Bulletin 113, January 2019
Welcome to the January issue of the College Bulletin
We seem to have been mourning the passing of great men in recent issues, and I was very sad to learn of the death in October of Bill Mapleson, a name known to all of us who have ever marvelled at the elegant simplicity of his classification for breathing systems. I was lucky enough to be a researcher in the Cardiff Department in the office next to Bill and, along with Paul Clyburn, whose affectionate and touching obituary can be found within, found him a great source of wisdom, comfort and humour. I still recall his ability to make an overhead projector presentation of the three-compartment pharmacokinetic model look like a continuously moving image, while explaining the concept in a way that even we dullards could comprehend.
As a passionate nature-lover, Bill would have been fascinated to learn of the impact of volatile agents upon global warming, a subject barely considered in his day. Tom Pierce and Lucy Williams have contributed an article in which they consider anaesthesia’s contribution to reducing the UK’s output of greenhouse gases to that mandated by the Kyoto protocol. I never like desflurane much, to be honest (nasty smelly stuff which made patients cough and needing a large vaporiser which took up one of my precious power sockets). It has now fallen even lower in my esteem, as Tom and Lucy report that, while it hangs around in the patient’s body for less time than isoflurane, it stays in the atmosphere over four times longer, making it by far our biggest source of CO2 equivalent emissions since nitrous oxide started to fall by the wayside. The good news is that, by losing the Bain system (a modified Mapleson D, of course) and switching almost universally to the circle, UK anaesthetists have reduced their CO2e by 75%, a trend likely to continue with the increasing use of end-tidal controlled volatile injectors and TIVA.
My hospital has, at the time of writing, just undergone an ACSA visit, and I know that our leads – and I really do recommend you have more than one – will empathise with Michael McGovern, who reports in this issue of his experience as the sole lead at Aintree University Hospitals NHS Foundation Trust. It is an exhausting role which seems to require the leadership skills of a CEO, the diplomacy of a politician, the enthusiasm of a school PE teacher and the patience of a saint. Michael has obviously now learnt the lesson that I was taught early on in my career – never say ‘yes’ to any position, however attractive it might sound, in your first year as a consultant – but is to be congratulated of having led his team to accreditation, a feather in the cap for all concerned. He rightly points out that ACSA can and should be a tool for driving quality in the department, and can even be used as a potent stimulus to unlock funding for service development. I was only sorry that my role in the College meant that I was unable to take a more active role in our own ACSA process for fear of a conflict of interests – honestly!