European Anesthetic?

[CodeBlu]

Hello everyone,

Recently, I was working with an OB anesthesia fellow who was from Brazil. She cited some major differences in anesthetic technique between North America and the rest of the world. An example being the induction room... where anesthesia is induced and the patient brought to the operating theatre. Sort of blew my mind.

She mentioned a "european anesthetic"... anybody have an insight on what this means? I'm picturing Gucci laryngoscopes and Prada endotracheal tubes...

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[ProwlerturnGas]

Eurotrash techno vs Britney Spears blaring in the OR.

 

[venacontracta]

From what I heard while doing a rotation abroad with students from all over the world, it sounds like many of the European countries have longer specialty training in anesthesia which includes more intensive care training. I also got the sense that the specialty gets a great deal more respect in certain places outside of the US. I'd love to hear more about the differences in anesthetic technique and training/culture between the US and Europe.

 

[Mman]

They do the same things we do here. Differences are minor. Having an induction room doesn't change your anesthetic plan, just changes the location of where you induce. One minor difference is that they don't have the overwhelming push for turnover time so they are generally in no rush to wake a patient up at the end of the case. Here in the US it's a point of pride if you've got the patient extubated as the dressing goes on, but they aren't in that hurry.

 

[Planktonmd]

1- No CRNAs: Anesthesiology is a well respected medical specialty not nursing
2- Single payer health care systems: No one cuts corners to make more money or squeeze in more cases
3- Less drug shortages: the government makes drug companies produce what's needed even if it's not the most profitable drug
4- Less litigation: Physicians tend to practice better medicine and do what is right for the patient without fear of lawyers

 

[dhb]

1- No CRNAs: Anesthesiology is a well respected medical specialty not nursing
2- Single payer health care systems: No one cuts corners to make more money or squeeze in more cases
3- Less drug shortages: the government makes drug companies produce what's needed even if it's not the most profitable drug
4- Less litigation: Physicians tend to practice better medicine and do what is right for the patient without fear of lawyers

1- Not true
2- Not true
3- Not true
4- Partially true but people still practice defensive medicine

Overall i think there are as many differences between the US and the EU as the East Coast vs West Coast

 

[propadope]

Don't they do a lot of TIVA-TCI?

 

[Spinach Dip]

They actually practice retrograde intubation.




[/joke]

 

[Planktonmd]

1- Not true
2- Not true
3- Not true
4- Partially true but people still practice defensive medicine

Overall i think there are as many differences between the US and the EU as the East Coast vs West Coast

So you are saying in Europe there are CRNA's ( like the ones we have here who claim that they are as good or better than you), and they don't have a single payer system, and they have drug shortages as severe as we do, and they get sued as much as we we do?
Keep in mind I used to work in France and I have to insist on what I already said.

 

[Planktonmd]

They actually practice retrograde intubation.




[/joke]

Yes all day long!

 

[urge]

They use target concentration pumps instead of dumb pumps like in the US.

They use some other catecholamine for boluses instead of phenylephrine/ephedrine.

All cases after noon are automatically cancelled.

They have never heard of morbid obesity or sleep apnea.

The fiberoptic scope is used to spy under the doors.

Do you know how easy anesthesia must be there? Everyone is size/weight proportionate and they refuse to take care of anything that might turn into a train wreck.

We occasionally get Europeans that were turned down there and come to the US so we can provide then with the expertise we amass from taking care of so many messed up people in this country.

 

[norwood]

They've had TCI pumps for years, like Urge said.

They call Tylenol "paracetamol" and albuterol "salbutamol."

They've had sugammadex for a good long while.

They take long lunch breaks.

They do a lot of stuff with LMA's... like abdominal cases with AC ventilation.

 

[CodeBlu]

They've had TCI pumps for years, like Urge said.

They call Tylenol "paracetamol" and albuterol "salbutamol."

They've had sugammadex for a good long while.

They take long lunch breaks.

They do a lot of stuff with LMA's... like abdominal cases with AC ventilation.

The bit about LMAs... it seems that in the UK they use them for almost every case conceivable. Just saying it aloud makes me nervous.

One of my attendings is UK trained and he said they use an LMA just about every chance they get.

 

[bashwell]

That's interesting, why do they use LMAs as much as they can? Is it because it saves them a lot of money? It makes me nervous just thinking about it as well! But maybe they have a good reason?

 

[narcusprince]

Diacteylmorphine spinals aka Heroin...... You also can step out of the room and have coffee and tea or smoke break while the patient is on pump. I worked with a Brit a few months on cardiac smart guy claimed to have done 10,000 epidurals and thousands of hours of anesthesia as a junior registrar.

 

[norwood]

You also can step out of the room and have coffee and tea or smoke break while the patient is on pump.

Or, according to at least one Brit I asked... stay IN the room and have a snack! Bit different over there, I guess.

I think a very few sites over in Europe also have xenon available.

 

[HollywdAnesth]

We had a few German staff members where I did residency. They always had us use remifentanil drips for every case over an hour, desflurane with the lowest fresh gas flow you could muster (.3 lpm!)

And we listened to nothing but David Hasselhoff!

 

[psychbender]

I worked with a Brit a few months on cardiac smart guy claimed to have done 10,000 epidurals and thousands of hours of anesthesia as a junior registrar.

I wonder how much of this is true, versus boasting. One of my coworkers worked with some British anesthaesia registrars when he was deployed (one of the programs apparently sent some of their seniors to Afghanistan for a month or two at a time), and he gave me the opposite impression. He said their residents were smoked by the pace and number of hours worked by American anesthesiologists downrange, since they never did 24 hours at a stretch, or more than 40-some hours a week. Maybe he just worked with a couple of weaker registrars.