Nalbuphine. 8. This study revealed that per- and postoperative. Dextromoramide. 4. Alfentanil. 4 respiratory events were rather rare and contrasted. Fentanyl. 4.
Paediatric Anaesthesia 1998
8: 485–489
Paediatric day case anaesthesia: estimate of its quality at home B. GRENIER, MD∗, M. DUBREUIL, Y. MEYMAT, MD†
MD†,
D. SIAO,
MD∗
AND
∗Department of Anaesthesiology 3 and †Department of Anaesthesiology 4, Hoˆpital Pellegrin, 33076 Bordeaux Cedex, France
Summary The aim of this clinical audit was to evaluate the home recovery and complications of 104 daycase anaesthetized children, as well as parent satisfaction. A questionnaire, explained at the time of preoperative visit, was given to parents at hospital discharge and returned by mail. Opioids were administered in 19% of the children whereas regional anaesthesia was performed in 28% of cases. In the recovery room, 8% of them suffered pain. At home, pain was the main problem (25%) and vomiting and agitation were found in 9% and 6% of the cases respectively. Parents reported anxiety in 45% of cases, and 14% called their general practitioner. Nevertheless, 94% were satisfied with the anaesthetic. A clinical audit is useful in detecting management deficiencies. Quality of home recovery may be improved by: wider use of perioperative analgesia, systematic prescription of take-home analgesia, designation of a hospital practitioner for advice, and closer collaboration with general practitioners. Keywords: day case surgery: recovery; quality
Introduction Paediatric outpatient anaesthesia is frequent and safe. Indeed, there is a move to increase the proportion of operations carried out as daycases, on the basis of efficiency and resource management. Thus, in many hospitals, about 40% of surgical patients undergo their operation as a daycase. In addition to the advantages observed in adult daycase surgery, a further advantage in paediatric practice is a reduction in separation between children and parents (1). Life threatening postoperative complications are Correspondence to: M. Dubreuil, De´partement d’Anesthe´sieRe´animation 4, Hoˆpital Pellegrin-Enfants, 33076 Bordeaux Cedex, France. 1998 Blackwell Science Ltd
infrequent, but minor incidents and discomfort are common. Nevertheless, few studies aim to evaluate the quality of recovery after the patient has returned home. The aim of this study is to assess the home recovery and comfort of children who have undergone day case procedures, as well as their parents’ satisfaction.
Methods An open study (clinical audit) was undertaken between November 1993 and March 1994. Parental consent was obtained in all cases. All children who fulfilled the usual criteria for paediatric outpatient procedures (2) were included. Patients were excluded 485
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if they were born prematurely, aged less than eight months, sustained an acute upper respiratory tract infection or were kept in hospital and considered as inpatients instead of being discharged. Patients for whom the data were incomplete were also excluded. A questionnaire presented and explained during the preoperative visit was given to parents before hospital discharge. It was accompanied by a stamped, addressed envelope. This questionnaire aimed to evaluate complications at home (including pain) reported by parents as well as their appraisal and reaction. The follow-up evaluated the first 24 h postoperatively. The following items were used to assess complications: agitation, apathy, sleepiness, difficulty with sleeping, vomiting, oral intake refusal, fever, hypersalivation, moaning, crying and pain. For the parental appraisal, the items were: calls for their general practitioner or any other medical advice, anxiety, opinions about the anaesthetic and about day care management. Patient data were also collected during the hospital stay. Details of the preoperative assessment, duration of preoperative fasting, premedication, anaesthetic management, surgical procedure and its duration were recorded. The anaesthetic technique was left to the discretion of the attendant anaesthetic consultant. In the recovery room (RR), length of stay, Aldrete recovery score (3) and complications were also registered. Children were allowed to leave the RR, to the outpatient ward, when the Aldrete score was above 8. Hospital discharge was authorized by the anaesthetist and the surgeon when the usual discharge criteria in day case paediatric practice were met (2). A trial period in the use of the questionnaire was undertaken by all the anaesthetists in the audit, in order to standardize the presentation and explanation of it to parents. The results of this period are not included. Data were analysed with the EPI INFO⊂ statistical program. Quantitative data are summarized as mean±standard deviation (range). Categorical variables were compared by a McNemar test or a v2 analysis with Yates correction when appropriate. Significance was assumed when P
