UNASSIGNED: Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention.
UNASSIGNED: This randomised controlled trial recruited 106 adult patients (18-65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro-Wilk test, and the independent samples t-test or the Mann-Whitney U test was used to compare continuous variables. Fisher\'s exact test was used to assess any non-random associations between the categorical variables.
UNASSIGNED: The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups.
UNASSIGNED: A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA.

UNASSIGNED: Penile plication is commonly performed for Peyronie\'s disease under general or spinal anesthesia. Conscious sedation (CS) offers decreased anesthetic risks, cost-effectiveness, and the ability to perform the procedure in outpatient settings with shorter wait times. We sought to compare tolerability of penile plication under deep intravenous sedation (DIS) administered by anesthesiologists and nursing-administered CS (NACS).
UNASSIGNED: Tolerability for penile plication was prospectively evaluated, excluding revision surgeries and those with hourglass or hinge deformities. DIS included midazolam and ketamine with infusion of propofol and remifentanil. NACS consisted of midazolam and fentanyl. Baseline characteristics, procedural information, and patient- and surgeon-reported pain assessments were collected. Patients were administered a standardized tolerability questionnaire on follow-up.
UNASSIGNED: Forty patients were enrolled (23 DIS; 17 NACS) with similar baseline characteristics. Median curvature of the DIS cohort was 55° (interquartile range = 43.75-76.25) and 45° (interquartile range = 45-60) in NACS. There was a 100% success rate with no procedure abortion or conversion to general anesthetic. On follow-up, all patients had functional curvature (<20°), and 100% of patients in the DIS and NACS cohorts reported that they would recommend CS to others. Over 93% of patients in both cohorts would choose CS over general anesthetic in the future, with no differences in perioperative and postoperative pain between groups.
UNASSIGNED: Penile plication with CS, whether administered by an anesthesiologist or nursing, is well tolerated with no differences in pain or complications. This indicates that outpatient penile plication with trained nursing staff administering CS can safely reduce costs, risks, and wait times.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) is an achievement in the field of minimally invasive surgery. However, the vantage point of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologicalprocedures remains unclear. The main purpose of this study was to compare vNOTES with laparo-endoscopic single-site surgery, and to determine which procedure is more suitable for ambulatory surgery in gynecologic procedures.
METHODS: This retrospective observational study was conducted at the Department of Gynecology, Chengdu Women\'s and Children\'s Central Hospital. The 207 enrolled patients had accepted vNOTES and laparo-endoscopic single-site surgery in gynecology procedures from February 2021 to March 2022. Surgically relevant information regarding patients who underwent ambulatory surgery was collected, and 64 females underwent vNOTES.
RESULTS: Multiple outcomes were analyzed in 207 patients. The Wilcoxon Rank-Sum test showed that there were statistically significant differences between the vNOTES and laparo-endoscopic single-site surgery groups in terms of postoperative pain score (0 vs. 1 scores, p = 0.026), duration of anesthesia (90 vs. 101 min, p = 0.025), surgery time (65 vs. 80 min, p = 0.015), estimated blood loss (20 vs. 40 mL, p < 0.001), and intestinal exhaustion time (12.20 vs. 17.14 h, p < 0.001). Treatment with vNOTES resulted in convenience, both with respect to time savings and hemorrhage volume in surgery and with respect to the quality of the prognosis.
CONCLUSIONS: These comprehensive data reveal the capacity of vNOTES to increase surgical efficiency. vNOTES in gynecological procedures may demonstrate sufficient feasibility and provide a new medical strategy compared with laparo-endoscopic single-site surgery for ambulatory surgery in gynecological procedures.

Introduction: Preanesthesia teleconsultation helps reduce availability constraints as well as direct and indirect expenses. The TELECAM trial was performed to assess the quality of preanesthesia teleconsultation in terms of clinical parameters evaluation, feasibility, patient satisfaction and preoperative anxiety, and anesthesiologist satisfaction. Methods: TELECAM was an investigator-initiated, prospective, single-center, randomized, controlled, parallel group, evaluator-blinded, open-label study. Patients with a scheduled ambulatory surgery (orthopedic or hand surgery) were randomized into the in-person preanesthesia consultation group or the preanesthesia teleconsultation (conducted at the patient\'s home or workplace) group. The quality of the teleconsultation was evaluated through agreement on intubation difficulty, predictable mask ventilation difficulty, and American Society of Anesthesiologists (ASA) scores between the preanesthesia consultation and the preanesthesia in-person visit. Results: A total of 241 patients were included, and 208 were considered in the analyses. The feasibility of teleconsultation was high, with a feasibility ratio of 87.5%. The quality of the preanesthesia consultation regarding the evaluation of predictable intubation, mask ventilation difficulties, and ASA score, did not differ between the two groups (p = 0.23, 0.29, and 0.06, respectively). The preoperative satisfaction was higher for patients who had a preanesthesia teleconsultation (p = 0.04). Patients\' preoperative anxiety did not differ between the two groups (p = 0.90). The median satisfaction of the anesthesiologists who performed the teleconsultation reached a maximum of 10 (IQR: 8.0; 10.0). Conclusion: This study showed positive results for the quality of preanesthesia teleconsultation on the evaluation of clinical parameters, with high feasibility and satisfaction of the patients and anesthesiologists. The trial was registered in ClinicalTrials (NCT03470896).

BACKGROUND: Ambulatory surgery is often followed by the development of nausea and/or vomiting (N/V). Although risk factors for postoperative nausea and vomiting (PONV) are frequently discussed, the distinction between PONV and postdischarge nausea and vomiting (PDNV) is unclear. This is especially troublesome given the potential consequences of postdischarge nausea and vomiting (PDNV), which include major discomfort and hospital readmission.
METHODS: In this retrospective cohort study, data from 10,231 adult patients undergoing ambulatory ophthalmology or otolaryngology procedures with general anesthesia were collected and analyzed. Binary and multinomial logistic regression was used to assess the association between patient and anesthetic characteristics (including age, body mass index (BMI), American Society of Anesthesiologists Physical Status (ASA P/S) classification, current smoker status, and intra- and postoperative opioid usage) and the odds ratios of experiencing only PDNV, only PONV, or both PONV and PDNV, as compared to not experiencing N/V at all.
RESULTS: We found that 17.8% of all patients developed N/V (PONV and/or PDNV). Patients who experienced PONV had a 2.79 (95% confidence interval 2.24-3.46) times greater risk of reporting PDNV. Binary logistic regression found that younger age, opioid use, and female sex were associated with an increased likelihood of experiencing any N/V. Increased use of nitrous oxide and a higher ASA P/S class was associated with elevated likelihood of PONV, but not PDNV or PONV plus PDNV.
CONCLUSIONS: Patients experiencing N/V in the PACU are observed to develop PDNV disproportionately by a factor of 2.79. The patients have distinct predictors, indicating important opportunities for care improvements beyond current guidelines.

BACKGROUND: Enhanced recovery after surgery pathways are essential for ambulatory surgery. They usually recommend lower intraoperative opioid use to avoid opioid-related adverse effects. This has led to opioid-sparing anaesthesia (OSA) techniques, with the extreme approach of opioid-free anaesthesia (OFA) mostly with dexmedetomidine. As evidence is lacking in day-case primary total hip arthroplasty, this study was performed to assess the potential benefits in postoperative analgesia of OFA over OSA.
METHODS: In this single-centre, prospective, triple blind study, we randomly allocated 80 patients undergoing day-case primary THA under general anaesthesia. Patients received a total intravenous anaesthesia with a laryngeal mask and multimodal analgesic regimen with non-opioid analgesics. The OSA group received low dose of sufentanil, and the OFA group received dexmedetomidine The primary outcome was the opioid consumption in the first 24 h in oral morphine equivalents (OME).
RESULTS: There was no difference in median cumulative OME consumption at 24 h between the OSA and OFA groups (12 [0-25] mg vs 16 [0-30] mg, respectively; P=0.7). Pain scores were similar and low in both groups with comparable walking recovery time. Adverse events were sparse and equivalent in both groups except for dizziness, which was more frequent in the OSA group (P<0.05).
CONCLUSIONS: In day-case total hip arthoplasty under general anaesthesia, opioid-free anaesthesia and opioid-sparing anaesthesia both provide early recovery and effective postoperative pain relief. When compared with opioid-sparing anaesthesia, opioid-free anaesthesia does not decrease opioid consumption in the first 24 h. These findings do not suggest any significant benefit from complete intraoperative avoidance of opioids.
BACKGROUND: NCT0507270.

UNASSIGNED: Establishing the optimum dose of intrathecal 1% 2-chlorprocaine may reduce the discharge time and encourage more widespread use of spinal anesthesia for day care procedures. The aim of this study was to compare the efficacy and recovery characteristics of three different doses of intrathecal 1% 2-chlorprocaine for short gynecological day care procedures.
UNASSIGNED: Fifty-one patients scheduled for elective day care gynecological procedures lasting less than 60 min and were randomly divided into three groups of 17 each to receive 35 mg, 40 mg, or 45 mg intrathecal 1% 2-chlorprocaine. Demographic data, time required to achieve readiness for surgery, time required to attain discharge criteria, maximum block height achieved, and adverse effects were recorded in each group.
UNASSIGNED: The time required to achieve readiness for surgery was similar between the three groups (P = 0.306). However, 35 mg group required the shortest time to ambulate and there was a significant difference as compared with both 40 mg (P = 0.012) and 45 mg (P = 0.001). Voiding and the fulfillment of the discharge parameters were also attained more rapidly in the 35 mg group [133 (120,155) min] as compared with both 40 mg [164 (145,175) min, P = 0.000] and 45 mg [160 (150,175) min, P = 0.000]. None of the patients reported neurological symptoms during the follow-up.
UNASSIGNED: The 35 mg intrathecal 1% 2-chlorprocaine not only provides reliable anesthesia for short gynecological procedures but also facilitates faster achievement of the discharge parameters as compared with the 40 mg and 45 mg doses.

OBJECTIVE: This aim of this study was to compare two anesthetic regimens in terms of extubation time and postoperative recovery in children undergoing ambulatory adenoidectomy.
METHODS: A retrospective cohort study with propensity score matching.
METHODS: The medical charts of 452 children aged between 3 and 8 years undergoing ambulatory adenoidectomy were retrieved for analysis, of which 438 were eligible to participate in this study. A majority (n = 327) were children exposed to a conventional propofol-pronounced general anesthetic regimen (high-dose propofol plus low-dose remifentanil, labeled as group P), while n = 111 were administered a modified remifentanil-pronounced anesthetic regimen (low-dose propofol plus high-dose remifentanil, namely group R). Propensity score matching was employed to adjust for confounders, resulting in 69 matched patients in each group. The primary endpoint of this study was extubation time. The secondary endpoints were total intraoperative fluid volume, length of stay in the postanesthesia care unit (PACU), postoperative pain rating, the incidence of emergence agitation, nausea and vomiting, as well as the level of consciousness (fully awake or waking by gentle patting) when transferred out of PACU, and any major complications (wound bleeding, reintubation, readmission, and overnight stay).
RESULTS: No major complications were observed in both groups. Compared to group P, group R had significantly shorter extubation time (8.2 ± 1.4 minutes vs 13.3 ± 2.4 minutes, P < .001), shorter length of stay in the PACU (14.1 ± 3.1 minutes vs 20.2 ± 3.4 minutes, P < .001), and a higher proportion of cases being fully awake when transferred out of the PACU (91% vs 46%, P < .001). Lastly, the pain rating, frequency of oropharyngeal airway usage, incidence of emergence agitation, and nausea and vomiting were comparable between the two groups (P > .05 for all).
CONCLUSIONS: Remifentanil-pronounced anesthesia was superior to propofol-pronounced anesthesia in children undergoing ambulatory adenoidectomy, given that the former was associated with a faster recovery time from anesthesia without jeopardizing patient safety.

UNASSIGNED: Shoulder arthroplasty is mostly performed as an inpatient procedure. Same-day discharge arthroplasty has shown positive results in hip and knee surgery. Primary objective of this study was to investigate whether a safe and satisfactory same-day discharge (SDD) can be predicted with a set of easy to use predefined criteria, without increasing complications and re-admissions.
UNASSIGNED: This study was a prospective cohort study. Patient selection criteria were: <85 years old, ASA 1, 2, and mild ASA 3. Primary outcome variables were successful SDD, complications, re-admissions and patient satisfaction. Secondary outcomes were patient-reported outcome scores. The results are compared with the inpatient cohort.
UNASSIGNED: In total, 163 patients were treated for elective shoulder arthroplasty. Of which 51 patients were selected for same-day discharge arthroplasty. 94% of pre-planned same-day discharge arthroplasty patients were discharged on the day of surgery. In the same-day discharge group, there were no complications related to the early discharge and a 2% readmission rate as opposed to a 3% readmission rate in the inpatient group. Surgery related as well as medical complications did not differ between the same-day discharge and inpatient cohort.
UNASSIGNED: Same-day discharge shoulder arthroplasty is a safe and satisfying treatment option in selected patient groups.

BACKGROUND: Saddle block anesthesia (SBA) is a frequently preferred method for ambulatory anorectal surgery. This study aimed to observe the effects of two different dose SBAs on discharge times and perioperative block characteristics in patients undergoing ambulatory anorectal surgery.
METHODS: The study was conducted as a prospective, randomized controlled study. Patients over the age of 18 who were scheduled for ambulatory anorectal surgery and had American Society of Anaesthesiologists (ASA) physical status I and II were included in the research. Patients were divided into two groups: 5 mg hyperbaric bupivacaine 0.5% (Group I; n=34) and 3 mg hyperbaric bupivacaine 0.5% (Group II; n=34). The primary outcome was discharge time. Characteristics of the spinal block like time to reach S4 blockade, maximum blocked dermatome, regression time of sensorial, first analgesic need time, voiding time, mobilization time, and side effects were the secondary outcomes.
RESULTS: Sixty-eight patients were included in the study. The groups were similar in terms of demographic and surgical characteristics (p > 0.05). In Group II, S4 sensory dermatome blockade time was statistically longer (p: 0.007) and the time to the disappearance of the sensory block was statistically shorter (p < 0.001). Also, voiding time and discharge times were statistically shorter in Group II (p: 0.049, p < 0.001, respectively).
CONCLUSIONS: SBA provided adequate anesthesia, and the complication rates were limited. Saddle block can be considered an advantageous technique because of conditions that adversely affect recoveries, such as postoperative cognitive problems, nausea, and vomiting due to general anesthesia. In addition, better recovery results and optimal surgical condition with 3 mg hyperbaric bupivacaine in our study suggest that this dose may be a good alternative.