Annual Queenstown Update in Anaesthesia Programme and Abstracts, 2012 Annual Queenstown Update in Anaesthesia, 2012 1 CONTENTS Welcome ................................................................................................................................................ 3 Social Programme ................................................................................................................................. 4 Scientific Programme ............................................................................................................................ 5 International Faculty .............................................................................................................................. 6 New Zealand Faculty ............................................................................................................................. 8 Abstracts ................................................................................................................................................ 9 An Update in Obstetric Anaesthesia .............................................................................................. 11 Airway Update ................................................................................................................................ 19 Managing the Obese – Lessons from bariatric surgery ................................................................. 23 What’s New in Regional Anaesthesia? .......................................................................................... 29 The New Generation Anaesthetic Machine .................................................................................... 33 Goal Directed Therapy – Experience at a tertiary care centre ....................................................... 45 What’s New in Ventilation? ............................................................................................................. 49 ICU Topics ...................................................................................................................................... 57 Drug Dosage – How many inches should you give? ..................................................................... 61 What’s the Solution? ...................................................................................................................... 67 Enhanced Recovery After Surgery Protocols ................................................................................. 71 Learning From Errors in Obstetric Anaesthesia – Designing systems to improve patient safety .. 77 A Bug’s Life – So simple, and yet so fascinating too ..................................................................... 79 Mercenaries, Misfits and Medics – Helping out overseas .............................................................. 85 Sponsors ............................................................................................................................................. 90 1 Annual Queenstown Update in Anaesthesia, 2012 Gold Sponsor 2 Silver Sponsors 2 Annual Queenstown Update in Anaesthesia, 2012 Welcome 3 Welcome to the fourth Annual Queenstown Update in Anaesthesia. AQUA 2012 continues with the theme of the previous meetings, which is to provide anaesthetists with an annual update on core topics relevant to current clinical practice. Add in an excellent social programme and the setting of Queenstown in the ski season, and the ingredients are in place for a great conference. AQUA is run in partnership with the NZSA and we are grateful for the enthusiasm and support of the NZSA executive. AQUA 2012 features five international speakers who will add further depth and diversity to this year’s scientific programme. The international faculty include; AP Nolan McDonnell, Dr Chris Thompson, Dr Laurence Weinberg, AP Frank van Haren and AP Peter Hebbard. Between them they will cover everything from obstetrics to the future directions of hardware, regional anaesthesia to goal directed therapy, patient safety and ICU care. Once again, we are indebted to our local faculty from around New Zealand for their hard work. Without their contribution, AQUA would not be possible. The organising committee would like to thank local speakers for their willingness to be involved. AQUA 2012 will again capitalise on the attractions Queenstown offers for the social programme. Although Coronet Peak has had a patchy season this year, we have arranged snow fall especially for the AQUA meeting. Night skiing will be held in conjunction with the AQUA BBQ on Friday night. The conference dinner will be held at Skyline Restaurant (not a buffet!). Sipping on a glass of bubbles, you will be whisked to the Skyline via the gondola enjoying spectacular views of Queenstown. Following a fantastic dinner accompanied by fine local wines, we will conclude with live test rugby featuring an All Blacks victory over the Wallabies.* We trust you will learn during the day, but also enjoy time off as well. Once again we acknowledge the generous support of our sponsors, in particular GE who are the AQUA 2012 Gold sponsor. We have been well supported by industry this year and we would like to thank them all for being here. Please visit them in the exhibit area. Enjoy. Neil MacLennan Martin Misur Kerry Gunn Karen Patching (KP) * After last year’s result, the Convening Committee do not guarantee the outcome of the rugby 3 Programme Annual Queenstown Update in Anaesthesia, 2012 SOCIAL PROGRAMME Thursday, 16 August 2012 4 AQUA Welcome Drinks 5:00 p.m. – 7:00 p.m. Friday, 17 August 2012 Ski bus to Coronet Peak departs Millennium Hotel 12:40 p.m. MedRecruit BBQ at Coronet Peak base building commences 6:00 p.m. Ski bus to Millennium Hotel departs Coronet Peak 9:00 p.m. Saturday, 18 August 2012 Ski bus to Coronet Peak departs Millennium Hotel 12:30 p.m. Ski bus to Millennium Hotel departs Coronet Peak 4:15 p.m. Dinner Gondola from 6:00 p.m. Dinner service from 7:00 p.m. NB – All transportation will leave promptly at the designated time. If you are late, you will be responsible for your own transportation. 4 Annual Queenstown Update in Anaesthesia, 2012 Programme SCIENTIFIC PROGRAMME Day 1 – Friday, 17 August 2012 5 0710-0755 Breakfast Exhibitor Area 0755-0800 Welcome and Introduction – Andrew Warmington Galaxy Room Session 1: SUBSPECIALTY SYNOPSIS 0800-0840 An update in obstetric anaesthesia Nolan McDonnell 0840-0905 Airway update Jeanette Scott 0905-0930 Managing the obese – Lessons from bariatric surgery Craig Birch 0930-0955 What’s new in regional anaesthesia Peter Hebbard 0955-1025 Morning break Exhibitor Area Session 2: BLACK BOXES Galaxy Room 1025-1105 The new generation anaesthetic machine Chris Thompson 1105-1130 Goal directed therapy – Experience at a tertiary care centre Laurence Weinberg 1130-1155 What’s new in ventilation? Chris Thompson 1155 Close – Lunch packs available for you to pick up Exhibitor Area 1240 Bus to Coronet Peak departs from Main Entrance, Millennium Hotel Day 2 – Saturday, 18 August 2012 0715-0800 Breakfast Exhibitor Area Session 3: POTPOURRI Galaxy Room 0800-0830 ICU topics Frank van Haren 0830-0855 Drug dosage – How many inches should you give? Tim Short 0855-0920 What’s the solution? Laurence Weinberg 0920-0945 Enhanced recovery after surgery protocols Matt Taylor 0945-1015 Morning Break Exhibitor Area Session 4: AND NOW FOR SOMETHING COMPLETELY DIFFERENT Galaxy Room 1015-1040 Learning from errors in obstetric anaesthesia – Designing Nolan McDonnell systems to improve patient safety 1040-1110 A bug’s life – So simple, and yet so fascinating too Ben Harris 1110-1140 Mercenaries, misfits and medics – Helping out overseas Wayne Morriss 1140 Close – Lunch packs available for you to pick up Exhibitor Area 1230 Bus to Coronet Peak departs from Main Entrance, Millennium Hotel 5 Faculty Annual Queenstown Update in Anaesthesia, 2012 INTERNATIONAL FACULTY Dr Nolan McDonnell 6 Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth Dr Nolan McDonnell graduated from the University of Auckland in 1998 and undertook his training in anaesthesia at Palmerston North and Waikato Hospitals. In 2006 he and his family moved to Perth, Western Australia where he undertook a one year research and obstetric anaesthesia fellowship under the guidance of Prof Michael Paech. He now works as a Staff Specialist in the Department of Anaesthesia and Pain Medicine at King Edward Memorial Hospital for Women. This is Western Australia’s only tertiary referral obstetric, gynaecology and gynae- oncology hospital and hence caters for a comparatively high risk population. During his time here he has continued his interest in research, undertaking a Masters of Clinical Research in post caesarean analgesia. He is now a Clinical Associate Professor with the School of Women’s and Infants’ Health and the School of Medicine and Pharmacology, University of Western Australia and is widely published on a number of areas of relevance to obstetric anaesthesia. In addition to these roles he sits on the executive of both the Obstetric Anaesthesia and the Welfare of Anaesthetists Special Interest Groups, and he is involved in a number of local and international research studies as well as having a large clinical education commitment. Dr Chris Thompson Department of Anaesthesia Royal Prince Alfred Hospital, Sydney Dr Chris Thompson graduated from the University of Sydney in 1979. He was trained at Prince Henry / Prince of Wales Hospitals before becoming a Staff Specialist at RPAH. During his training he was fascinated by ventilation, and was with John Lawrence and others at Prince of Wales when they developed Australia’s first CPAP / SIMV ICU ventilators from Bird machines. At the same time, his interest in electronics led to a high frequency ventilator driver, a simple ventilator alarm and a number of peripheral nerve stimulators. A lifelong interest in anaesthetic equipment ensued. Chris currently represents the College on international standards committees and has been a design consultant to several international equipment manufacturers. For the last 15 years he has worked with Dräger in Germany on the development of their latest anaesthetic machines. His primary clinical interests are neurosurgery, cerebral protection, ventilation optimisation with modern machines and monitoring. 6 Annual Queenstown Update in Anaesthesia, 2012 Faculty Dr Laurence Weinberg Department of Anaesthesia, Austin Hospital, Melbourne Dr Laurence Weinberg graduated from The University of Witwatersrand, South Africa in 1997. He worked in teaching hospitals in the United Kingdom for the following six years being awarded his membership of the Royal College of Physicians of London in 2002. He completed his anaesthesia training at the Austin 7 Hospital in Melbourne with clinical fellowships in cardiac anaesthesia and liver transplantation. In 2007, he was appointed as a staff specialist, and continues to serve the Department of Anaesthesia at Austin Hospital. He is also a Senior Fellow in the Department of Surgery, University of Melbourne, where he is completing a Doctorate of Medicine degree. His primary clinical and academic interests are in the areas of liver transplantation, major hepatobiliary and cardiothoracic surgery. He has been the recipient of numerous research grants and has lectured both nationally and internationally. Currently he is the principle investigator for seven randomised clinical trials, three of which are multicentre studies. A/Prof Frank van Haren Intensive Care Unit, The Canberra Hospital, Canberra, Australian National University Medical School Dr Frank van Haren completed his dual specialist training as Physician and Intensive Care Specialist in Nijmegen, The Netherlands in 2000. He has worked as an Intensive Care Specialist in large teaching hospitals in the Netherlands and lectured for the Dutch National Intensive Care training programme on topics such as sepsis, nutritional therapy, and ethics. From 2005 he worked in the Waikato Hospital, Hamilton, New Zealand, before moving to Canberra, Australia in 2011, where he has been appointed Associate Professor with the ANU Medical School, Senior Staff Specialist in the ICU of the Canberra Hospital, and Director of the ICU research programme. In 2010 he was awarded a PhD in Medical Sciences by the University of Nijmegen for his work on gastrointestinal perfusion and microcirculation in sepsis. Other research interests include the effects of hypertonic fluid resuscitation in sepsis, immunomodulation in sepsis, nutritional therapy, and non-conventional inotropes and vasopressors. He has published and presented on a wide range of topics, and is reviewer for several international medical journals. A/Prof Peter Hebbard Clinical A/Prof University of Melbourne Peter Hebbard is Clinical Associate Professor and member of the steering committee of the Diploma of Clinical Ultrasound at the University of Melbourne. He was the convener of the ASURA 2012 meeting in Sydney and has been an invited speaker on regional anaesthesia in the USA, Europe and Asia over the last two years. In 2008 he won the award for Innovation in Ultrasound guided regional anaesthesia at the ISURA meeting in Toronto for innovations in abdominal wall blockade. Current interests include novel regional anaesthesia, pain medicine and other techniques relating to ultrasound guidance. 7 Faculty Annual Queenstown Update in Anaesthesia, 2012 NEW ZEALAND FACULTY Dr Jeanette Scott Middlemore Hospital Auckland 8 Dr Craig Birch Middlemore Hospital Auckland Dr Tim Short Auckland City Hospital Auckland Dr Matt Taylor Middlemore Hospital Auckland Dr Ben Harris Southern Community Laboratories Christchurch Dr Wayne Morriss Christchurch Hospital Christchurch 8
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