Thorne A C, Malbin K F, Jain M, Stewart M, Gulati S C
Department of Anesthesiology, Cornel University Medical College, New York, NY, USA.
J Clin Anesth. 1996 Nov;8(7):551-6. doi: 10.1016/s0952-8180(96)00120-1.
To assess the experience with autologous bone marrow harvesting in outpatients.
Retrospective analysis of outpatients who underwent autologous bone marrow harvesting from 1990 to 1992.
University-affiliated surgical day hospital.
235 outpatients who underwent 264 autologous bone marrow harvests. Patients are candidates for autologous bone marrow harvesting on an outpatient basis if they are Karnofsky performance status of 80-100 and ASA status I, II or III.
The incidence of perioperative complications and hospital admission from the Surgical Day Hospital, the duration of the harvesting procedure and postanesthesia care unit (PACU) stay, details of the postoperative pain management, and costs and charges of the outpatient procedure compared with the same procedure performed on inpatients were assessed. Mean age was 37.7 years +/- 10.5 SD; + 7.7% patients were male and 52.3% were female. The disease process included non-Hodgkin's lymph/ma (30.3%), leukemia (24.3%), metastatic breast cancer (18.4%), Hodgkin's disease (17.3%), testicular carcinoma (6.5%) and other (1.6%). The patients were ASA status II (54.5%) or ASA III (45.5%) and received general endotracheal anesthesia. Each patient had 10.7 ml/kg +/- 2.8 SD of marrow harvested over a period of 110.7 minutes + 30.4 SD and total recovery room time of 233.7 minutes +/- 85.5 SD. Of 251 harvest, only three (1.1%) required hospital admission. PACU complaints included transient hypotension and dizziness (5.3%), nausea (3.8%), vomiting (3.4%), and (1.9%) temperature elevation. 83.7% of patients were reached at home the following day and 4.1% complained of nausea and/or vomiting at home. 6.8% of patients experienced temperature elevation at home. Only 27.1% of patients took the acetaminophen with codeine that was prescribed. The reminder required no opioid at home. Outpatient charge/ inpatient charge was 51.1%, and outpatient cost/inpatient was 74.4%.
Autologous bone marrow harvesting is an acceptable ambulatory surgical procedure that results in a very law postanesthesia complication rate. Postoperative pain is easily controlled. The outpatient setting offers cost and time advantages to the patient.
评估门诊患者自体骨髓采集的经验。
对1990年至1992年接受自体骨髓采集的门诊患者进行回顾性分析。
大学附属外科日间医院。
235例门诊患者接受了264次自体骨髓采集。如果患者的卡氏功能状态为80 - 100，美国麻醉医师协会（ASA）分级为I、II或III级，则为门诊自体骨髓采集的候选者。
评估外科日间医院围手术期并发症和住院率、采集过程持续时间和麻醉后恢复室（PACU）停留时间、术后疼痛管理细节以及门诊手术与住院患者相同手术的费用和收费情况。平均年龄为37.7岁±10.5标准差；男性占7.7%，女性占52.3%。疾病类型包括非霍奇金淋巴瘤（30.3%）、白血病（24.3%）、转移性乳腺癌（18.4%）、霍奇金病（17.3%）、睾丸癌（6.5%）和其他（1.6%）。患者的ASA分级为II级（54.5%）或III级（45.5%），接受全身气管内麻醉。每位患者在110.7分钟±30.4标准差的时间内采集了10.7毫升/千克±2.8标准差的骨髓，麻醉后恢复室总停留时间为233.7分钟±85.5标准差。在251次采集中，只有3例（1.1%）需要住院。PACU的不适包括短暂性低血压和头晕（5.3%）、恶心（3.8%）、呕吐（3.4%）和体温升高（1.9%）。83.7%的患者第二天在家中被回访，4.1%的患者在家中抱怨恶心和/或呕吐。6.8%的患者在家中出现体温升高。只有27.1%的患者服用了处方的对乙酰氨基酚可待因。其余患者在家中无需使用阿片类药物。门诊收费/住院收费为51.1%，门诊费用/住院费用为74.4%。
自体骨髓采集是一种可接受的门诊手术，麻醉后并发症发生率极低。术后疼痛易于控制。门诊手术为患者提供了成本和时间优势。
