Winter 2013

NEWS52
VOLUME 52 // WINTER 2013 // EDITOR GABRIEL M. GURMAN
EDAIC
08-11
20-21
ETPOS
Europe and the WFSA
14-15
24-25
To be or not to be …an intensivist //
When I started my residency in anaesthesiology, some 50 years
ago, nobody spoke about intensive care. All we knew was that an
anaesthesiologist, as part of the therapeutic team, was supposed to
take care of his or her orher patient in the immediate postoperative
period, but with much more commitment than their surgeon partner,
since the anaesthesiologist had a greater and deeper understanding of
physiology, pathophysiology, and pharmacology.
The period after the polio epidemics in the Scandinavian countries
witnessed a dramatic change in our profession. Little by little, every
country developed a network of special units for management of
acute respiratory failure (those wards have been called "respiratory
units"!), characterised by accumulation of knowledge, equipment, and
dedication, all for the sake of the critically ill patient. The task of taking
care of the patients admitted to those units fell on the shoulders of the
anaesthesiologist and nobody put this new reality under a question
mark. This anaesthesiologist took care of patients in respiratory distress
in the operating room, so it was only natural to see this professional
also taking care of the patient with respiratory failure from any etiology.
Reanimation, intensive care, or critical care became the usual and
natural addition offered to the names of an anaesthesia department.
Gradually, the anaesthesiologist was recognised as being what is called
today a perioperative physician: a doctor who takes care of the patient
before, during, and after a surgical procedure. The anaesthesiologist
became responsible not only for preparing the patient for surgery and
delivering anaesthesia, but also for the postoperative cardio-respiratory
homeostasis, fluid balance, pain management, anticoagulant regimens,
and even antibiotic administration in some cases.
In my own case, all my professional life I was considered by my peers
(and as such I considered myself) as an anaesthesiologist whose main
domain of interest was critical care. During my last years in clinical
practice I ran a 12-bed intensive care unit in a very big university hospital
in the south of Israel.
Things have changed since then. In the last few decades there has been
a general trend to separate anaesthesiology from intensive care. Many
professionals recognised the fact that intensive care is a multidisciplinary
field of medicine, that the critically ill patient needed more than the
routine knowledge and skills of only one specialty, and that there is
a place for improving the patient's management by involving experts
from other fields. This change in mentality brought a dramatic switch
in the attitude of the healthcare management and administration. In
some countries (not many), intensive care is a primary specialty, in
others it became a sub-specialty open to any specialist, not only in
anaesthesiology but also in internal medicine, pneumology, surgery,
paediatrics and other disciplines. Some intensive care national societies
today include just a small minority of anaesthesiologists as active
members. Finally, in various countries the majority of the intensive care
units are led and manned by non-anaesthesiologists.
A significant number of anaesthesiologists all over the continent
have left the operating room forever, and decided to dedicate their
professional activity to the domain of critical care.
This change is more evident outside our continent, but the trend did
not leave Europe aside. Today some European countries have their
own societies of intensive care and the European Society of Intensive
Care Medicine is open to "any physician, nurse, allied healthcare
professional, or trainee, residing in Europe who is interested in intensive
care medicine".

EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Some people, rather than face an inevitable reality, would rather try to
change a trend that seems to be irreversible.
01
“
Physicians tend to emphasise
their successes and, perhaps
subconsciously, minimise their
failures.
(RR Kirby, Crit Care Med 1977;5:167)
So, the question that must arise from this very short description is cui prodest: who would
benefit from this new reality? No doubt there would be some strong opinions in favor of
this significant change regarding the profile and domains of interest of our profession. The
argument in favor of this new (or already old!) situation would be that the main benefit
is directed to the critically ill patient. Rather than being treated by a physician whose
time is divided between the operating room, pre-anaesthetic out-patient clinic, or pain
management clinic, that patient is taken care of by a dedicated intensive care specialist,
possessing the necessary knowledge and experience for assuring the best result from the
treatment.
On the other side, nobody could ignore the fact that anaesthesiology, as a medical
profession, once separated from the field of critical care, becomes less attractive for
a young physician when she/he is supposed to select a future career. The pragmatic
translation of this situation is that the average anaesthesiologist would leave the
complicated surgical patient immediately after the first post-operative hours, in the
hands of another colleague—the dedicated intensivist. This anaesthesiologist, whose
daily activity does not include management of the critically ill, will be denied access to
seriously ill patients, surgical or nonsurgical, in need of intensive care: those having acute
respiratory failure, asthmatic crisis, acute renal failure, hepatic coma, intoxications and
other health emergencies.
I do not intend to extend the discussion beyond this point, or to take sides with one or
another of the above opinions.The situation nowadays is not uniform: there are, still,
many parts of our continent in which the field of critical care belongs to anaesthesiology.
I have no doubt that even in those countries, hospitals, and anaesthesia departments
there is vivid discussion about this dilemma. I can imagine that our readers are divided in
their opinions regarding this important aspect of our profession, with a clear practical and
philosophical impact on our daily activity.
My own aim is to offer our readers a framework for discussing the subject, for bringing
different opinions and data, to debate the different solutions, for the benefit of our
patients, but not putting aside the interest of our profession and anaesthesia manpower
in Europe.
Our newsletter is open for discussion. We will be glad to host letters and short articles on
the subject.
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Gabriel M. Gurman, MD
Editor // gurman@bgu.ac.il
02
Gabriel M. Gurman // ESA Newsletter Editor
”
PR
Nominations - ESA // Board
We are very happy to announce that Professor Walid Habre and Professor Andreas
Sandner-Kiesling have been elected as Board members during the Council meeting that
took place on Saturday 8 December in Brussels, Belgium. They have already started their
term of office on 1 January 2013.
We would also like to take this opportunity to warmly thank Professor Robert Sneyd and
Professor Paolo Pelosi for their services in the ESA Board. //
Prof. Walid Habre
Prof. Andreas
Sandner-Kiesling
RAGUE
ESA Autumn meeting 3 in Prague // Czech Republic
For the third year running, the ESA organised
its Autumn Meeting - a satellite event to the
summer Euroanaesthesia congress, with
an aim to extending educational activities
to European countries, which for practical
reasons cannot accommodate events of the
size of Euroanaesthesia, as well as to improve
access for attendees from Central and Eastern
Europe. The third ESA Autumn Meeting was
held in Prague, Czech Republic on 8 and 9
November 2012. It was held at the Clarion
Congress Hotel, which provided excellent
congress facilities and services.
ESA President Eberhard Kochs, and Karel
Cvachovec, President of the Czech Society of
Anaesthesiology and Intensive Care Medicine
(ČSARIM), welcomed the 300 attendees and
launched the two-day programme, which
included 18 presentations, grouped into
6 thematic sessions. The topics covered
guidelines on the management of severe
perioperative bleeding, paediatric anaesthesia
and intensive care, obstetric anaesthesia,
intensive care medicine, resuscitation and
emergency medicine and hot topics in
anaesthesia. Parallel sessions were also
organised, with two hands-on workshops on
the use of ultrasound in regional anaesthesia
and four problem-based learning disscussions
on various topics (preoperative risk assessment
and optimisation for the ambulatory surgical
patient, regional or general anaesthesia for
ambulatory surgery of the upper extremity,
cognitive
decline
after
anaesthesia,
management of subarachnoid hemorrhage).
An exhibition hall hosted the representatives
of 9 exhibitors, including 4 ESA partners. ESA
members and Autumn Meeting attendees can
download most of the presentations under the
Congress section in the subsection Autumn
meeting 2012 (www.euroanaesthesia.org).
The atmosphere during the meeting was
excellent, with productive interactions
between lecturers and the audience and active
exchanges between attendees throughout.
The overall feedback on the event was also
very good. The relevance of the topic areas
and the quality of speakers and presentations
were viewed positively by participants. The
attendance at the workshops and problembased learning dissussions confirmed the
interest for these session formats, and the
comments on organisation, venue, facilities
and catering were excellent.
Based on this success, the ESA will organise a
fourth Autumn meeting in Timisoara, Romania,
8-9 November 2013. //
03
Euroanaesthesia 2013 //
Scientific Programme Updates
The majority of workshops, symposia and refresher courses are planned more than one year before the
publication of the preliminary programme of the congress. However, the scientific programme is being updated
until the very last moment, in order to offer the Euroanaesthesia participants as many interesting sessions as
possible. This time, we would like to present to you the sessions that will be organised during the congress
by the ESA Specialist Society Members. For the complete, up to date programme please visit the ESA on-line
version of the programme on http://www.sessionplan.com/esa2013/ where you can create your own itinerary
well before the congress starts.
Spinal Sonography Symposium Lecture and demonstrations //
Pre-Congress Course Organised by the Society
for Ultrasound in Anaesthesia (SUA)
Friday, 31 May 2013, 9:00-18:00*
Ultrasound is increasingly being used in the perioperative period as an effective tool to enhance patient care.
Over the recent years, ultrasound has proven to be helpful in delineating the anatomy to anaesthetists, and
has proven to be an invaluable tool in improving the standards of patient care. The Society for Ultrasound in
Anaesthesia (SUA) is organising a pre-congress course on spinal sonography.
The pre-congress course on spinal sono-anatomy is aimed at anaesthetists and pain physicians who want to
access the advantages offered by the ultrasound to make a positive difference to their patients. Enlightening
master classes, demonstrations and panel discussions are planned. The speakers are planning to demonstrate
on live models (volunteers) the techniques that will eventually help you identify the sono-anatomy, and
improve the success rate of your blocks, be they for acute or chronic pain management.
Detailed programme of the course can be found on www.euroanaesthesia.org
CME Update on the Use of Ultrasound
in Perioperative Care //
Pre-Congress Course Organised by the Society
for Ultrasound in Anaesthesia (SUA)
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Saturday, 1 June 2013, 8:00-12:00*
04
The Society for Ultrasound in Anaesthesia (SUA) is organising a CME Update on the use of ultrasound in
perioperative care.
This update will cover important topics related to the use of ultrasound in perioperative care. The faculty of
international repute will deliver lectures related to the use of ultrasound for vascular access, accident and
emergency, and pain management. The programme has been designed to be comprehensive, and it also
includes a scintillating pro-con debate on the practice of ‘intraneural’ injections.
The faculty are very friendly and participants are encouraged to ask questions and even share their own views
or expertise with them.
Detailed programme of the course can be found on www.euroanaesthesia.org
*Please note that the session schedule still might be subject to changes. Consult the on-line programme on
http://www.sessionplan.com/esa2013/ or the Final Programme on-site for the final timing of the session.
U
Safe management of the respiratory system
in morbid obesity // Scientific Symposium
organised by the European Society for Perioperative Care of the Obese Patient (ESPCOP)
Monday, 3 June 2013, 8:30-10:00*
Chair: Yigal Leykin (Pordenone, Italy)
The co-morbidities of obesity: What really matters?
Speaker to be confirmed
Metrics for drug dosing: How pharmacology is different in the obese patient
Luc De Baerdemaeker (Gent, Belgium)
Obesity and sleep disordered breathing: The essential knowledge of sleep apnoea
Anupama Wadhwa (Louisville, United States)
Airways in the morbidly obese: The problems, the myths
Michael Margarson (Chichester, United Kingdom)
How to make a friend of your laparoscopic surgeon
Jan Paul Mulier (Bruges, Belgium)
PDATE
Seeing further: The fascination of Intravenous
Anaesthesia // Scientific Symposium organised
by the European Society for Intravenous
Anaesthesia (EuroSIVA)
Monday, 3 June 2013, 08:30-10:00*
Despite all technological developments, new diagnostic and therapeutic tools, new insights and training
in, for example the human interaction in the workplace, the core business of the anaesthesiologists is
still to make sure that the right drug with the right dose is applied to our patients to obtain the optimum
effect without doing harm. During the last few decades considerable scientific knowledge has been
built up about the intravenous drugs we use. However, there is still a gap between theory and practice.
In this short symposium we will try to decrease this gap by discussing caveats, new developments and
showing aspects of intravenous anaesthesia and sedation in real clinical practice.
Chair: Gavin Kenny (Glasgow, United Kingdom)
Developments in IV anaesthesia
Stefan Schraag (Glasgow, United Kingdom)
Safety and drug delivery
Frank Engbers (Leiden, The Netherlands)
New ways of sedation
Gavin Kenny (Glasgow, United Kingdom)
Seeing is believing
Nick Sutcliffe (Glasgow, United Kingdom)

05
Airway and respiratory care in critically ill
patients // Scientific Symposium organised
by the European Airway Management
Society (EAMS)
Monday, 3 June 2013, 10:30-12:00*
The session, endorsed by the European Airway Management Society (EAMS), an ESA Specialist Society,
will consider these two fields crucial for life and of increasing interest in literature. The session will be
chaired by the EAMS President, Flavia Petrini (Cheti-Pescara, Italy) and Paolo Pelosi (Genova, Italy), ESA
past President, a key opinion leader in ICU, and will host some of the main European experts in intensive
care and airway management: Massimo Antonelli, the actual SIAARTI President (2012-2015, Rome, Italy)
and Tim Cook (Bath, UK), main researcher from the NAP4 (the cornerstone 4th National Audit Project of
the Royal College of Anaesthetists and Difficult Airway Society, UK).
Tim Cook will start the session, highlighting the findings of the NAP4 regarding ICU: ”Critical airway
events on ICU: what goes wrong and how might we make it safer?”. He will analyse the adverse
airway incidents causing death and permanent brain damage, the contributory factors and the possible
solutions and the strategies to increase patient safety.
Massimo Antonelli, with his lecture on "The role of bronchoscopy in the management of airway
in the ICU?", will underline the role of education and training, especially but not exclusively for the
bronchoscope adoption, a fundamental technique for airway management in ICU.
Finally Paolo Pelosi (Genova, Italy), with a lecture entitled “In search of the "Holy Grail": does the
optimal tracheostomy technique exist?”, will provide an exhaustive review of critical questions
regarding the different approaches to tracheotomy in ICU, analysing the errors and the difficulties that
senior organisations and manufactures should address.
Abdominal compartment syndrome a multidisciplinary challenge // Scientific
Session organised by the World Society
of the Abdominal Compartment Syndrome
(WSACS)
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Monday, 3 June 2013, 14:00-15:30*
06
Unlike many commonly encountered disease processes which remain within the purview of a given
discipline, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) readily
cross the usual barriers and may occur in any patient population regardless of age, illness, or injury. As
a result, no one scientific society or association can represent the wide variety of physicians, nurses,
respiratory therapists, and other allied healthcare personnel who might encounter patients with IAH
and/or ACS in their daily practice. To fill this void, the World Society on Abdominal Compartment
Syndrome (WSACS) has been founded to serve as a peer-reviewed forum and educational resource for
all healthcare providers as well as industry who have an interest in IAH and ACS.
At this year's ESA-WSACS joint session that will be chaired by Paolo Pelosi (Genova, Italy) and Manu
Malbrain (Antwerpen, Belgium), keynote speakers will give an overview on different aspects of intraabdominal hypertension and abdominal compartment syndrome.
Paolo Pelosi will explain to us who is at risk and why. Afterwards Manu Malbrain will give an overview
of medical and surgical management while Annika Reintam Blaser (Tartu, Estonia) will help us to define
acute gastrointestinal injury. Finally Jan Mulier (Bruges, Belgium) will close the session with some
practical hints and tips on how to anaesthetise a patient with IAH or ACS. //
*Please note that the session schedule still might be subject to changes. Consult the on-line programme on
http://www.sessionplan.com/esa2013/ or the Final Programme on-site for the final timing of the session.
Euroanaesthesia 2013 //
Photo Contest
Win a free registration

The ESA is organising a photo competition, which is open to all current ESA members. The top
three contestants will win a free registration to Euroanaesthesia 2013.
The best 10 photos will also be exhibited at Euroanaesthesia 2013, and published in the
European Journal of Anaesthesiology.
What do you have to do?
Anaesthesia is everywhere in a hospital, and we would like you to capture it.
We are looking for photos that show:
• PEOPLE giving anaesthesia
• the PLACES they work
• SCIENCE in anaesthesia
Entries will be judged on whether they reflect these themes well, their visual impact and
composition, originality, aesthetic quality and technical expertise.
Key dates
The contest started on 1 January and closes on 31 March 2013. Winners will be notified by
30 April 2013.
Impress us with your creative talent and submit your photos:
http://www.euroanaesthesia.org/photocontest
ESA 2013 RESEARCH PROGRAMMES // HOT TOPICS

Clinical Trial Network //
A new Call for Clinical Trial Network study proposals is now ongoing. Proposals for multicenter
multinational studies are welcome, in particular observational epidemiological studies. The ESA
will offer administrative, technical, logistic and financial support as in previous studies.
Submission deadline : 11 February 2013.
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          

Call for Centers still open for CTN study ETPOS (European Transfusion Practice and Outcome Study).
Would your hospital like to join this study? See page 14-15 of this Newsletter
Masterclasses //
The Masterclass on Clinical Research is a workshop dedicated to acquire skills for designing and
interpreting clinical research, producing a detailed research protocol, etc. Held in Brussels on 5-7
March 2013. Deadline for applications: 12 February 2013.
The Masterclass on Clinical Trials & Clinical Epidemiology is an advanced scientific workshop
dedicated to refresh knowledge on design and analysis of clinical studies and to update on important
latest developments in design and analysis. Held in Utrecht on 31 October-2 November 2013.
Deadline for applications: 5 July 2013.
Masterclass on Scientific Writing: November 2013. More information to be coming soon on the
ESA website
Information on these programmes and application procedures are available at
http://www.esahq.org > “Research”
Should you have any additional questions regarding these programs, please do not hesitate to
contact Benoit Plichon at the ESA Research Department at research@esahq.org //
07
EDA
European Diploma in Anaesthesia and Intensive Care (EDAIC)
Report from the Examinations Committee 2012 //
S U E HI L L // CHAI R PE R SO N EDAIC PAR T I AN D OLA SU BC OM M ITTE E S / / su e h ill2@m a c .c om
// Introduction
The European Diploma in Anaesthesia and
Intensive Care (EDAIC) continues to go from
strength to strength: more candidates than
ever registered for both written and oral
examinations in 2012. For the first time
more than 1500 candidates took the Part I
Examination in centres in Europe and our
colleagues in Indonesia arranged their second
sitting of this written examination. Other
countries outside of Europe are expressing an
interest in the EDAIC: it is on its way to becoming
a truly worldwide examination thanks to the
hard (and persuasive!) work of our Chairperson,
Dr Zeev Goldik.
// Why is the EDAIC so successful?
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Each year this report documents the increasing
popularity of the EDAIC throughout Europe
and now beyond, thanks to the Glasgow
Declaration. This year it is worth reflecting on
this success and how to continue our growth.
What makes an examination successful? Why
are so many countries adopting either part
or all of the EDAIC as part of their National
assessment? There are many reasons and it is
likely that individual candidates and countries
will order their reasons quite differently.
Why is this examination so successful? Firstly,
the examination clearly achieves what it sets out
as its aim: to provide a standardised examination
for candidates to demonstrate that they have
not only acquired the relevant knowledge
(as shown by success in Part I) but have also
demonstrated application and understanding
of that knowledge by successfully passing Part
II. These two elements - acquiring knowledge
and then applying it - form the basis of Miller’s
triangle for educational development. Every
country in Europe requires their trainees to
develop this knowledge and understanding:
it makes sense to have a single, standardised
examination that is equally valid in all countries.
Without a bedrock of theoretical knowledge
and understanding, an anaesthesiologist
cannot adapt and develop their practice as new
equipment, drugs and operative techniques
08
are introduced. Evidence-based practice is
becoming paramount as resources are limited:
without an understanding of basic science,
including the principles of statistical analysis, it
is difficult to view new developments critically
and decide whether valuable resources should
be directed into such new areas.
Secondly, the medical workforce is becoming
more mobile. It is not uncommon for
anaesthesiologists to move from one side
of Europe to the other. Having successfully
completed an examination such as the EDAIC
automatically provides evidence of acquired
knowledge and understanding of our specialty.
Thirdly, a successful examination is one that
is accessible to and supported by those taking
the examination: if it does not cover topics
relevant to current practice then it is not fit for
purpose and will be avoided. The Chairpersons
of the Part I and Part II Subcommittees are
responsible for making sure the examination
remains relevant and accessible: questions
that were asked 20 years ago may no longer
be relevant to modern-day practice and it is
essential that they are replaced by newer and
more pertinent ones. Without the hard work
of these Subcommittees the examination
would not retain its current position as a highly
respected examination.
Fourthly, the examination must be respected
and supported by trainers and examiners
throughout Europe, both local and ESA
appointed. If trainers do not respect an
examination and consider it unreliable and
invalid, then it will not survive. Statistical
analysis of the performance of the elements
of the examination is crucial to providing
evidence of reliability and validity. The pass
score for the written examination must be
justifiable and validated. The pass score for the
Part I Examination is based neither on a fixed
value nor on a fixed percentage of candidates
but varies from year-to-year according to both
paper difficulty and cohort variability. Each
paper contains discriminator questions that
perform consistently from year-to-year and
allow cohort ability to be assessed and the pass
mark adjusted accordingly. Analysis of reliability
consistently show that each 60-question paper
has a Cronbach’s alpha well above the accepted
minimum of 0.8. The Part II Examination is
less easy to analyse statistically, but examiner
performance is audited and all new examiners
are required to be paired with a senior EDAIC
examiner to ensure their performance and
behaviour is at the high standard expected.
For individual countries it is important that the
EDAIC is not run by a single country but by a
committee that has both elected members and
invited representatives from all countries that
have adopted the examination as part of their
National assessment programme. Therefore
those countries adopting the examination are
included in all discussions, have direct input into
the way in which the examination runs and are
involved in examination setting and question
reviews. It is a very efficient use of resources:
one examination for many countries rather
than each country developing an examination.
With the very large number of candidates
sitting the EDAIC, analysis of performance
is meaningful and reliability and validity is
assured. Although the primary language for the
examination is English, the Part I Examination
can be taken in one of 12 languages: all 11
translated papers will also display the original
English version. Any country that adopts the
Part I Examination as a National examination is
entitled to have the papers translated into their
own language, which makes it readily accessible
to their trainees.
Respect for the examination is paramount:
without it the exam would fail. Our exam
continues to grow, both in Europe and
beyond. This growth is maintained by three
important factors. Firstly, a strong and
respected Examinations Committee whose
members work voluntarily and tirelessly to
maintain the credibility of the examination.
Secondly, the voluntary examiners and hosts
who ensure the exams are conducted fairly
and in optimal conditions and thirdly, but by
no means least, a supportive and dedicated
AIC
support team in the ESA office. Even all this
is not necessarily sufficient for continuing
success: the Examinations Committee needs to
be visionary. Future goals of the committee are
the development of online examinations (OLA),
home-assessment (HOLA) to help trainees work
logically through the European curriculum for
Anaesthesiology and the development of a
Europe-wide portfolio for recording training
and continuing professional development.
Enough work for many years to come!
// On-Line Assessment in
Anaesthesiology
In last year’s report we introduced the OnLine Assessment (OLA) project, the result of
a partnership between the Union of Medical
Specialties (UEMS), the European Board of
Anaesthesiology (EBA) and Orzone AB - a
Swedish company with an aspiration to deliver
state-of-the-art simulation and software
dedicated to medical education. As a result
of this successful collaboration we now have
a secure platform to run real-time online
assessments where participants can take an
examination for formative purposes. There
have been two successful pilots of this system,
the first was reported in the Summer 2011 issue
of this newsletter and the second was held at
the Annual ESA Congress in Paris as part of the
Basic Sciences Anaesthetic Course.
The exciting news for 2013 is that on April 19th
there will be the very first On-Line Assessment
accessible across Europe. Many centres in both
Europe and outside have already registered an
interest in providing the controlled environment
required for this assessment, which will be
available between restricted hours during the
afternoon. The structure of the assessment
will resemble the Part I written Examination,
with two “Papers” covering Basic Science and
Clinical Anaesthesiology. The questions all map
to one or more domains of the UEMS European
Curriculum for Anaesthesiology to ensure the
assessment covers all examinable domains.
Each centre will decide which 3-hour time slot
they will use within the nominated period. An
individual candidate will have a maximum of
3 hours to complete the assessment from the
time they log onto the OLA Platform. Ninety
minutes will be the maximum time allowed
for each paper of 60 questions: if the first
paper is completed in less time than this the
candidate can move on to the second paper but
cannot carry-over any unused time. Once the
assessment has been completed in that centre,
participants will have immediate feedback
on their performance - a score for each paper
will be given and they can look back over the
questions for a limited period to see which
ones they answered incorrectly. This provides
an opportunity for participants to find out
where their strengths and weaknesses lie and
allows them to better prepare themselves for
the official EDAIC, which will continue to be a
paper-based annual examination.
The feedback from participants has proved
very useful and a newly designed Basic
Sciences Anaesthetic Course will take place in
parallel with the 2013 Annual ESA Congress
in Barcelona. Participants will again have
the opportunity to attend certain congress
sessions, including the plenary and certain
invited speaker sessions. As in Paris, the course
will conclude with an online assessment based
on questions provided by the lecturers covering
the important take-home messages. The course
has an new organiser, Mario Zerafa from Malta,
who will continue to be assisted by Zeev Goldik
and Sue Hill from the Examinations Committee.
Interested participants should visit the ESA
website, www.esahq.org, and register as soon
as possible since numbers will again be limited.

Once the OLA has been established, the next
task of the hard-working OLA Committee will
be to develop the Home On-Line Assessment
(HOLA). This aspirational project will provide
a new way of assessing progress through the
European Curriculum for Anaesthesiogy - in the
comfort of the anaesthesiologist’s own home.
We hope to deliver an educational environment
in which the importance of both Basic Science
and Clinical knowledge can be understood
through online questions. Watch this space!
// Basic Sciences Anaesthetic Course /
Paris 2012
A further success in 2012 was the Basic
Science Anaesthetic Course that ran in parallel
with the Annual ESA Congress in Paris. The
participants were all very tired by the end of
this intensive course that provided lectures,
from EDAIC examiners and members of the
ESA Examinations Committee and ESA Board,
covering a wide variety of topics. The majority
of candidates found the course stimulating and
commented that they realised how much work
was needed to acquire the required knowledge
to be successful in the EDAIC Part I Examination.
A full report from the 2012 course was published
in the Autumn 2012 edition of this newsletter.
The John Zorab Prize, for the
highest marks in Part I, was won
by Dr. Christian Beilstein, so it
returns to Switzerland once more:
a challenge goes out to other
countries to better the Swiss
record for winners of this prize!
09
JOIN US AT THE
EUROANAESTHESIA
CONGRESS IN
BARCELONA!
“Symposium organised by the
ESA Examinations Committee"
Sunday 2 June 2013, 10.30 – 12.00
Fred Roberts:
Summative assessments
Elisabeth Van Gessel:
Formative assessments
Zeev Goldik:
Self assessments
“Workshop for Examiners”
Sunday 2 June 2013, 14.00 – 14.45
Zeev Goldik:
The Borderline Candidate
EDA
// New EDAIC Centres
// Examination Numbers and Figures
2012 was no different from previous years in that
new centres continued to open across Europe.
EDAIC Part I - Written Examination
Part I: Moldova became the newest
European country to officially adopt the Part
I Examination, with 28 candidates sitting the
EDAIC in Chisinau. Host: Dr Markus Schily.
ITA: Düsseldorf, hosted by Prof Benedikt
Pannen and Dr Sven Lindner.
Part II: Berlin, hosted by Prof Claudia Spies
and Dr Wolf Blaum. For the first time, both
Madrid and Barcelona were open the same
year due to increased numbers of candidates
opting to take the Part II Examination in Spain.
Indonesia ran the Part I Examination for the
second year running and 2013 is likely to see
Beirut becoming a Part I centre - Lebanon will
be the second non-European country opening
its doors to the EDAIC Part I. Talks continue
with both European and non-European
countries to adopt our examination: there
will be some interesting discussions during
2013.
Out of the 1541 candidates who sat Part I in
September 2012, 888 were successful, an
overall pass rate of 57.6%. This was marginally
lower but similar to previous years and can be
compared with overall pass rates of 59.8% in
2011 and 58.3% in 2010.
Part II - Oral Examination
In 2012, 387 candidates travelled to 10 centres
to sit the oral examination. This is yet another
record number of candidates - an increase of
13.8% compared with 2011. Of these, 289 were
successful, giving an overall pass rate of 74.7%.
ITA - In Training Assessment
In 2012 there were 332 candidates sitting the
ITA. We look forward to these candidates taking
the EDAIC Part I in the near future. //
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Board of Examiners // in Berlin
10
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1600
400
350
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
AIC
Candidates sitting the EDAIC Part I // 1984-2012
Pass
Fail
1400
1200
1000
800
600
400
200
0
Candidates sitting the EDAIC Part II // 1985-2012
450
Pass
300
Fail
250
200
150
100
50
0
11
FLASHES FROM THE HISTORY OF ANAESTHESIOLOGY //
FROM THE VERY BEGINNING UNTIL TODAY
GEORGE LITARCZEK // ROMANIA // glitarczek@yahoo.com
This is a serie of flashes to cover the evolution of medicine from its beginnings until anaesthesia appeared and later
developed to what it is today.
History of Anaesthesiology, flash 2 // from Greece to Rome
and a little bit of China
In this quarter’s look at the history of
anaesthesiology, we will look at medicine and
its application in the treatment of pain, in three
great civilisations: Greek, Roman and Chinese
(far eastern).
The Greek period starts in Crete more than
2500 BC. Contemporary to Egyptian civilisation,
it continues with the Mycenaean period around
1200 BC, and the classical period which starts
around 800 BC, and reaches its peak around 500
BC. Apart from the already cited episode in the
Iliad which occurred in the Mycenaean period
but was narrated by Homer at the beginning
of the classical period, two names deserve to
be mentioned: Asklepios (Aesculapius) and
Hippocrates.
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Asklepios is a legendary character who became
the symbol of physicians and medicine. Half
god, son of Apollo and Coronisa, a mortal, he
is considered as the founder of Medicine as he
is believed to be the first to create organised
institution for the treatment of ill people. His
symbol, a serpent entwining a staff, is used as
symbol of medicine even today. With his wife
Epione he had 6 daughters and 3 sons. The
names of some of his daughters like Hygea,
personification of health and cleanliness, Iso,
recuperation from illness, Aceso, healing,
Panaceea, universal remedy, are connected to
some aspects of medicine. Special places, called
“Asklepeions” including usually a temple, an
amphitheatre, and different establishments for
housing, nourishing and treating patients were
created in different Greek cities in Greece and
Asia minor.
Hippocrates (460-377 BC.) was born and lived
a major part of his life in the Isle of Cos in the
most glorious period of Greek civilisation, the
time of Pericles. The legend says that he was
a descendant of Asklepios on the paternal site
and of Herakles on his maternal. His parents
as well as his descendants were medical
practitioners. He is considered to be the father
of medical profession as he separated medical
practice from religion and considered disease
to be caused by natural causes and not by
any type of divine or spiritual intervention. He
believed in the power of nature to heal disease
and recommended rest and immobilisation.
He was reluctant in the use of drugs and we
have no hints about him using analgesic drugs
in spite of the fact that he must have had
knowledge of them. He introduced new types
of medical instruments like the lead pipe for
thoracic drainage and the Hippocratic bench for
extension of broken limb bones.
Greek medical practice was taken over by the
Roman conquerors and extended throughout
the empire. In Roman times 2 names deserve
our attention Dioscorides and Galen.
Pedanius Dioscorides, a Greek born in Asia
Minor, lived in the first century AD. And was a
personal doctor of emperor Nero and a surgeon
of the emperors army (40-90 AD.), meaning he
travelled extensively and acquired knowledge
on medical habits all around the Mediterranean.
He is the author of an impressive treaty in 5
volumes of pharmacology. The book was initially
written in Greek and translated in Latin titled
“Materia Medica”, the precursor of modern
pharmacopeia. The text was translated to many
European and Asian languages It was used up
to modern times in places where medication
based on plants was prevalent, meaning up to
the beginning of the 20th century. A last edition
was printed in 2000 in Johannesburg South
Africa. You will find in this book chapters written
in the style of modern treaties about all plant
remedies - used to produce sleep, sedation,
analgesia, oblivion or even act as a lethal toxin.
Aelius Claudius Galenius physician, surgeon
and philosopher (129-200 AD.) born in
Pergamon (Asia Minor), lived in Rome since
162. Of Greek origin and descended from an
educated family with an architect for a father,
he traveled a lot throughout the empire and
was a personal physician to some emperors:
Marc Aurelius, Commodus, Septimius Severus,
Caracalla. He studied medicine in the local
Asklepeion in Pergamon and Alexandria. He
was a practitioner involved as well in caring for
patients, combating epidemics like the great
epidemic from 168-69 (The Antonin plague,
probably smallpox) which killed almost 50%
HISTO
12
Editor's note: Professor George Litarczek is the founding father of the modern
Romanian Anaesthesiology and a very active author of textbooks.
Here he is inaugurating a new series about history of our profession.
of the population. He was involved in military
medicine accompanying the troops in the
northern part of the empire living with the
legions in Aquilaeia.
He had important and long lasting contributions
to many fields of medicine but there are few
mentions of his preoccupation for anaesthesia
and analgesia in spite of his experience with the
military. His experiments with nerve ligation
proved to him that the brain was in control of
all the body parts through nerves. His numerous
works were written in Greek language and
translated in Latin and Arabic.
Chinese medicine developed in parallel
with western medicine but on very different
theoretical basis. The first written document
that we know about is the first monograph on
medical theory dating from the 5th century
BC. (Pericles time). It presents the medical
knowledge accumulated during more than
2000 years of tradition including therapies
like acupuncture, herbal medicine, massage,
exercise and dietary concepts. A classical
document is the “Yellow Emperors Inner
Cannon” dating from the 1st century BC. in
which, in a form of a dialogue the main concepts
of medicine are resumed. They are based on
the Yin/Yang and the “Five Phases” (Wood,
fire, Earth, Metal and Water) theory to explain
physiology, pathology and etiology and guides
diagnosis, therapy, prevention and application
of drugs. Emphasis is put on function not on
anatomy. Pathology is considered as being
exogenous, endogenous and intermediate.
Disease is an imbalance in man's relationship
with his surroundings and within his body
and is not produced by evil spirits or gods.
The first analgesic used was a powder “NaFu”
(Aconite+Datura+other herbs) mixed with wine
proposed by Hun Tuo, during Han dynasty, as an
anaesthetic for surgery. Hun Tuo is considered
as the Hippocrates of China. Acupuncture was
mentioned as a method to produce different
therapeutic effects and specifically analgesia, by
interfering with “Qi”, the energy of life, during
the 1st and 2nd centuries BC. It is the period
when puncture points as well as the circulation
of energy through meridians was proposed. //
ORY
ESA Masterclass on Clinical Trials
and Clinical Epidemiology,
October 31 – November 2 2013
13
ETPO
European Transfusion Practice and Outcome Study (ETPOS)
to begin in spring 2013 //
T O N Y K I R B Y / / L O N D O N , U K / / t o n y @ t o n y k i r b y. c o m
One of the trials to be funded by ESA’s Clinical
Trials Network (CTN) is continuing to recruit
centres across Europe and will begin in Spring
2013. The European Transfusion Practice and
Outcome Study (ETPOS) aims to describe
differences in transfusion habits throughout
Europe and to correlate these habits to
perioperative outcome parameters.
The study follows work by an Austrian group
(Prof. H. Gombotz et al.) that established
different anaesthetists and hospitals could
reach different decisions on whether a blood
transfusion was necessary even if presented
with very similar patient circumstances. “This
work made us realise that we really don’t know
very much the decisions made across Europe on
blood transfusion, or why they are made,” says
lead investigator Professor Jens Meier, Clinic of
Anaesthesiology and Intensive Care, University
Tübingen, Germany. “Although many countries
in Europe have guidelines for transfusion,
subtle differences exist.” He points out there is
evidence starting to emerge that more liberal
transfusion practices can potentially harm
patients.
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Meier explains that there are two prevailing
concepts in this field: the first uses haemoglobin
levels in the blood, with a transfusion becoming
necessary if this level drops below a certain
14
value. “However, this threshold is not set, it’s
different for each patient and is determined by
the anaesthetist based on various factors,” he
says, adding that in general the sicker patients
receive blood earlier, while those who are in
a better condition would receive blood later.
“The other parameters than can be used are
the so-called physiological triggers, where
blood is only given if one or more trigger points
are passed. However, this system is rarely used
on its own in practice, and is often used in
conjunction with haemoglobin levels.”
It is not only whether and how many packed
red blood cells (PRBCs) are transfused that will
be analysed in EPTOS. Special focus will also
be put on the ratio of PRBCs to other blood
products or coagulation factors in the operating
room. “Bleeding patients are also losing the
other contents of their blood such as platelets
and coagulation factors. So the study will also
be about how coagulopathy is treated,” says
Meier. He explains that while in some centres
fresh frozen plasma and platelets are routinely
transfused in a fixed ratio with PBRCs, in others
only those factors actually identified as depleted
or missing from the patient are included in the
transfusion. Yet the very point-of –care tests
to determine which coagulation factors are
missing are themselves still under investigation
and are not generally used throughout Europe.
“
ETPOS is aiming to recruit around 150 centres
from more than 30 countries, ideally with the
number of centres from any one country being
in approximate proportion to its population
size. Spain, Germany, the UK, Italy and Romania
are among the countries with the highest
numbers of centres agreeing to participate so
far. “It will be interesting to see if the size of
the centre plays a significant role in transfusion
practice, since we have centres ranging in size
from the huge university hospitals down to
much smaller regional clinics,” says Meier. The
actual assessment period is between Spring
and Autumn 2013, with hospitals able to
choose when to start their 3-month continuous
participation during this window.
The study will assess transfusion practices in
around 10,000 patients undergoing all kinds of
elective surgery. Excluded will be those having
cardiac surgery and emergency room trauma
patients, since both of these situations have, in
most cases, protocols that remove the decision
making of the individual anaesthetist. 30-day
mortality will be a secondary outcome of the
study.
“It is clear that there are currently large
knowledge gaps in what we know about
transfusion practice across Europe,” concludes
Meier. “The ETPOS study should give us a clear
Physicians have an ethical code enforced by themselves, to
care for all people, to care for them when they are sick,
hostile, demanding, rich or poor.
(E. Stead Anesthesiology 1985;62:776)
OS
Results of 2013
Research Grant Applications //
ANDREAS HOEFT // CHAIRPERSON OF THE RESEARCH COMMITTEE // andreas.hoeft@esahq.org
// Thirty-nine applications for ESA Research Grants
picture about what different anaesthetists
in various centres are doing and why. With
availability of blood declining and the cost of
it increasing, it’s essential we find out exactly
what is going on to intensify the discussion in
this vital field and potentially establish best
practice guidelines that can improve outcomes
and reduce costs.”
“ETPOS will be challenging for the ESA Clinical
Trials Network, but it is doable and the study
deals with a highly relevant issue of perioperative
medicine,” adds Professor Andreas Hoeft,
Chairman of ESA’s Research Committee and
of the Department of Anaesthesiology and
Intensive Care Medicine, University Hospital
Bonn, Germany. “ETPOS will add another
important piece of knowledge to the puzzle
of perioperative blood management,” he
concludes.
Anyone wishing to get involved in the ETPOS
study should contact Jens Meier (Chief
Investigator) at jens.meier@gmail.com or the
ESA Secretariat (research@esahq.org). //
On November 16th 2012, the Research Committee met in Brussels to review and
discuss 39 Research Grant applications received: 8 applications for the 15,000 Euro
category, and 31 for the 60,000 Euro category
// A two-round evaluation
All 39 applications were reviewed in a first round by Research Committee members.
Each application was ranked independently and according to a predefined threshold
value, 23 were selected to a short list for final evaluation. These applications received
a second round of evaluation by other research committee members and finally also
external reviews The following criteria were considered for evaluation:
1) Scientific merit
2) Methodology
3) Relevance
4) Budget appropriateness
5) Research group and other consideration.
Finally, the following applications were successful:
// Research Grants up to 15,000 Euro:
•Stefan De Hert, University Hospital, Ghent, Belgium
“Role of myocardial oxygen balance in the pathogenesis of right ventricular
dysfunction and the impact of positive inotropic support.”
•Jurgen De Graaff, University Medical Center, Utrecht, The Netherlands
“Effect of time and duration of anesthesia during childhood on psychopathology in
monozygotic twins”
// Research Grants up to 60.000 Euro:
•Robert Dickinson, Imperial College London, United Kingdom
“Xenon – a neuroprotective treatment for blunt-traumatic brain injury and
associated cognitive dysfunction - pilot study”
•Niccolò Terrando, Karolinska Institutet, Sweden
“Neuroinflammation and cognitive decline after general anaesthesia and surgery.”
Due to the high quality of most applications, Research Committee members felt that
the selection process was rather difficult. In the end, we are confident that we have
chosen four really interesting projects of exceptionally high quality, which are all of
significance for our specialty; although many more projects would have deserved to
be funded.
We would like to thank all applicants for their interest and the work they have invested
into this scientific competition. We also hope that those who were not fortunate this
time will be motivated to contribute in the future. It became also obvious from our
review work that many of the applications will also have great chances to be funded
from alternative resources. In this regard we wish all applicants success. //
15
A young and active National Society //
D R . I R I NA T SI R KVADZE // TBILISI, GEORGIA / / ir inola1@gm ail.com
The Georgian Society of Anaesthesiology and
Critical Care Medicine (GSACCM) numbers
about 150 physicians, nurses, physiotherapists,
healthcare managers and healthcare providers
of different fields of medicine. The main goals
and priorities of our society are: creation of
a strong theoretical and practical basis for
anaesthesiology and critical care medicine in
Georgia, promotion of progress in the specialty,
continuous medical education activities,
scientific research, professional development
and collaboration with official structures
involved in Georgian healthcare.
Since 2005, a year which witnessed a new trend
in our activities: members of the society who
are at the same time prominent professionals
in medicine (and particularly anaesthesiology
and Critical Care) are now involved in various
activities which are helping promote future
improvement of anaesthesiology in Georgia.
The following lists some recent activities and
accomplished projects:
*Continuous medical education (CME) training
and points accreditation
*Publication of 5 textbooks in Georgian, for
the use of our students, residents and young
specialists
*Protocols and guidelines as per the request of
the Georgian Ministry of Health
*Preparation of the residency program and
track in anaesthesiology and critical care
*Training in the subspecialty of paediatric
anaesthesiology and critical care which was
accepted by the Ministry of Health – about
90 physicians have already completed the
training
*
Implementation of Advanced Trauma Life
Support (ATLS) training in Georgia – 6
physicians trained as instructors will participate
in ATLS inaugural course in the first months of
2013
* GSACCM sent three young specialists to the
ISIA (the International School for Instructors
in Anaesthesiology) 3 course and they just
graduated the school last October in the
island of Crete.
Our society is affiliated to ESA, WFSA, the
European Society of Intensive Care Medicine
(ESICM) and World Federation of Societies of
Intensive and Critical Care Medicine (WFSICCM)
and our members regularly participate in
international congresses organised by these
societies.
The new Committee for European Education
in Anaesthesiology (CEEA) centre has been
recently founded in Georgia. The director of
the centre is Professor Mamuka Chkhaidze. The
center was founded bv the National Training
Center at GSACCM, thanks to the close alliance
between our society and ESA.
2012, and almost 40 participants took part in
the two day-program. The faculty included
leading anesthesiologists from Georgia, as well
as two leading professors from Israel.
This type of post graduate education is very
important for the Georgian healthcare system,
especially for adaptation of our anaesthesiology
and intensive care medicine to European
standards. Our special interest and focus is
directed to the patient safety and all educational
projects are supposed to strengthen our
abilities to take care of the patient both in and
outside the operating room.
GSACCM is currently preparing a large
educational project with the occasion of its 1st
International Symposium, planned for August
29-31, 2013 in the splendid city of Batumi, on
the Black Sea shores.
The program will include, in addition to three
days of panels andworkshops and plenary
lectures, two more courses: the second CEEA
annual course and the first national educational
course organised and taught by our three ISIA
2012 graduates.
We would like to invite the ESA Newsletter
readers to participate in this event next August,
and to contribute to the scientific program,
while at the same time enjoying the splendid
weather and location of Batumi. //
SOCIET
16
The first course of CEEA in Georgia - “Respiration
and Thorax “ was held from September 21-23,
GSACCM Secretary
Editor's note: This is the first in a Series of articles
about National Societies of Anaesthesiologists.
Officers of other European national societies are
kindly invited to follow Georgia's example and
send presentations on their own organisations
and activities.
Survey on the ESA Newsletter //
A.FIRST PART: PERSONAL DATA
A1. Who are you?
a.resident in the 1st part of training
b.resident in final stage of training
c.specialist, less than 5 years
d.specialist, more than 5 years
A2. Currently you are working in a:
a.academic hospital
b.regional hospital
c.local/municipal hospital
The first CEEA class in Tbilisi //
September 2012
TY
A3.Your age:
a.less than 35 yrs
b.35-50
c.Over 50 years
A4. Your first language is:
a. English
b. French
c. Spanish
d. Russian
e. Italian
f.other
B.SECOND PART:
ABOUT THE ESA NEWSLETTER
One answer per question for questions
1 to 7
1.How do you read our Newsletter?
a.by internet
b.the printed form
c.I usually do not read it
2.How long, in general, does it take
you to read the Newsletter?
a.less than 10 minutes
b.between 10 minutes and one hour
c.more than one hour
3.What do you do with the brochure
after reading it?
a.keep it for a couple of days/weeks
b.throw it after reading
c.keep it for longer periods of time
c.too short
5.Do you think that the Newsletter includes
the expected information about the
professional and organisational aspects of
the European anaesthesiology?
a.yes
b.yes, partially
c.no: needs a lot more
6.What do you think about the general
content of the Newsletter?
a.interesting enough to be read
b.interesting only to be looked over
c.not so interesting
7.Would you recommend the Newsletter to
your colleagues?
a.yes
b. maybe
c. no
8.Please, specify what kind of topics would
you like to read in the Newsletter:
(more than one answer permitted)
a.Organisation of the profession
b.Residency track in various countries
c.Places for fellowship
d.National Societies activities
e.Presentation of anaesthesia departments
f. Professional debates
g.Short case presentations
h.History of European anaesthesia
i. Reviews of textbooks
j. Reviews of important articles / studies
Please send your answers to :
Newsletter@esahq.org
before 15 March 2013
One respondent will be drawn at random
and get free registration to Euroanaesthesia
in Barcelona. //
4.
What is your opinion about the
format of the Newsletter
a.a proper format
b.too long
EUROANAESTHESIA 2013
June, 1-4
Barcelona, Spain
17

The Institute of Anaesthesiology at the
University Hospital Zurich //
D ON AT R. S PA H N A N D P E TE R BI RO / / ZURI C H , S WI TZE RL A N D / / a n a e sth e siologie @u sz.c h
The Institute of Anaesthesiology (IFA) at the
University Hospital Zurich (USZ) is one of
the leading anaesthesiological departments
of the 5 university hospitals in Switzerland.
It comprises a staff of nearly 130 medical
doctors and 140 anaesthesia nurses of various
professional degrees and levels of experience.
Among the medical doctors, there are some 80
residents, who spend the largest part of their 5
years specialisation period in our institute. The
IFA is responsible to cover all anaesthesiological
services for the USZ. The campus is scattered
over various buildings and therefore separate
anaesthesiological teams are dedicated to each
of the existing 7 operation units comprising
more than 35 simultaneously active operating
rooms. The USZ runs all surgical disciplines
except paediatric and orthopaedic surgery,
which are allocated in separate neighboring
academic hospitals. With these external
hospitals there is a close collaboration and a
number of IFA residents work in these academic
hospitals in rotation turns of 6-12 months.
All residents of the IFA are assigned into a
meticulous rotation plan in order to obtain
full knowledge and experience in all fields of
modern anaesthesiology. A very active subunit
of the IFA is dedicated to transplant surgery,
thus representing the largest specialised team
of its kind in the country, where among others
14 hearts, 30 lungs and 47 livers have been
transplanted in 2011. In 2011, the IFA performed
all together more than 26000 anaesthesia cases
of all types and difficulty degrees.
// Clinical work
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Since the USZ is a tertiary unit responsible for a
large part of the country and as being located in
the most densely populated region, it attracts
complicated and severe cases that occur in
the region and beyond. By this condition, the
IFA has to adhere to the most recent advances
18
in anaesthesiological practice and science,
to which it also substantially contributes. In
the last years, the IFA became a worldwide
renowned center of expertise in the field of
patient blood management. Transfusion of red
cells and other blood components have been
minimised by a locally tailored transfusion
algorithm. The IFA integrates a steadily growing
pain unit which covers therapeutic services
for all hospital inpatients (3500 pain visits per
year in 2011) as well as a tertiary outpatient
clinic specialised in clinical and interventional
pain diagnostics and therapy for patients with
chronic pain conditions (400 newly admitted
patients per year). In addition to the regular
clinical anaesthesia in surgical units, the IFA
provides full coverage of resuscitation needs
in the hospital, as well as in the city and region
of Zurich. Thus the IFA runs its own emergency
division as a part of the emergency department
of the hospital and provides anaesthesiological
care to all emergency and non-elective cases in
the hospital, including every admission to the
emergency room. It also ensures the in-house
emergency call service and provides specialised
physicians to the urban emergency medical
service (EMS) and to a nearby helicopter base
of the Swiss Air-Rescue (Rega). Together with
the latter organisations, the IFA provides onsite emergency physician care to about 2000
patients a year.
// Scientific work
Many IFA staff members are involved in
basic scientific work as well as in clinical
investigations. Some senior investigators have
set up own laboratories dedicated to research
in nanotechnology, fluid management, organ
protection, inflammation (patho)physiology,
blood coagulation, team interaction and
related fields of interest. In the laboratory of
immunopathology relevant mechanisms of
organ protection such as ischaemia-reperfusion
injury are elucidated, which help translate
basic into clinical research, and vice versa.
Some projects within this topic are carried out
in close collaboration with the University of
Illinois Chicago, where young researchers of the
IFA are trained in basic research. In parallel to
molecular research, randomised clinical trials
are designed and performed in visceral and
thoracic surgery, together with other academic
centers of Switzerland. A second topic of this
research group is nanomedicine, where vascular
compatibility of magnetic nanoparticles is tested
in vitro and in vivo, an activity that is supported
by the Swiss Federal Institute of Technology
Zurich (ETHZ). Nanoparticles are capable of
binding high molecular compounds, thereby
opening a variety of possible therapeutic
applications such as blood purification. Both
research fields are funded by grants of the
Swiss National Science Foundation (SNSF). The
pain research laboratory focusses on peripheral
mechanisms of pain. Topics include electrical
and pharmacological modulation of nerve
excitability in normal and neuropathic pain states
(neuro-modulation) including in-vitro rodent
models, proof-of-concept studies in healthy
volunteers and phase-I-IV studies in patients.
This unit is supported by various research
grants from different grant providers including
the Swiss National Science Foundation. By
additional research cooperation with the ETHZ
we investigate the impact of team interaction
on anaesthesia team performance. Supported
by two grants from the SNSF, topics included
the impact of leadership, communication, and
speaking-up behaviour on team performance,
and more recently, the design, implementation
and evaluation of crisis resource management
training for anaesthesia staff.
The output of these research activities
results in obtaining more highly qualified
physicians as well as a considerable amount
of publications. The number of original as well
as review articles, editorials and book chapters
amounted to25 in 2009, 50 in 2010 and 58 in
2011. Clinical research is well rooted in various
subunits of the department and closely linked
by interdisciplinary collaboration with the
respective surgical clinics.
// Teaching and training
From the Medical Faculty of the Zurich
University the IFA parents the academic
teaching of medical students during their
bachelor as well as master study periods with
various lecture cycles, courses and by problem
oriented learning (POL). The spectrum of
teaching activities of medical students ranges
from Grand Round lectures for a whole
semester group to one-to-one bedside teaching
in the operating rooms. Some advanced
medical students attend a 2 to 4 month long
intensive practical training, where they are
instructed and trained in the same way as
residents at the beginning of their postgraduate
clinical education. In addition to the practical
teaching offerings, a web based interactive
eLearning platform is also maintained by the
IFA. The residents of the department undergo
a thorough education and training consisting
of regular courses (that are shared with
external departments via video conferencing)
and by personal assistance and instruction by
senior staff members and dedicated academic
teachers. Staff members are regularly invited
into the recently inaugurated and well equipped
simulation centre to participate in real-time
simulations of various clinical scenarios. These
activities incorporate definite training units
for resuscitation, difficult airway management
and critical intraoperative situations. Certain
simulation rounds are recorded and the
participants are debriefed with the help
of professionals in anaesthesiology as well
as in terms of occupational psychology
and team performance. Furthermore, the
residents are evaluated at least once a year by
dedicated senior staff members with a specific
performance appraisal. Recently, a work based
assessment program has been installed (Direct
Observation of Clinical Encounter, DOCE). The
immediate feedback of pre-defined processes
in clinical practice gives additional input to the
annual qualification for both, the teacher as well
as the trainee. Since 2011, the residents have
also the opportunity to evaluate the teaching
competence of their teachers twice a year with
a structured internet based questionnaire. This
is the first bottom-up qualification program
of its kind in Switzerland. The facilities of the
USZ are once a year the location for the Part
2, oral exam of the European Diploma of
Anaesthesiology, for which the IFA not only
provides the necessary infrastructure, but also
substantially contributes by sending competent
examiners and offering the local all-round
organisation of this event. Members of the staff
of the emergency division provide an emergency
physician course twice a year. This is one of
seven courses performed under supervision
of the Swiss Society of Emergency Medicine
(SGNOR) and forms a basic requirement in
obtaining the emergency physician certificate.
The IFA is continuously involved in national and
international collaborations which cover both
scientific as well as clinical projects. Over the
last years many young anaesthesiologists from
various countries have spent periods of weeks
to months of clinical practice in our institute
and were trained in the same way as the regular
residents. //
19
Preparation for EDAIC //
Multiple Choice Questions
for Part 1
(more than one answer could be correct for each questions)
Answers will be published in the next issue of the Newsletter.
1. In a patient with a hiatus hernia, anaesthetic complications at induction
can be reduced by
a. the use of ketamine
b.preoperative therapy with H2 receptor antagonists
c.the use of cricoid pressure
d.the use of a laryngeal mask
e.atropine premedication
2. Factors known to influence total respiratory compliance during
anaesthesia include
a.changing depth of anaesthesia
b.administration of depolarising muscle relaxants
c.duration of anaesthesia
d.body position
e.pneumoperitoneum
3.Possible complications of right-sided supraclavicular brachial plexus
block include
a.Horner's syndrome
b.phrenic nerve paralysis
c.recurrent laryngeal nerve paralysis
d.damage to the thoracic duct
e.subclavian artery puncture
4.In a patient with low intracranial compliance, cerebrospinal fluid
pressure
is directly increased by
a.hypercarbia
b.hypoxia
c.isoflurane
d.ketamine
e.propofol
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
5.In a patient suffering from a thyroid crisis, suitable treatment includes
20
a.beta adrenergic blockade
b.digoxin
c.corticosteroids
d.nasogastric potassium iodide
e.intravenous methimazole
In the next issue of the newsletter the correct answers and explanations
will be given.
Dr Sue Hill, Chairman Part I EDAIC Subcommittee


Editor's note: The Editor is grateful to Dr Sue Hill, Chairperson
of Part I EDAIC Subcommittee, for her contribution to this
section.
Preparation for EDAIC // Answers
These are the answers to the questions posed in the previous newsletter.
T= True, F=False
1. Total T4 level in serum:
a. has a reciprocal relationship with the free T3 level
b.is controlled by calcitonin from the C-cells of the thyroid
c.is affected by the level of thyroxine binding globulin
d.is controlled via a posterior pituitary hormone
e.is elevated by growth hormone
Answers: a) F b) F c) T d) F e) F
Explanation: The levels of total T3 and T4 are not strongly correlated in normal subjects.
T4 is carried in the plasma by thyroxine binding globulin (TBG), which
is normally only 25% saturated: changes in TBG levels will affect total T4
but not free T4. T4 is controlled by TSH from the anterior pituitary, which
is released under the control of TRH from the hypothalamus. Growth
hormone acts synergistically with T4 but does not affect plasma levels of T4.
2. Uptake of inhalational anaesthetics across the alveolar-capillary
membrane is affected by:
a. the partial pressure difference between the alveolar gas and that
dissolved in blood
b.membrane thickness
c.the presence of nitrous oxide within the alveolus
d.the cardiac output
e.hyperventilation
Answers: a) T b) T c) T d) T e) T
Explanation: Movement of volatile agent from alveolus to capillary depends on the
concentration gradient (difference in partial pressure), distance to diffuse
(membrane thickness), the second gas effect - nitrous oxide diffuses into
the capillaries faster than nitrogen exits the capillaries, so concentrating
the volatile agent in the alveolus and increasing the concentration
gradient; a high cardiac output slows and a low cardiac output speeds
uptake of volatile agent; increasing minute ventilation speeds uptake
(hyperventilation) and lowering minute ventilation slows uptake.
3. In type II halothane-induced hepatotoxicity:
a. severity of injury increases after each use
b.injury is invariably dose related
c.cross reactions with other volatile agents occur
d.specific treatment includes high dose steroids
e.injury never occurs on first exposure
Answers: a) T b) F c) T d) F e) F
Explanation: Type I halothane hepatitis is common and self-limiting, type II rare and
fulminant. Previous exposure produces antibodies against the haptens
formed during halothane metabolism, early re-exposure can then produce
a greater response. This adverse reaction is immune, not not dose-related
and requires a genetic predisposition. Other volatile agents that produce
similar oxidative metabolites can also trigger hepatotoxicity. Steroids
have not been shown to be beneficial. First exposure can be associated
with hepatotoxicity, although more commonly it is seen on second or
subsequent exposure particularly if close in time (within 6 weeks).
4.A gas chromatograph can be used to measure the:
a. concentration of nitrous oxide in a gas mixture
b.concentration of CO2 in expired air
c.concentration of a volatile agent in a gas mixture
d.blood pH
e.plasma thiopental level
Answers: a) T b) T c) T d) F e) T
Explanation: Gas chromatographs can identify compounds in a mixture that can be
converted into a volatile form without degrading, including compounds
in solution such as thiopental. Blood pH is determined by hydrogen ion
concentration, not hydrogen gas concentration.
5. The Chi-squared test (X2):
a. is an example of a parametric test
b.requires calculation of the squared (observed-expected frequencies),
divided by the expected frequency, for each cell of the contingency
table
c.Yates’ continuity correction is normally applied for a 2 x 2 table where
one expected value is less than 5
d.Fisher’s exact test is preferred for a 2 x 2 contingency table
e.a 2 x 2 contingency table has 3 degrees of freedom
Answers: a) F b) T c) T d) T e) F
Explanation: The Chi-squared test is a non-parametric test commonly used to
identify an association between categorical variables. The value of the
Chi-squared statistic is calculated as: ∑ (O-E)2/E where O and E are the
observed and expected frequencies for a given cell of the contingency
table. The continuity correction (Yates’) is used in 2 x 2 tables to allow
for the approximation of a discrete distribution by a continuous one,
more commonly for tables with small numbers of expected frequencies
- fewer than 5 expected observations in one cell is the generally quoted
limit. Fisher’s exact test was recommended only for 2 x 2 tables before
the advent of computers and acceptable computational methods. It
calculates the exact probability of the observed distribution of events
occurring rather than the approximate method used by the Chi-squared
test and works best when there is an uneven distribution of observations
in rows/columns. It is still preferred for small numbers of observations
and a 2 x 2 table. The number of degrees of freedom for any contingency
table is (number of rows - 1) x (number of columns - 1) so for a 2 x 2 table
this is (2 - 1) x (2 - 1) = 1 x 1 = 1.
21
ESA TRAINEE EXCHANGE PROGRAMME //
Academisch Medisch Centrum, The Netherlands.
A L E S S A NDR A B I NAG UI B UITUREIRA / /
T E N E RI F E , SPAI N.
It all started in November 2010 when I got the
confirmation of the Grant for the ESA Trainee
Exchange Programme and my destiny was
the Academisch Medisch Centrum (AMC) in
Amsterdam, The Netherlands.
The AMC is one of the eight university medical
centres in the Netherlands. They have 20 clinical
plus 5 day-care operating rooms and perform
about 20,000 anaesthesia procedures annually
excluding sedations. Approximately 800
procedures are cardiac surgery, from which 80%
are planned operations and 20% emergencies.
Next to clinical duties, the Department
of Anaesthesiology is involved in training
students from the University of Amsterdam.
The main focus of research concentrates on
cardioprotection, mechanical ventilation and
pharmacology of local anaesthetics.
From left to right:
Susanne Eberl,
Alessandra Binagui, Hettie Bosch
From left to right:
Nelson Monteiro De Oliveira,
Esther Reynecker, Alessandra Binagui,
Maartje Van Haperen.
In the back row: Markus Stevens.
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
We scheduled the first week of contact in
February 2011. The weather was much colder
than in Tenerife! I immediately realised that
Dutch language would play a central role in
my daily clinical practice as not all the patients
spoke English and all the medical data and
documents were in Dutch.
Once back at home I set my own goals which
I would like to achieve during the ESA-TEP.
I proposed myself 3 targets. First of all,
joining the Cardiac Team in my hospital and
starting to protocolise all the procedures,
as well as acquiring enough knowledge in
transesophageal echocardiography (TEE) for
intraoperative monitoring. Third, and probably
the most important of the three, learning as
much as possible in all the fields of anaesthesia.
For that purpose I had some work to do in
advance. I thought that learning some Dutch
could prove very useful in order to help me
to get better involved in the team and better
understand all the procedures and discussions
(I have to say that it was quite difficult to find
learning material in Tenerife!). Second and
more important, I had to update myself in
cardiac anaesthesia because in my hospital,
once you finish your residency you don't have
the possibility, straight away, to join the Cardiac
Team, so I lost practice during that year and
had to come back to my books and notes.
And third and probably the toughest one was
the BIG-Register, a “BIG-deal”, which took me
several months to finally acquire the medical
approval to be able to work and interact with
the patients in the AMC.
// The problem
Just one week before flying to Amsterdam a
problem occurred in my hospital and due to
last minute inconvenience I had to postpone
the rotation until March of the following year.
22
EACTA Meeting //
Back row, from left to right:
Carsten Schultheis, Edouard DeBeaumont,
Connie Bloom, Benedikt Preckel.
Front row, from left to right:
Veronika Evers, Daniel Brevoord,
Alessandra Binagui, Susanne Eberl,
Thomas Scheeren.
TRA
From left to right: Hennie Metske,
Suzana Tunovic, Wolfgang Schlack,
Alessandra Binagui.
Here I have to mention and thank the great
predisposition, cooperation and assistance of
the ESA-TEP Committee, with the Chairman
Dr. Gomar heading the group and Mrs.
Anny Lam doing immeasurable work in this
ESA-programme, which provides to all the
newcoming anaesthesiologists a priceless
opportunity to go further in our careers after
finishing the residency.
I also have to thank the AMC and especially to
Prof. Benedikt Preckel, for the collaboration and
support to overcome the unexpected problem
arising and for keeping my place till few months
later. So it was not an easy path but well worth
all the extra effort that these professionals put
in to help me retain my place in the exchange
programme.
// “And The Dutch created The
Netherlands...”
I arrived in March and started right away in
the Cardiac ORsO. There are 3 ORs for cardiac
surgery and the cath-lab for interventional
valve placements and treatment of rhythm
disorders. With support of Prof. Benedikt
Preckel and Dr. Susanne Eberl (Chairman of
the Cardiac Anaesthesia Section) I made a 3
months plan with the basic and more common
cardiac surgery cases that I had to get familiar
with. Next to completion of this initial plan I
was also able to join congenital cardiac cases
and more complex surgeries including children
and younger patients. As I was BIG-registered,
I was able to perform all the techniques while
being supervised by Cardiac Anaesthesiology
Staff during the surgery, just like a resident. I
gradually became more self-reliant. I had the
priceless help of the “medewerkers”, nurses
and perfussionists in the OR, helping me to
translate documents, understand discussions
and filling in data in the electronic anaesthesia
record. Also the surgeons were very kind in
helping me to understand the different parts
of the procedures and to switch to English
whenever I was in the OR and demanded
further information about the case. We usually
performed two surgeries per day and when
they were finished we visited the patients for
the day after, making sure everything from the
preoperative evaluation and the medication
was correct, and clarifying any doubt of the
patients. I also had the opportunity to stay for
emergency cases during the shifts which gave
me another view of Cardiac Anaesthesia in the
management of critical and acute patients.
The TEE for intraoperative assessment was
one of my main goals during the rotation. I was
already familiar with this monitoring option
because we use it in my hospital in Tenerife, but
I was not skillful enough and needed to learn a
systematic and efficient approach. Absolutely all
the Cardiac staff helped me a lot in this matter
and I am very grateful to all of them. That's how
I started gathering my own TEE examinations
supervised by Dr. Susanne Eberl.
The cath-lab was a very interesting point in
the rotation because in my hospital we are
introducing the TAVI (trans-catheter aortic valve
implantation) procedure this year. So there was
an extra value in learning the protocols from
the AMC in order to introduce the technique
once back at home. I got familiar with the
TAVI through the 2 existing approaches: transfemoral and trans-apical.
// The exam
As a wonderful coincidence, the EACTA congress
was to be held in Amsterdam at the end of May.
Prof. Benedikt Preckel suggested me to sit the
TEE exam, taking the advantage of being in the
Cardiac OR every day and preparing a special
rotation in the Echo-Lab with the cardiologists.
Dr Eberl and Prof. Preckel also provided me
reference material and books besides the ones I
already had. I had the opportunity to meet one
of my colleagues from my hospital in Tenerife in
the EACTA meeting and we both took the exam.
It was long and tough but 100% worth because
I fixed a lot of info and knowledge during the
intense study and parallel practice in the OR
and the Echo-lab. To be added to the initial
satisfaction for the hard work done I got the
results recently, and I passed!!
// “...Give oxygen!!”
I must say that one of the most valuable
things I took back home is the warm and
sincere friendship that I received from all of
the amazing team of the AMC, not only in the
beginning when it is fun to meet foreigners and
ask about other cultures, but during the hard
everyday-work in the OR in difficult situations
and towards the end of my rotation. No-one can
be excluded. From Jane Martens, responsible
for all administration in the OR area, through
Esther Reynekeer, Richard Meijs, Sonja Verbij,
André van Lonkhuizen and ending up with
the Cardiac Team: Dr. Veronika Evers, Dr.
Edouard de Beaumount, Dr. Nelson Monteiro
di Oliveira, Dr. Jan Frassdorf, Dr. Peter Meijer,
Dr. Suzana Tunovicz, Dr. Conny Blom and of
course Dr. Susanne Eberl and Prof. Benedikt
Preckel, Prof. Markus Hollmann and Prof.
Wolfgang Schlack.. My warmest thanks extend
to all the anaesthesiology Staff and residents
of the AMC, which really made me feel like at
home. I would like to encourage all newcoming
anaesthesiologists to visit other centers and
if possible to go out of borders. It is essential
for the nowadays clinical practice to explore
new ways of performing and understanding
anaesthesia. This is the key to provide a higher
standard of anaesthesia in quality and safety
and to improve our job at home, wherever we
might live and practice. //
AINEE
“
A stethoscope cannot function without a man at each side
(Dickinson Richards, Nobel prize winner, 1895-1973)
23
“
The history of medicine is that
what was inconceivable yesterday
and barely achievable today often
becomes routine tomorrow.
(Starzl TE et al Hepatology 1982;2:614)
”
WF
Europe and the World Federation of
Societies of Anaesthesiology (WFSA) //
Past present and future.
D AVID WILK I N S ON / / P RE S I DE N T, WF S A / / lor ik e e t08@gm a il.c om
Forty-five countries in Europe are members of
the WFSA. These societies represent around
44,000 members. This is a huge chunk of the
total WFSA membership and this is reflected
by European representation throughout the
WFSA structure. This includes the President,
5 members of the Executive Committee and
23 other European members on our various
Committees.
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
WFSA wants to maintain and develop its
good relationship with ESA. The European
Regional Section is the NASC (National Societies
Committee) arm of ESA. The reason is that the
WFSA is a Federation of national societies. Every
year during the Euroanaesthesia Congress,
the officials from the two organisations
meet to discuss matters relating to further
cooperation especially in educational and
scientific fields, and there are several other
meeting points throughout the year. Both
ESA and WFSA allow the other organisation
a free stand in the exhibition area during the
congresses.
24
During the last decade, the WFSA has
developed into a networking and solidarity
organisation, where most of the funds are
spent on educational activities in less affluent
countries. I recently listened to an economist
explaining why the USA works so well as an
economic federation because the states
which create a surplus of money subsidise
those other states that do not; so for example
the rich, highly industrial north western
states subsidise those less affluent areas in
the south. Very few people know about this
practice which has taken over 100 years to
develop and become accepted. It may be a
good model for the whole of Europe to adopt
if it wishes to become a similar integrated
federation but it is certainly the model that
WFSA utilises. The more affluent countries
throughout the world provide resources,
which can be financial or personal, which are
then used to enhance the practices of the
less affluent and more importantly improve
patient care around the world.
WFSA see that the less affluent nations have
no doubts about the value of their WFSA
membership and welcome the benefits they
enjoy from such educational activities and
also in organisational and political support.
So for example two recent letters written by
the ESA President and myself to the Acting
Minister of Health in Romania, just prior
to a large Congress in Timisoara, led to an
announcement at the Opening Ceremony
that the Government had granted everything
in the programme that the local Society had
requested, and that the ESA President and I
had endorsed in our respective letters.
Many member countries are fortunate to
live in affluent circumstances in terms of
anaesthesia provision, availability of drugs
and facilities, teaching and courses and
can afford to travel to achieve continuing
professional development. So these affluent
nations are net givers to both ESA and WFSA,
which in turn utilise that money to improve the
circumstances of colleagues either in Europe
or around the world. The cost of a medium
cappuccino per member per year to achieve
such positive outcomes does not seem to be
unreasonable. You can see our results on our
website (www.anaesthesiologists.org) and
read about them in our new e-newsletter or
follow us on Facebook or Twitter.
When WFSA was created in 1955 it was
not by chance that this occurred in Europe.
Francis McMechan (the American who had
founded the International Anaesthesia
Research Society [IARS]) and the newly
FSA
formed French Society for the Study of
Anaesthesia and Analgesia started to discuss
global co-operation in 1936. They planned
an anaesthesia congress in Europe but the
Second World War intervened and such a
congress was not initiated until 1951when
the French surgeon Robert Monod convened
an International Anaesthesiology Congress.1.
This French society was dominated by
surgeons and they contacted the UK
Anaesthesia Society (The Association of
Anaesthetists of Great Britain and Ireland
[AAGBI]) to ask for help in creating an
international society of anaesthesiologists.
Representatives from Denmark (also
representing Norway and Sweden), Belgium,
Italy, the Netherlands and Switzerland soon
joined the discussion. At around the same
time the AAGBI had a combined meeting
with the IARS and interested people gathered
to discuss the concept of an international
society. Again there were representatives
from Europe, and now these were joined by
anaesthetists from Brazil, Canada, Australia,
USA and Argentina.
This group formed an interim committee
with Harold Griffiths from Canada in the
chair. He was ably assisted by representatives
from Sweden, Belgium, UK, The Netherlands
and France. This interim committee met in
Brussels in 1953 and by 1954 had drawn up a
provisional constitution for the embryo WFSA.
The first World Congress of Anaesthesiologists
took place in Scheveningen, The Netherlands
on 5-10 September 1955. The WFSA was
created during the closing session of the
Congress. Of the 26 countries who sent
official delegates, 15 were from Europe and a
further 7 European countries were present as
observers.1 It is not surprising that Europe
has remained crucially important to the
WFSA ever since.
The First European congress in Vienna
was held in 1962, and this meeting led to
discussions about a European Regional
Section (ERS) of the WFSA. This was officially
formed after the Second European Congress
in 1966. In Eastern Europe a locally organised
International symposium was held every 2
years from 1963. In 1978 after several years
of discussion the European Academy was
formed which then held annual meetings
and in 1987 the original European Society of
Anaesthesiologists was formed. Soon after
this (1998) the ERS re-invented itself as a
Confederation of European National Societies
(CENSA) and started to hold meetings every
2 years.
So there were three major organisations
that represented European anaesthesiology
– the ESA with personal members, the
EAA, who dealt with the Diploma and the
CENSA. Anaesthesiologists in Europe saw
the benefit of joining forces between these
three, and eventually the new European
Society of Anaesthesiology (ESA) emerged
in 2004 2. This is a unique organisation
which has incorporated all the aspects of
the three original societies into one and
therefore has both individual and national
society membership. Its annual meetings
are rightly regarded by many as the highlight
of the European Conference season. The
WFSA now works in close collaboration with
ESA to further both sets of aims of the two
organisations which is to achieve a parity of
care for all patients throughout the continent.
contact our Secretary Gonzalo Barreiro by
email at any time (gbe@montevideo.co.uy)
or me (lorikeet08@gmail.com) . Please do
this. WFSA enacts the wishes of the delegates
of its General Assemblies. The next of these
will be in Hong Kong in August 28-September
2nd of 2016 and then in 2020 the WCA will
come to Prague in the Czech Republic. We
look forward to seeing you at these and many
other meetings. //
References
1. Mauve M. The long way towards the establishment
of the WFSA in World Federation of Societies of
Anaesthesiologists 50 years. Edited by Gullo A ,
Rupreht J. Springer Verlag, Milan. 2004. 6-34.
2.Wilkinson DJ. WFSA and Europe – a long but
complicated relationship in World Federation of
Societies of Anaesthesiologists 50 years. Edited by
Gullo A , Rupreht J. Springer Verlag, Milan. 2004.
159-173.
Europe sits at the very core of WFSA. We
value all of our member societies from this
continent and we constantly seek to improve
our communications with you and wish to
respond to your needs and ideas. We are
always happy to hear from you and you can
25

Future Anaesthesiology Meetings // 2013
2013
February, 21-24
2013 UBC Whistler Anesthesiology Summit
Contact: cpd.info@ubc.ca I www.whistleranesthesia.ca I Whistler, Canada
March, 5-7
ESA Masterclass on Clinical Research
Contact: research@esahq.org I www.euroanaesthesia.org I
Brussels, Belgium
March, 19-22
33rd International Symposium on Intensive Care and Emergency Medicine
Contact: sympicu@ulb.ac.be I www.intensive.org I Brussels, Belgium
April, 3-5
GAT Annual Scientific Meeting
www.gatasm.org I Oxford, UK
April, 5-7
International Symposium on Spine and Paravertebral Sonography for
Anaesthesia and Pain Medicine 2013
Contact: issps2013@aic.cuhk.edu.hk I www.usgraweb.hk/issps2013 I Hong Kong
April, 23-27
4th NWAC World Anesthesia Convention
www.nwac.com I Bangkok, Thailand
April, 25-26
10th Annual Critical Care Symposium
Contact: ct.veerappan@gmail.com I www.critcaresymposium.co.uk I Manchester, United Kingdom
April, 28 – May, 5
5th Association of South-East Asian Pain Societies Conference (ASEAPS 2013)
Contact: Aseaps2013@kenes.com I www.aseaps2013.org I Singapore
May, 2-3
European Pediatric Resuscitation & Emergency Medicine Meeting [PREM]
www.prem2013.be I Ghent, Belgium
May, 17-19
Tiantan International Neurosurgical Anesthesia Symposium (TINAS)
Contact: tinasbeijing@gmail.com I www.t-nas.com I Beijing, China
May, 22-25
6th World Congress on Abdominal Compartment Syndrome (WCACS)
www.wsacs.org I Cartagena, Colombia
May, 22-25
5th European-American Anesthesia Conference
EUROPEAN SOCIETY OF ANAESTHESIOLOGY
Contact: www.hdail.hr/2013 I Rovinj, Croatia
26
June, 1 - 4
Euroanaesthesia 2013
Contact: secretariat@euroanaesthesia.org I
www.euroanaesthesia.org I Barcelona, Spain
June, 6-9
FSA 2013 Annual meeting
Contact: executiveoffice@fsahq.org I www.fsahq.org I Palm Beach, Florida, USA
June, 8-11
23rd European Neurological Society Meeting
www.ensinfo.org I Barcelona, Spain
June, 17-20
9th International Symposium on Pediatric Pain
www.ispp2013.org I Stockholm, Sweden
August 26-29
32nd Congress The Scandinavian Society of Anaesthesiology and Intensive Care medicine
www.congress.utu.fi/ssai2013 I Turku, Finland
August, 28 – September, 1
11th WFSICCM Congress
www.criticalcare2013.com I Durban, South Africa
August 29-31
First International Georgian Symposium in Anesthesiology and related fields
Contact: gsaccm@yahoo.co.uk I www.gsaccm.ge I Batumi, Georgia
September, 9-15
Panarab Anaesthesia Congress
Beirut, Lebanon
September, 18-20
Annual Congress of the Association of Anaesthetists of Great Britain and Ireland (AAGBI)
www.aagbi.org I Dublin, Ireland
October 31 – November 2
ESA Masterclass on Clinical Trials
and Clinical Epidemiology
Contact: research@esahq.org I www.euroanaesthesia.org I
Utrecht, The Netherlands
November, 6-9
New Zealand Anaesthesia Annual Scientific Meeting
www.nzadunedin2013.com I Dunedin, New Zealand
November 8 - 9
ESA Autumn Meeting 4
Contact: secretariat@euroanaesthesia.org I
www.euroanaesthesia.org I Timisoara, Romania
2014
May 31 - June 3
Euroanaesthesia 2014
Contact: secretariat@euroanaesthesia.org I
www.euroanaesthesia.org I Stockholm, Sweden
Copyright 2013
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.
Printed on FSC certified paper
27
Barcelona, Spain
June 1- 4