Three months at King’s College Hospital, in the framework of ESA TEP

Three months at King’s College Hospital, in the framework of ESA TEP

  • issue 81

Lavinia Brezeanu

I am Lavinia Brezeanu, a specialist doctor in anaesthesia and intensive care at Fundeni Clinical Institute in Bucharest, and assistant professor in anaesthesia and intensive care at “Carol Davila” University of Medicine and Pharmacy, Bucharest.

I applied to the ESA Trainee Exchange Programme because I wanted to improve my skills and learn new things about liver transplantation and the management of critical liver patients, including acute liver failure patients.  The institute where I currently work is the main liver transplant centre in Romania, so I decided that King’s College should be my first choice.

I had previously heard a lot of things about King’s College Hospital and their achievements regarding liver transplantation and had also read many of their scientific publications. Considering all these, I decided this would be a good opportunity to get in contact and talk to people that have so much experience in dealing with critical liver patients.

Fortunately, I was accepted to take part in the ESA’s Trainee Exchange Programme and after a preliminary visit, I started my 3 months exchange experience. The most difficult part at the beginning was finding accommodation, but soon I managed to find one close to the hospital which made my morning walk to the hospital very pleasant.

My medical interest was in both anaesthesia and liver ICU departments, so I started my ICU rotation first. During my stay in the ICU department, I have met very nice trainees and consultants, eager to answer my questions and explain their decision making and protocols. They shared their experience and tried to get everyone involved in decision making and choosing the best treatment for each patient. I had the chance to see a lot of acute liver failure patients, most of them being paracetamol overdose. It was very recomforting for me to see that the management and protocols are overall the same in my centre.

During my ICU stay, I was pleased to discover that the department has a lot of scientific sessions during the week where patients are being discussed and this was a great opportunity for me to hear doctors debate and explain the most interesting/challenging cases and how they decided to treat the patients and their outcome. I took part in radiology meetings, histology and liver transplant meetings. This was a very interesting, but at the same time different experience, as back in my hospital these meetings do not usually occur so often and are not so well organised so that not all doctors can take part in them. It was a very good opportunity to find out new things from many perspectives and improve my knowledge.

I also had the chance to see the postoperative management of liver transplant patients, which I discovered is a bit different from my country regarding immunosuppression and transfusion policies.  In my unit, we guide perioperative transfusion by viscoelastic testing (we use the ROTEM machine), whereas King’s doctors tend to correct standard coagulation test values.

After my ICU rota, I started the anaesthetic one. Unfortunately, it was quite short and a bit different from ICU as many people there did not know about the programme and were not very keen on accepting and sharing information. I only had the chance to take part in a few liver transplant procedures and discovered that the main difference from my centre is the fact that they have the extra circulatory support machine that can be used in case of massive bleeding, haemodynamic problems or difficult surgical procedures. I think this is one important thing that my centre could benefit from as we deal with a lot of complicated procedures and patients during liver transplantation which can sometimes be a real challenge for us, the anaesthetists. Using the circulatory support machine could help us improve our practice.

Overall, I think the Trainee Exchange Programme was a very interesting and useful experience that improved my daily practice in my hospital.