Azienda Ospedaliera Universitaria Senese Santa Maria alle Scotte Anaesthesia and post-operative Intensive Care Anaesthesia and post-operative Intensive Care Information for patients and their relatives Dear Mr and Mrs, The Anaesthesia and Neurosurgical Intensive Care service of the University Hospital of Siena is a specialized anaesthesia service provided by the Neurosciences Department: University Neurosurgery, Hospital Neurosurgery, Paediatric Neurosurgery Contacts: http://www.ao-siena.toscana.it http://www.annualneuromeeting.it Secretary: Tel. +39 0577 585228 - 585284 - Fax +39 0577 586141 and Neuroradiology. Every year this service provides more than 1800 anaesthesia, elective or urgent surgical operations, diagnostics procedures that are particularly invasive and more than 400 Intensive Care admissions. STAFF Through these pages we would like to inform you about our activity in order to give Anaesthetists you the possibility to understand, in an easy way, the several procedures available. Ettore Zei (Director of Anaesthesia and Neurosurgical Intensive Care C.O.U.) The specialized doctors of the ward are at your disposal for any further information Antonella Buscalferri (Director of Pediatric Neuroanesthesia O.U.) or explanation you may need. Cesare Vittori (Education Director) Marco Ancilli, Caterina Auletta, Veronica Betti, Paola Castellani, Francesca Diana, Salvatore Frisone, Zion Levi, Davide Loffredo, Maria Materno, Francesca Tarantino, Rebecca Tinturini, Silvana Todaro, Michela Vozza. Wishing you a speedy recovery. Ettore Zei MD Director of Anaesthesia and Neurosurgical Intensive Care Unit Healthcare Assistants Giampaolo Costantino (Charge Nurse) Giulia Bandinelli, Paolo Calandrino, Giovanni Cannavacciuolo, Massimo Checchi, Gerardo Citera, Fausto Toni Cozzolino, Lucrezia De Vita, Monica Ghezzi, Emiliano Maisto, Giada Mari, Patrizia Merluccio, Antonia Delgado Moreno, Mirela Neagu, Simona Neri, Nocentini, Ambra Pierguidi, Aniello Giuseppe Pollasto, Rosy Portogallo, Stefania Rosati, Gianni Sabatini, Gianluca Volpi, Francesco Zapparella, Roberta Zonno. Health Workers Patrizia Bortone, Giovanna Buracchi, Rosanna Caridi, Maria Teresa Iarobino Quality Standards Congruent with the validation and implementation criteria of quality established by Tuscany Region conforming to the Clinic Risk Management Programme. 2 3 Anaesthesia and post-operative Intensive Care The informed consent Information for patients At the end of the medical examination the doctor will propose to sign the informed consent form. In this document the patient can certify that he received all information about anaesthesia, its possible risks and his general state of health. Anaesthesia and Neurosurgical Intensive Care ward staff The team is made up of medical specialist and nurses. The “neuro” anaesthetist is a doctor, specialized in anaesthesia, resuscitation and algology (medical treatment of pain). He takes care of neurosurgical patients before and after operation or the instrumental examination and he inspects the conditions once the operation is done. Through the agency of medications and specialized techniques, the doctor stamps out pain both during and after surgery. The risk of anaesthesia Thanks to the technological and scientific progress - in monitoring systems, equipment and medications - and thanks to the increased specialisation of health professionals, the possible risks are considerably reduced. In some rare cases, the eventual complication is linked to the patient’s health condition and to the operation complexity level. With the assistance of nurses and of some specific instruments, he monitors and keeps stable the vital signs such as blood pressure, pulsation and breathing. In some problematic cases, the patient is hospitalised in the ICU. The blood transfusion In many surgical operations, the blood transfusion can be necessary. In addition to the traditional blood transfusion there are also some other alternatives: The medical examination Before the operation, a medical examination is done by the anaesthetist in order to know, in a detailed way, the health condition of the patient. It is recommended to show the medical record - case history, updated therapy, x-ray, recent medical examinations - and to answer thoroughly the questions. During the examination the doctor can consider worthwhile another prescription about - autotransfusion: when a patient’s own blood is collected and reinfused during a surgery - “re”- transfusion: the patient’s own blood is collected and “cleaned” during the blood washing procedure. The patient can refuse the blood transfusion, but he has to communicate his personal motivations before the operation. additional verifications. At the end of the examination the doctor will explain the possible anaesthesia risks linked to the state of health, to the anaesthesia typology chosen and to the surgical operation. If the anaesthetist, who made the medical examination, will be absent at the time of the operation, he will communicate his evaluations to the doctor on duty in the operating theatre. The central venous catheter Sometimes, in order to facilitate surgical operations or to support the post-operative course, the central venous catheter is inserted in one of the biggest neck veins. Local anaesthesia and a chest X-ray is performed in order to verify the correct graft in blood vessels. The central venous catheter allows to monitor the vital functions during the operation. 4 5 - to infuse liquid substances (such as blood) sticky electrode, the BP value and the oxygen quantity present in blood. From - to infuse and give directly into veins (after the operation) a caloric nourish- this moment, the procedure will be different on the basis of the type of anaes- ment or chemotherapeuty drugs. thesia (general or local). Surgery Eve General anaesthesia (narcosis) The patient will be anxious, of course. Therefore, in order to relax, rest and The general anaesthesia is a medically induced coma and loss of protective re- face the operation calmly, the patient can require a sedative that must be pre- flexes resulting from the administration of one or more general anaesthetic scribed by the anaesthetist. agents. To face short and not invasive operations the respiration is helped by a mask endorsed on the patient’s face. While, for long and complex operations other methods are employed, such as the laryngeal mask airway (LMA) endorsed on the vocal cords. Another method employed is the tracheal intuba- Rules to follow For safety reasons, patients must respect the following rules: - starting from midnight of the day before the operation, patient must fast. This tion; this must be removed at the end of the operation, during the awakening phase. Once awake, the patient will find on his body the catheter which allows to eliminate urine, the nasogastric feeding tube (of NG-tube) in order to keep rule is not always for patient in paediatric age. the stomach empty, and the surgical drains (tubes used to remove pus, bloods - Patients must inform the anaesthetist if they use to take drugs. The doctor or other fluids from a wound). must assent to both administration and posology. - Patients must replace their personal things in their own locker. Some personal objects can be left in custody of the head nurse. - Take off your contact lenses before entering the operation room. In case of sensorial deficit you can only use your glasses or your hearing aid, subject to the doctor’s authorisation. - Do not smoke - Ladies must remove nail polish and make-up Anaesthesia side-effects Sometimes, the general anaesthesia can cause some temporary diseases: confusion, nausea, vomiting, throat inflammation and hypothermia. In some rare cases anaesthesia causes allergic reactions and aspiration pneumonia. In some uncommon cases it can cause damage to teeth, deglutition diseases and a loss of sensibility of arms. The day of the surgery The patient will be guided to the operation area on his bed and he will meet the anaesthetist and the specialised nurse. At this moment everything is ready for the operation. First of all, a vein of the hand or of the arm is linked, through a needle or a little plastic pipe, to an I.V. (medical intravenous feeding). After this, on a monitor screen will be displayed the pulse rate, measured by some 6 After surgery At the end of the operation the anaesthetist has to check the patient’s functions recovery. The quality depends on several factors: age, illness, operation duration and difficulty and type of anaesthesia. 7 In case of complex operations it is possible that the patient remain in the recovery room or is sent to the Intensive Care unit. The patient can come back to the ward when his health condition is stable; his relatives will be always informed about the path to recovery. The “neuro” anaesthesia in paediatric age Things already said before for adult patients are also valid for patients in paediatric age. In this case parents have an important role and they will be always informed in order to express their agreement. Parents must be calm and peaceful in order to spread calmness to their child. Moreover, in order to encourage the child to calm down, the anaesthesiologist The Local Anaesthesia - outpatient operations in Day Surgery will be the same in both medical examination and operation day. The duration depends and changes according to the age of the child. More and more, short operations are performed as day or short stay surgery The parents of the “little” patient are allowed to guide their child as far as the as they reduce length of hospital stay (observation of 12/24 hours). operation room and they will be immediately present at the moment of the Given that the anaesthesia, even if it is local, causes reduction in attention span, child awakening. we recommend patients to follows some important rules: - Come back home with a relative - Have a telephone at your fingertips - Do not leave house alone - Do not drive any means of transport - Do not work with dangerous tools - Follow the therapy prescribed by the doctor and avoid alcohol 8 9 Post-operative Intensive Care Ward access Once arrived at the ward entry, we ask you to inform us about your presence through the door phone. You must observe visiting hours, you will be led to Dear visitors, your relative’s bed where doctors will answer your questions about your rela- Our ward is charged to take care of patients in critical conditions. Their vital functions must be always supported and supervised thanks to complex hi-tech instruments. We know what worry, stress and troubles mean. We ask you to be patient and understanding because of the therapy that your loved one must follow, the waiting time is quite long. We try to meet your needs and to satisfy your requests. tive’s health conditions. We ask you to respect the following rules: - No more than one visitor at a time may visit. - Please respect the hygienic rules - Respect the visiting hours: from 12.00 to 13.00 and from 18.00 to 19.00. - Sometimes we are forced to ask you to wait in the lounge room or to go out - Please inform the staff about possible access problems during visiting hours - Due to Thank you privacy reasons, do not ask for information at the telephone, we can not answer Intensive care medical and nursing staff - Please give us your telephone number - Stay close to your relative’s bed respecting the privacy of other patients Main techniques employed in the ICU Don’t be scared of the complex equipments that you will find in the Intensive Care ward. The screen close to your relative’s bed monitors the heart rate, the blood pressure, the respiration and other important parameters. In case of vital functions alteration an alarm will rapidly signal it. Extracorporeal life support It helps the patient in having a suitable and autonomous respiration/breathing. Some little tubes allows to get oxygen into the lungs and the elimination of mucus. In this case patient can not speak. Artificial nourishment Many patients need artificial nourishment. In this case the substances (lipids, carbohydrates, proteins, water and mineral salts) are introduced in the organism through a catheter. The same device is used to introduce drugs. What you can do - last recommandations 10 11 If you would like to have a copy of this documentation, after the discharge, you You can safely touch your relative, if there aren’t any other indications. Do not have to request it at the case history bureau through fax, adding a copy of your be surprised if he does not show any reaction to contact; it could be caused identity card. You can also find the form on internet: by drugs or by his clinical conditions. If he is not able to speak, it is important http://www.ao-siena.toscana.it/modulistica that you do, so he may feel your presence and you affection. Try to avoid topics and tones that may create anxiety or concern: even the patient who look unconscious may perceive part of what is being said and he could get excited. In these moments the main need is to stay close to your relative as much Hospitalization Certificate as possible, but you will run the risk of neglecting yourself. It is important to face the situation trying to respect also your needs, such as relax, take some The patient can request it, for business or personal reasons, to the head nurse. time for yourself, away from the hospital. We believe that some time during the day dedicated to yourself is an advantage also for your relative. Hospitalization documentation The case history contains information about hospitalization, diagnosis, examinations results, recommendation, operation statement and discharge certificate. 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