Biomedical subjects

G E Rudkin

Publications and source records attributed to G E Rudkin.

At least 19 recordsLinked to original sources

PubMed2004

Impediments to the use of ankle block in Australia.

Anaesthetic trainees and consultants who enrolled in a regional anaesthetic workshop completed a questionnaire regarding their own ankle block practice. The questionnaire focused on frequency of use, barriers to use, technique and perceived success rate. One hundred and twelve respondents participated, with 73% performing less than 10 ankle blocks per year. Forty-eight per cent believed that they did not have an appropriate operating list or a suitable patient, whilst 27% believed time constraints were the major barrier. Of those performing less than 10 ankle blocks peryear, 22% cited lack of anatomical knowledge or technique as their major barrier and 71% perceived their success rate as medium to low. Eighty per cent performed their ankle block with the patient fully awake or sedated. Sixty-five per cent did not know the length of action of their ankle block. This survey supports recent suggestions that the practice of ankle block is under-utilized. Teaching workshops and clinical training for peripheral nerve blocks should receive high priority for the future.

Ankle↗

PubMed1999

Can medical students contribute to quality assurance programmes in day surgery?

CONTEXT AND OBJECTIVES: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to the QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Fifty-nine final year medical students followed allocated patients with common surgical conditions through all phases of the day surgery process. Students kept records about each case in a log book and also presented their cases at weekly Problem Based Learning tutorials. An audit of student log books and review of tutorial records was conducted for the 1996 and 1997 academic years, in order to evaluate student contribution to QA. RESULTS: Students followed 621 cases, representing a sampling of 14. 1% day surgery cases. Categories of problems highlighted by students included inappropriate patient and procedure selection, inadequate pain management, discharge, communication and resource issues. Students made a number of recommendations including the development of multilingual videotapes and patient information sheets for non-English speaking patients, avoidance of bilateral surgical procedures and improved links with local medical officers. They also developed new guidelines and protocols. CONCLUSIONS: Our study confirms that students are able to identify QA issues and propose solutions. We recommend that students have a formally recognized place in day surgery QA programmes, to close the QA loop and to adequately prepare them for medical practice in the 21st century.

Ambulatory Surgical Procedures↗

PubMed1999

The laryngeal mask airway in experimental pig anaesthesia.

The pig is used as a large animal model in many research projects. Standard practice for airway maintenance under general anaesthesia is using endotracheal (ET) intubation after intravenous induction to a near surgical plane. This is a technically demanding skill, requiring the assistance of an experienced technician. A technique is required which simplifies pig anaesthesia. This study examined the feasibility and potential advantages of using the laryngeal mask airway (LMA) in 10 pigs during laparotomy under spontaneous breathing anaesthesia. The results show that the LMA can be inserted rapidly, with minimal time for airway control by researchers relatively inexperienced in anaesthesia and is associated with few complications. By removing the need for intravenous induction, an entire step in the anaesthetic process is removed. The LMA designed for humans fits well in the pig hypopharynx; all pigs could be manually ventilated with no detectable gas leak. Although the pigs in this study were spontaneously breathing it is proposed that the LMA should be further investigated in studies of artificially ventilated pigs.

Adrenergic alpha-Agonists↗

PubMed1998

Day surgery: teaching the next generation.

The advent of day surgery presents new opportunities and challenges for medical education. The opportunity to see patients pre-operatively and follow them through surgery to discharge on the same day is unique to day surgery. However, with rare exceptions, the development of educational programmes in ambulatory surgical settings is still largely at a rudimentary level. An undergraduate pilot programme was conducted at the University of Adelaide to explore the practicalities, acceptance and educational value of a day surgery programme for final-year medical students. The programme had three components: day surgery patient follow through, practical procedure tutorials and problem-based learning tutorials. It incorporated assessment of practical skills and theoretical knowledge with the use of log books and clinical and practical simulations as important elements in the assessment process. The pilot programme was accepted by all stakeholders and students' perceived significant gains in knowledge and skills. This programme may provide a teaching model that could be adapted for use in other medical schools.

Ambulatory Surgical Procedures↗

PubMed1997

Does a teaching programme in day surgery impact on efficiency and quality of care?

BACKGROUND: Recent medical advances have led to an explosion in the use of day surgery, making traditional teaching untenable and necessitating a transfer of undergraduate teaching programmes into the day surgery setting. concerns have been raised about the impact of teaching on efficiency and quality of care in this environment. METHODS: Thirty-one final year medical students participated in a new teaching programme conducted in a dedicated day surgery unit in a major Australian public teaching hospital, Five commonly performed procedures were audited and analysed by a mixed model analysis of variance to determine whether students impacted significantly on operation time. Student performance was monitored using a logbook. Surgeons and nursing staff completed questionnaires about their perceptions of the impact of the programme on the overall efficiency of the day surgery unit. RESULTS: Students had no significant effect on operation time for the procedures examined. Staff did not perceive that students had significantly detracted from the overall efficiency of the unit. An unexpected finding was the substantial contribution that students made to quality of patient care.

Ambulatory Surgical Procedures↗

PubMed1996

Review of efficiencies and patient satisfaction in Australian and New Zealand day surgery units: a pilot study.

A pilot study was performed in eight Australasian day surgery facilities with a purpose of identifying common trends and differences. A prospective study was designed in which information was collected on 826 patients over a two-week period. Patients were well matched for age, anaesthetic type and mean surgical time. Three facility types were identified and results were statistically corrected for any differences that ASA status, age and surgical time may have made. Patient preoperative waiting time, recovery room times, delayed discharge time and unanticipated admission rates showed favourable outcome trends for free-standing facilities compared with hospital-integrated facilities where day patients had a shared recovery with inpatients. Similar trends were seen with patient opinions of waiting times and recovery periods. In summary, this pilot study has demonstrated the impact of different facility types on efficiencies and patient satisfaction both of which have important cost implications and relevance to those involved in continuous quality improvement processes in day surgery.

Adult↗

PubMed1996

Laparoscopic cholecystectomy as a day surgery procedure.

Outcome is presented for 40 consecutive laparoscopic cholecystectomies performed in a public teaching hospital day surgery unit. The unanticipated hospital admission rate on the day of surgery was 17.5% (seven patients) and the majority of these (12.5%; five patients) were due to surgery-related considerations. Two other admissions were due to nausea and vomiting. One patient was admitted to hospital on the second postoperative day with nausea and vomiting. Procedure duration for the day cases averaged 98 minutes (SD25; range 60-167). Recovery room times before discharge averaged 272 minutes (SD 58; range 125-365). Each day surgery patient averaged 3.3 postoperative home visits from community nurses. Most patients (94%) mobilized at home by the second postoperative day and 85% resumed normal activities of daily living by two weeks. At follow-up, 25 patients (76%) stated they were happy to spend the first night at home, but seven (21%) would have preferred to remain in hospital for the first postoperative night. Laparoscopic cholecystectomy can be performed successfully as a day-case procedure, but long operating and recovery room times and potentially high admission rates suggest that these factors should be considered in cost equations for day-case management of this procedure.

Activities of Daily Living↗

PubMed1995

Peri-operative outcome for day-case laparoscopic and open inguinal hernia repair.

This study documents the results obtained in 30 day patients undergoing open hernia repair under local infiltration block with patient-controlled sedation (group A) and 29 day patients undergoing laparoscopic hernia repair under general anaesthesia (group B). The mean operating time was less in group A (44.8 min) compared with group B (66.6 min) (p < 0.0001). Similarly, stage 1 recovery room times were longer in group B (98.1 min) than group A (45.1 min) (p < 0.0001). Time to discharge for group A (139.1 min) was significantly shorter than group B (224.2 min) (p < 0.002), with more peri-operative complications occurring in group B and greater analgesic requirements. An open inguinal hernia repair under local infiltration block is the optimal approach for unilateral non-recurrent herniae as a day surgical procedure. These results have important cost and efficiency implications.

Adolescent↗

PubMed1995

Inguinal field block for adult inguinal hernia repair using a short-bevel needle. Description and clinical experience in Solomon Islands and an Australian teaching hospital.

One of the limitations of an inguinal field block is that it does not reliably produce complete anaesthesia. The purpose of this study was to describe a modified short-bevel needle technique, facilitating correct needle placement, for inguinal hernia repair. Anaesthetists from two different institutions performed the described infiltration blocks. Prospective data were collected from these groups, each having 30 patients. We evaluated the safety and reliability of the described block. Of the 60 patients, two were "failed" blocks, requiring conversion to general anaesthesia. There were no other major intraoperative or recovery room complications. Results of the modified inguinal field block showed a 97% ability to achieve a "fair" block or better. Intraoperative and postoperative data showed high surgeon and patient satisfaction for the block. The described block using a short-bevel needle is recommended as a suitable method for adult patients undergoing inguinal hernia repair.

Adolescent↗

PubMed1994

Outcome from day-case knee arthroscopy in a major teaching hospital.

Outcome is presented for 465 knee arthroscopies performed under general anesthesia in a public teaching hospital day surgery unit. The unanticipated hospital admission rate on the day of surgery was 1.07%. There were 11 (2.37%) major complications in the combined perioperative and postdischarge periods (up to 4 weeks postdischarge). Surgery-related complications (incidence 1.08%) were more frequent than complications of anesthesia (0.65%). Four patients (0.86%) had delayed complications after discharge that required hospital readmission. Stepwise polychotomous logistic regression showed that these complications were not significantly related to patient age, sex, American Society of Anesthesiologists (ASA) status or type of surgery. Mean recovery times required for patients to sit out of bed and to be ready for discharge were 61 +/- 37 and 142 +/- 52 min, respectively. Both postoperative pain and postoperative nausea and vomiting, present in 76% and 11.5% of patients, respectively, significantly delayed patient recovery, with longer delays associated with nausea and vomiting. Times required for patients to be ready for discharge were not correlated to either patient age (r = 0.07; p = 0.15) or duration of procedure (r = 0.07; p = 0.13). At early follow-up, 4.7% and 2.5% of patients had presented to hospital accident and emergency departments and local family doctors, respectively, usually for minor problems. Ninety-nine percent of all patients were happy with the ambulatory surgery service. With careful patient assessment and selection, day-case knee arthroscopy in a teaching hospital can provide satisfactory outcome.

Adolescent↗

PubMed1994

Intra-operative patient-controlled sedation and patient attitude to control. A crossover comparison of patient preference for patient-controlled propofol and propofol by continuous infusion.

Intra-operative patient controlled sedation with propofol (bolus dose 18 mg over 5.4 s; lockout period 1 min) has been compared to continuous propofol infusion (3.6 mg.kg-1.h-1) in a randomised crossover study of 38 ASA 1 or 2 day surgery patients undergoing two-stage bilateral extraction of third molar teeth under local anaesthesia (76 procedures). Mean (SD) propofol used (mg.kg-1) was less with patient-controlled sedation (2.39 (1.28) than with the infusion (2.58 (0.84)) but the difference was not statistically significant. There were only minor differences between the methods in postoperative recovery of cognitive function and no differences for patient cooperation and surgeon's satisfaction with sedation. Patient-controlled sedation was preferred by 19 patients, continuous infusion by 10, with nine indifferent. Preferences, expressed as mild, moderate or strong, were significantly stronger for patient-controlled sedation (p < 0.05). Sedation was no deeper than eyelid closure with response to command in all 76 procedures. This level was reached in all 38 infusion cases but in only 26 cases with patient-controlled sedation, where 12 patients remained less sedated (p < 0.01). Patient-controlled sedation with propofol provided safe sedation and was strongly preferred over the infusion by a large proportion of patients.

Adult↗

PubMed1993

Assessment and selection of patients for day surgery in a public hospital.

OBJECTIVE: To describe methods used for adult patient assessment and selection for day case surgery at a major Australian teaching hospital. DESIGN: A prospective analysis of assessment data and information from the unit's computerised database. PATIENTS AND SETTING: Five thousand day patients consecutively admitted to the Day Surgical Unit, Royal Adelaide Hospital. MAIN OUTCOME MEASURES: The proportion of patients assessed only by trained nursing assessment staff was determined and compared with that for patients requiring additional anaesthetic assessment before surgery. The percentage of patients requiring preoperative investigations was established. Unanticipated hospital admission rates were calculated for surgical, anaesthesia-related and social reasons. RESULTS: After initial screening by a trained assessment nurse, 46% of patients required additional review by an anaesthetist before the day of surgery. The remaining 54% were assessed by an anaesthetist on the day of surgery. Preoperative investigations were ordered by anaesthetists in 8.5% of all day patients. The assessment methods outlined resulted in a 1.28% rate of unanticipated hospital admissions. This admission rate was mostly caused by complications of surgery (0.94%). Only 0.12% of patients were admitted for anaesthesia-related reasons and 0.14% were admitted for social reasons. CONCLUSIONS: This cost-effective system allows suitable patients and procedures to be identified, with a satisfactory unanticipated hospital admission rate. Satisfactory assessment also results in short preoperative waiting periods, fewer cancellations, reduced postoperative problems and more satisfied patients. The development of an efficient assessment system is aided by the use of a dedicated day surgery area with experienced nursing staff, the use of a comprehensive patient questionnaire and coordination by experienced day surgery anaesthetists.

Adolescent↗

PubMed1993

Outcomes after same-day oral surgery: a review of 1,180 cases at a major teaching hospital.

Outcome was measured from data collected on 1,180 consecutive ambulatory oral surgery patients, two thirds of whom were treated under general anesthesia and the remainder who were treated under local anesthesia supplemented with intravenous sedation. Three patients (0.25%) required admission on the day of surgery; all had undergone general anesthesia. The surgery-related complication rate in the general anesthesia group (1:132) was similar to that for local anesthesia and sedation (1:128). However, anesthesia-related complications had an incidence of 1:99 in the general anesthesia group, but were absent in those receiving local anesthesia and sedation. Eight patients (0.7%) required hospital readmission after being discharged, mostly because of complications of surgery. The incidence of postoperative nausea and vomiting in the recovery room after local anesthesia and sedation (6%) was less than after general anesthesia (14%) (P < .01) Average recovery times to sitting out of bed and being ready for discharge were less after local anesthesia and sedation (38 +/- 15 minutes and 120 +/- 39 minutes, respectively) than after general anesthesia (61 +/- 50 minutes and 141 +/- 62 minutes). At the time of follow-up during the first few postoperative days, 7% of patients had gone to a family doctor and 4% to hospital accident and emergency departments, usually for minor problems. Paracetamol 500 mg plus codeine phosphate 30 mg was effective in 97% of cases when provided as a take-home analgesic. Ninety-nine percent of patients were satisfied with their management.

Adult↗

PubMed1993

Outcome after day-care surgery in a major teaching hospital.

Outcome has been measured for 6000 consecutive procedures in a major public teaching hospital day surgery unit. The unanticipated hospital admission rate was 1.34% and surgery-related admissions (0.95%) exceeded those related to anaesthesia (0.13%). Perioperative complications related to surgery (1:105) were more frequent than those related to anaesthesia (1:176) and pre-existing medical problems (1:500). Anaesthesia-related complications were more frequent with general anaesthesia (1:114) than with local anaesthesia plus sedation (1:780) or regional anaesthesia (1:180). Recovery times after general anaesthesia were longer than after other anaesthetic techniques but did not correlate with patient age (r = 0.04; P = 0.02) and only weakly correlated with procedure duration (r = 0.21; P < 0.01). At early follow-up, 4.0% of patients had presented to a local medical practitioner and 3.1% to a hospital accident and emergency service, usually for minor problems. Take home analgesia was adequate for 95% of patients and 98.9% were happy with the day surgery service. Day surgery in a teaching hospital can provide satisfactory outcome, with low complication rates, high patient acceptance and low community support requirements after patient discharge.

Adolescent↗

PubMed1992

Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with patient-controlled midazolam.

Propofol and midazolam were compared for intra-operative patient-controlled sedation in 40 ASA 1 day patients undergoing surgical extraction of third molar teeth under local anaesthesia. All patients initially received 0.7 micrograms.kg-1 fentanyl. Patients in the propofol group self-administered 20 mg (2 ml over 6 s) bolus doses of propofol; successful demands averaged 8.0 (SD 4.4) and unsuccessful demands (during the 1 min lockout period) 2.8 (SD 4.1). The midazolam group self-administered 0.5 mg (2 ml over 6 s) bolus doses and averaged 14.0 (SD 6.3) and 17.6 (SD 19.8) successful and unsuccessful demands respectively. Postoperative memory, measured with delayed free recall, and postoperative mental performance, measured with the frequency accrual speed test index, were both significantly less impaired in the propofol group. Although there was no significant difference in patient satisfaction, measured postoperatively, propofol was judged the more suitable agent for patient-controlled sedation, because of its more rapid response to fluctuating intra-operative requirements, superior recovery characteristics and beneficial effect on mood.

Adult↗

PubMed1992

Double-blind comparison of patient recovery after induction with propofol or thiopentone for day-case relaxant general anaesthesia.

Postoperative recovery after induction with either propofol or thiopentone has been compared in forty ASA I unpremedicated day surgery patients undergoing surgical extraction of third molar teeth under relaxant general anaesthesia. Mean recovery times in the propofol group, required for patients to sit out of bed (44.8 minutes; SD 18.6) and meet discharge criteria (113.1 minutes; SD 34.5) were significantly (P less than 0.05) shorter than those in the thiopentone group (59.7 minutes; SD 21.4 and 133.5 minutes; SD 34.5). Fewer patients in the propofol group were treated in the recovery room for nausea and vomiting and the incidence of mild nausea not requiring treatment was less in the propofol group, but these differences were not statistically significant. Postoperative mental performance, measured by the FAST index, a new test of mental speed, was reduced on average by 1.7% of preoperative levels, during the recovery period tested, with no significant difference between the groups.

Adult↗

PubMed1991

Intra-operative patient-controlled sedation.

Patient-controlled sedation using propofol is described in 23 ASA 1 patients undergoing surgical extraction of third molars. Cardiovascular and respiratory stability was maintained and sedation was no deeper than full eyelid closure with prompt response to verbal command. Amnesia for the extractions was common (70%), but there was no significant amnesia for recovery room events. Intra-operative patient cooperation was good, postoperative patient satisfaction high and all patients stated they liked the self-administration and would use the same technique again. Propofol dose was correlated with both procedure length (r = 0.587; p = 0.003) and surgical difficulty (rs = 0.550; p = 0.010).

Adult↗

PubMed1991

Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with anaesthetist-administered midazolam and fentanyl.

The quality of sedation and postoperative recovery have been assessed for intra-operative sedation provided by either patient-controlled sedation with propofol or a standard method using divided doses of midazolam and fentanyl, in 40 ASA 1 day surgery patients undergoing extraction of third molar teeth under local analgesia. Patient-controlled sedation with propofol produced sedation no deeper than full eyelid closure with prompt response to verbal command, but deeper levels were seen in three patients in the midazolam and fentanyl group. Patient satisfaction was higher in the patient-controlled sedation propofol group for both subjective intra-operative feelings (p less than 0.01) and willingness to have the procedure again in the same manner (p less than 0.05). Amnesia was more limited to intra-operative events (rather than extending into the postoperative period) in the patient-controlled sedation propofol group (p less than 0.05). Drug dose was correlated with duration of procedure and surgical difficulty in the patient-controlled sedation propofol group but not in the midazolam and fentanyl group. Postoperative testing included a new computerised test, the FAST index, which indicated a dose-dependent reduction in cognitive function in the midazolam and fentanyl group, which persisted until the time of discharge. Changes in cognitive function in the patient-controlled sedation propofol group in the same postoperative interval were significantly less and not related to propofol dose.

Adult↗