The current situation in Brazilian anaesthesia

The current situation in Brazilian anaesthesia

  • Issue 74

Marcello Fonseca Salgado Filho

mfonsecasalgado@hotmail.com

Since 2014 the Brazilian Society of Anesthesiologists (BSA) has been developing an important partnership with the European Society of Anaesthesiologists, and this partnership is helping to spread Brazilian research in perioperative anaesthesia in the European community, in addition to strengthening the ties between the two societies.

During Euroanaesthesia 2016, held in London, the BSA had the opportunity to present a Guest Symposium showing what we are developing in many fields of research, ethics, and patient safety. Intraoperative transoesophageal echocardiography (TEE) is an important area of monitoring that has been supported by the BSA.

In 2011, the BSA promoted the meeting of 7 associate members who developed the Intraoperative Echocardiography Course of the Brazilian Society of Anesthesiology (ETTI/BSA). The course is divided into two modules: Module I, which presents basic notions of echocardiography, anatomy related to echocardiography, and hemodynamic calculations; and Module II that assesses ventricular systolic and diastolic functions, valvular pathologies, aorta diseases, and congenital heart disease. During these 7 years, 27 ETTI/BSA courses have been carried out (19 Module I and 8 Module II). Currently, the ETTI/BSA Course has 11 anaesthesiologist instructors, as well as invited echocardiographers. The course structure is based on theoretical classes, a wet lab of a porcine heart model, a simulation manikin of transoesophageal echocardiography (TEE), and a workshop on haemodynamic monitoring with transthoracic echocardiography.

More than 500 anaesthesiologists have completed Module I and/or Module II of the ETTI/BSA Course. Of the anaesthesiologists who attended the courses, 84% work with cardiac surgery regularly and 33% have the transoesophageal echocardiography in their service. One fact that demonstrates how we need to spread this knowledge in Brazil is that only 16% of anaesthesiologists routinely use TEE during their cardiac anaesthesia.

The first official meeting between the BSA and the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DCI-BSC) was in October 2016, with the objective to develop a task force to define training criteria and certification in intraoperative TEE. This intraoperative TEE Task-force published the Brazilian Consensus on Intraoperative Transesophageal Echocardiography (https://www.ncbi.nlm.nih.gov/pubmed/28867150) and is developing the Brazilian Board of Intraoperative TEE. The first Intraoperative TEE Board Exam will be held during the 65th Brazilian Congress of Anesthesiologists in November 2018.

Research in this area in Brazil is also developing. In 2015 a paper was published about myocardial performance index and levosimendan in on-pump CABG, and in 2017, with Prof. Landoni as a co-author, about levosimendan and mortality in cardiac surgery was published in the New England Journal of Medicine.

With the aim to improve learning and guide the decision making during an intraoperative hemodynamic instability for anaesthesiologists during training, a mobile application (APP) has been developed for the Android® platform: iEcho®, which is registered in the National Institute of Industrial Property (BR 512016001497-0). This APP is intended to assist the anaesthesiologists under supervision in their decision making during hemodynamic instability in cardiac and non-cardiac procedures.

Other important fields that are under constant development are experimental research and clinical trials in cardiac and non-cardiac anaesthesia. Much research has been developed about intraoperative TEE and pharmacological support; post-operative neurologic dysfunction and DNA polymorphism; cerebral oximetry and neurologic outcomes; cardiopulmonary by-pass flow and clinical outcomes; blood transfusion and mortality; neuromuscular blocking; and strategies in mechanical ventilation and pulmonary perfusion.

Patient safety is an important area that the BSA is working for. During national and regional meetings, patient safety and quality are always included in the scientific program, aiming to improve knowledge and follow the guidelines, such as to fill out intraoperative checklists and time out before the surgery begins. The BSA updated the Guidelines about intraoperative monitoring and the monitorization for neuromuscular blocking, and the central nervous system; an important recommendation was included for intraoperative echocardiography to be used in the intraoperative period.

As a result of the partnership of BSA/SAESP and ESA, the EDAIC part I and OLA have been attended by many anaesthesiologists in Brazil since 2016, and there are many centres in Brazil accredited to perform the exams. This year, EDAIC part II will take place for the first time in Brazil during the COPA – São Paulo Congress of Anesthesiology. We truly believe this cooperation has been very beneficial for both Brazil and Europe, reducing the distances of international anaesthesia. We are very honoured by this partnership and also for the opportunity to be part of the scientific program of Euroanaesthesia 2018, showing some of our areas of expertise.