Pre-anaesthesia Telephone Consultation: A Safe Alternative for Anaesthesia Assessment in Case of Repeated Low or Intermediate Risk Surgeries: A Prospective Cohort Study.

Objective: Telemedicine has widely expanded during the coronavirus disease-2019 pandemic. Our objective was to evaluate the feasibility, safety, effectiveness, and satisfaction of pre-anaesthesia telephone consultation (PATC). Methods: From December 2015 to October 2016, a prospective survey was administered to anaesthesiologists, nurse anaesthetists, and patients of the ambulatory and maxillofacial departments. Patients having a pre-anaesthesia consultation (PAC) within the previous year in the department, whose health state was considered stable, and for whom the surgical procedure was related to the previous one, were eligible for PATC. Three questionnaires concerning the pre- (Q1), per- (Q2), and postoperative (Q3) periods were answered by the patient, the anaesthesiologist, and the anaesthesiologist nurse to evaluate the feasibility and satisfaction of the PATC. We collected the cancelation rate and any incident occurring during the surgery. Results: Over the study period, 210 patients were included. The response rate was 200/210 (95.2%) for Q1, 108/208 (51.9%) for Q2 and 146/208 (70.2%) for Q3. PATC was performed in a median (IQR) of 13 (7-20) days before the procedure. Patients answered directly in 73% of cases without the need for recall. During surgery, 4 incidents occurred and none were attributable to PATC. Patient satisfaction was 93.3% and 85.8% of them preferred PATC to conventional PAC. The kilometric saving was 74 (30-196) km per PATC. Conclusion: Both patients and professionals were satisfied with PATC, which did not impact safety. On the selected patients, PATC brings many practical benefits and increases organizational flexibility.

[Telehealth in peroperative medicine]. / Télémédecine, téléconsultation en médécine périopératoire.

Telemedicine is booming in every medical sector. Besides being one of the WHO's priorities to deal with health cost and accessibility issues in both industrial and developing countries, recent COVID-19 sanitary crisis showed that it could be precious to ensure continuity of care in conditions of crisis. Telehealth is developing in anaesthesia in the whole perioperative period. This review focuses on recent data from literature on anaesthetic preoperative assessment. Four main issues are discussed: (1) eligibility and feasibility of telemedicine for anaesthetic preoperative assessment; (2) its effectiveness regarding time of consultation, surgery cancellation rate and concordance of physical examination; (3) patients' satisfaction and; (4) its potential economic impact.

Anxiety and stress among anaesthesiology and critical care residents during high-fidelity simulation sessions.

OBJECTIVES: High-fidelity simulation (HFS) calls heavily upon cognitive capacities and generates stress and anxiety. The objectives of this prospective, observational study were to assess trait anxiety and fear of negative evaluation (FNE) in anaesthesiology and critical care residents and appraise their state anxiety levels and cardiovascular responses during HFS training sessions. SUBJECTS AND METHODS: First-year anaesthesiology and critical care residents completed the French-Canadian adaptation of the State-Trait Anxiety Inventory (IASTA Y-1: state anxiety, IASTA Y-2: trait anxiety) and the French adaptation of the Fear of Negative Evaluation Scale (FNE). Their heart rate (HR) and blood pressure (BP) were assessed before and after the training session. RESULTS: Twenty-three residents (8 women, 15 men) were included in the study. IASTA Y-1 and Y-2 scores were low (respectively 40.2±9.9 and 39.7±8) and FNE scores were moderate (16.7±5.5). HR measurements before and after the training sessions were significantly higher than at rest (respectively 78±19, 80±17 and 63±9b/min; P<0.001). BP measurements before and after the HFS sessions were not significantly different. The IASTA Y-2 and FNE scores of female residents were significantly higher than those of male residents (respectively P=0.004 and P=0.049). CONCLUSION: First-year anaesthesiology and critical care residents had low trait anxiety and FNE. HFS training increased their HR but not their BP. Their state anxiety also remained low. Several differences between individuals were noted, particularly between men and women.

A program based on a 'selective' least-squares method for respiratory mechanics monitoring in ventilated patients.

This paper proposes a program for continuous estimation of respiratory mechanics parameters in ventilated patients. This program can be used with any ventilator providing airway pressure and flow signals without additional equipment. Overall breathing resistance, dynamic elastance (E) and positive end expiratory pressure (P(0)) are periodically estimated by multiple linear regression on selected parts of breathing cycles. Experimental validation together with justification of the selection procedure are based on signals obtained while ventilating a lung mechanical analogue with various intensive care ventilators. Clinical validity has been tested on 12 ventilated patients. The quality of estimation has been assessed by mean square difference between measured and reconstituted pressure (MSE), coefficient of determination (R(2)) and the condition number (a confidence index), and by comparison of E and P(0) with corresponding static values. The high R(2) and the low MSE obtained on most clinical cycles indicate that selected parts of cycles obey closely the model underlying parameter estimation. Agreement between static and dynamic parameters demonstrates the clinical validity of our program.

Non-invasive detection of respiratory muscles activity during assisted ventilation.

The instantaneous pressure applied by the respiratory muscles [Pmus(t)] of a patient under ventilatory support may be continuously assessed with the help of a model of the passive respiratory system updated cycle by cycle. Inspiratory activity (IA) is considered present when Pmus goes below a given threshold. In six patients, we compared IA with (i) inspiratory activity (IAref) obtained from esophageal pressure and diaphragmatic EMG and (ii) that (IAvent) detected by the ventilator. In any case, a ventilator support onset coincides with an IA onset but the opposite is not true. IA onset is always later than IAref beginning ((0.21 +/- 0.10 s) and IA end always precedes IAref end (0.46 +/- 0.16 s). These results clearly deteriorate when the model is not updated.