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PubMed1986

Intravenous fluids in minor surgery. Their effect on recovery from anaesthesia.

The value of infusing a total of 2 litres of intravenous fluids intra- and postoperatively was assessed in 212 fasting patients undergoing minor surgery procedures. The treated patients (108) recovered from the effects of surgery and anaesthesia more quickly than patients without fluids (104). The results of improved quality of the postoperative recovery, a shorter hospital stay and earlier return to work, especially in those patients who had some difficulty in recovering from anaesthesia on previous occasions, encourages the more frequent use of intravenous fluids in minor surgery.

Adolescent↗
PubMed2003

[Minor surgery in primary care: is continuing education within the team a valid strategy for improving quality?].

OBJECTIVE: To evaluate the impact of continuing education within the team (FCI, in Spanish) on the quality of minor surgery. DESIGN: Study of level of quality. SETTING. Primary care. PARTICIPANTS: First evaluation: all the lesions referred for biopsy during 1998 (62 samples). Second evaluation: those referred in 1999-2000 (150). MAIN MEASUREMENTS: Four explicit criteria regulating procedure and result were designed: C1, sufficient information; C2, correct referral; C3, correct extirpation of lesion; C4, clinical-pathological concordance. Request forms and anatomical-pathological reports were assessed. Evaluation was before and after corrective measures (FCI and organisational changes designed to support FCI). The Kappa index of inter-observer concordance, the Compliance Index and Fisher's Z index were analysed. RESULTS: 62 lesions were included in the first evaluation, with high reliability for C1 and C4, good for C2 and moderate for C3. 150 lesions were included in the second evaluation. The compliance indices showed statistically significant increases from the first to the second evaluation for C1 (38.09% and 50.66%, relative improvement of 19%) and C4 (68.85% and 85.2%, relative improvement of 53%). C2 showed an improvement, but without statistical significance (87.30% and 92.66%). The compliance index for C3 dropped (94.73% and 87.50%). 5.33% of cases in the second evaluation (8 biopsies) were malignant or pre-malignant lesions, compared with 20.96% in the first (P<.05). 100% of these latter showed free resection limits. 77.99% of lesions studied through a biopsy in the second evaluation were nevus, seborrhoeic keratosis or dermatofibroma. CONCLUSIONS: FCI is a valid strategy for improving the quality of programmes of minor surgery in primary care. There was significant improvement in the identification of malignant and pre-malignant pathology, in correct referral and in the clinical-pathological concordance of the lesions.

Education, Medical, Continuing↗
PubMed1994

A comparison of the effect on gastric emptying of either enflurane or propofol given during maintenance of anaesthesia for minor surgery.

Twenty patients scheduled for minor gynaecological surgery were studied. Anaesthesia was induced with propofol and maintained either with enflurane/oxygen/nitrous oxide or propofol/oxygen/nitrous oxide. The rate of gastric emptying was measured indirectly by the paracetamol absorption model. The results showed that there was no significant difference in gastric emptying rate between the two groups. Recovery in the propofol group was more rapid in that paracetamol ingestion occurred earlier in the recovery period compared with the enflurane group.

Acetaminophen↗
PubMed1994

A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery.

Twenty patients, scheduled for minor gynaecological surgery, were studied. Anaesthesia was induced with propofol and maintained with oxygen, nitrous oxide and enflurane. Patients were randomly allocated to two groups: group 1 were given alfentanil 0.2 mg; group 2 were given morphine 5 mg. The rate of gastric emptying was measured indirectly by the paracetamol absorption technique. The results showed that morphine caused greater delay in gastric emptying compared with alfentanil (p < 0.05). The observed effect on gastric emptying rate may potentially affect the risk of peri-operative regurgitation and aspiration. This study provides further evidence that in short day-case procedures, when oral medication may be required postoperatively, alfentanil may be preferable to morphine as an intra-operative opioid.

Acetaminophen↗
PubMed2005

Effects of anaesthesia using endotracheal intubation or the laryngeal mask airway, or spinal anaesthesia, on oral mucosal host defences during minor surgery.

BACKGROUND: Oral mucosal host defences are altered after anaesthesia and surgery. The effects of endotracheal intubation (ET) and the use of the laryngeal mask airway (LMA) on oral mucosal host defences after minor surgery were compared. METHODS: Immunological (immunoglobulin A (IgA), IgG and IgM) and non-immunological (myeloperoxidase, total peroxidase, thiocyanate) oral host defence factors, and amylase and protein concentrations, were measured from saliva pre-operatively and on the first post-operative day in 60 ASA I-II patients undergoing minor surgery. The patients underwent general anaesthesia using oral ET or LMA. Spinal anaesthesia (S) was used as control. Serum IgG, IgM and IgA concentrations were determined. RESULTS: Protein-related salivary secretion of amylase and salivary concentration of IgM showed the only statistically significant overall differences between the groups. By contrast, changes were observed within the ET group in the salivary flow rate, protein concentration, amylase activity and immunological host defence factors. Some changes were also observed in the LMA group, but none in the S group. Most non-immunological test values did not change within any of the groups. CONCLUSIONS: ET and LMA induced similar oral mucosal host defence responses. There were, however, observations in this study that indicated a stronger response during ET than when LMA was used.

Adult↗
PubMed1981

Total intravenous anaesthesia with low dose ketamine and Althesin. Assessment of a technique for minor surgery in difficult situations.

In 38 patients subjected to minor surgery, totally intravenous anaesthesia with low dose ketamine and Althesin produced adequate operating conditions in 92% of patients with minimal cardiorespiratory disturbance. Problems arose from muscular hypertonus, spontaneous movement and occasionally salivation. Initial recovery was quicker and the incidence of side-effects lower, than those reported when ketamine was used as the sole agent. The technique could be useful in difficult situations as an alternative to inhalation anaesthesia or other intravenous techniques.

Adult↗
PubMed1998

Acute-phase changes in children recovering from minor surgery.

The metabolic response to surgical stress is a nonspecific increase in hepatic synthesis of some specialized acute-phase proteins and a decrease in plasma concentrations of visceral proteins following surgical trauma. This study was undertaken determine which specific proteins were the better clinical indices in monitoring the metabolic response to surgical stress in children recovering from minor surgery. Forty-four patients undergoing elective inguinal surgical procedures under general anesthesia were studied. Blood samples were collected preoperatively (-1) and at 1(+1) and 5(+5) days postoperatively to determine albumin (AL), Prealbumin (PA), C-reactive protein (CRP), and a1-acid glycoprotein (AGP) values, and to calculate the prognostic inflammatory and nutritional index (PINI). Mean AL values were the same on all days. Mean PA +1 was significantly lower than PA -1 and PA +5 (P < 0.001). Median CRP +1 and mean AGP +1 values were significantly higher than median CRP -1 and mean AGP -1 (P < 0.0001), respectively. Although there was a decrease after postoperative day 1, median CRP +5 and mean AGP +5 values were still significantly higher than preoperative values (P < 0.01 and P < 0.0001). Moreover, the median PINI +1 was also greater than PINI -1 and PINI +5 (P < 0.0001), but the median PINI+5 was significantly higher than PINI -1 (P < 0.01). Median percent changes of PINI values were significantly higher than those of the other parameters from both preoperatively to postoperative day 1 and preoperatively to postoperative day 5. Although several specific proteins (AL, PA, CRP, and AGP) have been evaluated as indicators of the acute metabolic response, we suggest that the PINI is more valuable for reflecting the response to surgical stress in patients recovering from minor surgery.

Acute-Phase Proteins↗
PubMed2001

[Evaluation of continuous education: from the satisfaction to the impact. With regard to a formative programme in minor surgery in a health area].

OBJECTIVE: To compare the evaluation of reaction of an activity of continuous education (CE) in minor surgery (MS), with the impact in the realization of MS in a health area. DESIGN: Observational cross-sectional study. Setting. 27 centers in a health area that offer MS between their services. MEASUREMENTS: The valuation was studied in a scale from 1 to 10, of 9 theoretical-practical activities of CE in MS and the consideration of its utility. The number of activities of MS (NMS) carried out in all the units, was picked up during one year, and a model of lineal regression was built. The independent variable was the NMS, and the explanatory ones the assistance pressure (AP), the postgraduate formation (PF), the staff of the unit, the equipment (E), and the carried out CE. RESULTS: The valuation of the CE had a median of 8 (with interquartile range 1), 85.1% of the people who realized CE in MS said that this would be of utility. However in the explanatory regression model the PF was the only significant variable (beta = 6.7; 95% CI, 0.12-12.22). Neither the CE, nor the AP, nor the E, explained the variability among the NMS. CONCLUSION: The CE in MS with conventional methodology has a very positive reaction evaluation, but its impact in the later realization of MS is not significant.

Education, Medical, Continuing↗
PubMed2005

Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly.

PURPOSE: Postoperative cognitive dysfunction (POCD) is evident in 26% of elderly patients seven days after major non-cardiac surgery. Despite the growing popularity of day surgery, the influence of anesthetic techniques on next day POCD has not been investigated. Therefore, we evaluated the incidence of POCD and changes in serum markers of neuronal damage (S-100ss protein and Neuron-Specific Enolase), 24 hr after single-agent propofol or sevoflurane anesthesia in elderly patients undergoing minor surgery. METHODS: Patients (n = 30, mean age 73, range 65-86 yr) coming for cystoscopy or hysteroscopy, were randomized, in an observer-blind design, to receive either single-agent propofol or sevoflurane anesthesia. Changes in neuropsychological tests (the Stroop test and the modified Word-Recall Test), 24 hr postoperatively were compared with age-matched control subjects (n = 15) using Z-score analysis. Changes in S-100beta protein and Neuron-Specific Enolase levels were also documented. RESULTS: POCD was present in 7/15 [47% (95% confidence interval (CI) 21 to 72%)] patients who received propofol and 7/15 [47% (95% CI 21 to 72%)] patients who received sevoflurane, compared with 1/15 [7% (95% CI 6 to 19%)] control patients, P = 0.03. S-100beta protein and Neuron-Specific Enolase levels were not significantly different in anesthetized patients postoperatively compared with preoperative values. CONCLUSION: The incidence of POCD in elderly patients on the first day after minor surgery is higher than previously reported for seven days after major surgery, and is increased after both propofol and sevoflurane anesthesia, compared with age-matched controls. S-100beta protein and Neuron-Specific Enolase levels were unaffected by anesthetic technique.

Aged↗
PubMed1982

Phenylalanine levels in PKU following minor surgery.

Serum phenylalanine values were measured in 10 PKU patients who had minor operations. No individual value exceeded 17 mg/dl and the interpolated mean did not exceed 10 mg/dl on any postoperative day. These data confirm the consensus that minor surgery does not cause major and long-lived perturbations of serum phenylalanine levels in PKU and requires no special dietary measures.

Child↗
PubMed1996

Minor surgery and resources at small clinics in rural Kenya.

The output of minor surgery at 36 government and 49 non-government clinics in a rural Kenyan district was recorded over a period of one year and then compared with the surgery-related resources (equipment, supplies and trained staff) at the same clinics. The mean monthly numbers of operations varied between 2.8 and 7.0 at different resource levels, but we found no association between the surgical operation output of each clinic and its total surgery-related resources. When examining the resource components separately, we found a weak positive association between output and the presence of equipment but no association between output and supplies or trained staff. Other factors than resources, such as the quality of basic training or the preferences of individual health workers, may explain the large surgical output variations between clinics. They should be explored through further studies.

Efficiency, Organizational↗
PubMed1980

Mini-pump: method of diabetic control during minor surgery under general anaesthesia.

A simple method for maintaining diabetic control during and after minor surgery requiring a general anaesthetic was studied in 20 insulin-treated diabetics. Long-acting insulin was omitted on the night before the operation, and a mini-pump delivering insulin at a rate of 0.5 units/h was strapped to the arm early on the morning of the operation regardless of the time of operation. Insulin was infused at this rate throughout the day, the usual evening dose of insulin given and followed by supper, and the pump then stopped. In all 20 patients studied blood glucose concentrations fell steadily throughout the day. Hypoglycaemia did not occur. The mini-pump is simple to use and with the same standard insulin dose for all patients maintains satisfactory blood glucose concentrations throughout the day of operation.

Adolescent↗
PubMed1991

Symptomatic hyponatraemia due to inappropriate antidiuretic hormone secretion following minor surgery.

A rare case of the syndrome of inappropriate antidiuretic hormone secretion occurring after minor surgery is presented. A ten-year-old, previously healthy boy underwent general anaesthesia for detorsion and right orchiopexy. Throughout the operations, which lasted for one hour, he received 120 ml Ringer's lactate solution. The immediate postoperative period was uneventful. Twenty-two hours postoperatively he was found unconscious with generalized tonic-clonic seizures. Simultaneously obtained serum sodium concentration (121 mEq.L-1) serum osmolarity (265 mEq.L-1), urine sodium concentration (87 mEq.L-1) and urine osmolarity (525 mEq.L-1) suggested inappropriate antidiuretic hormone secretion which was confirmed by an elevated serum arginine-vasopressin (AVP) level of 14.5 pcg.ml-1 (normal 1-5 pcg.ml-1) measured by radioimmune assay. He was treated with a single iv dose of 30 mg furosemide and fluid restriction, which produced a gradual increase of his serum sodium concentration to normal within two days. He was well during the remainder of his hospitalization.

Child↗
PubMed1989

Minor surgery clinics: audit.

The validity of the use of time, skills and resources in minor surgery clinics can only be properly assessed by reviewing one's work and results, and ultimately by auditing oneself against accepted standards of practice, outcomes and costs.

Ambulatory Surgical Procedures↗
PubMed1982

Minor surgery -- one general practitioner's experiences.

A study was made of 869 personal cases of minor surgery performed in a cottage hospital over the seven years 1974-1980 inclusive. Results showed a wide range of procedures, little waiting time for patients, low infection rates and low referral to consultants subsequently. The cost benefits to the community and hospital services and the job satisfaction for the general practitioner are discussed.

Family Practice↗
PubMed1989

The nurse's role in giving pre-operative information to reduce anxiety in patients admitted to hospital for elective minor surgery.

Hospitalization, regardless of disease, is known to provoke anxiety in the patient admitted for minor surgery. If unrecognized, prolonged anxiety creates stress which may subsequently harm the patient and delay recovery. If nursing intervention is to be therapeutic, it is argued that recognition of and response to this area of patient need should be based on current research findings within the framework of a nursing model. The relationships between pre-operative anxiety, types of coping strategy and information received are discussed with reference to current literature. Open-ended and flexible assessment formats based on Orem's therapeutic self-care requirements and King's open-systems framework are proposed.

Adaptation, Psychological↗
PubMed1996

[Minor surgery in the family physician's office. Description of one year's experience].

OBJECTIVE: To describe the first results from minor surgery (MS) performed by the family doctor (FD) and to analyse the concordance between presurgical diagnosis and anatomical pathology. DESIGN: Prospective study. SETTING: Health centre and hospital anatomical pathology service. PARTICIPANTS: Interventions over a year by 4 FD and 8 third-year family medicine interns. MEASUREMENTS AND MAIN RESULTS: Descriptive variables for all the interventions were analysed. There were: age and gender; place, size and diagnosis of the lesion; reason for the MS; type of intervention; waiting time; and histological findings. The prior diagnosis was compared with the anatomical pathology for simple agreement. There were 243 interventions. Complete data were obtained for 229 (124 female and 105 male, aged between 4 and 79). The most common reason for MS was aesthetic, followed by fear of malignity and pain. The techniques used most often were: surgical exeresis (56.3%) and cryotherapy (36.2%). Most problems treated were naevi (72 cases), verrucas (83) and epidemic-sebaceous cysts (23). All the substances extracted (140) were sent to Pathology and there was 84.1% agreement between the Laboratory report and doctor's diagnosis. Average waiting time for the intervention was 15 days. CONCLUSIONS: Performing MS in primary care is feasible, as long as the FD is correctly trained. In our unit there is little waiting time and high histopathologic concordance.

Adolescent↗