Patrick Schoettker

• Professor
• Head of the Department of Anesthesia at Lausanne University Hospital

Background: Enhanced Recovery After Surgery (ERAS) protocols have been implemented in various surgical specialties to improve patient outcomes and reduce opioid consumption. In cardiac surgery, the traditionally high-dose opioid use is associated with prolonged ventilation, intensive care unit (ICU) stays, and opioid-related adverse drug events (OR...

Introduction Hypertensive disorders present significant morbidity and mortality during pregnancy. Although ambulatory blood pressure measurement remains the standard of care for normotensive women, self-monitoring at home is increasingly prevalent. The widespread use of smartphones worldwide has sparked interest in mobile applications that leverage...

Objective Hypertensive disorders present significant morbidity and mortality during pregnancy. While ambulatory blood pressure measurement remains the standard of care for normotensive women, self-monitoring at home is increasingly prevalent. The widespread use of smartphones worldwide has sparked interest in mobile applications that leverage the b...

A spinal cord injury (SCI) causes immediate and sustained hemodynamic instability that threatens neurological recovery and impacts quality of life. Here, we establish the clinical burden of chronic hypotensive complications due to SCI and expose the ineffective treatment of these complications with conservative measures. To address this clinical bu...

Objective Cuffless blood pressure measurement technologies have attracted significant attention for their potential to transform cardiovascular monitoring. This updated narrative review thoroughly examines the challenges, opportunities, and limitations associated with the implementation of cuffless blood pressure monitoring systems. By summarizing...

A double-lumen tube or bronchial blocker positioning using flexible bronchoscopy for lung isolation and one-lung ventilation requires specific technical competencies. Training to acquire and retain such skills remains a challenge in thoracic anesthesia. Recent technological and innovative developments in the field of simulation have opened up excit...

Background: Cuffless blood pressure measurement technologies have attracted significant attention for their potential to transform cardiovascular monitoring. Methods: This updated narrative review thoroughly examines the challenges, opportunities, and limitations associated with the implementation of cuffless blood pressure monitoring systems. Resu...

Introduction: Mobile health diagnostics have demonstrated effectiveness in detecting and managing chronic diseases. This method comparison study aims to assess the accuracy and precision of the previously evaluated OptiBP™ technology over a four-week study period. This device uses optical signals recorded by placing a patient’s fingertip on a smart...

BACKGROUND The potential benefit of “videolaryngoscopy use in facilitating” tracheal intubation has already been established. Its use was actively encouraged during the COVID-19 pandemic as it was likely to improve intubation success and increase the patient-operator distance. OBJECTIVES We sought to establish videolaryngoscopy use before and afte...

Background Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. H...

Background: The question of environmentally sustainable perioperative medicine represents a new challenge in an era of cost constraints and climate crisis. The French Society of Anaesthesia and Intensive Care (SFAR) recommends stroke volume optimization in high-risk surgical patients. Pulse contour techniques have become increasingly popular for s...

Purpose Obesity is a clear risk factor for hypertension. Blood pressure (BP) measurement in obese patients may be biased by cuff size and upper arm shape which may affect the accuracy of measurements. This study aimed to assess the accuracy of the OptiBP smartphone application for three different body mass index (BMI) categories (normal, overweight...

Airway management is a core competency for many different medical specialties. Despite continuous improvements in equipment, clinical understanding, education and training, airway management complications remain a significant cause of morbidity and mortality worldwide. Several international airway management guidelines already exist, but there has...

During anesthesia, noncritical patients are routinely monitored via noninvasive cuff-based blood pressure (BP) monitors. Due to the noncontinuous nature of the monitoring, the BP values of the patient remain unavailable between consecutive cuff measurements, carrying the risk of missing rapid and sudden variations in BP. We evaluated the added valu...

Background Arterial hypertension is a worldwide public health problem. While it is currently diagnosed and monitored non-invasively using the oscillometric method, having the ability to measure blood pressure (BP) using a smartphone application could provide more widespread access to hypertension screening and monitoring. In this observational stud...

To provide information about the clinical relevance of blood pressure (BP) measurement differences between a new smartphone application (OptiBP™) and the reference method (automated oscillometric technique) using a noninvasive brachial cuff in patients admitted to the emergency department. We simultaneously recorded three BP measurements using both...

Smartphones may provide a highly available access to simplified hypertension screening in environments with limited health care resources. Most studies involving smartphone blood pressure (BP) apps have focused on validation in static conditions without taking into account intraindividual BP variations. We report here the first experimental evidenc...

Study objective This study aimed to investigate the overall success of tracheal intubation using the intubating Laryngeal Tube Suction-Disposable (iLTS-D™, VBM, Sulz a. N., Germany) compared to the Laryngeal Mask Airway (LMA) Fastrach™ (Teleflex, Athlone, Ireland). We hypothesised that the iLTS-D™ would be non-inferior to the LMA Fastrach™ for trac...

Objective: The association between overweight-obesity and hypertension is well known with both pathologies considered as public health priorities. The current reference techniques for Blood Pressure (BP) measurement represent a challenge in the obese population since the cuff may not be fully adapted to patient's anatomy. OptiBP mobile application...

Background Arterial hypertension is a public health problem worldwide. It is currently diagnosed and monitored non-invasively using the oscillometric method. Being able to measure blood pressure (BP) using a smartphone application could provide more widespread access to hypertension screening and monitoring. In this observational study in intensive...

Orthostatic hypotension is a cardinal feature of multiple-system atrophy. The upright posture provokes syncopal episodes that prevent patients from standing and walking for more than brief periods. We implanted a system to restore regulation of blood pressure and enable a patient with multiple-system atrophy to stand and walk after having lost thes...

A high-quality, low-cost ventilator, dubbed HEV, has been developed by the particle physics community working together with biomedical engineers and physicians around the world. The HEV design is suitable for use both in and out of hospital intensive care units, provides a variety of modes and is capable of supporting spontaneous breathing and supp...

Background Several continuous monitoring solutions, including wireless wearable sensors, are available or being developed to improve patient surveillance on surgical wards. We designed a survey to understand the current perception and expectations of anaesthesiologists who, as perioperative physicians, are increasingly involved in postoperative car...

We compared blood pressure (BP) values obtained with a new optical smartphone application (OptiBP™) with BP values obtained using a non-invasive automatic oscillometric brachial cuff (reference method) during the first 2 h of surveillance in a post-anesthesia care unit in patients after non-cardiac surgery. Three simultaneous BP measurements of bot...

This article is a descriptive analysis of the organizational steps undertaken to transform eight OR (operating rooms) of the University Hospital Lausanne CHUV into a dedicated ICU (intensive care unit) during the COVID-19 pandemic. An efficient response of our institution was mandatory to timely increase the number of ICU beds. The transformation o...

Objective: Gliderite®, one of the first stylets designed specifically to assist tracheal intubation with non-channeled curved blades video laryngoscopes, can cause injury. The S-Guide® is a new, malleable, intubating guide allowing oxygenation. Its soft tip is designed to prevent trauma. We aimed to compare the duration of tracheal intubation with...

Objective: The aim of this study was to assess the accuracy of the OptiBP mobile application based on an optical signal recorded by placing the patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Measurements were carried out in a general population according to existing standards of the Association for the Advancement of...

Objective Hypertension is a preventable disease but only half of the affected population is aware of it. Digital health approaches, in particular mobile health diagnostics, have been shown to be effective and scalable for chronic disease detection and management. Smartphones are widely available and have the potential to be used as a “cuffless” blo...

Abstract Mobile health diagnostics have been shown to be effective and scalable for chronic disease detection and management. By maximizing the smartphones’ optics and computational power, they could allow assessment of physiological information from the morphology of pulse waves and thus estimate cuffless blood pressure (BP). We trained the parame...

HEV is a low-cost, versatile, high-quality ventilator, which has been designed in response to the COVID-19 pandemic. The ventilator is intended to be used both in and out of hospital intensive care units, and for both invasive and non-invasive ventilation. The hardware can be complemented with an external turbine for use in regions where compressed...

Arterial pressure (AP) is a crucial biomarker for cardiovascular disease prevention and management. Photoplethysmography (PPG) could provide a novel, paradigm-shifting approach for continuous, non-obtrusive AP monitoring, comfortably integrated in wearable and mobile devices; yet, it still faces challenges in accuracy and robustness. In this work,...

Background: Intraoperative hypotension is associated with postoperative complications and death. Oscillometric brachial cuffs are used to measure arterial pressure (AP) in most surgical patients but may miss acute changes in AP. We hypothesized that pulse oximeter waveform analysis may help to detect changes in systolic AP (SAP) and mean AP (MAP)...

Background Fibreoptic intubation is described as the preferred technique for the non-urgent airway control in patients with an unstable cervical spine injury. Indirect laryngoscopes offer promising advantages, but their safety and impact on cervical spine movement is still discussed. Aim We compared the incidence of significant neurophysiologic mo...

The purpose of this article is to review the main airway devices available to the emergency physician in a prehospital setting. Since the risk of difficult intubation is increased under pre-hospital conditions; the emergency physician should be aware of alternatives to direct tracheal intubation such as supraglottic devices, video laryngoscopes and...

Objectives: The purpose of this study was to provide an internationally comparable overview of pediatric trauma of the University Hospital of Lausanne to improve the care of children. Methods: We analyzed the data from all injured children (<16 years of age) listed in our trauma registry from 2011 to 2016. These children were admitted to the res...

Background: To date, the decision to set up therapeutic extra-corporeal life support (ECLS) in hypothermia-related cardiac arrest is based on the potassium value only. However, no information is available about how the analysis should be performed. Our goal was to compare intra-individual variation in serum potassium values depending on the sampli...

Secondary injuries are associated with bad outcomes in the case of severe traumatic brain injury (sTBI). Patients with a Glasgow Coma Scale (GCS) < 9 should undergo pre-hospital intubation (PHI). There is controversy about whether PHI is beneficial. The aim of this study was to estimate the effect of PHI in patients after sTBI. A multicenter, prosp...

The airway management of a patient with severe tracheal stenosis depends on its severity, length, location, and type of surgery. Its management is complex and requires the collaboration of an experienced team of anaesthetist and ear, nose, and throat surgeon. We report an innovative combination of Ventrain™ and S-Guide™ for airway management of a p...

Objective: The National Advisory Committee for Aeronautics (NACA) score is used by many emergency medical services to assess the severity of prehospital patients. Little is known about its discriminative performance regarding short-term mortality. Participants and methods: We retrospectively included adult missions between 2008 and 2014 in a Swi...

Routine monitoring of blood pressure during general anesthesia relies on intermittent measurements with a non-invasive brachial cuff inflated every two to five minutes. While all these patients are equipped by a fingertip pulse oximeter, the acquired optical signals currently only provide SpO2 estimates. Our running clinical trial (NCT02651558) pre...

Background and Goal of Study: Obtaining accurate continuous blood pressure (BP) monitoring is mandatory in critically-ill, anesthetized patients or during complex surgical procedures. The gold standard for continuous BP measurement invasive arterial catheter- is complex and associated with morbidity. To allow non-invasive beat-to-beat BP measuremen...

Obtaining accurate continuous blood pressure monitoring is mandatory in critically-ill, anesthetized patients or during long and challenging surgical procedures. The gold standard for continuous BP measurement (invasive arterial catheter) is complex and associated with morbidity. This study presents a simple way to measure non-invasive BP continuo...

Objective: To provide an update to French guidelines about "Difficult intubation and extubation in adult anaesthesia 2006". Design: A consensus committee of 13 experts was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent...

While hypertension globally affects two out of five adults worldwide, there exists no easily-scalable technology to measure blood pressure out of the clinics. The idea of using smartphone sensors to estimate blood pressure was already tackled in the past, but failed because of low accuracy. Based on data from a previous study (NCT02651558), we rece...

Background: Virtual reality (VR) simulation is an effective and safe method of teaching bronchoscopic skills. Few VR bronchoscopy simulators exist; all are expensive. The present study aimed to describe the design, development, and evaluation of a new, affordable, VR bronchoscopy simulator. Methods: Anesthesiologists and engineers collaborated t...

Cuffless blood pressure monitoring at the chest requires accurate detection of the arrival time of arterial pressure pulses at chest skin. A clinical trial was designed (NCT02651558) in order to assess the performance of single-and multi-channel reflective PPG sensors when no pressure is applied onto optical probe. Experimental setup involved invas...

The performance of estimating Systolic Blood Pressure (SBP) in anesthetized patients via Pulse Arrival Time (PAT) techniques was studied with respect to the minimum required time in between two recalibration procedures. Materials: a clinical trial [NCT02651558] involving 14 patients was conducted measuring PAT from an ECG and an arterial line inser...

Tracheal tube introducers and stylets are highly successful devices for the management of various airway scenarios. Their first-line use is advocated in many difficult airway algorithms. Although they have been used for decades, the shape and design of introducers and stylets as well as their patterns of use are constantly evolving. Our purpose is...

Les guides et mandrins sont des dispositifs régulièrement utilisés pour la gestion des voies aériennes difficiles dans différents scénarios. Leur utilisation en première intention est proposée par un grand nombre d’algorithmes. Leur forme et techniques d’utilisation évoluent régulièrement. Notre but est de fournir au clinicien une mise à jour conce...

Routine monitoring of blood pressure during general anaesthesia relies on intermittent measurements with a non-invasive brachial cuff every five minutes. This manuscript provides first experimental evidence that a physiology-based pulse wave analysis algorithm applied to optical data (as provided by a standard fingertip pulse oximeter) is capable o...

Study objective: Measure the displacements of endotracheal tube (ETT) tip displacement during head and neck movements. Design: Observational study. Setting: Ear-nose-throat (ENT) and neurosurgery operating room. Patients: We performed a maximal head-neck movement trial on 50 adult patients, American Society of Anaesthesiologists 1 or 2. Pati...

Transfusion of blood products can be life saving when used appropriately. It carries however at the same time a potential for morbidity and mortality, depending on the patient, the product or the setting. Numerous strategies have been elaborated to minimize these risks, and in recent years, transfusion has no longer been regarded as essential for t...

Background Videolaryngoscopes are aggressively marketed, but independent evaluation in difficult airways is scarce. This multicentre, prospective randomized controlled trial evaluates six videolaryngoscopes in patients with a simulated difficult airway. Methods With ethics committee approval and written informed consent, 12 senior anaesthetists in...

Background: The effectiveness of transoral microsurgery for early-stage glottic cancer relies on the possibility to obtain adequate exposure of the lesion. The purpose of this study was to design a new surgical technique allowing efficient endoscopic removal of these tumors in patients with unsatisfactory transoral exposure. Methods: A minimal i...

An 84-year-old man with symptomatic severe aortic-valve stenosis was admitted for transapical aortic-valve implantation to be performed while the patient was under general anesthesia. He had a history of chronic bronchitis and recurrent respiratory infections. After endotracheal intubation and tube-cuff inflation, a severe peritubal air leak was id...

Difficult tracheal intubation is a major cause of anesthesia related injuries with potential life threatening complications. Detection and anticipation of difficult airway in the preoperative period is thus crucial for the patients' safety. We propose an automatic face analysis approach to detect morphological traits related to difficult intubation...

OBJECTIVE: Since the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, standardized nationwide operative procedures are still lacking. This study aimed to assess surgical management and monitoring strategies in patients admitted throughout Switzerland with severe...

Hemorrhage is probably the most serious complication arising in neurosurgical procedures; it is associated with significant morbidity and mortality. Neurosurgical patients may face several risk factors of bleeding: past medical comorbidities, particular neurosurgical techniques and medication, intraoperative hemodynamic disturbances, and specific n...

We conducted a study assessing the quality and speed of intubation between the Airtraq with its new iPhone AirView app and the King Vision in a manikin. The primary endpoint was reduction of time needed for intubation. Secondary endpoints included times necessary for intubation. 30 anaesthetists randomly performed 3 intubations with each device on...

All anesthesiologists are confronted with patients who show bleeding disorders, whether congenital, acquired, or pharmacologically induced. Although many studies, meta-analyses, guidelines, and textbooks have been published on the subject, they mostly cover specific aspects or require a thorough knowledge of hemostasis. The goal of this book is to...

Objective: To examine the accuracy of brain multimodal monitoring-consisting of intracranial pressure, brain tissue PO2, and cerebral microdialysis--in detecting cerebral hypoperfusion in patients with severe traumatic brain injury. Design: Prospective single-center study. Patients: Patients with severe traumatic brain injury. Setting: Medic...

Viscoelastic tests (thromboelastography) were developed more than 60 years ago to assess bleeding and coagulation. Today, technical innovations and computer technology have brought these techniques to the bedside. Two types of point-of-care devices which assess viscoelastic changes in clotting whole blood are available on the market. They allow a d...

Aim: After the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, there is still a lack of knowledge regarding standardized operative procedures nationwide. The aim of this study was to assess the surgical management and monitoring strategies within a nationwide s...

Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest databas...

A 62-year-old man complaining of neck pain was found to have a mass in the left carotid region. He was on treatment for hypertension but had no symptoms suggestive of catecholamine excess. Urinary dopamine values were near or above the upper reference limit in 2 samples (Table 1). Free and total plasma methoxytyramine, plasma dopamine, …

Rotational thromboelastometry (ROTEM) is a whole blood point-of-test used to assess the patient's coagulation status. Three of the available ROTEM tests are EXTEM, INTEM and HEPTEM. In the latter, heparinase added to the INTEM reagent inactivates heparin to reveal residual heparin effect. Performing ROTEM analysis during cardiopulmonary bypass (CPB...

This adult cohort determined the incidence and patients' short term outcomes of severe traumatic brain injury (TBI) in Switzerland, and age-related differences. A prospective cohort study with a follow-up at 14 days was performed. Patients ≥16 years sustaining severe TBI and admitted to one of 11 trauma centers were included. Severe TBI was defined...

Background: Video-laryngoscopes are marketed for intubation in difficult airway management. They provide a better view of the larynx and may facilitate tracheal intubation, but there is no adequately powered study comparing different types of video-laryngoscopes in a difficult airway scenario or in a simulated difficult airway situation. Methods/...

Difficult tracheal intubation assessment is an important research topic in anesthesia as failed intubations are important causes of mortality in anesthetic practice. The modified Mallampati score is widely used, alone or in conjunction with other criteria, to predict the difficulty of intubation. This work presents an automatic method to assess the...

Fibreoptic intubation remains a key technique for the management of difficult intubation. We randomly compared the second generation single-use Ambu(®) aScope™ 2 videoscope with a standard re-usable flexible intubating fibrescope in 50 tracheal intubations in patients with a difficult airway simulated by a semirigid collar. All patients' tracheas w...

Background Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia.Methods Patient records of conscious adult trauma victims transported by our...

We sought to study the operational and medical aspects of helicopter rescue missions involving the use of a winch. A single helicopter-based medical service of a pre-alpine region of Switzerland. We prospectively studied consecutive primary rescue interventions involving winching of a physician, from October 1, 1998 to October 1, 2002. Demographic,...

Accurate identification of major trauma patients in the prehospital setting positively affects survival and resource utilization. Triage algorithms using predictive criteria of injury severity have been identified in paramedic-based prehospital systems. Our rescue system is based on prehospital paramedics and emergency physicians. The aim of this s...

In unconscious patients, including those under general anesthesia, the posterior displacement of the tongue against the pharyngeal wall, soft palate, and epiglottis tends to obstruct the upper airway. The resulting hypoventilation may lead to hypercarbia and hypoxemia, potentially leading to arrhythmia or cardiac arrest. The jaw-thrust maneuver, wh...