Deborah S. Kitz

Hospital resources used for inpatient and ambulatory surgery.

New hospital and physician payment schemes encourage physicians to participate actively in efforts to minimize hospital resource use. As an example of the type of evaluations anesthesiologists may conduct, we examined hospital resources used for comparable groups of inpatients (INPTs) and day surgery unit (DSU) patients. Although INPTs and DSU patients undergoing surgical arthroscopy of the knee or diagnostic laparoscopy were similar with regard to age, physical status, and staff surgeon, more preoperative tests were performed for INPTs than for DSU patients (P < .05). Hospital costs for these tests were four times greater for INPTs than for DSU patients. Operating room time was from 20 to 45 min longer for INPTs than for DSU patients (P < .05). Recovery room time was from 25 to 52 min longer for DSU patients (P < .05). Per patient nursing labor costs paralleled operating and recovery room times. These kinds of analyses are important in identifying opportunities to improve resource use, in assessing institutional costs for surgical care, and in designing strategies that allow institutions and physicians to respond to cost containment pressures.

Arthroscopic surgery of the knee under local anesthesia

This report delineates the efficacy of local anesthesia in the performance of arthroscopic surgery of the knee. A retrospective review of 500 cases revealed that only three required administration of general anesthesia to successfully complete the procedure. A prospective study comparing fentanyl, midazolam, and fentanyl/midazolam combinations as intravenous supplements was performed. Meticulous surgical technique combined with local anesthesia and some form of intravenous sedation in minimal therapeutic dosage will provide satisfactory conditions to perform surgical arthroscopy of the knee.