The Society of Anaesthetists of the South Western Region
Spring Scientific Meeting
The Cotswold Water Park, Gloucestershire
21st – 22nd May 2009
Dr Ed Morris, Honorary Secretary, SASWR
The Spring Meeting this year was organised
jointly by the departments in Cheltenham
and Gloucester, and from the outset it was
apparent that they had planned a meeting with
a difference.
The venue chosen was the Four Pillars Hotel
in the Cotswold Water Park – a smart new
hotel right in the middle of this beautiful
nature reserve near Cirencester. As soon as
the venue was decided upon the organisers,
led by Ted Rees in Cheltenham and Belinda
Pryle in Gloucester, spun into action to devise
an academic programme in the best traditions
of the society, and a social programme with
a difference. Read on to discover what a
shotgun, a tame duck, and an inflatable guitar
have in common…….
The meeting was opened by the President,
Dr Tricia McAteer. The first session was
entitled ‘Up in the Air’ and took advantage
of the proximity of the venue to several RAF
stations. Wing Commander Nic Green gave
a hugely entertaining and well-illustrated
talk on Acceleration Physiology: the science
and physical effects of speed and movement
in fighter aircraft. He explained the causes
and effects of the visual disturbances and
loss of consciousness that can accompany
such manoeuvres and discussed some of the
techniques and equipment used to compensate.
It soon became apparent that most of the
human guinea pigs in the series of films he
showed were actually military anaesthetists,
not a profession for the faint hearted then!
Group Captain David Bruce followed on with
a lecture on ejection injuries, starting with
a fascinating history of the ejector seat, or
‘assisted escape system’ to give it its full title.
The evolution of this device over the past 50
years has dramatically reduced the incidence
of injury for air crew who need to leave their
aircraft in a hurry, and this was an upbeat talk
demonstrating how in a significant majority of
cases airmen and women return to flying after
being forced to ‘abandon plane’.
Patrick Magee of Bath took us even higher ‘Up
in the Air’ with his history of Space Walking
and the equipment which has evolved to make
it possible. In the year of the 40th anniversary
of the moon landing (your correspondent
remembers watching it on his father’s knee)
Dr Magee, who as well as being an anaesthetic
colleague is also a Visiting Senior Lecturer in
Mechanical Engineering at the University of
Bath, took us from tethered ‘space walks’ to
the advent of jet packs such as those used at the
Space Station. The varied challenges to human
physiology that such activity requires, and the
remarkable technology which has developed to
support it, made for a fascinating talk.
After a lively lunch in the gastro pub attached
to the Four Pillars Hotel we reassembled to hear
two of Gloucester Royal Hospital’s finest tell us
about their current research interests. Richard
Vanner revised the physiology of one lung
ventilation and gave tips for the insertion and use
of bronchial blockers during oesophagectomy.
He demonstrated how the incidence of acute
lung injury can be minimised by the use of
careful ventilation strategies. Richard was
followed by his surgical colleague Professor
Hugh Barr, who is an international expert on
volatile diagnostics and pheromones. The
vapours and particles which arise from certain
infective processes and conditions are vastly
under-researched, and we were fascinated to
discover that up to 30% of the genome of many
creatures relates to chemosensory activity:
smell and taste. Newspaper stories about dogs
who can detect cancer may have a scientific
basis and the development of specialised
diagnostic equipment, the ‘e-nose’, may
ultimately become a reality, detecting illnesses
from the aromas that arise from the sputum
or other secretions of patients. A beguiling
and enthusiastic speaker, Professor Barr
finished with several anecdotes from his quest
to find the truth about human pheromones,
including the hilarious tale of his mission to
collect airborne chemicals released at times of
sexual excitement in humans. I suggest you
ask him about it personally as this writer has
successfully managed to bury the memory of
the exact details.
The remainder of the afternoon was given over
to the jewel in the crown of the organising
committee’s programme. A choice of Team
Building Activities with a Difference had been
arranged. Not for SASWR the usual corporate
menu of ‘blue sky thinking’, tugs of war, or
virtual river crossings. Our range of activities
took advantage of the beautiful Cotswold
surroundings, the rich history of the region,
its culture, and the ready availability of local
wildlife. And so we departed in our groups
to sample Laser Clay Pigeon Shooting, Water
Sports, and finally (and I must stress that no
wildlife were harmed during the activity) Duck
Herding. It was even rumoured that some
delegates had registered for the meeting purely
to find out what duck herding is.
The attached photographs will hopefully
explain everything. Sir Peter Simpson’s
natural authority over the ducks was evident
from a very early stage. Neville Goodman
apparently talked them into submission, while
Peter Ritchie managed to get the ducks to herd
a rather bemused sheepdog into their pen. As
far as the shooting went (of discs with lasers
rather than ducks with pellets) John Carter
demonstrated that his early military training
had not been forgotten, despite a valiant
attempt by Bill Brampton to claim a placing
for his adopted country. And as far as the
water sports went, a late change from wake
boarding to kayaking did nothing to dampen
the enthusiasm (geddit?!) of the twelve hardy
souls in wetsuits who took to the lakes with
aplomb.
There was therefore plenty to talk about at the
President’s Reception and Society Dinner that
evening. The president looked resplendent and
had chosen a ribbon on the medal to match her
outfit (or was it the other way round?).
Are Pink Floyd touring again?
She gave a heartfelt speech thanking the
organisers of the meeting but yet again failing
to tell any of the jokes which the Hon Sec had
supplied to her in the bar earlier. She did however
come up with one which he hadn’t heard before,
so all was not lost. Professor Hugh Barr replied
on behalf of the guests with the wit for which
he is legendary, and dancing continued into the
early hours to the band ‘Colloosion’.
Professor Barr furthers his research
On Friday morning Belinda Pryle chaired a
session on Equipment and Practice which
was very well attended and swelled by the
introduction of a new ‘one day’ ticket which
we hope will encourage those with other
commitments to attend at least part of future
meetings. David Gabbott of Gloucestershire
opened with a review of prehospital airway
care. As well as examining many of the
currently available supraglottic airway
devices David argued that because intubation
is such a difficult skill to maintain, the focus
in prehospital care should be on ensuring
a clear airway and oxygenation using the
aforementioned devices rather than intubation
per se. He was followed by Bill Brampton,
formerly of Cheltenham and now in Aberdeen,
who asked ‘is it time for Macintosh to retire?’
With the range of new laryngoscope blades now
available, particularly video laryngoscopes,
Bill questioned whether the Macintosh blade
should be the first choice in every situation.
He concluded that even if other devices are
introduced for potentially difficult scenarios,
training in their use must cross over with the
use of the Macintosh blade so that the skills
of ‘basic’ intubation can be readily maintained.
In the run-up to coffee Trevor Johnson of
Cheltenham entertained us with his lecture
‘New Perspectives in Regional Anaesthesia’
which he had generously illustrated with
photographs of himself dressed as a variety
of historical characters. He used his witty
presentation to discuss the strengths and
limitations of peripheral nerve stimulation,
the ascent of ultrasound-guided techniques,
and the success rates of various approaches to,
and techniques of, common nerve blocks. An
evidence base is slowly emerging in regional
anaesthesia and his ‘evidence-based tips for
success’ were well received.
At the end of the morning we were very
fortunate to have two of Gloucestershire’s
biggest exporters of anaesthetic knowledge
telling us their stories. James De Courcy
has been instrumental in establishing Truama
Care training in the third world, where
mortality from accidents is far higher than in
the West. James gave a moving account of
his experiences in visiting countries in Africa
and Asia to introduce context-sensitive trauma
management protocols to local populations.
He stressed the importance of enabling local
teams to work with available equipment and
resources to optimise their care of injured
people.
This theme was taken up by Roger Eltringham,
who had realised that Western anaesthetic
machines can rarely be maintained and repaired
in poorer countries, and so has spent much of
his career working towards the development
and distribution of his ‘Glostavent’ ventilator.
This is now mass produced and in use in over
30 countries. It was lovely to hear from Roger
again, and a fitting end to the scientific section
of the meeting that one of anaesthesia’s great
innovators was able to present his work to his
own local society on home ground.
Guests and retired members joined us for the
Friday afternoon session entitled ‘Sporting
Life’. Sue Smith of Cheltenham, who is
also lead doctor for Cheltenham Racecourse,
gave a fascinating and beautifully illustrated
account of her activities and also of the
risks to jockeys of horse racing and show
jumping. Great strides forward have been
made in safety for riders and in the treatment
of injured jockeys, but the incidence of injury
remains depressingly high. Sue was followed
by Dr Rod Jaques, a Gloucestershire GP
with a specialist interest in sports medicine.
Rod was Director of Medical Services at the
Beijing Olympics, at which Team GB were
so successful. He explained that in addition to
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extreme fitness and the medical care of athletes
who were injured or became unwell, the team’s
success had been in no small part due to the
psychological preparations that had been made
to help our elite athletes cope with the stresses
they faced in China. It was a privileged insight
into a branch of medicine with which few of us
have been involved, and a splendid way to end
our ‘meeting in the country’ before we left the
beautiful Gloucestershire countryside.
And so another meeting ends, and we prepare
for autumn in Exeter, and next spring in Rome.
The dates have been widely publicised and I
do hope to see as many of you as possible at
each meeting. I have just been flicking through
the feedback forms I received after the meeting
in Cheltenham: ‘Excellent science’, ‘Great
venue’, and ‘Good to see old friends’ are
recurrent phrases. As is ‘Why didn’t the Hon
Sec sing Karaoke again?’ Never mind – there’s
always next time.
