Ambulatory anaesthesia

Ambulatory anaesthesia for paediatric surgery has numerous benefits in appropriately selected patients. In rural surgical outreaches which constitute unusual environments with peculiar challenges, a specialized anaesthesia practice can improve outcome. This report highlights the experience of a
specialized anaesthesia team in a rural surgical outreach for paediatric day case inguinoscrotal surgeries by the Lagos State Ministry of Health, Nigeria. Following logistic preparations and presurgical screening, resolutions of the anaesthetic outreach team were documented, while demographic, surgical and anaesthesia records of paediatric patients billed for inguinoscrotal surgery at various health centres between March 2007 and March 2009 were reviewed. These included types of surgery and anaesthesia as well as perioperative sequelae. Findings were documented and analysed using the SPSS v.16 software, and results presented as frequencies and means ± standard deviation. A total of 535 patients aged 1-13yrs (mean-8±4.3) with M:F ratio of 4:1 were seen. With preoperative cancellations in 25(4.7%), 510 patients were recruited. Surgical procedures were herniotomies 495(97.1%) and orchidopexies 15(2.9%). General anaesthesia was administered using volatile agents in 340(66.7%) and ketamine as sole agent in 170(33.3%). Mean duration of anaesthesia was 37min±12.2. Intraoperative and postoperative sequelae occured in 8 (1.6%) and 49 (9.6%) patients respectively. No mortality or unanticipated admissions were recorded. Ambulatory anaesthesia for paediatric inguinoscrotal surgery offers advantages. Rural surgical outreaches are unusual settings with a need for high patient turnover, but specialised anaesthesia teams observing safe practice can improve outcome.

AIM: To evaluate and compare the complication rate of propofol-based deep sedation (PBDS) for colonoscopy in marked obesity (BMI > 30) and non-obesity (BMI < 25) patients in a teaching hospital in Thailand.
METHODS: We undertook a retrospective review of the sedation
service records of adult patients who underwent colonoscopic
procedures from December 2009 to April 2011. All patients were classified into two groups according to the body mass index (BMI). In group A, the patients had BMI < 25. In group B, the patients had BMI > 30. The primary outcome variable was the overall complication rate. The secondary outcome variables were sedation and procedure-related complications during and immediately after the procedure.
RESULTS: After matching age, gender, ASA physical status,
sedation time and indications of procedure, there were 100
colonoscopic procedures in group A and 33 colonoscopic
procedures in group B. All sedation was given by residents or
anesthetic nurses directly supervised by staff anesthesiologist in the endoscopy room. There were no significant differences in patients’ characteristics, sedation time, indication of procedure, overall complication rate, anesthetic personnel and mortality rate between the two groups. However, upper airway obstruction in group B was relatively higher than in group A. All complications were easily treated, with no adverse sequelae.
CONCLUSION: PBDS for colonoscopic procedure in marked
obesity patients by trained anesthetic personnel with appropriate monitoring was relatively safe and effective. The complication rate of this technique in marked obesity (BMI > 30) patients was not different or worse than in non-obesity (BMI < 25) patients. Serious complications were rare in our population.