SASWR Autumn Meeting Report
Bristol, November 27th – 28th 2008
Dr Ed Morris, Honorary Secretary
Anaesthesia Points West Vol. 42 No. 1
The autumn meeting of SASWR was held in
Bristol on 27th and 28th November 2008 under
the auspices of the department of anaesthesia at
the newly named ‘University Hospitals Bristol’.
This change of name by the new foundation
trust to emphasise its significant involvement
in education and research was reflected in the
academic programme. This was a meeting where
a high level of academic science went handin-
hand with a wealth of clinical experience to
provide a lecture programme of which the local
organising committee can rightly be proud.
The venue was once again the pleasantly
appointed Rosalind Franklin Room at the @t
Bristol complex on the city’s harbourside.
Chris Monk, Rachael Craven and others had
worked hard to ensure that the meeting had
that special SASWR ‘feel’ to it. In addition to
the excellent scientific programme the meeting
provided the usual welcome chance to catch up
with old friends and colleagues from around
the region, to enjoy lunch and dinner in scenic
surroundings, and as a base for the variety of
social activities on offer.
Dr Tricia McAteer from Bath, the incoming
president, opened the meeting by thanking
the organisers and commenting on the
healthy number of trainee delegates who were
attending. This had been helped, she reflected,
by the generosity of Intersurgical in sponsoring
the Trainee Prize for a second year running –
there had been twelve submissions for the
prize – and she extended her thanks to the trade
sponsors generally.
The first session of the meeting dealt with two
topical areas of obstetric practice at the moment.
Dr Mark Scrutton talked about the increasing
problem of obesity in the obstetric population,
producing some alarming statistics to
demonstrate how both maternal and foetal
morbidity – and mortality – were linked to an
increase in body mass index. Humorously
illustrating his lecture with evidence that
Bristol’s thinnest anaesthetists tend to
anaesthetise Bristol’s fattest patients, he
ended with the serious advice that consultant
involvement, invasive monitoring, carefully
prepared equipment and above all a ‘first do
no harm’ culture were essential components of
success in this challenging group of patients.
Mr Tim Draycott, consultant obstetrician and
former Hospital Doctor of the Year, continued
the obstetric theme by talking about his interest
in multidisciplinary training for obstetric
emergencies. The southwest leads the way in
this type of training which has been shown to
improve team working and reduce morbidity.
Many of the courses, such as the PROMPT
course, which members may have attended,
have significant input from anaesthetic
colleagues in the Southwest. Tim also provided
what in this writer’s opinion was the best joke
of the whole session, commenting that to the
majority of unenlightened obstetricians, an
airway was something which was used to go
on holiday……..
The first session after lunch was the SASWR/
Intersurgical trainees’ prize, judged by a panel
including Professors Wolf and Zacharowski of
Bristol and Dr Martin Coates of Plymouth, and
featuring three excellent presentations, which
reflected the current activities of trainees
across the region. The prize was won by Dr
Ben Howes, who presented the work of a
group of senior trainees who have devised and
implemented an extremely hands-on training
scheme for fibreoptic intubation in which the
candidates intubate each other to literally gain
first-hand experience of the technique. Ben
accepted the prize cheque of £1000 from Kate
Palmer on behalf of the group and received a
warm round of applause when he announced
his intention to reinvest the money in equipment
for the group.
Thursday’s academic programme was rounded
off by three presentations relating to the
management of sepsis and concentrating
strongly on the work of the ‘Toll Receptor Group’
headed up by Bristol’s departing professor, Kai
Zacharowski. Presentations from Prof Simon
Jackson of UWE, Dr Alex Koch of the BRI,
and new consultant Dr Matt Thomas guided
us gently through the intricacies of molecular
signalling mechanisms in sepsis, the role of the
newly discovered ‘Toll’ receptor (‘Toll’ means
‘Cool’ or ‘Wonderful’ in German slang!) and the
significant work that has gone into identifying
and testing the variety of Toll-like receptors
which are now being investigated. There is
significant polymorphism in these molecules
and their receptors. The ways in which they are
involved in the recognition of potential toxins
and the consequent up-regulation in response
mechanisms to sepsis are likely to herald great
advances in the management of infection,
atherosclerosis and even cancer. Matt Thomas
rounded off the session by reminding the
audience that although the search for a ‘magic
bullet’ continues, it is currently attention to detail
in the hour-by-hour clinical management of
critically ill patients that chips away at morbidity
and mortality and should never be neglected in
this group of complicated patients.
The President’s reception and Society Dinner
provided some light relief from such high
science. After a reception held in the fascinating
surroundings of the @t Bristol display area,
dinner was held in the Rosalind Franklin room.
It was as well attended as ever, with several
trainee tables, an excellent feast provided by our
regular caterers, and a lively performance by
the ever popular ‘Riff Toads’, fronted by local
ENT surgeon Mike Saunders. Between dinner
and dancing came some excellent speeches.
The President, Dr Tricia McAteer, delivered a
highly personal talk, explaining why she felt
Ben Howes receives the SASWR Trainee Prize
34
so honoured to preside over a very special
society, and crediting Dr Roger Eltringham of
Gloucester as a much appreciated mentor and
Dr John Carter (himself a recent President) as
a much appreciated husband. Despite the Hon
Sec’s attempts to persuade her to tell a risqué
after dinner joke (he had provided several by
text earlier in the day) Dr McAteer steered
a safer course by moving on to invite the
outgoing president Sir Peter Simpson to award
his President’s Prize for 2008. He awarded a
handsomely engraved Bristol Blue Glass bowl
to Dr Fiona Kelly, a stalwart trainee member
of SASWR, in recognition of her enthusiasm
for the society’s academic and social activities
over the previous several years.
Dr Mike Saunders, who by now has become so
involved in SASWR’s activities that honorary
membership would seem to be a mere formality,
responded on behalf of the guests with a goodhearted
treatise on ‘why anaesthetists are such
nice helpful people’ which was light on irony
and heavy on admiration. Or perhaps it was the
other way round; in any event it did not stop
members dancing the rest of the evening away
to Mike’s band with the usual enthusiasm.
The following day was once again packed full
of informative, relevant, and well-presented
talks as the society continues to demonstrate
that its meetings can rival in quality those
of much bigger national organisations.
Gareth Greenslade chaired a session on pain
management in which specialist pain nurse Sarah
Parry, pain consultant Peter Brook, and Senior
Research Fellow and Consultant Anaesthetist
Tony Pickering revealed the complexities and
challenges in managing chronic pain. The first
two speakers are extensively involved in the
management of pain in children and their talks
reflected their expertise and commitment in
this undersubscribed and underfunded area. Dr
Pickering took us gently but expertly through
the rapidly evolving understanding of ‘Central
Mechanisms of Pain’ and it was generally
agreed over coffee that his gentle sense of
humour had made a potentially very dry subject
much more accessible to his wide audience.
Sir Peter Simpson presents Dr Fiona Kelly with
the President’s Prize
The President Bopping
Morris Dancing?
35
Paediatric Anaesthesia is a subject which
many consider to becoming less relevant
with the centralisation of children’s services
but the three speakers in the next session left
us in no doubt that every anaesthetist should
have an interest in the challenges associated
with the subject. Dr Steve Sale discussed the
controversy surrounding brain cell apoptosis,
or neural cell death, as a result of anaesthesia
in neonates and premature babies, and declared
it ‘work in progress’. Professor Andy Wolf
spoke of his studies into spinal anaesthesia
for neonatal cardiac surgery and predicted that
although studies are not yet powerful enough
the reduction in stress response which neuraxial
anaesthesia and analgesia provides will prove
to be beneficial. The session ended with ENT
surgeon Mike Saunders (again) giving examples
of difficult paediatric airways he had shared
with his anaesthetic colleagues, particularly Dr
Pete Stoddart, and in a beautifully illustrated
talk, managing to inspire, inform, and quite
possibly frighten the assembled company with
examples of the very close collaboration which
is required between surgeon and anaesthetist in
the diseased early larynx and trachea.
After another excellent lunch two colleagues
from Bristol’s cardiac unit spoke about ‘Non-
Surgical Cardiac Surgery’. Dr Mark Turner
revealed the secrets of the cardiac catheter
laboratory and demonstrated how percutaneous
intervention is challenging the need for open
surgery in patients with diseases as diverse as
coronary artery disease, valvular disease, and
even septal rupture. Percutaneous technology,
he explained, is beginning to allow interventions
that would be considered too dangerous for open
surgery, and reducing morbidity and mortality
to a significant extent. He was followed by
Dr Ian Ryder, who explained the challenges
of providing anaesthesia for such procedures,
reviewed the data from the cases he had been
involved in, and agreed with Dr Turner that
great steps forward are being taken in the
management of high-risk surgical patients by
using less invasive techniques under general
anaesthesia.
Professor Kai Zacharowski has been a keen
supporter of SASWR and its activities during
his time in Bristol, and it was a pleasure to
welcome him to deliver this year’s Sir Humphry
Davy lecture during his last few weeks in the
department. It is without doubt Bristol’s loss
that he is returning to his native country, but we
were treated to an articulate and phenomenally
well structured summary of his work in
investigating inflammatory and infective
processes in disease and the steps forward
Dr Tricia McAteer presents Prof Kai Zacharowski
with the Sir Humphry Davy Lecturer’s Award
A panel of erudite speakers await questions
36
which his group has taken in our understanding
of the role of fibrin fragments in acute disease.
As well as explaining the science behind his
work he provided a fascinating insight of the
journey taken by a researcher from original
idea, through benchwork to publication (in his
case in Nature), and onwards to the challenges
of licensing, funding, and commercialising
such innovations. To prolonged applause he
was thanked by Dr McAteer and presented with
a gift to remind him of SASWR: he promised
to keep in touch with the society and we do
hope to welcome him back to future meetings.
And so another autumn meeting closed. As
SASWR enters its 77th year the science is as
strong as ever; the social aspect remains as
integral as always; and membership continues to
grow. I look forward to seeing members and their
partners (for whom the ‘away’ meetings provide
an excellent chance to explore less familiar parts
of the region) in Cirencester in May 2009 and
in Exeter in November 2009. Exeter will be
my last meeting as Hon Sec, and my friend and
colleague Dr Chris Monk is straining at the leash
to take over the role and to organise the overseas
meeting in Rome in mid-May 2010. Please clear
your diaries now!
