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There was a buzz of excitement in the airbefore the ACTA Autumn meeting in
Plymouth on Friday 1 November 2002.Wouldhe really show up? The ACTA Committee andinvited speakers swore blind that they hadencountered Ozzy Osbourne the previousevening on one of their famous pre-meetingbenders down at the Plymouth Barbican. Onlyquick thinking and prompt action had averteddisaster and loss of life when Ozzy attemptedto get the party to re-enact the departure ofthe Pilgrim Fathers from Plymouth, forgettingto provide the Mayflower.Alas, despite theGreat One’s love of all things academic, andpromises the night before he did not appearin person on the day of the meeting. However,this loss failed to spoil the enjoyment of anexcellent programme for the 150 delegates.
The meeting coincided with the fifthanniversary of the opening of the South
West Cardiac Centre (SWCC) and the local
organising committee had produced anoriginal and interesting programme thatconfirmed that Plymouth cardiac anaesthesiahas arrived clinically and academically.
The Free Paper session attracted papersfrom all over the country on a wide
variety of topics and the quality ofpresentation was outstanding.The JohnHargadon Prize was awarded to Dr ClareColes from Oxford, who presented thesurgical / anaesthetic collaboration on ‘Theuse of a novel imaging technique to evaluatecoronary graft patency’.A few hardliners fromNorth of the border were disgruntled withthe surgical leanings of the paper but the teamapproach in cardiac surgery is highlighting theimportance of cardiac anaesthetists in allaspects of the patients care, which is good.The ACTA Audit Prize was won by Dr Paul
NewsNEWSLETTER OF THE ASSOCIATION OF CARDIOTHORACIC ANAESTHETISTS
No.1
7Ju
ne20
03
Rocking ‘n’ Rolling in Plymouth
ACTA
Ozzy Osbourne and Mike Licina before attempting departure
Delegates at the Trade Exhibition
Sice for his poster of ‘Assessment ofneuromuscular function and residual paralysison ICU:Audit of the use of muscle relaxantsin the SWCC.’
After coffee and the trade exhibition,the delegates were eager to witness
two top-rate Scottish speakers debate themotion: ‘Thoracic epidurals should be usedroutinely for coronary artery surgery’.Awell-known enthusiast, with experience ofhundreds of cases, Dr Nick Scott supportedthe motion with arguments based heavily onproviding the best quality of care.The motionwas contested, in his usual objective andacademic manner, by Dr Peter Alston. Despiteconsiderable support for Dr Scott’s viewsduring the floor discussion, concerns oversafety and practicality led to the motion beingdefeated on a show of hands by
approximately two to one. Use of epidurals incardiac surgery has been discussedincreasingly over the past few years and thedelegates felt that this was an appropriatetime for it to be aired at ACTA, providing auseful consensus of opinion in the UK.
ACTA veterans expressed a huge reliefthat lunch was an excellent home-
cooked, four star gourmet buffet (with tables,chairs, metal cutlery, napkins etc.).Unfortunately classic Plymouth seasonalweather, mist and rain, excluded views ofPlymouth Sound from the 14th floorrestaurant of the Moat House Hotel.However, for a fleeting moment there wereclear views of a warship heading
determinedly through heavy seas up toDevonport Docks, beyond the statue of SirFrancis Drake, Smeaton’s 1750s granite
Eddystone Lighthouse, and the Royal NavalWar Memorial.
Thanks to generous sponsorship fromthe British Heart Foundation the next
session featured two speakers ofinternational renown, discussing medical andsurgical management of severe cardiac failure.First up was Dr Mike Licina from theCleveland Clinic, USA who is known to manyACTA members for his excellent TOE videos.Dr Licina presented a superb overview of theperioperative management of patients withsevere cardiac failure based on his ownexperience and the huge database that he hasaccrued at the Cleveland Clinic over manyyears. In his persuasive talk he presentedevidence of downregulation of adrenergicreceptors in this group of patients, that has
Drs Peter Murphy, Nick Scott and Peter Alston
Plymouth Sound from the Moat House
Professor Mike Licina and Mr Stephen Westaby
Continued on inside back page…
CHAIRMAN’S ReportThis edition of ACTA News should reassuremembers that ACTA remains an active andprogressive professional organisation! There-organised membership database is upand running and much more informationregarding this and the link-man organisationcan now be gleaned from the re-vampedACTA web-site. The UK examinations andaccreditation process for TOE should alsobe in place before the end of this year.Weall owe a debt of gratitude to JohnKneeshaw, Co-Chairman, jointtransoesophageal echocardiographyaccreditation committee, and his fellowcommittee members for the considerablework they have put in to develop thisprocess in conjunction with the BritishSociety of Echocardiography.
The autumn meeting in Plymouth proved agreat success and thanks are due to ChrisCummings for putting together such a well-organised and interesting meeting. Therewas some anxiety expressed by membersat the business meeting in Plymouthconcerning the future publication ofanaesthetic specific data for cardiac surgery.Indeed, the Central Cardiac Audit Database(CCAD) is now collecting the namedconsultant anaesthetist for every adultcardiac procedure. This name is locallyencrypted and is not available fordissemination without the individual’sconsent. In practice it is expected that suchconsent will be given, although individualconsultants should be consulted regardingdisclosure.Anyone who has read the latestGMC document on revalidation will realiseit is likely to be difficult not to agree to thisprocess in the future.
I have been lobbying, on behalf of ACTA, tohave our previous representation onCCAD re-instated in order to protect ourinterests. Dr Anthony Rickards, CCADChairman, has agreed in principle that weshould be represented on the CCADsteering group. In the first instance I willrepresent ACTA. It is not envisaged thatanaesthetic specific data will be in the publicdomain before 2005, however, so towardsthe end of 2004 we should review ourrepresentation on this body.
On, perhaps, an even more contentiousnote it has come to my attention thatspecialist societies in England and Wales (aslightly different system operates inNorthern Ireland and Scotland) can nownominate consultants to the AdvisoryCommittee for Distinction Awards(ACDA). This has been confirmed by SirNetar Mallick,ACDA Chairman. I intend toput in place a credible and transparentsystem for ACTA to nominate, or providean appropriate citation, to the relevantbody in respect of Distinction Awards ineach region. There will need to be aselection procedure, to ensure ournominations carry weight, but in general Ibelieve this can only be beneficial toconsultant members of ACTA. TheDistinction Awards system is a rapidlyevolving process, so ACTA’s role will needto be evaluated on an annual basis.
Finally, I would like to thank the ACTACommittee for their sterling work , andsupport, over the last year. I look forwardto meeting many of you at the Cambridge,June, meeting.
Readers who have been disappointednot to receive a copy of the minutes ofthe last business meeting included inthe envelope containing their copy ofACTA News will be relieved to knowthat they may read and print them fromthe ACTA website.This is one of themany improvements in the websitederived from engaging the professionalhelp of Blackcatwebsites.The improvedfunctions of the website have brought afew problems.The South Coast Hackerwas the first to point out the lack ofsecurity using GMC numbers aspasswords.This and other problemshave been resolved as soon as warningswere sent from the website.
ACTA News is available to all on thewebsite and there would be somesavings made by abandoning the paperversion. However, copies are distributedat meetings to non-members and areavailable at the new official residence ofACTA at the Association ofAnaesthetists of Great Britain andIreland at 21 Portland Place, LondonW1B 1PY.As tangible evidence ofACTA’s existence, the paper versionwill persist for at least a few moreissues.
David [email protected]
EDITORIAL
Statement from the joint
transoesophageal echocardiography
accreditation committee
In response to demand, a Committee of theBritish Society of Echocardiography includingmembers of ACTA have formulated aprogramme for a United Kingdomaccreditation in transoesophagealechocardiography.This accreditation isdesigned for all transoesophageal usersincluding cardiologists, cardiac anaesthetists,echocardiography technicians, intensivists andothers.Accreditation is offered as a means ofensuring standards of training and practice intransoesophageal echocardiography, and is notintended as a compulsory or regulatorycertificate of competence, nor is it intendedto be a device for credentialing of individualpractitioners.
Full details of the proposed accreditationtogether with enrolment and examinationapplication forms, and the study syllabus maybe found on the BSE website,www.bcs.com/affiliates/bse.html and on theACTA website, www.acta.org.uk
The accreditation is modelled on the currentBSE adult accreditation in transthoracicechocardiography; for that reason theadministration of the transoesophagealaccreditation will be through the BSE.
The accreditation consists of two main parts:* The maintenance and presentation of alogbook of activity and the retention ofimages from ten cases* Attainment of a suitable standard in amultiple-choice examination
The first examination will be held inconjunction with the BSE Scientific meeting inOctober 2003.The examination will be held at
9 am on Thursday 30 October 30 at theHilton Metropole Hotel at the NEC inBirmingham.This, the first examination, will bea pilot exam to enable testing of theexamination infrastructure.This pilotexamination will count as part of fullaccreditation for those candidates who aresuccessful. Because of the pilot nature of thisfirst examination, the number of places will belimited to 50. Candidates wishing to enrol foraccreditation and wishing to sit the exam inOctober 2003 may do so for a fee of £200rather than the £275 specified in theaccreditation document for future exams.
We would welcome comments on theaccreditation documents published on theweb sites from ACTA and BSE members.
John Chambers and John Kneeshaw,Joint Chairmen, the jointtransoesophageal echocardiographyaccreditation committee
John Gothard [email protected]
Currently,ACTA has 266 consultant and 76trainee members listed in the database. It isnow possible to update your entry in thesecure “Members Only” section ofwww.acta.org.uk; so information can be keptup to date by members themselves.Allaspiring ACTA members can download anApplication Form and Direct Debit Mandatefrom the website, and return it to theMembership Secretary.Anyone experiencingdifficulty should also contact the MembershipSecretary.
I am pleased to report that after considerabledifficulty, we have eventually managed tocollect annual membership fees from mostmembers, in December 2002.Transition fromthe CAFCash System to that administered byRBS was awkward, but should now paydividends. It is proposed that the annualsubscription remains £40 for consultants and£25 for trainees, for the coming year.Theadditional £30 charge for those wishingcombined EACTA membership will persist. Bythe time this report is printed, the 2003subscription, should have been collected on1st May, which will become the annual billingdate for subscriptions.
The annual accounts can be viewed in the“Members Only” Section of the ACTAWebsite, and have once again been producedby Cook & Co., Chartered Accountants.ACTA continues to have a sound financialfooting. In 2002 a surplus of approximately£6,000 was generated, despite increasingexpenditure.
ACTA’s income is heavily dependent onmembership subscriptions, but considerablesurpluses from recent meetings and efficiencysavings from reduction of banking charges andabstract publication costs, have contributed tothe current healthy position.The Committeewishes to express its appreciation to DrCummings for donating the entire surplus ofthe Autumn 2002 Plymouth meeting to ACTAfunds, and also thank Dr Hardy for thesuccessful Cambridge Meeting, in June lastyear.
Expenditure too, has risen in the past year, butwith tangible benefits. Legal fees for theincorporation of ACTA as a Limited Companyhave been met, and the application forcharitable status is now almost complete.Development of the website has been funded;educational expenditure has also increased,
with a £2000 grant towards the production ofa CD-Rom of the Leicester TOE Meeting byJustiaan Swanevelder.Two inauguraleducational grants of £250 have been madeavailable to trainee members. Guidelines foreducational grants will soon be available onthe website, and it is anticipated that anumber of awards will be made each yearleading to enrich future ACTA meetings.
Finally, I would like to thank everyone whohas helped over the past three years. I haveappreciated the cooperation of many whohave updated their membership and financialdetails promptly, and would once again like toencourage the others, still about 100individuals, to review their position. Recentchanges have not only modernised theorganisation but hopefully made it moreaccessible, and potentially useful, to the all ofthe membership.
Alex D Colquhoun,[email protected]
The minutes of the Business Meeting fromthe Autumn Meeting in Plymouth,
November 2002, are now available in theMembers Only section of the websitewww.acta.org.uk and will no longer be notcirculated with editions of ACTA Newsbefore ACTA meetings.
During the past six months theCommittee has sought to develop our
links with both the Royal College and theAssociation of Anaesthetists.We can now becontacted at the new premises of AAGBI, at21 Portland Place, London W1B 1PY, and it ishoped that we can make use of theseimpressive new facilities for workshops andsmall meetings as soon as renovations arecompleted.
Following concerns expressed by anumber of members regarding the
“Guidelines on Standards for Monitoring andAlarms During Cardiopulmonary Bypass”published in 2001, a survey of all theConsultant members regarding currentworking practice was completed inDecember 2002. I would like to thank themembers who participated and expressedtheir views so frankly and fully.While theresults will be discussed fully at the AnnualGeneral Meeting in Cambridge, the surveyconfirmed that Consultants are increasinglyhaving to anaesthetise patients single-handedly, and anticipate that this trend willcontinue. Interestingly, more than 80% ofConsultant Anaesthetists who repliedindicated that they leave theatre duringcardiopulmonary bypass. In a significant
number of instances this involved theassistance of non-anaesthetic personnel.TheCommittee is currently exploring theimplications of these findings with the RoyalCollege of Anaesthetists and AAGBI.
HACS, Haematologists Associated withCardiac Surgery, founded by Dr John
Burman, Royal Brompton Hospital, and DrKanchen Rege, Papworth Hospital, has beenformed to promote greater understanding ofthe issues of coagulation and transfusionsurrounding cardiothoracic surgery.Whiletwo successful meetings have been held sofar, the group are seeking the participation ofACTA Members for a further gathering inLondon this autumn. I have also beencontacted by the Secretary of the ESCTAIC,the European Society for Computing andTechnology in Anaesthesia and Intensive Care,regarding their meeting in Berlin in October.
Finally, the committee is aware that theremay be inequalities in cardiothoracic
anaesthetic facilities between centresthroughout the UK.To make meaningfulcomparisons, a centre profile has beendeveloped on the website for use by allmembers.While it can be viewed in the“Members Only” section, we hope linkmenwill upload their centre details. Some earlybirds have already been there! We hope thiswill provide useful information when seekingto develop your centres resources, and lookfor constructive comments.
Fiona [email protected]
Secretarial Matters
Treasury and Membership
Meeting AnnouncementsACTA Autumn 2003
28 November 2003Institute of Electrical Engineers, Savoy Place,
London,WC2R 0BLAssociation Dinner
Contact: [email protected]
The second annual multi-professionalmeeting to discuss transfusion alternatives
13 November 2003Friends Provident St. Mary’s Football Stadium,
Southampton
The future of blood transfusionCell salvage - Where are we and where are we going?
Platelet transfusionNovoseven in high risk cardiac surgeryLVAD’s or how to empty a blood bank!
New paediatric transfusion guidelines in practiceTransfusion in a war zoneAntifibrinolytics revisited
FFP guidelinesContact: [email protected]
3rd Haematologists Associatedwith Cardiac Surgery meeting
10 October 2003Novartis Foundation, 41 Portland Place,
London,W1B 1BNUse of new products for haemostasis in cardiac
surgery. Cell salvage in cardiac surgeryHeparin induced thrombocytopenia in cardiac
surgery. Heparin resistanceContact: [email protected]
European Society forComputing and Technology
in Anaesthesia and Intensive Care2-4 October 2003 - Berlin
http://esctaic.hcmb.org/
Royal College of Anaesthetists meeting19 - 20 June 2003
Le Meridien Russell Hotel, Russell Square, LondonCardiopulmonary disease and anaesthesia
Contact: [email protected] Tel: 02079 087340
BSI had a makeover last year and changed thenumbers of most of its committees.This was
intended to harmonise the numbers with theequivalent CEN committees, which I presume it hasdone.The Standards organisations run on longcomplicated numbers.Those who can remembernumbers that have no great logic to them alwaysimpress me. I think that is the source of one of myproblems with the BSI Website as it comes out withsuch wonders as “Document title: ISO/TC 150/SC2/WG 3 N246: Resolution of Ad Hoc Commentson Annex E for ISO 25539-1, rev. 4 (Feb 2002) -Oct- 02.” The only way to find out what it means isto open it, a rather time consuming process as boththe BSI and my hospital have many layers of firewallsand other security devices to get past, beforeanything will open.
I am a member of 4 BSI Committees - CH/121/2,CH150/2, CH/205/10 and CH62/4. I was put
forward by the Association of CardiothoracicAnaesthetists, and also represent their interests. Iam also on CEN BT TF 123 PG6.
CH/121/2 Tracheal Tubes and RelatedEquipment. I became a member of thiscommittee in September 2002. It producesstandards for a variety of airway products. Currenthot topics are whether there should be a differencebetween endotracheal and endobronchial suctioncatheters and the use of closed suction systems andtheir potential to destroy ventilators.Work onlaryngoscope standards should be interesting. InEdinburgh, we have just moved to, to disposableblades, and have had some major problems. Eventhe blades said to come from the same mould asthe metal ones we have been using for the last 10years, are not as easy to use. I hope we do not getinto the same problem as the ENT surgeons, whowere forced to use disposable equipment that wasinferior to the traditional instruments, causing realmorbidity in an attempt to avoid a perceived risk ofmad cow disease.
CH150/2 Cardiovascular Implants. Most ofthe activity of this committee is concerned witharterial grafts and stents, but it also deals with heartvalves and cardiopulmonary bypass equipment.Theproposal for a standard for electrical safety ofbypass machines is not going to get any supportfrom BSI.They have placed a ban on voting for anynew work proposals, and do not even appear onthe voting lists on the CEN / ELEC circularsregarding new standards.A standard forcardiopulmonary bypass tubing is being developed,which I have commented on.
CH/205/10 Sphygmomanometers. You mayremember my concern last year that CEN wasabout to drive a horse and cart through AAAMI’selegant statistical approach to the determination ofthe accuracy of NIBP machines.They are still not inagreement, but a current draft standard is incirculation that describes how to perform accuracytests, but does not say how accurate the machinesshould be before getting a CE mark. I think this isdaft, but there is a lot of behind the scene politicsinvolved.
CH62/4 Electromedical Equipment.This committee has a vast remit, looking after thesafety, especially electrical, of any item of medicalequipment that uses electricity. Many of theengineering terms used in the standards are wayover my head, but I can understand and comment
on things like “ Does this mean that it is acceptablethat the monitor indicates heart rate120 bpm or 30bpm with no input signal, if it disclosed in theinstructions for use?” This is not an isolatedproblem.The manufacturer’s of anaestheticmachines, are allowed to have them unusable for atleast a minute after the mains is switched off andback on, as long as they write it in the instructionbook. Similarly, ventilator manufacturers are allowedto supply ventilators that fail for good if the pipelinepressure increases to 10 bar, (within the range oftolerances of some pipelines,) as long as they writeit in the instructions. I hope that the presence ofclinicians on the standards committees willpersuade manufacturers to design the faults out ofthe equipment, rather than put a warning label deepwithin an instruction book that is unlikely to beread.
CEN BT TF 123 PG 6. This is a committee setup to devise a non-luer connector for NIBPmachines. On the basis of is anything can happen itwill, having their NIBP inflation hoses connected upto intravenous lines has killed several patients.“Howcould it possibly have happened?” you may ask, buthappen it did, and not just the once. Patients havealso had enteral feed and capnograph return linesconnected intravenously, as well as the well-publicised confusion between intrathecal andintravenous chemotherapeutics. CEN BT TF 123 hasbeen set up to come up with non-interchangeableconnectors for enteral feeding, respiratoryconnectors, NIBP hoses, urinary catheters,endoscopes and tourniquets.As ever a seeminglysimple solution (adopting the two decentconnectors that are on the market and allowingeither of them) fell foul of big business and politics.The firm with the biggest market share had themost awkward connector, and others felt acomplete redesign of the wheel was necessary. Inthe meantime, check all your NIBPs to makesure that do not have the simple taperedconnectors that are easy to fit onto almostanything, including IV lines.
Sir Humphrey lives on.The standardsorganisations are very bureaucratic and
continually remind me of the famous series “YesPrime Minister.” This statement “At the beginning ofJanuary 2001 it was identified that the resourcedemand within the Healthcare committees hadexceeded the resource allocation available. Duringthe year (2001) H/-/1 (Healthcare Programming andAdvisory Group) has met to discuss how best toaddress this.As this is still under consideration ithas been decided that until it is resolved the UKwill abstain when voting on new work itemproposals. Once H/-/1 has agreed upon thedistribution of work and this has beenimplemented, committees will be offered theopportunity to review UK participation on theseprojects (in accord with the resources agreed).”Means,“We are broke.” It also meant the end of aproposal to put covers round the connectors ofpacemaker wires and other electrophysiologicalconnectors, to stop them fitting in to detachablemains cables.When UK abstained, the proposedstandard failed by one vote.While some of thebureaucratic language can be amusing, I much preferthe naïve comments like “Define more preciselywhat does it mean “ECG monitor display shall bereadable”?” I have still not seen a satisfactory reply.
There is good news for the academics, prENISO 14155 is a draft standard covering
research on human subjects. It is over 40 pages
long, and covers many aspects of research, includinghow to perform a British Standard LiteratureSearch. I have no doubt that you will all have yourhands full trying to get your publications CE markedin future.
Syringe Labelling in Critical Care Areas.The Association of Anaesthetists, the Royal Collegeof Anaesthetists, the Intensive Care Society and theFaculty of Accident and Emergency Medicine, in ajoint initiative, have published a colour code chartfor syringe labelling.
Their rationale is: “We have been aware forsome time, of the differences in syringe
labelling in different parts of the UK and thepotential risk, which this poses, to patients andthose involved in the delivery of critical care.Thecoding system, which we are recommending, isalready used in North America and Australasia.” Ithink it is an excellent idea to standardise coloursthroughout the UK.The short term chaos fromchanging systems has to be a small price to pay forthe long term benefits of using the standardinternational colour codes.Anaesthetists movingfrom hospital to hospital in the UK, and thosecoming in from other countries, will not have tolearn new systems of colour coding, and should beat considerably lower risk of making potentially fatalerrors.
There is one small problem with the new systemhowever, and it mainly affects Cardiac and
Vascular Anaesthetists.The same colour codes areproposed for both Heparin and Protamine.As atrainee Cardiac Anaesthetist, I was told by a wiseold ODP that there were three major drug errors Iwould make sometime: confusing adrenaline andatropine, calcium and potassium, and heparin andprotamine.Twenty-four years later I can confirm hewas right. I do wish he had also told me aboutconfusing adrenaline and arfonad, which I did moreoften than the others in the days when we usedmagic markers to label all the syringes. Calling ittrimetaphan was the solution.
The colour code uses diagonal bars to indicateantagonists like neostigmine, naloxone and
nitroprusside, but does not seem to do this forprotamine.As the ACTA representative to theBritish Standards Institute, I raised the matter at theAAGBI Standards Group Meeting on 25 May 2003. Iwas advised to write to the promoters of the jointinitiative, and ask that protamine was classed andlabelled as an antagonist in the next revision of thecode. I hope I will have the support of ACTA, whichwill make my efforts more likely to succeed, andhope the matter will be discussed at the next ACTAbusiness meeting.
I am very happy to receive comments andsuggestions from members of ACTA.As well as
being very useful ammunition at the meetings, I amat BSI as your representative, and need your input.The Royal Infirmary of Edinburgh has moved to anew site, and the Postcode, Fax and Phone havechanged
David H T Scott [email protected]
Glossary of Abbreviations: BSI,The British Standards Institute. CEN,Centre European de Normalisation, Europe and CE marking.AAMI,American Association for the Advancement of MedicalInstrumentation. ISO, International Standards Organisation, mainlymechanical aspects of devices. IEC, International ElectrotechnicalCommission, electricity, with an emphasis on safety. CENELEC,TheEuropean equivalent of IEC, but with different procedures and votingrules from CEN. OIML, Organisation International de MetrologiqueLegale.
British Standards Institute Report
I want to become a paediatric anaesthetistwith sessions in cardiothoracic surgery.
Given the recent negative publicity from theBristol inquiry and the recommendations ofthe Monro report (see Department of Healthwebsite) I felt that it would be useful todescribe the career path that I have taken.
As anaesthetic registrar I had a healthyfear of anaesthetising children.To dispel
this I spent 12 months on secondment at theRoyal Hospital for Sick Children at Yorkhill inGlasgow. I then went to Seattle Children’sHospital, where I worked as an attending inthe operating theatres.This is one of the mainchildren’s hospitals in North America, and Iwas exposed to a wide range of complex,non-cardiac surgery.
I returned to the UK to complete myCalman training, hoping that no one would
notice my slightly unusual and often part-timepath as I entered my final RITA interview. Iknew that I wanted to be a paediatricanaesthetist, though I felt I should get a bitmore experience dealing with sick neonatesand improve my technical skills. I hadpreviously enjoyed my time at the FreemanHospital Cardiothoracic Centre, so appliedfor a newly created post as a fellow inpaediatric cardiothoracic anaesthetics.
This is a one year post, for whichaccreditation has been applied.The
department is small, with only 4 consultant
anaesthetists who anaesthetise children for allpaediatric cardiothoracic surgery and coverthe paediatric cardiothoracic intensive careunit.They also anaesthetise for a verydemanding weekly paediatric orthopaedic list.
As the first person in this post, I havebeen able to shape it into a form that
suits me. I am present for most of the theatresessions, where I assist for the more complexcases and am supervised for the morestraightforward. I also have sessions on thepost-operative paediatric cardiac intensivecare unit, and am exposed to the care ofneonates who require ECMO. Should aparticularly interesting case occur at night oranything the consultants think will interest me(a challenge for the on-call banding, which willchange in 2003) then I get called in.
As one of the four UK ECMO centres,and one of the two paediatric
cardiothoracic transplantation centres, thereis good exposure to more unusual cases. Ialso do my own paediatric cardiac catheterlist. I then have a whole day to do a researchproject in the medical physics department,and read up on all the things that have baffledme in the previous week.
What I enjoy about this job, is working ina small, dedicated, multidisciplinary
team. Everyone is on first name terms, andthe surgeons and nursing staff teach me in asimilar manner to the anaesthetists. I amregularly managing very sick children, and am
getting better at the practical aspects of thejob.
At the 2001 APA / ACTA meeting DrAnnette Davies suggested that in order
to feel confident applying for a consultantanaesthetic post in Paediatric CardiothoracicAnaesthesia, the applicant should have thefollowing experience:
● At least 6 months of adult cardiothoracic anaesthesia
● One year of paediatric anaesthesia● Specific training in paediatric
cardiothoracic anaesthesia
This is reiterated in the Munro CommitteeReport appendix on anaesthetic training.
I have now fulfilled most of these criteria andfeel I could confidently apply for a paediatricanaesthetic consultant post with a significantinterest in paediatric cardiothoracicanaesthesia, and that I have a goodbackground in a subspecialty that is very hardto obtain training.
In the aftermath of the Bristol Inquiry, beingadequately trained in paediatric
cardiothoracic anaesthesia is essential.As faras I know, this is the first post in the UK totry to provide specific training in this area.
As with ACTA, EACTA has had a fundamentalre-appraisal of its nature and charitable status,and after some consideration we felt itdesirable to be located fiscally within theEurozone.As a result, we are re-registered inDublin and I would like to thank our Hon.Treasurer Billy Blunnie for his excellent workin this regard.
EACTA now has over 650 members. Over100 of you in the UK are members, and manyhave taken advantage of the preferential ratesfor those who join or renew ACTA andEACTA membership at the same time.Wehope we can continue this arrangement in thefuture.
At EACTA, we rely heavily on the web forcommunicating with our members, and thishas proved immensely successful. Forexample, 95% of the abstracts for EACTA2003 were submitted via the web - anincredibly high proportion. By the time youread this, our secure server should be in placeallowing you to pay membership dues,
registration fees etc over the web. Most ofthese developments have been pioneered veryably by the webmaster, Carl-Johan Jacobson.
Echocardiography:.The developments in TOEaccreditation with the BSE / ACTA initiativehave be made in close association with similarmoves in Europe led by EACTA and theEuropean Society of Cardiology Workgroup inEchocardiography (ESC WGE).We expect tohave a similar accreditation in PerioperativeEchocardiography available to Europeananaesthesiologists soon.We have importantmeetings on this scheduled for the end ofMay, and definitive future information willappear on the web.
Meetings, Meetings, Meetings:
EACTA ECHO 2: This four day course,23 - 26 September 2003 at Imperial College,London, is designed for those intending totake accreditation exams, with the addedadvantage of hands-on training intransthoracic echocardiography.Why pay
double and travel across the Atlantic?
EURECHO 7: The annual meeting of ESCWGE is 3 - 6 December 2003 in Barcelona.This is an excellent meeting for those whoare interested in echocardiography. Last yearwas the first time EACTA was involvedformally, and the meeting has developed withmany topics relevant to cardiothoracicanaesthetists. Definitely one worth attending!
EACTA 2004: This meeting will serve as theSpring meeting of ACTA and the annualmeeting of EACTA.We have moved themeeting to June, and ACTA has agreed to actis the “local organisers” with theaccompanying financial benefits.We expectthis to be a terrific meeting and look forwardto seeing you all there.Details of all the EACTA meetings can befound at www.eacta.org, which of course alsohas web links with ACTA, ESC and SCA.
Rob Feneck, President, EACTA,[email protected]
One Size Fits All:How to become a paediatric cardiothoracic anaesthetist and do your Calman Training
EACTA News EACTA News EACTA News
led to milrinone / noradrenaline being adopted as the principal choice of intotropeat the Cleveland Clinic, the second mostfamous building in Cleveland.
Mr Stephen Westaby one of Britain’sbest cardiac surgeons expressed his
delight to be invited to address ACTA andgave a superb review of the role of surgery in
severe cardiac failure. He presented acomprehensive history of the development ofvarious artificial hearts and described hispersonal research with the Jarvik 2000 assist-device in animals and humans. Mr Westabyshowed that ‘resting’ the failing heart forweeks or months with the Jarvik 2000allowed myocardial function to improve andhe believes that humoral factors may be
isolated that could be important in achievingthis recovery.
After tea the final session providedanother ‘first’ at ACTA covering
‘Surgery for Adult Congenital Heart Disease’.Dr Matthew Barnard and Dr Seamus Cullenpresented their work at the specialist unit atthe Middlesex Hospital.This showed theimportance of teamwork and professionalrespect in achieving good clinical results. Bothspeakers delivered immaculate presentations,but Dr Cullen’s video of a prosthetic valvebeing inserted percutaneously was anoutstanding memory for many at the meeting.
Amemorable Association Dinner was
held at the Wardroom, HMS Drake,
Plymouth and attended by about half the
delegates.The evening began with the
remarkable antics of our Chairman John
Gothard, who missed the official bus, hijacked
a taxi, penetrated a high security military base
unchallenged, and was casually sipping a chilled
vodka martini in the bar, unruffled and
relaxed, and dressed in an immaculate dinner
jacket on our arrival (eat your heart out
Pierce Brosnan). Superb food, drink and music
until the wee hours made this an evening to
remember.We are very grateful to our
colleague, Surgeon Commander Dr David Birt
for hosting the dinner.
Many thanks are due to the speakers,delegates, sponsors and fellow organisers, whomade the meeting such a great success.
Chris Cummings,[email protected]
Rocking ‘n’ Rolling in Plymouth Continued…
Drs Seamus Cullen and Matthew Barnard
The Hon Secretary, Fiona Gibson andHon Treasurer, Alex Colquhoun
Chris Cummings saying a few words after dinner
Diners offering advice to the Editor flanked by the host, David Birt and Chris Cummings
www.eacta.org
EACTA 2004EACTA 2004June 9-11, 2004
London, UK
www.eacta.org
The European Association of Cardiothoracic AnaesthesiologistsThe Association of Cardiothoracic Anaesthestists (UK)
