The evolution of patient safety in Brazilian Anaesthesiology

From Ether to global collaboration

The story of anaesthesia in Brazil is inseparable from the relentless pursuit of patient safety. Modern surgical practice began in the country with the first public demonstration of ether anaesthesia in Rio de Janeiro in 1847. While the speciality grew over the following century, it often did so without formal oversight. This changed dramatically in 1948 with the founding of the Brazilian Society of Anaesthesiology (SBA – Sociedade Brasileira de Anestesiologia). The SBA provided national leadership and established the educational standards needed to promote safe anaesthetic care. The creation of the Brazilian Journal of Anaesthesiology (BJAN) in 1951 gave practitioners a dedicated scientific forum to share research and guidelines, firmly establishing safety as a cornerstone of the profession.

The strengthening of the National Regulatory Framework

Regulatory oversight sharpened significantly toward the end of the 20th century. The establishment of Anvisa (Brazilian Health Regulatory Agency – Agência Nacional de Vigilância Sanitária) in 1999 created a powerful body to oversee medicines, medical devices, and health services. A few years later, Anvisa’s Resolution RDC 50/2002 marked a turning point by setting mandatory infrastructure requirements for hospitals, including specific design standards for operating rooms and post-anaesthesia care units (PACUs). This move was critical in ensuring that structured recovery care became a standard part of the surgical process. In 2006, Anvisa launched NOTIVISA, a nationwide system for reporting adverse events, which allowed the entire health system to learn from complications and product failures.

In 2013, patient safety was firmly placed on the national agenda. The Ministry of Health launched the National Patient Safety Program (PNSP – Programa Nacional de Segurança do Paciente), and in parallel, Anvisa mandated the creation of Patient Safety Centres (NSPs – Núcleos de Segurança do Paciente) in all healthcare institutions, setting national guidelines for quality and safety.

The consolidation of professional standards

Alongside government regulation, professional standards were being solidified by the Federal Council of Medicine (CFM – Conselho Federal de Medicina). Resolution 2.174/2017 formally defined the “anaesthetic act” in Brazil, laying out clear rules for practitioners. Key among these was the mandate for an anaesthesiologist’s continuous presence during procedures, a ban on a single professional overseeing simultaneous anaesthetics, and compulsory monitoring standards, such as pulse oximetry for all patients and capnography for intubated cases. The resolution also formalised requirements for informed consent and detailed documentation.

Leadership in education and alignment with global practices

More recently, Brazilian anaesthesiology has focused on aligning with the best global practices, with the Anaesthesiology Society of the State of São Paulo (SAESP – Sociedade de Anestesiologia do Estado de São Paulo) playing a pivotal role. Brazil’s commitment to safety was evidenced as early as 2010 when the SBA endorsed the Helsinki Declaration on Patient Safety in Anaesthesiology, incorporating its principles into its strategic planning and residency curricula. SAESP demonstrated a similar active commitment, having representatives present at the declaration’s launch and again at its renewal during the Euroanaesthesia congress in 2025.

SAESP continuously fosters this culture of safety. Every year, its São Paulo Congress of Anaesthesiology (COPA) gathers more than 3,000 participants and gives a prime spot to the topic, featuring lectures, interactive case discussions, and adverse event analyses.

Dr. Gustavo Tsuha is the first ESAIC Safety Ambassador in Brazil and has been actively working alongside colleagues from SAESP to further strengthen patient safety in anaesthesia and perioperative care. His role represents an important step in bringing international initiatives closer to Brazilian practice, fostering collaboration, knowledge exchange, and the development of strategies that enhance the protection and well-being of our patients.

This commitment will reach a new milestone on October 24–25, 2025, when the European Society of Anaesthesiology and Intensive Care (ESAIC), in partnership with SAESP, will host the first Advanced Patient Safety Course (APSC) ever held outside of Europe. This landmark event will take place at SAESP’s modern Simulation Center in São Paulo.

According to Dr. Claudia Marquez Simões, Vice-President of SAESP, and Dr. Gustavo Tsuha, Director of Quality and Patient Safety, “we are looking forward to bringing the APSC to Brazil. This dynamic course encourages interaction and knowledge exchange through immersive 360° video sessions and structured discussions, ensuring an impactful learning experience for all participants.”

Authors:

• Dr Gustavo Tsuha, Patient Safety and Quality Director of Sociedade de Anestesiologia do Estado de São Paulo (SAESP)
• Dr Claudia Marquez Simões, Vice-Presidente of Sociedade de Anestesiologia do Estado de São Paulo (SAESP)