[Anesthesia for video-assisted surgery of the thoracic and lumbar spine: a survey of 44 patients]. / Anesthésie pour chirurgie vidéoassistée du rachis thoracolombaire.

INTRODUCTION: The development of video-assisted surgery of the dorsolumbar spine has led to the need for adaptations for appropriate anesthetic management. Data concerning anesthesia for such surgery is very sparse in the literature. AIM OF THE STUDY: The aim of this retrospective study of 44 patients was to learn more about anesthesia practices used for patients undergoing this type of surgery. PATIENTS AND METHOD: The files of 44 patients were studied retrospectively. Epidemiologic data and the perioperative phase were analysed. RESULTS: The preoperative phase was not specific with preoperative assessment adapted to each patient. Similarly, monitoring practices during the surgical procedure were not specific. The choice of the anesthetic agents depended on the patient's clinical status. For tracheal intubation, care was taken to enable lung exclusion, even if not often used. Thoracic drainage at the end of the surgery was required in the event of imperfect hemostasis and in selected patients was replaced by pneumothorax exsufflation during closure. The postoperative period was uneventful and did not require admission to intensive care; non-specific analgesia was used. DISCUSSION: Adaptations of anesthetic practices are required each time a new surgical technique is developed. Excepting lung exclusion, anesthesia for video-assisted dorsolumbar spine surgery is not specific.

[Risk assessment before non-cardiac surgery: what do anesthesiologists expect from cardiologists?]. / Evaluation du risque cardiologique en vue d'une anesthésie pour une chirurgie non cardiaque: qu'attend le médecin anesthésiste-réanimateur de la consultation spécialisée auprès d'un cardiologue?

Patients with a cardiac pathology are at high risk of perioperative cardiac complications. Therefore, an evaluation of the cardiac risk before a non-cardiac surgery has to be performed. The importance of the risk depends on the type of surgery, the patient's clinical symptoms and his adaptation to a physical effort. Exams are chosen according to the pathology, the information searched for and should be non invasive. After the evaluation, a specific preparation of the patient and the institution or an adaptation of cardioprotective medications should be discussed. The cardiologic consultation also allows a better management of antithrombotic or antiplatelet therapy. Preoperative evaluation of the cardiac risk is based on the collaboration between cardiologist and anesthesiologist to select the patients to evaluate, optimize their management, and decrease the risk of complications.