient satisfaction. METHODS: Eighty two patients aged between 50 and 85 were recruited into this prospective, randomised, double blind study. Patients, in four groups, received 0.015 mg x kg(-1) midazolam, 5 microg x kg(-1) alfentanil and 0.15 mg x kg(-1) propofol; 0.015 mg x kg(-1) midazolam and 0.15 mg x kg(-1) propofol; 0.015 mg x kg(-1) midazolam and 5 microg x kg(-1) alfentanil or 0.015 mg x kg(-1) midazolam alone. Blood pressure, heart rate, respiratory rate, pain, anxiety and sedation scores were measured. Times to discharge from the Post Anesthesia Care Unit (PACU) and Day Surgery Unit (DSU) were documented. A 24 hr telephone interview was carried out to determine patient satisfaction. RESULT: Systolic blood pressure of patients in groups that had received alfentanil was 6% lower than that of patients who had not (P<0.05) at the time of insertion of intraocular block. Patients in the alfentanil groups also had lower respiratory rates during the first 15 min after drug administration, but all patients were given supplemental oxygen therefore oxygen saturation was unaffected. Pain scores of patients who had been given alfentanil were lower during the first postoperative hour than those who had not. CONCLUSION: The addition of alfentanil to midazolam is advantageous in providing sedation for insertion of intraocular block.

Aged↗

PubMed2000

Intraoperative vs postoperative morphine improves analgesia without increasing PONV on emergence from ambulatory surgery.

PURPOSE: To compare the timing of administration of morphine in patients undergoing painful ambulatory surgical procedures to determine whether there was a difference in postoperative nausea or vomiting (PONV), quality of analgesia, and recovery profile. METHODS: In a double-blinded, placebo-controlled, prospective study, 70 ASA I-II patients were randomized to receive 0.1 mg x kg(-1) morphine intraoperatively (lop) (n=35), or postoperatively (Pop) (n=35). The severity of nausea and pain were measured using visual analog scales (VAS). RESULTS: There was no difference between the groups in postoperative nausea scores or the incidence of PONV. Upon awakening, patients who received Pop morphine had higher pain VAS scores with movement (7.6 +/- 2 vs 5.4 +/- 3, P < 0.003) and at rest (6.9 +/- 3 vs 5.1 +/- 3, P < 0.013) than the lop morphine group. The total number of PCA attempts and analgesic requirements were similar. Patients who received Pop morphine were able to drink sooner than the lop group (90 +/- 34 vs 111 +/- 38 min, P < 0.05). All other recovery milestones were similar. Times to discharge from hospital were similar. CONCLUSIONS: Administration of 0.1 mg x kg(-1) morphine iv intraoperatively improves postoperative analgesia upon emergence from painful ambulatory surgical procedures without increasing the incidence of PONV There was no increase in PONV when morphine was administered intraoperatively rather than postoperatively.

Adolescent↗