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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

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

Outcome of cancer patients admitted to the intensive cave unit [ICU].

This is a retrospective study aiming to determine the cause, the survival and the factors influencing survival in cancer patients admitted to an ICU. Between January 1998 and June1999, 181cancer patients were admitted to the ICU of HDF hospital [a general academic hospital of 300 beds]. One hundred fifteen patients were admitted after surgery and 66 for medical reasons. Among the non-surgical group, 37 had solid tumors and 29 had hematological malignancies. Most of non-surgical patients were admitted for respiratory or infectious complications due to their disease or treatment-related [59 patients]. Among the non-surgical group of patients, 44 required mechanical ventilation [MV]. The mortality rate was 41% during ICU recovery, 62% during the hospitalization period, 73% at 2 months from discharge and 83% at last follow-up. The duration of stay in the ICU was the only factor affecting mortality. Age, disease type and MV did not influence the mortality rate in this population