october a news - aagbi.org · pdf filegotiated by the bma. ... risks in determining the long...

Anaesthesia NewsNo. 183 October 2002ISSN 0959-2962

Anaesthesia NewsThe Newsletter of the Association of Anaesthetists of Great Britain and Ireland

1 The Proposed New ConsultantContract

3 Editorial

4 Letters to the Editor

5 History Page

6 GAT Page

8 Spec Soc Page

17 Anaesthesia Workstations andthe Checklist

19 Gas FloKeep up to date

20 Letter from Zimbabwe

The Association of Anaesthetistsof Great Britain and Ireland

21 Portland Place, London W1B 1PYTelephone 020 7631 1650Fax 020 7631 4352Anaesthesia News 020 7631 8817Email [email protected] www.aagbi.org

Anaesthesia NewsEditor: John BallanceDeputy Editor: Stephanie GreenwellAdvertising: Claire ElliottDesign and Printing:Eyekon Design & PrintTelephone / Fax 0121 350 2435.

Copyright 2002 The Association ofAnaesthetists of Great Britain and Ireland.

The Association cannot be responsible for thestatements or views of the contributors. No partof this newsletter may be reproduced withoutprior permission.

Contents The Proposed NewConsultant Contract

Recently, the Association sent out aletter to members detailing its re-

sponse to the proposed new contract ne-gotiated by the BMA. It would seem thatthe promised vote may come soon, al-though the question to be asked is amatter of some conjecture. The letterdetailed proposals for job planning, theworking week, pay progression, on callduties, out of hours work and extra pro-grammed activities. The conclusion tothe letter is printed below.

There is no doubt that, within the con-tractual arrangements, there is the oppor-tunity for a new enforceable job plan-ning system which will limit the work-ing hours of consultants and attract in-creased remuneration. The price appearsto be a much more significant manage-rial control, not only over the workinglives of consultants but also on their payprogression which hitherto has been amatter of seniority.

The new contract attempts to bringclarity to what has been a confused areabut, similarly, will almost certainly giverise to appeals, not only on job planningbut also on failure of pay progression.All consultants will be given the oppor-tunity to sign up to the new contract orkeep their existing contract.

It is welcome news that trusts no longerhave the freedom to offer their own con-tract to consultants. Newly appointedconsultants will, from April 2003, haveno choice but will be put on a new con-tract. Existing consultants will have tochoose whether or not to opt for the

package. Those with little private prac-tice at the early part of their career maysee financial advantages in aspiring to ahigher income and, possibly, a higherpension which will, of course, dependupon management decisions at a locallevel. Older consultants very near to re-tirement are unlikely to see the perceivedbenefits of staying on through the transi-tional arrangements.

Consultants with substantial privatepractice may choose to opt for the parttime contract, although this has inherentrisks in determining the long term futureof the private sector. Such worries in thepast have never been fulfilled.

The Association welcomes views fromits members and, when the dust is set-tled, will reconstitute the consultantworkload and contract working party andissue substantial detailed guidance onwhatever the outcome.

A full version of the letter appears on theAssociation’s website, www.aagbi.organd members may email their commentsto Portland Place.

What will happen after the vote is alsodebatable but a resounding ‘no’ maynecessitate a return to square one.

REMEMBER THAT THE

AAGBI HAS A NEW

ADDRESS:21 Portland Place, London W1B 1PY

2

Anaesthesia News October 2002

THE ASSOCIATION OF ANAESTHETISTS

of Great Britain and Ireland

Undergraduate Elective FundingUp to £750

All medical students in the UK who have successfullycompleted two years of clinical medical training areeligible to apply to the Association of Anaesthetists of

Great Britain and Ireland for funding towards a medicalstudent elective period. Preference will be given to thoseapplicants who can show that their intended elective has

an anaesthetic, intensive care or pain relief interest.

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

or email [email protected] or telephone 020 7631 1650.Closing date 10 January 2003

Anglia Society of Regional AnaesthesiaAnnual Scientific Meeting

Peripheral Nerve Blocksand Catheters

Officers’ Mess, Duxford, Cambs.Friday 6 December, 2002

Catheters for knee surgery Roy Greengrass Mayo, USALumbar plexus blocks Xavier Capdevila Montpellier

Interscalene catheters Nick Denny Kings LynnWhich twitch? Martin Herrick Cambridge

Further information from:Dr N M Denny, Deptartment of Anaesthetics,

Queen Elizabeth Hospital, Kings Lynn, Norfolk PE30 4ET.Tel: 01553 613583 Fax: 01553 613964

Email: [email protected]

Registration: Anglia SRA members £50 (inc. lunch)Non-members £70Approved for CME

Editorial

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Checking

Iwas recently saddened by the death of a former patientwho suffered an hypoxic episode more than twenty yearsago. Although no firm cause for the incident was ever

established, it was felt at the time that inexperience and tired-ness on the part of the anaesthetist must have played a part.

Although this tragic case caused us to review our workingpractices and the supervision of our trainees, much more goodeventually came of it. We were able to purchase decent moni-tors and we reviewed the checking of all our equipment.

The article on Anaesthesia Workstations and the Checklist,in this edition of the newsletter, introduces a review of thatuseful list that hangs on anaesthetic machines throughout theland. Modern equipment is by no means fail-safe and it is sadto note that an hypoxic mixture can still be given nearly aquarter of a century after our incident.

The answer must lie in checking the equipment that we useand ensuring we know what we are doing; also that we have aproperly qualified anaesthetic assistant who also isconversant with potential problems and how to avoid them.When you board an aircraft you expect the pilot to know howto work the knobs and the co-pilot also to be highly techni-cally competent. Surely, the public has the right to expect thesame of us?

The proposed new consultant contract is filling the pages ofthe medical press and is the topic for discussion in many cof-fee rooms. If my hospital is anything to go by – and we havetaken many of the recent insults to the NHS with a Herefordianshrug – there is seething discontent in all specialities with theefforts of the BMA on our behalf.

How much does Joe Public know what is going on in our

profession? Will he bewhipped into a fury by thetabloids (and one or twobroadsheets, inimical to doc-tors) into believing that we aremoney-grubbing, undertrainedrogues who care more aboutthe private sector than ourNHS work? Will he be happy that doctors will soon emergefrom a ‘fast track’ medical training and that colleagues arebeing brought in from abroad by the Government to help usreduce waiting lists?

By the time you read this, voting on the new contract shouldbe about to or already have happened and the outcome andfurther action will prove interesting. New contract in place ornot, it is up to us to ensure the quality of our training, theexperience necessary and the ‘quality control’ of what we do.Then, with appropriately checked and working equipment, wecan help prevent a tragedy such as that which happened to us.

John Ballance

DO YOU HAVE AN ARTICLE FORPOSSIBLE FUTURE PUBLICATION?

The Editor, Anaesthesia News, AAGBI, 21 Portland Place, London WCB 1PY

or email [email protected]

Letters to the Editor

4


YesI shall be voting a definite ‘yes’ for the proposed new consultant con-tract for a variety of reasons:

1. In my Trust, anaesthesia and anaesthetists are so highly regardedthat it would be inconceivable that they might be disadvantaged inany way and especially as this has never been the case to date whereawards, facilities and development are concerned.2. I have always admired the honesty and reliability of my currentmanagers who have selflessly never failed to achieve every promisethey have made in the past.3. Even if these inspirational leaders should move on to other jobs(which is very unlikely in the jobs-for-life culture of the NHS), I wouldhave supreme confidence in any new appointees to enhance andimprove any negotiated salary and job plan for my benefit in thefuture.4. Despite working in one of the most deprived socio-economic re-gions in Europe, I have confidence that my Trust will always have themoney to progress my pay rapidly up the scales quoted without anydetriment to patient care or facilities.5. I know that the BMA could not propose anything that would inany way be detrimental to its members as evidenced by their longhistory of support for hospital doctors over the years.

I hope that, should you publish this letter, it will encourage others tothink carefully about these matters before they vote.

Arthur Michael Anthony Duncan Pratt

ArroganceWhatever the pros and cons of the proposed new consultantcontract, it is clear that the profession must have complete trust in theintentions of Government and Management if it is to be implementedsuccessfully. After over a decade of medical involvement in the proc-ess of hospital management by Clinical Directors and Medical Direc-tors... if we don’t take part nobody will listen to us etc. etc... I wouldsuggest that any trust between the two sides has all but evaporated.

Those of us undertaking such roles have often realised the hardway that money does not arrive, promises are not kept and that ouroptimistic plans for the improvement of a service are ultimately notsupported. Many of us resigned. We know the NHS is disintegratingbut hear the contrary from politicians as meaningless statistics anddouble counting of money are endlessly repeated in press briefings.After three years of silence from the BMA we had all hoped for some-thing better... better for our patients, better for ourselves and betterfor our families... but are faced with a vague set of proposals subjectto local interpretation with a system of reward which is potentiallyeven worse than the justifiably derided merit awards (no, I haven’tgot one and good riddance to them).

The arrogance with which the BMA has treated consultants is stag-gering. Of course SpRs must vote. Of course all consultants must votewithout the demeaning need to register. When a comprehensive anddeafening ‘NO’ is recorded perhaps the negotiating team will havethe grace to resign, but somehow I doubt it.

Peter Hilton FRCAConsultant in Burns Anaesthesia and Intensive Care

National AnaesthesiaDay 2002Friday 8 November

“Education, Education, Education”The Association of Anaesthetists is again pleased to play asignificant part in supporting the Royal College’s NationalAnaesthesia Day for 2002.

This year it is concentrated on education and the Collegeis preparing a slide library and supporting notes to help par-ticipating departments which wish to put on presentationsfor invited secondary school pupils, to tell them more aboutanaesthesia, anaesthetists and the anaesthetic team. Theseslides will be issued on a free CD to all registered partici-pants and will be professionally produced and education-ally vetted. The presentations have been designed to tie inwith the National Curriculum and, so far, the responsefrom schools has been overwhelming.

If you wish to be part of this important educational effortto enhance the standing of our profession and to inform theyounger members of the community, contact the organisersat the College. The easiest way to do this is via the web at:www.smithsmedical.com/nad/index.php

Dr Michael Ward

Near missDr Ranjit Verma’s article entitled ‘Near Misses’ in the AprilAnaesthesia News has, I am sure, the best intentions. Hebelieves that reporting adverse incidents, as for example in thedrug administration error cited on the same page, will be “anexcellent learning exercise.”

Surely potentially dangerous episodes occurring during thecare of a patient should immediately be reported to the appro-priate authority responsible for recording and analysing suchevents. Adverse reactions to drugs are the responsibility of theMedicines Control Agency, either with or without the YellowCard scheme. The Medical Devices Agency maintains a simi-lar monitoring unit for incidents concerning medical devices.Both these authorities publish regular summaries of their work,the latest being the MDA’s Adverse Incident Report for 2001published in March of this year.

Further of course, the Association itself has its own Safety Com-mittee with the responsibility for all hazardous situations con-cerning anaesthetic practice. And further, shouId anaestheticequipment be involved this should be brought to the attention ofthe Association’s Standards Committee with its responsibility forthe maintenance of national anaesthetic equipment standards.

It is essential that these accepted authorities are initiallyinformed: later an anecdotal resume may be appropriate torAnaesthesia News. This must not be the only and final restingplace for such information.

John Stevens


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History Page

A well attended symposium opened with a pres-entation from our President, Professor Leo

Strunin who spoke on Liver Transplantation at KingsCollege Hospital (1972 to 1980). He outlined theenthusiasm of the senior surgeon contrasting with thereservations of the senior hepatologist, the lowsurvival rate of the 70s, the slow but steady improve-ment with perseverance, the attempts at taking therecipient to the donor, the importance of ischaemia time and, finally,the importance of monitoring and monitoring services. Unlike renaltransplantation, there is no fall back position.

Dr Elizabeth Gibbs, Billericay/Cambridge,followed with Anaesthesia for the First UK LiverTransplant, a description of how she was called onto give anaesthesia for the first Cambridge livertransplant in 1967 as a novice Senior Registrar. Nowarning was given, no senior advice was available,nor was there any help. The patient could not beseen prior to their appearance in the anaestheticroom. Atropine in the anaesthetic room was followed by thiopen-tone, flaxedil, nitrous oxide, oxygen and trilene from a Boyle’s Bottle.There was no monitoring other than hands, eyes and a BP machineand no real respite during a 19 hour procedure, using 54 pints ofblood and culminating in death after a failed haemostatic effort. Allnotes were then lost.

Dr Jonathon Freeman, Birmingham, followed withThe History of Anaesthesia for Liver Transplantation.The hepatotoxic actions of the inhalational agentswere considered and then the actions of the intrave-nous drugs. The poor results of the initial transplantswere improved by the isolation of the factors whichneeded assessing in detail, as did the increasingexperience of those involved. Recent improvements in drugs and inmonitoring in its ease and rapidity are important. The ability tocontrol coagulation, blood volume and cardiac performance areessential. Large volumes of citrated blood are now rarely required,six units being the norm. The use of haemodilution, heparinised bloodand FFP are still required. Recent success has allowed for morecomplex procedures such as bowel and liver transplant in childrenand heart, lung and liver transplants.

Dr DW Bethune made the final morning presenta-tion on Anaesthesia for the First Heart Transplant. Hestarted by giving credit to Shumway’s work and hisinfluence on Christiaan Barnard. The initial years ofheart transplanting resulted in survival times of 29 days.The Papworth research used pigs but their tendencyto malignant hyperthermia did not make progress easy.A visit to Shumway gave much guidance and help onpreservation. Of the first two Papworth transplants, one died at 17 daysand the other had a good quality of life for six years. Again, the use ofprotocols, care, advances in drugs and in monitoring, together withimproved postoperative care, accounted for much of the advance. Fund-ing was agreed to do 12 cases a year. This has now risen to more than80, the limitation being the number of donors available.

History of Anaesthesia Seminar Thursday 30 May 2002

The after lunch session began with Dr Aileen Adams,Cambridge, former Dean of the Faculty. The subjectwas Anaesthesia’s First Home. An original 1897invitation to 20 Hanover Square was shown and itshistory conjectured. The Society of Anaesthetists(SoA) formed in 1893 in London had its rooms atthe above address which it rented from the RoyalMedical and Chirurgical Society(RMCS). At the SoA steering commit-tee, the initial number of members and the numbers invited to the1897 meeting were discussed. The minor specialist societies occupy-ing 20 Hanover Square amalgamated with the RMCS to form the RSMin 1905 but the SoA did not join for a further three years, although itcontinued its use of Hanover Square. The movements of the Londonpopulation were outlined and the effect of only one bridge across theThames. Finally, it was observed that the RSM had retained theproperty until last year and that Frank Knight the estate agent hadbeen a 100 year tenant.

Dr Edward Mathews, Birmingham, presented SamGamgee of Tolkien. He said Gas Flo describes theuse of Gamgee tissue in March 2000. Invented bySampson Gamgee after some research and used insurgery from the 1880s, its use in anaesthesia startedsome 30 years later. It continued to be described inanaesthetic textbooks until the 1980s. It is to benoted that many advertisers spelt it with a small gnot the capital G as in the name of the inventor. Gamgee was both aqualified vet. and a doctor and he served in the British Italian Legionin the Crimea. His name was also used by Tolkien, in the Lord of theRings, as he had attended the same school as the sons of Sam Gamgee.Tolkien in his youth lived in the surburban village of Sarehole whichis said to be a model for The Shire. Tolkien claimed these were thehappiest days of his life.

The final paper was delivered by Dr Thomas BBoulton, Oxford/Reading. He described the eventswhich culminated in the setting up of the Associa-tion of Anaesthetists of Great Britain and Ireland(AAGBI) and of the pivotal role the first PresidentHenry Walter Featherstone had played; then givingthe developmental facts of the AAGBI throughoutthe pre-war, the war and post-war years. The initial elite membershipof 150 eventually became open to all with an interest. He alsomentioned the role of the AAGBI in the initiation of the academicbody the Faculty of Anaesthetists of the Royal College of Surgeonsand the current relationship between the AAGBI and the successorbody, the Royal College of Anaesthetists.

Concluding the meeting was theAntiques Road Show presented byDrs David Zuck and Neil Adams.This will be reported at a later datewith illustrations.

The Wednesday following thesymposium saw an educationalvisit by some St. Bartholomew’smedical students who were given a presentation by members of theHeritage Team of the AAGBI.

Geoff Hall-Davies

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GAT Page

Intensive Care Medicine for Trainees in AnaesthesiaSpR years 1/2. The second three months SpR training in ICMwould normally be obtained in year three.

IBTICM TRAINING REQUIREMENTS

All training must be undertaken in intensive care units thathave been approved by the IBTICM.

IBTICM requirements for SHO training in ICMBasic Level ICM. Three months, in blocks lasting one monthor longer.

To enter the joint CCST SpR ICM programme, trainees mustcomplete three months ICM training in an educationallyapproved post at SHO level. This training must be taken in blocksof not less than one month’s duration. Time spent in the SHOpost may be longer if the competencies are not acquired in threemonths, although there is no guarantee that this time will beshortened if the competencies are acquired more quickly.

Complementary speciality training(usually undertaken at SHO level)

For anaesthetic trainees, six months acute medicine (of which threemonths may be in A&E). For UK trainees the period may varyaccording to the rate at which competencies are acquired, inaccordance with the true concept of competency based training.

IBTICM REQUIREMENTS FOR SPR TRAININGIN ICM

Entry to joint CCST SpR ICM training programmeTrainees wishing to achieve the dual CCST in ICM and theirbase speciality must already have a national training numberin a base speciality - either anaesthesia, internal medicine,surgery or accident and emergency. The trainee should alsohave completed three months ICM at basic level (satisfyingthe criteria outlined above). Having achieved these basicentry requirements, trainees may apply in open competitionfor an SpR post in ICM.

Step 1 Intermediate Training. Six months - in blocks lastingthree months or longer.The components of step 1 training are:• completion of basic training (outlined above);• six months ICM, generally taken in the first three years of

base speciality training;• the six months ICM must be taken in blocks of minimum

three-month’s duration;• completion of Education and Training Record, including ten

case histories.

Training and service commitment in intensive care medicine (ICM) has been and continues to be a core part of the

working life of trainees in anaesthesia. The Royal College ofAnaesthetists (RCA), the parent College for training in ICM,has published the requirements for competency-based train-ing in anaesthesia for SHOs (July 2000) and SpR1-2 (Jan 2002).Included in these documents are the competencies to beachieved in ICM at the relevant stages of training.

The Specialist Training Authority (STA) approved the CCSTprogramme of training in ICM on 18 April 2002. The Intercol-legiate Board for training in Intensive Care Medicine (IBTICM)has also published a document on competency-based trainingin ICM. It is not surprising that the standards set by the RCAand the IBTICM are almost identical. The differences betweenthe documents are subtle but of enormous significance to train-ees in anaesthesia who may wish to consider pursuing ICM asa subspeciality.

There is currently much confusion amongst trainees inanaesthesia regarding the interpretation of these documents.This article attempts to clarify the differences between the RCArequirements for training in ICM leading to a CCST in anaes-thesia and those of the Intercollegiate Board leading to a dualCCST in ICM and anaesthesia.

RCA TRAINING REQUIREMENTS

The RCA requirements for SHO training in ICMTrainees in the two-year SHO programme must spend a totalof three months training in ICM in an educationally approvedpost. The RCA does not make any specifications about howthe training is delivered in terms of lengths of blocks. How-ever, the out-of-hours work during these periods of ICM train-ing should be primarily directed towards the sub-speciality,although flexibility in on call duties can be permitted at thediscretion of the Regional Advisers in Anaesthesia and Inten-sive Care Medicine. Finally, approval of intensive care unitsfor the training of SHOs in anaesthesia remains with the RCA.

The RCA requirements for SpR training in ICMThe current regulations apply to SpRs in anaesthesia who havetaken up post after 1 February 2002.

“Currently, during the five years of SpR training as an SpR inanaesthesia, the trainee should normally receive six months ofIntensive Care Medicine training. This should be to the samestandard as would be required for intermediate level trainingby the IBTICM.”

For anaesthetic SpRs there is no specification about the lengthof blocks, although the initial three months must occur during

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This is the area of difficulty for trainees in anaesthesia whostarted their ICM training before these regulations werepublished. Curiously, for competency-based training to berecognised by the IBTICM it must be undertaken in time-basedblocks of the designated duration. Trainees in anaesthesia arelikely to spend longer than six months in ICM throughout theirwhole SpR training period. Despite the competencies andexperience gained during these rotations, if the ICM blockduration is less than three months it will not count towardsintermediate level training as defined by the IBTICM. Indepartments that can sustain rotations of three months dura-tion for all SpRs, there will clearly be no problem for traineesgaining recognition of intermediate training. However, thereare many departments where this is not the case.

In addition, SpRs who have completed the ICM modules intheir anaesthetic rotation before these regulations wereintroduced cannot have their ICM training recognisedretrospectively. Those most likely to be affected (although notexclusively) are flexible trainees and those undertakingextended time out of programme.Step 2 Advanced Training. One continuous year.This involves a year’s ICM in a single block, generally taken inthe later stages of training.

Trainees wishing to undertake this training must havesuccessfully completed basic level and step 1 (SpR) training inICM. Advanced level training taken outside the joint CCST SpRICM programme will not count towards a CCST in ICM.

Trainees who are currently undertaking a year’s training inICM have expressed their disappointment that they will not be

Department of Anaesthesia Liverpool Women’s Hospitalin association with

Mersey School Anaesthesia and Peri-operative Medicine

BASIC OBSTECTRIC ANAESTHESIA COURSETuesday 19 November

DESIGNED SPECIFICALLY AS AN INTRODUCTORY COURSE IN OBSTECTRICALANAESTHESIA FOR SHO ANAESTHETISTS

LIVERPOOL WOMEN’S HOSPITAL

£95

APPLICATION BY EMAIL ONLY

[email protected]

able to have this training recognised retrospectively. In essence,despite fulfilling the clinical criteria (in terms of experienceand competencies), they will not be eligible for a dual CCSTbecause their advanced training was not conducted within thejoint CCST programme.

This article highlights the current conflicts and issues involvedin gaining recognition of ICM training from the RCA and theIBTICM. Whilst the criteria for training have been clearlydefined by the two regulatory bodies, there will undoubtedlybe some winners and losers during this transition period. Themost important message for anyone wishing to pursue acareer in ICM is to contact the Regional Educational Adviserfor ICM at the earliest stage of training. They are listed on theIBTICM website which is currently hosted by the Intensive CareSociety, www.ics.ac.uk

Catriona Connolly,Vice-Chairman, GAT Committee

Trainees should note that the only requirement to be a consultantin the United Kingdom is that, at the time of taking up theappointment, your name is on the specialist register of the GMC.

Although holding a CCST is one method of gaining entry to thespecialist register, it is not unique.

In the context of the dual CCST in the article above, it is not asole requirement to hold this in order to obtain a consultant postin ICM.

The Advisory Appointments Committee must review everycandidate’s CV and take into account any relevant ICM trainingas appropriate.

Leo Strunin


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Spec Soc

The Society was formed in July 1997 at the Royal Society ofMedicine and its first Annual Scientific Meeting was held inGlasgow later that year. The object of the Society is to pro-mote education and facilitate research into the use of drugsadministered intravenously in anaesthesia and science relatedthereto and to disseminate and help implement the useful re-sults of such research.

Membership is open to anyone in the UK who has an inter-est in intravenous anaesthesia and currently stands at just over250. The website is a forum for information, education anddebate on matters relating to intravenous anaesthesia and isaccessed by anaesthetists throughout the world.

Committee and Office BearersPresident – Professor John Sear, Oxford; Honorary Secretary –Dr Douglas Russell, Glasgow; Honorary Treasurer – Dr MildaSimpson, Manchester. Committee – Dr Tony Absalom (Nor-wich), Dr Nigel Huggins (Birmingham), Dr Kiran Jani(Stevenage), Professor Gavin Kenny (Glasgow), Dr WilliamMcFadzean (Swansea), Dr Alastair Nimmo (Edinburgh).

5th Annual ScientificMeeting

This was held in Stevenage inNovember 2001, with sessions onOutcome, Education, Sedation andControversies in Intravenous Anaes-thesia. The meeting opened withworkshops led by Dr Frank Engbers,Consultant Anaesthetist at LeidenUniversity Medical Centre.

The Graseby Prize for the bestFree Paper Presentation by a TraineeAnaesthetist wasawarded to DrDaphne Varverisfor her paperentitled “Target-controlled infu-sion of propofolfor inductionand maintenanceof anaesthesia inchildren using thePaedfusor”. She

received her prize from Mr Chris Hutchison, ManagingDirector of Graseby Medical Ltd, assisted by SIVA UK Presi-dent Professor Sear.

AAGBI Consultant Update Day – 2001Almost 400 delegates attended, with the Society participatingin the morning session. The SIVA UK presentation team areseen taking questions, chaired by Professor Sear.

2002 Annual Scientific Meeting – Thursday 28and Friday 29 November

This will be held in Oxford, with scientific sessions onThursday afternoon and Friday morning. Conference Organ-iser Professor John Sear has produced a stimulating programme,with a mixture of science, clinical practice and controversy.The SIVA UK Annual Dinner will be held on Thursday evening.

Abstracts are invited for poster presentation of topics relat-ing to Intravenous Anaesthesia. These should be sent to DrDouglas Russell (Department of Anaesthesia, Southern Gen-eral Hospital, Glasgow G51 4TF; e-mail: [email protected])as soon as possible and should be a single A4 page. Authors ofabstracts accepted for poster presentation may be invited tomake a short slide presentation during the free paper sessionon Friday morning, with the Graseby Prize being awarded forthe best presentation by a trainee anaesthetist.

Interactive workshops will take place on Thursday morning,tailored to the experienceof those attending. Tutorswill be drawn from a poolof clinicians experiencedin the field of IntravenousAnaesthesia. The work-shops are supported by aneducational grant fromElan Pain and Critical

9


Care so there is no additional registration fee but, since placesare restricted to 30, early registration is advised.

The meeting registration fee has been pegged at £150 with areduced rate of £75 for trainees and full details are availablefrom Departmental Secretaries. Alternatively, visitwww.Oxford2002.org for online registration and payment bycredit/debit card via the secure servers of WorldPay.

Honorary Membership“Persons of distinction who have contributed to the advance-ment of i.v. anaesthesia are eligible forelection as Honorary Members.”

Dr Iain Glen has been a member of theUK Society for Intravenous Anaesthesiasince its inception in 1997. He has madea unique contribution to intravenousanaesthesia and was awarded HonoraryMembership at the Annual ScientificMeeting held in Belfast. A copy of the fullcitation is available on the website.

Win a TCI System!Visit the SIVA website and answer a simple question for thechance to win a Fresenius Vial Master TCI system. The prizehas been donated by Draeger Medical UK and the winner willbe announced at the Annual Scientific Meeting in Oxford.

Spec Soc

Join SIVA UKMembership application forms are available from theHonorary Secretary; Dr Douglas Russell, ConsultantAnaesthetist, Southern General Hospital, Glasgow G514TF. Alternatively, join online via the website.

John Baird Glen

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Advertising Feature

References

1. Hospital infection control: guidance on the control ofinfection in hospitals HSG(95)10. London: Department ofHealth, 1995.

2. Plowman R, Graves N, Griffen M, Roberts JA, Swann AV,Cookson B, Taylor L. Socio-economic Burden of HospitalAcquired Infection. London: PHLS, 1999.

3. Nosocomial Infection National Surveillance Scheme.Surveillance of Hospital Acquired Bacteraemia in EnglishHospitals 1997- 1999. London: PHLS, 2002.

4. Rampling A, Wiseman S, Davis L, Hyett AP, Walbridge AN,Payne GC, Cornaby AJ. Evidence that Hospital Hygiene isImportant in the Control of Methicillin Resistant Staphylococcusaureus. J Hosp Infect 2001, 49: 109-116.

5. Department of Health. Standard Principles for PreventingHospital Acquired Infections. J Hosp Infect 2001, 47: S21-S37.

6. Palmer, L. An Evaluation of Silver Knight Breathing Circuits.Intersurgical, 2001.

Silver KnightTM from Intersurgical –leading the fight against MRSA

Intersurgical is pleased to announce a new addition to its anaesthesia product portfolio, by introducing the

Silver KnightTM range of breathing systems containing aunique formula to help fight dangerous bacterial infectionssuch as MRSA.

Infection is a major area of concern in every hospital.Hospital Acquired Infections (HAI) can range from minor tolife threatening and are continually placing an intolerableburden on the NHS. HAIs are estimated to be responsible forup to 5,000 deaths in UK hospitals every year and are esti-mated to cost the NHS up to £930 million per annum.1 , 2 Somestrains of bacteria have become resistant to antibiotics,the most prevalent being Methicillin ResistantStaphylococcus Aureus (MRSA).3 Whilst everyhospital takes precautions to reduce the risk,clinical evidence suggests both levels ofhygiene and direct transmission of micro-or-ganisms are major factors in the cause ofHAIs.4 , 5

Hand mediated transmission is a majorcontributing factor in the current infectionthreats to hospital patients.5 Constanthandling of breathing systems by operatingtheatre personnel can therefore increase the riskof pathogens being spread. By reducing thenumber of pathogens on the breathing system youcan help reduce the risk of transmission between colo-nised or infected patients and prevent their proliferation.

Material additives have been developed which, when incor-porated into everyday items, can fight and reduce the levels ofmicrobial contamination. Intersurgical has introduced into itsbreathing systems a unique formula to help fight dangerousbacterial infections such as MRSA. Silver KnightTM is anantimicrobial additive using silver ions that interfere with themetabolic activities of microbes, preventing them from repro-ducing and proliferating.6

For more information please go to www.silverknight.infoCrane House, Molly Millars Lane, Wokingham, BerkshireRG41 2RZTel: 0118 965 6300, Fax: 0118 965 [email protected]

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Liverpool Society of AnaesthetistsSLIM VOLUME SYMPOSIUM

Evidence-based anaesthesia and critical care – a slim volume?

MOAT HOUSE HOTEL CHESTER28 and 29 November 2002

Saxon Ridley Norfolk and Norwich Too sick for critical care?Luciano Gattinoni Milan Does mode of ventilation affect outcome?David Bennett St Georges Pre-optimisation: what’s the evidence?

David Goldhill London Does outreach alter outcome?Cameron Howie Glasgow Any evidence of progress in sepsis?

David Saunders Southampton Suicide: are anaesthetists really at greater risk?Sarah Harries Cardiff Trainees in the DGH: blessing or burden?

Peter Hutton President RCA Skill-mix in anaesthesia: how far should we go?Dorothee Bremerich Frankfurt Walking epidurals: wishful thinking?

Glen Russell Liverpool GA + LA: fashion or standard?Hervé Bouaziz Nancy Neurological complication: can we learn from

the French?Paul Edwards Chester Regional anaesthesia for carotid endarterectomy:

is it safe?

DEBATE: Children under four should be anaesthetisedonly in a specialist centre.

Neil Morton Glasgow Simon Bricker Chester

REGISTRATION FEEConsultants £300 Trainees and NCCGs £250

Georgina Hall, Department of Anaesthesia, Arrow Park Hospital,Wirral, Merseyside CH49 5PE. Tel 0151 604 7056, Fax 0151 604 7126

Email [email protected]

THE ASSOCIATION OF ANAESTHETISTS

of Great Britain and Ireland

THE WYLIE MEDAL UNDERGRADUATEPRIZE 2003

The Wylie Medal will be awarded to the most meritorious essayconcerning anaesthesia or associated clinical practice written by anundergraduate medical student at a university in Great Britain orIreland. Prizes of £300, £150 and £50 will be awarded to the best threesubmissions. The overall winner will receive the Wylie Medal in memoryof the late Dr W Derek Wylie, President of the Association 1980–82.

RULES: The deadline for submission of entries is 10 January 2003 andthe number of entrants from any one medical school will be limited toa maximum of five. The Association recognises that most medicalschools already offer prizes to medical students for an essay on a topicrelated to the speciality, and it has been decided that the winning of alocal prize will not bar the essay from being entered for the Associa-tion Prize. Essays should be prepared according to the general formatof the Notice to Contributors at the end of each issue of Anaesthesiaand be 2500–3000 words in length.

Four copies of the essay should be forwarded to:The Honorary Secretary, Association of Anaesthetists,

21 Portland Place, London W1B 1PY.

Foundation Courses in Acupuncture

A western, neurophysiologicalapproach to the use of acupuncturein the treatment of acute pain,chronic pain and PONV.

All courses are PGEA and CME approved

Course Venues and Dates

2002Manchester 19/20 Oct and 16/17 NovSlough 26/27 Oct and 23/24 Nov

2003London, Royal Marsden 3 /7 Feb(with special emphasis on Palliative Medicine)Leicester 22/23 Feb– 22/23 MarNorthamptonshire 21/22 May – 18/19 JuneYork 31 May/1 June – 28/29 JuneGlasgow 30/31 Aug – 27/28 SeptLondon 15-19 Sept Inst Child HealthManchester 18/19 Oct – 15/16 NovSlough 1/2 Nov – 29/30 Nov

British Medical Acupuncture SocietyTel: 01925 730727 for a full programmeWebsite: www.medical-acupuncture.co.uk

12


Cambridge FinalFRCA Course

Addenbrooke’s Hospital,Cambridge

Monday March 24 – Wednesday 26 2003

Interactive TutorialsVivas

SAQs and MCQsCourse Directors: Dr V Navapurkar, Dr A Gupta.

Further information from:Robert Loye, Postgraduate Centre, Box 111, Addenbrooke’s

Hospital, Hills Road, Cambridge CB2 2SP.Tel: 01223 216376Fax: 01223 217237

Email: [email protected]

Registration fee: £275 (excluding accommodation).Places on the Course are limited therefore early

application is advised.

Addenbrooke’sNHS Trust

PRIMARY FRCAREVISIONCOURSEAn intensive revision course with emphasis on small group

tutorial teaching and including MCQ and VIVA practicewith individual feedback.

DATE: Wednesday 27 – Friday 29 November 2002

VENUE: Clinical Education CentreLeicester Royal Infirmary

FEE: £250 including lunch and refreshmentsLimited accommodation is available£280 for two nights£295 for three nights

Dr Alex Ng / Dr Jonathan ThompsonCourse Directors

PLACES ARE STRICTLY LIMITED

Please contact Christine Gethins for a booking formTel: 0116 258 5291/email: [email protected]

Department of Anaesthesia, Critical Care and PainManagement, Leicester Royal Infirmary

Leicester Warwick Medical School

SCATA AUTUMN CONFERENCE“Being SMART in Anaesthesia”

13–15 November 2002, Liverpool, UK

DAY 1 HANDS ON TUTORIAL WORKSHOPTutorial/Workshop: Safety of IT Equipment in the Medical Environment

Invited Speaker: Practical Applications of Artificial Neural NetworksTutorial/Workshop: Programming Applications in Anaesthesia

Invited Speaker: Rapid Development Cycles of Microprocessor-Based Instruments“Ferry Trip Across the Mersey and Supper at the Bistro Restaurant”

DAY 2 “BRINGING INTELLIGENCE TO ANAESTHESIA”ORGANISED JOINTLY WITH IPEM / IEE

Invited Speaker: Biologically Motivated Computing: The New Artificial IntelligenceThe GRID Computing: An Unlimited Resource?

Demonstration: The use of Fuzzy Logic: Theory and AplicationIssues of Electrical Safety in the OR: A North American Perspective

Tutorial: The Use of Computers and the Internet in Anaesthesia

For more information contact Lynsey McNally, SCATA Autumn Conference, Department of Clinical Engineering,Royal Liverpool University Hospital, Duncan Building, Daulby Street, LIVERPOOL L7 8XPTel: 0151 706 4202, Fax: 0151 706 5803, Email: [email protected] www.scata.org.uk

Certificated Electrical SafetyWorkshop Carries Extra CMEPointsSuitable for Training Gradesand Consultants

“Invited free papersstill welcome”

13



PRIMARY PREP COURSE (MCQ)

“Nothing less than a TWO will do when you sit the MCQ”A Long Hard Week of MCQ Practice and Analysis

December 2–6 (8.00am–8.00pm daily)Fee £300 (incl. breakfast and lunch)

THOROUGH STUDY OF 850 MCQsPHYSIOLOGY • BIOCHEMISTRY • PHARMACOLOGY • PHYSICS

• MEASUREMENT • EQUIPMENT

This course is NOT an MCQ practice exercise but instead offers the opportunity for asystematic study of MCQ options.

N.B. Places only available to those sitting the Examination in December 2002.

PLEASE EMAIL FOR APPLICATION FORM

[email protected]


FINAL FRCA EXAMINATIONPRACTICE VIVA WEEKEND

6pm Friday, November 22 – 4pm Sunday November 24.

“A Weekend of Play before Judgement Day”

£225

N.B. This course is only suitable for those who ‘get a viva’.Thus late withdrawals are acceptable and the fee will be refunded.

PLEASE EMAIL FOR APPLICATION FORM

[email protected]


14

THE ASSOCIATION FORLOW FLOW ANAESTHESIA

Joint meeting of ALFA and the Section of Anaesthesiaof the Royal Society of Medicine, London

Thursday 27 and Friday 28 February 2003at the Royal Society of Medicine, London

A two-day scientific meeting on inhalational anaesthesia withan emphasis on Low Flow techniques

Speakers will include Prof Edmond Eger ll, Prof W.Mapleson, Prof Mervyn Maze and Prof Nigel Webster

Teaching Low Flow AnaesthesiaGetting your department to use low flows

MAC – is it still a useful concept?Inhalational agents and the immune system

The future of the anaesthetic machineNew measurement techniques

New anaesthesia administration systemsNew CO2 absorbents

Xenon for cardiac anaesthesia

Free Papers (Deadline 31 December 2002) Datex-Ohmedacash prize for the best trainee’s poster

For registration and poster submission forms please contact:Solitaire Morton, Section Administrator, Royal Society of

Medicine, 1 Wimpole Street, London W1G 0AE.Tel: 020 7290 2900. Email: [email protected]

α

Society for Education in Anaesthesia (UK)

Annual National ConferenceThursday and Friday 28–29 November 2002

Commonwealth Conference and Events CentreCommonwealth Institute, London W8

Programme includes: Current Practice in AnaesthesiaEducation • Education Theory • Distance learning

•Web-based learning resources • Simulation inAnaesthesia and Multi-professional Training

• Trainee Presentation and Prize • Conference Dinner

CALL FOR ABSTRACTSThe last date for receiving abstracts is 11 November

(We encourage abstracts of work in progress for discussion)

Registration (includes lunches and conference dinner):Members of SEA UK £250 (after 9 November £280)

Non-members £270 (after 9 November £300)

Further details, Abstract forms and Registration forms from:Mrs Simone Seychell, Magill Department of Anaesthesia,

Intensive Care Medicine and Pain Management, Chelsea andWestminster Hospital, London SW10 9 NH

Tel 020 8237 2763. Email [email protected] download from the SEA UK website: www.seauk.org

ULTRASOUND IN ANAESTHESIAAND CRITICAL CARE

A two day course of lectures and demonstrationsTuesday, 12 November 2002

and Wednesday, 13 November 2002Lectures and demonstrations covering:

Theory of ultrasound and DopplerAbdominal ultrasound

EchocardiographyVascular access

Regional nerve blocksEffusions, diaphragmatic function

Practical demonstrations and hands–on scanning.Maximum of 12 participants.

Course fee: £350

For further information or to book a place please contact:Dr Oliver Weldon, Course Organiser at

Department of Anaesthesia, Freeman Hospital,Newcastle-upon-Tyne NE7 7DN.

Telephone: 0191 223 1059. Fax: 0191 223 1180Email: [email protected]

Department of AnaesthesiaFreeman HospitalNewcastle upon Tyne

Postgraduate Medical CentreCharing Cross Hospital, London

Forthcoming symposia

Further information: Mrs S WelhamPANG Administrator7 Dover RoadSandwich, Kent CT13 0BL

Tel/fax: 01304 612520 Mobile: 07801 930370

(Approved for CEPD)(Concessionary rates available)

Thursday 17 October 2002Principles and practice of sedation

Monday 27 January 2003Cancer pain management - update

Thursday 13 March 2003Regional anaesthesia - current trends

Mon / Tues 19/20 May 2003London chronic pain symposium

Tuesday 17 June 2003London acute pain symposium

15


The 8th South Thames AcutePain Conference

Worthing and Southlands NHS Trust7 and 8 November 2002

Programme• Pre-emptive Analgesia – S. Schug (Perth, Australia) • Can Acute

Pain Services Help Prevent Phantom Limb Pain? – C. Stannard(Bristol) • Can ITU Outreach Teams and Acute Pain Teams Work

Together? – D. Counsell (Wrexham) • The Acute Back Pain Service –P. Mortimer (Sutton) • Cost of Acute Pain Services – C. Phillips

(Swansea) • Regional Analgesia – Before or After General Anaesthe-sia – B. Fischer (Redditch) • Risk Management for Acute Pain

Services – L. Strunin (London) • Continuous Regional Analgesia –W. Harrop-Griffiths (London) • Pain Management in Patients with

HIV – S. Cox (London) • Pain Services – The Experience DownUnder – S. Schug (Perth, Australia) • Plus a number of seminars andcontroversies • Conference Dinner at Avisford Park Hotel, Arundel,

Thursday 8 (places limited)

Registration:Doctors: £230

Nurses/Pharmacists: £125

For application forms and further information contact:Kathleen Durick, Anaesthetic Department, Worthing Hospital,

Worthing and Southlands NHS Trust, Lyndhurst Road,Worthing,West Sussex BN11 2DH

Tel: 01903 205111, Ext. 5942, Fax: 01903 285151Email: [email protected]

This meeting has been approved for 9 CME points

Magill SymposiumChelsea and Westminster Hospital

369 Fulham Road, London

20 November 2–6pm

XENON: no longer a stranger toanaesthesia

Course Fee: £50

Further details available from:Elizabeth Ogden

Department of AnaestheticsChelsea and Westminster Hospital

369 Fulham Road, London SW10 9NH

Tel: 020 8746 8816Email: [email protected]

Postgraduate Medical CentreCharing Cross Hospital, London

Monday 27 January 2003Cancer Pain Management - update

Neurophysiology of painOpioids and other medicationCoping with adverse events and drug interactionsEpidemiology of cancer painManagement of neuropathic painSpinal drug deliveryNeurolytic proceduresTrends in hospice care

Registration £130 Trainees £90 (inc.VAT)

Further information: Mrs S WelhamPANG Administrator7 Dover RoadSandwich, Kent CT13 0BL

Tel/fax: 01304 612520 Mobile: 07801 930370

(Approved for CEPD)(Concessionary rates available)


16

Anglia Society of Regional Anaesthesia

Lecture and demonstration course on

Local Anaesthesia andPeripheral Nerve BlocksAddenbrooke’s Hospital, Cambridge

February 10 –11, 2003

Limb block demonstrationsWorkshops

Pharmacology AnatomyOrganisers: Dr M J Herrick, Dr N M Denny

Further information from:Dr M J Herrick, Dept. of Anaesthesia, Box 93,Addenbrooke’s Hospital, Cambridge CB2 2QQ

Tel: 01223 217434 Fax: 01223 217223E-mail: [email protected]

Registration fee: £240Approved for CME

23–24 October, Team Training for Critical Incidents for nurses andclinicians ((£270)

30 October, Paediatric Anaesthesia Critical Incident Day for occasionalpaediatric anaesthetists (£150)

8 November, Medical Emergencies Course for SpRs and consultants inEmergency Medicine, ITU & Anaesthesia (£200)

14–15 November, Novice Anaesthetists Course for SHOs with 3 mths–2 yrsexperience, (£120 for 1 day/£200 for both days)

2 December, Simulated Airway and Ventilation Emergency Course for SpRsand consultants in Emergency Med, ITU and Anaesthesia (£150)

4 December, NCCG Critical Incidents Day for non-consultant career gradeanaesthetists (£150)

6 December, Training the Trainers for faculty starting a simulation project(£150)

12 December , Medical Emergencies Course for SpRs and consultants inEmergency Medicine, ITU and Anaesthesia (£200)

18 December, Paediatric Anaesthesia Critical Incident Day for occasionalpaediatric anaesthetists (£150)

Don't miss out. Book now!Specific Departmental Courses can be arranged upon request

(fee negotiable). Includes coffee, tea, biscuits and lunch. CEPD pointsapproved; 5 pts (for one day) and 8pts (for two day courses).

For bookings please contact Jane Southway, Secretary on Tel (0117)9277120 or Alan Jones, Centre Manager, The Bristol Medical

Simulation Centre, UBHT Education Centre, Level 5, Upper MaudlinStreet, Bristol BS2 8AE Tel (0117) 3420108.

Email [email protected] and/or visit the website athttp://simulationuk.com (this contains course details).

Anaesthesia Workstations andthe Checklist

In July 1990, a working party of the Association of Anaesthetistsunder its chairman Professor Tony Adams produced the first editionof a new booklet entitled ‘Checklist for Anaesthetic Machines’.

In the introduction to this booklet it was recognised that therewas a need for a formalised procedure to govern the pre-use

check of anaesthetic equipment and of anaesthetic machines inparticular. At the end of the introduction there appeared a state-ment that the trend towards microprocessor controlled anaestheticmachines and modern technology might lead to future revision ofthe document.

In due course the document was revised by a working partychaired by Dr Paul Cartwright and, in 1997, a new booklet ‘Check-list for Anaesthetic Apparatus 2’ was published.

Whereas the first booklet was specifically designed around thetraditional Boyle’s type pneumatically operated anaestheticmachine, the second booklet started the anaesthetic machinecheck with the words: “Check that the anaesthetic machine andrelevant ancillary equipment are connected to the mains electri-cal supply (where appropriate) and switched on”. These few wordsillustrate the enormous progress that has been made within thelast ten or fifteen years. The traditional Boyle’s type anaestheticmachine had developed over the last eighty years or so into theworkhorse that has given sterling service to generations of anaes-thetists. Problems have arisen from time to time but lessons havebeen learned, solutions found and most of the pitfalls have beenironed out. The developments thus far of the anaesthetic machinewere encapsulated in the International Standards Organisation(ISO) Standard: Anaesthetic machines for use with humans ISO5358 : 1992 and this standard is still in current use.

However, in 1998, a new International Standard entitled‘Particular requirements for the safety of anaesthetic workstations’ISO 8835-1 appeared. At almost the same time a new EuropeanStandard was introduced with the title ‘Anaesthetic workstationsand their modules – Particular requirements’ BS EN 740 : 1999.An important change had taken place. The words ‘anaestheticmachine’ had been replaced by ‘anaesthetic workstation’ and thiswas intended to emphasise the fact that, with the demise of ex-plosive anaesthetic agents, the way forward for an electrical inputinto the anaesthetic machine was now wide open. Not only wouldthis allow both machine and patient monitoring with their respec-tive alarms to be integrated into the machine, but it would alsopave the way for sophisticated microprocessor control of theactual function of the workstation.

There are, however, drawbacks to these developments. Not onlyhas the operation of the machine become more complex, requiringa much greater understanding of how it works, but also with everylayer of sophistication there is inevitably a greater risk of compo-nent failure. Manufacturers are obviously fully aware of the poten-tial for life threatening situations to develop should the machinefail to deliver accurate concentrations of oxygen and anaestheticagent and have generally gone to enormous lengths to ensure thereliability of their equipment. However, put very simply, light bulbsfail more often than gas taps! For this reason a variety of alarms andmessages are normally incorporated to advise the anaesthetist of

any problems that might arise. As a last resort, the workstation maycompletely shut down rather than run the risk, for example, ofdelivering an hypoxic mixture.

The manufacturers insist that loss of function cannot be consid-ered a safety hazard, since there will always be an anaesthetistpresent to take appropriate action. As far as the manufacturer isconcerned, the machine has functioned correctly, even to theextent of shutting down if the output was in any way unreliableand it would appear that the immediate responsibility of the manu-facturer ends here. This is also the view of the Medical DevicesAgency (MDA).

However, for the anaesthetist, this may just be the beginning ofhis problems! The anaesthetist will be faced with a very seriouscrisis if he suddenly finds himself with a patient who may beundergoing an emergency life saving procedure and suddenly hasno oxygen flow with which to ventilate the lungs, or is unable tomaintain anaesthesia. For this reason, it is mandatory that, whenthe anaesthetic machine check is carried out at the start of theoperating list, the anaesthetist must ensure that, in the event oftotal machine failure (e.g. power failure), there will always be analternative means present to ventilate the patient’s lungs with oxy-gen and to maintain anaesthesia. This may take the form of aseparate emergency flow of oxygen from the machine, togetherwith a reservoir bag that can be inflated by hand, but could meanthat the anaesthetist has to resort to an Ambu bag and a separateoxygen supply from a freestanding cylinder of oxygen. In the sameway, anaesthetic agents may continue to be dispensed by theanaesthetic machine, albeit without any monitoring, or the anaes-thetist must have a syringe of propofol or similar intravenous agentalways at the ready. The important take-home message is this: thefact that the anaesthetic workstation has failed may not alone beheld responsible for any critical incident affecting the patient thatarises as a result of the failure.

On a final note, the MDU has now agreed, through discussionwith the Safety Committee of the Association of Anaesthetists, thatwhen such catastrophic failure in a workstation occurs it will behappy to accept a report for entry on to its database, although itwould not normally pursue the matter further. This will, how-ever, enable the frequency of such occurrences to be monitored.

Nick Newton, Member of the Association of Anaesthetists’Standards Group and a Committee Member of the British

Standards Institution (BSI) Committee CH 121/1.

17


5–6 November 2002A multidisciplinary course for anaesthetists and O&G trainees

with simulations and hands-on workshops.• Failed intubation • Massive Obstetric Haemorrhage• Hypertensive Disorders • Intrapartum Complications

• Obstetric Collapse and resuscitation of the pregnant woman

Places are limited to 20£250 per person

Further info: [email protected] form: Alison Hodges: Tel: 0117 9595176

e-mail: [email protected]

Management ofObstetric Emergencies

19


Gas FloNotes from a Small HospitalA Tale of Everyday Folk in the North

For some time I have had the sneaking suspicion that I mayhave gone into the wrong speciality. It is only Wednesday

and, so far this week, I have done two emergency lists, twotrauma lists and one frenetic obstetric on call. I haveanaesthetised in excess of 20 emergencies, not yet got homebefore 1830 and, in all that time, I have seen a consultantsurgeon only once. He wandered in during a laparotomy,pushed the patient’s puds around importantly for a fewminutes and left. Actually, now I come to think about it, anorthopaedic consultant did appear for one nanosecondduring the trauma list but that was just to make sure our noseswere glued firmly to the grindstone before he pushed off to thelocal private hospital.

In fact, the only elective work I have done this week is myprivate gynae. list. Not surprisingly, a consultant did turn upfor this and I found it a great comfort to think that I wasearning almost half of what he was. Lucky me.

Where do the surgeons get all these able registrars (well, ‘able’is perhaps not the most appropriate adjective in some cases)who are willing to work unsupervised for hours on end (peroperation) without dobbing on the consultants to their College?It’s certainly not training or any kind of supervision. Why don’tthey complain? The answer can only be that they are dreamingof the time when they too can large it at the private hospital.

This week, I have been variously assisted by a brand newSHO, a PRHO and a visiting SHO who has never worked inthis country. Willing lads all three but no help at all. In fact,quite the reverse, since I have had to both teach at a very basiclevel and do all the work.

I’ve even had a cross letter from one of the ‘awfulpods’, full

Keep up to dateFive adorable siblings. One by itself may manifest an ENT

emergency. What is it? Answer on page 20

of indignation that he had to come in, in the middle of thenight at a time when I was snug in my bed (fit patient, easyanaesthesia, difficult surgery). Apparently, this was all my faultfor delaying surgery to comply with accepted fasting times. Tomy great amusement, he also accused me of not being a teamplayer. Priceless!

Of course, all this has occurred because it is the summer.Don’t you love it? You return from your holiday and then haveto work your socks off to ensure that your colleagues get theirsin turn. Your working week is turned completely upside down.There’s a huge influx of apparently clueless house officers atthe beginning of August. A happy band of children, encour-aged by the late nights and the school holidays, are falling outof trees or off bikes and filling the trauma list. It’s open seasonfor attempted suicide either by pills, alcohol or motor vehicleand sometimes all three. You are seriously considering bunkbeds in the ITU. Before you know it, you are just as stressed asyou were before you went away.

I think I might have cracked it this year, however. I took anearly holiday and have just booked a very late one, after eve-ryone else has returned. There is just a chance that I mightcome back to a calm and efficiently running department, fullystaffed and everything under control. I might even be able tofollow my normal work pattern. Well, there are two chancesactually. Fat and slim! I’ve almost forgotten what my normaljob plan is. I must look it up in my appraisal folder.

Recalling my appraisal, I am forced to smile. “You’re work-ing too hard”, said my appraiser. Pardon me but I thought thatwas my line. Well, we hummed and hawed over what sessionI could possibly drop, decided this was quite impossible with-out increased staffing and then he offered me a Trust lap-top tohelp me keep in touch during my non-clinical sessions! Itarrived last week. Top of the range of course – about the size ofa double-decker bus and almost as heavy. I’ll be lucky to avoida double hernia carrying it about but I’ll have to be carefuluntil after the holidays – after all who will be available to anaes-thetise me on the emergency list? What is much more to thepoint, who will do the surgery? Gas Flo

20


Keep up to dateWhat is the condition illustrated on page 19?

Acute Quinsy

Stop the madness!

Dyslexia, maybe, but regular readers of this page willknow many bizarre things happen in Africa! It is not

only an interest in this absurd road sign that brings me touse this picture but I use it to illustrate how minor changescan have major consequences. The simple switch of twoletters in the road markings results in a meaninglessinstruction. It is not uncommon nowadays for prominentpeople in high office to utter absurd statements: “Plant wheatand continue to farm” but “get off the land .” “Hospitalshave no shortages of drugs” but “relatives have to find themedication for their sick family member.” The presentconcern is what effect these ‘erroneous statements’ will haveon the country and its people in the future.

One consequence has been the migration of many trainedprofessionals, doctors, nurses, teachers, lawyers, etc. Muchdebate in the international press has ensued regarding thecauses of this migration of skilled staff ‘Out of Africa’. Thesepeople are voting with their feet and this is not onlypeculiar to Zimbabwe. Africa certainly is a great holidaydestination, with incredible scenery, exciting wildlife andmarvellous photo opportunities, but to try and live and workand to try raising a family in peace and security, Africaleaves much to be desired. The solution for many is migra-tion, not ‘Another day in Paradise’. Euro-politicians havestated that developed countries should not poachprofessionals from less developed countries. Sounds goodbut this moral high ground is compromised by the fact thatthere are many agencies recruiting staff from these coun-tries. Why should these people not move to a place wheretheir skills are recognised and rewarded appropriately? Whatdeveloping countries all over the world are slow to realiseis that the world is an open market place. It is becomingimpossible for governments or employing agencies torestrict or control an individual’s movement to a specificplace or country. Market forces of supply and demand willalways be the major driving force for migration. Historyalways repeating itself brings to mind the mass migrationof Irish people to the New World in search of a better life.

Another result has been the slide into academic medioc-rity. When a man with the ‘distinguished’ qualifications ofa ‘Form 1’ pass is regarded more highly than one with a

university degree,then society istreading danger-ously close to theideals of the Poll Potregime in Cambo-dia. A well knownZimbabwean activ-ist is paid more forhis ‘work’ as a warvet than a govern-ment specialist!What is the rewardfor the academic orprofessional in Zimbabwe, a progression to poverty? Thisyou may say is over dramatised, no, not so! Professionalsand academics who do not earn enough to put theirchildren into school have a reasonable standard of livingand those who are not respected or appreciated by societyare leaving in droves, either by migration or a change inprinciples or profession. They are going farming or mining,running an import-export business or moving into politics.The consequence is a loss of skills to the country and a lossof the individual’s own skills.

For those who stay to make a difference it is an uphillbattle. Simply maintaining the levels of their skills is extremelydifficult. A simple suction catheter for clearing secretions froman ETT now costs over Z$1000 (equivalent to one pound),twice as much as I was paid for my first month’s work as ajunior house officer. Before anyone says that was a long timeago and, enough of the “when I were a lad stories”, it wasonly 1985. Living in this hyperinflationary situation (currentlyrunning at 123%) means most people’s living standards, earn-ings and savings are declining at an alarming rate.

But, to return to the picture above, there is something notquite right with the sign, as it should obviously say “STOP”.Stop is the secret prayer whispered from the lips of many.Without a doubt, there is a strong desire by all to live in asociety with peace and justice, fairness and equity and whereall people are valued by society. This is possible. The onlyquestion is when.

When is all this madness going to stop?

Laurie [email protected]

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