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VOLUME 59 / / AUTUMN 2014 / / EDITOR GABRIEL M. GURMAN

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The ESA and the WFSA Sponsored Grants and PrizesDon’t miss the deadline!

Euroanaesthesia 2015Upcoming deadlines

Anaesthesiology // a universal profession GABRIEL M. GURMAN, MD / / ESA NEWSLETTER EDITOR / / gurman@bgu.ac . i l

The date was February 1, 1980. I stood up in front of the closed door of my future boss’ office, the director of the anaesthesia department at Toronto General Hospital. Months before I had successfully applied for the position as senior resident in that esteemed department, where Harold Griffith, in 1942, used for the first time a neuromuscular blocking drug for general anaesthesia.

My trip from Israel to Toronto was a long and difficult one, but I managed to reach the Canadian city just in time to be able to meet the department staff a few hours later. I was waiting to be introduced to the director of the department and I had time to cast a short glance at the multitude of announcements and posters hanging on the walls of the waiting room. Suddenly I discovered my name on the list of physicians on call for that month. To my stupefaction I was supposed to be on duty in the night of February 3, 48 hours after starting my job!

Not one of my future colleagues had met me before. My CV, sent just a few months earlier, mentioned only a few facts about my previous professional experience. Nevertheless the department decided to expose me (and my future patients!), from the first few days, to the routine activity of a very busy department!

Years later I tried to offer to myself an answer to the question regarding my fellows' confidence in my ability to fulfil the job, without interviewing me or seeing me at work. The answer was a simple one. After I had spent many years of anaesthesia and critical care practice in various Israeli hospitals, they were sure that we spoke the same language, used the same drugs and techniques, and mainly that we had the same concept about our profession and what had to be done for the sake of patient safety.

One can argue that today every single medical specialty is a universal one, since all the physicians around the globe are exposed to the same professional literature, to the same kind of philosophy, which eventually permits us to act as modern healers.

This may be true, but I have the confidence that anaesthesiology is a special domain in which the universality is more evident.

We have been among the first medical professions, if not the first, to have a World Federation. It was in 1955, only ten years after the second world war, that 800 anaesthesiologists from 44 countries attended the first world congress of the new World Federation of the Societies of Anesthesiologists (WFSA) in Scheveningen, Holland, and created a tradition which has run to the present day. Our congresses became a very efficient opportunity and framework to spread over the modern techniques, the use of the newest drugs, but especially to create the base for a unique approach to the surgical patient.

WFSA included in its constitution the goal of disseminating scientific information, but also the task of creating "desirable standards of training and… the establishment of safety measures including the standardisation of equipment".

The results did come quickly. All over the world anaesthesiologists started using the anaesthesia machines built according to universal principles and answering to the basic demands for routine activity. Tracheal intubation became the standard technique for administering volatile drugs and assuring proper ventilation of the patient. Ether replaced chloroform, halothane replaced ether, pancuronium replaced curare

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and gallamine, fentanyl replaced meperidine. N2O remained, together with oxygen, the main vehicle for volatile anaesthetics.

Gradually, protocols and guidelines have been created for the vast majority of our daily activity, from the use of clinical and instrumental monitoring to the performance of regional anaesthesia. Indications and contraindications for drugs and techniques became routine and have been implemented in every single operating room.

The average anaesthesiologist easily accepted the initiative of the American Society of Anesthesiologists (ASA) regarding the classification of the risk of the surgical patient. The ASA classification is today, decades since its introduction into practice, the main system of establishing the patient’s chances of safely undergoing surgical and anaesthesia procedures.

In other words, we started speaking the same professional language, and accepting the same principles, limits and indications for each of the details of our daily practice.

In the vast majority of our hospitals the surgical patient passes the same stations, from the outpatient anaesthesia assessment clinic to the last examination before entering the

operating room, and then postoperative care area or intensive care unit until full recovery. One anaesthesia chart is very similar to the other and it contains the same data, such as drugs, dosage, kind of techniques used, as well as evolution of the same vital signs monitored during the procedure.

We are still the only medical specialty which tries to harmonise the methods of professional education and training, by teaching the average anaesthesiologist the modern principles of teaching and assessment of results.

I could imagine that some of the readers of this editorial will dispute the view of a universal profession, emphasising the fact that universality is a question of availability. Not all our operating rooms have the same facilities, not all anaesthesia departments have access to the same modern equipment and drugs. And more than anything, not all our hospitals possess the necessary manpower in order to cover all our professional tasks.

To those who would bring into discussion these arguments I would answer that at least each of us knows today the goals for which every single anaesthesiologist is supposed to aim to achieve. Standardisation of our equipment, availability of all the necessary drugs and existence of the necessary facilities are all well

known today by every single professional in our domain.

But by creating a profession with universal principles, techniques and protocols, we also eased the phenomenon of manpower migration. The anaesthesiologist today is the medical professional who has the highest chance to accommodate him/herself to almost every single place of work, as distant from his original place at it could be.

This situation accentuates the manpower shortage in many countries and hospitals, but one cannot forget the simple fact that we live in a free world and each of us has the right to select his or her workplace. The solution for the lack of manpower resides in the hands of the medical administration in every single country and hospital and this reality should challenge the medical system in every single place in the way for finding a remedy to this real problem.

The above thoughts are supposed to produce reactions and comments. The Newsletter would be happy to host letters from our readers and it encourages them to write to us and express their views on this aspect of our profession. //

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Gabriel M.Gurman // ESA Newsletter Editor

UNIVERSAL

The ESA formally becomes the European regional section of the WFSA // 16 July 2014

The World Federation of Societies of Anaesthesiologists (WFSA) and the European Society of Anaesthesiology (ESA) are delighted to announce their agreement that with effect from July 2014 the ESA formally becomes the European regional section of the WFSA.

After extended deliberation and consultation (including with our colleagues in the NASC) we believe that this arrangement offers a solid working model for European member societies to contribute to, and benefit from, our global alliance. By assuming the role of regional section the ESA will have a more clearly defined collaboration with the WFSA, which is something that both organisations welcome wholeheartedly.

Please join us in celebrating this agreement as we look forward to enhanced co-operation and the positive impact this will have on our profession and those whom we serve.

David Wilkinson// President WFSA

Daniela Filipescu // President ESA

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ESA and Lifebox // supporting safer anaesthesia across Europe ESA is proud to announce a joint project with Lifebox Foundation and the Uzbekistan Society of Anaesthesiology and Intensive Care, which will make surgery and anaesthesia safer for colleagues and patients across Uzbekistan.

Oxygen monitoring and safety checks are essential for safe anaesthesia – but around the world, lack of resources and access to training means that many colleagues have to deliver anaesthesia without this support. Surgery becomes dangerous for the patient and difficult for the provider.

Lifebox is the only charity in the world specifically working to make surgery safer. The charity provides environment-appropriate pulse oximeters and training in oximetry and the World Health Organization (WHO) Surgical Safety Checklist.

This intervention is proven to reduce the risk of error and complication in low-resource settings by more than 40%.

ESA has a longstanding commitment to patient safety. A donation of essential equipment and training to Uzbek colleagues, via Lifebox, will continue this work, safeguarding hundreds of thousands of lives.

The first oximeter was formally presented to the Uzbek delegation at the recent Euroanaesthesia conference in Stockholm, Sweden, and many more will follow.

“For those of us who live in areas where anaesthesia services are available and safe, we should share our knowledge, competence and resources,” said Dr Jannicke Mellin-Olsen, vice chairman of the European Patient Safety Foundation. “Lifebox is a reliable, well documented programme to improve access to safe anaesthesia and surgery in every corner of the world.”

Links

http://www.wfsahq.org/about-us/national-member-societies/200-uzbekistan-uzbekistan-society-of-anaesthesiology-and-intensive-care

http://safersurgery.wordpress.com/2014/06/06/hej-hej-esa/

For more information, please visit www.lifebox.org or email info@lifebox.org VACANCYVACANCYVACANCY

Jannicke Mellin-Olsen, Dan Longrois and Uzbek // colleagues led by Professor Sabirov.

VACANCYVACANCYVACANCY05

“”

The most important factor contributing to the death of a patient undergoing ocular surgery is his pre-existing medical condition

(J. Petruscak, 1973)

Trainee Exchange Programme Committee Member Recruitment //The ESA is seeking to recruit a new member of the ESA Trainee Exchange Programme Committee.

The three-year mandate of the member of the Trainee Exchange Programme (TEP) of the ESA becomes vacant on 01/03/2015.

RoleThe new member will start on 01/03/2015. The TEP plays an important role in the activities of the Society. The Committee is currently composed of three members. The TEP member post requires close liaison with the Trainee Exchange Programme Department of the ESA Secretariat in Brussels throughout the year to:• Review and score the trainees applications selecting those

awarded every year• Review the centre applications to fulfil the requirements to be

included as host centre• Recruit centres, either directly or via the National Representatives

(Members of Council or Presidents of the National Member Societies)

• Generate an annual report to the ESA• Play an active role in the improvement of the Host Centres of the

TEP• Play an active role in the ESA Trainee Exchange Programme

The appointed members will be required to attend one meeting of the TEP at the Euroanaesthesia Congress. Travel expenses to attend meetings of the Committee are provided according to standard ESA policy.

RequirementsApplications are encouraged from active ESA members who meet the following criteria:• Experience of anaesthetic teaching and training nationally

• Experience of trainee exchange programme nationally and internationally

• ESA Contributions• National and international examinership experience• Personal experience of being a fellow or trainee abroad• Applicants must have an ESA Active Member for at least one year• Elected members will be requested to provide a conflict of interest

statement every year

The mandate is for three years, renewable twice for one year (maximum of five years).

ApplicationIf you are interested, and wish to apply, please send your CV and application letter (detailing the adherence to the requirements set forth above) and disclose any conflict of interest you may have to the Trainee Exchange Programme tep@esahq.org no later than 05/01/2015 (23:59 CET) with the following subject ‘ESA Trainee Exchange Programme Committee member - vacancy 2015’

Appointment will be made by the ESA Board following recommendations by the Nominations Committee. It is possible that interviews will be held at the ESA Secretariat to select the successful candidate.

If you would like to discuss any aspect of this post, please contact:Dr. Bazil AteleanuChairperson of Trainee Exchange Programme Committeebazilucu@hotmail.com

For more information about the ESA Trainee Exchange Progamme Committee please visit the ESA website (www.esahq.org). //

Sponsored Grants and Prizes // Don’t miss the deadline!

BAXTER Prize Outcome improvement in perioperative medicine //

The 2nd BAXTER Prize in Anaesthesia and Intensive Care Medicine is awarded for a clinical or a laboratory peer-reviewed publication of significant relevance on the following area of interest: Outcome improvement in perioperative medicine. The paper must have been published in the previous calendar year (award in 2015 for a paper published in 2014).

The paper of highest interest and importance will be rewarded with € 10,000.

DRÄGER Prize in Anaesthesia and Intensive Care Medicine //

The 9th DRÄGER Prize in Anaesthesia and Intensive Care Medicine is awarded for a clinical or a laboratory peer-reviewed publication of significant relevance on an intensive care topic. The paper must have been published in the previous calendar year (award in 2015 for a paper published in 2014).

The paper of highest interest and importance will be rewarded with € 10,000.

MAQUET Anaesthesia Research Grant //

The 4th MAQUET Anaesthesia Research Grant is awarded and sponsored by MAQUET Critical Care (MCC). The MCC aims to support research in a certain focus area every year which may be of importance for perioperative ventilation during complicated anaesthetic procedures and to support also the development of young or mid-career investigators. The area of interest for 2015 is Prolonged inhalation anaesthesia, the use of inhalation agents in the ICU. Risks? Benefits? Costs effectiveness?

The research plan of highest interest and importance will be rewarded with € 10,000.

PHILIPS Grant in Anaesthesia and Intensive Care Medicine //

The 1st PHILIPS Grant in Anaesthesia and Intensive Care Medicine is awarded and sponsored by PHILIPS. PHILIPS aims to support research dealing with routine data, such as in large electronic data bases of patient data management systems, electronic hospital data, or electronic anaesthesia records. The area of interest for 2015 is Research with perioperative routine data.

The research plan of highest interest and importance will be rewarded with € 20,000.

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GRANTS&PRIZES

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The aged and chronically ill have become the principal consumer of intensive care

(GE Thibault, 1980)

The submission deadline for each Grant/Prize is 1 February 2015, 23:59 CET.In the year the Prize/Grant is awarded, the winner receives free registration to the Euroanaesthesia Congress to accept the Prize/Grant during the Awards Ceremony.

Guidelines and Eligibility Criteria

• Anybody can apply for an ESA Grant or Prize. However, in the case of an experimental researcher, the applicant must be a full ESA member (either active, affiliate, non-physician health professionals, retired or honorary) or if there are co-investigators, at least one of these investigators should be a full ESA member at the moment of application.

• Any qualified member of an institution in one of the European countries that is represented in the ESA Council or from which the National Society is an active Society Member of the ESA may apply.

• Proposals co-authored by employees of BAXTER, DRÄGER, MAQUET, PHILIPS for their respective Grant/Prize are not considered. Any financial support from an industry or any other source for the research must be detailed in the application.

For more information on guidelines, eligibility criteria and application process, please visit www.esahq.org/research or email research@esahq.org.

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Masterclass in Statistics & Research Methodology 2014 // Feedback from participants ANA STEVANOVIC / / GERMANY / / as tevanov ic@ukaachen.de

Who, at the beginning of his academic career, did not experience the situation to sit in front of a manuscript-revision and wonder about the reviewers' comments regarding the statistics part of the manuscript? You try to get one of your experienced colleagues to help you with the statistical revision. They show you which statistical test is more appropriate for your question and you perform a new analysis and resubmit your manuscript. So far so good, but if you ask your colleagues “why” do I have to take this test and not the other, they cannot always give you a satisfactory answer. I decided to search via Internet for a real statistic course for researchers. And I was lucky to find one on the ESA website. I applied for the participation in the ESA Masterclass in Statistics & Research Methodology, and I was really thankful that my application was successful.

Arriving in Brussels, I did not really know what would await me. Eight hours of statistics in English language for 3 days, that sounds exhausting! But it was not exhausting at all; it was interesting, very educational and also very funny. The Master-lecturer Dr. Nadia Elia, Dr. Malachy Columb and Dr. Sergi Sabaté were fascinating, because they were really enthusiastic for statistics and methodology and they aimed to transfer this enthusiasm to us. This was an extensive course, where we learned all kinds of statistical analyses, which we need for the design and analysis of clinical trials. Each lecture section was followed by practical exercises on our own computer. The basic knowledge about statistical analyses varied between the attendees, but we had enough time to ask individual questions during the whole course and we helped each other with the exercises. We did not only learn how to perform the statistical analyses, we also learned “why” to take, which test. Furthermore, it was interesting to get to know some tips and tricks about the manuscript submission process and the initial appraisal factors by the editors. One take home message was that only a good abstract takes you further and you should never write “this data” or “reverse correlation” in your manuscript.

Beside the confidence in my statistical knowledge I have gained many new friends through this Masterclass course. There were attendees from different countries in Europe and also from far away Asia. It was interesting to share our experiences of our anaesthesiological every day and researcher life. After the courses we could enjoy Brussels together and we were lucky to be accompanied by Belgian sun and summer temperatures.

This Masterclass course was perfectly organised and I would like to thank the ESA team and especially Brigitte Leva. I highly recommend applying for upcoming ESA Masterclasses, as you can only gain fantastic experience and knowledge.

MONA MOMENI / / BELGIUM / / mona.momen i@uc louva in .be

I have had the privilege to participate to the Masterclass in Statistics held from 2-4 September in Brussels. The Masterclass on Statistics is one of the many Masterclasses organised by the ESA. When I first noticed the announcement, I knew this was a great opportunity not to miss. Doing research is a process of falling and standing up. To conduct good clinical trials, good research methodology is mandatory and this has been very well highlighted during this course. The three members of the Faculty have managed to clarify many easy and complex subjects in such a professional way during only 3 days. Although I have performed my statistical analyses since a while, by attending this Masterclass I have learned so many new elements. As a matter of fact I have recently put some of the theoretical sessions into practice.

From a personal point of view, to conduct my very first meta-analysis during this course has been really great fun. It was also a pleasure to discover the ESA headquarters—a very beautiful building in a very quiet street where I had never been earlier although I have lived in Brussels many years.

The 3 members of the Faculty, Malachy Columb, Nadia Elia and Sergi Sabate have really done a great job during these 3 days and I would really like to thank them again. I would also like to thank ESA and in particular the Research Department for emphasising the importance of research in the field of Anaesthesia. Last but not least, this Masterclass has been a success thanks to the professional organisation of the ESA’s Brigitte Leva. //

Ana Stevanovic // University Clinic RWTH Aachen, Germany

Mona Momeni // Cliniques Universitaires Saint-Luc, Belgium

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Learning from your evaluation of Euroanaesthesia 2014 // DAN LONGROIS, ON BEHALF OF THE ESA BOARD OF DIRECTORS AND ESA SECRETARIAT // dan.longrois@bch.aphp.fr

Both those that evaluate and those who are evaluated have much to learn from all the evaluations from the 1094 responses out of 5255 registered participants to Euroanaesthesia 2014. The detailed numbers of the survey are available on the ESA website (www.esahq.org). You are invited to analyse them.

Science //A scientific meeting, such as Euroanaesthesia 2014, is first about science. Most of the respondents came to update their knowledge of anaesthesia. Perioperative and intensive care medicine were the next two domains of interest. The ESA Board and the Scientific Committee have decided to allocate more sessions to these two domains without altering the quality of the sessions dedicated to anaesthesia. General and regional anaesthesia were the most attractive topics, followed by intensive care, monitoring/equipment, neuro-, obstetric and cardiothoracic anaesthesia. The “least attractive” were experimental anaesthesia and ethics. Did the majority of the respondents attended mainly sessions that are relevant to their daily practice? That could have been the case. More than half of the respondents were not able to attend all the sessions they intended to. It is tempting to interpret that there should be fewer sessions in the future.

Format //Scientific content and scientific format are related. Lectures, refresher courses and symposia were the top ranking formats. The least preferred were the “Pro-Con Debates” and the “Meet the Experts” formats. Why? It is difficult to give one single answer. But a better definition of which scientific content profits most from a given format provides food for thought for the Scientific Committee.

Communication //Most of the respondents perceived that the communication before and during Euroanaesthesia was excellent or good, relating to both announcements of the Congress and the ESA mobile application. This is excellent news, as ESA has invested much into implementation of the ESA mobile application. Nevertheless, approximately 30 % of the respondents did not use the ESA mobile application or the Daily Congress E-News. For Euroanaesthesia 2015, ESA will improve the communication that these communication tools exist to help delegates use their time more efficiently.

Other aspects //1. In addition to scientific exchange, Euroanaesthesia is also the place to be to meet

colleagues and visit attractive cites in Europe. Meeting colleagues from all over Europe and the rest of the world is an important motivation to attend Euroanaesthesia. The respondents sent a clear message to those who anticipate that virtual congresses will replace face-to-face scientific meetings, that this is not what they want. The ESA Board has definitely got your point.

2. Most of the respondents financed their participation themselves. They obviously mean that the quality of Euroanaesthesia is worth this effort. This is an additional incentive to aim for the highest possible quality for the future Euroanaesthesia meetings.

3. The organisation of the meeting, in all its aspects, was considered by the overwhelming majority of the respondents as excellent or good. One can always improve, and ESA pledges to do so. Still, this feedback is rewarding for all who contributed to Euroanaesthesia 2014. The members of the ESA Secretariat worked hard to deserve such excellent evaluation forms.

Conclusion //The efforts made to fill in the evaluation forms will be of benefit to you as participants in future Euroanaesthesia meetings. The Board of Directors of the ESA, the Scientific Committee and all members of the Committees and Sub-Committees of the ESA thank the respondents and all the participants to Euroanaesthesia 2014. We take your engagement to work even harder to allow ESA and Euroanaesthesia to contribute to improved training of anaesthesiologists from Europe and other parts of the world. See you in Berlin 2015! //

Back row (from left to right) // G.Nardai (HU), A. Cortegiani (IT), S.Sabaté (ES speaker), E.Rossetti (IT), T.Muders (DE), E.Fominskiy (RU), A.Sciusco (UK), V.Russotto (IT), S.Spadaro (IT)

Second Row (from left to right) // A. Frigyik (UK), L. Pasin (IT), N.Elia (CH speaker),M.Columb (UK Chair), M.Momeni (BE),A. Stevanovic (DE), F.Merella (UK), G.Tsaousi (GR), M. Ferner (DE), A.R.Tantri (ID), I.Blaskovics (UK), B. Leva (ESA BE)

First row (from left to right)//I.Kajtor (UK), A.Wolfler (IT), Z.Mokini (AL), R.Karan (RS)

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Dr Jane Fitch //THE CURRENT PRESIDENT OF THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS // jane-f i tch@ouhsc.edu

1. Was this your first participation at an ESA congress?

Yes it was my first time at the ESA congress. But the first of many to come!

2. Do you see any significant differences between the annual ASA meeting and ours?

I think the biggest difference is there is always a global perspective at Euroanaesthesia. The ANESTHESIOLOGY™ annual meeting tends to focus on USA national issues such as education and advocacy issues that we experience here in America. The feel I got at the ESA congress is more of a multinational, global focus and interest.

3. In accordance to what you saw and heard, what do you think about the way ESA succeeds in fulfilling its role of coordinating our profession activities in Europe?

It’s obvious that the ESA does a terrific job in reaching out and involving all the European nations. It’s just incredible that there were so many different countries present at the congress, it was truly a global affair. The ESA has done a wonderful job attracting so many international attendees.

4. European anaesthesiologists, in the vast majority of countries, are involved daily in critical care, pain management and emergency medicine, since in many countries all these belong to anaesthesiology. Could you refer to this significant difference in how we practice on each side of the Atlantic?

Interestingly enough, our practice is evolving to be more and more like the European practice. We are making critical care and pain medicine a much more integral part of what we do, especially in our education and training program. As we pursue the perioperative surgical home model of care delivery, it will allow us to expand and further highlight critical care, pain medicine

and other areas such as palliative care. Our practice is going to look more and more like the European model as we make strides with the perioperative surgical home model of care.

5. How could you describe the relations between ASA and ESA?

Terrific. They have never been better, and I think it’s because we are realising that it is such a small world in terms of anaesthesiology. We all have very common goals and interests related to patient safety and education. When we come together we have the opportunity to learn something with a slightly different slant. We can take what we learned and enrich what we’re doing with our patients and our practice locally because of the international perspective we gain when we work together.

6. Do you intend to use your media in order to tell your American fellows what did you see in Stockholm?

Yes! In fact, there is an article on Euroanaesthesia 2014 in the September edition of the ASA NEWSLETTER. We also have an ESA booth in the Exhibit Hall at the ANESTHESIOLOGY™ 2014 annual meeting this October, where attendees will hear about the congress and be able to pick up information. We are also happy to share Euroanaesthesia information on ASA social media platforms. //

Editor’s note: The last Euroanaesthesia congress, in Stockholm, was attended by a large number of participants from all European countries, but not only this... We have been fortunate to host three presidents of National Societies outside our continent. All three of these special guests have been kind enough to answer to some questions related to their participation to our congress, as well as about the future of the relations between ESA and other professional organisations. Here are their answers.

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Dr Richard Grutzner //THE CURRENT PRESIDENT OF THE AUSTRALIAN SOCIETY OF ANAESTHETISTS // r ichard@grutzner.net .au

I was privileged to be invited to attend the European Anaesthesiology Congress in Stockholm as a guest of the ESA. The meeting was preceded by my attendance at the Common Issues Group (CIG) meeting of the major English speaking anaesthesia societies including Canada, the United Kingdom, New Zealand, South Africa, the United States and Australia. One of the major themes of the CIG meeting was the sustainability of health systems in the developed world and how to provide better value from scarce health resources. The ESA meeting and the Prof Francois Clergue’s Sir Robert Macintosh lecture was fascinating as the problems we face in anaesthesia are the same throughout the world. The issues of an ageing population, the obesity epidemic and providing equitable access to health care remain challenges faced by all of our countries. How we deal with these challenges will define our success as health professionals.

I was able to attend sessions related to my own practice interests of safety, regional anaesthesia, and management of the shared and difficult airway,

welfare of anaesthetists and workforce issues. The breadth of the program was outstanding and the most challenging aspect of the meeting was to choose which lectures I could attend from the huge selection on offer. I was also privileged to attend a dinner with the heads of the various anaesthesia societies from around the world and it is at these functions where we can talk about the challenges we face in a more relaxed environment. All of our countries are dealing with the challenges in different ways and it is very helpful to come back to Australia with a more global perspective on our profession.

Away from the congress we were delighted to make our first visit to Scandinavia and the beautiful city of Stockholm. The Vasa Museum was a highlight and the story of the launch of this awesome battleship was amazing and possibly a metaphor for some of the health systems around the world in which we work. I am most grateful for the invitation to attend your wonderful meeting and I will endeavour to attend Euroanaesthesia 2015 in Berlin. //

Prof Sumio Hoka //THE CURRENT PRESIDENT OF THE JAPANESE SOCIETY OF ANAESTHESIOLOGISTS // shoka@kuaccm.med.kyushu-u.ac. jp

1. Is it your first participation to an ESA congress?

This is my third participation at an ESA congress.

2. How did you find the scientific program and the way it reflected the last developments of our profession?

Very interesting and informative. The most exciting one for me was the Sir Robert Macintosh Lecture entitled "The challenges of anaesthesia for the next decade"

3. Only one Japanese speaker was invited to this congress. Is it because of the weak relations between the two societies?

I do not think our relations are weak, but in the future I anticipate more invited speakers from Japan, if possible.

4. A nice number of abstracts have been presented by Japanese young researchers. Is there any intention for further scientific cooperation between ESA and your Society?

Previously our target was ASA, but recently a lot of Japanese anaesthesiologists are wanting to participate in ESA. We at the Japanese Society of Anaesthesiologists would like to cooperate more with your Society.

5. Is there any Japanese professional publication, preferably in English, which could be used by your European colleagues in order to improve the cooperation between us?

Our JSA’s official journal is “Journal of Anesthesia”, written in English. Please read and cite the interesting articles to improve our relations.

6. How much is the average Japanese anaesthesiologist involved in Critical Care and Emergency Medicine? Could you describe in short the residency track of a young Japanese anaesthesiologist?

Approximately, 5-10% are involved in Critical Care and Emergency Medicine. Regarding our residency program, after graduation of the 6-year medical school, the young physician has to spend two years in a compulsory residency program, which is mainly aimed at training as a general physician but they can choose short-term anaesthesia training during those two years. After that, if they decide to become an anaesthesiologist, they begin a special anaesthesiology residency program. After at least 4 or 5 years of anaesthesiology residency training, they can get the right to take examination to obtain the title of Japanese Board-certified anesthesiologist.

7. Would you like to receive the ESA Newsletter on a regular basis?

Of course, yes! //

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HISTORY OF ANAESTHESIA - FLASH 7 // FROM THE VERY BEGINNING UNTIL TODAY

HISTORY

This is a series 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 // glitarczek@yahoo.com

Airway and breathing // Breathing is a vital function recognised as such probably very early in human history being used either to administer gases or fumes or to be stopped with aim of killing. The relation between the movements of the thorax and the abdomen and respiration were also guessed.

Modern “controlled breathing” has its ancestors in resuscitation before being used in anaesthesiology. Both airway clearance and gas insufflation were tried with different solutions and rates of success. There are 2 items to be followed: 1. history of airway clearing and 2. ventilation of the lungs.

The problem of clearing an obstructed airway seems to be a very old preoccupation since the first document indicating a probable tracheotomy was discovered on a fresco found in the tomb of a pharaoh of the first dynasty (4000 BC), the Ebers papyrus (1550 BC) also mentions it, Indian texts dated 2000 BC mention it, Hypokrates (460 BC) used a shepherd's flute introduced in the upper airway while Asklepios of Bithynia describes also this method, Avicenna (1025) was teaching it and Detharding suggests it to facilitate artificial ventilation in drowning accidents. The technique had no success and was seldom used and accepted in usual practiced measures of resuscitation which were very peculiar and included measures like rectal insufflation, smoke inhalation, tearing of the tongue, flagellation, and also mandibular protrusion (Esmarch manoeuvre) under others. Tracheotomy came back and started to be used rationally in the middle of the XIX-th century under the impulse of Aramand Trousseau (1859) in France, Snow (1858) on animals and man in Britain, Trendellenburg (1871) in Germany who was

also credited to have the first time used tracheal intubation for anaesthesia and used a cuffed tracheotomy tube to seal the airway and prevent aspiration. In 1880 W.McEven performed tracheal intubation by mouth, his method being supported and extended by F.Kuhn (1901) who even wrote a book on the subject. O'Dwyer (1885) performed intubation blindly guiding a bronze-zinc tube with his finger and R.Kelly started to use oro-tracheal intubation in 1911.

Tracheal intubation was performed using different kinds of rigid and even flexible tubes made of metal or leather armed with a metal spiral wire (Anode) which was reinvented by Hargrove who used rubber instead of leather. Flagg like Kuhn used flexible metallic ring tubes. Silver was also considered a good material in some early tubes. Later tracheal tubes were made of varnished silk fabric (Gueddell-Waters), rubber (Elsberg, Maggill, Rowbotham, 1912) or plastic since around 1960. The initial tracheal catheters had no sealing cuff, this was added as a separate piece to be slipped over the tube. With uncuffed tubes sealing was provided by padding the pharynx with gauze pads provided with threads which were removed at the end of the procedure. Built-in cuffs became available only at the end of the 1950s. Development in this field includes introduction of low pressure cuffs, monitoring cuff pressure, all to prevent tracheal mucosal ischemia. Alongside with the usual tubes, special specimens used to block one bronchus or separate the airway of the two lungs (Carlens tube) were produced. In 1913 Chevalier Jackson was the initiator of direct vision tracheal intubation. He also introduced the distal light bronchoscope along with a special right blade of the

laryngoscope. Later laryngoscopes specially designed for tracheal intubation were imagined and built by Miller, Lundy, Janeway, Maggill (the father of the curved rubber tracheal tube and special introducing forceps), and Sir Robert McIntosh whose curved blade became a standard for adults.

A simple and very useful instrument to facilitate intubation was introduced by W. Curtis Cane (1949) - it was the stylet that later had a light bulb introduced in its front to permit its visualisation from outside (Ellis DG1968). Important improvement of all these instruments came with the introduction of fiber optic which first permitted the location of the light bulb in the handle of the laryngoscope so the blades could be sterilised by heat or in solutions and later fiber optic laryngoscopes replaced the classical ones in many services. External light sources and displays completed the system in recent years.

We must also remember the classical pharyngeal airway introduced by Hewitt in 1908 in a shorter oral version not reaching the pharynx, and later the real oro-pharyngeal airway at the Mayo Clinics in Rochester, MN, USA, and known as the Mayo airway which was modified by Lumbard in 1915. Models of open wire cage items were also proposed and produced by the Forregger company in 1930. In 1933 Gueddell proposed his now classical, rubber, metal reinforced, pharyngeal tubes, Leech in 1937 introduced the first pharyngeal tube provided with a inflatable sealing cuff.One step forward in the evolution of a patent airway-ventilator connection was the invention of the laryngeal mask, an alternative, less traumatic and easier to perform than tracheal intubation to obtain a

13HISTORY

secure airtight connection of the respiratory system of the anaesthesia machine to the patient's airway. It was invented and perfected by Archie Brain in Britain at the beginning of the 1980s and commercially available in 1987. The mask proved to be usable in many cases and gained a solid position in modern anaesthesiology.

The previously described methods ensure a clear airway and a secure connection of the patient's airway to the anaesthetic machine, preventing also aspiration of eventually regurgitated stomach content. The idea to assist the patient's insufficient breathing was not new as history mentions numerous attempts made on animals as well as on man to enhance respiration. If one of the problems of breathing was the airway, the second one was how to introduce the air in to the lungs in the absence of spontaneous movements of the thorax. Blowing it in to the lungs of a subject with one's own bellows (lungs) was the first idea of mankind. Even gorillas are cited to resuscitate their newborns by blowing their own breath in to the baby's mouth. It was cited also as being used usually by midwifes to resuscitate newborns. Own expired air resuscitation was scientifically certified by Peter Safar in 1958. Fire enhancing bellows to resuscitate were used also by some important figures of medicine like Vesalius, Paracelsus, Hook and others. Some of them even succeeded in maintaining alive thoracotomized dogs (which have a single pleural space) by inflating their lungs with the mentioned bellows. But again this was accepted as a method of resuscitation only at the beginning of the 20th century. With the event of the Draeger “Pulmotor” (1907) meant to be used outside hospitals mainly in mining. It was

followed by the “Combi” in 1911 a machine which included the first closed circuit with CO2 absorption. Based on the same principle to inflate the lungs by applying over pressure to the upper airways of the subject was the glass bell by Brown and Janeaway (1909), who proposed the placing of the subject's head in to a glass bell tightened with a neck collar, in to which alternative positive and negative pressures were applied. None of the mentioned devices became standard in anaesthesiology although some of them were tried. The problem of ventilatory support had longtime an evolution outside the field of anaesthesiology. The first idea of supporting expiration by other means than the blowing of own air and the bellows made by R. Eisenmenger with his cuirass (1903) and later Stewart (1918) in South Africa imagined the first “tank” or “steel lung” ventilator which was improved by Drinker, McKahn and Saw had a large recognition in the 1920s to the 1950s. In 1951 CG Engstroem produced his high performance respirator which, electrically driven, became a standard in general respiratory assistance and was later used also in anaesthesiology. During the same time in Germany, the “Poliomat”- a gas driven respirator - appeared, followed in France by the RPR (Rosenstiel, Pesty, Richard), also a gas driven respirator. The first anaesthetic machine permitting assistance of a patient's ventilation during anaesthesia was the “Boyle” (1918) and later the Waters to and fro closed system (1923) and the Schmidt-Draeger (1923) which was the first closed circuit followed in 1928 by the Sword-Forregger closed circuit, the first to gain popularity. And so bag-assisted or controlled respiration became accepted in anaesthesiology but was not used as routinely, a fact proven by

the Beecher statistics with the use of curare where patients receiving relaxants had no or insufficient supported ventilation leading to an increased mortality.

Mechanical ventilation in anaesthesiology, although used the first time by Craaford and Frenkner in Sweden (1938) with their “Spiropulsator”, could not be suggested and was not introduced before the intermittent positive pressure ventilation proved to be efficient. This happened only after World War 2 in Denmark with the advent of the polio epidemic (1952) with a special characteristic namely an early respiratory insufficiency due to early affection of the bulbar respiratory centres. Patients were tracheostomised and ventilated with closed Waters Systems by anaesthesiologists under the direction of Dr. Bjorn Ibsen. The first anaesthesia ventilators were bag or bellows in bottle type driven by various types of pumps functioning either with electricity or compressed gas. Blease (1945) in Britain developed an intermittent positive pressure ventilator, the “Pulmoflator” which was one of the first in his class and was later adapted for anaesthesia. Between the first anaesthesia ventilators, I want to mention the “Pulmomat” by Draeger (1956), derived from the “Poliomat” by making it to act upon a bag in bottle, both gas driven, and the “Narkose-spiromat”electrically driven items. It was quickly followed by other producers and the tendency became to convert intensive care respirators to be used in anaesthesiology. Slowly it became evident that a performing respirator is the key component of any anaesthesia machine, and this led us to consider that we are blessed with working with the most advanced devices in this field. //

George Litarczek// Professor

The Obstructive Sleep Apnea Death and Near Miss Registry //The Society of Anesthesia and Sleep Medicine (SASM) has partnered with the Anesthesia Quality Institute to launch a new Registry: The Obstructive Sleep Apnoea Death and Near Miss Registry. The goal of this new registry is to identify perioperative recurring patterns or themes underlying death or adverse events suspected to be related to obstructive sleep apnoea with the ultimate aim of risk prevention and improved anaesthesia patient safety. The registry seeks to obtain a large number of case reports to achieve these goals. Any medical provider can submit a case, but patients are not allowed to submit cases. Case report instructions and forms are available on the OSA Death and Near Miss Registry website:http://depts.washington.edu/asaccp/projects/obstructive-sleep-apnea-osa-death-near-miss-registry

“”

The cardiac anesthesiologist is the most important member of the team in helping the cardiac patient safely through surgery

(Logue and Kaplan, 1982)

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APNEA

An Italian anaesthesiologist in Africa ... //BRUNO TURCHETTA // bturche@gmai l .com

I am an Italian anaesthesiologist who divides his work between his native country and many other places in the world. This started many years ago, almost even before I finished my residency in anaesthesia and critical care in Milan, Italy, in 1985.

At the age of 27, rather than doing my military service, I volunteered in North Uganda as an anaesthesiologist involved in the activity of a missionary hospital. The experience accumulated there has been impressive and I was deeply touched by the fact that I was able to offer assistance to sick people who could not make it without my help Coming back to Italy I finished my residency, but my interest in alleviating human suffering created a new track of interest, one which made me use my annual leaving for working in remote places like Haiti and Uganda. Since then I have been in many places, outside Italy, spending my time in various remote locations, always in a small hospital which needed professional help.

Now, 40 years after I started my practice as an anaesthesiologist I accepted, last year, the invitation of a colleague to take the position of head of the anaesthesia department at CCBRT (Community Based Rehabilitation and Treatment) Hospital in Dar es Salam, Tanzania. This is a tiny hospital of 200 beds and its surgical activity is mainly focused on correcting problems in children. Last year we performed almost 1800 general anaesthesias for procedures in the fields of plastic surgery, eye surgery, orthopedic surgery, and other specialties. The daily routine of work is completely different from what we do in Europe. Lack of equipment and basic drugs obliges the anaesthesiologist to improvise.

Fortunately, we could use ketamine, diazepam or suxamethonium and pancuronium, as well as lignocaine or bupivacaine, but as volatile drugs we have only ether and halothane. Yes, we could use the basic vital signs equipment, like ECG, pulse oximetry and non-invasive blood pressure, but end tidal CO2 is available only in two operating rooms since the other four CO2 monitors need to be repaired. We lack central oxygen supply and use only cylinders, and have no possibility to warm infusion fluids in case of emergency.

Some cases present special anaesthetic challenges, like that case of severe stenosis of the mouth (cancrum oris), as a consequence of measles in a malnourished child (figure 1). Since there was no fiber-optic equipment available we decided to perform an elective tracheostomy. A comisurotomy was performed and everything went uneventfully. Some patients come from far away and transport cost has a very relevant impact on the parents’ decision to bring the child to the hospital.

Figure 2 presents a 3-year old boy, coming from a remote place, with very severe post-burn contractures, in need for plastic reconstruction of the neck. Since we expected serious intubation difficulties (Mallampati 3), with a minimal mouth opening, a decision was taken to start general anaesthesia on spontaneous respiration, using ketamine and fentanyl and adding local anaesthesia when possible. We prepared everything we could have in case of emergent intubation, including laryngeal mask and two different laryngoscopes. Once the adhesions have been cut off, the neck motility was once again possible and tracheal intubation succeeded on the first attempt. Surgery and anaesthesia were completely uneventful and the child successfully recovered.

This kind of case is not uncommon in our daily practice. Sometimes the activity in the operating room is hectic, but professional and personal satisfaction are a wonderful compensation for everything we do there. The fact that many of your patients would not survive without you being there and helping them makes my professional activity interesting and human. //

Editor's note: Dr Turchetta is one of the few European anaesthesiologists dedicated to helping populations in less developed countries. This is a short description of what he is doing now in Dar Es Salam, Tanzania.

Figure 1 //

Figure 2 //

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The On-Line Assessment // OLA!SUE HILL MA PHD FRCA // CHAIRMAN OF THE OLA SUBCOMMITTEE // suehi l l2@mac.com

The Online Assessment (OLA) is designed to help those preparing for the EDAIC written papers. It is an invigilated, computer-based assessment that provides rapid feedback on performance so that a participant can see how close their scores are to the usual pass scores for Paper A and Paper B of the EDAIC. The standard of question and composition of the papers is similar to that in the EDAIC although the use of computers allows inclusion of artefacts such as CT scans and X-rays to make the questions more clinically relevant. The OLA is deliberately held around six months before Part I so that should a potential EDAIC candidate find that they perform less well in specific sections, then there is time to focus attention on these before the actual examination.

On April 11th 2014, 303 anaesthetists participated in the second OLA across Europe and, for the first time, were joined by a group from Argentina. This was a 50% increase in participants compared with 2013 accompanied by an increase from 36 centres across 18 countries in 2013 to 39 centres across 21 countries this year. The first OLA in 2013 was available only in English but for 2014 it was translated into six additional languages: French, German, Polish, Russian, Spanish and Turkish. Next year we plan to extend this to cover Portuguese and possibly Italian.

Although the majority of participants selected English as their chosen language, we were encouraged by a significant number of German and Spanish speakers and would like to invite greater participation from anaesthetists whose first language is other than English. This is a great way to test knowledge and identify areas where there are “gaps” that should be filled. In the same way as the 2013 exam, the majority of the questions were specially constructed for the OLA by a dedicated question writing subcommittee of the Examinations Committee, the OLA Subcommittee. All questions map to the European Curriculum and cover all possible examinable domains. A small number of well-established questions from the EDAIC database were also included to allow comparison of performance in OLA to that in the EDAIC.

The participants for the 2014 OLA were spread widely across very junior to more senior trainees as well as some specialty doctors. The mean score in Section 1, equivalent to Paper A was 67.2% and for Section 2, equivalent to Paper B, was 70.3%. This can be compared with the mean scores for the EDAIC Part I averaging 73.5% and 76.6% for Papers A and B respectively over the last five years. The overall performance was a little below the performance in the EDAIC Part I, as would be expected from a different mix of experience of the participants. Examination preparation was the original reason for developing this assessment, but it can also be used as an annual test for anaesthetists in training so they can see their knowledge grow and scores improve as they become more familiar with the specialty of anaesthesia and intensive care and experience the subspecialties such as chronic pain, and anaesthesia for paediatric, neurosurgical and cardiac patients. The Netherlands has adopted the EDAIC/ITA and the OLA in this way: all trainees sit the EDAIC/ITA in September, and those that could not attend or did not perform as well as expected are invited to attend the OLA. There is no pass score set for the OLA - but it is possible for an individual hospital or a region or even a country to decide on the score they feel is appropriate to achieve for each stage of training. The cost of the OLA is less than for the ITA and EDAIC Part I; the fees are currently €80 for the OLA compared with €100 for the ITA and €240 for the EDAIC Part I. We envisage an on-line examination replacing the ITA in the not-too-distant future and eventually the EDAIC Part I will also become an on-line examination.

A potential wider use of the OLA is for more senior anaesthetists to demonstrate that they are up-to-date with their clinical knowledge and have retained and maintained their basic science knowledge. With annual appraisal and revalidation already introduced in some countries, this would be a great way to prove that behind a competent clinical performance is the relevant scientific and theoretical knowledge.

So I would like to challenge senior clinicians take part in the OLA, experience the breadth of the UEMS curriculum, and then run their own centre to encourage their more junior colleagues to use this formative assessment both for their own appraisal portfolios and to join the EDAIC community who have successfully completed both Part I and Part II.

On a final note, I would like to thank all the hosts for the OLA and their support staff who have made this assessment possible. Thanks also to the members of the OLA Subcommittee and the ESA office staff who co-ordinate all the behind-the-scenes work. //

TRAINEE

ESA FOCUS MEETING ON PERIOPERATIVE MEDICINE: THE PAEDIATRIC PATIENTNovember, 14 - 15Athens, Greece 17

Trainee representatives at the ESA Council //DIOGO SOBREIRA FERNANDES // PORTUGAL // d iogosobre i rafernandes87@yahoo.com.br

For the first time ESA has not one, but two trainee representatives. This is a golden opportunity, especially if we consider that this idea came from the council. As so, we were looking forward to embody this important task and saw on the 2014 ESA Symposium at Stockholm a great chance to do it.Our first impression as young residents was of a very well structured and organised society, enriched with an enormous European and worldwide diversity. We found a multiplicity of scopes of interests, namely education, investigation and promotion of our specialty. However, we noted the asymmetries that exist among the European trainees which are intrinsic to the geographical, socio-economical and cultural differences between countries.

We believe that as residents we have more things in common than as specialists. We are all submitted to an intensive and demanding training that almost reaches the burnout but still, we are optimistic in our future, despite all difficulties. Beyond that, our interests are purely academic. Our main goals for this 3 year term of office are to create a National Trainee Network between all ESA countries members and identify the three main concerns of ESA Trainees.

To establish this network, we intend to create an effective communication system between Local, National and European Trainee Representatives. This way we would be able to inform each other on relevant issues discussed in the council and also to acknowledge the main concerns of the trainees. As soon as we identify which are the three main issues that the ESA trainees would like to address, we will disclose them to the council so that a statement can be issued about them.

This network would also enable us to share our current practices and thus understand our differences and similarities. We believe that the promotion of this interchange of experiences and ideas, might be the basis of an increasingly number of exchange programs and a common pathway on the long anaesthesiology journey.

We believe that by establishing these objectives, we are empowering ourselves with a stronger communication and working for a firmer society. Although we are young voices in the ESA Council, we think this might be our greatest contribution to its growth.

Thus, you can count on us because we are counting on all of you. //

TRAINEE“

”The value of life lies not in the length of days but in the use we make of them

(Michel de Montaigne, 1533-1592)

ESA Trainee Exchange Programme // Hospices Civils de Lyon, FranceSTEFANO PEZZATO / / GENOA, ITALY / / s tepezza@gmai l .com

My name is Stefano Pezzato and I am a fourth-year resident from the Anaesthesiology and Intensive Care Department of “San Martino - IST Hospital” in Genoa, Italy.

It all started in the afternoon of 19 April 2012, when, as usual, I attended one of the monthly plenary lectures organized by the residency educational program. The topic on the poster was “The European Diploma in Anaesthesiology and Intensive Care: a new opportunity for European anaesthesiologists” and the speaker, invited by Prof. Pelosi, was Dr. Zeev Goldik - Chairman of EDAIC Examination Committee. At this point, I could not imagine how many opportunities were waiting for me in following months.

Listening to the presentation I thought over the meaning of my ESA membership, and the enthusiasm for a new “European” and “high-quality” point of view about our profession prompted me to send immediately my subscription to 2012 EDAIC Part-1 in Milan. Preparing for part 1 in few months was a challenge, but attending the first Basic Science Course during Euroanaesthesia 2012 in Paris and spending several sunny days revising, I successfully passed the exam. During these months, surfing the ESA website I discovered other interesting opportunities and in particular the Trainee Exchange Programme (ESA-TEP). I realised that ESA-TEP was exactly what I was looking for to improve my clinical experience during residency. So I tried to apply the award for the following year, and step by step I finally gained this great opportunity.

During my training in Genoa I experienced a semester in cardiac anaesthesia, so I was very excited discovering my destination for the exchange: “Hôpital Louis Pradel” in Lyon,

one of the most important cardiac surgery centres in France.

But as we know, “a traveller's life is full of surprises” … so when I contacted Prof. JJ Lehot, I discovered that he had recently moved from cardiothoracic anaesthesia to the nearby “Hôpital Neurologique” to become director of the neurosurgical anaesthesia and intensive care department. When I made contact, he suggested that I start in his team and to then move to the cardiac anaesthesia service for the second part of my three-months exchange. Now I have to thank Prof. Lehot for having proposed this “wide-horizon” experience.

“Hospices Civil de Lyon” (HCL) is the second Hospital-University Center (CHU) in France and consists in a network of 14 multidisciplinary or specialised hospitals that provide public health services in all medical and surgical disciplines. Different hospitals are grouped in 6 different medical centres around the city. This pattern of organisation leads to the “centralisation” of many activities to discipline-dedicated hospitals that treat a large number of patients.

The “Hôpital Neurologique Pierre Wertheimer”, situated in the Groupement Hopitalier Est, is the neurological and neurosurgical centre of HCL. Founded in 1963, the hospital has more than 300 beds with 4 neurosurgical services for adults and 1 for paediatric patients, several medical neurological services and the associated neurophysiologic and radiology services.The anaesthesia service works on 10 ORs supporting different neurosurgical activities and invasive-radiology procedures, in elective or urgent categories. I started my exchange attending neurosurgical OR and during my first

month I followed a lot of neurosurgical cases, taking part in patient management from pre-operative evaluation to early post-operative care in the excellent recovery room. Working with different seniors was a great occasion to observe different approaches, and during operating sessions I had time to ask a lot of clinical questions and to experience some skills in a new context. I have to thanks especially Dr. Guerin, Dr. Carillon and Dr. Bapteste and all the anaesthesia nurses who supported me with clinical explications and friendly dedication. In this month I saw treatment of neoplastic, vascular, endocrine, malformative and functional neurosurgical pathology, becoming more confident in their relative anaesthesiologic peculiarities.

During the second month I moved to focus my experience on neurointensive care medicine.The 32-beds neuro-ICU directed by Dr. F Dailler, is organised in two continuous half-units to receive patients from the OR to follow surgical patients during their routine monitoring post-operative care, but also and primarily to admit neurological critically-ill patients when an advanced neuro-intensive care setting is indicated. The ICU receives patients with severe traumatic brain injury and cerebrovascular accidents from the whole Lyon metropolitan area but also from other regional hospitals and more.

In ICU the day started at 8 am with a brief round with night-ward doctors. After the usual coffee-break with the staff, the morning round opened, demanding radiologic and biochemical exams, defining advices to require, examining patients and optimising treatments. Staying continuously with other residents allowed me to understand their role and to compare their experience with mine: to meet Amine, Oscar, Gustaf and Jean-

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Operating theatre during 3D video-assisted mitral valve replacement surgery //

Phlippe was a lucky occasion… thank you for sharing these weeks with me. The afternoon started with the daily whole-staff briefing with ICU nurses who presented each case to make the point and to share information on patients’ evolution. In the afternoon there were new admissions of daily post-surgical patients, but I had also occasion to become familiar with peripherally-inserted central venous line insertion and to practice with echo evaluations in ICU.

During my stay I had occasion to observe a lot of interesting clinical issues and I experienced neurological examination signs finding, neuro-imaging evaluation, ICP and PtiO2 monitoring, haemodynamic management and early-rehabilitation guidelines application.I have to thank Dr. Dailler and all doctors I met in ICU including Dr. Bodonian, Dr. Gregorescu and Dr. Terrier, but especially Dr. Diroio and Dr. Grousson for the training on trans-cranial Doppler evaluation.

In May, I moved to the cardio-thoracic-vascular anaesthesia service directed by Prof. O Bastien for the third and final part of my exchange. “Hôpital Cardiologique et Pneumologique Louis Pradel” is also situated in the Hospital-Group Est of HCL, near to “Hôpital Neurologique” Founded in 1969, is a large hospital where cardiac, thoracic and vascular surgery is concentrated, with a total of 397 beds (2012). The anaesthesia and ICU Service provides peri-operative management of surgical patients for scheduled or urgent procedures including heart transplants (25 in 2012 including 21 heart-lung) and paediatric surgery with a specific interest in cardiac malformations. In the ICU during 2012, there were admitted 69 patients with ECMO and 21 patients with ventricular-assistance devices.In these weeks I had the great opportunity

to follow different type of cardiac surgery including CABG and valve surgery, off-pump coronary surgery and mini-invasive video-assisted CABG and mitral surgery, to note corresponding anaesthesia specific issues.

Also vascular and thoracic surgical sessions were very interesting referring to anaesthesia and analgesia management. I had also the opportunity to spend some days in ICU: it was very interesting, but the time was too short and I would have needed more weeks to better understand the different clinical activities in such a complex ICU. I have to Thanks Prof. Bastien for this great occasion and Dr. Pavalkovic, Dr. Diarra, Dr. Koffel and Dr. Dellanoy who dedicated to me a part of their valuable time.

During the exchange Prof Lehot invited me to participate at interesting meetings on “heart involvement in non-cardiologic diseases ”, “fast-track surgery”, “end-of-life care” and to take part in a practical seminar about “difficult-airway management”. To participate at these meetings and to study the French books I received were very useful to improve my competencies and my medical French language during the exchange. I found also some interesting educational resources on the anaesthesia-service informatics directory.

Living for three months in Lyon was a very pleasant experience. Walking in the large historical centre called “Vieille Lyon” or in the central district of Presqu’ile, you can discover the cultural and commercial heart of Lyon. Climbing up the hill of Croix-Rousse you can admire the beautiful landscape of the entire city centre, and for a dinner you can appreciate the typical French-touch of Lyon, capital of gastronomy. After a day’s work you

can make a run from the Rhône riverside until the great park of Téte-d’or. Whatever your choice, a good integrated transport system helps you to move easily...but in my opinion the best way to live Lyon is the well-organised bike-sharing service: simple and smart, I used it daily to reach the hospital!

French people were very friendly with me inside and outside of the hospital, most of people was very understanding of my “intermediate-level” French. I met also some Italian residents and seniors at HCL: it was interesting to find something “familiar” in a different context and to interchange personal and professional experiences. Thanks to Elena for the apartment, and to Chiara e Domenico for their friendship and their smile.

In conclusion I consider ESA Trainee Exchange Programme a great formative experience during my residency training. I tested myself in different contexts, meeting on my way the right mix of difficulty and enthusiasm. My expectations were fulfilled and I recommend ESA-TEP as a useful opportunity in professional development.

Here I would like to express first my gratitude to Prof JJ Lehot and Marie his secretary, for their friendly welcome at HCL and for their constant support. I hope to see you and all the staff in future occasions. I have also to thank to ESA Committee for implementing and to promoting the ESA Trainee Exchange Programme, and especially to Anny Lam for her accurate and kind assistance during this precious experience. //

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Professor Jean-Jacques Lehot and me //

A picture with Intensive Care Unit medical staff at “Hôpital Neurologique Pierre Wertheimer” //

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The Hypnos Foundation // DICK THOMSON / / FOUNDING PRESIDENT / / BERNE

The Hypnos Foundation was instituted by Prof. D. Thomson in 1992 at the Department of Anaesthesiology, lnselspital, University of Bern, Switzerland. The aim of this foundation has been to support education in anaesthesiology in Eastern European countries. The Hypnos Foundation has given travel grants to anaesthetists in training enabling them to come and spend time in its institution. Furthermore, the foundation has also given grants to help establish education facilities in Eastern European countries.

In the beginning travel expenses, board and lodging was paid for several young anaesthetists from Eastern Europe, who were invited to come for 2 - 6 months to the department. We had anaesthetists from Siberia, Moscow, Romania and the Ukraine. The costs were partly paid by other funds in the department.

Travel costs and congress fees were paid to young eastern colleagues going to European meetings.

In 1992 two members of the department drove a lorry laden with anaesthesia machines and other equipment to Plsen Romania.

In 1998 and 99 two Anaesthesia departments in Latvia and Romania were given funds for building libraries (books and computers).Members of the Department gave refresher courses in Latvia and Romania.

In 2000 it was decided to support Eastern European candidates for the EDAIC Part II examinations. Around 40 candidates out of 50 had been supported. For the successful candidates also the completion fee was paid together with the costs for attending the European congresses, where the diplomas were given.

In the beginning of 2007, the Hypnos Foundation was dissolved and funds were transferred to the ESA to continue the goal of the Hypnos Foundation in supporting education in anaesthesia and intensive care in Eastern European countries.

Hypnos Grant //

Eligibility and Regulations //Eligible applicants:

• Must be resident and work in one of the countries listed under the ESA membership category “Reduced Fee Countries”. Only the countries listed under the ESA membership category “Reduced Fee Countries” will be eligible for the Hypnos Grant.

• Must have been successful at the EDAIC Part I examination. Preference will be given to candidates who passed the EDAIC Part I examination at the first attempt.

• Must be taking the Part II examination for the first time and must fulfil all conditions to sit the EDAIC Part II examination. This means that candidates who paid a reduced Part I fee will have to pay the Part I Upgrade fee to be eligible for the Part II examination. This fee can be paid after the announcement of the Hypnos Grant winners.

• Cannot be working for industry.

To be considered for the Hypnos Grant, eligible applicants must e-mail to the ESA Examinations Office:

• Their Hypnos Grant application form (available on www.esahq.org/HypnosGrant).• Evidence that they are registered in anaesthesiology in one of the

eligible countries.• A copy of their diploma of specialist in anaesthesiology (and,

should this document not be written in one of the languages used for the EDAIC Part I or Part II examinations, a certified translation into English; this document can be sent in the year of the Part II examination).

OR• A letter written in English from their department to certify that

they are in the last year of their specialist training (the last year of training must start before or on the day of the Part II registration deadline).

• A short Curriculum Vitae of maximum one page written in English language.

• A recent picture of themselves.

The application deadline for the Hypnos Grant will be mentioned on the Hypnos Grant application form. The Hypnos Grant cannot be given retroactively: candidates who already passed the Part II examination cannot apply for the Hypnos Grant.

HYPNOS

21EUROANAESTHESIA 2015May, 30 - June, 2Berlin, Germany 21

Reduced Fee Countries

Hypnos Grant winners will receive:

1. The Part II examination fee (370 Euro).2. A contribution towards the travel and accommodation expenses incurred by the EDAIC

Part II examination up to a maximum of 300 Euro (provided that original receipts for travel to and accommodation at the examination venue are received by the ESA Examinations Office)

And, for successful Part II candidates:

3. The EDAIC Part II Completion Fee (340 Euro)4. A contribution towards the travel and accommodation expenses incurred by the attendance

at the European Diploma Presentation Ceremony of the Euroanaesthesia congress up to a maximum of 300 Euro (provided that original receipts for travel to and accommodation at the congress venue are received by the ESA Examinations Office).

Hypnos Grant Managing Group

The Hypnos Grant Managing Group will select the recipients of the grants on the basis of the received applications. The decision of the Hypnos Grant Managing Group is final. A maximum of five grants can be awarded every year. Less than five grants will be given if less than five applicants are found eligible for the grant in a particular year. //

HYPNOSAlbaniaArmeniaAzerbaijanBelarusBosnia and HerzegovinaBulgariaCroatia Czech RepublicEstoniaFormer Yugoslav Republic of Macedonia

GeorgiaHungaryKazakhstanKosovo KyrgyzstanLatviaLithuaniaMacedoniaPolandRepublic of MoldovaRomania

Russian FederationSerbia and MontenegroSlovakiaSlovenia TajikistanTurkmenistanUkraineUzbekistan

STORY

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THE EUROPEAN DIPLOMA IN ANAESTHESIOLOGY & INTENSIVE CARE (EDAIC) IS: • Amultilingualtwo-partexamination• OrganisedbytheEuropeanSocietyof

Anaesthesiology(ESA)• EndorsedbytheEuropeanBoardof

Anaesthesiology(EBA)

THE EDAIC COVERS:• Basicappliedscience• Managementofanaesthesia,intensive

care,peri-operativecare,chronicpain,resuscitationandemergencymedicine

Boost your career!

Setting the European Standard for Anaesthesiology and Intensive Care

ThecurriculumandexamaresetbyindependentEuropeananaesthesiologists.

RaiseyourtrainingtoEuropeanlevel.

European Society of Anaesthesiology, 24 Rue des Comédiens, B-1000 Brussels, Belgium T: +32-(0)2-743-3290 | F: +32-(0)2-743-3298 | E: info@esahq.org | www.esahq.org

Moreinformationonwww.esahq.org

A4-EDAIC-AD.indd 1 10/10/2013 12:28:12

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STORY

THE EUROPEAN DIPLOMA IN ANAESTHESIOLOGY & INTENSIVE CARE (EDAIC) IS: • Amultilingualtwo-partexamination• OrganisedbytheEuropeanSocietyof

Anaesthesiology(ESA)• EndorsedbytheEuropeanBoardof

Anaesthesiology(EBA)

THE EDAIC COVERS:• Basicappliedscience• Managementofanaesthesia,intensive

care,peri-operativecare,chronicpain,resuscitationandemergencymedicine

Boost your career!

Setting the European Standard for Anaesthesiology and Intensive Care

ThecurriculumandexamaresetbyindependentEuropeananaesthesiologists.

RaiseyourtrainingtoEuropeanlevel.

European Society of Anaesthesiology, 24 Rue des Comédiens, B-1000 Brussels, Belgium T: +32-(0)2-743-3290 | F: +32-(0)2-743-3298 | E: info@esahq.org | www.esahq.org

Moreinformationonwww.esahq.org

A4-EDAIC-AD.indd 1 10/10/2013 12:28:12

The ESA Short Story Contest // don’t miss your chance to win a FREE registration for Euroanaesthesia 2015!The submission deadline of 31 December 2014 is getting close! The author of the best short story will receive a free registration for Euroanaesthesia 2015 in Berlin, Germany and the best short stories, selected by the Media Committee, will be published in future issues of the ESA Newsletter.

Conditions of participation• participants must be 40 years old or younger;• participants must be ESA members;• all stories must be 800 words maximum and based on a true story.

What type of anaesthesiology stories are we looking for?• stories about mistake(s) which have been made, by you or by a colleague – these may be

kept anonymous;• experiences about a humanitarian trip you are (or have been) involved in;• a report of a cultural event in your city or country;• etc., be creative!

Interested?Send your stories to Gabriel Gurman, ESA Newsletter Editor, at gurman@bgu.ac.il

Submission deadline 31 December 2014 //

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“”

The intensive therapy unit is not a substitute for post-operative recovery area, nor is it a place for terminal illness

(J. Ledingham, 1982)

EDAIC

Answers and Explanations // (T=True and F=False for each part of the questions on the left)

1. Answers: TFFTFThe two major buffering systems in the blood are haemoglobin (A) and the bicarbonate systems (D). Phosphate and ammonia can buffer, but are not important in the blood, more in the kidney. Albumin in the blood can contribute to buffer capacity but is a very minor system compared to the main two.

2. Answers: TFTTFThis anatomy question is part of the neurophysiology section. Just like the brain, blood supply to the spinal cord is autoregulated. The question also requires understanding of the anterior and posterior blood supplies to the spinal cord. The segmental paired posterior arteries supply the posterior part of the cord (mainly sensory tracts) whereas the single anterior spinal artery supply (to mainly motor tracts) is more precarious. This anterior spinal artery arises from the vertebral arteries and is supplemented by some small branches but the major supplementary artery is the artery of Adamkeivicz, which is variable in terms of where it arises, usually from a posterior intercostal artery between T8 and L1 levels. The longest stretch of anterior spinal artery without supplementation occurs in the thoracic region, not the lumbar region, making the thoracic cord most susceptible to ischaemia.

3. Answers: TTFTFThis is from the pharmacology section, on side effects of drugs and toxins. It could also be used as an ICM question. In trauma, damage to muscle, especially crush injuries, leads to release of myoglobin, which is a well recognised cause of acute renal failure. Many drugs can affect renal function and impaired renal function can reduce renal excretion of drugs and their metabolites so prolonging clinical effects (such as with morphine-6-glucuronide). Anti-cancer medications such as cisplatin (D), antibiotics, especially aminoglycosides, can cause acute renal injury as can the non-steroidal anti-inflammatory drugs. However, paracetamol is not classified as a NSAID and does not cause renal injury. Angiotensin converting enzyme (ACE) inhibitors can also precipitate acute renal failure.

4. Answers: FTFFFRotameters are tubes with a variable taper - wider at the top than at the bottom (a variable orifice) - containing a rotating bobbin. At the top, gas flow is turbulent. Turbulent flow depends on the density of the gas. At the bottom of the tube gas flow is laminar. This flow in this section is determined by the Hagen-Poiseille equation and dependent on viscosity of the gas. The height to which the bobbin rises is therefore dependent on both the viscosity and density of the gas passing through it. Calibration is therefore specific for a given gas and will not be accurate for a different gas. Temperature affects both density and viscosity of a gas, so calibration must be done at ambient temperature for optimum accuracy.

5. Answers: TFFFFThis is a statistics question about the normal distribution. Characteristics of the normal distribution are: it is symmetrical and the mean, median and modal values are the same; 68% of observations lie between -1 and +1 standard deviations from the mean; 95% of observations lie between -2 and +2 standard deviations from the mean; the variance is independent of the mean value. //

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Part I EDAIC // Sample Questions SUE HILL // CHAIRMAN PART 1 EDAIC SUBCOMMITTEE // sue.h i l l@uhs.nhs.uk

1. The main buffers of hydrogen ions in the blood areA. haemoglobinB. ammonium ionsC. phosphateD. bicarbonateE. albumin

2. Characteristic features of the blood supply to the spinal cord include

A. autoregulation of blood flow is presentB. the lumbar region of the spinal cord is the most

susceptible to ischemiaC. paired posterior spinal arteriesD. reduced anterior spinal arterial supply affects

mainly motor functionE. the arteria radicularis magna (artery of

Adamkievicz) arises from the vertebral arteries

3. Acute renal injury is a recognised toxic effect ofA. myoglobinB. ramiprilC. paracetamolD. cisplatinE. morphine

4. Concerning rotametersA. in a variable orifice flowmeter only laminar

flow occursB. at low flows the viscosity of the gas is the most

important determinant of flowC. calibration is unaffected by the density of the

gasD. a rotameter calibrated for nitrous oxide can

also be used for carbon dioxideE. accuracy is independent of ambient

temperature

5. Body weight of all adult male patients is normally distributed. This indicates that

A. the mean and median weights are identicalB. exactly 50% of all weights fall within one

standard deviation on either side of the meanC. exactly 90% of all weights fall within two

standard deviations on either side of the meanD. the mean and mode of the weights are not

necessarily identicalE. the variance of the weight is dependent upon

the mean weight

EDAICEDAIC 25

"Three generations" of EDAIC part II examiners from one family. //

EDAIC Questions //Paper B, Clinical Aspects of Anaesthesia, Intensive Care, Internal and Emergency MedicineSUE HILL // CHAIRMAN PART 1 EDAIC SUBCOMMITTEE // sue.h i l l@uhs.nhs.uk

1. Inadvertent surgical pneumothorax is associated with

A. nephrectomyB. cervical sympathectomyC. adrenalectomyD. thyroidectomyE. splenectomy

2. A 3-month-old infant is listed for primary closure of a cleft lip. Abnormalities associated with cleft lip and palate include

A. prolonged INR (International Normalised Ratio)

B. cardiac anomaliesC. thrombocytopaeniaD. renal anomaliesE. micrognathia

3. Nerves which must be blocked to provide anaesthesia for amputation of the leg above the knee include

A. sciaticB. suralC. femoralD. common peronealE. tibial

4. Complications in a patient who survives near-drowning in fresh water include

A. intrapulmonary shuntingB. metabolic acidosisC. pulmonary oedemaD. hypernatraemiaE. hypotension

5. Bilateral hilar lymphadenopathy is a feature ofA. pulmonary tuberculosisB. Hodgkin's diseaseC. erythema multiformeD. sarcoidosisE. systemic lupus erythematosus

Professor Wolfram Engelhardt is an EDAIC part II examiner since 1999 and has been an examiner frequently in 10 centres. His daughter, Dr Ria Engelhardt passed the part II in Göttingen/Germany in March 2013 and received her diploma. She has been an examiner for the part II exam in Erlangen 2013 and in Istanbul and Vienna in 2014. On the 4th of February 2014, she gave birth a daughter named Marie Lara. The three generations of the family are pictured.

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Euroanaesthesia 2015 // Upcoming deadlines1 NOVEMBER 2014

Abstract submission opens

15 DECEMBER 2014 Online registration opensPhoto contest submission opensAbstract submission closes

31 JANUARY 2015 ESA Membership entitles you to a significant reduction

on the Euroanaesthesia registration fee. Renew your ESA Membership before 31 January 2015 to

benefit from the reduced fee for Euroanaesthesia 2015. More information on www.esahq.org/Membership

25 FEBRUARY 2015 Early Bird Registration deadline

More about Euroanaesthesia 2015: www.esahq.org/euroanaesthesia2015

Photo Contest 2015 //Get those creative juices flowing - the ESA annual photo contest is back!

Win a free registration for Euroanaesthesia 2015 and get published in the European Journal of Anaesthesiology (EJA)

• The top 3 contestants win a free registration for Euroanaesthesia 2015

• The 20 best photos will be exhibited at Euroanaesthesia 2015

• The 12 best photos will be published individually on the cover of the EJA

Photo Contest ThemeAnaesthesia, anaesthesia, and more anaesthesia!Anaesthesia is everywhere in a hospital, and we would like you to capture it.

Some ideas:• people giving anaesthesia• a working environment where anaesthesia takes

place• science in anaesthesia• ... be creative!

Entries will be judged on how well they reflect the chosen theme, on their visual impact, composition, originality, aesthetic quality and technical expertise. The judges’ decisions are final and binding on all matters.

Conditions of participation• Participation in the photo contest is free of charge• Only current ESA members can participate• All photos submitted where a patient is

photographed and recognisable must have the patient’s consent (photos without patient consent will be disqualified)

• By participating, all contestants agree to attend Euroanaesthesia 2015 if they win

• Participants may only submit a maximum of three pictures (more entries will not be taken into consideration)

• Photos submitted should have a minimum resolution of 300 dpi or higher (and should be large enough to be printed on an A3 size poster)

For more about the photo contest: www.esahq.org/PhotoContest2015

Scientific Programme // Plan your sessionsThe Scientific Programme will comprise of: 7 pre-congress courses, 24 refresher courses, 76 symposia, 4 workshops, 5 Interactive Sessions, 13 lectures, 2 meet the expert sessions, 12 pro-con debates as well as several guest sessions and specialist society meetings. Please note that some courses require pre-registration and have a limited participation.

More about the Scientific Programme: www.esahq.org/Euroanaesthesia2015/ScientificProgramme

Access the Euroanaesthesia On-line Programme: www.sessionplan.com/esa2015

2015The European Anaesthesiology Congress

2015Euroanaesthesia

Future Anaesthesiology Meetings // 2014 - 2015

2014November 14 - 15ESA Focus Meeting on Perioperative Medicine: The Paediatric PatientContact: info@esahq.org I www.esahq.org/FocusMeeting I Athens, Greece

November 15 - 1910th WINFOCUS World Congress on Ultrasound in Emergency & Critical Carewww.winfocus.org I Kuala Lumpur, Malaysia

November 17PAIN OUT Symposium 2014http://pain-out.med.uni-jena.de I Brussels, Belgium

November 18 - 20Masterclass in Scientific Writing 2014www.esahq.org/masterclasses I Brussels, Belgium

November 20 - 22International Joint congress on paediatric anesthesia and paediatric critical care-Innovations and advanced technologies in paediatric careContact: info@mcascientificevents.eu

November 24 - 284th World Congress of Regional Anaesthesia and Pain Therapywww.wcrapt2014.com I Cape Town, South Africa

November 26 - 29AIC 2014Linz, Austria

November 27 - 294th International Fluid Academy Days (IFAD)www.medical.theconferencewebsite.com/conference-info/4-international-fluid-academy-days-2014 I Antwerp, Belgium

December 4 - 67th Baltic Congress of Anaesthesiology, Intensive Care and Emergency Medicinewww.anaesthesiology.lv I Riga, Latvia

2015January 14 - 16AAGBI Winter Scientific Meeting www.aagbi.org I London, UK

March 12 - 14Annual Congress of the Portuguese Society of Anaesthesiology www.spanestesiologia.pt I Lisbon, Portugal

May 7 - 9DAC 2015 – The 62nd German Anaesthesia Congresswww.dac2015.de I Düsseldorf, Germany

Spring 2015 Masterclass on EU fundings: Horizon 2020www.esahq.org/masterclasses I Brussels, Belgium

May 30 - June 2Euroanaesthesia 2015www.esahq.org/Euroanaesthesia2015 I Berlin, Germany

Copyright 2014The 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.

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2015MAY 30 - JUNE 2BERLIN, GERMANY

The European Anaesthesiology Congress2015Euroanaesthesia

SymposiaRefresher CoursesWorkshopsAbstract PresentationsIndustrial Symposia & Exhibition

CME Accreditation will be requestedEACCME - UEMS

RegistrationP +32 (0)2 743 32 90F +32 (0)2 743 32 98E registration@esahq.orgwww.esahq.org/Euroanaesthesia2015

Abstract submission from 1 November - 15 December 2014

CME Accreditation will be requested