A Letter on Neuroanesthesia and Neurocritical Care Services in Italy

Federico Bilotta, MD, PhD
Chair, Neuroanaesthesia Study Group of SIAARTI
Department of Anesthesiology, Critical Care and Pain Medicine
Policlicnico Umberto I, “Sapienza” University of Rome
Rome, Italy

Dr. Sharma
Frederico Bilotta, MD, PhD

In Italy, there are 54 accredited neurosurgical centres; 30 are specialized and dedicated sections where elective and emergency cases are treated, while in 24 only neurosurgical emergency patients are treated along with general emergencies. Neuroanesthesiologists and neurointensivists are represented, for a large majority, by the “Neuro group” of the Italian Society of Anaesthesia (SIAARTI: Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Società Italiana di Anestesia ed Analgesia, Rianimazione e Terapia Intensiva) that aims to promote best clinical practice, optimal patient care and safety by diffusion of knowledge and research that now involve 80 members. There are several initiatives and meetings dedicated to various aspects of the clinical practice. The most important among them are the national meeting of the SIAARTI in October, which includes some sections dedicated to neuroanesthesia and neurocritical care; and the Neuromeeting in May which is an event of two full days, intended exclusively for the practitioners of this subspecialty.

In recent years, many research and academic activities have flourished. The dedicated hands-on workshop on transcranial Doppler, organized in Naples in 2016, was made free in the first short edition. Thanks to the great interest generated, it became a real pre-course fee of SIAARTI with many members participating with strong enthusiasm. In September 2017, ICONA: Italian Consensus for Anaesthesia in Neuroradiology was published as a result of the previous coordination; international multicentre trials such as TIRASH and POSE were followed. The study group, in addition to various joint projects (eg. mapping of Italian neuroreanimations, participation in various surveys, etc.), have developed a brief document of recommendation on management subarachnoid hemorrhage. During the IX Neuromeeting in 2017, the first satellite symposium on "Neuro Elements Dedicated to Anaesthetists" was held, an overview on neuromonitoring and brain oxygenation which, developed over the following years, hesitated in 2019 in the establishment of the ENLS (Emergency Neurological Life Support) certification course, approved by the Neurocritical Care Society, in cooperation with North American trainers and a high number of certified participants. This year (2019), ENLS will be dedicated to a limited number of participants enriched by a simulation section along with a practice section.

In recent years, the strong relationship has been stabilized between the Neuro study groups in Italy and the European Society of Anaesthesiology (ESA), with several Italian members also active in the European group. There is still a lot of work that needs to be done, in the relationship with other study groups for example. This is especially true in the light of new arrangements established by the CD of SIAARTI: an idea could be to bring together groups with neighbouring issues (e.g. neuromuscular diseases). The goal is to bring specialist elements of neurology beyond the boundaries of the dedicated centres. As the patients and diseases are increasingly unique in anesthetic performance, the brain remains the control room, which you cannot ignore in this field of knowledge.

Historical Aspects of the Italian Anaesthesiology Society:

  • During a meeting held in the Policlinico Umberto I in Rome on September 24, 1934, the "Società Italiana di Anestesia ed Analgesia" (Italian Society of Anesthesia and Analgesia, SIA) was established. The first Statute and Regulations of the SIA deliberated on the proposal of a Promoter Committee was drawn up there. The birth of the SIA was officially recognized at the International Congress of Anesthesia in Boston.
  • The first SIA Congress was held in Bologna on 26 October 1935 and was reviewed in the Italian Journal of Anesthesia and Analgesia.
  • The first Specialisation School was established in Turin in 1948, followed by Naples, Milan (1949), Florence and Rome (1951), and after that each University developed their own School which became training centers for specialists. Meanwhile, the need to establish autonomous hospitals were realized; in 1954, the Law established the Anesthesia Services in Hospitals.
  • In 1966, in recognition of the affirmation of the new role played by the anaesthetist in Italian hospitals, the Italian Anesthesia Society took the name of Italian Society of Anaesthesia and Resuscitation (SIAR) which was maintained for a long time. In 1979, the Assembly of Members meeting in Pesaro on the occasion of the XXXI National Congress decided to change the association name to Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).

Doctors working in the field of neuroanaesthesia and neurocritical care in Italy face a different reality in day-to-day practice, and some of them have a substantial role in international scientific and research activities. There is a common interest and commitment to enlace international partnership in order to warrant the best possible outcome on patient care in our subspecialty.

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