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Objective to analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care. Design quasi-experimental longitudinal study. Setting hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain. Participants we included older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation. Methods a CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain (functional gain/functional loss) ≥ 0.35; and (c) favourable crisis resolution (health + functional) = a + b. We compared between-groups outcomes using uni/multivariable logistic regression models. Results clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3-6.9) versus 11.2 (10.5-11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution 79.1% (versus 75.2%), OR 1.62 (1.09-2.41) and on favourable crisis resolution 73.8% (versus 69.6%), OR 1.54 (1.06-2.22), with shorter length of intervention, with a reduction of -5.72 (-9.75 and -1.69) days. Conclusions in our study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system.

Purpose To compare the results of vitrectomy with internal limiting membrane (ILM) peeling and inverted ILM flap for treating myopic macular hole without retinal detachment. Methods Twenty-eight eyes of 28 patients undergoing vitrectomy with either ILM peeling (n = 16) or inverted ILM flap technique (n = 12) were included. Outcomes were myopic macular hole closure by optical coherence tomography and visual acuity at 6 months and at the end of follow-up. Results Closure of myopic macular hole was achieved in 13 eyes (81.2%) of the ILM peeling group and in 11 eyes (91.7%) of the inverted ILM flap group. The median length of follow-up was 18 months in the peeling group and 10.3 in the inverted group. There were not statistically significant differences between restoration of the external limiting membrane, external limiting membrane and ellipsoid zone, and none of both layers between the two groups. The median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.25 (20/35 Snellen) in the peeling group and 0.4 (20/50) in the inverted group (P = 0.027). Conclusion Both techniques were associated with high closure rates of myopic macular hole but the small sample size and the retrospective design prevents any claims of superiority of one technique over the other.

Background Current knowledge of the risk for postoperative pulmonary complications (PPCs) rests on studies that narrowly selected patients and procedures. Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables, we aimed to develop a predictive index for a broad surgical population. Methods Patients undergoing surgical procedures given general, neuraxial, or regional anesthesia in 59 hospitals were randomly selected for this prospective, multicenter study. The main outcome was the development of at least one of the following: respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis. The cohort was randomly divided into a development subsample to construct a logistic regression model and a validation subsample. A PPC predictive index was constructed. Results Of 2,464 patients studied, 252 events were observed in 123 (5%). Thirty-day mortality was higher in patients with a PPC (19.5%; 95% [CI], 12.5-26.5%) than in those without a PPC (0.5%; 95% CI, 0.2-0.8%). Regression modeling identified seven independent risk factors: low preoperative arterial oxygen saturation, acute respiratory infection during the previous month, age, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration of at least 2 h, and emergency surgery. The area under the receiver operating characteristic curve was 90% (95% CI, 85-94%) for the development subsample and 88% (95% CI, 84-93%) for the validation subsample. Conclusion The risk index based on seven objective, easily assessed factors has excellent discriminative ability. The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care.

In different peripheral nerve blocks, it has been speculated that needle guidance by ultrasound improves onset time and success rate compared with the more frequently used nerve stimulation-guided technique. In the present study, we tested the hypothesis that ultrasound guidance improves onset time of coracoid infraclavicular brachial plexus block (IBPB) when compared with a nerve stimulation-guided technique.Seventy patients scheduled for hand or forearm surgery were randomly assigned to receive coracoid IBPB using either ultrasound guidance (group U, n = 35), or nerve stimulation (group S, n = 35). Patients were assessed for sensory and motor block every 5 mins after injection of local anesthetic. Onset time, the primary end point, was defined as the time required for complete sensory and motor block. Time required to perform the block, success rate, and time to resolution of motor blockade were also recorded (secondary end points).Onset of complete sensory and motor blockade was similar in the 2 groups (17 mins [8 mins] in group U and 19 mins [8 mins] in group S; P = 0.321). Time required to perform the block was shorter in group U (3 mins [1 min]) as compared with group S (6 mins [2 mins]; P0.0001). No differences were observed in success rate (89% in group U and 91% in group S; P = 0.881) and time to resolution of motor blockade (237 mins [45 mins] in group U and 247 mins [57 mins] in group S; P = 0.418).The present investigation demonstrates that ultrasound guidance and nerve stimulation provide similar onset time, success rate, and duration of motor blockade for coracoid IBPB; however, ultrasound guidance reduces the time required to perform the block.

Background Lightwand tracheal intubation is a suitable technique for patients who are difficult to intubate but who are receiving effective ventilation. The effect of muscle relaxants on the efficacy of lightwand intubation has not yet been evaluated. The authors conducted a prospective, double-blind, placebo-controlled study to assess the effectiveness and incidence of complications of lightwand tracheal intubation performed during general anesthesia with and without the use of a muscle relaxant in patients with apparently normal airway anatomy. Methods One hundred seventy-six patients who required orotracheal intubation were prospectively included. Anesthesia was administered using propofol (2 mg/kg, then 3 mg . kg (-1). h(-1)) and remifentanil (1 microg/kg, then 0.3 microg . kg(-1) . min(-1)). Patients were randomly assigned to one of two groups (n = 88 for each) to receive rocuronium 0.6 mg/kg or saline intravenously. Lightwand orotracheal intubation (Trachlight; Laerdal Medical Inc., Armonk, NY) was attempted after 3 min. The authors recorded the number of successful intubations, the number of attempts and their duration, and events during the procedure. Results The failure rate of lightwand intubation was 12% in the placebo group and 2% in the rocuronium group (P = 0.021). Patients in the placebo group received more multiple intubation attempts (P < 0.001), required a greater intubation time (77 +/- 65 vs. 52 +/- 31 s; P = 0.002) and experienced a greater incidence of events during intubation (61 vs. 0%; P < 0.001) than patients in the rocuronium group. Conclusions The use of muscle relaxants in patients with apparently normal airways is associated with a lower failure rate, decreased intubation time, and fewer attempts when performing lightwand orotracheal intubation.

BACKGROUND: Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE:/nThe objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN: A prospective observational study of a multicentre cohort. SETTING: Sixty-three hospitals across Europe. PATIENTS: Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES: Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO2) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation./nRESULTS: PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO2; at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION: A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes.The study was registered at ClinicalTrials.gov (identifier NCT01346709). The PERISCOPE study was funded and supported through the European Society of Anaesthesiology’s Clinical Trials Network.

Neuromuscular blockers (NMBs) have traditionally been thought to increase the risk of respiratory complications, although drawing conclusions in this respect would require complex studies in large patient samples. The aim of this study was to analyze data from the ARISCAT study to obtain an overall picture of how NMBs are being used and blocks are reversed in Catalonia, Spain.NMB use as reflected in data from the ARISCAT study was analyzed. Case information from the database was organized into 4 groups: for patients not receiving a NMB (No-NMB), patients whose NMB block was performed with succinylcholine alone (SC), patients who received a single dose of a nondepolarizing NMB (SD-NMB), and patients who received additional doses of a nondepolarizing NMB or a continuous perfusion (AD-NMB). We analyzed patient characteristics, clinical and surgical characteristics, and complications during and after surgery in each of the groups. Variables were also analyzed according to whether the NMB effect had to be reversed.Of the 2991 patients included in the ARISCAT study, 1545 received general or combined anesthesia. Of the 1545 patients, 1267 (89%) received a NMB and the block was reversed with an anticholinesterase agent in 54%. The group distribution was as follows: No-NMB, 103 patients; SC, 31; SD-NMB, 527; and AD-NMB, 709. The highest rate of comorbidity, longest duration of surgery, highest rate of complications during and after surgery, and the longest hospital stays were observed in the last of the 4 groups (AD-NMB). Reversion was required significantly more often after cardiothoracic and upper abdominal surgical procedures; the complication rates after those 2 types of surgery were statistically similar.Nondepolarizing NMBs are used in combination with general anesthesia often in Catalonia; their use is associated with duration and type of surgery. A reversal drug is administered relatively more often in Catalonia than in other geographic areas.

To determine the anesthetic, surgical, and postoperative characteristics of patients who underwent thoracic surgery in Catalonia, Spain, in 2003.A prospective, cross-sectional survey was carried out on 14 randomly chosen days in 2003. All hospitals performing thoracic surgery in Catalonia took part. Data were collected on patient characteristics, anesthetic techniques, procedures, analgesia, and postoperative care.Data on 171 anesthetic procedures in thoracic surgery were collected from 27 hospitals; these procedures represented 0.7% of the total anesthetic workload. Extrapolation from the collected data indicated that 4458 anesthetic procedures were performed in thoracic surgery in 2003 (95% confidence interval, 3624-4823 procedures). Of these procedures, 75.4% were performed in public hospitals and 24.6% in private hospitals. The median age of patients was 55 years (10th-90th percentiles, 22.4-73 years) and 63.9% were men. Surgical procedures were scheduled in 92.8% of the cases. The most common interventions were lung and bronchial surgery other than resection (36.8%), lung and/or bronchial resection (24.6%), and thoracoscopy and mediastinoscopy (20.5%). The median duration of pneumonectomies and lobectomies was 180 minutes (10th-90th percentiles, 90-221 minutes). General anesthesia was the most commonly used procedure (74.3%). Postoperative recovery took place in a conventional recovery room in 54.4% of cases, in a postanesthetic intensive care unit in 33.3% of cases, and in an intensive care unit in 12.3% of cases.This survey provided information on anesthesia in thoracic surgery, which represented 0.7% of all anesthesia procedures in an area with a population of 7 million.

This article provides an epidemiological description of anesthesia practice in Catalonia, Spain, in 2003.Descriptive data on sex, age, and physical status of patients according to American Society of Anesthesiologists (ASA) classification were taken from responses to the questionnaire used in the ANESCAT 2003 survey. The results were extrapolated to the population of Catalonia in 2003 and the annual rates of anesthesia per 100 inhabitants calculated.Based on the 23,136 completed questionnaires collected in the ANESCAT 2003 survey, it is estimated that 603,189 anesthetic procedures were performed in Catalonia (95% confidence interval [CI], 579,010-627,368). The annual rate of anesthesia was 9 per 100 inhabitants (95% CI, 8.6-9.4). Women represented 58% of the population in which anesthesia was performed. The median (10th-90th percentile) age was 52 (21-78) years and anesthetic procedures performed in patients over the age of 60 accounted for 39.3% of the total. The largest number of anesthetic procedures was performed in the 70 to 74 year age bracket (56,000 procedures). Below the age of 14, more males than females received anesthesia, while above that age the majority of patients were female. The highest rate of anesthesia was in men aged between 75 and 79 years (22.0%) and the lowest was in girls aged between 10 and 14 years (1.8%). The percentage of patients with an ASA class of 3 or more was 26.7%. Physical status was worse in male than in female patients. Forty-seven percent of all anesthetic procedures were performed in the city of Barcelona.The annual rate of anesthesia in Catalonia was 9 per 100 inhabitants, and was almost 3 times higher in the city of Barcelona than in the rest of the geographical area. Comparison with data from other European countries revealed higher severity and a larger proportion of women and older patients in Catalonia.

This arm of the ANESCAT survey sought to characterize and quantify nonsurgical anesthesia practice in Catalonia, Spain.Information about anesthesia for nonsurgical procedures in 131 Catalan hospitals was gathered prospectively on 14 days in 2003. We analyzed patient characteristics, anesthetic techniques, procedures, duration, interventional context for the anesthetic procedure, type of hospital, and geographic distribution.Nonsurgical anesthesia accounted for 10.4% of all acts. Endoscopy of the digestive tract accounted for 70.4% of all nonsurgical procedures, electroconvulsive treatment for 11.7%, radiology for 11.5%, and electrical cardioversion for 1.5%. Anesthesia was provided outside an operating room in 73.7% of the cases. Most procedures were scheduled to be performed in outpatients under sedation or general anesthesia. The most commonly performed digestive tract endoscopic examinations were colonoscopy and gastroscopy, and most took place in private hospitals.Over 10% of anesthesia practice is for nonsurgical procedures and digestive tract endoscopy accounts for the largest proportion of such practice. As the trend is for such procedures to increase in number, their frequency should be studied so that organization and training can be planned.

The aim of this arm of the ANESCAT 2003 study was to describe the temporal distribution and types of anesthesia used in Catalonia, Spain, in 2003, along with the associated human resources used.Data were used from a survey of 23,136 anesthetic procedures collected on 14 randomly selected days in 2003 and an individual questionnaire was completed by 765 anesthesiologists working in Catalonia.Anesthesia practice was divided into that associated with surgery (78.4%), obstetrics (11.3%), and other nonsurgical procedures (10.4%). Of all anesthetic procedures performed, 84.3% took place in operating theaters and 7.0% in obstetric areas. Emergency procedures accounted for 20.3% of the total. Most procedures (71.2%) were undertaken within 08:00 and 16:00 h, and the lowest number of procedures performed on workdays took place on Fridays. The median duration of anesthesia was 60 minutes. The most common technique was regional anesthesia (41.4%), with spinal block being the most widely used. There were an estimated 12.5 anesthesiologists per 100,000 inhabitants, with a median (10th-90th percentile) age of 45 (34-57) years; women made up 47.2% of that group. The mean number of standard working hours was 46 hours per week and 65% of anesthesiologists also undertook on duty shifts. Anesthesiologists spent 77% of their time performing anesthesia and the remainder in postoperative recovery and critical care units and pain clinics.Emergency anesthesia represents 20% of the total workload and obstetrics and nonsurgical procedures another 20%. The use of regional anesthesia was very widespread. The population density of anesthesiologists is comparable to that of other European countries, but with a higher proportion of women.

The objective of this arm of the ANESCAT 2003 study was to analyze the characteristics of the youngest and oldest patients receiving anesthesia in Catalonia, Spain, and the procedures for which they require it.We analyzed data from questionnaires pertaining to pediatric (under age 14 years) and geriatric patients (older than age 65 years).Pediatric patients underwent 6.3% of all anesthetic procedures and patients over 65 years old accounted for 32.9% of the sample population. Two of every 3 pediatric patients were males, whereas 55% of patients over age 65 years were females. The most frequently performed interventions requiring anesthesia in patients under 14 years of age were tonsillectomy and/or adenoidectomy (19.3%), nonsurgical procedures (11.5%), circumcision (10.6%), inguinal herniorrhaphy (8.3%), and appendectomy (4.2%). The most common procedures in elderly patients were cataract extraction (31.9%), nonsurgical procedures (9.5%), inguinal herniorrhaphy (4.4%), total knee replacement (3.6%), transurethral bladder surgery (3.2%), and repair of femoral neck fractures (2.6%). Because of the high incidence of appendectomy in patients between 8 and 14 years old and of femoral neck fractures in patients over 85 years old, the rate of emergency anesthesias in patients in those age brackets was around 30%.Pediatric and geriatric patients and the interventions for which they are administered anesthesia have particular features. Taking them into consideration in the short term would facilitate the development of new therapeutic strategies and the introduction of changes in health care organization.

The aim of this arm of the ANESCAT study was to analyze the characteristics of patients who underwent anesthesia for surgical procedures in Catalonia, Spain, in 2003.Based on data obtained from the survey undertaken in 131 hospitals, we describe the anesthesia practice associated with surgical specialties, excluding anesthesia performed for obstetric and nonsurgical procedures. Data are provided for all surgical procedures and for each surgical specialty separately. The results are expressed as medians (10th-90th percentile).Surgical anesthesia represented 78.4% of anesthesia practice, corresponding to an estimated 472,857 anesthetic procedures per year. The most common surgical specialties associated with anesthetic procedures were orthopedics and traumatology (23.8%), ophthalmology (20.2%), general and digestive surgery (18.9%), and gynecology (9.7%). The median duration of anesthesia was 60 (25-165) minutes. The physical status of the patients according to the American Society of Anesthesiologists (ASA) classification was as follows: ASA 1, 37.9%; ASA 2, 32.5%; ASA 3, 23.9%; and ASA 4 or higher, 5.7%. The median age of the patients was 52 (21-78) years. Ambulatory procedures accounted for 33.6% of the total, and 9.2% of patients were admitted to postoperative critical care units. The most common procedure was cataract extraction (estimated 76,963 cases) followed by inguinal herniorrhaphy (23,315). Public hospitals performed 74.4% of all anesthetic procedures. Ophthalmology and plastic surgery were the most common procedures requiring anesthesia in private hospitals.Three out of 4 anesthetic procedures performed in Catalonia in 2003 was for surgery, 1 in 3 of those procedures was ambulatory, and almost 1 in 10 patients required postoperative critical care.

The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003.We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training.A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals.The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status.

The aim of this arm of the ANESCAT study was to describe the characteristics of ambulatory anesthesia in Catalonia, Spain.Relevant data was extracted from a survey of anesthetic procedures in 131 public, publicly contracted, and private hospitals on 14 representative days in 2003.Of the estimated 603,189 anesthesias performed, 206,992 (34.32%; 95% confidence interval, 33.3%-35.4%) were on outpatients. The median (10th to 90th percentile) age of patients was 59 (22-80) years and 56.6% were women. The physical status of patients according to the American Society of Anesthesiologists (ASA) classification was ASA I or II for 75.1% of the patient sample. The most common approach to anesthesia was sedation/monitoring (47.7%), followed by regional anesthesia (28.9%). The types of regional anesthesia reported most often were peri- or retrobulbar blocks (50.8% of the regional blocks), followed by spinal anesthesia (22.2%). Anesthesia was required for surgery in 76.5% of the cases and for diagnostic or other nonsurgical procedures in 22%. The individual surgical specialties creating the greatest demand for anesthetic procedures were ophthalmology (39%) and orthopedic and trauma surgery (10.9%). The specific interventions accounting for the largest percentages of anesthetic procedures were cataract extraction (32.3%) and digestive tract endoscopy (16.7%). In 8.2% of the cases, patients did not require a stay in the postanesthetic recovery unit. Private hospitals, facilities with fewer than 250 beds, and those not accredited to provide medical resident training had higher rates of ambulatory anesthesia.Ambulatory procedures account for approximately a third of the anesthesia workload in Catalonia. Sedation/monitoring and regional anesthesia are the approaches that predominate in this category. Ambulatory anesthesia is applied mainly in ophthalmology and the rate of endoscopic procedures requiring outpatient anesthesia is also high.

The aim of this arm of the ANESCAT 2003 study was to describe the use of emergency anesthesia in surgical specialties in Catalonia, Spain.The data analyzed came from a prospective study of the anesthetic procedures performed in 131 hospitals in Catalonia on 14 randomly chosen days in 2003. Emergency anesthetic procedures for surgery (excluding obstetrics and nonsurgical procedures) were selected and the following variables analyzed: type of hospital, patient characteristics, procedure, anesthetic technique, time used, postoperative care, and type of emergency (deferrable or not). Data are expressed as medians (10th-90th percentile) and extrapolated to the population of Catalonia.Out of 23,136 anesthetic procedures recorded, 2,088 (corresponding to an estimated 54,437 anesthetic procedures in Catalonia annually) were associated with surgical emergencies; that figure represents 9% of all anesthetic procedures and 11.5% of anesthetic procedures performed for surgery. The emergency was deferrable in 51% of cases (an estimated 26,906 anesthetic procedures annually). A total of 81.2% of the emergency procedures were performed in hospitals belonging to the public system and 18.8% in private hospitals. Procedures performed from Monday to Friday accounted for 80.6% of emergency procedures. Procedures performed between the hours of 08:00 and 16:00 accounted for 46.5% of the total and 8.1% were performed between 00:00 and 08:00. Sixty percent of deferrable procedures were undertaken between 08:00 and 16:00. Men accounted for 52.4% of all patients, the median age was 51 (15-83) years, and 15.3% of patients were severely ill (American Society of Anesthesiologists physical status class 4). Taken together, orthopedic surgery and traumatology, and general and digestive surgery accounted for 74.4% of the anesthesia practice considered. General anesthesia was used in 51% of cases and regional anesthesia in 38%. The length of anesthesia was greater in deferrable emergencies (90 minutes). Patients were admitted to postoperative critical care units in 18% of cases.Anesthesia for surgical emergencies accounted for around 10% of the anesthetic procedures performed in Catalonia in 2003, and more than 50% of those procedures could have been deferred.

Perioperative care and chronic pain therapy are anesthesia practices that aim to improve patient safety and well-being. The purpose of this arm of the ANESCAT survey of anesthesia practices in Catalonia, Spain, in 2003 was to describe and quantify these 2 services.Taking relevant responses to the ANESCAT 2003 questionnaires, we analyzed type of preanesthetic assessment, use of specialized techniques for postoperative analgesia, and provision of postoperative critical care. We also estimated type and volume of procedures performed by anesthesiologists to treat chronic pain.A preanesthetic assessment visit took place in an outpatient clinic setting in 47.4% of cases, on a hospital ward in 18.3%, and in the operating room waiting area in 34.3%. Specialized analgesic techniques were provided for 7.6% of postoperative patients, a rate that would put the estimated number of such procedures at 30,321 per year. Postoperative critical care was afforded to 7.7% of patients in the sample, a rate that extrapolates to anesthesia in 44,686 patients in Catalonia annually. Patients benefiting from specialized analgesic techniques and postoperative critical care were older, had worse physical status classifications, and were anesthetized for more aggressive procedures. Approximately 120,000 medical acts related to treatment for chronic pain were undertaken by anesthetists in Catalonia in 2003.The findings of ANESCAT 2003 reveal the considerable scope of Catalan anesthetists' practice in perioperative care management and chronic pain therapy, but more human resources and organizational attention are still needed for ideal workload management.