Annual Scientific Meeting - 2001

DAY CASE SURGERY AT TORBAY HOSPITAL- FIVE YEARS EXPERIENCE WITH TOTAL INTRAVENOUS ANAESTHESIA.

 Dr Rachel Johns, Dr Jane Montgomery, Dr Kerri Houghton.

In Torbay Hospital we have a dedicated stand-alone day surgery unit attached to the main hospital consisting of two theatres and one treatment room.  We treat up to 7,000 patients a year over a wide variety of specialties.  Patients are pre-assessed within the unit and are also followed up 24 hours post discharge by telephone (with the exclusion of Community Dental cases, which accounts for up to 800 patients a year.)  The unit uses Daynamics (Calcius Systems Ltd) to support and record each patient episode, and thus record data detailing anaesthetic techniques used, admission rates, feedback from patients and rates of contact with other health care professionals post discharge are available from the system. 

Over the last five and a half years 33,053 patients have been treated in our unit.  Of these 16,244 (49%) received total intravenous anaesthesia (TIVA), 9241 were given inhalational anaesthesia and 7568 received local anaesthesia or sedation.  The admission rate for patients receiving TIVA was well within National Standards at 3.5%.  Out of the 15312 patients who had received TIVA  that we attempted to contact by telephone 24 hours post operatively, we actually managed to follow-up 11122 (73%).  Patients received a structured interview to ascertain their general feeling post operatively and if they had experienced any untoward effects following anaesthesia and surgery.  In addition they were asked about their general satisfaction with the service provided.  Some of the results of this follow-up are shown in Table 1.Response rates to individual questions varied as not all patients answered every question.

Table 1.

Less than 2% of patients reported feeling bad or very bad after the operation with 89% feeling good or very good.  Unplanned contact with primary health care professionals post operatively was also low at 2.2%.  99.5% of patients contacted were satisfied or very satisfied with the service provided.   No attempt has been made to compare these rates with those who received other types of anaesthesia because of the presence of too many confounding factors.

In our experience the use of TIVA in Day Case Surgery gives low rates of post operative symptoms and high rates of patient satisfaction and is also well within the guidelines and standards from the Royal College of Anaesthetists  for Day Case Anaesthesia (2) – is there a need for these guidelines to be updated?

1. Moore J.K –Unplanned admission after Day Surgery. Raising the Standard. Royal College of Anaesthetists-2000.

2. Jackson I.B- Adequacy of Postoperative pain relief after discharge.  Raising the Standard. Royal College of Anaesthetists –2000.