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On-line version ISSN 1806-907X
Rev. Bras. Anestesiol. vol.58 no.5 Campinas Sept./Oct. 2008
*07/22/1935 - 04/28/2008
I had the privilege to know Dr. João Lopes Vieira when he began his activities at the Anesthesiology Teaching and Training Center of the Instituto Penido Burnier in 1969. At that time, I was a medical student and spent my vacations at the center. Since I attended the same medical school he graduated from seven years before, we had a lot to talk about.
He told me about his origins, the dream that came through, and his perspectives in the new home. I witnessed his skills as an anesthesiologist, his love for studying, loyalty, and the respect with he treated his patients.
He told me: "If you want to be an anesthesiologist, you need to have a large body of knowledge about physiology, pharmacology, anatomy, and clinical aspects. Anesthesiologists should not be restricted to the operating room. We should be present from the preoperative period throughout the immediate postoperative care." Dr. Vieira was a pioneer of what is currently recommended: the anesthesiologist should dedicate himself to perioperative medicine.
In fact, in 1972, when I started my subspecialty training, Dr. Vieira, along with Drs. Alfredo Porto and Masami Katayama, inaugurated a Pre-Anesthetic Evaluation Clinic at the Hospital de Otorrinolaringologia do Instituto Penido Burnier, currently know as Hospital Santa Sofia. Since that time, the hospital cultivated other surgical subspecialties such as: Plastic, Urology, Pediatric, Orthopedic, Proctology, Gynecology, and Odontology. Thus, from that time on, all patients are evaluated a few days before their surgeries. The patient-anesthesiologist-surgeon relationship improved considerably, making the hospital one of the pioneers on the care of patients undergoing short-term hospitalizations.
Dr. Vieira had a memorable life. He was born in Araçatuba, in the state of São Paulo, Brazil, and was the son of a Portuguese couple. He moved to Rio de Janeiro and graduated in Medicine at the Faculdade Nacional de Medicina da Universidade do Brasil (Praia Vermelha), known nowadays as Faculdade de Medicina da Universidade Federal do Rio de Janeiro.
Being of a humble origin, he had to fight in the big city to fulfill his dreams. He lived at the dormitory of the university, and he was its coordinator for several times.
With the opportunities that Rio de Janeiro has always offered to students, Dr. Vieira did not waste his time and attended in surgeries, and worked in emergency rooms and at the Clara Basbaum maternity. With his experience as a surgeon, clinician, and obstetrician, the doors were opened to him, but he chose to be an Anesthesiologist.
He married Vera Lúcia Lopes Vieira and moved to the city of Oswaldo Cruz and, afterwards, to Birigui, near his hometown. His four daughters: Sheila, an engineer who lives in the USA, Letícia, an anesthesiologist at PUCCAMP, Denise, a pharmacist in Campinas, and Gladys, an astronomer at NASA, were born during that time. When he was living in Birigui, he went to the city of Porto Alegre, in the State of Rio Grande do Sul, Brazil, to take the board tests, which he passed and was awarded the Superior Title in Anesthesiology (TSA, from the Portuguese).
Seven years after he received his medical degree, worried about the education of his daughters, he did not hesitate to accept the invitation of Dr. Alberto Afonso Ferreira and moved to Campinas to start over. Notwithstanding, he did not lack courage and confidence.
This courage was the source of a great controversy when, in 1970, he recommended the use of beta-blockers in general anesthesia to induce hypotension and, consequently, decrease bleeding in the surgical field. He went even further when he stated, in his speeches, that beta-blockers protected the heart and prevented the undesirable development of tachycardia and that they should not be discontinued preoperatively. With the primitive monitoring available at the time, he was really brave to propose such conduct, but his body of evidence and results, which were corroborated by studies published in the international literature, eventually made his proposal unquestionable.
He was also an aficionado of regional blocks. He handled with extreme ability all segments of the spine. His experience with more than 2,000 cases of thoracic epidural block entitled him to state that the technique was safe. However, this was done at a time in which thoracic epidural block was a matter of controversy and, therefore, another polemic issue was introduced in the national literature by Dr. Vieira, along with other authors.
In co-authorship with Dr. Masami Katayama, he was the first to report, in the Brazilian Journal of Anesthesiology (RBA), the use of subarachnoid block for outpatient arthroscopic knee surgery. Once again he was in the midst of the discussion about an important issue. He wrote, along with other authors, several studies that were published in the RBA.
He received several awards for his work. In co-authorship with Katayama M he was awarded the AGA prize five times for original publications on the clinical use of nitrous oxide, and in co-authorship with Lutti MN, Cangiani LM, Simoni RF, and Silva LA, he was awarded the 2000 SAESP Award by the Anesthesiology Society of the State of São Paulo, Brazil, as the best article published in that year. This article was on epidural patient controlled analgesia with morphine or fentanyl.
An anatomy scholar, he spent hours studying the brachial plexus, both on reports and anatomical samples. According to him, the muscular-aponeurotic cuff that involves the plexus could be approached in several levels, and he focused his experience in one of them when he developed the technique that carries his name.
This technique was the subject of his doctorate dissertation (he was then 63 years old) presented at the Faculdade de Ciências Médicas de Botucatu, under the guidance of Professor Pedro Thadeu Galvão Vianna, MD. Nowadays, using the ultrasound, it is possible to achieve more easily the site he recommended.
He was an Anesthesiology Professor of the Faculdade de Medicina of PUC Campinas and PUC Sorocaba, both in the state of São Paulo.
He was fully aware of the importance of SBA and SAESP, having collaborated direct and indirectly with those organizations. He contributed directly by participating in the Scientific Commission of SAESP and in the Scientific Teaching and Training Commission (CET) of the SBA, and indirectly by making it possible for members of CET to participate in associated activities. He was responsible for the CET of the Instituto Penido Burnier from 1986 to 2000.
On the personal level, he battled coronary artery problems (undergoing several coronary angioplasties), but always reassumed his prior level of activity. However, he lost the battle to a stroke that kept him out of the operating room. He struggled for three years in an attempt to recover. During this time, he wrote chapters for different books, and a study from his doctorate thesis was published in the journal Anesthesiology, but his despair for not being able to resume his work as an anesthesiologist was evident.
He was happy as an anesthesiologist. Completely involved in his work, for him anesthesiology was a pleasurable activity. He served patients, surgeons, the institution, and his friends with dedication and generosity. I am certain that the place he went to, where probably there is no space for dissention, he will go on spreading faith, hope, and support, with special care for those who make anesthesia an enjoyable activity.
Luiz Marciano Cangiani,
Co-Responsible for the CET of the Instituto Penido Burnier and the Medical Center of Campinas