Head of the Anesthesia Department
Carlos Manuel Machado Correia was born on 4th July of 1952 in Luanda, Angola. He finished the Medical School in 1975 in Oporto and he worked in the anatomic laboratory of the medical school in Luanda. He began anesthesia speciality in 1981 in Guimarães and finished in 1985.
He was the head of the Anesthesia Service in the Famalicão Hospital from 1985 until 1991 and he returned to Guimarães Hospital in 1991. Since 1999 up now he has been the head of the anesthesia department in Guimarães. He was one of the pioneers of labor analgesia in Portugal and he gave a lot of sessions in this area in Portuguese Anesthesia Meetings. He introduced the peripheral nerve blocks in the orthopedic area in his hospital and he introduced the ultrasound guidance for peripheral nerve blocks in Portugal. He and together with his Colleagues are a reference in this field in Portugal and they regular welcome residents from all over the country.
He coordinated the Portuguese Guidelines of Patients Medicated with Anticoagulation Drugs Proposed to Regional Anesthesia (Part I and II). Those guidelines were published in the Journal of the Portuguese Society of Anesthesia.
He was coauthor of the Guidelines Of Obstetric Anesthesia in the Portuguese Society of Anesthesia.
He was awarded with the UPAIN Project by the Development and Innovation Agency with the following scientific investigation: Ubiquitous Analgesia Control System for the Real time Monitoring of Acute and Chronic Pain. U.S. Patent and Trademark Office, U.S.A., filed.
He was the founder of the Anesthesia Nurse Course in the University of CESPU.
He participated in Course of Advanced Regional Anesthesia from the Medical Universidade Nova de Lisboa (I and II).
He has collaborated in the Nysora School since the beginning and he ran workshops in ultrasound anesthesia peripheral nerve blocks in its annual meeting. He also ran workshops in the IMEA/Spanish Society of Anesthesia.
He has been invited by the Portuguese Society of Anesthesia to participate in the Ultrasound Workshops since the beginning of this activity.
He is going to ran a Workshop concerning Chronic Pain and XR in the World Congress of Pain Medicine in Kolkata, India.
He published in the Journal of the Portuguese Society the first papers regarding peripheral nerve blocks ultrasound guided in adults and in pediatric patients.
He is the author of the chapter Basic Anatomy for Anestesiologists, in “Fundamentos em Anestesiologia”, Lidel , in press.
In 2010 he was awarded with the second price, by the European Society of Regional Anesthesia, with the poster Continuous Spinal Anesthesia in High Risk Patients Proposed to Major Surgery.
He is the author of those papers published in Anesthesia Journals with impact factor:
Isabel Flor de Lima, Filipe Linda, Angela Cabral, Neusa Lages, Carlos Correia. Bilateral continuous TAP block in a patient with previous surgery. Journal of the Brazilian Society of Anesthesia, in press.
Ana Marinho, Neusa Lages, M José Guimarães, Carlos Correia. The role of non invasive ventilation in the perioperative period in patients with muscular disorders – case report. . Journal of the Brazilian Society of Anesthesia, in press.
Diana Vieira, Neusa Lages, Joana Dias, Lúcia Maria, Carlos Correia. Retrograde Intubation ultrasound guided- case report. Anaesthesia, October, in press.
Comments a recent paper about the Popliteal Block
Anahi Perlas and cols. Regional Anesthesia and Pain Medicine, 38,3 May-June 2013
A very interesting paper about a common block for anesthesia and analgesia for ankle and foot surgery was published by the Canadian Anesthesia School. This block has been associated with different success rates even with the use of ultrasound machine with or without neurostimulation. Still I have some academic and clinical issues for analysis and discussion.
This paper is a clinical research, after an anatomic and ultrasound cadaveric study by Anderson and cols [ı]. They clearly demonstrated that sciatic nerve has a common sheath, paraneural sheath, and this continues after the division in common peroneal nerve and tibial nerve.
My academic comment, according to Manoj Karmakar [ıı] paper, is very important to all the Anesthesiologysts. The anatomic structures should have an only nomenclature that could be understood by all easily and without any doubts.
There are some clinical points regarding this common block which I would like to discuss:
Like Manoj Karmakar, in the same paper, the paraneural sciatic sheath visualization needs a good ultrasound machine and some “tricks” and I think, that we must learn first before trying “paraneural sheath block”. And why?
Anahy Perlas and her cols visualized sciatic nerve in a transversal section using the “out of plane approach” in the division of common sciatic nerve. Besides using a short bevel, and as we all know the visualization of the tip of needle in the “out of plane approach” is not so easy, this increases the risks of subepineurum injection. This issue should be highly considered once they reported one case with this complication in their study, fortunately without sequelae.
Another important issue that Anderson and cols demonstrated is the diffusion of contrast is proximal, distal and circumferential, around the common sciatic and the two branches.
Anahy in this very nice work confirmed the cadaveric results of Danish Anesthesiologysts, with up and down diffusion about 10 and 5 cm respectively. This is very important in clinical terms because we can reach paraneural sciatic space more cephalad choosing the local where we can see better the paraneural sheath and consequently performing the block, with the needle in-plane (with all advantages, namely, seeing the needle and its tip).
With this paper some old concepts that the separate block of sciatic branches has a short onset time are now out of date. Although for us onset time it is not so important because we must have an organization which allow us to perform a popliteal block within one hour before the surgery.
Unfortunely Anahy, used stimulating needle and did not report about currents and pression in these two techniques, “ sciatic paraneural sheath block” and “conventional separate sciatic branches block “. I hope that some papers regarding these issues will come out soon. Finally I considered this article along with Andersen and Manoj papers, cited down, will modify our old concepts and could allow us to learn better the paraneural sciatic sheath.
[ı] Andersen and cols. Injection inside the paraneural sheathof sciatic nerve;direct comparison among ultrasound imaging, macroscopic anatomy and hystologic analysis
Regional Anesthesia and Pain Medicine. 2012;37:410-414
[ı] Manoj Karmakar and cols . High-definition ultrasound imaging defines the paraneural sheath and the fascial compartments surrounding the sciatic nerve at popliteal fossa
Regional Anesthesia and Pain Medicine Volume 38;5:September- October 2013 ( in press)
CARLOS CORREIA MD
Interview with the expert
1- You are one of the pioneers in ultrasound guided regional anesthesia in Portugal. You have learned like a self-taught before the birth of this area in this country… How did you live those moments?
I lived those moments as a child, first crawling, then walking and finally running! I have always had a life motto: everything I read and if it was scientifically proven as a benefit for the patient then, I tried to do it by myself. The same happened to labour analgesia in the beginning of the eighties, with the combined anesthesia and with peripheral nerve blocks….I studied, talked to experts and colleagues and applied the knowledge in my patients. Later on in my department and in collaboration with my colleagues and with nurse team we created a Regional Anesthesia School.
2- What is the most interesting thing that is currently happening in ultrasound guided regional anesthesia?
In my opinion the ultrasound can be used in many and different a lot of fields helping anesthesiologists and other medical and surgical specialties! It is relevant to Perioperative Medicine for example in the pulmonary and cardiac diagnosis. In chronic pain its use has been growing avoiding the X side effects and allowing more accurate and reliable diagnosis.
3- Now we are all in this flight together. Everybody is sharing pictures, videos, tips, experiences… What do you think about the ever-growing demand for websites, blogs and forums specialized in regional anesthesia?
I think the ultrasound globalization is a way of democratising this field of anesthesia. If the pictures, videos and papers are scientifically correct we can learn from them and use the knowledge acquired in the future, doing better and better …