This year's Euroanaesthesia 2022 Congress was very unique for me. It was the first time I represented our country in the Council of ESAIC (Council of European Society of Anaesthesiology and Intensive Care). The meeting of the ESAIC Council took place on Friday, before the start of the Congress itself. After two years of virtual meetings, conferences and trainings, it was very pleasant to meet representatives of all ESAIC member countries in person. It was a surprise to me how many enthusiastic colleagues interested in the same corners of our field (paediatric anaesthesia, simulation education, regional anaesthesia...) I had the pleasure to meet. In addition to the introduction of everyone in the room and the basic agenda of the society, the key moment of the meeting was the election of the next ESAIC President for the next two years, Prof Wolfgang Buhre. There followed 3 days of congress events, where I was proud to watch the Czech participation in the professional program. A big surprise for me was the fact that most of the active contributions, whether in the form of poster presentations or invited talks, came from Brno. It seems that Brno will not only be the famous last turn before Vienna, but also an important point on the map of scientific knowledge in the field of anaesthesiology and intensive care medicine. To give you an idea, below are the works from Brno that were presented during the poster sessions on Saturday and Sunday:
Oral tissue injuries during intubation in orofacial cleft patients: pilot study - Petr Štourač
Comparison of tidal volume between paediatric anaesthesia and paediatric intensive care patients (TIVAC): retrospective cohort trial - Tereza Kramplová
Duration of inhalation versus intravenous anaesthesia induction in paediatric patients: prospective observational trial - Martina Klincová
Central venous catheters in pediatric anesthesia and intensive care: prospective observational trial - Václav Vafek
PIMS-TS venous thrombotic event in 4-year old patient - Tamara Skříšovská
Malignant hyperthermia in Czechia and Slovakia: a description of the largest Slavonic group of patients investigated for risk of malignant hyperthermia. A retrospective observational national cohort study - Martina Klincová
New approach to mouth-to-mouth ventilation in BLS training during COVID-19 pandemic (MOVERESP study) - Václav Vafek
Another enrichment of the professional program were two lectures, bravely managed by active collaborators of the portal AKUTNĚ.CZ Martina Klincova and Tamara Skříšovská. Thanks to Tamara, AKUTNĚ.CZ's interactive multimedia learning algorithms have made it to the screen of a congress of global importance. They were mentioned in a lecture entitled Education of medical students regarding PBM. The icing on the cake of our activity in ESAIC was the award of one of the founders of the portal AKUTNĚ.CZ, Prof. Petr Štourač, with the Fellow of the European Society of Anaesthesiology and Intensive Care (FESAIC), which is a recognition of exceptional level and contribution in the field of anaesthesiology and intensive care medicine.
Prof. Petr Štourač was awarded Fellow of the European Society of Anaesthesiology and Intensive Care (FESAIC).
This year's Euroanesthesia was an exceptional opportunity to meet face-to-face after a long break. The atmosphere was still heavily influenced by the pandemic, but it was more in the spirit of what we have learned and where it has taken us than regret. However, the minute of silence for all colleagues who gave their lives in the pandemic was a very emotional moment and it was very appropriate to include it in the opening section. From the large number of lectures and blocks, I will select one that might be interesting to residents and specialists in our field who are preparing for the EDAIC exam. In his lecture, Anastasios Antonogiannakis from Athens Greek (How to best prepare to EDAIC part I) emphasized that we will never know everything, but we must have a strong foundation in order to work safely. He mentioned the possibility of taking the Basic Science organized courses (BCSAC), after which we can take 2 mock exams in the form of On-line assessments (OLAs). We should apply for the exam after we have completed clinical rotations (e.g., obstetric anesthesia) so that we have the clinical knowledge of the practice. He recommended to choose only 2 books to study.
Choose only 2 books to study for EDAIC.
One covering general overview (e.g. Morgan, Barash, Miller) and Dr. Podcast's Scripts for primary FRCA, which covers much of Basic Science. After that, just practice and go through the MCQs and SBA questions. He recommended preparing 2-6 months in advance, but this is very individual. More than 6 months can be mentally challenging. A few days before the exam, he recommended reviewing only notes especially in pharmacology. The day before the exam and especially on the day of the exam, the state of mind plays an important role. It is therefore better to focus on relaxation, trying to learn as much as possible at the last minute can be rather counterproductive. The next lecture in the block belonged to Dr. Zeev Gildik from Israel. He followed up with How to best prepare to EDAIC part II. He started with a short introduction of the history of the exam. He recommended studying from the literature that we would use for the specialty exam in our country. He also mentioned how each viva is graded- demonstrating only literary knowledge, without clinical context, earns the candidate only 1 point out of a possible 2. The successful candidate should approach the questions in a structured manner and demonstrate knowledge of the concepts within the context of clinical practice. It is good to have experience in teaching, discussion and basic presentation skills - to speak clearly, understandably and to the point. Dr. Liliana Valeanu from Romania focused her lecture on the most common reasons for exam failure. We should not try to read all the recommended books and try to know everything. What we should know instead are up-to-date guidelines. During the EDAIC Part I exam, we will encounter different types of questions that require different types of answers - factual (basic physiology, pharmacology, knowledge), deductive (have to figure out the answer) and complex (combination of basic knowledge and clinical skills). For EDAIC Part II, examiners will seek to have a dialogue based on safe clinical practice, the ability to respond to complications and come up with different approaches. The first sentence of our response will represent our entire presentation, so we should consider how we introduce ourselves. We should listen carefully to the question and never interrupt the examiner. The mentioned lectures were followed by discussion. I recommend all EDAIC Part I and II candidates to watch this session.
Dr. Guarracino opens several talks about the topic "The patient with aortic stenosis undergoing non-cardiac surgery: myths and reality". He highlights the rising prevalence of aortic calcification in the whole world. Then he claims that preoperative examination is very important, especially consideration of the severity of aortic stenosis, risks of valvular intervention, or chance of heart complications during non-cardiac surgeries. We also hear about the difference between a patient with symptomatic and an asymptomatic aortic stenosis. It is recommended for patients with symptomatic aortic stenosis to undergo aortic valve replacement surgery before another surgery. But for asymptomatic patients, there is no such recommendation. The main idea of this talk is that patients with aortic stenosis have an increased risk of perioperative complications.
Dr. Monemi starts her talk called "Pitfalls and good practice for anesthetic management" with a recommendation for grading the severity of aortic stenosis. Then she mentions AS subtypes and points out that we need to think about them if our patient's clinical presentation doesn't show as a classic type of AS. As anesthesiologists, we should manage adequate volume therapy to prevent congestive heart failure, especially in elderly patients.
The next speaker is Dr. Bernad Cholley - "When is an aortic valve replacement (TAVI or open-heart surgery) indicated prior to non-cardiac surgery?" In the beginning, we see graphs that describe and compare the causes of death in patients who underwent either TAVI or open-heart surgery. It is obvious that after TAVI, stroke is the most common cause of death, and on the other hand, after open-heart surgery, other cardiovascular diseases are the most common cause of death. In the next few minutes, we learn that, according to a study in Lille, there is no difference in 3-month survival rate between patients who have had balloon valvuloplasty (BAV) and those after another type of valve replacement. Dr. Cholley says that aortic valve replacement performed on symptomatic patients with severe AS is recommended.
A topic of the second block is bleeding management issues. Dr. Duranteau begins with a recommendation of viscoelastic tests usage for early detection of coagulopathy caused by the injury. During the talk, we hear about many studies which confirm the positive effect of viscoelastic tests. Fast reaction to coagulation defects or blood loss in traumatic injuries is the main motivation for using these tests.
Dr. Victor Viersen, the next speaker, introduces his talk about a case study of a severely injured motorcycle rider. This motorcyclist lost a large amount of blood, which led to significant hypovolemia. This patient received several units of transfusion products, approximately one liter in volume. In this case, correctly indicated administration of blood derivatives led to life-saving, possibly even completely neurological convalescence. According to the RePhill trial study, which investigated the efficiency of this type of transfusion, the trial study shows we do not observe any significant differences in the mortality of patients with and without prehospital transfusion. Dr. Viersen adds that improved blood pressure and other systemic values have been observed in transfused patients, which allows us to save lives more effectively. A problem with the use of various blood derivatives is their short shelf life, especially for plasma or platelet concentrates. Therefore, the possibility of using dried plasma is offered, which is, however, more practical for use in a hospital environment, as it needs to be mixed before administration. Finally, transfusion in pre-hospital care has a place in the right circumstances.
The lecture block on the topic of bleeding management ended with Dr. Da Luz. The main idea was to clarify the advantages of using clotting factor concentrates instead of transfusing blood plasma in injuries. Thanks to them, we can save a lot of other blood derivatives.
The "50 Shades in Pediatric Preparation" block was particularly intriguing. In his presentation, Dr. Nicola Disma from Italy summarized the effect of fluid and food consumption before surgery on the risk of aspiration under general anesthesia. The basic clinical questions took into account the risk and benefit of changing the time limit of oral administration of fluids and food before anesthesia. Permission for oral administration depends on the amount and composition of fluids or food, the effect of comorbidities or used medication. Doctors should avoid prolonged fasting in children due to the onset of anxiety. The children's fasting pattern is 1-3-4-6. Research allows the administration of pure fluids (sweetened or unsweetened water, tea) 1 hour before the introduction of general anesthesia, breast milk has a maximum of 3 hours in advance and its artificial substitutes 4 hours in advance. A solid diet should not be taken later than 6 hours before the start of anesthesia.
Mr. Michael Brackhahn from Germany starts his presentation with the well-known but very important statement that a child is not a small adult. Pharmacokinetic processes in children and adults proceed differently. Mr. Brackhahn summarized the functioning of the gabaergic receptors that Midazolam targets and its various dosage forms and routes of administration. The currently used solution of Midazolam per os in children is not very popular due to its bitter taste. An orally variant of Midazolam with γ - cyclodextrin was presented, which regulates the bitter taste of the product and is thus a more suitable choice for children. An orally variant of Midazolam with γ - cyclodextrin was presented, which regulates the bitter taste of the product and is thus a more suitable choice for children. The conclusion of the study was unexpected and showed that even a small dose of 0.25 mg/kg was as effective as 2 larger doses.
At the beginning of the lecture "Good premedication is essential in the perioperative clinical environment," Dr. Martin Hölzle from Switzerland classified children's fear perception into different age categories. They examined the effect of premedication on a child's behavior after general anesthesia, and as we could see in the presentation, children without premedication suffered from bad dreams, awakening from sleep, frequent crying and outbursts of anger, which persisted in some subjects for more than 14 days. The toleration of postoperative complications by calm and anxious children was compared. Anxious children may be less able to tolerate pain after surgery and have a higher consumption of analgesics. The presence of parents during hospitalization and administration of Midazolam before general anesthesia is also associated with the toleration of postoperative complications. The highest YPAS score is reported by children without Midazolam who are hospitalized without parents. According to the study, Midazolam has a different effect on explicit and implicit memory. Implicit memory remains functional after premedication. Compared to Dexmedetomidine, Midazolam has a more anxiolytic and less sedative effect.
Another very interesting topic was called "Family presence during pediatric resuscitation: pro-con". On Sunday, there was a discussion on the presence of family members during the child's resuscitation. The defense was presented by Dr. Karin Becke from Germany, and her opponent was Dr. Tom Giedsing Hansen from Denmark. In her lecture, Dr. Becke summarized the history of child health care, recommendations, parental expectations, health care providers' concerns, and the implementation of FPDR (family presence during resuscitation). In the 20th century, the term "family-centered care" was introduced. Special wards for children have been set up, and the mother's presence during hospitalization has been normalized. According to the EACH (European Association for Children in Hospitals), a child has the right to have his or her parents present at the time of visiting the hospital 24/7, regardless of age, during all situations, including resuscitation. And most parents want to be present! It helps them understand what is happening to their child and realize the seriousness of the situation.
Dr. Hansen looks at the issue from the other hand. He claims that the parents' presence at resuscitation has a significant effect on the performance of physicians during the provision of urgent care. Parents may suffer from post-traumatic shock (PTSD) after such a strong emotional experience. He also sees a possible negative family background as a fundamental problem. Violence or alcoholism in the family could lead to the child himself not wanting the parent's presence. In Dr. Hansen's opinion, the presence of a person would be necessary, who would have the task of explaining the individual actions to the parents at the time of resuscitation.
Now we can only invite all readers of AKUTNĚ.CZ reports to the next EUROANAESTHESIA 2023, which will take place in Glasgow, Scotland, on 3-5 June 2023.