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Authors:

• Dr Sangita Kindred, Anaesthetic Trainee, North Central School of Anaesthesia
• Dr Tim Jackson, Anaesthetic Trainee, North Central School of Anaesthesia
• Dr Kate Sherratt, Consultant Anaesthetist and North Central London Training Programme Director, 
  Royal Free Hospital

We are in the midst of a climate emergency. With record-breaking heat waves and flooding over the last few years, the danger to our patients’ health is undeniable. Even the World Health Organization described climate change as ‘the single biggest health threat facing humanity’.¹ Therefore, we have a duty as healthcare practitioners to change our practice to protect our future patients. Even the GMC has changed its guidance on ‘Outcomes for Graduates’ to reflect this need.²

Anaesthetic gases make up more than 2 per cent of the NHS’s carbon footprint, and reduction in their use is central to the NHS long-term plan to reach carbon net zero by 2045.³ Desflurane is a particularly harmful greenhouse gas, with a global warming potential over 100 years (GWP100) which is 2,540 times greater than carbon dioxide.⁴

‘How many?’, ‘Yes, four children’. I usually feel a bit like a freak of nature at this point in the conversation. Cue jokes about anaesthetists hating odd numbers or the efficiency of having children in pairs.

So I’m a medic turned anaesthetist turned dual ICM trainee with two sets of twins; I toddled off to medical school more than 20 years ago and have been ‘in training’ ever since. It is hard, but life is hard and this isn’t about how I’ve overcome immense odds and struggled through, but about how children and the scenic career route have made everything better.

When I returned to my role as a CR&I/RCoA perioperative quality improvement programme (PQIP) fellow, I found this came with unique expectations and required planning. Hopefully by sharing what I learnt, it will help those who are returning to work after a period of leave, especially those returning to job roles that do not necessarily fit the norm.

Returning to work: general things to consider

When RTW there are key dates and tasks to consider. Table 1 details some of the things that need to be arranged and when these need to be done. There are also many resources to consult (see below ). Using these in conjunction with your hospital policy is a good starting point.

As a medical student, someone once told me that helping patients stop smoking was the single best intervention available to us as doctors. I’ve never found a reference for that, but it stuck with me.

While I might not have the evidence for my claim, we do know that each year, smoking-related disease costs the NHS £2.6 billion and causes up to 76,000 deaths. The good news is that rates of smoking are decreasing each year, with the latest figure at 12.9%.

Aside from the general health benefits of quitting, several specific perioperative outcomes exist.

It is safe to say that the laryngoscope is one of the most recognisable tools within anaesthesia. A piece of equipment that has evolved throughout the years to be used by airway specialists, the humble laryngoscope allows us to perform one of the fundamentals of anaesthesia: to intubate an airway.

The COVID-19 pandemic has accelerated a trend within anaesthesia – a move away from direct laryngoscopy (DL) towards video laryngoscopy (VL) as the primary method of intubating the airway.¹ Indeed, from recent conversations with my colleagues about their choice of airway tool, I’ve noted a general theme: DL is fast becoming an unfavoured and unfamiliar technique for management of a patient’s airway. This sentiment was reflected in the updated Difficult Airway Society (DAS) guidelines in 2015: laryngoscopy as part of Plan A can now comprise either DL or VL attempts.²

Author: Dr Maya Sussman, Anaesthetic Senior Clinical Fellow, Guy's & St Thomas' NHS Foundation Trust; RCoA Patient and Public Involvement Fellow

The Patient and Public Involvement team at the RCoA regularly develops patient information resources to help individuals prepare for elective surgery.

These materials aim not only to improve recovery, but also to use the ‘teachable moment’ of surgical preparation to promote healthier lifestyles and long-term wellbeing.

As surgical waiting times grow, there’s an increased drive to use this period for positive health interventions. However, we realised we didn’t fully understand how healthcare professionals, particularly anaesthetists, were using our resources in practice.

To explore current attitudes, behaviours, and barriers to supporting patients psychologically and emotionally before surgery, we decided to launch a survey through the College.

Dear Editor,

I read the wellbeing and burnout articles in the Bulletin (Summer 2024) with interest. Though highlighted for some, it is an ‘eyeroll subject’, but the importance of wellbeing is undeniable. In particular, it is important to ensure that anaesthetists and the wider multidisciplinary team receive appropriate wellbeing and psychological support after traumatic incidents. Exposure to traumatic events is inevitable in anaesthesia. Having systems to support staff afterwards is crucial to recovery and to reduce long-term burnout and emotional toll.

Delivering training is a complex process. One of the disconnects that crops up between the FICM and intensivists in training is fuelled by the constraints of how the curriculum is delivered. While there are aspects of training that we can adjust, we are very much constrained by the GMC, which is our statutory body for training.

Dennis has an anaesthetic is an online Beano comic strip, developed by the RCoA in partnership with the Association of Paediatric Anaesthetists of Great Britain and Ireland.