Purpose: To survey the general public's attitude towards preoperative assessment and commonly perceived fears about general anesthesia.Methods: A province wide telephone survey was conducted in Alberta. General and regional anesthesia were defined, a scenario involving major knee surgery was described, and participants were asked to choose between regional and general anesthesia. Respondents used a seven-point scale to rate the importance of seeing an anesthesiologist preoperatively and were questioned about the timing of such a visit. Attitudes towards commonly perceived fears associated with anesthesia were also assessed.Results: A total of 1,216 people were surveyed. Over 30% of respondents felt that it was very important to see an anesthesiologist preoperatively, with a total of over 60% attributing a high degree of importance to this. Fifty percent felt that this assessment should occur on the day prior to surgery. A preference for regional or general anesthesia was not expressed in the situation. Approximately 20% of respondents were very concerned about brain damage, waking up intraoperatively and memory loss. Twelve percent were concerned about dying intraoperatively. Nine percent expressed concern about postoperative pain, with 12% reporting being concerned about nausea and vomiting.Conclusions: The general public considers anesthetic assessment on the day prior to surgery an important part of preoperative preparation. Fears of brain damage, death and intraoperative awareness associated with general anesthesia remain prevalent, suggesting that preoperative education of patients should address these concerns. The general population was less concerned about realistic fears such as nausea, vomiting and postoperative discomfort. ATIONALIZATION of hospital services has resulted in a reduction in the number of in-patient surgical beds and the introduction of pre-admission clinics (PAC) and same day surgery. This has allowed significant savings to be made in both perioperative expenditure and GENERAL ANESTHESIA 333

The public's fears and conceptions about regional anesthesia are greatly distorted. The anesthesia community has not been successful in keeping the public informed about regional anesthesia. Future anesthesia-related educational programs should address the concerns of the public about anesthesia matters, particularly regional anesthesia.

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Purpose: To report a case of anaphylaxis to rocuronium and the sensitivities to multiple neuromuscular blocking drugs in a patient with no previous exposure to this group of drugs. We describe the current recommendations for both intraoperative and postoperative testing of these patients.Clinical Features: A 36-yr-old man was admitted for repair of a ruptured Achilles tendon. Following induction of general anesthesia with fentanyl and propofol, 60 mg of rocuronium were given to facilitate tracheal intubation. He immediately became profoundly hypotensive with impalpable pulses, and blood pressure could not be recorded. Airway pressure increased markedly, and hand ventilation of the lungs became very difficult. His airway was secured and he was successfully resuscitated with 3 mg epinephrine and three litres crystalloid and colloid intravenous fluid therapy. His recovery in the intensive care unit was uneventful and the operation was performed four days later under spinal anesthesia. Subsequent skin prick testing, performed six weeks later, demonstrated strong positive weal and flare reactions to rocuronium, vecuronium and pancuronium, and some cross-reactivity with the benzylisoquinolinium group of muscle relaxants.Conclusion: Muscle relaxants are responsible for 61.6% of cases of anaphylaxis during general anesthesia. Cross-reactivity is common, as this group of drugs share a quaternary ammonium group. It is mandatory that patients be tested for both the agent responsible and cross-reactivity following an anaphylactic response. We suggest a protocol for investigation of suspected anaphylaxis.Objectif : Rendre compte d'un cas d'anaphylaxie au rocuronium et de sensibilité à de multiples myorelaxants chez un patient non exposé auparavant à ce genre de médicaments. Décrire les recommandations courantes de tests peropératoires et postopératoires à réaliser dans de tels cas.Éléments cliniques : Un homme de 36 ans a été admis pour la réparation d'une rupture de tendon d'Achille. Après l'induction de l'anesthésie générale avec du fentanyl et du propofol, on a administré 60 mg de rocuronium pour faciliter l'intubation endotrachéale. Une importante hypotension s'est immédiatement installée, les pouls étaient impalpables et la pression sanguine ne pouvait être enregistrée. La pression a beaucoup augmenté dans les voies aériennes et la ventilation manuelle des poumons est devenue très difficile. On a libéré les voies aériennes et le patient a été réanimé avec succès suivant l'administration intraveineuse de 3 mg d'épinéphrine et de 3 L de cristalloïde et de colloïde. La récupération s'est déroulée sans incident à l'unité des soins intensifs et l'opération a été réalisée quatre jours plus tard sous rachianesthésie. Le test de cutiréaction pratiqué ultérieurement, six semaines après l'opération, a montré une réaction papulo-érythémateuse fortement positive au rocuronium, au vécuro-nium et au pancuronium ainsi qu'une réaction croisée avec les myorelaxants du groupe benzylisoquinolinium. Conclusion :Les myorelaxants sont respon...