NEWSnewsletter.esahq.org/wp-content/uploads/ESA_NEWSLETTER_WINTER_2013.pdfrespiratory failure,...
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VOLUME 52 // WINTER 2013 // EDITOR GABRIEL M. GURMAN EUROPEAN SOCIETY OF ANAESTHESIOLOGY To be or not to be …an intensivist // 08-11 20-21 14-15 24-25 EDAIC ETPOS Europe and the WFSA Some people, rather than face an inevitable reality, would rather try to change a trend that seems to be irreversible. When I started my residency in anaesthesiology, some 50 years ago, nobody spoke about intensive care. All we knew was that an anaesthesiologist, as part of the therapeutic team, was supposed to take care of his or her orher patient in the immediate postoperative period, but with much more commitment than their surgeon partner, since the anaesthesiologist had a greater and deeper understanding of physiology, pathophysiology, and pharmacology. The period after the polio epidemics in the Scandinavian countries witnessed a dramatic change in our profession. Little by little, every country developed a network of special units for management of acute respiratory failure (those wards have been called "respiratory units"!), characterised by accumulation of knowledge, equipment, and dedication, all for the sake of the critically ill patient. The task of taking care of the patients admitted to those units fell on the shoulders of the anaesthesiologist and nobody put this new reality under a question mark. This anaesthesiologist took care of patients in respiratory distress in the operating room, so it was only natural to see this professional also taking care of the patient with respiratory failure from any etiology. Reanimation, intensive care, or critical care became the usual and natural addition offered to the names of an anaesthesia department. Gradually, the anaesthesiologist was recognised as being what is called today a perioperative physician: a doctor who takes care of the patient before, during, and after a surgical procedure. The anaesthesiologist became responsible not only for preparing the patient for surgery and delivering anaesthesia, but also for the postoperative cardio-respiratory homeostasis, fluid balance, pain management, anticoagulant regimens, and even antibiotic administration in some cases. In my own case, all my professional life I was considered by my peers (and as such I considered myself) as an anaesthesiologist whose main domain of interest was critical care. During my last years in clinical practice I ran a 12-bed intensive care unit in a very big university hospital in the south of Israel. Things have changed since then. In the last few decades there has been a general trend to separate anaesthesiology from intensive care. Many professionals recognised the fact that intensive care is a multidisciplinary field of medicine, that the critically ill patient needed more than the routine knowledge and skills of only one specialty, and that there is a place for improving the patient's management by involving experts from other fields. This change in mentality brought a dramatic switch in the attitude of the healthcare management and administration. In some countries (not many), intensive care is a primary specialty, in others it became a sub-specialty open to any specialist, not only in anaesthesiology but also in internal medicine, pneumology, surgery, paediatrics and other disciplines. Some intensive care national societies today include just a small minority of anaesthesiologists as active members. Finally, in various countries the majority of the intensive care units are led and manned by non-anaesthesiologists. A significant number of anaesthesiologists all over the continent have left the operating room forever, and decided to dedicate their professional activity to the domain of critical care. This change is more evident outside our continent, but the trend did not leave Europe aside. Today some European countries have their own societies of intensive care and the European Society of Intensive Care Medicine is open to "any physician, nurse, allied healthcare professional, or trainee, residing in Europe who is interested in intensive care medicine". 01 NEWS 52
Transcript of NEWSnewsletter.esahq.org/wp-content/uploads/ESA_NEWSLETTER_WINTER_2013.pdfrespiratory failure,...
VOLUME 52 / / WINTER 2013 / / EDITOR GABRIEL M. GURMAN
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To be or not to be …an intensivist //
08-1120-21
14-15 24-25
EDAIC ETPOS Europe and the WFSA
Some people, rather than face an inevitable reality, would rather try to change a trend that seems to be irreversible.
When I started my residency in anaesthesiology, some 50 years ago, nobody spoke about intensive care. All we knew was that an anaesthesiologist, as part of the therapeutic team, was supposed to take care of his or her orher patient in the immediate postoperative period, but with much more commitment than their surgeon partner, since the anaesthesiologist had a greater and deeper understanding of physiology, pathophysiology, and pharmacology.
The period after the polio epidemics in the Scandinavian countries witnessed a dramatic change in our profession. Little by little, every country developed a network of special units for management of acute respiratory failure (those wards have been called "respiratory units"!), characterised by accumulation of knowledge, equipment, and dedication, all for the sake of the critically ill patient. The task of taking care of the patients admitted to those units fell on the shoulders of the anaesthesiologist and nobody put this new reality under a question mark. This anaesthesiologist took care of patients in respiratory distress in the operating room, so it was only natural to see this professional also taking care of the patient with respiratory failure from any etiology.Reanimation, intensive care, or critical care became the usual and natural addition offered to the names of an anaesthesia department. Gradually, the anaesthesiologist was recognised as being what is called today a perioperative physician: a doctor who takes care of the patient before, during, and after a surgical procedure. The anaesthesiologist became responsible not only for preparing the patient for surgery and delivering anaesthesia, but also for the postoperative cardio-respiratory homeostasis, fluid balance, pain management, anticoagulant regimens, and even antibiotic administration in some cases.
In my own case, all my professional life I was considered by my peers (and as such I considered myself) as an anaesthesiologist whose main domain of interest was critical care. During my last years in clinical practice I ran a 12-bed intensive care unit in a very big university hospital in the south of Israel.
Things have changed since then. In the last few decades there has been a general trend to separate anaesthesiology from intensive care. Many professionals recognised the fact that intensive care is a multidisciplinary field of medicine, that the critically ill patient needed more than the routine knowledge and skills of only one specialty, and that there is a place for improving the patient's management by involving experts from other fields. This change in mentality brought a dramatic switch in the attitude of the healthcare management and administration. In some countries (not many), intensive care is a primary specialty, in others it became a sub-specialty open to any specialist, not only in anaesthesiology but also in internal medicine, pneumology, surgery, paediatrics and other disciplines. Some intensive care national societies today include just a small minority of anaesthesiologists as active members. Finally, in various countries the majority of the intensive care units are led and manned by non-anaesthesiologists.A significant number of anaesthesiologists all over the continent have left the operating room forever, and decided to dedicate their professional activity to the domain of critical care.
This change is more evident outside our continent, but the trend did not leave Europe aside. Today some European countries have their own societies of intensive care and the European Society of Intensive Care Medicine is open to "any physician, nurse, allied healthcare professional, or trainee, residing in Europe who is interested in intensive care medicine".
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02Gabriel M. Gurman // ESA Newsletter Editor
So, the question that must arise from this very short description is cui prodest: who would benefit from this new reality? No doubt there would be some strong opinions in favor of this significant change regarding the profile and domains of interest of our profession. The argument in favor of this new (or already old!) situation would be that the main benefit is directed to the critically ill patient. Rather than being treated by a physician whose time is divided between the operating room, pre-anaesthetic out-patient clinic, or pain management clinic, that patient is taken care of by a dedicated intensive care specialist, possessing the necessary knowledge and experience for assuring the best result from the treatment.
On the other side, nobody could ignore the fact that anaesthesiology, as a medical profession, once separated from the field of critical care, becomes less attractive for a young physician when she/he is supposed to select a future career. The pragmatic translation of this situation is that the average anaesthesiologist would leave the complicated surgical patient immediately after the first post-operative hours, in the hands of another colleague—the dedicated intensivist. This anaesthesiologist, whose daily activity does not include management of the critically ill, will be denied access to seriously ill patients, surgical or nonsurgical, in need of intensive care: those having acute respiratory failure, asthmatic crisis, acute renal failure, hepatic coma, intoxications and other health emergencies.
I do not intend to extend the discussion beyond this point, or to take sides with one or another of the above opinions.The situation nowadays is not uniform: there are, still, many parts of our continent in which the field of critical care belongs to anaesthesiology. I have no doubt that even in those countries, hospitals, and anaesthesia departments there is vivid discussion about this dilemma. I can imagine that our readers are divided in their opinions regarding this important aspect of our profession, with a clear practical and philosophical impact on our daily activity.My own aim is to offer our readers a framework for discussing the subject, for bringing different opinions and data, to debate the different solutions, for the benefit of our patients, but not putting aside the interest of our profession and anaesthesia manpower in Europe.
Our newsletter is open for discussion. We will be glad to host letters and short articles on the subject.
Gabriel M. Gurman, MDEditor // [email protected]
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Physicians tend to emphasise their successes and, perhaps subconsciously, minimise their failures.
(RR Kirby, Crit Care Med 1977;5:167)
PRAGUE
Nominations - ESA // BoardWe are very happy to announce that Professor Walid Habre and Professor Andreas Sandner-Kiesling have been elected as Board members during the Council meeting that took place on Saturday 8 December in Brussels, Belgium. They have already started their term of office on 1 January 2013.
We would also like to take this opportunity to warmly thank Professor Robert Sneyd and Professor Paolo Pelosi for their services in the ESA Board. //
Prof. Andreas Sandner-Kiesling
Prof. Walid Habre
ESA Autumn meeting 3 in Prague // Czech RepublicFor the third year running, the ESA organised its Autumn Meeting - a satellite event to the summer Euroanaesthesia congress, with an aim to extending educational activities to European countries, which for practical reasons cannot accommodate events of the size of Euroanaesthesia, as well as to improve access for attendees from Central and Eastern Europe. The third ESA Autumn Meeting was held in Prague, Czech Republic on 8 and 9 November 2012. It was held at the Clarion Congress Hotel, which provided excellent congress facilities and services. ESA President Eberhard Kochs, and Karel Cvachovec, President of the Czech Society of Anaesthesiology and Intensive Care Medicine (ČSARIM), welcomed the 300 attendees and launched the two-day programme, which included 18 presentations, grouped into
6 thematic sessions. The topics covered guidelines on the management of severe perioperative bleeding, paediatric anaesthesia and intensive care, obstetric anaesthesia, intensive care medicine, resuscitation and emergency medicine and hot topics in anaesthesia. Parallel sessions were also organised, with two hands-on workshops on the use of ultrasound in regional anaesthesia and four problem-based learning disscussions on various topics (preoperative risk assessment and optimisation for the ambulatory surgical patient, regional or general anaesthesia for ambulatory surgery of the upper extremity, cognitive decline after anaesthesia, management of subarachnoid hemorrhage). An exhibition hall hosted the representatives of 9 exhibitors, including 4 ESA partners. ESA members and Autumn Meeting attendees can
download most of the presentations under the Congress section in the subsection Autumn meeting 2012 (www.euroanaesthesia.org). The atmosphere during the meeting was excellent, with productive interactions between lecturers and the audience and active exchanges between attendees throughout. The overall feedback on the event was also very good. The relevance of the topic areas and the quality of speakers and presentations were viewed positively by participants. The attendance at the workshops and problem-based learning dissussions confirmed the interest for these session formats, and the comments on organisation, venue, facilities and catering were excellent. Based on this success, the ESA will organise a fourth Autumn meeting in Timisoara, Romania, 8-9 November 2013. //
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CME Update on the Use of Ultrasound in Perioperative Care // Pre-Congress Course Organised by the Society for Ultrasound in Anaesthesia (SUA)Saturday, 1 June 2013, 8:00-12:00*
The Society for Ultrasound in Anaesthesia (SUA) is organising a CME Update on the use of ultrasound in perioperative care.This update will cover important topics related to the use of ultrasound in perioperative care. The faculty of international repute will deliver lectures related to the use of ultrasound for vascular access, accident and emergency, and pain management. The programme has been designed to be comprehensive, and it also includes a scintillating pro-con debate on the practice of ‘intraneural’ injections.
The faculty are very friendly and participants are encouraged to ask questions and even share their own views or expertise with them.
Detailed programme of the course can be found on www.euroanaesthesia.org
UPDATE
The majority of workshops, symposia and refresher courses are planned more than one year before the publication of the preliminary programme of the congress. However, the scientific programme is being updated until the very last moment, in order to offer the Euroanaesthesia participants as many interesting sessions as possible. This time, we would like to present to you the sessions that will be organised during the congress by the ESA Specialist Society Members. For the complete, up to date programme please visit the ESA on-line version of the programme on http://www.sessionplan.com/esa2013/ where you can create your own itinerary well before the congress starts.
Euroanaesthesia 2013 //Scientific Programme Updates
Spinal Sonography Symposium - Lecture and demonstrations // Pre-Congress Course Organised by the Society for Ultrasound in Anaesthesia (SUA)Friday, 31 May 2013, 9:00-18:00*
Ultrasound is increasingly being used in the perioperative period as an effective tool to enhance patient care. Over the recent years, ultrasound has proven to be helpful in delineating the anatomy to anaesthetists, and has proven to be an invaluable tool in improving the standards of patient care. The Society for Ultrasound in Anaesthesia (SUA) is organising a pre-congress course on spinal sonography.
The pre-congress course on spinal sono-anatomy is aimed at anaesthetists and pain physicians who want to access the advantages offered by the ultrasound to make a positive difference to their patients. Enlightening master classes, demonstrations and panel discussions are planned. The speakers are planning to demonstrate on live models (volunteers) the techniques that will eventually help you identify the sono-anatomy, and improve the success rate of your blocks, be they for acute or chronic pain management.
Detailed programme of the course can be found on www.euroanaesthesia.org
* Please note that the session schedule still might be subject to changes. Consult the on-line programme on http://www.sessionplan.com/esa2013/ or the Final Programme on-site for the final timing of the session.
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Safe management of the respiratory system in morbid obesity // Scientific Symposium organised by the European Society for Peri-operative Care of the Obese Patient (ESPCOP) Monday, 3 June 2013, 8:30-10:00*
Chair: Yigal Leykin (Pordenone, Italy)
The co-morbidities of obesity: What really matters? Speaker to be confirmedMetrics for drug dosing: How pharmacology is different in the obese patient Luc De Baerdemaeker (Gent, Belgium)Obesity and sleep disordered breathing: The essential knowledge of sleep apnoea Anupama Wadhwa (Louisville, United States) Airways in the morbidly obese: The problems, the myths Michael Margarson (Chichester, United Kingdom)How to make a friend of your laparoscopic surgeon Jan Paul Mulier (Bruges, Belgium)
Seeing further: The fascination of Intravenous Anaesthesia // Scientific Symposium organised by the European Society for Intravenous Anaesthesia (EuroSIVA)Monday, 3 June 2013, 08:30-10:00*
Despite all technological developments, new diagnostic and therapeutic tools, new insights and training in, for example the human interaction in the workplace, the core business of the anaesthesiologists is still to make sure that the right drug with the right dose is applied to our patients to obtain the optimum effect without doing harm. During the last few decades considerable scientific knowledge has been built up about the intravenous drugs we use. However, there is still a gap between theory and practice. In this short symposium we will try to decrease this gap by discussing caveats, new developments and showing aspects of intravenous anaesthesia and sedation in real clinical practice.
Chair: Gavin Kenny (Glasgow, United Kingdom)
Developments in IV anaesthesiaStefan Schraag (Glasgow, United Kingdom)Safety and drug deliveryFrank Engbers (Leiden, The Netherlands)New ways of sedationGavin Kenny (Glasgow, United Kingdom)Seeing is believingNick Sutcliffe (Glasgow, United Kingdom)
Airway and respiratory care in critically ill patients // Scientific Symposium organised by the European Airway Management Society (EAMS)Monday, 3 June 2013, 10:30-12:00*
The session, endorsed by the European Airway Management Society (EAMS), an ESA Specialist Society, will consider these two fields crucial for life and of increasing interest in literature. The session will be chaired by the EAMS President, Flavia Petrini (Cheti-Pescara, Italy) and Paolo Pelosi (Genova, Italy), ESA past President, a key opinion leader in ICU, and will host some of the main European experts in intensive care and airway management: Massimo Antonelli, the actual SIAARTI President (2012-2015, Rome, Italy) and Tim Cook (Bath, UK), main researcher from the NAP4 (the cornerstone 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, UK).
Tim Cook will start the session, highlighting the findings of the NAP4 regarding ICU: ”Critical airway events on ICU: what goes wrong and how might we make it safer?”. He will analyse the adverse airway incidents causing death and permanent brain damage, the contributory factors and the possible solutions and the strategies to increase patient safety.Massimo Antonelli, with his lecture on "The role of bronchoscopy in the management of airway in the ICU?", will underline the role of education and training, especially but not exclusively for the bronchoscope adoption, a fundamental technique for airway management in ICU. Finally Paolo Pelosi (Genova, Italy), with a lecture entitled “In search of the "Holy Grail": does the optimal tracheostomy technique exist?”, will provide an exhaustive review of critical questions regarding the different approaches to tracheotomy in ICU, analysing the errors and the difficulties that senior organisations and manufactures should address.
Abdominal compartment syndrome - a multidisciplinary challenge // Scientific Session organised by the World Society of the Abdominal Compartment Syndrome (WSACS)Monday, 3 June 2013, 14:00-15:30*
Unlike many commonly encountered disease processes which remain within the purview of a given discipline, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) readily cross the usual barriers and may occur in any patient population regardless of age, illness, or injury. As a result, no one scientific society or association can represent the wide variety of physicians, nurses, respiratory therapists, and other allied healthcare personnel who might encounter patients with IAH and/or ACS in their daily practice. To fill this void, the World Society on Abdominal Compartment Syndrome (WSACS) has been founded to serve as a peer-reviewed forum and educational resource for all healthcare providers as well as industry who have an interest in IAH and ACS.
At this year's ESA-WSACS joint session that will be chaired by Paolo Pelosi (Genova, Italy) and Manu Malbrain (Antwerpen, Belgium), keynote speakers will give an overview on different aspects of intra-abdominal hypertension and abdominal compartment syndrome.Paolo Pelosi will explain to us who is at risk and why. Afterwards Manu Malbrain will give an overview of medical and surgical management while Annika Reintam Blaser (Tartu, Estonia) will help us to define acute gastrointestinal injury. Finally Jan Mulier (Bruges, Belgium) will close the session with some practical hints and tips on how to anaesthetise a patient with IAH or ACS. //
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06 * Please note that the session schedule still might be subject to changes. Consult the on-line programme on http://www.sessionplan.com/esa2013/ or the Final Programme on-site for the final timing of the session.
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Win a free registration
The ESA is organising a photo competition, which is open to all current ESA members. The top three contestants will win a free registration to Euroanaesthesia 2013.The best 10 photos will also be exhibited at Euroanaesthesia 2013, and published in the European Journal of Anaesthesiology.
What do you have to do?
Anaesthesia is everywhere in a hospital, and we would like you to capture it.We are looking for photos that show: • PEOPLE giving anaesthesia • the PLACES they work • SCIENCE in anaesthesiaEntries will be judged on whether they reflect these themes well, their visual impact and composition, originality, aesthetic quality and technical expertise.
Key dates
The contest started on 1 January and closes on 31 March 2013. Winners will be notified by 30 April 2013.
Impress us with your creative talent and submit your photos: http://www.euroanaesthesia.org/photocontest
Euroanaesthesia 2013 //Photo Contest
A new Call for Clinical Trial Network study proposals is now ongoing. Proposals for multicenter multinational studies are welcome, in particular observational epidemiological studies. The ESA will offer administrative, technical, logistic and financial support as in previous studies. Submission deadline : 11 February 2013.
Call for Centers still open for CTN study ETPOS (European Transfusion Practice and Outcome Study). Would your hospital like to join this study? See page 14-15 of this Newsletter
The Masterclass on Clinical Research is a workshop dedicated to acquire skills for designing and interpreting clinical research, producing a detailed research protocol, etc. Held in Brussels on 5-7 March 2013. Deadline for applications: 12 February 2013.
The Masterclass on Clinical Trials & Clinical Epidemiology is an advanced scientific workshop dedicated to refresh knowledge on design and analysis of clinical studies and to update on important latest developments in design and analysis. Held in Utrecht on 31 October-2 November 2013. Deadline for applications: 5 July 2013.
Masterclass on Scientific Writing: November 2013. More information to be coming soon on the ESA website
Information on these programmes and application procedures are available athttp://www.esahq.org > “Research”
Should you have any additional questions regarding these programs, please do not hesitate to contact Benoit Plichon at the ESA Research Department at [email protected] //
ESA 2013 RESEARCH PROGRAMMES // HOT TOPICS
Clinical Trial Network //
Masterclasses //
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// Introduction
The European Diploma in Anaesthesia and Intensive Care (EDAIC) continues to go from strength to strength: more candidates than ever registered for both written and oral examinations in 2012. For the first time more than 1500 candidates took the Part I Examination in centres in Europe and our colleagues in Indonesia arranged their second sitting of this written examination. Other countries outside of Europe are expressing an interest in the EDAIC: it is on its way to becoming a truly worldwide examination thanks to the hard (and persuasive!) work of our Chairperson, Dr Zeev Goldik.
// Why is the EDAIC so successful?
Each year this report documents the increasing popularity of the EDAIC throughout Europe and now beyond, thanks to the Glasgow Declaration. This year it is worth reflecting on this success and how to continue our growth. What makes an examination successful? Why are so many countries adopting either part or all of the EDAIC as part of their National assessment? There are many reasons and it is likely that individual candidates and countries will order their reasons quite differently.
Why is this examination so successful? Firstly, the examination clearly achieves what it sets out as its aim: to provide a standardised examination for candidates to demonstrate that they have not only acquired the relevant knowledge (as shown by success in Part I) but have also demonstrated application and understanding of that knowledge by successfully passing Part II. These two elements - acquiring knowledge and then applying it - form the basis of Miller’s triangle for educational development. Every country in Europe requires their trainees to develop this knowledge and understanding: it makes sense to have a single, standardised examination that is equally valid in all countries. Without a bedrock of theoretical knowledge and understanding, an anaesthesiologist cannot adapt and develop their practice as new equipment, drugs and operative techniques
are introduced. Evidence-based practice is becoming paramount as resources are limited: without an understanding of basic science, including the principles of statistical analysis, it is difficult to view new developments critically and decide whether valuable resources should be directed into such new areas.
Secondly, the medical workforce is becoming more mobile. It is not uncommon for anaesthesiologists to move from one side of Europe to the other. Having successfully completed an examination such as the EDAIC automatically provides evidence of acquired knowledge and understanding of our specialty.
Thirdly, a successful examination is one that is accessible to and supported by those taking the examination: if it does not cover topics relevant to current practice then it is not fit for purpose and will be avoided. The Chairpersons of the Part I and Part II Subcommittees are responsible for making sure the examination remains relevant and accessible: questions that were asked 20 years ago may no longer be relevant to modern-day practice and it is essential that they are replaced by newer and more pertinent ones. Without the hard work of these Subcommittees the examination would not retain its current position as a highly respected examination.
Fourthly, the examination must be respected and supported by trainers and examiners throughout Europe, both local and ESA appointed. If trainers do not respect an examination and consider it unreliable and invalid, then it will not survive. Statistical analysis of the performance of the elements of the examination is crucial to providing evidence of reliability and validity. The pass score for the written examination must be justifiable and validated. The pass score for the Part I Examination is based neither on a fixed value nor on a fixed percentage of candidates but varies from year-to-year according to both paper difficulty and cohort variability. Each paper contains discriminator questions that perform consistently from year-to-year and
allow cohort ability to be assessed and the pass mark adjusted accordingly. Analysis of reliability consistently show that each 60-question paper has a Cronbach’s alpha well above the accepted minimum of 0.8. The Part II Examination is less easy to analyse statistically, but examiner performance is audited and all new examiners are required to be paired with a senior EDAIC examiner to ensure their performance and behaviour is at the high standard expected.
For individual countries it is important that the EDAIC is not run by a single country but by a committee that has both elected members and invited representatives from all countries that have adopted the examination as part of their National assessment programme. Therefore those countries adopting the examination are included in all discussions, have direct input into the way in which the examination runs and are involved in examination setting and question reviews. It is a very efficient use of resources: one examination for many countries rather than each country developing an examination. With the very large number of candidates sitting the EDAIC, analysis of performance is meaningful and reliability and validity is assured. Although the primary language for the examination is English, the Part I Examination can be taken in one of 12 languages: all 11 translated papers will also display the original English version. Any country that adopts the Part I Examination as a National examination is entitled to have the papers translated into their own language, which makes it readily accessible to their trainees.
Respect for the examination is paramount: without it the exam would fail. Our exam continues to grow, both in Europe and beyond. This growth is maintained by three important factors. Firstly, a strong and respected Examinations Committee whose members work voluntarily and tirelessly to maintain the credibility of the examination. Secondly, the voluntary examiners and hosts who ensure the exams are conducted fairly and in optimal conditions and thirdly, but by no means least, a supportive and dedicated
European Diploma in Anaesthesia and Intensive Care (EDAIC)Report from the Examinations Committee 2012 //SUE HILL // CHAIRPERSON EDAIC PART I AND OLA SUBCOMMITTEES // suehi l [email protected]
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support team in the ESA office. Even all this is not necessarily sufficient for continuing success: the Examinations Committee needs to be visionary. Future goals of the committee are the development of online examinations (OLA), home-assessment (HOLA) to help trainees work logically through the European curriculum for Anaesthesiology and the development of a Europe-wide portfolio for recording training and continuing professional development. Enough work for many years to come!
// On-Line Assessment in Anaesthesiology
In last year’s report we introduced the On-Line Assessment (OLA) project, the result of a partnership between the Union of Medical Specialties (UEMS), the European Board of Anaesthesiology (EBA) and Orzone AB - a Swedish company with an aspiration to deliver state-of-the-art simulation and software dedicated to medical education. As a result of this successful collaboration we now have a secure platform to run real-time online assessments where participants can take an examination for formative purposes. There have been two successful pilots of this system, the first was reported in the Summer 2011 issue of this newsletter and the second was held at the Annual ESA Congress in Paris as part of the Basic Sciences Anaesthetic Course.
The exciting news for 2013 is that on April 19th there will be the very first On-Line Assessment accessible across Europe. Many centres in both Europe and outside have already registered an interest in providing the controlled environment required for this assessment, which will be available between restricted hours during the afternoon. The structure of the assessment will resemble the Part I written Examination, with two “Papers” covering Basic Science and Clinical Anaesthesiology. The questions all map to one or more domains of the UEMS European Curriculum for Anaesthesiology to ensure the assessment covers all examinable domains. Each centre will decide which 3-hour time slot they will use within the nominated period. An
individual candidate will have a maximum of 3 hours to complete the assessment from the time they log onto the OLA Platform. Ninety minutes will be the maximum time allowed for each paper of 60 questions: if the first paper is completed in less time than this the candidate can move on to the second paper but cannot carry-over any unused time. Once the assessment has been completed in that centre, participants will have immediate feedback on their performance - a score for each paper will be given and they can look back over the questions for a limited period to see which ones they answered incorrectly. This provides an opportunity for participants to find out where their strengths and weaknesses lie and allows them to better prepare themselves for the official EDAIC, which will continue to be a paper-based annual examination.
Once the OLA has been established, the next task of the hard-working OLA Committee will be to develop the Home On-Line Assessment (HOLA). This aspirational project will provide a new way of assessing progress through the European Curriculum for Anaesthesiogy - in the comfort of the anaesthesiologist’s own home. We hope to deliver an educational environment in which the importance of both Basic Science and Clinical knowledge can be understood through online questions. Watch this space!
// Basic Sciences Anaesthetic Course /Paris 2012
A further success in 2012 was the Basic Science Anaesthetic Course that ran in parallel with the Annual ESA Congress in Paris. The participants were all very tired by the end of this intensive course that provided lectures, from EDAIC examiners and members of the ESA Examinations Committee and ESA Board, covering a wide variety of topics. The majority of candidates found the course stimulating and commented that they realised how much work was needed to acquire the required knowledge to be successful in the EDAIC Part I Examination. A full report from the 2012 course was published in the Autumn 2012 edition of this newsletter.
The feedback from participants has proved very useful and a newly designed Basic Sciences Anaesthetic Course will take place in parallel with the 2013 Annual ESA Congress in Barcelona. Participants will again have the opportunity to attend certain congress sessions, including the plenary and certain invited speaker sessions. As in Paris, the course will conclude with an online assessment based on questions provided by the lecturers covering the important take-home messages. The course has an new organiser, Mario Zerafa from Malta, who will continue to be assisted by Zeev Goldik and Sue Hill from the Examinations Committee. Interested participants should visit the ESA website, www.esahq.org, and register as soon as possible since numbers will again be limited.
European Diploma in Anaesthesia and Intensive Care (EDAIC)Report from the Examinations Committee 2012 //
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The John Zorab Prize, for the highest marks in Part I, was won by Dr. Christian Beilstein, so it returns to Switzerland once more: a challenge goes out to other countries to better the Swiss record for winners of this prize!
EDAIC
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// Examination Numbers and Figures
EDAIC Part I - Written Examination
Out of the 1541 candidates who sat Part I in September 2012, 888 were successful, an overall pass rate of 57.6%. This was marginally lower but similar to previous years and can be compared with overall pass rates of 59.8% in 2011 and 58.3% in 2010.
Part II - Oral Examination
In 2012, 387 candidates travelled to 10 centres to sit the oral examination. This is yet another record number of candidates - an increase of 13.8% compared with 2011. Of these, 289 were successful, giving an overall pass rate of 74.7%.
ITA - In Training Assessment
In 2012 there were 332 candidates sitting the ITA. We look forward to these candidates taking the EDAIC Part I in the near future. //
JOIN US AT THE EUROANAESTHESIA CONGRESS IN BARCELONA!“Symposium organised by the ESA Examinations Committee"
Sunday 2 June 2013, 10.30 – 12.00
Fred Roberts: Summative assessments
Elisabeth Van Gessel: Formative assessments
Zeev Goldik: Self assessments
“Workshop for Examiners”
Sunday 2 June 2013, 14.00 – 14.45
Zeev Goldik: The Borderline Candidate
Board of Examiners // in Berlin
// New EDAIC Centres
2012 was no different from previous years in that new centres continued to open across Europe.
Part I: Moldova became the newest European country to officially adopt the Part I Examination, with 28 candidates sitting the EDAIC in Chisinau. Host: Dr Markus Schily.
ITA: Düsseldorf, hosted by Prof Benedikt Pannen and Dr Sven Lindner.
Part II: Berlin, hosted by Prof Claudia Spies and Dr Wolf Blaum. For the first time, both Madrid and Barcelona were open the same year due to increased numbers of candidates opting to take the Part II Examination in Spain.
Indonesia ran the Part I Examination for the second year running and 2013 is likely to see Beirut becoming a Part I centre - Lebanon will be the second non-European country opening its doors to the EDAIC Part I. Talks continue with both European and non-European countries to adopt our examination: there will be some interesting discussions during 2013.
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Candidates sitting the EDAIC Part I // 1984-2012
Candidates sitting the EDAIC Part II // 1985-2012
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FLASHES FROM THE HISTORY OF ANAESTHESIOLOGY // FROM THE VERY BEGINNING UNTIL TODAY
HISTORY
History of Anaesthesiology, flash 2 // from Greece to Rome and a little bit of ChinaIn this quarter’s look at the history of anaesthesiology, we will look at medicine and its application in the treatment of pain, in three great civilisations: Greek, Roman and Chinese (far eastern).
The Greek period starts in Crete more than 2500 BC. Contemporary to Egyptian civilisation, it continues with the Mycenaean period around 1200 BC, and the classical period which starts around 800 BC, and reaches its peak around 500 BC. Apart from the already cited episode in the Iliad which occurred in the Mycenaean period but was narrated by Homer at the beginning of the classical period, two names deserve to be mentioned: Asklepios (Aesculapius) and Hippocrates.
Asklepios is a legendary character who became the symbol of physicians and medicine. Half god, son of Apollo and Coronisa, a mortal, he is considered as the founder of Medicine as he is believed to be the first to create organised institution for the treatment of ill people. His symbol, a serpent entwining a staff, is used as symbol of medicine even today. With his wife Epione he had 6 daughters and 3 sons. The names of some of his daughters like Hygea, personification of health and cleanliness, Iso, recuperation from illness, Aceso, healing, Panaceea, universal remedy, are connected to some aspects of medicine. Special places, called “Asklepeions” including usually a temple, an
amphitheatre, and different establishments for housing, nourishing and treating patients were created in different Greek cities in Greece and Asia minor.
Hippocrates (460-377 BC.) was born and lived a major part of his life in the Isle of Cos in the most glorious period of Greek civilisation, the time of Pericles. The legend says that he was a descendant of Asklepios on the paternal site and of Herakles on his maternal. His parents as well as his descendants were medical practitioners. He is considered to be the father of medical profession as he separated medical practice from religion and considered disease to be caused by natural causes and not by any type of divine or spiritual intervention. He believed in the power of nature to heal disease and recommended rest and immobilisation. He was reluctant in the use of drugs and we have no hints about him using analgesic drugs in spite of the fact that he must have had knowledge of them. He introduced new types of medical instruments like the lead pipe for thoracic drainage and the Hippocratic bench for extension of broken limb bones.Greek medical practice was taken over by the Roman conquerors and extended throughout the empire. In Roman times 2 names deserve our attention Dioscorides and Galen.
Pedanius Dioscorides, a Greek born in Asia Minor, lived in the first century AD. And was a
personal doctor of emperor Nero and a surgeon of the emperors army (40-90 AD.), meaning he travelled extensively and acquired knowledge on medical habits all around the Mediterranean. He is the author of an impressive treaty in 5 volumes of pharmacology. The book was initially written in Greek and translated in Latin titled “Materia Medica”, the precursor of modern pharmacopeia. The text was translated to many European and Asian languages It was used up to modern times in places where medication based on plants was prevalent, meaning up to the beginning of the 20th century. A last edition was printed in 2000 in Johannesburg South Africa. You will find in this book chapters written in the style of modern treaties about all plant remedies - used to produce sleep, sedation, analgesia, oblivion or even act as a lethal toxin.
Aelius Claudius Galenius physician, surgeon and philosopher (129-200 AD.) born in Pergamon (Asia Minor), lived in Rome since 162. Of Greek origin and descended from an educated family with an architect for a father, he traveled a lot throughout the empire and was a personal physician to some emperors: Marc Aurelius, Commodus, Septimius Severus, Caracalla. He studied medicine in the local Asklepeion in Pergamon and Alexandria. He was a practitioner involved as well in caring for patients, combating epidemics like the great epidemic from 168-69 (The Antonin plague, probably smallpox) which killed almost 50%
This is a serie of flashes to cover the evolution of medicine from its beginnings until anaesthesia appeared and later developed to what it is today.
GEORGE LITARCZEK // ROMANIA // [email protected]
ESA Masterclass on Clinical Trials and Clinical Epidemiology,October 31 – November 2 2013 13
HISTORY
of the population. He was involved in military medicine accompanying the troops in the northern part of the empire living with the legions in Aquilaeia.He had important and long lasting contributions to many fields of medicine but there are few mentions of his preoccupation for anaesthesia and analgesia in spite of his experience with the military. His experiments with nerve ligation proved to him that the brain was in control of all the body parts through nerves. His numerous works were written in Greek language and translated in Latin and Arabic.
Chinese medicine developed in parallel with western medicine but on very different theoretical basis. The first written document that we know about is the first monograph on medical theory dating from the 5th century BC. (Pericles time). It presents the medical knowledge accumulated during more than 2000 years of tradition including therapies like acupuncture, herbal medicine, massage, exercise and dietary concepts. A classical document is the “Yellow Emperors Inner Cannon” dating from the 1st century BC. in which, in a form of a dialogue the main concepts of medicine are resumed. They are based on the Yin/Yang and the “Five Phases” (Wood, fire, Earth, Metal and Water) theory to explain physiology, pathology and etiology and guides diagnosis, therapy, prevention and application of drugs. Emphasis is put on function not on
anatomy. Pathology is considered as being exogenous, endogenous and intermediate. Disease is an imbalance in man's relationship with his surroundings and within his body and is not produced by evil spirits or gods. The first analgesic used was a powder “NaFu” (Aconite+Datura+other herbs) mixed with wine proposed by Hun Tuo, during Han dynasty, as an anaesthetic for surgery. Hun Tuo is considered as the Hippocrates of China. Acupuncture was mentioned as a method to produce different therapeutic effects and specifically analgesia, by interfering with “Qi”, the energy of life, during the 1st and 2nd centuries BC. It is the period when puncture points as well as the circulation of energy through meridians was proposed. //
Editor's note: Professor George Litarczek is the founding father of the modern Romanian Anaesthesiology and a very active author of textbooks.Here he is inaugurating a new series about history of our profession.
One of the trials to be funded by ESA’s Clinical Trials Network (CTN) is continuing to recruit centres across Europe and will begin in Spring 2013. The European Transfusion Practice and Outcome Study (ETPOS) aims to describe differences in transfusion habits throughout Europe and to correlate these habits to perioperative outcome parameters.
The study follows work by an Austrian group (Prof. H. Gombotz et al.) that established different anaesthetists and hospitals could reach different decisions on whether a blood transfusion was necessary even if presented with very similar patient circumstances. “This work made us realise that we really don’t know very much the decisions made across Europe on blood transfusion, or why they are made,” says lead investigator Professor Jens Meier, Clinic of Anaesthesiology and Intensive Care, University Tübingen, Germany. “Although many countries in Europe have guidelines for transfusion, subtle differences exist.” He points out there is evidence starting to emerge that more liberal transfusion practices can potentially harm patients.
Meier explains that there are two prevailing concepts in this field: the first uses haemoglobin levels in the blood, with a transfusion becoming necessary if this level drops below a certain
value. “However, this threshold is not set, it’s different for each patient and is determined by the anaesthetist based on various factors,” he says, adding that in general the sicker patients receive blood earlier, while those who are in a better condition would receive blood later. “The other parameters than can be used are the so-called physiological triggers, where blood is only given if one or more trigger points are passed. However, this system is rarely used on its own in practice, and is often used in conjunction with haemoglobin levels.”
It is not only whether and how many packed red blood cells (PRBCs) are transfused that will be analysed in EPTOS. Special focus will also be put on the ratio of PRBCs to other blood products or coagulation factors in the operating room. “Bleeding patients are also losing the other contents of their blood such as platelets and coagulation factors. So the study will also be about how coagulopathy is treated,” says Meier. He explains that while in some centres fresh frozen plasma and platelets are routinely transfused in a fixed ratio with PBRCs, in others only those factors actually identified as depleted or missing from the patient are included in the transfusion. Yet the very point-of –care tests to determine which coagulation factors are missing are themselves still under investigation and are not generally used throughout Europe.
ETPOS is aiming to recruit around 150 centres from more than 30 countries, ideally with the number of centres from any one country being in approximate proportion to its population size. Spain, Germany, the UK, Italy and Romania are among the countries with the highest numbers of centres agreeing to participate so far. “It will be interesting to see if the size of the centre plays a significant role in transfusion practice, since we have centres ranging in size from the huge university hospitals down to much smaller regional clinics,” says Meier. The actual assessment period is between Spring and Autumn 2013, with hospitals able to choose when to start their 3-month continuous participation during this window.
The study will assess transfusion practices in around 10,000 patients undergoing all kinds of elective surgery. Excluded will be those having cardiac surgery and emergency room trauma patients, since both of these situations have, in most cases, protocols that remove the decision making of the individual anaesthetist. 30-day mortality will be a secondary outcome of the study.
“It is clear that there are currently large knowledge gaps in what we know about transfusion practice across Europe,” concludes Meier. “The ETPOS study should give us a clear
European Transfusion Practice and Outcome Study (ETPOS) to begin in spring 2013 //TONY K IRBY / / LONDON, UK / / tony@tonyk i rby.com
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“
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Physicians have an ethical code enforced by themselves, to care for all people, to care for them when they are sick, hostile, demanding, rich or poor.
(E. Stead Anesthesiology 1985;62:776)
ETPOS
picture about what different anaesthetists in various centres are doing and why. With availability of blood declining and the cost of it increasing, it’s essential we find out exactly what is going on to intensify the discussion in this vital field and potentially establish best practice guidelines that can improve outcomes and reduce costs.”
“ETPOS will be challenging for the ESA Clinical Trials Network, but it is doable and the study deals with a highly relevant issue of perioperative medicine,” adds Professor Andreas Hoeft, Chairman of ESA’s Research Committee and of the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany. “ETPOS will add another important piece of knowledge to the puzzle of perioperative blood management,” he concludes.
Anyone wishing to get involved in the ETPOS study should contact Jens Meier (Chief Investigator) at [email protected] or the ESA Secretariat ([email protected]). //
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// Thirty-nine applications for ESA Research Grants
On November 16th 2012, the Research Committee met in Brussels to review and discuss 39 Research Grant applications received: 8 applications for the 15,000 Euro category, and 31 for the 60,000 Euro category
// A two-round evaluation
All 39 applications were reviewed in a first round by Research Committee members. Each application was ranked independently and according to a predefined threshold value, 23 were selected to a short list for final evaluation. These applications received a second round of evaluation by other research committee members and finally also external reviews The following criteria were considered for evaluation: 1) Scientific merit 2) Methodology 3) Relevance4) Budget appropriateness 5) Research group and other consideration.
Finally, the following applications were successful:
// Research Grants up to 15,000 Euro:
• Stefan De Hert, University Hospital, Ghent, Belgium “Role of myocardial oxygen balance in the pathogenesis of right ventricular
dysfunction and the impact of positive inotropic support.”
• Jurgen De Graaff, University Medical Center, Utrecht, The Netherlands “Effect of time and duration of anesthesia during childhood on psychopathology in
monozygotic twins”
// Research Grants up to 60.000 Euro:
• Robert Dickinson, Imperial College London, United Kingdom “Xenon – a neuroprotective treatment for blunt-traumatic brain injury and
associated cognitive dysfunction - pilot study”
• Niccolò Terrando, Karolinska Institutet, Sweden “Neuroinflammation and cognitive decline after general anaesthesia and surgery.”
Due to the high quality of most applications, Research Committee members felt that the selection process was rather difficult. In the end, we are confident that we have chosen four really interesting projects of exceptionally high quality, which are all of significance for our specialty; although many more projects would have deserved to be funded.
We would like to thank all applicants for their interest and the work they have invested into this scientific competition. We also hope that those who were not fortunate this time will be motivated to contribute in the future. It became also obvious from our review work that many of the applications will also have great chances to be funded from alternative resources. In this regard we wish all applicants success. //
Results of 2013 Research Grant Applications // ANDREAS HOEFT // CHAIRPERSON OF THE RESEARCH COMMITTEE // [email protected]
ETPOS
SOCIETY16
A young and active National Society //
The Georgian Society of Anaesthesiology and Critical Care Medicine (GSACCM) numbers about 150 physicians, nurses, physiotherapists, healthcare managers and healthcare providers of different fields of medicine. The main goals and priorities of our society are: creation of a strong theoretical and practical basis for anaesthesiology and critical care medicine in Georgia, promotion of progress in the specialty, continuous medical education activities, scientific research, professional development and collaboration with official structures involved in Georgian healthcare.
Since 2005, a year which witnessed a new trend in our activities: members of the society who are at the same time prominent professionals in medicine (and particularly anaesthesiology and Critical Care) are now involved in various activities which are helping promote future improvement of anaesthesiology in Georgia.
The following lists some recent activities and accomplished projects:
* Continuous medical education (CME) training and points accreditation
* Publication of 5 textbooks in Georgian, for the use of our students, residents and young specialists
* Protocols and guidelines as per the request of the Georgian Ministry of Health
* Preparation of the residency program and track in anaesthesiology and critical care
* Training in the subspecialty of paediatric anaesthesiology and critical care which was accepted by the Ministry of Health – about 90 physicians have already completed the training
* Implementation of Advanced Trauma Life Support (ATLS) training in Georgia – 6 physicians trained as instructors will participate in ATLS inaugural course in the first months of 2013
* GSACCM sent three young specialists to the ISIA (the International School for Instructors in Anaesthesiology) 3 course and they just graduated the school last October in the island of Crete.
Our society is affiliated to ESA, WFSA, the European Society of Intensive Care Medicine (ESICM) and World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) and our members regularly participate in international congresses organised by these societies.
The new Committee for European Education in Anaesthesiology (CEEA) centre has been recently founded in Georgia. The director of the centre is Professor Mamuka Chkhaidze. The center was founded bv the National Training Center at GSACCM, thanks to the close alliance between our society and ESA.
The first course of CEEA in Georgia - “Respiration and Thorax “ was held from September 21-23,
2012, and almost 40 participants took part in the two day-program. The faculty included leading anesthesiologists from Georgia, as well as two leading professors from Israel.This type of post graduate education is very important for the Georgian healthcare system, especially for adaptation of our anaesthesiology and intensive care medicine to European standards. Our special interest and focus is directed to the patient safety and all educational projects are supposed to strengthen our abilities to take care of the patient both in and outside the operating room.
GSACCM is currently preparing a large educational project with the occasion of its 1st International Symposium, planned for August 29-31, 2013 in the splendid city of Batumi, on the Black Sea shores.
The program will include, in addition to three days of panels andworkshops and plenary lectures, two more courses: the second CEEA annual course and the first national educational course organised and taught by our three ISIA 2012 graduates.
We would like to invite the ESA Newsletter readers to participate in this event next August, and to contribute to the scientific program, while at the same time enjoying the splendid weather and location of Batumi. //
GSACCM Secretary
DR. IRINA TSIRKVADZE // TBILISI , GEORGIA // i r ino la1@gmai l .com
SOCIETY
Editor's note: This is the first in a Series of articles about National Societies of Anaesthesiologists. Officers of other European national societies are kindly invited to follow Georgia's example and send presentations on their own organisations and activities.
The first CEEA class in Tbilisi // September 2012
A. FIRST PART: PERSONAL DATA
A1. Who are you?a. resident in the 1st part of trainingb. resident in final stage of trainingc. specialist, less than 5 years d. specialist, more than 5 years
A2. Currently you are working in a:a. academic hospitalb. regional hospitalc. local/municipal hospital
A3.Your age:a. less than 35 yrsb. 35-50c. Over 50 years
A4. Your first language is:a. Englishb. Frenchc. Spanishd. Russiane. Italianf. other
B. SECOND PART: ABOUT THE ESA NEWSLETTER
One answer per question for questions 1 to 7
1. How do you read our Newsletter?a. by internetb. the printed formc. I usually do not read it
2. How long, in general, does it take you to read the Newsletter?
a. less than 10 minutesb. between 10 minutes and one hourc. more than one hour
3. What do you do with the brochure after reading it?
a. keep it for a couple of days/weeksb. throw it after readingc. keep it for longer periods of time
4. What is your opinion about the format of the Newsletter
a. a proper formatb. too long
c. too short5. Do you think that the Newsletter includes
the expected information about the professional and organisational aspects of the European anaesthesiology?
a. yesb. yes, partiallyc. no: needs a lot more
6. What do you think about the general content of the Newsletter?
a. interesting enough to be readb. interesting only to be looked overc. not so interesting
7. Would you recommend the Newsletter to your colleagues?
a. yesb. maybec. no
8. Please, specify what kind of topics would you like to read in the Newsletter:
(more than one answer permitted)a. Organisation of the professionb. Residency track in various countriesc. Places for fellowshipd. National Societies activities e. Presentation of anaesthesia departmentsf. Professional debatesg. Short case presentationsh. History of European anaesthesiai. Reviews of textbooksj. Reviews of important articles / studies
Please send your answers to : [email protected] before 15 March 2013
One respondent will be drawn at random and get free registration to Euroanaesthesia in Barcelona. //
Survey on the ESA Newsletter //
EUROANAESTHESIA 2013June, 1-4Barcelona, Spain 17
ZURICH
The Institute of Anaesthesiology (IFA) at the University Hospital Zurich (USZ) is one of the leading anaesthesiological departments of the 5 university hospitals in Switzerland. It comprises a staff of nearly 130 medical doctors and 140 anaesthesia nurses of various professional degrees and levels of experience. Among the medical doctors, there are some 80 residents, who spend the largest part of their 5 years specialisation period in our institute. The IFA is responsible to cover all anaesthesiological services for the USZ. The campus is scattered over various buildings and therefore separate anaesthesiological teams are dedicated to each of the existing 7 operation units comprising more than 35 simultaneously active operating rooms. The USZ runs all surgical disciplines except paediatric and orthopaedic surgery, which are allocated in separate neighboring academic hospitals. With these external hospitals there is a close collaboration and a number of IFA residents work in these academic hospitals in rotation turns of 6-12 months. All residents of the IFA are assigned into a meticulous rotation plan in order to obtain full knowledge and experience in all fields of modern anaesthesiology. A very active subunit of the IFA is dedicated to transplant surgery, thus representing the largest specialised team of its kind in the country, where among others 14 hearts, 30 lungs and 47 livers have been transplanted in 2011. In 2011, the IFA performed all together more than 26000 anaesthesia cases of all types and difficulty degrees.
// Clinical work
Since the USZ is a tertiary unit responsible for a large part of the country and as being located in the most densely populated region, it attracts complicated and severe cases that occur in the region and beyond. By this condition, the IFA has to adhere to the most recent advances
in anaesthesiological practice and science, to which it also substantially contributes. In the last years, the IFA became a worldwide renowned center of expertise in the field of patient blood management. Transfusion of red cells and other blood components have been minimised by a locally tailored transfusion algorithm. The IFA integrates a steadily growing pain unit which covers therapeutic services for all hospital inpatients (3500 pain visits per year in 2011) as well as a tertiary outpatient clinic specialised in clinical and interventional pain diagnostics and therapy for patients with chronic pain conditions (400 newly admitted patients per year). In addition to the regular clinical anaesthesia in surgical units, the IFA provides full coverage of resuscitation needs in the hospital, as well as in the city and region of Zurich. Thus the IFA runs its own emergency division as a part of the emergency department of the hospital and provides anaesthesiological care to all emergency and non-elective cases in the hospital, including every admission to the emergency room. It also ensures the in-house emergency call service and provides specialised physicians to the urban emergency medical service (EMS) and to a nearby helicopter base of the Swiss Air-Rescue (Rega). Together with the latter organisations, the IFA provides on-site emergency physician care to about 2000 patients a year.
// Scientific work
Many IFA staff members are involved in basic scientific work as well as in clinical investigations. Some senior investigators have set up own laboratories dedicated to research in nanotechnology, fluid management, organ protection, inflammation (patho)physiology, blood coagulation, team interaction and related fields of interest. In the laboratory of immunopathology relevant mechanisms of
The Institute of Anaesthesiology at the University Hospital Zurich //DONAT R. SPAHN AND PETER BIRO // ZURICH, SWITZERLAND // anaesthesio [email protected]
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organ protection such as ischaemia-reperfusion injury are elucidated, which help translate basic into clinical research, and vice versa. Some projects within this topic are carried out in close collaboration with the University of Illinois Chicago, where young researchers of the IFA are trained in basic research. In parallel to molecular research, randomised clinical trials are designed and performed in visceral and thoracic surgery, together with other academic centers of Switzerland. A second topic of this research group is nanomedicine, where vascular compatibility of magnetic nanoparticles is tested in vitro and in vivo, an activity that is supported by the Swiss Federal Institute of Technology Zurich (ETHZ). Nanoparticles are capable of binding high molecular compounds, thereby opening a variety of possible therapeutic applications such as blood purification. Both research fields are funded by grants of the Swiss National Science Foundation (SNSF). The pain research laboratory focusses on peripheral mechanisms of pain. Topics include electrical and pharmacological modulation of nerve excitability in normal and neuropathic pain states (neuro-modulation) including in-vitro rodent models, proof-of-concept studies in healthy volunteers and phase-I-IV studies in patients. This unit is supported by various research grants from different grant providers including the Swiss National Science Foundation. By additional research cooperation with the ETHZ we investigate the impact of team interaction on anaesthesia team performance. Supported by two grants from the SNSF, topics included the impact of leadership, communication, and speaking-up behaviour on team performance, and more recently, the design, implementation and evaluation of crisis resource management training for anaesthesia staff.
The output of these research activities results in obtaining more highly qualified
physicians as well as a considerable amount of publications. The number of original as well as review articles, editorials and book chapters amounted to25 in 2009, 50 in 2010 and 58 in 2011. Clinical research is well rooted in various subunits of the department and closely linked by interdisciplinary collaboration with the respective surgical clinics.
// Teaching and training
From the Medical Faculty of the Zurich University the IFA parents the academic teaching of medical students during their bachelor as well as master study periods with various lecture cycles, courses and by problem oriented learning (POL). The spectrum of teaching activities of medical students ranges from Grand Round lectures for a whole semester group to one-to-one bedside teaching in the operating rooms. Some advanced medical students attend a 2 to 4 month long intensive practical training, where they are instructed and trained in the same way as residents at the beginning of their postgraduate clinical education. In addition to the practical teaching offerings, a web based interactive eLearning platform is also maintained by the IFA. The residents of the department undergo a thorough education and training consisting of regular courses (that are shared with external departments via video conferencing) and by personal assistance and instruction by senior staff members and dedicated academic teachers. Staff members are regularly invited into the recently inaugurated and well equipped simulation centre to participate in real-time simulations of various clinical scenarios. These activities incorporate definite training units for resuscitation, difficult airway management and critical intraoperative situations. Certain simulation rounds are recorded and the participants are debriefed with the help
of professionals in anaesthesiology as well as in terms of occupational psychology and team performance. Furthermore, the residents are evaluated at least once a year by dedicated senior staff members with a specific performance appraisal. Recently, a work based assessment program has been installed (Direct Observation of Clinical Encounter, DOCE). The immediate feedback of pre-defined processes in clinical practice gives additional input to the annual qualification for both, the teacher as well as the trainee. Since 2011, the residents have also the opportunity to evaluate the teaching competence of their teachers twice a year with a structured internet based questionnaire. This is the first bottom-up qualification program of its kind in Switzerland. The facilities of the USZ are once a year the location for the Part 2, oral exam of the European Diploma of Anaesthesiology, for which the IFA not only provides the necessary infrastructure, but also substantially contributes by sending competent examiners and offering the local all-round organisation of this event. Members of the staff of the emergency division provide an emergency physician course twice a year. This is one of seven courses performed under supervision of the Swiss Society of Emergency Medicine (SGNOR) and forms a basic requirement in obtaining the emergency physician certificate.
The IFA is continuously involved in national and international collaborations which cover both scientific as well as clinical projects. Over the last years many young anaesthesiologists from various countries have spent periods of weeks to months of clinical practice in our institute and were trained in the same way as the regular residents. //
The Institute of Anaesthesiology at the University Hospital Zurich //DONAT R. SPAHN AND PETER BIRO // ZURICH, SWITZERLAND // anaesthesio [email protected]
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(more than one answer could be correct for each questions)Answers will be published in the next issue of the Newsletter.
1. In a patient with a hiatus hernia, anaesthetic complications at induction can be reduced by
a. the use of ketamineb. preoperative therapy with H2 receptor antagonistsc. the use of cricoid pressured. the use of a laryngeal maske. atropine premedication
2. Factors known to influence total respiratory compliance during anaesthesia include
a. changing depth of anaesthesiab. administration of depolarising muscle relaxantsc. duration of anaesthesiad. body positione. pneumoperitoneum
3. Possible complications of right-sided supraclavicular brachial plexus block include
a. Horner's syndromeb. phrenic nerve paralysisc. recurrent laryngeal nerve paralysisd. damage to the thoracic ducte. subclavian artery puncture
4. In a patient with low intracranial compliance, cerebrospinal fluid pressure
is directly increased by
a. hypercarbiab. hypoxiac. isofluraned. ketaminee. propofol
5. In a patient suffering from a thyroid crisis, suitable treatment includes
a. beta adrenergic blockadeb. digoxinc. corticosteroidsd. nasogastric potassium iodidee. intravenous methimazole
In the next issue of the newsletter the correct answers and explanations will be given.
Dr Sue Hill, Chairman Part I EDAIC Subcommittee
Preparation for EDAIC //Multiple Choice Questionsfor Part 1
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These are the answers to the questions posed in the previous newsletter.T= True, F=False
1. Total T4 level in serum:
a. has a reciprocal relationship with the free T3 levelb. is controlled by calcitonin from the C-cells of the thyroidc. is affected by the level of thyroxine binding globulind. is controlled via a posterior pituitary hormonee. is elevated by growth hormone
Answers: a) F b) F c) T d) F e) F
Explanation: The levels of total T3 and T4 are not strongly correlated in normal subjects. T4 is carried in the plasma by thyroxine binding globulin (TBG), which is normally only 25% saturated: changes in TBG levels will affect total T4 but not free T4. T4 is controlled by TSH from the anterior pituitary, which is released under the control of TRH from the hypothalamus. Growth hormone acts synergistically with T4 but does not affect plasma levels of T4.
2. Uptake of inhalational anaesthetics across the alveolar-capillary membrane is affected by:
a. the partial pressure difference between the alveolar gas and that dissolved in blood
b. membrane thicknessc. the presence of nitrous oxide within the alveolusd. the cardiac outpute. hyperventilation
Answers: a) T b) T c) T d) T e) T
Explanation: Movement of volatile agent from alveolus to capillary depends on the concentration gradient (difference in partial pressure), distance to diffuse (membrane thickness), the second gas effect - nitrous oxide diffuses into the capillaries faster than nitrogen exits the capillaries, so concentrating the volatile agent in the alveolus and increasing the concentration gradient; a high cardiac output slows and a low cardiac output speeds uptake of volatile agent; increasing minute ventilation speeds uptake (hyperventilation) and lowering minute ventilation slows uptake.
3. In type II halothane-induced hepatotoxicity:
a. severity of injury increases after each useb. injury is invariably dose relatedc. cross reactions with other volatile agents occurd. specific treatment includes high dose steroidse. injury never occurs on first exposure
Answers: a) T b) F c) T d) F e) F
Explanation: Type I halothane hepatitis is common and self-limiting, type II rare and fulminant. Previous exposure produces antibodies against the haptens
formed during halothane metabolism, early re-exposure can then produce a greater response. This adverse reaction is immune, not not dose-related and requires a genetic predisposition. Other volatile agents that produce similar oxidative metabolites can also trigger hepatotoxicity. Steroids have not been shown to be beneficial. First exposure can be associated with hepatotoxicity, although more commonly it is seen on second or subsequent exposure particularly if close in time (within 6 weeks).
4. A gas chromatograph can be used to measure the:
a. concentration of nitrous oxide in a gas mixtureb. concentration of CO2 in expired airc. concentration of a volatile agent in a gas mixtured. blood pHe. plasma thiopental level
Answers: a) T b) T c) T d) F e) T
Explanation: Gas chromatographs can identify compounds in a mixture that can be converted into a volatile form without degrading, including compounds in solution such as thiopental. Blood pH is determined by hydrogen ion concentration, not hydrogen gas concentration.
5. The Chi-squared test (X2):
a. is an example of a parametric testb. requires calculation of the squared (observed-expected frequencies),
divided by the expected frequency, for each cell of the contingency table
c. Yates’ continuity correction is normally applied for a 2 x 2 table where one expected value is less than 5
d. Fisher’s exact test is preferred for a 2 x 2 contingency tablee. a 2 x 2 contingency table has 3 degrees of freedom
Answers: a) F b) T c) T d) T e) F
Explanation: The Chi-squared test is a non-parametric test commonly used to identify an association between categorical variables. The value of the Chi-squared statistic is calculated as: ∑ (O-E)2/E where O and E are the observed and expected frequencies for a given cell of the contingency table. The continuity correction (Yates’) is used in 2 x 2 tables to allow for the approximation of a discrete distribution by a continuous one, more commonly for tables with small numbers of expected frequencies - fewer than 5 expected observations in one cell is the generally quoted limit. Fisher’s exact test was recommended only for 2 x 2 tables before the advent of computers and acceptable computational methods. It calculates the exact probability of the observed distribution of events occurring rather than the approximate method used by the Chi-squared test and works best when there is an uneven distribution of observations in rows/columns. It is still preferred for small numbers of observations and a 2 x 2 table. The number of degrees of freedom for any contingency table is (number of rows - 1) x (number of columns - 1) so for a 2 x 2 table this is (2 - 1) x (2 - 1) = 1 x 1 = 1.
Preparation for EDAIC // Answers
Editor's note: The Editor is grateful to Dr Sue Hill, Chairperson of Part I EDAIC Subcommittee, for her contribution to this section.
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It all started in November 2010 when I got the confirmation of the Grant for the ESA Trainee Exchange Programme and my destiny was the Academisch Medisch Centrum (AMC) in Amsterdam, The Netherlands. The AMC is one of the eight university medical centres in the Netherlands. They have 20 clinical plus 5 day-care operating rooms and perform about 20,000 anaesthesia procedures annually excluding sedations. Approximately 800 procedures are cardiac surgery, from which 80% are planned operations and 20% emergencies. Next to clinical duties, the Department of Anaesthesiology is involved in training students from the University of Amsterdam. The main focus of research concentrates on cardioprotection, mechanical ventilation and pharmacology of local anaesthetics.
We scheduled the first week of contact in February 2011. The weather was much colder than in Tenerife! I immediately realised that Dutch language would play a central role in my daily clinical practice as not all the patients spoke English and all the medical data and documents were in Dutch.
Once back at home I set my own goals which I would like to achieve during the ESA-TEP. I proposed myself 3 targets. First of all, joining the Cardiac Team in my hospital and starting to protocolise all the procedures, as well as acquiring enough knowledge in transesophageal echocardiography (TEE) for intraoperative monitoring. Third, and probably the most important of the three, learning as much as possible in all the fields of anaesthesia. For that purpose I had some work to do in advance. I thought that learning some Dutch could prove very useful in order to help me to get better involved in the team and better understand all the procedures and discussions (I have to say that it was quite difficult to find learning material in Tenerife!). Second and more important, I had to update myself in cardiac anaesthesia because in my hospital, once you finish your residency you don't have the possibility, straight away, to join the Cardiac Team, so I lost practice during that year and had to come back to my books and notes. And third and probably the toughest one was the BIG-Register, a “BIG-deal”, which took me several months to finally acquire the medical approval to be able to work and interact with the patients in the AMC.
// The problem
Just one week before flying to Amsterdam a problem occurred in my hospital and due to last minute inconvenience I had to postpone the rotation until March of the following year.
ESA TRAINEE EXCHANGE PROGRAMME //Academisch Medisch Centrum, The Netherlands. ALESSANDRA BINAGUI BUITUREIRA // TENERIFE, SPAIN.
From left to right: Susanne Eberl,
Alessandra Binagui, Hettie Bosch
From left to right: Nelson Monteiro De Oliveira,
Esther Reynecker, Alessandra Binagui, Maartje Van Haperen.
In the back row: Markus Stevens.
EACTA Meeting //Back row, from left to right: Carsten Schultheis, Edouard DeBeaumont, Connie Bloom, Benedikt Preckel.Front row, from left to right: Veronika Evers, Daniel Brevoord, Alessandra Binagui, Susanne Eberl, Thomas Scheeren.
From left to right: Hennie Metske, Suzana Tunovic, Wolfgang Schlack,
Alessandra Binagui.
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TRAINEE
Here I have to mention and thank the great predisposition, cooperation and assistance of the ESA-TEP Committee, with the Chairman Dr. Gomar heading the group and Mrs. Anny Lam doing immeasurable work in this ESA-programme, which provides to all the newcoming anaesthesiologists a priceless opportunity to go further in our careers after finishing the residency.
I also have to thank the AMC and especially to Prof. Benedikt Preckel, for the collaboration and support to overcome the unexpected problem arising and for keeping my place till few months later. So it was not an easy path but well worth all the extra effort that these professionals put in to help me retain my place in the exchange programme.
// “And The Dutch created The Netherlands...”
I arrived in March and started right away in the Cardiac ORsO. There are 3 ORs for cardiac surgery and the cath-lab for interventional valve placements and treatment of rhythm disorders. With support of Prof. Benedikt Preckel and Dr. Susanne Eberl (Chairman of the Cardiac Anaesthesia Section) I made a 3 months plan with the basic and more common cardiac surgery cases that I had to get familiar with. Next to completion of this initial plan I was also able to join congenital cardiac cases and more complex surgeries including children and younger patients. As I was BIG-registered, I was able to perform all the techniques while being supervised by Cardiac Anaesthesiology Staff during the surgery, just like a resident. I gradually became more self-reliant. I had the priceless help of the “medewerkers”, nurses and perfussionists in the OR, helping me to translate documents, understand discussions and filling in data in the electronic anaesthesia record. Also the surgeons were very kind in
already had. I had the opportunity to meet one of my colleagues from my hospital in Tenerife in the EACTA meeting and we both took the exam. It was long and tough but 100% worth because I fixed a lot of info and knowledge during the intense study and parallel practice in the OR and the Echo-lab. To be added to the initial satisfaction for the hard work done I got the results recently, and I passed!!
// “...Give oxygen!!”
I must say that one of the most valuable things I took back home is the warm and sincere friendship that I received from all of the amazing team of the AMC, not only in the beginning when it is fun to meet foreigners and ask about other cultures, but during the hard everyday-work in the OR in difficult situations and towards the end of my rotation. No-one can be excluded. From Jane Martens, responsible for all administration in the OR area, through Esther Reynekeer, Richard Meijs, Sonja Verbij, André van Lonkhuizen and ending up with the Cardiac Team: Dr. Veronika Evers, Dr. Edouard de Beaumount, Dr. Nelson Monteiro di Oliveira, Dr. Jan Frassdorf, Dr. Peter Meijer, Dr. Suzana Tunovicz, Dr. Conny Blom and of course Dr. Susanne Eberl and Prof. Benedikt Preckel, Prof. Markus Hollmann and Prof. Wolfgang Schlack.. My warmest thanks extend to all the anaesthesiology Staff and residents of the AMC, which really made me feel like at home. I would like to encourage all newcoming anaesthesiologists to visit other centers and if possible to go out of borders. It is essential for the nowadays clinical practice to explore new ways of performing and understanding anaesthesia. This is the key to provide a higher standard of anaesthesia in quality and safety and to improve our job at home, wherever we might live and practice. //
helping me to understand the different parts of the procedures and to switch to English whenever I was in the OR and demanded further information about the case. We usually performed two surgeries per day and when they were finished we visited the patients for the day after, making sure everything from the preoperative evaluation and the medication was correct, and clarifying any doubt of the patients. I also had the opportunity to stay for emergency cases during the shifts which gave me another view of Cardiac Anaesthesia in the management of critical and acute patients.
The TEE for intraoperative assessment was one of my main goals during the rotation. I was already familiar with this monitoring option because we use it in my hospital in Tenerife, but I was not skillful enough and needed to learn a systematic and efficient approach. Absolutely all the Cardiac staff helped me a lot in this matter and I am very grateful to all of them. That's how I started gathering my own TEE examinations supervised by Dr. Susanne Eberl.
The cath-lab was a very interesting point in the rotation because in my hospital we are introducing the TAVI (trans-catheter aortic valve implantation) procedure this year. So there was an extra value in learning the protocols from the AMC in order to introduce the technique once back at home. I got familiar with the TAVI through the 2 existing approaches: trans-femoral and trans-apical.
// The exam
As a wonderful coincidence, the EACTA congress was to be held in Amsterdam at the end of May. Prof. Benedikt Preckel suggested me to sit the TEE exam, taking the advantage of being in the Cardiac OR every day and preparing a special rotation in the Echo-Lab with the cardiologists. Dr Eberl and Prof. Preckel also provided me reference material and books besides the ones I
“”
A stethoscope cannot function without a man at each side
(Dickinson Richards, Nobel prize winner, 1895-1973)
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Forty-five countries in Europe are members of the WFSA. These societies represent around 44,000 members. This is a huge chunk of the total WFSA membership and this is reflected by European representation throughout the WFSA structure. This includes the President, 5 members of the Executive Committee and 23 other European members on our various Committees.
WFSA wants to maintain and develop its good relationship with ESA. The European Regional Section is the NASC (National Societies Committee) arm of ESA. The reason is that the WFSA is a Federation of national societies. Every year during the Euroanaesthesia Congress, the officials from the two organisations meet to discuss matters relating to further cooperation especially in educational and scientific fields, and there are several other meeting points throughout the year. Both ESA and WFSA allow the other organisation a free stand in the exhibition area during the congresses.
During the last decade, the WFSA has developed into a networking and solidarity organisation, where most of the funds are spent on educational activities in less affluent countries. I recently listened to an economist explaining why the USA works so well as an economic federation because the states which create a surplus of money subsidise those other states that do not; so for example the rich, highly industrial north western states subsidise those less affluent areas in the south. Very few people know about this practice which has taken over 100 years to develop and become accepted. It may be a good model for the whole of Europe to adopt if it wishes to become a similar integrated federation but it is certainly the model that WFSA utilises. The more affluent countries
throughout the world provide resources, which can be financial or personal, which are then used to enhance the practices of the less affluent and more importantly improve patient care around the world.
WFSA see that the less affluent nations have no doubts about the value of their WFSA membership and welcome the benefits they enjoy from such educational activities and also in organisational and political support. So for example two recent letters written by the ESA President and myself to the Acting Minister of Health in Romania, just prior to a large Congress in Timisoara, led to an announcement at the Opening Ceremony that the Government had granted everything in the programme that the local Society had requested, and that the ESA President and I had endorsed in our respective letters.
Many member countries are fortunate to live in affluent circumstances in terms of anaesthesia provision, availability of drugs and facilities, teaching and courses and can afford to travel to achieve continuing professional development. So these affluent nations are net givers to both ESA and WFSA, which in turn utilise that money to improve the circumstances of colleagues either in Europe or around the world. The cost of a medium cappuccino per member per year to achieve such positive outcomes does not seem to be unreasonable. You can see our results on our website (www.anaesthesiologists.org) and read about them in our new e-newsletter or follow us on Facebook or Twitter.
When WFSA was created in 1955 it was not by chance that this occurred in Europe. Francis McMechan (the American who had founded the International Anaesthesia Research Society [IARS]) and the newly
Europe and the World Federation of Societies of Anaesthesiology (WFSA) //Past present and future.DAVID WILKINSON // PRESIDENT, WFSA // lor ikeet08@gmai l .com
WFSA“
”
The history of medicine is that what was inconceivable yesterday and barely achievable today often becomes routine tomorrow.
(Starzl TE et al Hepatology 1982;2:614)
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formed French Society for the Study of Anaesthesia and Analgesia started to discuss global co-operation in 1936. They planned an anaesthesia congress in Europe but the Second World War intervened and such a congress was not initiated until 1951when the French surgeon Robert Monod convened an International Anaesthesiology Congress.1. This French society was dominated by surgeons and they contacted the UK Anaesthesia Society (The Association of Anaesthetists of Great Britain and Ireland [AAGBI]) to ask for help in creating an international society of anaesthesiologists. Representatives from Denmark (also representing Norway and Sweden), Belgium, Italy, the Netherlands and Switzerland soon joined the discussion. At around the same time the AAGBI had a combined meeting with the IARS and interested people gathered to discuss the concept of an international society. Again there were representatives from Europe, and now these were joined by anaesthetists from Brazil, Canada, Australia, USA and Argentina.
This group formed an interim committee with Harold Griffiths from Canada in the chair. He was ably assisted by representatives from Sweden, Belgium, UK, The Netherlands and France. This interim committee met in Brussels in 1953 and by 1954 had drawn up a provisional constitution for the embryo WFSA. The first World Congress of Anaesthesiologists took place in Scheveningen, The Netherlands on 5-10 September 1955. The WFSA was created during the closing session of the Congress. Of the 26 countries who sent official delegates, 15 were from Europe and a further 7 European countries were present as observers.1 It is not surprising that Europe has remained crucially important to the WFSA ever since.
The First European congress in Vienna was held in 1962, and this meeting led to discussions about a European Regional Section (ERS) of the WFSA. This was officially formed after the Second European Congress in 1966. In Eastern Europe a locally organised International symposium was held every 2 years from 1963. In 1978 after several years of discussion the European Academy was formed which then held annual meetings and in 1987 the original European Society of Anaesthesiologists was formed. Soon after this (1998) the ERS re-invented itself as a Confederation of European National Societies (CENSA) and started to hold meetings every 2 years.
So there were three major organisations that represented European anaesthesiology – the ESA with personal members, the EAA, who dealt with the Diploma and the CENSA. Anaesthesiologists in Europe saw the benefit of joining forces between these three, and eventually the new European Society of Anaesthesiology (ESA) emerged in 2004 2. This is a unique organisation which has incorporated all the aspects of the three original societies into one and therefore has both individual and national society membership. Its annual meetings are rightly regarded by many as the highlight of the European Conference season. The WFSA now works in close collaboration with ESA to further both sets of aims of the two organisations which is to achieve a parity of care for all patients throughout the continent. Europe sits at the very core of WFSA. We value all of our member societies from this continent and we constantly seek to improve our communications with you and wish to respond to your needs and ideas. We are always happy to hear from you and you can
contact our Secretary Gonzalo Barreiro by email at any time ([email protected]) or me ([email protected]) . Please do this. WFSA enacts the wishes of the delegates of its General Assemblies. The next of these will be in Hong Kong in August 28-September 2nd of 2016 and then in 2020 the WCA will come to Prague in the Czech Republic. We look forward to seeing you at these and many other meetings. //
References1. Mauve M. The long way towards the establishment
of the WFSA in World Federation of Societies of Anaesthesiologists 50 years. Edited by Gullo A , Rupreht J. Springer Verlag, Milan. 2004. 6-34.
2. Wilkinson DJ. WFSA and Europe – a long but complicated relationship in World Federation of Societies of Anaesthesiologists 50 years. Edited by Gullo A , Rupreht J. Springer Verlag, Milan. 2004. 159-173.
Europe and the World Federation of Societies of Anaesthesiology (WFSA) //Past present and future.
WFSA
Future Anaesthesiology Meetings // 2013
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2013February, 21-242013 UBC Whistler Anesthesiology Summit Contact: [email protected] I www.whistleranesthesia.ca I Whistler, Canada
March, 5-7ESA Masterclass on Clinical Research Contact: [email protected] I www.euroanaesthesia.org I Brussels, Belgium
March, 19-2233rd International Symposium on Intensive Care and Emergency Medicine Contact: [email protected] I www.intensive.org I Brussels, Belgium
April, 3-5GAT Annual Scientific Meeting www.gatasm.org I Oxford, UK
April, 5-7International Symposium on Spine and Paravertebral Sonography for Anaesthesia and Pain Medicine 2013 Contact: [email protected] I www.usgraweb.hk/issps2013 I Hong Kong
April, 23-274th NWAC World Anesthesia Convention www.nwac.com I Bangkok, Thailand
April, 25-2610th Annual Critical Care Symposium Contact: [email protected] I www.critcaresymposium.co.uk I Manchester, United Kingdom
April, 28 – May, 55th Association of South-East Asian Pain Societies Conference (ASEAPS 2013) Contact: [email protected] I www.aseaps2013.org I Singapore
May, 2-3 European Pediatric Resuscitation & Emergency Medicine Meeting [PREM] www.prem2013.be I Ghent, Belgium
May, 17-19 Tiantan International Neurosurgical Anesthesia Symposium (TINAS) Contact: [email protected] I www.t-nas.com I Beijing, China
May, 22-25 6th World Congress on Abdominal Compartment Syndrome (WCACS) www.wsacs.org I Cartagena, Colombia
May, 22-25 5th European-American Anesthesia Conference Contact: www.hdail.hr/2013 I Rovinj, Croatia
June, 1 - 4Euroanaesthesia 2013 Contact: [email protected] I www.euroanaesthesia.org I Barcelona, Spain
Future Anaesthesiology Meetings // 2013
Copyright 2013The European Society of Anaesthesiology a.i.s.b.l. (ESA) No part of this Newsletter may be reproduced without prior permission. The views expressed in this Newsletter are not necessarily those of the ESA. Where identified, the opinions are those of the author. Otherwise the views expressed are those of the Editor(s). The ESA cannot be responsible for the statements or views of the contributors.
27Printed on FSC certified paper
June, 6-9FSA 2013 Annual meeting Contact: [email protected] I www.fsahq.org I Palm Beach, Florida, USA
June, 8-1123rd European Neurological Society Meeting www.ensinfo.org I Barcelona, Spain
June, 17-209th International Symposium on Pediatric Pain www.ispp2013.org I Stockholm, Sweden
August 26-2932nd Congress The Scandinavian Society of Anaesthesiology and Intensive Care medicine www.congress.utu.fi/ssai2013 I Turku, Finland
August, 28 – September, 111th WFSICCM Congress www.criticalcare2013.com I Durban, South Africa
August 29-31First International Georgian Symposium in Anesthesiology and related fields Contact: [email protected] I www.gsaccm.ge I Batumi, Georgia
September, 9-15Panarab Anaesthesia Congress Beirut, Lebanon
September, 18-20Annual Congress of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) www.aagbi.org I Dublin, Ireland
October 31 – November 2ESA Masterclass on Clinical Trials and Clinical Epidemiology Contact: [email protected] I www.euroanaesthesia.org I Utrecht, The NetherlandsNovember, 6-9New Zealand Anaesthesia Annual Scientific Meeting www.nzadunedin2013.com I Dunedin, New Zealand
November 8 - 9ESA Autumn Meeting 4 Contact: [email protected] I www.euroanaesthesia.org I Timisoara, Romania
2014
May 31 - June 3Euroanaesthesia 2014 Contact: [email protected] I www.euroanaesthesia.org I Stockholm, Sweden
June 1- 4
Barcelona, Spain
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