37372 - Anesthesiology 2 (AK-B)

Learning outcomes

At the end of the course, students will have acquired:

• The principles of general and regional anesthesia, including the indications, relative and absolute contraindications, associated risks, and safety considerations of the different anesthetic techniques.
• Fundamental knowledge of pain in clinical practice. In particular, students will be able to understand:
  • the socio-clinical and epidemiological aspects of pain in both pre-hospital and in-hospital settings;
  • the neurophysiological and pathophysiological mechanisms underlying pain, as well as its classification, providing the rationale for pain management;
  • the methods used for pain assessment;
  • the basic principles of pharmacological and interventional pain management.
• The fundamentals of basic and advanced life support (resuscitation and emergency care), including the organizational aspects of the pre-hospital emergency medical system, with particular reference to the Emergency Medical Services (EMS) organization in the Emilia-Romagna Region.
• The principles of the management of the critically ill patient (intensive care medicine), including the diagnosis of brain death and the process of organ donation, with particular attention to ethical issues concerning the limitation of life-sustaining treatments and the criteria for admission to the Intensive Care Unit (ICU).

Course contents

1. Assessment of the Critically Ill Patient

• The ABCDE approach to the patient with time-dependent emergencies.
• Early recognition of clinical deterioration.
• Assessment of vital signs.
• Early Warning Scores (NEWS2, MEWS).
• Activation of the Rapid Response System.

2. Airway Management and Acute Respiratory Failure

• Functional anatomy of the airway.
• Oxygen therapy.
• Airway management devices:
  • oropharyngeal and nasopharyngeal airways;
  • face mask ventilation;
  • supraglottic airway devices;
  • tracheal intubation.
• Invasive and non-invasive mechanical ventilation:
  • indications;
  • physiological principles;
  • complications.
• Acute respiratory failure:
  • classification;
  • diagnosis;
  • principles of management.

3. Monitoring of the Emergency Patient

• Clinical and instrumental monitoring.
• Continuous electrocardiographic (ECG) monitoring.
• Pulse oximetry.
• Capnography.
• Non-invasive and invasive blood pressure monitoring.
• Fluid balance and urine output monitoring.
• Arterial blood gas (ABG) analysis: clinical interpretation.

4. Principles of Anesthesia in Emergency Settings

• Urgent preoperative assessment.
• American Society of Anesthesiologists (ASA) Physical Status Classification.
• Preoperative fasting and aspiration risk.
• Rapid Sequence Induction (RSI).
• Major classes of anesthetic drugs:
  • hypnotic agents;
  • analgesics;
  • neuromuscular blocking agents;
  • reversal agents.
• Perioperative management of the critically ill patient.

5. Cardiovascular Emergencies

• Shock:
  • hypovolemic shock;
  • cardiogenic shock;
  • distributive shock;
  • obstructive shock.
• Diagnostic approach.
• Fluid resuscitation.
• Vasoactive medications.
• Principles of hemodynamic monitoring.

6. Cardiac Arrest and Cardiopulmonary Resuscitation

• Chain of Survival.
• Basic Life Support (BLS).
• Principles of Advanced Life Support (ALS).
• Defibrillation.
• Management of reversible causes (the 4 Hs and 4 Ts).
• Post-resuscitation care.

7. Intensive Care Medicine

• Indications for Intensive Care Unit (ICU) admission.
• Organ support therapies.
• Sepsis and septic shock.
• Sedation and analgesia in the critically ill patient.
• Prevention of complications associated with intensive care unit hospitalization.

Readings/Bibliography

Recommended Textbooks

• Butterworth J.F., Mackey D.C., Wasnick J.D. Morgan & Mikhail's Clinical Anesthesiology. 7th Edition. McGraw-Hill Education, 2022.
  A comprehensive reference textbook in anesthesiology, with particular emphasis on the principles of general and regional anesthesia, perioperative monitoring, airway management, and the care of the critically ill patient.
• Gropper M.A., Eriksson L.I., Fleisher L.A., Cohen N.H., Leslie K., Johnson-Akeju O. (Eds.). Miller's Anesthesia. 10th Edition. Elsevier, 2024.
  A leading reference text for advanced study of anesthetic physiology, pharmacology, intensive care medicine, perioperative medicine, and the management of emergency and critically ill patients.

Recommended Scientific Journals

Students are encouraged to consult the following peer-reviewed journals for further reading and updates on current evidence and clinical practice:

• Anesthesiology
• British Journal of Anaesthesia
• European Journal of Anaesthesiology
• Intensive Care Medicine
• Critical Care
• Resuscitation

Teaching methods

The course is delivered through interactive lectures, complemented by the discussion of clinical cases and the analysis of clinical scenarios commonly encountered in emergency and perioperative medicine.

During the lectures, multimedia teaching resources -including presentations, diagnostic images, clinical decision-making algorithms, and videos of anesthetic and resuscitation procedures- are used to facilitate the understanding of pathophysiological principles and evidence-based diagnostic and therapeutic approaches.

 

Assessment methods

The assessment consists of an oral examination, which may include the discussion of clinical cases, designed to evaluate not only the student's theoretical knowledge but also their ability to apply it to the analysis and management of clinical problems.

The evaluation is based on the accuracy and completeness of the knowledge acquired, the appropriate use of scientific terminology, the ability to integrate concepts across the topics covered, and the clinical reasoning skills demonstrated during the examination.

The final grade is expressed on a 30-point scale (out of 30) and contributes to the overall assessment of the Integrated Course, according to the criteria established by the Degree Programme Board.

Teaching tools

The course makes use of both traditional and digital teaching resources to support theoretical learning and facilitate its integration with clinical practice.

Office hours

See the website of Fabrizio Monaco