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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

Prevention of hypotension after spinal anesthesia for cesarean section: 6% hydroxyethyl starch 130/0.4 [Voluven] versus lactated Ringer's solution

The aim of this study is to compare the efficacy of HES 130/0.4, a new hydroxyethyl starch, to lactated Ringer's solution [LR] in the prevention of hypotension after spinal anesthesia for cesarean section [CS]. One hundred and twenty nonlaboring ASA I and II women having non urgent CS were enrolled in this prospective and randomized study. Subjects were randomly assigned to receive prior to anesthesia either 1 liter of LR [Gr I: n = 59] or 500 ml of HES 130/0.4 [Gr II: n = 61] Blood pressure was measured until discharge from the post anesthesia care unit. Hypotension was treated with IV boluses of 3 mg of ephedrine. The nausea scale was recorded. Arterial and venous umbilical blood gazes were obtained. Data were compared using Mann-Whitney U-test and Student's t-test [p < 0.05 was significant]. Thirty-nine patients in Gr II while 48 pts in Gr I experienced hypotension [p = .033]. The total dose of ephedrine was statistically smaller in Gr II compared with Gr I [p = .001]. Nausea after induction of spinal anesthesia occurred with similar frequency in both groups. Neonatal outcome was excellent and similar in both groups. HES 130/0.4 is more effective than LR to prevent hypotension following spinal anesthesia for CS; its routine use in this purpose should be considered

Obstetric admissions to the intensive care unit: an eight year review

Between 0.1 and 0.9% of women develop complications of pregnancy that require admission to an intensive care unit [ICU]. The purpose of this study was to review all obstetric patients admitted to the ICU over an 8-year period to determine the causes and outcomes of these admissions and the frequency and causes of maternal mortality. This retrospective study was based on all obstetric patients admitted to the ICU at Hotel-Dieu de France hospital [January 1998-December 2005]. Data collected includes maternal age, gestational age, parity, past medical and obstetric history, delivery data, indication for ICU transfer, complications, ICU length of stay and death during hospital-ization. Specific interventions were recorded. A total of 15 patients were admitted during the 8 years. The frequency of admissions was 0.24% of deliveries and obstetric patients represented 0.43% of all ICU admissions. The mean duration of stay in ICU was 7 +/- 5 days. The indications for admissions were preeclampsia [26.7%], sepsis [26.7%], obstetric hemorrhage [20%], cerebral encephalopathy [6.65%], amniotic fluid embolism [133%] and preexisting medical problems [6.65%]. Fourteen patients [93%] had invasive monitoring and 9 patients [60%] required ventilation. There were five deaths, representing 333% of obstetric ICU admissions. The need for maternal intensive care should be one of the most important measure considered in the quality of maternal care. Early admission and management of critically ill obstetric patients in the ICU may decrease maternal mortality and morbidity

Use of remifentanil and propofol without muscle relaxant combine with intrathecal morphine in children with duchenne"s muscular dystrophy undergoing spinal surgery

Duchenne's muscular dystrophy [DMD] is the most common and severe form of myopathy occurring in pediatric patients. Sensitivity of patients with DMD to sedative, anesthetic and neuromuscular blocking agents may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. Anesthetic management of these patients is challenging and may cause serious problems to the anesthesiologist. We report the use of a total intravenous anesthesia technique [TIVA] with remifentanil and propofol without muscle relaxants, associated with intrathecal morphine in three children with DMD undergoing posterior spinal surgery [PSS]. Tracheal intubation was successfully done with good conditions. The intraoperative course of these patients was uneventful. Controlled hypotension, rapid recovery and uneventful postoperative period were achieved with this tehnique. In conclusion, good conditions for tracheal intubation, controlled hypotension, rapid recovery and uneventful postoperative period can be achieved with this anesthesia technique in patients with DMD

accuracy of non-invasive nasal capnography in morbidly obese patients after bariatric surgery

To assess the accuracy of nasal capnography for the monitoring of ventilation in extubated morbidly obese patients, following bariatric surgery. prospective descriptive study. Post-anesthesia care unit. 25 consecutive morbidly obese patients admitted to the PACU after open bariatric surgery. Patients had a nasal cannula designed to administer oxygen [3 L/min] and to sample expired CO[2] by a coaxial catheter. Capnographic waveform, end-tidal CO[2] [ETCO[2]] and respiratory rate [RRd] were displayed by a capnometer [Datex-Ohmeda]. Arterial CO[2] pressure [PaCO[2]] was measured by blood gas analysis. Respiratory rate was measured by visual inspection of chest breathing motions [RRm]. Differences between PaCO[2] and ETCO[2] and between RRd and RRm were calculated for every simultaneous set of measurements. Bias, precision, limits of agreement [bias +/- 2 precisions] between PetCO[2] and PaCO[2] were respectively as follows: 3.1, 1.4, 0.3 to 5.9 mmHg with a Pearson correlation coefficient of 0.6 and a P value of 0.001. As for RRd v/s RRm the values were: 2, 0.5, 1 to 3 breaths per minute and 0.8 with the same P value for the Pearson coefficient. Limits of agreement between PaCO[2] and ETCO[2] pressure and between RRd and RRm are clinically acceptable. Nasal capnography is accurate for the monitoring of ventilation in extubated morbidly obese patients, following bariatric surgery

Addition of small doses of clonidine to bupivacaine in ilioinguinal and iliohypogastric nerve block following spinal anesthesia for inguinal herniorraphy

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