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
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