SummaryIncreasing numbers of patients presenting for surgery are receiving concurrent medication with low-dose aspirin. We surveyed the opinions and working practices of consultant members of the Neuroanaesthesia Society regarding patients who present for elective intracranial surgery whilst taking this form of medication. Identical questionnaires were sent to 140 members of the society and proffered four main questions: (1) the adherence to any policy of stopping aspirin preoperatively, (2) the preferred method of treatment for excessive bleeding in this context, (3) personal knowledge of haemorrhagic complications in this group of patients, (4) the neurosurgical unit concerned. There were 121 responses (86.4%) of which 116 (82.9%) were valid. Of the respondents, 78 (67.2%) were unaware of a written departmental policy for the discontinuation of pre-operative aspirin treatment and had no personal policy. Thirty-two respondents (27.6%) had a personal policy but were unaware of a written departmental policy; only six respondents (5.2%) stated that a written departmental policy was in place. The mean time suggested for discontinuation of aspirin pre-operatively was 11.3 days (range: 1-42 days). Fifty-one respondents (44.0%) considered that patients taking low-dose aspirin were at increased risk of excessive perioperative haemorrhage and 15 (12.9%) anaesthetists reported having personal experience of such problems. Fifty-seven respondents (49.1%) would use a platelet infusion, alone or in association with other blood products or prohaemostatic agents, if haemorrhagic complications developed. The majority of neuroanaesthetists felt that aspirin was a risk factor for haemorrhagic complications associated with intracranial procedures, but most adopt no policy regarding its preoperative discontinuation.Keywords Surgery; neurosurgical. Analgesics; salicylates, aspirin. ...................................................................................... Correspondence to: D. N. James, Department of Anaesthesia, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK. Accepted: 18 October 1996 Aspirin is increasingly prescribed for its antithrombotic properties [1][2][3][4][5] and more patients are therefore presenting for surgery with dysfunctional circulating platelets. Aspirin is also a common constituent of many 'over the counter ' medications [6].The contribution of low-dose aspirin to increased perioperative blood loss is a contentious issue with conflicting published results from different surgical groups. Data from neurosurgical patients are sparse [7] but aspirin has been identified as an important risk factor in the development of postoperative haematomata following intracranial surgery [8].This survey examined the opinions and working practices of consultant neuroanaesthetists with regard to patients taking low-dose aspirin medication who present for elective intracranial surgery. MethodsIdentical questionnaires with stamped addressed return envelopes were sent to practising consultant members o...
Background:Traditionally propofol has been used for providing sedation in dilatation and curettage (D and C). Recently, dexmedetomidine has been tried, but very little evidence exists to support its use.Aims:The aim was to compare hemodynamic and recovery profile of both the drugs along with a degree of comfort experienced by patients and the usefulness of the drug to surgeons.Settings and Design:Tertiary care center and open-label randomized controlled trial.Materials and Methods:Patients posted for D and C were enrolled in two groups (25 each). Both groups received fentanyl 1 μg/kg intravenous (IV) at the beginning of the procedure. Group P received IV propofol in dose of 1.5 mg/kg over 10-15 min and Group D received dexmedetomidine at a loading dose of 1 μg/kg over 10 min, followed by 0.5 μg/kg/h infusion until Ramsay sedation score reached 3-4. Hemodynamic vitals were compared during and after the procedure. In the recovery room time to reach modified Aldrete score (MAS) of 9-10 and patient's and surgeon's satisfaction scores were also recorded and compared.Results:In Group D, patients had statistically significant lower heart rate at 2, 5, 10 and 15 min as compared to Group P. Hypotension was present in 52% in Group P and 4% in Group D (P < 0.05). MAS of 9-10 was achieved in 4.4 min in subjects in Group D in contrast to 16.2 min in Group P (P < 0.05). Group D showed higher patient and surgeon satisfaction scores (P < 0.05).Conclusion:Dexmedetomidine provide better hemodynamic and recovery profile than propofol. It can be a superior alternative for short surgical day care procedures.
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