RESUMO
OBJECTIVE: To see if transporting paediatric patents to operation theatres using a battery operated vehicle decreases preoperative anxiety and reduce incidents of postoperative adverse events. METHODS: The study was conducted from May to August 2019 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised paediatric patients aged 3-5 years assessed as American Society of Anaesthesiologists grade I and II who were scheduled to undergo elective intrathecal chemotherapy under general anaesthesia. The subjects were randomised into intervention group A and control group B. Patients in group A were part of an incentive-based game in the holding bay area and were transported to the operation theatre using a battery-operated toy vehicle. Those in group B watched a pre-decided cartoon on television screen in the holding bay and were transported further using wheel chair. Induction of anaesthesia was done in the presence of guardians in both the groups. Patient anxiety was assessed using the modified Yale Preoperative Anxiety Scale in holding bay area T0, prior to induction of anaesthesia T1, and postoperative anaesthesia-related recovery T2. Data was analysed using SPSS 22. RESULTS: Of the 36 patients, 18(50%) were in group A; 12(66.6%) boys and 6(33.3%) girls with mean age 4.01±0.48 years. The remaining 18(50%) subjects were in group B; 13(72.2%) boys and 5(27.8%) girls with mean age 3.96 years. The difference in anxiety between the groups at T0 was non-significant (p=0.73). At T1 and T2, the scores were significantly lower group A compared to group B (p<0.05). Group A patients had better bag mask ventilation compliance at induction and remarkably less incidence of hypoxia, bronchospasm, postoperative agitation and early discharge from PACU. CONCLUSIONS: Incentive-based game therapy decreased anxiety among paediatric patients preoperatively, made them more compliant and improved postoperative recovery.
Assuntos
Ansiedade , Motivação , Masculino , Feminino , Criança , Humanos , Pré-Escolar , Ansiedade/prevenção & controle , Anestesia Geral , PaquistãoRESUMO
BACKGROUND: Among all the abdominal cancers, pancreatic cancer is the second most common one. Majority of the patients present with an excruciating pain when they are diagnosed with the disease. Coeliac plexus neurolysis (CPN) is a procedure that can control the pain in pancreatic cancer while precluding further consumption of analgesics in higher doses and quantity. The procedure of neurolysis is performed by injecting phenol/alcohol into the coeliac plexus ganglionic neural network. There is a high proportion of pain relief with CPN in up to 80% of the patients. AIM: The aim of our study is to assess the pain relief after CPN, reduction in analgesics consumption and evaluation of patient satisfaction post procedure. METHODS: A cross sectional study was done and we collected the retrospective data from December 2016 to November 2017. A total of 35 patients of either gender (male and female) were included in this study. Neurolysis was done with transcrural approach using 6% phenol. Follow up of patients was done after 1 and 4 weeks of the procedure. The patients were evaluated for pain scores on numeric rating scale (NRS), reduction in analgesia and patient satisfaction regarding the procedure and pain relief. The analysis was based on mean values. RESULTS: Total numbers of patients were 35. The mean age was 54.11±12.51 (SD) years with a male to female percentage of 31.43% and 68.57%. Follow up was done after 1 week and 4 weeks. Patients reported decrease in mean pain score (1 from 9 in Males and 0 from 9 in Females), reduction in analgesics (81.8% among Males and 18.2% among Females) and over all patient's satisfaction was (72.7% Males and 27.3% Females). CONCLUSIONS: It has been observed from the results that CPN works effectively for pancreatic cancer patients. There is a strong recommendation of neurolysis in patients with pancreatic cancer pain as it improves the pain scores, significant reduction in analgesia consumption with good patient satisfaction.