Introducing the Universal Anaesthesia Machine Apollo 13: A - aagbi

36 Pages·2010·2.54 MB·English

Anaesthesia
News
ISSN 0959-2962
The NewsleTTer No. 273 April 2010
of The
AssociATioN
of ANAesTheTisTs
of GreAT BriTAiN
ANd irelANd
Introducing the Universal
Anaesthesia Machine
Apollo 13: A space age
anniversary
Scottish Trainee Survey
Letter from America:
checklist mania
World leader and specialist in hand-carried ultrasound.
UltrasoUnd training CoUrses 2010
2010 course dates: SonoSite, The World Leader and Specialist in Hand-Carried Ultrasound, has teamed up with some
Advanced Ultrasound Guided of the leading specialists in the medical industry to design a series of courses, for both novice and
Regional Anaesthesia experienced users, focusing on point-of-care ultrasound.
21 – 22 June — Brighton (A)
9 – 10 September — Liverpool
Advanced Ultrasound Guided Regional Anaesthesia
3 – 4 December — Nottingham (A)
These courses are organized by Regional Anaesthesia UK –
Introductory Ultrasound Guided RA-UK (formerly ESRA UK & Ireland) the official UK national
Regional Anaesthesia regional anaesthesia society affiliated to ESRA, in conjunction
17 – 18 May — Hitchin with Sonosite Ltd. This two-day course is aimed at anaesthetists
5 – 6 July — Hitchin wishing to improve their skills in UGRA and comprises of
22 – 23 November — Hitchin didactic lectures covering all commonly used regional techniques, clinical and cadaveric anatomy
demonstrations and practical hands-on workshops. Further information on the faculty and content of
Ultrasound Guided Venous Access
this course can be found on the RAUK website www.RA-UK.org, these courses are also recognized for
15 April — Hitchin
10 June — Hitchin the ESRA diploma.
22 July — Hitchin Introductory Ultrasound Guided Regional Anaesthesia
16 September — Hitchin The two-day introductory course is designed to teach those who have little or no experience in the
11 November — Hitchin use of ultrasound in their normal daily practice. The course comprises of didactic lectures on the
Ultrasound Guided Chronic Pain Management physics of ultrasound, ultrasound anatomy and regional anaesthesia techniques. The lectures and
12 May — Hitchin hands-on sessions will concentrate on the brachial plexus, upper and lower limb blocks.
22 September — Hitchin Ultrasound Guided Venous Access
15 November — Hitchin This one-day course is aimed at physicians and nurses involved with line placement and comprises
didactic lectures, ultrasound of the neck, hands-on training with live models, in-vitro training in
ultrasound guided puncture and demonstration of ultrasound guided central venous access.
The emphasis is on jugular venous access, but femoral, subclavian and arm vein access will also
be discussed.
Ultrasound Guided Chronic Pain Management
The course is aimed at chronic pain specialists, or other interested parties practising in chronic pain
For the full listing of SonoSite training
medicine who have little or no experience of musculoskeletal ultrasound and who wish to obtain an
and education courses, dates and to
register go to: introduction to ultrasound in chronic pain medicine skills.
www.sonositeeducation.co.uk
Fees: £350 / £450 (A) (two-day courses) includes VAT, lunch, refreshments and course materials.
£250 (one-day courses) includes VAT, lunch, refreshments and course materials.
(A) – Anatomy based courses / with cadaveric prosections.
If you have any questions or should need further information please contact:
Jes Tiller, SonoSite Ltd, Alexander House, 40A Wilbury Way, Hitchin Herts, SG4 0AP
Tel: [phone] Fax: [phone] E-mail: [email protected]
2 Anaesthesia News April 2010 Issue 273
© 2010 SonoSite, Inc. All rights reserved. 02/10
AN_training_2010_v17.indd 1 09/02/2010 15:46
Welcome
Editorial
because it is hard’. Anaesthesia can seem Hilary Aitken (the immediate past editor of
difficult at times, but we should surely keep Anaesthesia News) has written an account
this in perspective. of the winter scientific meeting; modesty
no doubt prevented her from mentioning
Of course, some anaesthetists do routinely
put their lives on the line in the service of
This month sees the fortieth anniversary their fellow members of the armed forces
of the Apollo 13 mission, and David and their country. The contribution of some
Banks has written an interesting article of these brave individuals was recognised
about the technical fix which enabled at the awards ceremony during the Winter
the astronauts on that fated mission to Scientific Meeting in London in January;
survive. Astronauts really must be made of when General Sir Richard Dannat (former
different stuff. I am struck by the fact that Chief of the General Staff) presented
the Apollo 13 astronaut shown on page 22 members of Defence Anaesthesia who
with the cobbled-together CO absorber served in Iraq with the Pask Award. Dr Hilary Aitken
2 receives her awards
on which his life depended looks quite Somewhat ironically, elsewhere in the
fro General Sir
happy; contented even. Kennedy famously same building, the whys and wherefores of
Richard Dannat
remarked that he had decided to send men that war were being dissected at the Iraq
to the moon ‘not because it is easy but inquiry.
Contents
The Association of Anaesthetists
of Great Britain and Ireland
21 Portland Place, London W1B 1PY
Telephone: [phone]
Fax: [phone]
03 Editorial 18 Letter from America Email: [email protected]
Website: www.aagbi.org
04 Anaesthesia Digested 20 NICE guideline
Anaesthesia News
05 Maternal mortality and anaesthesia technology 22 Apollo 13 and its CO absorber, 40 years on
2 Editor: Val Bythell
in the 21st Century 28 Letters Assistant Editors: Susan Williams (GAT),
Isabeau Walker and Felicity Plaat
10 Presidents Report 30 Obstetric Anaesthetists’ Association
Advertising: Claire Elliott
11 The history of the SAS Committee 32 WFSA – an active player on the world scene [email protected]
13 GAT and RCoA Advisory Board for Scotland: 34 Barcode Bonanza: NPSA launches new drug Design: Amanda McCormick
Scottish Trainee Survey safety campaign McCormick Creative Ltd,
Telephone: [phone]
16 How to write a paper 36 Particles Email: [email protected]
Website: www.mccormickcreative.co.uk
Printing: C.O.S Printers PTE
Ltd – Singapore
22 30 Email: [email protected]
Copyright 2010 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.
32
5 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
AAnnaaeesstthheessiiaa NNeewwss AApprriill 22001100 IIssssuuee 227733 offered in advertisements. 33
Anaesthesia
her own awards. Hilary received the
Anniversary Medal, the Editor’s Award Digested
and a Council Award, reflecting her
sterling service to the specialty, the
Association and this newsletter -
congratulations Hilary!
Many of the speakers at WSM 2010 have
given their presentations to the AAGBI
so that members can access them via
our website: check them out at http:// Anaesthesia April 2010
www.aagbi.org/events/past/wsm.htm.
I enjoyed many excellent talks (and
Nitrous oxide was isolated in the 1770s by from 1986 with studies up to 2008. Does
mentioned some last month); I will
Joseph Priestley. Its benefits soon became this suggest that evidence based anaesthesia
have another look at Mark Lema’s (past
apparent and Humphrey Davy was renowned started in the 1970s, or that PONV was first
President of the ASA) presentation as
for throwing parties fuelled by copious identified as an important problem at that
soon as it is online; one of his key points
as I recall was that one cannot keep amounts of the gas. The English poet Robert time? The review and analysis is confined
doing less (in terms of hours reduction, Southey was so taken with its properties to adult patients. The definition of PONV
operating theatre throughput and so that he wrote "I am sure the air in heaven must included nausea, vomiting, or both, regardless
on) whilst being paid more (or even as be this wonder working gas of delight". Davy of the degree of nausea, the number of times
much perhaps) – whilst spoken from a apparently even considered marketing NO they vomited or whether this occurred early
2
US perspective, this truism is probably as he calculated that he could supply it in bags (within 6 hours of surgery) or later (up to 48
the nub of the debate regarding SPA time for less than the cost of alcohol. Gardner hours). Despite this wide definition it may
etc. Quincy Colton also saw the possibilities and be worth noting that PONV only occurred in
quit medical school to peddle nitrous oxide about 30% of patients. I’m not going to give
On the subject of the AAGBI website;
demonstrations. If nausea and vomiting was away the punchline and you should read the
anyone who has used this lately will
a concern it appeared to be outweighed by paper if you want to find out whether NO
have noticed that it is looking rather 2
the sensations experienced. It was following has an effect.
dated. A totally new website is at an
Colton’s show in 1844 that Horace Wells
advanced stage of development and will
realised that the gas may have useful analgesic Many other factors affecting PONV are under
hopefully be ready for use soon.
properties. our control. These include anaesthetic agents,
As an antithesis to the celebration the use of opioids and the administration
of space-age antics, Paul Fenton It seems extraordinary that 166 years later we of antiemetics. The approach of individual
continues his outstanding contribution have still to decide whether nitrous oxide is an anaesthetists seems to mirror their philosophy
to anaesthesia in the developing world important cause of postoperative nausea and on life and their attitude to risk. We can all
with the development of the Universal vomiting. Clearly PONV is a bit complicated. understand the evidence and issues. You may
Anaesthesia Machine which he Drugs may have some responsibility, but so already avoid nitrous and give two antiemetics
describes on page 5. This is a brilliant do the procedures and the susceptibility of to every patient, or alternatively routinely give
idea and I hope it will be successful in the patient. It occurs in some 20-30% of the gas and sparingly prescribe medication for
helping to drive down the shocking rates postoperative patients and probably accounts postoperative nausea. This review delivers
of maternal mortality in parts of the third for a similar percentage of the anaesthetic interesting information. However, after 166
world which he describes by way of an literature. years I suspect there will be little in this paper
introduction. to change your practice.
What do we learn from this paper? Many, but
Readers should bear in mind that this not all, previous studies have suggested an David Goldhill
month includes April Fool’s day, so association between NO and PONV. There
2 Editor, Anaesthesia
please think twice before sending me have been previous meta-analyses but the
‘outraged of Tunbridge Wells’ letters. last ones were published in 1996. Back then J. Fernandez-Guisasola, J. I. Go mez-Arnau,
Caveat emptor! there was concern that omission of nitrous Y. Cabrera and S. G. del Valle. Association
would increase the incidence of awareness, between nitrous oxide and the incidence of
something I suspect is less of a consideration postoperative nausea and vomiting in adults:
Val Bythell these days. The earliest of the 33 trials a systematic review and meta-analysis
included dates from 1973, the next oldest Anaesthesia 2010; 65: 379 – 387.
4 Anaesthesia News April 2010 Issue 273
Maternal mortality
and anaesthesia
technology in the
21st Century

Paul M Fenton DTM&H, FFARCSI
Formerly Professor and Head
Dept of Anaesthesia
College of Medicine
Malawi, Africa 1986-2001
Here is an interesting bit of market of 4-5%. Over several decades they have of complicated labour, much of which
research: in 2008, two thirds of the world’s ensured that only their types of machine needs surgical intervention.
population (4.5 billion people) bought comply with the International Standards
just 4% by value of the global output of Organisation (ISO) safety regulations; But somehow anaesthesia and surgery were
anaesthesia machines. The balance (96% machines that are unusable by half the left out of the debate3 about what to do. For
of mainstream production) cannot even be planet because the support infrastructure is over three decades a mindset has existed
used in most of the places where those 4.5 lacking. For this half of humanity there is that technical advances in medical science
billion people live. currently no standard machine specified or are treatments for western populations
while the same problems in poor countries
available.
Compressed oxygen from fractional need a preventive, public health solution.
distillation of liquid air, pressurized pipeline Is there no machine with a simple bag to
systems needing regulators, cylinders, inflate the lungs using a volatile agent and Gasping on the floor, having fallen between
transport, and now computerized gas flow, oxygen? It should be such an easy thing, these two widely separated, unsupportive
have become so inseparable from hospital stools we find World Anaesthesia.
but there is not. ‘There is no market’ they
construction and equipment manufacture,
will tell you. Is that not a challenge for a
at such vast cost and regulatory complexity, Why was MDG #5 so unrealistic?
simple minded gasman? But researchers in
that ‘Western’ anaesthesia is now placed
this field have long gone: I was once told 30 years ago we were still in the Space
well out of reach of poor countries.
by an expert that everything was electronic Age. People believed that improved health,
Elaborate safeguards are mandatory to
these days and my devices would be better like technology, would just flow around
counter the inherent dangers – not of
used for inflating air beds. the world, as have computers and mobile
anaesthesia so much, but of the systems
phones. It did happen in many places but
themselves. Mishaps involving pressurized Meanwhile, far removed from the strictures
few people – only science fiction writers
gas + oxygen systems are surprisingly of market forces, the politicians and health
- anticipated the extremes of wealth and
common. The more complex any system developers have agreed that reduction
poverty that we have come to accept today.
becomes, the more safeguards and of maternal mortality is important and
regulations are needed. But big companies
have created Millennium Development By the late 80s, two changes were clear:
favour complex regulation, even if it is
Goal 5 (MDG#5). In 1995 the target was an economic free-for-all was in full swing
ineffective: small companies cannot afford
unrealistic. Today it’s just silly. Of all the and health had become monetised.
to comply with it and go to the wall.
MDGs, #5 will fail the most spectacularly Meanwhile the job of improving health
in 2015, in the very places it was supposed in poor countries, mainly Africa, had
So it is with anaesthesia; except that for
to make a difference. Rather tongue-in- become a professional management career
‘go to the wall’ read ‘human death’, not
cheek reports say in South Asia it might be whereas before it had been the realm of
corporate collapse.
met in 20761, in Zimbabwe by 30332, in clinicians, amateurs and missionaries.
GE (with 43% of global market share) and the rest of sub Saharan Africa: never. India People making hard-nosed decisions
Draeger (35%) dominate this half-billion has 22% of all maternal deaths worldwide, based on a mythical ‘cost recovery’ (i.e. an
dollar market which has an annual growth while Africa has the most crippling burden economic return on improved health) said
Anaesthesia News April 2010 Issue 273 5
they would get it done, replacing ideology
and scientific interest. Statistics with little
validity assumed biblical importance.
Clinical medicine was subordinated to
accountancy. I remember, even in 1977, the
mystified faces of those interviewing me for
a job as a General Duties Medical Officer
in the New Hebrides, now Vanuatu, at my
proposed medical career in the tropics. “Is
he mad?” they were thinking.
The MDG#5 target of reducing 1990
maternal mortality rates (MMRs) by 75%
by 2015 puzzled health workers in the
field, who knew the obstacles involved.
They noted the strategies for the success of
MDG #5 differed little from those proposed
in 1978 (HFA 2000), 1987 (the SMI), 2002
(G8 Kananaskis) or 2008 (Countdown to
maternal survival). No change had resulted
from any of these previous targets.
technology, as well as people to shift tasks One CS can cost as little as US$30, of which
to. anaesthesia comprises US$5. With the right
I know there is still nothing happening:
methods and technology, intervention in
a recent WHO-sponsored study of
Technical solutions are deemed expensive, childbirth can be cheap.
deliveries in Africa, involving 7 pages of
mysterious, elitist, difficult to maintain and
individual reporting data, set out to show
prone to break down; a consumer product, Methods of giving anaesthesia
that caesarean delivery was a bad thing,
sold for profit, unsustainable, without cost
corrupting the health service and harmful
recovery. Someone has to buy it, then it gets In the West, general anaesthesia for CS has
to mothers. It reached no conclusions on
abused or stolen by the private sector. The given way to spinal. But in poor countries,
maternal outcome, did not count how
decision- makers don’t trust or understand especially in Africa, because of the
many births or Caesareans took place, how
it. 10 years ago, the British Government frequency of pre-operative complications,
many mothers died. The authors were so
gave £100,000 to buy anaesthesia resuscitation followed by general
far removed from African reality that they
machines. The money was wasted. anaesthesia remains an important choice to
had missed the point that the areas they
optimise outcome in high risk cases5 .
examined did not have a health service to But the original problems persist: poor
corrupt. people want operations; a service solution In one recent study6 almost 10% of mothers
is still needed, multiplied by three to treat coming to the OR after prolonged labour
It is in this way that MDG#5 has become
another failure of prevention: population were in a shocked state. Mortality in this
a box-ticking leper with no new ideas, no
growth. Maybe cheap technology that group was 8.2% compared to 1% overall.
cure in sight.
does not break down or get stolen can be Spinal anaesthesia would be deemed
developed and can spread as widely as the unsuitable for such cases in the West and
What are the soluble problems?
mobile phone. That technology seems to so it is in the South.
have no problem.
Sri Lanka reduced its MMR from
‘Let them eat Ketamine’
555/100,000 to 30/100,000 in 20 years.
The rate of Caesarean section (CS) in
Cote d’Ivoire with the same GDP remains
sub-Saharan Africa is about 1-1.5% of Many hospitals lack adequate manpower
stuck at 830/100,0004. Three things
deliveries. Every day, countless thousands and equipment even to give a spinal and
promoted change in Sri Lanka: reliable
of labouring mothers obstruct or suffer use only a ‘ketamine-and-stand-back’
audit, midwives (+ a functional referral
haemorrhage, die or sustain injury because technique. No one knows how many
system for complications) and hospital
nothing is done. The ‘ideal’ rate of CS ‘ketamine-only’ hospitals there are in the
based training and equipment. An effective
differs by region but is around 5-10% in world; such institutions don’t issue a lot of
anaesthesia service scores 2½ out of these
an adequately supervised, not-for-profit reports.
three.
system. This ‘medicalisation’ of the natural
Some claim that this is good enough, until
process of childbirth is anathema to many
The most recent call is for ‘task shifting’,
the mythical Space Age anaesthesia arrives.
(it exercises the usual commentators more
that is the transfer of emergency care
No comparison of patient outcome has
than does the lack of a health service) but
away from doctors to paramedics, making
ever been made between ‘ketamine only’
CS is life-saving for those mothers who
services more available. Good, but not
and ‘proper’ anaesthesia, nor ever will
need it, especially in Africa: in Malawi it
new. It has been practised all over the world
be, but even surgeons would agree that
has been shown that not performing the
for decades. Without all the emphasis on
to complement ketamine the availability
operation, even at the current rate of only
a preventive solution it would have been
1.2%, would quadruple the MMR3. of airway and fluid resuscitation skills,
the world standard by now, but it needs
equipment to give oxygen, hand-assisted
6 Anaesthesia News April 2010 Issue 273
ventilation and inhalation anaesthesia abandoned as loss-making by their makers users yet capable of functioning in remote
all given by a trained paramedic is who are not interested in developing areas without gas or electric supplies. It
essential management, avoids predictable anything new when it won’t sell. The costs the same as a cheap continuous flow
complications and saves life. Just giving necessary components are hardly made machine. It is also an attractive product that
ketamine is not good enough. anymore and are poor value for money buyers might choose in the market place,
(Cost of a military PAC vaporiser plus bag: rather than being a donated item foisted on
Anaesthesia machines US$6,146). a reluctant recipient as ‘some contraption
suitable for developing countries’.
Total intravenous anaesthesia (TIVA) with Anyway, developing country
a syringe driver can be dismissed in a anaesthesiologists don’t want draw-over; Because it can be used nation-wide and
paragraph: without elaborate monitoring, it’s Stone Age, unpopular in major hospitals has a high output oxygen concentrator,
any theoretical convenience or saving because of theatre pollution (scavenging the UAM avoids the need for sourcing
is outweighed by the risk of overdose or is difficult), wastefulness (no recycling is compressed oxygen. Production and
disconnection. And you still need oxygen, possible) and hand ventilation is obligatory transport of oxygen is expensive and
a bellows and a trolley so you may as well (no ventilator). An inflating valve must environmentally damaging. The eventual
add a more robust vaporiser which safely be close to the airway, which makes the aim is to do away with all compressed
links depth of anaesthesia to a more easily fitting of a bacterial filter impractical gas supplies. It thus introduces the
monitored function: respiration. and is unacceptable for surgery round concept of low cost, environmentally
the head. Standard paediatric breathing friendly anaesthesia while allowing
There are many cheap continuous flow circuits cannot be connected. There is not modern bacterial filters, gas recycling and
anaesthetic machines available, but they enough oxygen for pre-oxygenation before scavenging and other features which are
must have cylinders of compressed oxygen anaesthesia, when you need high flows for legally required in some places.
to work. Most places in the world do not a few minutes.
have compressed oxygen. Machines that How is the UAM design different from
need it – donated or misguidedly bought This causes a second equipment divide other anaesthesia machines?
- make a large contribution to the famous within poor countries, between urban
‘high tech graveyards’ of junk that are to and rural, making it impossible to have The design has undergone many changes in
be found hidden away round the back of a universal system that could be used all the 10 years of its development. Advances
hospitals in every developing country. over the country, as is the case in the West. in oxygen concentrator technology have
In most countries you find inefficient ‘gas greatly reduced prices and increased
More advanced machines have electronic guzzlers’ in town and any old cobbled output and reliability, but no major
gas flow-meters and other features that together junk in the country. And the twain manufacturer has yet used a concentrator
further limit their usefulness outside well do not meet. in an anaesthetic machine.
funded centres. Their cost is far higher
and even high tech centres have problems Introducing the Universal Anaesthesia The current model provides a continuous
as everything is dependent on software Machine (UAM) flow of up to 10 litres/min oxygen feeding
and delicate circuit boards which easily into a demand flow patient breathing
malfunction. But manufacturers like these The UAM started as a design in 1999 in system with a newly designed draw-over
features which commit the purchaser to Malawi, using improvised materials in order vaporiser for halothane or isoflurane.
service contracts and upgrades. to put incompatible donated continuous A reservoir bag and valves for over and
flow machines into service using an oxygen under pressure allow for flow and pressure
While continuous flow machines will not
concentrator. The 2010 UAM combines differences between the two. A combined
work where they are needed, the original
continuous flow and draw-over; it uses oxygen and pressure touch screen sensor
robust table-top draw-over anaesthesia
a modern patient breathing circuit with operated by a rechargeable battery shows
systems (that will) are defunct in 2010;
system monitoring that is acceptable to all FiO and informs the user about excessive
2
fresh gas flow, patient apnoea and air entry
into the system. A hand operated bellows
resembles traditional draw-over and a new
balloon operated inflating valve is located
on the machine, not at the patient’s head.
This balloon valve differs uniquely from
standard inflating valves in that it cannot
get jammed when continuous pressure is
applied and has no component that needs
to be upstream from the patient.
Early versions of the balloon valve have
been used in Malawi, Africa from 2001. The
latex rubber did not last and was replaced
by silicone in 2009. There is a recorded
total of over 24,000 cases anaesthetised
in six locations using the balloon valve
Anaesthesia News April 2010 Issue 273 7
breathing system, some under conditions The high performance concentrator
of extreme heat, dust and humidity. Apart replaces oxygen cylinders and dependence
from the latex perishing, no problem has on environmentally damaging industrial
yet been recorded with this type of valve. oxygen production. The first UAM prototype
has been developed in 2009/10 with ISO
The UAM thus has the best of both systems: and CE compliance. It will be evaluated in
the useful features of continuous flow, selected UK sites and launched later this
including circle system recycling and gas year.
scavenging, while retaining all the safety
features and simplicity of draw-over, and it The design is that of the author and
can use any oxygen source at any pressure, OES Medical, Abingdon ( anaesthesia
allowing room air to enter through the equipment manufacturer). All the research
vaporiser if all else fails. Hypoxic fail-safes and development costs have been funded
are built in. Nitrous oxide is offered as an by a private foundation which continues to
option, with a separate hypoxic failsafe cut support the project.
off.
References:
A ventilator is planned as well as a back
up power supply and an electronic audit
1. Maternal health in the year 2076.
system for monitoring the location and
Hussein J, Braunholtz D, D'Ambruoso L.
performance of the machine, and collection
Lancet. 2008 Jan 19;371(9608):203-4.
of patient data.
focussed effort to reduce maternal deaths in 2. Dr. Steve Munjanja, unpublished
The UAM is robustly made of corrosion- the poorest countries on earth. data.
resistant high quality materials, with a 3. Countdown to 2015 for maternal
A new approach is needed, to include survival: what happened to surgery and
long-life silicone bellows for adult and
surgical and anaesthetic services, making anaesthesia? Fenton PM. Lancet. 2008
paediatric use. The standard Ayre’s T-piece
them more widely available at low cost. Aug 2;372(9636):369. and Lancet. 2008
paediatric system can also be used. It is
Aug 30;372(9640):718.
ideally suited to remote locations, but
Lack of suitable anaesthesia equipment 4. Dr. Yemi Olufolabi, presentation at All
can also be used for everyday anaesthesia
significantly limits the performance Africa Anaesthesia Congress 2009
and training in central hospitals, replacing
of life saving surgery in developing
5. Caesarean section in Malawi:
sophisticated machines and giving lower
countries which contributes to morbidity
prospective study of early maternal
running and servicing costs as well as
and mortality for all surgical patients
and perinatal mortality. Fenton PM,
allowing anaesthetists deployed to remote
but especially for those suffering the
Whitty CJ, Reynolds F. BMJ. 2003 Sep
locations to continue to use a machine
complications of childbirth.
13;327(7415):587.
they were trained on and understand. It is
easy for these users to carry out essential The Universal Anaesthesia Machine is a low 6. Life-saving or ineffective? An
servicing. cost, trolley-based workstation providing observational study of the use of cricoid
inhalation anaesthesia using an oxygen pressure and maternal outcome in an
Conclusion/Summary concentrator if there is electricity or, if not, African setting. P. M. Fenton, F. Reynolds
using any external source of oxygen, even International Journal of Obstetric
In 2015, MDG#5 will mark 37 years of the room air. System monitoring fail-safes to Anesthesia (2009) 18: 106–110
failure of a preventive, primary health care-
Western standards are integral.
Anaesthesia News Advertising Rates

Anaesthesia News reaches over 10,000 anaesthetists every month and is a great way of advertising your course, meeting or seminar.
Contact: Claire Elliott on 020 7631 8817 or e-mail: [email protected]

All prices shown are exclusive of VAT
One Month Two Months (5% Three Months (10% Six Months (25% Twelve Months (50%
Discount) Discount) Discount) Discount)
Full Page Four Colour £1360 £2585 £3684 £6121 £8161
Full Page Two Colour £869 £1651 £2346 £3910 £5215
Half Page Four Colour £707 £1345 £1912 £3186 £4248
Half Page Two Colour £531 £1009 £1433 £2388 £3186
Qtr Page Four Colour £354 £671 £ 956 £1594 £2125
Qtr Page Two Colour £265 £504 £715 £1190 £1588
8 Anaesthesia News April 2010 Issue 273
Core Topic Day RCoA
The Anaesthetists Paediatric anaesthesia 2010
28 June 2010 (code: D31)
Agency
Manchester Conference Centre
Registration fee: £200 (£150 for registered trainees)
safe locum anaesthesia, Approved for 5 CPD Points
throughout the UK ❚❚Airway ❚❚Child protection:
safeguarding (Baby P)
❚❚Pain: old drugs, new tricks
❚❚Revalidation
❚❚Pre-op: day case selection
for the general anaesthetist ❚❚Three common problems:
murmur, sniffles, full
Freephone: 0800 830 930 ❚❚Fluids in children
stomach
Tel: [phone] ❚❚DEBATE: Ventilation before
Fax: [phone] laryngoscopy
Event organiser: Dr O Dearlove
Freepost (SO3417), Lymington,
Hampshire SO41 9ZY
Further information: [email protected]
email: [email protected]
www.TheAnaesthetistsAgency.com
5th Oxford Paediatric
Difficult Airway Workshop
Friday 18 June 2010

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]
Telephone: [phone]
Cheques payable to “Paediatric Anaesthesia & Resuscitation Fund”
Anaesthesia News April 2010 Issue 273 9
PRESIDENT'S

We are now well in to 2010 and we some of the issues raised in the report. emphasise the importance of this new, more
continue in a period of economic stringency, Education/Events remains a priority in terms efficient way of reporting safety incidents
wondering how any new government will of AAGBI activity. Last year was a successful and collecting information from those
tackle all the demands on the public purse. year for all our meetings, particularly the reports. Communicating issues of safety to
Health, of course is our main concern but relatively new venture of Core Topics individual anaesthetists has occasionally
whatever happens pressure on all doctors in meetings held around the country. These of been problematic and can vary from Trust to
terms of how we work and how we may work course will benefit members as revalidation Trust. To this end we are developing a Safety
more efficiently has not been as intense for progresses. The AAGBI produces a wealth of Net where a targeted individual in each Trust
years. educational resources and a group is looking would be the AAGBI’s link for issues of safety.
into how these may be harnessed with the This could be anyone from the incumbent
In our specialty there are significant issues e- learning project within the RCoA. Those linkman to the governance lead. Initially, we
in both the public and private sector. Recent attending the Winter Scientific meeting are piloting this in a handful of trusts.
articles in this publicatioRn on SPA time ewillp recall ora very sutccessful meeting. This Increasingly ,potent anaesthetic drugs are
and remuneration in the private sector are was coupled with our presentation of Pask being administered by non anaesthetists
testimony to this. Initially in Scotland but certificates to those anaesthetists of all three as ‘sedation’. This particularly occurs in
now within many trusts in England and services for their outstanding work during the the A and E department and in a variety of
elsewhere review of SPA time is prevalent . Iraq war. I was very grateful to General Sir endoscopy units. We are joining with the
We still believe that 2 to 2.5 SPA s is within Richard Dannatt, former head of the Army, College to look into this and eventually to
the reach of the many anaesthetists who for presenting the certificates and for his comment. Podiatry, with the increased use
contribute significantly to the running of eloquent and appropriate words afterwards. of ever larger doses of local anaesthetic
their departments and to other areas within A significant financial outlay has been agent by non medically qualified personnel
their hospitals/ Trusts. We will publish some committed to the development of a new is also a potential problem which we will
guidelines as to what activities we believe website for our members’ benefit. Some of shortly make comment on, along with other
should reasonably qualify for SPA time us have had a ‘sneak preview’ of this and I organisations, focussing specifically on
over and above that necessary for CPD can assure members this will be a significant patient safety.
and revalidation. The European Working improvement. We now place all our ‘glossy’ A small taste, therefore, of the current
Time Directive as we know has an effect publications on the website for comment activities of the AAGBI. Important meetings
on training but there is of course ‘fall out’ before publication. New ‘glossies’ have approach, GAT in Cardiff in July and the
affecting consultant working patterns. There recently been published on Preoperative Annual Congress in Harrogate in September.
will shortly be some information- gathering Assessment and The Anaesthesia Team. It is our turn to host the Common Issues
probably through linkmen trying to gauge It is interesting to note that whilst many Group meeting with Australia, Canada and
the continuing impact of the EWTD and members may prefer to have information sent the US and this will take place after the
the extent of the pressure on SPA time. electronically, the ‘glossy’ remains the one Congress and some if not all the Presidents
Already reviewed is a publication by our publication where hard copy is preferred. will be in Harrogate. I encourage you all, as
SAS committee on the working patterns of Safety within our specialty should be always to attend these meetings, the scientific
our Specialty Doctors. As a group they are important to us all. The Safety Committee programmes are truly excellent!
probably under more pressure than their has been actively involved in the e reporting
consultant colleagues and we are pursuing system and road shows have taken place to richard Birks, President
10 Anaesthesia News April 2010 Issue 273