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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

On 27 August 2011, The Times alerted readers to a craze originating in Spain: a drink high in alcohol was vaporised in a hand-held inhaler that contained a heater and a supply of oxygen. 

The alcohol rapidly reached the bloodstream via the lungs, quickly producing intoxication. A local newspaper reported:‘Oxy shots – the latest madness of the British in Majorca’. One of us (AD) recounted the story to an anaesthetist friend, Keith Pooley, who announced that once in his career he had actually anaesthetised a patient with ethyl alcohol vapour. He told me the full story which I later wrote up in The Times as an addendum to the oxy shots’ article. He was visiting a local cottage hospital on a weekly basis to prepare patients for minor surgery, mainly using halothane. On this occasion the induction was slow, with the patient resisting, spluttering and coughing. ‘But’ said Keith ‘I eventually got him down and he had his operation’. Recovery was atypical of that from halothane, and some detective work was called for. Keith unscrewed the vaporiser bottle and sniffed the contents – surgical spirits (typically 70–99% ethyl alcohol). It seems that the previous week he had discarded an empty 250 ml bottle of halothane. Someone else, keen on recycling, later retrieved the bottle from the bin and used it to store the surgical spirits. Unlabelled, it had wandered around the hospital until eventually finding its way back into the anaesthetics’ cupboard….

The Nuffield Department of Anaesthesia in Oxford is the largest clinical department in our trust. We are based across five different sites, with more than 200 anaesthetists. Our department has a strong history of engaging in national projects, including the National Audit Projects (NAPs). 

One component of the latest NAP (NAP7) was a baseline survey of all anaesthetists in the UK. We identified that tracking and responding to more than 200 survey participants posed a significant challenge. In this article, we seek to describe how technological solutions can aid participation, compliance tracking, and survey administration.

Authors:

• Dr Andrew Kane, ST7 in Anaesthesia, South Tees Hospitals NHS Foundation Trust
• Dr Simon Davies, Reader in Anaesthesia and Perioperative Medicine, Hull York Medical School; Honorary Consultant in Anaesthesia, York and Scarborough Teaching Hospitals NHS Foundation Trust
• Dr David Yates, Consultant in Anaesthesia and Intensive Care Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust; Honorary Senior Lecturer, HYMS
• Professor Gerard Danjoux, Honorary Professor, HYMS; Consultant in Anaesthesia, South Tees Hospitals NHS Foundation Trust

Chatting in a pub in York in 2019, Simon Davies, David Yates and Gerard Danjoux were reflecting on their academic careers to date. The three colleagues from York and South Tees Hospitals had worked together successfully since 2012, securing prestigious grant funding and delivering high-quality academic studies. Yet something was missing – strategy and infrastructure to create a sustainable programme of work and develop the researchers of the future.

As the evening progressed, more and more ideas were generated in direct correlation to the consumption of the excellent York ales!! Before the end of the evening, an idea was hatched, and the colleagues would form a new collaboration with an academic partner: the North Yorkshire Academic Alliance of Perioperative Medicine.

I have recently been offered a role as a specialist anaesthetist. This is the final stage of my career pathway. To most, becoming a consultant is the final stage. To those not on the trainee pathway, the goal is to become a specialist.

The introduction of the specialist grade in April 2021 has finally given SAS doctors a new genuine career progression opportunity. This contract allows experienced anaesthetists to have a role that recognises the value we bring to our departments. Although this is a very new role, many trusts have created specialist anaesthetist posts that offer a fair and balanced job plan.

I will have started in my new role by the time of publication of this article. The agreed job plan is very different to the role that I currently have. I will be working on a variety of elective, urgent and emergency lists in a range of specialties in a major trauma centre. My employers have been very understanding about my family situation, and have agreed to keep my days fixed and close together so that time away from home is minimised.

As the 2021 curriculum enters its second year, the new curriculum continues to evolve. At each step, this process has been informed by feedback from anaesthetists in training and trainers to guide changes, aid additional clarification, and influence future improvements.

In this article, we explore some of the recent key updates and improvements in the curriculum and look forward to future developments.

Authors:

• Dr Hamish McLure, Medical Director (Professional Standards and Workforce Development) and Consultant Anaesthetist, Leeds Teaching Hospitals NHS Trust
• Dr Natalie Drury, Consultant Anaesthetist and Anaesthesia Associate Lead, Leeds Teaching Hospitals NHS Trust

The pandemic has generated a staggering backlog, with more than 7 million patients waiting for care. In order to treat these patients in a timely way, we need to increase our work rate beyond pre-pandemic levels but with our current workforce and model of care, this will be difficult. 

Fatigue, burnout, repeated acute illnesses and a punitive tax system mean we have a fragile workforce with minimal capacity or interest in additional work. RCoA workforce data shows little to be optimistic about, with a projected gap of 11,000 anaesthetists by 2040. This demand cannot be met without a massive increase in training numbers. Given the pressures in virtually every other specialty, this is unlikely.

At Nottingham University Hospitals (NUH), it was felt that for our patients with cardiovascular disease, obtaining a preoperative cardiology assessment and perioperative management strategy was prolonging non-cardiac surgery waiting times. 

This was especially compounded by the surgical backlog and increased demand on preoperative services following the COVID-19 pandemic. In order to streamline the assessment process and facilitate safer surgery, a joint cardiology-anaesthesia multidisciplinary team (MDT) meeting was established.

The global problem

It is no surprise that underlying cardiovascular disease can contribute significantly to perioperative morbidity and mortality, with cardiac events being the leading cause of such.¹ Almost half of adults aged over 45 years undergoing major non-cardiac surgery have at least two cardiovascular risk factors, and conditions such as coronary heart disease, heart failure and arrhythmias put patients at increased risk of cardio- and cerebrovascular events in the immediate postoperative period.²