The Anaesthesia and Intensive Care Unit of Monzino (OU AR) ensures its activity in support of surgical, electropysiological and interventional activities and manages post-intervention intensive care.
The OU AR's structure is organized with a manager, two supervisors, seven anesthesist resuscitators senior, four anesthesist resuscitators junior and four specialists in training.
Most of the doctors have previous abroad experience in clinical or research.
The OU AR handles preoperative assessment, from intraoperative anesthesia to prerioperative intensive care.
Patients are examined and evaluated in the anesthesiologic clinic and the treating cardiologist, the cardiac surgeon and the senior anesthesiologist (Heart Team) discuss altogether the operation's indication.
More than 1.200 interventios are performed in the four hospital's operating theaters and various "tailor made" techniques are used in every intervention of cardiac or vascular surgery: inhalation, intravenous or locoregional anesthesia.
Patients are monitored for all physiological parameters, not only heart, but also respiratory, neurological and renal. Transesophageal echocardiography, even three-dimensional, is used extensively, with the assistance of a senior echocardiographic cardiologist.
In addition to the commitment in the operating theater, anesthesiologists are involved daily in the two electrophysiology operating theaters, where more than 800 procedures of ablation of both atrial and ventricular arrhythmias are performed every year, both in deep sedation and under general anesthesia.
Since 2010, the Operating Unit has an electronic data collection system (electronic folder) both in the Operating Rooms and in the Electrophysiology Rooms and in Intensive Care. This software allows unexceptionable documentation of clinical data, prevent procedural errors, increases therapeutic management and allows a higher level of care and data collection for scientific research.
Great importance is given to the control of postoperative pain that is evaluated with appropriate scales (NRS, CPOT) both before and after drug treatment. Equally important is the evaluation of sedation (RASS scale) and delirium (ICDSC scale);
It is possible to require psychological support for both patients (especially long-term patients) and relatives. A questionnaire was recently introduced to assess the relative’s satisftaction on the quality of care provided to patients in TYPE; the data that will emerge will be useful to improve the service.
The management of the transfer of the patients to the department of origin takes place by evaluating objective parameters on score scales validated at international level (NEWS). Intensive care service’s quality control is performed every four months, using indicators taken from the clinical literature.
Furthermore, the anesthetists resuscitators answer to the emergency calls from the wards and the emergency room and are involved in approximately 1,500 electrical cardioversion performed under general anesthesia every year.
The OU AR evaluates also the possibility of patients’ transfer to another hospital and often the same specialist accompanies patients in critical conditions. In addition to the clinical activity, the staff of AR’s doctors trains the specializing doctors from the School of Specialization of the University of Milan; several AR doctors are Contract Professors or Tutors at the aforementioned School.
The UO AR is committed in the updating and clinical training of both medical and nursing staff by organizing staff meetings twice a month and also courses aimed at all the doctors and nurses of the CCM. For example, the latest topics are the early recognition of Sepsis and its treatment and the good use of blood and blood components.
Intensive care takes care of most of the patients that undergoing surgery and of all emergencies; the department is equipped with medical personnel specialized in Anesthesia and Intensive Care 24/7.
The department has 11 beds equipped with the best hemodynamic, respiratory and advanced neurological monitoring systems as well as with the "electronic folder". All diagnostic procedures are available 24/7 (conventional radiology, CT scan, angiography, transthoracic and transesophageal echocardiography, gasanalysis, patient bed coagulation (ROTEM), traditional analysis and interventional laboratory (operating room, angiocoronarography, electrophysiology studies).
Patients with respiratory failure are treated either with invasive ventilation (IPPV, BiPAP, SIMV, CPAP) or non-invasive (NIV with helmet), with inhalation of nitric oxide (NO), with ECMO v-v and subjected to procedures if necessary diagnostic (bronchoscopy) or invasive therapeutic (percutaneous tracheostomy).
The doctors of the OU are involved in scientific research activities. The research is very closely linked to the daily clinical activity and the type of patients that most frequently come to observation, such as the search for early markers of perioperative renal insufficiency, the study of new pharmacological protocols that allow the maintenance of optimal neurological parameters, the study of alternative methods of ventilation and the optimization of the heart-lung interaction.