[Evaluation of perioperative risk by anaesthesiologists]. / Evaluation du risque périopératoire par les anesthésistes-réanimateurs.

OBJECTIVE: The aim of this survey was to evaluate anaesthesiologists' ability to quantify a given risk of perioperative morbidity. STUDY DESIGN: Descriptive study. METHODS: Nine hypothetical patients with well-defined single-organ failure related to three validated perioperative risk indexes (cardiac risk, respiratory-failure risk and cirrhosis decompensation) were described in vignettes and submitted to 30 anesthesiologists issued from two institutions and distributed in two groups (10 residents and 20 staff anesthesiologists). Physicians were asked to estimate the patient's risk using qualitative (scored using a categorical scale) and quantitative (scored using a number, i.e., the estimated frequency that a given complication would occur in the given case) evaluations of the considered risk for each case proposed. RESULTS: Both qualitative and quantitative evaluation of the most severe cases showed a tendency to underestimate respiratory and hepatic risks and a tendency to overestimate cardiac risk. No major difference in the accuracy of evaluations was found between trainees and staff anaesthesiologists. Both provided imprecise risk evaluation and had difficulty to define the expected level of risk, even for clear-cut clinical situations described in the vignettes. CONCLUSION: Both qualitative and quantitative evaluations were overall very imprecise. This survey showed that a rigorous evaluation of a patient's perioperative risk cannot be considered as intuitive and needs objective material supports to be performed.

[Anesthetic management of 52 deliveries in parturients with idiopathic thrombocytopenic purpura]. / Prise en charge anesthésique de 52 accouchements chez des parturientes atteintes de purpura thrombopénique idiopathique.

OBJECTIVES: To study the anesthetic management of parturients with idiopathic thrombocytopenic purpura (ITP) which is a frequent cause of thrombocytopenia in pregnant women and may lead to a dilemma since a low platelet count usually dictates not to perform epidural anesthesia. MATERIALS AND METHODS: We report a retrospective study assessing the anesthetic management of 39 parturients with ITP corresponding to 52 deliveries found in a database of 10,203 deliveries over a 52-month-period. RESULTS: On the day of delivery, 32 parturients (61.5%) had a platelet count less than 100,000/mm(3) and 19 (36.5%) received a neuraxial block. Six parturients with a platelet count less than 100,000 mm(3) (19%) received neuraxial analgesia. The lowest platelet count among women who received epidural analgesia was 88,000/mm(3). No anesthetic or neurological complication occurred. CONCLUSION: Regional anesthesia should not necessary be withheld in ITP when the platelet count is less than 100,000/mm(3).

Servicio Hotline SOS de Anestesia Locorregional: notificación de incidencias y resolución de dudas / Service of Hotline SOS of Regional Anesthesia: reporting of complications and seeking advice

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[Regionalization of obstetric services and anaesthetic workload in a tertiary level perinatal unit]. / Régionalisation des services d'obstétrique et charge de travail anesthésique lors des transferts in utero dans un centre périnatal de niveau III.

OBJECTIVE: Evaluation of anaesthetic workload associated with care of high-risk pregnant women (i.e. patients transferred to a referral perinatal center). STUDY DESIGN: A case-control prospective study. METHODS: During a three-month period, 63 women with in-utero transfer and their control counterparts (63 normal pregnancies) were prospectively followed until discharge. RESULTS: At inclusion, high-risk patients (n = 63) were more frequently scored ASA 2 or more (21 vs 0%, p < 0.05). ASA score had increased at delivery in 8% of high-risk women and in none of controls. ICU admission (4 vs none), Caesarean delivery (57 vs 11%), preanaesthetic visit at night (41 vs 0%) and general anaesthesia (27 % versus none) were all more frequent in high-risk parturients (p < 0.05). CONCLUSION: Comparison of the workload associated with high-risk patients and normal pregnant women confirms the need for increased anaesthetic staffing in referral perinatal centers and provides a basis for better understanding the distribution of anaesthetic requirements in each perinatal network.