Neuroanesthesiology in Spain

Lucía Valencia, MD, PhD
Lucía Valencia, MD, PhD

Lucía Valencia, MD, PhD
Department of Anesthesiology
Hospital Universitario de Gran Canaria Doctor Negrín
Vice-President of the Neuroanesthesia Section of the Sociedad Española de Anestesiología y Reanimación (SEDAR), Spain

Ricard Valero, MD, PhD
Senior Consultant, Head of Neuroanesthesiology
Department of Anaesthesiology, Hospital Clínic de Barcelona
Associate Professor, University of Barcelona
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Spain

Fernando Iturri, MD
Hospital Universitario Cruces
Barakaldo, Bizkaia, Spain

Fernández-Candil J, MD, PhD
Department of Anesthesiology,
Parc de Salut Mar-IMIM,
Barcelona, Spain

Rafael Badenes, MD, PhD, DESA, MSc
Transplant Coordinator, Sector Valencia
Head of Section, Department of Anesthesiology and Surgical-Trauma Intensive Care
Hospital Clinic Universitari, Valencia
Professor Anesthesiology and Intensive Care
University of Valencia, Spain

Neus Fàbregas, MD, PhD
Senior Consultant, Department of Anaesthesiology
Hospital Clínic de Barcelona
Associate Professor, University of Barcelona, Spain

The practice of neuroanesthesia is carried out in tertiary hospitals throughout Spain. Only a few of those centers have anesthesiologists who dedicate their daily work to perioperative care of neurosurgical patients. However, the majority of centers combine the practice of neuroanesthesia with other anesthesia subspecialties. After obtaining a six-year medical degree in Spain, another four years of training is necessary to acquire a specialization in anesthesiology and critical care. Subsequently, clinical practice may lead some anesthesiologists to superspecialize in neuroanesthesia, although no official subspecialization exists to date.

Several options that expand knowledge and competence in neuroanesthesia stand out. There is the Neuroanesthesia Master Course from Barcelona University with the participation of experts from all over Spain or the possibility of doing a fellowship in neuroanesthesia there. Currently, there is a fellowship in neuroanesthesia at the Hospital Clinic of Barcelona. It is undergoing the process of accreditation by the International Council on Perioperative Neuroscience Training (ICPNT) offered by Society for Neuroscience in Anesthesiology and Critical Care (SNACC). Hopefully, this will be the first of many others that will offer the chance to anesthesiologists from Spain and other countries to improve their neuroanesthesia competencies and skills.

To organize a meeting point for all those anesthesiologists interested in acquiring knowledge and practice in neuroanesthesia, a group of neuroanesthesiologists founded a neuroscience section within the Spanish Anesthesiology and Critical Care Society (Sociedad Española de Anestesiología y Reanimación or “SEDAR”), in 2006. Since then, the neuroscience section has worked to achieve some common objectives for our members. Specifically, we promote continuing education, teaching, and research for neuroanesthesiology in Spain. We focus not only on perioperative neurosurgical and neuroradiological patient care but also on the care of the neurocritical patient, as well as those with neurologic diseases.

Among our projects, we carry out surveys to better understand the opinions of Spanish neuroanesthesiologists on topics that are interesting and relevant. During the section meeting celebrated at each biennial congress of SEDAR, we agree on the main topic to develop in the following two years, among other matters. Following an initial survey of the selected topic, the scientific literature on the subject is reviewed, recommendations are drafted, and in some cases, a narrative review is written. These articles are then published in the Spanish Journal of Anesthesiology and Critical Care (Revista Española de Anestesiología y Reanimación or “REDAR”). Accordingly, every two years, we work together to update some clinical aspects or procedures. The most recent was dealing with the postoperative circuits in neurosurgery, acute post-craniotomy pain, neurophysiological monitoring, etc. Currently, we are working on a survey concerning postoperative delirium and cognitive dysfunction. All of these articles are available on the Neuroscience web page of the SEDAR.

We also contribute to the neuroscience content design for SEDAR congresses. During these years, there is no scheduled congress; the section organizes its own meetings on a specific topic, taking advantage of these events to increase the links among us and reinforce common objectives. Thus, we facilitate scientific communication and collaboration among Spanish anesthesiologists dedicated to neuroanesthesia and neurocritical patient care. For example, the meeting held in Bilbao about neuromonitoring in neuroanesthesia and critical care, the symposium in Madrid, together with the Hemostasia, transfusion medicine, and fluid therapy section of the SEDAR, or the last, also organized in Madrid, about dexmedetomidine in neuroanesthesia.

We share information on congresses, courses, research projects, and other teaching matters among the section members. This is done through email, updating our web page, as well as posting on the social media accounts of SEDAR on platforms such as Twitter and Facebook.

Through the training and teaching division of the society, we are working on professional re-certification established by the EU, which will soon be implemented. We will begin to develop training activities in the field of neuroanesthesia that will be useful for updating our specialty. Afterward, these courses will be assessed to meet the pre-established criteria for a quality set out by the board of SEDAR.

Finally, the neuroscience section links with international institutions likewise related to the neurosciences to maintain a firm connection to them, such as the neuroanesthesia subcommittee of the European Society of Anesthesiology (that recently actualized its name to European Society of Anaesthesiology and Intensive Care (ESAIC)), the European Society of Intensive Care Medicine (ESICM), the SNACC, the Association des Neuro-Anesthésistes-Réanimateurs de Langue Française (ANARLF), the British Neuro Anaesthesia and Critical Care Society;(NACCS), and the Latin American Neuroanesthesia Community. We actively participate and contribute to their projects. Within the framework of these collaborations, the EuroNeuro 2016 congress entitled the 9th International Update Neuro-Anaesthesia and Neuro-Intensive Care Meeting was organized in Barcelona.

As with other societies, the COVID pandemic has forced us to find alternatives to in-person meetings. The section meetings are, therefore, now online. We are organizing webinars to continue our work to distribute scientific knowledge on neuroanesthesia. Training is our primary interest. However, we would like to extend our social media presence to help us gain a wider audience. We would also like to increase our international contacts in Europe, North America, as well as in Latin America to tighten bonds and create common future projects. There are only 160 members in our section, but our numbers will undoubtedly grow with our desire to work and our determination.

Figure 1

Figure 1: Participants in the first meeting of the Neuroanesthesia section of the Spanish Society of Anesthesiology, held during the XXVII Spanish Anesthesia National Congress in Mallorca in 2005.

Figure 2

Figure 2: Last meeting of the Board of the Neuroanesthesia section of the Spanish Society of Anesthesiology,  the XXXIV Spanish Anesthesia National Congress in Canary Island in 2019.

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