Anaesthesia News - AAGBI

32 Pages·2010·2.92 MB·English

Anaesthesia
News
ISSN 0959-2962
The NewsleTTer No. 278 September 2010
of The
AssociATioN
of ANAesTheTisTs
of GreAT BriTAiN
ANd irelANd
Breathing system
obstruction:
a continuing issue
GAT report from Cardiff
Treasurer's annual
summary
The disappearing needle
phenomenon has finally
been conquered.
Enhanced needle visualisation
at steep angles.
The value of ultrasound guidance during nerve block is well established.
But seeing the needle clearly when approaching a deep structure from
a steep angle can be very challenging. (See “Study Ranks Needle
Visibility Under Ultrasound,” Pain Medicine News, March 2010.)
Now a simple software upgrade clearly enhances needle visualisation
while maintaining striking image quality of the target and surrounding
anatomy – especially at the steep angles needed on deep procedures.
Advantages of SonoSite’s enhanced needle visualisation:
• No setup time
• No need for expensive additional hardware
or special needles
• Simple on/off functionality
• Perfect for point-of-care procedures
Physicians involved in early evaluations call this a significant step
Dr. David Auyong
Staff Anaesthesiologist forward in visualising the needle. To see what they have to say, go to
Seattle, WA www.sonosite.com/needle
Saphenous nerve block
OFF
World leader and specialist in hand-carried ultrasound.
Saphenous nerve block
SonoSite Ltd
European Headquarters
Alexander House, 40A Wilbury Way, Hitchin, Herts SG4 0AP, United Kingdom
ON
Tel: [phone] Fax: [phone] E-mail: [email protected]
www.sonosite.com/needle
2 Anaesthesia News September 2010 Issue 277
©2010 SonoSite, Inc. All rights reserved. Specifications are subject to change. MKT02106 06/10
0742_MKT02106_UK Anaesthesiology Ad for AN v1.indd 1 24/06/2010 15:01
Editorial
September is a sort of ‘cusp’ month – in September; replacing myself (I remain
not quite summer, not quite Autumn, as a co-opted member of Advisory whilst I
but definitely ‘back to school’ and the am editor of this estimable rag), Drs Ranjit
new academic year. Dr Dick Birks will Verma (moving onwards to RCoA Council –
hand over the Presidency of the AAGBI congratulations Ranjit) and Andrew Hartle.
to Dr Iain Wilson, and Dr Les Gemmell I have really enjoyed my time as an AAGBI
(Hon Sec) will hand over to Dr Andrew Council member and leave (as an elected
Hartle at this year’s Annual Conference member) with the sense that I have been
in Harrogate. Dick and Les have done a able to make a difference in the areas in really felt till then. I think the passing of
good job, helping to steer your Association which I have worked; I hope that our new one of our number, or of those who have
though tricky financial times (see our Hon members will be empowered to achieve in made a contribution to our specialty, is
Treasurer’s report), and taking a firm stand their turn. worthy of note, and so I make no apology
on threats to our professionalism such as for including two obituaries in this edition
the difficulties with SPA time and relations I was forcefully reminded of the relentless of Anaesthesia News. They celebrate the
with insurance companies; I wish them turn of the wheel yesterday; I opened lives of two very different men, but I think
all the best for the future and welcome a set of patient’s notes to review an old both make interesting reading. I would be
our new President and Hon Sec. We also anaesthetic chart. The chart had been prepared to include obituaries in future
welcome three new council members , Drs meticulously written in Ed Charlton’s very editions of Anaesthesia News; though in
Abhiram Mallick, Samantha Shinde and recognisable hand; it came home to me due course (when the current update of our
Sean Tighe who will also take up their posts that he has gone in a way that I had not website is complete) I would anticipate that
Contents
The Association of Anaesthetists
of Great Britain and Ireland
21 Portland Place, London W1B 1PY
Telephone: [phone]
Fax: [phone]
Email: [email protected]
03 Editorial 21 Obituary - Dr Michael Slazenger
Website: www.aagbi.org
05 Annual update from the Honorary Treasurer 22 Obituary - Sir Cecil Clothier, KCB, QC Anaesthesia News
Editor: Val Bythell
08 Breathing system obstruction - a cautionary 23 Clinical Excellence Awards Assistant Editors: Kate Mccombe (GAT),
tale Isabeau Walker and Felicity Plaat
24 Anaesthesia Training and the Internet: Address for all correspondence,
advertising or submissions:
10 History Page - The early days of anaesthetic Updating the SESA website
E mail: [email protected]
nurses Website: www.aagbi.org/publications/
27 Your Letters
anaesthesianews
12 The Challenges in Setting up a Regional
Anaesthesia Workshop in Tanzania 30 Particles Design: Amanda McCormick
McCormick Creative Ltd,
32 Victor Telephone: [phone]
16 GAT - Report from Cardiff
Email: [email protected]
Printing: C.O.S Printers PTE Ltd –
Singapore
Email: [email protected]
9 17 32
Copyright 2010 The Association of
Anaesthetists of Great Britain and Ireland
The Association cannot be responsible for
the statements or views of the contributors.
No part of this newsletter may be
reproduced without prior permission.
Advertisements are accepted in good faith.
Readers are reminded that Anaesthesia
News cannot be held responsible in
12 any way for the quality or correctness
of products or services offered in
advertisements.
AAnnaaeesstthheessiiaa NNeewwss SSeepptteemmbbeerr 22001100 IIssssuuee 227777 33
these would be best placed on our website, A colleague (it seemed best for this piece problem resolved rapidly when I deflated
with perhaps an edited notice in the print to appear anonymously) describes their the cuff. My dislike of reinforced tubes
version. I would be interested to hear your experience of a near miss due to a blocked persists (irrationally) to this day. It may be
views on this. circuit on page 8. Blocked breathing circuits that the relative infrequency of such events
have always been a hazard in anaesthesia these days has led to a lack of awareness
The front cover of July’s Anaesthesia News
but I guess the causes have changed over of the problem, and I must say that I had
generated some adverse comments (see
time. In my youth, kinking of rubber thought (until I read this article) that the
letters); I am working on a better solution,
tubes and cuff herniation were relatively fact that so many elements of the breathing
but meanwhile would be delighted to
commonplace, and I have resorted to use system are transparent would mean that
receive any images* from readers for use
of the adage ‘if in doubt take it out’ on a visual inspection would detect ‘foreign
on the front cover. What do you want our
numerous occasions for these problems. I bodies’. Perhaps the old adage needs an
newsletter to look like?
particularly recall an unpleasant incident appendix – ‘if in doubt, take it out and use
during a carotid endarterectomy. A bit of a self-inflating bag and mask’. That leaves a
I haven’t received any comment about the
‘wheezing’ progressed rapidly to complete discussion about what exactly should lead
paper on which Anaesthesia News is printed
airway obstruction. The (very senior) to ‘doubt’ for another day...
– we have changed (from July 2010) to
surgeon had just reached a delicate point
lighter weight paper in order to reduce the
Hope to see you in Harrogate!
of the procedure. When I asked him to stop
carbon cost; we are continuing to look at
so that I could get at the airway (the head
other ways of reducing our carbon footprint Val Bythell
was wrapped in a towel) there was a bit of
further in future (both at Anaesthesia News
a frank exchange of views. The cuff of an *Images need to be free from copyright,
and across the Association).
old-fashioned latex re-inforced tube had to have the appropriate permissions and
herniated over the end of the tube, so the should be 300dpi at A4 size.
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4 Anaesthesia News September 2010 Issue 277
AnnuAl updAtE from thE
September heralds the approach of the 2008-09 was a turbulent year in the stock local support in “taking the meetings to the
Honorary Treasurer
Annual Members’ meeting (to be held at the market and we, along with the majority members” and is regularly oversubscribed.
Annual Congress in Harrogate), and hence of investors, took a “hit” in terms of our AAGBI meetings are remarkable value for
the end of my first year in office as Honorary investments. Despite the general downward money when compared to those of many
Treasurer. Although the time seems to have trend in the stock market it was felt that our comparable organisations and I encourage
just flown past, it has been a fascinating investment managers were not performing you all to continue supporting them.
twelve months, complicated by the ongoing as well as we would have wished and so
All of these sources of income have allowed
recession and unpredictability of the stock we took the carefully considered step of
market combined with structural changes replacing them and we are now delighted us to carry on with our core activities
at the Association. On the gloomy side (it’s to have appointed Williams de Broe to look but there is no time to rest on our laurels.
after our funds. Experts in the investments of Despite the remarkable turnaround with our
always easier to start with the most depressing
charitable organisations, they duly reshaped investments their continuing growth cannot
subjects and progressively “lighten up”) the
our portfolios within our agreed policy and be guaranteed. The recession is likely to
next few years are not going to be easy. The
both portfolios have subsequently shown an persist for some time and it is probable
enormous national debt will affect us all,
astonishing improvement and significantly that the United Kingdom may be one of
both personally through salary freezes, rising
outperformed the benchmarks. Nevertheless, the last of the major economies to recover.
taxation and the likely reduction in funding
despite the encouraging capital growth of The stock market appears misleadingly
of public services, and indirectly through
our investments, the income generated from healthy due to the substantial investment
restrictions in the funding of the NHS. It is
savings is poor. in overseas equities which are flourishing
estimated that the NHS budget deficit will
and many of those economies (particularly
be approximately £20 billion and so we can Our journal “Anaesthesia” remains as well those of the Pacific rim countries) are already
expect increasing scrutiny, from both the read and cited as ever and royalties from well on their way to recovery. The current
public and politicians, over value for money advertisements and reprints have seen a weakness of the pound only serves to further
in the current system, and pressures from our sudden rise this year making a substantial accentuate this.
managers for further efficiency savings and contribution to our income. 21 Portland
improved productivity (dare I mention SPA Place has proven to be a popular venue The AAGBI has always enjoyed an excellent
time?) are inevitable. for meetings in central London and the working relationship with our colleagues from
facilities team at the Association have done the medical equipment and pharmaceutical
On a happier note, however, those of you a tremendous job in marketing our in-house industries and over the years we have been
who have taken time to read the Annual facilities on the days when they are not being extremely fortunate to benefit from their
Report and Audited Accounts of the utilised by our members. Despite restrictions sponsorship of our events and involvement
Association and Foundation (http://www. on study leave and budgets (a concern with our building. Regrettably they, also,
aagbi.org/publications/annualreports.htm) expressed by all membership groups) the are not immune to the effects of the global
will appreciate that our current financial last year has been one of the most successful economy as their budgets progressively
status is far from catastrophic and we remain ever in the AAGBI’s Education Programme tighten and several have chosen to merge
on a secure footing. This is due to a variety and we are grateful to Richard Griffiths and in a quest for greater efficiency. Whilst this
of factors, not least of which is our ever his team for organising such high quality relationship between us is likely to continue,
increasing membership as we continue to meetings. Of particular note is the popularity the funds available to us will inevitably
expand beyond the 10,000 mark. of the “Core Topics” series which attracts diminish and we have already seen an effect
Anaesthesia News September 2010 Issue 277 5
of this in the withdrawal of sponsorship from Their alternative approach has now which they might give. To complicate
the GAT Annual Meeting. The last few years developed into a strategic plan involving matters further, several Council members
have seen a rapid expansion in the number ‘corporate patrons’ and ‘commercial and had employed Cavendish as their personal
of specialist societies in anaesthesia and we professional partnerships’. Not only is a financial advisors through their contact
have always been keen to welcome them substantial income generated but there are at Annual Congress, seminars and in
into the Association and provide them with also associated benefits to the society’s Anaesthesia News and although none had
secretarial support and specialist services members. For example, a large airline received any additional benefits a conflict of
when required. The vast majority of members company offers a personalised booking interests clearly existed. One could argue
of these societies are also members of the service, 20% discount on published fares that the best possible recommendation
AAGBI so it is only appropriate that we offer and, frequently, a cabin class upgrade. A
to the Association would be that Council
them such assistance but it is possible that quality car manufacturer provides a small
members were delighted with the services
this expansion may eventually cause us to fleet of cars for the duration of each of the
provided but not all would see it that way!
outgrow our current premises. It is only 8 society’s scientific meetings, to be used at the
The upshot of this was that it was agreed
years since we moved into Portland Place discretion of the society, an extended loan of
that Cavendish should continue providing
and we have no immediate intention to a chosen model of car for a comprehensive
these services for a trial period but that all
relocate but we must always look forward test drive delivered to the member’s door,
financial benefits should be directed to the
and prepare for such eventualities. and should he (or she) choose to purchase
members rather than the Association itself
it, a guaranteed “best price” agreement.
Council of the Association is ever aware and all AAGBI members are now entitled
There are also partnerships with a variety
of the financial pressures on its members, to a free “Financial Advice Helpline”,
of banks, independent financial advisors,
principally the escalating costs of many substantial discounts off their standard fees,
insurance companies and solicitors all
of the professional organisations, and we access to “Financial Planning/Planning for
offering benefits to members.
strive to keep our annual subscriptions to a Retirement“ seminars along with many
minimum. We are therefore delighted that For some time now the AAGBI has enjoyed other benefits from Cavendish Medical.
we have managed to freeze our subscription a close working relationship with Cavendish
Whilst it is always gratifying to provide
rates for 2010-11. To maintain this, however, Medical Ltd., Independent Financial
services for members, we are well aware
we are always looking for new sources Advisors, whose articles on financial advice
that we are in a rapidly changing financial
of external income for without this the for anaesthetists have occasionally been
climate and we must keep exploring all
burden falls upon the members. In order published in Anaesthesia News. Cavendish
avenues. We are fortunate in having a large
to continue with our primary objectives also run a 'Planning for Retirement' session
of patient care and safety, education and at our Annual Congresses and have recently membership base compared with other
research, and representation and support provided brief 'financial advice add-ons' at organisations but there is no doubt that
of our members we need to maintain our the end of some of our seminars. These have delving into the world of partnerships and
strong financial base. Perhaps surprisingly all proved to be popular and informative sponsorships may reduce the burden on
in the current climate there are many to those who attend them with minimal our members. Is this what we are all about?
organisations either involved with, or totally promotion of the company. The proposal Is it unprofessional for an organisation of
unrelated to, medicine who are keen to that Cavendish Medical Ltd. be invited professionals to be seeking support from
be associated with us and who would be to become a ‘Professional Partner’ to the totally unrelated bodies even if substantial
prepared to pay for this privilege. Some AAGBI , by which they would be offered additional benefits are available to the
years ago, a large UK motor manufacturer continuing access to our members, with the members; should we be selective in
requested permission to promote their cars aim of offering financial advice, in return for choosing our patrons and partners or should
by taking a stand in the trade exhibition at an annual partnership fee, was discussed we just be happy to accept donations from
our Annual Scientific Meeting. At the time at some length by Council in early 2010. any reputable company that is keen to be
it was felt that this was unprofessional and It was finally decided, however, that it associated with us? Council is elected to
we should only allow companies allied to would be irregular to select one particular represent and support the members and
medicine to exhibit there, so the request company out of the multitude specialising is always happy to hear their views and
was refused. At the same time our sister in this field as it could be perceived that act upon them. If you have any strong
organisations (such as the ASGBI) were we were assuring their quality and integrity views on this matter please contact us at
taking a different approach by exhibiting a over and above that of their competitors [email protected] or, alternatively,
variety of goods totally unrelated to medical when we had insufficient evidence to do
air them in the next issue of Anaesthesia
products but which they believed would be this, and it was also conceivable that, as
News.
of interest to the delegates - high quality a consequence of our financial gain, we
designer menswear being one example. would be held responsible for any advice ian Johnston
6 Anaesthesia News September 2010 Issue 277
The Anaesthetists
Agency
safe locum anaesthesia,
throughout the UK
Freephone: 0800 830 930
Tel: [phone]
Fax: [phone]
Freepost (SO3417), Lymington,
Hampshire SO41 9ZY
email: [email protected]
www.TheAnaesthetistsAgency.com
Anaesthesia News September 2010 Issue 277 7
Breathing system
obstruction:

a cautionary tale
There is a certain justice about anaesthesia. laryngeal mask. I removed the laryngeal of the circuit, the paediatric spirometry
Omit the basic rules and they will come mask and attempted face mask ventilation sensor tubing had been pushed through the
back to bite you. The speed with which a using the same circuit – still no CO trace cellophane wrapper thus coring out a disc
2
routine ENT list can turn into a potentially nor chest movement. My working diagnosis of clear plastic.
fatal ‘near miss’ critical incident is alarming, at this point was laryngospasm. I knew
It has been widely documented that
and something I hope never to experience in something was wrong, this wasn’t anything
anaesthetic breathing circuits can become
my career again. I have learnt many things I’d dealt with before. The possibility of a
obstructed by foreign bodies (1,2,3,4). Our
from this event, both about anaesthesia and blocked circuit crossed my mind. I could not
patient made a full immediate recovery. In
myself. explain how a previously patent anaesthetic
some cases the patient was not so fortunate.
circuit had become completely blocked
I had finished my adult list early, and agreed
without disconnection from the patient and
Basic rule of anaesthesia - always check
to anaesthetise a child for repair of a small
in the absence of anything visibly blocking the patency of all circuits prior to the start
laceration at the end of the list. As usual,
the tubing. I called for help and moved of anaesthesia. A visual check is not enough
the ODA replaced the adult circuits with
down the laryngospasm algorithm in my when an adult circuit is substituted with
equipment suitable for an 18kg child. By
head. Still no chest movement nor CO2 a paediatric one in the middle of a list.
the time I had checked the equipment in
trace. I intubated the patient and a second ‘specific checks should be carried out for
the anaesthetic room, a very tearful child
consultant paediatric anaesthetist arrived. each new patient during a session on any
and anxious mother had arrived. I walked
alteration or addition to a breathing system’
into theatre and did a visual check of the Over the next three quarters of an hour,
(5).
paediatric anaesthetic circuit and changed severe bronchospam, pnemothorax,
the ventilator settings – I had conducted a mediastinal mass were all suspected. Another basic rule of anaesthesia – if
full check of everything at the start of the list. Emergency drugs were administered and a ventilation is difficult use an alternative
needle thoracocentesis performed to try and method of ventilation eg. the Ambubag.
I performed a gas induction – the anxious
resolve the situation. We asked the ODA ‘Ensure that it is directly connected to the
child was less scared of the ‘green balloon’
to change the whole anaesthetic circuit. I ET tube, removing all parts of the existing
than ‘the needle’. I inserted a cannula
became fixated on making a diagnosis, not circuit’ (6).
and a laryngeal mask. The child was easy
dealing with the clinical scenario in the
to ventilate and was now spontaneously I have also learnt that the support of
most sensible way. I had a strong desire to
breathing with normal tidal volumes. colleagues is invaluable, not only during
return to the anaesthetic room where things
the immediate crisis, but in the subsequent
We transferred the child into theatre, had previously been normal. I could not
weeks and months that follow the event.
bringing the Ayres T-piece with us from the rationalize this and when I spoke it seemed
anaesthetic room. I connected the child to the to be lost in the chaos of the situation. I was
anaesthetic machine in theatre via the circle about to go and talk to the child’s parents
system. Spontaneous ventilation continued when it was decided that rigid bronchoscopy 1. Hall C. Staff error, not sabotage, to blame
with a normal capnograph and good tidal should be performed. Prior to this, someone for boy’s death. Daily Telegraph, July 23,
volumes. The wound was cleaned and suggested connecting an Ambubag directly 2002
draped. There was an increase in respiratory to the ET tube - finally the chest moved up 2. Ward M.M., Collins S. J. Another case
rate during cleaning which prompted me and down. Everyone watched as a small disc of obstruction to an anaesthetic circuit. Br J
to give a small dose of fentanyl. As the of cellophane wrapper floated out of the Anaesthesia 2003; 91; 452
opioid took effect, the respiratory drive anaesthetic circuit (now disconnected and
3. Choi J., Cooper G. M. Circuit obstruction.
fell and I gently assisted ventilation. It was lying on the child’s chest). The cellophane
Br J Anaesth 2003; 91; 452
at this point that I felt something unusual, had acted as a flap valve inside the clear
4. Chacon A.C. ,Kuczkowski K.M., Sanchez
an increased resistance to ventilation. I spirometry sensor tubing, and had remained
RA. Unusual case of breathing circuit
changed to the Ayre’s-t and again attempted present despite repeated disconnections and
obstruction; plastic packaging revisited.
positive pressure ventilation which proved reconnections. Unknown to us, every part
Anaesthesiology 2004 100(3); 753
impossible. The situation immediately felt of the circuit had been changed except this
strange, the usual tachycardia and pattern one. How could clear tubing be blocked 5. AAGBI. Checking anaesthetic equipment
of obstructed ventilation with laryngospasm when it appeared to be empty from the (2004)
were absent. There had been no obvious outside? Answer - when blocked with 6. MHRA Medical Devices Alert.
change in a previously well positioned transparent cellophane. During preparation MDA/2010/036 – May 6th 2010
8 Anaesthesia News September 2010 Issue 277
npSA
The leading centre in the delivery of awake upper limb Regional
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Course features:
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The AAGBI have been in The RCOS are also very
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top-level negotiations over a concerned that operating theatre Course Organisers: Dr Adrian Searle, Dr Zahid Sheikh
a nSimmaalll mgrooudpe lwsorkshops with
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the operating theatre. of their consultants and risking Livaen iumltarla msooudneCdlsM blEo cakpsproved 5 points
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sterilization protocols. An Focused lectures
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All delivered by
explained NPSA spokesman concerned a senior surgeon ApploliAccaalltl i doeenxl pifvoeerrrmtesds abnyd more information from:
Terry Cereus. “We have good who announced in theatre Coursloe csaelc erextpaerryt sMrs. Shirley Goddard
evidence from orthopaedic
that he had been able to do a [email protected]
theatres that staff are being
jigsaw marked 5-6 years during Tel. [phone] Sponsored by:-
victimized and finding it Sponsored by:-
the weekend. Apparently Royal Derby Hospital, Anaesthetic Office, Uttoxeter Road,
difficult to concentrate during sniggering from the SHO Derby DE22 3NE
complex surgery.”
in anaesthesia had been
unacceptable, and the scrub
AAGBI has learned from
nurse had barely been able to
contacts in the Incident
maintain sterility due to shaking
Reporting Centre that a number
so much. “An initial delight
of incidents appear to have
in an academic achievement
been generated from a hospital
suitable for the ACCEA CVQ
in the South East of the country.
was turned to derision by a few South West Regional
Reports have also been made to
cynical theatre staff”.
the NPSA by the Royal College Anaesthesia Course
of Orthopaedic Surgeons
The NPSA sees no alternative
(RCOS) explaining that humour
to a ban on all humour in the 1st & 2nd November 2010
involving orthopaedic surgeons
operating theatre, otherwise
Royal Devon & Exeter Hospital, Exeter
and surgery had gone too
it is only a matter of time
far, and was causing a loss of
before a staff member sues
• Popular course with experienced faculty
confidence in the profession.
the financially- depleted
• Upper and lower limb peripheral blocks
NHS. “This will also increase
Senior examiner Mr Harry
safety for patients as staff • Ultrasound & landmark techniques
Thickster explained “Recently
will no longer be smiling but
one of our excellent trainees • Abdominal blocks e.g. T.A.P, Rectus Sheath
concentrating hard. The NHS is
undertaking the exit exam in • Video demonstrations
not about enjoyment after all.”
knee and hip specialist surgery
• Lectures and workshops
caused great confusion to the
The AAGBI have made
• Aimed at anaesthetists in training
examiners by claiming that the
representation to the NPSA
heart was in fact a pump to
about the importance of
deliver cefuroxime to the bones. Cost: £205
humour in the workplace
Apparently he had learned this Register early – strictly limited to 30 participants
but without any success. A
fact in all seriousness from one
frustrated spokesman explained
of the anaesthesia trainees. This For details & application forms visit:
“This is all very well, but who
kind of thing could result in www.sowra.org.uk
are we going to get to help zero
great confusion.” Or email [email protected]
the cerebral function monitor
on ICU?”
Anaesthesia News September 2010 Issue 277 9
history page
The early days of anaesthetic nurses…
Having retired from clinical anaesthesia appears, worked well provided everything
after 37 years at the ‘coal face’ it is good to ran smoothly. If something unexpected
reflect on how the provision of anaesthesia happened, such as an unexpected difficult
has changed over time. airway, then it went pear-shaped very
quickly. For that reason, if the anaesthetist
I started anaesthetic training as a Senior
was uncertain of the patient, the door to the
House Officer at King’s College Hospital
theatre was often left open, or at least ajar,
in London in 1970. The theatres had
so that a cry for help would be heard and
been designed many decades before, and
Theatre Sister could despatch another more
I recollect that each theatre had a very
experienced individual to run in and sort Pethidine ampoules
small room that was used as the induction
us out! Monitoring was not used routinely,
room. It was just possible to accommodate these checks it was necessary to arrive in
and oximetry was not available at all, so
a theatre trolley, a patient, an anaesthetist, theatre at least thirty minutes before the first
many shades of blue to black could be seen
an assistant or student (but rarely both). The patient was called for. One advantage was
in even the best run anaesthetic rooms.
‘anaesthetic helper’ was always a nurse. that the patients for the list were seen at the
What training did this anaesthetic nurse Checking the anaesthetic equipment was latest the night before since all anaesthetic
receive? Usually none, occasionally a few not part of the anaesthetic nurse’s routine. cases were admitted at least one day prior
hours if she was required to help in cardiac The anaesthetic machines (one in theatre to surgery to allow for investigations and
theatre. and one in the anaesthetic room) were clerking by the House Surgeon. In fact it
checked by the anaesthetist without fail was the norm at King’s in the ‘70s for the
I once asked how the anaesthetic nurse was
at the start of the list; all were cylinder House Surgeon to call the anaesthetist to
chosen from the ranks of the theatre staff,
machines as we had no piped oxygen, so tell him about the patients on the next day’s
and was told that the anaesthetic nurse was
that meant four cylinders on all machines list so the anaesthetist could prioritise his
generally the least experienced student
to be checked. We used a Bosun oxygen preoperative visits to see the sicker or older
nurse in the theatre team, as she couldn’t
patients first.
do anything anywhere else. Her assigned
duties were the traditional nursing duties When I began my anaesthetic training
of being kind to the patient, receiving in 1970, glass syringes, which had
handover from the ward nurse, acting as a certainly been the standard when I was a
chaperone if required, fetching and carrying student five years earlier, had now been
and generally assisting the anaesthetist, and phased out in favour of disposable plastic
clearing up the mess made by the doctor ones. The drugs were drawn up before
induction; thiopentone or less commonly
after the patient had gone into the theatre
This illustration of a
proper. Bosun's whistle is taken methohexitone, an analgesic, generally
from the AAGBI's Heritage
pethidine or morphine, and any relaxant
Collection
I soon learnt that before the patient arrived
deemed suitable, suxamethonium for
at the start of a list it was worth quizzing failure alarm that depended on the cylinder
intubation followed by tubocurare or
the anaesthetic nurse as to her previous pressures opposing each other, so that if the
gallamine for maintenance. A suitable
knowledge and experience, as otherwise oxygen pressure went down it opened the
range of ETTs was also prepared as were
a request for a ‘catheter mount’ could be system to air and blew the nitrous oxide
two laryngoscopes as the bulbs were very
met with a very blank look at a vital stage across a whistle giving an audible alarm.
prone to failure. The ‘Liverpool technique’
of induction. Drawing up drugs was very
Checking equipment also included all the had taken hold at Kings then and most
properly NOT part of the helper’s role, but
laryngoscopes and red rubber endotracheal paralysed patients received no additional
holding the controlled drug (CD) cupboard tubes (ETTs) which might be required for volatile agent.
key was, even though technically illegal,
the list, and that included testing the cuffs
If endotracheal intubation was not
as it required a state registered nurse to
that were likely to show wear after a few
deemed necessary, a Guedel airway was
sign the register and be responsible for the
autoclavings. In order to complete all
inserted and spontaneous breathing was
safety of the CDs. The system, ad hoc as it
10 Anaesthesia News September 2010 Issue 277
Anaesthesia News September 2010 Issue 277 10