H. Jlala

Real-time Three-dimensional Ultrasound-guided Central Venous Catheter Placement

We present the first description of real-time 3-dimensional ultrasound for insertion of a central venous catheter in a surgical patient. An HD11 XE™ ultrasound machine with a V8-4 transducer (Philips Medical Systems, Bothell, WA) was used throughout. Three-dimensional multiplanar and volume-rendered views allowed us to simultaneously view the neck anatomy in 3 orthogonal planes. Needle entry into the vein and subsequent catheter placement were also visualized. We were able to rotate the views in real time, thereby enabling visualization of the catheter within the lumen of the vein. The ability to see simultaneous real-time short- and long-axis views along with volume perspective without altering transducer position is an exciting development with the potential to confer a safety benefit to the patient. Although the operator is required to assimilate more information, the limitations we encountered were mainly related to processing power and transducer size, which we expect will be overcome with advancing technology.

Patient satisfaction with perioperative care among patients having orthopedic surgery in a university hospital.

This survey aimed to validate the English version of the multidimensional Leiden Perioperative Patient Satisfaction questionnaire (LPPSq) and use it to assess patient satisfaction with perioperative care and the influence of type of anesthesia. One hundred patients having orthopedic surgery under regional and general anesthesia verbally consented to participate. Different aspects of satisfaction were assessed (eg, provision of information, and staff-patient relationship). The reliability estimate of the LPPSq (Cronbach’s-α) was good (0.94). Overall, patient satisfaction score was 86.7%, lowest was for information (80.8%) and highest for staff-patient relationships (90.3%). Patients were more satisfied with the provision of information regarding regional anesthesia.

Anesthesiologists’ perception of patients’ anxiety under regional anesthesia

The aim of this survey is to report anesthesiologists’ perception of patients’ anxiety under regional anesthesia, its frequency, effects and causes, and the strategies employed to reduce it. Electronic questionnaires were sent to all grades of anesthesiologists in Nottingham, UK. The response rate for the survey was 79%. Over half of the anesthesiologists in our region believe that anxiety during regional anesthesia is not common. Surgery and anesthesia, followed by block failure were reported by anesthesiologists as the most common causes of patients’ anxiety. Frequently employed techniques to manage anxiety were communication or sedation. Most respondents felt that regional anesthesia provides good analgesia and patient satisfaction. However, 20% felt that regional anesthesia is painful or unpleasant for patients, perhaps explaining the reluctance by some anesthesiologists to perform regional anesthesia.