Introductory note
Mission. Establishing an effective system within the Institute, integrated into the European and national clinical and research space, which through research development and application of contemporary and approved diagnostic and treatment protocols contributes to the quality of health care services and drafting European guidelines in the field of cardiovascular medicine and anesthesia.
Vision. The vision of the Clinic is based on a high level system which supports excellence and relevance for the development of cardiovascular medicine. Introducing new surgical and interventional procedures in cardiovascular medicine is supported by sophisticated and safe anesthesia methods. Evidence-based medicine requires a high level of knowledge, as well as turning such knowledge into new clinical procedures, services and therapeutic approaches
HISTORY
The Clinic for Anesthesia and Intensive Care began operating in 1978 within the Center for Cardiovascular Surgery of the CHC “dr Dragiša Mišović” as the Department of Anesthesiology and Resuscitation under the management of the director of the clinic prof. dr Lalević. Upon the establishment of the Clinic for Cardiovascular Surgery “Dedinje”, in 1989 (founded by the City of Belgrade), the Department of Anesthesiology and Resuscitation had 6 medical doctors – specialists in anesthesiology with the head of the department Prim. Dr. Ilija Trifunović and 10 nurses and anesthetic medical technicians distributed in 4 operating theaters and about 34 nurses and intensive care medical technicians covering 16 beds. A heart and liver transplantation program was introduced in 1995. The team of anesthesiologists, nurses and technicians at that point made a significant step forward in the field of contemporary transplant medicine, with successful heart and liver transplants. The Transplant Team and Medical Advisory Board were led by prof. dr Božina Radević and doc. Dr. Boško Radomir. A total of 17 liver transplantations and 7 heart transplantations were performed.
ABOUT THE CLINIC – SCOPE OF WORK
The work of the clinic is organized under very complex organizational conditions in 7 operating theatres; 3 rooms for interventional cardiology and electrophysiology, as well as in the Intensive Care Unit with 37 patient beds. The Clinic for Anesthesia and Intensive Care provides anesthesia 8-10 times every day for cardiac surgery procedures and 6-8 times for vascular surgeries, whereas the Intensive Care Unit, receives and cares for 14-18 patients on a daily basis, and treats patients in critical conditions. The scope of work of the medical doctors at the Clinic for Anesthesia and Intensive Care includes about 4500-5000 operations and invasive interventions annually, in seven operating theatres, rooms for interventional cardiology and electrophysiology, with 37 patients at the Department of Intensive Care, constantly striving to keep pace with the latest achievements in the field of modern anesthesiology and intensive care.
ORGANIZATIONAL STRUCTURE
The Clinic for Anesthesia and Intensive Care has the following organizational units:
LIST OF PROCEDURES
- Preoperative assessment and preparation of patients and giving anesthesia for cardiac surgery procedures (reconstructive surgery of the thoracic aorta, heart valves, surgical revascularization of the myocardium and complex concomitant procedures), for vascular surgery (reconstruction of the supraaortic arteries, thoracic and abdominal arteries, and peripheral arteries) in regional, general or combined anesthesia, cardiac insufficiency (left ventricular reconstructive surgery, implantation of various types of mechanically assisted circulation, intra-aortic balloon pump, EKMO).
- Perioperative treatment and treatment during anesthesia with invasive hemodynamic and metabolic monitoring and medication support of circulation.
- Effective outpatient unit preparation of patients for surgical treatment and anesthesia with the aim of achieving the shortest possible preoperative treatment with well-organized outpatient unit operation as well as the operation of anesthesiology outpatient unit.
- Implementation of the Early Recovery After Cardio (Vascular) Surgery program – ERAC(V)S – protocol. Early and rapid recovery after surgery protocols (ERAS) are expanding into multidisciplinary and multimodal forms of patient treatment that are applied in almost all areas of surgery, and include:
- optimal preoperative medication therapy and anemia correction,
- preoperative physical and respiratory preparation and therapy
- preoperative hydration and nutrition
- multimodal approach to perioperative pain therapy, preoperative, intraoperative and postoperative,
- targeted fluid therapy and individual optimization of hemodynamics
- еarly patient mobilization protocol
- early food intake after surgery
- Treating acute and chronic renal failure using intermittent dialysis and continuous veno- venous dialysis (hemodiafiltration).
- Mechanical ventilation of patients in critical condition. Application of non-invasive mechanical ventilation (NIV) and various forms of oxygen therapy during the perioperative period
- Perioperative hemodynamic optimization of patients using contemporary monitoring methods (Swan Ganz catheter, transpulmonary and thermodilution method of measuring cardiac output, LIDCO technology, Flo track, EV 1000, continuous monitoring of cardiac output and venous blood saturation, transthoracic and transesophageal echocardiography…)
- Anesthesia and postoperative treatment with mechanical cardiovascular support, application of intraaortic balloon pump (IABP), mechanical support of the left and right ventricles (LVAD, RVAD), total artificial heart (TAH)
- Anesthesia for emergency and elective cardiac surgery procedures with and without extracorporeal blood flow
- Anesthesia for vascular surgery procedures, internal carotid artery surgery (general anesthesia combined with infiltrative local anesthesia), abdominal aortic surgery (general anesthesia or combined general / epidural anesthesia), anesthesia for lower extremity surgery (general, epidural, spinal anesthesia, or primary peripheral nerve block)
- Anesthesia for videothoracoscopic procedures of cardio-thoracic surgery using unilateral lung ventilation and transesophageal echocardiography
Anesthesia for interventional cardiac procedures (EVAR, TEVAR, TAVI), primarily in patients with low functional and cardiac reserve and numerous concomitant diseases. Application of various methods of hemodynamic and cerebral monitoring with cerebrospinal fluid pressure measurement and cerebrospinal fluid drainage.
Anesthesia for interventional electrophysiological procedures, with emphasis on procedures in patients with low functional and cardiac reserve and numerous concomitant diseases who need careful hemodynamic monitoring and/or mechanical circulatory support and perioperative transesophageal echocardiography
Anesthesia for thoracic and thoracoabdominal aortic surgery with unilateral lung ventilation, hypothermia and hypothermic circulatory arrest, transesophageal echocardiography, cerebrospinal fluid pressure measurement and adequate drainage thereof, neuro-cerebral monitoring (somatosensory and motor evoked potentials), brain perfusion and oxygenation, selective organ perfusion with a clear strategy and protocols for clinical transfusion and protection of the brain and other organs - Perioperative clinical transfusion
- Postoperative pain therapy following protocols in cardiac surgery and vascular patients, with pain measurement and regular therapy.
MOST SIGNIFICANT RESULTS
- Adopted new technologies, perioperative treatment of patients with mechanical circulatory support, LVAD, TAH program, IVAC, IABP, ECMO, CMIC, AFR – atrial flow regulator)
- 4500-5000 cases of anesthesia administered with perioperative treatment of patients at the Department of Intensive Care and consultative examinations in other departments of the Institute by 17 specialists in anesthesiology, five specialists in internal medicine – intensivists, two residents in anesthesiology and two residents in internal medicine, 95 nurses and technicians at the Department of Intensive Care and 18 anesthesiology technicians and nurses.
- Participation in multicenter studies (Muriad, Pain out, Prompt, ETPOS, POPULAR, MetRepair)
EMPLOYEES
CONTACT DETAILS
- 011 360 1717 – anesthesia unit (operating block)
- 011 360 1648 – medical doctor room – department of intensive care
- 011 360 1715 – Division for Vascular Intensive Care
- 011 360 1717 – Division for Cardiac Surgery Intensive Care II
- 011 360 1719 – Division for Cardiac Surgery Intensive Care III
- 011 360 1764 – Division for Prolonged Intensive Care and Isolation
