Can J Anaesth.2016 Sep;63(9):1022-32. doi: 10.1007/s12630-016-0673-3. Epub 2016 Jun 9.
BACKGROUND: Ambulatorysurgerypatientsare at risk of adverse psychological outcomes such as anxiety, aggression, fatigue, and depression. We developed and validated aclinicalpredictionmodeltoidentifypatientswho werevulnerableto these psychological outcome parameters. METHODS: We prospectively assessed 383 mixedambulatorysurgerypatientsfor psychological vulnerability, defined as the presence of anxiety (state/trait), aggression (state/trait), fatigue, and depression seven days aftersurgery. Three psychological vulnerability categories were considered-i.e., none, one, or multiple poor scores, defined as a score exceeding one standard deviation above the mean for each single outcome according to normative data. The following determinants were assessed preoperatively: sociodemographic (age, sex, level of education, employment status, marital status, having children, religion, nationality), medical (heart rate and body mass index), and psychological variables (self-esteem and self-efficacy), in addition to anxiety, aggression, fatigue, and depression. Apredictionmodelwas constructed using ordinal polytomous logistic regression analysis, and bootstrapping was applied for internal validation. The ordinal c-index (ORC) quantified the discriminative ability of themodel, in addition to measures for overallmodelperformance (Nagelkerke's R (2) ). RESULTS: In this population, 137 (36%)patientswere identified as being psychologicallyvulnerableaftersurgeryfor at least one of the psychological outcomes. The most parsimonious and optimalpredictionmodelcombined sociodemographic variables (level of education, having children, and nationality) with psychological variables (trait anxiety, state/trait aggression, fatigue, and depression).Modelperformance was promising: R (2) = 30% and ORC = 0.76 after correction for optimism. CONCLUSION:This study identified a substantial group ofvulnerablepatientsinambulatorysurgery. The proposedclinicalpredictionmodelcould allow healthcare professionals the opportunity toidentifyvulnerablepatientsinambulatorysurgery, although additional modification and validation are needed. (ClinicalTrials.gov number,NCT01441843).
BACKGROUND AND AIMS: The growing popularity and trend of day care (ambulatory) anaesthesia has led to the development of newer and efficient drug regimen. We decided to evaluate the efficacy of two drug regimens namely dexmedetomidine and propofol with midazolam and fentanyl for moderate sedation characteristics in minor surgical procedures in terms of analgesia, intra-operative sedation, haemodynamic stability and side effects related. METHODS: Totally, 60 adult American Society of Anaesthesiologists class I-II patients posted for day care surgeries of duration <45 min divided into two groups; Group D, where dexmedetomidine loading dose at 1 μg/kg was administered over 10 min followed by maintenance infusion initiated at 0.6 μg/kg/h and titrated to achieve desired clinical effect with dose ranging from 0.2 to 0.7 μg/kg, Group P, where midazolam at 0.02 mg/kg and fentanyl at 2 μg/kg IV boluses were given followed by propofol infusion. Statistical analysis was done using student t-test, analysis of variance and Chi-square analysis. P < 0.05 was considered to be significant. RESULTS: Degree of sedation (Observer's Assessment of Activity and Sedation Scale ≤3) was comparable in both groups (P > 0.05). Rescue analgesia with fentanyl was needed in 30% patients of Group D compared to 17.63% patients of Group P (P < 0.05). The level of arousal was faster and better in Group D at 5 min after the procedure (P < 0.05). Haemodynamics were stable in Group D as with Group P patients (P < 0.005). Dry mouth reported by 16.67% patients. CONCLUSION: Dexmedetomidine can be a useful adjuvant rather than the sole sedative-analgesic agent during minor surgeries and be a valuable alternative to propofol in terms of moderate sedation, haemodynamic stability with minimal transient side effects.
KEYWORDS: Day care; dexmedetomidine; fentanyl; moderate sedation; propofol