OutpatientSurgery.net > April 2000

Disposables vs. Reusables: Does it Really Matter?
Disposable endoscopic biopsy forceps cost about the same as reusable ones, says a University of Southern California study.

Investigators tested disposable vs. reusable forceps in 100 biopsy sessions each. The diposable forceps cost $38 each. The reusable models cost $415 plus about $17 for each reprocessing session. Since the typical reusable instrument lasted for no more than 25 uses due to rusting, bent spikes and other problems, the cost worked out to between $58 and $37 per use, depending on longevity.

(Gastrointest Endosc 2000;51:3:266-70)

Yang R, Ng S, Nichol M. Lane

Anxiety Does Not Affect PONV
Children's preoperative anxiety has no bearing on whether they will experience nausea and vomiting postoperatively, according to a 51-patient Yale study.

Researchers studied kids scheduled for outpatient surgery under general anesthesia. They evaluated the children's anxiety preoperatively and during induction, then recorded instances of post-op nausea and vomiting. They found no connection.

(Anesth Analg 2000;90:3:571-5)

Wang SM, Kain ZN

Dexamethasone Reduces Vomiting
Dexamethasone after laparoscopic cholecystectomy may reduce nausea and vomiting, suggests a randomized, double-blind, placebo-controlled Taiwanese study. Researchers gave 8 mg of IV dexamethasone to half the study population and 2 ml of saline to the other half. A third of the patients in the saline group vomited post- operatively, compared to a tenth of the patients in the dexamethasone group.

(Br J Anaesth 1999;83:5:772-5)

Wang JJ, et al

Preemptive Analgesia of Limited Efficacy
Pre-emptive analgesia may only work in patients who are pain-free prior to surgery, suggests a Japanese study.

Investigators preoperatively administered either epidural morphine or saline in patients and maintained the treatment until skin closure.

They found preemptive anal-gesia to be significantly effective in patients undergoing removal surgery for a tumor, nail, or plate. But it was ineffective, regardless of pain level, in patients under-going fracture and arthritic surgery. They suggest that presurgical pain causes central sensitization, which lasts until surgery ends.

(Pain 2000;84:2-3:169-73)

Aida S, Fujihara H, Taga K, Fukuda S, Shimoji Kl

Steroids Reduce LASIK Complications
Surgeons should apply an intrastromal steroid during LASIK procedures in order to lower the incidence and sev-erity of nonspecific, diffuse intralamellar keratitis. So finds a 210-eye prospective California study.

Researchers divided LASIK patients into two groups. One got a drop of prednisolone sodium phosphate 1% solution to the flap's underside before ablation, and the other did not. Seventeen percent of non-steroid eyes developed non- specific diffuse intralamellar keratitis, vs. 7 percent of the eyes that received the steroid drop. In the latter group, the keratitis tended to be mild and unilateral, whereas in the former group it tended to be more severe and more often bilateral.

The authors advise applying the steroid cautiously so that none contacts the stromal bed.