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742: Antiaggregation in Carotid Surgery and Cervical Cervical Plexus Block
242
Posters
•
Miscellaneous
584. Preoperative information given to patients regarding risk and regional anaesthesia E. Docker, A. Troy Countess of Chester NHS Foundation Trust, Anaesthesia, Chester, UK Background: Anaesthetists have a clear duty to inform patients in detail about the choices available to them and to ensure patients have understood the risks involved before giving informed consent. Good communication is vital in this process. (Raising the Standard; Information for Patients 2003). Aims: To determine what information patients receive about the risks of anaesthesia and if they are satisfied with the information, and to determine what information the anaesthetists give to patients regarding regional anaesthesia and what they understand by risk. Methods: Two questionnaires were designed by the audit lead; one for patients and one for Anaesthetists.The audit lead interviewed patients using the anonymous patients’ questionnaire and distributed the Anaesthetists’ questionnaire to staff in the Anaesthetic Department for them to complete anonymously. The data from the questionnaires was entered and analysed in Excel by the Clinical Audit Facilitator. Results: Forty patients were interviewed. Types of regional anaesthesia included spinal, epidural, major lower limb and upper limb blocks. The majority of patients recalled seeing their anaesthetist before the operation and a discussion about the risks of their regional anaesthetic however they rarely recalled any quantification of the risks involved nor was the discussion well documented in the notes. Very few received a patient information leaflet however the majority were more than happy with the information they did receive. Anaesthetists use terms such as common, uncommon and rare frequently but few really understand what these terms mean. Conclusions: Anaesthetists have a poor understanding of risk and are therefore poor at explaining risk and fully documenting any discussion with patients. Clear guidance is provided by the Royal College and the Association of Anaesthetists and we must utilise this to ensure good written communication is provided for every patient.
742. Antiaggregation in carotid surgery and cervical cervical plexus block M. Estruch-Pe´rez1, M. Morales-Sua´rez-Varela2, J. Soliveres-Ripoll1, J. Balaguer-Domenech1, C. Solaz-Roldan3 1Dr. Peset University Hospital, Anesthesiology and Intensive Care, Valencia, Spain, 2Unit of Public Health, Hygiene and Environmental Health., Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain, 3Dr. Peset University Hospital, Anesthesiology and Critical Care, Valencia, Spain Introduction: Antiplatelet drugs(AAP) such as acetylsalicylic acid(ASA) and thienopirydine derivatives(TD) are licensed for secondary strokes prevention . AAP are assumed to have a higher bleeding and their discontinuation could be indicated in peripherical block(GradeD). The peripherical block bleeding risk has not been reported. However, it is recommended withdrawing TD before cervical block(GradeC). Discontinuing AAP increase risk of ischemic stroke. Our objective is to assess the bleeding risk according to the AAP previously administrated and in relation to age and vascular disease in patients underwent carotid surgery(CEA) under cervical block(CB). Material and Methods: After approval of the local ethics committee, 78ASAI-IV patients scheduled for CEA under CB were enrolled. Group 0, 17 patients were not given AAP. Group 1, 17 patients were given AAS. Group 2, 19 patients were given TD. Group 3, 13 patients were given AAS⫹TD. Haematoma caused by the injecting needle leading to cancellation of surgery or postoperative cervical haematoma was recorded. Data were percentage and confidence interval 95%(CI). Differences were analysed by 2. Relative risk(RR) was calculated, crude and adjusted by age, physical status, AAP and arterial disease. Results and Discussion: Results are shown in the table. 2 p⫽ 0.576 There weren⬘t any haematoma caused by the injecting needle. There were 9(7.02%) patients with postoperative bleeding. We haven⬘t found differences in relation to postoperative bleeding between groups. However, RR is increased in TD groups although without differences too. This could suggest an increased risk in the TD group as another reports confirm but it is not enough to avoid a CB. An increase in postoperative bleeding has been reported in patients using TD. No significant aspirin effect on postoperative bleeding has been observed.
Drug 0. 1. 2. 3.
Percentage(CI)
RRc(CI)
RRa(CI)
No AAP 5.88% (0.3-30.76) 1 (Reference) 1 (Reference) AAS 10.52% (1.84-34.53) 1.79 (0.18-18.02) 0.06 (0.01-2.1) TD 17.86% (6.77-37.91) 3.04 (0.39-23.84) 0.12 (0.01-0.85) AAS⫹TD 7.69% (0.4-37.91) 1.31 (0.09-19) 0.21 (0.01-4.65)
Posters
•
Miscellaneous
584. Preoperative information given to patients regarding risk and regional anaesthesia E. Docker, A. Troy Countess of Chester NHS Foundation Trust, Anaesthesia, Chester, UK Background: Anaesthetists have a clear duty to inform patients in detail about the choices available to them and to ensure patients have understood the risks involved before giving informed consent. Good communication is vital in this process. (Raising the Standard; Information for Patients 2003). Aims: To determine what information patients receive about the risks of anaesthesia and if they are satisfied with the information, and to determine what information the anaesthetists give to patients regarding regional anaesthesia and what they understand by risk. Methods: Two questionnaires were designed by the audit lead; one for patients and one for Anaesthetists.The audit lead interviewed patients using the anonymous patients’ questionnaire and distributed the Anaesthetists’ questionnaire to staff in the Anaesthetic Department for them to complete anonymously. The data from the questionnaires was entered and analysed in Excel by the Clinical Audit Facilitator. Results: Forty patients were interviewed. Types of regional anaesthesia included spinal, epidural, major lower limb and upper limb blocks. The majority of patients recalled seeing their anaesthetist before the operation and a discussion about the risks of their regional anaesthetic however they rarely recalled any quantification of the risks involved nor was the discussion well documented in the notes. Very few received a patient information leaflet however the majority were more than happy with the information they did receive. Anaesthetists use terms such as common, uncommon and rare frequently but few really understand what these terms mean. Conclusions: Anaesthetists have a poor understanding of risk and are therefore poor at explaining risk and fully documenting any discussion with patients. Clear guidance is provided by the Royal College and the Association of Anaesthetists and we must utilise this to ensure good written communication is provided for every patient.
742. Antiaggregation in carotid surgery and cervical cervical plexus block M. Estruch-Pe´rez1, M. Morales-Sua´rez-Varela2, J. Soliveres-Ripoll1, J. Balaguer-Domenech1, C. Solaz-Roldan3 1Dr. Peset University Hospital, Anesthesiology and Intensive Care, Valencia, Spain, 2Unit of Public Health, Hygiene and Environmental Health., Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain, 3Dr. Peset University Hospital, Anesthesiology and Critical Care, Valencia, Spain Introduction: Antiplatelet drugs(AAP) such as acetylsalicylic acid(ASA) and thienopirydine derivatives(TD) are licensed for secondary strokes prevention . AAP are assumed to have a higher bleeding and their discontinuation could be indicated in peripherical block(GradeD). The peripherical block bleeding risk has not been reported. However, it is recommended withdrawing TD before cervical block(GradeC). Discontinuing AAP increase risk of ischemic stroke. Our objective is to assess the bleeding risk according to the AAP previously administrated and in relation to age and vascular disease in patients underwent carotid surgery(CEA) under cervical block(CB). Material and Methods: After approval of the local ethics committee, 78ASAI-IV patients scheduled for CEA under CB were enrolled. Group 0, 17 patients were not given AAP. Group 1, 17 patients were given AAS. Group 2, 19 patients were given TD. Group 3, 13 patients were given AAS⫹TD. Haematoma caused by the injecting needle leading to cancellation of surgery or postoperative cervical haematoma was recorded. Data were percentage and confidence interval 95%(CI). Differences were analysed by 2. Relative risk(RR) was calculated, crude and adjusted by age, physical status, AAP and arterial disease. Results and Discussion: Results are shown in the table. 2 p⫽ 0.576 There weren⬘t any haematoma caused by the injecting needle. There were 9(7.02%) patients with postoperative bleeding. We haven⬘t found differences in relation to postoperative bleeding between groups. However, RR is increased in TD groups although without differences too. This could suggest an increased risk in the TD group as another reports confirm but it is not enough to avoid a CB. An increase in postoperative bleeding has been reported in patients using TD. No significant aspirin effect on postoperative bleeding has been observed.
Drug 0. 1. 2. 3.
Percentage(CI)
RRc(CI)
RRa(CI)
No AAP 5.88% (0.3-30.76) 1 (Reference) 1 (Reference) AAS 10.52% (1.84-34.53) 1.79 (0.18-18.02) 0.06 (0.01-2.1) TD 17.86% (6.77-37.91) 3.04 (0.39-23.84) 0.12 (0.01-0.85) AAS⫹TD 7.69% (0.4-37.91) 1.31 (0.09-19) 0.21 (0.01-4.65)