Neuroanesthesiology in Russia
By Andrey Lubnin, MD, PhD and Alexander Kulikov, MD, PhD
Department of Anesthesiology
Burdenko National Medical Research Center of Neurosurgery
Andrey Lubnin, MD
Alexander Kulikov, MD, PhD
Neuroanesthesiology in Russia has a rather long history. To understand its current state and level of development, one should first understand the Russian neurosurgical care structure. Neurosurgery as an independent clinical discipline was founded in Russia (the Soviet Union at that time) in the 1920’s. Initially the network of neurosurgical clinics was planned as an “inverted triangle” - a lot of small regional departments and regional hospitals were at the top of triangle and several large, highly specialized centers in the big cities were at the bottom. In modern Russia this structure has generally been preserved.
The main advantage of this system is the ability to concentrate advanced technologies and experienced staff who use these technologies in several places. Difficult cases from all over our large country are also concentrated in these several centers. Of course such systems mainly focus on elective neurosurgery, which in turn is not a big shortcoming if we take into account the structure of neurosurgical disorders, which in Russia is not much different from other developed countries: 60-65% of neurosurgical patients are TBI patients; 20% - spinal degenerative disease; and only 15-20% - all the remaining neurosurgical cases, mainly vascular or neuro-oncology.
At the bottom of the neurosurgical “inverted triangle” there are large specialized neurosurgical centers. Russian neuroanesthesiology was founded, developed by and still exists mainly in these clinics. These centers include Burdenko National Medical Research Center of Neurosurgery in Moscow, Polenov Neurosurgical Institute and neurosurgical clinic of Kirov Military Medical Academy in Saint-Petersburg, Departments of Neurosurgery in Sklifosovsky Research Institute of Emergency Medicine, and Research Center of Neurology in Moscow. In recent years new neurosurgical centers have also appeared in Yekaterinburg, Novosibirsk, Irkutsk, Tyumen, and Kaliningrad.
The largest neurosurgical clinic in our country is Burdenko Neurosurgical Center where the authors of this article work. It consists of ten specialized neurosurgical departments with 300 beds in total. Each department focuses on different fields of modern neurosurgery, including pediatric neuro-oncology and malformations, surgery of intracranial aneurysms, brain tumors, traumatic brain injury and spinal neurosurgery.
Distinguished researchers and doctors have worked at the center over the years: Prof. Alexander Konovalov was the Director of the center for 38 years and now he is Honorary President of our clinic; Prof. Fedor Serbinenko, the founder of the endovascular neurosurgery; Head of the Laboratory of Pathophysiology of Cerebral Circulation, Prof. Alexander Shakhnovich; the founder of Quantitative Neuroanatomy, Prof. Samuil Blinkov; the founder of Neuropsychology, Prof. Alexander Luria; the founder of Reanimatology, Prof. Vladimir Negovsky, and many others.
In recent years about 10,000 neurosurgical interventions are performed annually in our clinic with 0.37% postoperative mortality. Of course, this huge workload requires serious Neuroanesthetic support which is carried out in 20 operating rooms and on 42 ICU beds. Neuroanesthesiology and Intensive Care division consists of two separate departments, the Department of Anesthesiology, where currently 32 doctors work, and the Department of Intensive Care, where 18 doctors work. The founders of these departments are Prof. Victor Salalykin and Prof. Alexey Manevich, who wrote the first Russian Handbook on Neuroanesthesiology (1977).
The main scientific and clinical issues which we are trying to improve in the Department of Anesthesiology during recent years include enhanced recovery in neuroanesthesiology, including optimizing of postoperative pain management, PONV prevention, depth of anesthesia monitoring; awake craniotomy; xenon anesthesia; perioperative dexmedetomidine using; cerebral oximetry; perioperative blood management including point-of-care (POC) hemostasis tests (TEG, Rotem, thrombodynamics), massive bleeding, prevention of postoperative intracranial hematomas etc.
Education in our specialty consists of six years in medical school and two years clinical residency in Anesthesiology and Intensive Care. Typically, anesthesiologists in our clinic should graduate from our residency program to be part of our team. There is also special program for introducing into neuro-subspecialty for other doctors who come to our center from other hospitals. We also have a three-year postgraduate (PG) study program for thesis preparation (for the “Candidate of Medical Science” grade; the Russian analogue of a PhD). Our center provides an on-the-job training program for professional development for colleagues from other clinics with an individually selected duration of training.
Communication between specialists in our subspecialty continues on special sections on annual FAR (Federation of Anesthesiologists and Reanimatologists of Russia) meetings and on the platform of the Russian Association of Neuroanesthesiologists and Neuroreanimatologists (“NeuroNN”)-conducted annual “Runeuro” meeting, as well as numerous other smaller international symposiums.
We believe that real clinical progress in our field can be possible only through wide cooperation and discussions between the experienced specialists all around the world, and so, we are absolutely open for any communication and collaboration.
Figure 1. Burdenko National Medical Research Center of Neurosurgery, Moscow
Figure 2: Polenov Neurosurgical Institute, Saint-Petersburg
Figure 3. Founders of the Departments of Anesthesiology and Intensive Care in Burdenko NMRC of Neurosurgery Prof. Victor Salalykin (Left) and Prof. Alexey Manevich (Right)
Figure 4. Operating room and anesthesia equipment in Burdenko Neurosurgical Institute (1984)
Figure 5. Modern view of operating room and anesthesia equipment in Burdenko NMRC of Neurosurgery
Figure 6. Faculty of the one of the scientific meetings at Burdenko NMRC of Neurosurgery