**7. Conclusion**

Two questions were asked at the beginning of this chapter and one aim was pursued. Regarding anticipation performed by anaesthetists, we wanted first to highlight the explicit elements of anticipation. However, the results show that the anaesthetist has on the one hand, explicit predictions about specific events and on the other hand, builds expectations that are not clearly communicated (implicit expectations) but known as points for consideration. This result confirms a certain "risk allostasis" (Fuller, et al., 2008). Further analysis (Neyns, 2011) enables us to explain this risk allostasis through the availability of algorithms developed by scientific societies such as SFAR (French Society of Anaesthesia) or the American Society of Anesthesiologists (ASA). These algorithms allow the anaesthetist to manage promptly when a problem occurs. For example, the management algorithm of malignant hyperthermia describs all the symptoms and strategies to use for stopping the crisis.

Thus, during the consultation all the risks are not assessed but it allows the anesthetist to put warning on specific problems that may arise. The anaesthetist therefore has a schematic representation and uses generic and abstract plans with a particularisation in real time (Anceaux et al., 2002; Thuilliez et al., 2005; Van Daele & Carpinelli, 2001). This means that during the intervention, this representation is the result of filtering information and a highlighting of risks. Throughout the surgery, the anesthetist will complete this representation with contextual information. Finally, when a problem occurs, anaesthetists tend to put routines in place to assess the situation (algorithms, hypothesis generation). We also observed, whatever the risks they face (frequent/infrequent, predictable/unpredictable) anaesthetists tend to explain the situation using several hypotheses. This result demonstrates that the situation of anesthesia is a complex situation where multiple variables interact and can be the source of several problems. Moreover, epidemiological studies pointed out that there were problems arising from inadequate evaluation and a bad patient's preparation for surgery. Our results tend to show that it can only be part of a highlighting of several risks as those actually involved. The anaesthetists' representation is distorted by some points for consideration when they have to assess the situation. Another study (Neyns, 2011) shows that certain events (such as difficult intubation) could be due to a misidentification according to qualitative judgments on criteria.

But these first results cannot attest to the necessity or not of a preanesthetic consultation but allow to emphase the importance of the anaesthetists' experience and the need to develop habits of action (Norros & Klemola, 1999) to recognise and manage some cases. For example, the infrequent risks. Because rare does not mean impossible, it is important to establish some specific training through simulations, conference, seminar, etc. In another study (Neyns, 2011) we compared the risk management between France (with consultation) and Quebec (without specific anaesthesia consultation). This study showed that in Quebec they have developed specific patterns of actions that allow them to quickly manage the problem, even if they took longer time to identify the problem.

often correctly assessed, dectected and recovered. The explanation lies in algorithms developed and the current practice that allow the anaesthetist to identify problems quickly

Two questions were asked at the beginning of this chapter and one aim was pursued. Regarding anticipation performed by anaesthetists, we wanted first to highlight the explicit elements of anticipation. However, the results show that the anaesthetist has on the one hand, explicit predictions about specific events and on the other hand, builds expectations that are not clearly communicated (implicit expectations) but known as points for consideration. This result confirms a certain "risk allostasis" (Fuller, et al., 2008). Further analysis (Neyns, 2011) enables us to explain this risk allostasis through the availability of algorithms developed by scientific societies such as SFAR (French Society of Anaesthesia) or the American Society of Anesthesiologists (ASA). These algorithms allow the anaesthetist to manage promptly when a problem occurs. For example, the management algorithm of malignant hyperthermia describs all the symptoms and strategies to use for stopping the

Thus, during the consultation all the risks are not assessed but it allows the anesthetist to put warning on specific problems that may arise. The anaesthetist therefore has a schematic representation and uses generic and abstract plans with a particularisation in real time (Anceaux et al., 2002; Thuilliez et al., 2005; Van Daele & Carpinelli, 2001). This means that during the intervention, this representation is the result of filtering information and a highlighting of risks. Throughout the surgery, the anesthetist will complete this representation with contextual information. Finally, when a problem occurs, anaesthetists tend to put routines in place to assess the situation (algorithms, hypothesis generation). We also observed, whatever the risks they face (frequent/infrequent, predictable/unpredictable) anaesthetists tend to explain the situation using several hypotheses. This result demonstrates that the situation of anesthesia is a complex situation where multiple variables interact and can be the source of several problems. Moreover, epidemiological studies pointed out that there were problems arising from inadequate evaluation and a bad patient's preparation for surgery. Our results tend to show that it can only be part of a highlighting of several risks as those actually involved. The anaesthetists' representation is distorted by some points for consideration when they have to assess the situation. Another study (Neyns, 2011) shows that certain events (such as difficult intubation) could be due to a

But these first results cannot attest to the necessity or not of a preanesthetic consultation but allow to emphase the importance of the anaesthetists' experience and the need to develop habits of action (Norros & Klemola, 1999) to recognise and manage some cases. For example, the infrequent risks. Because rare does not mean impossible, it is important to establish some specific training through simulations, conference, seminar, etc. In another study (Neyns, 2011) we compared the risk management between France (with consultation) and Quebec (without specific anaesthesia consultation). This study showed that in Quebec they have developed specific patterns of actions that allow them to quickly manage the problem,

misidentification according to qualitative judgments on criteria.

even if they took longer time to identify the problem.

(by information filtering).

**7. Conclusion** 

crisis.

This chapter, in line with the work on resilience, contributes to a positive view of risk management in anaesthesia. The operator is a central key to the system resilience, not only in terms of preparation but also in real-time management. It points out adaptation strategies to the system variabilities by a proactive identification of risk factors and reactive strategies in response to changes of the patient's health conditions (Patterson et al., 2010).

Finally, the use of different approaches to address resilience is relevant, it permits to obtain and confront additional information. It is interesting to use several techniques to obtain additional information. However, methods used are subject to numerous biases. The categorization of files can not really be considered as a consultation. The patient was not present, the anesthetist has to build his representation on written data, not physical or verbal ones. In the simulation, the anesthetist is confronted alone to the case but it is a team-work where detection by a third person is very important. Thus, detection strategies could not be identified. Moreover, in this second study, we focused on the risks occurring in the operating room. It is clear that these risks also require increased monitoring after surgery because they can affect the patient's health. However, for purposes of the study, the simulation did not take into account the latter period.

#### **8. Acknowledgment**

This research project would not have been possible without the support of many people. The lead author wishes to express her gratitude to her three colleagues, Prof. Dr. Cellier, Dr. Carreras and Ms Planes who offered invaluable assistance, support and guidance in these two studies. She also whishes to thank all the anaesthetists who were abundantly helpful to understand their work. Deepest gratitude are also due to all the members of the Laboratory of Cognition for sharing the literature and invaluable assisstance, and the members of the French Society of Anaesthetists whithout whose knwoledge and assistance these studies would not have been successful. The authour would also like to convey the Faculty for providing the financial means and laboratory facilities.

Finally, the lead author would also like to express her love and gratitude to her beloved families for their understanding and endless love.

#### **9. References**


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**12** 

*Taiwan* 

**Effects of Wearing Gloves and Sex on** 

Yuh-Chuan Shih\* and Yo-May Wang

*Zhongyang N. Rd., Taipei City,* 

**Endurance Time and the Corresponding Finger** 

**Skin Temperature During a Cold Immersion** 

*Department of Logistics Management, National Defense University No. 70, Sec. 2,* 

Many workers, such as commercial fishermen, power-line workers in temperate climates, and frozen-food processing industry workers, need to perform manual work in cold environments. Exposure to cold environments and contact with cold materials have been reported impair tactile sensitivity in the hands (Enander, 1984), hand dexterity (Schiefer et al., 1984; Riley & Cochran, 1984; Enander & Hygge, 1990; Heus et al., 1995), and tracking performance (Goonetilleke & Hoffmann, 2009). Manual dexterity is frequently used to evaluate hand function and is important during hand manipulation. Hand/finger skin temperature is considered a vital factor in dexterity (Schiefer et al., 1984; Enander, 1984; Enander & Hygge, 1990; Brajkovic & Ducharme, 2003, Chen et al., 2010) and hand performance (Riley & Cochran, 1984; Havenith et al., 1995, Chen et al., 2010). More importantly, such impairment may lead to an increased number of accidents (Müller, 1982;

Several epidemiologic studies have shown that, in addition to heavy physical work, awkward and static postures, repetition of movements, and vibration, cold may be a risk factor for occurrence or aggravation of musculoskeletal disorders (MSDs), such as in the fish-processing industry (Chiang et al., 1993; Nordander et al., 1999) and meat-processing factories (Kurppa et al., 1991; Piedrahíta et al., 2004). A report by the European Agency for Safety and Health at Work (2010) also noted that the risk of MSDs increases with work in

In order to protect the hands from cold, gloves are recommended as a first line of defense. Unfortunately, although wearing gloves does not affect muscular fatigue (Chang & Shih, 2007), doing so could cause a negative effect on exertion (Shih, 2007; Chang & Shih, 2007) and dexterity (Bishu & Klute, 1995; Ou, 2003). On the other hand, gloves can insulate the hands against cold. For example, in a dialogue test of 12°C-water and 5-minute immersion to assess the hand-arm vibration syndrome (ISO/CD 14835-1, 2001), researchers have

**1. Introduction** 

cited by Havenith et al., 1995).

cold environments.

Corresponding Author

 \*

