History of the Anaethesiology Service

After World War II, anaesthesia became increasingly important in the practice of surgery, and most surgeons acknowledged its relevance for the good practice of medical care.The surgeons of Hospital Santo António (HSA), led by Dr. Araújo Teixeira, transmitted this notion to the board of Santa Casa da Misericórdia.The name of Pedro Ruella Torres was mentioned while he was completing his studies in Lisbon. In November 1947, Ruella Torres returned to Porto and negotiated the creation of an Anaesthesiology Service composed by a director and a first assistant.In January 1948 the board of Santa Casa da Misericórdia deliberated the composition of the Anaesthesiology Service, appointing Dr. Pedro Ruella Torres as director and Dr. Alfredo António Ribeiro dos Santos as first assistant. Ribeiro dos Santos, a young doctor working with Dr. Veiga Pires in Internal Medicine since 1943, demonstrated his interest in Modern Anaesthesia. He went to Lisbon to make his internship with Drs. Eusébio Lopes Soares, Carlos Silva and Lúcio Ferreira, in Hospitais Civis de Lisboa.Meanwhile Dr. Ruella Torres signed a contract as director of the Anaesthesiology Service of HSA on the 3rd March 1948, and at his own expense left to England to specialize in Anaesthesiology. He returned to Porto in July 1948, and both doctors started to work together. The 15th July 1948 marked the beginning of their functions as Anaesthesiologists.The need for surgeons and anaesthesiologists to work as a team in the best interest of medical care contributed to change existing mentalities. Concurrently, relevant logistic changes occurred and the south wing was rebuilt as operating theatre with four operating rooms divided in two floors. The practice of anaesthesia and surgery evolved slowly but consistently. In 1950, Anaesthesiology was recognized as a speciality by the Portuguese Medical Council, which established the rules of Internship. The competence for its teaching was attributed to the Anaesthesiology Service of Hospital Santo António.In 1951, a new assistant was admitted, Dr. Leonor Ribeiro, who was also returning from her internship in Lisbon and who remained in the Service until 1962. By this time, the director, Dr. Ruella Torres, extended his activity to other hospitals, such as Hospital Rodrigues Semide, Hospital Maria Pia, in Porto and Hospital de Matosinhos.In 1952, Dr. Raul Nascimento da Fonseca joined the anaesthetic team as a specialist in Paediatric Anaesthesia. The same year witnessed the beginning of the first official internship of Anaesthesiology; the candidate was Adelino Lobão who later joined the team in HSA. Dr. Adelino Lobão took a particular interest in the anaesthetic practice at the emergencies and was the chief of his emergency team for many years. He worked in the hospital until he retired in 1993.In turn, following her training in England, nurse Clara Palmares introduced new rules in the operating room, namely specific gowns and nurse teams.The first exam at the Medical Council was held in 1954, and the candidate was Dr. Raul Nascimento da Fonseca.In 1954 Dr. Ruella Torres went to India on a military commission handing over the direction of the service to Dr. Ribeiro dos Santos, until his return one year later.The Society of Portuguese Anaesthesia (SPA) was created in 1955, and its first President was Dr. Eusébio Lopes Soares; in 1962 Dr. Ruella Torres became the President.Anaesthesia as a medical speciality was growing and more doctors were hired in 1956 to meet the needs of the hospital. These doctors were Dr. José Luis Barroso and Dr. Manuel Silva Araújo. In 1958 Dr. Silva Araújo was approved in his exam before the board of the Medical Council and became specialist in Anaesthesiology. One year later Dr. Ruella Torres presented a “remodelling plan” of the service, proposing the organization of teams composed of two specialists and an intern, and a 24-hour presence of an Anaesthesiologist at the emergency service, earning 150 escudos. He also listed all the necessary material and claimed the need of six more doctors; among these new doctors were Drs. Costa Almeida, Ricardo Magno e Ruy Oliveira. The plan was approved and carried out.In 1961 a new hospital was launched in Porto: Hospital S. João. For some time Dr. Ruella Torres worked in both hospitals, creating the Anaesthesiology Service in the new hospital; years later he chose to stay there and left Hospital Santo António in 1967. Once again Dr. Ribeiro dos Santos led the service as interim director.Dr. Silva Araújo took a consistent interest in Resuscitation and collaborated with a multidisciplinary team to create the first Resuscitation Service; he was appointed chief of the surgical Respiratory Resuscitation Service section in 1963. In 1971 he became the head of the Anaesthesiology Service and re-organized the service according to three components: internship, emergency, and postgraduate teaching.Since the 1970s the service started hosting scientific meetings, the first being the International Course in Anaesthesiology: Muscle Relaxants. Since 1979 the service has been collaborating in the teaching of the Medical Course at Instituto Ciências Biomédicas Abel Salazar (ICBAS).In the late 1980s the service engaged in new activities outside the operating room: a Pain Unit supervised by Dr. António Meireles; an Intensive Care Unit led by dr. Mário Lopes in collaboration with the Internal Medicine Service. The structure of the service expanded to meet these new needs.The 21st century brought about major administrative changes, which included the creation of departments; the Anaesthesiology Service integrates the Department of Anaesthesiology, Intensive Care and Emergency (DACIE), directed by Dr. António Marques. The period between 2005 and 2012, under the leadership of Dr. Isabel Aragão, coincided with major physical and organizational changes in the hospital, namely the creation of Centro Hospitalar do Porto (CHP), resulting from the merging of Hospital Pediátrico Maria Pia and Maternidade Júlio Dinis.Dr. Humberto Machado, who had previously directed the Emergency Service for ten years, was appointed Director of the Anaesthesiology Service in September 2012. In turn, Dr. Fernando Rua became head of the DACIE and Dr. António Marques took up the leadership of Centro Materno Infantil do Norte (CMIN).Under and postgraduate training, which has always played an important role in the activities of the staff, gained a new impetus with the creation of the Biomedic Simulation Centre, in October 2014, led by Dr. Eduarda Amadeu.In September 2013, the Certificate of Accreditation of a European Centre for training of Anaesthesiologists for the period 15 november 2013-15 november 2018 was attributed to the Anaesthesiology Service by the accreditation board of the European Society of Anaesthesiology (ESA). The Anaesthesiology Service of CHP is so far the only one in Portugal that meets the criteria stipulated by European standards.Two years after being launched, CMIN opened its doors in May 2014 and concentrated the provision of mother and children care. Dr. Paulo Lemos, as leader of the anaesthetic team, and Dr. Pedro Pina, in charge of Paediatric Anaesthesia, have been instrumental in the swift organization and good performance in this area.The Anaesthesiology Service is one of the largest services in CHP, with 78 specialists and 31 interns, and maintains a highly diversified activity.