Aspects of recovery following day care anaesthesia : A clinical and experimental study
Abstract: A new test for the assessment of psychomotor recovery - the perceptive accuracy test - was designed and tested in a group of volunteers. It was found to be reproducible and not associated with any significant learning. Two hundred patients (ASA I-ll) undergoing day care arlhroscopic surgery were then studied in order to determine which anaesthetic technique is associated with the best recovery profile. No pharmacological premedication was given to any of the patients. The methodology was standardized in all studies so that the anaesthetic technique was similar between the groups, except for the study dmgs. Postural stability was measured following the injection of midazolam intravenously, using computerized dynamic posturography, Recovery was assessed using a combination of tests including a recovery scale, psychomotor tests and assessment of mood. Discharge times and post-operative complications were also recorded. Results showed that induction of anaesthesia with propofol followed by maintenance with isoflurane in oxygen and air, and alfentanil as analgesic, were associated with a good recovery profile. Maintenance of anaesthesia with propofol instead of isoflurane proved to be a satisfactory alternative. Early recovery was more rapid in patients anaesthetized with desflurane, but this group had a worse overall mood score, and a higher incidence of minor postoperative complications compared to the group in which anaesthesia was based on isoflurane. Postural stability was affected at 45 min after midazolam administration. The perceptive accuracy test was found to be sensitive in the detection of residual effects of anaesthetics, it was not associated with significant 'learning', it was easy to use, and the results obtained were 'on-line' and did not require tedious calculations.In summary, induction of anaesthesia with propofol followed by maintenance with isoflurane in oxygen and air, and alfentanil for analgesia is associated with rapid recovery, minimal post-operative complications and good overall mood scores. total intravenous anaesthesia based on propofol is a suitable alternative. Computerized dynamic posturography is a new method for studying balance disturbances. Perceptive accuracy test is sensitive in the detection of residual effects of anaesthetics but more studies are needed to describe its exact place amongst the battery of psychomotor tests.
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