Prediction of reactivity during tracheal intubation by pre-laryngoscopy tetanus-induced ANI variation.

The ANI is a nociception monitor based on the high frequency parts of heart rate variability. Tracheal intubation may induce potentially deleterious hemodynamic disturbances or motor reactions if analgesia is inadequate. We investigated whether ANI modification generated by a standardized moderate short tetanic stimulation performed before laryngoscopy could predict hemodynamic or somatic reactions to subsequent intubation. We designed a prospective, interventional, monocentric, pilot study. Regional ethics board approved the study, written informed consent was obtained from each participant. Before laryngoscopy, under steady-state total intravenous anaesthesia with propofol and remifentanil, the ulnar nerve was stimulated with a 5 s tetanus (70 mA, 50 Hz). After another steady-state period, orotracheal intubation was performed. ANI variation, hemodynamic parameters and somatic reactions associated with tetanus and intubation were collected. To assess the predictability of hemodynamic or somatic reaction during laryngoscopy by tetanus-induced ANI variation, we calculated the area under the corresponding Receiver Operating Characteristic curve (AUCROC) and the 95% confidence intervals. Thirty-five patients were analyzed. ANI decreased by 21 ± 17 after tetanus. Regarding the ability of tetanus-induced ANI variation to predict hemodynamic or somatic reactions during subsequent intubation, the AUCROCs [95% CI] were 0.61 [0.41-0.81] and 0.52 [0.31-0.72] respectively. ANI varied after a short moderate tetanic stimulation performed before laryngoscopy but this variation was not predictive of a hemodynamic or somatic reaction during intubation.Trial registration NCT04354311, April 20th 2020, retrospectively registered.

A multicenter study of the Ambu laryngeal mask in nonparalyzed, anesthetized patients.

We designed this multicenter trial to evaluate the performance and safety of the Ambu laryngeal mask, a new disposable supraglottic airway device, in patients scheduled for elective surgery. One-hundred-eighteen nonparalyzed, anesthetized patients (ASA physical status I-II, age, 18-65 yr, body mass index, 18-30 kg/m(-2)) receiving total IV anesthesia were included in this study. After device insertion, fiberoptic position and oropharyngeal leak pressure were determined at an intracuff pressure of 60 cm H2O. Ease of ventilation was determined by controlling ventilation at 6 mL/kg tidal volume. Any complications were noted and recorded. Device placement was successful in all patients on the first or second attempt (92.4% or 7.6%, respectively) with an insertion time (removal of face mask until first tidal volume) of 44.9 +/- 37.91 s. Adequate ventilation was achieved in all patients and the vocal cords could be visualized by fiberoptic endoscopy in 91.5% of patients. Oropharyngeal leak pressures were 24.1 +/- 5.44 cm H2O. Blood was detected on the device in 8.5% of patients. Complications and patient complaints were minor and quickly resolved. The Ambu laryngeal mask is easy and quick to insert and provides a safe and efficient seal during positive pressure ventilation in nonparalyzed patients scheduled for elective surgery.

User-centred, multidimensional assessment method of Clinical Information Systems: a case-study in anaesthesiology.

This paper describes a multi-dimensional assessment method to support the choice and acquisition process for Clinical Information Systems. The method addresses three different dimensions: (1) Quality management, which evaluates the fulfillment of Users Requirements, and the Users' satisfaction with the existing functions; (2) Usability assessment, which includes a Usability inspection, and a Usability test; (3) Performance evaluation, which assesses the exhaustiveness and quality of documentation. The method is illustrated using the case study of a Clinical Information System (CIS) acquisition for anaesthesiology. It proved efficient and promising as a support for the decision process, for enhancing users' involvement in the project, and for initiating the necessary re-engineering of the Human Computer Interface.

Multidimensional evaluation of a Clinical Information System for anaesthesiology: quality management, usability, and performances.

This paper describes a multi-dimensional assessment methodology to support the choice and selection process of Clinical Information Systems. The methodology includes 4 evaluation components: Fulfilment of Users Requirements, Usability Inspection, Usability Testing and Performance Evaluation. The methodology is illustrated with the case study of a selection of a CIS for anaesthesiology. It proved to be very efficient and powerful to support the selection process, to enhance users' involvement in the project, and to initiate the necessary re-engineering of the HCI.