Discharge Criteria and Complications After Day Care Surgery.

Abstract

Aim of study: Determining essential components of an effective discharge scoring system, discussing potential complication and its prevention and treatment during day care anaesthesia and comparing relative importance of propofol and thiopentone sodium in day care anaesthesia as their role in early discharge and better recovery. Material and method: 100 patients of ASA grade I and II to be divided into two groups of 50 each. Group I received Inj. Propofol 1.5mg/kg and group II received Inj thiopentone sodium 5mg/kg intravenously as induction agent. Short diagnostic surgical procedures less than 20 minutes were included. After completion of surgery patients were assessed for the recovery phase. Phase 1 recovery time: Discontinuation of anaesthesia to recovery of protective reflexes. Phase 2 recovery time: Patients assessed in recovery room with the help of the modified aldrete scoring system at 0, 5, 10, 15 and 20 minutes. We observed various complications like nausea, vomiting, pain, headache, difficulty in voiding urine, drowsiness and hangover. Patients were discharged after they have no complains. Results: Phase1 mean recovery time in group I was 8.77±1.66 minutes as compared to group II it was 11.18±2.61 minutes. Modified aldrete score for phase II recovery in group I was 6.39±0.97,8.17±0.69,9.71±0.25,10±0,10±0 at 0,5,10,15,20 minute respectively while in group II score was 4.77±0.97,5.88±0.96,6.88±0.87,8.52±0.65,9.87±0.33 at 0,5,10,15,20 minutes respectively (P value <0.0001). Discharge time for group I varies from 110 to 160 minutes with mean time of 136.98±11.46 minutes as compared to group II it was 135 to 195 minutes with mean time of 164.5±12.22 minutes (P value <0.0001). In group I complain of pain, nausea and vomiting, headache found in 23,6,2 patients respectively while in group II pain, nausea and vomiting, headache, dizziness and hangover was higher as 28,11,3,2,1 respectively. Conclusion: Propofol is safe anaesthetic drug for early patient discharge in day care unit compare to thiopentone sodium. Proper preoperative preparation, intra operative anesthetic management and proper monitoring enhance the recovery. Each anesthetist should develop the technique that permits the patients to undergo the surgical procedure with minimal stress and maximum comfort and optimize his/her chance of early discharge.