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Background Venous thromboembolism (VTE) is a major cause of perioperative morbimortality. Despite significant efforts to advance evidence-based practice, prevention rates remain inadequate in many centres.Objective To evaluate the effectiveness of different strategies aimed at improving adherence to adequate VTE prophylaxis in surgical patients at high risk of VTE.Method Before and after intervention study conducted at a tertiary hospital. Adherence to adequate VTE prophylaxis was compared according to three strategies consecutively implemented from January 2019 to December 2020. A dedicated hospitalist physician alone (strategy A) or in conjunction with a nurse (strategy B) overlooked the postoperative period to ensure adherence and correct inadequacies. Finally, a multidisciplinary team approach (strategy C) focused on promoting adequate VTE prophylaxis across multiple stages of care—from the operating room (ie, preoperative team-based checklist) to collaboration with clinical pharmacists in the postoperative period—was implemented.Results We analysed 2074 surgical patients: 783 from January to June 2019 (strategy A), 669 from July 2019 to May 2020 (strategy B), and 622 from June to December 2020 (strategy C). VTE prophylaxis adherence rates for strategies (A), (B) and (C) were (median (25th–75th percentile)) 43.29% (31.82–51.69), 50% (42.57–55.80) and 92.31% (91.38–93.51), respectively (pA=B). There was a significant reduction in non-compliance on all analysed criteria (risk stratification (A (25.5%), B (22%), C (6%)), medical documentation (A (68%), B (55.2%) C (9%)) and medical prescription (A (51.85%), B (48%), C (6.10%)) after implementation of strategy C (p

Outside of anesthesia, lumbar puncture (LP) is commonly performed for diagnostic and therapeutic purposes. (From discussions with oncologists, LP is performed immediately after platelet transfusion in cases of extreme thrombocytopenia, without performing a post-transfusion platelet count.) Table 1 A summary of eight case series of lumbar puncture (LP) in oncology patients with varying degrees of thrombocytopenia The risks data presented for extreme thrombocytopenia and LP will nevertheless reassure that the risks associated with less severe thrombocytopenia are probably low enough to make neuraxial block worth considering. [Extracted from the article]

For example, in paravertebral block using the landmark approach, once the block needle contacts the transverse process, the practitioner may tilt the needle in a cephalad or caudad direction to "walk off" the transverse process. Depending on how much the needle has to be tilted (and this is quite variable) to just clear the transverse process, the depth at which the needle actually clears the transverse process could be very close to the depth of the transverse process for small tilt angles or could be substantially larger for larger tilt angles. Likewise, in landmark (without US) paravertebral block as discussed above, knowing when the needle tip clears the transverse process is also important as it is beyond this point that loss of resistance is sought or the needle is advanced by ~1 cm to reach the paravertebral space.[1]. [Extracted from the article]