[A scale of perioperative satisfaction for anesthesia. II--Preliminary results]. / Echelle de vécu périopératoire de l'anesthésie. II--Résultats préliminaires.

PURPOSE: To assess the patient's experience of anaesthesia in the early postoperative period, with a self-completed questionnaire (Evan). STUDY DESIGN: Descriptive and evaluative study. PATIENTS: The study included 742 adults undergoing an elective surgical or non surgical procedure under anaesthesia. METHODS: An Evan questionnaire with 25 questions was completed 24 hours after anaesthesia by the patient. The questionnaire explored six areas, each one being marked out from 0 to 100, as the visual analogue scale. The marks were compared with consideration of age, gender, ASA physical class, type of anaesthesia, anaesthesia duration and type of surgery. RESULTS: The mean global mark was 76 +/- 9 (min-max: 34-99). Marks were lower in the youngest patients, in females, in ASA 1 patients, in longest surgical procedures, especially with regard to areas belonging to "apprehension", "pain-discomfort" and "physical needs". The lowest mark was given for the "information" provided during the pre-anaesthetic evaluation. Differences in marks occurred also between surgical specialities. CONCLUSION: The Evan questionnaire is a valuable tool for assessing the patient's opinion on the perioperative period. Further studies are required to extend its use to other fields, as ambulatory surgery.

[Blood loss from diagnostic laboratory tests performed in intensive care units. Preliminary study]. / Spoliations sanguines liées aux prélèvements en réanimation. Etude préliminaire.

OBJECTIVE: To assess the volume of blood samples withdrawn for laboratory testing in intensive care unit (ICU) patients and to determine the influence of the resulting blood loss on transfusion requirements in patients staying in the ICU for more than seven days. STUDY DESIGN: Prospective clinical open study. PATIENTS: Fifty patients treated in the ICU over the 3-month study period, neither admitted for a systematic postoperative monitoring, nor experiencing bleeding or haemolysis. METHODS: For each patient the following data were obtained: duration of ICU stay, volume of the daily withdrawn blood, the concentration of haemoglobin (Hb) at the time of ICU admission, ICU discharge and before each transfusion, volume of transfused blood. RESULTS: A mean volume of 62 +/- 29 mL.d-1 of blood was taken. It decreased from 85 +/- 6 mL on admission day, to 66 +/- 6 mL after seven days and 60 +/- 8 mL after 14 days. About 27% of the withdrawn blood was rejected (initial blood reflowing through cannula and connection tube). Twenty-one patients (42%) had a length of stay greater than 7 days. In this population, a first group (13/21) was given transfusions of packed red cells during their hospitalisation and a second group (8/21) was not transfused. The mean volume of blood taken per day (67 +/- 21 mL.d-1 vs 55 = 15 mL.d-1) and the total volume (1.204 +/- 810 mL vs 810 +/- 389 mL) were not significantly higher in the transfused group. Conversely, the mean haemoglobin concentration on ICU admission (97 +/- 22 g.L-1 vs 136 +/- 26 g.L-1) was significantly lower (P = 0.001) in the transfused patients. CONCLUSION: Blood losses from blood withdrawal for laboratory tests are important and in agreement with the results of other reports. It is generally accepted that iatrogenic blood loss of this magnitude can cause anaemia if repeated over a prolonged period. Conversely, our data suggest that blood sampling does not contribute significantly to anaemia and transfusion requirements in patients with a prolonged ICU stay.

Combined mortality and morbidity of direct surgical treatment of abdominal aortic aneurysm.

Two hundred aneurysms of the abdominal aorta were treated surgically from 1980 to 1987 by the same surgeon. There were 187 men and 13 women whose mean age was 66.1 years. Nine patients were 80-years-old or more. Eighty-seven percent of patients had preoperative risk factors, 30% of which were coronary artery disease. The operative approach was through a transverse laparotomy in 188 patients compared to 11 midline incisions and one lumbotomy. An aortoaortic tube was inserted in 87 patients, a bifurcated prosthesis in 99, and a tube bypass in 14. Five patients (2.5%) died within the 30 day perioperative period. Death was due to colonic necrosis, right heart chamber thrombosis, renal failure after repeat operation for acute lower limb ischemia, and myocardial infarction associated with renal and respiratory failure. The morbidity rate was 15.7% (31 patients) and included seven neurologic accidents, four respiratory complications, five ischemic events of the lower limbs requiring reoperation and one amputation, four cardiac complications, two renal failures, one reversible colonic ischemia, one revision for incomplete hemostasis, one phlebitis, one sliding syndrome, and five minor infections or cutaneous complications. Mean duration of hospital stay was 10.9 days. These results confirm that direct operation on aortic aneurysms can be performed in patients from all age groups and even with associated diseases. A rapid, simple technique based on a transverse approach, minimal dissection and insertion of aortoaortic tubes, whenever feasible, appears to reduce combined mortality-morbidity.