anaesthesia points west

61 Pages·2011·5.25 MB·English

ANAESTHESIA POINTS WEST
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THE SOCIETY OF ANAESTHETISTS OF THE SOUTII WESTERN REGION
PRESIDENT: DRJ. M. EATON FrenchayHoqitrl
VICE PRESIDENT: DRR. W. JOHNSON IJBHT
SHUTT
PRESIDENT-ELECT: DRL. UBHT
IIONORARY SECRETARY: DR K. HOLDER Southmead Ilospital
IIONORARYTREASIIRER: DRP.RITCHIE CheltenhamGeneralHospital
HONORARY SECRETARY ELECT: DR M. TAYLOR IJBHT
PURDAY
COMMITTEE: DRJ. Exeter
KELLY
DR F. Trainee Representative Bristol School
DR G. ANSTELL Trainee Representative South West School
EDITORIAL COMMITTEE: DRN. WILLIAMS Editor Gloucestershire Royal Hospital
DRP. McATEER Assistant Editor
Royal United Hospital, Bath
FINCH
C. Secretary to Editor
Gloucestershire Royal Ilospital
WEBSITE: DR S. COURTMAN Plymouth
www.saswr.co.uk
ANAESTHESIA POINTS
WEST
CONTENTS
Vol.37 No.1 Autumn,2003
Page
Editorial 3
Future Meetings of the Society 4
Honorary Life Membenhip 5
News of the West 9
Exarrination Successes and Honours t'l
Society of Anaesthetists of the South Western Region
Sp.ing 2003 Scientific Meeting Report Kathr,/n Holder l8
SASWR Trainees' Meeting Report Fiona Kelly 2t
The Bristol/Bath GAT Annud Scientific Meeting
The Good, the Bad and the Dowmight Naughty! Samantha Shinde 23
NBM: 'No beneficial medication?' Neil Muchatuta 27
HIV Post-Exposure prophylaxis - a Suwey of
StaffAwareness Ian Thomas 3l
Inadvert€nt Durdl Punctw€ md Postdrral
Puncture Headache Chris Laxton and Fiona Donald 35
Videolaryngoscopy using a Digital Blade Chris Thompson 39
Standing Up and Speaking Out for Staffand
Associate Specialist (SAS) Doctors Kate Bullen 43
A Visit to Fort St George - There's Life
after Retirernent! Kay Huggins 46
Monkey Business for the Anaesthetist -
A Simian Emergency John Covell 49
Mostly About Pens, with a Bit About Grammar Neville Goodman 50
Pitfrnan on Plonk James Pittman s2
Poets'Corner
The Theatres are Quiet Now John Teague 53
Res Cogitans Graham Brownlie 54
Tonight the Air Robin Forward 55
Obituary - Kathy Graham Peter Baskett 56
Crossword B. W. Peniss 57
Cartoon Kathy Smith 59
Notice to Contributors 60
@2003 The Society of Anaesthetists of the South Western Region
Editorial
By the time you read this I shall be down under, who are itching to write on their pet tryc drnpw
basking in the tropical sunshine of the Whitsunday a line and I will see what u.e can do- Atr\r mSilD
Islands, where the only decisions to be made will considered! News of the West is alv-ays a pqlrr
be which book to read, when to go diving and section of the journal and I v-ant to thank thc
whether to have red or white wine with dinner. It Linkmen for their articles. There are a fen g4r
seems to have been a busy year and writing this this time, either because I received asrhing dcqrEl
editorial will be the last in a long list of tasks to be reminders or the copy arrived too late for pmmirg-
done before heading offto the airport. The fact that We will look forward to hearing even more ners
you are reading anything at all will be thanks to next time!
Tricia sorting out the final proof before she too No feedback required in this edition (unless ruy
goes off on holiday! That will be Tricia's last act of the articles are sufficiently controversial to
as she will finally be stepping down from the prompt letters) as no suitable photos have
editorial committee at the AGM. She has provided appeared. I had only one response to the captim
invaluable help and support in my first year as contest picture in the spring edition (some hing to
Editor, for which I thank her. I hope she will not do with spots) and as it came from Les Shutl sto
mind the odd phone calM will be welcoming a is about to become President I decided he q-as nor
new Assistant Editor but guess I ought to wait until eligible for the prizet The picture in James
after the AGM to do so. Rogers's article was of Rumps Point near Padstos-
As always I am grateful to those of you who - spotted again by Les. It is great to knou'that
have contributed to the journal, either voluntarily someone reads the journal!
or in response to my coercion. I am particularly The last few years have seen huge changes in the
pleased to have a number of articles from trainees Health Service. We have been "assessed"-
throughout the region, all of which are interesting "improved", "modernised" and made to "excel--
and informative and in the case of Chris None of these seem to have made much impact on
Thompson's article, innovative. He won the the way I work, except perhaps that it takes longer
SASWR prize last year for his presentation and I to do less and is more frustrating in the process-
hope he manages to develop and market his useful The latest change is the New Contract and I know
design. Kate Bullen's article is a timely update on that between now and my next editorial there is
the politics affecting the non-consultant career going to be frenzied activity to get job plans
grades who bolster up all anaesthetic departments; written, agreed and implemented in a frighteningly
there is a lot about them in the medical press as I short time frame, for those who chose to rake t+
write this. Robin Forward, our regular poet, has the new offer. There are interesting times ahead
clearly inspired some of you as I have received a and as the saying goes "the devil will be in the
flurry of poems - hence Poets' Corner in this detail". I am sure we will hear more in the next
edition. The regular contributors provide the News of the West. I hope this edition of
skeleton of the journal and unfortunately we are Anaesthesia Points West provides an enjoyable
about to lose a limb as James Pittman is giving up respite from the process. Good luck!
having exhausted his knowledge of plonk. Only
joking! Actually he is moving on to bigger and Nicky Willirns
better things. So, ifthere are any experts out there Gloucester
Future Meetings of the Society
2004
Spring Meeting Spring 2005
Bologna l3th-l5thMay2Oo4
Torbay
Autumn Meeting 20O4
Bristol
lgth and 20thNovember20D4
Anaesthesia Points West Vol. 37 No. I
Article
Honorary Life Membership
to the Society of Anaesthetists of the
South Western Region
Fields Hospital with the famed Dr Hugh Joll;'. He
returned to Plymouth in 1962 as SHO in paediarics
and enjoyed life so much (his love of sailing begm
at this time) that he later joined the Anaesrhetic
Department whist still harbouring the intention of
going into General Practice. The enthusiasm of his
seniors quickly converted him to the challenges.
variety and excitement of anaesthetic practice ad
for that we should all be grateful. The Anaesthetic
Department at that time consisteil 6f $ Q615sltants.
I Registrar and 6 SHOs (it has since grown to 44
Consultants, 20 SpRs and 12 SHOs).
After Registrar and Senior Registrar posts at
G.O.S., a 3-year stint in Saigon with the British
Paediatric team and many other adventures, he
completed his training at the Middlesex and
Harefield and was appointed as Consultant in
Plymouth in 1977. His brief was to establish the
first proper I.C.U. in the city and he set about it with
such gusto that a six bedded unit opened in October
Dr Mike T. Inman 1912. He was soon joined by Peter Taylor and John
Lytle and the 3 of them ran the unit on a l:3 basis
Dr Mike T. Inman for the next 15 years, until the advent ofthe modem
To describe Michael Inman as the Leonardo da breed of Intensivists in the mid 1980s. His non-
Vinci of 20th Century anaesthesia in the far South clinical activities were equally time consuming and
West is perhaps somewhat effusive, but he is successful.
certainly a man of great talent, multiple interests and His enduring passion throughout his career has
significant achiev ements. been his love of teaching the principles and practice
After graduating at the Middlesex in 1956, he of anaesthesia, and this, coupled with his
signed a 3-year short service commission in the organisational skills were recognised by the Britisb
Royal Navy. This clearly infected him with Council who invited him to visit Nepal to set up a
wanderlust and we should be grateful that one of his training programme in 1983. This led to numerous
early secondments brought him to Plymouth for a other overseas educational ventures on behalf of
10-day course in basic anaesthetics at the RNH, W.H.O. and other institutions, in Malawi, Sri I -nka,
Stonehouse (clearly sufficient for the Navy's Shanghai, the Philippines and most recenrly
purposes at that time!) and later as M.O. at Romania. His contribution to anaesthetic educatim
Dartmouth Naval College where sheer boredom led in less fortunate areas of the world cannot be
to him attending paediatric ward rounds at Freedom overstated, but he was equally active at home in
local hospital developments and politics, where his Flying Eye Teaching Hospital and visited Cuba
wise counsel and management experience were in 2001, Bangladesh, 2002 and Ethiopia in 2003 - he
constant demand. has future visits to Tanzania and Hanoi in his diary.
He was a major player in planning the new The new Peninsula Medical School in Plymouth
Plymouth Postgraduate Medical Centre on the and Exeter demanded his involvement and he is at
Derriford Hospital Site, serving as Chairman from present the Foundation Campaign Chairman, a
1984 - 1993. He was elected as Chairman of the charity raising funds for research, equipment and
H.M.S.C. 1990 - 92 and has worked tirelessly on bursaries for students in need.
many working parties and committees. On the This tribute to Michael would be incomplete if I
national stage, he was elected to the Council of the did not mention the immense support and
A.A.G.B.I. in 1980, and served as Hon. Sec. From understanding that he has received from his lovely
1982 - 86 and Vice President until 1988. wife Annie - "behind every great man . . etc" -
Michael first attended a S.A.S.W.R. meeting in who has been a most gracious hostess on numerable
1963 and has been an active member ever since, occasions at their beautiful home on the edge of
organising the Plymouth meeting in 1974 with Dartmoor. He lists his hobbies as sailing, gardening
James Smith, representing Plymouth on the and family: hopefully he will be able to spend more
committee in the early 1980s and was elected time on all three in the future but I wouldn't bet
President in 1988 - 89. He has encouraged countless on it!
younger colleagues to join by his sheer enthusiasm. His continuing enthusiasm and involvement over
Michael retired from full-time practice in 1997, the years are an object lesson to all ofus and he is an
then worked part-time mainly in Ophthalmic extremely worthy recipient of the honour that
anaesthesia until 2000. If we all expected him to S.A.S.W.R. is to bestow on him.
then hang up his stethoscope and sail into the sunset, Martin Coates
we were sorely mistaken. He joined ORBIS, the
Peter John Firth Baskett
How can one person cram so many outstanding
achievements into one career? An impossible act to
follow. These are my immediate thoughts after
spending the best part of an afternoon studying Peter
Baskett's curriculum vitae.
Peter Baskett was born in Belfast in 1934 and
graduated from Queen's University, Belfast and
Cambridge University in 1959. His initial
postgraduate training, including his first post in
anaesthesia, was at the Royal Victoria Hospital,
Belfast. Peter has fond memories of his time there
and has enjoyed several opportunities to return as an
invited lecturer. ln 1962, Peter crossed the water to
Bristol where he completed his anaesthetic training
as a Registrar and then Senior Registrar at United
Bristol Hospitals and Frenchay Hospital. Peter was
appointed as a Consultant Anaesthetist to United
Bristol Hospitals and Frenchay Hospital in 1966, a
position he held until retirement from clinical
Dr Peter Baskett practice in 1999.
Peter is one of those rare individuals who introducing Entonox into the Ambulance Service m
combine immense enthusiasm and hard work with the UK in 1970. He was a founder member of
extensive knowledge and practical skills. Add to this BASICS and was chairman of this organisation for
a remarkable diplomatic ability and the scene is set four years. As the Royal College of Anaesthetist's
for achievements on an unimaginable scale. My representative on the Board of the Faculry of A&E
challenge in writing this citation is to find an Medicine, Peter was the key person at the interface
organisation that Peter has not chaired or presided between anaesthesia and emergency medicine as the
over. Peter has been president or chairman latter evolved into an independent speciality. He was
("Officer-in-Charge") of the Association of awarded an honorary FFAEM in recognition of this
Anaesthetists of Great Britain and lreland, the achievement.
British Association for Immediate Care Schemes Peter has been at the forefront of cardiopulmonary
(BASICS), the United Services section of the Royal resuscitation for three decades. His interest in the
Society of Medicine, the World Association for subject started in the early 1960s just as the
Emergency and Disaster Medicine, the European technique of closed chest massage and mouth-to-
Resuscitation Council (ERC), the International mouth ventilation was being described. As a founder
Trauma Anaesthesia and Critical Care Society member of the Resuscitation Council (UK) he was
(ITACCS), the Triservice Society of Anaesthetists responsible for making resuscitation training among
and, of course, the Society of Anaesthetists of the UK health professionals the best in the world.
South Western Region. Peter did not find the time to Through the International Liaison Committee on
be president of the Royal College of Anaesthetists, Resuscitation (ILCOR), Peter developed the
but he did spend 12 years on the College Council international guidelines on airway management
and its equivalent predecessor! during resuscitation, and healthcare professionals
I first met Peter in 1986, when he gave a tutorial across the world respect his expertise on this subject.
on the Bristol Part I FFA exam course. He entered Peter was founder chairman of the ERC and through
the tutorial room with one leg in a plaster cast and a this organisation he has been responsible for
lit cigarette in his hand. He proceeded to deliver the developing resuscitation throughout Europe.
most entertaining and compelling tutorial I had ever Although he technically "retired" in 1999, Peter has
attended; I guess it was the sharp sense of humour continued to work harder than most of us in full time
liberally interspersed with a variety of fruity employment! In his retirement, he has personally
expletives, which I subsequently learnt was introduced the European Advanced Life Suppott
characteristic of a P. Baskett lecture. The subject, of course into 13 countries. This has involved directing
course, was cardiopulmonary resuscitation - not about two ALS courses a month for the last three
something I had been particularly interested in until years. Peter has been Editor-in-Chief of the journal
then. It was this introduction to the subject that Resuscitation since 1997 and he contilues to help
stimulated much of my own involvement over later and encourage researchers from all over the world to
years. Peter was, and still is, an extraordinary funher the science of resuscitation.
lecturer and it has been my privilege to watch him Peter has been very influential in the development
inspire audiences around the world. He loved to of trauma services both locally and nationally.
challenge conventional practice, and frequently did Throughout his career Peter used his international
so with a delivery that excited the open minded and connections to provide training opportunities for
with vocabulary that created new levels of political numerous anaesthetic registrars from Bristol and
incorrectness! He was the only one who had the elsewhere in the UK. In particular, he set up a strong
charm to get away with it. Following Peter as a alliance with the Shock Trauma Center in Baltimore,
lecturer still ranks as one of the most difficult tasks which gave many British anaesthetists, several of
of my career. whom were military doctors, the opportunity to
Peter is a world leader in anaesthesia and enhance their skills and knowledge in trauma
emergency medicine. Along with Douglas resuscitation.
Chamberlain, he developed advanced training for Peter has always led from the front. He was
the ambulance personnel who became the first among the first group of doctors in the UK to be
paramedics in Europe. Peter was responsible for trained as an Advanced Trauma Life Support
(ATLS) course instructor. As such, he pioneered this recently Michael Schumacher. As the helicopter was
course in the South Western region. He inspired hovering over the landing zone near Northampton
many doctors to follow his lead and subsequently General Hospital, the injured Schumacher glanced
the region has developed an enthusiastic cadre of down at the large crowd of people that had
ATLS instructors. assembled in the hope of catching a glimpse of the
Despite considerable commitments to world's most famous racing driver. Never one to
international societies, Peter made a very valuable miss an opportunity, Peter spoke to Michael over the
contribution to anaesthesia and intensive care in radio headset and quipped - "don't worry, they are
Bristol, and Frenchay Hospital in particular. During here to see me - I am a very famous anaesthetist in
his long career at Frenchay Peter had several these parts"!
important positions including Chairman of the Peter has always loved to play the host; his drinks
Division of Anaesthesia, Chairman of the District parties are legendary and he is the life and soul at
Medical Committee, and Chairman of the Medical any social event. But, drinks at the Basketts' should
Staff Committee. come with a health warning. Indeed, if the more
In 1983, Peter noticed that he had an occasional seasoned guests are playing fair, appropriate
weekend to spare. This oversight was promptly warnings are given to any newcomers to the Baskett
corrected by joining the Territorial Army. Consistent residence. For example, the Baskett "gin and tonic"
with his successful career in the National Health has rarely been in contact with tonic. Those who
Service, he was promoted to the rank of Colonel and ignore or forget this advice will generally have little
was Commanding Officer of 2I9 Wessex Field recollection of the latter part of the evening. Peter
Hospital. has always had an extraordinary ability to party hard
Peter has had a long-standing and passionate into the early hours and yet be up and at the desk or
affair with motor sport. As a man who lives life in on a flight by 06.00.
the fast lane, this is entirely appropriate. In the What is Peter doing now? Most importantly, he is
1950s, Peter raced minis, but he eventually realised able to spend more time at home with his wife Fiona
that he might live marginally longer if he placed and daughter Beatrice. Of course, he is still directing
himself on the outside of the track as a "doc on the ALS courses throughout Europe and is editor-in-
corner". Peter was appointed as Chief Medical chief of Resuscitation. In the remaining time he
Officer to Castle Combe circuit in 1968, a position enjoys hobbies such as gardening and collecting
he held for 30 years. Even now, he still manages to clocks. Perhaps the latter is the key to one of Peter's
get to more race meetings than the current Chief best kept secrets - the ability to extract 48 hours out
Medical Officer! Over all these years his enthusiasm ofevery day!
and charisma attracted many doctors to volunteer The name of Peter Baskett is familiar to doctors
their services and join the Castle Combe medical all over the world. He has accumulated a staggering
team. To this day, it is well known in motor sport number of achievements and they impact
circles that Castle Combe consistently attracts more significantly on many disciplines. He is highly
medical officers than any other circuit in the respected, not just by his own generation, but also
country. From the 1970s onwards Peter was a by the generation that follows him. As a
regular doctor at the British Grand Prix. As the representative ofthe latter, I am delighted to see him
"helicopter doc" he was responsible for evacuating awarded with honorary membership of the Society.
several Formula One drivers, including most Jerry Nolan
News of the West
This is where you are kept up to date on all the news and gossip from each department in the South Western
region (andfrom our member in "exile" in New Zealand). The name of the correspondent appears at the end of
each contribution and he/she is also the SASWR LINKMAN for that department. Anyone wishing to find out
more about SASWR or wishing to join should search out the local linlcman who will readily supply detaik and
application forms. In addition to other benefits, members receive the twice yearly editions of APW -
FREE!
Barnstaple wait for their operations this summer is that the
I'll be brief as Linsey is away on sick leave and Pat Consultants were swanning about in the Bahamas,
is struggling to man (should that be woman?) the all at once. I ask you! Can we any more afford to
pumps singlehandedly. swan anywhere in peak season? (That was
We're pleased to report the safe return from rhetorical; even though the SpRs are so
active service of Gareth Sowden. His absence and comparatively wealthy, Comwall in July is no less
Tony Laycock's continuing dalliance in the States accessible to Consultants.) This scurrilous piece of
have been ably filled by several locums - Kate reporting was immediately objected to by our loyal
Tipping, John Spiers, George Hartwig and Tony and decent new temporary Chief Executive, who
Heenan - to them our thanks. Congratulations go to had a letter published in the paper. And the source?
Helen and Glynn Matthews on the birth of their son Our very own Non-executive Director. Or at least,
last spring. that's what I heard. (You can simply never trust
Farewell to stalwarts SHOs Gareth Davies, Pete gossip.)
Forster and Adam Kwiatkowski and hello to Earlier in the year, we were concemed to hear in
replacements Marie Thomas and Ben Howes. May that the RUH's hard-eamed reputation has been
Steve Forster stands down as lead clinician soon put at serious risk, as Frenchay and Southmead
and Tim Cobby takes up this role in his stead - our hospitals have raced into the lead of the Largest
thanks to Steve for his stirling efforts and best Budget Deficit Competition. Our late lamented (and
wishes to Tim for the next couple of years. last permanent) Chief Executive departed in July,
Hopefully the secretariat will have been restored having made a HUGE impact (staff parking
to full capacity by the next time I write, enabling me charges). In the meantime, the second previous but
to wax lyrical and at length - until then . . . adieu! one Chief Executive, during whose tenure began the
Nick O'Donovan inexorable slide into zero ratings, has added to the
budget deficit by being paid compensation of
Bath f210,000 for being ousted.
Bath has simply been a hive of activity recently. It On to other, less shameful, things. Our delightful
is a pity, perhaps, that I have not been very involved. Delia, departmental damsel ('secretary' didn't
Most dramatically, we have lost a Consultant in the alliterate) has popped a sprog. He is called
form of Alex Mayor. Alex has trooped off to Sebastian, according to my sources. Luckily,
Plymouth, presumably for the better weather. We Elspeth remains, or we would all just have to go
all hope that he has a lovely time, and remembers home.
that sunscreen. Speaking of sunscreen, Bath has had We have had lots of movement in more ordinary
a really glorious summer, which your author would ways, as always. Welcome back from maternity
have enjoyed more had it not been attached to a leave to Drs Lesley Jordan and Kim Carter (the
planetary health waming. There is no guilt-free fun latter then making a hasty departure for the BRI);
when you're a grown-up. and congratulations to Sara Keeley on the birth of
On the subject of guilt, the Consultant body got her second daughter in an astonishingly short time
into trouble with the local media about holidays this since her first. SpRs Douglas Mein, Raju Kalidindi,
year. The Chronicle, which traditionally keeps us Steve Snyders have all gone to the BRI. SHOs
all under very close supervision, gave front page Abdul Lalkhen has fled to Manchester, Harry
priority to a story that helpfully explained the Akerman to wedded bliss and an SpR post in
waiting list problem. The reason why people had to Wessex, Matt Thomas (mark 2) to an SpR post and