ssa annals 2018-4 · Scottish(Society(of(AnaesthetistsAnnals2017(4( (EDITORIAL!! Another! year!...

Scottish Society of Anaesthetists Annals 2017

2


3

CONTENTS Page Editorial

Introduction

04 06

Presidents address 08

Funding and grants 21

Regional reports 29

Reports from meetings/events – Spring annual meeting, Dunkeld

– Joint AAGBI/SSA winter scientific meeting

– Annual Golf outing

57

Abstract prize winners

64


4

EDITORIAL Another year passes and the world becomes an even crazier place. Despite the continued dual threat from Tweedledum and Tweedledee, a North Korean despot with a penchant for nuclear rocket testing and a US President whose reckless disregard for constitutional convention may yet lead to his impeachment, we all hope this deadly duo will not bring about Armageddon.

Depressingly at a time of the year when “goodwill to all men” is sung by Christmas choirs across Western Christendom, racial intolerance, sexual harassment, violence and scores of wars across the Middle East and Africa continue to grab the headlines and the dreaded “B word”, Brexit rumbles on and, in most people’s eyes, has put Britain on the back foot at best and, at worst, has millions of people across the planet think less of us as a nation. In Scotland our First Minister seems to have softened the blow to the NHS that England is facing. This, as we know, is only a short term remedy so let us enjoy the moment while we can. In the murky world of anaesthesia, we seem to be rambling on in a relative state of happiness. We remain positive

in our approach to developing the SSA and it is certainly bearing fruit. We have formed closer links with other societies, as charted on our website and our meetings have been very well attended. The feedback from our spring meeting was excellent and the fun run we organised had a good turnout despite some sore heads and, despite some attempts by our retired members to cut corners on the course, it was a great success. Our annoyingly ultra fit SSA secretary Ewan Jack took the crown, so it is here we call upon you iron man wannabe trainees to take over the mantel and beat ‘the machine’ next time around. We collaborated with the AAGBI for our winter meeting in Edinburgh which resulted in a fantastic programme and a sold out meeting. The meeting report will be released in due course but it’s fair to say the eclectic content kept everyone happy and the AAGBI are keen to continue this positive relationship. This is the second of my three editorials and despite my historic inability to construct sentences at school without the repeated prominence of red pen lines and minus scores, I have enjoyed the process in spite of my challenge to show any kind of command of the English language. So, with the changing times then how do we as anaesthetists evolve? Pre-anaesthesia, the surgeons were up against the clock and mortality rose by the second, practitioners were unable to enter body cavities, before the advent of ether.


5

Of course, this was an illicit drug at the time and with our continued use of heroin I can technically class myself as a drug dealer. It was then we allowed these knife wielding madmen more time to perfect their trade. They could enter abdomens, heads, chests and even varicose veins! We had to match their progress and find better drugs, faster acting, faster wake ups, less nausea and we now even have to think of the environment! We pride ourselves on being able to avoid volatiles, run the lowest flow the machine allows, to block that sensory nerve that only we can see yet we don’t have a clue how our agents result in anaesthesia. Well, we all know it has got something to do with sodium channels! We don’t like to admit it but evidence is showing anaesthesia can be very bad for the young and old! To be honest, I’m more worried what it can do for the middle-aged man. Having recently receiving an anaesthetic can I

now blame my cognitive dysfunction, grumpiness, despair at midwives etc. on anaesthesia? Well, it is not all bad. Local anaesthetics could show a reduction in metastatic spread of cancer patients. As a regional anaesthesia expert (or one who practices witchcraft) we finally may be

able to justify spending all that time in a darkened anaesthetic room! We have progressed from broadsheets in theatre to the BBC news app to angry birds and further down the IQ scale to Candy Crush. We have reached a plateau in our development in theatre anaesthesia and much has now moved to all the elements before and after. It is in these areas that we can make the most effective change and here I go with the dreaded term we all love to hate, the ‘perioperative physician’ which has become our new role! Pre-habilitation and ERAS continue to be the buzz words and as recent studies have shown, we as anaesthetists have little outcome on mortality following surgery so preventing patient morbidity should be where we concentrate our efforts. We continue to evolve but we must not forget the basics as many mentors I’ve had over the years have

taught me, “keep it simple as to overcomplicate will lead to mistakes”. Happy Holidays everyone! Matthew Freer


6

Introduction It is a huge honour and privilege to serve as the Society’s President. I have to thank the previous President, Liz McGrady, the Executive and Society members for their generous invitation. Liz was an excellent President and the society prospered during her presidency. While I initially viewed the prospect of being your president with some trepidation it has been hugely enjoyable thus far. Those who suggested to me that all I had to do was turn up, give a presidential address and then sit back to enjoy things while the Executive and Council members did all the hard work were to a significant degree correct. I hope I`ve contributed a little more than that but there is no doubt others carry the greater load. Thus, huge thanks to our trusty executive, John Donnelly, Matt Freer and Ewan Jack who work tirelessly on our behalf. In addition our Vice President Gordon Byers has been a huge help to me this year. We have again hosted two highly successful meetings this year. The two day meeting in Dunkeld in April was a tremendous success and again showed the best of our Society in terms not only of educational content but also fellowship and camaraderie, aspects that have long been a strength of our meetings. Both days of the meeting were well attended and feedback was very positive. I was delighted that we managed to facilitate the Royal College “Listening Event” on the Friday afternoon. This was of particular value

to the many trainees in attendance and I know was viewed very positively by the College President, Liam Brennan and Russell Ampofo (Director of Education and Training) who attended. We will return to Dunkeld in April 2018. The Society held a first ever joint meeting with the Association of Anaesthetists of Great Britain & Ireland in Edinburgh in October. We were delighted to welcome Paul Clyburn and the Association team to what was a fully subscribed meeting. Both organisations are keen that this should be the first but not the last such event. I am also delighted to note that “one of our own” Kathleen Ferguson from Aberdeen is President-elect of the AAGBI. Congratulations Kathleen. The Society thus has strong links with the College and the Association both at Scottish and UK level. This is to the benefit of all three organisations and to the wider specialty. As President I was delighted to present a silver salver to the College on behalf of the Society to mark the 25th anniversary of the College Royal Charter. Planning is already at an advanced stage for a two day joint meeting with the RCoA in Dundee in November 2018. The Society continues to actively support “good works” by way of both travel and research grants. This is an important aspect of our work and we have given financial support to a number of excellent projects proposed by consultants, trainees and undergraduates.


7

I`m pleased to report that the entire collection of Scottish Society Annals and Newsletters from 1960 to the present day has now been digitised by the British Library. Every copy is available as a PDF file which has been processed by optical character recognition (OCR) software to identify words and make the text searchable. These digital records can be reached via the 'Annals' link on the menu bar on the homepage of our website. https://www.ssa.scot/annals-archive/ My thanks to my colleague Dr Paul Fettes both for driving this forward and also for explaining the technology involved to your President. On a sadder note, I have to record the death of a Past-President of the Society, Dr John Mackenzie. John was a tremendous supporter of and gave sterling service to the Society over many years. He was a great friend, colleague and mentor to many and is sorely missed. Our society continues to evolve while looking to hold true to our long held objectives. Item 2 of our constitution states the following: - “The objects of the Society will be to further the study of the science and practice of Anaesthesia and the proper teaching thereof and to conserve and advance the interests of Anaesthesia”. We remain well placed to achieve these objectives with an excellent executive team and council members who work diligently on our behalf. During my time on Council our trainee reps have worked with great enthusiasm and

professionalism. This bodes well for the Society going forward. Your Society is in good health. I look forward to seeing you in Dunkeld in April and Dundee in November. Eddie Wilson


8

Presidential Address Dr Eddie Wilson Ninewells Hospital, Dundee TROUBLED TIMES BUT KEEP THE FAITH I am both honoured and delighted to be President of the World`s oldest and best national anaesthetic society. I`ll be even more delighted once this address is complete! Looking down the roll of previous eminent Presidents I`m still a little mystified as to how I come to be standing here now. It must be OK though;; no sensible group of people would pick the wrong person to be President! It`s a genuine pleasure to see many friends and colleagues here today, including a good number of former Presidents. Your attendance and support is much appreciated. Those of you who know me well will fully realise that I`m somewhat daunted by delivering this talk but I`m reassured to be amongst friends. I`m hopeful that you might be at least a little entertained rather than necessarily educated but time will tell. I`ve noted that I`m the 4th President Wilson, as it were, following in the esteemed footsteps of Paul in 2011, Jimmy, whose obituary is in this year`s annals, in 1992 and Howard in 1956. In addition, I’m pleased to note I`ve worked with as many as 9 Scottish Society Presidents during my time in Dundee.

This slide, gratefully received from Neil Mackenzie highlights the group he described as the Magnificent 7 in his excellent centenary address. As many of you will know, they are Alf Shearer, Iain Gray, Stuart McGowan, Ian Lawson, Sandy Forrest, Farquhar Hamilton and Tony Wildsmith all of whom have had a significant influence on my own career.

This slide includes another dynamic Dundee Presidential Duo in Neil Mackenzie and Charlie Allison and shows a number of other Presidents many of whom I have had the good fortune to get to know over the years. In my own time as President I`m hoping to be somewhat less controversial than the man across the Pond though it`s perhaps too early to be sure. Firstly, in the manner of all public speakers today I should declare any conflicts of interest. There are none. Nobody has offered me any financial inducement and no animals were harmed in the making of this production. I should confess that there will most likely be some dreadful attempts at humour, some short accounts of one or two individuals whose life stories have interested me,


9

some mention of troubled times in the past and the present but little in the way of science (no change there then I hear you cry!). There will also be some speaker`s indulgence in the past, some thoughts on our future and, of course, some embarrassing photographs. I have very much enjoyed many of the Presidential addresses of the past and indeed as already noted I`ve stolen a slide from one talk and will be directly quoting from another. The subject matter has been varied and interesting over the years. It`s traditional for the address to include something of the President’s own background, who is this individual, where is he or she from, how on earth did they come to be standing here today? For me, that`s a long story and one which includes a bit of graft, some lucky happenstance and huge support from many, many people along the way. Your President was born in Cresswell Maternity Hospital, Dumfries on 1st September 1958. Even then I was causing trouble as that day was my sister Margaret`s first day at primary school and she was the only child whose father took her to school given her mother was otherwise engaged. To her real credit Margaret didn`t hold that against me and by all accounts somewhat spoiled her little brother. Talking of schools, I`d like to briefly share an amusing story with you. My daughter, Rachel, is just about to complete a postgraduate year at Dundee University in order to become a primary school teacher. On a recent placement in a Dundee primary school one of the pupils announced during

class that he had got a “new daddy” over the holidays. The proud dad`s name was duly announced to which a voice from the back of the class piped up, “I`ve had him as a dad, he`s rubbish!” Anyway, I digress. This slide shows a photograph of my grandparents on my father`s side. My grandfather was a lovely man. He was a real grafter and was the kindest and gentlest of people. My branch of the Wilson family tree has its roots in Fife, my grandfather having been raised in Torryburn and Burntisland before moving to Dumfriesshire where he worked on a farm all his days. I`ve now lived in Fife longer than anywhere else so I suppose I`m to an extent back to my roots. I had a really happy upbringing with parents (Edward (known as Ted) and Margaret (known as Peggy) (you will have spotted some really imaginative child naming there) who had a great ethos of hard work, good fun, kindness and looking to treat others as you would wish to be treated.

Thus your President is a proud DOONHAMER. The origin of the term Doonhamer is attributed to 19th century workers on the West Coast rail line who


10

would say they were going “doon hame” to Dumfries for the weekend. You will notice that the “proud to be a Doonhamer” badge is related to my home town football team, Queen of the South. A fine wee team, although the concept of troubled times has often been appropriate here. Indeed, when growing up and having heard this so often I actually thought their real name was Queen of the South nil! Latterly their fortunes have improved to a significant degree with an appearance in the Scottish Cup Final in 2008. This slide shows the result of the Scottish Cup semi-final- what a day that was! We sadly lost the final 3-2 to Rangers. You might remember them;; they used to be a big club from Glasgow. Whatever happened to them? As many of you will know Dumfries has at least a claim for the first administration of ether anaesthesia on this side of the Atlantic. It is stated that on the 19th December 1846 William Scott administered ether in Dumfries Infirmary to facilitate the amputation of a fractured limb. This claim is accepted by some, and was indeed investigated and accepted by Sir James Young Simpson, but is disputed by others. Many assert that Robert Liston (another Scot) was the first to use Ether in the UK for an “operation of magnitude” and certainly there is firm evidence of that happening on 21st December while the evidence around William Scott is perhaps less clear. Our own College website in a section on the History of Anaesthesia describes the “events” as follows: - The first (ether) anaesthetics in these islands

were given on 19 December 1846, one ‘probable’ in Dumfries (there is no contemporary record) and the other ‘definite’ at 24 Gower Street, London. Dr. Francis Boott, an expatriate American, learning of Morton’s success by letter from Boston, arranged for a Miss Lonsdale to have a tooth removed by James Robinson before a group which included Robert Liston. Liston, then the leading London surgeon, was so impressed that he arranged to perform an amputation under ether on December 21st at University College Hospital, the first public demonstration in Britain. I did consider concentrating on this topic as a main part of my address today but given books have been written on the subject and there are most certainly several people here with significantly more detailed knowledge of the history of anaesthesia than I do I`m not going to dwell on it. That said, it is a significant claim to fame for my home town. Anyway, Dumfries and the wider county have association with many other famous names. These include, amongst others, Rabbie Burns, JM Barrie, Thomas Telford (the civil engineer), Thomas Carlyle (the essayist and historian), John Paul Jones (of US Navy fame) and Kirkpatrick Macmillan who is credited as inventor of the pedal bicycle and thus presumably an iconic figure in my own department. Macmillan`s bicycle was by all accounts hugely heavy and must have taken enormous effort to propel. One of his


11

early exploits was to ride the 68 miles to Glasgow. Now 68 miles is just a training spin to some of the keen cyclists I know but this trip took Macmillan 2 days and apparently, he was fined 5 shillings for causing minor injury to a small girl who ran across his path. The cyclists in my own department seem more adept at injury to self rather than o thers. Anyway enough of the famous Doonhamers and back to me. I was educated at Locharbriggs Primary and Dumfries Academy. The Academy school motto is Doctrina Promovet (Learning Promotes) and as a school it served me very well both academically and otherwise. There were some excellent teachers and one of them (Dr Hawley in chemistry – a proper doctor) really had faith in me. Not unusually for the time, nobody from my family had ever gone to university and his support and that of my parents (in particular my mum) reassured me that my ambition of being a doctor was a realistic and achievable goal. Dumfries Academy has some famous alumni. These include the aforementioned JM Barrie who although born in Kirriemuir in Angus was educated at Dumfries Academy and was apparently inspired to write Peter Pan by the garden at Moat Brae in Dumfries. Moat Brae subsequently became the private hospital in Dumfries i.e. where the posh folk went. Other alumni include John Laurie of we`re DOOMED fame. He looks uncannily like a Wilson!

Another is this lady, Jane Haining, who many of you may not know much about. Until recently, me neither but as I was driving to work on the very day after I started to write a rough draft of what this talk might contain I heard a brief radio piece about her. It sparked my interest. She is a largely unsung Scottish hero who certainly lived in troubled times and who I`d like to briefly highlight to you today. Haining is a common name in Dumfriesshire having originated from the “Lands of Haynyng” which was in the old county. Born in 1897, Haining lost her mother at the age of 5. Records suggest she grew up to be a determined and capable woman.

Haining was a Church of Scotland missionary in the 1930s and early 1940s and worked extensively with Jewish children in Budapest. As the political situation worsened in Europe she was ordered home by the Church of Scotland on more than one occasion. She had, in fact, been home in Scotland, on leave, when World War 2 broke out, but immediately undertook what was a hazardous journey back to Budapest to continue her work. When the Nazis invaded Hungary in 1944 the Church again ordered all missionaries to return to Scotland to safety. Haining refused, insisting that the children`s need of her help was greater than ever.


12

She wrote "If these children need me in days of sunshine, how much more do they need me in days of darkness?” Her steadfast faith ensured that she refused to reject the children in her care. She was arrested in late April or early May 1944 and detained by the Gestapo, accused, amongst other things, of working among Jews and listening to the BBC. Now I know the BBC has its detractors but it seems harsh to criminalise listening to its broadcasts. Haining admitted all the charges, except those of political activity. She was initially held in prison in Budapest then placed in a holding camp before being sent to Auschwitz in May 1944, where she was tattooed as prisoner 79467. She is one of a possible total of ten Scots thought to have died in the Nazi extermination camps. Although not widely acclaimed in her own country until relatively recent times, Haining is widely honoured throughout the world. The State of Israel honoured her in 1997 when her name was added to those of the Righteous Among the Nations (or ‘Righteous Gentiles’ – non-Jews who, often at great risk to themselves, helped Jewish people during the Holocaust.) A tree was planted, and Jane’s name inscribed on the wall of the huge Holocaust Memorial in Jerusalem. Haining’s medal and certificate from the Holocaust and Martyrs Remembrance Authority are now displayed in the St. Mungo Museum in Glasgow. I can commend her story to you as one of enduring faith and courage. It would have been so easy to have obeyed the orders to

return home. A sombre, but also a quite inspiring tale of a largely unsung Scot. Anyway, time to lighten the mood! As stated previously Haining was educated at Dumfries Academy and apparently gained an impressive 44 prizes at secondary school. Rumours that this is 44 more than your President achieved are unsubstantiated at this time. Nonetheless I did well enough and by Christmas time of 6th year had an unconditional offer for Glasgow University Medical School. The rest of 6th year was thus spent in vital preparation for university life! So, at the end of the long hot summer of 1976 I headed off to Glasgow. My main, albeit hazy, memory of the first few days in Glasgow was that it rained and rained and rained. Now, as already noted I`m a Doonhamer so well used to rain. As my dad often says it doesn`t always rain in Dumfries, sometimes it`s only threatening to rain. I loved Glasgow, still do in fact. I made many great friends there, some of who are here today, and I learned a great deal. Some of what I learned was even about medicine. We worked hard, played hard and with a sense of some achievement (and no doubt some relief) made our way through medical school to graduation in 1981. This is me as a Final Year Student. A good number of people in my year went on to have careers in anaesthesia. A couple of them are in the audience today.


13

So, on to life as a doctor. First house job in Glasgow Royal Infirmary in the professorial medical unit. It was busy. I was the only male amongst 6 residents and was not unreasonably described by one of the consultants as “the thorn amongst the roses”. I`m sure I looked very inefficient when compared to the girls. They were so much better organised than me. Apparently, males mature later. I`m looking forward to it. Next stop, Surgical JHO at Stobhill Hospital in Glasgow with Frank “the knife” Crossling. I loved that job;; I think I’d got the hang of being a House Officer by then. On my first day, 2 of my patients went to ICU, I don`t think that was cause and effect, given one had a ruptured aortic aneurysm and the other severe acute pancreatitis. In all honesty, ICU looked a bit scary at that point. Sometimes it still does. Typically for the young Dr Wilson, I got to near the end of my pre-registration year with no real idea of what I wanted to do next. I knew a couple of people who had done anaesthesia and enjoyed it. They gave sound advice that even if I decided it wasn`t for me, anaesthesia would give me some excellent generic skills. I was lucky enough to get an SHO post at Monklands and pretty much right from

the outset realised that this was the specialty for me. I was one of 4 new starts in a relatively small department, 3 of who went on to be consultants. Monklands was a great place to train as a novice anaesthetist. The consultants taught us well and importantly had enough faith in us to give us the space to develop our skills. I learned so much from the likes of Peter Paterson, Veronica Reid, Jo Thorp, Edith Pink, Alastair Naismith, Mike Inglis and others. Edith Pink was a real character. Very stylish, even sophisticated, but a lady with forthright views. She was probably the first person I ever heard voice concern about growing sub-specialisation in medicine, telling me in the coffee room at Bellshill Maternity Hospital, one day, that some doctors seemed to be getting more and more specialised and that everyone was flying round in ever decreasing circles such that one day soon someone would fly right up their own asshole. (I`m quoting a lady here so it`s OK to use such a term). The memory still makes me chuckle to this day and over the years I`ve seen it ring true (as it were) in many specialties, to their real disadvantage and to the detriment of the wider health service`s ability to deliver acute care. Our own College deserves tremendous credit for having maintained a generalist curriculum within which sub-specialty training is not only accommodated but encouraged. Another life changing event happened while I was at Monklands. I met the beautiful girl who thankfully agreed to be my wife more than 30 years ago. It`s not quite accurate to say we met at

Who are these young men?


14

Monklands, it was in fact in a nearby bar. Elaine is a special person and remains the absolute rock in our lives, lives which have been blessed by 2 wonderful children, Rachel and Euan, who I`m hugely proud of. Next stop was off to Dundee, in 1985, for a registrar job. Many people, including Elaine, were somewhat perturbed by this decision. I reacted to Elaine`s concerns by making a hugely romantic proposal. From memory, I said, “we`ll just have to get married”. How could anyone resist such romance? Thankfully she said yes. Anyway, the move to Dundee has been fantastic for us, both professionally and personally. We have loved it there. I was immediately made to feel very welcome. Iain Gray was boss and ran a great department. I learned so much from so many people. The clinical training was excellent. The 2 main hospitals were Dundee Royal Infirmary (the DRI) and Ninewells. DRI closed in 1998 but in its day had the A&E department (casualty as was), neurosurgery, orthopaedics, urology and plastics. Major trauma was done there;; it was a regular occurrence as an SR to spend many hours in theatre with a trauma patient only to then have to transfer the patient by ambulance to the ICU which was in Ninewells. The Neuro unit at that time in DRI regularly had ventilated patients in a hospital with no resident anaesthetist. We also anaesthetised neuro patients for cerebral angiography in a small dark room where the contrast was delivered by direct carotid artery

puncture by the neurosurgeon. Changed days but happy times nonetheless. I feel very fortunate to have trained as Registrar and SR in Dundee, including also 6 months in Inverness in 1990, at SR stage, which I hugely enjoyed. The links between Ninewells and Raigmore remain strong, a fact emphasised by the large number of former Tayside trainees who are Consultants in Inverness. The Scottish Society has been a regular feature in the lives of the Wilson family with yearly and much anticipated visits to society meetings at Peebles Hydro. That could easily not have been the case though. You would imagine that if you are going to have an acute airway obstruction then a room full of anaesthetists might be a good place to have it. Unfortunately when the heavily pregnant Mrs Wilson choked on a tattie in the Peebles Hydro dining room she didn`t want to make a fuss so decided to quietly leave the area. Thankfully Iain Gray`s wife Ann (a non-anaesthetist) spotted Elaine`s distress, followed her out and saved the day. I was delighted to gain a Consultant post in Dundee in August 1991, replacing, if that`s possible, Stuart McGowan who had just retired. A lovely man, a great clinician and a very hard act to follow but I think I`ve done ok. Now, I’m no fan of the 9:1 contract and recently as Clinical Director in Tayside, working with other senior clinicians and some enlightened managers who see the bigger picture and the added value consultants can bring, we have managed to get all our new consultants on 8:2 contracts pretty much from the


15

outset of their jobs. That said, and just as Paul Wilson previously highlighted in his excellent presidential address, my initial job plan was also high on direct clinical care, something that I`m sure did me no harm. The key thing was established consultants who had faith in the new appointees and gave us the encouragement and perhaps more importantly the space to develop interests and take on the additional things as time went on. Dundee, as many of you know was famous for jute, jam and journalism but also has a significant history as a sea port. The history going back includes shipbuilding, the whaling industry, significant inputs to polar exploration and goes right up to modern times with an on-going role in the oil industry. If you haven`t visited Discovery in Dundee then you should and in particular if you get a chance to dine on board, it`s a great experience. I`ve done it 3 times and this photograph was taken on the most recent occasion which was a splendid evening where Charlie Allison hosted a celebratory dinner for some friends and colleagues. This photo might suggest that it was such a good night that I had to book a room on board, but of course the ship`s doctor on Discovery was also a Dr Edward Wilson. He was the subject of my address when I was fortunate enough to be President of the North East of Scotland Society of Anaesthetists. He`s an interesting chap who only worked as a medical doctor in a conventional sense for a relatively brief period of time. He also found time to be a hugely important part of 2

Antarctic expeditions. In addition, he was a talented artist and an expert in wildlife and in particular ornithology who is credited with having saved the Scottish Grouse Industry (that`s birds not whisky) in the early 1900s by way of his diligent scientific work in proving what was causing the premature demise of many of these valuable birds. If anyone is interested the culprit was threadworm species, not the previously assumed pneumonic process, so not bird flu. Dundee is a city which is really on the up with an impressive riverside development well underway and of course the long awaited V&A Museum of Design which is due to open next year. I`ve very much enjoyed being a consultant in Dundee. The clinical work (always the best bit in my view), with some great colleagues, has been rewarding but I`m pleased that I have had the opportunity to pursue other professional interests (the added value bit I hope!). The significant majority of my on-call work as a Consultant has been for ICU. I`ve thoroughly enjoyed this and have worked with some splendid colleagues, both medical and other staff. Our ICU team is just that, a team. I`ve been lucky to share an office with Sally Crofts and Ian Mellor. We often put the world to rights over a pot of tea. I`ve recently been tempted to put a Yorkshire tea teabag into my appraisal documentation to evidence this key area of working cohesively with colleagues. There is no truth in the rumour that tea making has become an essential workplace based assessment for trainees in our ICU- not yet anyway.


16

Critical care services in Scotland provide excellent care to what is an ever increasingly complex group of patients. That said data from the Scottish Intensive Care Society Audit Group confirm a decrease in both crude and standardised mortality rates over a 10-year period.

That is a heartening statistic for those of us involved in critical care and given good critical care very often starts before the patient reaches ICU or HDU that will be many of us. As we know the mortality figures don`t tell the whole story and I do worry that we are “saving” some patients for a poor quality of life going forward. We still have work to do in this area, although progress is being made.

This slide which has some familiar faces shows some of the team from the Critical Care Unit in Glasgow Royal Infirmary who won a prestigious BMJ Award for “Innovation into Practice Team of the Year” in 2016 for the

INSPIRE project which looks to improve the health and well-being as well as rates of return to work of patients discharged from their ICU. This is excellent work which looks to tackle many of the issues around quality of life after critical illness. As a specialty anaesthesia is at the heart of discussions with our patients around risk. I regard this is a crucial aspect of our job and I strongly support the CMO`s case for shared decision making as part of the work around realistic medicine. This reminds me of my favourite story around risk. I`ve told the story to many people so apologies to those hearing it again. I had a long discussion with an elderly lady who had significant heart disease re the pros and cons of surgery and anaesthesia. She had a gynae cancer. Eventually after a long discussion she asked me what I would tell her to do if she was my mum. I made it clear I wasn`t about to tell my mum to do anything but that I would suggest that she had the op as that was the best chance of a good outcome albeit there were some risks involved. We chatted on for a few minutes more and I then thought I’d smoothly wrap things up by asking if she had any more questions. Just one she said, “Do you like your mum?” In some ways, I think this gets the nub of risk and consent! The case went well. Dundee and surrounds have also been a fine place to pursue another passion. Mark Twain clearly wasn`t a golfer. Had he been so he would surely have known that there are lies, damned lies and, of course, preferred lies. Those of you hoping for even the vaguest hint of any


17

science in this address should pay attention now-this is it! I’m a very keen golfer. I was thus very pleased to come across an article in the British Journal of Sports Medicine which confirms the positive benefits of golf around improved physical health and mental well-being. I knew all that time on the course was time well spent though I do know a good number of players who might belie the notion that golf is in any way good for their mental well-being. I love my golf and sometimes it loves me back. It`s a fickle mistress though. I think, I`m thus far the only person to have had the good fortune to have a hole-in-one while playing a Scottish Society outing. Achieved on the 7th hole at Aberdour in the splendid company of Sandy Buchan and Alastair Chambers. A fond memory. Anyway, back to my professional life. My main non-clinical interests have largely involved training and eventually as a direct result of that work a significant role in workforce planning. Those who have heard me talk endlessly on that in a variety of forums will doubtless be relieved to know I’m not going to dwell much at all on that. I do think it remains crucial to the specialty going forward though. Having robust workforce data and being able to present our case in a reasoned and non-shroud waving manner has served us very well over many years and has seen off some significant threats to our trainee numbers. The training environment has suited me well. I`ve had the pleasure of working

with some great colleagues both in Tayside, in wider Scotland and further afield. Training in anaesthesia, intensive care and pain medicine in Scotland is of a very high standard. We can rightly be proud of that and it reflects tremendous credit on those who both plan and deliver the training involved. Challenges remain, of course, but we have as a group picked our way through tough times before now.

Going back 10 years or so to some more troubled times, I`ve long thought that if Modernising Medical Careers was the answer then it was a damn stupid question. Apparently, MMC was intended (and I quote) “to improve patient care by improving medical education with a transparent and efficient career path for doctors”. I`ve struggled to find a slide to properly reflect my view of that statement. This slide largely does it but doesn`t seem appropriate for this learned audience so we`ll move swiftly on. Another aim of MMC was to somehow rescue the lost tribe of SHO`s. We didn`t really have a lost tribe and those who looked to progress in our specialty


18

largely did so, gaining excellent clinical skills and valuable experience along the way even if it did sometimes take a bit longer than planned. Anyway, even the real challenges posed by MMC brought some great rewards. Anaesthesia in Scotland really pulled together to make the best out of what was an extremely difficult time. We worked cooperatively around training numbers across the regions and crucially as a group rescued the national recruitment process in 2007 which had real potential to be an absolute disaster for our specialty. We have very much kept that ethos going forward and it`s been an absolute pleasure to work with some great people over many years in terms of developing a really robust recruitment process. As many of you will recall we reached the conclusion that the 2007 recruitment application form was at best an effort in creative writing having been produced by educational psychologists-whoever they may be! It was not fit for purpose to shortlist applicants so we decided to interview everyone who had applied. It was the only thing to do;; this was young doctors` career paths we were deciding. We therefore interviewed hundreds of applicants over many long days. It`s interesting to look back at a UK government review of the 2007 process. The report conclusion confirms that the concerns we had resonated with those felt UK wide, stating that;; - “The introduction of the new Specialty Training arrangements in 2007 was disastrous. The manifest weakness of the national recruitment system made the collapse of

confidence in the selection process inevitable. The design of the initial application forms was particularly inappropriate, failing to recognise doctors’ key achievements and giving undue weight to “white space” questions. The short-listing process, critical to the futures of so many, therefore descended into little more than a creative writing exercise. Candidates and assessors alike were justifiably outraged by the sheer inadequacy of the Medical Training Application Service (MTAS)”. The interviews were thus a marathon process delivered over many, very long days. I also vividly remember a small group of us sitting in Heriot Watt University writing interview questions while in the adjacent rooms the interviews were going ahead. We`ve had years since when the interviews have been hugely disrupted by blizzards, blocked roads, rail strikes and even one year where a few candidates had travel disruption due to volcanic ash clouds but that first year was a particular challenge. No matter the difficulties over the years we have strived to adapt and improve to deliver the best recruitment process possible. Adapt and improve - it`s what anaesthetists do. We should of course remember that the challenges faced impacted hugely on the trainees involved. Our current troubled times aren`t unique. As noted previously I’m going to take the liberty of quoting directly from a previous Presidential address. The quote comes from Alan McDonald who was President in 1995-96. It reads thus:-


19

“Trainees at the moment are having a rough time, and must feel frustrated at the widespread changes which are taking place in medicine and in particular anaesthesia. The trainee of today needs a resilient strength of character, a tough sense of direction and a real hunger in order to succeed. That hunger needs to be fed by unsparing encouragement from senior colleagues and teachers. There is nothing very glamorous about training junior anaesthetists, or students, at the grass roots in theatre: it is time-consuming, and it is stressful, because we are already so stretched ourselves, but there is nothing more rewarding than a trainee or a student saying to you at the end of a long day, “thank you very much, it`s been terrific, I`ve really learned a lot”. The main message in that piece rings true 22 years later in 2017. As most people who know me will realise I’m an optimistic person. I`m extremely positive about the quality of people we are training for a career in our specialty. I thus find myself irritated by the view held by some that because trainees work fewer hours than we did they somehow have it easy now. It`s different than when I trained, some of it better, some of it not so good in my view. It`s different. As Alan went on to say we have a duty to nurture and look after those in our training schemes and we largely do that very well. We don`t always do so and I`m well aware of trainees I could have supported better when they were having difficult times. We don`t always get it right. The things that have troubled me over the years in terms of training and workforce will

inevitably have worried the trainee group at various times. MMC as discussed above, subsequent messages at different times of too many trainees, not enough trainees, planned reductions in trainee numbers, training people while telling them they probably won`t get a job (the CCT bulge) and latterly changes to Intensive Care training- we still haven`t got that bit right. It`s always been the case that trainees need our support and that remains true now and going forward. The future work patterns in our hands-on, front line acute specialty can look a daunting prospect as can concerns around pensions and likely age of retirement. We must lead by example, show faith in our trainees, give them encouragement, support and reassurance while crucially affording them the appropriate space to develop clinically and otherwise (we do have a tendency to over-supervise). Of course, trainees are crucial to our service delivery and that should remain the case. Appropriate supervision is the key. That said, having acknowledged the concerns that do exist in the group, many of the trainees I speak to on a day-to-day basis are very positive and seem to very much enjoy what they do. There is therefore a real opportunity for us to continue to build on the positivity which there is within the trainee body and thus enable them to be role models going forward. It`s clear from national training surveys year on year that our training schemes in Scotland are very well regarded by the trainees. That`s to the credit of us all, Consultants, Non-Consultant Career Grades and trainees alike. It`s really heartening to see that trainees across Scotland have


20

nominated trainers from all 4 regions such that 12 of our number are recognised for excellence in training in the 25th Anniversary RCoA Trainer Awards. Congratulations to them all. In my own region, I`m very impressed by the time many trainees put in to support their more junior colleagues thus developing a culture that supports learning and well-being. In addition, the recent work both locally and nationally championed by John Colvin and others around increasing trainee involvement in the wider aspects of leadership, professionalism and management can only be of value to the specialty going forward. There are undoubtedly challenges ahead for our specialty and for medicine in general. It`s crucial as a profession that we continue to collect robust data, engage politically and challenge those in power to deliver the health service our patients need. We must play a key role in shaping that service and in discussions around what is desirable but also deliverable. Despite these huge challenges, I retain a real faith that our specialty is in a good place. We must not be complacent though and take every opportunity to influence healthcare strategy and delivery going forward. Anyway, it`s time to hop off that soapbox. As my granny used to say, the moral high ground is a fine place but it`s a long way to fall from a high horse.

You will be pleased to know that the end is in sight and the bar is hopefully open. I`m hoping that at least some of you are still awake. I`d again like to thank the Society for the tremendous honour of being President. Particular thanks to Liz McGrady for her excellent work as President over the last year and to the members of the executive, Ewan Jack, John Donnelly and Matt Freer who do a sterling job on our behalf. I’d also like to acknowledge again all of those who have helped me throughout my career thus far. As stated, I think our specialty is in a healthy place. Our talented younger consultants and those coming through our high-quality training schemes give me firm reassurance around its strength going forward in these challenging and troubled times. Keep the faith!

Dr Eddie Wilson some years earlier J


21

TRAVEL GRANTS AND FUNDING STORIES


22

GRANTS Travel

The Society is keen to encourage both trainees and career grade staff to travel for the purposes of working in or teaching in developing or disadvantaged countries. Grants will not normally exceed £1000. Travel grants may also be awarded to those wishing to another centre to learn a new technique or acquire experience in a particular specialty.

In 2014 we awarded two maximal grants and were keen to give out more.

In 2017 we have granted in excess of £6000 in travel and research monies

Research

The Society is also willing to consider applications from members for similar sums to support research in any area of anaesthesia, patient safety, pain management or critical care.

All suggested projects will be assessed on their individual merits by a sub-committee of the councilTo apply for either a travel or research grant please write an application, outlining your position with details of the activity (travel or research) which you propose to undertake and the sum sought.

Please explain how the grant will be used to support your proposed activity.

Further details can be found on the website (www.ssa.scot)

Please send your application to the Honorary Secretary of the Society: Dr Ewan Jack, Department of Anaesthesia, Forth Valley Royal Hospital [email protected]


23

FUNDING STORIES Implementation of the World Health Organisation Surgical Safety Checklist in the Republic of Benin The World Health Organisation Surgical Safety Checklist (WHO SSC) was just another piece of paper to fill in. My hospital introduced it as I started my basic anaesthesia training, and to me it was just part of the process of giving an anaesthetic. With everything else you learn in those first few months, I had never really thought about the why. And honestly, at times I complained about it as much as the next person. Fast forward 3 1/2 years and I am on a plane on my way to the Republic of Benin. When I first heard about the opportunity, I had to look on a map to find this francophone country in West Africa, sandwiched between Nigeria and Togo. Now, I'm on my way to meet the Africa Mercy, a hospital ship with Mercy Ships and the largest non-governmental hospital ship in the world. My plan is to spend 4 months working with their Medical Capacity Building (MCB) team on a project to implement the Checklist across the country. I arrive in Cotonou, Benin’s largest city, after 36 hours of travelling - tired, hot, slightly overwhelmed but mainly excited about the task ahead.

On the first night I meet my cabin mates, the three people I will be spending a lot of time with in a very small space! As I stand in the middle of the cabin, swaying slightly (I

discovered in the morning that the boat does still move even though it is in port), I learn that between us, we have 4 nationalities and speak 5 languages, which is representative of many of the 400 crew aboard the Africa Mercy. From 49 nationalities with different language and cultural backgrounds, we make a community striving to bring surgery to those with limited or no access and improve the provision of safe of surgery within the country. As I learn more about my project in particular, I am struck by the enormity of the task we have set ourselves. Over 10 months we aim to contact 37 government run hospitals providing surgical services to many of the 10.87 million people living in Benin. The programme includes information and workshops around the WHO SSC (affectionately referred to as 'La Checklist'), surgical instrument counting for the surgical teams and Lifebox/hypoxia teaching for the anaesthetic teams. The project has already been going for 6 months by the time I arrive, so I need to hit the ground running. Within 48 hours of boarding the ship, we are off on our first road trip. Leaving the ship at 0500 with our Landrover packed and our last minute checks done, we head north. In 3 days we will visit 5 hospitals,


24

in each meeting the medical director followed by the theatre team. We go on to have a discussion about the Checklist and then have a simulation or live case to watch them using it. And of course, it is all done in French. I start to leave my sense of strict scheduling behind, and get a little better at falling into local patterns. It is a gruelling and exhausting few days, but the enthusiasm and passion of my team is infectious and helps to keep me motivated. The following trips, lasting anywhere from 3 days to 3 weeks, become a routine of early starts and long dusty hours on the road, contending with potholes, dirt roads, speeding articulated lorries and overladen motorbikes. And of course, the journey wouldn't be complete without the infamous road closed sign - a tree branch across the road - with no diversion signs and limited GPS to decide on an alternative route. This alone taught me my first important lessons of working in Africa: flexibility and patience, two lessons that would stand me in good stead!

The 4 months is a roller coaster of emotions as we teach and provide ongoing support and follow up to each theatre team. The daily challenges faced by these teams are incredible, and the ‘lack of personnel, equipment, infrastructure and reliable electricity’ statement is echoed through many of the institutions. One hospital in particular was using a series of shipping containers as their operating suite, a temporary solution devised several years ago while construction of a permanent facility took place. When we visited, they were still waiting to break ground! However, the commitment from the teams to providing a surgical service in these adverse conditions is inspiring, as is the enthusiasm with which they embrace the initiatives to improve their patient safety. Particularly where the teams had put in place additional systems to improve patient safety as a result of the Checklist, including patient identification labels, specimen labels, ensuring the midwife is present at the


25

beginning of the caesarean section and specific areas of theatre dedicated to neonatal care and resuscitation.

It turns out our task was possible. Over the 10 months, we taught 877 participants and followed up directly with 32 of the 37 hospitals. The majority were using the Checklist on a regular basis, or at least trying to. There are already stories of where it has reduced morbidity, and potentially mortality. One hospital had two patients with the same name from the same village, for two different procedures, and the Checklist identified this. In another hospital, they identified that a key piece of equipment wasn’t working before the patient received their anaesthetic. Whether it is finding that missing surgical swab, or ensuring the right procedure is being done on the

right patient, these stories continue to be told. It was a privilege and humbling experience to work with these incredible, hardworking and passionate teams (both on board the Africa Mercy and within the local hospitals). I would like to thank Mercy Ships for the opportunity to work on this project, and the Scottish Society of Anaesthetists for their generous support. 22nd November 2017 Dr Kirsty Wright “Take me to the Duke’s place…” – observership at Duke University Hospital, North Carolina, USA Thinking outside of the box has always been a virtue I have aspired to achieve. I prefer to gather fresh, outside experiences and then attempt to fit lessons from them into the "box" I work in daily to benefit our existing system. That was the motivation behind my recent visit to Duke University Medical Center in North Carolina, USA. I wanted to see if their reported efficiency and excellence in regional anaesthesia and acute pain services can be applied to NHS Scotland. As a senior trainee I have learned that skill is only a small part of the successful delivery of regional anaesthesia services. Although I am still passionate about learning new blocks and techniques, I am fully aware that the nerve block itself is just the tip of the iceberg when it comes to the success of a regional anaesthesia service. Learning about the successful systems underlying the provision of service is best done “on site”, the


26

opportunity to do this materialized in May 2017 with kind support of Scottish Society of Anaesthetists travel grant. I spent almost two weeks observing how regional anaesthesia is provided in two sites (Ambulatory Surgery Centre and Duke University Hospital). I not only observed the blocks, but was able to look into patient flow, interactions with surgical teams and nursing staff, reasons for delays and post-procedure follow up systems. The Duke utilizes both single shot as well as continuous nerve blocks and patients are discharged with ongoing infusions. Systems underpinning the safety of the provision of regional anaesthesia are similar to the UK and it was interesting to observe how they are implemented in busy private healthcare environment. Ultimately, I have learned both big and small lessons from the placement, met some very inspiring “regionalists” (some even with strong Scottish ties!). Hopefully some of these lessons I will be able to employ for the benefit of NHS patients. Dr Anna Cormack ST6 WOSSA

Project title: The Effect of oxygenator design on the arterial blood concentration of isoflurane

During cardiopulmonary bypass (CPB), volatile anaesthetic agents, such as isoflurane, may be delivered through the sweep gas supply to the oxygenator. However, differences in oxygenator design may affect the concentration reaching the patient’s

blood, and therefore their anaesthestic depth. This has been suggested by previous in vitro research showing differences in arterial isoflurane concentration when bubble, polymethylpentene and polypropylene oxygenators have been compared1-3. Additionally, during CPB, clinical signs typically relied upon to indicate depth of anaesthesia are obscured or absent. The Bispectral Index Score (BIS) may be used to overcome this, however its reliability during CPB is controversial4. Monitoring oxygenator exhaust isoflurane concentration – analogous to end-tidal concentration – has been proposed as an alternate method5. The primary aim of this study was to compare arterial isoflurane concentrations between two different polypropylene oxygenators. Secondary aims were to examine the relationships between arterial and oxygenator exhaust concentrations of isoflurane and BIS.

The study was a single-centre randomised control trial. Consenting adult patients presenting for elective cardiac surgery using CPB, in whom volatile anaesthesia was used throughout, were randomised into having the Sorin Inspire (n=12) or the Medtronic Affinity Fusion oxygenator (n=13) used during CPB. Arterial samples were taken at time points representing cooling, stable hypothermia and rewarming. These were analysed using gas chromatography and mass spectrometry. BIS, exhaust isoflurane concentrations and other variables were also recorded.


27

When averaged across the three time points, no statistically significant difference in the arterial isoflurane concentration was found between the two oxygenators [5(95%CI: -11, 22)] µg.ml-1. Exhaust concentration was strongly, positively correlated with arterial blood isoflurane concentration (r = 0.810, p < 0.0005). Both were significant, univariate, correlates of BIS (r= -0.472, r = -0.580, p< 0.05).

These results show that oxygenator exhaust predicted arterial blood concentrations of isoflurane, suggesting that it may be used to assess depth of anaesthesia during CPB. Despite the differences in design, the choice of oxygenator did not significantly affect arterial blood concentrations of isoflurane in the dose range examined. In conclusion, the findings of this study indicate that when delivering isoflurane for anaesthesia during CPB, either oxygenator may be used without affecting arterial isoflurane concentration.

References

1. Henderson JM, Nathan HJ, Lalande M, Winkler MH, Dube LM. Washin and washout of isoflurane during cardiopulmonary bypass. Canadian Journal of Anaesthesia. 1988;;35(6):587-90. 2. Philipp A, Wiesenack C, Behr R, Schmid FX, Birnbaum DE. High risk of intraoperative awareness during cardiopulmonary bypass with isoflurane administration via diffusion membrane oxygenators. Perfusion. 2002;;17(3):175-8.

3. Wiesenack C, Wiesner G, Keyl C, Gruber M, Philipp A, Ritzka M et al. In vivo uptake and elimination of isoflurane by different membrane oxygenators during cardiopulmonary bypass. The Journal of the American Society of Anesthesiologists. 2002;;97(1):133-8. 4. Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA et al. Anesthesia Awareness and the Bispectral Index. NEJM. 2009;;358:1097-108. 5.Lockwood GG, Byrne SM, Adams S. A comparison of anaesthetic tensions in arterial blood and oxygenator exhaust gas during cardiopulmonary bypass. Anaesthesia. 1999;;54(5):434-6. Dr Cathy Kitchen Report for Scottish Society of Anaesthetists, Annals. Over two weeks during November 2017, I travelled to Toronto General Hospital in order to observe anaesthesia for lung transplantation as part of my advanced cardiothoracic anaesthesia training, during my ST7 training year. I currently work at the Golden Jubilee National Hospital, Glasgow, which acts as Scotland’s national cardiac transplant and mechanical circulatory support centre, performing around 15 cardiac transplants per year. Currently it does not perform lung transplantation, and I was keen to gain insight into how such a service is run, how the patients are cared for perioperatively and how


28

anaesthesia for this complex population is managed. Toronto General Hospital performs around 150 lung transplants per year, most of which are bilateral sequential transplants, and around 70% of cases are undergone with the use of Extra Corporeal Membrane Oxygenation. Its 1 year mortality for transplant patients was around 10-15% in 2016, and it serves the population of the East side of Canada, excluding Quebec. The most common indications for transplantation in these patients are cystic fibrosis, COPD and pulmonary hypertension, and their assessment consists of a week-long series of consultations with respiratory physicians, thoracic surgeons, psychological/psychiatric clinicians, and anaesthetists, after which they are placed on the waiting list. If these patients are not local to Toronto then they receive funding assistance to allow them to move to the area. The majority of transplants occur overnight, and the anaesthetic cover consists of one of three thoracic anaesthesia fellows who is on-call purely for lung transplantation, and a ‘staff’ anaesthetist (consultant equivalent) who is also covering another emergency theatre. The fellows gain considerable experience of managing lung transplant anaesthesia, most of which is with distant supervision after induction/ line insertion etc. and such a busy service seemed highly reliant on this system.

The patients were a challenging group that were difficult to ventilate on one lung, with significant potential for cardiovascular instability, mainly during the period of reperfusion of the donor lungs. I was impressed with the team work that I witnessed between surgeon, anaesthetist, nursing staff and perfusion scientist and I feel that I gained a lot from witnessing this fascinating and challenging procedure. I would like to thank the Scottish Society of Anaesthetists for their financial support which helped to fund travel and accommodation expenses during my time in Toronto, from which I gained a lot. Dr Andrew Nath, ST7, West of Scotland Current advanced cardiothoracic anaesthesia fellow Golden Jubilee National Hospital, Glasgow


29

REGIONAL REPORTS 2017


30

REGIONAL REPORTS Borders General Hospital The department here in BGH continues to expand and we have four new consultants – Sweyn Garrioch and Rachel Harvey are starting their consultant careers and we have increased the John count and now have 3, with John Bonnar joining us from Guernsey. He has taken to the Borders lifestyle very quickly and already has a farm and is channelling Cath Livingstone, keeping an impressive collection of livestock. Eva Biczo has made a seamless transition from Associate Specialist to consultant. Maxine Bunton has stepped into her shoes as our new Specialty Doctor. Contrary to last years report, Nigel Leary and Tom Cripps have not fully retired from practice and still continue to make regular appearances in the department. Nigel keeps telling us he is doing his final ITU week but we think that’s only to get more cake baked by the ITU nurses at his leaving tea party…… Joyce Cameron has decided to head for sunnier shores to set up a brand new ITU in the Maldives. We wish her luck and hope she has room for a few holidaymakers from the chilly Borders to camp out now and again. We have (almost) royalty in the department as Cath Livingstone has been awarded an MBE for her Military work. Vanessa MacKenzie is currently missing in action, having returned from maternity leave for 5 months before leaving to have her second baby, Cara.

Jane Montgomery retires in November, and Chris Richard is easing himself into retirement in July 2018 by handing over Head of Service to Jon Aldridge. On the social side, the MAMILs in the department have pushed themselves to even greater achievements - Jon Antrobus and Simon McAree have recently completed their first triathlon. The ladies in the department have decided that their annual Stobo health spa visit is the limit of their endurance events. Audrey Jeffrey Stracathro Hospital Stracathro feels like it is on a rollercoaster ride again- we have very busy periods then very quiet spells. Hopefully, with the lack of elective beds elsewhere in Tayside, we will only get busier. We welcome Fiona Anderson and Ben Shippey to our anaesthetic team. Both are home grown and we are delighted to have them in the family. Most of our ANPs are up and running now and this has already made a huge difference to our patient pathway as well as releasing FYs for elsewhere in the service. I have handed over the anaesthetic lead baton to Pavan Raju. Pavan is already involved in many projects in Stracathro including the setting up of a block room and the continued excellent scenario training for all theatre staff. Stracathro is in safe hands. Jan Beveridge has retired this year leaving a big hole in Stracathro. She


31

has been the continuity in Stracathro for many years and every member of the theatre team has loved working alongside her. Jan has had a difficult start to her retirement with the sad loss of her husband. We wish her happy times with her wonderful family and new grandchild. We also saw the retirement of our resident orthopaedic surgeons Richard Buckley and Pete Rickhuss. Thankfully Richard has come back to us for a wee while to soften the blow. I am also extremely sad to report the early death of our friend and colleague Lois Fell. Lois was a genuinely lovely lady. She was gentle, patient, kind and supportive. She had a year-long battle with cancer which she bore with great dignity and bravery. She touched all our hearts and we will miss her greatly. Norma Munnoch

St John’s Hospital, Livingston It has been a busy year here in Livingston with changes in personnel and new arrivals both in the department and for members of the department. It seems to be 3 babies, 2 weddings and a funeral. The services offered continue to develop and expand thanks to the hard work of my colleagues. Firstly, a warm welcome to newbies Dr Edward Mellanby and Dr Alistair Partridge. Ed has returned from sunny Antipodean climes to join us as our latest appointed Consultant with an airway interest. Alistair has joined as a Specialty doctor. Dr Richard Burnett has returned from Nepal- how long

before our helicopter hero has itchy feet again?! Departing from us are, Dr Elaine Martin who has retired to pursue external interests, namely writing that one-woman fringe show, Dr Simon Rowbottom who has retired and Dr Bill Brown who sadly died in May this year. Congratulations are due to Dr Pam Milligan with baby Fergus and Dr Du Toit de Wet with baby Luka joining our extended family. Dr Rachel Smith has returned from maternity leave and is furiously pursuing the ACSA goal on the department’s behalf. More congratulations to our new Consultants from last year’s annals. Both Dr Rowena Clark and Dr Thalia Monro-Sommerville celebrated weddings this year. The hand and eye unit has been completed! Drs Joanna Renee and Lorraine Harrington have succeeded in their bid to expand the pain service. Outpatient clinics are now running at St John’s thus saving West Lothian patients a day trip to sunny Leith. X ray procedures are due to follow in the new theatre suite. Obstetric ERAS continues apace with Dr Sarah Cross acting as link person to the remainder of our Scottish maternity units on that front. Teaching and education continue at St John’s with the handing of the Part A course to Dr Clark. Many thanks to Dr Sam Moultrie for her years of hard work ensuring that this runs smoothly. Dr Moultrie has now applied those talents


32

to running a fantastic Scottish mock OSCE day in November. She was ably assisted by Dr Alistair McNarry. The Simulation Suite is being well used by the Anaesthetic dept. We are running many courses using its facilities including MEPA (Managing Emergencies in Paediatric Anaesthesia) & PROMPT (Practical Obstetric Multi Professional Training). Other courses are being developed and with so many Simulation enthusiasts, finding faculty becomes ever easier. Dr Duncan Henderson & Dr Murray Geddes have been delivering a new ICU course in Hong Kong alongside two others. This is a joint venture between RCSEd and Hong Kong College of Surgeons. Looks like we’ll need to gift them a box of TED stockings this Christmas! Dr Audrey Jeffrey & Dr Alasdair Waite (WGH) co hosted the inaugural Joint Winter Meeting of the Scottish Society of Anaesthetists and the Association of Anaesthetists this October. It was a sell out meeting in Edinburgh and hopefully the beginning of a regular event between the two organisations. In the name of work hard, play hard, special mention must go to our bare-foot running champ, Dr Kenneth Stewart. Well done on some lightning race times! Finally, congratulations to Drs Lynn Carragher and Sarah Cross who have won the Scottish ECT Accreditation Network award for 2017 for their work in bringing ECT into the modern age

with Simulation based training for the staff. Well done ladies! Audrey Jeffrey Glasgow Royal Infirmary 2017 has been an industrious year at Glasgow Royal Infirmary. Alex Patrick, Traven Mclintock and Kenny Lamb have gallivanted off into the shiny happy place that is retirement;; they will all be sorely missed. Dr Myra Mcadam was appointed in April which leaves us with vacancies to which we will hopefully appoint in the new year. Other changes include Kerry Litchfield replacing Drew Smith as our Obstetric Anaesthesia Lead and his appointment to the training committee as deputy regional advisor. Advances in perioperative medicine have been pushed forward including regular preoperative clinics for major upper GI surgery spearheaded by Sonya McKinlay. Work on smoothing our emergency workload continues with a vengeance and has included the introduction of daily plastics trauma lists much to everybody’s delight. Intensive Care continues to provide excellent care with a sustained record of standardised mortality rates below the mean. This on top of ever increasing numbers of patients and staff shortages is a real credit to the unit. The award winning INSPIRE ICU rehab clinic also continues its great work with the rollout of the concept to other units and boards, a fantastic tribute to Tara Quasim and her team.


33

The Princess Royal Maternity continues to keep us busy, our caesarean section rate reaching the 40% mark at times throughout the year! Strategies are being sought to address the increasing theatre resource this requires. Despite this there has been much quality improvement work ongoing including the abnormal invasive placental service and introduction of an epidural bundle to decrease the postdural puncture headache rate. This project was nominated at the recent Quality Improvement Scotland Awards! Well done to Malcolm Broom and his “Top Team” Another initiative has been the appointment of trainee “chief residents”. Kathryn Hill and JP Byars are the first to take on the mantle and have distinct roles within clinical governance and education;; they are already proving their worth. In tandem with their appointment was the arrival of two shiny new parking permits for our duty senior trainee, increasing our desirability as a training centre significantly! K Lake Perth Royal Infirmary If our department were a ship, we might be named “Titanic.” As we steam towards the iceberg, all are having the best of times aboard, with many fantastic happenings in the last year. The annual sailing week is now a two yacht affair. It was a lobster pot, not an iceberg, off the west coast, that led to me getting up close and personal with

the RNLI. The sailors on our sister ship ate ice cream and watched as we were towed into Tobermory- fun in the face of adversity is a theme this year. Earlier in the year, Clinical Leader Ewan Ritchie decided a team building outing involving problem solving and a laser beam would help morale. But it seemed that his “team” didn’t want to be built (by him, at least!) At the gin bar afterwards, arms and legs grew on the tales of his problem solving ineptitude. So while others’ morale took a definite lift, Ewan was grumpy for weeks. After more than three years in charge, and still waiting for the new printer to arrive, Ewan feels it is time to hand over the helm. Departmental minutes record that Dr Ritchie feels it is time for his “strong and stable“ leadership to be replaced by someone “young and thrusting!” One young thruster, Ravi Anandampillai, has breathed life into the fish tank. From teetering on the brink of liberation to the Tay, the fish are now rejuvenated, reproducing and healthier than ever. And his ultrasound skills march on, with his introduction of awake shoulder surgery in Tayside. Rob Vaessen has been very young and thrusting on the hills, falling more and more in love with the mountains of Scotland, often with Arthur Ratcliff and Tim Smith in tow. Another young thruster did a marathon “to just do one. ” She did it so quickly that she was given a place at next year’s London marathon, so she’ll have to just do another one- well done Rhona Younger. Simon Scothern, Arthur Ratcliff and Stephanie Sim all had trips to New Zealand this year, but only one of them had a baby (Lewis Alexander)- congratulations Steph. Claire Wallace


34

has won the departmental "The most weird things to go wrong in a week, but I'm still smiling" M&M award (again). Simon bought a mountain bike with an electric engine- then labelled the rest of us with proper bikes “purists.” Tim Smith continues as long serving locum, and mountain man. While training (upside down in his garden?) he managed to give himself a decent head and neck injury, but went on to complete a Skyline Mountain Race in Glencoe. Tony Davis’ name will forever be associated with what became “toast-gate” this year. He is fed by an ever increasing circle of staff, testament to the many friends he has made in PRI. Tony also shaves (but does not VEET) his legs - we think this is to do with cycling, rather than gender reassignment. And when not eating or shaving, he has become the destruction tester-in-chief in the department, making very short work of the new anaesthetic room machines. Cliff Barthram, our kit guru, claims the machines weren’t broken;; they were just designed not to work. And not working is what some at the non- young, non- thrusting end of the department are looking towards. But Arthur is as busy as ever, teaching, appraising, and keeping the department supplied with biscuits and ice cream. And Duncan Forbes continues valiantly producing the rota. Duncan can also rest very proud of his many years doing good for all Tayside Medical Staff, as Chair of the LNC. Like MI5, he can’t boast of his successes, but he has undoubtedly scuppered many dastardly plots over the years. Sine Steele, Yevgenniy Kossko, Jo Doughty and Simon Parkin are our ever

supportive Staff Grade crew. We have always known how invaluable they are, but it was great when a respected retiring physician went out of his way recently to thank them for their help over the years. Together with our visiting trainees, they have kept PRI on an even keel, giving anaesthetics, looking after the ITU, and bailing out the physicians and surgeons in the darkest of nights. So, we are a happy ship. Coming to work is great fun, and we get on fantastically, in and out of work. Perth Royal Infirmary, and the anaesthetics department, are special places to work. But there is an iceberg looming.... Tayside management has no money and is a shambles. While there are deckchairs to rearrange, that’s what will be done! Outsiders have been drafted in to sort out the management mess. Asset stripping is rife- the rivets are being removed from the bulkheads. Management are heading the good ship PRI straight for the iceberg. Meanwhile, we keep on having fun... Michael Forster University Hospital Ayr News from the Seaside… After an unfortunate absence from recent Annals, we would like to report that we are still very much alive and kicking here in Ayr. We would like to welcome Katrina Dick to our department. She is a much appreciated addition with her tales from her holidays to exotic locations and diving expeditions, and also her


35

Chronic Pain management expertise. She has also brought a talent for instigating departmental socialising, including a fantastic wine tasting evening and tour of the cellars of Corney & Barrow in Ayr, and also a departmental trip to Poland for the girls (with a mission to find the gnomes of Wraklow), along with any excuse for gin consumption. Several other nights out have been had at the local Thai restaurant (yes… Ayr now does have a fantastic Thai restaurant – how cosmopolitan!) along with venturing up to Glasgow to be on the trainees turf, and experience the delights(?) of the last train home to Ayr (well, those who made it…!). And then more gin… David Ryan still appears in the department, despite officially retiring 2 years ago. He seems to have discovered an antidote for aging with the concept of working less with time to enjoy life… and now says that we work too much! (Words of wisdom we need to heed!). The same goes for our SAS doctors Tim Saw and Yogesh Parikh, who both retired last year but have been very much appreciated in filling for lists. Paul Wylie is eyeing up the chance to retire early next year. Rose McRobert has now taken on the role of Clinical Director and will be leading the crew through times of pending change, with talk of relocating orthopaedic acute/elective services between Ayr and Crosshouse (although when it actually happens is another matter) and the ongoing issues with staffing rotas. Many thanks to Iain Taylor for his work in guiding the ship over the last 3 years. Kenny Kerr has succeeded Kevin Walker as the College Tutor, and

instigated a ‘Wall of Success’ which I am delighted to report is being rapidly filled by the trainees in their achievements for both the Part I and Part II of FRCA whilst they have been in Ayr. Kevin Walker has taken up the post of Deputy Regional Advisor, and Deputy Training Programme Director. Judith Ramsey is working hard to co-ordinate and deliver the Final Exam teaching course for the West of Scotland, and would be delighted for any additional offers of help! Derek McLaughlin is the Assistant Director of Medical Education, and can often be found ensuring the new FY1s are still managing to stay afloat as they face the ‘big pool’ for the first time, occasionally throwing out a life buoy for assistance! Gavin Scott has taken of the role of H@n Solo-handed for Ayr. Watch this space as the Force Awakens, however he feels that he hasn’t quite found the Ark of the Covenant, but more of a poisoned chalice! Perioperative medicine has arrived in UHA. A lot of time and effort is put in the Preop clinics to educate patients about lifestyle choices, however the biggest shock that came to many of us is that ‘social alcohol’ means that you are classified as ASA 2! Preoperative anaemia is proving to be a challenge as the thresholds are raised ever higher, along with trying to educate surgeons that this is for their patients benefit! As for the rest of us? Well, predictably there is a considerable amount of lycra in the department, the with portakabin office (yes very prestigious!) colloquially known as ‘The Bike Shed’.


36

The fact is that cycling is the best way to avoid the traffic, and an excuse to explore the fantastic ‘Ayrshire Alps’ Road Cycling park which is on our doorstep. http://www.ayrshirealps.org/ (Nothing like a blatant bit of self promotion!) We still await the pipeline plans of the ‘superhospital’ for Ayrshire… Joellene Mitchell Royal Alexandra Hospital Collating and scribing ‘newsworthy’ items for the Annals initially fills me with that dreaded overdue homework feeling…what do folk want to know about, how much to write, have I missed the deadline yet? But here I am, time to reflect with a cup of tea, during a moment of peace, two days before the deadline, with a list of ‘stuff’ to flesh out – here goes! We were delighted to welcome Lisa Gemmel into the department in October. No one has retired during the last year, and we are enjoying having a full complement of staff! Lisa joins the ICU team who are amid preparations for a new unit. For many years, a hazard tape has crossed the floor of the existing ICU (directly above A&E) – covering a crack. Repeated warnings that the floor is not quite up to scratch and that the crack is enlarging has finally led to surgical ward 26 being vacated in order to create space for a new ICU, adjacent to the HDU in the surgical tower. When finished, this will be great.

Actual refurbishment is now in full swing. There are, however, temporary unintended consequences…Surgical beds have been shuffled similar to a game of musical chairs to minimise disruption during the works, more same day admissions, no new SDA area – queues of staff trying to see patients before they head off to theatre...sound familiar? And then there’s CAR PARKING. What was a difficult situation has got worse. We suspect that the workers undertaking the refurbishment may be the same folk who are parking vans in the staff car park (and why not, this is where they are working as well), which may explain why trying to get a parking space is becoming ridiculous. This is impacting negatively everywhere…eg. delay in an orthopaedic case whilst the equipment rep drove around the car park for 40 minutes waiting for a space! I do not envy those who must sort this out on a limited budget…watch this space. On a more positive note, we now have access to ‘The Green Lunch Box’ – a private company providing lunches prepared to order, and delivered to the department. Good food makes up for almost anything! Orders must be in by 10:30, if our Superhuman Secretary - Vicky - is not there to sort us all out, then the departmental what’s app gets a lunch logistics takeover. Finally, ‘The Dickson Challenge’ (an annual departmental sporting event established in 2012, the only firm rule is that it is inclusive – training, non-training and non-clinical staff participate), saw a takeover of a local


37

gym one Friday evening in May. This year the event was a team triathlon. It was great to have trainees in control of the treadmill controls (Aaahhhh – I can’t run that fast!), senior clinicians (JD) beating everyone on the static bike, and Shashi Timalapur sorting out the spreadsheet and stopwatch. I wonder if that’s why his team won? Refuelling occurred in the time honoured fashion of curry and beer later that evening. I have heard rumours that 2018 might turn into a trip to ‘The Ninja Warrior’ obstacle course. I’m sure that these team building map to a section on SOAR... Jennifer Edwards Wishaw Hospital This report will include some events from the preceding year as I believe that we missed the last Annals. A shock for many was the sudden hard Brexit of Dr Mifsud in 2016, who returned to a Consultant Post in his homeland Malta with a sunnier climate and almost all year outdoor swimming opportunities. Many will miss him albeit he is still working in his 2nd job as tourist guide for regular delegations from Wishaw Theatres and recovery. We wish him all the best for his future. Talking about outdoor swimming: Our trainees Madeleine McHendry, Emily Robertson and Jen Willder have started this activity in some quarry in Glasgow and plans are under way to participate as Team Wishaw in an outdoor distance swimming competition in 2018. Next comes crossing the channel, a talent which will also help to avoid the long future queues at immigration control at

Dover and vice versa. But I better don’t get started on this topic! Otherwise of course Wishaw is going from strength to strength. After 15 years of debate we eventually managed to “split” the ICU and Theatre/Maternity on-call Rota and have never looked back since. Kat Bennett, Aneta Sowinska, Lorna Young, Ogechi Lubeigt, Yuvaraj Kummur and Nicola Doody have joined the Consultant Team – Dominic Strachan and Miriam Stephens are going to follow next year – in March 2018 we will have a department with no vacancies. Clearly the cultural heritage, outstanding architecture and cosmopolitan cuisine in Wishaw keeps attracting high quality candidates to our centre of excellence – “hot desking”, lack of parking space etc. on other dead planets (or stars?) may also contribute to make us a relatively attractive career destination. In addition we are a maximal diverse department with 29 permanent staff members from 11 different countries of origin at the last count. We also have seen our fair share of major service reorganisations. Phase I Trauma & Orthopaedics reorganisation has just been completed (Concentration of all T&O at Wishaw and Hairmyres) with Phase II just around the corner now (Wishaw will become the only Trauma Centre in Lanarkshire). The Maternity Unit has undergone complete refurbishment and redesign with some minor frictions (Antenatal Clinic Room suddenly found occupied by Physiotherapy and initially no replacement catered for), but finally


38

all organisational needs could be addressed in a satisfactory manner. Amongst many Clinical Improvements and educational successes feature the introduction of Regional Anticoagulation with Citrate for RRT (Dr Lang), ERAS-Protocols for Gynaecology, Colorectal Surgery, Trauma and Major Joint Replacements (Drs Peters, Padmanabhan, Bennett and Dalchow), start of a Major Trauma Response Team (Dr Bennett), the ever popular LEAT-Course (Dr Padmanabhan), regular Theatre placements for Paramedics for airway skills (Dr Dalchow), inclusion of an Anaesthetic Block with defined objectives for Medical Students during their surgical placement (Dr Doody) etc. etc. Also in other respects Wishaw remains highly fertile ground with at peak 5 staff members simultaneously on Maternity Leave in 2017 – welcome to the next generation! Managerial Leadership remains highly unorthodox – the beatings will continue until morale improves. Stephan Dalchow NHS Fife As I sit in a frosty Fife musing the year that’s been, the Fife Department of Anaesthesia suddenly find ourselves in a rudder-less ship! John Donnelly, who has been the Clinical Lead for Anaesthesia for 5 years, has been “abducted” to the management suite to serve in their ranks as Clinical Director for Planned Care. John has led the department

through a number of changes over the past few years. This has included the successful introduction of the electronic rota (which if nothing else means that I turn up to work at the right time. The unfathomable excel spreadsheet previously led to many a missed/mixed up session on my part!) Time will tell who will steps up to take the reins of the department. We are hoping to fare better than others this year who have found themselves under new leadership! #Trump Other changes in personnel this year have included Andreas Rogowski stepping down as College Tutor. The role has been taken on by Simon Bolton, who has already made identifying the trainees easier, by circulating mug shots on their arrival! Ben Slater continues as College Tutor for ICM and Marcia MacDougall as Clinical Lead for ICU. Robert Thompson has taken over from Bob Savage as the Clinical Lead for Organ Donation. In these times of austerity, a novel role has been taken on by Arif Rahman who is now our lead for efficiency savings. We will hopefully be increasing our recycling and reducing waste in the year to come. We have had another year of successful recruitment with Neil Shaw joining as a new Consultant having completed his training in Tayside and Ross Simmons moving to join our department from the West where he was an established Consultant in Crosshouse Hospital. They have both settled in well and have even mastered our overly complex TIVA pumps! Ian


39

Leeuwenberg arrived in the summer. He trained in Edinburgh but stopped off briefly in Australia and Glasgow to collect some post CCT fellowship experience. He is bringing fresh knowledge to our paediatric lists. Caroline Ferguson completed dual Anaesthetic/ICM training in Edinburgh and has joined the ICU on-call bringing with her enthusiasm and new ideas. Bob Savage made a bold decision in the depths of last year’s winter to move to Australia. He negotiated a career break for 2 years and left in June to take up a Consultant post in Bathurst, Australia. We are hoping that being at least 2 hours from the beach will mean that it isn’t that great and he’ll want to come back –his dry banter is missed in the ICU grand round! Ruth Cruikshank also departed this year after a long duty of service to NHS Fife. She continues her Educational role at St Andrews University and we wish her all the best with moulding the minds of the next generation of medics. Laura Gill has been very busy this year -growing a human from food! Baby Alasdair was born in January and Laura will be returning to work in the next few weeks. The usual niggles arise in the theatre environment –the new theatre beds are heavy to push and break all the time, the x-ray slots in the new beds in ICU can’t be used because the mattresses cause artefacts, the new perioperative checklist is…….new! But, all in all we are a happy ship and will hopefully have a new “Captain” soon with the appointment of a Clinical

Lead to work alongside John in his new role. Anyone can hold the helm when the sea is calm. —Publilius Syrus Dr Lucy Hogg Crosshouse “RATATATATATATATATTATATATATATATAATTAATA”…. Drones on in the background of theatre. “Is it supposed to make that noise?” – the strangely astute surgical trainee asks, looking suspiciously at the vapouriser of our Maquet. The voice of Phil (our equipment guru) rings in my ears – “You wouldn’t notice if you were here more often! Anyway it’s designed to be reassuring, an audible comfort blanket to let you know you are delivering sevo to your patient…AND it gets you to turn your flows down”. I grimace, looking at my Ayre’s t-piece and reply to the surgeon “if you spent this much on a car that made that much noise you would take it straight back!”. The question interrupts me from my reflection on the year at Crosshouse. More comings and goings than an episode of Eastenders! Janie “Babs” Collie has handed over the reins of annual report so she can concentrate on mothering her boys – I think she means the ones in the department rather than at home. This combined with setting up a Consultant Peer support group, teaching MOET in Lausanne and selling timeshares at Gleneagles means she has passed on the reporting duties to me.


40

Dr Chris Hawksworth retired this year to pursue his love of trains. Unfortunately, he was unsuccessful in his application to be Virgin rail driver due to someone in the department substituting his picture with that of Mr Grumpy from the Mr Men. If anyone wants to catch up with Chris he can be found on the beaches of the Ayrshire coast in his running gear recreating chariots of fire. Crosshouse suffered not one but two major blows to its delivery of deadpan sarcasm this year as Dr Steven Lawrie also retired. He told me secretly that he was extremely excited about spending his NHS 20 year service award of £7.03 on a new clock so that he can watch each second pass until I finally get the joke. I’m still not sure if he was being serious. I suspect when he is not watching the clock he will be found along with Dr Alec Macleod on some golf course, working on his handicap whilst reprising the roles of Waldorf and Statler. The Departmental Toilet/Bike shed has missed the departure of Dr Ross Simmons to the Victoria Hospital Kirkcaldy. Ayrshire’s loss is Fife’s gain. Ross has a love of bicycles (in the horizontal position), expensive pens and intricate coffee making rituals. Given the amount of lycra, suction tubing and lubrication involved I suspect there will be an office in Kirkcaldy that is now reminiscent of a “specialist interest shop” in Amsterdam. Described by one of the surgeons as “an Iron fist in a velvet glove” the retiral of Jane Chestnut this year has been a major blow in the herding of rampaging surgeons in Ayrshire. Jane had a huge and positive impact as a

compassionate friend and colleague, an excellent clinician and on the training and lives of numerous trainees. She began her retirement as you would expect of her by taking on the training of FY2s in Ayrshire. You may ask how do you rebuild a department after the so many stalwarts have left? Well like a phoenix rising from the ashes of Ross’s automatic hotwater dispenser (think kettle) a new generation of consultants has stepped into the breach. Joining us are Dr Kim Flatman, and Dr Kerwei Tan on the general rota with Dr Jan Leemries returning from the Golden Jubilee to take up an ICU post along with Dr John Allan. Dr Allan was actually appointed over two years ago but was aggrieved to have not made it into the Annuls and is refusing to do any on-call until he does. Dr Caroline Whymark is taking a year’s sabbatical in advanced pain to support the service in Ayrshire and Arran. Sadly, this year saw the tragic death of Dr John McKenna, one of our trainees. We as a department, a hospital and all those who knew him struggled to come to terms with this. I cannot begin to imagine the impact this had on his wife and family and our thoughts remain with them. The support given to his family and to our department, such as the messages of condolence from other departments, and the sheer number of people at John’s service made me realise how widely he was known and loved. It brought home that we are more than a group of individuals, but a community of friends and colleagues who, like the tick of the vapouriser, are


41

there in the background and are often taken for granted until we need them. Tim Geary Golden Jubilee Report 2017 So it's been two years since the Jubilee submitted its last update to the Annals - and a lot has happened in the world during this time! A new US president, Brexit, a U.K general election, and sadly the loss of Wholefoods from the South side - first world problems are now really getting to an intolerable level. Still one of the best phrases to come out of 2017 has been "fake news" and I plan to implement the concept during this exquisitely written article So what's new in the little paradise area of Dalmuir? Well we're planning a wee bit of expansion so that every orthopaedic procedure below the waist in Scotland will happen at our place!** We don't need robots in the workplace - my ortho colleagues don't tire and work for long periods without service or maintenance. No lubrication needed for their moving parts! The recent budget may have been pessimistic about UK productivity but a short visit here would bring a tear of joy to the eye of Philip Hammond. Dr Andy Woods joined us in 2016 but has been working so hard in theatre that he's rarely been seen since! Catching a glimpse of him is like capturing a rare Pokemon! Catastrophe hit in the middle of summer with the unexpected death of our most loved colleague. The all-singing, all-dancing coffee machine passed away in a flurry of steam and a faint hiss. Tears were

shed and as departmental catecholamine levels started to decline so did our efficiency. It was a difficult couple of weeks until we could find a suitable shinier and frankly better replacement,but we've now moved pretty seamlessly through the grief cycle. As the BMJ has recently suggested 3-4 cups of day may be beneficial to health, there is almost constant dripping, whipping ,foaming or frothing activity in the department. Within the Cardiothoracic anaesthetic directorate, we continue to carry on with a spring in our step and a ready smile for everyone ** Like superheroes we thrive on getting increasing numbers of patients with their interesting pathologies and advancing years. We want to spend more time in the cath labs bonding with our cardiology colleagues. Give us as many electrophysiology patients as you can with their rear - entry tachyarrhythmias ....or is it re-entry! Probably need to look at that "ECG made easy" book again! Dr Neil Roux joined the CT group in the new year of 2017 after spending a post CCT year in Cardiothoracic anaesthesia. We must thank Stockholm syndrome for giving us our new consultant colleagues. The development of that strong psychological attachment that happens as a survival strategy whilst in captivity has allowed us to form a close-knit department. Neil is originally from South Africa and cuts a dashing figure on the ITU ward round chewing on biltong and wearing khaki safari suits. Not that I'm a fan of stereotyping! Dr Bill Reeve retired and then returned back after a month to our welcoming arms.


42

That's how great CT is - you never want to leave even when the gates are opened wide for you! Or maybe it's the Stockholm thing again...... However I prefer to believe it's due to the Friday Mac n cheese in the canteen. Dr Adarsh Lal left the ITU on call rota and now wanders round the hospital with an enormous grin on his face ;; looking visibly younger every time I see him I wonder what the UK stock levels of Botox are at! I suspect low... Dr Derek Paul finally retired from all forms of anaesthesia in May 2017. We're have been able to get rid of a lot of unwanted rubber objects since his departure - all work related of course. Derek was a stalwart member of the department and we wish both him and Pam a long, happy and healthy retirement. Currently we are fortunate to have Dr Andrew Nath as our advanced CT trainee;; he appears to be more psychologically robust than previous ones but we believe we will be able to make him love us eventually! Also our ongoing appreciation to the trainees from the West of Scotland and Tayside who throw themselves into the mayhem with hardly a whimper and look reasonably perky! Maybe that's the real fake news!!!!!! **Fake news I Quasim Queen Elizabeth University Hospital Another year and life in the QEUH continues to be a hive of activity, despite the hive having unfortunate structural problems. We reminisce over our previous homes which no longer

exist. The end of an era. The family is growing;; we welcome Iain Thomson, Luay Kersan, Kevin Holliday and Euan McIntosh. We wish Brian McCreath well in his new appointment in Sussex. We also wish Mani Chandran well, having recently moved to Birmingham. Congratulations to Sarah Ramsay, who has been elected to the Council of the Royal College of Anaesthetists. We have no doubt that she will do a stellar job in this position. Educational activities continue to be paramount within the department. The second European Trauma Course was again very successful. Thanks to Victor Tregubov for bringing an amazing opportunity to spend even more time with our surgical colleagues, as we continue to prepare for becoming one of the national major trauma centres. We congratulate our education team, as they were recognised for their hard work by receiving the NHS GG&C South Sector Excellence in Education Award. The West of Scotland Anaesthetic Teaching Group (WOSAT) continues to flourish, and we look forward to the CPD day in May 2018. Despite the hive of activity, we are still making time for social events. The inaugural Summer BBQ was a great success, despite the usual Scottish weather. Our annual charity football match saw us victorious over Glasgow Royal Infirmary by an outstanding five goals to two. A special mention to Mike MacMillan, Chris Hawthorne, Guy Coady and Pete Paisley, for ensuring our success. May the good times continue in 2018!

Genevieve Lowe


43

NHS Dumfries and Galloway As I write this we are 3 days away from the move to our new hospital. As you read this, news will have already spread across the country that it was one of the smoothest and best planned hospital migrations in history. Planning for the next couple of weeks has certainly dominated our department’s activity for the last few years. Many of us have been privileged to have been involved with the design and we are soon to find out if we have got it right. In general we are very pleased with the building: the challenges are all operational. We leave a shell of a hospital that has an uncertain future. Part is to be redeveloped for chronic dialysis and Ophthalmology and will be known as the Mountainhall Treatment Centre.Tthe Dumfries and Galloway Royal Infirmary title will be passed on to the new hospital which presumably means a Grand Opening Ceremony with Minor Royalty. The new hospital is on an elevated rural site to the west of the town and will give much better access to most of our population. We move in to an eight theatre complex with integrated short stay ward and endoscopy suite, adjacent to the 17 bed Critical Care Unit and our department offices on the first floor. The trainees and Specialty Drs have the best office in the building with a wall of floor to ceiling glass and a great view. Not exactly wildebeest crossing the Serengeti, just Belted Galloways grazing in a scene of pastoral bliss.

Our department remain as stable as ever with no one yet tempted in to early retirement but a forecasted major turnover in the next few years. In contrast, Maggie Nicol was tempted out of retirement, having got bored within 10 minutes of leaving her previous dept in the South of England and ‘retiring’ to an idyllic cottage overlooking the Solway. At Specialty Dr grade we have welcomed Alison Thompson and Kashif Munshi– fully staffing that grade for the first time for a while. Judy Deutsch moved on and we wish her well. We have become used to our Specialty Dr posts being used as stepping stones and stopgaps and whilst the turnover causes extra recruitment work it provides cross fertilisation of the sort that benefits our department. We have, again, a bunch of excellent trainees who add much to our department and seem to be happy with the experience they gain. They are all actively involved in the migration and we hope they will learn much from that. We have an open door policy to all except orthopaedic surgeons, so if you are in the region we’d be delighted to show you around. And for the record, I’m safe in saying that as we have a great relationship with our surgical (and medical) colleagues. Wayne Wrathall Royal Infirmary of Edinburgh In such a large department it is unsurprising that we have a reasonable turnover of staff and this past year has been no exception. Our leadership


44

remains unchanged with Michael Gilles as AMD and Bernhard Heidemann as Clinical Director. However, we have been joined by Katrina Bramley (cardiac), Simon Heaney (general), Naomi Hyndman (obstetrics), Katriona Montgomery (general) and Nafees Jafry. Katrina will soon be off on maternity leave and we wish her well. Helen Usher (HPB/Transplant) had a second boy in spring time and Ollie Daly is feeling bleary eyed following the recent arrival of his second child. Olly Robinson has joined the transplant crew as locum cover for Helen’s maternity leave and has regularly been helping out the department by covering rota gaps. We have also had some noticeable losses. Dave Scott has retired!! Yes, you have read that correctly and he has actually left the building on this occasion having retired several times previously but always returned for more fun in cardiac. A fitting retirement present was a work bench as Dave was known for his handy work in creating a number of useful adaptations for the cardiac theatres. We will remember him fondly for his smelly tinned fish, his tool belt which advanced to a tool waistcoat (you always knew who to ask for a stapler, hole punch, spanner, hammer which would all be produced instantly) and ‘The Scotty Knot’. So, although he never managed to patent his way of tying in a central line, we will be certain to pass it down the generations. Our recently awarded anaesthetic historian and Obstetric Anaesthetist, Alistair MacKenzie has also retired. Like Dave, he has worked on longer

than many of his peers and due to staffing issues continues to play a role in the on call rota for obstetrics until rota changes come into effect from April. We also said farewell to Ben Funke who had joined us from Germany in November 2013, initially as a trainee before obtaining a consultant position in August 2014. Ben decided to return to Germany in July so Funke Fridays in CEPOD are now a thing of the past. RIE will be facing many changes in the coming year. The DCN and Sick Children’s build is progressing although the date for the move continues to slip and will likely be after the summer. This will obviously be a challenging time as departments attempt to integrate but hopefully we can all look on it positively as patients will benefit greatly from avoiding an ambulance trip across town for specialist neuro input. Trauma teams are also being introduced and this will potentially stretch both anaesthetic and ODP capacity, although again, will undoubtedly improve patient care. One thing that won’t be changing though is the amount, or lack of, car parking and now even bike parking facilities on the site. The first meting of BUG (bike users group) for some years takes place next week so hopefully some progress can be made although I think we have all learned that changes in the NHS never happen quickly! Linzi Peacock Inverclyde A turbulent year or so. John Myles took early, very early, retirement, to the envy


45

of many and has been tending his garden and playing with his variety of Land Rovers in various states of (dis)repair. After a cameo reappearance to cover ITU sessions, and no more!, he drove off, waving happily. This left many gaps, not least in ITU and we have been supported by the venerable John Dickson from RAH, who dusted down his Critical faculties and covered ITU on Tuesdays for a year, much appreciated. His boots are now being filled by Brian Digby, another RAH colleague, hopefully helping to foster closer working between the two departments. We appointed Arshiya Sheik to a SpDr post and she is growing into the role having worked previously in Ayrshire. She has lifted the departmental cooking repertoire and has introduced a number of new taste sensations. Grant Tong feels threatened by this and has vowed to up his game. None of your cake nonsense, this is all about spice. Sadly, we have lost one member of the department, Derek McIntosh, a long term locum who had been with us for ten years. After climbing Mt Kilimanjaro earlier this year and finishing up his Business degree, he died suddenly at home. He was the glue that held our out of hours rota together and is hugely missed. He was well liked throughout the hospital and helped many a trainee during their time here. His football interest was legendary, particularly the travails of Rangers FC, although, as an avid Dunfermline supporter. Of others, Martin “I’ll be in Cuba” Schwab, Manfred “parliamo Italiano” Staber and Artur “Cousteau” Pryn are

along with the rest of us, particularly interested in the Brexit fiasco. Maybe by the time of printing it will all be sorted and we will wonder what all the fuss was about, or not. Looking locally, we have pressing concerns surrounding the cover of ITU, particularly brought to a head by the loss of a Consultant and middle grade. We await developments Duncan Thomson Hairmyres Well it’s been a traumatic year here in Hairmyres. I say that as we have had a lot more trauma since the orthopaedics re-configuration commenced in late 2016 with Hairmyres being chosen along with Wishaw to provide all orthopaedics for Lanarkshire. We did however benefit from more consultant posts created to facilitate this and welcomed Ali Maddock and Raj Ahmed this year albeit temporarily before they head off for fellowships elsewhere in due course. Expansion in numbers has allowed us to successfully trial a split rota which will formally come into effect in the new year with equal numbers in dedicated intensive care and general theatres rotas. It’s been fairly productive on the baby front with Vanessa Vallance welcoming wee Magnus and Laura Robertson (CCP) baby James this year. Conveniently arranging departure to coincide with Nina Tatarkowska and Natalie’s (CCP) return from maternity


46

leave, well done girls. Julia Kerr was also delighted to inform the department that she will be expecting a baby in 2018. Congratulations also went to our anaesthetic PA Fiona who got engaged and joins all 3 of our new start trainees in fervent wedding planning. Clearly love is in the gases?!? As for 2018 and the future, what does it hold? Trauma services are due to be centralised in Wishaw by next summer, the general surgeons have embarked discussions on their own reconfiguration and with the Monklands regeneration renewal project looming further into the future I’m not entirely sure. Less traumatic clearly. I am personally happy enough not to have any more ITU ward rounds left. Shona McConnell Raigmore It’s been a busy 2017 up in the frozen north in Inverness (literally, partly due to the inexplicable success of the North Coast 500 route – ‘a bit like Route 66, but with midges’) Apart from the standard issue NHS bed crisis, things are quite upbeat. The incessant sound of hammers means that the shiny new combined critical care unit will open on time in February, we hear. Level 2 surgical patients will be co-located with ICU, and come under the soothing umbrella of the Anaesthesia & ITU dept. This should make the movements between them much easier, and there have been few regrets from the surgeons about relinquishing HDU.

The other side of the dept is just getting going with its 3 year refurb and expansion;; the clinical impact has been negligible so far but in early January rolling theatre closures start and there is some foreboding. It all sounds pretty disruptive to gain one extra theatre, perhaps the new shiny stuff will be worth it though. We will all be moved to new ‘compact’ offices;; no doubt the ‘horizontally stacked desks’ rumour is false. Isn’t it? Staffing has changed a bit, and some welcome cross-pollination has been happening. We now have 24 consultants having welcomed Dora Paal (Fort William), Ian Hunter (Middlesbrough) and Ben Greatorex (Bristol). Our bearded orienteering champ Kevin Holliday has mysteriously lost his way and ended up down at the Death Star in Glasgow where we are unsure how his headtorch and lycra will blend in, and Tash Burley has left for substantially more attractive GP-land (SASG contract negotiators take note!) Hamish Hay has passed the selection for the International Red Cross and will be working for them for part of each year in global crisis zones. We congratulate Jenny Parsons on another baby, and the fecund Head of Service Mike Duffy joins the ranks of the “I’ll need a van” brigade with the imminent arrival of a fourth. There are a couple of other things going on outwith gassing and crit care;; the dept is contributing enthusiastic volunteers to the BASICS-linked Pre-Hospital Response initiative called PICT, and the ties with both the SAS


47

and Coastguard Seach and Rescue are deepening. The PPE and kit for this has been possible with brilliant support from the Sandpiper Trust, and thankfully (given our climate) no blue bodypaint is required. 500m away across the A9 the ground within the new campus University has been identified for a new Elective Treatment Centre for the North, and the bid is at a very advanced stage. If that gets final approval our shiny new offices will be instantly too small, but the clinical and research opportunities are eagerly anticipated. Exciting times, and the door is always open if you want to come and visit. Dan Baraclough Monklands So here at Monklands all eyes are focused on the MRRP. Despite many changes over the last few years there hasn’t been much movement on the Monklands Really Rubbish Parking situation. However, the Massive Recovery Room Proposals have been realised. Just as well, really, as the reconfiguration of trauma and orthopaedic services away from the Monklands (bring on the icy weather!) seems to have opened the floodgates for ureteric stents, gall bladders (does anybody still have theirs? – Please form an orderly queue...... according to Scot PFA criteria....) and children with overactive lymphoid tissue. No, really, the Monklands Refurbishment/Replacement Project seems to be gathering steam. As well as the Massive Recovery Room, we now have 4 fancy new theatres open (watch out for the doors!) and we are

working on the Feng Shui therein. We still have our trendy loft style shabby chic ceilings which I am sure are improving the patient experience as they are wheeled into their theatre, and we hardly notice the noise from the builders which has replaced the noise from the orthopods. All this while consultations continue regarding a potential new build so exciting times. Other changes in our department in the last year include the departure of our Pain Sister, Lynn McCaffer who we wish well in her new post in GG and C and the appointment of her replacement, Ashleigh Connolly who is already well known to us for her previous employment in the massive recovery room. Roddy Chapman is also soon to leave us for pastures new at the GJNH where he will not doubt soon make up for a year’s worth of missed orthopaedics. All the best, Roddy! All these changes have not dampened our celebratory spirits and with no shortage of birthdays, weddings and babies to mark we are now looking forward to Christmas and the next Monklands Right Rowdy Party. Aberdeen Royal Infirmary Greetings from the North-East. Well it’s been another busy year at Aberdeen Royal Infirmary with several comings and goings. Firstly, we had the sad news this year of the passing of Dr John McKenzie in August. For many in Aberdeen he was a contemporary, a colleague and a friend. For others, like myself, he was


48

also an inspiring Consultant to the trainee Anaesthetist;; cool under pressure, clinically excellent and on first name terms with everyone in the theatre suite. To many outside Aberdeen he was also a friend, a colleague and a past President of the Society in 2004-2005. As in other years a more complete obituary will be made available elsewhere. Over the last year the Department has seen a few changes in personnel with some arriving, some going and coming back and some going! This year has seen the retirements of Dr Donald MacLeod, Professor Nigel Webster and Dr Bryce Randalls. Of these only Nigel has fully escaped whilst Donald and Bryce continue to work clinically on reduced hours. We have also said goodbye to Drs Jan and Andrea Jansen who have made the move to Birmingham, Alabama, USA during the summer months. We have made several appointments during the year as well with Drs Jolene Moore, Bahadur Niazi and Faszillah Ismail joining the Consultant body. Added to this we have also appointed Drs Kevin Sim and James MacBrayne to joint ICM/ Anaesthesia / Medical HDU posts. We have also welcomed Dr Julia Csajkovszki to the Department as an Associate Specialist and finally we must congratulate Dr Tom Engelhardt as he became Professor Engelhardt earlier this year. Clinically there have been a few changes over the year. Robotic surgery seems so 2016 now (!) and whilst the department and theatres have remained much the same plans are at

an advanced stage for the new Baird Family Hospital attached to ARI which will host Maternity, Gynaecology and Breast surgical services. 2017 also saw two members of our Department honoured with Dr Gordon Byers becoming President-elect of the Scottish Society of Anaesthetists and Dr Kathleen Ferguson becoming President-elect of the Association of Anaesthetists of Great Britain and Ireland! Gordon will take on the role of President at the SSA Spring meeting in April in Dunkeld whilst Kathleen taking on the President’s role at the AAGBI Annual Congress in Dublin in September. A busy year for all concerned and an honour for the Department. So, another busy year clinically and socially in Aberdeen, whilst 2018 is already looking a year to remember. See you in Dunkeld, Dublin or at the SSA WSM in Dundee next year. Paul Bourke NHS Forth Valley The last year has been a period of significant change in Forth Valley. We have said farewell to several long established colleagues- Crawford Reid, Brian Kennedy and Mark Worsley have all retired from front line anaesthesia. While Crawford no longer sings for us, we are delighted that his voice is now heard as Councillor for Strathallan and in his non executive role on the Board of NHS Tayside. Hopefully they all enjoy Neil Diamond songs! Brian has followed his first love, and now gives


49

guided tours around East Fortune, revelling in the proximity to his beloved aircraft, while Mark is happiest outside on a hill or in a boat. The spaces left in the rota have been ably filled by new consultants Lorna Stevens (nee Gallacher) and Louise Welsh who have brought among other things, teaching and training expertise and paediatric and perioperative specialist knowledge. Both are possessed of a musical talent that more than replaces Crawford! We were also delighted to welcome Stuart Hannah back as a consultant with a special interest in obstetric and regional anaesthesia, and Andy Longmate has also returned from Scottish Government with even more enthusiasm for development of safe and effective departmental practice. Congratulations to Jillian Brand, one of our PA-As who welcomed a lovely little boy in the last year. Many of our trainees are also “matching” and “hatching” with their own events as cause for celebration. We were also delighted to welcome Paula and Helen, as theatre co-ordinators and Liz MacLeod as our new theatre manager, so we are anticipating change and new direction. Departmental chair has moved from Matt Freer to Simon Evans (and given Matt’s escapades in the past year, I think he must be trying to recreate the excitement of it!). Grateful thanks go to both for their contributions. Workload continues to be high, time pressures persist and staffing remains challenging, but the coffee fund

continues to be full, and with “office gate” over, we are settling into our new facilities. Fiona McIlveney RHC Glasgow Report 2017 Greetings from sunny but smelly Govan. We are now two and a half years post move from the Yorkhill campus and there have been many changes to working life since our move from the West End. Initially the greatest pressures seemed to be experienced at ward level with the build’s move to mainly single rooms meaning massive pressure on the nursing staff numbers to provide safe care in this new environment. While many new staff have been appointed there is still a shortage on the wards and this continues to have implications throughout the hospital. We are now also caring for ‘children’ up until their sixteenth birthday. This has exposed us to the adolescent population on more than a few occasions where smoking, drinking and substance abuse are now becoming all too familiar but yet so inappropriate in a children’s hospital! Additionally this age group is adding to clinical pressures that are already stretching resources. Waiting times across the services seem to be increasing and we are struggling to accommodate everything asked of us in our current theatre suite. If only the powers that be had thought about a little bit of future proofing! What goes around comes around as they say and ultimately I can envisage a time in the not too distant future where some of the


50

non-tertiary referral work the we get through (of which there is a reasonable amount) needs to be moved off site to let us do what we are really trained to and that is look after children who need tertiary level paediatric care. Also within the theatre suite in March of this year, the Learning from Excellence initiative was introduced. This runs in parallel with the Datix reporting system and critical incident reporting and has already generated in excess of fifty reports for deserving staff across all disciplines but very many of whom are our selfless and wonderful theatre and recovery nursing staff. Indeed they do an excellent job and while the LFE is good for morale it is unfortunately a very poor substitute for a proper pay rise for our very deserving nurses! The anaesthetic department has seen some very significant departures this year. Firstly we said a very fond farewell to Crispin Best who has retired to his boat somewhere on the West Coast via an Oxfam shop somewhere in a northern leafy suburb of Glasgow. The place is really not the same without him (certainly a wee bit quieter and he won’t mind me saying I am sure!). We all miss him hugely. We also said farewell to John Sinclair. We will always miss his wit, wisdom and dry sense of humour. Everything John said or did was thoughtful and considered and the department has certainly lost a bright guiding light. We wish them both very long and happy retirements. The department also says farewell to Rob Ghent who will continue plying his trade in the European Union. Rob has

gone to Dublin to be nearer his family. Again Rob will be sadly missed and we wish him well in his new found home. We are also losing Ailie Pigott who has been our long term locum. She is heading off to Dubai. At the beginning of the year the department made four new consultant appointments. In May of this year the Department welcomed husband and wife team Dannie Seddon and Rhys Jones. Dannie has joined our cardiac team and Rhys is working with the sane members of the Department. Jocelyn Erskine and Adele King will join us early in 2018. Ross Fairgrieve Western General, Edinburgh Western devolution didn't happen. No Dexit here. With a minimum of fanfare, we learnt from the press that DCN wouldn't be moving to the Little France site in September as had been planned. Why not? We don't know but it's given us more time to avoid making a decision about what the out of hours rotas will actually entail once we get there. The next inkling of a date was guessed at when rumours of "no leave around certain dates in March 2018" circulated. This turned out to be but a twinkle in the eye of a public relations officer. We now officially don't know when we'll move, but work continues and a lot of people are very busy trying to get DCN and RHSC there as soon as possible. Don't ask about parking at the new site, but the building looks like it’s fitting into the site nicely.


51

There's been a little flux in our departmental constitution with the arrival of Tracey Bowen as departmental secretary. Sandra Murray decided to move to neurosciences and we wish her well there. Tracey brought Jim with her but you won’t hear Waiting for the Sun unless you’re in when she is at 7.30 every morning. Tracey's a great addition to our department and Lynda Lord still makes very welcome appearances from time to time. Sometimes she even does some work. Professor Lesley Colvin was on BBC Radio 4 this year contributing to the programme "Blood, guts and swearing robots" Downloadable as a podcast, it’s very much worth listening to. Our Da Vinci robot hasn’t sworn at anyone yet, but we’re waiting for the culturally appropriate Begbie upgrade. Lesley deserves more congratulations as she has just been appointed to the Chair of Pain Medicine at the University of Dundee. We’re sorry to see her go, but as Dundee’s complex regional pain history starting with the Bash St Kids we hope she has a beano. We’ve no doubts all will be fine and dandy and are chipping in to buy her a nice black and red stripy top. Kirsteen Brown is flying the flag as TPD and Jeremy Morton arranging the bunting as College Tutor. Both are working very hard with Clair and Damien to keep the CT and ST training up to standards. Our trainees at FY, CT and ST level have been a great bunch and are always much appreciated.

The WGH did some conference organising this year. The Age Anaesthesia Association met in May in Edinburgh keeping Clair, Irwin and Jon very busy in the run up. Alasdair W co-organised the SSA part of the joint meeting with the AAGBI meeting in October. Irwin is one of the more seasoned FRCA examiners and he, Alastair McNarry, Peter Andrews and Jonathan Rhodes continue to be asked to speak in far off places. Jon Wedgwood has run off to sea with his favourite Pogues album and joined the Clipper race. As you read this he's probably still at sea, not because they made him navigator, but because he's travelling 40000 nautical miles circumnavigating the globe. We're following his progress on the Clipper website. According to his skipper, he's a dab hand at rescuing porridge and making Moroccan chicken stew. He's sailing with Nasdaq, who aren't overburdened with points, but they are still afloat unlike one team and on a more serious note haven't lost any crew like another. We'll find out when he returns whether they’ve managed to teach our salty old sea dog new tricks. From frying pan into the fire, Clair Baldie handed over her CAR post to Damien Mantle and took over as Clinical Director from Mike Robson. Mike had always planned to step aside at this time to manage our DCN move. Apparently, being CD is as much fun as pulling teeth, but multiply qualified Clair will be able to tell us. Her skills should help up us fill any gaps, though whether she'll scale and polish our job plans remains to be seen. Damien is ensuring


52

we turn up in the right theatre at the right time and managing to retain his sanity and good humour despite last minute / first thing morning calls with list cover problems. Matt Royds took over the ST rota and moved house (not related) and Kiran Sachane now manages the CT rota. Chris Winter, our sole PAA remains in constant demand not only for his anaesthetic skills but also for his AirBNB management expertise. Debbie Morley joined Matt & Damien in the pre-assessment clinic and they're developing ST training there. She'll liaise wonderfully with cardiology as they know us so well now. Susan Rae is doing her best to make Information Paper Lite work for us, but it’s imposition has meant the length of time to assess a patient pre-op has risen exponentially. Old anaesthetic forms are now being added to TRAK which is better and not just one small step for a man, but a large leap for anaesthetists. We welcomed Tom Anderson, David Falzon and Judith Deutz this year as locum consultants. Judy has headed west now and David and Tom fitted in apparently effortlessly. Their presence remains greatly appreciated though David heads off at the end of December. There are a selection of permanent jobs advertised across the region and we're hopeful we'll attract great colleagues. The offer of 2 SPAs from the outset is progress. Keith Kelly has caught the boomerang that is organising the Friday meetings and keeps us resuscitated. Faisal Jafar organises the trainee tutorials, and Phil

Roddam co-ordinates the WLI volunteers. Margaret Cullen keeps the medical students on track at university level and her wise words are always appreciated. Liz Steel is helping choose artwork for the new DCN building and making sure whatever goes on the walls doesn't frighten children. Sue Midgely continues to help her and Kirsteen by storing their excess paperwork on her desk. Ivan Marples can often be found in Tim’s Kitchen when he’s not building tree houses while Susan Nimmo and pain team nurses Debbie, Jayne and Lesley continue to keep a watchful eye on our post op patients, ever vigilant in case it’s not just pain that’s a problem. We're training a lot of nurses as anaesthetic assistants due the decline in numbers of nationally trained ODPs. Professor Andrews, Murray Blackstock, Rosie Baruah, Jon Rhodes, Stuart McLellan and Charles Wallis all spend time in theatre as well as ICU doing lists. Rosie and Murray are well acquainted with FICE and CUSIC and Charles is regional lead for organ donation for NHS Blood and Transplant. Alasdair Hay is joining us in theatres when his ICU rota allows and Ross Paterson brings a smile to the happy people of Costorphine as well as being Quality Academy lead. Antony Bateman looks after our regions home ventilation patients and Frauke Weidanz joins Graham Nimmo with one foot in ICU and the other in medicine. Congratulations to Adventure Medic Rowena Clark on getting married. Some of the WGH ICU are deciding whether to stay or go with the DCN


53

move, but there’s no clash that we’re aware of. Peter and Jonathan maintain the academic focus of the unit with SPICE iii, NOSTRA and CENTRE- TBI trial involvement. Talat Aziz has decided to give up his mobile phones (for some of the day) while Douglas Duncan writes anaesthetic programmes and apps. Farrukh flies the TIVA flag and Andrew Marchant has been busy co-ordinating our site’s assessment of the next NHS Lothian anaesthetic machine. His attention to details is especially welcome as we’ll have them for a decade. Al McNarry is still smiling despite a SAD national procurement exercise and with Rob Sutherland and Caroline Brookman, is keeping our airway skills polished. Alistair is the RCoA’s Airway lead though he sometimes takes the train. On that note, it’s time to for us to bid farewell to 2017 and rumble along the rails towards 2018. Alasdair Waite Ninewells Ninewells anaesthetic department continues to be a happy team, despite the dire state of finances in both Tayside and the NHS as a whole, and with Brexit forecasts on the gloomy side of miserable. The spectre of more cost cutting looms like the ghost of Christmas yet to come. Our Clinical Director Eddie Wilson is enjoying his term as SSA President before handing on the reins to Gordon Byers at the Spring meeting. Eddie is

due to retire in a few months, and Pamela Johnston will take over as Clinical Director. Jason Hardy will jump out of the frying pan of Rotameister into the fire of Clinical Lead when he replaces her in that role. Andrew Dalton will now be gently sizzled in Jason’s place. Ben Shippey has been promoted from Director of Clinical Skills to the dizzy heights of Consultant Anaesthetist. This will allow him to spend more time with surgeons. Our other Ben (Ulyatt) took on the role of Associate Director of Medical Education just in time for a GMC visit. Fiona Cameron is steadily climbing up the NES ladder and is now Associate Postgraduate Dean. Having done an excellent job of lead the Theatre Admission Suite, Matthew Checketts has been appointed Clinical Lead for the new Elective Care Centre. Presumably this will replace the mobile theatres which have recently been removed as a cost cutting measure. Lesley Crichton is currently on a two year sabbatical to Zambia partly funded by an SSA travel grant. Praveen Manthri, Sally Crofts and Dave Coventry have all hung up their clogs this year. Along with Eddie they have all made a huge contribution to this department. Praveen is back doing his own locum. Sally has sailed off to enjoy a Loch Earn sunset, and Dave is adamant that he won’t be coming back either, although he seems genuinely sad to be leaving. In response, we are delighted to welcome home-grown Pauline Austin, Fiona Anderson and Lynsey Foulds to the consultant fold so to speak. Pauline is joining the ICU


54

gang, Fiona the HDU gang, and Lynsey the obstetric gang, although they will all work as ‘normal’ anaesthetists too. We continue to put a great emphasis on breeding in our department. Congratulations to Steph Sim, Karen Pearson, Jonny Seeley, Iain Belford and Liz Broadbent who have all had babies in the last 12 months. Pamela Farquharson and Ayman Mustafa also got married this year, but not, I hasten to add, to each other. This year also saw the sad and untimely death of our colleague Lois Fell who worked in the Pain department as well as in anaesthetics, mainly in Stracathro. She will be sadly missed. A couple of colleagues in our department are off sick at the time of writing. We wish them well and a speedy recovery. This also applies to anaesthetic nursing colleagues who have been rocked by ill health. On the bright side of things, I am pleased to report that there have been no serious bike injuries this year for a change, although several of us have signed up to do the Strathpuffer 24 mountain bike event (held in January) so I hope that I can report the same thing next year. The SSA / RCoA winter meeting 15/16 November 2018 promises to be a cracker. It will be held in the Apex Hotel which sits on the Waterfront. Development in Dundee has continued apace and the new station building will open in the spring followed by the V&A which is due to open in the summer. Thus both should be open when you visit what GQ genuinely called ‘Britain’s coolest little city’ in November for the SSA meeting. We have some great

speakers already booked. Another reason to visit Dundee which has recently been named by The Wall Street Journal as one of 10 'hot destinations' in the world to visit. Along with the Faroe Islands. Hmmm. As I write things are winding down (up?) for Christmas. This is traditionally marked by festive events in the department. The Christmas night out was attended by 60 people, and was a memorable occasion for those of us that can remember it. The ‘mixed case presentation’ has been a firm and popular fixture in the calendar for a couple of decades. As usual there was a fine range of wines and cheeses to sample. Of recent years alcohol has not been permitted on NHS property – so we now hold it in the University Department. Our December CEHD had some high quality presentations (including one from guest speaker Stephen Hickey from the Golden Jubilee), a quiz, a prize-giving, and a debate. This year the debate was about NSAID use in the peri-operative period. While presenting his case, Fergus Millar caused a little bit more mirth than intended with the statement ‘I used to like Cox-2’ (which you might have to read out loud, but not in a public place). Paul Fettes INS, Glasgow Over the past year we are delighted to welcome Dr Cristina Niciu and Dr Mark Patek to the department. One post is an expansion post due to increased neurosurgical and maxillofacial surgery and the other is a replacement for Dr


55

Doug Walker who retired. Doug has since returned to work 1 day per week so we can still benefit from his skills and experience. We still eagerly await the opening of the new ICE building which apparently will happen as soon as all the pendants are moved from doorways, the cupboards are brought down to a height that you don’t need to be a basketball player to reach, and the scrub sinks are raised off floor level. I suppose these minor snagging items are unavoidable! Hopefully we will get access to the 4 new theatres in the ICE building soon. In some good news, our cladding appears to be of better quality than the main QEUH building across the link corridor and did not fail the post ‘Genfell Tower’ checks, so won’t need replaced. We also wish Diane Fraser well in her retirement after working at the INS for 30 years, the vast majority as neurosurgical theatre sister. Diane will be missed and not just because the theatre tea and coffee fund organisation that she did has now collapsed. Kevin Fitzpatrick Elgin This year we have bought new quantitative nerve stimulators to keep up with the new guidelines. We have also received tablets for accessing the EPR in a move to a paperless organisation. Theatres submitted a team for the

biennial Rotary Marafun raising money for local charities with Alastair Ross and Chris Smith running 5.2 of the 26.2 miles each. Participation was encouraged by ex-anaesthetist George Duthie who is now President Elect of the Rotary Club and enjoying his retirement. This year's team managed 3 hours and 12 minutes (11 minutes faster than 2015). In 2019 we’re hoping for sub-3. Chris Taylor has retired and we wish him well in his retirement. Brodyn Poulton has joined us from Shetland in his place and started in December. Even though Chris gave management 1 year notice of his retiral, we still had a 4 month gap between posts. David Milne was an excellent locum filling in for us before taking up his post in Kirkcaldy. Marek Wolanski has finally moved in to his new house after a long delay with building works. Andrej Andrasovsky continues leading the world with airways and organised the Dr Gray’s International Airway Day in June which received a RCOA Jubilee bursary. Alastair Ross is now fully kitted out in orange pyjamas and responds for BASICS as well as trying to set up a northern retrieval hub, dealing with trauma, resuscitation and M&M. Bernd Zaunseder has taken on medical student tutelage for Dr Gray’s in addition to his departmental student role. Chris Smith has managed PBs in 5k, 10k & 10 mile distances as well as a bronze medal in the North District half marathon championships. He is now


56

signed up for his 3rd marathon in May coinciding with the APA meeting in Liverpool. Iain Macdonald overdid the training and didn't make the Edinburgh marathon so did the half instead. He is set for his first marathon at London in April. Along with Doug McKendrick he went to Val d’Isere on “study leave” and there was too much snow for skiing. We didn’t laugh....honestly. Doug is our Clinical Lead once again taking over from Rob George. You can find out how Doug’s wine cellar is doing and which plants are potting out as well as the latest on medical advances and research from his twitter account. As for the A96 corridor, Chris Smith remains the transfer king with 21 trips

to Aberdeen in 2017, followed by Marek with 11 (conspiracy?). Overall transfer numbers are up with 77 in 2017, although the majority of these are now to Aberdeen with less diversions south for capacity reasons. We remain fully staffed at present but the other departments at Dr Gray’s continue to be held together with locums. Chris Smith


57

SSA MEETINGS AND SOCIAL EVENTS 2017


58

SSA Annual Spring Trainee Report April 27th and 28th saw the society hold their annual spring meeting in the fabulously picturesque setting of Dunkeld for the 3rd year running. With a line up of knowledgable, enthusiastic speakers and just under 40 trainee abstracts we knew we were in for another great meeting. For those not slowly emerging from the haze of what was a hugely sociable and enjoyable dinner the night before, the day began with a morning run along the beautiful river Tay. This trainee rep was far too busy organising for the day ahead, or at least if the fitness enthusiasts of the society ask that’s the excuse I’m sticking with! The Friday meeting was officially opened by the Society’s new President Dr Eddie Wilson and we certainly hit the ground running with our first speaker Dr Peter McGuire. Having travelled all the way from Newry in Northern Ireland he gave us a sobering insight in to the potential changes facing the health service post-Brexit. Incredibly skilled and talented workers originating from other EU countries and beyond fill many roles within the NHS. Brexit has done nothing to instill confidence in job security or the right to remain for many of these key workers. As a doctor already working across borders in Newry, Northern Ireland and Monaghan, Republic of Ireland he was well positioned to share some insight in to potential changes we may face. Next up was Dr Angela Baker, a consultant anaesthetist at the Queen

Elizabeth University Hospital with her talk on optimization, risk assessment and shared decision making. Perioperative medicine is a growing part of anaesthetic practice and this has certainly been reflected by its formal introduction to the college curriculum. Dr Baker spoke about the recognition and assessment of frailty and the impact of frailty on post-operative outcomes. She discussed realistic medicine (or should that be #realisticmedicine) and the importance of recognizing the wishes of our patients when embarking on treatment and management and how formal risk assessment scoring such as Surgical Outcome Risk Tool (SORT) can aid the anaesthetists in such decisions and discussions. Poster judging got underway during the first break of the day before everyone made their way back, caffeinated and ready for our next speaker Dr Euan Sandilands from the National Poisons Information Service (NPIS). Dr Sandilands gave a very interesting talk on an update in clinical toxicology. The huge increase in psychoactive drug use in the UK has led to many clinicians needing the expert support of the NPIS. His case presentations covering tricyclic overdoses to ethylene glycol poisoning (and the eye watering cost of Fomepazole treatment) made for a very engaging presentation. Dr Neal Willis from the Royal Hospital for Children delivered an entertaining talk on hot topics in paediatrics. His description of the challenges of neuraxial anaesthesia in infants led on to a discussion about the impact of


59

anaesthesia on neurocognitive development in children. While this question will continue to be investigated there is currently a lack of clear evidence that short duration exposure to anaesthesia in the early years is associated with neurocognitive deficits. A great lunch spread was provided by Dunkeld House Hotel and once refueled the committee were back in action judging more of the high quality abstracts submitted by trainees and medical students from across Scotland. This year was the first year the SSA spring meeting had hosted a Royal College of Anaesthetists listening event. Having invited the RCoA President Dr Liam Brennan up from London there was no sign of a post-prandial lull in proceedings as trainees got the opportunity to feedback on issues affecting training and working conditions. What a fantastic opportunity to work constructively with the people best positioned to affect change. It’s little wonder this session over-ran a little! Our final session of the day got underway with Dr Phil McCall. Dr McCall is an ST4 and clinical lecturer in anaesthesia and a qualified barista, a combination surely destined for greatness. Having been the recipient of an SSA funding grant he returned to talk about his research work on Procollagen Peptide III as a predictor of lung injury after cardiac surgery and discussed other biomarkers such as BNP in risk stratification.

Last but not least Dr Jill Austin, a consultant anaesthetist from Aberdeen Royal Infirmary gave a talk on her first year as a consultant anaesthetist: the uncut version. This was a topic which certainly piqued the interest of the senior trainees amongst us but which was warmly received by the greater audience. Dr Austin shed light on a side of anaesthesia trainees have limited exposure to: job planning. Her honest account of the trial and tribulations of her new role as well as the need to forge new professional relationships and overcome the (apparently commonly experienced) imposter syndrome not only gave us a fascinating insight in to what awaits us at the end of training but also reassured us of the support available from colleagues. Her experience clearly echoed with the consultants in the audience and it was a great way to round off the talks. Two newly elected trainee representatives were welcomed in to the fold: Dr Jonathan Hetherington and Dr Nicola Hogan. This was followed by presentation of prizes to the highest scoring posters of the day with Dr Maura Hutton scooping the top prize. SSA President Dr Eddie Wilson then brought what was a hugely successful meeting to a close. We are incredibly grateful to all the speakers who gave such fantastic talks, to the committee who not only worked incredibly hard to organise the rest of the 2 day meeting but assisted in the frantic business of poster judging and to all the trainees who submitted such high quality abstracts.


60

Dr Marie Davidson SSA Trainee Representative Joint SSA/AAGBI winter scientific meeting Well the collaboration with the AAGBI and SSA resulted in a fantastic meeting in Edinburgh. A great programme was met by a full house and some excellent discussions. We really did have to turn potential delegates away at the front door. First day We kicked off with Prof Tim Walsh who gave us non ICU bods a much better understanding of the complexities in patients surviving ICU admissions, including the physical and psychological impact post admission. We also learned that pre-existing health is the biggest factor in post ICU mortality. This raised lots of interesting debate on when patient’s escalation plans should be discussed and the need for more support for patients on discharge. Our ‘token surgeon’ Prof Susan Moug from Glasgow then discussed the ever growing research into the importance of prehabilitation on patients perioperative outcomes. It appears from emerging data that if the opportunity arises for improving patients exercise capacity before major surgery it has a significant impact on reducing several post op surgical complications. The first session was concluded by Dr Zoey Dempsey who has done some great work in standardising pathways for patients in the South East to receive fast, effective

investigation for suspected anaphylaxis. It was refreshing to see that we don't need to send our patients down to England to receive care we can provide here in Scotland. From a personal point of view I was interested to learn that Mast cell tryptase levels should not be relied on and our fast treatment of suspected cases can actually limited the tryptase rise. We should therefore be more liberal with our referrals to prevent headaches for our colleagues down the line. Following the first coffee break we were all glued to the medicolegal presentation by Dr Rhona Das. An excellent talk which reminds us all that we are in fact human beings and to stop being so harsh on ourselves. We all make mistakes but, it is how we handle them that will be our saving grace. Such a good take home message that ‘being human’ to patients and family following an error is what is needed. We should move away from our ‘defensive practice’ and apologise, be honest, reflect and remediate our practice. Worryingly, she pointed out the ill health prevalence amongst doctors which was a scary eye opener. This led into the presentation by Dr Dougie Duncan on computer programming. I have to say I was lost on the second slide but that was due to my illiteracy in the language of the computer. I assume I was not alone but we would all agree we could all do with a ‘Douglas Duncan’ in our department. The programmes that he has set up for patient feedback and see.pod were of particular interest. These both highlighted the lack of foresight by the NHS not to capture his expertise and developments that could


61

make our lives easier and the entire NHS more efficient. Hopefully, now that we all know of their presence, we can go back to our departments and try and push for their use. Following a lovely lunch which included a ‘raspberry tiramisu’ (better known as trifle!) we were given the more visual presentation by the very impressive Dr Richard Burnett. His talk which guided us through Finland, London, Nepal then back to Livingston stopped the post lunch tiredness setting in. We were dealt with some amazing stories of extreme pre hospital care and other ways of thinking ‘out of the box mentality’. I am in full agreement with him that we should be encouraging trainees to broaden their horizon and wish this was more prevalent during my dreadful ‘MMC scare mongering times’. We are lucky to have the Dr Burnetts in this world to keep us safer in these dreadful situations. This was followed by the light hearted presentation on ‘toxic terrors’ by Prof Michael Eddleston. Luckily lunch had past the gastric outlet point to prevent any accidents but what he showed was the shear brutality of what is happening in our world today. Terrorists are clever people and have the ability to conjure up a huge variety of ways to inflict significant harm and chaos on a grand scale. He highlighted the scary reality that this may happen here and we need to be ready. Chemical attacks produce such devastating morbidity and mortality that we need to keep updated in how to manage these incidents. We ended a day of such eclectic topics with the traditional Gillies lecture. We at the SSA were honored to have Prof Ellen

O’Sullivan from Dublin come and talk to us about the history and advancement in airway management. It was great to see photographs of the original LMA prototype and how this has developed over the years and the people instrumental into its design, safe placement and role in difficult airways. As the title depicts ‘have we reached the Holy Grail?’ there was a great area of discussion. Yes, we have advanced to such an incredible level but has some of the technology confused the situation? Are there too many options? I personally feel this was answered by the new DAS guidelines where FONA (front of neck access) has gone back to the blade, bougie and ETT method. She gave us great food for thought and it was a fantastic end to the first day. Second day The morning kicked off with the AAGBI presidential welcome Dr Paul Clyburn, followed by our very own past trainee rep Callum Kaye on the power of social media. This resulted in a frenzy of tweets which are worth a re-visit. Dr Tom Engelhardt’s take home message was keeping physiological parameters in the normal range is the best protective measure for the developing brain. After coffee we were entertained by Dr Andy Klein (Editor-in-Chief, Anaesthesia) who sucker punched us with the fact we as anaesthetists have no impact on mortality but highlighted our need to look into how we impact on morbidity. Dr Anne-Marie Doherty from Edinburgh showed us how to properly interpret research, a skill we should all possess. Then before a well needed lunch we welcomed Dr Alistair Nimmo


62

who presented the new guidelines in TIVA, with much of the twitter chat showing surprise that some of us still mix multiple drugs in a syringe using drug specific syringe devices. Something we should probably reflect on. The afternoon was always going to be ambitious – five incredibly important topics all squeezed into two and a half hours but……the chairs and presenters managed it! Dr Jon Antrobus started the ball rolling with a fantastic round up of the data available to all of us to improve the local care of those mainstays of almost every hospital – the patients with fractured neck of femurs. The second edition of the Scottish standards for treating these patients are being published as Jon spoke and the variation around the country remains an area for improvement as we can learn for each other and improve the care for all. Dr Kathleen Ferguson then graced us with some seasoning of salt and pepper common sense we should all be applying to guidelines, incident reports and checklists. The audience was wise to congratulate her on her appointment as the President elect of the AAGBI. The fact that she will become the first female president of the organization in its 85 year history is an extra reason to celebrate. Next up was Dr Tom Meek is the honorary secretary of the AAGBI and he regaled us with the work of the equipment standards committee which certainly seems to have its work cut out interacting with a myriad of groups and individuals from around the world (and this is before Brexit!) in fact that he put

out a serious plea for audience members to consider joining the committee. The final session of the meeting was chaired by the outgoing chair of the Scottish Standing committee who had been instrumental in not only organizing the actual programme but setting up the joint meeting in the first place. Dr David Ray is a stalwart of Scottish anaesthesia and his work is appreciated by all who know him. He introduced our friendly physicians to the hallowed hall of the Royal college of Physicians of Edinburgh. Dr Derek Connelly (Cardiologist from Glasgow) felt a minor unease as he is a fellow of the equivalent college in Glasgow! Dr Connelly was about to do a dance or two but instead educated us on the complexities and developments around ion channelopathies which present with cardiac dysrhythmias. Long QT seemed to be the most common and worrisome but the genetic background to thme has now been elucidated and treatment centres around betablockade while avoiding bradycardia….prevent hypokalaemia and magnesaemia as well as pain. Websites such as www.qtdrugs.org and www.brugada.org give handy lists of which drugs to avoid etc. Dr Tom MacKay (Respiratory from Edinburgh) is well placed to lead us on all things sleep related as he leads the Edinburgh sleep centre which has witnessed a huge increase in referrals to the point that sleep issues now outnumber all other referrals to respiratory…combined! The importance of a good quality sleep is easier for some than others and the


63

concerns of Sleep breathing disorders (a spectrum), hypoventilation and the much rarer narcolepsy were covered in detail. The idea of screening in pre op is not new as most treatments (e.g. CPAP for Obstructive Sleep Apnoea and NIV for Hypoventilation) are incredibly effective and cheap (<£250 for a CPAP machine that will last up to ten years) All in all the meeting was very well received from the floor with much discussion and questioning continuing into the coffee breaks and lunch. The location was exquisite and organization excellent. The collaboration between both SSA and AAGBI was novel and we hope to continue this adventure on a biannual basis. Matt Freer & Ewan Jack 2017 SSA Golf Report by Another Wee Divot The Society’s annual golf day was held in June at Newmachar Golf Club, located on the outskirts of Aberdeen and was played on the Hawkshill Championship course, endorsed by Peter Alliss and regarded as one of the toughest tests of golf in the area with its many water hazards and its strategic bunkering of fairways and greens. Our 14 members met for a morning’s Stableford, organised by local SSA member, Andrea Harvey and found that the water certainly proved to be quite a challenge;; coming into play frequently on both course and players as heavy rain fell more or less continuously throughout play. Andrea Harvey was

successful in defending her title and will hold onto the SSA trophy for a second year, Alex Macleod (Glasgow) won the nearest-the-pin competition and Steven Lawrie (Crosshouse) was successful with the longest drive. After lunch the weather improved marginally and the afternoon’s Texas scramble on Newmachar’s second course, Swailend, was less punishing for all involved! Those venturing up for the Glasgow & Ayrshire outing the day before, saw again 14 players attempting to play through deluge conditions at the usually sunny and picturesque spot of Banchory Golf Club. However conditions were such that only 7 determined players completed the 18 holes;; the rest seeking shelter and nourishment at the aptly named Shepherd’s Rest Restaurant in Westhill. This year’s golf outing was not without high drama off the fairways. Our SSA President, Eddie Wilson was delayed on the way up to Aberdeen as his roadside assistance was required at an accident and one of our players had to leave the course to seek medical assistance, although thankfully an inpatient stay was not required! Our numbers were overall slightly down this year mainly due to a variety of physical ailments preventing play, with cardiac, lumbar, abdominal and foot conditions all causing short notice cancellations for regular attendees. Hopefully everyone will be back to form for the 2018 outing!


64

Next year’s golf day will be arranged by Gavin Scott from Ayr, who hopefully will be able to provide some drier summer weather!! Apologies for the lack of artistic photographs as outdoor conditions on the day did not permit anything remotely useable!! Andrea Harvey


65

Abstract Prize Winners 2017


66

Perioperative Anaemia in Elective Joint Replacements Neil Brown, Jacqui Howes, Marian MacKinnon Department of Anaesthesia, Raigmore Hospital, Inverness Introduction Anaemia is known to be an independent risk factor for post-operative complications.1 Blood transfusion is an expensive therapy associated with significant morbidity.2 A recently published consensus statement provides new recommendations for best clinical practice in this area.3

The elective joint replacement service presents a large population of purely elective patients undergoing major surgery, with potential for intervention to optimise preoperative condition. Preoperative anaemia is common, and time spent on the waiting list could be used to investigate and correct any iron deficiency and/or anaemia before surgery. Given that this population accounts for significant blood usage, we wanted to investigate the prevalence of preoperative anaemia, the use of blood products and any association with outcome. Methods Data were collected retrospectively for all elective hip and joint replacements during 2015. Demographics, operation details, length of stay, pre- and post-

operative haemoglobin (Hb) and details of any transfusion were recorded. For the purposes of this project anaemia was defined as haemoglobin of less than 120 g/l. Results

Hip Replacement (n=310)

Knee Replacement (n=293)

Female, n (%)

179 (58%) 164 (56%)

Age mean, median, (range)

67.5, 69 (31-90)

69, 69 (42-89)

ASA 1-2, n (%)

239 (83.5%)

229 (83%)

ASA 3-4, n (%)

47 (16.3%) 46 (16.6%)

Preop Hb mean, median, (range)

135.5, 135 (96-180)

138, 138 (92-171)

Preop anaemia, n (%)

41 (13.2%) 27 (9.2%)

Received transfusion, n (%)

25 (8.1%) 10 (3.4%)

A total of 603 cases were reviewed, of which 68 patients (11.3%) were anaemic. Thirty-five patients (5.8%) were transfused a combined total of 80 units of red cells. Preoperative anaemia (Hb <120) was present in 13.2% of elective hip and 9.2% of elective knee replacements.


67

Preoperative anaemia was associated with longer inpatient stay – particularly in ASA3 patients, where mean length of stay was increased from 5.8 days to 10.6 days if preoperative anaemia was present. Joint replacement surgery was found to consistently drop haemoglobin by ~20 g/l from baseline. Two thirds of patients who received blood transfusion were anaemic preoperatively. Conclusion/next steps This project quantified the rate of red cell transfusion in this purely elective group of patients to be 5.8%, with an estimated cost of over £13,000 per year4 and potential for morbidity from transfusion. It was interesting to note that the majority of patients who received blood transfusion were anaemic preoperatively, and also that preoperative anaemia was associated with an increased length of stay. We have introduced a protocol to investigate patients with preoperative anaemia by checking ferritin and C-reactive protein (CRP) levels. In cases consistent with iron deficiency, a letter will be forwarded to the patient’s GP and they will be commenced on iron supplementation. If anaemia of chronic disease is suspected, patients will be given intravenous iron and reviewed on admission. Data are being collected on an ongoing basis following the introduction of this protocol to review any impact on transfusion rates, length of stay and any associated benefits from treating and

prompting investigation of preoperative anaemia. References 1. Preoperative anaemia. Hans

GA, Jones N 2013 Continuing Education in Anaesthesia, Critical Care & Pain

2. The 2015 Annual SHOT Report PHB Bolton-Maggs (Ed) D Poles et al. on behalf of the Serious Hazards of Transfusion (SHOT) Steering Group 2016 Available at http://www.shotuk.org/shot-reports/

3. International consensus statement on the peri-operative management of anaemia and iron deficiency. Munoz M, Acheson A et al 2017 Anaesthesia

4. Costing statement: blood transfusion NICE 2015

Preoperative risk scoring;; Uptake and correlation with postoperative course in a tertiary teaching hospital

R Foye, S Dwyer, A Baker Queen Elizabeth University Hospital, Glasgow

Introduction

With the ever increasing demand for critical care and downstream acute beds nationally,1 methods to estimate the length of stay for patients undergoing major surgery and to allow appropriate planning could be a valuable bed management resource. Furthermore, with recent further emphasis regarding the importance of patient consent,2 being able to offer


68

objective measures of perioperative risk seems appropriate where possible. One such method, the Surgical Outcome Risk Tool (SORT) scoring system, may prove worthwhile in our institution for these issues;; it takes into account the patients’ ASA, age, urgency and nature of the procedure, and provides a predicted 30 day mortality.3 We sought to assess how widely risk scoring was being used at our institution, and how well it correlated with length of stay in critical care, acute hospital stay and rate of postoperative complications.

Methods

Beginning May 2016, we followed one hundred consecutive patients undergoing major colorectal and urological procedures, and looked up their electronic case records. We sought to establish if they had been given a mortality risk score, and if not, proceeded to calculate it retrospectively using the SORT online tool. We then followed up their hospital progress and recorded the presence or absence of postoperative complications, and the length of both critical care and hospital stays.

Results

We divided our one hundred patients into those who had a retrospective SORT predicted mortality score of less than 2%, and those with 2% or greater. We had 60 patients in the <2% predicted mortality group, and 40 in the 2% and above group. The mean ages for both groups were 57.4 and 73 respectively. Only 3 patients in total had

risk assessments performed;; 1 in the <2% group and 2 in the >2% group.

Average length of hospital stay for those with a SORT score of >2% was 12.35 nights (9.73-14.97) compared to those with a SORT score of <2% of 7.32 nights (6.1-8.54). 95% confidence intervals applied show these to be statistically significant. Average high dependency stays were 2.03 nights for the <2% group, and 2.83 for those in the >2% group;; these did not show statistical significance. Our lengths of hospital stay, both in critical care and downstream wards, are shown in the table below.

We took note of any complications occurring in the postoperative period. Many such complications were better described as side effects of the anaesthesia or surgery, such as ileus or epidural induced hypotension, and were excluded from the data.

In total, 16 (27%) of our cohort of <2% had postoperative complications, most of which were represented by acute kidney injury and respiratory failure. In our >2% group, 23 (58%) had complications. While acute kidney

0 10 20

SORT<2%

SORT>2%

Mean length of postoperative stay (nights)

HDU nights Total hospital nights


69

injury and respiratory failure accounted for many of these, more serious complications including arrhythmias, postoperative myocardial infarction, stroke and one death also occurred in this cohort.

Conclusion

Calculating SORT scores is a simple method of providing an illustration to patients of the risk of their procedure, and has demonstrated very poor uptake in out department. On analysing the information available, we found that a substantial proportion of the complications were in the category with higher predicted mortality, with this cohort also accounting for longer lengths of stay in both critical care units and downstream wards. We postulate that risk scoring patients as part of the consent process, followed by discussion at the team briefing, would aim to better inform both patients and the surgical team providing care of the best estimate of their perioperative course. In light of the statistically significant large difference in hospital stays between the two groups, bed management would also stand to gain from better estimates of anticipated hospital bed usage, which could easily be calculated in advance.

References

1. State of the health system Beds in the NHS: Scotland. British Medical Association. 2017.

2. GMC Hot Topics Guidance;; Consent.http://www.gmc-uk.org/guidance/27164.asp

3. Surgical Outcome Risk Tool. University College London Hospitals.http://www.sortsurgery.com/SORT_home

Not too fast? Service evaluation after introducing change to improve fasting time for elective caesarean delivery U Ikram, K Litchfield, H Elliot, A Clark Princess Royal Maternity, Glasgow Royal Infirmary, Glasgow, UK Introduction AAGBI guideline suggests minimum of 2 hours fasting for clear fluid before general elective surgery.1 In obstetrics, the ASA obstetric task force recommends a similar period.2 Fasting for longer duration can cause significant dehydration, ketosis and maternal dissatisfaction.3 Our previous audit4 showed that parturients were fasting for a prolonged period of time before elective caesarean delivery. We engaged mothers at an antenatal education class as part of our enhanced recovery after surgery (ERAS) pilot and highlighted the importance of sustained oral intake. On the day of surgery, we actively encouraged mothers to drink clear fluids up to 2 hours of their expected theatre arrival time. Methods Prospective data collection was undertaken for mothers admitted for elective caesarean delivery from September 2016-January 2017. All mothers were asked 1) when did she


70

have her last meal? 2) when did she have clear fluid to drink? After team briefing before starting the elective list, mothers expected to have surgery later that day were provided with clear fluids and encouraged to take them until 2 hours before theatre arrival time. Data was analysed with excel spreadsheet and z ratio for significant difference of proportions for all mothers fasted for 4 hours or less (pragmatic cut off agreed). Results Data was collected for 115 parturients. Mean fasting time for food was 15 hours (range 10-24). Mean fasting time for clear fluids was 4 hours (range 1-20), a reduction from mean of 10.5 hours in 2014. When comparing mothers fasted for 4 hours or less in 2014 audit vs. recent data results were significantly different: 15% vs. 60% with a z score of 5.4 and 2 tailed p value of <0.0002. Discussion Our results showed a significant improvement in fasting time for clear fluids and proportion of mother's fluid fasting for less than 4 hours. There was no improvement in food fasting. We have demonstrated even before introducing fasting bundles, improved fasting time for clear fluids by introducing a small change: encouraging mothers with antenatal education and a focus by staff on limiting fasting. We hope by incorporating fasting bundles as part of our ERAS protocol, we can also improve fasting time for food. References

1. AAGBI. Fasting policies. Pre-operative assessment, the role of the anaesthetist. London: AAGBI, 2001:11. 2. Practice guidelines for obstetric anaesthesia, an updated report by the American Society of Anaesthesiologists task force on obstetric anaesthesia. Anesthesiology 2007;; 106:843-63. 3. Mackenzie, M., Yentis, S., Woolnough, M. and Johnson, M. Fasting periods and dehydration before elective caesarean section. Anaesthesia 2010;; 65:99. 4. Clark, A, Agaram, R. Too fast? Ketonuria as a marker of prolonged fasting in elective caesarean section. Int J Obstet Anesth 2014;; 23:S15 Efficacy and Side Effects of Different Epidural Opioids, a Local Audit of Beliefs Versus Reality M Hutton, K Pollock. QEUH, Glasgow Introduction Opioids are commonly added to epidural infusions to augment analgesia, however the efficacy and side effect profiles of the different options remains controversial. As a result, the choice of opioids and their concentration varies between departments and anaesthetists. Our aim was to investigate the practices and beliefs of our anaesthetic department, and compare this to the side effects seen post operatively with the choice of epidural opiates used in our hospital for acute post-operative pain.


71

Methods Firstly a survey of the consultant and trainee body performing epidurals, regarding their choice of epidural opiate as apposed to the other regimens. Secondly a retrospective audit of patients over a 5 month period, reviewing the efficacy of analgesia on a numeric rating scale, the frequency of epidural top-ups, and the occurrence of side effects with continuous epidural opiate infusions for acute post-operative pain. Obstetric and intra-thoracic surgery excluded. Fisher’s exact test was used for categorical data, Student’s t test for continuous. P value 0.05 set as significant. Results 12 Anaesthetic staff were surveyed, 8 of which Consultants and 4 Senior Trainees. One anaesthetist preferred diamorphine as epidural opioid additive, 3 anaesthetists had a preference for 4mcgs/ml fentanyl, 8 preferred 2mcg/ml fentanyl. 50% of those preferring 2mcg/ml fentanyl sited unfamiliarity with 4mcg/ml as their concern with this formulation, whereas 25% quoted respiratory depression as their concern with 4mcg/ml fentanyl. All 67 patients had epidurals with 0.125% L-bupivacaine as the local anaesthetic base. Two patients had L-bupivacaine only epidurals, 2 had diamorphine added by the anaesthetist, 42 patients had pre-prepared bags with fentanyl 2mcg/ml, and 21 patients had pre-prepared bags with fentanyl 4mcg/ml. Only the fentanyl groups were analysed due to small numbers of other groups. There was no significant

difference in the number of patients with postoperative day 1 pain scores of greater than 4 between those with added fentanyl 2mcg/ml and fentanyl 4mcgs/ml (p=0.45). Additionally, no significant difference in the number of epidural top-ups required between these two groups (p=0.92). There was no significant difference in occurrence of nausea and vomiting, respiratory depression, pruritus, nor hypotension requiring vasopressors between the groups with fentanyl 2mcg/ml and 4mcg/ml (p=0.40, 0.35, 0.28, 0.50 respectively). Conclusions This audit shows a departmental preference for the 2mcg/ml fentanyl in 0.125% L-bupivicaine pre-prepared epidural opioid regimes. It also suggests that there is no difference in efficacy or side effect profiles with the two most commonly used epidural opioid regimens used in the Queen Elizabeth University Hospital. This could be used to rationalise the options available to one formulation. The effect of peripheral access devices on intravenous infusion rate Philip Jackson, Aberdeen Maternity Hospital Background The use of peripheral access devices for intravenous cannulae has been steadily increasing and is often mandated in hospital policies. Evidence for their use includes reduced systemic infection rates, reduced needlestick


72

injury and reduced blood spillage and contamination. In theatre, it was noticed that various combinations of device were present in women being transferred from the labour ward for intervention and it was hypothesised that they had the potential to significantly reduce the maximum infusion rate of intravenous fluids. Method 500 ml of 0.9% sodium chloride solution was run via a blood giving set through various device setups connected to an intravenous cannula. The time taken in each case via gravity (1.7m) and pressurised to 300 mmHg was noted. This was repeated five times per setup and a mean result taken. The resulting times were then converted into a flow rate. Results Mean flow rate ±

standard deviation / ml·min-1

Setup Via gravity Pressurised to 300 mmHg

16G cannula 217 ± 5.0 369 ± 11.3 16G cannula + anti-reflux valve*

165 ± 5.4 270 ± 16.6

16G cannula + access hub†

106 ± 3.9 168 ± 4.8

16G cannula + “Coventry” connector‡

152 ± 7.5 257 ± 29.0

16G cannula + Y-connector¶

136 ± 2.9 188 ± 11.06

16G cannula + access hub† + Y-connector¶

70 ± 1.1 103 ± 4.1

16G cannula + “Octopus”§

71 ± 2.8 100 ± 3.2

*Vygon SA †“Bionector®”, Vygon SA ‡Mediplus Ltd ¶“Protect-A-Line® 3”, Vygon SA §(with integral “Bionector®) Vygon SA Discussion All devices restrict flow to varying degrees. Using an access hub effectively halves maximum flow rate. Devices with integral hubs and combining devices are even worse. The “Coventry” connector appears performs the best. Recommendations Peripheral access devices should be used with care in patients at risk of significant haemorrhage, for example, labouring women. If they are used then users should be aware of their limitations and, if necessary, take steps to mitigate them. Preoperative anaemia adversely impacts overall survival following resection for pancreatic ductal adenocarcinoma Introduction A significant proportion of patients undergoing surgery for pancreatic cancer will be anaemic at the time of resection. Controversy exists as to whether the administration of perioperative blood transfusions negatively impacts overall survival.


73

We aimed to assess the impact of preoperative anaemia on overall survival in patients undergoing potentially curative resection for pancreatic ductal adenocarcinoma (PDAC). Methods In a single-centre cohort of 156 consecutive patients who underwent pancreaticoduodenectomy for PDAC with curative intent, between 2009 and 2013, the prognostic significance of preoperative haemoglobin was investigated along with perioperative blood transfusion. Anaemia was defined according to the WHO classification (haemoglobin <130g/L in men and <120g/L in women) and assessed within one week before surgical intervention. Multivariate Cox-regression analysis was used to establish independent prognostic factors. Results For the 89 patients (57%) with preoperative anaemia, there was a significantly reduced overall median survival (16.0 months;; 95 % confidence interval, 12.0-19.1) compared to 67 non-anaemic patients (43%) (29.0 months;; 95 % confidence interval, 19.7-38.3;; P<0.0001, log-rank test). However, preoperative anaemia was not related to 90-day survival (P>0.5). In a Cox-regression analysis, preoperative anaemia was a predictor of overall survival (P<0.05) independent of established pathological prognostic factors,

including tumour stage, size and lymph node status, and administration of perioperative blood transfusion. Conclusion Preoperative anaemia is commonly present in resectable PDAC and negatively influences overall survival independent not only of established pathological factors but also of perioperative blood transfusion. These data have implications for the optimization of patients in the perioperative period in addition to longer-term risk stratification. Basic Airway Training for FY1s Introduction Despite receiving Basic Life Support training during medical school, FY1 doctors reported low confidence in airway management. Simple airway techniques, if performed correctly, can be life saving in the emergency situation. We planned to provide training in basic airway management to FY1s to improve their competence and confidence. Methods FY1s were invited to attend a simulation-based teaching session Participants managed an emergency scenario, assessed by a structured marking scheme A teaching session on airway techniques was delivered Further opportunity to manage the scenario was offered following teaching


74

A questionnaire assessed subjective confidence in airway management before and after teaching Results Seven FY1s attended the session. None had attended a Basic Life Support course in the preceding 6 months. The average score (maximum 17) for the scenario prior to skills teaching was 10.4, and after 16.5, a clear improvement. Analysis of participant questionnaires revealed that confidence in various aspects of airway management was enhanced (Table 1). Table 1: Mean Likert scores of confidence in aspects of Basic Life Support. Likert scores were 1= Never performed skill, 2= Not competent even with supervision, 3= Competent with supervision, 4= Competent without supervision, 5=Expert Conclusion A simulation based teaching session clearly improved confidence and competence in airway management. We subsequently worked closely with the resuscitation officer to deliver airway training to all foundation doctors during their mandatory teaching programme, allowing doctors a regular opportunity to refresh their airway skills. The sessions were positively received, with participants finding the interactive nature of the teaching enjoyable, and the topic very useful to their training. We have found this method of training

delivery to be sustainable in the longer term.

Pre-teaching Post-teaching Initial assessment 4 4.1 Simple airway manouvres

3.8 4.2

When to use adjuncts 3.4 3.6

Choice and insertion of adjunct

3.2 3.9

Insertion of igel 2.4 3.8


75

Future Meetings

SSA Annual Spring Meeting, 26th and 27th April 2018

The Annual Spring Meeting of the Scottish Society of Anaesthetists is the highlight for many around the country. Both socially and educationally this promises to be the best two day conference/event of the year.

With an early draft of the programme looking even better than next year with the usual cast of stellar speakers we are all sure to gain.

There will be the traditional dinner on the Thursday night and the accommodation at the Dunkeld house Hotel is excellent. As we are renowned as the fittest department in any hospital there will also be a return of the five K fun run on the Friday morning to wake everyone up. Further details to follow......

The joint SSA/RCOA winter scientific meeting, 15th and 16th November 2018

Following on from the success of the inaugural joint meeting in Aberdeen held in 2016 we are jointly hosting another meeting with the Royal College of Anaesthetists in Dundee.

The programme is being developed and promises to be brilliant.

With a very easy to reach centre centre location and the possibility of a drinks reception in the soon to open V&A museum on the water front this is certainly going to catch everyone's attention.

Further details to follow but get those dates in your diaries now for your study leave.

Date post:	28-Jul-2020
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times

ssa annals 2018-4 · Scottish(Society(of(AnaesthetistsAnnals2017(4( (EDITORIAL!! Another! year!...

Documents