ABSTRACT
Introduction: Preoperative anesthesia evaluation is an important step in the management of the surgical patient, and must be integrated in a risk stratification strategy. Systematic preoperative workup alone has shown little value and is not a substitute to detailed history and physical exam
Study design: A national survey on preoperative patient evaluation by Lebanese anesthesiologists has been submitted focused on the cardiac evaluation and preoperative coagulation studies
Results: A total of 250 questionnaires were sent, 91 anesthesiologists responded. For preoperative cardiac evaluation, 75% of anesthesiologists referred patients over 60 years to the cardiologist, and more than 80% did so in stable cardiac patients. As for the bleeding risk evaluation, a detailed bleeding history was performed by 73% of anesthesiologists. Coagulation studies were ordered systematically by 44% of responders regardless of the type of surgery, and was up to 84% for spinal anesthesia. In babies, 34% of anesthesiologists ordered coagulation studies. Furthermore, 80% of anesthesiologists acknwoledged that specialized consultation and systematic coagulation workup do not decrease their responsibility
Conclusion: Our survey demonstrated a lack of knowledge or non compliance with international guidelines. Implementation of national guidelines should be considered
ABSTRACT
Addition of clonidine to bupivacaine improves and prolongs analgesia following central blocks. In peripheral nerve blocks, divergent results have been reported. The aim of this study was to determine the efficacy of clonidine mixed with bupivacaine on postoperative analgesia provided by an ilioinguinal and iliohypogastric nerve block following herniorrhaphy in adult patients. After institutional approval and informed consent, 60 adult patients scheduled for unilateral inguinal herniorrhaphy under spinal anaesthesia were included in this prospective and randomized study. At the end of surgery, patients received an ilioinguinal and iliohypogastric block with 20 ml of 0.25% bupivacaine mixed with 1 mcg/kg of clonidine [group I] or mixed with 1 ml of 0.9% saline [group II]. Visual Analogue Scores [0-10 cm] at rest and during mobilization, sedation, hemodynamic variation and first analgesic request were recorded at 2, 6, 12, 18 and 24 postoperative hours. Statistical analysis was performed by two-way ANOVA, Fisher, Student and Mann-Whitney tests. P
ABSTRACT
Goal of the study: Lumbar micro discectomy surgery is already performed under spinal anesthesia [SA] in many institutions. The aim of this study is to compare the quality of analgesia and recovery after SA when compared to general anesthesia [GA] after lumbar microdiscectomy surgery. methods: Following light sedation, SA is performed with the patient in the left lateral decubitus position, one to two levels above the herniated disc level. Isobaric 0.5% bupivacaine 3-3.5 ml was injected intrathecally followed by wound infiltration with 15 ml of bupivacaine with 1/200 000 epinephrine prior to surgical incision. Despite randomization, we found significantly more females in the GA group. Pain scores at 4 and 8h postoperatively were lower in SA group as well as total analgesic consumption during the first 24 h. Postoperative recovery including time to drinking, eating and walking were more rapid after SA when compared to GA. During the postoperative period, the incidence of urinary retention was comparable between groups but the occurrence of postoperative nausea and vomiting was significantly higher in the GA group. Moreover, the overall patient's and surgeon's satisfaction were significantly better in the SA group. SA associated to wound infiltration using bupivacaine is an interesting alternative to general anesthesia for outpatient lumbar microdiscectomy surgery