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BACKGROUND: We organized a training program for oral fiber optic intubation (FOI) under conscious sedation. The efficacy of the program was evaluated by comparing the performances of experts and novices. METHODS: The training procedure was divided into two sessions: a theoretical session on difficult airways, the fiber optic bronchoscope (FOB), remifentanil, topical anesthesia and patient interactions; and a session involving simulations of the FOI technique on dummies. For in vivo FOI, we enrolled patients requiring orotracheal intubation for elective surgery. Electrocardiograms, mean arterial pressure was railroaded over the fiberscope, and tracheal intubati6 and 7) FOIs, respectively, joined the study. To reach ±23 bpm, P=0.02), and RR was decreased (from 16±3 to 12±4 bpm, P<0.05). No differences were recorded between the experts and less-experienced anesthesiologists. The average duration of FOI was 3.3±2.0 min for experts and 4.2±2.4 min for novices (P=0.03). Procedures were successful in both groups, with patients in each group being equally satisfied with the procedures. CONCLUSION: This study highlights the importance of a structured FOI training program, demonstrating that it is possible to learn to perform FOI proficiently by practicing on dummies.

COPYRIGHT 2013 EDIZIONI MINERVA MEDICA Y E A R I N R E V I E W A year in review in Minerva Anestesiologica 2012 D. CHIUMELLO 1, M. ALLEGRI 2, F. CAVALIERE 3, G. DE COSMO 3 G. IOHOM 4, O. LANGERON 5, D. PIETRINI 3, M. ROSSI 6 1Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italia; 2Department of Surgical Clinical Diagnostic and Pediatric Science, Pain fterapy Service, University of Pavia-Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 3Istituto di Anestesia e Rianimazione, Università Cattolica Sacro Cuore, Policlinico “A. Gemelli”, Roma, Italia; 4Department of Anesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Wilton, Cork, Ireland; 5Department of Anesthesiology and Intensive Care, Hôpital de la Pitié-Salpêtrière, Paris, France; 6Dipartimento di Anestesia, Terapia Intensiva e Terapia del Dolore, Centro di ricerche e formazione ad Alta Tecnologica nelle Scienze Biomediche “San Giovanni Paolo II”, Università Cattolica Sacro Cuore, Campobasso, Italia General anesthesia he analysis of electroencephalogram (EEG) signal is of the outmost importance in the perioperative period. It is indeed useful to evalu- ate the depth of anesthesia, particularly when muscle relaxant are used; to point out early al- terations of cerebral metabolism due to hypoxia or ischemia, such as during carotid surgery; to diagnose seizure disorders; and to titrate drugs in pharmacologically-induced coma.1 Gross EEG abnormalities (absence of electrical activ- ity, burst suppression) are immediately apparent even to non-specialists, but subtle pronounced changes are more difficult to detect. For this rea- son, some computerized systems are now avail- able that process EEG signals and provide anes- thetists with numeric scores informative of the depth of anesthesia.2 As each system is based on its own mathematical algorithm, the usefulness

Analgesia in thoracic surgery