AAGBI Council/Board Elections 2016 Lifeboxes for Rio - The story

ISSN 0959-2962 No. 345

APRIL 2016

The NewsleTTer of The

AssociATioN of ANAesTheTisTs of GreAT BriTAiN

ANd irelANd

INSIDE THIS ISSUE: AAGBI Council/Board Elections 2016 Lifeboxes for Rio - The story so far... Academic training in anaesthesia, what’s it all about?

Anaesthesia News April 2016 • Issue 345 3

16

contents

16

03 editorial

05 President's report

06 lifeboxes for rio - The story so far...

09 AAGBi council/Board elections 2016

11 The Association of Paediatric Anaesthetists of Great Britain & ireland (APAGBi)

13 Anaesthesia Cases

15 Anaesthesia digested

17 we invite you to stand for election to the Group of Anaesthetists in Training

18 designing an international Anaesthesia Machine - Part 3

22 safety matters

25 combat Anesthesia: The first 24 hours

26 Academic training in anaesthesia, what’s it all about?

29 Bloggadder returns

31 eponymous lectures

32 Particles

36 Your letters

06

09

13

26

11

The Association of Anaesthetists of Great Britain and Ireland21 Portland Place, London W1B 1PYTelephone: 020 7631 1650Fax: 020 7631 4352Email: [email protected]: www.aagbi.org

Anaesthesia NewsManaging Editor: Upma MisraEditors: Phil Bewley (GAT), Nancy Redfern, Richard Griffiths, Sean Tighe, Mike Nathanson, Rachel Collis, Felicity Platt, Gerry Keenan and Elizabeth McGradyAddress for all correspondence, advertising or submissions: Email: [email protected]: www.aagbi.org/publications/anaesthesia-news

Editorial Assistant: Rona GloagEmail: [email protected]

Design: Chris SteerAAGBI Website & Publications Officer Telephone: 020 7631 8803Email: [email protected]: Portland Print

Copyright 2016 The Association of Anaesthetists of Great Britain and Ireland

The Association cannot be responsible for the statements or views of the contributors. No part of this newsletter may be reproduced without prior permission.

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3

Editorial

In preparation for my appraisal I recently attended an educational supervisors’ update and sat next to a colleague who typed furiously on their laptop (the keys clicking loudly!) for the duration of the first talk. I found it difficult to concentrate and couldn’t understand why it was so urgent for them to type so loudly in the middle of the talk. Imagine my surprise when they informed me proudly in the coffee break that their reflection on the update was being recorded simultaneously on their laptop.

I must admit I find it difficult to reflect on a talk before it is completed, but perhaps I am in the minority. After several years, Blogadder returns in this issue of Anaesthesia News and records his reflections on WSM 2016 in London. I would urge the organisers and speakers not to take offence at this light hearted account of an excellent meeting. I could empathise with him, but perhaps that’s because we might belong to the same era.

I am a firm believer in learning from case reports, and an article from the editorial team of Anaesthesia Cases, from the journal Anaesthesia, explains how important they can be and how you can submit your case reports online to their website. Our specialty has a number of specialist societies. This month, we bring you the APAGBI (Association of Paediatric Anaesthetists of Great Britain and Ireland) and hope to introduce the work of other societies over the next few months. The wellbeing and support of our 11,000 members is a very important part of the work of the AAGBI. In times of need it is sometimes easier to talk to a stranger about your stresses. The members of our Support and Wellbeing committee would like you to consider them as friends who are there to listen to your worries, fears and sorrows. You could be subject to a referral to the GMC, facing a coroner's inquest or simply not happy at work. If you prefer to write to us about this and would like to publish your account, we could help with that as well.

Time is of the essence these days, and if you feel you could share your enthusiasm and ideas as a member of the GAT Committee or as an AAGBI Board member, the last date for nominations is 8 April. If you want to know more, read the articles on pages 9 & 17 from our Honorary Secretary, Samantha Shinde, and the GAT Executive Committee. We would love to receive more contributions from our readers, so please send in your submissions.

Upma MisraManaging Editor, Anaesthesia News

The first quarter of the year is almost over and, for some of us, appraisals and revalidation are looming. Some find the whole process fairly tedious and stressful, while others start preparing for their appraisal months in advance.

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PRESIDENT'S REPORT


Did I approach the knife with a certain sangfroid? Absolutely not! Since my (anaesthetist) husband first made the diagnosis last summer I collected an astonishing number of confirmatory tests and investigations. No diagnosis was too obscure not to consider or throw in the ‘differential’ melting pot. It was important to give non-operative options (conservative management, anti-inflammatories, steroid injections, physical therapy, splints, ageing, Christmas and New Year) their best chance. However even I knew I was clutching at straws when I suggested waiting for retirement; just 15 short years and a few months until I can draw (what’s left untaxed of) the pension the Chancellor has allowed me to keep.

I was unconcerned about the surgery and had absolute confidence in the surgeon. He’s a nice chap. A recently appointed former registrar who delivers superb service to the ICU patients, and he’s very pleasant when I anaesthetise for his list. And I’m his appraiser (I wasn’t taking too many chances!). My biggest concern was of course…the anaesthetic. Actually the anaesthetist…or both! If a President of the AAGBI has undergone surgery while in office in the last decade it’s a secret well kept. My dilemma was that faced by every patient, and investigated by the Competition Commission (as was), that I might choose the surgeon, but they chose the anaesthetist. I work in an Academic Health Science Centre Trust with five (maybe three) hospitals and a major trauma centre. There are lots of anaesthetists; a few trained me, more who I helped train, most I know, some better than others but others I’ve not met or heard of! I’d happily let any of them anaesthetise my nearest and dearest. Unfortunately my nearest and nearest didn’t need surgery or offer to have it done on my behalf. My appraiser’s login wouldn’t give me* access to all the department’s inputs and outputs, leaving only one sensible option. Rather than favour one eminent, distinguished colleague over another eminent, distinguished one, or even a younger, promising (and, inevitably, in the future, eminent, distinguished) colleague, I would have the op done under local.

Of course it all turned out well. The theatre staff were marvellous (I have another 15 years to work there, remember). They may have been anxious that everything should go well, but nowhere near as anxious as me! I hope never again to have such little responsibility for the WHO Safer Surgery Checklist being performed as efficiently and enthusiastically as it was, or such gratitude for it. It did feel odd when the surgeon checked the local anaesthetic with someone else, and I tried quite hard not to calculate drug dosages. The surgery was quick, bleeding minimal, suturing neat, dressings and bandage worthy of a St John Ambulance award, and post op instructions were clear and concise. But back to the anaesthetic. It worked. Not my most pleasant experience, but I wasn’t going to blub with Sister holding my hand (!) In fact I had all the advantages of an anaesthetic, without an anaesthetist. But before vast swathes of the

membership march on Portland Place demanding my resignation or impeachment, let me share the best bit about my anaesthetic (and my surgeon/anaesthetist); the block took twice as long to work as the surgery! Truly a mark of excellence!

Several weeks post op I’m making an excellent recovery/milking it for all it’s worth (delete according to view point). Even this experience of day surgery (my first since grommets, 1970, premed, cyclopropane, 2 night admission, don’t get me started!) under local has been salutary. Very few patients want surgery; they’ve no other option. Fewer want an anaesthetic (or anaesthetist). We don’t know what’s worrying them, so ask, don’t presume. Be even nicer to every member of the theatre staff, every day – one day you may rely on them to get you to the right theatre for the right operation by the right surgeon AND stop your gown flapping too much.

And now to change direction completely. Modern 24 hour news inevitably means the President’s Report is retrospective, speculative or just wrong. So many issues challenge medicine – the NHS, doctors, anaesthetists and the AAGBI – that none can be covered comprehensively in 1,000 words on alternate months. Members will find the most recent news and views from the AAGBI and me on the website and via social media. However, for those who missed the junior doctors’ dispute, or who don’t do websites, Twitter or Facebook and to ensure the same key messages also appear in Anaesthesia News:

I deplore the decision to impose a contract on trainees in England. It reinforced the view that this government has no respect for trainees or the essential contribution they make to the healthcare of the nation, nor understands the NHS and its significance to the people of this country. Repeated mis- and dis-information by politicians, despite the best advice from medical, scientific and other independent advisers, demeans their office. Imposition didn’t end the dispute and I fear the trainee experience will be repeated for consultants. Members in the Republic of Ireland have already been through this; those in Scotland, Wales and Northern Ireland have a (hopefully) less aggressive and abrasive process still to endure.With turmoil in medical politics, real politics and the real world, members may question the topic and style of this Report. If nothing else a patient’s perspective made it into the President’s Report. And to my surgeon, ward and theatre teams – thank you.

Andrew hartlePresident, AAGBI

*Dear IT governance/Caldicott Guardian – this is a joke! Really

since my last report i’ve had surgery. i’d not given an anaesthetic for several months. it may surprise some of you that i give anaesthestics; as you may have thought Presidents should not be left unsupervised in theatre without a responsible adult, ideally one possessing the frcA. i recall similar rumours in my youth about Professors, but am assured, by Professors, that this is not true and never was (and my hospital mislaid its Professor before i was appointed). in fact solo anaesthetic lists are the default in my hospital, but an unwelcome surprise 50th birthday present last summer of carpal tunnel syndrome meant that by christmas, these were no longer an option for me. imagine an unexpected difficult airway or laryngospasm, then add having less than five minutes before only one hand works? dAs has yet to write that algorithm! Most of my job plan is intensive care, where the impact was less and easier to mitigate, and i’m grateful for the support of my icU and anaesthetic colleagues. Just in case it occurs to anyone, i stopped private practice as well.


Time flies (faster) as you get older, so even though it feels like yesterday,

I shouldn't be surprised that it's four years since my Gamesmaker

training ahead of the London 2012 Olympics, which led to the idea for

Lifeboxes for Rio.

It doesn't seem a minute has passed since I launched this AAGBI

campaign, aiming to raise an ambitious £96,000 in two years which will

buy 600 Lifebox pulse oximeters for the developing world. That’s the

same as the number of Team GB athletes attending this year’s Olympic

and Paralympic Games in Rio de Janeiro.

With a year and a half of the campaign behind us, we have already

raised over £64,000, including Gift Aid. I wanted to take the opportunity

to thank everyone who has contributed their time, blisters, kitchens and

waistlines...and, more importantly, money – you have been incredibly

generous. And, with 6 months to go, I encourage everyone to get

involved and help us reach our target of £96,000.

dr Andrew hartlePresident, AAGBI

Lifeboxes for RioThe Story so far...

"Lifeboxes for Rio is one of those

charitable drives that is a simple

thing to do, but genuinely able to

make a big difference to a lot of

people."

Dr Robert Dennis

"We grab this opportunity to assure

you that this tool will be fruitfully

utilised and maintained to improve

anaesthesia safety in Mbarara."

Dr Elizabeth Namugaya Igaga,

on behalf of the Association of

Anesthesiologists of Uganda

How far is left to go?

We've raised £64,000 towards our target and the money raised so far

is already saving lives. We have already presented £40,500 to Lifebox

which has bought 253 pulse oximeters, they will go a long way to saving

countless lives in the developing world.

so with a quarter of the campaign left we only need to raise – £32,000.

We know of marathon runners and cyclists, and there must still be

anaesthetists who've not raised money doing a bake sale! If you're retiring

this year we hope you'll consider sharing a fraction of your lump sum, so

others can enjoy the reassuring beep that has been part of your working

life, or at least 20 years of it.

Saving lives in the developing world:

How your generous donations are being used.

"My patients will be monitored

adequately and effectively. Having

the knowledge and the equipment

makes me complete."

Benjamin Banda, Clinical Officer

Anaesthetist, Chilonga Mission

Hospital, Zambia

Thanks to the contributions of everyone who has

taken part we have raised over

£64,000!!Become a Lifeboxes for Rio fundraiserWe encourage all AAGBI members to raise money for the Lifeboxes for Rio fundraising campaign. There are lots of ways to take part: Bake, bike ride, run or walk – or devise your own unique fundraising concept.You’ll find fundraising ideas on our website or you can come up with your own. www.aagbi.org/about-us/aagbi-fundraising/lifeboxes-rio

Better still, why not donate today at the secure Lifeboxes for Rio MyDonate webpage

mydonate.bt.com/events/lifeboxes4rio/182427

£96k


BoARd/CounCIL ELECtIons 2016AAGBI

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+ This year three positions on the Board and Council of the AAGBI will become vacant. Drs Matthew Checketts (Dundee), Rachel Collis (Cardiff) and Roshan Fernando (London) are approaching the end of their official term of office, although Matthew stepped down 6 months ago. All three have contributed hugely to the work of the AAGBI. As Chair of the Education Committee, Matthew organised WSM London and Annual Congresses (AC) in Harrogate and Edinburgh. He increased the delegate numbers and positive feedback by leaps and bounds, and even followed in the footsteps of another past Chair of Education, Richard Griffiths, by cycling to each of the Annual Congress meetings. Matthew has also been a member of the Skin Asepsis for Neuraxial Blockade Working Party (2014) and chaired the Standards of Monitoring and Recovery (Review) Working Party (2015). Rachel in her role as Chair of the International Relations Committee (IRC) has worked tirelessly to develop the strategy and direction of this workstream, and has increased collaboration with other organisations. She has contributed to the grant awarding processes, has been pivotal in suggesting that a lay person should sit on the IRC, and was a member of the Blood Transfusion Working Party (2016). In addition to organising the Art Exhibition at AC, Rachel has amazed us with her beautiful paintings. Roshan has been a valuable member of Council. As Chair of the E-Education task group he has helped to shape and develop Learn@AAGBI into the valuable resource that it is today, and has been a driving force in bringing us into the 21st century by introducing us to E-Posters, which we trialled at WSM London 2016.

Thanks go to all three for their contributions to the AAGBI and anaesthesia over the past four years. We will be sad to say goodbye, and hope that their enthusiasm and drive will encourage the next generation to stand for election. Whether your interests lie in education, international relations, safety, standards, trainees, wellbeing, mentoring, independent practice, research, environmental issues, innovation, heritage, developing guidelines, being on the Editorial Board of Anaesthesia or Anaesthesia News, there is something for each of you. Being on the AAGBI Board and Council is fun and rewarding. Each new Council member is allocated a buddy to guide them through their first year, and we encourage individuals to come up with fresh ideas and challenge old ones!

Board members are automatically members of the Council. Candidates must be ordinary members of the AAGBI in good standing and must represent and work for the whole speciality. The AAGBI is more than a membership organisation for over 11,000 members. It consists of two legal entities (a limited company and a charity), employs 30 staff, and has a combined turnover of over £4 million per year. Board members are automatically directors/trustees of both company and charity and so must be eligible to serve in this capacity.

Elected members are expected to attend Board and Council meetings and will be allocated to 2-3 other committees (e.g. IRC/Safety/Education/Anaesthesia News/Wellbeing/GAT/Research and Grants). All of the meetings are on a Friday. Elected members should

expect to be at the AAGBI’s headquarters at 21 Portland Place, London, for at least two Fridays a month: always the first Friday and usually one other Friday. You may not be able to attend all of the meetings, but you should try to attend most of them. We now have facilities for videoconferencing so this relieves some of the pressure for people who live further away or who can only make part of the meeting.

In addition, Council members will be expected to attend WSM, Annual Congress and the Linkman meeting. You may also be asked to represent the AAGBI at Core Topics/Seminars and at occasional external meetings, such as the RCoA. These meetings may be on a different day of the week.

I would strongly advise that you talk to your Clinical Director and Medical Director before seeking nomination, to ensure you have departmental and Trust support for this work, and that Friday is a day that works well for you to come to London.

So if you are interested in joining us... stand for election! I would not hesitate in encouraging you to be part of the AAGBI family at 21 Portland Place; we laugh together and work hard together to make a difference to improve safety, standards, research and education in anaesthesia. I would be more than happy to chat to you about life at the AAGBI. The closing date for nominations is 17:00 on friday 08 April 2016 and the successful candidates will take up their posts from the Annual Members Meeting at Annual Congress Birmingham,14-16 September 2016.

dr samantha shindeHonorary Secretary


The Association of Paediatric Anaesthetists has now grown to a membership of over 1,200 members with a broader appeal to all those involved in the anaesthesia of children. This includes trainees with an interest in this work and Associate Specialists, specialist consultants working exclusively with children and generalists who undertake occasional paediatric practice. The common aim is to support the safe practice of paediatric anaesthesia in all its forms and to provide help, guidance and awareness of new developments in the speciality. We recognise the particular issues associated with practitioners working outside specialist centres and a significant part of our activities are directed at providing support through meetings, and educational activities centred from the educational committee and the APAGBI website.

The business of the Association is conducted by a Council, which is elected by the members and includes representation from all the constituent geographical areas, together with specialist and non-specialist interests. The work is grouped under four main committees:• The Professional Standards committee oversees the production

of information for patients and families and evidence based guidelines for professionals as well as developing and maintaining a conduit for the passage of information to and from the members via the Linkman scheme and its annual meeting. The well-respected Peer Review process also falls under this committee and offers professional, unbiased and non-judgemental reviews of paediatric anaesthetic departments.

• The Education committee develops and supports educational materials and has recently been extremely busy producing some very interesting interactive content on the website.

• The Science committee awards research grants and support audits and surveys and evaluates scientific statements from other organisations.

• The Meetings committee organises our Annual Scientific Meetings, the next of which is in Belfast in May this year. The 2017 meeting will be in Bristol.

As a consequence of these activities and the large membership, the APAGBI is now seen as the primary source of information and guidance for all aspect of paediatric anaesthesia by the Royal Colleges and other regulatory authorities in the UK and Ireland. As a trainee, Associate Specialist or consultant, we would encourage membership of the Association to support your professional activities and have a voice in all aspects of paediatric anaesthesia. We have a three day meeting in late spring each year (as mentioned above), and while membership is encouraged, it is not a requirement.

For more information on the background to the organisation, up to date information on the speciality and the work of the Council please visit us at: www.apagbi.org.uk

The Association of Paediatric Anaesthetists of Great Britain & Ireland (APAGBI)

Venue : ITC Grand Chola,Chennai, India

rd th 3 - 4SEPTEMBER

2016

WCOA-20164th WORLD CONGRESS OF OPHTHALMIC ANAESTHESIA

Patron

Dr Badrinath S S

Organizing Chairman

Dr Jagadeesh V

International President

Prof Ezzat Azziz, Egypt

Organizing Co-chairman

Dr Pramod Bhende

Scientific Chair

Prof Chandra M Kumar

�International and national speakers

�Lectures – Basic science and update in ophthalmic anaesthesia

�Hands-on practice regional eye blocks

�Free paper sessions

�Poster presentations

�Wet-lab session: Subtenon’s block

For more details contact:Dr Jaichandran V V - Organizing SecretarySANKARA NETHRALAYA, Mobile: +91 9884096860 / Email : [email protected]

Web : www.sankaranethralaya.org/wcoa2016

Jointly organized by Sankara Nethralaya & British Ophthalmic Anaesthesia Society Last date for Abstract submission:

31st July 2016Last date of Regular Registration :

Sept 1st 2016

Sessions to include:

Controversies in cataract surgery, Paediatric ophthalmology,

Vitreo-retinal surgery and anaesthesia, National artificial eye service,

Wet lab workshop.

For further information and registration visit

www.boas.org

17th Annual Scientific Meeting

10-11th November 2016

Austin Court, Birmingham

Abstract Submission Date 16th September 2016

Trainee prizes: £500 for best paper £100 best poster

The APAGBi was formed in 1973, which we think makes it the first specialist paediatric anaesthesia association in the world. The initial intention of the founding members was to develop a forum for the meeting of anaesthetists from the specialist children’s hospitals in the UK and the republic of ireland. There was also much interest from overseas paediatric anaesthetists, mainly from europe and the British commonwealth, so a separate membership category was introduced for them.

Professor Andy wolfPresident, APAGBI

TRAUMA AND NEUROANAESTHESIA FELLOWSHIPS

Commencement date: August 2016 and Feb 2017

Applications are invited for two fellowships, one in Advanced Trauma Anaesthesia and one in Advanced Neuro Anaesthesia within Queen Elizabeth Hospital - a level 1 trauma centre, Birmingham.

An excellent opportunity for post FRCA / post CCT trainees to attain advanced skills in Trauma and Neuroanaesthesia.

Trauma Anaesthesia: Queen Elizabeth Hospital, Birmingham (QEHB) is part of University Hospitals Birmingham NHS Foundation Trust, a Royal Centre for Defence Medicine and is one of the leading hospitals in Europe. It is a regional centre for trauma, burns and reconstructive plastics and has the largest solid organ transplant programme in Europe. It has three dedicated trauma theatres with dedicated trauma and burns intensive care unit.

Neuro Anaesthesia: It is the tertiary referral centre for neurosurgery. It has a dedicated neurosurgical emergency theatre, along with two theatres for cranial work, two for spinal work work, supported by consultant delivered neuroanaesthesia pre-op clinic and a dedicated neuro-radiology suite.

Although these posts are not RCoA recognised training posts, training will be provided in a similar way to the college curriculum and with competencies required for future progress. Fellows will be supported in their application to the college for retrospective approval of training. A letter of completion of fellowship will be awarded at the end of one year on successful completion of all the modules.

UNIVERSITY HOSPITAL BIRMINGHAM NHS FOUNDATION TRUST

Dr. Chetan Parcha, Consultant Anaesthetist, (Trauma)E-mail: [email protected] Phone: 0121 371 6112

Dr. Hannah Church, Consultant Anaesthetist, (neuro-anaesthesia)e-mail: [email protected] Phone: 0121 371 6603

FOR MORE DETAILS CONTACT

Duration: 1 year

13TH ANNUAL CRITICAL CARE SYMPOSIUM & ccm-l meeting28th AND 29th APRIL 2016MANCHESTER TOWN HALL, MANCHESTER M2 5DB

International Faculty of 60

Opening Remarks: Professor David Crippen (Pittsburgh, USA) Dr Roop Kishen (Manchester, UK)

Keynote Address: The view from the bed Professor Timothy Buchman (Atlanta, USA)

Themes:• ARDS - 1 and 2 • Sepsis - 1 and 2 • Fluids • Ventilation • Renal • Haematology • Ultrasound • ICU Issues • Infections • Haemodynamic Monitoring • Manpower and Quality of Care in ICU • Prevention • Antibiotics • Neuro Critical Care • Special Lecture - 10 Pitfalls in Intensive Care

Parallel sessions including pro-con debates, tutorials/workshops, masterclass, roundtable discussions and more.

To receive a copy of the full programme, please contact Alex [email protected]

CONTACT:Symposium website: www.critcaresymposium.co.ukEmail: [email protected]: 01565 621967

12 CME Points Register online atwww.hartleytaylor.co.ukby The Royal College of Physicians


Anaesthesia CasesDespite being low in the research hierarchy, a memorable case report may have a greater impact on our practice than a large randomised controlled trial. For example, Christiaan Barnard’s description of the world’s first heart transplant and the first clinical description of malignant hyperpyrexia were both published as case reports. Case reports are the building blocks that form our body of medical literature. As long as one is aware of their limitations, case reports broaden our knowledge and understanding of medicine. While evidence-based medicine guides practice, case reports fill the gap where the evidence does not currently exist and are used as a platform to launch formal studies, to document trends in new patient management options and for educating clinicians.

The AAGBI recognises that our actions have an impact on the environment and regards global warming and climate change as pressing issues. In 2013 the Environmental Task Group of the AAGBI was formed to develop the idea of sustainable practice and to promote greener anaesthesia. The Task Group and the Association have linked with Barema, the Association for Anaesthetic and Respiratory Device Suppliers (representing companies that manufacture or supply anaesthetic and respiratory equipment in or to the UK), to establish the Barema & AAGBi environment Award. This will recognise excellence in sustainability within the speciality and engage with industry partners to further develop a greener anaesthesia agenda.

Apply for the NEW Barema & AAGBI Environment Award!

The award will be for the single best initiative or project and will consist of £200 to the individual(s) or body(ies) concerned, in addition to a grant of £800 for support and development of the initiative or project.

The deadline for applications is 29 April 2016 with the winners being announced at the AAGBI Annual Congress in Birmingham, 14-16 September 2016.

New award for excellence in sustainability

Developing a green anaesthesia agenda

Applicants will have to demonstrate how their activity, project, campaign or other work (including original research), related to anaesthesia, intensive care or pain management, has had (and will continue to have) a measurable beneficial effect on the environment. The wider applicability (to other departments) and the sustainability of the initiative are important parts of the award and will be assessed by the judges.

To find out more about the award and the application process visit

www.aagbi.org/about-us/environment or email [email protected]

Anaesthesia Cases was launched in January 2013 as an online library of case reports in anaesthesia, pain and intensive care medicine. These are case reports that previously would have been considered for publication in Anaesthesia. Journals have reduced the number of case reports they publish, or even excluded them altogether, often because they are not citable and therefore do not contribute to a journal’s impact factor. Anaesthesia Cases was created in order to ensure that informative and important case reports continue to be published.

Each case report submission is reviewed by at least two Editorial Board members and the author of an accepted case report will see it published online, usually within a week of submission. It will be given a unique reference number and we are currently applying for entry onto PubMed. Exceptional case reports will be considered for publication in Anaesthesia.

Here are just a few reasons why you should submit a case report to Anaesthesia Cases:

• It is free to AAGBI members (and non-members can log on to the website free of charge)

• You are twice as likely to have your case report published compared with an original research article

• There is a fast turnaround time – from submission to publication takes about a week

• No previous research experience is necessary• It provides an opportunity for the author to develop writing

skills, share information and learn from the experience of others

• It encourages improvement in an individual’s personal understanding of a topic

• The new comments functionality allows you to respond to published case reports and aims to stimulate debate, especially regarding controversial patient management

The types of case reports we publish include descriptions of new regional nerve blocks, novel oxygenation techniques, as well as unusual complications related to common conditions or drugs. Each case report will be considered on its individual merit; all we ask is that the case provides an interesting and original learning point. We have already published 150 case reports since our launch, a rate of one each week.

h. laycockAssistant Editor

s. changAssistant Editor

c.r. BaileyEditor

Over 100 cases published Cases viewed worldwide

Please submit your interesting case report today, or browse our website and comment on case reports that have already been published. The library of case reports and information regarding submissions can be accessed at http://www.anaesthesiacases.org

AAGBI PATIENT SAFETY PRIZE 2016The AAGBI is offering a Patient Safety Prize to showcase examples of improved safety in anaesthesia.

The prize is open to members of the AAGBI. The project could involve an individual, department, medical students or allied health care professionals, provided the project lead is a member of the AAGBI. Applicants may like to consider projects based on themes identified in SALG patient safety updates.

You will need to demonstrate:

Clear aims and objectives An innovative idea(s) How the project was introduced and implemented How performance was measured and benchmarked How information about the project was disseminated The sustainability of the project Transferability of the project to other departments

Amount: Up to £500 (at the discretion of the awarding Committee). There may be more than one prize.Awarded: At the AAGBI Annual Congress, BirminghamFormat of submissions: Poster presentation

The winner will be expected to: Make a five minute oral presentation during the prize giving

at Annual Congress

Please visit www.annualcongress.org/content/aagbi-patient-safety-prize for further details. If you have any queries, please contact the AAGBI Secretariat on 020 7631 1650 (option 3) or [email protected]

The deadline for submissions is 23:59 on Monday 18 April 2016


April 2016

Digested

N.B. the articles referred to can be found in either the latest issue of Anaesthesia or on Early View (ePub ahead of print)

Intravenous lidocaine infusions given during abdominal surgical procedures are associated with reductions in postoperative pain and length of hospital stay. However, potentially toxic levels of lidocaine have been seen in previous clinical trials. In order to try and minimise this risk, the authors of this study used a subcutaneous infusion of lidocaine (after an initial intra-operative intravenous infusion) for 24 hours postoperatively, on the basis that this may reduce variability of plasma lidocaine levels. Patients who received lidocaine had a reduction in mean length of stay of 1.3 days compared to placebo. The

use of lidocaine was also associated with reductions in postoperative pain scores and morphine consumption at 24 hours postoperatively. Reassuringly plasma lidocaine levels were below levels associated with toxicity. This was a relatively simple clinical intervention that resulted in significant benefits for both patients and healthcare providers alike. Over the past decade there has been increased interest in accelerated recovery programmes for major surgical procedures and it may be that lidocaine infusions could contribute to future care bundles and pathways.

A randomised controlled trial of peri-operative lidocaine infusions for open radical prostatectomyWeinberg L, Rachbuch C, Ting S et al.

M.D. Wiles Editor, Anaesthesia

The use of cognitive aids such as checklists during anaesthetic emergencies has been shown to improve task completion by individuals, but this is not reflective of the majority of clinical situations where care is delivered by a team. This study aimed to establish the effect of cognitive aids on team performance during the management of simulated anaphylaxis events. The use of a flowchart was associated with improvement in several measures of team

performance including leadership and team-coordination and the verbalisation of situation information. Of particular interest was that a linear rather than a branched flowchart appeared to improve team performance to a greater degree. This will be of particular interest to those individuals who develop guidelines in the future; it may be that the method of presenting information is as important as the content.

The effect of two cognitive aid designs on team functioning during intra-operative anaphylaxis emergencies: a multi-centre simulation studyMarshall SD, Sanderson P, McIntosh CA and Kolawole H.

SAS AUDIT POSTER PRIZE 2016The AAGBI invites abstracts for the SAS Audit Poster Prize. The prize is open to all SAS grade anaesthetists.

A preliminary review of the abstracts received will determine which ones are accepted for poster presentation at the Annual Congress in Birmingham.

Prizes will be awarded to authors of the best posters and the abstracts will be published in Anaesthesia in the form of a fully referenceable online supplement (NB Editor-in-Chief reserves the right to refuse publication, e.g. where there are major concerns over ethics and/or content).

The deadline for submission is 23:59 on Monday 18 April 2016 and full instructions can be found on our Annual Congress microsite: www.annualcongress.org/content/oral-poster-presentations

If you have any queries, please contact the AAGBI Secretariat on 020 7631 1650 (option 3) or [email protected]

Abstracts for presentation at the AAGBI Annual Congress14-16 Birmingham 2016

CALL FOR ABSTRACTS

You are invited to submit an abstract for oral (free paper) or poster presentation at the Annual Congress. The deadline for submission is 23:59 on Monday 18 April 2016 and full instructions can be found on our Annual Congress microsite: www.annualcongress.org

After the deadline, a preliminary review of the abstracts received will determine which ones are accepted for presentation at the Annual Congress in Birmingham. Some authors will be invited to present their work orally, under the following three categories: case reports, original research and audit, quality improvement and surveys. The remaining successful authors will be invited to present a poster.

All accepted abstracts will be published in Anaesthesia in the form of a fully referenceable online supplement (NB Editor-in-Chief reserves the right to refuse publication, e.g. where there are major concerns over ethics and/or content).

Authors of the best free papers and poster(s) will be awarded cash prizes.

If you have any queries, please contact the AAGBI secretariat on 020 7631 1650 (option 3) or email [email protected]

CALL FOR NOMINATIONSBOARD/COUNCIL ELECTIONS 2016

Nominations are now invited from members of the Association wishing to stand for election.

Further information and nomination forms are available from the AAGBI secretariat on 020 7631 1650 (option 3), [email protected] or can be downloaded from the AAGBI website www.aagbi.org/about-us/council

Closing date is Friday 08 April 2016 at 17:00.

19th Anaesthesia, Critical Care and Pain Forum Da Balaia, The Algarve

26-28 September 2016

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Videolaryngoscopy is becoming increasing popular for the management of the difficult airway, especially among trainee anaesthetists. I increasingly feel like a dinosaur when I ask for a bougie rather that the shiny new device in the corner! Tracheal intubation in the patient who has an immobilised cervical spine due to actual or potential injury remains a challenging procedure, due to increased difficultly in visualisation of the glottis. In this study the authors compared tracheal intubation using the McGrath® videolaryngoscope and Macintosh blade in patients wearing a semi-rigid cervical collar.

The use of the McGrath was associated with an improved laryngeal view and intubation success rate (100% vs 72%) with no increase in the time taken for the procedure. It could be argued that this study has limited clinical applicability as many anaesthetists would opt for manual in-line stabilisation of the cervical spine during tracheal intubation attempts, rather than leave a collar in place. However, the application of a cervical collar is used frequently in research studies to simulate a difficult airway and, as such, this study adds further evidence of the value of videolaryngoscopy in airway management.

A randomised cross-over trial comparing the McGrath Series 5® videolaryngoscope with the Macintosh laryngoscope in patients with cervical spine immobilisationFoulds LT, McGuire BE and Shippey BJ.


What do we do?The Committee has 13 elected members, with an executive comprising the Chair, Vice Chair, Honorary Secretary and Trainee Network Lead Officer and co-opted trainee members from other organisations such as the British Medical Association, Royal College of Anaesthetists (RCoA), College of Anaesthetists of Ireland and Defence Anaesthesia. We meet twice a year at the AAGBI headquarters in London plus at the GAT Annual Scientific Meeting and the Annual Congress. The Chair and Honorary Secretary are members of AAGBI Council and voting members of the Board; the Vice Chair is co-opted to Council. The GAT Committee members represent trainees on all AAGBI committees and working parties; they are also co-opted onto several external committees including the RCoA Trainee Committee and the BMA Junior Doctors Committee. We provide anaesthetic trainee representation for, and review of, important national initiatives, which in the last 12 months have included the Shape of Training Review, the initial report on contract reform by the DDRB and several published national anaesthetic guidelines. The GAT Committee has editorial control of the trainee section of the Association’s monthly newsletter Anaesthesia News, and organises seminars and the GAT ASM specifically for trainees.

Interested? What to do next…In 2016, there will be a minimum of two vacancies available on the Committee. Those standing for election will be expected to serve a minimum term of two years, up to a maximum of four years. Committee members need to be resident in the UK or Ireland for their term of office. Most meetings will take place at the AAGBI headquarters in London and are usually on Fridays. If elected, nominees agree to fulfil the duties and responsibilities required of

them. The term of office officially commences at the GAT ASM in Nottingham from 15-17 June 2016. As an elected Committee member you would expect to have AAGBI commitments on approximately 10-12 days over the course of a year, in addition to the 3-day ASM. There is also a significant amount of discussion that takes place via email and increasingly on social media. The GAT Committee tends to attract senior trainees, but we encourage core trainees and ACCS trainees to also stand for election to ensure all grades of anaesthesia trainees are represented. We also like representation on the Committee from all parts of Great Britain and Ireland, so encourage nominations from Ireland, Northern Ireland and Wales in particular as they are currently unrepresented.Being part of the GAT Committee is always interesting and a big responsibility. It is also lots of fun, and offers great scope for the development of personal skills in leadership, management, negotiation, committee working and authorship and presentation at a national level. If you feel you can represent your peers honestly, can think outside the box, and the prospect of working with this team leaves you with a smile on your face, we would love to have you on the GAT Committee.

Further information and nomination forms are available from the AAGBI secretariat on 020 7631 1650 (option 3), by email via [email protected] or can be downloaded from the AAGBI website (www.aagbi.org/gatcommittee). All nominees should be proposed and seconded by other trainee members of the AAGBI and submitted to: GAT Committee, 21 Portland Place, London, W1B 1PY; by email to [email protected] or faxed to 020 7631 4352. The closing date is friday 8th April 2016 at 17:00. We look forward to receiving your nomination form.

Ben fox, rowena clark & emma Plunkett GAT Chair, Vice Chair & Honorary Secretary

We invite you to stand for election to the Group of Anaesthetists in Training

What is the Group of Anaesthetists in Training (GAT) Committee?

We are the trainees’ committee of the AAGBI, elected from its trainee members. We represent the medical and political views of over 4,000 anaesthetic trainees within Great Britain and Ireland. GAT has a hugely varied remit; from the advancement of educational resources to the wellbeing of our members. By joining the committee you will potentially be in a position to impact nationally on how training in anaesthesia evolves over the next decade. Particularly now, given the turbulent climate junior doctors are living in within the UK and Ireland, it is vital to have a committee made up of innovative, resourceful and enthusiastic individuals.

GAT ANNUAL SCIENTIFIC MEETING2016

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18 Anaesthesia News April 2016 • Issue 345 Anaesthesia News April 2016 • Issue 345 19

This final part gives an outline of how a generic international anaesthesia machine (IAM) would be configured in order to satisfy the two opposing extremes of user requirement in one machine: (a) a full spec anaesthesia workstation for a general hospital and (b) ability to function in poorly resourced, remote locations where electricity and compressed oxygen are not dependable. The effects on the environment are also considered.

Some commentators have said that such a machine is not needed: you simply have different machines for different places and it need not be of concern to anaesthetists in the West that their machines are ‘gas guzzlers’ that cannot function outside the standard working environment, despite the recent ‘global health’ dialogue.

However, we have seen over the last 50 years that such a two-speed equipment divide reinforces global inequalities: no anaesthetist wants the second best, it creates divisions between grades of anaesthetist between and within countries, differences in the quality of care they can offer and increases the mountains of donated junk destined to lie around in the poor half. If some future IAM was donated, it would at least be serviceable in the recipient country. A recent survey of 132 brand new gas-supply, electricity-dependent machines was conducted in Uganda. After more than a year, only 8 were in use.[1]The IAM must be a hybrid system – i.e. a supply and demand system, as opposed to the supply-only (continuous flow) machines that 99% of anaesthetists know and consider essential for safe patient management today. There is nothing especially novel in the reasoning.

If compressed gas is too expensive to supply internationally then the IAM needs a way to function without it. The challenge is to devise a patient system that can do this without creating a hazard or requiring the user to adjust anything, while at the same time providing all of the features of the supply-only system. Four basic structures are required: (i) a gas source (ii) an ‘equaliser’ block upstream from a draw-over vaporiser (iii) a patient system with one-way valves and (iv) a compatible ventilator.

(i) is a conventional rotameter block which supplies oxygen, at least 10 l/min flow, taken from a concentrator, but which will also accept other types of compressed oxygen at any pressure as back up, with additional options of air and/or nitrous oxide. If nitrous is supplied, a suitable hypoxic cut-off must be provided.

(ii) This oxygen-gas mixture flows into an ‘equaliser’ block which allows for the pressure and flow inequalities that arise when continuous flow meets the intermittent demand flow required for patient ventilation. This multi-function unit can take any form but should include: • Closed reservoir bag which moves with respiration• Fixed positive pressure relief valve set at 5-10 cm water to provide

a continuous flow if a Mapleson D type system is required • Air entry into the system• Pressure change indicator to show the equilibrium between the

supply side and the demand side. For example, if the patient’s respiration slowed or stopped, the continuing supply would

Outline of a design. How long should it last to prevent wastage and help the environment?

Designing an International Anaesthesia Machineraise the pressure and show a red light, if the patient was breathing strongly and the supply was too little to fill the system, pressure would be sub-atmospheric and would show green. Air would be drawn in. If supply and demand were equal, a white light would show.

Downstream from this unit is a draw-over vaporiser, with a quick change facility for different agents, as current ISO standards require. Until recently halothane was the gold standard, but now isoflurane is as widely used and soon both may be overtaken by sevoflurane. In real terms, inhalation agents now cost one tenth of their price 20 years ago.[2]

(iii) This gas combination feeds into a specialised patient breathing system with one-way valves, self-inflating manual ventilator and patient inflating valve. The valves are needed to ensure one-way flow because, unlike with a conventional machine, if the supply fails the user must be able to draw gas or air via the vaporiser into the system using the manual ventilator. The patient inflating valve is a specialised device that automatically directs the gas to the patient during a positive pressure inspiration, then, when the pressure falls to zero during expiration, it opens and allows the gas to exit. It must be of the non-jamming type.[3] Many types have been described in the last 75 years, now mainly used with resuscitation kits, but for the IAM to conform to international standards, for example to allow scavenging or the use of a bacterial filter, the valve must be located on the anaesthetic machine. Another valve prevents re-breathing during spontaneous breathing. This arrangement allows use of the standard Y-piece patient connection.

(iv) Ventilator. This must have its own power source, not dependent on cylinder compressed gas. An electric motor may directly drive a bellows, suitable for demand-flow systems because it can pull and push, imitating the manual ventilator, or an alternative is to drive a ventilator using the gas from the concentrator compressor. However, the former is preferable in the event of a power cut because a small DC motor directly driving a bellows can run for hours on a small 12 volt battery, whereas the concentrator compressor needs mains AC power at about 600 watts which requires a large separate battery and inverter.

Volume and pressure ventilation modes should be provided with values displayed on a screen and the ventilator should also monitor spontaneous breathing, showing pressure and tidal volume and alarms for patient disconnect, etc.

The components can be diagrammatically represented thus:

The components should be mounted to allow ease of removal for service and replacement by the user.

Additional features required

• Oxygen monitor in the inspiratory limb of the patient system• Oxygen flush – in a traditional demand-flow system a flush can

cause a hazard, [4] which is increased if using a non-distensible silicone self-inflating bag. A flush is also wasteful of oxygen which may be in limited supply and if the source is a concentrator there will be a fall in oxygen percentage

However, an oxygen flush is desirable to provide CPAP via a facemask for the management of some airway emergencies, e.g. laryngospasm during induction or recovery, which earlier draw-over systems cannot provide. So, provided the flush pressure is limited and the inflating valve is of the non-jamming type which limits patient system pressure to 40–45 cm water, it is a safe and desirable feature for management of emergencies

• Air rotameter to reduce the oxygen percentage from the concentrator. Cylinder compressed air for use in theatre is hard to find. A solution is to take air from the compressor of the oxygen concentrator but the inevitable condensed water will quickly render an anaesthetic machine inoperable due to blockage and corrosion. Drying compressed air remains a challenge for equipment manufacturers

• Alarms – less than required for a conventional system but over-pressure, patient disconnect, low oxygen, in addition to standard alarms on the ventilator.

• PEEP would normally be provided mechanically.• Supplementary oxygen outlet – e.g. to give oxygen to the baby at

caesarean or for spinal anaesthesia

What are the disadvantages of a demand flow system?

1. Draw-over vaporisers are less accurate: they tend to over-deliver at low flows and are usually not temperature compensated. However the accuracy of plenum vaporisers is also variable [5] and the error is no more than a clinician’s error in estimating the correct dose, added to the variation in individual patient response. The output of a draw-over vaporiser tends to fall with time and over-dosage has never been a problem.

2. During the inspiratory phase of IPPV a demand-flow system delivers a parcel of gas, fixed for that breath by the valves. In the supply-flow system, the gas given to the patient comes from a limitless source and may be adjusted throughout the respiratory cycle: more gas can be added, e.g. to provide PEEP, or excess may be spilled using an adjustable pressure limiting valve. The more frugal demand-flow system cannot do this. However, the flush mentioned above and a mechanical PEEP valve will satisfy any requirements.

Saving wastage: what is the ideal life span of an anaesthesia machine?

I have earlier outlined the difficulties of keeping an inhalation anaesthesia machine in service in the low resource hospital setting.

In the West, a machine lasts about 10 years. An airliner can remain airworthy for 30+ years, and during that time almost all the original components will have been replaced with new or reconditioned parts.

Part 3

Supplying compressed oxygen: a major drain on scarce hospital resources in low and middle income countries

20 Anaesthesia News April 2016 • Issue 345

No such replacement scheme exists for anaesthesia machines. No manufacturer supports a simple system of exchange, by users in the field, of defective components for reconditioned ones to prolong the life of a machine and save wastage, though it could become a lucrative business.

The Malawi Machines shown in the previous article still have perfectly good frames after almost 30 years and could theoretically be refurbished but no compatible parts exist.

I propose that an IAM, if well maintained using service exchange parts, could last at least 15 years and remain in the top two of the following fault categories:

• No faults: all manufacturer’s specified operating features are functional

• As above but with 1–2 faults. Still safe to use• Used but with 3–4 faults or a major fault, e.g. ventilator not

working. Not safe to use• Not used for anaesthesia – residual function only, e.g. as a trolley• Absent: sent out for repairs, but still theoretically counted as

theatre stock • Sits in the corner/never used at all/scrapped

A machine survey would have difficulty finding machines outside on the scrapheap but ideally, to be a useful record for future purchases, the survey should include all the machines that have ever been supplied.

A Coefficient of Survival can be calculated to grade machines:

Number found safely in use (cat. 1&2) --------------------------------------------------- X average years’ service all machines of that typeNumber supplied since first installation

Two recent machine surveys conducted in Africa in 2012 and 2014 showed a Coefficient of Survival of 1 or less for five types of machine found and 4.9 for the 1985 Malawi Machine, out of the ideal score of 15.

So there is still a long way to go to correct the hardware wastage.

Last but not least: the environment

When considering anaesthesia and the environment, one must bear in mind that the polluting part of our profession – the continuous flow machine and its support infrastructure – is a very small business by global standards. According to market research, global drug sales have 1,500 times the value of anaesthesia machines, even sales of vitamins and supplements are worth over 100 times the value. Sub-Saharan African countries spend 0.00009% of their average GDP on anaesthesia machines. India spends 0.0002%.

When in use, the release of nitrous oxide to atmosphere is miniscule compared to natural emissions from soil and rocks and man-made emissions from agriculture and industry. Thus the environmental impact is small there has been no incentive to have a better, less wasteful alternative.

Nonetheless, the conventional gas supply-dependent anaesthesia machine is surely the most wasteful, inefficient and polluting device ever made by man: its high pressure serves only to move the gas and the gas dissipates unchanged to atmosphere with only a small fraction of it even reaching its intended destination: the patient’s brain. It is fortunate for the environment that anaesthesia machines are few.

But this would all change if the goal of ‘safe anaesthesia for all’ was ever realised for countries like India. In, say, 20 or 50 years’ time, inhalation anaesthesia could become a significant environmental polluter.

So this is the time to anticipate that goal and for manufacturers to move to less gas-guzzling, less infrastructure-dependent and less polluting demand-flow systems.

References1. Dr Bukwirwa Henry. Paper presented to GPAS meeting, Uganda, 2015 2. Fenton PM. The cost of Third World anaesthesia: an estimate of consumption

of drugs and equipment in anaesthetic practice in Malawi. Central African Journal of Medicine 1994 40: 137–9. http://www.ajol.info/index.php/cajm/article/view/113735 (accessed 28/01/2016).

3. Fenton P, Bell G. The patient inflating valve in anaesthesia and resuscitation breathing systems. Anaesthesia and Intensive Care 2013; 41: 163–74.

4. Fenton P. Anaesthesia machine check. 15 June 2012. http://www.respond2articles.com/ANA/forums/thread/1159.aspx?vol=67&iss=6&art=326486 (accessed 28/01/2016).

5. Kelly JM, Kong KL. Accuracy of ten isoflurane vaporisers in current clinical use. Anaesthesia 2011; 66: 682–8.

Paul M fentonFormerly Professor and Head, Department of Anaesthesia, College of Medicine, Malawi, 1986–2001

For further information and an application formplease visit our website: http://www.aagbi.org/international/irc-fundingtravel-grantsor email [email protected] or telephone 020 7631 1650 (option 3)

Closing date: 31 May 2016

The International Relations Committee (IRC) offers travel grants to anaesthetists who are seeking funding to work, or to deliver educational training courses or conferences, in low and middle-income countries.

TRAVEL GRANTS/ IRC FUNDING

Please note that grants will not normally be considered for attendance at congresses or meetings of learned societies. Exceptionally, they may be granted for extension of travel in association with such a post or meeting. Applicants should indicate their level of experience and expected benefits to be gained from their visits, over and above the educational value to the applicants themselves.

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SAFETY MATTERS

The National Essential Anaesthesia Drug List (NEADL) continues to provide a useful resource to members, not least when making a case for inclusion or retention of drugs on local formularies. NEADL remains a ‘work in progress’ and the Committee intends to review the contents of the list in due course. Members have raised the issue of disappearing drugs, most recently vecuronium, and have asked us to intervene. Unfortunately, we have no power to compel companies to continue production of drugs that are no longer commercially viable. On a wider stage, we were pleased to contribute to the arguments that defeated the proposed international restrictions on the access to ketamine.

The Safety Committee receives frequent queries about non-Luer connectors and we continue to work with the Small Bore Connector Advisory Group. Members will have lived through recent attempts at standardisation, with all the issues arising, and it seems that the unifying ISO standard will materialise in 2017. We send representation to the relevant British Standards committee, which in turn inputs to the ISO process. We hope to have an updated information page on the AAGBI website in the very near future.

We are engaged with our military colleagues who are working to produce a machine checklist relevant to the apparatus and environment that their work involves. All parties recognise the need to ensure the same standards of safety apply wherever in the world members of the Armed Forces have to deliver anaesthesia.

There has been much recent media interest in the illicit use of nitrous oxide – it seems a sizeable minority of young people have used it. Such use is currently possible entirely within the law, but the forthcoming Psychoactive Substances Bill will outlaw supply and possession of nitrous oxide for this purpose. The AAGBI will be supporting the Home Office in the passage of this legislation. Members may be interested in a related issue – the theft of nitrous oxide cylinders from hospitals. A cylinder can contain several thousand pounds worth of nitrous oxide when dispensed and the Government has issued guidance to trusts relating to security.

There is space to mention two projects not directly undertaken by the Safety Committee, but with a strong safety link.

First, some members of the Committee have been involved in the development of the Association’s Quick Reference Handbook (QRH) for anaesthesia emergencies. This is currently in its testing phase, but when released it will provide a freely downloadable emergency manual that any individual or department can access and implement, without having to re-invent the wheel. It contains guidelines to help with the management of nearly 30 scenarios. Further details can be found on the Safety page of the AAGBI website.

Second, members are reminded about NHS England’s NatSSIPs (National Safety Standards for Invasive Procedures). This is a national framework of standards for operating department practice. NatSSIPs have been created for local providers to use to develop and maintain their own more detailed standardised local operating procedures. Written under the chairmanship of William Harrop-Griffiths, our own Immediate Past-President, these standards are intended to sit alongside and complement existing safeguards.

Finally, the Safety Committee would like to take this opportunity to thank Dr Tom Woodcock, who has just stepped down as Chair. Tom has worked tirelessly and with enthusiasm promoting safety topics on behalf of members and their patients, and we wish him well in his well-earned retirement.

The Safety Committee – yet another busy year…

Tim MeekChair, Safety Committee

Useful resources

• AAGBI. National Essential Anaesthetic Drug List (NEADL). https://www.aagbi.org/safety/neadl

• AAGBI. Quick Reference Handbook. https://www.aagbi.org/safety/qrh

• NHS England. New safety standards published for invasive procedures. https://www.england.nhs.uk/2015/09/natssips/

Dear EditorWe would like to report two cases of sudden ventilator failure on two separate Datex Ohmeda Aisys CS2 (GE Healthcare, Madison, USA) anaesthetic machines in our hospital. The anaesthetists and operating department practitioners had checked both machines beforehand. No faults were identified during the checks, including the electronic ‘self check’, which the machines in question passed. Sudden failure of the ventilators on these machines occurred midway through cases (and after the machines had been used for mechanical ventilation on previous cases on the same lists). In each case the problem with the ventilator was identified immediately and the patients kept stable and safely anaesthetised while anaesthetic machine changes were made. After each event the hospital’s Electro-Biomedical Engineering department confirmed that there was a mechanical fault with the machines that could not be fixed. The manufacturer was contacted and the machines decommissioned. Subsequent findings revealed previous fluid contamination of the electrical circuitry that controls the switch from manual to mechanical ventilation on the machine – the contamination occurred some time (we are unsure when) before each case. Hartmann’s solution was the contaminant of the electrical circuitry on one machine and coffee on the other.

In the last year the trust has upgraded from older Datex Ohmeda anaesthetic machines, with a switch allowing the operator to physically adjust between manual and mechanical ventilation. The newer Datex Ohmeda Aisys CS2 retains a switch on the surface of the machine that can be moved between manual and mechanical ventilation (Figure 1); however, the actual switch is electronic and subject to damage from fluids spilled onto the surface of the machine. Reviewing the literature, we could not find any other similar cases of fluid contamination of the electrical circuitry causing delayed ventilator failure. A 2011 paper [1] explored critical incidents relating to the malfunction or misuse of anaesthetic equipment as reported to the National Reporting and Learning System for England and Wales between 2006 and 2008. Of 1,029 reported incidents, sudden ventilator failure during anaesthesia accounted for 142 (13.8%) of cases. All of these machines were reported to have previously passed machine checks. There was one case in which a partially used bag of intravenous fluids had been placed on the machine surface and then leaked into the machine causing ventilator failure and a ‘smell of burning’. There were no instances in which prior fluid contamination was later identified as a cause for ventilator failure.

As a result of these incidents, strict guidance has been issued in our department to ensure that opened bags of fluids (and drinks) are not placed on the anaesthetic machines. The majority of our colleagues were not aware of this as a cause of ventilator failure and we would like to make sure that others using these machines are also aware.

Natasha constandinou CT2 Anaesthetics

rony cherian Specialty Doctor in Anaesthetics

lucy evans Consultant Anaesthetist

Princess Alexandra Hospital, Harlow

Reference1. Cassidy CJ, Smith A, Arnot-Smith J. Critical incident reports concerning

anaesthetic equipment: analysis of the UK National Reporting and Learning System (NRLS) data from 2006-2008. Anaesthesia 2011; 66: 879–88.

Dear Editorcoring of rubber ‘stoppers’ #1

We wish to highlight a potential risk posed by the inadvertent shearing-off and aspiration of a rubber core of various medication vials. We used a 20 ml syringe and a 17G white needle to pierce the rubber seal of a 100 ml bottle of IV paracetamol in order to inject it via a 3-way tap on an IV line. On inspecting the syringe contents, a small fragment of rubber was noted (Figure 1). The contents were discarded, and paracetamol was instead administered via a giving set connected to the 3-way tap.

The issue of ‘coring’ has been studied in the past, with one report describing the incidence as high as 29% with blunt needles and 4% with sharp, bevelled needles [1]. The incidence of core fragment embolisation is unclear, but reported complications range from local tissue granulomas to pulmonary infarction and death [2,3]. Anaphylaxis and infection may also be potential risks. Riess and Strong reported a case where a cored piece of rubber stopper obstructed an infusion of propofol during total intravenous anaesthesia, requiring the immediate insertion of another IV cannula [4].

The piercing of rubber vials for the aspiration and reconstitution of medications is part of our daily practice. It would seem prudent to minimise subsequent needle aspiration whenever possible by using a dedicated giving-set or anti-coring ‘spike’, particularly when drawing up opaque medications such as propofol. Whichever method is used, it is advisable to check for rubber fragments before injection.

Tom Yeoman & Mike scanlan Chesterfield Royal Hospital

References1. Wani T, Govinda R, Wadhwa A. Studying incidence of coring in anesthesia practice and

difference between blunt and sharp needles. Anesthesiology 2008; 109: A368.2. Lehr HA, Brunner J, Rangoonwala R, Kirkpatrick CJ. Particulate matter contamination

of intravenous antibiotics aggravates loss of functional capillary density in postischemic striated muscle. American Journal of Respiratory and Critical Care Medicine 2002; 165: 514–20.

3. Kirkpatrick CJ, Lehr HA, Otto M, et al. Clinical implications of circulating particulate contamination of parenteral injections: a review. Critical Care & Shock 1999; 4: 166–73.

4. Riess ML, Strong T. Near-embolization of a rubber core from a propofol vial. Anesthesia & Analgesia 2008; 106: 1020–1.

Dear Editorcoring of rubber ‘stoppers’ #2

Drs Topor and Collins highlighted the importance of using the filter needle for drawing up propofol in order to avoid the formation of air bubbles [1]. Another potential problem in using a blunt needle is that at times the needle pierces through the rubber cap in such a way that small rubber pieces gets stuck in the lumen of the needle and become a foreign body in the injectate. While it is mandatory to look for a clear solution before injecting any drug, these particles may not always be seen propofol emulsion. Thus, there is another advantage of using a filter needle for drawing up propofol, or any other drugs from vials, to avoid this potential but serious problem.

VK MahadevanNorth Tees and Hartlepool NHS Trust

Reference1. Topor B, Collins S. Propofol, the ‘aero’ effect and filter needles. Anaesthesia News 2015;

330: 25.

Figure 1. Syringe of IV paracetamol with core of rubber (circled)

Figure 1. Switch to choose manual or mechanical ventilation

Figure 1. Syringe of clear injectate with core of rubber (circled)


review of an online resource

Combat Anesthesia: The First 24 Hours

Elsewhere, in the organisations no longer receiving these patients on a regular basis, both institutional and personal memories of regular trauma laparotomies and complex neuroprotection strategies have faded. Without numbers, remaining polished is impossible. Besides, these hospitals have their own areas of expertise to deliver and govern.

That said, we are all expected to deal with whatever pathophysiology comes through the door. Like a mythical creature respected by those who remember and feared by those who don’t, a complex major trauma patient arrives at the ’wrong’ hospital. A team is mobilised that has to stabilise, image and transfer a patient they are not used to handling on a daily basis. The responsibilities weigh heavily on the shoulders of emergency department, anaesthetic, intensive care and surgical specialties.

Trauma training is difficult, even for the staff at major trauma centres. Often an individual must cradle a personal interest to drive formal learning and CPD. So how can the ‘casual’ major trauma practitioner stay current and enter these unfamiliar situations with background knowledge to support clinical decision-making? Fortunately, there are many free and open resources online. These are often signposted by social media and exist in a wide variety of formats. They are written by pre-hospital and trauma specialists and include (dare I say it?) blogs, vlogs, websites, forums and live presentation and conference screenings. More recently, organisations themselves have started to publicise online resources. To mention ATACC, Sydney HEMS and various regional trauma networks (a favourite is the West Yorkshire MTN) is just scratching the surface. Local and national guidelines and standard operating procedures are easy to find and most websites provide links to recommended resources, the emphasis being on sharing knowledge and ideas. Checklists are bandied around and new equipment is critiqued. The latest evidence is analysed and discussed in great depth and dogma is reassessed. Bad or wrong information is rapidly highlighted by the hyperactive ‘Twitterati’, providing an immediate and comprehensive form of peer review. The significant numbers involved alongside the presence of real experts with large followings and open minds mean that the unsupported, inaccurate or just plain self-publicising minority are sufficiently diluted to render discussions extremely meaningful.

So, via social media and a senior colleague (the AAGBI President), this magnificent resource came across our desk(top). Entitled Combat Anesthesia: The First 24 hours, it is broken down into separate PDFs available to download for free. It is published by the Office of The Surgeon General Department of the US Army and the US Army Medical Department Center and School. This gives the impression that it might be very US oriented but from one of the very first pages, which reveals a sketch of British Army medical personnel in a British helicopter, you can feel the influence of Colonel Peter F. Mahoney of the Royal Army Medical Corps. His co-editor, Colonel Chester Buckenmaier III, is a serving Colonel in the US Army Medical Corps.

Another excusable misconception is that the content is specific to combat casualties but almost all of the information is transferable to the civilian setting. This huge resource covers the background pathophysiology of trauma, anatomically categorised specific advice on dealing with an injured patient including team preparation, the role of pain, necessary equipment, critical care (including transfer and intensive care) and it finishes with some special circumstances such as the obstetric trauma patient. It is comprehensive – the reference list is a resource in its own right – and it is a mammoth task to read it in its entirety, but that is neither the purpose nor a useful undertaking. Easy to navigate, it guides the reader to relevant sections.

Topics are as far reaching and specific as: how to secure epidural catheters and endotracheal tubes for transfer; ventilator settings for chest wall trauma; how and when to intubate burns patients; multimodal analgesia for specific injury patterns; and the differential diagnosis of fever in the trauma patient.

The style is typically matter of fact and the text is accompanied by useful tables, diagrams (including photographs of interest such as equipment and injuries) and exhibits that summarise and organise the information. The arguments are balanced when areas of potential controversy are covered. For example, all the pros and cons are considered when discussing the use of regional anaesthetic techniques for limb injuries and available evidence is provided. No group of specialists is over-represented.

On occasion the text can be battlefield specific. Some topics are peppered with titbits regarding care-under-fire and semi-permissive environments which are clearly not relevant for (most) UK hospitals. The discussion of terrorism and patterns of injury in mass casualty blast scenarios however, are increasingly relevant to certain regions.

Is it the answer to all our trauma teaching needs? No, of course not. Can we use it as a useful adjunct to our learning? Yes, most definitely. There is some content for everyone, irrespective of the speciality you or your hospital focus on. If you want to perfect your trauma transfer technique because your on-calls are dominated by head injuries or you just want to do some background reading on pain physiology, you could do worse than to start here.

Matthew harry ThompsonCT2 Anaesthetics, Imperial School of Anaesthesia, London

helgi JohannssonConsultant Anaesthetist, St Mary’s Hospital, Paddington, London

www.cs.amedd.army.mil/borden/ Portlet.aspx?id=4f129d5e-973b-48d9-9fb1-514e6daf90e6

The centralisation of major trauma services in the UK has resulted in a few hospitals becoming very proficient at dealing with complex trauma. Establishing set pathways enables patients to smoothly transition from the Emergency Department to the operating theatre or radiology suite. Specialist trauma Intensive Care Units and local rehabilitation capabilities have matured and vastly experienced personnel are emerging. The multidisciplinary trauma team has becoming slick and the body of knowledge is growing. Associated pre-hospital services are receiving coordinated feedback and can improve their standard operating practices in an evidence-based fashion. It’s a sexy area of medicine that receives lots of media and charity attention.


XXXth Edinburgh Anaesthesia FESTIVAL

eafest.org

17th-19th AUGUST 2016@ EDINBURGH INTERNATIONAL CONFERENCE CENTRE EICC

Registration:1 day: Early Bird* £165 Trainee/Retiree £85 Standard £1853 days: Early Bird* £475 Trainee/Retiree £250 Standard £515Conference Dinner on 18th August: £50 ppn (3 courses inc drinks)

*Early Bird - Payment required before Monday 30th May 2016

The Edinburgh Anaesthesia Festival is organised by Edinburgh Anaesthesia Research and Education Fund, Charity Registration No: SC002854

[email protected] 07731 823 289

Keynote Speakers:

Prof. Nicolai Bang-Foss (Copenhagen)Prof. Robert Hahn (Södertälje)Prof. Colin McCartney (Ottawa)Dr. Anna-Marie Rollin MBE (London)Prof. Herbert Schöchl (Salzburg)Prof. Tim Walsh (Edinburgh)

15 CPD points applied for

Join 300 delegates and watch local, national & international speakers delivering topical lectures on a wide variety of anaesthesia, intensive care & pain medicine related subjects over 3 days

30th Anniversary


Integrated Academic Training was set up by the NIHR as a response to the falling number of trainees in all specialities pursuing an academic career. It has a number of strands, from Academic Foundation Programme posts for four months during a new doctor’s first few years in practice to Clinical Lecturer posts to support those more experienced both clinically and academically

The Academic Clinical Fellowships are three-year programmes comprising 25% research and 75% clinical time. Since the inception of the programme in the Bristol school, applicants have completed the programme during the ST3–5 years. Last year an ACF in Intensive Care Medicine was appointed in the region for the first time – one of the first outside of London. The Academic Clinical Fellowships are three-year programmes comprising 25% research and 75% clinical time. Since the inception of the programme in the Bristol school, applicants have completed the programme during the ST3–5 years. Last year an ACF in Intensive Care Medicine was appointed in the region for the first time – one of the first outside of London. This year, applications for our ACF are also being accepted for CT1/2 level - two new ACFs have recently been appointed from a competitive field at core trainee level for the first time. Also this year, we are offering academic foundation positions in anaesthesia to pick up trainees straight out of medical school. Another important change in the past year is the requirement to complete the application and be appointable for both the ACF job and normal specialty anaesthetic job (whether at CT1 or ST3).The ST3–5 clinical training programme for academic trainees has been designed by the Bristol School of Anaesthesia to allow competencies to be obtained quickly and efficiently so that in-programme time in research does not interfere excessively with clinical training, and so that the academic time can be pursued without distraction from the need to complete modules of training.

The programme has been set out as follows:

sT3: full time clinical training with accelerated modules (two months each instead of three months) for obstetrics, paediatrics and cardiothoracics. During this time, you find a supervisor and research project with the support of the Deanery, the Bristol School of Anaesthesia and the wealth of established research networks here. In many deaneries, projects are already organised and you are simply allocated to them. However, in Severn, there is a real opportunity to follow your own research interests. This is a tough year as you are also expected to take the final FRCA but it is manageable with only a small degree of lurking in theatre corridors to get assessments/books signed off!

sT4: The first half of the year involves a day a week of time out of clinical to start developing your project. The second half of the year is full time academic work with no clinical commitments to allow time to gather pilot data, develop a dangerous addiction to caffeine and start thinking about PhD fellowship applications if academia agrees with you!

sT5: Back to a day a week of research – the stage people reach here varies and can involve writing up of projects, grant applications or even starting PhD fellowships. ACF is completed at the end of ST5, and trainees completing the programme will either take time out of their clinical training to pursue study for a higher research degree or slot back into normal clinical training at ST6.

Despite occasionally being viewed as slight oddities by rota coordinators and some colleagues (‘what’s this academic stuff again and why are you doing it?!’), four of us have now embarked on and two graduated from the scheme. This in itself is testament to the

support we have received as trainees and the understanding shown as we have rotated through the subspecialties in the region. Here’s a little summary of what we’ve been up to, what we’ve achieved, and how our experiences have differed.Martin: I came to Bristol with an interest in the interaction between basic molecular biology, and translation of cardiovascular science into clinical practice. I’ve formed a link with Professor MS Suleiman at the Bristol Heart Institute, where I’ve set up a project looking at developmental changes in the heart as it ages towards adulthood, and in particular the changing roles of intracellular signalling during development. This work has been supported both by the Above and Beyond charitable funds of University Hospitals Bristol, as well as the National Institute for Academic Anaesthesia and Association of Paediatric Anaesthetists. This pilot work has enabled me to develop a further project looking at novel signalling cascades in the neonatal heart and their potential for protecting the paediatric heart undergoing surgery, which I’ll be looking at during my PhD supported by the Medical Research Council who have awarded me a Clinical Research Training Fellowship.

Katrina: After CT2, I took a year out to do an MSc in Human & Applied Physiology in London. I then decided to head back to my roots in the south west. At the beginning of ST3, I found the Cardionomics research group at the Bristol Heart Institute. I have been lucky enough to combine my research interests in cardiovascular physiology and the role of the carotid body in autonomic diseases. I approached Professor Julian Paton and with the help of the research group have successfully set up and started my project, using mild hypoxia and IV dopamine to assess carotid body chemosensitivity in hypertensives during exercise (don’t worry the study does have ethics approval!). Earlier this year, I was awarded a grant from the David Telling Trust to purchase cardiopulmonary exercise testing

equipment for this study. Actually acquiring the equipment through NHS procurement has been an ‘interesting’ process at times but plenty of lessons learned! I am now applying for funding for a PhD looking at improving exercise tolerance in heart failure patients via a novel ATP-receptor pathway. I’ve also been involved in public engagement in science events for the Pint of Science Festival and Bristol Science Café, which has been great. The ACF has been a brilliant opportunity to do research in a supported environment while developing clinically and gaining other research skills such as grant writing, setting up a study, applying for ethics approval, data analysis, critical appraisal, and project management. There are of course plenty of ups and downs to research but as Albert Einstein once said: ’If we knew what it was we were doing, it would not be called research, would it?’

Useful resources• Academic Clinical Fellow in Anaesthetics. http://anaesthesia.

severndeanery.nhs.uk/recruitment/vacancies/show/academic-clinical-fellow-in-anaesthetics

• NIHR Academic Clinical Fellowships. http://www.nihr.ac.uk/funding/academic-clinical-fellowships.htm

Academic training in anaesthesia, what’s it all about?Now that the Nihr Academic clinical fellowships (Acfs) in Anaesthesia have been up and running for four years in the severn deanery, we thought it was time for an update on the scheme and changes to the application process.

dr Martin lewis MRC Clinical Research Training Fellow, University Hospitals Bristol

dr Katrina hope ST5 Registrar & Academic Clinical Fellow in Anaesthesia, University Hospitals Bristol


Acronyms. Don’t you just love them? My appraiser told me I needed to get more CPD. I saw a film once where a doctor played by Harrison Ford had to hide from the CPD. I doubt if it’s the same thing though, it’ll be different in Chicago. I know. It’s me. If my career was a long haul flight, I’m now at the stage of headbanging frustration at not being allowed to undo the seat belt in anticipation of the surge of intolerance towards my fellow travellers caused by not being able to stand up or get to my bag. I don’t know why the urge is so strong just to queue in an agitated, sweaty, squashed fashion breathing hot recycled, oxygen depleted, virally enhanced air for an interminable length of time before the door opens and the prospect of relief swells the heart, but it is. Finally I will be able to jostle inch by inch, elbow by leaden stare, towards the steps down to retirement. I will then turn and try to fight my way back on to the plane only to be swept away by the tide of smart, keen young things.

I’ve just been to the AAGBI’s fabulous Winter Scientific Holiday in London. I made a brave attempt to confront my ignorance by attending a session on LTFT working. It took them a while to get the point across but I hung in and got it eventually. They meant part-time working. Something my colleagues think I’m rather adept at as it happens. I got out my fancy phone (iswear I can hear it laughing) turned on the app (see how I’m down with the kids...) and began the process of typing and retyping and... well, you’re with me. When at last this supposedly convenient way of recording my

reflections was done I looked up to discover I was in Groundhog Day. They were still banging on about part-time working although it now seemed to have yet another new acronym, LGBTI. Again it took a while for the penny to drop. Not the same topic at all! This was one of those sessions by a Londoner for a Londoner, this time about public transport presumably. Oh the joys of Scottish rural living!

The previous night’s dinner had been uncommonly good. I’d not been up that late since I was a senior registrar. And I suppose I’m just not used to the weight of all that kilt and caboodle as I was still a bit tired. When I awoke from my dream – Susan Calman and Sandy Toksvig had been teaching me jokes – Prof. Eminent was droning on about some poor devil who’d been wide awake during one of his lectures. Astonishingly this too had an acronym: AAGA. That Mary Berry gets everywhere. The Professor went on to advise using various techniques and gizmos to avoid this AAGA. I know this from the AAGBI’s helpful lecture abstracts booklet – because whatever the techniques and gizmos are, they don’t work. Unlike the poor devil though, I didn’t get PTSD. Whatever that is – it’s not in the abstract.

The next conundrum – I do like Countdown – was supplied by the haematologists. Idarucizumab. You’ve got to be kidding me - 12 letters! Try as I might I couldn’t work that one out.

Another lecture was on 'The Second Victim'. Where I work this is just the second patient on the list but no – ah ha, post traumatic stress disorder! Got it. Apparently a bottle of Jacob’s Creek after one’s trauma list is not the answer and can lead on to GMC – which is one I have seen before. It’s revolting or something. Revalidation, that’s it! I had that once too. Never again though, or at least that’s what my appraiser said.

There was a talk about acid-base balance but I can’t stand modern music so I went instead to one about NAP6 – more my cup of tea. This was disappointing in that it was far too exciting to get any actual sleeping done. I may even have learned something – apparently Lucozade is a good second line choice in anaphylaxis. Next I learned that apparently we have to start telling patients about risks and choices and such. Good grief! All this is due to some learned judge in Lanarkshire. What a palaver. However it may give me a last chance to contribute nationally to UK anaesthesia. Sooner rather than later, I’m bound to supply the Law Lords with an opportunity to reconsider this preposterous decision. On the other hand they do make a good point and when you think about it, by the time I’ve explained everything properly there will be no time left, I can just go home again and another life will have been saved.

Roll on Birmingham in September!

Or, Idarucizumab vs. omgntanthracrnymBloggadder returns

Lectures from WSM London 2016 available online now!

Go to www.aagbi.org/education and use Learn@AAGBI for your reflections at our meetings, and for your ongoing CPD and exam preparation.

MOBILE RESPONSIVE SITE

AUDIO WITH SLIDES ON MOBILE DEVICES

ARCHIVE FACILITY

NEW NEW NEW

Step-by-step guide available from www.aagbi.org/stepbystepguide

EXCLUSIVE AAGBI MEMBER BENEFIT

@learnatAAGBiTweet with #GAT2012

The AAGBI makes videos from its three major annual conferences (Winter Scientific Meeting in January, GAT Annual Scientific Meeting in May/June, and Annual Congress in September) available online on Learn@AAGBI as a powerful educational resource. The AAGBI has a rigorous Quality Assurance process that includes on-site assessment by a member of Council. In addition, all videos are checked and undergo further Quality Assurance before being added to the Learn@AAGBI platform. The Education Committee is now seeking to appoint a Quality Assurance Panel, consisting of 15-20 members, to assist with this process. We anticipate 1-3 videos to review per Panel member during the few weeks following each conference, using a standardised assessment template. Training/support will be available as appropriate/required. Interested candidates must be AAGBI members and can be of any grade; they should have a clear interest in medical education. Applications should be by email to [email protected] and should include a brief (< 300 words) personal statement describing their suitability for the position. Appointment to the Panel is for one year renewable.

For further information please contact Professor Steve Yentis, Chair of the Education Committee, via [email protected]. The closing date for applications is 30th April 2016.

Panel of Quality Assurance assessors for Learn@AAGBI videos

Like most professional bodies, the AAGBI likes to acknowledge the contributions made by our predecessors, as any visitor to our headquarters in Portland Place can see from the portraits on the walls and the historical items in the cabinets. We currently award medals, awards and honours named after Magill, Snow, Featherstone and Pask (and someone – presumably an eminent anaesthetist – called ‘Anniversary’), while at our major conferences we have the Snow (Annual Congress), Pinkerton and Wylie (at alternate GAT Annual Scientific Meetings) eponymous lectures.

Pity the poor old Winter Scientific Meeting each January, then, without such a name to attach to a keynote lecture. In order to bring some consistency to events, we are therefore calling on the AAGBI membership to suggest a suitable name to attach to the WSM eponymous lecture, to be introduced from January 2017.

Please send your suggestions, with a brief explanation (maximum two sentences) of why he/she should be thus honoured. Please also consider whether other bodies already honour the person suggested; e.g. those honoured by the Royal College of Anaesthetists include Snow, Hewitt and Macintosh, and specialist societies may also have eponymous lectures – an existing honour associated with another body is not in itself a disqualifying feature, but this will be taken into account by the Education Committee when it makes its decision.

Please send your suggestions to [email protected]

The deadline for suggestions is 31 May 2016

GAT COMMITTEECALL FOR NOMINATIONS 2016

The Group of Anaesthetists in Training (GAT Committee) comprises elected trainees of all grades. We are a democratically elected body representing anaesthetic trainees at AAGBI committees, Royal College of Anaesthetists Trainee Committee and other national medical bodies. The GAT Committee also works on publications, seminars and the ever-popular Annual Scientific Meeting.

Nominations are now invited from trainee members of the Association wishing to stand for election. In 2016 there will be at least two seats available on the committee. Those standing for election will be expected to serve a minimum term of two years and be resident in the United Kingdom or Ireland. If elected, nominees agree to fulfil the duties and responsibilities required of them. Further information and nomination forms are available from the AAGBI Secretariat on 0207 631 1650 (option 3), by emailing [email protected] or can be downloaded from the AAGBI website (www.aagbi.org/gatcommittee).

All nominees should be proposed and seconded by other trainee members of the AAGBI and submitted to: GAT Committee, 21 Portland Place London W1B 1PY, by email to [email protected] or faxed to 020 7631 4352.

Closing date is Friday 08 April 2016 at 17:00.

Eponymous LecturesNominations are sought for these awards introduced in 2014:The AAGBI Award is awarded by the Board of Directors of the AAGBI to those who have made significant contributions to the AAGBI, its objects and goals, or its members. The award is not restricted to members of the AAGBI. The current objectives of the AAGBI are:• To advance and improve patient care and safety

in the field of anaesthesia and disciplines allied to anaesthesia.

• To promote and support education and research in anaesthesia, medical specialties allied to anaesthesia and science relevant to anaesthesia.

• To represent, protect, support and advance the interests of its members.

• To encourage and support worldwide co-operation between anaesthetists.

The AAGBI Foundation Award is awarded by the Board of Trustees of the AAGBI Foundation, the AAGBI’s charity, to those who have made significant contributions to the AAGBI Foundation, its objects and goals. The award is not restricted to members of the AAGBI. The current objectives of the AAGBI Foundation are:• The advancement of public education in and the

promotion of those branches of medical science concerned with anaesthesia, including its history.

• The promotion of study and research into anaesthesia and related sciences and the publication of the results of all such study and research.

• The advancement of patient care and safety in the field of anaesthesia and disciplines allied to anaesthesia in the UK, Ireland and anywhere else in the world.

Nominations should take the form of a short description of the nominee’s contributions (no more than one side of A4 paper*). Self-nomination is acceptable. If you nominate someone else, you should gain their approval for your nomination. The closing date for nominations, which should be sent to [email protected], is 16 May 2016.

The AAGBI’s Honours and Awards Committee will consider nominations at its meeting on 03 June 2016, and will make recommendations to the Board of Directors of the AAGBI and the Board of Trustees of the AAGBI Foundation, which will determine the recipients of the 2016 AAGBI Awards and AAGBI Foundation Awards at their meetings on that date. The successful nominees will be informed shortly afterwards. The awards will be made at the AAGBI’s Annual Congress in Birmingham (14-16 September 2016) or at WSM London 2017 (11-13 January 2017).

* Minimum font size = 12 pt

Call for nominations for the AAGBI Awards and AAGBI Foundation Awards

Nominations are sought for the AAGBI’s 2016 Featherstone Professorship, which is awarded to practising clinicians and scientists who have made a substantial contribution to anaesthesia and its related subspecialties in the fields of safety, education, research, innovation, international development, leadership, or a combination of these.

Nominations should take the form of an abbreviated curriculum vitae (no more than two sides of A4 paper*) and a description of the nominee’s contributions to anaesthesia or its related subspecialties (no more than one side of A4 paper*). Self-nomination is acceptable. If you nominate someone else, you should gain their approval for your nomination. The closing date for nominations, which should be sent to [email protected], is 16 May 2016.

The AAGBI’s Honours and Awards Committee will consider nominations at its meeting on 03 June 2016, and will make recommendations to the Board of Directors, which will determine the recipient of the 2016 Featherstone Professorship (if any) at its meeting on the same date. The successful nominee will be informed shortly afterwards. The award will be made at the AAGBI’s Annual Congress in Birmingham (14-16 September 2016).

Featherstone Professorships are held for two years, during which the holder will be required to deliver a Featherstone Oration at a major AAGBI meeting.

* Minimum font size = 12 pt

Call for nominations for the Featherstone Professorship

The Society for Obesity and Bariatric Anaesthesia presents

Key Issues in Anaesthesia for the Morbidly Obese

The SOBA One-Day Course

The first running this year of the ever-popular Key Issues course on how to anaesthetise the morbidly obese / bariatric patient:

• Online Booking is now available • Early Bird and Discounts £125 Standard Booking £150 • All bookings include lunch and refreshments

Topics Include:

Risk Assessment

Sleep Apnoea

Friday 27th May 2016

Venue: ROYAL COLLEGE OF PHYSICIANS, LONDON

Full details at: www.sobaconference.com 5 CPD points

approved

Ventilation & Airway Management

Metabolic Syndrome

Top Tips and Tricks

Lessons from Large Animal Anaesthesia..

The Society for Obesity and Bariatric Anaesthesia presents

Key Issues in Anaesthesia for the Morbidly Obese

The SOBA One-Day Course

The first running this year of the ever-popular Key Issues course on how to anaesthetise the morbidly obese / bariatric patient:

• Online Booking is now available • Early Bird and Discounts £125 Standard Booking £150 • All bookings include lunch and refreshments

Topics Include:

Risk Assessment

Sleep Apnoea

Friday 27th May 2016

Venue: ROYAL COLLEGE OF PHYSICIANS, LONDON

Full details at: www.sobaconference.com 5 CPD points

approved

Ventilation & Airway Management

Metabolic Syndrome

Top Tips and Tricks

Lessons from Large Animal Anaesthesia..

Par

ticl

es


Papachristofi O, Sharples LD, Mackay JH, Nashef SAM, Fletcher SN, Klein AA on behalf of the Association of Cardiothoracic Anaesthetists (ACTA)

The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery

Anaesthesia 2016; 71: 138–46

BackgroundSurgeon-specific mortality rates are published in the public domain for all cardiac surgeons in the UK (http://www.scts.org/patients/hospitals/). There has been longstanding debate about the impact of other members of the multidisciplinary team on mortality, in particular, the anaesthetist. Additionally, there is concern that anaesthetists with low caseloads may have poorer patient outcomes [1]. The impact of the cardiac anaesthetist was first correlated over 30 years ago, in an observational study by Slogoff and Keats [2]; this study highlighted intra-operative tachycardia as an important factor in patient myocardial outcome. There have been more recent studies but they have had significant limitations including inadequate sample size, their statistical modelling approach or the use of composite outcome measures [3,4]. For these reasons, the Association of Cardiothoracic Anaesthetists undertook a UK multicentre study to assess the impact of anaesthetists and their caseload on mortality following cardiac surgery.

MethodsAll 36 UK specialist cardiac centres were invited. Data were collected prospectively over ten years for participating centres. Consecutive cardiac cases were analysed using random-effects models that were capable of adjusting for the centre, surgeon and anaesthetist. The primary outcome was defined as in-hospital mortality up to three months postoperatively. The EuroSCORE controlled for case mix and gave a percentage for predicted mortality associated with cardiac surgery.

resultsTen of the 36 UK centres participated. Over the ten-year period 110,769 cardiac surgical procedures were analysed, accounting for 127 consultant surgeons and 190 consultant anaesthetists. The mean EuroSCORE was 7.4%. Patient risk was by far the most important determinant of outcome, accounting for 95.75% of mortality. While the surgeon accounted 4.00%, the anaesthetist had a random-effects variance of just 0.25%. After accounting for the surgeon there was no centre effect. Similarly if anaesthetists’ outcomes were corrected for surgeon then their contribution in variance mortality returned to baseline. The majority of anaesthetists (79%, 150/190) anaesthetised for over 50 operations each year. This study did not find a relationship between anaesthetic caseloads and mortality.

discussion To date this is by far the largest study assessing the impact of the anaesthetist on patient mortality. Importantly, it is the first study to use modelling to control for surgeons. The implication of these findings is that if the anaesthetist has little or no impact on mortality then publishing anaesthetist-specific mortality rates would likely be an unwise use of resources. Future studies may wish to investigate which patient morbidity outcomes are influenced by the anaesthetist to help inform adequate caseloads to maintain competence.

conclusionMortality following cardiac surgery is overwhelmingly determined by patient factors, with a small but significant influence from the operating surgeon. Importantly, anaesthetists have minimal, if any, impact on mortality associated with cardiac surgery.

hannah watsonCT2 ACCS Anaesthesia, South East Scotland Deanery

References 1. Papachristofi O, Mackay JH, Powell SJ, Nashef SAM, Sharples L. Impact of

the anesthesiologist and surgeon on cardiac surgical outcomes. Journal of Cardiothoracic and Vascular Anesthesia 2014; 28: 103-9.

2. Slogoff S, Keats AS. Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 1985; 62: 107-14.

3. Merry AF, Ramage MC, Whitlock RM, et al. First-time coronary artery bypass grafting: the anaesthetist as a risk factor. British Journal of Anaesthesia 1992; 68: 6-12.

4. Glance LG, Kellermann AL, Hannan El, et al. The impact of anesthesiologists on coronary artery bypass graft surgery outcomes. Anesthesia and Analgesia 2015; 120: 526-33.

Young P, Bailey M, Beasley R, et al.

effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care Unit. The sPliT randomized clinical TrialJournal of the American Medical Association 2015; 314: 1701–10

BackgroundIntravenous fluids are one of the most commonly prescribed interventions on the Intensive Care Unit (ICU). The recent 6S [1] and CHEST [2] trials demonstrated an association between colloids and increasing rates of acute kidney injury (AKI), resulting in a move away from colloids towards crystalloid solutions. Options include 0.9% (‘normal’) saline or balanced fluids such as compound sodium lactate (‘Hartmann’s’) or Plasma-lyte. The occurrence of hyperchloraemic metabolic acidosis following prolonged infusion of 0.9% saline is a well recognised and long debated phenomenon, the clinical significance of which is unclear [3]. This study was designed to investigate the hypothesis that this might contribute to the development of AKI.

MethodologyThis was a prospective, multicentre, blinded, cluster-randomised, double crossover trial conducted in four tertiary ICUs in New Zealand. All patients receiving crystalloid fluid therapy were eligible with consent presumed unless the patient or relatives opted out. Patients expected to require renal replacement therapy (RRT) within 6 hours or those already on RRT were excluded, as were patients admitted for organ retrieval or palliative care. The blinded study fluids were 0.9% saline (chloride content 154 mmol/l) and Plasma-Lyte 148 (chloride 98 mmol/l). The 28 week study period was divided into 7 week treatment blocks during which the study fluids were used on an alternating basis, such that by the end of the trial both fluids had been used in each ICU for two 7 week periods. The primary outcome was the proportion of patients with AKI as defined by the RIFLE criteria.

resultsIn total, 2092 patients (92% of those initially enrolled) completed the study and were included in the primary analysis. There was no statistically significant difference in development of AKI (9.6% Plasma-Lyte vs 9.2% saline), or in the secondary outcomes of requirement for RRT, duration of mechanical ventilation, ICU or hospital length of stay, ICU or hospital mortality.

discussionThe pragmatic study design and presumed consent allowed for the recruitment of a large number of patients, the majority of whom completed the study. The makeup of the study population differs markedly from that seen in the majority of UK ICUs and this limits the degree to which the findings can be generalised. Of the study population, 50% were elective admissions post cardiac surgery. Mean APACHE II score was 14 and the overall rate of AKI was less than 10%. The median volume of fluid given during the study period was just two litres and patients were discharged from ICU after an average of 1.5 days. The study hypothesis was that administration of saline causes a harmful hyperchloraemic acidosis, but serum chloride measurements were not reported.

conclusionUse of 0.9% saline vs balanced crystalloid solution conveys no higher risk of AKI or requirement for RRT in a group of predominantly postoperative patients receiving a modest volume of fluid. Further trials are needed to establish whether this holds true when using larger volumes of fluid in a more unwell population.

John raeST5 Anaesthesia/ICM

Ninewells Hospital, Dundee

References1. Perner A, Haase N, Guttormsen AB, et al. Hydroxyethyl starch 130/0.42

versus Ringer's acetate in severe sepsis. New England Journal of Medicine 2012; 367: 124–34.

2. Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. New England Journal of Medicine 2012; 367: 1901–11

3. Myburgh JA, Mythen MG. Resuscitation fluids. New England Journal of Medicine 2013; 369: 1243–51.

Abad-Gurumeta A, Ripollés-Melchor J, Casans-Francés R, et al.

A systematic review of sugammadex vs neostigmine for reversal of neuromuscular blockadeAnaesthesia 2015; 70: 1441–52

introductionThe importance of monitoring and reversing neuromuscular blockade has been highlighted in recent AAGBI guidelines [1].

Sugammadex has been shown to produce a more rapid and reliable reversal of neuromuscular blockade when compared to neostigmine [2]. Despite this, the role of sugammadex for the routine reversal of neuromuscular blockade is uncertain, with the cost of sugammadex being the primary stumbling block. The time and subsequent cost savings observed in clinical trials are yet to be reproduced in clinical practice [3].

Postoperative respiratory complications associated with residual neuromuscular blockade can result in significant morbidity and mortality. This review examined whether or not sugammadex was superior to neostigmine in reducing this risk.

MethodologyRandomised controlled trials (RCTs) comparing the reversal of neuromuscular blockade by either sugammadex or neostigmine were identified through searches of Embase, MEDLINE and CENTRAL. Studies that compared sugammadex to placebo, or combined sugammadex with neostigmine were excluded, as were those that compared different doses of sugammadex. The rates of postoperative residual paralysis and drug-related adverse events were measured as primary and secondary outcomes, respectively. Signs of residual paralysis included hypoxaemia after intervention, respiratory distress and non- or invasive ventilation. Trial sequential analysis determined the statistical significance in outcome between sugammadex and neostigmine.

resultsA total of 14 RCTs were included in the analysis. The signs of residual paralysis were reduced with sugammadex when compared to neostigmine. A reliable relative risk reduction of at least 50% was demonstrated. The rate of residual paralysis after neostigmine was 8.4 per 100 compared to 3.9 per 100 with sugammadex. To prevent 1 episode of residual paralysis, 22 patients would have to be given sugammadex rather than neostigmine.

The rates of postoperative nausea and vomiting were similar for the two reversal agents and sugammadex did not reduce the rate of residual paralysis requiring re-intubation.

discussionThe authors concluded that signs of residual paralysis were reduced when neuromuscular blockade was reversed with sugammadex rather than neostigmine. The apparent increased rate of side effects associated with neostigmine could not be proven due to a small study sample. Apart from nausea and vomiting, the authors did not specify the side effects they were comparing between the studies, which may have been useful to know.

conclusionDespite its limitations, this review goes some way to demonstrating the clinical benefits of sugammadex over neostigmine. It suggests that reducing the risk of postoperative respiratory complications associated with residual neuromuscular blockade could be achieved by using sugammadex instead of neostigmine.

If further research could demonstrate a reduction in life-threatening respiratory complications, a change in practice might occur that could transcend the current financial restrictions on the use of sugammadex.

Alastair duncanST6 Anaesthetics, on behalf of the North West Research & Audit Group (NWRAG)

References

1. Checketts MR, Alladi R, Ferguson, K et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2016; 71: 85–93.

2. Abrishami A, Ho J, Wong J, et al. Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade. Cochrane Database of Systematic Reviews 2009; 4: CD007362.

3. Paton F, Paulden M, Chambers D, et al. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. British Journal of Anaesthesia 2010; 105: 558–67.

ANNUAL SCIENTIFIC MEETING

Thurs 12 & Fri 13 May 2016

HULL

REGIONAL ANAESTHESIA UK

FOR MORE DETAILS, REGISTRATION OR ABSTRACT FORM, GO TO

www.ra-uk.org

CONTROVERSIES AND CONSENSUS IN REGIONAL ANAESTHESIA

Royal Hotel

SPECIALITY AND GENERIC RA WORKSHOPS

PROBLEM BASED LEARNING DISCUSSIONS

POSTER COMPETITION

CONFERENCE DINNER

2016

In assocation with

RCoA SUMMER SYMPOSIUM:Improving patient outcomes in anaesthesia and perioperative medicine

Sessions include: ■ Pushing the pre-operative

envelope: opportunities for testing and treatment

■ Risk, anaesthesia and surgical outcomes

■ Sugar, salt and water: where are we now?

■ Future Visions: how does it look?

■ Blood and blasts: what have we learnt?

■ Organisational factors: raising the bar to improve outcomes

■ Improving outcomes in specific high risk patient groups

7 June – 8 June 2016Hilton Brighton Metropole£395 (£295 for RCoA registered trainees)Event organisers: Dr C Carey

CPDCREDITS

10

The Royal College of Anaesthetists

For the 2016 Royal College of Anaesthetists Summer Symposium we have assembled a group of renowned national and international experts who will present on a wide range of subjects with a common theme of improving outcomes.

020 7092 1673 | [email protected] | www.rcoa.ac.uk/events |

The event will include: ■ Workshops ■ Abstract competition ■ Trade exhibitions ■ Social evening

an-APRIL16.indd 2 28/01/2016 16:50

Place your message here. For maximum impact, use two or three sentences.

Difficult Airway Day Thursday 16th June 2016

Stamford Court, Leicester

A one-day Symposium and Workshops for Anaesthetics Trainees, Career Grade and Consultants

Update on airway management – speaker TBC

Practical Sessions to Include: ORSIM bronchoscopy simulator - NEW FOR THIS YEAR

Ultrasound and the airway - NEW FOR THIS YEAR Nasal Fibreoptic Intubation

Oral Fibreoptic Intubation and Oxford Box Awake Fibreoptic Intubation

Simulation of airway scenarios Aintree Intubating Catheter (AIC) and

supraglottic devices Double lumen tube

Optimising position for laryngoscopy Video Laryngoscopes

Front of neck (FON) access to the airway (needle and surgical)

5 CPD points applied for to the Royal College of Anaesthetists

Registration fee: £160 inc. lunch and refreshments

Course Directors: Dr M Mushambi and Dr P Ali, Consultant Anaesthetists

For further details, please contact: Beckie Marriott, Operations Manager

Tel: 0116 258 5547

Email: [email protected]


your lettersSEND YOUR LETTERS TO:

The Editor, Anaesthesia News at [email protected] see instructions for authors on the AAGBI website

For the latest news and event information follow @AAGBI on Twitter

Dear EditorThe personal account in Anaesthesia News entitled ‘Reversal of non-depolarising neuromuscular blockade’[1] makes harrowing reading. The accompanying contribution by Grant Rodney is scholarly and interesting and makes good points. However there is a danger that we fail to see the wood for the trees on this topic. The crucial error is not residual paralysis, but discontinuing anaesthesia and ventilation when it is not recognised. The big question for me is not the doses of drugs, not the use or otherwise of neuromuscular monitoring but why this patient was left in the care of recovery staff without the simple tests of a sustained head lift and obeying the command to protrude the tongue. This is not only a failure to manage neuromuscular blockade to a high modern standard but also, and more importantly, a failure to use simple clinical skills that have been taught for at least the last 30 years.

Andrew skinner Consultant Anaesthetist, Middlesbrough

Reference1. Anonymous. Reversal of non-depolarising neuromuscular blockade [and

response]. Anaesthesia News 2016; 342: 10-11

Dear EditorWe read with interest the survey on smartphone use by anaesthetists performed Drs Conway and Guy [1]. The RCoA Census 2015, with data returned from 100% of departments, reported 11,010 anaesthetists in the UK and so we feel a response rate of 2.3% for this survey would be more accurate.

The authors correctly warn of the pitfalls of commercial software with a limited revenue stream leading to the product becoming obsolete. While a subscription may spread the income over a longer period of time, this model in itself will not prevent data loss and the method and format of backup is an essential factor to consider when choosing a logbook.

The growth and competition of commercially available anaesthetic logbooks has spurred welcome improvements in the field, especially with regards to user interface and experience. In order to assist fellows and members making an informed decision with whom to trust their data, the College has recently published some guidance on logbooks [2] and is considering them further as part of the Technology Strategy Review.

Jamie strachan ST6 in Anaesthesia and Intensive Care Medicine,

Oxford University Hospitals

Technology Strategy Fellow, RCoA

JP lomas Council Member, RCoA

References

1. Conway RM, Guy R. The BIG Anaesthetics and Smartphone Survey. Anaesthesia News 2016; 343: 7–8.

2. RCoA. Logbooks: Advice to trainees and trainers. July 2015. https://www.rcoa.ac.uk/sites/default/files/TRG-LOGBOOK-STMT2015.pdf (accessed 17/02/2016).

Dear Editor A novel way to practice loss of resistance technique!

As a core trainee, starting your obstetrics block and performing your first labour epidural can be a daunting task. The combination of a screaming patient and anxious partner watching expectantly while you attempt to site an epidural only serves to make it more nerve-wrecking. Everyone has experienced the hesitation in advancing the needle for the fear of causing an inadvertent dural puncture. It is extremely helpful to be able to practice the feel of the loss of resistance technique on a model/manikin before actually attempting it on a patient.

We have come up with a cheap, cheerful, effective and realistic way of practicing the feel of the loss of resistance technique – by using a potato! From our experience, we have felt that the potato feels like the ligamentum flavum. The loss of resistance that is felt when the Tuohy needle comes out at the other end of the potato, gives the same loss of resistance feeling when you have gone through the ligamentum flavum, i.e. your successful endpoint. You will need a buddy to hold the potato but a suitable holder for the potato can be developed.

Top tips: Use a potato of the firmer variety for best results. You can use the same potato a few times until it gets waterlogged.

Betadine was used in place of normal saline for the purpose of demonstration in the picture shown.

Yin Yong choo CT2 Anaesthetics, Preetam Tamhane,

Consultant Anaesthetist, Basildon University Hospital

Dear Editorlessons from pre-hospital care for in-hospital care

Having recently started a six month out of program training post (OOPT) with the Kent, Surrey and Sussex (KSS) Air Ambulance I was discussing with a paramedic colleague the differences between pre-hospital and in-hospital practice. We were immediately struck by a number of lessons that we believe have great relevance to in-hospital anaesthesia.

The esprit de corps of the institution we work for is second to none. This is achieved without the huge budget of a foundation trust. On our arrival we had personalised kit bags waiting for us full of pre-hospital goodies, like Christmas come early! Neither of us had encountered such high levels of enthusiasm and support on joining a new organisation. While we aren’t advocating a full set of personal protective equipment for all new anaesthetic trainees, how about a personalised mug or theatre cap? Low cost but priceless in terms of making people feel valued. The rigor of the pre-hospital induction process, the fastidious use and adherence to checklists and learning of standard operating procedures has been a challenging but sadly novel experience.

A flattened hierarchy comprising senior consultants in both anaesthesia and emergency medicine and top class paramedics lends itself to open and honest feedback and helps to minimise human factor errors. Being told what you’ve done wrong is actually a refreshing experience and a positive way to influence learning. Sadly in the hospital environment there seems to be an aversion to telling people how their practice could be improved. The doctor-paramedic relationship is vital and draws parallels with our own ODP-anaesthetist relationship. The levelheadedness and overarching scene awareness of an experienced pre-hospital paramedic compliments the added technical skills provided by a doctor, and ways of reinforcing this relationship are developed through training and regular governance days. Sadly I cannot recall going to any hospital audit or training days with joint involvement of ODPs and anaesthetists. I suspect I am not the only anaesthetist who has made this observation?

I will take away numerous lessons from my six month OOPT and would strongly advocate a pre-hospital post in any guise (either a subspecialty training post, OOPE or OOPT) to interested anaesthetic trainees. I can guarantee the skills learnt will be both unique and highly relevant to a consultant post in anaesthesia or critical care and will have an overarching and lasting effect on your clinical practice.

Major david hunt KSS HEMS SPR, Marden, Kent

Alan cowley KSS HEMS Paramedic, Marden, Kent

DATES FOR YOUR DIARY

Trainees

Trainees

CORE TOPICSEXETER

Friday 15 April 2016

Full programme available at www.aagbi.org/core-topics

Check availability and book online today www.aagbi.org/education

Core Topics prices£175 - AAGBI members£110 - AAGBI trainee members£87.50 - Retired members£240 - Non-membersAll meetings & seminars are held at 21 Portland Place,

London unless otherwise stated.

All AAGBI seminars are priced as listed below unless otherwise stated£145 - AAGBI members£95 - AAGBI trainee members

£72.50 - Retired members£285 - Non-members

CORE TOPICSWESSEX

Friday 07 October 2016


CORE TOPICSMANCHESTER

Friday 24 - Saturday 25 June 2016


Trainees

Special fees apply Trainees

Special fees apply

Ultrasound in obstetric anaesthesiaThursday 07 July 2016Organiser: Drs Nhathien Ngnuyen-Lu & Mubeen Khan, London

An introduction to obstetric regional anaesthesia for traineesTuesday 27 September 2016Organiser: Dr Sunil Halder, London

CORE TOPICSBELFAST

Tuesday 07 June 2016

Full programme available at www.aagbi.org/core-topicsOrganisers: Dr Nicholas Levy, Bury St Edmunds & Dr Bev Watson, Kings Lynn

APRIL 2016

AAGBI management & leadership courseMonday 18 – Tuesday 19 April 2016Organisers: Dr Jonathan Price, London & Dr Nancy Redfern, Newcastle Upon Tyne

Obstetric anaesthesia for the advanced traineeWednesday 20 April 2016Organiser: Dr Lynn Fenner, Bristol

Current topics in anaesthesia, pain and ICMMonday 25 April 2016Organiser: Dr Olivera Potparic, London

MAY 2016Trainee anaesthetists in the developing world: Where to go and how to organise it?Monday 23 May 2016 Organisers: Drs Melissa Dransfield & Francesca Mazzola, London

LTFT Matters 2016 Thursday 26 May 2016Organiser: Dr Emma Plunkett, Birmingham

JUNE 2016

Ultrasound in perioperative careWednesday 08 & Thursday 09 June 2016Organisers: Dr Atul Gaur, Leicester & Dr Vijay Kumar, Scunthorpe

AAGBI Scottish SeminarFriday 10 June 2016Organiser: Dr Gerry Keenan, EdinburghLocation: Radisson Blu, Edinburgh

Anaesthetists and the lawWednesday 22 June 2016Organiser: Prof Steve Yentis, London

JULY 2016

SEPTEMBER 2016

OCTOBER 2016

NOVEMBER 2016Peri-operative management of the surgical patient with diabetes mellitusMonday 14 November 2016

DECEMBER 2016Bleeding, clotting & haemorrhageThursday 08 December 2016Organiser: Dr Ravi Rao Baikady, London

EventsApril2016.indd 1 24/02/2016 10:39

14 -16 September 2016

ANNUAL CONGRESSBIRMINGHAM

BOOK NOW www.annualcongress.org

@AAGBIAAGBI1

European Accreditation Council

for Continuing Medical Education

(EACCME)applied for

Join your peers and the international anaesthesia community at this year’s AAGBI Annual Congress

Keynotes:Andy McCann, Performance Coach, DNA Definitive – Walking the tightrope: dynamic resilience in actionProfessor Alistair Burns, Manchester – Dementia: a challenge for everyoneProfessor Paul Myles, Melbourne – Quality of recovery and disability-free survival Plus, scientific topics, practical workshops, social events and more!

BOOK NOWEARLY BIRD DISCOUNTSFOR AAGBI MEMBERS

AC2016_ANews.indd 1 26/02/2016 09:22

Documents

AAGBI Council/Board Elections 2016 Lifeboxes for Rio - The story