G. Berlot – författare

Quest'opera vuole offrire ai cultori dell'anestesia un testo essenziale per approfondire l'importante tematica dell'anestesia e malattie concomitanti, privilegiando la trattazione degli aspetti legati alle patologie d'organo e sistemiche di più frequente riscontro nella pratica clinica; l'attuale orientamento ha solide basi e mira a rafforzare la convergenza di vari specialisti in funzione del paziente. Lo scopo è di valutare attentamente il rischio chirurgico e anestesiologico, ottimizzare gli standard di sicurezza e l'approccio clinico interdisciplinare.

Trauma has assumed a prominent role in contemporary medicine as an event that can significantly influence clinical variables such as morbidity, functional deficits and consequential disability, and mortality. Trauma is the principal cause of death in the population below 40 years of age in industrialized countries. Therefore, there is great interest in studying traumatic events from both the clinical and epidemiological viewpoints. The importance of trauma is exemplified by the fact that in many countries, the trauma patient is first treated in specialized trauma centers in which the diagnostic and treatment processes are facilitated by the 24 hour presence of personnel having interdisciplinary competences.

Sepsis represents a life threatening condition to ICU patients. The evolution of sepsis to severe sepsis or septic shock may occur in an unpredictable way. In the coming millennium the prevention and management of sepsis and organ dysfunction will present a real challenge for researchers and clinicians.

An experienced physician knows how to recognize a patient suffering from sepsis, but cannot accurately determine whether the patient will survive. Cardinal elements of the treatment for sepsis include specific antibiotic and vasoactive drugs, enteral and parenteral nutrition, artificial respiration, and optimization of the oxygen transport to tissues. Nonetheless, with a certain frequency, these techniques are insufficient to ensure the recovery of a critically ill patient, especially when it is necessary to overcome functional alterations subsequent to organ and vital-system overload. The key elements in the progression of the sepsis-MODS syndrome are tied to numerous factors. These include: the severity and location of the lesion; the patient's age; the remaining functional reserve; and the presence of mediatory which may be stimulatory, inhibitory or both. This overview is aimed at anaesthesiologists and doctors.

Sepsis evolution and organ dysfunction are still an enigmatic topic. Severe infection causes an important aggression of the whole body, and the so-called inflammation mediators play an important role in this evolution. It is however certain that the immune system is a key factor in sepsis progression. The volume focuses on some primary aspects such as the research of the rationale of the immune system activation during sepsis, on the molecular strategies available for ARDS treatment and on techniques of emofiltration and absorption of endotoxins through apheresis in the septic patient.

This volume presents the most recent results of research in the study of sepsis and the new treatments that have become available, mortality rate however still being high. It focuses on the complexity of the several biohumoral factors involved in this process and the consequent organ failure, which grows in a sequential way and in relation with the lesion gravity and the functional reserves of the patient.

The mission of health operators and hospitals is nowadays patient satisfaction, which is to be achieved through the provision of high-quality medical care and the training of graduates and postgraduates with the highest level of proficiency, integrity and skill. This book offers a broad panorama of recent progress in the fields of perioperative medicine, critical care and end-of-life care, thus contributing to achieve these aims in the fields of anaesthesia and critical care.

Sepsis is a syndrome or sometimes it is a clinical condition evoked by uncontrolled endotoxin-reactions. These pathophysiological alterations can disturb the organism's homeostasis leading ultimately to a condition of severe organ dysfunction which in itself means a bad prognosis for patient survival. In the last decades researchers and clinicians have been involved in process directed to a better understanding of the basic mechanisms of sepsis and MODS. The best goal will be the achievement of preventive measures and optimization of management in patients suffering severe infections and critical conditions. This objective represents a true challenge at the dawn of the XXI century.

Continuing medical education and specialty training procedures represent highly dynamical processes, with a continuously evolving content. The specific teaching methods available (micro-teaching, team teaching, mastery learning, simulation, and e-learning) are essential elements of this process to promote professional updating and teaching at the bedside, aimed at providing an excellent clinical practice. The didactic laboratory is the core of this process: teachers, students and the School must be able to integrate in order to encourage this trend, and following this trend, the Trieste School of Medicine has long recognised the importance of supporting educational aspects and teaching programmes that promote our discipline.This volume is the result of the co-operation of the Trieste School of Medicine with experts at a national and international level who, in 2005, took part in seminars or micro-teaching sessions held at the Cattinara University Hospital.

by S. GUASCHINO Dean, Trieste University School of Medicine The society we live in is in continual development and has a number of priori­ ties for improving the standards of communication. The scientific sector in par­ ticular thrives on the exchange of information, which is the foundation of progress itself. The channels through which this interaction takes place are many and are aimed at optimising teaching methodology. Researchers and scholars, research centres and the places of higher learning themselves are increasingly aware of the growing importance of universities, which, thanks to their intrinsic ability to renew themselves, have taken on a vital central and propulsive role. Communication develops as a result of free exchange, debate of the materials available and the study of the various references and analysis sources. With the advent. of information systems, the teaching methodology has assumed a decisive role, both in terms of the quantity of data available and the quality of the information. Distance learning is a new and important opportu­ nity for the immediate future. The Anaesthesia and Critical Care School of Trieste has promoted this inter­ esting and highly relevant initiative by drawing together teaching material from the academic year 2003/2004. Numerous international lecturers have con­ tributed to this valuable achievement. In addition, a large part of the material is the fruit of a real consortium between the various Italian Schools of Anaesthesia.

Trauma has assumed a prominent role in contemporary medicine as an event that can significantly influence clinical variables such as morbidity, functional deficits and consequential disability, and mortality. Trauma is the principal cause of death in the population below 40 years of age in industrialized coun­ tries. Therefore, there is great interest in studying traumatic events from both the clinical and epidemiological viewpoints. The importance of trauma is exem­ plified by the fact that in many countries the trauma patient is first treated in specialized "trauma centers", in which the diagnostic and treatment processes are facilitated by the 24-hour presence of personnel having interdisciplinary competencies. Trauma in this context consists of any acute, often unexpected, condition. Many of the medical difficulties associated with trauma occur in a relatively brief period that spans from the first call for help to the initiation of first aid measures. A correct approach depends on the availability of experienced personnel. The first measures of aid must guarantee, above all, the patient''s survival. The most critical, initial phases of care to trauma patients are represented by the triad: first aid, triage, and transport. Specific morbidity indices, whether anatomical, func­ tional or mixed, are indispensable elements for monitoring a patient''s clinical evolution. The immediate availability of "essential" drugs is imperative to con­ front the clinical situations that often present in the acute post-traumatic phase.

Even if in the last years more information on sepsis and new treatments has become available, mortality rate is however high. In fact, the complexity of the several biohumoral factors involved in this process is difficult to understand. Another major problem is the consequent organ failure, which grows in a sequential way and in relation with the lesion gravity and the functional reserves of the patient. The volume presents the most recent results of research in this field.

Sepsis evolution and organ dysfunction are still an enigmatic topic. Severe infection causes an important aggression of the whole body, and the so-called inflammation mediators play an important role in this evolution. It is however certain that the immune system is a key factor in sepsis progression. The volume focuses on some primary aspects such as the research of the rationale of the immune system activation during sepsis, on the molecular strategies available for ARDS treatment and on techniques of emofiltration and absorption of endotoxins through apheresis in the septic patient.

Sepsis represents a life threatening condition to ICU patients. The evolution of sepsis to severe sepsis or septic shock may occur in an unpredictable way. In the coming millennium the prevention and management of sepsis and organ dysfunction will present a real challenge for researchers and clinicians.

Sepsis is a syndrome or sometimes it is a clinical condition evoked by uncontrolled endotoxin-reactions. These pathophysiological alterations can disturb the organism''s homeostasis leading ultimately to a condition of severe organ dysfunction which in itself means a bad prognosis for patient survival. In the last decades researchers and clinicians have been involved in process directed to a better understanding of the basic mechanisms of sepsis and MODS. The best goal will be the achievement of preventive measures and optimization of management in patients suffering severe infections and critical conditions. This objective represents a true challenge at the dawn of the XXI century.