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Background: Postoperative day-case patients are usually allowed to recover from anaesthesia in a postanaesthesia care unit (PACU) before transfer back to the day surgical unit (DSU). Bypassing the PACU can decrease recovery time after day surgery. Cost savings may result from a reduced nursing workload associated with the decreased recovery time. This study was designed to evaluate the effects of bypassing the PACU on patient recovery time and nursing workload and costs., Methods: Two hundred and seven consenting outpatients undergoing day surgery procedures were enrolled. Anaesthesia was induced and maintained with a standardized technique and the electroencephalographic bispectral index was monitored and maintained at 40-60 during anaesthetic maintenance. At the end of surgery, patients were randomly assigned to either a routine or fast-tracking (FT) group. Patients in the FT group were transferred from the operating room to the DSU (i.e. bypassing the PACU) if they achieved the FT criteria. All other patients were transferred to the PACU and then to the DSU. Nursing workload was evaluated using a patient care hour chart based on the type and frequency of nursing interventions in the PACU and DSU. A cost associated with the nursing workload was calculated., Results: The overall time from end of anaesthesia to discharge home was significantly decreased in the fast-tracking group. However, overall patient care hours and costs were similar in the two recovery groups., Conclusion: Bypassing the PACU after these short outpatient procedures significantly decreases recovery time without compromising patient satisfaction. However, the overall nursing workload and the associated cost were not significantly affected.

Unlabelled: We designed this study to evaluate postural stability in outpatients after either desflurane or propofol anesthesia. After IRB approval, 120 consenting women undergoing gynecological laparoscopic procedures were randomly assigned to receive either desflurane or propofol-based general anesthesia. After surgery, patients' postural stability was measured as body sway velocity by using a computerized force platform in the following conditions: 1) standing on a firm surface with eyes open versus closed and 2) standing on a foam surface with eyes open versus closed. These measurements were made before anesthesia, immediately after the patient achieved a Post-Anesthesia Discharge Score of 9, and at actual discharge home. At the time patients first achieved a Post-Anesthesia Discharge Score of 9, the body sway in the Propofol group was significantly more than in the Desflurane group when patients were asked to stand on a foam surface with eyes closed (testing the ability of using vestibular information for balance control). We concluded that the desflurane-based anesthetic was associated with better postural control than the propofol-based anesthetic in the early recovery period after outpatient gynecological laparoscopic procedures., Implications: The residual effects of the short-acting general anesthetics desflurane and propofol on patient's balance function during recovery after surgery were assessed with a computerized force platform. The results showed that desflurane seemed to be associated with better postural control than propofol in the early recovery period.

Patients undergoing day surgical procedures are given postoperative instructions not to drink alcohol, drive vehicles or make important decisions for 24 h. They are also advised to have a responsible adult stay with them at home overnight. Seven hundred and fifty patients were telephoned at 24 h postoperatively to determine their compliance with these instructions. Four per cent of patients drove vehicles, 1.8% consumed alcohol, while one patient made an important decision. A higher proportion of patients (5%) drove after general anaesthesia than regional anaesthesia or intravenous sedation (2.4%). The percentage of patients consuming alcohol was similar in both groups (1.8% vs. 1.9%). Four per cent of patients had no one staying with them overnight despite being accompanied out of the hospital. Patient compliance with instructions to not drink alcohol, drive or make important decisions may be improved by physician reinforcement of instructions and patient education.

Purpose: Music has long been known to reduce anxiety, minimize the need for sedatives, and make patients feel more at ease. The purpose of the study was to evaluate the effect of music in elderly outpatients undergoing elective cataract surgery with retrobulbar block and monitored anaesthetic care using fentanyl or alfentanil and midazolam., Methods: One hundred and twenty one patients were prospectively and randomly assigned to hear: relaxing suggestions, white noise, operating room noise or relaxing music via audio-cassette headphones. Vital signs were documented before and after retrobulbar block and every 15 min thereafter. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) before and after surgery. Visual analogue scales (VAS) were used to assess anxiety and patient satisfaction postoperatively with a standardized questionnaire. Between group comparisons were made using Chi-Square, or ANOVA, where appropriate., Results: There were no differences between groups in STAI or anxiety VAS scores at any time. Differences were noted in systolic blood pressure, but not in other vital signs. Patients' ratings of the whole operative experience, satisfaction with the tape played, general level of relaxation and preference for the chosen tape for subsequent surgery were different (music > relaxing suggestions > white noise and OR noise, P < 0.05)., Conclusions: Elderly patients undergoing cataract surgery under retrobulbar block were more satisfied with their experience if they heard relaxing music, rather than relaxing suggestions or white noise or OR noise. The type of auditory stimuli to which the patients were exposed did not influence the level of anxiety.

This study investigated the impact of perioperative fluid status on adverse clinical outcomes in ambulatory surgery. Two hundred ASA grade I-III ambulatory surgical patients were prospectively randomized into two groups to receive high (20 mL/kg) or low (2 mL/kg) infusions of isotonic electrolyte solution over 30 min preoperatively. A standardized balanced anesthetic was used. A minimal amount of fluid was given during the intraoperative and postoperative periods. Adverse outcomes were assessed by an investigator blinded to the fluid treatment group at 30 and 60 min after surgery, at discharge, and the first postoperative day. The incidence of thirst, drowsiness, and dizziness was significantly lower in the high-infusion group at all intervals. We recommend perioperative hydration of 20 mL/kg for patients undergoing general anesthesia for short ambulatory surgery.