**4. Conclusion**

Our findings suggest that in individuals with and without RAR, different regulatory mechanisms are involved into adaptation to varying environmental conditions, due to which they can respond to physical and psychoemotional loads in different ways at both the organism level and metabolic level. The pattern of systemic responses for humans with and without RAR are apparently genetically determined. The intensity of RAR, in turn, decreases under the action of flight factors. It can be hypothesized that individual radiosensitivity reflects general resistance of the organism to negative environmental influences.

Authors are grateful to M. M. Antoshchina, Chief Researcher of Medical Radiological Research Center, Ministry of Health Care and Social Development of the Russian Federation, Obninsk, for her help in the experiments.

#### **5. References**

202 Novel Approaches and Their Applications in Risk Assessment

difference from the control attained the level of statistical significance in the group with long flight time. It is currently accepted that the total power of HRV spectrum reflects the influence of the humoral system on myocardial functions. The decrease in HRV is associated with exhaustion of functional reserves of the organism (Baevsky et al., 2004). It can be hypothesized that flight factors produce a negative impact on the humoral component of the cardiovascular system regulation. The data of LC spectrometry confirm

In the control group, the contribution of LF component into the total spectral power of HRV and SBPV increased in response to functional test. Calculated parameters AB and SI also increased under these conditions. In pilots, functional test elevated the percent contribution of VLF band into HRV and increased SI. According to averaged data obtained on adult individuals not employed in aviation, a decrease in relative LF power and an increase in relative HF power were observed during testing in spirometric mask, the total spectral power being unchanged. Hence, activation of the respiratory system leads to relative strengthening of the influences of the autonomic regulatory contour. Reduced HF power and/or increased LF power together with the increase in HF/LF ratio are related to activation of the sympathetic ANS, which is considered to be an adaptive response to stress load. Increased contribution of VLF band into HRV spectrum in pilots can attest to both metabolic changes and psychoemotional factors. Elevated SI attest to mobilization of functional reserves leading to their exhaustion with increasing the degree of sympathetic activation. An unfamiliar test included into aviation medical expertise can act as significant stress factor and the response of pilots and examinees of the control group to this stress can

Functional test led to an increase in peripheral vascular resistance and BP in examinees without RAR. In this subgroup, no changes in HRV spectra and no significant differences in subfraction composition of blood serum from the control were revealed. In examinees with RAR, BP and peripheral vascular resistance remained unchanged during the functional test. However, a redistribution of the HRV and SBP spectral power was observed: increase in LF power and decrease in HF power. In pilots with RAR, pronounced metabolic shifts in blood

It is now proven that activation of signal pathways (cytokines, protein kinase C, etc.) plays an important role in induction of RAR. Adaptation in cell culture is associated with an increase in the content of reactive oxygen species and NO, which can act as the key signal molecules (Coates et al., 2004). According to the hypothesis of V. N. Titov, in cell pools regulated by paracrine mechanisms, stress induces metabolic changes accompanied by weakening of the dilatation effect of NO, functional shutdown of peripheral peristaltic pumps (muscular arteries), and increase in total peripheral vascular resistance (TPVR). The compensatory reaction consists in participation of the myocardium as the central pump in

Our findings suggest that in individuals with and without RAR, different regulatory mechanisms are involved into adaptation to varying environmental conditions, due to

serum in comparison with the control were detected.

the regulation of homeostasis and increase in systemic BP.

this assumption.

differ.

**4. Conclusion** 


**11** 

*France* 

Valérie Neyns, Ophélie Carreras, Laurie Planes and Jean-Marie Cellier

*University of Toulouse le Mirail* 

**Risk Assessment in the Anaesthesia Process** 

Typically, the patient considers the anaesthesia process as risky (Marty, 2003). Indeed, the anaesthetist has to understand risks related to the patient and also to the surgery. There are

In medical setting, risk can be defined using the ISO 12000-1 and the OSHAS 18001 standards. So, risk is defined as a measure of threat expressed in terms of the occurrence of an adverse event (*i.e.* its probability and its frequency) and a measure of its effects or its consequences. In anaesthesia, three criteria are commonly used to describe risk: the event gravity, the occurrence frequency and the level of acceptability. The first one, the event gravity, can be seen as a qualitative scale with 4 major steps: minor risk (*i.e.* error without prejudice for the patient), significant risk (*i.e.* self–limiting prejudice), major risk (*i.e.* error needing a recovery action) and risk evaluated as serious to critical (*i.e.* permanent damage). The second scale, the occurrence frequency, contains 5 major steps: highly unlikely (*i.e.*  frequency≤10-5), very unlikely (*i.e.* 10-5<frequency≤10-4), unlikely (*i.e.* 10-4<frequency≤10- 3), probable (*i.e.* 10-2<frequency≤10-1) and very likely to sure (*i.e.* >10%). The last one, the level of acceptability, is divided into 3 parts: non-critical risks (*i.e.* acceptable risky situations), risks to be monitored (*i.e.* acceptable risky situations but actions are needed to identify and monitor them) and rush through risks (*i.e.* not acceptable risky situations

In France, there is a step entirely devoted to anaesthesia risk assessment: the pre-anaesthesia consultation. But this is a French uniqueness. Indeed, in other countries (*e.g.* Quebec), the anaesthetist will see the patient at the entrance to the operating room. However, the anaesthetist may not assess all risks during the anaesthesia consultation. In this chapter, we will study how does an anaesthetist assess risks linked to a patient who must have a surgical

We will present this chapter as follow. First, we will describe the anaesthesia process in France and some epidemiological studies on risks in anaesthesia. Then, we will present some cognitive psychology concepts related to planning, information gathering, resilience engineering and management (*i.e.* error detection, identification and recovery). Two studies will be presented by the method used and results obtained. The first one concerns a card sorting experimentation (with patient records) to understand how anaesthetists gather

many ways to define risks according to the point of view adopted.

requiring actions to reduce risks or to monitor them).

operation before and during this one.

**1. Introduction** 

