James C. Eisenach, M.D., Editor.

World Congress of Aneasthesiologists. Sydney, Australia, April 14–20, 1996.

Multinational business corporations, world sports competitions, and international news agencies are bringing the world together. So also is the World Congress of Anesthesiologists, which met recently for the eleventh time, with the theme “Anaesthesiology -- Coming Together 150 Years On.” The World Federation of Societies of Anaesthesiologists sponsors this meeting, which has been held quadrennially since 1960. The Federation and meeting objective is to “make available the highest standards of anesthesia, intensive care, pain control and resuscitation to all peoples of the world.”

Delegates sensed they were attending an important international meeting. More than 6,000 anesthesiologists from 103 countries attended, with approximately 500 from the United States. This was the largest World Congress, and the largest medical meeting ever in Australia. Sir William Deane, the Governor-General of Australia, opened the Congress with a speech calling for more recognition for anesthesiologists. He said, “In surgery, particularly major surgery, where the basic modern concept is that of the team approach, the staggering advances in all the various subspecialties would not have been possible if there had not been a concomitant advance in patient assessment, anesthesia and post-operative support and management -- all of which are carried out by the anaesthestist.”

History. This World Congress commemorated the 150th anniversary of modern anesthesiology, which began with the successful public demonstration of ether anesthesia by William Morton. At the opening ceremony, delegates were treated to a live tour, via video satellite connections, of the operating theater at Massachusetts General Hospital, where this demonstration occurred.

Several program sessions focused on the history of anesthesia practice. Thirty national speakers described how modern anesthesia arose in their countries. Together, they documented the quickness with which anesthesia knowledge spread after Morton's demonstration on October 16, 1846. Dr M.T. Cousin described an ether anesthetic on December 15, 1846, in France, and S.M. Basu reported its use in Britain on December 19, 1846, and in India, in February 1847. W.J. Hanna reported a successful anesthetic with ether in Jamaica by March 30, 1847; R.S. DeLeon described its use in Guatemala on November 30, 1847. A compendium of abstracts for all invited and submitted presentations and posters at the meeting will make this information available for future use.

Multinationalism. The scientific program was organized into categories, with multiple speakers, generally from different countries, presenting short (10–30 min) talks. This format stimulated interest and facilitated point-counterpoint discussions. For instance, during a session on general anesthetic agents, E. Eger (USA) identified desflurane as superior to sevoflurane in the areas of bioelimination, toxicity, and cost. K. Ikeda (Japan) reported that sevoflurane anesthesia has been administered more than 2.5 million times since its approval in Japan in 1990, with little toxicity identified. C. Prys-Roberts (United Kingdom) said optimal conditions of general anaesthesia can be achieved by balanced combinations of agents, including total intravenous anesthesia. T. Gin (Hong Kong) reported that coexisting disease and surgical technique affect patient outcome more than choice of anesthetic technique. In one morning session on future directions in anesthesia monitoring, eight speakers were from five countries, and in a day session on trauma management, 14 speakers were from 10 countries.

Original Investigations and Workforce. Many delegates discussed socioeconomic issues important in their countries and practice settings. B. Wetchler (USA) reported that managed care, exclusive contracting, and economic credentialing were forcing anesthesiologists to reduce practice costs and to pay attention to the 4 A's -- affability, accessibility, ability, and affordability. M. Cousins (Australia) described the importance of community support for anesthesia research, such as using the public interest in heroin to win government funds. H. Askitopoulou (Greece) reported that only 43% of operating rooms in her country are associated with postanesthesia care units, and that Greek anesthesiologists need more perioperative facilities to grow. C. Prys-Roberts (United Kingdom) reported on the need for crossrecognition of anesthesiologists trained throughout Europe and on the frustration of 10% of funds previously budgeted for British anesthesia departments now going to administrators.

F. Orkin (USA) reported that the United States was training too many anesthesiologists, who were now having difficulty getting jobs. This problem appeared unique in the world. M. James (South Africa) described a shortage of trained anesthesia providers throughout Africa, with many difficult practice conditions, and only $3.96 available for drugs and supplies per case in one location. J. Lertakyamanee (Thailand) described a similar shortage of trained anesthesiologists in Southeast Asia that resulted from an unpopularity of the specialty among potential trainees. Workforce shortages were even reported in Australia (M. Martyn), where 14% of public hospital positions are vacant and 1 in 10 anesthesiologists work more than 70 hours per week. Arduous working conditions may contribute to a high rate of suicide, which is the cause of death for 1 in 10 anesthesiologists in Australia's two largest states.

Griffith Lectures. Two featured lectures at the World Congress are named after Dr. Harold Griffith, the founding president of the World Federation and the introducer of curare into clinical anesthesia. Rod Westhorpe (Australia) presented one lecture, with the theme that keeping an open mind is what allowed some anesthesia researchers to advance the specialty, whereas others missed opportunities. J. Garreth Jones (United Kingdom) presented the other Griffith lecture on the future of anesthesia. With witty observations on the changes in society (more population, lawyers, and poverty, but also more expectations of success), he opined that the increasing pressures to deliver patients for surgery at minimal cost, and with marginal safety, may well erode the opportunities both for research and for providing a high quality anesthetic service.

Overall. This meeting was a massive, and successful, undertaking, with something for everyone. Even such uncommon topics as veterinary anesthesia, gender equity issues, anesthesia during military conflict, and anesthesiology as a health hazard were addressed. The multicultural, multinational approach stimulated and broadened even the most jaded or recently trained anesthesiologists. American anesthesiologists were amazed to find 16 companies displaying and selling anesthesia machines for the world market. Technologies such as patient-controlled nasal spray analgesia, immediate point-of-service laboratory testing, and anesthesia equipment to deliver xenon were unfamiliar to many.

Delegates learned much about the diversities and commonalties of issues, interests, and talents within the world community of anesthesiologists. Saywan Lim (Malaysia), President of the World Federation, described this in his welcoming remarks:“The quadrennial World Congress…is a timely reminder of the long and arduous struggle by anesthesiologists all over the world for their specialty to be accepted and recognized as a major medical discipline. Coming together in Sydney will not only strengthen fraternal ties amongst the anesthesiologists of the world but also enable them to inspire one another in the common endeavor to make anesthesia safer for the patient.”

The next World Congress is scheduled for Montreal in 2000; if similar to the 11th, it will be worth attending.

Robert E. Johnstone, M.D., Department of Anesthesiology, West Virginia University, Morgantown, West Virginia 26506.