Hungarian Society of Anaesthesiology and Intensive Therapy (HSAIT)

Address: Semmelweis Egyetem Aneszteziológiai és Intenzív Terápiás Klinika
1125 Budapest; Kútvölgyi út 4; Hungary
Telephone: +36 - (1) 356-5068
Fax: +36 – (1) 355- 7975
Website: www.anesztinfo.hu
E-mail: anesztinfo@doki.net

Current President: Professor László Vimláti
Current Vice-President: Professor Lajos Bogár

Fully registered anaesthesiologists: 790
Anaesthesiology trainees: 722

Established: 1966
Affiliations: WFSA - WFSICCM - ESA - FEEA- UEMS - ESICM

About Hungary

Member State of the EU since 2004
Political system: Republic
Capital city: Budapest
Total area: 93 000 km²
Population: 10.1 million
Currency: Forint

Hungary is a landlocked country in the Carpathian Basin of Central Europe bordered by Slovakia, Ukraine, Romania, Serbia, Croatia, Slovenia and Austria. Its landscape is mostly flat, with low mountains in the northern areas. Lake Balaton, a popular tourist centre, is the largest lake in Central Europe.

The ancestors of the ethnic Hungarians were the Magyar tribes, which moved into the Carpathian Basin in 896, conquering the people already settled in the region. Hungary became a Christian kingdom under St. Stephen in the year 1000. The Hungarian language is unrelated to those of its geographic neighbours and only distantly related to Finnish and Estonian.

The capital city, Budapest, which originally consisted of two separate cities - Buda & Pest – straddles the River Danube. It is rich in history and culture and famed for its curative thermal springs.

Hungary is a highly musical country whose traditional folk music inspired such of its great composers as Liszt, Bartók and Kodály.

There are 159 hospitals in Hungary where Anaesthesia and Intensive Care service is provided.

Milestones of Hungarian anesthesia

February 11th, 1847: 4 months after Morton’s narcosis in Boston, Janos Balassa performed its first ether anaesthesia in Budapest.

March 9th, 1847: Council of Governor-General of Pest (later Budapest) issued a statutory rule that required licensed physician supervision during ether anaesthesia.

March 10th, 1847: The world’s third monograph on ether anaesthesia was published by Jozsef Rosenfeld, a Hungarian physician in Leipzig, Germany.

1848-1849: Hungarian War of Independence was the first war in Europe where ether and chloroform anaesthesia were used in the field.

April 1949: First endotracheal anaesthesia was performed in Budapest.

May 1953: The first full-time anaesthetist, Dr. Laszlo Palos was appointed in Budapest.

1958: Section of Anaesthesia was established by the Hungarian Society of Surgery.

1961: The first national conference on anaesthesia was held in Pécs.

1966: Hungarian Society of Anaesthesia and Intensive Care was established (HSAIC, president: Dr .Laszlo Lencz).

2009: 37th National Conference of HSAIC was held in Balatonfüred.

What was Hungary's contribution to world anaesthesia?

First Hungarian book on anaesthesia

March 10th, 1847: World’s third monograph on ether anaesthesia was published by Jozsef Rosenfeld, a Hungarian physician in Leipzig, Germany.

Vilmos Vajna (1854-1932)

Vilmos Vajna, a Hungarian physician, invented a glass facemask that was popular for open ether and chloroform anaesthesia. It was provided with a rubber edge for proper sealing and prevention of burns on the eyes and skin caused by ether. Later, the glass facemask was modified by D.W. Buxton who popularised it in the 1860’s.

Francis F. Foldes (1910-1997)

Francis F. Foldes was a world-renowned pharmacologist who made great discoveries and research in the field of analgetics and peripheral muscular relaxants. At the age of 31 he left Hungary and initially worked as an anaesthetist at the Massachusetts General Hospital, Harvard University; later on at the Mercy Hospital, Pittsburgh, Columbia University as well as the Albert Einstein University. Professor Foldes introduced 2-chloroprocain and naloxone to the practice, developed the technique of continuous muscle relaxant infusion and invented low flow anaesthesia.

Activities of the Society

• Organising the annual national congress (participation: 1500 delegates)
• Organising international congresses
• Establishing and holding trainings and education programs
• Running a full-scale simulation training center
• Editing a bi-monthly journal,
• Editing textbooks for teaching in Hungarian
• Setting up and maintenance of the official Website

International conferences organised by HSAIT

• 1992: EACTA
• 1993: IGSC
• 1999: EAA
• 2005: EACTA
• 2007: NATA

Membership of the Hungarian Society of Anaesthesia and Intensive Care (1966-2007)

(Population of Hungary: 10.1 million)

Nationwide Reporting system

Hungarian Society of Anaesthesia and Intensive Care developed the ANESZTINFO NRS (Nationwide Reporting System) with contributions from the Ministry of Information and Communications for collecting nationwide data for our specialities.

Website: www. anesztinfo.hu

The HSAIT established its own web-page called www.anesztinfo.hu in 1998. Here the Society handles its daily affairs, such as membership registry, newsletters, society updates.

Hungarian Anaesthesia Simulation Centre

Hands-on practice of several skills in anaesthesia and intensive care
Computer simulation of anaesthetic techniques (VIMA, TCI, etc.)
Simulation of characteristic scenarios of Anaesthesia and Intensive Care on manikins.

Professional Sections

• Cardio-vascular
• Pain management
• Transoesophageal Echocardiography
• Donor Management
• Airway Management

Regional Sections

• Central Region
• North-East Region
• South-East Region
• South-West Region
• North-West Region

Scientific activity in Hungary

The scientific activity of the Hungarian Society of Anaesthesiology and Intensive Therapy (HSAIT) is organised through national and regional forums. In addition to the HSAIT’s Scientific Committee, there are 5 regional sections responsible for holding scientific symposia, workshops and conferences within their area. There are several smaller symposia all over the country mainly for the local members of the region throughout the whole academic year, whilst two large regular conferences are held annually with attendants from every corner of Hungary. One of them takes place in Debrecen (north-east Hungary), the other one is wandering around year-by-year in the beautiful cities of the South-Trans-Danubian region.

The most eagerly awaited event in our society’s life is the national annual conference which is organised by the HSAIT and the Scientific Committee. The number of participants usually exceeds 1200, including nurses and doctors from anaesthesia and intensive care as well as other specialities. The conference lasts for 3 days, with the first day being reserved for courses and workshops. There is also a possibility of submitting abstracts either in Hungarian or English, which are then reviewed by the Scientific Committee and the selected ones are thence orally-presented or displayed as a poster.

A competition awards the eponymous Wittek Prize and the Boros Prize - named after the legendary Hungarian anaesthetists - to junior doctors and researchers. The industry shows a keen interest and actively takes part at our national meetings. This year, more than 50 companies participated and held 7 symposia.

The real scientific work and the actual research are done at the 4 universities. The society has no influence on their activities but can support by funding certain projects and sponsoring young researchers to present their results at international meetings.

Publications from the last years

C. Molnár, G. Settakis, P. Sárkány, S. Kálmán, S. Szabó, B. Fülesdi. Effect of sevoflurane on cerebral blood flow and cerebrovascular resistance at surgical level of anaesthesia: a transcranial Doppler study. Eur J Anaesthesiol. 2007 Feb;24(2):179-84

Settakis G, Páll D, Molnár C, Katona E, Bereczki D, Fülesdi B. Hyperventilation-induced cerebrovascular reactivity among hypertensive and healthy adolescents. Kidney Blood Press Res. 2006;29(5):306-11

Katona E, Settakis G, Varga Z, Juhász M, Paragh G, Bereczki D, Fulesdi B, Páll D. Both nitric oxide and endothelin-1 influence cerebral blood flow velocity at rest and following hyper- and hypocapnic stimuli in hypertensive and healthy adolescents. Kidney Blood Press Res. 2006;29(3):152-8

Katona E, Settakis G, Varga Z, Paragh G, Bereczki D, Fülesdi B, Páll D. Target-organ damage in adolescent hypertension. Analysis of potential influencing factors, especially nitric oxide and endothelin-1. J Neurol Sci. 2006 Sep 25;247(2):138-43

Peták F, Habre W, Babik B, Tolnai J, Hantos Z. Crackle-sound recording to monitor airway closure and recruitment in ventilated pigs. Eur Respir J. 2006 Apr;27(4):808-16

Reis HJ, Teixeira AL, Kálmán J, Bogáts G, Babik B, Janka Z, Teixeira MM, Palotás A. Different inflammatory biomarker patterns in the cerebro-spinal fluid following heart surgery and major non-cardiac operations. Curr Drug Metab. 2007;8(6):639-42

Bogáts G, Piros G, Tiszlavicz L, Iványi B, Sasi V, Csepregil L, Simon J, Babik B, Csillik A, Kardos L, Palkó A, Matin K, Hanzély Z, Korányi K, Nyáry I, Végh M, Kolozsvári L, Kahán Z, Bajcsay A, Tóth A, Balázs G, Simor T, Pávics L, Palotás A. Erdheim-Chester's disease of the heart: a diagnostic conundrum and collision with the same mass in the orbit. Heart Surg Forum. 2006;9(1):E549-54

Kálmán J, Juhász A, Bogáts G, Babik B, Rimanóczy A, Janka Z, Penke B, Palotás A. Elevated levels of inflammatory biomarkers in the cerebrospinal fluid after coronary artery bypass surgery are predictors of cognitive decline. Neurochem Int. 2006 Feb;48(3):177-80

Zöllei E, Csillik A, Rabi S, Gingl Z, Rudas L. Respiratory effects on the reproducibility of cardiovascular autonomic parameters. Clin Physiol Funct Imaging. 2007 Jul;27(4):205-10

Kertai MD, Bax JJ, Boersma E, van Urk H, Poldermans D. The prognostic value of dobutamine stress echocardiography in patients with abdominal aortic aneurysm and concomitant coronary artery disease. J Cardiovasc Surg (Torino) 2003; 44; 423-430.

Kertai MD, Bogar L, Gal J, Poldermans D. Preoperative coronary revascularization: an optimal therapy for high-risk vascular surgery patients? Acta Anaesthesiol Scand 2006;50:816-827.

Székely A, Balog P, Benkö E, Breuer T, Székely J, Kertai MD, Horkay F, Kopp MS, Thayer JF. Anxiety predicts mortality and morbidity after coronary artery and valve surgery a 4-year follow-up study. Psychosom Med. 2007;69: 625-631.

J. Gal, T. Kovesi, D. Royston, N. Marczin: Dynamics of nitroglycerin-induced exhaled nitric oxide following lung transplantation: evidence of pulmonary microvascular injury? Journal Heart and Lung Transplantation, 2007. 26(12):1300-5

J. Gal, B. Riedel, G. Jancsó, M.D. Kertai, Gy. Acsády, E. Rőth, D. Royston. Effects of fructose-1,6-diphosphate on endo- and myocardial purine metabolism during coronary artery bypass graft surgery. Journal of Cardiovascular Surgery, 2007. Dec ;48 (6):751-6.

J Gal, L Bogar, G. Acsady, M. Kertai: Cardiac risk reduction in non-cardiac surgery: the role of anesthesia and monitoring techniques. European Journal of Anesthesiology, 2006. 23. No. 8. 641-648.

Hauser B, Gröger M, Ehrmann U, Albicini M, Bruckner UB, Schelzig H, Venkatesh B, Li H, Szabó C, Speit G, Radermacher P, Kick J: The PARP-1 inhibitor INO-1001 facilitates hemodynamic stabilization without affecting DNA repair in porcine thoracic aortic cross-clamping-induced ischemia/reperfusion. Shock 2006;25:633-640.

Hauser B, Kick J, Iványi Z, Asfar P, Ehrmann U, Muth CM, Albicini M, Wachter U, Vogt J, Bauer M, Brückner UB, Radermacher P, Bracht H: Effects of 15-deoxyΔ12,14-prostaglandin-J2 during hyperdynamic porcine endotoxemia. Intensive Care Med 2006;32:759-765.

A. Csomos Diagnosis Related Group (DRG) funding for intensive care. ICU Management, 2007;7(2):9.

A. Csomos. Cost containment and patient safety. ICU Management, 2007;7(4):7.

Hupuczi P, Rigó B, Sziller I, Szabó G, Szigeti Zs, Papp Z. Follow up analysis of pregnancies complicated by HELLP syndrome. Fetal Diag Ther 2006; 21:519-522.

Hupuczi P, Nagy B, Sziller I, Rigo B, Hruby E. and Pappp Z. Characteristic laboratory changes in pregnancies complicated by HELLP syndrome. Hypertension in Pregnancy 2007; 26:389-401.

Medical education in Hungary

Gradual education: 6 years

• 3 year “basic sciences”
• 2 years “clinical sciences”
• 1 year internship
• Final state examination at the end of the 6th year
  

Specialist training

• 2 years “Formative Residency Training” at universities or accredited teaching hospitals
• 3 years detailed training program at base hospital where doctor employed on contractual terms; requires a minimum of partial accreditation

Subspecialization: 2 years

Logbook

• 100 credit hours
• Participation in organized courses and scientific meetings accepted by the Accreditation Board

Anaesthesia minimal training periods

• Abdominal Surgery (incl. Urology & Vascular Surgery) 8 month
• Traumatology (incl. orthopaedic surgery) 3 month
• Paediatric Surgery 2 month
• Gynaecology & Obstetrics 2 month
• Neurosurgery 1 month
• Thoracic Surgery 1 month
• Ophthalmic Surgery 1 month
• Ear-Nose-Throat, Head & Neck, Dental Surgery 1 month
• Cardiac Surgery 1 month
• Selected compulsory topic 4 month 24 month

Anaesthesia minimum number of cases: 1200 cases of anaesthesia, including at least

General anaesthesia

• Caesarean Section 15
• Paediatric operations 40
• Intracranial operations 15
• Pulmonary operations (selective endobronchial intub.) 15
• Laparoscopic procedures 25
• Fiberoscopic intubation 15
• Nasal intubation 10
• Day-case anaesthesia 25

Regional anaesthesia

• Epidural anaesthesia 50
• Spinal anaesthesia 50
• Peripheral nerve block 50

Examinations

MCQ examination by end of 4th year

Final examination:

• practical
  • 1 week clinical practice, tutor-supervised
• Board Examination
  • basic science
  • anaesthesia
  • intensive care

Continuing medical education

Historical background

Obligatory by law since 1958

• postgraduate course in 5 years minimum
• financed by state
• central institutional basis: Postgraduate Medical School, 1958
• centrally managed programs
• multi-level structured courses

New regulation: order on CME, 1999

• obligatory for licence renewal every 5 years by the Medical Chamber
• organized by medical universities
• under patronage of Boards of Medical Specialities and the Medical Chamber
• supervized by the State (Bodies of Ministry of Health)
• based on credit hours
  • accredited courses and scientific meetings
  • minimum: 250 credit hours / 5 year

Directory Board of MAITT

President

Dr. Vimláti László

Members

Dr. Janecskó Mária, Former President
Dr. Bogár Lajos, Vice-President
Dr. Nagy Géza, Secretary-General
Dr. Csomós Ákos, Secretary
Dr. Völgyes Barbara, Treasurer
Dr. Molnár Zsolt, Scientific Commitee
Dr. Fülesdi Béla, Education Commitee
Dr. Babik Barna, Youth Committee
Dr. Bede Antal, Legal Commitee
Dr. Morvay Balázs, Ethics and Discipline Commitee
Dr. Kerekes László, Audit Commitee

Professional Sections

Dr. Babik Barna, Cardio-vascular
Dr. Budai Erika, Pain manegement
Dr. Gál János, Transoesophageal Echocardiography
Dr.Méray Judit, Airway Management Section

Regional Sections

Dr. Bobek Ilona, Central Region
Dr. Jobbágy Lajos, North-West Region
Dr. Márton Sándor, South- West Region
Dr. Szűcs Attila, North-East Region
Dr. Havas Attila, South.East Region

Pro Anaesthesia et Therapia Intensiva Honours list

Dr. Aranyosi János
Dr. Barna Béla
Dr. Boros Mihály (†)
Dr. Darvas Katalin
Dr. Félegyházi Árpád
Dr. Forgács István (†)
Dr. Gurdon János
Dr. Incze Ferenc (†)
Dr. Jakab Tivadar (†)
Dr. Janecskó Mária
Dr. Makláry Elek (†)
Dr. Oszwald Péter
Dr. Pálos László (†)
Dr. Széll Kálmán
Dr. Tekeres Miklós
Dr. Török Endre (†)
Dr. Ugocsai Gyula
Dr. Uray Éva
Dr. Varga Péter (†)
Dr. Vass-Eyssen Ervin
Dr. Wittek László (†)

Honorary Members

Francis F. Foldes (†) (USA)
Paul Goldiner (USA)
Günter Hempelmann (Germany)
Barankay András (Germany)
Josef A. Richter (Germany)
George Silvay (USA)
Hans Sonntag (Germany)
Dietrich Kettler (Germany)
Elena Damir (Russia)
Dag Lundberg (Sveden)
Werner List (Austria)
Gaby Gurmann (Israel)
Simon de Lange (Holland)
Szabó Zoltán (Hungary)
Kulka Frigyes (†) (Hungary)