An Honorary Member of the European Society of Aneasthesiology speaks about the past and future of our profession

An Honorary Member of the European Society of Aneasthesiology speaks about the past and future of our profession

  • Issue 67

Prof. Maurice Lamy, Belgium

During the opening ceremony of the 2016 ESA Congress in London, I received an ESA Honorary Membership from the hands of the president, Zeev Goldik. On this occasion, I had the opportunity to express my deep gratitude to the Board of Directors:

“I feel very much honoured. This award is a real privilege for me and for my parents, who would be very proud, if they were still alive. Let me tell you a little story about them.

“Fifty years ago, in 1966, when I was about to finish medical school at the University of Liège, my parents were anxious at knowing the medical speciality I would embark on. They were living in Bastogne, in the Belgian Ardennes. My father was a primary school teacher, and my mother a housewife. They wanted, indeed, the best profession and position for their 8 children.

“During a training period in surgery, I got impressed by Professor Marcel Hanquet. His practice of anaesthesia and intensive care medicine was so dynamic and so efficient, that I decided to become an anaesthesiologist. When I announced this decision to my parents, they both became pale, and nervous. All of a sudden, and exactly at the same time, they both said: ‘But, Maurice, you will become a surgeon afterwards, won’t you?’. At that time, anaesthesia and intensive care medicine were rather new and poorly known specialities.

“My father had practiced anaesthesia in 1942 for his sister, during the delivery of my cousin, at home. The general practitioner was having some difficulties with the obstetrical procedure; he asked my father to administer a few drops of chloroform through a handkerchief on his sister’s face. Fortunately, the delivery was uneventful! Without knowing it, he had reproduced ‘l’anesthésie à la Reine’, provided by John Snow, in 1853, to the Queen Victoria, who was delivered of Prince Leopold, her eighth child. This funny scene was my father’s view and personal experience of anaesthesia!

“Regarding their view and experience of intensive care medicine, my parents had seen, in 1956, one of my father’s young students, a victim of poliomyelitis, in an iron lung at the University Hospital of Liège. They had been impressed by the fact that this young boy could be removed from the iron lung, and sited on a chair for only a few minutes, while poorly ventilated using a cuirass ventilator.

“In 1966, I was really disappointed by my parent’s reaction to my decision of becoming an anaesthesiologist, instead of a surgeon or cardiologist as they would have liked! I then decided that I would spend my professional life proving to myself, but also to my parents, that my choice was a good one, and indeed the best one.

“Knowing this story, you now understand why I would be very happy to bring this award to my parents, at our family home in Bastogne, 50 years later.”

Marcel Hanquet created the first Department of Anaesthesiology at the University of Liège, at the beginning of the golden sixties. At that time, he was already practicing perioperative anaesthesia care, visiting patients the day before surgery, performing anaesthesia, and ordering all post-operative medications. He was performing rounds daily with the head nurse, very early on in the intensive care unit, and shortly later on the surgical ward. These rounds were always done while keeping good relationships with the surgeons. The anaesthesiologists were considered as the “internists of the surgical patients”.

Our specialty really exploded during the second half of the 20th century, with the advent of new anaesthetic agents, the availability of new equipment, and the emergence of loco-regional anaesthesia techniques. This progress not only allowed important developments of surgical procedures that were not conceivable before, but also a progressive generalization of obstetrical analgesia, and the spreading of anaesthesia care outside the operating room for the management of new radiological approaches, endoscopies, etc. Anaesthesiologists started working with several other specialists, everywhere in the hospital, always keeping in mind improved safety and outcome for their patients. Research activities in close cooperation with pharmaceutical and technological industries were essential. In particular, the enlargement of the indications of old medications such as lidocaine or clonidine as well as the development of blood-saving techniques contributed to patient care improvement. Anaesthesia for day care surgery grew considerably, and it rapidly became necessary to organize routine pre-anaesthesia visits, at a distance from surgery or other procedures. It also became necessary to put efforts into the improvement of post-operative care. Recovery rooms and post-anaesthesia care units (PACU; for more severe cases) were created for that purpose. Analgesic units were also organized in the surgical wards, and involved the reinforcement of nursing care and the setting of non-invasive monitoring for patients that were kept on epidural or spinal continuous analgesia postoperatively.

Intensive care and burn units were also developed and expanded. In 1962, Marcel Hanquet created a 12-bed ICU that he called Centre de Réanimation. Already at that time, he expanded the cooperation between the anaesthesiologists and other specialists, surgeons, internists, paediatricians, etc., with the idea of providing optimal care to patients. Later on, out-of-hospital (SAMU, helicopters) and in-hospital emergency services were developed by the anaesthesiologists, together with other specialists. Maternal intensive care units (MIC) were also created in association with the obstetricians to provide continuous monitoring and care of pregnant women with severe pathologies.

The anaesthesiologists with strong interest in pain management and loco-regional techniques created the chronic pain clinics; and their know-how rapidly became useful in palliative medicine. New methods such as hypnosis, which progressively received scientific validation through functional neuroimaging studies, were also successfully introduced, not only in these pain clinics, but also in anaesthesia practice. Our specialty played an important role in ethical issues, over all its fields of activity with respect to the patient’s auto-determination and the individualized therapeutic projects.

In conclusion, during the last 50 years, anaesthesiologists have increased their presence and expertise in all the important steps of life, from birth to end-of-life situations.

In my opinion, our specialty should seek ameliorating some important points in the future:

  • We should first do our best to promote basic, clinical, and technical research in order to achieve anaesthetic agents, medications, and techniques that have fewer side effects, and are less invasive. More efficient monitoring and organ support systems should be developed with the involvement of artificial intelligence, in order to improve safety, comfort, and the prevention of chronic pain.
  • Second, patient care should be personalized through an improved anticipation, a better knowledge about eventual genetic predispositions, an increased empathy, and a dedicated consideration for the therapeutic wishes of patients, for example in case of care limitation, provided that they have received optimal information on their condition.
  • Third, we should keep on being present and active in all fields, while keeping intact the prerogatives of the anaesthesiologist, and favour a multidisciplinary approach in the hospital, as well as at the level of national, European, and world societies of anaesthesiology, intensive care, pain, emergency, palliative medicine, etc.
  • Fourth, the teaching of trainees should be enhanced using simulators, safety meetings, exchanges. Education should be kept continuous and involve all staff members of the department. This should resemble a symphony orchestra, each actor playing his/her own instrument for an excellent harmony, to the benefit of our patients.