 blockers “recommended”

 blockers “recommended”

•  blockers “recommended”

• Statins “suggested” in selected pts

• 2 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”

EPIDURAL ANESTHESIA (non-cardiac surgery)

• EPIDURAL ANESTHESIA (non-cardiac surgery)

• BETA BLOCKERS (non-cardiac surgery) ??!!

• VOLATILE AGENTS (cardiac surgery)

• LEVOSIMENDAN (cardiac surgery)

VOLATILE AGENTS (cardiac surgery)

• VOLATILE AGENTS (cardiac surgery)

• LEVOSIMENDAN (cardiac surgery)

FENOLDOPAM

• FENOLDOPAM

• PEXELIZUMAB (cardiac surgery)

• DOPEXAMINE

• EARLY ENTERAL NUTRITION (intestinal surgery)

• INSULINE !!??

• STATINS

I Meta-analysis and/or large randomized studies

• I Meta-analysis and/or large randomized studies

• II Randomized trials

• III Non-randomized prospective trials

• IV Retrospective studies

• V Case reports and Expert Opinion

• VI Animal / Laboratories Studies

22 randomized studies (15 CPB-CABG; 6 OP-CABG; 1 mitral valve surgery)

• 22 randomized studies (15 CPB-CABG; 6 OP-CABG; 1 mitral valve surgery)

• 1922 patients (904 TIVA and 1018 DES or SEVO)

• 16 studies administered volatile anesthetics throughout all the procedure (6 studies for 5-30 minutes)

4/977=0.4% v 14/872=1.6%

• 4/977=0.4% v 14/872=1.6%

• NNT=84

• RRR=(1,6-0,4)/1,6=75%

• OR: 0.31(0.12-0.80)

• P=0.02

NNT=84

• NNT=84

• Treat 84 to save one

24/979=2.4% v 45/874=5.1%

• 24/979=2.4% v 45/874=5.1%

• NNT=37

• RRR: (5.1-2.4)/5.1 = 53%

• OR: 0.51(0.32-0.84)

• p=0.008

NNT=37

• NNT=37

• Treat 37 to save one

6219 patients

• 6219 patients

• 2842 sevoflurane

• 609 desflurane

400 authors

• 400 authors

• 240 reviewers

• 90 editors

• RCTs should confirm the promising results of volatile anesthetics in noncardiac surgery

• Cardiac Troponin I could be an excellent intermediate (surrogate?) outcome in cardiac and non-cardiac high risk surgical patients

The risk of epidural haematoma or other serious complications ( before systemic heparitation) is 1:4500 Ruppen W et al, BMC Anesthesiol. 2006;6:10

• The risk of epidural haematoma or other serious complications ( before systemic heparitation) is 1:4500 Ruppen W et al, BMC Anesthesiol. 2006;6:10

• No epidural haematoma has ever been described in a randomized setting

• Two case reports have been recently published

• Sharma S et al, J Cardiothorac Vasc Anesth. 2004;18:759-762

• Rosen DA et al, Anesth Analg 2004;98:966-969

• A meta-analysis of

• 33 trials randomized

• 2366 patients ( 1231 receiving general anaesthesia and 1135 receiving epidural anaesthesia)

β blockers “recommended”

• β blockers “recommended”

• Non riportata mortalità ed infarto nei due gruppi (34 studi, 1739 pazienti)

• • Non riportata mortalità ed infarto nei due gruppi (34 studi, 1739 pazienti)

11/235=4.7% v 26/205=12.7%

• 11/235=4.7% v 26/205=12.7%

• P=0.007

2/183=1.1% v 9/153=5.9%

• 2/183=1.1% v 9/153=5.9%

• P=0.04

VOLATILE ANESTHETICS

• VOLATILE ANESTHETICS

• FENOLDOPAM

• DESMOPRESSIN

• ESMOLOL

• LEVOSIMENDAN

• VALVOLE PERCUTANEE

• [e-mail]

• www.itacta.org

• Gruppi esistenti ad oggi 27-3-2009 (per piu’ informazioni www.itacta.org), aperti ad iscrizioni

• 1. Sostituzioni valvolari percutanee ([e-mail])

• 2. Monitoraggio emodinamico mini-invasivo ([e-mail])

• 3. Statistica in anestesia e terapia intensiva ([e-mail])

• 4. Analgesia selettiva in chirurgia toracica ([e-mail])