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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

Tissue oxygen saturation [StO2] is not correlated with mixed venous oxygen saturation [SvO2] and fails to detect adverse events during and after coronaryartery bypass graft [cabg] surgery

Introduction: Mixed venous oxygen saturation [SvO2], is an invasive monitoring technique that reflects the balance between systemic oxygen transport and tissue oxygen consumption. Whereas tissue oxygen saturation [StO2] is a noninvasive technique that allows early detection of tissue hypoperfusion. The purpose of this study is to evaluate StO2 in patients undergoing elective coronary surgery: single cardiopulmonary bypass [CPB], and to find a correlation between StO2 and SvO2

Material and Methods: All patients scheduled for elective coronary surgery from May to July 2013, were included in the study. The anesthetic management and hemodynamic monitoring were the same. The following parameters: BP, HR, CI, SaO2, SvO2, StO2 at the eminence thenar, Hb and deltaPCO2 were monitored at the following times: T1: before anesthesia induction, T2: after induction, T3: 30 min after the beginning of CPB, T4: after the weaning from CBP, T5: H 12, at D1, D2 and at the occurrence of an adverse outcome such as anemia, hypotension, arrhythmia, hypoxia, fever with or without chills

Results: Forty-five patients were included in this prospective study. Forty patients had 63 events: low cardiac output, isolated hypotension, hypoxia, anemia, AFib and atrial flutter. There was no statistically significant difference in StO2 from pre-induction till up to 2 days postoperatively, except after the weaning from CPB and 12 hours postoperatively. No correlation was noted between SvO2 and StO2 during the events that occurred both during and after the operation

Conclusion: Microcirculation at the eminence thenar may be altered after CPB. This fact is reflected by the decrease in StO2 that was noted immediately after CPB and that returned to normal 12 hours postoperatively. However, StO2 is not correlated with SvO2 upon the occurrence of an event during or after elective cardiac surgery. Further studies are needed to show the benefit of this noninvasive monitoring in cardiac surgery

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

Hyperthermie maligne per operatoire: a propos d'un cas

Malignant hyperthermia [MHS] is a rare potentially fatal complication of general anesthesia. Anesthetic agents most frequently incriminated are succinylcholine and halogenated agents. Respiratory acidosis is the most specific and sensitive sign. Hyperthermia per se may occur secondarily or may stay totally absent. Tachycardia and/or arrhythmias often develop due to hyperkaliemia and metabolic acidosis. Muscle rigidity whenever present is pathognomonic the gold standard test for the diagnosis of MHS is the halothane caffeine contracture test. Dantrolene is the treatment of choice and prognosis depends on the early administration of this agent