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Newsletter July 2020: A Report from Portugal

Carolina Mateus

carolina_armateus@hotmail.com

 

My name is Carolina Mateus and I’m a 5th year resident of Centro Hospitalar do Porto, Portugal. I applied to the Trainee Exchange Programme in Barcelona for this reason (see photo). No, I’m just kidding (the rotation was from October to December!!!).

Having done almost all of my residency in Portugal, I found that something was missing. Despite Portugal being an excellent country with great hospitals and mentors, I felt the need for something more. The will to go abroad. Besides, throughout my residency, my interest in airway management and ventilation began. And where you can find it all together? In thoracic anaesthesia. In Portugal, I had already done a 2-month rotation on thoracic anaesthesia, but I felt that was not enough.

I chose Hospital del Mar in Barcelona because it is a hospital engaged in teaching and investigation. The hospital is not very large, but has unique challenges related to its history and its people and serves the multicultural districts of Ciuttad Vella and Sant Martí. The high percentage of immigrants imposes a language barrier that must be overcome and this is sometimes a challenge. Besides this, the districts that the hospital serves face problems like poverty and addiction, so the patients often have a lot of uncontrolled comorbidities. From a learning point, it was very challenging to anaesthetise these types of patients and this was one of the most fulfilling aspects of the internship.

My weekly schedule was divided between the thoracic operating room and diagnostic procedures in pneumology (anaesthesia for endobronchial ultrasound and bronchofibroscopy). The thoracic anaesthesia group is small, so I had a very warm and easy welcome. During the rotation, I had the opportunity to train in all aspects related to one-lung ventilation and perform several regional techniques, such as thoracic epidural blocks or paravertebral blocks. Thoracic anaesthesia is very rewarding: we know we did a great job when a patient wakes up from a thoracotomy, smiling, without any pain.

Weekly, I participated in the multidisciplinary session (with thoracic surgeons, thoracic anaesthesiologists and nurses), where the surgical cases for the next week are discussed. In this session, we would also discuss the post-operative complications, if any, of the patients admitted to surgery.

Pneumology was very demanding as well. Patients are often very nervous about doing the exam, most of them are heavy smokers, and that can impose challenges to anaesthetic management.

Besides thoracic anaesthesia and pneumology, I was given the chance to participate in other major surgeries in the hospital, such as citorreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). It is a very aggressive surgery and was an excellent opportunity for me at the end of my residency to complement my knowledge.

Apart from the anaesthetic practice, I had the opportunity to lecture two sessions (oriented by two of the thoracic anaesthesiologists) related to thoracic anaesthesia, one to the department and another to the other residents.

This Exchange Program was the experience of a lifetime: I learned a new language and new medical skills; but I had also to adapt to a different national health system, culture and training programme. It was the best way to end my residency. I return to Portugal knowing that I can use that knowledge in the management of all my patients, even outside thoracic anaesthesia.

First I would like to thank the European Society of Anaesthesiology for this wonderful opportunity. Second, to the people that encourage me to apply to the programme: Paula Sá Couto MD e Pedro Amorim MD, for the help and support; Last but not the least, I want to thank Hospital del Mar: to all thoracic anaesthesiologists, I will always remember the time spent with you all (Teresa Silva MD, PhD; Sílvia Bermejo MD, PhD; Lluis Gallart MD, PhD; Alex Perez MD; Enrique Vela MD and Carol Castro MD); Jesus Cordobéz MD for the guidance and support; to thoracic surgeons and nurses and pneumology staff; and finally to the residents of Hospital del Mar, I learned a lot from you as well. Thank you all!

 

References

1.Vreede E at al. Anesth Analg 2019;129:1199

2.Law TL et al. Anesth Analg 2019;129:839

3.Lemos P et al. Acta Medica Portuguesa 2018;31:254

4.Kempthorne P et al. Anesth Analg 2017;125:981

5.Eggers BC, Macario A. Curr Opin Anesthesiol 2006;19:207

6.Del Grosso B, Boyd S. AANA Journal 2019;87:205

7.Gunn IP et al. AANA Journal 1987;55:97

8.Beutler JM. HealthAffairs.org January 16, 2020

9.Bortmann  J et al. AANA 2019;87:269

10.Ostrowski AM et  al. AANA 2019;87:11

11.Meursen V et al. Eur J Anaesth 2010;27:773

12.Clergue F. Eur J Anaesth 2010;27:761

13.Tenedios C et al. Eur J Anaesth 2018;35:108

14.Abenstein JP, Warner MA. Anesth Analg 1996;82:1273

15.Dony P et al. Eur J Anaesth 2019;36:64

16.American Society of Anesthesiologists. Statement on the Anesthesia Care Team (last amended on October 23, 2019)

 

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