Purpose:To evaluate the magnitude of subjective cognitive failure in the three days following general anesthesia (GA) for ambulatory surgery. Methods:After Research Ethics Board approval, 258 patients undergoing general anesthesia (GA) and 250 patients scheduled for local anesthesia (LA) were recruited from our ambulatory surgical unit. Following the method of Tzabar, Asbury and Millar, patients were asked to complete the cognitive failures questionnaire (CFQ) before their procedure (with respect to the previous three days) and on the third postoperative day (with respect to their recovery period).Results: General anesthesia and LA groups were similar in demographic make-up, except that the LA group contained more patients of American Society of Anesthesiologists physical status I (64.5% vs 52.7%, P < 0.05) and had significantly shorter procedure duration (25 vs 51 min, P < 0.01) than the GA group. Median preoperative CFQ scores (interquartile range) were 26 (18) for the LA group and 26 (18) for the GA group. Postoperative CFQ scores were 25 (20) for the LA group and 28 (22) for the GA group. There was no significant difference in preoperative CFQ score between groups (Mann-Whitney U). When preoperative and postoperative CFQ scores were compared, the small increase seen in the GA group was statistically significant (P < 0.05, Wilcoxon). Conclusion:A statistically significant impairment of cognitive function in the three days following GA, but not LA was found. However, the magnitude of this impairment was small, and is of doubtful clinical significance. Modern ambulatory anesthesia may cause less delayed cognitive impairment than was previously thought. Objectif

INTRODUCTION: Cardiovascular surgery is still associated with significant morbidity and mortality due to bleeding. Several case reports have suggested that a new agent, recombinant Factor VIIa (rVIIa), may reduce bleeding in patients failing conventional treatment (1; 2). The purpose of this study was to determine if adding rVIIa to the already thrombogenic environment of new vascular anastomoses could result in higher incidence of graft occlusion. METHODS: With Animal Care Committee approval, 19 rabbits were anesthesized with ketamine (10mg/kg), xylazine (2mg/kg), and 1-2% isoflurane in 100% oxygen. Through a midline neck incision, the right jugular and both carotid arteries were exposed. The animals were anticoagulated with heparin, and a 2-3 cm section of right jugular vein was then excised and grafted to the right carotid artery with two end to side anastomoses. The left carotid artery was ligated and re-anastomosed in an end to end fashion. Following protamine administration the grafts were inspected before skin closure to ensure adequate flow. Animals then received either placebo or 300ug/kg of rVIIa intravenously. An ultrasound was performed at 3 hours and 24 hours to assess graft flow, and the presence of occlusive clot. On sacrifice, the grafts were visually inspected for thrombus. The primary outcome was ultrasound evidence of no flow or presence of occlusive thrombus in the graft. Data was analyzed using ANOVA, chi-square or fisher's exact test where appropriate, with p<0.05 considered significant. RESULTS: Three animals were excluded for technical reasons. rVIIa treated animals had a significantly higher incidence of graft occlusion (vein 7/8 vs 1/8, p=0.01; artery 7/8 vs 2/8, p<0.05) and lower average vein graft flow (26.7 +/-15.34 vs 5.5 +/-13.47 ml/min, p<0.05). There was no significant difference between the two groups in graft diameter, physiological variables, hemodynamics or anticoagulation. DISCUSSION: This study suggests that high dose rVIIa (300ug/kg) leads to an increased incidence of fresh vascular graft thrombosis. It is still unknown if these results would be obtained with lower doses. Our findings may guide further research and clinical use of rVIIa