Journal of perioperative practice
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Aspiration pneumonitis (AP) is a recognised complication of general anaesthesia (GA) that has an associated morbidity and mortality. Sellick's manoeuvre--the application of a sustained pressure to the cricoid cartilage--is one commonly taught anaesthetic practice that is deemed to reduce this risk of aspiration. However, this practice is not without its failings and some of the evidence base surrounding the use of cricoid pressure is examined in this short article.
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In excess of 100,000 inguinal hernia repairs are performed in the UK each year (Devlin & Kingsnorth 1998). It is the most commonly performed general surgical procedure and is routinely undertaken in patients receiving local anaesthesia in the day case setting. ⋯ The differences between the traditional and laparoscopic repair of hernias are explored as well as the use of materials such as polypropylene mesh to enhance the repair. The need for thromboprophylaxis and antibiotic therapy are outlined together with patient discharge advice.
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The Department of Health (DH) proposes that 75% of elective surgery should be performed as a day case procedure (NHS Plan 2000). To achieve this some modification of the traditional selection criteria may be required and careful thought given to the patient pathway, including the anaesthetic technique. ⋯ Suitable patients need to be selected (Digner 2007), prepared both physically and psychologically, undergo minimally invasive surgery with a suitable anaesthetic technique encompassing good pain relief and the avoidance of postoperative nausea and vomiting (PONV). Pain and PONV are the most common causes for a patient to require unplanned admission (Junger 2001).
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Two of the advantages of day surgery are less disruption to patients' lives and the comfort of recovering at home. However, despite advances in analgesic and anaesthetic techniques, pain following day surgery is not well managed: recent studies have shown that between 30-60% of patients suffer moderate to severe pain during the first 24 hours after discharge home following day surgery (Beauregard et al 1998, McGrath et al 2004, Pavlin et al 2004). A significant proportion of patients (25-30%) continue to report pain of this severity at seven days following day surgery (Beauregard et al 1998, Watt-Watson 2004). This article reviews published studies of patient experiences of pain and analgesia consumption after day case surgery and provides a model for the introduction of standardised take-home analgesic packs.