[Use of a single-use fiberscope for the training in tracheal intubation under fiberscopy on labyrinth]. / Utilisation d'un fibroscope à usage unique pour la formation sur labyrinthe à l'intubation sous fibroscope.

GOAL OF THE STUDY: To evaluate a single-use fiberscope, the Ascope-Trainer, for the training in the intubation under fiberscope. TYPE OF STUDY: Prospective randomized study approved by the local ethic committee. METHODOLOGY: After evaluation of their level of expertise, "experienced" or "novices" in intubation under fiberscope, the doctors attending the Training for Referents in Difficult Airway Management performed a test on labyrinth with a standard fiberscope (T1). After they were assigned to two groups, training with the Ascope-Trainer (group A, n=35) or with a classic fiberscope (group C, n=29), they trained during 15 minutes and performed a new test (T2). An analysis of variance was used to compare means. A goal for the training was determined according to the "experienced" doctors' mean T1. A test of Khi(2) was used for the comparison of the number of participants having reached this goal as well as the progress in both groups A and C. RESULTS: The T1 in the "experienced" group was 76 ± 31 s and the training improved significantly T2 (53 ± 17 s). Considering the novices, T2 was significantly lower than T1 in the group A (77 ± 38 s versus 135 ± 68 s) as well as in C (64 ± 28 s versus 122 ± 60 s), and the proportion of the novices having reached the goal of training was comparable in both groups. CONCLUSIONS: Because its use is similar to the standard fiberscope, the Ascope-Trainer may be interesting for this type of training.

Systematic follow-up increases incidence of anaphylaxis during adverse reactions in anesthetized patients.

BACKGROUND: The incidence of hypersensitivity reactions during anesthesia is underestimated because clinical symptoms may vary and diagnosis is not obvious. Our aim was to investigate the consequences of a systematic follow-up of patients on the estimated incidence of allergic reactions during anesthesia. METHODS: We conducted a prospective study over a 2-year period (70,000 anesthesias). When patients were suspected with hypersensitivity reactions or with unexplained adverse reactions during anesthesia, blood was sampled to measure histamine and tryptase, and then skin tests were performed 4-6 weeks later. RESULTS: During the studied period, 39 patients were enrolled in the database. Eight were excluded because of lack of skin tests. Twenty-two patients had clinical features compatible with immediate hypersensitivity reaction, and nine had reactions rated as 'unexplained' by the attending physician. Following systematic investigation, we found 22 hypersensitivity reactions (15 patients with obvious and seven with unexplained reactions) during anesthesia. This increases the estimated incidence of hypersensitivity reactions from 1 : 4667 to 1 : 3180 anesthesias. Tryptase concentrations were increased in only 50% of these patients. In our series, positive and negative predictive values of tryptase at T(0) for the diagnosis of anaphylaxis were 100% and 60%, respectively. Latex was the major causative agent, followed by neuromuscular blocking agents and antibiotics. CONCLUSIONS: Systematic follow-up of patients with unexplained reactions during anesthesia increases the estimated incidence of IgE-mediated hypersensitivity reactions during anesthesia by 50%.