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We would like to use this Bulletin issue to present some data on the College’s CPD event-accreditation scheme over the previous 12 months. 

Applications continue to be welcome from regional bodies and specialist societies and associations. Accredited events appear on the College website and in the Lifelong Learning Platform (LLP) – if you have attended an event aimed at a regional or national audience please always first check in the LLP if it has been approved. You will then be able to save duplication of effort by associating the event to your newly created CPD activity.

I’m hoping that no one reading this has missed the launch of NAP7: perioperative cardiac arrest. The NAP7 data touched every part of anaesthesia practice – from maternity and neonates right through to the frail and older patient – so there’s something there for everyone.

But NAPs don’t stand still; NAP8 is on its way and will be looking at regional anaesthesia and neurological complications of anaesthesia. We are delighted that Professor Alan MacFarlane has been appointed to lead NAP8 – more news will be coming soon.

The work of CR&I is supported by a diverse group of clinical fellows (and this issue of the Bulletin even has a piece from a future research leader – aged 11). We couldn’t do our work without them, and they in turn are supported by their clinical workplaces – both in the NHS and the independent sector – who pay their salaries and give them the space to work with CR&I. I’m delighted that some of our fellows have given an insight into what the role is like – and the challenges of going and coming back from maternity leave.

The NIHR-HTA funded Continuous rectus sheath Analgesia in eMErgency LaparOTomy (CAMELOT) is another trial led by the Perioperative Medicine Clinical Trials Network (POMCTN) that is currently open for recruitment. 

The study aims to find out whether adding rectus sheath catheters (RSCs) to standard analgesia provides better pain relief, fewer side effects and complications, and greater satisfaction for patients undergoing emergency laparotomy. It will also determine whether RSCs are safe and cost-effective. All POMCTN trials are registered with the NIHR Associate Principal Investigator (API) scheme. In this article, one of our trainees shares her experience working on the CAMELOT study.

Welcome to the autumn edition of the Bulletin.

As I write this, there is a sombre atmosphere as the funeral arrangements for Queen Elizabeth II proceed, and I want to take the opportunity to pay my respect to her and to her devotion to duty in this editorial. Although it was not unexpected, I was surprised how deeply her death affected me – I felt keenly what a historic moment the death of the longest-serving monarch in British history, and the second-longest in world history, was.

This is also my last editorial as editor of the Bulletin as I take on the vice-president’s robe and hand the Bulletin role to one of my colleagues. It has been a pleasure, and I have very much enjoyed the challenge of curating, commissioning, and advising our authors. I am so proud of the achievement as we head towards a much better digital version of the Bulletin, and I particularly want to thank the publishing co-ordinators, Anamika and Mandie, for the support, encouragement, chasing and cajoling they have done. Without them the Bulletin would be a shadow of what it is.

These colleagues are easily recognised and often appreciated but, with the merry-go-round of training and rotational placements, attaining formal acknowledgement of their work can be overlooked. 

We recently took steps to nominate our College tutor and were delighted when he received a President’s Commendation from our College.

Several years ago, Dr Minich took over the school-wide final FRCA teaching programme. With his dedication and blindingly structured approach, it quickly became clear that we were fortunate to have an excellent educator in our midst. To say we all benefited from the provision of exam-practice resources and Dr Minich’s efforts coordinating hours of SOE practice feels like an understatement; it simply does not portray the level of help and support Dr Minich provided to the trainee body preparing for the exams.

Welcome to October's issue of the Bulletin. As I write this piece, we may be struggling to see the light at the end of the tunnel for UK healthcare; an unprecedented state of industrial action by doctors at all stages of their careers, the recent release of an open report on sexual misconduct in healthcare and, as clinicians, the challenges of ensuring high quality care for patients can be a daily struggle. The height of the pandemic may be behind us, but the disparities it has revealed will have to be addressed for years to come.

A new year signals a new Editor for the Bulletin, and it gives me immense pleasure to welcome you to the January 2023 edition. As I write this, the UK’s NHS is experiencing winter pressures, nurse strike action seems imminent, purple seems the new black in terms of hospital bed status, and elective surgical recovery targets seem an insurmountable challenge. It would be easy to feel discouraged, but a new year always heralds new hope.

Scrolling through the articles in this Bulletin, I am filled with delight at the examples and opportunities for change during these uncertain times. Innovation has long been the forte of our specialties – doing things differently, more efficiently, and more safely for the betterment of patient care. Whether it is the small tweaks made to TIVA settings, the slight adjustment of the ultrasound image during a nerve block, or refining the ergonomics of running an operating theatre list or ICU ward round, continuous improvement is innate to our specialties and specialists.

Approximately two million people attend the Hajj pilgrimage in Saudi Arabia every year. The journey is obligatory for those who have the physical and financial means, once in a lifetime. The pilgrimage lasts five days and is based in and around the city of Makkah.

The climate is one of a hot desert with day temperatures regularly exceeding 45ºC (113ºF) during the summer. This is made all the tougher with average relative humidity reaching 33%. Pilgrims travel from around the world. They include all ages and backgrounds, and individuals with complex medical conditions.

I was lucky enough to be given the opportunity to attend this year. My journey began like any other pilgrim’s, initially solely focusing on the religious events ahead. The first few days went as planned, with challenging walks, but nothing more than I had physically and mentally prepared for. Things however changed as the days went on and as the weather deteriorated. I cannot emphasise enough the combined effects of extreme heat and huge crowds. Despite an umbrella to keep one out of direct sunlight and copious amounts of water consumption, heat exhaustion is relatively common. I was also soon to learn that heat stroke was becoming dangerously frequent during my time there. As anaesthetists, our challenge is often to keep patients undergoing major surgery warm. As I entered my hotel lobby, my job was to do the opposite and help cool my fellow pilgrims down!

Airway management is a crucial aspect of patient care, where effective and prompt actions can be life saving. The RCoA recognises the importance of continuous education and training to ensure healthcare professionals are well equipped to handle complex airway scenarios.

Multidisciplinary simulation has arisen as a valuable tool in this regard, offering an immersive and dynamic learning experience that fosters collaboration among different professionals involved in patient care.

Traditionally, training in airway management has often been siloed, with the focus on individual disciplines. However, real-life situations demand a coordinated effort from various healthcare professionals, including anaesthetists, operating department practitioners, nurses, physiotherapists, surgeons and theatre nurses. Therefore, conventional training styles may not adequately prepare individuals for the intricacies of interdisciplinary communication and cooperation.