No.27 June 2008
NEWSLETTER OF THE ASSOCIATION OF CARDIOTHORACIC ANAESTHETISTS
Association of Cardiothoracic Anaesthetists
24th Autumn Meeting, The City Hall, Cardiff
H ow whim comes to fruition. It seemed
to such a long time ago that I persuaded
my colleagues that we should host the autumn
ACTA meeting 2007 in Cardiff. It was even
worse folly that following the Cambridge
Spring ACTA meeting, I agreed that it would be
even better if we hosted a Thoracic/Upper GI
day before the Cardiac ACTA.
I n the planning, we had to overcome a few
hurdles including two of our speakers
pulling out of the meeting for various reasons,
our named contact for delegates’ registration
etc leaving the anaesthetic department and
then to top it off, the postal strike.Thus it was
with a leap of faith and our fingers tightly
crossed that we found ourselves hosting a
two-day meeting in Cardiff City Hall.
Cardiff City Hall. Entry to fair not included in registration fee.
Upper Gastrointestinal & Thoracic Anaesthesia
Thursday 15th November 2007
M y eternal gratitude goes to Dr Barbara
Bahaman (our Upper GI Consultant
Anaesthetist Colleague) whose strength,
talk on cardiac output monitoring during one-
lung anaesthesia followed by the presentation
of the Japanese experience in lung isolation
enthusiasm and continued optimism ensured techniques by Dr T Asai.
that we secured the appropriate speakers and
equipment for the first day.
T hree upper GI surgeons Mr G Clark, Mr
W Lewis and Mr S Wajeed took up the Drs Martin Breutsche (left), Denny Levett (centre)
and Barbara Bahlmann (right).
O n the morning of the 15th, 141
colleagues and I settled in for what were
hopefully informative presentations, workshops
early afternoon session giving us an insight into
their own practices and the implications for
their upper GI anaesthetic colleagues. The late workshops (LIT). My colleagues Drs Rob Abel,
and good food. In the early morning session Dr afternoon session had pain after thoracotomy Barbara Bahlmann, S Balachandran, K
Denny Levett, of the University College as the theme with very interesting Karthikeyan, Iliaz Hodzovic, D PLACE, Ash
London Hospitals recalled her experience of presentations from Dr Ng from The Heart and Wagle and Mike Gilbert effectively facilitated
Cardiopulmonary Exercise Testing at altitude Lung Centre,Wolverhampton UK and our own the LIT workshop. I am grateful to Nick
on Everest and Dr M Brutsche of Basel colleague Dr S Khot. Chapman of Medical Graphics for providing the
provided a variety of informative details of hardware for the CPX workshop and to Drs
cardiopulmonary exercise testing and its
clinical application Dr D Reuter from the
Ludwig Maximilians University Munich gave a
T wo of the major successes of the day
were the Cardiopulmonary Exercise
Testing (CPX) and Lung Isolation Techniques
Denny Levett and Martin Breutsche for
interpreting the data and engaging the audience
Cardiac Anaesthesia / Cardiac Intensive Care
Friday 16th November 2007
Dr Duncan Wyncoll of St. Thomas’ Hospital,
London, in the early afternoon session gave us
an insight in the use of levosmendan followed
by an enlightening presentation from Dr
Zaheer Yousef (UHW) into perioperative
The meeting was finally coming to a close and
it was with a huge sense of relief that I listened
to the final presentation by Dr Albert T Cheung
from the University of Pennsylvania,
Philadelphia, on the management of
postoperative hypertension. Though he had an
unenviable task of delivering the final lecture to
a flagging audience, he did it with the required
enthusiastic panache. Dr Judith Hall presented
the prizes for the best paper and poster. Finally
having closed the meeting I looked forward to
the dinner at the National Museum of Wales.
Audience at the Cardiac Anaesthesia/Intensive Care meeting.
One hundred and fifty two attendees were to
have an early start on the Friday though all did
not pitch up at 08:30. Dr Judith Hall who kept
the seven presenters to time masterfully
chaired the first session, dedicated to the free
paper presentations. Concurrently there were
15 poster presentations, each of them manned
by the appropriate authors to answer any
After coffee Dr Yoanna Skrobik an intensivist
from Université de Montréal, Canada,
gave an excellent thought provoking
presentation on delirium in the ICU Patient
followed by Dr Harry Van Wezel and Dr
Dietrick Gommers both from the Netherlands
who spoke about metabolic modulation and
the open lung concept in cardiac surgical
John Dunne relaxing at the reception before dinner in the National Museum of Wales.
After a lunch we had a very enthusiastic debate
on the motion; “Cardiac anaesthetists should and Dr Chris Aps spoke against the motion I am grateful to all my colleagues in organising
look after the cardiac surgical patient from while Dr Julian Barker and yours truly spoke such a successful meeting, Dr Christine Tan for
admission to discharge from the Intensive for the motion. Dr Jack Parry Jones very ably designing the flyers for the meeting, Dave Place
Care”. The debate, while offering little towards defended his position though on occasions he and Arun Kumar for ensuring their circulation,
inter-speciality harmony, was in equal measure may have felt that he had entered a lions’ den. Drs S Balachandran, C Tan, Rafail Baraz and K
entertaining, topical and well informed. Dr Jack However in the end the majority of the Karthikeyan for being the official
Parry Jones (our General Intensivist Colleague) delegates voted in favour of the motion. photographers. My thanks also to the Emma
Davies and Juliet Lanchbury and Anne
Leneghan for manning the registration desk. I
would also like to acknowledge the individual
contribution of Dr Rob Abel whose total
attention to detail and military precision in the
organisation of ACTA autumn meeting ensured
its financial success.
In conclusion I would like to thank the
secretarial staff of the anaesthetic department
for all their hard work, the exhibitors and
sponsors who supported the meeting and
finally the delegates for attending.
Drs Judith Hall and Justiaan Swanevelder judging Dr Chris Aps speaking against the motion.
CHAIRMAN’S Report EACTA
Whilst preparing to write this report I jotted ACTA were pleased to receive a number of high Message for ACTA members with a current
down on a piece of paper those areas of ACTA quality applications for research monies for the linked ACTA-EACTA subscription
activity I felt needed mentioning. Having got 2007 round of awards. Committee members
Most ACTA members with linked EACTA
more than half way down the page with these have scored the applications and will meet
subscriptions will be aware that EACTA
notes, I realised what a busy six-months the shortly to decide where the money will go.The
changed to the North American Red
Association has had and the myriad of activities difficulties in initiating and delivering high quality
Elsevier ‘Journal of Cardiothoracic &
in which we are currently involved. local research projects have been identified in
many circles. The committee have received a Vascular Anesthesia’ (JCVA) in 2008. In lieu
November 2007 saw the annual round of proposal for establishing an ACTA research of missing 18 months EJA, Marco Ranucci
committee changes. Sean Bennett and David network – similar to that of the ICS- to (EACTA President) agreed to supply
Smith left after two terms on committee facilitate multi-centre cardiothoracic EACTA-ACTA members with the bimonthly
making way for Alistair MacFie from Glasgow anaesthesia and ICU research projects across JCVA until December 2008 without charge.
and Ravi Gill from Southampton. It goes without the UK. At a higher level, the National Institute In return, ACTA agreed to move the next
saying that both Sean and David have made for Academic Anaesthesia which is a recently collection date of both ACTA and EACTA
enormous contributions to ACTA during their established joint venture between the Royal subs back from May to November 2008 to
time in office and we wish them both well in College of Anaesthetists and the AAGBI, has synchronize subscription years and facilitate
their future roles with EACTA. We welcome approached us to become involved in cross sub- bulk ordering of JCVA on a calendar year
Alistair as Secretary with responsibilities for specialty collaborative research.We are keen to basis. The good news is that - as well as
thoracic issues and Ravi as Meetings Secretary support any ventures that help in advancing the getting a more relevant journal - your
with responsibilities for paediatric issues. role of cardiothoracic academic anaesthesia and EACTA subscription has been extended to
Alistair’s first major task has been to identify, will be seeking to optimise and develop the the end of 2008 without charge.
with our solicitors whether or not we are research capabilities for all our members in
compliant with the regulations introduced The bad news is that EACTA have
developing these initiatives.
under the Charities Act 2008/Companies Act withdrawn the block discounted rate
2006 which come into law in April and if not In conversation with an ACTA member at a formerly given to ACTA and increased the
what steps we need to take to ensure our recent meeting I was asked whether ACTA linked annual subscription from 75 to 100
compliance. could set up a page on the website which could euros. Because the euro has also
form a portal for access to the plethora of significantly strengthened against the pound
The committee year began with news of the cardiothoracic guidelines currently available. I in the past year, we will probably need to
suspension and subsequent withdrawal of have asked Pete Alston to look into the collect £75-80 per linked EACTA
Aprotinin -aside from on a named patient basis feasibility of setting up and maintaining this subscription in November 2008. I will
- resulting from adverse outcome reports in the facility and would welcome comment from email the exact amount in early autumn.
BART trial. The news was met with mixed members on what content should be included.
feelings by ACTA members and we await Even with the increase, the annual EACTA
further analysis before making any revised Following on from the successful ACTA meeting subscription represents excellent value and
position statement upon its use. in Cardiff last November- thanks to John Dunne is still considerably cheaper than a ‘stand
and the organising Committee- many ACTA alone’ JCVA subscription. EACTA have
ACTA are presently involved with the members managed (selflessly) to make the long also asked me to advertise that they still
Department of Health in a number of projects journey to the ACTA/EACTA sponsored offer a discounted three year 250 Euro
and initiatives involving cardiothoracic practice. Cardiovascular and Thoracic Anaesthesia subscription rate to individuals who pay
Donna Greenhalgh and David Smith represent Seminar in South Africa. The South African EACTA directly via www.eacta.org
us on a working party advising on perfusionist meeting - a satellite to the World Congress in
prescribing, following on from a recent highly All ACTA members who paid an additional
Cape Town - was largely organised by a UK
publicised adverse incident in this area. ACTA’s EACTA subscription last May, should already
contingent of expatriate South African cardiac
view – along with others- is that their needs to have received the February edition of JCVA.
anaesthetists ably led by Justiaan Swanevelder
be statutory legislation on this rather than local Please email me ASAP if you have not yet
and more than matched expectations in all
individual agreements, as currently proposed by received a copy of JCVA this year. Please
aspects of its delivery.
the Department of Health. also email me before October if you do not
ACTA now look forward to the Spring round of wish to renew your linked EACTA
John McKay and I have joined the steering group meetings that will be held in London. ACTA subscription for 2009.
of the National Cardiothoracic Benchmarking Echo 2008 hosted by St George’s Hospital and
Collaborative, this organisation which produced A message for ACTA members without a
organised by Nick Fletcher takes place on
its first report in 2007, aims to audit/benchmark 2008-linked EACTA subscription. If you
Thursday June 5th followed on the Friday by the
national service delivery. Although the initial want to set up a 2009-linked EACTA
25th ACTA Spring Meeting hosted by the Heart
dataset is largely composed of demographic subscription - that is prefer the
Hospital, organised by Mathew Barnard and
data the wider remit is to extend this over time convenience of ACTA collecting both
which continues the wild life theme of South
to quality of care data acquisition, by the subscriptions together in November to
Africa in taking place at London Zoo.
incorporation of established audit activity from two separate direct payments - then
SCTS, BCIS etc. This initiative, which has been Should you wish to comment upon any of the please email me before October to allow
driven by a collaboration of specialty managers topics or issues raised in this piece or any other time for your direct debit instruction to be
is a potential portal for the collection of ACTA related issues please e-mail your amended.
cardiothoracic anaesthetic related data. ACTA comments to our ACTA administrator at the
are further involved with the DH Cardiac RCoA. I look forward to seeing you in London. Jon Mackay
Workforce Review Team the first meeting of ACTA Membership Secretary
which is scheduled to take place in late spring. J-P van Besouw, ACTA Chairman firstname.lastname@example.org
Training in TOE as an Anaesthetic Specialist Registrar
the 20 standard perioperative views and study leave afternoon once a week to
started reading about the Doppler principle, continue to attend the outpatient TOE clinics.
the continuity equation and how Bernouille This enabled me to continue to build my
had been modified. My logbook of cases began logbook numbers, whilst maintaining the skill
to grow at a rate of fifteen to twenty a of performing TOE. Another six months and I
month. One afternoon a week, a TOE had completed 125 logbook cases. I was
outpatient clinic is run by a consultant cardiac delighted to submit my logbook shortly after
anaesthetist so I was also able to learn the that. Much to my surprise, the recent changes
technique on awake patients, using lidocaine in the system for marking of logbooks meant
throat spray alone in most cases. that my completed logbook was returned to
me just three months after submitting it. I was
realised that it would be in my own very pleased to have passed.
Dr Alison Parnell in TOE action.
I interests to sit the recently developed UK
BSE/ACTA TOE Accreditation examination as am just coming to the end of another six-
had decided that Cardiothoracic soon as possible, in the desire to never have I month post as a Senior Clinical Fellow in
I Anaesthesia was my career intention by
the end of my first three-month module in
any more exams to sit! A consultant colleague
was also planning to sit the exam at the end
Cardiothoracic Anaesthesia at the Glenfield
Hospital in Leicester and have continued to
the speciality, during my second year as a of October 2006, so we tested each other maintain and improve my TOE skills. One of
Specialist Registrar on the Sheffield (North regularly and benefited from the frequent TOE the challenges of being a rotating Anaesthetic
Trent) Anaesthetic rotation. It rapidly became meetings in the department. Our hard work SpR is that maintaining and furthering ones
apparent to me that the role of paid off and we both passed the written skills in TOE can be difficult whilst based in
transoesophageal echocardiography (TOE) in examination. district general hospitals, or whilst working in
cardiac theatres was permanent; therefore I specialities based in hospitals where there is
n the latter part of the six-month block in no cardiac unit. However, I would strongly
needed to get going on learning the technique
as soon as possible if I wanted a consultant I cardiothoracic anaesthesia, I made a
conscious effort to concentrate on my
encourage trainees interested in cardiac
anaesthesia to start reading and learning
post in a few years time.
anaesthetic skills, beginning to perform cases about TOE as soon as possible.Try not to be
requested a six-month block at the with more distant supervision and doing put off by the fact that still rotating as a SpR
I Northern General Hospital in
cardiothoracic anaesthesia in my third year as
thoracic lists more regularly. I managed to
maintain performing TOEs also, so that by the
could make this difficult – there are ways and
means! Proficiency in TOE will undoubtedly
a SpR. From day one, I was immersed into time I finished the six-month block I had play an important part of achieving a
TOE, both the practical and theoretical sides. I performed and reported nearly 80 cases, well consultant post in the future.
was fortunate to have intensive teaching from over half of that required for the logbook
four of the cardiac anaesthetic consultants in submission. Dr Alison Parnell, FRCA
our department that perform TOE regularly. I SpR Anaesthesia, Sheffield.
then rotated out to a district general
am indebted to them for their time and
patience. I began by learning how to acquire I hospital for six months. I was granted a
ACTA Echo 2008
Thursday 4th June 2008
Royal Society of Medicine, London.
For more information, look-up
Editorial http://www.actaecho.com or contact Nick
Fletcher at St Georges Hospital, London.
Editing this issue has been given us an interesting account of Email: Nick.Fletcher@stgeorges.nhs.uk
very gratifying for me as there has been a experiences training in TOE. I am keen to 25th Spring Meeting - ACTA
lot of copy to edit in addition to regular read more accounts of trainees’ London Heart Hospital
Friday 5th June 2008,
reports from the office bearers.We are experiences so please encourage them to London Zoo.
have excellent report from John Dunne on submit articles that are relevant to ACTA For more details look-up
ACTA’s Autumn meetings in Cardiff and News. Sean Bennett has provided a report www.acta2008.org or contact
Dr Matthew Barnard
well as meeting reports from a lot further on the Educational Award from ACTA. Sadly,
ACTA 2008, Department of Anaesthesia,
away in South Africa.There is has been Wynne Aveling has provided us with an The Heart Hospital, 16 - 18 Westmoreland
many photographs submitted for this issue obituary for Bill Pallister - a well-known Street, London.W1G 8PH
and many of which have not been published ACTA member. Please all continue to Tel: 0800 3213005, Fax: 020 87470995
because of lack of space. In particular, consider writing articles that you think
Christine Tan did an excellent job recording might be of interest to members for ACTA 25th Autumn Meeting of ACTA
Friday 14th November
the Cardiff meetings. Photographs greatly News.
Royal Hall, Harrogate.
add to the written material so if you have For more details, contact Dr Michael
any that you think might of interest to R Peter Alston Cross, Department of Anaesthesia, Leeds
General Infirmary, Great George Street,
members, please send them in with email@example.com
Leeds. LS1 3EX. Email:
appropriate captions. Dr Alison Parnell has firstname.lastname@example.org
ECHO NEWS Prescribing by
Since the last newsletter there has been a the Friday night and is well recommended to As some of you are aware an unusual
couple of echo meetings.The first was the members. situation has arisen with the perfusionists. It
TOE Sub-committee where provision of has come to light following an incident with
courses was discussed. Although anaesthetists Niall O’Keefe, Justiaan Swanevelder, Henry too much calcium in the prime, that they, as a
still make the up the majority of course Skinner and Mr Tom Spyt participated in a profession are not legally allowed to
delegates, there are also around 20% TOE workshop at the annual meeting of the prescribe or give drugs. A working party has
intensivists, 7.6% cardiologists and 6.7% Society of Cardiothoracic surgeons in been set up by the Department of Health
surgeons. Consequently many courses are Edinburgh, in March.This was well received (DoH) to look into this issue and hopefully
altering their emphasis according to the mix and a good session.The surgeons are keen to prevent any further incidents.The working
of their delegates.There is a lot of discussion have joint meetings with the cardiothoracic party consists of DoH officials chaired by
about training of intensivists in Echo. anaesthetists and in my opinion, a good Professor Roger Boyle and Professor Sue
Echocardiography only being a part - all be it direction to go. Hill, two surgeons, two perfusionists, two
an important part - of the general use of echo anaesthetists and NHS employment
in critical care as it is used for central lines, One of the highlights this year was the World representatives.
abdominal examinations etc. In Europe, Congress of Anaesthesiology in Cape Town, One way to overcome this problem is to
Dr Eric Sloth has shown that FATE (Focused South Africa, which was preceded by the regulate the perfusionists as a profession, for
Assessed Transthoracic Examinations) is a satellite meeting in Kapama game reserve. which they as a professional group have been
useful screening tool and easily applied with As part of the World Congress there was an lobbying since 2003.This would put them
minimal training. However, there is concern Echo workshop, which ran for two days and into a category along with nurses and ODP’s.
over conditions being missed, so it is was then repeated on the following two days. However, the DoH are reluctant to do this
important that a member of the team has This was organised by Justiaan Swanevelder, separately and wish to do this with the other
further training and accreditation to provide Henry Skinner and Johan Bence, who all put medical science groups; e.g. clinical
back up. Different levels of competency may in an enormous amount of work to make this physiologists. However, it is possible to
be the end result. It is important to note that a successful part of the whole meeting. Apart regulate professions separately, as they did
this is still under discussion and nothing has from the UK speakers, which were myself, with the ODP’s.The interim proposal is to
yet been decided. Justiaan, Henry, Sean Bennett, David Duthie, have Patient Specific Directive’s (PSD’s). A
Andy Roscoe, Gavin Wright and Sue Wright, regulated professional signs for any drugs
Fifty-four took the perioperative exam - an they had Jack Shanewise, Solomon Aronsen, given and takes responsibility for this. (The
increase of ten from last year - and 72% Jan Poelaert, Jan Hultman, Fabio Guarracino, drugs Act states that drugs can then be given
passed, Anaesthetists made up the majority of Dominique Bettex, Marco Ranucci to name a with a verbal or written directive).This
candidates, 24 compared to 14 cardiologists. few.There was a hands-on session at the end would include the pump prime solution,
The top three candidates tied and were all of the day, demonstrating the FATE views. cardioplegia, heparin and any vasoactive
anaesthetists.The next exam will be in Apart from an excellent day programme there drugs.
Harrogate prior to the Autumn ACTA was a good social programme. One of the The surgeons have said they can’t sign whilst
meeting on the 13th November 2008. events was an African experience at Mojo’s operating and the DoH is pushing for the
where a number submitted to traditional face anaesthetists to be responsible.We can
Regarding logbooks, there is improved turn painting! foresee problems with this.
around as the BSE Accreditation Association is
now managing TOE logbooks. A comment The next main echo event will be the 3rd ● In some centres perfusion is managed by a
from the markers for those who have still to Echo meeting in London on 5th June, prior to firm contracted to provide perfusion
submit logbooks is that the tick box format the ACTA Spring meeting and the venue is the services and are not NHS employees.
● In other centres perfusionists are under
doesn’t provide enough information and it is Royal Society of Medicine. There is an
difficult to assess how the sonographer has exciting programme on “New and Emerging the surgical directorate.
● We have no control over the management
assessed valves and reached conclusions. So Technology” and trainee case presentations.
either a written report or one in addition to Submissions for this please visit of cardiopulmonary bypass e.g. how long
the standard format is preferable. http://www.acta.org.uk/ACTA2Meetings.asp. the pressure is down or what goes in the
There will be a prize for this. prime.
● The composition of the cardioplegia is at
Unfortunately the BSE meeting, which is a
very good meeting and shows a different Overall in the Echo world education is the request of the surgeon, as is the
aspect of echocardiology, have changed their progressing well. Until next time, frequency of administration.
format this year so there won’t be an ACTA PSDs have been implemented in some
session.This meeting is also in Harrogate on Dr Donna Greenhalgh centres with varying success. At times, the
October 3rd / 4th with the dinner being on prescription is not signed until the end of the
case.There is no provision as to what would
happen if an untoward incident.
As anaesthetists we have taken the fall in the
past when providing a Good Samaritan
Educational Award service.
By the time you read this, the Committee
will have emailed the membership for their
Dr Sunit Gosh form Papworth Hospital has won ACTA’s Educational Award for 2008.
views as to whether they would be prepared
He has been awarded £5000 for a study entitled ‘Pre-clinical evaluation of the ease of to sign up for Patient Specific Directives or
intubation and efficacy of securing lung isolation using a novel design of double lumen not.These views will be submitted to the
endotracheal tube and bronchus blocker – the Papworth BiVent tube’.
Erythropoietin (EPO) as part of a O B I T U A RY
multifaceted blood conservation programme William Knott Pallister (1926-2008)
in cardiac surgery: an interim report
Previously we produce a significant reduction Practical problems and efficacy of an EPO
in blood and blood product usage with the programme
introduction of a conservation strategy 1) We could only access patients at our central
involving; reducing ordered blood, reducing clinic and not at the 4 peripheral sites.
bypass prime, high dose aprotinin, cell savage 2) Only two of four surgeons agreed to
and new ‘blood transfusion triggers’. Our data participate.
also demonstrated that the patients being 3) We were only allowed to screen patient Bill Pallister with Judith Hulf.
transfused tended to be in high risk groups with a chronic disease. One of the founder members of ACTA Bill
that included pre-operative anaemia i.e. 4) We missed all urgent referrals. Pallister, always known as ‘Uncle Bill’, has died
haemoglobin (Hb) <12.0 g/dl. About 40 of our 5) We missed all valve surgery (for the first at the age of 81. Famous for his invention of
surgical patients per annum. six months). the Brompton triple cuffed tube he was a
6) We could not give second and third doses great practical anaesthetist who made several
We proposed to identify these patients, of EPO if the Hb was >12.0g/dl thus other notable contributions to the specialty.
screen for anaemia of chronic disease and reducing the total possible red cell mass Bill grew up in South Wales and at his local
treat consenting patients with EPO.Then effect. grammar school excelled both as a scholar
follow-up transfusion requirements.This was a 7) EPO is not licensed for this use. and an all round games player. He studied
pilot study. Our aim was to identify the 8) During the programme there was an FDA medicine at the Westminster, which he loved.
However, after the port at ACTA spring
practical problems and efficacy of an EPO warning on excessive deaths associated
meetings he always confessed his regret at
programme. with EPO, which temporarily halted the
not having applied to Cambridge. He showed
programme. an early interest in anaesthesia and after
Method national service in Aden took it up in
Recruitment has been very disappointing but
Patients for coronary surgery with chronic earnest.
we have learnt valuable lessons and plan to
disease other than cardiac had a full blood
screen at all cardiac clinics.The cost of the Bill learned blind nasal intubation at the feet
count done at the first outpatient visit. If Hb
anaemia screen means that this is only done of the master himself, Ivan Magill, and a skill
<12.0g/dl the patient had an anaemia screen
in patients with a low Hb.The dose and that he later taught me. He loved his time at
performed; iron, ferritin, transferin saturation
frequency of EPO plus the use of oral iron is the Brompton, later claiming that he only left
and reticulocyte He. Patients with low iron
restrictive. More flexibility and intravenous the building for a haircut. It was to facilitate
stores had a course of oral iron, then checked
iron would increase the total red cell mass bronchial sleeve resections that he invented
three weeks pre-operatively. If the Hb was still
achievable. the tube that bears his name.The tube was a
<12.0g/dl they received EPO 150 U/kg by s.c.
single lumen with a tracheal cuff and a
injection weekly for up to three weeks. We would like to thank ACTA for the bronchial double cuff - the second being a
Patients with normal iron returned at three education award in support of our ongoing spare in case the surgeon punctured the first
weeks pre-op for a course of EPO and oral programme. one. It largely fell out of use when double
iron. EPO patients were then tracked lumen tubes came along but remained much
throughout their hospital stay for transfusion Sean Bennett beloved by final fellowship examiners.
requirements. Cardiac Anaesthetist (email@example.com)
and He was appointed consultant at the
Middlesex Hospital at a time when
Results Deborah Pinchon
“hypotensive anaesthesia” was in its heyday.
Table 1. Patients that received EPO Transfusion Nurse Specialist Working with the gifted reconstructive
urologist Richard Turner Warwick, Bill came
Patient disease Presenting Hb Pre-op Hb Units of red Discharge Hb to the conclusion that to reduce bleeding it
g/dl cells was more important to reduce cardiac
output (or blood flow to the operative field).
Arthritis/diabetic 9.6 10.4 2 11.0 He called this rheostasis and gave a
Diabetic 11.8 12.2 0 9.0 Hunterian lecture on the subject, backed up
Heart failure 11.1 12.9 0 10.3 by his meticulous records held on punched
cards. Relevant data could be fished out with
Rheumatoid 10.9 12.4 4 (post op 9.8 knitting needles. Sadly, he never condensed it
arthritis, Lupus bleed Hb _ 6.8)
down to the 10000 words required by the
There were five patients whose Hb was >12.5g/dl editor for publication.
with iron alone and did receive EPO.
After his retirement in 1991, Bill studied
classical Greek and travelled widely in the
Middle East until ill health got the better of
Nomination for ACTA Honorary Membership him. He was proud of the honorary
membership that ACTA awarded him at one
His colleagues in Sheffield have nominated Dr Russ Powell for ACTA Honorary Membership. of the Cambridge spring meetings. He was
Honorary membership is awarded to full members who are judged by their peers to be predeceased by his wife and had no children.
distinguished contributors to cardiothoracic anaesthesia. Russ was a founder member of
William Pallister, anaesthetist, born 21 March
ACTA and became one (the largest) of three ACTA Trustees when Derek Pearson
1926, FFARCS 1955, died 8 Feb 2008.
(Newcastle) retired. It is hoped that the membership will endorse this nomination at the
Spring Business Meeting. Wynne Aveling.
Seminar - Kapama Game Reserve - South Africa
24-28 February 2008
Ravi Mahajan and Jonathan Thompson brought
proceeding to a close with a stimulating session
on protective strategies for the kidneys and
T he lectures were exceptionally well
attended and feedback from delegates
was very positive. The vast majority of
delegates rated the scientific value,
organisation, venue, and social aspect of the
seminar as excellent or good. Constructive
criticism centred on the audiovisual difficulties.
The staff at Kapama has been extremely
helpful, flexible and professional throughout
our stay. A number of delegates felt the
programme was rather full and left too little
time for relaxation. However, our primary aim
was for the seminar to stand independently as
Kapama Lodge. a scientific endeavour and to that end we
A CTA and EACTA co-sponsored a
Cardiovascular and Thoracic
Anaesthesia Seminar hosted by the University
breakfast, Prof Deepak Tempe updated us on
the state of off-pump surgery and Marco
Ranucci explained the intricacies of
of Stellenbosch in Kapama Game Reserve - inflammation. Jack Shanewise delivered the first
South Africa, 24-28 February 2008. of two excellent presentations on
One hundred and fifteen delegates, many of transoesophageal echocardiography, Stefan de
whom are ACTA members, including 21 Hert gave an overview on myocardial
speakers from 14 countries, attended a hugely protection and Peter Slinger kept the non-
successful meeting at this fantastic venue. In cardiac anaesthetists entertained with a great
addition to delegates and speakers, there were talk on advances in thoracic anaesthesia. The
65 accompanying persons. evening feast in the Kapama River Lodge boma
was accompanied by a local choir and later the
D ue to overwhelming interest, the
accommodation at Kapama were rapidly
filled and the adjacent Hongonyi and Matumi
game rangers started jamming on guitars and
sang around the campfire.
It’s not often at meeting that one gets to see two
Game Lodges put up additional delegates. This
ensured a good turnout at the seminar but A fter another late night and early morning
game drive, David Duthie and Peter
lions, up a tree, very close!
created minor logistical difficulties with
transferring delegates to and from the
Slinger got the final day started with good talks
on lung isolation and lung injury after D ue to an awe-inspiring Bushveld
thunderstorm, the barbeque on the last
evening was strategically relocated to the
conference centre. resection. Prof David Rowbotham then
addressed novel strategies in post-operative conference hall but the African theme retained.
A high calibre faculty provided 5 hours of
medical education each day for three
days. ACTA were strongly represented on the
pain management. Prof Andre Coetzee, Prof Most folk still got up in time for the final game
drive. By know many visitors had already ticked
off all animals on the “big five” list before
faculty list. Highlights on day one was John setting off for the World Congress of
Murkin’s insightful talk on cerebral monitoring, Anaesthesia in Cape Town or back to Europe,
Ravi Gill’s synopsis of coagulation and Eric Australia, America and Asia.
Sloth’s proposal to use echocardiography as an
extension to clinical examination on ICU. Sean
Bennett told us eloquently how not to give A ll participants and stakeholders have
benefited from this concerted effort.
ACTA have supported this venture from the
blood.After a memorable game drive delegates
and guests were served mouth-watering start and can rightly feel proud about raising
African cuisine in a dry riverbed.The songs and the profile and enthusiasm for cardiovascular
movement of the Marimba dancers was and thoracic anaesthesia. We thank ACTA for
something to behold. the support.
S leep was not high on the agenda and a few
hours later some folk were privileged to
see leopard on the morning game drive. After
Eating area at River Lodge. No, its not on fire just Henry Skinner
water mist to keep the area cool!
The 14th World Congress of Anaesthesia
Cape Town, South Africa, March 2-7, 2008
he 14th World Congress of
T Anaesthesiologists was held in March this
year in Cape Town, South Africa. The venue
was the International Conference Centre at
the foot of Table Mountain, close to the Cape
Town Waterfront. Around six thousand
delegates attended this 4-yearly event to meet
international friends, share information, learn,
and also enjoy the best hospitality that the host
country could offer.
everal ACTA members were involved in the
S organisation and faculty of the
Perioperative Echocardiography Workshops
during this memorable event. These
interactive, hands-on, 2-day workshops ran
View out over Cape Bay from the editor’s hotel room.The hotel was also the venue for the Association of
points. The short lecture sessions contained Peninsula, up Table Mountain, and the
‘pearls of wisdom’ with clear take home Stellenbosch wine region, the echo workshops
messages. The case based discussions involved were exceptionally well attended and feedback
expert panels and stimulated audience from delegates was very positive.
participation. The high quality contributions At completion of the workshops the delegates
from younger ACTA members like Andy had an appreciation of the significant impact of
Roscoe (Wythenshawe) and Justin Williams echocardiography on perioperative decision
(Glenfield) were particularly refreshing, making in different clinical scenarios.
demonstrating that ACTA has actually Everybody involved in this project gained a lot
succeeded over the past 15 years in developing of experience and information, and many new
and raising echocardiography standards in the friends were made. ACTA can rightly feel
UK to a world class level. proud about the involvement of their members
raising ACTA’s profile at international level in
uring the afternoon sessions there was the field of perioperative echocardiography.
D plenty of opportunity to perform and
practice hands-on ‘focussed assessed trans-
One of the more exotic delegates - Jackass or Cape Justiaan Swanevelder
penguin, Boulder Beach, Jonestown, Cape Peninsula. thoracic examinations (FATE)’. The organisers
are very grateful to GE, Philips, Siemens and
Sonosite (in alphabetical order!) for supplying
parallel to six other simultaneous academic
their state of the art equipment. At one stage
sessions. The strong international
there were 14 stations with ultrasound
echocardiography faculty contained 30
machines running simultaneously! Each of the
speakers from 13 countries all over the world.
echo stations had a model and supervising
Of these 10 were ACTA members.
teacher for real-time trans-thoracic scanning
The workshops were limited to 50 participants
to maximise educational value. Johan Bence
per day and designed for anaesthetists,
(Glenfield) co-ordinated these sessions with
intensivists, cardiologists, cardiac surgeons and
precision, and Eric Sloth (Copenhagen) and
echocardiographers involved with the
Sean Bennett (Castle Hill) led the teaching.
perioperative care of the cardiac, and critically
Add to that the experience of David Duthie
(Leeds), Donna Greenhalgh (Wythenshawe),
and the combination of Wrights (Gavin-
here was not enough time in the
T programme to cover a comprehensive
course on echocardiography, but the objective
Harefield and Sue-Heart Hospital), nothing
could go wrong! The 25 digital
echocardiography laboratory workstations
was to improve the foundation of the
kindly supplied by GE were also very well
perioperative echocardiography practitioners
received. Henry Skinner (Nottingham) and
that attended. It covered more advanced
Heinz Tschernich (Vienna) led these sessions
topics of difficult decision-making, interesting
and elegantly guided the participants to report
examples and rare pathology. Each lecture
pre-recorded patient studies.
consisted of a brief summary of the topic Cape-Dutch style outbuilding at Groot Constantia
information, together with plenty of echo estate and vineyard, Cape Town that was established
lthough competing with official World
examples to demonstrate important learning
A Congress day-trips around the Cape in the early 18th century.