Patient-Satisfaction Measures in Anesthesia

A Four-Arm Randomized Clinical Trial of Topical Pain Control for Sentinel Node Radiotracer Injections in Patients with Breast Cancer

BACKGROUND

Radioactive tracer injections for breast cancer sentinel lymph node mapping can be painful. In this randomized trial, we compared four approaches to topical pain control for radiotracer injections.

METHODS

Breast cancer patients were randomized (9 April 2021-8 May 2022) to receive the institutional standard of ice prior to injection (n = 44), or one of three treatments: ice plus a vibrating distraction device (Buzzy®; n = 39), 4% lidocaine patch (n = 44), or 4% lidocaine patch plus ice plus Buzzy® (n = 40). Patients completed the Wong-Baker FACES® pain score (primary outcome) and a satisfaction with pain control received scale (secondary). Nuclear medicine technologists (n = 8) rated perceived pain control and ease of administration for each patient. At study conclusion, technologists rank-ordered treatments. Data were analyzed as intention-to-treat. Wilcoxon rank-sum tests were used to compare pain scores of control versus pooled treatment arms (primary) and then control to each treatment arm individually (secondary).

RESULTS

There were no differences in pain scores between the control and treatment groups, both pooled and individually. Eighty-five percent of patients were 'satisfied/very satisfied' with treatment received, with no differences between groups. No differences in providers' perceptions of pain were observed, although providers perceived treatments involving Buzzy© more difficult to administer (p < 0.001). Providers rated lidocaine patch as the easiest, with ice being second.

CONCLUSION

In this randomized trial, no differences in patient-reported pain or satisfaction with treatment was observed between ice and other topical treatments. Providers found treatments using Buzzy® more difficult to administer. Given patient satisfaction and ease of administration, ice is a reasonable standard.

Cross-cultural adaptation and validation of the Iowa Satisfaction with Anesthesia Scale for use in Brazil: a cross-sectional study

BACKGROUND

The Iowa Satisfaction with Anesthesia Scale (ISAS) was developed to assess the satisfaction of patients undergoing sedation with monitored anesthesia care. This study aimed to cross-culturally adapt the ISAS instrument and evaluate the acceptability, validity, and reliability of the proposed Brazilian version (ISAS-Br).

METHODS

The cross-cultural adaptation process involved translation, synthesis, back-translation, expert committee review, pre-testing, and final review of the ISAS-Br. A cross-sectional study was conducted, involving 127 adult individuals undergoing ambulatory surgeries with moderate/deep sedation. The acceptability, reliability, and construct validity of the scale were assessed.

RESULTS

The cross-cultural adaptation process did not require significant changes to the final version of the scale. The ISAS-Br demonstrated excellent acceptability, with a completion rate of 99% and an average completion time of 4.6 minutes. Exploratory factor analysis revealed three factors: emotional well-being, physical comfort, and anxiety relief, with respective composite reliability coefficient values of 0.874, 0.580, and 0.428. The test-retest reliability of the ISAS-Br, measured by the intraclass correlation coefficient, was 0.67 (95% confidence interval [95% CI] 0.42 to 0.83), and the Bland-Altman plot showed satisfactory agreement between the measurements.

CONCLUSION

The proposed Brazilian version of the ISAS underwent successful cross-cultural adaptation according to international standards. It demonstrated good acceptability and reliability, regarding the assessment of temporal stability. However, the ISAS-Br exhibited low internal consistency for some factors, indicating that this instrument lacks sensitivity to assess the satisfaction of deeply sedated patients. Further studies are necessary to explore the hypotheses raised based on the knowledge of its psychometric properties.

A randomised controlled trial comparing quality of recovery between desflurane and isoflurane inhalation anaesthesia in patients undergoing ophthalmological surgery at a tertiary hospital in South Africa (DIQoR trial)

Background

The patient's experience of their postoperative recovery is an important perioperative outcome, with the 15-item quality of recovery scale (QoR-15) recommended as a standardised outcomes measure. Desflurane has a faster emergence from anaesthesia compared with other volatile anaesthetics, but it is uncertain whether this translates to better subjective quality of recovery. The hypothesis for this study is that patients receiving desflurane for maintenance of anaesthesia would have better postoperative quality of recovery than patients receiving isoflurane.

Methods

Male and female adult patients undergoing ophthalmological surgery under general anaesthesia were randomly allocated to receive desflurane or isoflurane for maintenance of anaesthesia. The primary outcome was to compare postoperative QoR-15 scores. Secondary outcomes included comparing preoperative QoR-15 scores, volatile agent consumption, and time spent in the recovery room.

Results

Data from 164 patients were analysed (80 desflurane, 84 isoflurane). Median (Q1, Q3) postoperative QoR-15 scores were not significantly different (desflurane: 145 [141, 148], isoflurane: 144 [139, 147], 95% confidence interval 0-3, P=0.176, minimal clinically important difference=8). Median (Q1, Q3) volatile agent consumption was 15.4 (12.5, 19.3) ml hr-1 in the desflurane group, and 7.4 (5.9, 9.7) ml hr-1 in the isoflurane group. Median (Q1, Q3) time spent in the recovery room was significantly shorter in the desflurane group (desflurane: 18 [13, 23]; isoflurane: 25 [19, 32], 95% confidence interval -10 to 5, P<0.001).

Conclusions

This study found no difference in quality of recovery between patients who received desflurane or isoflurane for maintenance of general anaesthesia during ophthalmological surgery. A shorter time in the recovery room was not associated with improved QoR-15 scores.

Clinical trial registration

NCT04188314.

Can Positive Emotions Predict Consumer Satisfaction in Adverse Services?

Background

Managing emotions during hospital visits is important to enhance patient satisfaction. The purpose of this paper is to explore the relationship between patients' happiness and satisfaction through patients' mood and perceived service quality at a healthcare setup.

Methods

This study was conducted in a tertiary care hospital located in coastal Karnataka during the period from November to December 2021. Primary data was collected through a structured questionnaire from 227 respondents. "Statistical Package for the Social Sciences (SPSS) 27.0" and "SmartPLS 3.0" software was used for data analysis.

Results

Hypotheses proposed in this study were examined by comparing the direct effect of patients' happiness level on perceived service quality and the indirect effect of the level of patients' happiness on patient satisfaction. The influence of all the exogenous latent variables namely, happiness, mood, perceived service quality, on the endogenous latent variable of patient satisfaction is estimated to be moderate (R 2=62.5%).

Conclusion

This study empowers hospital managers to recognize how patient satisfaction is dependent on patients' happiness. In order to enhance patient satisfaction, the quality of care provided by health services, human resources, and infrastructure must be improved. As a result, the entire service encounter can be made enjoyable to the customers by reducing the distress caused by adverse services. Managers can utilize the outcomes of the study to develop marketing strategies to influence patients' emotions in the healthcare setup by modifying the servicescape elements.

Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis

OBJECTIVES

Ongoing controversies persist regarding risk factors associated with the failure of transition from epidural labor analgesia to cesarean section anesthesia, including the duration of labor analgesia, gestational age, and body mass index (BMI). This study aims to provide an updated analysis of the incidence of conversion from epidural analgesia to general anesthesia, while evaluating and analyzing potential risk factors contributing to the failure of this transition to cesarean section anesthesia.

METHODS

We conducted an extensive literature search utilizing databases such as PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WANGFANG, and the Chinese Biomedical Literature Database (CBM) up to September 30, 2022. The meta-analysis was performed using STATA 15.1 software. The quality of the included studies was assessed using the 11-item quality assessment scale recommended by the Agency for Healthcare Research and Quality (AHRQ).

RESULTS

A total of 9,926 studies were initially retrieved, and after rigorous selection, 19 studies were included in the meta-analysis. The overall incidence of conversion from epidural analgesia to general anesthesia was found to be 6% (95% confidence interval [CI]: 5-8%). Our findings indicate that, when compared to patients in the successful conversion group, those in the failure group tended to be younger (weighted mean difference [WMD] = -1.571, 95% CI: -1.116 to -0.975) and taller (WMD = 0.893, 95% CI: 0.018-1.767). Additionally, the failure group exhibited a higher incidence of incomplete block in epidural anesthesia, received a higher dosage of additional epidural administration, experienced a greater rate of emergency cesarean sections, and received anesthesia more frequently from non-obstetric anesthesiologists. However, no statistically significant differences were observed in gestational age, depth of the catheter insertion into the skin, epidural catheter specifics, duration of epidural analgesia, infusion rate of epidural analgesia, primiparity status, cervical dilatation during epidural placement, BMI, or weight.

CONCLUSION

Our study found that the incidence of conversion from epidural analgesia to cesarean section under general anesthesia was 6%. Notably, the failure group exhibited a higher rate of incomplete block in epidural anesthesia, a greater incidence of emergency cesarean sections, a more frequent provision of anesthesia by non-obstetric anesthesiologists, a higher dosage of epidural administration, and greater height when compared to the success group. Conversely, women in the failure group were younger in age compared to their counterparts in the success group.

Therapeutic efficacy of intravenous lidocaine infusion compared with thoracic epidural analgesia in major abdominal surgery: a noninferiority randomised clinical trial

BACKGROUND

Open major abdominal surgery is one of the most risky surgical procedures for acute postoperative pain. Thoracic epidural analgesia (TEA) has been considered the standard analgesic approach. In different reports, lidocaine i.v. has been shown to have an analgesic efficacy comparable with TEA. We compared the analgesic efficacy of i.v. lidocaine with thoracic epidural analgesia using bupivacaine in patients undergoing major abdominal surgery.

METHODS

In this noninferiority clinical trial, 210 patients were randomised to thoracic epidural bupivacaine with morphine or i.v. lidocaine. Dynamic pain at 24 h after surgery was measured using a numerical pain rating scale (NPR), and morphine consumption was also measured. A difference in i.v. the lidocaine-epidural bupivacaine NPR of ≤1 for dynamic pain was considered a noninferiority margin.

RESULTS

The NPR for dynamic pain in the lidocaine group at 24 h was between 5.7 (1.8) and 5.2 (1.9) in the epidural group, with a difference of 0.53 (95% confidence interval 0.0-1.0). In the first 24 h, the average difference in morphine consumption was 1.8 mg between the i.v. lidocaine and epidural groups (95% confidence interval 1-3 mg). No differences were found in adverse events or complications associated with the procedures.

CONCLUSIONS

Intravenous lidocaine is noninferior to thoracic epidural analgesia for acute postoperative pain control in major abdomial surgery at 24 h postoperatively.

CLINICAL TRIALS REGISTRATION

NCT04017013.

Analgesia quality index improves the quality of postoperative pain management: a retrospective observational study of 14,747 patients between 2014 and 2021

BACKGROUND

The application of artificial intelligence patient-controlled analgesia (AI-PCA) facilitates the remote monitoring of analgesia management, the implementation of mobile ward rounds, and the automatic recording of all types of key data in the clinical setting. However, it cannot quantify the quality of postoperative analgesia management. This study aimed to establish an index (analgesia quality index (AQI)) to re-monitor and re-evaluate the system, equipment, medical staff and degree of patient matching to quantify the quality of postoperative pain management through machine learning.

METHODS

Utilizing the wireless analgesic pump system database of the Cancer Hospital Affiliated with Nantong University, this retrospective observational study recruited consecutive patients who underwent postoperative analgesia using AI-PCA from June 1, 2014, to August 31, 2021. All patients were grouped according to whether or not the AQI was used to guide the management of postoperative analgesia: The control group did not receive the AQI guidance for postoperative analgesia and the experimental group received the AQI guidance for postoperative analgesia. The primary outcome was the incidence of moderate-to-severe pain (numeric rating scale (NRS) score ≥ 4) and the second outcome was the incidence of total adverse reactions. Furthermore, indicators of AQI were recorded.

RESULTS

A total of 14,747 patients were included in this current study. The incidence of moderate-to-severe pain was 26.3% in the control group and 21.7% in the experimental group. The estimated ratio difference was 4.6% between the two groups (95% confidence interval [CI], 3.2% to 6.0%; P < 0.001). There were significant differences between groups. Otherwise, the differences in the incidence of total adverse reactions between the two groups were nonsignificant.

CONCLUSIONS

Compared to the traditional management of postoperative analgesia, application of the AQI decreased the incidence of moderate-to-severe pain. Clinical application of the AQI contributes to improving the quality of postoperative analgesia management and may provide guidance for optimum pain management in the postoperative setting.

Patient satisfaction in anesthesiology: a narrative review

PURPOSE OF REVIEW

Healthcare is increasingly expanding its view in outcome discussions to integrate patient-reported outcomes such as patient satisfaction. Involving patients in the evaluation of services and the development of quality improvement strategies is paramount, especially in the service-oriented discipline of anaesthesiology.

RECENT FINDINGS

Currently, while the development of validated patient satisfaction questionnaires is well established, the use of rigorously tested scores in research and clinical practice is not standardized. Furthermore, most questionnaires are validated for specific settings, which limits our ability to draw relevant conclusions from them, especially considering the rapidly expanding scope of anaesthesia as a discipline and the addition of same-day surgery.

SUMMARY

For this manuscript, we review recent literature regarding patient satisfaction in the inpatient and ambulatory anaesthesia setting. We discuss ongoing controversies and briefly digress to consider management and leadership science regarding 'customer satisfaction'.

Indonesia Translation and Cross-Cultural Validation of Pediatric Anesthesia Parent Satisfaction (PAPS) Questionnaire

BACKGROUND

Many questionnaires have been widely used to assess patient satisfaction. One of them is the Pediatric Anesthesia Parent Satisfaction (PAPS) questionnaire. However, in Indonesia, the parent satisfaction of pediatric patients undergoing surgery has never been studied. Knowing patient satisfaction can provide feedback to improve the quality of anesthesia services. Furthermore, the PAPS questionnaire has never been used in Indonesia, so it needs to be translated and tested for validity and reliability before being implemented in Indonesia.

AIM

to validate the Indonesian version of the PAPS questionnaire Method: This study uses a descriptive-analytic method with a cross-sectional design. The PAPS Questionnaire was translated into Indonesian version with the following steps (1) forward translation, (2) establish an expert committee, and (3) backward translation. After that, pilot testing and FGD with the expert were conducted to obtain the final questionnaire. Pearson's correlation and confirmatory factor analysis (CFA) were employed for the validity test. Sampling measurement before CFA was carried out with Keyser-Meyer-Olkin (KMO) and Bartlett's test. Cronbach's alpha determined the reliability test evaluation.

RESULT

Total number of subjects is 125 subjects. The PAPS questionnaire in the Indonesian version was obtained with help from INCULS and an anesthesiologist expert. Pearson's correlation found that all items ranged from r = 0.531-0.796 with p < 0.001. The CFA showed two factors that explained 65% of the total variance, with KMO being 0.937 (X2=1283.452, p < 0.001). Cronbach's alpha coefficient was 0.937.

CONCLUSION

Indonesian version of the PAPS questionnaire is valid and reliable for assessing parents' satisfaction with the anesthesia services their child received.

Patient satisfaction with divided anesthesia care

BACKGROUND

Up to now, no prospective cohort study using a validated questionnaire has assessed patients' expectation and perception of divided anesthesia care and its influence on patient satisfaction.

OBJECTIVE

We assessed patient satisfaction with divided anesthesia care in a district general hospital in Switzerland. We hypothesized that patient expectations, combined with their perceptions of the (un)importance of continuous anesthesia care would influence patient satisfaction.

MATERIAL AND METHODS

A total of 484 eligible in-patients receiving anesthesia from October 2019 to February 2020 were included and received preoperative information about divided care via a brochure and face-to-face. The primary outcome was the assessment of patient satisfaction with divided anesthesia care using a validated questionnaire. In group 1 continuity of care was considered important but not performed. In group 2 continuity was ensured. In group 3 continuity was regarded as not important and was not performed. In group 4 patients could not remember or did not answer. A psychometrically developed validated questionnaire was sent to patients at home after discharge.

RESULTS

A total of 484 completed questionnaires (response rate 81%) were analyzed. In group 1 (n = 110) the mean total dissatisfaction score was 25% (95% confidence interval [CI] 21.8-28.1), in group 2 (n = 61) 6.8% (95% CI 4.8-8.7), in group 3 (n = 223) 12.1% (95% CI 10.7-13.4), and in group 4 (n = 90) 15% (95% CI 11-18); ANOVA: p < 0.001, η = 0.43. Of the patients 286 (59%) considered continuity of care by the same anesthetist relatively unimportant (34%) or not important at all (25%). The other 40% considered it important (22%) or very important (18%).

CONCLUSION

Despite receiving comprehensive preoperative information about divided anesthesia care, 40% of patients still considered continuity of care by the same anesthetist important. We recommend further research evaluating whether and how patient expectations can be modified towards the common practice of divided care and patient satisfaction can be increased.

Validation of the translated version of the EVAN-G scale in a Chinese-speaking population

BACKGROUND

This study aimed to translate the French version of a perioperative satisfaction questionnaire (EVAN-G) scale, a validated questionnaire for assessing perioperative patient satisfaction, into a Chinese version and validate it in Chinese-speaking patients.

METHODS

We developed the Chinese version of the EVAN-G (EVAN-GC) scale based on the original French version of the EVAN-G. The EVAN-GC scale, the Short version of the Spielberger State-Trait Anxiety Inventory (S-STAI), and the McGill pain questionnaire (MGPQ) were administered on the WeChat mini program. We invited patients to complete these questionnaires within 4 to 24 h after surgery. The psychometric validation of the EVAN-GC scale included validity, reliability, and acceptability.

RESULTS

Among 220 patients, 217 (98.6%) completed the EVAN-GC scale after surgery. The item-internal consistency revealed good construct validity. Compared with the total scores of the S-STAI and MGPQ, the EVAN-GC scale showed excellent convergent validity (ρ = - 0.32, P < 0.001; ρ = - 0.29, P < 0.001). The EVAN-GC scale could differentiate between groups, which showed good discriminate validity. The Cronbach's alpha coefficient (0.85) of the translated scale demonstrated satisfactory internal consistency reliability, and a 36-patient subsample retest evidenced good test-retest reliability (ρ = 0.82, P < 0.001). In addition, the median [interquartile range] time of completing the EVAN-GC scale was 3.7 [2.9-4.9] min.

CONCLUSIONS

The EVAN-GC scale has good psychometric properties similar to those of the original French version. The EVAN-GC scale is a valid and reliable measurement to assess patient satisfaction in Chinese-speaking patients.

TRIAL REGISTRATION

The Chinese Clinical Trial Registry, ChiCTR2100049555.

Efficacy and Safety of Oral Hydration 1 Hour After Extubation of Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial

BACKGROUND

Thirst is one of the most common and uncomfortable symptoms in patients after cardiac surgery. The postextubation time for early oral hydration (EOH) remains unclear, and there is a lack of studies on its safety and effectiveness.

OBJECTIVE

The aim of this study was to investigate the effects of oral hydration 1 hour after extubation on thirst, salivary pH, salivary flow, oral mucosa, halitosis, gastrointestinal adverse reactions, aspiration pneumonia, and satisfaction in patients undergoing cardiac surgery.

METHODS

Eighty-four patients who underwent cardiac surgery were randomly assigned into 2 groups, for either conventional oral hydration (COH) or EOH. The EOH group drank 30 mL of warm water 1 hour post extubation and thereafter 50 mL hourly for 4 hours. The COH group had nil per os for 4 hours after extubation. If no dysphagia was evident after 4 hours, the patients were instructed to slowly drink water. Thirst intensity was evaluated every hour before the intervention. Nausea and vomiting were recorded after drinking water. The salivary pH, unstimulated salivary flow rate, oral odor, and oral mucosal moisture were evaluated at 1 hour post extubation, immediately before the intervention, and at 4 hour post intervention. Aspiration pneumonia data were collected within 72 hours post intervention. Satisfaction was assessed before leaving the intensive care unit.

RESULTS

The scores for thirst (3.38 ± 1.04; F = 306.21, P < .001), oral mucosa (2.03 ± 0.74; P < .001), and halitosis (2.77 ± 0.63; P < .001) in the EOH group were significantly lower than those in the COH group. The EOH group had significantly higher salivary pH (6.44 ± 1.06; P < .001), unstimulated salivary flow rates (0.18 ± 0.08; P < .001), and patient satisfaction (4.28 ± 0.45; P < .001) than the COH group. Nausea and vomiting did not differ significantly between groups (P = .60). Aspiration pneumonia was not observed in either group.

CONCLUSIONS

Oral hydration 1 hour after extubation significantly alleviated thirst and stabilized the oral environment without gastrointestinal adverse reactions or aspiration pneumonia, and with increased patient satisfaction.

Patient-Controlled Sedation in Port Implantation (PACSPI 1) - A feasibility trial

Background

Central venous access is essential for the administration of chemotherapy and frequent blood sampling in patients with cancer. The subcutaneous venous port is commonly used for this purpose. Subcutaneous venous port implantation is a minor surgical procedure; however, it can provoke pain and anxiety in these vulnerable patients. The aim of this study was, before a full-scale RCT, to determine the feasibility of patient-controlled sedation with propofol and alfentanil as an adjunct to local anaesthesia during SVP implantation.

Methods

We prospectively studied 40 patients scheduled for SVP implantation between 14 April 2021 and 15 October 2021 at a 500-bed secondary level hospital in Sweden. Anaesthesiologists performed subcutaneous venous port implantation with patient-controlled sedation using propofol and alfentanil. We determined pain perception (primary outcome), patient satisfaction, sedation score, and key safety measures.

Results

Of the 40 patients with cancer, 80% reported a pain score ≤3 on an 11-point numeric rating scale during subcutaneous venous port implantation. Overall satisfaction with pain management and operating conditions was graded as 10 of 10 on the numeric rating scale. Four patients (10%) had bradypnoea (<8 bpm) without oxygen desaturation to ≤90%. Rescue sedation was administered to one patient (2.5%).

Conclusion

Patient-controlled sedation with propofol and alfentanil during subcutaneous venous port implantation is feasible and well accepted. Ultimately the efficacy of patient-controlled sedation with propofol and alfentanil needs to be evaluated in an RCT to provide clinicians with evidence-based guidance for choosing the optimal perioperative strategy for subcutaneous venous port implantation.

Clinical trial registration

NCT04631393.

Comparison of continuous with single-injection regional analgesia on patient experience after ambulatory orthopaedic surgery: A randomised multicentre trial

BACKGROUND

The optimal approach to improving patient experience and analgesia after ambulatory orthopaedic surgery remains unclear.

METHODS

This multicentre, randomised clinical trial compared single-injection nerve block analgesia with home delivery of continuous nerve block analgesia by remote-controlled electronic pump. The primary outcome was patient-reported satisfaction (Evaluation du Vecu de l'Anesthesie Generale [EVAN-G]; 0-100) assessed on postoperative Day 2. Secondary outcomes focused on pain, opioid consumption, quality of rehabilitation, activity tracking using a wearable electronic device, and 90-day quality of life.

RESULTS

We randomly assigned 294 patients to continuous pump delivery or single injection. For subjects with normal level of pain catastrophising (Pain Catastrophizing Scale <30; n=211), median global EVAN-G was higher with the electronic pump compared with the single injection (78 [69-86] vs 72 [63-84]; P=0.03), as were pain satisfaction scores (P=0.01). For the maximum pain levels, the numerical rating scale score was 2.0 (1.0-5.0) in the electronic-pump group vs 5.0 (3.0-7.0) in the single-injection group on the first 2 days after surgery (P<0.0001). Total opioid consumption in morphine equivalent was higher with single injection (mean [standard deviation]): 70.5 [73.8] vs 31.9 [54.2] mg; P<0.01). The groups did not differ in early rehabilitation on Day 1 or quality of life on Day 45. Electronic activity tracking indicated higher activity in the electronic-pump group (P<0.01).

CONCLUSIONS

Self-reported patient satisfaction at home was better with continuous nerve block analgesia via electronic pump vs single injection, without impairing early rehabilitation. Single-injection analgesia was associated with higher pain levels and opioid consumption and lower satisfaction. Patient catastrophising negatively affected the experience of pain.

CLINICAL TRIAL REGISTRATION

NCT02720965.

Factors affecting perioperative patient satisfaction with regional anesthesia: A patient-centered survey study

Objective: To determine the demographic and clinical characteristics that affect patient satisfaction with regional anesthesia. Methods: This study was conducted at Kahramanmaras Sutcu Imam University Hospital between June-July 2019. The patients were included on a voluntary basis and all had undergone obstetrics, urology, orthopedics, or general surgery, and met the following inclusion criteria: (1) age >18 years, (2) received regional anesthesia, (3) ASA-PS score of ≤ 3, and (4) no cognitive problem that would prevent self-expression. A Personal Information Form and the Evaluation of the Experience of Regional Anesthesia Questionnaire were applied to 402 patients at 48 hours after surgery performed under regional anesthesia in a university hospital in Turkey. Results: The EVAN-LR total scores were 71.2±15.6 in obstetrics patients, followed by 54.9±24.9 in orthopedic patients, 26.6±24.4 in urology patients and 15.9±7.2 in general surgery patients (p

Patient satisfaction and its associated factors towards perioperative anesthesia service among surgical patients: A cross-sectional study

Background

Patient satisfaction with perioperative anesthesia services is not well established in developing countries like Ethiopia. This study aimed to assess surgical patients' satisfaction with perioperative anesthesia service and its associated factors.

Method

A cross-sectional study design was conducted in patients who underwent surgeries at Debre Tabor Comprehensive Specialized Hospital, in North Central Ethiopia. Data were collected by Leiden perioperative care patient satisfaction questionnaire (LPPSq) within 24 h postoperatively, after translating to the local language (Amharic). Bivariable and multivariable logistic analyses were done to identify factors associated with satisfaction with perioperative anesthesia service care. Statistical significance level was set at P < 0.05 with 95% CI.

Results

Analysis was done on 387 patients with a response rate of 94.8%. The overall mean satisfaction of patients with perioperative anesthesia care was 62.62% and about 53.7% [95% CI= (48.6-58.4)] of patients were satisfied with perioperative anesthesia service. The mean satisfaction of perioperative anesthesia service in the patient-staff relationship domain was 61.44%; in the information provision domain was 60.32%, and in the fear and concern domain was 72.06%.

Conclusion

There was a moderate level of satisfaction in patients with perioperative anesthesia service. Among the subscales of LPPSq, the lowest satisfaction score was in the information provision and the highest satisfaction score was in the fear and concern domain.

Positive Treatment Expectations Shape Perceived Medication Efficacy in a Translational Placebo Paradigm for the Gut-Brain Axis

Placebo research has established the pivotal role of treatment expectations in shaping symptom experience and patient-reported treatment outcomes. Perceived treatment efficacy constitutes a relevant yet understudied aspect, especially in the context of the gut-brain axis with visceral pain as key symptom. Using a clinically relevant experimental model of visceral pain, we elucidated effects of pre-treatment expectations on post-treatment perceived treatment efficacy as an indicator of treatment satisfaction in a translational placebo intervention. We implemented positive suggestions regarding intravenous treatment with a spasmolytic drug (in reality saline), herein applied in combination with two series of individually calibrated rectal distensions in healthy volunteers. The first series used distension pressures inducing pain (pain phase). In the second series, pressures were surreptitiously reduced, modeling pain relief (pain relief phase). Using visual analog scales (VAS), expected and perceived treatment efficacy were assessed, along with perceived pain intensity. Manipulation checks supported that the induction of positive pre-treatment expectations and the modeling of pain relief were successful. Generalized Linear Models (GLM) were implemented to assess the role of inter-individual variability in positive pre-treatment expectations in perceived treatment efficacy and pain perception. GLM indicated no association between pre-treatment expectations and perceived treatment efficacy or perceived pain for the pain phase. For the relief phase, pre-treatment expectations (p = 0.024) as well as efficacy ratings assessed after the preceding pain phase (p < 0.001) were significantly associated with treatment efficacy assessed after the relief phase, together explaining 54% of the variance in perceived treatment efficacy. The association between pre-treatment expectations and perceived pain approached significance (p = 0.057) in the relief phase. Our data from an experimental translational placebo intervention in visceral pain support that reported post-treatment medication efficacy is shaped by pre-treatment expectations. The observation that individuals with higher positive expectations reported less pain and higher treatment satisfaction after pain relief may provide first evidence that perceived symptom improvement may facilitate treatment satisfaction. The immediate experience of symptoms within a given psychosocial treatment context may dynamically change perceptions about treatment, with implications for treatment satisfaction, compliance and adherence of patients with conditions of the gut-brain axis.

Satisfaction measures in pediatric anesthesia and perioperative care

Patient satisfaction is routinely used to assess the quality of care in medicine. In the field of anesthesia, research has been primarily directed toward developing satisfaction measures in adults with little attention paid to the pediatric population. Satisfaction in pediatric anesthesia and perioperative care is poorly understood. We have identified existing satisfaction measures in pediatric perioperative care and examined their similarities and differences. A search of relevant published trials up to January 2021 identified 17 studies using 14 unique satisfaction measures of perioperative care in children. Eleven of these assessed satisfaction multidimensionally while three assessed overall satisfaction of parents with their child's anesthesia. Of the six dimensions of satisfaction identified, all were duplicated to some degree across studies. The dimensions were: "staff rapport and communication" and "anesthetic and nursing quality of care" in eight satisfaction measures; "information giving" in seven measures; "postoperative symptom control" in six; "hospital experience" in five; and "involvement in decision-making" in three. The most important items from the parents' perspective were: "staff rapport and communication;" "information giving;" and "decision-making". No study examined all dimensions of satisfaction. Although all studies questioned parents, only three asked satisfaction questions of the child. No study was analyzed the child's direct responses. In three studies, parental involvement in decision-making was reported to be important as a satisfaction measure of their child's perioperative care. Of the few existing satisfaction measures evaluated, there is no accepted standard in current practice. Future studies identifying the important determinants of satisfaction in pediatric perioperative care, perhaps also using a Delphi approach with parents, might allow for the development of a patient-focused standardized measure in this setting.

The situation and influencing factors of outpatient satisfaction in large hospitals: Evidence from Henan province, China

BACKGROUND

The level of outpatient satisfaction plays a significant role in improving the quality and utilization of healthcare services. Patient satisfaction gives providers insights into various aspects of services including the effectiveness of care and level of empathy. This study aimed to evaluate the level of patient satisfaction in the outpatient department and to explore its influencing factors in large hospitals (accommodating over 1000 beds) of Henan province, China.

METHODS

We analyzed data from Henan Large Hospitals Patient Satisfaction Survey conducted in the year 2018 and included 630 outpatients. Structural Equation Model (SEM) was used to explore the relationship among evaluation indicators of outpatient satisfaction levels. We used Dynamic Matter-Element Analysis (DMA) to evaluate the status of outpatient satisfaction. Binary Logistic Regression (BLR) was adopted to estimate the impact of personal characteristics towards outpatient satisfaction.

RESULTS

The overall score for outpatient satisfaction in large hospitals was 66.28±14.73. The mean outpatient satisfaction scores for normal-large, medium-large, and extra-large hospitals were 63.33±12.12, 70.11±16.10, 65.41±14.67, respectively, and were significantly different (F = 11.953, P < 0.001). Waiting time, doctor-patient communication, professional services, and accessibility for treatment information were shown to have directly positive correlations with outpatient satisfaction (r = 0.42, 0.47, 0.55, 0.46, all P < 0.05). Results from BLR analysis revealed that patients' age and frequency of hospital visits were the main characteristics influencing outpatient satisfaction (P < 0.05).

CONCLUSIONS

The outpatient satisfaction of large hospitals is moderately low. Hospital managers could shorten the waiting time for outpatients and improve the access to treatment information to improve the satisfaction of outpatients. It is also necessary to enhance service provision for outpatients under the age of 18 as well as the first-time patients.

Safety and Efficacy of the Combination of Propofol and Ketamine for Procedural Sedation/Anesthesia in the Pediatric Population: A Systematic Review and Meta-analysis

BACKGROUND

Drugs such as propofol and ketamine are used alone or in combination to provide sedation for medical procedures in children. The purpose of this systematic review was to compare the safety and effectiveness of propofol and ketamine to other drug regimens.

METHODS

We searched Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), Web of Science, and the grey literature (meta-Register of Controlled Trials, ClinicalTrials.gov, and Google Scholar) for randomized controlled studies comparing intravenous propofol and ketamine to any other single or combination drug regimen administered to children undergoing diagnostic or therapeutic procedures. Meta-analyses were performed for primary (hemodynamic and respiratory adverse events) and secondary outcomes using RevMan 5.3. We assessed the risk of bias and the certainty (quality) evidence for all outcomes using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

RESULTS

Twenty-nine studies were included for analysis. Based on low-to-moderate quality evidence, we concluded that the use of propofol and ketamine may result in a slight-to-small reduction in the risk of hypotension, bradycardia, and apnea, and a slight increase in the risk of tachycardia, hypertension, and other respiratory adverse events, such as cough or laryngospasm. The ratio of propofol to ketamine and comparator drug regimen subgroups effects were important for desaturation and some secondary outcomes.

CONCLUSIONS

The use of propofol and ketamine had a minimal effect on the incidence of adverse events and other secondary outcomes. Large-scale studies are required to more accurately estimate adverse event rates and the effects of propofol and ketamine on patient-important outcomes.

Patient satisfaction with regional anaesthesia and general anaesthesia in upper limb surgeries: An open label, cross-sectional, prospective, observational clinical comparative study

Background and Aims:

An important assessment of the quality of health care is patient satisfaction. However, only few studies are available which look into this aspect. The primary objective of this study was to compare patient satisfaction between regional anaesthesia (RA) and general anaesthesia (GA) in patients undergoing upper limb surgeries. The length of hospital stay and duration of analgesia between the two techniques were the secondary objectives.

Methods:

This cross-sectional study was carried out in a tertiary care teaching hospital. Patients aged between 18 years and 60 years, of physical status American Society of Anesthesiologists (ASA) grade 1–3, undergoing upper limb surgeries were included in the study. Patient satisfaction with anaesthesia was assessed in patients receiving GA and RA, with 100 patients in each group, at least 24 h after the surgery with a 10-item predesigned peri-operative questionnaire. The continuous variables were compared between the groups using Mann–Whitney–Wilcoxon test, and for categorical variables Chi-square test was used.

Results:

The patients in group RA showed significantly higher satisfaction scores than those in GA (P < 0.001) with respect to all the 10 items of the questionnaire and the total score. Duration of analgesia was also significantly longer in RA than GA (P < 0.001). Duration of hospital stay was also significantly longer in GA than in RA (P < 0.001).

Conclusions:

RA for upper limb surgeries provides better patient satisfaction than GA, along with a longer duration of analgesia and lesser duration of hospital stay.

The impact of parental health mindset on postoperative recovery in children

BACKGROUND

Mindset, or one's beliefs about the ability to change one's outcomes, has been studied in the educational domain but not in surgical settings. The purpose of this study was to examine the role of parental health mindset on children's recovery.

METHODS

Participants were part of a larger National Institutes of Health-funded trial that included 1470 children undergoing outpatient tonsillectomy and adenoidectomy. We used measures of parental coping style (Monitor Blunter Style Scale; MBSS) and medication attitudes (Medication Attitudes Questionnaire; MAQ) to validate the Health Beliefs Scale (HBS; Criterion validity, Cohen's kappa). HBS categorizes parents as having a growth mindset, or the belief that health can be changed, or a fixed mindset, which reflects the belief that individuals cannot change their health. Next, we identified demographic and personality variables (eg, temperament, anxiety) as predictors for the HBS. Finally, we examined the relationship between the HBS with postoperative outcomes.

RESULTS

Findings supported criterion validity of the HBS. Parents with a growth mindset reported seeking out more medical information (MBSS, 7.15 ± 3.32 vs 6.22 ± 3.38, P < .001, CI = -1.387 to -0.471) and reported fewer misconceptions regarding analgesic use (MAQ, 22.11 ± 4.09 vs 21.41 ± 4.25, P = .035, CI = 0.046 to 1.229). In assessing outcomes, we found that fixed-mindset parents rated their children's postoperative pain as more severe on days 1 (9.22 ± 3.82 vs 8.37 ± 3.71, P = .007, CI = 0.234 to 1.459) and 3 (8.13 ± 4.28 vs 7.27 ± 4.28, P = .007, CI = 0.094 to 1.638) and reported that their children received more doses of ibuprofen on postoperative day 1 (2.91 ± 1.24 vs 2.44 ± 1.44, P = .041, CI = 0.089 to 0.848). There was no difference in children's self-reported pain scores between groups (P = .585).

CONCLUSIONS

These findings, coupled with recent mindset intervention studies in the educational space, suggest that parent mindset is an important target for clinical intervention in the context of children's surgical recovery.

Cross-cultural adaptation, analysis of psychometric properties and validation of the Spanish version of a perioperative satisfaction questionnaire (EVAN-G)

Background

Patient satisfaction is a reliable and measurable indicator of the quality provided by a healthcare service. There are several questionnaires for measuring it, but only a few have shown good psychometric properties, an outstanding one being the EVAN-G (Evaluation du Vécu de l’Anesthésie Générale) questionnaire, which measures patient satisfaction regarding perioperative care and is validated in French. The aim of this study is the validation of a Spanish version of the EVAN-G questionnaire.

Methods

A translation/back-translation of the questionnaire into Spanish was carried out and the final version obtained was administered to three hundred patients. Its psychometric properties were measured and compared with those of the original EVAN-G questionnaire to verify that they had been maintained after the previous translation process. The questionnaire’s content, construct and external validity were measured. To calculate reliability, Cronbach-α coefficient and test-retest method were used. The Global Satisfaction Index was calculated and satisfaction level in our sample was analyzed.

Results

Content, construct and external validity were proven with similar results that in the original EVAN-G. The translated version of the questionnaire showed good reliability: Cronbach-α coefficient was 0.92 and intraclass correlation coefficient measured by test-retest method was 0.9. The acceptability was high. The average Global Satisfaction Index in our sample was 73 ± 12.

Conclusions

The translation into Spanish and cross-cultural adaptation of the EVAN-G questionnaire has proven its validity, reliability, and acceptability to measure patient satisfaction in interventions performed under general anesthesia.

Patient-reported outcomes for ambulatory surgery

PURPOSE OF REVIEW

To discuss the importance of validated tools that measure patient-reported outcomes and their use in ambulatory surgery.

RECENT FINDINGS

Sustained increases in ambulatory surgical care reflect advances in surgical techniques and perioperative anaesthetic care. Use of patient-reported outcomes allows identification of minor adverse events that are more common in this population compared with traditional endpoints such as mortality. Variability in reported outcomes restricts research potential and limits the ability to benchmark providers. The standardized endpoints in perioperative medicine initiative's recommendations on patient-reported outcomes and patient comfort measures are relevant to evaluating ambulatory care. Combining validated generic and disease-specific patient-reported outcome measures (PROMs) examines the widest spectrum of outcomes. Technological advances can be used to facilitate outcome measurement in ambulatory surgery with digital integration optimizing accurate real-time data collection. Telephone or web-based applications for reviewing ambulatory patients were found to be acceptable in multiple international settings and should be harnessed to allow remote follow-up.

SUMMARY

Use of validated tools to measure patient-reported outcomes allows internal and external quality comparison. Tools can be combined to measure objective outcomes and patient satisfaction. These are both key factors in driving forward improvements in perioperative ambulatory surgical care.

Prevalence, risk factors, and optimized management of moderate-to-severe thirst in the post-anesthesia care unit

Post-operative thirst is common and may cause intense patient discomfort. The aims of this retrospective study conducted in a high-volume post-anesthesia care unit (PACU) were as follows: (1) to examine the prevalence of moderate-to-severe post-operative thirst—defined as a numerical rating scale (NRS) score of 4 or higher, (2) to identify the main risk factors for moderate-to-severe post-operative thirst, and (3) to maximize the efficacy and safety of thirst management through a quality improvement program. During a 1-month quality improvement program conducted in August 2018, a total of 1211 adult patients admitted to our PACU were examined. Moderate-to-severe thirst was identified in 675 cases (55.8%). The use of glycopyrrolate during anesthesia was associated with moderate-to-severe thirst (71.7% versus 66.4%, respectively, p = 0.047; adjusted odds ratio: 1.46, p = 0.013). Following a safety assessment, ice cubes, room temperature water, or an oral moisturizer were offered to patients. A generalized estimating equation model revealed that ice cubes were the most effective means for thirst management—resulting in an estimated thirst intensity reduction of 0.93 NRS points at each 15-min interval assessment (p < 0.001)—followed by room temperature water (− 0.92/time-point, p < 0.001) and the oral moisturizer (− 0.60/time-point; p < 0.001). Patient satisfaction (rated from 1 [definitely dissatisfied] to 5 [very satisfied]) followed a similar pattern (ice cubes: 4.22 ± 0.58; room temperature water: 4.08 ± 0.55; oral moisturizer: 3.90 ± 0.55, p < 0.001). The use of glycopyrrolate—an anticholinergic agent that reduces salivary secretion—was the main independent risk factor for moderate-to-severe post-operative thirst. Our findings may provide clues towards an optimized management of thirst in the immediate post-operative period.

Undesirable Postoperative Anesthesia Outcomes at Two National Referral Hospitals: A Cross-Sectional Study in Eritrea

Background

Postoperative undesirable anesthesia outcomes are common among patients undergoing surgery. They may affect body systems and lead into more serious postoperative problems. This research is conducted in the Eritrean National Referral Hospitals with the aim of assessing the prevalence of undesirable anesthesia outcomes during the postoperative period.

Method

A cross-sectional study design was applied on 470 patients who underwent different types of surgeries within a three-month period. Patients were interviewed 24 hours after operation (POD 1) using the Leiden Perioperative care Patient Satisfaction questionnaire (LPPSq). This study reports one component of a large study conducted. The dimension "Discomfort and needs" of the LPPSq was considered, and the measurements of that dimension are presented in this report. Items of the dimension were standardized and measured using a five-point Likert scale from "Not at all" to "Extremely." Multivariable logistic regression was used to look for the association of the outcomes with the types of surgery and types of anesthesia using SPSS (Version 22).

Results

The prevalence were computed in two manners, prevalence of those with 'at least a little bit' outcomes, which was computed to see the total occurrence of these outcomes, and prevalence of those having 'more than moderate' outcomes to see the severe experience of these outcomes. Prevalence of the predominant undesirable outcome, postoperative pain, for 'at least a little bit' and 'more than moderate' were 82.6% and 43.6%, respectively. The rest of the postoperative undesirable outcomes were less frequently reported.

Conclusion

Postoperative pain was found to be the most prevalent undesirable outcome. Enhancement of proper assessment and management of postoperative pain through the development and implementation of specific pain management modalities is needed.

High level of satisfaction among women who underwent oocyte retrieval without anesthesia

OBJECTIVE

To assess the level of satisfaction of women undergoing transvaginal oocyte retrieval (TOR) without anesthesia as well as the comfort of the gynecologists.

DESIGN

Single-center, prospective cohort study of women undergoing TOR from July 2017 to January 2018.

SETTING

This study was conducted in an academic public hospital.

PATIENT(S)

Women with ≤15 follicles for retrieval were eligible. Women with body mass index > 35, difficult vaginal approach, endometrioma > 5 cm, or pelvic inflammatory disease were excluded.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Our primary endpoint was patient satisfaction. Secondary endpoints were women's willingness to recommend or undergo the procedure again without anesthesia, anxiety levels before the procedure, expected level of pain, actual pain levels during the procedure, and gynecologist's level of difficulty or technical compromise.

RESULT(S)

During the study period, 500 TORs were performed, of which 402 (80%) were screened for study eligibility. Overall, data were analyzed for 50 eligible women who had their first in vitro fertilization cycle (participating in the study) without anesthesia. High rates of satisfaction were reported, and 90% would recommend the procedure without anesthesia to their friends. Physicians graded the difficulty of the procedure as very easy in 35 procedures; in only two procedures was difficulty reported.

CONCLUSION(S)

TOR without anesthesia is feasible, with a relatively high satisfaction rate from both patients and gynecologists, suggesting that it should be considered in selected women.

EVAN-G score in patients undergoing minimally invasive gynecology oncologic surgery in an Enhanced Recovery After Surgery (ERAS) program

INTRODUCTION

Enhanced Recovery After Surgery (ERAS) has been proven to decrease the length of hospital stay without increasing re-admission rates or complications. There are limited data on the satisfaction of patients undergoing minimally invasive surgery for gynecologic malignancy within ERAS programs. The aim of this study was to evaluate patient satisfaction after minimally invasive surgery for gynecologic malignancy within the ERAS program using the 'Evaluation du Vécu de l'Anésthésie Génerale (EVAN-G)' questionnaire.

METHODS

This observational retrospective study was conducted at the Paoli-Calmettes Institute between June 2016 and December 2018. All the included patients underwent minimally invasive surgery for a gynecologic malignancy. EVAN-G, a validated questionnaire, was used to measure peri-operative patient satisfaction. This questionnaire consists of 26 items assessing six elements: attention, privacy, information, pain, discomfort, and waiting time. Each element is assessed via a 5-step numerical scale and then transformed to a 0-100 scale according to the degree of satisfaction. The EVAN-G questionnaire was given to patients before surgery and collected during the post-operative consultation (2-3 weeks after surgery).

RESULTS

A total of 175 patients underwent minimally invasive surgery for gynecologic malignancy within the ERAS program. Of these, 92 patients were included in the study and 83 patients were excluded. The overall patient compliance rate with our ERAS program was 90%. The analysis of the EVAN-G score of all participants showed an overall high level of satisfaction with a mean score of 81.9 (range 41.6-100). Patients with peri-operative complications or having prolonged hospitalization also showed high levels of satisfaction with a mean score of 80.5 (41.6-100) and 83.2(55-100), respectively.

CONCLUSION

In this study we showed a high patient satisfaction with the ERAS program. When comparing length of stay and complications, neither extended length of stay nor development of complications after minimally invasive surgery impacted patient satisfaction.

A systematic review of pain outcomes reported by randomised trials of hip and knee arthroplasty

It is difficult to pool results from randomised clinical trials that report different outcomes. We want to develop a core set of pain-related outcomes after total hip or knee arthroplasty, the first stage of which is to systematically review published outcomes. We searched PubMed, Embase and CENTRAL for relevant trials to January 2020. We identified 165 outcomes from 565 trials with 50,668 participants, which we categorised into six domains: pain; analgesic consumption; quality of care; adverse events; mobility; and patient-reported outcome measures. The outcome in each domain reported by most trials was: visual analogue score for pain, 401 (71%); morphine consumption, 212 (38%); length of hospital stay, 166 (29%); nausea or vomiting, 425 (75%); range of motion, 173 (31%); and patient satisfaction score, 181 (32%). A primary outcome was reported in 281 (50%) trials: 101 (18%) trials reported consumption of rescue analgesics and 95 (17%) trials reported pain. We plan to publish a consensus on outcomes that should be reported in postoperative pain trials after hip or knee arthroplasty.

Patient satisfaction survey scores are not an appropriate metric to differentiate performance among anesthesiologists

STUDY OBJECTIVE

With the focus of patient-centered care in healthcare organizations, patient satisfaction plays an increasingly important role in healthcare quality measurement. We sought to determine whether an automated patient satisfaction survey could be effectively used to identify outlying anesthesiologists.

DESIGN

Retrospective Observational Study.

SETTING

Vanderbilt University Medical Center (VUMC).

MEASUREMENTS

Patient satisfaction data were obtained between October 24, 2016 and November 1, 2017. A multivariable ordered probit regression was conducted to evaluate the relationship between the mean scores of responses to Likert-scale questions on SurveyVitals' Anesthesia Patient Satisfaction Questionnaire 2. Fixed effects included demographics, clinical variables, providers and surgeons. Hypothesis tests to compare each individual anesthesiologist with the median-performing anesthesiologist were conducted.

MAIN RESULTS

We analyzed 10,528 surveys, with a 49.5% overall response rate. Younger patient (odds ratio (OR) 1.011 [per year of age]; 95% confidence interval (CI) 1.008 to 1.014; p < 0.001), regional anesthesia (versus general anesthesia) (OR 1.695; 95% CI 1.186 to 2.422; p = 0.004) and daytime surgery (versus nighttime surgery) (OR 1.795; 95% CI 1.091 to 2.959; p = 0.035) were associated with higher satisfaction scores. Compared with the median-ranked anesthesiologist, we found the adjusted odds ratio for an increase in satisfaction score ranged from 0.346 (95% CI 0.158 to 0.762) to 1.649 (95% CI 0.687 to 3.956) for the lowest and highest scoring providers, respectively. Only 10.10% of anesthesiologists at our institution had an odds ratio for satisfaction with a 95% CI not inclusive of 1.

CONCLUSIONS

Patient satisfaction is impacted by multiple factors. There was very little information in patient satisfaction scores to discriminate the providers, after adjusting for confounding. While patient satisfaction scores may facilitate identification of extreme outliers among anesthesiologists, there is no evidence that this metric is useful for the routine evaluation of individual provider performance.

Extending epidural analgesia for intrapartum cesarean section following epidural labor analgesia: a retrospective cohort study

Objective: To determine the effectiveness of extending epidural analgesia following epidural labor analgesia for intrapartum cesarean section, and provide a reference for clinical practice.Methods: Data of 1254 singleton parturient who failed trial of epidural labor analgesia and underwent intrapartum cesarean section were retrospectively included. After entering the operating room, parturient were given 3 ml of 1.5% lidocaine with 1:200,000 epinephrine 15 µg as a test dose, followed by a dose of 10 ml 0.75% ropivacaine plus 5 ml of 2% lidocaine mixed solution was administered via the epidural catheter. Case data were reviewed and analyzed of cesarean section anesthesia implementation methods, results and maternal and neonatal outcomes.Results: Of the 1254 parturient, 4.7% (59 of 1254) underwent general anesthesia directly, 7.1% (89 of 1254) were given combined spinal and epidural anesthesia, and the other 88.2% (1106 of 1254) underwent extending epidural anesthesia, 3.5% (39 of 1106) of them were given general anesthesia after extending epidural anesthesia failed, and 96.5% (1067 of 1106) parturient have a successful extending epidural anesthesia. Adverse reactions of extending epidural anesthesia: 6.7% (72 of 1067) parturient experienced hypotension and 12.1% (129 of 1067) of nausea and vomiting occurred. For the neonatal Apgar scores at 1 min, eleven of 1254 (0.9%) newborns were between 0 and 3 points, 107 (8.5%) newborns between 4 and 7 points, and 1136 (90.6%) newborns Apgar scores between 8 and 10 point. 24 (1.9%) newborns with Apgar scores between 4 to 7 points at 5 min transferred to the department of neonatology, and the rest 1230 (98.1%) newborns with Apgar scores 8-10 points.Conclusion: Extending epidural analgesia using the well-functioning epidural catheter for epidural labor analgesia might be a reliable and effective anesthetic method for intrapartum cesarean section.

Factors Associated with Poor Satisfaction with Anesthesia in Patients Who Had Previous Surgery: A Retrospective Study

Background

As most studies investigating patient satisfaction with anesthesia have some bias, previous results may underrepresent the true level of dissatisfaction with anesthesia.

Objectives

This study aimed to identify factors associated with patient satisfaction with anesthesia.

Methods

Data from patients aged ≥ 20 years who had previous surgery and were scheduled for additional surgery were obtained retrospectively through preoperative interviews conducted. Informed consent for anesthesia was obtained by an anesthesiologist prior to the additional surgery. The patients were assigned to one of four anesthesia satisfaction levels, then were categorized into two groups; a high satisfaction group and a low satisfaction group. After comparing parameters between the two groups, logistic regression analysis was performed to identify factors that were negatively associated with satisfaction with anesthesia.

Results

Of 478 patients interviewed subjects, 469 patients were analyzed. Five individuals were excluded because they were unable to provide informed consent, and four subjects were excluded because they were aged < 10 years at the time of their previous surgery. Age < 65 years, previous surgery for malignancy, female sex, estimated operation duration < 3 hours, and American Society of Anesthesiologists Physical Status score 1 or 2 were included in a logistic regression analysis. Age < 65 years, previous surgery for malignancy, and female sex were predictive of poor patient satisfaction with anesthesia. Reasons for poor satisfaction with anesthesia included postoperative shivering and chills, fear of surgery, ineffective spinal anesthesia, and postoperative surgery-related pain. Of the patients awaiting surgery for malignancy, 57.3% had previous surgery for malignancy.

Conclusions

Age < 65 years, previous surgery for malignancy, and female sex were negatively associated with patient satisfaction with anesthesia. These factors should be considered when preparing patients for future procedures to improve postoperative patient satisfaction.

Transcultural validation of a French version of the Iowa Satisfaction with Anesthesia Scale (ISAS-F)

PURPOSE

We sought to validate a French translation of the Iowa Satisfaction with Anesthesia Scale (ISAS), a tool to assess the patient's satisfaction with monitored anesthesia care for surgery. The ISAS tool is particularly pertinent as surgery with monitored anesthesia care is increasingly used in ambulatory surgery settings.

METHODS

We studied content validity, internal consistency, convergent validity (vs physician-estimated satisfaction), and test-retest reliability of the French version of the ISAS (ISAS-F) in 122 adult patients undergoing a brief outpatient invasive procedure under conscious sedation. The ISAS-F was answered twice by the patient, once in the postanesthesia care unit and once before discharge from the ambulatory care unit.

RESULTS

The median [interquartile range (IQR)] time of completion at the first assessment was 2 [2-4] min. The total median [IQR] ISAS-F score was 2.3 [1.8-2.7]. Internal consistency of the ISAS-F was found to be good (Cronbach's α = 0.68). Test-retest reliability was significant, with an intra-class correlation coefficient at 0.74 (95% confidence interval [CI], 0.63 to 0.85). The ISAS-F score correlated with the physician-estimated satisfaction score, with an intra-class correlation coefficient of 0.28 (95% CI, 0.12 to 0.44; P = 0.01).

DISCUSSION

This validated version of the ISAS can now be used by French-speaking researchers and physicians to assess patient satisfaction with the anesthesia technique.

Patient satisfaction with peri-operative anesthesia care and associated factors at two National Referral Hospitals: a cross sectional study in Eritrea

BACKGROUND

Measuring patient satisfaction has become an important parameter of the continuous quality assessment and improvement in anaesthesia services. The aim of this study was to assess the level of patient satisfaction with perioperative anaesthesia care and to determine the factors that influence satisfaction.

METHOD

This study is an cross sectional design, conducted on 470 patients who underwent different types of surgeries at two National Referral Hospitals in Asmara, Eritrea between January and March of 2018. Patients were interviewed 24 h after the operation using a Tigrigna translated Leiden Perioperative Care Patient Satisfaction questionnaire (LPPSq). Descriptive and inferential analysis were made using SPSS (version 22). Statistical significance level was set at P < 0.05.

RESULTS

The overall satisfaction score was 68.8%. Less fear and concern was observed among patients with satisfaction scores of 87.5%. Staff-patient relationship satisfaction score was 75%. Patients were least satisfied with information provision (45%). Multivariable analysis revealed that satisfaction of patients who did surgery at Halibet hospital is significantly higher (p < 0.001) than those patients who did at Orotta hospital. Moreover, those patients who did elective surgery had higher level of satisfaction that those who did emergency surgery (p < 0.001).

CONCLUSION

Moderate level of satisfaction was observed among the patients. Generally, the study emphasized that the information provision about anesthesia and surgery was low. Patients described better staff-patient relationship and low fear and concern related to anesthesia and surgery was observed.

Regional anaesthesia is associated with less patient satisfaction compared to general anaesthesia following distal upper extremity surgery: a prospective double centred observational study

BACKGROUND

Patient satisfaction is a well-established indicator to evaluate the quality of medical care and there is an increasing support for the use of patient-reported experience measures (PREMs) to evaluate satisfaction. To anesthetize the upper limb for surgery, both general and regional plexus anaesthesia are appropriate techniques. However, the best technique in the anaesthesiologist's perspective might not necessarily result in the highest patient satisfaction. The aim of this study is to investigate patient satisfaction following general and regional anaesthesia, and to identify areas where anaesthesiologists can focus on improving patient care.

METHODS

Patients scheduled for elective distal upper extremity surgery under either general or regional plexus anaesthesia were prospectively included. On the first postoperative day, patient satisfaction and main reason for dissatisfaction with the anaesthesia technique were investigated during a telephone interview.

RESULTS

Of the 243 patients included in the current study, 79.8% report being "fully satisfied" with their anaesthesia technique. 32.1% of the patients who received regional anaesthesia reported not feeling "fully satisfied". This figure is 5.5% following general anaesthesia. Main reason for dissatisfaction following regional anaesthesia are reported as "insufficient anaesthesia prior to surgery", and "the discomfort of having a long-lasting insensate extremity postoperatively".

CONCLUSIONS

Following regional plexus anaesthesia, a third of the patients are not "fully satisfied". To optimize patient satisfaction following regional anaesthesia techniques, we advocate stronger focus on patient counselling preoperatively, addressing the issues of block failure and prolonged postoperative sensory and motor block.

Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial

BACKGROUND

Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication.

OBJECTIVE

The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs.

DESIGN

A randomised controlled single-centre trial.

SETTING

University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015.

PATIENTS

A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion.

INTERVENTIONS

Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up.

MAIN OUTOMES

Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs.

RESULTS

Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096).

CONCLUSION

Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general.

TRIAL REGISTRATION

German Clinical Trials Register, www.drks.de, identifier: DRKS00005989.

Rationale and design of PASSAT - patients' satisfaction with local or general anaesthesia in video-assisted thoracoscopic surgery: study protocol for a randomised controlled trial with a non-randomised side arm

BACKGROUND

Although general anaesthesia (GA) with one-lung ventilation is the current standard of care, minor thoracoscopic surgery, i.e. treatment of pleural effusions, biopsies and small peripheral pulmonary wedge resections, can also be performed using local anaesthesia (LA), analgosedation and spontaneous breathing. Whilst the feasibility and safety of LA have been demonstrated, its impact on patient satisfaction remains unclear. Most studies evaluating patient satisfaction lack control groups or do not meet psychometric criteria. We report the design of the PASSAT trial (PAtientS' SATisfaction in thoracic surgery - general vs. local anaesthesia), a randomised controlled trial with a non-randomised side arm.

METHODS

Patients presenting for minor thoracoscopic surgery and physical eligibility for GA and LA are randomised to surgery under GA (control group) or LA (intervention group). Those who refuse to be randomised are asked to attend the study on the basis of their own choice of anaesthesia (preference arm) and will be analysed separately. The primary endpoint is patient satisfaction according to a psychometrically validated questionnaire; secondary endpoints are complication rates, capnometry, actual costs and cost effectiveness. The study ends after inclusion of 54 patients in each of the two randomised study groups.

DISCUSSION

The PASSAT study is the first randomised controlled trial to systematically assess patients' satisfaction depending on LA or GA. The study follows an interdisciplinary approach, and its results may also be applicable to other surgical disciplines. It is also the first cost study based on randomised samples. Comparison of the randomised and the non-randomised groups may contribute to satisfaction research.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00013661 . Registered on 23 March 2018.

Efeitos da abreviação do jejum pré-operatório com solução de carboidrato e proteína em sintomas pós-operatórios de cirurgias ginecológicas: ensaio clínico randomizado controlado duplo-cego

RESUMO Objetivo: investigar os efeitos da abreviação do jejum pré-operatório, uma recomendação do protocolo de “Aceleração da Recuperação Total Pós-operatória” (ACERTO), em sintomas pós-operatórios de pacientes submetidas à cirurgias ginecológicas. Métodos: estudo controlado, randomizado, duplo-cego, de 80 cirurgias ginecológicas realizadas no período de janeiro a junho de 2016. As pacientes foram aleatoriamente alocadas em dois grupos: Grupo Controle, com 42 pacientes, e Grupo Suco, com 38, e que receberam, respectivamente, 200ml de solução inerte ou 200ml de líquido enriquecido com carboidrato e proteína quatro horas antes da cirurgia. Os sintomas pós-operatórios estudados foram sede, fome, dor, agitação, satisfação e bem-estar, em ambos os grupos. Para medir a intensidade dos sintomas foi utilizada a Escala Visual Analógica (EVA), associada à Escala Facial (EF) para dor, aplicadas dez horas após a cirurgia. Resultados: as pacientes do Grupo Suco apresentaram menos dor (3,51x1,59), sede (3,63x0,85), fome (3,86x2,09) e agitação (2,54x0,82) em relação ao Grupo Controle (P<0,05). As variáveis satisfação (6,89x8,68) e bem-estar (5,51x7,12) foram maiores (P<0,05) quando houve a ingestão do líquido contendo carboidrato e proteína (Grupo Suco) em relação à solução inerte (Grupo Controle). Conclusão: a abreviação do jejum pré-operatório com líquido contendo carboidrato e proteína antes de cirurgias ginecológicas reduz sede, fome, dor, agitação e favorece maior satisfação e bem-estar do que a ingestão de solução inerte.