BACKGROUNDAnaesthesiologists and intensive care doctors have become progressively more mobile across Europe. The standardisation of training systems has been recommended by the European Union of Medical Specialist (UEMS) to facilitate the mutual recognition of professionals.OBJECTIVEWe aimed to assess the level of compliance with the 2018 European training requirements (ETR) for the specialty of anaesthesiology, pain and intensive care medicine.METHODSAn electronic questionnaire on the duration of the training and assessment methods in anaesthesiology and intensive care medicine was circulated via e-mail to the National Anaesthesia Societies Committee (NASC) representatives of all 41 European countries as defined by the WHO.RESULTSAll 41 countries replied. The average duration of training was 4.7 years; in 29% of the countries, it was less than 5 years. In 78% of the countries, a mandatory written examination was required, and the most common form was a national test (44%), with only 27% using the European Diploma of Anaesthesia and Intensive Care. In the subgroup of the 26 EU countries investigated, the average duration of the training was 5 years and in 19% was less than 5 years. In the subgroup of the 15 non-EU countries, the average duration of training was 4.25 years, with 46% of the countries having a duration shorter than 5 years.CONCLUSIONSThis survey highlighted the diversity in the training in anaesthesiology and intensive care medicine in Europe despite the recommendations advocated by the EBA-UEMS. The findings on the duration of training demonstrated that the target of 5 years has not been universally achieved yet with a substantial difference between EU and non-EU countries. The presented evidence suggests the need for initiatives dedicated to implement compliance with the advocated duration and competence requirements reported in the European Training Requirement for anaesthesiology and intensive care by UEMS.
Mechanical thrombectomy (MT) has become a standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Recent evidence suggests that general anesthesia (GA) and mechanical ventilation do not lead to inferior neurologic outcomes if compared to non-GA. However, the guidelines lack specific recommendations for ventilation targets during MT under GA. This systematic review aims to identify ventilation strategies correlating with better neurological outcomes in AIS patients undergoing MT, particularly focusing on oxygenation and carbon dioxide (CO2) targets. A systematic search of multiple databases was conducted to identify human studies reporting the correlation between ventilation strategies and neurological outcomes in MT for AIS. Eligible studies included clinical trials, observational studies, and case–control studies. Out of 157 studies assessed, 11 met the inclusion criteria. Five studies investigated oxygenation targets, while six studies explored CO2 targets. The published studies highlighted the controversial role of supplemental normobaric oxygen therapy and its potential association with worse outcomes. Regarding CO2 targets, the studies identified a potential association between end tidal CO2 levels and functional outcomes, with hypocapnia being unfavorable. This systematic review demonstrates that the current available evidence still lacks strength to suggest specific ventilation targets, but it highlights the potential risks of hyperoxia and hypocapnia in this specific cohort of patients.
Perioperative care of the neurosurgical patient describes the processes required to facilitate safely and professionally neurological operative interventions and outcomes. An account is given of the systematic preoperative evaluation needed to optimize a patient’s medical conditions before surgery, the intraoperative anaesthetic management, the postoperative care, and the possible complications that may be encountered. Anaesthetic considerations for specific neurosurgical interventions are also described. Overall, emphasis is placed on the importance of requesting the appropriate investigations, adhering to strategies for the correction of coagulation disorders along with the prevention of venous thromboembolic complications, understanding the effect of anaesthesia on cerebrovascular haemodynamics and providing specialist postoperative facilities and expertise.
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