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The Second Baltic Anaesthesiology Refresher Course: A Personal View (page 1)
Vol 1 No 1 (1997) Article 14: Page 1 of 2 Go to page: 1 2
The Second Baltic Anaesthesiology Refresher Course: 14-17th May, 1996,
Tallin, Estonia. A Personal View.
Dr. Keith Thomson,
North Hampshire Hospital, Basingstoke, UK.
Introduction Sponsorship
The course Social events
Anaesthesia for Caesarean Section
Local hospitals
Training & incentives Postscript
ESTONIA, 53 miles due south of Finland is one of the three Baltic States
which recently regained its freedom from the former Soviet Union after
over 50 years of oppressive rule. It has a population of 1.5 million, a
third of whom live in Tallinn, the capital. Since gaining independence,
this proud and long suffering people who against all the odds have
maintained their unique culture, have embraced capitalism and already
shops and supermarkets are over-flowing with western goods. They have
their own currency, the Estonian Krone (EEK), supported by a proliferation
of banks and an efficient telephone service, installed by Eriksen of
Sweden.
The Course
This WFSA course was organised by Dr. Richard Jack and Dr Juri Samarutel.
There were about 120 delegates representing all three Baltic States:
Latvia, Lithuania and Estonia. The conference was held at the Laulassma
resort complex about 30 miles west of Tallinn. The lecturing team was
completed by Dr. Sam Perov from Detroit, USA, who was born in Siberia of
Latvian parents, brought up in Riga and studied medicine in Belarus in
order to avoid conscription into the Soviet Army. He eventually emigrated
to the USA, where he had to retrain in medicine after initially working as
a paramedic.
There were four lectures a day. Topics included, obstetric anaesthesia,
acute and chronic pain, difficult airways, monitoring, post-operative
recovery, and anaesthesia in the cardiac patient. The subjects were
carefully chosen to be of interest to the wide range of experience found
among the delegates, from first year interns to longstanding specialists.
All the lectures were scheduled to last 75 minutes to allow for
translation time into Russian by Dr. Samarutel and for questions which
increased in number as the week progressed and the audience became less
inhibited!
Anaesthesia for Caesarean Section
I was particularly interested in the fact that general anaesthesia is
still very much the technique of choice for Caesarian Section throughout
the Baltic. I didn't meet a single anaesthetist at the conference who used
an inhalational agent (only halothane is generally available) at any time
during this procedure. The techniques used were ketamine (1mg/kg) or
thiopentone (or both), suxamethonium, intubation, relaxant, IPPV with N20
and 02 (with Fi02 ranging from 0.5 to 1.0). A Lithuanian confided that he
had recently performed an audit of 'awareness' during G.A. Caesarian
Section at his hospital and that 12% of 150 patients questioned remembered
the pain of surgery. He has now become a strong advocate of spinals.
Prompted by this information I gave an extra lecture entitled: "The worst
anaesthetic technique for Caesarian Section -G.A.". The talk concentrated
on the main disadvantages of general anaesthesia including awareness,
aspiration and failed intubation (with guidelines for a drill). I felt
strongly that in some way I could make a small contribution to the
delightfully attractive Baltic women, by firstly explaining why regional
anaesthesia is the safer technique and secondly, by arguing that the risk
of awareness could be dramatically decreased by the routine addition of
halothane to the G.A. technique.
I carried out a survey of the female anaesthetists present, asking the
same question both a few hours before and immediately after my lecture :
"If you were to have a Caesarian Section tomorrow, which anaesthetic
technique would you choose: general anaesthesia or regional anaesthesia ?"
Results Pre-Talk Post-Talk
G.A.
18
10
R.A.
33
30
Undecided 14
It seemed that the older ladies preferred G.A. Unfortunately several
people did not vote at all. (The previous political situation in Eastern
Europe did not encourage one to air one's view in public.).
Training and Incentives
In the Baltic states, it takes about three years to become a specialist in
Anaesthesia. This was increased only recently from one year. If money is
your main motivation, then Estonia is the country to work in, with monthly
consultant pay at about US$333 compared with $200 in Latvia and only $100
in Lithuania. Emergency medical treatment is free in all three states, but
in Latvia and Lithuania there are some charges for drugs and equipment
(e.g. epidurals); in Estonia money is deducted from wages towards a
government-run insurance scheme. There are also some private facilities.
Anaesthetic techniques in the Baltic tend to follow the Russian system
where everyone does what the professor says. As I concluded after my last
lecture, in the words of Frank Sinatra, the epigram for every anaesthetist
is "I did it my way" but for a professor, it is "Everyone did it my way."
Sponsorship
Sponsorship was vital to keep the meeting affordable for the delegates and
this was kindly provided by various companies including SIMS, Datex
Engstrom, Bair Hugger and Dameca A/s. But as Dr. Jack stressed in his
lecture, with such a diversity of new equipment available, purchasers
should define very carefully what their needs are and be prepared to shop
around. He also reminded the audience that the only monitor shown to
significantly decrease morbidity and mortality was the pulse oximeter. In
his lecture on infection in the ITU, he similarly stressed that a major
factor in reducing cross infection was hand washing by doctors! Remember
the KISS principle (Keep it Simple, Stupid - or as a rep giving a complex
talk on ventilation said - to generalised laughter - Keep it Stupid,
Simple.).
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