Anaesthesiology // a universal profession

Transcription

NEWS59
VOLUME 59 // AUTUMN 2014 // EDITOR GABRIEL M. GURMAN
The ESA and the WFSA
Sponsored Grants and Prizes
Don’t miss the deadline!
Euroanaesthesia 2015
Upcoming deadlines
3
6
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Anaesthesiology // a universal profession
GABRIEL M. GURMAN, MD // ESA NEWSLETTER EDITOR // [email protected]
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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Gabriel M.Gurman
// ESA Newsletter Editor
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.
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
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. //
UNIVE
02
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.
ERSAL
David Wilkinson
// President WFSA
Daniela Filipescu
// President ESA
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Jannicke Mellin-Olsen, Dan Longrois and Uzbek // colleagues led by Professor Sabirov.
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-uzbekistansociety-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 [email protected]
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VA
“
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.
Role
The 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
•
•
•
•
•
•
”
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).
Application
If 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 [email protected] 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.
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.
If you would like to discuss any aspect of this post, please contact:
Dr. Bazil Ateleanu
Chairperson of Trainee Exchange Programme Committee
[email protected]
Requirements
For more information about the ESA Trainee Exchange Progamme
Committee please visit the ESA website (www.esahq.org). //
Applications are encouraged from active ESA members who meet the
following criteria:
• Experience of anaesthetic teaching and training nationally
ACANCY
05
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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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 [email protected].
GRANTS
&PRIZES
“
The aged and chronically ill have become
the principal consumer of intensive care
(GE Thibault, 1980)
”
07
Masterclass in Statistics & Research
Methodology 2014 // Feedback from
participants
A N A S T E VA N O V I C / / G E R M A N Y / / a s t e v a n o v i c @ u k a a c h e n . d e
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.
Ana Stevanovic // University Clinic RWTH
Aachen, Germany
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 // [email protected]
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. //
08
Mona Momeni // Cliniques Universitaires
Saint-Luc, Belgium
Learning from your evaluation of
Euroanaesthesia 2014 //
DAN LONGROIS, ON BEHALF OF THE ESA BOARD OF DIRECTORS AND ESA SECRETARIAT // [email protected]
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.
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)
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! //
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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.
Dr Jane Fitch //
TH E C URREN T PRESID ENT OF TH E A M E RI C A N S OC I E TY OF A N E S TH E S I OL OGI S TS / / ja n e -f itc h @ou h sc .e du
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?
10
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. //
Dr Richard Grutzner //
T HE CUR R E NT PR E SI D EN T OF TH E AU STRALIAN SOC IETY OF A N A E S TH E TI S TS / / r ic h a rd@gr u tzn e r.n e t.a u
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 //
T HE CUR R E NT PR E SI D EN T OF TH E JAPAN ESE SOC IETY OF AN A E S TH E S I OL OGI S TS / / sh ok a @k u a c c m .m e d.k yu sh u -u .a c .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! //
11
HISTORY OF ANAESTHESIA - FLASH 7 //
FROM THE VERY BEGINNING UNTIL TODAY
GEORGE LITARCZEK // ROMANIA // [email protected]
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.
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
12
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 orotracheal 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
George Litarczek
// Professor
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 “Narkosespiromat”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.
//
13
“
The cardiac anesthesiologist is the
most important member of the team
in helping the cardiac patient safely
through surgery
(Logue and Kaplan, 1982)
”
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.
EUROPEAN SOCIETY OF ANAESTHESIOLOGYA
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
APNEA
14
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.
An Italian anaesthesiologist in Africa ... //
B R UNO T UR CH ETTA / / b turche@gm ail.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.
Figure 1 //
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 postburn 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.
Figure 2 //
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. //
15
The On-Line Assessment // OLA!
S U E HI L L MA PHD F R CA // C H AIRM AN OF TH E OLA SUBC OM M ITTEE / / su e h ill2@m a c .c om
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-todate 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. //
16
TR
Trainee representatives at the ESA Council //
D I OGO SOB R E I R A F E RN AN D ES / / POR TU GAL / / d iogosob reir afe r n a n de s87@ya h oo.c om .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, socioeconomical 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. //
RAINEE
“
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 FOCUS MEETING ON PERIOPERATIVE MEDICINE:
THE PAEDIATRIC PATIENT
November, 14 - 15
Athens, Greece
”
17
ESA Trainee Exchange Programme //
Hospices Civils de Lyon, France
S T E FA N O P E Z Z AT O / / G E N O A , I TA LY / / s t e p e z z a @ g m a i l . c o m
My name is Stefano Pezzato and I am a fourthyear 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 “highquality” 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,
18
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 “widehorizon” 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
Operating theatre during 3D
video-assisted mitral valve
replacement surgery //
month I followed a lot of neurosurgical cases,
taking part in patient management from preoperative 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 halfunits 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-
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-thoracicvascular 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
Professor Jean-Jacques Lehot
and me //
to follow different type of cardiac surgery
including CABG and valve surgery, off-pump
coronary surgery and mini-invasive videoassisted 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. //
A picture with Intensive
Care Unit medical staff
at “Hôpital Neurologique
Pierre Wertheimer” //
19
The Hypnos Foundation //
HY
Hypnos Grant //
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.
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.
20
YPNOS
Reduced Fee Countries
Albania
Armenia
Azerbaijan
Belarus
Bosnia and Herzegovina
Bulgaria
Croatia
Czech Republic
Estonia
Former Yugoslav
Republic of Macedonia
Georgia
Hungary
Kazakhstan
Kosovo
Kyrgyzstan
Latvia
Lithuania
Macedonia
Poland
Republic of Moldova
Romania
Russian Federation
Serbia and Montenegro
Slovakia
Slovenia
Tajikistan
Turkmenistan
Ukraine
Uzbekistan
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. //
EUROANAESTHESIA 2015
May, 30 - June, 2
Berlin, Germany
21
Setting the European Standard for
Anaesthesiology and Intensive Care
Boost your career!
Raiseyourtrainingto
Europeanlevel.
Moreinformationon
www.esahq.org
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
Thecurriculumandexamaresetby
independentEuropeananaesthesiologists.
22
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: [email protected] | www.esahq.org
S
“
The intensive therapy unit is
not
a
substitute
for
postoperative recovery area, nor is
it a place for terminal illness
(J. Ledingham, 1982)
”
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 [email protected]
Submission deadline
31 December 2014 //
STORY
23
Part I EDAIC //
Sample Questions
Answers and Explanations //
S U E HI L L // CHAI R MAN PA R T 1 EDAIC SU BC OM M ITTEE / /
su e . h i l l@ u h s .n h s .u k
1. Answers: TFFTF
The 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.
1. The main buffers of hydrogen ions in the blood are
A. haemoglobin
B. ammonium ions
C. phosphate
D. bicarbonate
E. albumin
2. Characteristic features of the blood supply to the
spinal cord include
A. autoregulation of blood flow is present
B. the lumbar region of the spinal cord is the most
susceptible to ischemia
C. paired posterior spinal arteries
D. reduced anterior spinal arterial supply affects
mainly motor function
E. the arteria radicularis magna (artery of
Adamkievicz) arises from the vertebral arteries
3. Acute renal injury is a recognised toxic effect of
A. myoglobin
B. ramipril
C. paracetamol
D. cisplatin
E. morphine
4. Concerning rotameters
A. in a variable orifice flowmeter only laminar
flow occurs
B. at low flows the viscosity of the gas is the most
important determinant of flow
C. calibration is unaffected by the density of the
gas
D. a rotameter calibrated for nitrous oxide can
also be used for carbon dioxide
E. 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 identical
B. exactly 50% of all weights fall within one
standard deviation on either side of the mean
C. exactly 90% of all weights fall within two
standard deviations on either side of the mean
D. the mean and mode of the weights are not
necessarily identical
E. the variance of the weight is dependent upon
the mean weight
24
(T=True and F=False for each part of the questions on the left)
2. Answers: TFTTF
This 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: TTFTF
This 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 morphine6-glucuronide). Anti-cancer medications such as cisplatin (D), antibiotics,
especially aminoglycosides, can cause acute renal injury as can the nonsteroidal 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: FTFFF
Rotameters 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: TFFFF
This 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. //

EDAIC Questions //
Paper B, Clinical
Aspects of
Anaesthesia, Intensive
Care, Internal and
Emergency Medicine
S UE H I L L / / C H A I RM A N PA R T 1 E DA I C S UBC OM M I TTE E / /
su e .h ill@u h s.n h s.u k
1. Inadvertent surgical pneumothorax is
associated with
A. nephrectomy
B. cervical sympathectomy
C. adrenalectomy
D. thyroidectomy
E. splenectomy
"Three generations" of EDAIC part II examiners
from one family. //
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 anomalies
C. thrombocytopaenia
D. renal anomalies
E. micrognathia
3. Nerves which must be blocked to provide
anaesthesia for amputation of the leg above
the knee include
A. sciatic
B. sural
C. femoral
D. common peroneal
E. tibial
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.
4. Complications in a patient who survives neardrowning in fresh water include
A. intrapulmonary shunting
B. metabolic acidosis
C. pulmonary oedema
D. hypernatraemia
E. hypotension
5. Bilateral hilar lymphadenopathy is a feature of
A. pulmonary tuberculosis
B. Hodgkin's disease
C. erythema multiforme
D. sarcoidosis
E. systemic lupus erythematosus
25
2015
Euroanaesthesia
The European Anaesthesiology Congress
Euroanaesthesia 2015 // Upcoming deadlines
1 NOVEMBER 2014
Abstract submission opens
25 FEBRUARY 2015
Early Bird Registration deadline
15 DECEMBER 2014
Online registration opens
Photo contest submission opens
Abstract submission closes
More about Euroanaesthesia 2015:
www.esahq.org/euroanaesthesia2015
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
Scientific Programme // Plan your sessions
The 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
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
• The 20 best photos will be exhibited at
• The 12 best photos will be published individually on
the cover of the EJA
26
Photo Contest Theme
Anaesthesia, 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


Future Anaesthesiology Meetings // 2014 - 2015
2014
November 14 - 15
ESA Focus Meeting on Perioperative Medicine: The Paediatric Patient
Contact: [email protected] I www.esahq.org/FocusMeeting I Athens, Greece
November 15 - 19
10th WINFOCUS World Congress on Ultrasound in Emergency & Critical Care
www.winfocus.org I Kuala Lumpur, Malaysia
November 17
PAIN OUT Symposium 2014
http://pain-out.med.uni-jena.de I Brussels, Belgium
November 18 - 20
Masterclass in Scientific Writing 2014
www.esahq.org/masterclasses I Brussels, Belgium
November 20 - 22
International Joint congress on paediatric anesthesia and paediatric critical care-Innovations and
advanced technologies in paediatric care
Contact: [email protected]
November 24 - 28
4th World Congress of Regional Anaesthesia and Pain Therapy
www.wcrapt2014.com I Cape Town, South Africa
November 26 - 29
AIC 2014
Linz, Austria
November 27 - 29
4th International Fluid Academy Days (IFAD)
www.medical.theconferencewebsite.com/conference-info/4-international-fluid-academy-days-2014 I Antwerp, Belgium
December 4 - 6
7th Baltic Congress of Anaesthesiology, Intensive Care and Emergency Medicine
www.anaesthesiology.lv I Riga, Latvia
2015
January 14 - 16
AAGBI Winter Scientific Meeting
www.aagbi.org I London, UK
March 12 - 14
Annual Congress of the Portuguese Society of Anaesthesiology
www.spanestesiologia.pt I Lisbon, Portugal
May 7 - 9
DAC 2015 – The 62nd German Anaesthesia Congress
www.dac2015.de I Düsseldorf, Germany
Spring 2015
Masterclass on EU fundings: Horizon 2020
www.esahq.org/masterclasses I Brussels, Belgium
May 30 - June 2
www.esahq.org/Euroanaesthesia2015 I Berlin, Germany
Copyright 2014
The 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.
27
MAY 30 - JUNE 2
BERLIN, GERMANY
2015
Euroanaesthesia
The European Anaesthesiology Congress
Symposia
Refresher Courses
Workshops
Abstract Presentations
Industrial Symposia & Exhibition
CME Accreditation will be requested
EACCME - UEMS
Registration
P +32 (0)2 743 32 90
F +32 (0)2 743 32 98
E [email protected]
www.esahq.org/Euroanaesthesia2015
Abstract submission from
1 November - 15 December 2014

Anaesthesiology // a universal profession

Transcription

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