Victor Koryachkin, dm, Professor, Head of the Research Department for Diagnostics of Diseases and Injuries of Musculoskeletal System of the Vreden Russian Research Institute of Traumatology and Orthopedics, Member of Presidium of the All-Russian Society of Regional Anesthesia and Treatment of Acute Pain:
– Dr. Koryachkin, why the Anesthesiology and Critical Care section has become part of the forum for trauma and orthopedic surgeons?
– Firstly, it is impossible to do without high-quality anesthesia during orthopedic and trauma surgeries and in providing emergency medical aid to patients with injuries. Secondly, anesthesiologists, traumatologists, and surgeons work in a team, and it is our common task to ensure effective and safe treatment. We should not have differences in the patient management tactic at all stages of treatment, when choosing a method of anesthesia and infusion-transfusion therapy, and to that end we should all speak the same language.
– Tell us about the key trends in the global anesthesia and critical care.
– One of the main trends is the improvement of regional anesthesia techniques with visualization of blind procedures when using ultrasound devices. In addition, early rehabilitation of patients after surgery is increasingly developing, which is carried out by a well-coordinated team of specialists, including an orthopedic and trauma surgeon, a rehabilitation professional, a physiotherapist and, of course, an anesthesiologist, since there should be reliable pain relief to achieve our goal.
– What are the most frequent difficulties related to anesthesia?
First of all, it is a steady increase in the number of senior and aged patients with severe concomitant somatic pathology. The number of proximal femoral fractures is increasingly growing, which by estimates will reach 6.26 million cases by 2050 in the US alone. Femur fracture is an indication for surgical treatment. Specialists have not agreed on an appropriate anesthetic technique in these patients yet. There is an acute issue of the prevention and treatment of postoperative delirium, the opinions on which differ widely. There is no definitive answer even to a simple question whether it is necessary to conduct preoperative bowel cleaning. Therefore, cooperation at a global level and exchange of experience in this specialty are required.
– Are you familiar with the working methods of the Asian critical care anesthetists?
– I am familiar with some works by RuiFangetal (China), Johnny CA Ong et al. (Singapore), Fu PL et al. (China). All of them are devoted to analgesia after knee joint arthroplasty. The research results show excellence in anesthesiology, which the authors have achieved in their own countries. Of course, it is interesting to learn more about this experience and, if possible, discuss details in person.
– What interesting projects is your research department working on now?
– We are working on such methods of anesthesia as combined spinal-paravertebral anesthesia for hip arthroplasty, genicular nerve block during knee surgeries, application of dexason as an analgesic drug, and research in lumbar plexus sonoanatomy. At the EOF, we will present the protocol of anesthetic management of distal femur fractures in the senior and aged patients, which includes not only the actual issues of anesthesia but the special features of preoperative and postoperative periods.
Alexey Ovechkin, dm, Professor, the Head of the Anesthesiology and Intensive Care Department, the Faculty of Therapeutics of the Sechenov First Moscow State Medical University, the President of the Russian Acute Pain Medicine and Regional Anesthesia Fellowship, the Chairman of the Moscow Scientific Society of Anesthesiology and Resuscitation, Member of the European Society of Anesthesiology (ESA) and the European Society of Regional Anesthesia (ESRA):
– Dr. Ovechkin, is there any experience in your practice of joint training of anesthetists and orthopedic and trauma surgeons?
– In my opinion, a multidisciplinary approach is very important for the successful training of doctors, and we have recently started to implement it at the meetings of the Moscow Scientific Society of Anesthesiology and Resuscitation. A joint meeting with trauma and orthopedic surgeons has already been held. We have discussed which anesthetic technique is optimal for large joints arthroplasty. The results are very interesting. Traumatologists took part in the discussions, expressed their point of view and generally favored the continuing cooperation.
At the EOF, we will continue to discuss this topic, and I am going to make a presentation on choosing the optimal anesthetic technique for large joints arthroplasty. Such surgeries are made by dozens, but the anesthesia community has no consensus about which technique is preferable, although there are international research findings that certain anesthetic techniques have a positive effect on the postoperative course, reduce morbidity and even mortality. In my opinion, the issue is highly relevant, and I would like to raise it at the federal and international level.
– The program of the Anesthesiology section is developed jointly by civilian and military doctors. What is the benefit of this approach?
– In recent years, for a number of reasons civilian doctors are increasingly faced with the need to provide medical care to victims of accidents and disasters that occur in the localities. The military doctors have extensive experience of assisting in these conditions, as well as in combat trauma and in the mass arrival of victims. The opportunity of sharing this experience cannot be overestimated. Besides, it is possible that in case of major emergencies, we all will have to work together, and it is important to understand each other.
– Do you have experience of working with colleagues from Asia?
– To date, it's just the neighboring countries. I have been to Kazakhstan several times, communicated with colleagues in the cities of Astana and Almaty, including anesthesiologists and intensive care therapists of orthopedic departments. In Astana, I visited two well-equipped clinics of European level. This is a highly beneficial cooperation. Interaction is always mutually enriching. We would like to establish contacts with foreign countries. There are interesting papers on anesthetics by authors from India and China; my colleagues and I always study them closely, thinking about how it can be used in practice, but no personal contact has been established yet. I hope they will appear soon.
Valery Stets, Head of the Center of Anesthesiology and Resuscitation, Critical and Intensive Care, Main Anesthesiologist of the Burdenko Main Military Clinical Hospital:
– What topics the experts of the Burdenko Main Military Clinical Hospital are planning to focus on in the course of the EOF Anesthesiology Section?
– Anesthesiologists of the Burdenko Main Military Clinical Hospital were the first in Russia to apply regional anesthesia techniques both in the provision of emergency trauma care and in the course of limb surgeries. This work was intensified during the military operations in Afghanistan, continued while eliminating the consequences of the earthquake in Armenia, then in local conflicts in combat zones, and during routine work in the Hospital's in-patient facilities. Now regional anesthesia techniques are recognized globally to be most practical, efficient, and safe because of their low toxicity, so we try to keep up with foreign colleagues. Once they were ahead of us in using ultrasound-navigation with regional anesthesia, but now we have mastered this area, too.
Treatment of combat injuries of limbs, including with the use of local anesthesia, is a vital issue for both military and civilian doctors. Regional methods produce good results in the removal of pain impulses in cancer patients, and the patient can remain conscious, in some situations being able to control their pain relief, thereby improving efficiency and reducing or even stopping the use of narcotic drugs. The topic is very acute today. Another important area is perioperative anesthetic management, due to which the operation goes easier, faster and rehabilitation is more efficient. We will share all these experiences in the session with fellow anesthesiologists and trauma and orthopedic surgeons.