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Author: Dr Stuart Connal, Specialty Registrar in Anaesthesia, North Central London Deanery

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine – tripom.org) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.

Dyslexia is not just a learning difficulty affecting reading and writing; it can be related to difficulty processing and remembering information such as phonological processing, rapid naming, working memory, processing speed, and the autonomic development of skills.¹ 

Up to 10% of the population is estimated to have dyslexia. The newer term ‘neurodivergent’ is postulated to be the wider term, encompassing having cognitive functioning different from what is seen as ‘normal’,² and it includes dyslexia.

Chat Generative Pre-trained Transformer (ChatGPT) is the latest iteration freely available on the internet. Trained using transformer architecture, it generates human-like text by sifting through terabytes of data and billions of written works from internet sources¹ – many from familiar authors – to create human-like answers to prompts or questions.

As an experiment, I prompted ChatGPT to write this article, and it produced a not-terrible piece of work – although Reader, you will be reassured to know that this publication is man-made.

For your enjoyment, here is an example of a prompt related to anaesthesia:

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….

Our working lives as anaesthetists revolve around effective teamwork, communication, and empathy with the many different professions we interact with. Interprofessional education (IPE) is an increasingly familiar teaching methodology which aims to enhance and improve these collaborative abilities. 

Considering recent critical reports on the lack of teamwork and interprofessional co-operation within clinical systems, we present a review of IPE and how its increased adoption may help address these failings.

‘You always own the option of having no opinion. Things you can't control are not asking to be judged by you. Leave them alone.’

Marcus Aurelius (121–180 CE)

For the record: I am a full-time NHS consultant in pain medicine and anaesthesia, and the sole provider of ‘interventional pain procedures’ to my local hospice, where I have a weekly session to see inpatients, outpatients and discuss complex pain problems in the end, and not-so-end, of life scenarios. I am also a former dean of the Faculty of Pain Medicine.

Discussions have started within the RCoA on whether the College, and its faculties, should take a stand on the issue of ‘assisted dying’.

They should not. Not pro, anti, or neutral (this last stance is multifaceted and arguably not ‘neutral’ at all).

You may well ask why you should think of becoming an AAC (advisory appointments committee) assessor. Perhaps it will be too arduous/boring/difficult. We hope to persuade you that this is not the case, and further explain what it can do for you and your department.

When your department appoints a new consultant or specialist doctor, there are specific requirements that must be fulfilled. One of the most important of these is to hold an AAC. This is a legally constituted interview panel established by an employing body. Its function is to decide which, if any, of the applicants is suitable for appointment and to make a recommendation to the employing body.

At the time of writing this article we can be fairly confident that we have left the worst of the pandemic behind us. However, the NHS now faces the challenge of tackling spiralling waiting times for elective surgery. Now, more than ever, it is critical that patients (especially the most complex cases) receive, wherever possible, a comprehensive preoperative assessment.

This should include information to help them prepare for their procedure, understand the risks and, through shared decision-making discussions with their healthcare team, achieve the best possible outcomes.

Despite the disruption caused by the pandemic, the College’s Patient Information Group has continued to update existing resources and produce new ones to support patients and NHS colleagues through this difficult time. We remain committed to providing evidence-based, high-quality patient information resources, and we are delighted that we have been recertified through the Patient Information Forum Trusted Information Creator Kitemark (PIF TICK) for the third year in a row.

Anaesthetists are familiar with the ‘Schimmlebusch Mask’. This article evolves from Arusha, Tanganyika and a small boy’s memory of a white mask descending over his face circa 1963, having fallen while climbing the household log heap and splitting his eyebrow open, requiring sutures by the local doctor.

Open-ether-mask anaesthesia was a common and safe technique utilised in many countries at the time. Tadeusz Szreter’s recollections of performing ether anaesthesia for children in the late 1950s in Poland is an illuminating read. He describes how two facemasks had to be prepared for each procedure, and how when one became covered in frost, it was replaced by the other. Each mask had to be covered with several layers of gauze neatly trimmed to prevent cheek frostbite. With regard to the safety of ether, Perndt in 2010 and Chang et al in 2015 wrote papers advocating a rethink of this abandoned agent.^1,2,3

Numerous articles have been written about Curt Theodor Schimmelbusch (1860–1895) and his eponymous mask; this article is not attempting to review them all, the intention is to stimulate colleagues to explore for themselves.

Authors:

• Dr Gemma Summons, Perioperative Medicine Fellow/SpR Anaesthetics, University College London Hospital
• Professor Tarannum Rampal, Consultant Anaesthetist and Lead, Perioperative Prehabilitation Unit, Princess Royal University Hospital (PRUH), King’s College London NHS Foundation Trust
• Ms Shana Hall, Specialist Physiotherapist, Cancer Rehabilitation, Princess Royal University Hospital (PRUH), King’s College London NHS Foundation Trust

John is a retired white British man, who drove to clinic and has a good rapport with his doctor. He feels motivated by the exercise classes at his private gym and tracks his progress using prehab apps and his FitBit. His wife (who does all the cooking) finds the dietary advice helpful because it gives healthy alternatives for traditional British food that they eat.

Winnie is from Barbados. She had to get the bus to clinic (and now she’s late for her shift). She’s offered exercise sessions, if they can fit around work, but the bus links are awful. The dietary information is unhelpful as she can’t get the ingredients from Brixton Market and her budget is tight. She doesn’t have the time to learn lots of new recipes.