Anesthesia Congress Takes a Look at Legal, Ethical Issues

Anesthesia Congress Takes a Look at Legal, Ethical IssuesAnesthesia Congress Takes a Look at Legal, Ethical Issues

The most common cause of hospitalization in intensive care units, of Iranians who are otherwise healthy, is injuries in car accidents. Trauma is a major reason for admission to the ICU, said Dr. Atabak Najafi, executive secretary of the 12th International Congress of Anesthesiologists, Critical Care and Pain.

The three-day congress in Tehran saw the presence of heads of anesthesiologist societies and senior scientific ministers from 27 countries.

Major topics discussed were anesthesia and its legal and ethical use as well as intensive care and pain management, reports IRNA. Of the 350 articles sent to the congress, 200 were accepted and 65 papers in the field of anesthesia were presented electronically.

Pointing to the use of the Apache II Score  that estimates ICU mortality based on a number of laboratory values and patient’s vital signs taking both acute and chronic disease into account, Najafi said Apache II indices shows that patients commonly admitted in ICU are: usually older than 65 years, need to be on ventilator for more than 14 days, are in septic shock, or have renal and cardiac problems and nosocomial (hospital) infections, which are also common causes of mortality in the ICU ward.

Additionally, aging by itself is a very important factor in mortality increase and the rate goes up with the process of growing older.

Nearly 70-80% of patients admitted to ICU are most often discharged in good health while 20-30% may not survive.


Infection is seen to be one of the main causes of death in ICU wards, while timely treatment and use of antibiotics and infection control, can help reduce mortality rates among intensive care patients. Common ICU infections include ventilator-associated pneumonia, sepsis, urinary tract infection and catheter-related bloodstream infection.

Increased risk of infection is also associated with the severity of the patient’s illness, exposure to multiple invasive devices and procedures, greater patient contact with healthcare personnel and longer ICU stay, all of which prolong the risk to exposure.

Stressing that hygiene of ICU personnel and sterilization of ICU equipment are most important in preventing ICU infections, he said a strict routine should be followed in sterilizing gloves, plastic aprons, deposable filter masks, feet and head coverings and all ICU equipment.  

Najafi also pointed to the 50% drop in anesthesia charges when compared to surgery fees. New tariffs had reduced anesthesia fee but surgery fees were 19-fold higher, while globally the difference was 6.5-fold. The Health Ministry should take necessary action to bridge the discrepancy. “Anesthetists are on par with surgeons and the discrimination in payment strongly affects the spirit of their services,” he added.

Notable anesthesiologists including William Wilson, University of Adelaide anesthesiology department, Ronald D. Miller, one of the best-known anesthesia authors in the world, Maximilian Jonas, consultant intensivist at the University Hospitals Southampton in Britain, Donat Spahn, anesthesiologist and professor and chairman of the Institute of Anesthesiology, University Hospital, Zurich, Switzerland, Michael Ramsay, chairman of the Department of Anesthesiology and Pain Management, Baylor University Medical Center (BUMC), Dallas, Texas, Miray Karnekull, from Stockholm, Sweden, Don Langrois, professor of Anesthesia and Intensive Care Medicine, Paris, France, and Kammerzell Sergej of Germany, were invitees to the confab.