1. Rochester, Minnesota
October 2009.
Helga Komen Ušljebrka , MD
anesthesiologist

2. Mayo Clinic
Rochester,
Minnesota
1889.
Scottsdale,
Arizona
1987. Jacksonville,
Florida
1986.

3. 1883. Tornado in Rochester, MN

4. St. Marys Hospital, 1889.

5. St. Marys Hospital, 1930s.

6. William and Charlie Mayo
Dr. Will Mayo: ‘The best interest of the patient
is the only interest to be considered’

7. Operating room, 1890s

8. First X-ray image on Mayo Clinic, 1897.

9. - 1901. First Clinic Business Manager
- 1905. L. Wilson, quick-frozen tissue
stained with methylene-blue
- 1914. Isolated thyroxin
- 1915. One of the world’s first formal
graduate training programs, many visiting
physicians
- 1920. System for grading cancer (AC
Broders)
- 1920. Basal metabolic rate (WM Boothby)
- 1934. Isolated cortisone (E. Kendall)
- 1934. First use of thiopental (JS Lundy)
- 1944. First application of streptomycin

10. Aero Medical Unit, 1942. (CA Lindbergh)
...developing prototype oxygen mask for pilots

11. Aero Medical Unit - centrifuge

12. - 1950. Nobel prize (Kendall and Hench)
- 1954. Methodist Hospital
- 1955. First open heart surgery (JW
Kirklin)
- 1969. Total hip replacement
- 1973. First CT scanner in North America
- 1975. Computerized system with bar
codes
- 1992. Mayo Health System – a regional
network of clinics and hospitals
- 2000. Mayo Clinic Transplant Center
- 2002. Comprehensive Cancer Center
- 2005. Electronical Medical Record

14. St. Marys Hospital

15. St. Marys Hospital

16. St. Marys Hospital

17. Plummer building, 1928.

18. Lobby of Plummer building

19. Library of Plummer building

20. Methodist Hospital, 1954.

21. Gonda building, 2001.

22. Lobby of Gonda building

23. Government
- Private group practice
- 33-member ‘Board of Trustees’-
public members, Mayo physicians and
administrators
-President and CEO of Mayo Clinic
John Noseworthy, MD, Professor of
Neurology, Interests - multiple sclerosis,
Editor-in-chief of ‘Neurology’

24. 2008. Personnel (MN)
- 2.000 staff physicans and scientists
- 2.800 residents, fellows and students
- 28.000 health staff
- 32.800 TOTAL
Florida 4.869 total staff
Arizona 5.079 total staff

25. Mayo Clinic Hospitals
Saint Marys Rochester
Hospital Methodist
Hospital
Licensed beds 1,265 794
available
Admissions/ye 43,002 18,662
ar
Operating 55 41
rooms
Surgical 28,071 24,421
cases/year
.......5 MILLION M2 .........

26. A typical day at Mayo Clinic:
Outpatient visits 5,746
Admissions to hospital 241
Surgical procedures 205
Lab tests 41.000
Radiology procedures 3.779
CT scans 647
Chest X-rays 702
MRIs 244
Units of blood components used 213

27. 2008. Financial information
Revenue $7,222 millions
Total Assets $8,333 millions
Education and Research Funding Sources $763 m.
(Government $372 m., Benefactors $391 m.)

28. ....Second best U.S. Hospital for 2009. (U.S.
News&World Report, July 17, 2009.)
No.1 hospital in: Digestive disorders
Diabetes and endocrine disorders
Neurology and Neurosurgery
Orthopaedics

29. Mayo Clinic Model of Care
Clinical Research
practice
Education

30. Education
Everyday lectures
- Clinical Case Conferences
- Core Curriculum Lectures
- Introductory Lecture Series
- Journal Clubs
- Key Word Phrase Mini-lectures
- Morbidity and Mortality Conferences
- Oral Board Reviews
- Formal practice oral examinations
- Subspecialty Mini-lectures
- Written Board Reviews
- Multidisciplinary Simulation Center
OBLIGATE! – BLS, ALS

31. Education
Evaluation
.........Monthly evaluation of trainees by supervising faculty memebers
........Quarterly each trainee meets with their faculty advisor to review
progress and goals
........Twice a year chair of Clinical Competence Committee gives
written clinical competence evaluation of trainee
.........Trainees monthly evaluate faculty and rotations
....American Board of Anesthesiology (ABA) In-Training Examination
yearly. ....nine members of Mayo’s current anesthesiology faculty
CERTIFICATION – Written and oral exam by ABA

32. Clinical practice
Patient orientated
Dr. Will Mayo: ‘The best interest of the
patient is the only interest to be considered’

33. Clinical practice
Patient orientated
- Collegial staff teamwork .....’no one is big
enough to be independent of others’
- An unhurried examination
- Physicans personal responsibility for
patient care
- Comprehensive evaluation
- Availability of advanced diagnostic and
therapeutic technology

34. Research
- Clinical Research Units – inpatients,
outpatients, mobile facility (research vehicle)
- cca 400 projects/year
- 2800 publications a year in biomedical
journals
- Research training – clinical and laboratory
....Optional - Clinician-Investigator Program

35. Research
Some of projects...
- Genetic markers for intracranial aneurysms among family members
-The influence of tobacco on the extent and likelihood of proximal
progression of ulcerative colitis
-Supplemental method of controlling pain in pancreatic cancer patients
-Left ventricular-based cardiac stimulation post
AV node ablation evaluation (PAVE)
-Effectiveness of sildenafil to placebo in patients
with diastolic heart failure
-Comparison of Tacrolimus and Sirolmius
immunosuppression in kidney transplant patients
-Memory support system for patients with amnestic
mild cognitive impairment
..........
Impact factor 4,81

36. Similarities and differencies
Drugs
- phenylephrine vs. efedrine
- glycopirolate vs. atropin
- sucynilcoline vs. rocuronium
- Isoflurane® vs. Sevoflurane® STUDIJA
.....propofol, fentanyl
...Drug delivery in induction by Consultant
- bupivacaine vs. levobupivacaine

37. Similarities and differencies
Ventilation in OR
- anesthesia machine
BLEASE®
- protective lung ventilation:
6 ml/kg x f of breathing,
etCO2 4.7-6.0 kPa, PEEP 5 kPa,
recruitment every 1.5 hour

38. Similarities and differencies
Regional anesthesia
- 2 month rotation – recovery days, OR days
- US (Sonosite® Micromax) guided blocks
- Neurostimulator guided continous blocks
- aseptic conditions
- premedication with midazolam, monitoring (SpO2,
BP cuff, ECG, temperature probe)

39. Similarities and differencies
Regional anesthesia
Examples:
1. Knee replacement – sciatic block (30 ml 0,25%
bupivacaine) + femoral cont. block (test 5 ml xylo.,
bolus 20 ml 0,25% bupivacaine).......+ SAB
2. Hip replacement – psoas cont. Block (test 5 ml
xylo, bolus 25 ml 0,25% bupivacaine) + femoral cont.
block (test 5 ml xylo., bolus 20 ml 0,25%
bupivacaine).......+ SAB

40. Mayo Clinic Model of Care
....Obama’s Model of Care Sept. 2009.,
ABC News
‘.....best quality and the lowest
cost........because of the minimized patient
tests, fixed doctors salaries, electronic
records and team work....’

41. Referring patient to Mayo Clinic
.......Anyone can request an appointment at
Mayo Clinic
Mayo Clinic’s Referring Physician Offices (24
hours a day) – tel: 800-533-1564
.....Online services
www.mayoclinic.org/medicalprofs

42. Collaboration with:
J. Sprung, MD, Ph.D., prof. anesthesiology
O. Gajić, MD, Ph.D., anesthesiologist (head medical ICU)
R. Flick, MD, pediatrician, anesthesiologist (head PICU)
H. Smith, MD, anesthesiologist, regional ansthesia
B. Hoelzer, anesthesiologist , invasive pain procedures
M. Huntoon, MD, anesthesiologist, cancer pain
T. Harrison, MD, anesthesiologist (pediatric), pain clinic
J. Munis, MD, neuroanesthesiologist
E. Wijdicks, MD, Ph.D., neurologist (head ICU)
W. Nicholson, MD, clinical pharmacologist
R. White, MD, anesthesiologist, reanimatology

43. Art&Healing.....since 1955.
Ivan Meštrović,
‘Man and Freedom’
Lobby of Gonda building

44. Art&Healing.....since 1955.
Dale Chihuly’s
Chandeliers,
Lobby of Gonda
building

45. Art&Healing.....since 1955.
Auguste Rodin,
‘Jaine d’Aire’
Siebens building

46. Art&Healing.....since 1955.
Andy Warhol,
‘Flowers’

47. Art&Healing.....since 1955.
Joan Miro

48. H Komen U, RD Miller, J Sprung
Plummer house
Miller RD, Hyatt RE. Evaluation of obstructing lesions of
the trachea and larynx by flow-volume loops.
Am Rev Respir Dis. 1973 Sep;108(3):475–481.

49. HVALA !