Rev Bras Anestesiol.2016;xxxxx:xxx---xxxREVISTA ANESTESIOLOGIA Publicação Oficial da Sociedade Brasileira de Anestesiologia www.sba.com.br CLINICAL INFORMATION Marcello Fonseca Salgado Fi
Trang 1Rev Bras Anestesiol.2016;xxx(xx):xxx -xxx
REVISTA
ANESTESIOLOGIA Publicação Oficial da Sociedade Brasileira de Anestesiologia
www.sba.com.br
CLINICAL INFORMATION
Marcello Fonseca Salgado Filhoa , b
aUniversidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
bCurso de Ecocardiografia Intraoperatória, Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil
Received21May2015;accepted8September2015
KEYWORDS
Intraoperative
echocardiography;
Anesthesia;
Transtoracic
echocardiography;
Transesophageal
echocardiography
Abstract
Background and objectives: TheBrazilianSocietyofAnesthesiology(SBA)hasbeenpromoting continuingeducationinintraoperativeechocardiographyinBrazilsince2011,withthe imple-mentationofanIntraoperativeEchocardiographyCourse(ETI/SBA).Althoughechocardiography
isarealityofanesthesiologypracticeinBrazil,westilldonothaveanestablishedpolicyon theareaofexpertise,jobtraining,andrecognitionbytheothersocieties,suchastheBrazilian Society ofCardiology(SBC) Theaimofthispaperistocontextualizetheanesthesiology in theintraoperativeechocardiographyinBrazilandpromoteadiscussionontheformationofa TaskForcealongwiththeSBCtobegindrawinguptheBrazilianGuidelinesonIntraoperative Echocardiography
Case report: ThefirstreportsontheinvolvementofanesthesiologyinBrazilwithintraoperative echocardiographyarefromthe80sand90s.However,thistechniqueimplementationinroutine practiceintheBraziliananesthesiology occurredin2011with theformation oftheETI/SBA Course.Sincethen, theSBAhasbeenpromotingacontinuingeducationofitsmembersand disseminatingtheETI/SBACoursethroughoutBrazil.Morethan200associateshavetakenthis course,andthevastmajorityworkswithcardiacsurgery
Conclusion: IntraoperativeechocardiographyisarealityinthepracticeoftheBrazilian anes-thesiology,andtheETI/SBACoursehasbeenpromotingitscontinuingeducation,however,we stilldonothaveagroundedguideline.Asoccurredinmajorworldwidecenters,wehaveto promote aTaskForcealongwiththeSBC inordertobeginthedrawing upoftheBrazilian GuidelinesonIntraoperativeEchocardiography
©2016SociedadeBrasileiradeAnestesiologia.Publishedby ElsevierEditoraLtda.Thisisan openaccessarticleundertheCCBY-NC-NDlicense(
E-mail:mfonsecasalgado@hotmail.com
http://dx.doi.org/10.1016/j.bjane.2015.09.002
0104-0014/© 2016 Sociedade Brasileira de Anestesiologia Published by Elsevier Editora Ltda This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ).
Trang 22 M.F.Filho
PALAVRAS-CHAVE
Ecocardiografia
intraoperatória;
Anestesia;
Ecocardiografia
transtorácica;
Ecocardiografia
transesofágica
Diretrizes da ecocardiografia intraoperatória no Brasil - Chegou a hora de uma forc ¸a-tarefa?
Resumo
a educac¸ão continuada em ecocardiografia intraoperatória no Brasil desde 2011, com a implantac¸ãodoCursodeEcocardiografiaIntraoperatória(ETI/SBA).Apesardeaecocardiografia serumarealidadedoanestesiologistabrasileiro,aindanãotemosumadiretrizestabelecidano quediz respeito àáreade atuac¸ão,capacitac¸ão profissional eao reconhecimentojunto às demaissociedades,como,porexemplo,aSociedadeBrasileiradeCardiologia(SBC).Oobjetivo desteartigo écontextualizaraanestesiologia naecocardiografia intraoperatórianoBrasile promoverumadiscussãosobreaformac¸ãodeumaforc¸a-tarefajuntoàSBCparainiciarmosa formac¸ãodasDiretrizesBrasileirasemEcocardiografiaIntraoperatória
Relato do caso:Osprimeirosrelatosdoenvolvimentodaanestesiologia noBrasilcoma eco-cardiografiaintraoperatóriasãodadécadade1980e90.Contudo,aimplantac¸ãodessatécnica
napráticarotineiranaanestesiologia brasileiraocorreuem2011, comaformac¸ãodoCurso ETI/SBA.Desdeentão,aSBAvempromovendo aeducac¸ão continuadadeseusassociados e divulgandooCursoETI/SBAemtodooBrasil.Jáfizeramessecursomaisde200associados.A grandemaioriatrabalhacomcirurgiacardíaca
Conclusão:Aecocardiografiaintraoperatóriaéumarealidadenaanestesiologiabrasileiraeo CursoETI/SBAvempromovendoasuaeducac¸ãocontinuada.Contudo,aindanãotemos uma diretrizfundamentada.Comoocorreunosgrandescentrosmundiais,temosdepromoveruma forc¸a-tarefajuntoàSBCafimdeiniciarmosaformulac¸ãodasDiretrizesBrasileirasem Ecocar-diografiaIntraoperatória
©2016SociedadeBrasileiradeAnestesiologia.PublicadoporElsevierEditoraLtda.Este ´eum artigoOpen Accesssobumalicenc¸aCCBY-NC-ND(
Intraoperativeechocardiographyisarealityinmajor
Amer-ican,Canadian, andEuropeancenterssincethe1980s.1In
the1990s,itacquiredgreatpopularizationwiththe
appoint-ment of Anesthesiology and Cardiology/Echocardiography
SocietiesTask Forces.1This taskforcehasformulatedand
published the guidelines and examination techniques for
intraoperativetransesophagealechocardiography.InBrazil,
thefirstanesthesiapapersonintraoperative
echocardiogra-phydatefromde1980s/90s,withtwoscientificpapersby
Dr.JoséAulerpresentedasfreethemesinthe1987and1994
BrazilianCongressofAnesthesiology.2,3
Theaimofthispaperistocontextualizeanesthesiology
inintraoperativeechocardiographyinBrazilandpromotea
discussionontheformationofataskforcewiththeBrazilian
SocietyofCardiologytodelineatetheBrazilian
Intraopera-tiveEchocardiographyGuidelines
Inthe1990s,theUnitedStates,Canada,andEurope
devel-oped their intraoperative echocardiography guidelines,1
which promoted a worldwide dissemination of this
tech-nique.Whattheseopinionmakercentershadincommonwas
theunionoftheanesthesiologysocietieswiththe
echocar-diographyand/orcardiologysocieties.Thus,theypromoted
ataskforceandvalidatedtheintraoperative
echocardiogra-phyperformancebytrainedanesthesiologists.InBrazil,this
techniquebeganinthe1980s/90s.Dr.JoséAulerpresented twoscientificpapersasfreethemesintheBrazilianCongress
of Anesthesiology in 1987 and 1994.2,3 Although we have worksdatedfromthe1980s,therewasawidespread contin-uationofthistechnologyinBrazilbetween1990and2000
Itwasthroughthepersonalcommitmentofsome anesthesi-ologistsandfewhospitalsspecializedincardiacsurgerythat intraoperativeechocardiographypickedupitsdevelopment againinBrazilmorerecently,especiallyaftertheAmerican Society of Cardiovascular Anesthesiology (ACS) guidelines and theAmericanSociety of Echocardiography (ASE) The ACS/ASErefreshercourseswerealsoimportanttopromote thistechniqueinBrazil.1
Faced with an increasingly growing demand in the Brazilian scenario, the SBA formed a group in 2011 to promotecontinuingeducationinintraoperative echocardi-ography.Thus,theIntraoperativeEchocardiographyCourse
of the Brazilian Society of Anesthesiology (ETI/SBA)4 is initiated
ThefirsttwocourseswerebasedontheACS/ASE immer-sion course models This model was not fit for Brazil,
as it wasextremely long and often unproductive So,we begin totailorthe course toa model that wasclosest to the Brazilian anesthesiologist profile Thus, the ETI/SBA course was divided into two modules: Module I, which introducesthebasicsofechocardiography,anatomyrelated
toechocardiography,andhemodynamiccalculations; Mod-ule II, which evaluates ventricular function and valvular pathologies.4 With this change, the course became more palatable and with better acceptance for the Brazilian
Trang 3IntraoperativeechocardiographyguidelinesinBrazil 3 anesthesiologists.Overfouryears,8ModulesIand5Modules
IIwereperformed.4
ETI/SBAcoursehaseightanesthesiologistinstructors,in
additiontoguestechocardiographers.Thecoursestructure
isbasedonlectures,laboratorywithporcineheart model,
realisticsimulationmannequinoftransesophageal
echocar-diographywithmorethan20diseases,andatransthoracic
echocardiographyworkshop.4
Of the 265 anesthesiologists who took the ETI/SBA
Course,233(88%)worksregularlywithcardiacsurgeryand
107 (40%) have the echocardiography machine on their
services.5Afactthatdemonstrateshowweneedtoexpand
thisknowledgeinBrazilisthatofthe233anesthesiologists
whoworkwithheartsurgery,only77(33%)usethe
echocar-diogramtwiceormoreduringtheweekintheiranesthetic
procedures.5
The interest andfamiliarity withechocardiographyare
continuallyincreasing,andwe canseethisevolutionboth
by the number of articles publishedby our associates6 -12
andthemeanETI/SBACourseevaluations,whichhasgrown
everyyear,andbythenumberofthird-yearresidentstaken
the courses that already use the echocardiogram in
car-diacandnon-cardiacsurgeryintheirEducationandTraining
Centers(ETC).5
Conclusion
With the implementation of the ETI/SBA Course and
theechocardiogrampopularizationamonganesthesiologists
who are in the labor market and training in the ETCs,
the first step was taken However, we must continue to
provide becausewe have toimplement a taskforce with
theBrazilianSocietyofCardiologysothatwecanformulate
theBrazilianIntraoperativeEchocardiographyGuidelinesin
ordertoprovide moresafety andqualityin anesthesiato
ourpatientsinastandardmanner
Conflicts of interest
Theauthordeclaresnoconflictsofinterest
References
1 Shanewise JS, Cheung AT, Aronson S, et al ASE/SCA guide-lines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommenda-tions of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Car-diovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography Anesth Analg 1999;12:884 -900.
2 Pereira JCD, Picciani JL, Camargo GP, et al Estudo compar-ativo entre o diazepan e o midazolan na induc ¸ão anestésica avaliado pelo ecocardiograma bidimensionl Rev Bras Aneste-siol 1987;37:122.
3 Auler JOC, Moraes A, Pereira JCD, et al Monitorizac ¸ão intraoperatória com ecocardiograma transesofágico durante aneurismectomia do ventrículo esquerdo Rev Bras Anestesiol 1994;44:144.
4 Sociedade Brasileira de Anestesiologia www.sba.com.br
5 Relatórios do curso ETI/SBA Sociedade Brasileira de Anestesi-ologia.
6 Filho MFS, Siciliano A, Diego LAn, et al Transesophageal echocardiography in Ross procedure Rev Bras Anestesiol 2011;61:344 -50.
7 Filho MFS, Fernendes A Monitorizac ¸ão em anestesia: o ecocar-diograma transesofágico SAERJ 2012;1:364 -74.
8 Filho MFS, Siciliano A, Siciliano A, et al The importance of trans-esophageal echocardiography in heart harvesting for cardiac transplantation Rev Bras Anestesiol 2012;62:262 -8.
9 Júnior CG, Botelho ESL, Diego LAdS Intraoperative monitoring with transesophageal echocardiography in cardiac surgery Rev Bras Anestesiol 2011;61:495 -512.
10 Filho MFS, Versosa N, Cavalcanti IL, et al Impacto do eco-cardiograma transesofágico intraoperatório na mortalidade em cirurgia de revascularizac ¸ão do miocardio com circulac ¸ão extra-corpórea Rev Col Bras Cir 2013;40:357 -62.
11 Silva AA, Segurado A, Kimachi PP, et al Transesophageal echocardiography in anesthesiology: characterization of use profile in a tertiary hospital Rev Bras Anestesiol 2012;62: 636 -53.
12 Gaia DF, Couto A, Breda JR, et al Transcatheter aortic valve-in-valve implantation: a selection change? Rev Bras Cir Cardiovasc 2012;27:355 -61.