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Neuraxial Anaesthesia (neuraxial + anaesthesia)
Selected AbstractsBlood volume is normal after pre-operative overnight fastingACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2008M. JACOB Background: Pre-operative fasting is assumed to cause a deficit in intravascular blood volume (BV), as a result of ongoing urine production and insensible perspiration. Standard regimes consist of volume loading prior or simultaneous to any anaesthetic procedure to minimise the risk of hypotension. However, fluid overload in the context of major abdominal surgery has been shown to deteriorate patient outcome. Our study aimed to quantify total intravascular BV after fasting by direct measurements and to compare it with calculated normal values in comparable non-fasted patients. Methods: After 10 h of fasting, total plasma volume (PV) and red cell volume (RCV) were measured via the double-label technique (indocyanine green dilution and erythrocytes labelled with fluorescein, respectively) following induction of general anaesthesia in 53 gynaecological patients suffering from malignoma of the cervix. The corresponding normal values were calculated individually from age, body height and body weight. Results: Measured BV, RCV and PV after fasting were 4123±589, 1244±196 and 2879±496 ml, respectively. The differences to the corresponding calculated normal values were not significant (3882±366, 1474±134 and 2413±232 ml, respectively). The measured haematocrit reflected a slight anaemic state (0.35±0.03). Conclusion: Our data suggest that even after prolonged pre-operative fasting, cardio-pulmonary healthy patients remain intravascularly normovolaemic. Therefore, hypotension associated with induction of general or neuraxial anaesthesia should perhaps be treated with moderate doses of vasopressors rather than with undifferentiated volume loading. [source] Spinal anaesthesia and caesarean section in a patient with hypofibrinogenaemia and factor XIII deficiency,ANAESTHESIA, Issue 6 2010A. A. Hanke Summary We report the peri-operative management of a 32-year-old patient suffering from symptomatic hypofibrinogenaemia and factor XIII deficiency scheduled for caesarean section. Starting with an impaired fibrinogen (1.04 g.l,1) and factor XIII level (48%), fibrinogen and factor XIII administration was guided by point-of-care rotational thrombelastometry (ROTEM®) to achieve normal whole blood coagulation, which allowed uncomplicated spinal anaesthesia and an uneventful surgical procedure. We conclude that rotational thrombelastometry may be suitable to guide administration of coagulation factors in patients with hereditary bleeding disorders and allow otherwise contraindicated neuraxial anaesthesia and surgery to proceed without increased risk of blood loss. [source] The hidden cost of neuraxial anaesthesia?ANAESTHESIA, Issue 5 2010N. M. Bedforth No abstract is available for this article. [source] Effect of informational internet web pages on patients' decision-making: randomised controlled trial regarding choice of spinal or general anaesthesia for orthopaedic surgeryANAESTHESIA, Issue 3 2010N. D. Groves Summary This study explored whether patients' preference for particular types of anaesthesia could be influenced pre-operatively by giving them the addresses of various relevant websites. Patients at an orthopaedic pre-assessment education clinic completed a questionnaire, which included a short multiple-choice general knowledge quiz about anaesthesia, and also questioned them as to their choice of anaesthesia (general or neuraxial). Patients were randomly assigned to intervention or control groups. Intervention group members were given the addresses of three relevant anaesthesia and health related websites to access at home. All patients were asked to complete the questionnaires on a second occasion, before surgery. Initially, most patients stated a preference for general anaesthesia. Subsequently, the intervention group altered their preference towards neuraxial anaesthesia compared to the control group (p , 0.0001). The increase in median (IQR [range]) anaesthesia knowledge test score was greater in the intervention group (from 10.0 (9.0,12.0 [5.0,14.0]) to 13.0 (11.0,14.0 [6.0,14.0])) than in the control group (from 10.0 (9.0,11.5 [3.0,13.0]) to 11.0 (9.0,12.0 [4.0,14.0]); p = 0.0068). [source] | ||||||||||