Design development and implementation of an irradiation station at the neutron time-of-flight facility at CERN

A new parasitic, mixed-field, neutron-dominated irradiation station has been recently commissioned at the European Laboratory for Particle Physics (CERN). The station is installed within the neutron time-of-flight (n_TOF) facility, taking advantage of the secondary radiation produced by the neutron spallation target, with neutrons ranging from 0.025 eV to several hundreds of MeV. The new station allows radiation damage studies to be performed in irradiation conditions that are closer to the ones encountered during the operation of particle accelerators; the irradiation tests carried out in the station will be complementary to the standard tests on materials, usually performed with gamma sources. Samples will be exposed to neutron-dominated doses in the MGy range per year, with minimal impact on the n_TOF facility operation. The station has 24 irradiation positions, each hosting up to 100 cm3 of sample material. In view of its proximity to the n_TOF target, inside protective shielding, the irradiation station and its operating procedures have been carefully developed taking into account the safety of personnel and to avoid any unwanted impact on the operation of the n_TOF facility and experiments. Due to the residual radioactivity of the whole area around the n_TOF target and of the irradiated samples, access to the irradiation station is forbidden to human operators even when the n_TOF facility is not in operation. Robots are used for the remote installation and retrieval of the samples, and other optimizations of the handling procedures were developed in compliance with radiation protection regulations and the aim of minimizing doses to personnel. The sample containers were designed to be radiation tolerant, compatible with remote handling, and subject to detailed risk analysis and testing during their development. The whole life cycle of the irradiated materials, including their post-irradiation examinations and final disposal, was considered and optimized

Multivariate Analysis of the Failure Risk of First Tracheal Intubation Attempt in a Population of Patients Scheduled for Bariatric Surgery

BACKGROUND: Airway management during the administration of anesthesia to patients undergoing bariatric surgery is challenging. The goal is to avoid multiple intubation attempts because the risk of complications increases with the number of attempts. The objective of this study was to determine the failed first intubation attempt rate, as well as variables associated with this failure, in patients undergoing bariatric surgery. METHODS: We enrolled patients scheduled for bariatric surgery in this prospective, observational, single-center study. We determined predictive criteria for difficult intubation at the preoperative anesthesia consultation. All patients were evaluated for obstructive sleep apnea by polygraphy. The primary study endpoint was a failed first intubation attempt. RESULTS: We enrolled 519 patients between December 2012 and January 2015. The cohort consisted of 425 women (82%), with a median (interquartile range [IQR]) age of 39 (30-50) years and a body mass index of 42 (39-46) kg/m(2). The first intubation attempt failed in 60 patients, with an incidence rate of 11.5% (95% confidence interval [CI], 8.8-14.2%). We included nine variables in the final multivariate model. Two variables were associated with failed first intubation attempt: male sex (odds ratio [OR] [95% CI], 6.9% [2.5-18.7%]) and Mallampati score 3-4 (OR [95% CI], 2.2% [1.0-4.7%]). CONCLUSIONS: In this morbidly obese population, the first intubation attempt failed in 11.5% of patients, and the risk factors for failure were male sex and a high Mallampati score

Guidelines on muscle relaxants and reversal in anaesthesia

International audienceObjectives: To provide an update to the 1999 French guidelines on “Muscle relaxants and reversal in anaesthesia”, a consensus committee of sixteen experts was convened. A formal policy of declaration and monitoring of conflicts of interest (COI) was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE®) system to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making strong recommendations based on low-quality evidence were stressed. Few of the recommendations remained ungraded. Methods: The panel focused on eight questions: (1) In the absence of difficult mask ventilation criteria, is it necessary to check the possibility of ventilation via a facemask before muscle relaxant injection? Is it necessary to use muscle relaxants to facilitate facemask ventilation? (2) Is the use of muscle relaxants necessary to facilitate tracheal intubation? (3) Is the use of muscle relaxants necessary to facilitate the insertion of a supraglottic device and management of related complications? (4) Is it necessary to monitor neuromuscular blockade for airway management? (5) Is the use of muscle relaxants necessary to facilitate interventional procedures, and if so, which procedures? (6) Is intraoperative monitoring of neuromuscular blockade necessary? (7) What are the strategies for preventing and treating residual neuromuscular blockade? (8) What are the indications and precautions for use of both muscle relaxants and reversal agents in special populations (e.g. electroconvulsive therapy, obese patients, children, neuromuscular diseases, renal/hepatic failure, elderly patients)? All questions were formulated using the Population, Intervention, Comparison and Outcome (PICO) model for clinical questions and evidence profiles were generated. The results of the literature analysis and the recommendations were then assessed using the GRADE® system. Results: The summaries prepared by the SFAR Guideline panel resulted in thirty-one recommendations on muscle relaxants and reversal agents in anaesthesia. Of these recommendations, eleven have a high level of evidence (GRADE 1±) while twenty have a low level of evidence (GRADE 2±). No recommendations could be provided using the GRADE® system for five of the questions, and for two of these questions expert opinions were given. After two rounds of discussion and an amendment, a strong agreement was reached for all the recommendations. Conclusion: Substantial agreement exists among experts regarding many strong recommendations for the improvement of practice concerning the use of muscle relaxants and reversal agents during anaesthesia. In particular, the French Society of Anaesthesia and Intensive Care (SFAR) recommends the use of a device to monitor neuromuscular blockade throughout anaesthesia