[Enhanced recovery following uncomplicated elective caesarean section in France: a survey of national practice]. / Réhabilitation périopératoire des césariennes programmées non compliquées en France : enquête de pratique nationale.

INTRODUCTION: Enhanced recovery is a concept currently recognised and adopted in a number of surgical specialties. In obstetrics however, this concept remains surprisingly underdeveloped. The purpose of this survey was to study the practice of obstetric anaesthetists in France as regards the recovery of women undergoing uncomplicated, elective caesarean section. MATERIAL AND METHOD: An online 39-point questionnaire was displayed for 2months on the Caro (Club d'anesthesie réanimation en obstétrique) website. The questionnaire related to uncomplicated, elective Caesarean sections and aimed to define the following: preoperative information given regarding the recovery period, intraoperative care - both anaesthetic and surgical, postoperative analgesia, measures taken to prevent post-partum haemorrhage, reintroduction of fluids and diet, return to mobility, local practices designed to promote bonding between mother and baby. RESULTS: The overall response rate for our survey was 45%. Forty-nine percent of practitioners report that patients are provided with specific information on the recovery period preoperatively. Sixty percent of those surveyed state the absence of any specific recovery protocol for this patient population in their hospital. Eighty-one percent of respondents state that, in the majority of cases, patients are admitted on the eve of surgery and remain hospitalised for more than 72hours (89%). Ninety-nine percent of practitioners employ a regional technique to deliver anaesthesia for elective section and 44% rely on intrathecal morphine for postoperative analgesia. The concept of 'Patient Controlled Oral Analgesia' (PCOA), although widely recognised, is used by only 17% of practitioners. Forty-one percent of practitioners report the reintroduction of fluids as soon as patients return to the ward following surgery and at the same time as the urinary catheter is removed (51%). Diet is commenced 4 to 6hours following surgery amongst 40% of those surveyed. Fifty-one percent of practitioners report removal of the intravenous catheter 24hours postoperatively. Finally, 49% of practitioners feel patients are independently functioning and mobile within 24hours of surgery. CONCLUSION: This survey of national practice shows that the concept of 'enhanced recovery' following elective caesarean section can be again developed. Standardisation of practice with the design of local protocols relating to postoperative analgesia, timing of removal of the intravenous access and urinary catheter, time to first mobilisation and to commencement of diet would appear to be warranted. Surely this surgery, more than any other, merits an expeditious and effective return to normal and independent function, allowing mother to better look after baby.

[Patient associated fire in theatre: are we ready to prevent and/or manage it? Assessment of the anaesthetist's knowledge in Lorraine]. / Feu d'un patient au bloc opératoire: sommes-nous prêts à gérer ce type d'incident ? Résultats d'une enquête faite auprès des médecins anesthésistes-réanimateurs lorrains.

OBJECTIVE: To assess knowledge amongst anaesthetists as regards to fire involving surgical patients in Lorraine. STUDY DESIGN: A cross-sectional study was conducted using a postal questionnaire. METHOD: A 22-item postal questionnaire was therefore sent to all anaesthetists working in Lorraine between January and March, 2011. RESULTS: One hundred and twenty-eight questionnaires were returned (response rate: 36%). Sixty-two percent of the respondents had never participated in fire safety training. Fifty percent could not recollect the location of the fire extinguisher in their surgical unit. Sixty-three percent ignored the existence of a memo written by the Afssaps summarizing how to use safely alcohol-based skin preparations in the presence of an electrosurgical unit. Sixty-five percent gave at least one incorrect response in grading the various modes of oxygen supply regarding the risk of fire. Only 48% were able to identify the surgeries which posed the greatest fire risk. In such cases, 40% of respondents were not aware that a FiO(2) should be maintained below 30%, 43% that the use of nitrous oxide was forbidden and 32% that it was necessary to respect a drying time after the application of an alcohol-based solution. Concerning the management of a fire, most of the answers were correct. Finally, 97% of the respondents wished to be better informed on this particular topic. CONCLUSION: Our survey underlines a lack of knowledge amongst anaesthetists towards the risk of patient associated fire in theatre.