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Surgeon-Anaesthetist-Intensivist Crosstalk In Abdominal Emergencies (Zsolt Bodnar WSACS session ESA 2018 #EA18)

“One man never made a team.”
Detailed and well-structured handover from operating theatre to ICU is a cornerstone for uncomplicated postoperative care. The constant handover of the information between the members of the perioperative team (surgeon+anaesthetist+intensivist) is a crucial importance. Surgeon and anaesthetist are the key players in the operating room, aiming for a common goal – safety and good outcome for patient. Communication is the glue that holds the team together and is the source of motivation for all and the followings always should been discussed (Reintam et al.):
- exact description of surgical procedure (type of resection, number and placement of drains, timing of drain removal, etc...)
- possible bowel distention and impaired perfusion
- contamination of peritoneal cavity
- location of anastomosis, stoma (small bowel or colon), quality of anastomosis
- risk for bleeding
- type of closure (mesh, fascial, open abdomen, etc...)
- when to start oral diet / enteral feeding

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Surgeon-Anaesthetist-Intensivist Crosstalk In Abdominal Emergencies (Zsolt Bodnar WSACS session ESA 2018 #EA18)

  1. 1. SURGEON-ANAESTHETIST-INTENSIVIST CROSSTALK IN ABDOMINAL EMERGENCIES Mr. Zsolt Bodnar, MD, PhD, FICS, FRCSI
  2. 2. Do you know any more sad than un train broken-down in the rain?
  3. 3. Probably yes...
  4. 4. The surgeon alone with his complicated patient...
  5. 5. The surgeon alone with his complicated patient...
  6. 6. Are you around? Something wrong with your patient…
  7. 7. …and you have to go to the hospital
  8. 8. …this way is always long, very long
  9. 9. Do you know any more sad than un train broken-down in the rain?
  10. 10. The anaesthetist alone with the complicated surgical patient...
  11. 11. The anaesthetist alonewith the complicated surgical patient...
  12. 12. One man never made a team.
  13. 13. “Imagine a match where there were no passes, no gesticulation, or no verbal or non-verbal communication.” “Communication is the glue that holds the team together and is the source of motivation for all.”
  14. 14. Surgeon and anesthesiologist are the key players in the operating room, aiming for a common goal – safety and good outcome for patient.
  15. 15. Surgeon and anesthesiologist are the key players in the operating room, aiming for a common goal – safety and good outcome for patient. In this game, winning or losing may prove to be unacceptably expensive, translating into an increase in morbidity and mortality.
  16. 16. Surgeon and anesthesiologist are the key players in the operating room, aiming for a common goal – safety and good outcome for patient. In this game, winning or losing may prove to be unacceptably expensive, translating into an increase in morbidity and mortality. Quality communication is the key for everyone to remain focused on the goal.
  17. 17. J Anaesthesiol Clin Pharmacol 2013;29:374-378.
  18. 18. 43% adverse events as a result of communication failure.
  19. 19. “Detailed and well-structured handover from operating theatre to ICU is a cornerstone for uncomplicated postoperative care.”
  20. 20. Summary: ! always communicate the following ! - exact description of surgical procedure (resection, drains, etc...) - bowel distention, possible impaired perfusion - contamination of peritoneal cavity - location of anastomosis, stoma, quality of anastomosis - risk of bleeding - type of closure (mesh, fascial, open abdomen) - when to start oral diet / enteral feeding
  21. 21. Summary: ! always clarify the following ! - risk for NG tube - special risks related to the surgery (oral feeding) - analgesia and sedation (opioid free tecniques) - plan for nutrition - damage control surgery plan - special wound treatment (when? how? who?) - special monitoring (IAP measurement)
  22. 22. Summary:
  23. 23. Summary:
  24. 24. Take home message...
  25. 25. Take home message...
  26. 26. Thank you very much! Take home message...

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