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I doubt there are many Bulletin readers who are old enough to remember the 1963 Disney film ‘The Incredible Journey’. Luath – a golden labrador, Bodger – an aging bull terrier, and Tao – a Siamese cat make a perilous journey across the Canadian wilderness to get to their home 300 miles away. As a little girl I sat in the Ritz Cinema with tears flowing because it seemed inevitable that Bodger had died in the final few miles of the journey. Of course he hadn’t. He trotted over the horizon to an ecstatic welcome from his animal and human family.

I was reminded of Bodger and his fictional achievement when I read about a dog called Pip. Last year Pip’s owner took him for a run in Leigh Woods, a beauty spot in Bristol. They became separated, and Pip’s frantic owner took to social media to get help finding him. Pip was soon spotted on the city’s security cameras. He crossed Brunel’s iconic suspension bridge, ran past the famous BBC studios in Whiteladies Road and was captured on camera running by the steps of the museum. Somehow he safely negotiated the notoriously dangerous traffic in the city centre and found his way to his front garden in Bedminster – about four miles from where he’d left his owner. In fact he got home before she did!

The Difficult Airway Society (DAS) recommends awake tracheal intubation as a primary airway management technique in people with difficult airways. It can be achieved either by fibreoptic bronchoscopy or videolaryngoscopy. However, in our experience, despite the guidance, anaesthetists are sometimes reluctant to perform either.

While it’s useful to be able to perform both techniques depending on what’s needed for the patient, videolaryngoscopy requires fewer technical skills and can be applied with a comparable success rate and safety profile to fibreoptic intubation. Furthermore, the more commonly the procedure is undertaken, the more that anaesthetists and the wider anaesthesia and theatre teams come to regard it as a straightforward, almost ‘everyday’ event. This creates a virtuous circle where it then becomes even easier to consider and perform.

With this in mind, we suggest that anaesthetists should be introduced to awake video intubation early in their career. Seeing that airway management can take place without general anaesthesia opens up a range of possibilities and gives them further confidence for managing the various patients that could present with anticipated and unanticipated difficult airways.

October’s Black History Month celebrates the contributions of individuals of Black heritage, including those within the NHS. It is also an opportunity to highlight the academic challenges faced by healthcare professionals from under-represented groups, emphasising the need for diversity in our healthcare system.

Disparities in clinical academia stem from the intersection of ethnicity and gender, in addition to other contributing factors, including lack of mentorship, systemic biases, and the ‘minority tax’. For ethnic minorities, the negative correlation between clinical time and scholarly productivity diverts time away from career advancement, hindering their professional growth compared to peers.

Embracing research diversity improves care equity, reduces differential attainment for anaesthetists, and bridges gaps in academic leadership. It promotes equity-minded environments and builds a workforce that reflects the population it serves. This article examines these disparities and efforts to improve diversity in anaesthesia research.

I’ve been wondering recently how far I should be embracing or resisting my own background when speaking as a patient voice.

I took on the role of Chair of PatientsVoices@RCoA in September, and I’ve found it fascinating to learn about a whole range of issues that are new to me and to contribute to discussions about them. But I’ve also been struck by how often I’ve found myself thinking that the need for good communications lies at the heart of whichever issue is under discussion. And I’ve been wondering whether that reflects the reality, or my own particular interests.

It has both a favourable side-effect profile compared with traditional anticholinesterases and allows for emergency reversal.

With the expiry of its original patent last year, high cost is no longer a factor prohibiting its use, which will invariably further increase. In this article, we seek to highlight the resulting increased potential for contraceptive failure and propose methods to better inform and protect patients.

The risk of contraceptive failure

Due to its ability to encapsulate progesterone – present in contraceptive pills, vaginal rings, implants and intra-uterine devices – the administration of sugammadex may reduce their biological effect and cause contraceptive failure. This was identified in in-vitro studies, using isothermal microcalorimetry, performed as part of the drug’s development. While in-vivo studies to quantify the reduction in serum progesterone concentration following sugammadex administration have not been performed, these results have shaped current manufacturer guidance.

Pursuing excellence in our services for members

Member service is the focus of the first year of our Five-Year Commitment. We want to provide the right services to you at all stages of your career and deliver a programme of improvement so that your experience of the College is the best it can be.

I fully appreciate that there are some areas where we need to do better – you have told us where we need to improve, and we have been listening, acting and improving wherever we can. Our response time is one example. We have made it a priority to respond to your enquiries in a more timely way and to reduce the number of outstanding emails, particularly those relating to training.

Training in anaesthesia is one of the cornerstones of the profession. It is often cited as one of the specific attractions of choosing anaesthesia as a career. However, anaesthetists in training are unfortunately not immune from the challenges faced by all resident doctors working within the UK.

In recent years, there have been growing concerns about low morale and burnout. Anaesthetists in training provide a pivotal role in the provision of services in many areas of secondary care. Furthermore, there is a well recognised shortage of consultant anaesthetists in the UK. It’s essential that the NHS is able to train and retain this uniquely skilled workforce to provide care for patients both now and in the future.

It’s apparent from both the College’s own work, such as the 2017 survey on morale and welfare in anaesthetists in training (‘A need to listen’) and also evidence from the GMC’s National Trainee Survey (NTS), that there is a high proportion of anaesthetists in training at risk of burnout. There have also been significant external factors impacting on the training programme, such as the transition to the 2021 curriculum and the COVID-19 pandemic. Competition ratios to enter anaesthetic training are at record levels, and concerns remain about training-post numbers and progression between Core and Higher training programmes.

December 2022 saw the final conversion of the initial dataset into a web-based survey tool. Further testing followed, which was exciting and challenging in equal measure. We are very grateful to our beta-testers who tested the questionnaire to destruction to ensure its future functionality.

Their feedback has been fundamental to the next steps in the project, even though their key finding was that the questionnaire was too long. The length of the form was originally dictated by airway experts from around the world with the aim of developing a set of questions they believed would capture all relevant data around an eFONA episode. To reduce its length, a ‘Delphi’ exercise is underway which will identify and agree on the fundamental questions to be answered when reporting an eFONA event.