Autumn 2007
The much-anticipated Diamond Jubilee meeting of the Society took place on 22nd and 23rd November 2007. Organised by a committee made up from officers of the Society and the remarkably enthusiastic Dr Samantha Shinde of Frenchay Hospital, it was seen as an opportunity both to celebrate 60 years of SASWR history, and more importantly to look forward to the next 60 years. With the aim of attracting as many trainees and younger consultants as possible, and mindful of the need to provide excellent value for money in these times of shrinking study leave budgets, the meeting was given a significantly academic focus and held over two full days on a Thursday and Friday, with dinner on the Thursday night. This proved a very successful change and the committee plans to continue it where possible for the next few meetings at least.
The venue was the superbly appointed Rosalind Franklin Room above the @Bristol exhibition centre in the Harbourside, Bristol. With stretching views over Bristol and its river, and plenty of space for caterers, exhibitors, and delegates, it was able to accommodate the 120 or so delegates who attended the meeting over its two days, and equally importantly the 150 diners on the Thursday evening!
After a lively Annual General Meeting the Diamond Jubilee Scientific meeting of SASWR was opened by the President of the society, Sir Peter Simpson. He praised the organising committee and congratulated them on an excellent scientific programme, and on securing the participation of the presidents of both the Royal College of Anaesthetists (RCA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI). He then thanked Dr Tom Simpson of Bath for his involvement in the preparation of the recently updated history of the society, which had been distributed to all members to celebrate the Diamond Jubilee. Lastly he read a message from Dr Peter Baskett, a past president of the society and well known to many present, who was unable to attend due to ill health.
The Meeting
The first session on Thursday morning – ‘Updates in Pharmacology’ – drew upon local expertise. Chaired by Neville Goodman in the month before his retirement, the session started with Quentin Milner from Exeter reviewing the recent introduction of intravenous paracetamol. He encouraged the use of loading doses in excess of the traditional 1g, particularly in larger patients, and presented some evidence on the mode of action of the drug, suggesting a possible cannabinoid-like effect – something which, he reflected, the parents of young children have suspected for years.
Steve Mather of Bristol, whose lecture was conducted either side of an unscheduled fire alarm test, spoke about low-flow anaesthesia and provided some welcome revision of the physics and pharmacology of circle systems, before drawing on his experience from the Bristol Simulator Centre to demonstrate a simulation programme explaining his points. Lastly Rob Sneyd of Plymouth provided a light-hearted ‘equation free’ guide to the pharmacology of remifentanil, comparing it to other opioids, offering advice on its use alongside propofol, and discussing roles that the drug has outside of general anaesthesia, including its use as a sedative and in the obstetric unit.
Before an excellent lunch Martin Wolfe of Guernsey gave a wonderfully illustrated and enthusiastic preview of the Society’s spring meeting in Guernsey in June 2008, with details of the type of venue, meeting, and activities which we could look forward to. There was a large crowd around the ‘Visit Guernsey’ table which he had squeezed between the other trade stands and we apologise to our generous sponsors for distracting members from their displays!
The second session, chaired by Peter Simpson, focussed heavily on the trainee members of the society, many of whom had come to the meeting. Sir Peter awarded the Feneley Travelling Award with a grant of £500 to Dr Matt Carey Thomas in support of his visit to the USA to study techniques of anaesthesia for bariatric surgery. He then introduced Mr Vik Vijayan, a surgical trainee and friend of Dr Ross Davis, the anaesthetic SpR killed in a road accident in 2006. Vik, who had been accompanied to the meeting by Ross’s partner Kate, announced the establishment of the Ross Davis Adventure Bursary, an annual award of up to £1000 funded by Ross’s family to facilitate ‘Adventures in Anaesthesia’. Vik invited applications from trainees of ST3 level or above who wanted to finance trips or ventures which involve some medical work but also involve some degree of adventure or experience which confirms that ‘there is more to life than medicine’. The prize will be administered by the society with all applications coming through the Hon Sec by the closing date each spring meeting, and Ross’s friends and family will be heavily involved in selecting the recipient, to be announced at each November meeting of the society.
There were three excellent presentations for this year’s SASWR Abbot Trainee Prize. Suzanne Carty presented an anatomical study of the course of the median nerve using ultrasound; Mike Duffy presented a review of the Role of Recombinant Factor VIIa in traumatic injury; and Charlotte Steeds and Sarah Love-Jones presented the winning entry describing their involvement in a project entitled ‘Homotropic Stimulation and its effect on Allodynia in Neuropathic Pain’. As your writer was unable to understand even the title of their presentation, I was grateful to the judges – Dr Judith Hulf, Dr Rob Sneyd, and Dr Neville Goodman – for making what was a difficult decision on behalf of the Society before presenting Charlotte and Sarah with their prize of £1000 and 2 free tickets for dinner later that evening.
Three anaesthetists who have been significantly involved with Education and Training issues in recent turbulent times spoke to us in the last session of the afternoon. Chris Johnson, our Regional Adviser, spoke of his own experience of ‘MMC and MTAS – the Good, the Bad, and the Ugly’, explaining the significant impact this has had on the lives of the trainees involved and those colleagues charged with trying to make the system work against all odds. Dr Judith Hulf followed by gazing into ‘The Future of Anaesthetic Training’, stressing that quality and standards must remain paramount in an environment which was rapidly changing. Dr Hulf gave us her thoughts on systems of training and assessment which might be used in future years and expressed enthusiasm for the Tooke Report and its recommendations. Lastly Anne Thornberry of Gloucester, who had managed to reschedule a Royal College meeting to talk to us about ‘The Influence of Europe on Training’ took us on a lively tour of that continent’s impact on our working lives from Mediaeval times to the 21st century, via the European Working Time Directive.
Diamond Celebrations
The dinner to celebrate the diamond jubilee of the Society was a suitable sparkly affair, carefully organised by Sam Shinde and attended by around 150 members and their guests. A champagne reception with the opportunity to explore some of the exhibits in @Bristol presented a good chance for colleagues from across the region to meet and share their news, and also for many to show off their ‘60s dress’ fancy dress costumes. At least a dozen members – both ladies and gentlemen – had risen to the occasion with an impressive array of apparel from the swinging era. Suggestions that some of the more mature ladies present had needed to go no further than their own wardrobes to meet the challenge were not tolerated. The catering was exceptional, and there were strong voices of support for the venue.
The after dinner speeches featured our own Sir Peter Simpson toasting the Queen and the Guests, with Dr Brian Sweeney from Poole responding in a humorous fashion and raising a glass to the Society. In a startling coincidence both Sir Peter and Brian told jokes which involved latex, although Peter’s joke (about an errant party balloon) was slightly cleaner than the guest speaker’s offering! One other significant presentation during dinner was that of the President’s Prize: John Carter had chosen to award the prize, a handsome glass bowl, to Kate Prys-Roberts in recognition of ten years’ sterling service as the Society’s administrator.
As the dancing started, Tricias McAteer and Weller acted as judges in a catwalk style ‘best dressed’ competition with prizes going to Venetia Rogers, Juliet Hull and Mike Taylor as winning guest, trainee, and consultant respectively. Music was provided by local band ‘The Riff Toads’, whose lead singer is local ENT surgeon Mike Saunders. Mike gamely gave up his microphone for a few minutes to allow the Hon Sec, swiftly followed by 60s icon Mike Taylor, to demonstrate their prowess at ‘Mustang Sally’, before very sensibly completing the performance himself.
A second day of science
The first session on Friday morning was chaired by APW editor James Pittman and dealt with the management of high risk patients of different types. Will Woodward of Truro, sporting an interesting moustache which he claimed to have grown for a charity event, talked about malnutrition in both elective and emergency surgical patients, and the absolute importance of timely nutrition in optimising outcome. Commenting on the important difference between ‘fasting’ and ‘starving’ patients, he spoke of the complications which follow poor perioperative nutrition and explained how we as anaesthetists can influence outcome by careful attention to detail.
Tracey Clayton from Gloucester, talked about the challenges and techniques which are associated with bariatric surgery and with obese patients in general. As this type of surgery becomes more common across our region it is likely that more of us will be involved with these patients, who represent a significant challenge. She was followed by John Carlisle of Torquay, who illustrated his talk on ‘predicting perioperative survival’ with an entertaining journey through actuarial life expectancy statistics which had most members over 40 squinting at his graphs on the screen and wondering if they should still make plans for the weekend.
After coffee Dr David Whitaker, president of the Association of Anaesthetists, spoke of some of the more recent developments in our specialty including lipid therapy for local anaesthetic toxicity, and several patient safety initiatives relating to blood transfusion. Barry Nichols from Taunton, an acknowledged national expert in his field, discussed the use of ultrasound in regional anaesthesia, suggesting that ultrasound was the natural successor to the nerve stimulator and predicting – with beautiful illustrations – that it would soon become the gold standard in local anaesthetic blockade. His colleague Alf Collins completed the session by giving a personal view on the future role of chronic pain management and emphasising that new ways of working and organising services, rather than new drugs or techniques, might well represent the immediate future of his specialty.
Following another well presented lunch and well attended trade exhibition, Alan Cohen chaired a session entitled ‘Precious Blood’, which looked at both the appropriate use and salvage of blood and of blood products. Dr Dafydd Thomas from Swansea explored the importance of, the indications for, and the techniques associated with cell-saving in current surgical practice, looking at the evidence for the process and stressing that we have a responsibility to salvage blood not just to avoid transfusion, but also to save blood products for emergency situations. This fitted in well with an excellent talk from Surgeon Commander Steve Bree of Plymouth, who gave a fascinating account of his personal involvement in the battlefields of Afghanistan, including the establishment of field hospitals and the use of blood products in resuscitation. Steve told us of the increasing and aggressive early use of blood products, including FFP and cryoprecipitate, in significant traumatic haemorrhage with the aim of preventing coagulopathy and acidosis early. He finished by discussing the use of recombinant factor VIIa, arguing that its early use in military trauma was, empirically at least, saving lives.
The final speaker of the session was Dr Janet Birchall, Consultant in Blood Transfusion Medicine, who presented a wealth of data on the subject of Factor VIIa and concluded that in the hospital setting, there was an incidence of side effects from the drug which was not balanced by any conclusive evidence of benefit; she did concede however that the drug might be of use if targeted to specific indications such as military trauma and much discussion ensued over the tea break which followed.
The Sir Humphry Davy Lecture was given this year by Dr Brian Sweeney of Bournemouth and Poole Hospitals, whose particular interest in the genetics associated with anaesthesia fascinated both members and their guests. In a beautifully illustrated and entertaining talk, Dr Sweeney showed how advances in genetics, as well as providing remarkable innovations in the diagnosis and treatment of particular disorders, has the potential to provide significant and useful information for each of us individually, which might be used both negatively and positively. He focussed however on positive uses, predicting a time when one’s response to particular drugs would be predictable based on a knowledge of one’s own genetic code: the advent of Gene Chips. Sir Peter Simpson thanked Dr Sweeney and presented him with an appropriate gift in thanks before closing what had been an excellent Diamond Jubilee meeting from both an academic and social point of view.
And that’s it from your correspondent for another six months. I felt it was important to record a précis of all the talks from this anniversary meeting both for posterity and because we on the committee hope that the move to Thursday/Friday meetings in the future will enable the strong scientific content of the meetings to continue, and to attract new and enthusiastic members to your Society. Having said that, I trust that the pre-existing arrangements to hold the Spring 2008 meeting on a Friday/Saturday in Guernsey will not put too many of you off – there are worse places to be for a weekend in June!