Morbidity after day-case gynaecological surgery. Comparison of enflurane with halothane

Is outpatient laparoscopic cholecystectomy wise?

The authors report a prospective analysis of their experience with 506 consecutive laparoscopic cholecystectomies to examine the appropriateness of outpatient or same-day laparoscopic cholecystectomy. Thirty-eight patients experienced at least one postoperative complication. The complication was clinically evident or suspected in only 4 of these 38 patients within 8 h following surgery. Thirty-nine percent and 76% of complications were clinically detected at 24 and 48 h, respectively. Nausea and vomiting occurred among 32% of all patients on the day of operation and extended into the 1st postoperative day in 10%. Compared to predicted values, forced vital capacity was 61 +/- 5% 1 h postoperatively in 32 patients studied. At 6 and 24 h postoperatively, forced vital capacity was 63 +/- 7% and 66% respectively. Postoperative analgesic medication requirement was determined in 220 patients who were provided with a patient-controlled intravenous morphine analgesia machine with no basal rate. Consumption of morphine was highly variable but substantial on the day of operation: 17 +/- 16 mg. Most complications of laparoscopic cholecystectomy, including life-threatening complications, are not apparent by 8 h postoperatively and may not be apparent at 24 h. The potential for delay in the diagnosis and treatment of complications, variable but substantial analgesic requirements, impaired postoperative ventilation, and postoperative gastrointestinal dysfunction argue for the need to use great caution in selecting patients for outpatient laparoscopic cholecystectomy. Criteria are proposed to identify patients who are safest for outpatient laparoscopic cholecystectomy.

Recovery and morbidity after daycase anaesthesia. A comparison of propofol with thiopentone-enflurane with and without alfentanil

The anaesthetic conditions, recovery and side effects for 48 hours postoperatively were compared after anaesthesia for day surgery using propofol or thiopentone-enflurane with and without alfentanil. Propofol provided good conditions for surgery with faster immediate recovery (p less than 0.001); patients who received it were fit for discharge significantly sooner (p less than 0.001). Visual analogue scores of postoperative wellbeing showed an improvement in both propofol groups (p less than 0.01); after thiopentone and enflurane the scores were reduced and took 2 days to return to the pre-operative values. There was a significant (p less than 0.001) reduction in postoperative morbidity in both the groups that received propofol up to 24 hours after discharge. The addition of alfentanil improved anaesthetic conditions and reduced postoperative morbidity with both propofol and thiopentone-enflurane.

A comparison of alfentanil, halothane and enflurane for day-case gynaecological surgery

Sixty patients received either alfentanil, halothane or enflurane for maintenance of anaesthesia during short day-case gynaecological procedures. The alfentanil group recovered more rapidly but there was no difference between halothane and enflurane in terms of recovery time. Apnoea and movement during surgery only occurred in the patients who received alfentanil. The incidence of other side effects was the same in each group, including late subjective feelings of drowsiness and unsteadiness.

Use of alfentanil in short anaesthetic procedures

The pharmacokinetics of alfentanil, a new and very short-acting opioid, are discussed. Its use in day-case gynaecological procedures is described, and the results of the initial study presented. Alfentanil is a valuable adjunct to anaesthesia for day-case surgery and for short, painful procedures.

Alfentanil in short procedures. A comparison with halothane using etomidate or methohexitone for induction of anaesthesia

Ninety patients, premedicated with temazepam 20 mg, undergoing suction termination of pregnancy, were studied. Forty patients received alfentanil (500 micrograms), and thirty halothane (1.5%) as supplements to either etomidate or methohexitone-nitrous oxide-oxygen anaesthesia. A further 20 patients received alfentanil 250 micrograms at induction of anaesthesia with methohexitone, followed by a further 250 micrograms immediately prior to the onset of surgery. Recovery was assessed by the time patients took to open eyes on command, to giving their correct date of birth, and to performing the 'p' deletion test. Satisfactory operating conditions were not obtained with the combination of etomidate and halothane. Faster recovery was seen in patients with either etomidate or methohexitone and receiving alfentanil (p less than 0.01) Testing by the 'p' deletion test showed impaired psychomotor performance at 30 minutes after cessation of anaesthesia in all groups compared with the pre-operative scores. Side effects leading to unsatisfactory anaesthesia were more frequent in patients who had received etomidate (p less than 0.01).

Postoperative morbidity following gynaecological outpatient laparoscopy. A reappraisal of the service

Fifty-six women having out-patient gynaecological laparoscopies were studied to determine anaesthetic problems and postoperative morbidity. It is concluded that the procedure is safe, and although the postoperative morbidity appears high it is very acceptable to the patient.

Comparison of halothane and enflurane anaesthesia for tonsillectomy in adults

Halothane and enflurane in combination with N2O/O2 were compared in 103 adults undergoing tonsillectomy. Anaesthesia was induced with thiopental, and intubation was facilitated with suxamethonium. During halothane anaesthesia the mean heart rate ranged from 91 to 106 beats/min and the mean systolic arterial pressure from 111 to 127 mmHg. The values did not differ significantly from the corresponding values during enflurane anaesthesia. Electrocardiographic changes occurred in 56% and 31% of the patients anaesthetized with halothane or enflurane, respectively. the incidence of junctional rhythm, the most common ECG change, was 46% in the halothane group and 29% in the enflurane group. 19% of the patients in the halothane group and 31% in the enflurane group responded to surgical stimulus by swallowing or coughing. The responses were mostly short-lasting and did not much disturb the surgeon. The incidence of laryngospasm was 6% after halothane and 2% after enflurane anaesthesia. The mean total recovery score (0-10) was 6.1 after halothane and 6.3 after enflurane at arrival in the recovery room and 9.8 in both groups 30 min later. After halothane, nausea and vomiting occurred in 8 and 12% of the patients, respectively. The corresponding figures after enflurane were 2 and 8%. It is concluded that both halothane and enflurane are suitable anaesthetics for tonsillectomy in adults. The most striking difference between the anaesthetics was the significantly more common occurrence of ECG changes during halothane than enflurane anaesthesia.

Halothane and enflurane in dental anaesthesia

A clinical trial was designed to compare the use of halothane and enflurane in outpatient dental anaesthesia. A wholly inhalational technique was chosen. Basal nitrous oxide and oxygen was delivered from a Walton V demand-flow machine and was supplemented alternately with halothane or enflurane delivered from paired Goldman vaporisers in series. Under these circumstances, enflurane produced significantly fewer dysrhythmias than halothane, but was a more difficult, more expensive and less versatile agent to use. Overall, it was considered inferior to halothane in this context except, perhaps, where repeat anaesthetics may be required at short intervals of time.