Our Autumn Scientific Meeting was hosted
by the local department in Exeter in the
lovely campus setting of Reed Hall, at Exeter
University, complete with garden, ponds and
parking. The local team, of James Pittman,
Quentin Milner and Emma Hartsilver,
were capably led by Pippa Dix, and created
both excellent scientific and super social
programmes. These were complemented
by smooth running administration achieved
by a new management technique of the
“chopping hand”. This method of achieving
complete agreement, and instant action, was
demonstrated by Pippa throughout the meeting.
Many observing her prodigious talent believe
her to be a third Dan at least. The Society
congratulates the Exeter department on a very
successful event.
The meeting was opened by the outgoing
President, Dr Tricia McAteer who then chaired
the AGM. After reporting the sad deaths of
Tony Bennett, Geoff Hall and Neil Harvey
(past president 95/96) she warmly thanked
the outgoing Hon Sec, Ed Morris, for his
hard work, energy and success in developing
the Society over the past three years. Under
his tenure the membership has grown with
increasing interest from our trainees – 19
posters were submitted for the research prize
this year. Another stalwart to thank was James
Pittman as he stepped down from his Editorial
duties. Vanessa Purday, also from Exeter, has
stepped into the position of Deputy Editor to
support the present Editor.
One of the more pleasurable duties for the
departing President is to award their eponymous
prize. This year Ben Howes rightly stepped
forward to receive the honour for the effort
he has put into the Society by promoting it
with the trainees, developing the website and
reinvesting the Intersurgical prize won last year
to develop the airway training programme.
Bill Harvey reported that the Society is in
balance, the success of the Cheltenham meeting
plus the new subscription levied has offset the
costs of the previous Bristol meeting.
The new president, Dr Stephen Mather, was
then installed to a warm accolade from the
members, in recognition of his unstinting
support of the Society over many years;
Stephen having previously been both Treasurer
and Editor.
It was then agreed that Peter Ritchie from
Cheltenham, would be his successor. Business
was concluded with the award of the Ross
Davis Adventure Bursary which encapsulates
what the family of anaesthesia is all about.
The main award was given to Nigel Hollister
to support his elective work in Africa whilst
the “adventure” component of the award was
fulfilled by helping Frank Swinton mountain
bike through British Vancouver, by providing
the bike!
Of interest to those nearing retirement was
the unopposed decision for all new retirees to
continue paying the full subscription. Although
this clarifies the expectation it changes little,
as the majority of our retirees continue to
subscribe to the Society.
The new President, resplendent in his gong,
opened the scientific programme with the
first session. The meeting proved to have
an excellent programme with relevance to
everyone, raising the question whether the
SASWR meetings should be advertised more
vigorously to increase national interest.
The first session considered life and death,
opening with Dr Marina Morgan exposing
the large number of medical murderers even
before Dr Shipman took it to a new level for
the press and GMC. Whilst being regaled with
the differing techniques to dispatch loved ones
we discovered many new facts. Firstly, CASK
is not a resting place for the victim, but Care
Associated Social Killing and secondly, there
are probably 5 medical serial killers running
amok in the UK. The latter did cause a few
sideways glances and knowing nods, many
considering that they work with some serious
contenders!
The focus of the session then shifted towards
learning how anaesthetists manage not to
stay alive themselves as Dr Andrew McLeod
explained how we have an increased incidence
of stroke, HIV and cirrhosis compared to other
doctors. He considered whether our underlying
personality traits were possible causes for our
increased drug and alcohol abuse but did not
mention poor short-term memory as a factor;
observing the fun that was had at the Society
Dinner it appears that few remembered the
warning about cirrhosis. The final lecture of
the session challenged us by using Aristotle’s
Virtue Theory to consider how to behave
when caring for patients and practicing triage.
Giving a talk which ranges from concepts of
being “best at what you are” through to the
acquisition of knowledge and practical wisdom
is challenging. Dr Andrew Tillyard showed
how good his understanding of the philosophy
is. Many are still pondering on his thoughts on
the concepts of wisdom and how anaesthetists
develop a habitual disposition to make the right
choices in complex circumstances. Perhaps
the Society needs a follow-up talk.
After a delightful lunch the meeting reconvened
with the Intersurgical sponsored Trainee Prize
session where the three shortlisted abstracts
were presented by their authors.
Chris Bordeaux reported his work on the use of
a ubiquitous drug, sodium bicarbonate, in the
treatment of raised intra-cranial pressure. He
gave a clear explanation of the physiology behind
its use and demonstrated its effectiveness. The
second paper was presented by Alice Braga,
on the topic of venous thromboembolism in
a paediatric setting, explaining how she had
found little evidence of protocols to provide
best care. Having covered the risk factors to
be aware of, the protocol she offered provided
a clear way forward. The third entry for the
prize was given by Gemma Crossingham, who
considered the strengths and weaknesses of the
current training systems based on the direct
observation of procedures. The ability of the
trainee to choose their assessor is a weakness
which could be countered by the inclusion of
other factors. Gemma advocated that nontechnical
skills should be formally assessed,
suggesting that areas to be considered are
communication, empathy and sensitivity,
organisational ability plus the maintenance of
good decision making under pressure.
All three speakers faced vigorous questioning
from the judges and responded with clear and
concise answers. A few minutes were needed
during the afternoon coffee break to decide
which was the best paper. The judges were
unanimous in applauding the quality of the
presentations and pronounced Dr Crossingham
the winner of the Intersurgical Prize 2009.
The prize was presented at the start of the
last session by Mr Mark Ellis, the UK Sales
Manager of Intersurgical who, thankfully for
us, has agreed to continue to sponsor the prize.
Their continued generosity in supporting the
Society is much appreciated.
The second afternoon session was chaired by
John Saddler and opened with Professor Tony
Watkins explaining how useful a radiologist
can be with a set of bendy sticks to deliver some
rather clever devices. Stories of retrieving lost
wires, plugging bleeding holes and dealing with
traumatic and GI bleeds grabbed the attention of
everyone. Without a doubt the superb talk made
the audience think that no emergency service
should be without a radiologist on hand, as
many hours of squeezing in blood and products
could have been avoided by a simple coil or
two. I suspect that it might be a little harder in
practice than in the telling. This was followed
by Dr Dominique Mumby who gave an update
on obstetric anaesthesia, easily holding the
attention of the audience as many have not seen
the inside of a labour ward this millennium. A
broad variety of ways to improve the outcome
of pregnancy were considered emphasising the
role that anaesthesia has to play. The challenge
given was to make an impact by improving
resuscitation and increasing the input of senior
clinicians. The take away message is that
simply developing multi-professional working
through better teamwork and training may well
be the key to improving success, something not
just limited to the obstetric setting.
The Sir Humphry Davy lecture is always good
value, this year it appeared to risk putting
David in with the lions when the lecture was
to debate whether complementary therapies
reduce pain. How many preconceived opinions
about homeopathy were there? However a marvellous talk by Professor Edzard Ernst from
the Peninsula Medical School entranced the
audience; good scientific evidence was used to
consider the value of various complementary
treatment modalities. Acupuncture was
awarded a cautious rating as being beneficial
but chiropractic care did less well. The latter
failing, the Professor explained, as no positive
evidence of benefit exists and it has even
been associated with 25 deaths. The biggest
confounder in research hoping to demonstrate
benefit from complementary medicine proved
to be the impact of the placebo effect.. The
challenge here was for the audience to consider
how our own pre-operative communications
should be structured to maximise our placebo
impact. The choice of the organising committee
to invite Professor Ernst to give the Humphry
Davy lecture was quite inspired.
The evening’s entertainment found the
delegates and guests enjoying both the
President’s reception and Society Dinner. Few
seemed to recall the earlier advice of Andy
McLeod so the volume of conversation rapidly
grew as the libations flowed.
No more food thanks – just wine
The newly installed President took to the stage
and thanked the organising committee for
all their work in producing such a successful
meeting after regaling the diners with advice on
horse racing. So many people were mentioned
that the Hon Sec became quite breathless
carrying the flowers and champagne. Quentin
Milner replied on behalf of the guests using
home ground advantage to tell a story close
to the knuckle but, with consummate skill, not
beyond. The dancing to an excellent, home
grown band carried on until the early hours, as
did the conversation.
The future of the society – and Ed
The second day of the meeting was attended
by a large number of trainees, well done to
the Exeter Department for organising the
theatre schedules to free their time. The first
session dealt ably with three topics that can
cause difficulties every day. Dr Mark Jackson
outlined how to best care for patients who are
opioid dependent, distinguishing between the
differing patient behaviours when they are
tolerant, addicted, have physical dependence or
a pseudo-addiction through poor analgesia. The
message was so clear that everyone felt better
able to cope with the ever growing problem of
intravenous drug users. Continuing the how to
do it theme, Dr Alex Grice questioned the South
West’s preoccupation with epidurals by asking
whether the known side effects are balanced
by the gains. Changes in surgical techniques allow the simple technique of a rectus sheath
catheter (RSC) block to provide excellent
analgesia. Eschewing modern IT solutions,
Alex illustrated the message by exposing his
abdominal wall; very effective and one wonders
where this idea may lead to in the future. The
closing message that the RSC technique offers
good analgesia with lower nursing costs will
resonate with our managers whose mantra is
to cut costs whilst maintaining quality.
Following these two good practical talks proved
no problem for Dr Bruce McCormick as he
discussed how to manage the recurring issues, in
one lung ventilation, of hypoxia, high inflation
pressures and a misplaced tube. The suggestion
of pushing forward a double lumen tube with the
bronchial cuff inflated has not yet been needed
by the author. But it does offer another way in
which to intubate the correct bronchus when the
only surviving bronchoscope is in the steriliser,
yet again.
The morning coffee break was spent visiting
an excellent trade exhibition and perusing the
abstracts. Thank you to the Trade and well
done everyone who submitted their work.
Before the next session the audience warmly
applauded the presentation to Mike Yates by
Dr Michael Dobson of a certificate recognising
his work to support world anaesthesia. Mike,
based at Plymouth, has taught in countries
around the world on how to keep anaesthetic
kit working, saving countless lives. He is
now using the internet to widen access to his
teaching, producing the anaesthetic equivalent
of the Haynes manual. His initiatives have
changed the depressing picture of monitors and
machines lying in a corner of a remote hospital
for the sake of a simple repair.
The science then continued with Dr Richard
Telford doing what he does best in taking a
simple topic, pointing out the issues of concern
and then providing a clear path forward. This
time it is was bleeding and clotting; with
discussion of the whys and what to do’s for the
ubiquitous drugs of warfarin and clopidogrel
plus a newcomer, prasugrel. This lecture
seamlessly morphed into Dr Peter Ford’s
talk on near-patient testing of coagulation.
Thromboelastograms abounded and everyone
soon really did want one to help with that
surgical ooze, even if they never seem to work at 3 am. These two lectures worked so well
together that we knew what to do to minimise
the risks of bleeding before anaesthesia and
then what to do when it inevitably happens
anyway.
The third lecture portrayed the dangers of
being married to the organiser. Being in a
morning clinic with a serious man cold were
apparently not acceptable excuses, so Dr
Richard Haigh spoke on the new biologics used
in rheumatology. Not content with educating
us on treatment protocols and the important
risk assessment of patients with severe cervical
spine disease, he made the audience rack their
memories for the song titles of some classic
rock and roll quotes. Where are Neville
Goodman and his encyclopaedic knowledge
when you need them?
The excellent lunch was enjoyed by all, and
the guests and retired members joined us for
the afternoon session. Any thoughts of a post
prandial snooze disappeared as the afternoon
speakers enthralled. Lauren Barker opened the
batting by describing the limits of endurance
experienced by riders in the Tour de France.
From the early self-sufficient pioneers through
to the doping of recent years, the almost
incomprehensible extremes of fitness needed
to win were illustrated. Colin Berry’s aptly
named “Not waving but drowning” put world
disasters into context before delving into the
problems of drowning. The numerous pictures
of his sailing experiences emphasised his points
but also added to the bucket list of things to
do. Mike Grocott travelled from Southampton
to recount the realities of adapting to altitude
by presenting how he organised 200 people to
climb up Everest with exercise bikes and blood
gas machines and got them to agree to undergo
physiological testing at ridiculous heights.
Whether the PaO2 data or his skills of persuasion
were the more amazing remains a moot point.
The session was stolen however, by the last
lecture by Dr Jim Down who recounted the sad
story of the death of Alexander Litvinenko from
the perspective of the clinical lead for the ITU.
The sequential story, told in a laconic style, of
the slow, “walking ghost” demise and how the
Polonium-210 poisoning was finally diagnosed
was completely gripping. This final session
reflected the essence of the whole programme
as it provided science, provoked thought and
interest, whilst being delivered with skill and
careful preparation.
The President then closed the 2 day meeting
observing how successful it had been
and thanked the local committee for their
organisational flare and the production of an
excellent scientific programme. Dr Mather
also noted the social programme had been
enjoyed by all those able to visit Topsham.
The Society looks forward to the Rome
meeting in May and the subsequent meeting in
Bristol, this being organised by the Southmead
Department. The latter will be held in Raymond
Blanc’s restaurant and associated rooms so
I look forward to both. The Society is going
from strength to strength having followed
the highly successful Cheltenham meeting
with another in Exeter. My advice, plan your
study leave now by finding the dates of all our
meetings on the web site, www.saswr.org.uk.
