Antiemetics in laparoscopic surgery.
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Ambulatory Surgical Procedures↗
Biomedical subjects
T W Ogg
Publications and source records attributed to T W Ogg.
Omeprazole in outpatient surgery.
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Ambulatory Surgical Procedures↗
An armored laryngeal mask airway.
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Equipment Design↗
Day case laparoscopy. A comparison of two anaesthetic techniques using the laryngeal mask during spontaneous breathing.
Forty women undergoing day case laparoscopy were randomly allocated to receive either an inhalational or total intravenous anaesthetic. All patients breathed spontaneously through a Brain laryngeal mask. There were no clinically significant cardiovascular or respiratory differences between the two techniques. No episodes of clinical aspiration occurred and there were no peri-operative arrhythmias. We conclude that spontaneous respiration with a laryngeal mask is a safe and effective method of anaesthesia for laparoscopy provided certain guidelines are followed.
Adolescent↗
Propofol: bolus or continuous infusion. A day case technique for the vaginal termination of pregnancy.
Forty patients undergoing vaginal termination of pregnancy were randomly allocated to receive a propofol anaesthetic using either a repeat bolus or infusion technique. The Ohmeda 9000 Infusion Pump was used in the study. Patients in the infusion group recorded significantly longer induction times, greater maintenance doses and prolonged immediate recovery characteristics. Both techniques offered cardiovascular stability but no advantages were demonstrated for the infusion technique over a conventional repeat bolus method.
Abortion, Induced↗
Oral fluids prior to day surgery. The effect of shortening the pre-operative fluid fast on postoperative morbidity.
One hundred day surgical patients undergoing first trimester termination of pregnancy were randomly allocated to receive either 150 ml of clear fluid 1.5-2 hours before anaesthesia or to remain fasted from midnight the night before. Patients were anaesthetised using a total intravenous technique which consisted of propofol and alfentanil. No adverse intra-operative events were noted in either group. There were no significant differences in immediate recovery time, or pain, nausea and headache scores at 30 or 120 minutes following recovery. The fasted group had less pain (p less than 0.05) at 60 minutes after recovery than the fluid group, although the mean pain scores in both groups were low. Eighty two per cent of the patients returned questionnaires about pain, nausea and headache scores on arriving home, and at 12 and 24 hours after surgery. There were no significant differences between the two groups. In conclusion, pain, nausea and headache scores are low following total intravenous anaesthesia with propofol and alfentanil for termination of pregnancy and these were unaffected by the administration of 150 ml of clear fluid given approximately 1.5 hours pre-operatively.
Adolescent↗
Recovery after day-case anaesthesia. A 24-hour comparison of recovery after thiopentone or propofol anaesthesia.
Sixty patients who presented for day-case dilatation and curettage were allocated randomly to receive either thiopentone or propofol for induction and maintenance of anaesthesia. One anaesthetist administered all the anaesthetics whilst all assessments were made by one other. The results indicate that early recovery of memory function, critical flicker fusion frequency and subjective feelings of tiredness, drowsiness and alertness were superior in the propofol group. There was a significant difference in subjective feelings of tiredness and drowsiness recorded by the two study groups at 24 hours. Memory function assessed by Wechsler logical memory function passages at 24 hours was impaired in the propofol group in comparison to a group of 'reference' subjects.
Adolescent↗
Prophylactic analgesia for daycase termination of pregnancy. A double-blind study with controlled release dihydrocodeine.
The incidence and severity of pain and nausea experienced by 40 primigravid day patients who presented for vaginal termination of pregnancy were examined. Controlled-release dihydrocodeine had no effect upon the incidence or severity of these minor sequelae. The requirements for escape analgesia and antiemetic therapy were less than anticipated and possible explanations are discussed. The low incidence of significant nausea and vomiting recorded in this study confirms that vaginal termination of pregnancy may be safely performed as day cases.
Abortion, Induced↗
Temazepam and recovery in day surgery.
A double-blind trial of temazepam premedication for day cases was undertaken. Effective anxiolysis was recorded in the groups that received temazepam 10 or 20 mg and there was no prolongation of delayed recovery times as measured by memory test cards. All patients were discharged from the day unit 3 hours after the administration of general anaesthesia.
Abortion, Induced↗
Hypnosis and daycase anaesthesia. A study to reduce pre-operative anxiety and intra-operative anaesthetic requirements.
Fifty-two female patients who underwent gynaecological operations as day cases received either a short pre-operative hypnotic induction or a brief discussion of equal duration. Hypnotized patients who underwent vaginal termination of pregnancy required significantly less methohexitone for induction of anaesthesia. They were also significantly more relaxed as judged by their visual analogue scores for anxiety. Less than half of the patients were satisfied with their knowledge about the operative procedure even after discussions with the surgeon and anaesthetist. A significant correlation was found between anxiety and perceived knowledge of procedures. The results suggest that pre-operative hypnosis can provide a quick and effective way to reduce pre-operative patient anxiety and anaesthetic requirements for gynaecological daycase surgery.
Adult↗
Which intravenous induction agent for day surgery? A comparison of propofol, thiopentone, methohexitone and etomidate.
Eighty day patients for the vaginal termination of pregnancy were randomly allocated to receive thiopentone, propofol, methohexitone or etomidate as intravenous induction agents. The same anaesthetist administered the anaesthesia and all the observers were blind to the agents used. The results show that thiopentone and propofol produced the least sequelae at induction and in recovery. Furthermore, both agents produced a high quality of induction and recovery. All patients were discharged home 2 hours postoperatively and there was no obvious delay in recovery. This study has altered clinical practice in our Day Surgery Unit.
Abortion, Induced↗
The workload of a purpose built day surgical unit.
The workload and utilisation of a purpose built day surgical unit at Addenbrooke's Hospital, Cambridge has been reviewed. Senior medical personnel are involved in the unit and 5071 operations were performed in the first two years. Despite a reduction of inpatient beds the surgical waiting lists have also decreased, we believe as a direct result of the day surgery programme. The results presented support the recommendations made in the recent report on day surgery by the Royal College of Surgeons of England.
Ambulatory Surgical Procedures↗
Alfentanil and memory function. A comparison with fentanyl for day case termination of pregnancy.
Two groups of 20 patients undergoing day case vaginal termination of pregnancy received either methohexitone and alfentanil 7.5 micrograms/kg or methohexitone and fentanyl 1.5 micrograms/kg. Their recovery times and memory function at 1 and 2 hours after surgery were compared. No difference in the recovery of the 2 groups was noted but at 2 hours after operation the alfentanil group showed impairment of memory for new facts compared with pre-operative memory function testing. This was not evident in the fentanyl group. Apart from this finding alfentanil was adjudged to be a suitable agent for day case anaesthesia.
Abortion, Induced↗
Day case dental anaesthesia. Evaluation of three methods of anaesthesia.
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Adolescent↗
Anaesthesia for myringotomy. The effect of nitrous oxide and intermittent positive pressure ventilation in children with secretory otitis media.
The effect of two methods of anaesthesia on the findings at myringotomy in children with secretory otitis media was studied. One group of patients spontaneously breathed a mixture of nitrous oxide, oxygen and halothane whereas a second group had assisted ventilation, tracheal intubation and breathed a mixture of halothane and oxygen. Nitrous oxide diffused significantly into middle ears which had gas under reduced pressure (with or without fluid present) when compared with normal ears (p less than 0.05). Assisted ventilation prior to tracheal intubation did not introduce gas into the middle ear. It is concluded that impedance audiometry is a reliable method of assessing the middle ear prior to surgery.
Acoustic Impedance Tests↗
Day-case anaesthesia for termination of pregnancy. Evaluation of a total intravenous anaesthetic technique.
An investigation was undertaken to assess the use of a total intravenous anaesthetic technique of fentanyl and methohexitone for outpatient vaginal termination of pregnancy. When compared with a technique of fentanyl, methohexitone, nitrous oxide and trichloroethylene the total intravenous method caused swifter recovery, minimal side-effects and no cardiovascular depression. However, both anaesthetic techniques produced significant postoperative reduction of memory for new facts when compared with a control group receiving no general anaesthesia. There is a need to continue the search for anaesthetic methods appropriate for day cases.
Abortion, Induced↗
Day-case dental anaesthesia. Evaluation of pre-operative sublingual buprenorphine.
Sixty patients undergoing day-case dental surgery were either given sublingual buprenorphine 0.2 mg or 0.4 mg or a buffered placebo 1 hour prior to general anaesthesia. Pre-operative anxiety was not allayed and there was no significant analgesia afforded by buprenorphine in the immediate postoperative period. The synthetic opiate depressed psychomotor function and both 0.2 mg and 0.4 mg buprenorphine yielded a significantly higher incidence of postoperative nausea and vomiting.
Adolescent↗
Teaching anaesthetics to medical students. The design and evaluation of a course in a new clinical school.
The paper describes the rationale and implementation of anaesthetics teaching in the new 2 1/4-year clinical medical course at Cambridge University. A programme designed to monitor and evaluate the teaching established, and the results are reported. Significant improvements in students' knowledge of anaesthetics and their experience of practical procedures were noted, as compared to a control group. It is concluded tha the course achieves the dual aims of providing an introduction to the scope and vocabulary of modern anaesthesia and giving students the opportunity to practise a variety of specified practical skills.
Anesthesiology↗