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Abstract: Objective: The aim of the survey was to describe current practice in management of hypotension during spinal anaesthesia for elective caesarean section in Lorraine. Study design: Cross-sectional study by a mail survey. Methods: A 20-item postal questionnaire was sent to all anaesthetists working in public or private hospital with a maternity unit in Lorraine. Results: The response rate was 65%. Fifty-one percent of the respondents did not have a written procedure for the management of spinal-induced hypotension. Fluid preloading with or without vasopressor was the most common practice. Colloids were used by 20% of the respondents. For prevention of hypotension, 37% used ephedrine, 28% used phenylephrine mostly in association with ephedrine and 9% based their choice on heart rate. Twenty-six percent did not administer any vasopressor to prevent hypotension. First choice vasopressor for treatment of hypotension was ephedrine. Anaesthetists in academic practice were more likely to use coloading and phenylephrine administration, but none of them used colloids for pre- or coloading. Conclusion: Management of hypotension during spinal anaesthesia for elective caesarean section was significantly influenced by the type of practice. [Copyright &y& Elsevier]

Abstract: Objectives: To study the assessment of hygiene practices in anaesthesia in Lorraine between 1998 and 2007, after recommendations from the French Society of Anaesthesia and Reanimation (SFAR) in December 1997, and different local actions. Study design: Two surveys performed at a nine-year interval in Lorraine hospitals. Population and method: Questionnaires about risk infection management and hygiene practices were sent by post to all anaesthetists, nurse anaesthetists and recovery room nurses in 1998 (n =279) and in 2007 (n =259). Results: Between the two surveys multidrug-resistant bacteria signalling, movements of the staff in operating rooms, septic isolation protocol and management of single-use disposable anaesthesia material have been improved (p <0.05). Central venous catheters are less performed in recovery rooms and rings wearing decreased by 16% (p <0.05). Wearing of nonsterile gloves for peripheral venous catheter and intubation is not generalized (p <0.05). About half of the hospitals have cleanup procedures of anaesthesia furniture. Washing of hands by anaesthesia staff is not sometimes respected but it''s more frequent for medicine preparation and between two operations. A good skin disinfection (cleaning – rinsing – drying – antiseptic) is more recurrent in 2007 (61.4%) than in 1998 (41.9%) for arterial catheter. Wearing of glasses for intubation is each times rare, about 15%. Conclusion: Hygiene practices in anaesthesia in Lorraine have been improved between the two surveys by recommendations from the Sfar and the work of the Antenne Régional de Lorraine (audits, manuals, formations). Promising progress has been made but some points must still be worked on. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate the results of Off Site preanaesthetic consult in Lorraine and to draw up a method for these pre-operative visits. Study design: Two surveys of the Lorraine-regional practice (from both the anaesthetists and surgeons from Lorraine) and one survey of patient satisfaction. Patients and method: Questionnaires were sent by mail to all anaesthetists (n =270) and surgeons (n =339) in the Lorraine region. In the immediate postoperative period, specific questionnaires were sent by mail to selected patient groups (n =73 in each group), one group having and the other (control) not having Off Site preanaesthetic consult. Results: Anaesthetists'' survey: 48.4% of interviewed anaesthetists belonged to the pre-anaesthetic consult network. 81.2% of these anaesthetists performed Off Site pre-anaesthetic consult. The main recognized advantages were patient comfort (89.6%) and cost effectiveness (57.3%). 26.1% of anaesthetists who did not participate to the network were strongly opposed to this practice, while 60.9% were prepared to enter the network. Surgeons'' survey: 15.6% of surgeons were not satisfied that anaesthetists in their institutions practiced the Off Site pre-anaesthetic consult. Patients'' survey: no difference in satisfaction towards the quality of information delivered during the consultation (anaesthetic technique, analgesia and evaluation of the perioperative risk) nor in terms of perioperative anxiety. The average transportation distance spared by Off Site preanaesthetic Consult was 98 miles. Conclusion: Off Site preanaesthetic consult may have real benefits in terms of, patient satisfaction, comfort and cost-effectiveness. In the Lorraine region, a majority of anaesthetists has experience with this practice. [Copyright &y& Elsevier]