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The Difficult Airway Society (DAS) recommends awake tracheal intubation as a primary airway management technique in people with difficult airways. It can be achieved either by fibreoptic bronchoscopy or videolaryngoscopy. However, in our experience, despite the guidance, anaesthetists are sometimes reluctant to perform either.

While it’s useful to be able to perform both techniques depending on what’s needed for the patient, videolaryngoscopy requires fewer technical skills and can be applied with a comparable success rate and safety profile to fibreoptic intubation. Furthermore, the more commonly the procedure is undertaken, the more that anaesthetists and the wider anaesthesia and theatre teams come to regard it as a straightforward, almost ‘everyday’ event. This creates a virtuous circle where it then becomes even easier to consider and perform.

With this in mind, we suggest that anaesthetists should be introduced to awake video intubation early in their career. Seeing that airway management can take place without general anaesthesia opens up a range of possibilities and gives them further confidence for managing the various patients that could present with anticipated and unanticipated difficult airways.

In the last Bulletin issue, ACSA reviewed the achievements of the scheme upon its 10^th anniversary. We continue to reflect now by celebrating anaesthetic departments who have been accredited and re-accredited over the last year. They share their experiences in their own words.

Part of the Quality Improvement Working Group’s (QIWG) role is to deliver the College’s Quality Improvement (QI) strategy. To accomplish this, we have been working to strengthen the Quality Network (QN), plan projects and events to promote QI development, and consider how best to engage members.

Context

After previously focusing on the QI compendium¹ and facilitating resource sharing during the COVID pandemic, this year the QIWG has worked to assess and strengthen the QN. Our ‘Prep, Stop, Block’ project was part of this strategy, a summary of which was included in July’s Bulletin,² with the full report available on the our website.

Dyslexia is not just a learning difficulty affecting reading and writing; it can be related to difficulty processing and remembering information such as phonological processing, rapid naming, working memory, processing speed, and the autonomic development of skills.¹ 

Up to 10% of the population is estimated to have dyslexia. The newer term ‘neurodivergent’ is postulated to be the wider term, encompassing having cognitive functioning different from what is seen as ‘normal’,² and it includes dyslexia.

Authors:

• Dr Ee-Neng Loh, Anaesthetic NELA fellow
• Ms Lyndsay Pearce, NELA Surgical/ Research Lead
• Dr Sarah Hare, Deputy Director RCoA Centre for Research and Improvement 

Email the NELA team

The challenges of providing care for an aging surgical population require no further introduction. Perioperative clinical teams are often managing surgical patients with multiple complex co-morbidities, higher levels of frailty, and poorer physiological reserve.

In the eighth annual report of the National Emergency Laparotomy Audit (NELA), we found that more than half of the patients undergoing emergency laparotomy (EL) were 65 years old or more, and that around 20% were aged over 80 years.¹ Despite improvements in perioperative care, one in ten patients die within 30 days of their surgery and mortality risk doubles in patients living with frailty.^1,2 Are we doing more harm than good by subjecting these patients to surgery?

The rigorous demands of anaesthetic training in the UK are well known, with long hours, high-stress situations, and the constant need for precision and vigilance. Adding to this the stress of COVID, change in the curriculum, and a wedding to plan led me to look for ways to refresh and rejuvenate myself.

Looking through the Health Education England (HEE) Gold Guide, you can find the information about an Out-of-Programme Career Break (OOPC). OOPCs allow trainees an opportunity to step away from training to give them time to pursue other interests, including interests not connected with medicine. This is different from the other out-of-programme options which are more related to clinical training (OOPT), clinical experience (OPPE) or research (OOPR). This led me down a path I will never regret.

There is a mental-health crisis among doctors in the United Kingdom, with 51% experiencing poor mental health, nearly 50% wishing to reduce their working hours, and 10% planning to quit.¹ There are excessively high levels of burnout being reported among anaesthetists in training.² Burnout impacts on the delivery of high-quality patient care,³ and a ‘healthy’ work environment is associated with approximately 30% less intention to leave the profession.⁴

In an attempt to prevent burnout in our trainee cohort, we created a regular wellbeing initiative: Coffee Club. We wanted to provide a time and a place in which trainees could reflect on their individual and collective experiences. It was essential that this was a warm, welcoming, safe and confidential space.

Interested in standing for a place on College Council? Self-nominations are currently open for three consultant positions and two positions for anaesthetists in training.

We asked Chris Taylor, Consultant Council member, and Catherine Bernard, Anaesthetist in Training Council member, why they decided to stand in last year’s election, and more.

This year, Santa turns 2,403 years old. Although Greek by birth, the modern-day figure of Santa is based on images drawn by American cartoonist Nast in 1863 from the description given in the poem “ 'Twas the Night Before Christmas”, first published by Moore in 1823. 

During a typical 85-year lifespan, the average American requires 9.17 surgeries. It’s not inconceivable, therefore, that with his rather risky lifestyle, Santa, too, may one day need to go under the knife.

Santa may be reluctant to take time away from work, but thinking of the not-impossible event that he ever requires surgery (perhaps due to Tim Allen-esque trauma), I have started to risk-stratify the jolly old man. Should Santa experience an untimely demise perioperatively, not only will millions of children no longer wake to gifts under the tree, but in true Santa Claus™ style, someone in the hospital might be required to eternally take up his mantle, and the rota in our hospital is difficult enough to staff as it is.

Authors:

• Dr Natalie Constable, ST6 Anaesthetic Registrar, Department of Anaesthesia, UHBW Foundation Trust, Bristol
• Dr Fiona Oglesby, ST6 Anaesthetic Registrar, Department of Anaesthesia, UHBW, Bristol
• Dr George Bainbridge, Anaesthetic Clinical Fellow, Department of Anaesthesia, UHBW, Bristol
• Dr Helen Howes, Consultant Anaesthetist, Department of Anaesthesia, UHBW, Bristol
• Dr Rachel  McKendry, Consultant Anaesthetist, Department of Anaesthesia, UHBW, Bristol

The Bristol Royal Infirmary’s Difficult Airway Response Team (DART), developed in 2017, is a successful, innovative, cross-specialty response unit designed to expedite the arrival of clinical expertise and advanced equipment to the patient’s bedside in complex airway emergencies. Five years following DART’s inception, we intend to highlight the challenges intrinsic to maintaining the service and how we have attempted to overcome these.