Mini-pump: method of diabetic control during minor surgery under general anaesthesia.
(65/79)
A simple method for maintaining diabetic control during and after minor surgery requiring a general anaesthetic was studied in 20 insulin-treated diabetics. Long-acting insulin was omitted on the night before the operation, and a mini-pump delivering insulin at a rate of 0.5 units/h was strapped to the arm early on the morning of the operation regardless of the time of operation. Insulin was infused at this rate throughout the day, the usual evening dose of insulin given and followed by supper, and the pump then stopped. In all 20 patients studied blood glucose concentrations fell steadily throughout the day. Hypoglycaemia did not occur. The mini-pump is simple to use and with the same standard insulin dose for all patients maintains satisfactory blood glucose concentrations throughout the day of operation. (+info)
Minor surgery -- one general practitioner's experiences.
(66/79)
A study was made of 869 personal cases of minor surgery performed in a cottage hospital over the seven years 1974-1980 inclusive. Results showed a wide range of procedures, little waiting time for patients, low infection rates and low referral to consultants subsequently. The cost benefits to the community and hospital services and the job satisfaction for the general practitioner are discussed. (+info)
Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans.
(67/79)
In order to quantitate the effect of spinal anesthesia on adrenergic tone, plasma levels of norepinephrine (NE) and epinephrine (EPI) were measured by radioenzymatic assay in 24 patients were then compared to those of 10 patients receiving inhalation anesthesia (halothane-nitrous oxide). High thoracic dermatome spinal anesthesia caused suppression of both arterial plasma NE and EPI and a fall of mean arterial pressure (MAP); in contrast, no changes of NE, EPI, or MAP were observed in patients receiving low spinal anesthesia. Overall, there was a relationship between the sensory dermatome anesthesia level and changes of both plasma NE (r = 0.71, P less than 0.001) and EPI (r = 0.52,P less than 0.02). In the inhalation anesthesia group, plasma NE increased during the operation and plasma levels of NE, EPI, growth hormone, and cortisol were elevated during the postoperative recovery period. These neuroendocrine responses to surgical stress were not observed in patients receiving either low or high spinal anesthesia. Thus, the effect of spinal anesthesia on adrenergic tone depends on the cord level of anesthesia and can be quantitated by measurement of plasma catecholamines. The neuroendocrine responses to surgical stress were prevented in patients who received low spinal anesthesia and who had no suppression of efferent adrenergic tone. These findings indicate that neural afferents from the site of tissue injury, which were blocked by low spinal anesthesia, mediated both the adrenergic and the hormonal responses to surgical stress in the inhalation anesthesia group. (+info)
Surgical day care: measurements of the economic payoff.
(68/79)
A careful and detailed cost analysis that measured all the costs, direct and indirect, generated in the course of an episode of surgical care demonstrated that there are very large savings from the substitution of surgical day care for inpatient care. Surgical day care appears to be an ideal alternative to inpatient care, from the points of view of those who pay for medical care (governments) as well as those who provide it (hospitals and health professionals) and those who receive it (patients). From an economic perspective the potential savings have not been achieved, and present policies provide no incentives to encourage these savings. These problems, together with strategies to encourage cost savings, are discussed. (+info)
How long is your waiting list? Experience of a urological waiting list initiative.
(69/79)
Experience with a urological waiting list initiative is presented, wherein a list of 231 non-urgent cases was cleared over a 5 month period by a single operator. Some patients had waited 10 years for surgery. Following a postal request, the waiting list was validated; 31.2% of patients wished to be removed. The remaining 68.8% desired surgery and consisted of 51 requiring minor surgical procedures and 108 who needed more major surgery mostly for the relief of bladder outflow obstruction. Minor cases received dates for surgery; however, only 68.2% of this group attended despite being given more than one date for admission. Major cases were reviewed in a pre-admission clinic. General and urological condition was assessed, improved where necessary and surgery booked or delayed accordingly. A small number of patients did not attend or only attended to be reassured that surgery was not needed. Following clinical review, 18.5% of this group did not require operation. The long urological waiting list is a unique situation where patients listed may no longer require surgery. Reviewing these patients not only reduces numbers but also markedly increases percentage attendance for surgery. (+info)
Transient radicular irritation after spinal anaesthesia with hyperbaric 5% lignocaine.
(70/79)
We have studied prospectively 600 patients who had spinal anaesthesia for minor surgery, to evaluate the incidence of transient radicular irritation after the block. The anaesthetic agent (hyperbaric 5% lignocaine, hyperbaric 0.5% bupivacaine or plain 0.5% bupivacaine) was chosen according to the anticipated duration of surgery. We obtained information after operation from 537 patients (282 by telephone, 255 by letter). Ten percent of patients anaesthetized with hyperbaric 5% lignocaine (27 patients) had transient bilateral radiating pain in the lower extremities, buttocks, or both. Typically the pain started within 24 h after spinal anaesthesia, lasted less than 2 days and was described as mild. Lignocaine was the only variable that correlated with this pain. Two patients complained of symptoms after hyperbaric 0.5% bupivacaine but these were atypical compared with pain after lignocaine. None of the patients anaesthetized with plain bupivacaine had similar complaints. We conclude that the use of 5% hyperbaric lignocaine for spinal anaesthesia should be reconsidered. (+info)
Quality of minor surgery by general practitioners in 1990 and 1991.
(71/79)
BACKGROUND: The 1990 contract for general practitioners encouraged them to undertake minor surgical procedures in their practices. AIM: A study was undertaken to determine whether the subsequent expansion of general practitioner minor surgery activity was accompanied by changes in quality of care. METHOD: Data were analysed relating to minor operations conducted in 22 practices during April-June 1990 and April-June 1991. RESULTS: The volume of general practitioner minor surgery increased by 41% between the two study periods. Waiting time, accuracy of diagnosis, use of histology, adequacy of excision, complications and the need for corrective treatment in hospital did not change significantly between the two periods. CONCLUSION: The findings do not support suggestions that the expansion of general practitioner minor surgery activity following the 1990 contract has been associated with an erosion of quality of care. (+info)
Minor surgery by general practitioners under the 1990 contract: effects on hospital workload.
(72/79)
OBJECTIVE: To determine the extent to which minor surgery undertaken by general practitioners after the introduction of the 1990 contract substituted for hospital outpatient workload. DESIGN: Before and after observational study. SETTING: Four English family health services authorities. SUBJECTS: Patients in 22 practice populations who were operated on by their general practitioner or referred to hospital for minor surgery during April to June 1990 or April to June 1991. MAIN OUTCOME MEASURES: Numbers of minor surgical procedures undertaken in general practice and in hospital, numbers of referrals to hospitals for conditions treatable by a minor surgical procedure, and the mix of diagnoses and procedures undertaken in each setting. RESULTS: General practitioners claimed reimbursement for 600 minor surgical procedures during April to June 1990 and for 847 during April to June 1991, an increase of 41%. Referrals to hospital for comparable conditions showed no compensatory decrease (385 during April to June 1990 and 388 during April to June 1991, 95% confidence interval for change in referrals -51 to 57), and the number of hospital procedures resulting from those referrals also remained constant (187 in the first period, 189 in the second, 95% confidence interval for change in procedures -36 to 40). The mix of procedures did not change significantly from one study period to the next in either setting. CONCLUSIONS: Many or all of the additional patients receiving minor surgery under the terms of the 1990 contract may not have previously been referred to hospital. General practitioners seem not to have systematically shifted towards treating the more trivial cases. The overall increase in minor surgical activity may reflect an improvement in accessibility of care or changes in patients' perceptions and attitudes. (+info)