Abbreviation English Vietnamese
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ASA American Society of Anesthesiologists
FASA Federated ambulatory surgery
association
IAAS International Association for
Ambulatory Surgery OAA/S Observer's Assessment of
Alertness/Sedation
p-LMA ProSeal laryngeal mask Air way
SAMBA The Society for Ambulatory
American Society of Anesthesiologists
Federal Ambulatory Surgery Association
International Society of Ambulatory Surgery
Sedation level in recovery room
Proseal laryngeal mask
Association of Ambulatory Anesthesia
TCI Target controlled infusion
VAS MADPE
MDPE BMI LBM
Visual Analogue Scale
Median Absolute Performance Error
Median Performance Error Body Mass Index
Lean Body Mass
Pain scale
Median of absolute performance values
Median deviation of performance Body Mass Index
Lean body mass index
Table 1.1. Performance of some methods with propofol 13
Table 1.2. Main pharmacokinetic parameters in the Marsh 20 model
Table 2.1. Evans PRST score 38
Table 2.2. Revised Aldrete criteria for leaving the recovery room 39
Table 2.3. Discharge criteria according to revised General 40
Table 2.4. OAA/S 41 Sedation Score
Table 3.1. Gender, age, weight and BMI 51
Table 3.2. ASA and Mallampati 52
Table 3.3. Location of ureteral stones 53
Table 3.4. Anesthesia time, intervention time 53
Table 3.5. Degree of anesthesia according to PRST in 2 groups 54
Table 3.6. Time assessment 55
Table 3.7. Propofol and fentanyl consumption 56
Table 3.8. Movement during anesthesia 57
Table 3.9. Machine adjustment in anesthesia 58
Table 3.10. Number of times MNTQ is placed 58
Table 3.11. Surgeon satisfaction according to reverse VAS 59
Table 3.12. Pain levels of patients at some points in the study 60
Table 3.13. Consciousness incidents and wishes for next anesthesia 60
Table 3.14. Discharge, overnight stay and readmission 61
Table 3.15. Brain NDĐ (Ce, µg/ml) of propofol at different time points in TCI group 62 Table 3.16. Changes in heart rate 63
Table 3.17. Change in HATT 64
Table 3.18. Change in HATTr 65
Table 3.19. Change in HATB 66
Table 3.20. Use of atropine, ephedrine and infusion 68
Table 3.21. Mean pressure and airway probe pressure 71
Table 3.22. Undesirable effects of MNTQ placement 71
Table 3.23. OAA/S score 72
Table 3.24. Postoperative complications 73
Figure 1.1. Compartment and direction of drug movement 9
Figure 1.2: Context-dependent half-life 10
Figure 1.3: Context-dependent half-life of opioid group 11
Figure 1.4. Relationship between NĐ and the effect of a drug 12
Figure 1.5: Alfentanil administration at the time of catheter placement and skin incision 13
Figure 1.6. 2,6-diisopropylphenol 16
Figure 1.7. Major metabolic pathways of propofol 17
Figure 1.8: Slow induction of anesthesia 21
Figure 1.9: Rapid induction of anesthesia 22
Figure 1.10: Step-by-step induction of anesthesia 22
Figure 1.11. ProSeal laryngeal mask (according to Brimacombe) 23
Figure 2.1. Datex-Ohmeda anesthesia machine and Nihon Kohden 33 monitor
Figure 2.2. Terumo TCI Machine (Japan) 33
Figure 2.3. B/Braun electric syringe pump (Germany) 34
Figure 2.4. VAS score 42
Chart 3.1. Changes in HATB at time points 67
Figure 3.2. Changes in SpO 2 at 69 time points
Figure 3.3. Changes in EtCO 2 at 70 minutes
PROBLEM STATEMENT
Ambulatory surgery was first described by Ralph Walters in 1919.
[135] and has developed rapidly in recent years. Outpatient surgery does not separate patients from their home environment, prevents hospital overload, limits infection and saves costs. The basis of outpatient surgery is safety and the same quality as inpatient surgery. The purpose of outpatient surgery is to quickly bring patients back to their families while still ensuring the highest efficiency and safety. This is an idea with profound humanistic meaning.
With the advent and continuous development of laparoscopic surgery, the advancement of anesthesia and resuscitation techniques and many new anesthetics with the ability to be eliminated quickly and with few side effects have created a leap forward in the field of anesthesia, making outpatient surgery develop more strongly than ever.
Recent studies have shown that the number of outpatients has exceeded the number of inpatients [107]. There is a sequential shift from inpatient to ambulatory surgery in surgical centers. It is predicted that in the future, hospitals will have more operating rooms and fewer hospital beds. The establishment of the Federal Ambulatory Surgery Association (FASA), the International Association for Ambulatory Surgery (IAAS, 1995) and the Society for Ambulatory Anesthesia (SAMBA, 1985) has demonstrated the great interest of society in a new surgical method with great potential waiting for human discovery.
Recently, target controlled infusion (TCI) with propofol is a new intravenous anesthesia method with many benefits such as smooth induction of anesthesia, stable anesthesia control, monitoring of drug amount and infusion rate, predicting recovery time, thus making anesthesia safer.
[103]. Worldwide, many studies on target-controlled propofol anesthesia for outpatient surgeries, including urological interventions, have been published.
Laryngeal mask airway is an airway support device that has been introduced in recent years with the advantages of rapid airway access, minimally invasive, and can be placed without muscle relaxation. Therefore, it has quickly replaced endotracheal tubes in most short and medium-sized surgical cases with very few unwanted effects[7], [40].
At the University of Medicine and Pharmacy Hospital in Ho Chi Minh City, the number of patients waiting for outpatient ureteral lithotripsy is very large. The advantage of this group of patients is that most can be performed endoscopically, the intervention time is short, natural sugars can be used and pain can be controlled orally.
In Vietnam, target-controlled propofol anesthesia has been applied for many surgeries in many different specialties. However, there has been no published work on target-controlled propofol anesthesia with laryngeal mask ventilation without muscle relaxants for outpatient retrograde ureteral lithotripsy.
Therefore, we conducted a study on the topic " Evaluation of the anesthetic efficacy and safety of target-controlled propofol anesthesia for retrograde ureteral lithotripsy in outpatients" with the following two objectives:
1. Comparison of anesthetic efficacy of target-controlled anesthesia with continuous propofol infusion controlled airway by ProSeal laryngeal mask airway for retrograde ureteroscopy lithotripsy in outpatients.
2. Evaluate the safety of the above anesthesia method.
Chapter 1
DOCUMENT OVERVIEW
1.1. OUTPATIENT SURGERY
1.1.1. Definition of outpatient surgery and anesthesia
1.1.1.1. Outpatient surgery
The terms “outpatient surgery,” “day surgery,” or “ambulatory surgery” refer to a patient who has been carefully selected and prepared, admitted to the hospital on the day of surgery for a non-emergency surgical procedure, and then discharged within a few hours of surgery.
An outpatient surgery (ISP) is a patient admitted to the hospital for surgery on a non-stay basis. However, it is emphasized that patients from far away should spend the first night at the surgical center [46].
1.1.1.2. Outpatient anesthesia
- Outpatient anesthesia is a separate field of anesthesia, responsible for patient care before, during and after surgery for patients undergoing PTNT.
Outpatient anesthesia is adapted to meet the needs of PTNT. Rapid-acting anesthetics, along with specialized anesthesia techniques and intensive care techniques focused on the goal of returning home the same day, help ensure that surgery is performed safely and with the same quality as inpatients [46].
1.1.2. Selecting patients for PTNT
1.1.2.1. Patient selection
These are patients under 70 years old, BMI ≤ 30 kg/m 2 , ASA I and II according to the classification of the American Society of Anesthesiologists.