TELEANESTESIA - ANESTESIA CON CONTROLLO REMOTO TRANS-CONTINENTALE

Il progetto è stato chiamato Teleanestesia. Quest'ultima potrebbe, essere definita come il controllo a distanza dell’anestesia – valutazione preoperatoria e gestione perioperatoria attraverso il controllo a distanza di un sistema, presente localmente, che mantiene il livello di anestesia in modo automatico. La valutazione pre-operatoria è effettuata tramite un sistema di video-conferenza tra l’Italia e il Canada, l’anamnesi del paziente e la valutazione delle vie aeree è eseguita a distanza . I dati del paziente sono in seguito inseriti in un sistema che infonde i farmaci anestetici(Oppioide, ipnotico e miorisolutore) in modo automatizzato. L’anestesia (con tutti e tre le componenti), induzione - tra cui intubazione videolaryngoscopica, il mantenimento ed il risveglio, che avviene a Pisa è monitorizzata e controllata a distanza dal Canada tramite una rete virtuale. I requisiti specifici sono: una postazione remota (Montreal) con computer che permettono il monitoraggio del paziente e il controllo del sistema di somministrazione automatizzata dell’anestesia (presente a Pisa). Quest’ultimo fornisce lo stato dell'arte dell’anestesia totale per via endovenosa. I due centri universitari sono in collegamento audio-video in modo continuo mantenendo cosi una comunicazione permanente durante l’intervento. Quattro telecamere poste strategicamente monitorizzano - in tempo reale a Pisa - ogni aspetto della cura del paziente: una schermata video mostra i parametri ventilatori (come ad esempio la frequenza respiratoria del paziente), un altro video mostra i segni vitali (ECG, frequenza cardiaca, saturazione di ossigeno), una videocamera fornisce immagini in diretta della chirurgia ed infine un’altra videocamera permette inizialmente di visualizzare le immagini della videolaringoscopia e poi serve come eventuale backup. Questa prova di concetto vuole dimostrare che l'uso di mezzi di comunicazione standard - video-conferenza, reti virtuali – permettono di eseguire a distanza un’anestesia grazie anche all’impiego di sistemi automatizzati presenti localmente. In effetti, si potrebbe, ad esempio, realizzare la valutazione preoperatoria anestesiologica e la somministrazione dei farmaci anestetici, in aree remote oppure nei paesi del terzo mondo o, semplicemente, regioni in cui un ato livello di esperienza non è disponibile

Efficient diode-pumped Yb3+:Y2SiO5 and Yb3+:Lu2SiO5 high-power femtosecond laser operation

International audienceWe report the mode-locked operation of two new Yb-doped oxyorthosilicates, Y2SiO5 (YSO) and Lu2SiO5 (LSO), that are longitudinally diode pumped. Yb:YSO supplied pulses as short as 122 fs with 410mW of output power at 1041 nm. More than 2.6W of average output power, for pulse durations of 198 fs at 1044 nm and 260 fs at 1059 nm for Yb:YSO and Yb:LSO, respectively, were provided. These are, to our best knowledge, the highest values ever obtained and the most efficient mode-locked laser in such a classic fibercoupled diode-pumping configuratio

Temporal cleaning of a high energy fiber-based ultrafast laser using cross-polarized wave generation

International audienceWe report the use of cross-polarized wave generation to perform both pulse shortening and temporal cleaning of a high-energy ytterbium-doped fiber-based femtosecond laser system. The nonlinear processes allow both a highly efficient nonlinear conversion of 20% and a large compression ratio of 3.5, with inherently improved coherent and incoherent contrasts. This results in the generation of 37 μJ, 115 fs pulses at a repetition rate of 100 kHz with high temporal quality

High peak-power stretcher-free femtosecond fiber amplifier using passive spatio-temporal coherent combining

International audienceWe report on the passive coherent combining of up to 8 temporally and spatially separated ultrashort pulses amplified in a stretcher-free ytterbium-doped fiber system. An initial femtosecond pulse is split into 4 temporal replicas using divided-pulse amplification, and subsequently divided in two counter-propagating beams in a Sagnac interferometer containing a fiber amplifier. The spatio-temporal distribution of the peak-power inside the amplifier allows the generation of record 3.1 µJ and 50 fs pulses at 1 MHz of repetition rate with 52 MW of peak-power from a stretcher-free fiber amplifier and without additional nonlinear post-compression stages

Nonlinear compression of high energy fiber amplifier pulses in air-filled hypocycloid-core Kagome fiber

International audienceWe report on the generation of 34 fs and 50 µJ pulses from a high energy fiber amplifier system with nonlinear compression in an air-filled hypocycloid-core Kagome fiber. The unique properties of such fibers allow bridging the gap between solid core fibers-based and hollow capillary-based post-compression setups, thereby operating with pulse energies obtained with current state-of-the-art fiber systems. The overall transmission of the compression setup is over 70%. Together with Yb-doped fiber amplifier technologies, Kagome fibers therefore appear as a promising tool for efficient generation of pulses with durations below 50 fs, energies ranging from 10 to several hundreds of µJ, and high average powers

Coherent beam combining with an ultrafast multicore Yb-doped fiber amplifier

International audienceActive coherent beam combination using a 7-non-coupled core,polarization maintaining, air-clad, Yb-doped fiber is demonstrated as amonolithic and compact power-scaling concept for ultrafast fiber lasers. Amicrolens array matched to the multicore fiber and an active phasecontroller composed of a spatial light modulator applying a stochasticparallel gradient descent algorithm are utilized to perform coherentcombining in the tiled aperture geometry. The mitigation of nonlineareffects at a pulse energy of 8.9 μJ and duration of 860 fs is experimentallyverified at a repetition rate of 100 kHz. The experimental combiningefficiency results in a far field central lobe carrying 49% of the total power,compared to an ideal value of 76%. This efficiency is primarily limited bygroup delay differences between cores which is identified as the maindrawback of the system. Minimizing these group delay issues, e.g. by usingshort and straight rod-type multicore fibers, should allow a practical powerscaling solution for femtosecond fiber systems

Two-photon fluorescence imaging with 30 fs laser system tunable around 1 micron

We developed a low-cost, low-noise, tunable, high-peak-power, ultrafast laser system based on a SESAM-modelocked, solid-state Yb tungstate laser plus spectral broadening via a microstructured fiber followed by pulse compression. The spectral selection, tuning, and pulse compression are performed with a simple prism compressor. The output pulses are tunable from 800 to 1250 nm, with the pulse duration down to 25 fs, and average output power up to 150 mW, at 80 MHz pulse repetition rate. We introduce the figure of merit (FOM) for the two-photon and multi-photon imaging (or other nonlinear processes), which is a useful guideline in discussions and for designing the lasers for an improved microscopy signal. Using a 40 MHz pulse repetition rate laser system, with twice lower FOM, we obtained high signal-to-noise ratio two-photon fluorescence images with or without averaging, of mouse intestine section and zebra fish embryo. The obtained images demonstrate that the developed system is capable of nonlinear (TPE, SHG) imaging in a multimodal operation. The system could be potentially used in a variety of other techniques including, THG, CARS and applications such as nanosurgery

Sevoflurane causes less arrhythmias than desflurane after off-pump coronary artery bypass grafting: a pilot study.

Background: Volatile anesthetics provide myocardial protection during cardiac surgery. Sevoflurane and desflurane are both efficient agents that allow immediate extubation after off-pump coronary artery bypass grafting (OPCABG). This study compared the incidence of arrhythmias after OPCABG with the two agents. Materials and Methods: Forty patients undergoing OPCABG with immediate extubation and perioperative high thoracic analgesia were included in this controlled, double-blind study; anesthesia was either provided using 1 MAC of sevoflurane (SEVO-group) or desflurane (DES-group). Monitoring of perioperative arrhythmias was provided by continuous monitoring of the EKG up to 72 hours after surgery, and routine EKG monitoring once every day, until time of discharge. Patient data, perioperative arrhythmias, and myocardial protection (troponin I, CK, CK-MB-ratio, and transesophageal echocardiography examinations) were compared using t-test, Fisher′s exact test or two-way analysis of variance for repeated measurements; P < 0.05. Results: Patient data and surgery-related data were similar between the two groups; all the patients were successfully extubated immediately after surgery, with similar emergence times. Supraventricular tachycardia occurred only in the DES-group (5 of 20 patients), atrial fibrillation was significantly more frequent in the DES group versus SEVO-group, at five out of 20 versus one out of 20 patients, respectively. Myocardial protection was equally achieved in both groups. Discussion: Ultra-fast track anesthesia using sevoflurane seems more advantageous than desflurane for anesthesia, for OPCABG, as it is associated with significantly less atrial fibrillation or supraventricular arrhythmias after surgery

Autonomous systems in anesthesia : where do we stand in 2020? A narrative review

As most of us are aware, almost every facet of our society is becoming, for better or worse, progressively more technology-dependent. Technological advancement has made autonomous systems, also known as robots, an integral part of our life in several fields, including medicine. The application of robots in anesthesia could be classified into 3 types of robots. The first ones are pharmacological robots. These robots are based on closed-loop systems that allow better-individualized anesthetic drug titration for optimal homeostasis during general anesthesia and sedation. Recent evidence also demonstrates that autonomous systems could control hemodynamic parameters proficiently outperforming manual control in the operating room. The second type of robot is mechanical. They enable automated motorized reproduction of tasks requiring high manual dexterity level. Such robots have been advocated to be more accurate than humans and, thus, could be safer for the patient. The third type is a cognitive robot also known as decision support system. This type of robot is able to recognize crucial clinical situation that requires human intervention. When these events occur, the system notifies the attending clinician, describes relevant related clinical observations, proposes pertinent therapeutic options and, when allowed by the attending clinician, may even administer treatment. It seems that cognitive robots could increase patients' safety. Robots in anesthesia offer not only the possibility to free the attending clinicians from repetitive tasks but can also reduce mental workload allowing them to focus on tasks that require human intelligence such as analytical and clinical approach, lifesaving decision-making capacity, and interpersonal interaction. Nevertheless, further studies have yet to be done to test the combination of these 3 types of robots to maintain simultaneously the homeostasis of multiple biological variables and to test the safety of such combination on a large-scale population