History of the Society for Neuroanesthesia of Philippines, Inc. (SYNAPS, INC.)

Geraldine B. Jose, MD, DPBA
President, SYNAPS
Section Chief, Neuroanesthesia
University of the Philippines - Philippine General Hospital (UP-PGH)
Manila, Philippines

Dr. Sharma
Geraldine B. Jose, MD, DPBA

In the University of the Philippines - Philippine General Hospital (UP-PGH), the number of patients undergoing neurosurgical procedures steadily increased over the years. It reached approximately 1,500 patients per annum by the year 2002, and the trend was maintained until 2010. There is a gradual increase in this trend up to the present. The neurosurgical case load varies widely with the inclusion of neurodiagnostic and interventional neuroradiologic procedures. The types of neurosurgical procedures done earlier were not much different from the ones being performed today. It included neurovascular lesions, intracranial tumors, cranio-facial anomalies, and ubiquitous intracranial trauma cases etc. However, during those days, the ease and convenience of technologies were lacking which necessitated development of a keen clinical eye, a skill that is tirelessly still imparted to each succeeding generation of aspiring anesthesiologists.

For a long time, the UP-PGH Consultant Staff of the section of neuroanesthesia would conduct preceptorials to a small-group of residents posted in neuroanesthesia on rotation to discuss relevant perioperative management. Later on, with the help of the members of neuroanesthesia section of UP-PGH namely; Drs. Merle de la Cruz-Odi, Loreto A. Fellizar, Iluminada T. Camagay, Maria Concepcion L. Cruz, Serafin L.  Bernardo, Antonio Alan S. Mangubat and Geraldine Raphaela B.  Jose, a formal fellowship program was established, which was first of its kind in the Philippines.

In 2004, the proposal on the Neuroanesthesia Fellowship program was brought forth and presented to the administration of the PGH and the University of Philippines College of Medicine. Among the goals of the proposed program was to offer the opportunity for trainees to gain more experience in providing anesthesia for neurosurgical cases and to address the deficit in demand of trained neuroanesthesiologists in the country. Prior to the Neuroanesthesia Fellowship Program, there were approximately 50 board-certified neurosurgeons in the country, half of whom were trained in PGH. About 20 of these neurosurgeons were centered in the vicinity of the National Capital Region while the rest used to practice all over the Philippines. The plan is to train a corresponding number of neuroanesthesiologists vis-à-vis the increasing number of trained neurosurgeons. Neurosurgery training programs in the Philippines at present are able to graduate an average of three to four candidates per year. However, there is no corresponding increase in the number of neuroanesthesiologists; and the need for a change in the ratio was well-felt. The program was finally given the green light on March 22, 2006 and the first batch of fellows joined the course in July of the same year. To date, the program has graduated 30 fellows who practice their skills in different parts of the country. The introduction of the fellowship program has also brought forth a resurgence in the section of neuroanesthesia at the UP-PGH.

With the increasing number of fellows who completed the training program at the UP-PGH, the need to establish a neuroanesthesia society was proposed. The goal was to form a society that is dedicated to the art and science of neuroanesthesia with a goal of providing a venue for learning current perioperative management techniques and exchange of research work in the field of neuroanesthesia in the Philippines. The groundwork for the organization of a ‘Society of Neuroanesthesiologists of the Philippines’ was initiated.

Figures 1 and 2

The first successful awake craniotomy in PGH was performed in October 2006. A number of such cases have been performed since then, and the results are encouraging. On April 2008, a formal opening of the Pediatric Neurosurgical and Cranio-Facial Operating Unit (PNCOU) was held. In conjunction with the UP-PGH Section of Neurosurgery, this unit was conceptualized to accommodate the voluminous number of pediatric patients with congenital central nervous system (CNS) anomalies and tumors. To date, approximately 800 patients have benefited from the creation of this unit. In May 2010, the first meeting of anesthesiologists who practice neuroanesthesia in the Philippines was held. This meeting was spearheaded by the members of the Section of Neuroanesthesia of the UP-PGH. Concepts and ideas regarding the name, mission and vision of the fledgling Society was discussed. On July 2010, the name “Society for Neuroanesthesia of the Philippines, Inc.” (SYNAPS, Inc.) was created. On August 2010, the election of the officers of the Society for Neuroanesthesia of the Philippines was carried out. Dr. Minerva Patawaran-Calimag, President of the Philippine Society of Anesthesiologists, Inc. (PSA) subsequently approved the request for affiliation of SYNAPS as a subspecialty society. On September 18, 2010, The First General Assembly and the Inductions of the Officers and Members of the Society for Neuroanesthesia of the Philippines, Inc. (SYNAPS) was held (Figures 1, 2). The following Officers and Board of Directors were the first inducted along with recognition of 81 members to this subspecialty society:

President: Merle de la Cruz-Odi, MD, DPBA
Vice-President: Geraldine Raphaela B. Jose, MD, DPBA
Treasurer: Jonell L. Lim, MD, DPBA
Secretary: Antonio Alan S. Mangubat, MD, DPBA
Board of Directors:
Ernesto F. de la Cerna, MD, DPBA
Maria Concepcion L. Cruz, MD, DPBA
Lydia M. Egay, MD, DPBA
Loreto A. Fellizar, MD, DPB
Grace Anne B. Herbosa, MD, DPBA
Eric V. Nagtalon, MD, DPBA
Restituto C. de Ocampo, MD, DPBA

Figure 3

On February 25, 2011, SYNAPS was recognized by the Asian Society for Neuroanesthesia and Critical Care (ASNACC) as one of its members (Figure 3). The Philippines is the 8th Asian nation affiliated to ASNACC. As a result of this progress, more and more anesthesia trainees are now attracted towards neuronaesthesia. Emphasis is being given to honing the clinical skills and research acumen of the fellows and residents. In 2017, the Philippines was chosen as the host country of the ASNACC biennial meeting in 2021.  In 2017, a Neuroscience Institute was conceptualized in the UP-PGH which has been established to be projected as a venue for learning and research on neurosciences in the Philippines during the next five years. These are a few highlights of the history of neuroanesthesia activities in the Philippines. In its march towards the future, we strive to keep up with the latest developments in the dynamic field of neuroanesthesia, and ensure that all these achievements are directed for providing safe anesthesia to all who might need it.

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