AAGBI WSM 2015

Summary of the first day at the 2015 Winter Scientific Meeting. The full programme of the meeting can be found here.

This is a summary (with references) of the talks I was able to attend.

LV Assessment and its Pitfalls. Dr Jim Newton, Oxford

  • EF correlates with postoperative mortality; < 35% sees big increases in mortality.
  • Best assessment of EF is radionuclide assessment but toxic. 2D assessment not very accurate. 3D volumetric echo or cross-sectional methods (e.g. MRI) much better.
  • TTE 2D via M-mode assessment basically hopeless and only measures a fraction of the whole cardiac cycle.
  • Large intraobserver variation with all methods of EF measurement – often up to 16% variation in EF!
  • 3D Echo is much better and correlates with cardiac MRI.
  • What we really need is a global measure of cardiac function. Myocardial performance index (MPI) via Doppler measures global ventricular function: abnormal if >0.4. Independent of HR, valvular disease, preload and afterload.
  • Almost impossible to assess EF in the presence of AF; might as well pluck a number at random!!
  • Take home message; beware the EF numbers and review the qualitative assessment (ie what the operators impression of the ventricular function was).

The Very Obese Patient. Dr Martin Dresner, Leeds

  • Pre-op screen for OSA via STOP-BANG (high-risk 5-8); often not possible to optimise with CPAP etc due to urgency of surgery.
  • Forearm cuff for DINAMAP helpful with bingo-wings, but tends to overread.
  • Ramping for pre-O2 either with Oxford pillow or lots of pillows! Ensure ear level with sternum.
  • Obesity not a predictor in itself for difficult intubation. Look at the patient’s head; don’t get distracted by the adiposity!\
  • Start to gently bag ASAP; if easy, relax. If difficult BVM then start intubation ASAP. You have no FRC so time is short…
  • Use lean body weight for everything apart from sux & reversal (90 kg for men, 70 kg for women)
  • SAB Issues: start feeling at the thoracic spine (which is always palpable) and work down.

Preoperative fasting – What’s the issue? Dr Ian Smith, Stoke-on-Trent

  • Many guidelines on the fasting but all agree that 6 h for solids and 2 h for clear fluids, but lots of grey areas.
  • Drinking fluids 2 h prior to anaesthesia actually decreases gastric volumes but anaesthetic departments still being conservative i.e. NBM from midnight.
  • Most patients are actually NMB for longer than 2 h (8-21 h). Due to lack of instructions, lack of understanding or the fact that all instructions are based on the start of the list time (not individual time of surgery).
  • Patients who drink 2 h pre-op are less thirsty, less anxious, reduced PONV, and have improved recovery…

Getting patient feedback for your appraisal. Dr Liz McGrady, Glasgow

  • GMC do not specify a minimum number of patient feedback returns, but expect 15-30 to be achievable.
  • Patient feedback assesses communication skills, ability to inspire trust and inclusion of patient in decision-making process. Not a measure of patient satisfaction.
  • Form must be GMC approved. Should be a random selection of patients, should be distributed by a third party and collected anonymously and collated by a third party. Should reflect your whole practice.
  • Optimum time to collect feedback is after pre-operative consultation. Make sure the patients know who there anaesthetist was! Perhaps we need a photograph on the form to make sure that the patient isn’t given feedback about the porter!!
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Update on the Management of Acute Spinal Cord Injury

This is a copy of the slides I used during a talk I gave at the 2015 Winter Scientific Meeting organised by the AAGBI. The full programme of the meeting can be found here.

The talk was designed to provide an update for anaesthetists in the management of acute spinal cord injury, with a particular focus on cervical spine trauma. I have focused particularly on the evidence (or lack of it) relating to spinal immobilisation techniques and how to safely undertake tracheal intubation in the patient who has proven, or suspected, cervical spine instability.

The pdf of my presentation can be downloaded by clicking the link below:

SCI Update AAGBI WSM 2015 Handout