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Principles of anesthesia for medical students

IRCCS Ospedale San Raffaele Milano Università Vita-Salute San Raffaele. Principles of anesthesia for medical students. Vita-Salute University of Milano May 14° 2009. Speaker: Landoni G. VOLATILE ANESTHETICS FENOLDOPAM DESMOPRESSIN ESMOLOL LEVOSIMENDAN VALVOLE PERCUTANEE

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Principles of anesthesia for medical students

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  1. IRCCS Ospedale San Raffaele Milano Università Vita-Salute San Raffaele Principles of anesthesiaformedicalstudents Vita-Salute University of Milano May 14° 2009 Speaker: Landoni G

  2. VOLATILE ANESTHETICS FENOLDOPAM DESMOPRESSIN ESMOLOL LEVOSIMENDAN VALVOLE PERCUTANEE landoni.giovanni@hsr.it www.itacta.org 4 200 AIFA 2006 34 1.000 MINISTRY 2008 3 200 3 200 10 1.000 3 150 ITACTA ONGOING RCTsTOPICS HOSPITALS PATIENTS GRANTS

  3. HSR • 100 ANESTHESIOLOGISTS • 30 students/residents (6 per year)

  4. Clinical duties • Research • Teaching • Congresses • (developing countries)

  5. Anesthesiology (US) • Anesthesiologists 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.

  6. CLINICAL DUTIES (ITALY) • ANESTHESIA • INTENSIVE CARE • EMERGENCY DEPARTMENT • IN-HOSPITAL EMERGENCY • OUT-OF-HOSPITAL EMERGENCIES • HYPERBARIC MEDICINE • PAIN THERAPY

  7. CLINICAL DUTIES (ITALY) • ANESTHESIA

  8. IPNOSIS • MUSCLE RELAXATION • PAIN • (REFLEXES)

  9. CLINICAL DUTIES (ITALY) • ANESTHESIA • INTENSIVE CARE

  10. NEUROLOGIC STATUS • LUNGS • CARDIOVASCULAR • KIDNEYS • DRUGS

  11. CLINICAL DUTIES (ITALY) • ANESTHESIA • INTENSIVE CARE • EMERGENCY DEPARTMENT • IN-HOSPITAL EMERGENCY • OUT-OF-HOSPITAL EMERGENCIES

  12. BLS • ALS • ATLS

  13. INVASIVE PROCEDURES • Hai mai utilizzato un vero defibrillatore manuale? Si No 97% • Hai mai utilizzato un vero defibrillatore semi-automatico? Si No 94% • Hai mai effettuato una cardioversione sincronizzata? Si No 95% • Hai effettuato la gestione di base delle vie aeree (apertura delle vie aeree, estensione del capo, posizionamento cannula orofaringea)? Si No 81% • Hai effettuato la gestione avanzata delle vie aeree (intubazione orotracheale, posizionamento maschera laringea)? Si No 88% • Hai effettuato una cricotiroidotomia? Si No 100% • Hai effettuato una ventilazione manuale con pallone autoespansibile (“Ambu”)? Si No 70%

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

  15. Hai posizionato un’agocannula venosa? Si No 39% • Hai effettuato un prelievo venoso? Si No 0% • Hai effettuato un prelievo arterioso (emogasanalisi)? Si No 9% • Hai effettuato una rachicentesi? Si No 99% • Hai posizionato un sondino naso-gastrico? Si No 73% • Hai effettuato una paracentesi? Si No 95% • Hai posizionato un drenaggio toracico? Si No 99% • Hai effettuato una pericardiocentesi? Si No 100%

  16. Hai effettuato esercitazioni di rianimazione cardiopolmonare? Si No 69% ( 0%) • Hai effettuato esercitazioni sull’esame del paziente adulto in rapido peggioramento? Si No 87% • Hai effettuato esercitazioni di valutazione e assistenza al paziente critico pediatrico? Si No 81% • Ti senti adeguatamente preparato per una prima valutazione ed assistenza ad un paziente critico? Si No 82%

  17. Clinical duties • Research (ENGLISH) • Teaching • Congresses • (developing countries)

  18. Levosimendan and Mortality in Cardiac Surgery

  19. Levosimendan and Mortality in Cardiac Surgery • 11/235=4.7% v 26/205=12.7% • P=0.007 • NNT = 12

  20. Impact Factor 2006 51,3 25,8 23,2 14.8 10,9 9,7 7,3 6,6 5,5 4,2 2,1 Journal • NEW ENGL J MED • LANCET • JAMA • ANNALS OF INTERNAL MEDICINE • CIRCULATION • J AM COLL CARDIOL • EUR HEART J • CRITICAL CARE MEDICINE • CLINICAL CHEMISTRY • ANESTHESIOLOGY • ANAESTHESIA ANALGESIA

  21. Cardioprotection & anaesthesiaVolatile Anesthetics • b blockers“recommended” • Statins “suggested” in selected pts • a2 agonists “may be considered” in selected pts • Ca++ antagonists “may be considered” in selected pts • Insulin “reasonable” in hyperglycaemic pts • Volatile Anesthetics “can be beneficial”

  22. Looking for evidence?

  23. Every 1.000 patients receiving extended release METOPROLOL • PREVENTION OF 15 MYOCARDIAL INFARCTON • PREVENTION OF 3 CABG • PREVENTION OF 7 ATRIAL FIBRILLATION

  24. Every 1.000 patients receiving extended release METOPROLOL • EXCESS OF 8 DEATHS • EXCESS OF 5 STROKE • EXCESS 53 HYPOTENSION • EXCESS 42 BRADICARDIA

  25. NON-RCT

  26. Clinical duties • Research (ENGLISH) • Teaching • Congresses • DEVELOPING COUNTRIES

  27. www.projectforpeople.org

  28. AWARENESS

  29. Are you still with me? All of you?

  30. WHERE DID IT ALL START?

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