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Principles of anesthesia for medical students Speaker:Landoni G Vita-Salute University of Milano May 14° 2009 IRCCS Ospedale San Raffaele Milano Università

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Presentazione sul tema: "Principles of anesthesia for medical students Speaker:Landoni G Vita-Salute University of Milano May 14° 2009 IRCCS Ospedale San Raffaele Milano Università"— Transcript della presentazione:

1 Principles of anesthesia for medical students Speaker:Landoni G Vita-Salute University of Milano May 14° 2009 IRCCS Ospedale San Raffaele Milano Università Vita-Salute San Raffaele

2 ITACTA ONGOING RCTs TOPICSHOSPITALSPATIENTS GRANTS zVOLATILE ANESTHETICS zFENOLDOPAM zDESMOPRESSIN zESMOLOL zLEVOSIMENDAN zVALVOLE PERCUTANEE z 4200AIFA 2006 z MINISTRY 2008 z 3200 z z 3150

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5 HSR z100 ANESTHESIOLOGISTS z30 students/residents (6 per year)

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7 zClinical duties zResearch zTeaching zCongresses z(developing countries)

8 Anesthesiology (US) zAnesthesiologists are physicians that administer anesthetics to alleviate pain and suppress consciousness, as well as monitor and support life functions during surgery. They also provide medical care and consultation outside the operating room and participate in the diagnosis and treatment of pain syndromes.

9 CLINICAL DUTIES (ITALY) zANESTHESIA zINTENSIVE CARE zEMERGENCY DEPARTMENT zIN-HOSPITAL EMERGENCY zOUT-OF-HOSPITAL EMERGENCIES zHYPERBARIC MEDICINE zPAIN THERAPY

10 CLINICAL DUTIES (ITALY) zANESTHESIA

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13 zIPNOSIS zMUSCLE RELAXATION zPAIN z(REFLEXES)

14 CLINICAL DUTIES (ITALY) zANESTHESIA zINTENSIVE CARE

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16 zNEUROLOGIC STATUS zLUNGS zCARDIOVASCULAR zKIDNEYS zDRUGS

17 CLINICAL DUTIES (ITALY) zANESTHESIA zINTENSIVE CARE zEMERGENCY DEPARTMENT zIN-HOSPITAL EMERGENCY zOUT-OF-HOSPITAL EMERGENCIES

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19 zBLS zALS zATLS

20 INVASIVE PROCEDURES zHai mai utilizzato un vero defibrillatore manuale? SiNo 97% zHai mai utilizzato un vero defibrillatore semi-automatico? SiNo 94% zHai mai effettuato una cardioversione sincronizzata? SiNo 95% zHai effettuato la gestione di base delle vie aeree (apertura delle vie aeree, estensione del capo, posizionamento cannula orofaringea)? SiNo 81% zHai effettuato la gestione avanzata delle vie aeree (intubazione orotracheale, posizionamento maschera laringea)? SiNo 88% zHai effettuato una cricotiroidotomia?SiNo 100% zHai effettuato una ventilazione manuale con pallone autoespansibile (Ambu)? SiNo 70%

21 Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Vita-Salute San Raffaele University, Milan, Italy INTRA AORTIC BALLOON PUMP

22 zHai posizionato unagocannula venosa? SiNo 39% zHai effettuato un prelievo venoso? SiNo 0% zHai effettuato un prelievo arterioso (emogasanalisi)? SiNo 9% 1.Hai effettuato una rachicentesi? SiNo 99% zHai posizionato un sondino naso-gastrico? SiNo 73% zHai effettuato una paracentesi? SiNo 95% zHai posizionato un drenaggio toracico? SiNo 99% zHai effettuato una pericardiocentesi? SiNo 100%

23 zHai effettuato esercitazioni di rianimazione cardiopolmonare? SiNo 69% ( 0%) zHai effettuato esercitazioni sullesame del paziente adulto in rapido peggioramento? SiNo 87% zHai effettuato esercitazioni di valutazione e assistenza al paziente critico pediatrico? Si No 81% zTi senti adeguatamente preparato per una prima valutazione ed assistenza ad un paziente critico? Si No 82%

24 zClinical duties zResearch (ENGLISH) zTeaching zCongresses z(developing countries)

25 Levosimendan and Mortality in Cardiac Surgery

26 711/235=4.7% v 26/205=12.7% 7P= NNT = 12 Levosimendan and Mortality in Cardiac Surgery

27 Journal zNEW ENGL J MED zLANCET zJAMA zANNALS OF INTERNAL MEDICINE zCIRCULATION zJ AM COLL CARDIOL zEUR HEART J zCRITICAL CARE MEDICINE zCLINICAL CHEMISTRY zANESTHESIOLOGY zANAESTHESIA ANALGESIA Impact Factor ,3 25,8 23, ,9 9,7 7,3 6,6 5,5 4,2 2,1

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30 Volatile Anesthetics Cardioprotection & anaesthesia Volatile Anesthetics blockers recommended CStatinssuggested in selected pts 2 agonists may be considered in selected pts CCa ++ antagonistsmay be considered in selected pts CInsulinreasonable in hyperglycaemic pts CVolatile Anesthetics can be beneficial

31 Looking for evidence?

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33 Every patients receiving extended release METOPROLOL zPREVENTION OF 15 MYOCARDIAL INFARCTON zPREVENTION OF 3 CABG zPREVENTION OF 7 ATRIAL FIBRILLATION

34 Every patients receiving extended release METOPROLOL zEXCESS OF 8 DEATHS zEXCESS OF 5 STROKE zEXCESS 53 HYPOTENSION zEXCESS 42 BRADICARDIA

35 NON-RCT

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42 Name of the Hospital % mortality at 30 days CLINICA SAN ROCCO - BRESCIA 0,26% OSPEDALE SAN RAFFAELE MILANO 0,36% PRESIDIO OSPEDALIERO "C. POMA" MANTOVA 0,48% OSPEDALE CIVILE LEGNANO - MI 0,67% OSPEDALE SANTA CROCE E CARLE CUNEO 1,15% OSPEDALE S. CHIARA TRENTO 1,16% NUOVO POLO CARDIOLOGICO - TRIESTE 1,22% HESPARIA HOSPITAL S.R.L. MODENA 1,32%

43 zClinical duties zResearch (ENGLISH) zTeaching zCongresses zDEVELOPING COUNTRIES

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48 AWARENESS

49 Are you still with me? All of you?

50 WHERE DID IT ALL START?

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60 ITACTA ONGOING RCTs TOPICSHOSPITALSPATIENTS GRANTS zVOLATILE ANESTHETICS zFENOLDOPAM zDESMOPRESSIN zESMOLOL zLEVOSIMENDAN zVALVOLE PERCUTANEE z 4200AIFA 2006 z MINISTRY 2008 z 3200 z z 3150

61 For these and further slides on these topics please feel free to visit the metcardio.org website:


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