INTERNATIONAL

Neuroanesthesia in Germany

Martin Söhle, MD, PhD, MHBA

Werner Klingler, MD, PhD

Peter Michels, MD

Martin Söhle, MD, PhD, MHBA
Spokesperson I, Scientific Working Group on Neuroanesthesia
German Society for Anaesthesiology and Intensive Care Medicine
Professor and Vice Head, Department of Anaesthesiology and Intensive Care Medicine
University Hospital Bonn
Bonn, Germany

Werner Klingler, MD, PhD
Spokesperson II, Scientific Working Group on Neuroanesthesia
German Society for Anaesthesiology and Intensive Care Medicine
Professor and Head, Department of Anaesthesiology and Intensive Care Medicine
SRH Hospital
Sigmaringen, Germany

Peter Michels, MD
Secretary, Scientific Working Group Neuroanesthesia
German Society for Anaesthesiology and Intensive Care Medicine
Consultant Anaesthesiologist, Department of Anaesthesiology, Emergency and Intensive Care Medicine
University Hospital Göttingen
Göttingen, Germany

The Scientific Working Group on Neuroanaesthesia was founded on March 20, 1991, within the German Society of Anaesthesiology and Intensive Care Medicine to allow interested participants to exchange experience and ideas about neuroanaesthesia.

In addition, the Scientific Working Group promotes scientific and professional progress in the field of Neuroanaesthesia. It supports the German Society of Anaesthesiology and Intensive Care Medicine in preparing guidelines on neuroanaesthesia and putting together scientific sessions on neuroanaesthesia for the Society's congresses.

Starting with 46 participants in 1991, the Scientific Working Group on Neuroanaesthesia has grown to 182 active and many more passive members and organizes its own annual scientific autumn meeting. In these meetings, the group awards scientists for outstanding achievements in the field of neuroanaesthesiology. Furthermore, the group is actively involved in clinical studies, the preparation of guidelines of related topics, and the compilation of patient information on specific issues, e.g., patient leaflets for anesthetic precautions for Parkinson´s disease or neuromuscular disorders.

The working group has designed and conducted a skill lab course on diagnosing brain death and has developed a guideline on neuromonitoring in cardiac anesthesia. It is in close collaboration with other scientific working groups (for example, cardiac anaesthesia, pediatric anaesthesia, and emergency medicine) and maintains a close relationship with the Malignant Hyperthermia Group.

Germany is a federal republic with 16 states and 83 million inhabitants. By law, everyone is covered either by public or private health insurance and has full and low-threshold access to the health system. In 2018, there were a total of 1,925 hospitals with 498,000 beds (600 beds/100,000 inhabitants). There was a decrease of 25% of the facilities during the last 30 years, in an attempt to reduce health care costs. Germany seems adequately staffed with neurosurgeons, of which 2,800 are board-certified. Currently, 185 neurosurgical departments with 6,988 beds treat 253,252 neurosurgical cases per year. It leads to a density of 84 neurosurgical beds per million inhabitants.

The German Scientific Working Group on Neuroanaesthesia is a welcoming association of clinicians, scientists, and other health professionals open to all interested members of the German Society of Anaesthesiology and Intensive Care Medicine and associated groups. The group also fosters neuroanaesthesiological aspects of specialist training in anaesthesia, which takes at least five years in Germany, and requires a certain minimum experience in neuroanaesthesia. This training includes involvement in at least 25 anesthetics in intracranial procedures, which residents acquire either in their own hospital or as part of a job shadowing at another hospital with a neurosurgical unit.

Anesthesia for neurosurgical, neurointerventional, or psychiatric interventions is performed or overseen by the anaesthesiologists, who acquired considerable experience in neuroanaesthesia for many years. However, neither a formal fellowship nor a special neuroanaesthesia examination exists. Nevertheless, neuroanaesthesiologists are trained in performing evoked potential monitoring (e.g., for carotid endarterectomy or acoustic neuroma), trans-esophageal ultrasound (e.g., for a semi-sitting position), and awake craniotomies. Other important topics are specifics for spinal surgery, implantation of deep brain stimulation electrodes, peripheral nerve reconstructions, stereotactic brain biopsy, and the use of intraoperative magnetic resonance imaging. In the German system, anaesthesiology is a multifaceted subject, and, in addition to Intensive Care Medicine, it also includes Emergency Medicine, Pain Therapy, and Palliative Medicine. Neurocritical care is not an independent subspecialty but an integral part of the speciality of Intensive Care Medicine. The neurocritical care is provided by the neurosurgeons, neurologists, and anaesthesiologists.

Current discussions of the German Scientific Working Group on Neuroanaesthesia include the optimal anesthetic technique for mechanical thrombectomy in stroke patients, advanced TEE-monitoring for procedures in the semi-sitting position, and a functional circulatory arrest for aneurysm clipping. In addition, we deal with other neuro topics such as prevention of postoperative delirium, treatment of traumatic brain injury, and processed EEG-monitoring to assess the depth of anaesthesia. We encourage all interested readers to become actively involved in the fascinating field of neuroanaesthesiology and join conferences for discussion and sharing of ideas.

Information on upcoming events and a collection of highlighted literature can be found on our website: https://www.wakna.dgai.de/.