INTERNATIONAL NEWS
Neuroanesthesiology in Switzerland
An Example for Europe
Nicolai Goettel, MD, DESA, EDIC
Senior Consultant, Anesthesiology, University Hospital Basel, Basel, Switzerland
Research Group Leader, Department of Clinical Research, University of Basel, Basel, Switzerland
 |
Nicolai Goettel, MD, DESA, EDIC |
Switzerland is a federal, democratic state in Central Europe, landlocked between Germany in the north, Austria and Liechtenstein in the east, Italy in the south, and France in the west.
With a population of approximately 8.5 million people, Switzerland is one of the more densely populated countries in Europe. The majority of people live in the Swiss Midlands, located between the Jura Mountains and the expansive Alps. The seven largest cities and economic centers include Zurich, Geneva, Basel, Bern, Lausanne, Winterthur, and Lucerne. Due to its location, Switzerland shares the German, French, and Italian languages of its neighbors, as well as Latin-based Romansh language.
Switzerland’s country code is CH from the neutral Latin Confoederatio Helvetica. It ranked second on the human development index in 2019, making it one of the most highly developed countries in the world. While ranking 133rd in terms of land area and 98th in number of inhabitants, it holds the 20th place among the world’s largest economies (source: Wikipedia).
 |
Switzerland’s iconic Matterhorn |
Currently, there are 281 medical institutions in Switzerland. Thirty-six percent are general care hospitals and 64% are specialist clinics or birthing centers. This large per-capita number of hospitals has declined as facilities merge. In 2018, 216,000 people (168,000 full-time equivalents) were employed in healthcare. With just under 40,000 hospital beds (4.5 beds per 1,000 inhabitants), the annual operating expenses of the hospitals amounts to more than 30 billion Swiss francs. About two thirds of the medical institutions provide anesthesia and pain services; the number of intensive care units being much lower and dedicated to the larger university and cantonal hospitals, as well as a few private establishments. A considerable number of anesthesiologists, critical care physicians, and nursing staff who practice in Switzerland, were trained aboard.
 |
The five university hospitals in Switzerland: Geneva, Lausanne, Zurich, Bern and Basel Copyright: HUG, CHUV, USZ, Inselspital Bern, USB |
The importance of the field of neurosurgery has grown significantly over the past two decades. In 2018 alone, more than 5,000 intracranial procedures were performed in Switzerland. On the one hand, this has to do with improved diagnostics and technological development. Cerebral and spinal pathologies such as injuries, tumors, aneurysms or malformations are not only better recognized, they are also surgically treated with more safety and less invasiveness, resulting in superior outcomes. On the other hand, the population is aging, and people are staying active for longer. In particular, the frequency of degenerative diseases of the spine has increased.
Neurosurgery in Switzerland has become, technically and conceptually, one of the most modern surgical specialties worldwide. The high level of clinical experience, operational expertise and scientific performance in surgery is backed by the full spectrum of state-of-the-art neuroanesthesia practice.
 |
Clipping of an intracranial aneurysm, hybrid OR, University Hospital Basel |
The latest ventilators, monitors, airway management tools, drug infusion systems, and intraoperative neuromonitoring are readily available for interventions performed in the operating rooms and interventional neuroradiology suites, some of which are hybrid ORs. As experience trickles down from academic centers, total intravenous anesthesia with target-controlled infusion of short-acting hypnotics and opioids has become the standard of care, not only for neurosurgical patients. Academic centers in Switzerland have yet to install formal neuroanesthesia fellowship training; hence, professional resources and knowledge are often brought in from surrounding countries.
Healthcare in Switzerland is under the jurisdiction of the cantons (or states), i.e. every canton has its own system and most provide a wide range of medical services to their inhabitants. Therefore, neurosurgical cases are distributed to smaller hospitals or the private sector. This prevents us from establishing fellowship programs, since hardly any anesthesiologist exclusively performs neuroanesthesia. Often, the caseload at a single institution is too low for an effective training program to take place.
An increasing number of health care professionals in Switzerland are interested in the neuroscience of anesthesiology and critical care. However, only a handful regularly participate in SNACC activities. This may change as SNACC continues to foster international ties. Demographic change is particularly visible in the Swiss population. By 2022, the elderly population aged >65 years is expected to overtake those under 20 years. This affects not only daily anesthesia care, as our patients get older and older, but also provides many opportunities to study neurological outcomes of surgery and perioperative neurocognitive disorders. Geriatric anesthesia has become a mission for Swiss clinicians and researchers alike.
On a national level, anesthesiologists and critical care physicians are represented by the Swiss Society of Anaesthesiology and Reanimation (www.sgar-ssar.ch). However, neuroanesthesia has yet to be launched as a special interest group of our professional society. Clinicians and researchers enthusiastic about neuroanesthesia and neurocritical care often extend to their European peers: the Scientific Subcommittee in Neuroanesthesiology of the European Society of Anaesthesiology (www.esahq.org), the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland (www.naccs.org.uk), the Wissenschaftlicher Arbeitskreis Neuroanästhesie of the German Society of Anesthesiology and Intensive Care (www.wakna.dgai.de), and the Association de Neuro-Anesthésie Réanimation de Langue Francaise (www.anarlf.eu). These associations regularly organize international neuroanesthesia meetings.
Geographically, socially, and politically situated in the heart of Europe, Switzerland and its small community of neuroanesthesiologists is exemplary for a successful cross-boundary medical culture, as we hope to extend collaborations and friendships with others.
