Mdoloris ANI Monitor V1 User manual

Continuous analgesia monitoring system
MD/PRD/IN16.ANIV1 V.14 - 12 MAR 2020
Analgesia Nociception Index
ANI Monitor V1
User manual
Software version 1.1.4.0
(CE mark first approved on April 2012)
MDOLORIS MEDICAL SYSTEMS SAS
Biocentre Fleming
Bâtiment C Epi de Soil
270 rue Salvador Allende
59120 LOOS (France)
Tel: [phone] - Fax: [phone]
www.mdoloris.com

Continuous analgesia monitoring system
MD/PRD/IN16.ANIV1 V.14 - 12 MAR 2020
©Mdoloris Medical Systems. All rights reserved. Copying or other
reproduction of this document is prohibited without prior written
consent of Mdoloris Medical Systems.
Mdoloris Medical Systems is registered trademark.
Important information about using the continuous analgesia
monitoring system:
The Mdoloris Medical Systems’ continuous analgesia monitoring
system is intended for use in a medical environment and under the
direct supervision of a licensed healthcare practitioner or by
personnel specifically trained for its use. The system is intended
for use on adult and pediatric patients, in a facility providing patient
care by monitoring parasympathetic nervous tone activity.
The continuous analgesia monitoring system may be used to
monitor the effects of certain analgesic agents.
The Analgesia Nociception Index (ANI) is a complex monitoring
technology intended for use as an adjunct to clinical judgment.
Clinical judgment should always be used when interpreting the ANI
index in conjunction with other available clinical signs. Reliance on
ANI alone for interpreting analgesic management is not
recommended. As with any monitored parameter, artifacts and poor
signal quality may lead to inappropriate ANI values. Potential
artifacts may be caused by muscle activity or rigidity, patient
motion, improper sensor placement or electrical interference. The
essential performance identified for the ANI Monitor V1 is the
display of ANI index if the signal quality is good.
The ANI Monitor V1 needs special precautions regarding
environments. The ANI Monitor V1 has to be installed and put into
service in hospitals and away from the RF source magnetic
resonance imaging.
ANI is a protected trademark.

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Contents
1Safety precautions .........................................................................................................1
1.1 Warning....................................................................................................................1
1.2 Caution.....................................................................................................................6
1.3 Notes ........................................................................................................................8
1.4 Key to symbols.........................................................................................................8
2ANI Monitor V1 ............................................................................................................9
3Installing the ANI Monitor V1....................................................................................11
3.1 Perfusion stand .......................................................................................................11
3.2 ANI Sensor V1 / ANI Sensor V2 / ANI Sensor V1 PLUS .......................................11
3.3 ANI Monitor V1 connection ...................................................................................13
3.4 Battery....................................................................................................................14
4Beginning ANI Monitoring .........................................................................................15
5Using the ANI Monitor V1 and setting parameters ...................................................17
5.1 ECG Capture ..........................................................................................................17
5.2 Respiratory pattern..................................................................................................18
5.3 ANI index...............................................................................................................19
5.4 ANI navigation.......................................................................................................19
6ANI Monitor V1 settings.............................................................................................20
6.1 Language parameters ..............................................................................................20
6.2 Threshold................................................................................................................20
6.3 Events.....................................................................................................................23
6.4 Expert mode and Energy index ...............................................................................23
7Ending ANI monitoring ..............................................................................................26
7.1 Stopping the recording of a case..............................................................................26
7.2 Demo......................................................................................................................27
7.3 New patient.............................................................................................................27
7.4 Maintenance ...........................................................................................................27
7.5 Deleting patient data...............................................................................................27
7.6 Screen capture ........................................................................................................28
7.7 Exporting data files.................................................................................................29
7.8 Updating events......................................................................................................30
7.9 Setting date and time...............................................................................................31
7.10 Updating monitor....................................................................................................32
7.11 Shutting down.........................................................................................................34
8Trouble shooting..........................................................................................................34

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9Monitor disposal..........................................................................................................36
10 Environment................................................................................................................36
10.1 Shipping and storage conditions..............................................................................36
10.2 Operating Environment...........................................................................................37
10.3 Power requirements and grounding.........................................................................37
11 Cleaning and disinfection............................................................................................38
11.1 Cleaning .................................................................................................................38
11.2 Maintenance ...........................................................................................................39
12 Specifications, warranty and software license contract.............................................39
12.1 Specifications .........................................................................................................39
12.2 Warranty.................................................................................................................41
12.3 Software License Agreement ..................................................................................43

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1Safety precautions
INTRODUCTION
Caution: read this entire manual carefully before using the monitor in a clinical setting.
WARNING
A warning advises against certain actions or situations that could result in physical injury or
death. Accidents may result from the inability to avoid a hazardous situation. This is why it is
important to follow the instructions in these warnings, to prevent personal injury.
CAUTION
A caution advises against actions or situations that could damage equipment, produce
inaccurate data, or invalidate a procedure, when personal injury is unlikely.
NOTE
A note provides useful information regarding a function or procedure.
KEY TO SYMBOLS
A key to the symbols that may appear on the ANI Monitor V1 appears at the end of this
section.
1.1 Warning
GROUND LEAKAGE CURRENT MUST BE CHECKED BY A QUALIFIED
BIOMEDICAL ENGINEERING TECHNICIAN WHENEVER INSTRUMENT CASE IS
OPENED.
PROTECTION AGAINST HEART DEFIBRILLATION SHOCK DEPENDS ON USING
THE APPROPRIATE CABLES.

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EXPLOSION HAZARD: DO NOT USE THE ANI Monitor V1 IN A FLAMMABLE
ATMOSPHERE OR WHERE CONCENTRATIONS OF FLAMMABLE ANESTHETICS
MAY OCCUR.
NEITHER THE MONITOR NOR THE ELECTRODES ARE DESIGNED FOR USE IN A
MAGNETIC RESONANCE IMAGING (MRI) ENVIRONMENT.
THIS ANI Monitor V1 CANNOT BE IN ANY CASE CONSIDERED AS AN ECG
MONITORING SYSTEM.
WHEN USING ELECTRO-CONVULSIVE THERAPY (ECT) EQUIPMENT DURING
ANI MONITORING: place ECT electrodes as far away as possible from the sensor to
minimize the effect of interference. Some ECT equipment may interfere with the ANI
Monitor V1 signal. Check for equipment compatibility during patient setup.
ONLY USE THE POWER CORD SUPPLIED BY THE MANUFACTURER. NEVER
ADAPT THE PLUG FROM THE MONITOR TO FIT A NON-STANDARD OUTLET.
IF THE INTEGRITY OF GROUNDING IS IN DOUBT, DO NOT USE THE ANI Monitor
V1.
BE SURE THE MONITOR IS INSTALLED SECURELY TO AVOID INJURY TO
PERSONNEL OR PATIENTS.

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WHEN CONNECTING EXTERNAL EQUIPMENT (e.g., DATA CAPTURE
COMPUTER), THE GROUND LEAKAGE SYSTEM CURRENT MUST BE CHECKED
AND MUST BE LESS THAN THE IEC 60601-1 LIMIT.
USING ACCESSORIES AND CABLES OTHER THAN SPECIFIED OR PROVIDED BY
THE MANUFACTURER OF THE ANI Monitor V1 (MDOLORIS MEDICAL SYSTEMS)
MAY RESULT IN INCREASED ELECTROMAGNETIC EMISSIONS OR DECREASED
ELECTROMAGNETIC IMMUNITY OF THE ANI Monitor V1 AND MAY RESULT IN
AN INAPPROPRIATE OPERATION.
CONSIDERATION RELATING TO THE CHOICE OF EQUIPMENT SHALL
INCLUDE:
- EVIDENCE THAT USING THE ACCESSORY IN THE PATIENT VICINITY AND OR
SURGERY VICINITY IS COMPLIANT
- EVIDENCE THAT THE ACCESSORY'S "CE" SAFETY CERTIFICATION
COMPLIES WITH STANDARD (IEC 60601-1) AND THAT THE ACCESSORY IS
COMPATIBLE WITH THE ANI Monitor V1
TO AVOID PATIENT INJURY DUE TO HIGH SURFACE TEMPERATURE, DO NOT
PLACE THE INTERFACE EQUIPMENT DIRECTLY IN CONTACT WITH SKIN.
THE CONDUCTIVE PARTS OF ELECTRODES OR SENSORS AND CONNECTORS
SHOULD NOT CONTACT OTHER CONDUCTIVE PARTS, INCLUDING EARTH.
TO MINIMIZE THE RISK OF PATIENT BURNS FROM THE NEUTRAL ELECTRODE
FOR HF SURGERY, DO NOT PUT THE ANI ELECTRODES BETWEEN THE
SURGICAL SITE AND THE ELECTROSURGICAL UNIT'S RETURN ELECTRODE.

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ENSURE PROPER CONTACT OF THE ELECTROSURGERY RETURN ELECTRODE
TO AVOID POSSIBLE BURNS ON THE PATIENT VIA ANI ELECTRODES.
THE CHARACTERISTICS OF ANI Monitor V1 EMISSIONS ALLOW IT TO BE USED
IN INDUSTRIAL AREAS AND HOSPITALS (CISPR 11 CLASS A). WHEN USED IN
RESIDENTIAL ENVIRONMENTS (FOR WHICH CISPR 11 CLASS B IS REQUIRED),
ANI Monitor V1 CANNOT GUARANTEE PROVISION OF ADEQUATE PROTECTION
OF RADIO FREQUENCY COMMUNICATION. THE USER MIGHT NEED TO
PERFORM CORRECTIVE ACTIONS, SUCH AS REIMPLANTATION OR
REORIENTATION OF THE ANI Monitor V1.
TO MINIMIZE THE RISK OF PATIENT STRANGULATION, THE PATIENT
INTERFACE CABLE MUST BE CAREFULLY PLACED AND SECURED.
DO NOT PLACE THE SKIN ELECTRODES BETWEEN DEFIBRILLATOR PADDLES
WHEN THEY ARE USE ON A PATIENT CONNECTED TO THE ANI Monitor V1.
REUSING A SENSOR ALREADY USED ON ANOTHER PATIENT COULD LEAD TO
CROSS-CONTAMINATION.
IF THE PATIENT DEVELOPS A SKIN REACTION OR OTHER UNUSUAL
SYMPTOMS, REMOVE THE ELECTRODES. IT IS IMPORTANT TO TAKE
PARTICULAR CARE WITH PATIENTS SUFFERING FROM DERMATOLOGICAL
PROBLEMS.
NEVER PUT ELECTRODES ON SKIN INJURIES.

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ELECTRICAL SHOCK:
-DO NOT ATTEMPT TO DISCONNECT THE POWER CORD WITH WET
HANDS.
-DO NOT REMOVE MONITOR COVERS DURING OPERATION OR WHILE
POWER IS CONNECTED TO MONITOR.
-THE MANUFACTURER'S INSPECTION OF THIS APPARATUS VERIFIED
THAT THE GROUND LEAKAGE CURRENT AND THE PATIENT SAFETY
CURRENT WERE BELOW THE LIMITS SPECIFIED BY THE APPLICABLE
SAFETY STANDARDS. AS A MATTER OF SAFE PRACTICE, THE FACILITY
MUST CONDUCT TESTS TO VERIFY THESE CURRENTS ESPECIALLY
WHEN A BIOMEDICAL ENGINEERING TECHNICIAN PERIODICALLY
PERFORMS MAINTENANCE.
WHENEVER AN EVENT SUCH AS SPILLAGE OF BLOOD OR LIQUIDS
OCCURS ON THE ANI Monitor V1, RE-TEST GROUND LEAKAGE CURRENT
BEFORE FURTHER USE.
OBSERVE UNIVERSAL PRECAUTIONS TO PREVENT CONTACT WITH BLOOD OR
OTHER POTENTIALLY INFECTIOUS MATERIALS. CONTAMINATED MATERIALS
MUST BE HANDLED IN ACCORDANCE WITH THE FACILITY'S APPLICABLE
HEALTH AND SAFETY REGULATIONS.
DO NOT MIX DISINFECTING SOLUTIONS (e.g., BLEACH AND AMMONIA), AS
TOXIC GASES MAY RESULT.
THE ANI Monitor V1 COMPLIES WITH THE ELECTROMAGNETIC
COMPATIBILITY REQUIREMENTS OF EN 60601-1-2. OPERATION OF THIS
DEVICE MAY AFFECT OR BE AFFECTED BY OTHER EQUIPMENT IN THE
VICINITY DUE TO ELECTROMAGNETIC INTERFERENCE (EMI). IF THIS
OCCURS:
- INCREASE SEPARATION BETWEEN DEVICES
- CHANGE THE ORIENTATION OF DEVICE CABLING
- PLUG DEVICES INTO SEPARATE OUTLETS

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- CONTACT YOUR MDOLORIS MEDICAL SYSTEMS REPRESENTATIVE.
IN OPERATING ROOMS THE ANI Monitor V1 MUST BE PLACED OUTSIDE THE
EXPLOSION HAZARD ZONE.
MAKE SURE THE MONITOR IS INSTALLED OUTSIDE THE LIQUID PROJECTIONS
HAZARD ZONE, E.G. PERFUSION BAG.
NEVER MODIFY THE MONITOR WHEN OPEN.
USE OF ANI Monitor V1 ADJACENT TO OR STACKED WITH OTHER EQUIPMENT
SHOULD BE AVOIDED BECAUSE IT COULD RESULT IN IMPROPER OPERATION.
IF SUCH USE IS NECESSARY, THIS EQUIPMENT AND THE OTHER EQUIPMENT
SHOULD BE OBSERVED TO VERIFY THAT THEY ARE OPERATING NORMALLY.
PORTABLE RF COMMUNICATIONS EQUIPMENT (INCLUDING PERIPHERALS
SUCH AS ANTENNA CABLES AND EXTERNAL ANTENNAS) SHOULD BE USED NO
CLOSER THAN 30 CM (12 INCHES) TO ANY PART OF THE ANI Monitor V1,
INCLUDING CABLES SPECIFIED BY THE MANUFACTURER. OTHERWISE,
DEGRADATION OF THE PERFORMANCE OF THIS EQUIPMENT COULD RESULT.
1.2 Caution
Read this entire manual carefully before using the monitor in a clinical setting.
Before starting, ensure there are no USB devices (USB sticks for example) connected to
the monitor.
The patient should not be able to reach the equipment directly or indirectly; avoid for instance
placing equipment on top of another equipment with a metal casing.

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To remove power supply from the monitor, unplug the power cable.
Staff should avoid touching simultaneously patient and ANI Monitor V1.
Do not autoclave the monitor or the acquisition device. Autoclaving will seriously damage
both components.
Do not block ventilation inlet holes of monitor (there are some on top of it also).
Using accessories other than those specified by the manufacturer may result in increased
electromagnetic emissions or decreased electromagnetic immunity of the ANI Monitor V1.
Using electrode sensors other than those specified by the manufacturer can damage the device,
and increases risk of harm to the user or the patient.
Reusing a sensor could reduce adhesion, leading to a possible decrease in ECG signal
acquisition performance.
Reusing a sensor could reduce its adhesion.
The ANI Monitor V1 should not be used near or placed on top of another electrical
equipment. If however this is unavoidable, check regularly that the ANI Monitor V1 operates
properly in this configuration.
Only Mdoloris Medical Systems qualified biomedical technicians are trained to perform
service or repairs on ANI Monitor V1.
The ANI Monitor V1 contains an internal battery. This battery must be removed by an
authorized technician and discarded or recycled in accordance with local regulations. Contact
Mdoloris Medical Systems or the local distributor for battery maintenance.
The internal battery is not designed for long-term monitoring. The ANI Monitor V1 internal
battery allows the system to keep calculating the ANI while the patient is being moved or in

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case of temporary interruption of the main power supply. Mdoloris Medical Systems
recommends using the ANI Monitor V1 without power supply (battery mode) for 15 minutes
maximum.
Check the battery charge symbol before unplugging the main power supply; if the internal
battery is insufficiently charged, the ANI Monitor V1 will switch off automatically.
After reconnecting the ANI Monitor V1 to the main power supply, press the power switch on
the front side of the monitor. In case the monitor does not start, press the switch at the back of
the monitor in order to reboot the device.
Never use the ANI Monitor V1 only on battery power during surgery. The monitor must be
plugged on the main power supply, especially while an electric knife is being used.
Only personnel trained by Mdoloris Medical Systems can safely perform service or repairs on
ANI Monitor V1. However, the following elements may be replaced by personnel untrained in
technical maintenance (following the manufacturer's instructions):
-End User Cable;
-Power cord;
-Acquisition unit (BA-ANI-V1);
-Pole clamp.
This medical equipment, its components and packaging must be recycled in accordance with
local regulations on the environment and disposal of electric waste.
1.3 Notes
"Notes" can be found at the end of each section.
1.4 Key to symbols
Symbol
Description
Symbol
Description
Operator's manual;
operating instructions
Serial number
Caution: Federal law
restricts this device to
European compliance Mark

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sale by or on the order
of a (licensed
healthcare practitioner)
of compliance with the
European Medical Device
Directive
Do not expose to
sunlight
This way up
Check the packaging
quality upon delivery
Needs special waste
disposal
Upper and lower
temperature limits
(Shipping and Storage
Environment)
Keep dry
Fragile; handle with
care
BF Type equipment,
protects against
defibrillation
General safety sign
Manufacturer +
Manufacturing Date
Protective earth;
protective ground
2ANI Monitor V1
Indications for use:
The Mdoloris Medical Systems SAS ANI Monitor V1 is intended to acquire, display, and
analyze electrocardiographic information and to measure-heart rate variability. These and
other measurements are not intended for any specific clinical diagnosis. The clinical
significance of HRV and other parameters must be determined by the physician.

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ANI (Analgesia Nociception Index) is a standardized continuous measurement of the relative
ptone. Each respiratory cycle (spontaneous and artificial) induces a fast, temporary decrease
of the ptone, which accounts for Respiratory Sinus Arrhythmia, and leads to a transient
shortening of the R-R intervals (increased heart rate). ANI quantifies these "respiratory
patterns" in order to measure the "relative quantity" of ptone (see 5.2).
The series of normal, non-ectopic, R-R intervals is displayed on the screen of the ANI
Monitor V1 after normalization, resampling and filtering. The amount of ptone is measured
in relation to the total window surface through the area comprised between the lower and the
upper envelope of the RR series, which is continuously displayed as a shaded area. The higher
the p, the higher the shaded surface, and reciprocally.
ANI measurement cannot be interpreted in the following situations:
•arrhythmia
•apnea (e.g. apnea induced by anesthesia)
•respiratory rate lower than 9 cycles/min
•electric noise during the measurement period (64 seconds)
•irregular spontaneous ventilation (patient speaking, laughing or coughing)
•pace maker (certain types)
•heart transplant
•drugs affecting the sinus node (atropine and other anticholinergic drugs, etc.)
The ANI is expressed between 0 and 100. Each ANI value is computed on one time window
of 64 sec. This number shows the relative pactivity as a part of ANS activity: it expresses
the relative amount of ptone present as compared to sum of sympathetic and pactivities.
The ANI Monitor V1 displays two averaged ANI measurements: ANIi results from the
average of ANI measured over the last 120 sec, and ANIm results from the average of ANI
measured over the last 240 sec.
There are multiple ways of interpreting an ANI value: one is probabilistic, as this index has
been developed in order to predict hemodynamic reactivity during nociceptive stimulation.
When surgical stimulation was constant, all hemodynamic reactivity episodes (20% increase
of heart rate or systolic blood pressure compared to a reference) were associated with a
decreased ANI up to 10 min beforehand. The predictive thresholds need yet to be established,
but preliminary studies suggest:

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•that an ANIm measure between 50 and 70 during surgery makes a hemodynamic
reactivity episode unlikely in the following 10 minutes;
•that an ANIm lower than 50 makes hemodynamic reactivity very likely in the
following 10 minutes.
3Installing the ANI Monitor V1
3.1 Perfusion stand
Position the ANI Monitor V1 in order for the main power supply to be easily plugged in. The
monitor can be installed on a perfusion stand (figure 1) by using a specific "pole clamp",
which fit pole diameters ranging from 19 to 38 mm. The user is responsible for ensuring
that a suitable stand is used.
Figure 1
3.2 ANI Sensor V1 / ANI Sensor V2 / ANI Sensor V1 PLUS
ANI calculation is based on R-R interval variability in ECG. Since the ANI Monitor V1 is not
an ECG monitor, the electrodes have been designed to retrieve information related to QRS
complexes. The acquisition of a cardiac vector is enough to get an ANI calculation.
The electrodes are composed of a two-part device: a dual sensor and a single sensor connected
together by an electrical thread (figure 2).
The sensor itself is divided into two areas. One part is an adhesive area and the other, the
active area, is covered with conductive gel (figure 3).

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The principle of this two-part device is to place it on each side of the heart (thus on each side
of the chest) to get a cardiac vector (the axis of the average cardiac vector according to the
reference anatomical position is: forward, down and left). In this case the dual sensor is
applied on the patient's chest, the big patch on the upper chest and the small patch on the left
side of the chest (see figure 4).
WARNING:
Reusing a sensor already used on another patient could lead to a risk of cross-
contamination.
If the patient develops a skin reaction or other unusual symptoms, remove the electrodes. It
is important to take particular care with patients suffering from dermatological problems.
Never put electrodes on skin injuries.
Figure 4
Figure 2
Figure 3
Adhesive portion
Conductive gel

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NOTE: The ANI Monitor V1 has been designed to work with specific disposable sensors. It is
inadvisable to use another kind of electrode.
Electrodes are packaged ten per bag. New electrodes can be purchased in boxes of ten bags
i.e. one hundred devices in total.
The maximum consecutive period that the electrodes can adhere to the skin is 24 hrs. The
electrodes' shelf life is noted on the opaque white pouch: in an opaque white pouch, it is two
years. In an opened opaque pouch, the electrodes' shelf life is six months.
Biocompatibility has been tested on all Mdoloris Medical Systems sensors. They meet
standards ISO 10993-5 and ISO 10993-10.
Before connecting, carefully align the notches on the connection sheet to make the pins
correspond perfectly (figures 5 and 7). To disconnect the electrodes, grasp the plastic portion
while pressing on the locking mechanism and pull gently to disengage it (figure 6). Do not
pull by grasping the electrode itself.
3.3 ANI Monitor V1 connection
Connect the electrodes to the acquisition device using the cable provided by your Mdoloris
Medical Systems representative (figures 8 and 9).
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Plastic portion
Electrodes
Locking mechanism
Acquisition device

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Connect the black cable of the acquisition device to the monitor at the plug in the bottom left
hand corner of the monitor's front (figures 10 and 11).
3.4 Battery
The ANI Monitor V1 contains an internal battery. The battery means the system can keep
calculating the ANI while the patient is being moved or in case of main power supply failure.
The internal battery is not designed for long-term monitoring. The battery gauge has ten
graduations; each symbolizes around 10 min of battery life. As soon as the power supply is
interrupted, a message appears on the screen with a warning sound to ask the user to plug the
monitor back on the main power supply. The ANI index is still calculated during this time.
NOTE: plug the ANI Monitor V1 on the main power supply before trying to switch it on.
ANI Sensor
Sensor cable
ANI Sensor V1
ANI-SENS-V1
ANI-SC-V1
ANI Sensor V2
ANI-SENS-V2
ANI-SC-V1
ANI Sensor V1 PLUS
ANI-SENS-V1PLUS
ANI-SC-V1PLUS
Figure 10
Figure 11
ANI-SC-V1
ANI-SC-V1PLUS

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Check the battery charge symbol before unplugging the main power supply; if the internal
battery is insufficiently charged, the ANI Monitor V1 will switch off automatically.
After reconnecting the ANI Monitor V1 to the main power supply, press the power switch on
the front side of the monitor (figure 12). In case the monitor does not start, press the switch at
the back of the monitor (figure 13) in order to reboot the device.
Never use the ANI Monitor V1 only on battery power during surgery. The monitor must be
plugged into the main power supply, especially while an electric knife is being used.
4Beginning ANI Monitoring
Turn the monitor on using the switch on the front at
the bottom right (figure 12).
NOTE: If the front switch does not turn the monitor on, check that the green rear button is
lighted. If this power indicator is off, lift up the light's transparent cover and push the button to
reboot the device (figure 13).
WARNING: Only use this green button on the rear to turn the monitor on. Never use it to
shut the device down. Stopping suddenly could lead to dysfunction when it is next switched on
and prevent normal use.
Switch
Figure 12

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Figure 13
The monitor will start by showing the Mdoloris Medical Systems logo animations
successively. The screen will then show the start page automatically, indicating “Calibration”
on the central screen (figure 14). The first ANI measurement will take at least 80 seconds. No
data can be interpreted before this initialization time lapse.
Figure 14
Once the monitor is connected to the patient with the electrodes, the calculation algorithm will
automatically begin (see figure 15 next page).
Note: The ANI technology can be used with both conscious and unconscious patients,
whenever the physician wishes to use it.
Rear power switch