programma - Nederlandse Vereniging voor Anesthesiologie

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GASTSPREKER Basic and Clinical Science in Neuromuscular Block Lars I Eriksson, MD, PhD, FRCA Professor and Academic Chair Dept of Anesthesiology and Intensive Care Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm Sweden Neuromuscular blocking agents (NMBAs) are widely used in anesthetic practice and occasionally in patients within intensive care. The molecular target for this class of agents are the nicotinic acetylcholine receptor (nAChR), widely spread with the central and peripheral nervous systems. This family of nicotinic cholinergic receptors consists of several subtype receptors, each having a typical structural conformation and subsequent function within neuromuscular transmission (muscle type nAChR) or neuronal control (neuronal subtype nAChRs). The nAChR is a membrane-bound and ligand-gated ion channel that operate over a wide range of synapses involved in critical control of vital functions. Non-depolarizing NMBAs interact with all subtype nAChRs, hereby producing a classical neuromuscular block with subsequent muscle paralysis and in addition an array of interactions with regulatory control of vital functions with significant clinical relevance. The interaction with muscle type nAChRs and neuronal subtypes nAChRs by non-depolarizing NMBAs (but not depolarizing NMBA) give rise to impaired neuromuscular transmission and typical changes in neurochemical transmission of action potentials over the synaptic cleft. This lead to typical electrical (EMG) and mechanical response patterns underlying the routine neuromuscular monitoring devices clinicians apply in daily clinical practice. The relationship between NMBA dose and neuromuscular blocking effect (sensitivity) varies considerably between different muscle groups, with muscles involved in pharyngeal control and airway integrity being the most sensitive among the vital muscle groups. In addition, the affinity of NMBAs to neuronal nAChRs lead to distinct changes in neurotransmission within the wakefulness and regulation of breathing, and in particular oxygen sensing and signaling systems involved in regulation of breathing during hypoxia. Residual effects of NMBAs therefore target vital control of ventilation in such as way that patient with residual neuromuscular block after extubation may encounter airway obstruction, aspiration and impaired ventilatory response to acute hypoxia. This lecture will provide basic molecular and cellular understanding of neuromuscular transmission and other relevant areas of neurotransmission, and furthermore the mechanisms by which neuromuscular blocking agents target regulatory control of vital functions of clinical relevance for anesthesia and intensive care.
GASTSPREKER Wetenschappelijke ontsporingen in de anesthesiologie Frank van Kolfschooten, wetenschapsjournalist Frank van Kolfschooten (Den Haag, 1959) is free lance wetenschapsjournalist. Hij studeerde filosofie aan de Faculteit der Wijsbegeerte van de Universiteit van Amsterdam. Van 1989 tot 1998 was hij hoofdredacteur van het weekblad van de Vrije Universiteit. Sinds 1986 is hij wetenschapsjournalist, en schrijft met name over (medische) wetenschap, sport en geschiedenis. Hij publiceerde onder andere in NRC Handelsblad, de Volkskrant, Vrij Nederland, Hard Gras, AMC Magazine, The Lancet, Nature en New Scientist. In 1993 verscheen van zijn hand het boek Valse vooruitgang. Bedrog in de Nederlandse wetenschap. Dit boek, dat destijds opschudding veroorzaakte binnen de UMC’s en universiteiten, krijgt nog dit jaar een vervolg. Van Kolfschooten deed nieuw onderzoek onder duizenden wetenschappers dat in oktober 2012 wordt gepubliceerd in Ontspoorde wetenschap. Over fraude, plagiaat en academische mores. Het boek bevat ook enkele casussen uit de wereld van de anesthesiologie. Op de wetenschapsdag zal Van Kolfschooten deze Nederlandse zaken bespreken in combinatie met enkele geruchtmakende buitenlandse zaken en ze in een breder perspectief plaatsen. Metabolic modulation of myocardial function (YIG 2010) R. Arthur Bouwman, VU University Medical Center, Amsterdam Arthur Bouwman completed medical school at the University of Groningen and his anesthesiology residency at the VU University Medical Center in Amsterdam. During residency he was supported by a ZonMW clinical research fellowship, and received his Ph.D. degree (cum laude) in 2006. After residency he joined the staff of the Anesthesiology department in the VU university medical center, where he focused on cardiac anesthesia. During his Ph.D. he studied the effects of volatile anesthetics on the heart with special focus on mechanisms of anesthetic-induced cardioprotection. After his Ph.D. he continued his research interest for anesthesia-related effects on myocardial function and perfusion. He was intrigued by the observation that diet composition affects myocardial function such that its sensitivity to peri-anesthetic ischemia and reperfusion injury and cardioprotective signaling is altered. As it suggest that lifestyle, in particular dietary intake, interferes with anesthesiarelated effects on the heart, this led to the hypothesis that lifestyle modification could be employed to improve myocardial function in the perioperative period. Using translational approaches, his research focus is now directed towards interventions that improve perioperative cardiovascular function in patients at risk for cardiovascular stress responses because of comorbidid conditions.
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Page 9: PARALLEL PRESENTATIONS GROEP 2 GROE

programma - Nederlandse Vereniging voor Anesthesiologie

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