Anaesthesia and Intensive Care

The Unit of Anesthesia and Intensive Care operates in support of surgical, electrophysiological and interventional activity, and manages the Intensive post-operative care. The Unit deals with preoperative evaluation, intraoperative anesthesia and perioperative intensive care. Patients are examined and evaluated in the anesthesiological surgery and the indication to the operation is discussed daily with the attending cardiologist, the heart surgeon and a senior anesthesiologist (Heart Team).

In the four operating rooms different anaesthesia techniques are used: inhalation, intravenous or locoregional anaesthesia carried out "to measure" for each patient and for every type of cardiac or vascular surgery. In addition to the work in the operating room, anesthesiologists are involved daily in the two electrophysiology rooms where every day procedures of ablation of both atrial and ventricular arrhythmias are performed, both in deep sedation and in general anesthesia. In addition to this, the Anaesthetists Resuscitators cover emergency calls from the hospital wards and the Emergency Department and they are involved in about 1,500 Cardioversions electric /yearly performed under general anesthesia.

Since 2010, the Unit has been equipped with an electronic system for the collection of clinical data (electronic records) in operating theatres, electrophysiology rooms and intensive care. This software allows flawless documentation of clinical data, facilitates the prevention of procedural errors, increases therapeutic management and allows a higher level of care and data collection for scientific research purposes.

Patients undergo monitoring of all physiological parameters, not only cardiac, but also respiratory, neurological and renal. Great importance is given to the control of postoperative pain, 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).

In addition to the clinical activity, the specialists collaborate with the University of Milan teaching to the residents.

The intensive care after surgery

The post operative intensive care takes care of most of the patients undergoing surgery and also of all emergencies/ urgencies.
The department is equipped with medical staff specialized in Anesthesia and Resuscitation 24 hours a day, 7 days a week, with 11 beds equipped with the best hemodynamic, respiratory and advanced neurological monitoring systems as well as with the "electronic folder".

Patients with respiratory failure are treated with both invasive ventilation (IPPV, BiPAP, SIMV, CPAP) and non-invasive (NIV with helmet), inhalation of nitric oxide (NO), with ECMO v-v and if necessary are subjected to diagnostic procedures (bronchoscopy) or invasive therapeutic (percutaneous tracheostomy). Treatment of cardiovascular insufficiency, from the mildest stages to overt cardiogenic shock, includes pharmacological therapies, aortic counterpulsation (IABP), ECMO v-a or ventricular assist devices (VAD).

Patients who experience renal failure (one of the most frequent complications of cardiovascular surgery) are staged according to international criteria (AKIN), are treated pharmacologically and those who need control of fluid imbalances, metabolites and electrolytes are subjected to hemofiltration or hemodialysis sessions.
There are also devices able to continuously monitor the neurological condition (NIRS, EEG) and in some particular interventions the pressure of the cerebrospinal fluid (CSF) is monitored.