[Evaluation of the haemostasis before a central block in children: what is the French anaesthesiologist's attitude?].
OBJECTIVE
Because of the lack of controlled studies, there is no consensus regarding the practice of routine haemostasis tests before neuraxial blockade in children. The purpose of this study was to describe the French surgical practice about the preoperative evaluation of coagulation in children who were scheduled for paediatric neuraxial anaesthesia.


METHODS
Descriptive analysis of the practice.


METHODS
A telephone survey for coagulation screening was conducted in French surgical paediatric units, known to perform paediatric neuraxial anaesthesia on a routine basis. The aim of the standardized questionnaire was to evaluate the expertise in performance of neuraxial block, the modalities of the preoperative haemostasis screening, and the indications of biological tests and to assess whether a standardized team procedure was used.


RESULTS
Forty-two hospitals (27 universities, 10 general hospitals and five private institutions) were contacted; 61 anaesthesiologists with an expertise with central block answered the survey. Thirty-five institutions used a standardized procedure and 57,1% of them undertook routines tests only in children who are not walking. In the remaining 42,9%, the strategy was to screen systematically all patients whatever their age, familial and personal history as well as physical examination. However, only 54% of the anaesthesiologists performed an extensive physical examination in order to detect symptoms in favour of signs of haemostatic disorders.


CONCLUSIONS
While numerous data suggest that routine testing does not to provide much extra information in the absence of a positive history, a systematic strategy is still widely applied in children. Guidelines need to be developed to insure the safety of oriented tests.
Pajot
S
S
Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu-hôpital Mère-Enfant, CHU de Nantes, place Alexis-Ricardeau, 44093 Nantes cedex 01, France.
Asehnoune
K
K
Le Roux
C
C
Léturgie
C
C
Surbled
M
M
Bazin
V
V
Lejus
C
C
D000293:Adolescent; D000328:Adult; D000763:Anesthesia, Caudal; D000767:Anesthesia, Epidural; D000776:Anesthesiology / Q000592:standards / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D001772:Blood Cell Count; D001774:Blood Chemical Analysis; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005602:France; D019538:Health Care Surveys; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D007223:Infant; D008487:Medical History Taking; D009407:Nerve Block; D010808:Physical Examination; D011300:Preoperative Care; D055815:Young Adult