G. M. M. Thoms

Clinical and economic choices in anaesthesia for day surgery: a prospective randomised controlled trial.

Summary We compared the cost‐effectiveness of general anaesthetic agents in adult and paediatric day surgery populations. We randomly assigned 1063 adult and 322 paediatric elective patients to one of four (adult) or two (paediatric) anaesthesia groups. Total costs were calculated from individual patient resource use to 7 days post discharge. Incremental cost‐effectiveness ratios were expressed as cost per episode of postoperative nausea and vomiting (PONV) avoided. In adults, variable secondary care costs were higher for propofol induction and propofol maintenance (propofol/propofol; p < 0.01) than other groups and lower in propofol induction and isoflurane maintenance (propofol/isoflurane; p < 0.01). In both studies, predischarge PONV was higher if sevoflurane/sevoflurane (p < 0.01) was used compared with use of propofol for induction. In both studies, there was no difference in postdischarge outcomes at Day 7. Sevoflurane/sevoflurane was more costly with higher PONV rates in both studies. In adults, the cost per extra episode of PONV avoided was £296 (propofol/propofol vs. propofol/ sevoflurane) and £333 (propofol/sevoflurane vs. propofol/isoflurane).

The global oximetry initiative

Global Oximetry (GO) is an initiative launched recently in Uganda, India, the Philippines and Vietnam. The overall aims are to promote oximetry utilisation and reduce oximetry costs in lower income countries. Research objectives include studying the feasibility of cost reduction; overcoming non‐cost barriers to global oximetry including issues of prioritisation; education and guidelines; servicing and access to parts. Promotional objectives include creating new policy, influencing oximetry design, and setting new global standards for safer monitoring.

The impact of increasing oximetry usage in India: A pilot study.

The overall goal of the global oximetry (GO) project was to increase patient safety during anaesthesia and surgery in low and middle income countries by decreasing oximetry costs and increasing oximetry utilisation. Results from the overall project have been previously published. This paper reports specifically on pilot work undertaken in four hospitals in one Indian State. The aim of this work was to assess the impact of increasing oximetry provision in terms of benefits to anaesthetists and in the identification of patient problems during anaesthesia, to identify training needs and to explore perceptions regarding barriers to more comprehensive oximetry coverage. Data collection was by interview with hospital staff, use of a log-book to capture data on desaturation episodes and a follow-up questionnaire at 10 months after the introduction of additional oximeters. Increasing oximetry utilisation in the four hospitals was viewed positively by the anaesthetic staff and enabled improvement in monitoring patients. Of the 939 monitored patients studied, 214 patients (23%) experienced a total of 397 desaturation episodes. For nearly half of the patients undergoing caesarean section under regional anaesthesia following a desaturation event supplementary oxygen was required. In 53 of the 379 female sterilisations (14%) desaturation episodes occurred and in eight patients, there were 17 episodes of desaturation due to obstruction. In the recovery room, 91 of the 939 patients were monitored using the oximeters with 12 patients (13%) requiring oxygen. This study has highlighted that pulse oximetry must be used even in patients having surgical procedures or caesarean section under regional or local anaesthesia as these procedures are associated with hypoxic episodes. Anaesthetists must ensure they are complying with the Indian Society of Anaesthesiologists monitoring standards for anaesthesia and ensure patients are monitored by pulse oximetry.