Anaesthesia News - AAGBI · Anaesthesia News No. 261 April 2009 ... 30 Reverification is the new revalida-tion ... One of the first questions colleagues ask

The Newsletter of the Association of Anaesthetists of Great Britain and Ireland ISSN 0959-2962

AnaesthesiaNews No. 261 April 2009

Anaesthesia News April 2009 Issue 261 1

21 Portland Place, London W1B 1PY, Tel: 020 7631 1650, Fax: 020 7631 4352, Email: [email protected], Website: www.aagbi.org

Anaesthesia publishes “virtual” safety issue

The AAGBI Foundation is officially

launched

Cycling for anaesthetists

2 Anaesthesia News April 2009 Issue 261

Contents03 Your Association needs you!

05 Reflections of a road cyclist – Lands End to John O’Groats

07 Editorial: The end is nigh....

09 President's Report

10 AAGBI Member’s landscape photography exhibition

13 GAT Page: European Working Time Directive (EWTD): Countdown to August 2009

16 History Page: A fire to be ignited? Teaching the History of Anaesthesia to

Ten Year olds

18 The launch of the AAGBI Foundation

20 Safety Page: Safety and Human Factors - The first Virtual Edition of Anaesthesia

22 WSM London Awards Ceremony

25 Specialist Society Page: The Neuroanaesthesia Society of Great Britain and Ireland (NASGBI)

27 News from the WFSA

28 Dear Editor…

30 Reverification is the new revalida-tion – more changes in GMC plans

32 Scoop

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 NewsEditor: Hilary AitkenDeputy Editor: Val BythellAssistant Editors: Mike Wee and Isabeau WalkerAdvertising: Claire Elliott

Design: Amanda McCormickMcCormick Creative Ltd, Telephone: 01536 414682Email: [email protected]: C.O.S Printers PTE Ltd – SingaporeEmail: [email protected]

Copyright 2009 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.

Advertisements are accepted in good faith. Readers are reminded that Anaesthesia News cannot be held responsible in any way for the quality or correctness of products or services offered in advertisements.


Your AssociAtion

needs You!I’d been warned but despite this, I fell for

it. The editor of this esteemed newsletter

trapped me over lunch one Friday, made

some flattering remarks and before I

knew it, I had been hooked and reeled

in, having agreed to write something for

Anaesthesia News about being the new

boy on Council.

It all began last June while I was fighting

a losing battle against the ferocious

weeds that have invaded our garden

(never my favourite pastime), when

the wife announced that the President

wished to speak to me. Not knowing

many Presidents, I thought it might be

one of my mates, or worse, someone

from the Dead Ringers team, trying to

pass themselves off as George W. It got

worse. The voice on the other end of the

phone (mercifully not a Southern drawl)

was telling me that I’d been elected to

the Council of the Association – it had

to be one of my mates taking the p….

When I finally overcame my disbelief and

returned to my chores the weeds never

stood a chance.

So, what is it like being the newbie on

Council? The first thing to say is that it’s a

steep learning curve, and I’m still trying to find my feet and minding my p’s and q’s. Part of the learning is finding out more about what the Association actually does. Despite being a member for ……oh a long time, my understanding of what the Association actually does was, I now realise, limited. I knew that it put on some good annual meetings (which gave an opportunity to network with distant colleagues, have a slap up black tie dinner and pick up the necessary CPD points), produced an excellent anaesthetic journal (some would say the best - but I’m biased), and every now and then a “glossy” would come through the letterbox which I could use to convince managers that we needed more widgets or to do things differently and better. However, I now know that there is a lot more to what the Association does.

First, there are the meetings. In addition to the Annual Congress and Winter Scientific Meeting, I hadn’t appreciated how the seminar programme held in 21 Portland Place has gone from strength to strength, with 39 well-subscribed meetings last year and 44 planned for this year. A new venture was initiated last year

of Core Topics meetings which are held in a number of centres around the country. These one day meetings with stimulating programmes and excellent speakers bring CPD closer to the workplace, reducing travel time and expenses - important when study leave budgets are becoming increasingly squeezed.

Then there’s the groundbreaking work that the Association is doing on improving anaesthetic safety. In addition to publishing glossies, many of which deal with safety issues, there are regular sessions devoted to safety issues at educational meetings and close cooperation on the safety agenda with other agencies such as industry through Barema, the National Patient Safety Agency and the Royal College of Anaesthetists.

Through the National Institute of Academic Anaesthesia the Association is contributing £1 million over the next 5 years to help fund important anaesthetic research.

The International Relations Committee of the Association sponsors overseas anaesthetists and provides educational material and books for anaesthetic practitioners in developing countries. We take oximetry for granted but in many countries, monitoring is yet to progress from a finger on the pulse. The Global Oximetry (GO) project seeks to increase the use of oximetry in developing countries not just by providing equipment but also by delivering a package of education and training so that it can be used safely and effectively.

There are some exciting new developments, which have either been or are soon to be publicised in Anaesthesia News. I was quickly roped in to help with the production of podcasts which are being rolled out via the website and are intended to be a useful source of education and to contribute to CPD. To date, several podcasts have been produced where so called “experts” give their views on tricky medical ethics problems and difficult obstetric anaesthetic cases. These are available on the website, with further ones on regional anaesthesia in the pipeline.

In response to our increasing reliance on electronic communication and educational material, plans are afoot to modernise and improve the current website and increase the resources available to the benefit of members. No doubt, details of what is planned will appear in Anaesthesia News in the near future.

What of the Council meetings themselves? One thing that has struck me is how Council members and officers of the Association are keenly aware of their responsibility to the membership. During discussion on all sorts of topics, a constant question raised is “what would the members think or want?” This acts as a constant reminder that Council members always have a duty and responsibility to act on the members’ behalf.

One of the first questions colleagues ask about my involvement with the AAGBI is how much of my time do I need to spend in London? Every two months there is a Council meeting on Friday afternoon coupled with either Finance or Advisory meetings in the morning, which members of Council are expected to attend. In addition, Council members are usually allocated to several sub-committees; in my case, the Events and Seminars Committee (overseeing the programme and organisation of educational meetings), the International Relations Committee and the Editorial Board of Anaesthesia. These sub committees usually only need to meet two or three times per year, once again on a Friday, though much of the work between meetings is conducted by e-mail. Thus, in the first six months of my four year term as an elected Council member, I have needed to attend meetings at 21 Portland Place about once or sometimes twice per month. As most, if not all, meeting occur on a Friday, it is helpful to re arrange your job plan such that Friday is free of clinical sessions to help maintain a full clinical commitment to your Trust and keep your Clinical Director sweet.

Before my first council meeting, I was told that it would be preceded by a “sleepover”. Visions of giggling American teenagers

wearing pink pyjamas, practising with makeup, eating chocolates and watching videos ‘til the early hours flashed through my mind. But I was reassured that it simply meant meeting late on Thursday afternoon for an informal brain storming (or should it more correctly be called a “thought shower”?) to discuss important topics in a less formal setting the evening before the Council meeting. Sleepovers are held throughout the year before three of the six Council meetings.

What of my remaining time on Council? I expect my involvement will steadily increase as I become involved in working parties and contribute more to the work of the sub committees.

April sees the Association’s call for nominations to stand for election to Council. I have found the experience of my first six months both extremely enjoyable and rewarding. I would therefore urge all members to consider whether you are prepared to put your head above the parapet and allow your name to go forward for election as the Association is in constant need of new cannon fodder, I mean valiant new soldiers to fight the good cause for the specialty of Anaesthesia and serve on its Council.

Paul ClyburnAAGBI Council Member



What is it about anaesthetists and the great outdoors? Every department seems to have more than its fair share of fitness freaks addicted to windsurfing, rock-climbing, triathlon* etc. This love of fresh air seems to run so strongly within the specialty that prospective candidates attending interview for a career in anaesthesia may be well advised to dismiss the standard dress code - instead an outfit consisting of cycling

helmet, wetsuit, skis and a canoe paddle held casually in hand is sure to send the message that you’re made of the right stuff for a career in gassing.

In particular, road cycling seems to be particularly popular among the anaesthetic fraternity – no morning department meeting seems complete without a sweaty, lycra-clad contingent. Our surgical colleagues

may suggest that a pastime involving sitting down all day doing something monotonous, repetitive and boring should naturally appeal to us. In reality road cycling is a great way of satisfying a competitive edge, a love of fancy monitors and shiny, lightweight kit and, for some, testing your physiology to the limit.

In early 2008, as a novice “roadie” I accepted an invitation, with unusual enthusiasm, to cycle from Land’s End to John O’Groats for charity, in just over eight days. Pasties in Cornwall, cream teas in Devon and so on – what could be better? This level of ignorance would not serve me well in the months that followed. The other doctors on this cycling expedition were already experienced roadies; well capable of cycling, teleconferencing, eating a banana and changing bib-shorts all at the same time. I had a lot of training to do.

The subsequent weeks and training miles flew by and in late June I set out from Land’s End with much trepidation as part of team “Mostly Medics”. Progress on what was predicted to be the toughest day through Cornwall was initially steady and reassuring. Then things went downhill, or rather uphill, down hill, uphill and so on for the rest of the day accompanied by freezing rain and headwinds. These were problems I had anticipated when planning to average over 100 miles a day from one

* Note to any reading orthopods – this is the discipline that consists of cycling, swimming and running, not starter, main and pud.

Reflections of a road cyclist – Lands End to John

O’Groats


end of the island to the other but others I was less prepared for. Knee, hip and back pain meant that most of us were soon on at least step 2 of the WHO analgesic ladder and by day 3 severe saddle-sores required application of nappy-rash cream to parts of my anatomy that are too indecent to print. Having to cram in the thousands of calories meant I was almost constantly eating and never hungry for eight days. In addition spending all day, every day on a bike with a constant time pressure to meet targets added a mental dimension to the challenge and our morale frequently suffered.

In contrast to this there were, of course, incredible high points. The miles constantly ticked down and every county boundary served as a boost. The generosity we encountered along the route was

remarkable and on the rare occasions when the sun shone we were treated to some of the finest scenery Britain has to offer – the northern Lake District and Scottish Highlands being particularly memorable. On finally reaching John O’Groats we were elated and relieved in equal measure. The £6,800 we raised for The Cystic Fibrosis and Jessie May Trusts underlined our sense of achievement. A massive thank you goes to all who sponsored us.

However we could not have managed this without assistance and therefore a special mention must go to the Mostly Medics Support Team. This highly specialised unit of amateur sports administrators, psychologists and dieticians (i.e. our friend Charlotte, my wife and mother-in-law!) worked tirelessly over the trip

and maintained a constant supply of Mrs Carey’s Special Homemade Flapjack – the best kept secret in the sports nutrition world.

So if you’re not already a cyclist then why not tackle that middle age spread head on and give it a go. There are many benefits; meet new friends, raise a few quid for charity or cycle to work to do your bit for the planet and get fit at the same time – potentially even become your department’s all-time CPET champion!

In short, get on your bike!Anthony Carey

ST3 AnaesthesiaFrenchay Hospital, Bristol


The end is nigh....

Editorial

Like all Council posts, the Anaesthesia News editor has a defined term of office, which is three years. And I am on the home straight... During the summer, there will be a seamless (we hope) transition to the new editor, whom I can now reveal officially will be Val Bythell. I am delighted Val has agreed to take on the newsletter, and am confident it will be in safe hands for the next few years.

We recently had one of the “sleepover” discussions Paul Clyburn mentions in his article on P3 about how to move Anaesthesia News forward, and have come up with lots of new ideas and features, some of which will start to appear during the next few months as I bow out, and some will arrive with Val. One of the ideas we came up with was features on anaesthetists’ extra-curricular activities, and by coincidence I have recently received a couple of articles which fit into this category – this month I have a feature about Nigel Webster’s photography which has been exhibited at Congress Art Exhibitions, and is now going global with an exhibition in the USA. Also in this issue is an article by one of the very many cycling anaesthetists, who extended his activities beyond the daily commute and cycled from Lands’ End to John O’Groats.

So what do you do? Do you play sport to a high level? Are you a musical virtuoso? Do you have a nationally important geological collection? (I happen to know that one of you does). So tell us about it!

We have another feature we’d like to introduce - to quote Mrs Merton, “Let’s have a heated debate!” I have badgered a couple of people about this already, and if all goes well, next month we should have pieces for and against the statement “Consultants doing first on call are part of the solution to implementation of the EWTD”. Val and I have a little mental list of topics guaranteed to raise anaesthetists’ blood pressure, but if you have a topic you would like to suggest, or even better contribute to, please do so. We have already started a regular safety page, so if you are part of an initiative, large or small, we’d like to hear about that too.

We’d like to run interviews with anaesthetists (possibly retired) who were involved in significant events. Do you know somebody who was in a position of power and influence? Go and ask them what they think now of the events they were involved in, and write it up. Anaesthetists always have Opinions, so we’d like more regular contributors to give their jaundiced views

along the lines of Dr Ruxton and Gas Flo. And we’d still love more cartoons...

Do you ever wonder, as you leaf through Anaesthesia News, “Who writes this stuff?” The answer is that you do. So please don’t think you don’t have anything to write about - you almost certainly do. My ambition is to leave Val with a stack of accepted articles when I sail off into the sunset, and I need you, the readers, to contribute them.

So much for the future – what about this month? The EWTD is one of those issues dominating the coffee rooms at the moment, so I make no apology for having a number of articles on this topic over the next few months. This month, a joint article by Peter Maguire, who is one of the BMA’s experts on the minutiae of the directive, and Michael Parris of the GAT committee keep us up to date. President Dick Birks writes one of his regular updates, and Paul Clyburn gives a flavour of what you might expect if elected to Council (closing date for nominations April 17th), and this being the April issue, we have the usual modicum of nonsense. Sometimes working in the NHS, it’s difficult to sort the spoofs out from the genuine...

Hilary Aitken


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President's ReportApril 2009

The beginning of 2009 was heralded

as the most depressing year financially

in the majority of individuals’ lifetimes.

The AAGBI on the other hand began the

year well with a very successful Winter

Scientific Meeting. A superb programme by

the Events team, good lectures, impressive

keynote speakers and a well-received

dinner with entertainment enjoyed by

around 600 delegates. We were pleased to

welcome guests from the Chinese Society

of Anaesthetists and Dr Richard Clarke,

immediate past President of the Australian

Society of Anaesthetists. The ‘Events’ of

the AAGBI are an important part of its

core business, whether it be the WSM,

Congress, GAT, seminars or core topics and

as many know these have been increasingly

successful in recent years. They have

always been organised by the Education

and Research Trust, the charity arm of

the AAGBI. Under recent constitutional

reforms this charity is now known as the

AAGBI Foundation. Around the time you

are reading this, the Foundation will be

officially launched (see report on page 18),

heralding a new era in educational services

to our members. We will continue to look

for ways to improve both content and

finances for the new Foundation.

The Foundation also provides funding to

the newly created National Institute for

Academic Anaesthesia. This collaboration

between the AAGBI, ‘Anaesthesia’, RCoA,

the 'British Journal of Anaesthesia' and

others has been hugely successful in its first

year. A very robust selection process for a

variety of research grants and the ability to

fund them appropriately has led to awards

in rounds 1 and 2 beyond expectations;

let’s hope the NIAA continues to raise the

profile of anaesthetic research in the UK.

It would be wrong for me to shy away

from mentioning financial issues during

these times of financial crisis. The value

of our investments has diminished as they

have in other similar organisations and our

stance on ethical investment may not have

helped! We have, however no immediate

need to realise money and in order to try

and pre-empt further problems have sought

advice from two external financial experts

with different areas of expertise.

Personal financial issues are always

important for members. Parity of payment

for NHS work outside NHS establishments

is still a problem and many will be aware

that private practice fees/benefits are being

increasingly controlled by the insurer. We

have, along with others, complained about

this to the Office of Fair Trading, who, while

not rejecting our complaint outright have

confirmed (as they have to others) that this

issue is not one of their priorities. We will

press on. One of the problems is that we

all have a different level, often for very

good reason, at which we are prepared to

anaesthetise a case and to our ‘opponents’,

this is the Achilles heel which they exploit.

10 Anaesthesia News March 2009 Issue 261

Help for Doctors with difficultiesThe AAGBI supports the Doctors for Doctors scheme run by the BMA which provides 24 hour access to help (www.bma.org.uk/doctorsfordoctors). To access this scheme call 0845 920 0169 and ask for contact details for a doctor-advisor*. A number of these advisors are anaesthetists, and if you wish, you can speak to a colleague in the specialty.

If for any reason this does not address your problem, call the AAGBI during office hours on 0207 631 1650 or email [email protected] and you will be put in contact with an appropriate advisor.

*The doctor advisor scheme is not a 24 hour service

Awards for clinical excellence both locally and nationally

continue to fall numerically below many other specialties.

It was hoped that increasing the number of applicants for

different award levels would increase the conversion rate

but this has not happened. It is true to say that the ACCEA

are as concerned as we are about this and we have met to

discuss how we may move forward. Specific examples of

excellence for anaesthetists in the different domains will

be made available before the next round.

Revalidation looms, led chiefly by Professor Chris Dodds

at the College. The AAGBI has important input via the Joint

Committee on Good Practice, the Welfare committee,

and standards documents in the form of the well known

glossies. New glossies for this year include revamps of

the Anaesthesia Team and Recovery documents. We are

being urged to address issues of fatigue, resident on call,

the fall out from the implementation of the European

Working Time Directive, and these topics are under

consideration.

Finally Jo Silver (formerly Barnes), the General Manager

of the AAGBI has started her period of maternity leave.

We will all miss her and we wish her well.

Richard Birks

President

AAGBI Member’s landscape photography exhibitionNigel Webster, Professor of Anaesthesia and Intensive Care in Aberdeen, is to open his first professional photography exhibition in Phoenix, Arizona. In 2008 Professor Webster was part of an exchange programme with two American photographers from Phoenix. In order to obtain the pictures he travelled extensively around the region to obtain some stunning black and white images. This involved climbing mountains carrying 15kg of camera equipment in blistering heat, and being lowered 30 feet down a crevasse to take a photograph. Following an exhausting trip around most of Arizona, over 300 large format negatives then had to be developed and printed. Setting up the camera to take a picture could take up to half an hour, then up to two hours in the dark room to obtain the final print on fibre paper, coated in silver gelatin.

The two American photographers made a return visit to Scotland and based themselves in Edinburgh, making trips to the famous photographic sites around Glen Coe and Skye. They will be mounting a joint exhibition in Phoenix, and hopefully another one in Scotland at a later date. These photographs were on view in Aberdeen Royal Infirmary earlier this year, and AAGBI members may remember seeing Professor Webster’s photographs at recent Congress Art Exhibitions.

Professor Webster says he has been taking photographs for about 50 years and his cameras are getting bigger and bigger. The one he used for the current exhibition is handmade in Arizona, using walnut and satellite parts, and it takes 4x5 inch negatives.


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Background

The European Working Time Directive

(EWTD), Directive No 93/104/EC, was

introduced on 23rd November 1993 and

was incorporated into United Kingdom

Law by the Working Time Regulations,

1998/1833, on 1st October 1998.

The original 1993 EWTD is concerned with

the health and safety of workers within

the European Union. With regard to the

organisation of working time, it lays down

a number of basic principles concerning

the maximum weekly hours an employee

is required to work, daily rest time, breaks,

weekly rest time, annual holidays and

the duration of night work for night shift

workers.

As of August 1st 2009 the European

Working Time Directive (in force for

doctors since 1998, other than those

in training) will apply in full to trainee

doctors. This will introduce a maximum 48

hour working week for these doctors. The

Directive also provides for other measures

to include one rest day per week (24 hours

per 7 days which can be aggregated to 48

hours rest per 14 day working period), a

maximum working duty period of 13 hours

allowing for 11 hours rest period per day

and a 20 minute break per 6 hours worked.

This requirement for an 11 hour break per

day has led to widespread shift working

in the NHS for doctors resident within

the hospital. The daily rest requirement

has provided the biggest challenge for

healthcare providers.

What is a directive?

A Directive is one of five different legislative acts that can be adopted by the European Parliament or Council. Directives, as defined by Article 249 of The Treaty of Rome (1957), are not binding generally – they are only relevant to those persons to whom the directive is addressed. Importantly, not only are they not binding generally, they are binding only “as to the result to be achieved’’ – i.e. a Directive lays down an objective but allows the government of each member state to achieve the required objectives by the means it regards as most suitable.

Two cases adjudicated upon by the

European Court of Justice (SiMAP and

Jaeger) have resulted in European case law

decreeing that all hours spent on hospital

or healthcare premises are working hours,

whether the doctor is active or not working

(resting on the premises at the disposal of the

employer). This is fully supported by BMA

policy but is a decision opposed by many

EU National Governments and therefore

the EU Council of Ministers. It should be

noted that the EWTD has probably been

fully implemented in only 25 of 27 EU

member states at present. A position paper

European Working Time Directive (EWTD): Countdown to August 2009

Dr Peter Maguire

Consultant in Anaesthesia and Pain Management

Dr Michael Parris

GAT Committee Member

GAT Page


on the current implementation status of the

Directive on a country by country basis was

due towards the end of 2008; however this

information has been extremely difficult

to collate. This information is expected to

be formally published during April 2009.

The European Commission has however

commenced infringement proceedings

against Greece for their failure to implement

the Directive for doctors working in their

public health service. Their drive in these

proceedings is that the Directive is “Health

and Safety” legislation, designed to protect

the welfare of employees. It is anticipated

that infringement proceedings against other

member states is imminent.

Within the Directive a provision was made

for an interim maximal average working

week of 52 hours, applied for by specific

derogation, where there are “difficulties in

meeting the working time provisions” in

the healthcare sector by August 2009. If

applied, this derogation would last until

2011. Subsequently, application can be

made for a final derogation to apply this

limit of 52 hours until 2012 if necessary,

when the 48 hour maximum working

week will definitively be applicable to all

doctors. Current thinking amongst some

stakeholders (including the Departments of

Health and some Royal College members)

is that a derogation applying the 52 hour

maximal working week will allow some

more time for minds to be focused on

“Managed Reconfiguration” and change to

the way services are provided in the NHS.

Latest position and recent developments

European Parliamentary debate

On 17 December 2008 the European

Parliament voted to amend the EWTD in

the following key ways:

• all time spent on-call, including inactive

time, should be counted as working

time. However, by agreement, member

states can decide to weight inactive on-

call time differently.

• phasing out of the opt-out within 3 years.

Since the decision of the Parliament is, in part, contrary to the position of the Council of Employment Ministers, a process of conciliation must now follow with the aim of reaching an agreement that will be acceptable to both parties. This will take place under the auspices of the Czech presidency of the European Union. The Czech presidency has four months to respond officially to the Parliament's decision and start the conciliation process. There are very significant entrenched opposing positions between the Council and the MEPs. A meeting was scheduled between the MEP Rapporteur on EWTD and the European Commission in late February 2009 to attempt to agree some common ground. In the background there is time pressure to reach agreement in

advance of the European Parliamentary elections in June 2009 otherwise the current conciliation process will fall and the status quo will continue to apply, including the provisions of SiMAP and Jaeger case law. On current assumptions a final decision could be available by May 2009. Member states then would have up to three years to implement any new legislation.

UK position

Latest data from NHS Employers indicates that around 50% of junior doctors in England are still in Band 2 posts, which would be non-compliant with the 48hr limit in August 2009. Whilst employers in England appear largely content to proceed with the existing implementation timescale, the Royal College of Surgeons of England is pressurising the government

Dr Maguire and BMA colleagues lobby the European Parliament in December 2008


to adopt some kind of opt-out that would allow surgical

trainees throughout the UK to work a maximum of 65 hours

per week. In addition, the Royal College of Physicians of

London and certain other medical royal colleges have lobbied

government to utilise the 52-hr derogation (described below)

for some acute emergency specialties. It is known that the

UK government has applied for a derogation as outlined. A

two-stage process has been suggested; initial application for

a wide derogation for acute specialities (acute surgery, acute

medicine, paediatrics, obstetrics and critical care), followed

by approval of derogation at a national level for individual

rotas. The timescale for approval of a derogation from the

European Commission (if any) is by the end of May 2009. It

should be noted that individual employees (including doctors

in training) can “opt out” of derogation, even if it has been

agreed for their rota, and only work the 48 hour maximum.

What is a derogation?

This is a special provision in a Directive that allows it to be applied to particular groups of people or organisations in different ways. A derogation is not an exemption. It usually just permits greater flexibility in the application of the law to take into account special circumstances.

The EWTD has been looming over the NHS for over 10 years.

The full impact of the directive is only a short number of weeks

away. Whilst some areas of the NHS are ready for the impact

of the directive, much work remains to be done in other areas

to prepare for full compliance by August 1st 2009. Meanwhile

urgent debate is ongoing within the EU considering revision

of the Directive.

The future of training?

As early as 2004, long before the full reduction in hours to 48

hrs a week, Sim et al found a 20% reduction in the number

of anaesthetic cases being performed by junior anaesthetists

following the introduction of a full shift system. The GAT

Annual Training Survey has repeatedly found that over 50% of

trainees wish for training to be extended to compensate for the

reduction in the number of working hours.

So, a longer training time before achieving CCT or to continue

the status quo accepting that our trainees are now better

trained within the reduced hours framework with competence

prevailing over experience and excellence? Or the NHS

Employers way forward of a junior consultant post with

resident on call?

TWENTY TUNES NOT TO PLAY IN THE PRESENCE OF

PATIENTSWhilst acknowledging that this Top Twenty is not entirely original, we have been working hard to compile a list of the least appropriate tunes to play in the presence of patients in theatre / ICU / pain clinic. This is our best effort; further contributions would be most welcome.

Perhaps number 20 could become the signature tune of Safe Surgery Saves Lives?

1. Another one bites the dust – Queen

2. The first cut is the deepest – Cat Stevens

3. Girlfriend in a coma – The Smiths

4. The drugs don’t work – The Verve

5. Comfortably numb – Pink Floyd

6. Spirit in the sky – Doctor and the Medics

7. Wake me up before you go-go – Wham

8. Every breath you take – The Police

9. Take me down to the infirmary – Cracker

10. The medication is wearing off – Eels

11. Sister morphine – Rolling Stones

12. Stairway to heaven – Led Zeppelin

13. When under ether – PJ Harvey

14. I wanna be sedated – The Ramones

15. Heart attack – Olivia Newton John

16. Miracle drug – U2

17. I ain’t goin’ out like that – Cypress Hill

18. Bedside manners are extra - Greenslade

19. Needles and pins – The Searchers (a good pain clinic one)

20. An orgy of flying limbs and gore – General Surgery (yes – this one IS real)

Dr Dan WheelerLecturer in Anaesthesia

University of Cambridge


A fire to be ignited? Teaching the History of Anaesthesia to Ten Year olds

History Page

“By learning you will teach; by teaching you will learn”

Latin Proverb

It is not clear what effect events such as the now defunct National Anaesthesia Day have achieved with regards to raising awareness about our profession in the public eye. The now infamous MORI survey of 2000 (1,2) suggested that over a third of the British public did not believe that anaesthetists were medically qualified doctors, a misconception that was commonest amongst the under 35’s (45%); and which does not seem to have changed since 1978 (3). Nearly half of those questioned in 2000 incorrectly believed that anaesthetists trained for a similar or shorter length of time as GPs, and over a third thought that anaesthetists had undergone a shorter or equivalent period of specialist training to that of physiotherapists. In 1978, “anaesthetist” was ranked 4th in order of importance in the hospital medical hierarchy, after “ward sister”.

However, there is an opportunity to improve the public perception of the profession by raising our profile with primary school children. As part of their history education,

pupils are asked to examine in detail the Victorian period; a time that was rich in not only the worst of human nature, but the best in human inventiveness and perseverance. The Victorian era is an exciting one to study, as it is a period when First World society changed utterly: the urban age gave way finally to the industrial; that of steam gave way to the age of electricity; it was an epoch when empires were both falling and expanding; an age when British society changed drastically in nature. The rate of human progress in that short period is breathtaking, and is easily illustrated with reference to events in the USA at the same time: in one lifetime a man could have traversed that continent by horse, then by train, and finally by car and plane.

Local schoolchildren had been asked to choose a subject from this era to examine in detail as part of their studies. With so many developments and inventions to choose from, I was pleasantly surprised to be asked to talk to my son’s class regarding that very essential Victorian innovation: anaesthesia. It was particularly gratifying that this subject had been chosen as a project by the pupils themselves (without prompting from my son!) due to the good experience one of them had during a recent hospital stay.

The talk I gave was so successful that I was invited back the following year.

I initially accepted the challenge because I had originally studied history at University, and, as it is a subject for which still have a passion, I was eager to flex my teaching muscles in this direction. After all, it could not be harder than giving a lecture to a room full of bored SHOs. I was also flattered to be picked, and was confident that I was more than a match for a roomful of eleven-and-unders. Finally, the history of anaesthesia is an interesting one, for, as well as being the springboard that revolutionised the practice of medicine, it is full of the unique and eccentric anecdotes that can bring a subject to life.

I immediately began to search for useful information and resources. Luckily the Association had recently created a teaching package (pictured) to assist with projects of this type and were keen to have it tried out (4). Additional information was available from a variety of sources on the internet (e.g. the Old Operating Theatre http://www.thegarret.org.uk/tour.htm), and I was able to find a variety of authorative primary and secondary sources thanks to my local library and helpful drug reps.


After liaising closely with the class teacher (including confirmation of what kind of visual aids would and, more importantly, would not be acceptable!), I arranged an appropriate date, furnished the school with the relevant websites, dusted off some old kit from the anaesthetic department cupboard and turned up full of educationalist zeal.

“The mind is not a vessel to be filled, but a fire to be ignited”.

Plutarch

Teaching children is different to teaching trainees. Firstly, trainees are paid to turn up to listen to you and at least feign interest, so they will pretend to hang on to your every word even if they are bored. However, the adage of the paediatric anaesthetist – that children are much more than just small adults - is also certainly true in teaching: children are very different animals when it comes to education. If you do not interest them, they will have no hesitation in letting you know in a variety of interesting ways, usually involving eye rolling. I was therefore coached to try and make the session as punchy and interactive as possible. Short of giving a practical demonstration of anaesthesia on a volunteer, I was initially a bit puzzled as to how to achieve this goal. In the end, I decided on several gimmicks to grab their attention.

Firstly, I decided to show that in relative terms 1846 is actually not that long ago if you measure it in people (i.e. from my son to my Victorian great grandfather is only five people’s lives, and to Roman Britain it is only about 100). We soon had a chain of youngsters shouting contemporaneous headlines that the person in the “chain of history” would have read about in the papers. Jack the Ripper created a large amount of interest, although I was mildly distressed to realise that to these children key landmarks in my life such as the Falklands War and the Space Shuttle launch are as far away conceptually as the ancient Greeks. I

tried to keep the actual dry dates-and-names part of the talk as brief as possible, but was surprised (and pleased) to learn that they had already heard of John Snow and James Simpson, and wanted to know more. Items such as a facsimile of Hannah Greener’s death certificate aided this section greatly. Finally, I “volunteered” two sets of pupils to demonstrate the difference between modern surgery, (using paper theatre gowns, masks, old salvaged kit and boxes mocked up to be monitors) and pre-anaesthesia surgery (using two hefty boys to hold the patient down , a bottle of “whisky” and toy swords) which seemed to be wildly appreciated.

The final question and answer session was the most nerve-wracking part of the day. Children have no inhibitions about asking the embarrassing, awkward or difficult questions; the only consolation being that their inquisitiveness is driven by a genuine desire to know the answer and absorb knowledge. Firstly, there was a string of questions regarding which “gross” things that I may or may not have seen or touched (e.g. had I ever seen a man with a knife in his head? Had I ever touched some guts and so on). This led onto enquiries which fully tested my diplomatic skills such as how sex change operations were performed. Teacher did intervene when I was asked if I had ever killed anyone, after which the question was altered to, had I ever killed anyone accidentally. The trickiest question was being asked what the anaesthetist did if the anaesthetic machine broke. Foolishly, I used a recent example where the exact thing had happened to me. The child thought about my answer, in which had I described heroically saving the day, and then threw back at me “Why didn’t you check it before you started?” (I had - honest!). Fortunately, this opened the way to allow comparison between anaesthetists and pilots, and discussion about pre-operative checks; as well as highlighting how extensive training allows the anaesthetist to save the patient in an unexpected crisis. Through this

session I was able to achieve my target of widening their perceptions as to the role of anaesthesia in 21st century medicine as the “patient safety specialty”.

At the end of the afternoon, several children approached me to confirm that they had been inspired to pursue a career in medicine, although one suggested he would prefer to be a plastic surgeon so he could buy a big sports car.

I found the process of teaching these children stimulating, because it allowed me to see my own career through the eyes of someone totally outside the system. In addition, it meant that I had to train my educating skills to work in a different way. If any colleagues get the chance to participate in teaching children I would thoroughly recommend it. However, whether I have made even a small impact into the public perception of the profession will have to wait for the fullness of time to resolve.

J Watts BSC MB CHB FRCAConsultant in Anaesthesia and Critical

Care MedicineEast Lancashire Trust

1. Davies JM. Do the Public think we are Doctors? Results of a MORI SurveyRoyal College of Anaesthetists Newsletter 200:51p319http://www.rcoa.ac.uk/docs/newsletter2000-51.pdf

2. Corrado M Carluccio A. Perceptions of Anaesthetists - A Survey of the General Public - Research Study conducted for the Royal College of Anaesthetists for National Anaesthesia DayRoyal College of Anaesthetists Newsletter 2000: .51p319-21http://www.rcoa.ac.uk/docs/newsletter2000-51.pdf

3. Keep PJ Jenkins JR. As others see us. The patient's view of the anaesthetistAnaesthesia, 1978, 33, pages 43-45

4. Rugg JA. History of Anaesthesia Booklet. AAGBI, London http://www.aagbi.org/heritage/heritage%20centre/educationbooklet.htm


Association of Anaesthetists of Great Britain and Ireland

The charitable arm of the AAGBI was once the proud owner of the longest name in the official register of English charities - the ‘Association of Anaesthetists of Great Britain and Ireland Education and Research Trust’. The changes brought in during 2008 necessitated by the Companies Act 2006 resulted in a name change to “The AAGBI Foundation”; the name now more accurately representing it as a charitable foundation whose aim is to promote research into patient care and safety. The official launch of the renamed AAGBI Foundation will take place on April 2nd and allow the Association to reflect on the past successes and achievements of the E & R Trust and look forward to an exciting future for the new Foundation. Professor Mike Harmer, Past President of the Association, will officially launch the new Foundation following a Patient Safety meeting on the same day.

EducationThe E & R Trust has a proud record of achievement; the provision of educational scientific meetings in the early days was the remit of the Section of Anaesthetists of the Royal Society of Medicine. But in 1945 it was decided by the AAGBI Council that there was inadequate provision of educational opportunities. Interestingly the first venture embarked upon by the AAGBI

was a series of films prepared by the Westminster Hospital Department of Anaesthesia (they included: “How not to do it”, “Spinal anaesthesia”, “Respiratory and cardiac arrest”). Now video podcasts will be one of the new methods of providing educational material to the AAGBI members. This development has already started: several audio podcasts called “AAGBI Foundation CPoDcasts” are already available for download from the AAGBI website. They cover topics such as clinical ethics, obstetric anaesthesia and regional anaesthesia. Plans are afoot for making keynote lectures at the GAT ASM 2009 Cambridge and Annual Congress 2009 Liverpool available as streaming video to registrants.

The 1955 Annual General Meeting was the first occasion when the AGM was combined with an academic lecture. The AAGBI has now developed a sophisticated Events department which produces an impressive array of educational events, covering 50-60 days of the year and including one-day seminars, core topics (delivered at regional venues across the UK), themed “one-off” meetings and three major multi-day meetings (the Winter Scientific Meeting, Group of Anaesthetists in Training and the Annual Congress). This comprehensive programme

provides a mix of formats including small group reflective sessions, workshops, interactive seminars, debates, demonstrations and lectures.

ResearchThe AAGBI began its support of anaesthesia research soon after the Second World War by sponsoring research fellowships and a “Research Fund” was included in the 1949 accounts. A separate legally-constituted Research Trust was established in 1955. Promoting and supporting research into anaesthesia, critical care and pain has now become a key strategy of the Association’s charitable activities. The AAGBI has provided three types of funding: research fellowships; departmental project grants; and research grants. The new NHS Research and Development Funding Strategy has changed the arrangements for research funding in the UK, and in response to this the National Institute for Academic Anaesthesia (NIAA) has been set up by a partnership of the AAGBI, the Royal College of Anaesthetists, the British Journal of Anaesthesia, and our own journal Anaesthesia.

Support for anaesthesia in the Developing WorldThe Association’s interest in this area is long-standing – the AAGBI was a founder member

THE LAUNCH OF THE

AAGBI FOUNDATION


of the World Federation of Societies of Anaesthesiologists in 1955, and in the 1960s there were a number of initiatives, including articles in Anaesthesia and the formation of a temporary “Subcommittee on Aid to Developing Countries” which reported to Council in September 1966. The International Relations Committee (IRC) was established in 1976 as a standing committee reporting to AAGBI Council. Its original function was to monitor and influence EEC Directives, but in 1977 it began to extend its remit towards anaesthesia in developing countries, which is now its primary function.

In 2005, the Overseas Anaesthesia Fund (OAF) was launched, enabling members and other interested parties to donate directly to this work. The success of this fund from an early stage is indicative of the concern the AAGBI membership has about the problems facing colleagues overseas. OAF and the IRC budget are run separately

and have slightly different objectives – OAF was initially more directed to purchase of objects such as books or equipment than IRC, which tends to provide expenses, fund joint projects, and donate to other selected organisations’ projects. However, the success of OAF has allowed it to extend into sponsorship of anaesthetic trainees in Africa, where lack of trained practitioners is one of the major problems.

AuditThe AAGBI became one of the earliest organisations to audit outcome of practice. 1949 saw the first formal investigation into “deaths associated with anaesthesia”. These important pioneering reports continued until a more structured inquiry was conducted – “Mortality associated with anaesthesia”. This was carried out by the Association and published by the Nuffield Provincial Hospital Trust in 1982. This ultimately was the origin of NCEPOD. The Foundation will have patient safety as a

number one priority and continue the hard work of the E & R Trust in improving patient outcomes.

The Association Council is determined that the changes will have no adverse impact on the way that the AAGBI conducts its “core business”: advancing patient safety, defending and promoting the interests of its members, fostering research into anaesthesia and its associated disciplines, and encouraging co-operation and friendship between anaesthetists throughout the world. In fact the changes may allow a more efficient system to fulfil its core business more effectively. The Council hopes that the continued and increased measurable output from the Association demonstrates the commitment of the AAGBI to provide increasing value for money for its membership.

This article was written jointly by several members of the AAGBI Council and Executive.

St George’s Anaesthesia Day

Thursday, 23rd April 2009 (St George’s Day)from 2pm

at St George’s Healthcare NHS Trust

Blackshaw Road, Tooting, London SW17 0QT

Innovation in MedicineSpeakers will include:

Dr J Clarke, Dr T Cook, Professor J Hunter, Dr S Wright

Keynote speaker Mr A Dillon

Chief Executive NICE

Followed by dinner

For programme details and registration see www.stgeorgesanaesthesia.org

or call Marthe Krassheim on 02087250051


It may come as a surprise to those of you who, like me, have come to regard the Internet in much the same way as oxygen and water – essential to life – but the information superhighway is something of a mixed blessing to journal editors. You might, on casual reflection, think that it can only be a boon. After all, the Anaesthesia office has now done what the NHS can only dream of, and become totally paper-free. Authors around the world are available at the touch of a mouse, essential for those last-minute proof corrections and queries that inevitably arise on deadline day. Distinguished referees can assess and comment on papers as they sit on very expensive train or plane journeys, whizzing to and fro from committee to conference (but hopefully not on the rare occasions when they are in theatre giving an anaesthetic). That select band of readers who can actually remember their passwords may read the journal on-line, share their views with their peers at our new correspondence website, get sneak previews of forthcoming papers, and access sound and video files to enhance their experience. What could possibly go wrong?

Well, it seems that good, old-fashioned processed trees still hold a special place in the hearts of many readers. There is a tactile pleasure in holding a nice glossy journal which cannot be simulated even by the sleekest laptop. It’s not dependent on mains or battery, and it also shows your

fellow passenger that you really are a serious scientifically-minded individual and are not spending the journey playing ‘Doom’ (whatever that is). Advertisers – like it or not, the people who are largely responsible for journals making a profit which, in our case, goes to support anaesthetic research – still prefer to target journals with large paper circulations. More than one Editorial Board (in the field of anaesthesia as well as more generally) has learned the hard way that abandoning or side-lining traditional paper publication can lead to seriously upset readers and financial brouhaha.

However, sometimes something comes along which would have been impossible in the days before the Internet, blowing away the Luddite tendencies of even the fustiest of us. E-Bay? Amazon? Catsthatlooklikehitler.com? How did we ever cope without them? And so it is with the latest development, the Virtual Issue of Anaesthesia, in which papers and editorials on a particular topic – originally published in different issues and often over a period of some years – can be brought together online to produce a single-topic resource.

When this was first mooted by our publishers, Wiley-Blackwell, there was no doubt in my mind as to the subject of the first virtual issue. Safety is a constant pre-occupation of anaesthetists in general and the Association of Anaesthetists of Great Britain and Ireland in particular. The AAGBI had a Safety Committee, working

Safety and Human Factors - The first Virtual Edition of Anaesthesia

Safety Page

David BogodEditor-in-Chief, Anaesthesia


in conjunction with manufacturers, long before Bristol Children’s Hospital and intrathecal vincristine forced safety to the forefront of the Department of Health’s agenda, and its crest has always proudly borne the motto that informs all its activities, ‘In Somno Securitas’, recently celebrated in its 75th anniversary strapline, ’75 years advancing patient safety’.

To mark the launch of the AAGBI Foundation on April 2nd, the Editorial Board of Anaesthesia has published a virtual issue on ‘Safety and Human Factors’. This comprises some 31 papers originally published between 2006 and 2008, and is available as an open-access document by a link from the journal web-site at http://www3.interscience.wiley.com/journal/118530025/home.

I was, of course, aware that Anaesthesia was the natural home for submissions on the subject of anaesthetic safety, but even I was surprised by the wealth of material available from which I could select the best of the best for this special issue. The topics range widely around the basic theme and, in order to make navigation easier, the issue has been divided up into five sections. The first is titled ‘Reporting and Learning’, and reflects the concern of the profession – matched by the Department of Health in the guise of the National Patient Safety Agency – that adverse incidents are recorded, shared nationally, and act as a stimulus for improvements in health care. It is fitting, given his international reputation in the field, that this section is opened by a powerful editorial from Alan Merry. The work of the NPSA is highlighted in a series of reports based upon their dataset, and this is followed by some individual examples of good reporting practice, including a paper from Pakistan which shows that there may be lessons to learn from the Developing World in this area.

The second and largest section, ‘Safety in Practice’, is devoted to practical consideration of areas of risk. The risks and benefits of postoperative epidural analgesia are highlighted in a landmark paper from Christie and McCabe and a controversial editorial by Low, Johnston and Morris. A survey of implementation of safe epidural practice in the maternity unit, an area identified as at high risk of cross-over errors in the recent National Audit report from the Royal College, reveals how good intentions do not always translate into a roll-out of good practice. The role of equipment, both as safety solution and risk catalyst, is considered, and a thought-provoking paper from Austria suggests that pipeline cross-over incidents, sometimes with fatal consequences, are still occurring and have not been consigned, as many of us might fondly think, to the history books. Lipid rescue for local anaesthetic toxicity is, as you might expect from its coverage in the journal and its promulgation by AABGI, represented in this section. The sacred cow of checking ability to ventilate by mask before administering a muscle relaxant is challenged by Yentis and Calder, and the section closes on the topical issue of check-lists in the operating theatre.

Wrong route errors are a particular problem for anaesthetists, who typically handle multiple drugs in a short space of time and have patients with several access routes, all usually amenable to a Luer-tipped syringe. The third section details three such incidents, tied together with a powerful editorial by Bell, who uses the term ‘A professional shame’ to describe the collective failure of the health community to come up with workable solutions to prevent these recurrent errors.

The role of simulation in training is now well-established, but exposure to such training probably remains the exception rather than the rule for many of us at the ‘senior’ end of the profession, and we lag a long way behind that other notoriously risk-averse industry, aviation, in its implementation. The fourth section considers the place of high-fidelity simulators in risk management, but also usefully highlights the point that studies of, for example, drug administration errors and their dependence upon labelling, can be done with nothing more than a computer and some simple software.

Monitoring of vital signs and early-warning systems are considered in the final section. Outreach, ‘track-and-trigger’ and other ward-based monitoring methods theoretically allow early detection of deviations from normal physiology, and may help to preserve hard-pressed ICU beds, but the studies described here show that high error rates in recording vital signs limit the usefulness of these low-technology but often labour-intensive tools. Indeed, even electronic monitoring methods used for high-risk surgical and medical patients do not appear to lower the incidence of adverse events and death.

In short, there is something in this virtual issue of Anaesthesia for everyone, whether your interest lies in error prevention, training, computer simulation, technological solutions, reporting systems or behaviour modification. I hope that you gain as much enjoyment from reading this issue as I did from preparing it. Please let me know what you think by feeding back to [email protected]. Finally, if you have any other topics in mind that you feel might benefit from a similar treatment, I’d be delighted to hear of them.


WSM London Awards Ceremony The following awards were presented at the recent WSM London

Evelyn Baker MedalDr Neville Robinson, Consultant Anaesthetist, Northwick Park Hospital.

The Evelyn Baker Medal was instituted in 1998 for outstanding clinical competence, recognising the ‘unsung heroes' of clinical anaesthesia and related practice. The defining characteristics of clinical competence are deemed to be technical proficiency, consistently reliable clinical judgement and wisdom, and skill in communicating with patients, their relatives and colleagues. The ability to train and enthuse junior colleagues is seen as an integral part of communication skill, extending beyond formal teaching or academic presentation.

The award is open to all practising anaesthetists who are members of the Association of Anaesthetists of Great Britain and Ireland. Previous nomination does not preclude further nomination in future.

Honorary Membership:Dr Anna-Maria Rollin, Epsom

Dr Richard Clarke, Immediate Past-President of the Australian Society of Anaesthetists.

Honorary Membership was instituted in 1932 at the time that the Association was founded, and has been granted to the following categories:

•BritishandIrishanaesthetistswhohaveeitherheldhighofficeinthe Association or have been distinguished in other areas.

•Eminentoverseasanaesthetists.

•Membersofothermedicaldisciplineswhohavecontributed tothe specialty of anaesthesia.

•Membersofotherprofessionswhohaverenderedsignalserviceto the Association


WSM London Awards Ceremony The following awards were presented at the recent WSM London

The Anniversary Medal: Dr Veronica Reid, Monklands District General Hospital, Scotland.

The Anniversary Medal was instituted in 2007 as part of the celebrations of the 75th anniversary of the AAGBI. It is awarded to British and Irish anaesthetists who have held office in the Association and have provided exceptional service to the Association, or who have given significant service to AAGBI members but may not have held office in the Association

The Langton Hewer Award: Mr Ronan Moran (Abbott Laboratories)

This award was instituted to enable Council of the AAGBI to honour members of the medical industries who have made significant contributions to anaesthesia or to the Association.

Awarded at the Scottish Standing Committee Open Meeting, Stirling

The Council Award: Dr Neil MacKenzie

This is awarded to all Council Members as they demit office.

Editor’s Award: Dr Jeremy Langton

As the name suggests, this award is given in recognition of editorial services to the Association’s publications.


THE FINAL FRCA SAQ EXAMINATIONTUESDAY SEPTEMBER 1ST 2009

&THE FINAL FCARSI E&SAQ EXAMINATION

MONDAY SEPTEMBER 7TH 2009

The Mersey Writers ClubMembership of the Club will Expose You to the

Subtleties & Intricacies of the Written Papers of the Respective Examinations.

31 WC Members sat the exam in October 200827 passed the SAQ Paper

3 of those who failed have admitted they faltered* and did not stick to the Discipline of The Mersey Method

CLUB EIGHT Opens on June 1st - Registrations Close May 29th

Interested trainees are invited to attend

Introduction to The Writers Club & The Mersey Method Liverpool Saturday 9th May 10.00 – 14.00

Dublin Saturday 16th May 10.00 – 14.00London Friday 22nd May 14.00 – 18.00London Saturday 23rd May 10.00 – 14.00

Edinburgh Sunday 24th May 10.00 – 14.00Liverpool Saturday 29th May 10.00 – 14.00

No Charge to attend Introduction – No Obligation to Join

Note: Prospective Members must either attend an Introduction Session or have attended an SAQ Weekend Course.

One Fee for Membership of £400 will entitle the Member to Remain in the Club and to attend

Any or All of the Mersey SAQ Weekend Courses

Free of Any Further Charge

until

Successful in the SAQ or E&SAQ Examination

For Details, Registration, Club Rules & Commendations.

www.msoa.org.uk

* Writers Club Motto “In the Discipline Lies the Reward”


When I spoke to the editor of a well-known anaesthetic newsletter about NASGBI, she had to google the acronym to work out what I was talking about! So, I thought it was about time that I updated you on what NASGBI stands for, what the Society does, and what the Council members get up to!

The Neuroanaesthesia Society of Great Britain and Ireland (NASGBI) evolved from the Neurosurgical Anaesthetists Travelling Club (NATC). NATC was founded in 1965, and was the first Specialist Anaesthetic Society. We currently have 251 full members and 60 trainee members from the 40 neurosurgical centres in Great Britain and Ireland and from non-neurosurgical centres, which are often the first point of call for many of our patients.

What are the aims of the Society? Well, quite simply, they are to advance

education, encourage research and promote high standards of practice and patient care in Neuroanaesthesia and Neurointensive care.

We organise an Annual Scientific Meeting (ASM). This year’s meeting is in Liverpool on 7th and 8th May 2009. Ian Calder will be giving the McDowell Biennial Lecture on ‘the Triumph of Evil’. You do not need to be a Neuroanaesthetist to come: the first morning is an update session on a wide range of current topics. Details are on the NASGBI website (www.nasgbi.org.uk).

Trainees, Research and Grants The interests of trainees are a top priority for the Society. One of the highlights of the ASM is the award of the Harvey Granat prize for the best oral presentation. Over the years the standard of submission for both posters and presentations have been

very high, resulting in additional prizes

being awarded. All the abstracts are published in the Journal of Neurosurgical Anaesthesiology (JNA). The Society is currently negotiating to get reduced JNA subscription rates for its members and also a link via the NASGBI website to access the ASM abstracts. The website also has a link to the RCoA guidance for training and e – learning. There is also information on ‘How to boost your CV for a career in Neuroanaesthesia’ and on further higher

The Neuroanaesthesia Society of Great Britain and Ireland (NASGBI)

Specialist Society Page


training opportunities in neuroanaesthesia for trainees in Great Britain and Ireland. The Society has a Travelling Fellowship for research, study or teaching, with an annual budget of £2500, to a maximum of £1250 per applicant (email [email protected] for more details). Applicants for this must have been a trainee or full member of the Society for more than one year.

ACCEA

In 2007, NASGBI became a nominating Society for the ACCEA. Martin Smith, immediate Past President of the Society, was appointed to coordinate this function. In the last two years, applicants have been successful at Bronze, Silver and Gold levels. This is a reflection on the strong commitment of neuroanaethetists to the NHS and bodes well for future applications.

Membership

There are lots of reasons to be a member of NASGBI: reduction on rates for the ASM, eligibility for the Travelling Fellowship Grant, support by NASGBI for ACCEA application, and access to bits of the website that others can’t reach! Another reason to become a member of NASGBI is to effect change. Application forms can be downloaded from the website and also obtained from Busola Adesanya-Yusuf ([email protected]) who is our NASGBI Coordinator at the AAGBI. At the AGM in 2008, the Society voted to communicate with all its members electronically. We are constantly trying to update our records, and we would be grateful if you could let us know via Busola if you have changed your email address.

The Council currently consists of four Officers : Basil Matta, (President), Martin Smith, (Immediate Past President), Mike Nathanson, (Honorary Treasurer) and Nigel Huggins,(Honorary Secretary). Other members on Council include Praveen Manthri (webmaster), Margery MacNab (web assistant), Ian Tweedie (NASGBI NCCNet representative), Samantha Shinde (Training, Linkman Coordinator), Plat Razis (Coordinator of Trade Sponsorship), and John Andrzejowski (Survey Coordinator). However, as Martin falls off the top and Basil steps down, followed by the customary re-jigging of posts, there will be a national election for new members for Council. If you are enthusiastic, full of ideas and a member of NASGBI, then apply! You can email/contact any of the Council members to have a chat about ‘the job’. Watch the website for details.

The NASGBI website is constantly being updated and revamped. If you haven’t visited it recently, it is worth checking it out (www.nasgbi.org.uk). We would love to hear your ideas and contributions for making it even better. We are also lucky to have a NASGBI Linkman in each of the forty neurosurgical centres in Great Britain and Ireland. Their role is vital in enabling a two-way correspondence between the neurosurgical centres and the Council of the NASGBI.

I hope that I have given you a taster of what we get up to. So, if you are interested, join NASGBI, stand for election, get in touch, come to the ASM, or do all four! See you in Liverpool in May!

Samantha Shinde Council Member of NASGBI

Anaesthesia News is pleased to receive reports (around 1000 words) from affiliated specialist societies who use the AAGBI’s administrative services.

4th Oxford Paediatric Difficult Airway Workshop

Thursday 14th May 2009

The Paediatric Difficult Intubation Workshop is for trainees and consultants who anaesthetise children and wish to refresh and update

skills in managing children with a difficult airway. The course aims to discuss the management of the anticipated and unanticipated paediatric difficult airway. The format of the day is one of short

interactive lectures, videos and hands-on small group workshops. The workshops cover care and basic use of the fibre-optic laryngoscope, modified airway and LMA access techniques using guidewires and

exchange catheters.

Delegate numbers are limited to 24 places to allow maximum opportunity to interact and interrogate the faculty.

Early booking recommended.Registration fee includes refreshments and lunch.

Course organisers: Dr David G. Mason, Dr Mansukh T Popat and Dr Stuart W Benham

Registration Fee: £220 5 CEPD points

All enquires: Marguerite Scott, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headington, Oxford OX3 9DU

[email protected]: 01865 221590

Cheques payable to “Paediatric Anaesthesia & Resuscitation Fund”


The goal of the World Federation of Societies of Anaesthesia (WFSA) is to improve the standard of anaesthesia world-wide. The Safety and Quality of Practice Committee is contributing to this through several projects and liaises with other organisations such as ANZCA, the RoCA, Operation Smile, and with several member societies, notably AAGBI and NZSA.

Website Development: The internet has been an important part of establishing communication with members of WFSA. The site continues to be updated regularly by the Safety and Quality of Practice webmaster Dr Nian Chih Hwang (Singapore). An alerts section has been created.

Standards: The International Standards for Safe Anaesthesia developed by an independent task force, endorsed by the WFSA at the Hague, and published in 1993 have been revised as part of a WHO Global Challenge, Safe Surgery Saves Lives. Many people assisted me with this task, notably Iain Wilson (UK), Meena Cherian (WHO), Olaitan Sanyanwo (Nigeria), Jeff Cooper (USA) and John Eichhorn (USA), who was part of the original task force. The revised standards were endorsed by the General Assembly of the WFSA in Cape Town in 2008 and can be viewed on the website.

The Executive of WFSA has also endorsed a standard promoting the interoperability of anaesthesia equipment, and this too can be seen on the website.

The Global Oximetry Project (GO) is a collaborative project between WFSA, AAGBI and GE Healthcare, to provide

low cost pulse oximeters in a package that includes education, collection of data and agreements with local anaesthesia providers and healthcare administrators to achieve long-term sustainable change in practice. The GO Committee was initiated from the Safety and Quality of Practice Committee, with Dr Gavin Thoms (UK) as our representative and overall Chair. Sub-projects are underway in Uganda, the Philippines, Vietnam and India. The aim has been for each sub-project to be self-funding. GE Healthcare has donated a total of 58 oximeters, 125 sensors, and training materials and has provided considerable logistical support (hosting teleconferences, delivering the oximeters, providing maintenance etc). GE has proven to be a great partner in this effort and we are grateful for the ongoing support for this important effort. We are particularly grateful for the ongoing commitment of Mark Philips and Colin Hughes.

The participating anaesthesia professionals have completed logbooks, and data were presented at the World Congress in Cape Town. A final report is in preparation, to be followed by submission to peer-reviewed publications.

The GO remains this Committee’s single most important activity, and follow-on visits to Uganda and Vietnam to nurture the progression of these projects to the goal of “sustainable change in practice” were planned for the second half of 2008.

WHO, Safe Surgery and Pulse Oximetry: Iain Wilson and I have also been involved in the World Health Organisation Safe Surgery Saves Lives (not as representatives

of WFSA) and have been very gratified to see the development of a universally applicable checklist with considerable relevance to the promotion of teamwork in the operating room and support for the importance of anaesthesia in safe surgery. The WHO is now progressing a follow-on initiative to advance the GO project, which will build on the work of the WFSA.

The Virtual Anesthesia Machine (an independent educational project under the direction of Dr Sem Lampotang) is supported by the SQPC, and links to this project are in place from our website.

Crisis Management Manual: A link from which a PDF of the Australian Patient Safety Foundation Crisis Management Manual is to be made available through the website. We are very grateful to the APSF for this.

Incident Reporting: Professor Quirino Piacevoli (Italy) is responsible for a new project to make incident reporting available to countries that do not currently have access to this facility.

Drug safety: Efforts to promote clearer, more standardised presentation of information on the labels of drug ampoules will be an activity of increased importance for the SQPC over the next four years.

Please contact me if you have any comments or suggestions, or would like to contribute to any of this Committee’s activities.

Alan Merry (New Zealand)Chairman,

Safety and Quality of Practice Committee, WFSA

News from the WFSAContinuing a series of reports about the work of the WFSA

Safety and Quality of Practice Committee


Dear Editor…SEND YOUR LETTERS TO:

The Editor, Anaesthesia News, AAGBI, 21 Portland Place, London W1B 1PY or email: [email protected] TO THE VOLuME OF CORRESPONDENCE RECEIVED,

LETTERS ARE NOT NORMALLy ACkNOWLEDGED.

Botox…. Another tick box on the anaesthetic pre-assessment?

An emergency laparotomy was listed in a 50 year old woman

with an acute abdomen. On pre-assessment she was found to

be normally very fit, the only thing of note being previous breast

enhancement surgery and blepharoplasty. During the case I

monitored neuromuscular blockade using a nerve stimulator on the

facial nerve to elicit twitching of the eyebrows. However, despite it

being 45 minutes since my last dose of atracurium I could not elicit

a single twitch on train of four or double burst stimulation. It was

then that I realized her forehead had hardly any wrinkles. Could

she have had botox injections in addition to her other cosmetic

procedures? I moved the site of the nerve stimulator and was easily

able to elicit twitches. The rest of the surgery was uneventful and

when I visited her post operatively she did admit to having had

botox injections into her forehead.

Often the facial nerve is the most convenient site for assessing

neuromuscular blockade, but botulinum toxin, frequently injected

into the forehead, inhibits the release of acetylcholine from the

presynaptic terminal, interfering with monitoring the blockade.

So, should we be asking now if our patients have received such

treatments as part of our pre-assessment? Perhaps another tick box

on the anaesthetic chart would help?!

Dr Dipesh Odedra

Anaesthetic SpR

Leeds General Infirmary

Assessment for FFPMRCA

I enjoyed Delia Hopkins’s informative article about FFPMRCA

assessment in the February 2009 issue of Anaesthesia News.

However, it does not mention one very important component of the assessment – the logbook. The faculty requirements include a quarterly review

of the logbook with the Local Pain Medicine Educational Supervisor (LPMES) or a nominated assessor1. The logbook should also be forwarded to the

Regional Adviser (RAPM) by the end of month 11.

The Multi-Source Feedback (MSF) raters can be six to fifteen in number and are chosen by the LPMES, not by the trainee. The trainees should also

complete their own feedback.

Finally, a quarterly review of the competency check form would ensure the necessary progress and would pick up any deficiency to be dealt with

before the final completion of the form at month 12.

Dr Quazi Siddiqui, SpR Anaesthesia

Guy’s and St. Thomas’ Hospitals, London

Reference:

1. http://www.rcoa.ac.uk/index.asp?PageID=1193

History of obstetric anaesthesia

It was good to read Dr Bhadresha’s excellent contribution to the

History page1 in your recent journal but sadly there is a repetition of

what has become a major anaesthesia history myth. As it is one that

I have repeated on many occasions both in word and print I feel not

too bad about bringing to the attention of your readers.

While Simpson did indeed publish a pamphlet answering religious

objections to the use of analgesia/anaesthesia in childbirth; there is

absolutely no written evidence that such objections were made by

the clergy and only a few anecdotal ones about individual patients

questioning the propriety of such action. The topic has been well

covered in several publications2,3, and I believe it is now time for all

of us (including myself!) to stop repeating such myths and sticking

to the proven facts.

David J Wilkinson,

Emeritus Consultant Anaesthetist,

St Bartholomew’s Hospital,

London

References;

1. Bhadresha S. Through troubled waters – the turbulent history of

obstetric anaesthesia. Anaesthesia News 2009; 259: 20-22.

2. Farr AD. Religious opposition to obstetric anaesthesia: a myth?

Annals of Science 1983; 40: 159-177.

3. Adams CN., Maltby JR. Religious objections 1: blaming the

church, labouring under a misconception. Proceedings of the

History of Anaesthesia Society 2001; 39: 42-49.


Page AAGBI EVENTS


There can be few – if any – anaesthetists in the UK who have not heard that the GMC is introducing a new process this year that seeks to confirm that all doctors have the necessary skills, knowledge and attitudes to practise medicine safely. The awful spectre of Harold Shipman and his dark deeds still haunts us and has spawned, amongst other things, this new initiative that should mean that his like will never be seen again. Originally called “revalidation”, this has now been developed from a relatively simple paper-based process into a complex, comprehensive, web-based meta-evaluation programme that involves 720-degree feedback, frequent simulator assessment and two-yearly written exams. Given that the whole reverification takes in the order of 50 hours (excluding travelling) for each consultant or GP to complete, it is obviously not possible to reverify every doctor every year. In a pragmatic decision taken by medical leaders Sir Graeme Catto, Sir Liam Donaldson and Lord Darzi, doctors will only have to reverify every other year. It is easy to find out whether you need to reverify this year. If you were born in an “odd year”, you need to reverify every “odd year”; if you were born in an “even year”, you need to reverify every “even year”. Those who were born in 1958 will therefore have to reverify in 2010, 2012, 2014 and so on. Those born in 1963 will have to reverify in 2009, 2011, 2013 and so on. It’s simple and logical.

The structure of the process is also as transparent as it is methodical. Reverification has five primary components: revalidation, relicensure, recertification, re-evaluation and resuscitation. I will briefly outline the processes necessary to reverify within each of the components.

RevalidationThis remains as before - a fusion of relicensure and recertification, but it will depend upon a successful assessment by a lay panel of a doctor’s ability to perform the more technical aspects of his/her speciality using a combination of videos of real clinical situations, mannequin-based simulation exercises and informal group interviews.

RelicensureThis is a process that confirms that a doctor has the generic skills, knowledge, attitudes and abilities to function safely as a medical practitioner. It will include gathering information on both praise and complaints from patients and co-workers, and will include documentary evidence from a psychologist that the doctor does not have the personality profile associated with the murder of patients. 720-degree feedback will be an integral part of relicensure. If you are wondering how this differs from the more commonly used 360-degree feedback, the difference is obvious - in 720-degree feedback you go through the whole process twice.

RecertificationThe RCoA will work with the Specialist Societies in Anaesthesia, Intensive Care and Pain Medicine to create a list of knowledge, skills and Continuing Professional Development (CPD) points that consultants working in specialist areas would be expected to have. These will be fed into a rigorous simulator and web-based questionnaire assessment process that will test consultants on a regular basis. Frequent attendance at RCoA and Specialist Society educational meetings will be mandatory. Every consultant will be to expected attend a Difficult Airway Workshop at least once every six months.

Re-evaluationThis is the radical, exciting and new element of reverification that builds on the existing basis of revalidation by driving consultants into a productive, positive and seemingly endless cycle of critically re-evaluating their skills, knowledge, attitudes, fitness to practise and likelihood of murdering their patients. Using web-based, 720-degree,

Reverification is the new revalidation – more changes in GMC plansDr William Harrop-Griffiths, AAGBI Lead on Reverification


mannequin simulation supervised by lay members of the public and infection control nurses, every consultant and GP will be asked to re-evaluate their role in society and their ability to offer safe and cost-effective care to both patients and mannequins.

ResuscitationIf all the above complete nonsense isn’t enough, every consultant will have to prove that they can resuscitate a lifeless, plastic mannequin that goes “beep”. This will be really useful if a previously healthy plastic mannequin should suffer an unexpected cardiac arrest. Although optional for anaesthetists and Accident & Emergency consultants, this will be mandatory for all dermatologists and chemical pathologists.

Anaesthesia News asked RCoA Reverification Lead Dr Olaf Riplo what the new process will mean for the average clinical anaesthetist. “About £685.00 in additional GMC and RCoA subscriptions and a wasted week of his life” was the succinct reply. Expanding on the subject, Dr Riplo, said: “This is not about protecting the public; it is about protecting politicians while punishing doctors”.

With the start of reverification just weeks away, we would encourage all AAGBI members to be particularly nice to patients, their colleagues, infection control nurses, members of the lay public and plastic mannequins.

INTERNATIONAL RELATIONS COMMITTEE (IRC) FUNDING

The IRC considers applications from members who are seeking funding for projects usually, but not exclusively,

in the developing world.

The project must have a strong relationship with anaesthesia or one of its associated disciplines. Higher priority will be given to small

projects which can demonstrate efficient use of funds. Applications to fund equipment purchase must be supported by evidence that the environment and training of local staff is adequate to support

appropriate use.

Those awarded grants will be expected to provide a report to IRC. If a project lasts more than six months, reports will be submitted to IRC at intervals of not more than six months in addition to the final report.

For further information and an application form please visit our website: www.aagbi.org or email [email protected] or

telephone 020 7631 8807

Application forms should be forwarded to [email protected] and a signed hard copy posted to:

The Honorary Secretary, 21 Portland Place, London, W1B 1PY

TRAVEL GRANT The Travel Grant is aimed at those undertaking visits in Great

Britain and Ireland or overseas which include teaching, research, or study.

GRANTS UP TO £1,000

RULESThere is no deadline for the submission of entries and theoretically

there is no limit to the number of travel grants that may be awarded. However, grants will not be considered for the purpose of taking up a post abroad, nor 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. Candidates should indicate the expected benefits to be gained from their visits, over and above the educational value to the applicants themselves.

For further information and an application form please visit our website: www.aagbi.org

or email [email protected] or telephone 020 7631 8807.

Application forms should be forwarded to [email protected] and a signed hard copy posted to: The Honorary Secretary, 21

Portland Place, London, W1B 1PY

nine year old Girl Appointed as consultant shockFrom our correspondent Scoop O’Lamine

Communications officer Ms Wiley Spinem confirmed that Chubley NHS Foundation Trust has recently appointed nine year old Lizzie O’Brain as a consultant anaesthetist adding that “She was appointed at a special appointments procedure and staff are all very fond of her”.

Chief Executive Tony Gloating expressed satisfaction with what he hoped would be a long term appointment, although accepting it was a little controversial in terms of NHS training. The appointments process followed the new age discrimination legislation for the first time.

The Royal College and the BMA have expressed outrage at the appointment, but both admitted that with the powers of Foundation Trusts there was little they could do apart from communicate their concerns to the relevant people.

Investigation has revealed that Lizzie had managed to enroll on the new e-Learning in Anaesthesia course run by the Royal College of Anaesthetists and had found the course so fascinating that she had completed the entire 1000 tutorials and all the self assessments successfully within six months. Following an unexplained series of events with computers at the RCoA, it would appear that Lizzie was issued a CCT completion certificate which allowed her to gain specialist registration.

“At interview, Lizzie was the only candidate and due to her high scores in the eLA system, we felt she would be an ideal candidate for us” explained Tony Gloating. In fact it wasn’t until Lizzie joined the department during the summer break that her colleagues realized what had happened.

“She has never seen a patient or given any anaesthesia, but knows everything theoretical. In fact she is like a small anaesthesia encyclopaedia, which really irritates some of my colleagues such as Dr Harry Thikster” admitted Dr Isle Killim, the clinical director who was absent on the day of the interview. “However she is making progress and we hope that she will join our team in the next month or two – she will be good with the kids. Also she has been very good for the budget as we have appointed her on her pocket money plus a little extra - £8.50 / week. The only disadvantage is she does not do on call as her Mum does not let her stay up late”.

Tony has already put out feelers for other staff trained in this unique way. Although he would not confirm it, there are strong rumours that an eight year old

boy is reporting CT scans from his bedroom after training in radiology using the eLA scheme. Unofficial sources explained the boy was brilliant as he had been playing with scans since the age of five and could diagnose most disorders.

Dr Ivan O’Brain was reluctant to be drawn into conversation about the interviews or appointments except to say that the eLA was changing the face of medical training and that age discrimination worked both ways. When asked how the NHS could appoint consultants who had never been medically trained, he explained it happened all the time – nurse consultants, travel consultants; and if the NHS was going to keep pace with popular change, then the new child consultant grade was only sensible. “Look at how efficient this new grade will be” he enthused.

Documents

Anaesthesia News - AAGBI · Anaesthesia News No. 261 April 2009 ... 30 Reverification is the new revalida-tion ... One of the first questions colleagues ask