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Whether you are producing a report, a poster, or even revising your hospital’s anaesthetic charts, colour choice is important.

Choosing colours

A colour wheel is a simple tool to help choose colours and shades (Figure 1). Analogous colours are adjacent to one another, and generally combine well. Likewise, complementary colours (those opposite one another) work. Triadic schemes are based on three equally spaced colours, while quadratic schemes use four. Colour combinations found in nature are also considered pleasing.

Understandably, well-being means something different to all of us, but does it have more awareness and recognition than 20 years ago?

Dr Marie Nixon, Consultant Anaesthetist and Dr Thom O'Dell, ST7 Trainee discuss their experiences of wellbeing and what it means to them. 

Authors:

• Dr Rachael Brooks and Dr Eleanor Warwick, PQIP Fellows and Anaesthetic Registrars, University College London Hospital
• Dr James Bedford, former PQIP fellow and Consultant Anaesthetist, University College Hospital NHS Foundation Trust
• Professor Ramani Moonesinghe, PQIP Chief Investigator

In 2023, the Perioperative Quality Improvement Programme (PQIP) is launching new postoperative morbidity variable life adjusted display charts (pomVLAD) for all sites recruiting patients undergoing colorectal surgery. Having previously been run as a pilot study in 10 hospitals, the quality-improvement dashboard has been refined and will now provide all sites with near-real time, risk-adjusted morbidity monitoring accompanied by the display of a number of key enhanced-recovery quality-improvement (QI) targets. 

For sites recruiting patients of other surgical specialties, there is also a newly developed QI dashboard which does not incorporate risk-adjustment. Dr James Bedford explains how they can be used to stimulate QI initiatives in your local hospital.

Following the murder of George Floyd in the United States in 2020, which moved and touched so many individuals and organisations across the world, the ‘Black Lives Matter’ campaign has acted as a catalyst for positive action and renewed debate about how best to address systemic racism in our society and issues that affect the Black, Asian and Minority Ethnic communities.

During this time the College published its own statement alongside the Faculty of Pain Medicine and the Faculty of Intensive Care Medicine; this was welcomed by members, staff and the public.

The Royal College of Anaesthetists has undertaken a two-year national project in collaboration with The Healthcare Improvement Studies (THIS) Institute to use new approaches to improve the time it takes for patients to have emergency bowel surgery.

The time taken for patients to get to the emergency operating theatre remains a stubborn problem, despite many years of research and national guidance emphasising the importance of prompt surgery to reduce morbidity and mortality.

The diagnostic and treatment pathways are complex – involving clinicians from emergency medicine, anaesthesia, surgery, critical care, radiology, and often other specialties. Patients also require resources like CT scanners and operating theatres that are often in short supply. Thinking about the multiple steps each patient must traverse, it is no surprise that they often don’t get speedy access to the operating theatre.

I doubt there are many Bulletin readers who are old enough to remember the 1963 Disney film ‘The Incredible Journey’. Luath – a golden labrador, Bodger – an aging bull terrier, and Tao – a Siamese cat make a perilous journey across the Canadian wilderness to get to their home 300 miles away. As a little girl I sat in the Ritz Cinema with tears flowing because it seemed inevitable that Bodger had died in the final few miles of the journey. Of course he hadn’t. He trotted over the horizon to an ecstatic welcome from his animal and human family.

I was reminded of Bodger and his fictional achievement when I read about a dog called Pip. Last year Pip’s owner took him for a run in Leigh Woods, a beauty spot in Bristol. They became separated, and Pip’s frantic owner took to social media to get help finding him. Pip was soon spotted on the city’s security cameras. He crossed Brunel’s iconic suspension bridge, ran past the famous BBC studios in Whiteladies Road and was captured on camera running by the steps of the museum. Somehow he safely negotiated the notoriously dangerous traffic in the city centre and found his way to his front garden in Bedminster – about four miles from where he’d left his owner. In fact he got home before she did!

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.

October’s Black History Month celebrates the contributions of individuals of Black heritage, including those within the NHS. It is also an opportunity to highlight the academic challenges faced by healthcare professionals from under-represented groups, emphasising the need for diversity in our healthcare system.

Disparities in clinical academia stem from the intersection of ethnicity and gender, in addition to other contributing factors, including lack of mentorship, systemic biases, and the ‘minority tax’. For ethnic minorities, the negative correlation between clinical time and scholarly productivity diverts time away from career advancement, hindering their professional growth compared to peers.

Embracing research diversity improves care equity, reduces differential attainment for anaesthetists, and bridges gaps in academic leadership. It promotes equity-minded environments and builds a workforce that reflects the population it serves. This article examines these disparities and efforts to improve diversity in anaesthesia research.

I’ve been wondering recently how far I should be embracing or resisting my own background when speaking as a patient voice.

I took on the role of Chair of PatientsVoices@RCoA in September, and I’ve found it fascinating to learn about a whole range of issues that are new to me and to contribute to discussions about them. But I’ve also been struck by how often I’ve found myself thinking that the need for good communications lies at the heart of whichever issue is under discussion. And I’ve been wondering whether that reflects the reality, or my own particular interests.

It has both a favourable side-effect profile compared with traditional anticholinesterases and allows for emergency reversal.

With the expiry of its original patent last year, high cost is no longer a factor prohibiting its use, which will invariably further increase. In this article, we seek to highlight the resulting increased potential for contraceptive failure and propose methods to better inform and protect patients.

The risk of contraceptive failure

Due to its ability to encapsulate progesterone – present in contraceptive pills, vaginal rings, implants and intra-uterine devices – the administration of sugammadex may reduce their biological effect and cause contraceptive failure. This was identified in in-vitro studies, using isothermal microcalorimetry, performed as part of the drug’s development. While in-vivo studies to quantify the reduction in serum progesterone concentration following sugammadex administration have not been performed, these results have shaped current manufacturer guidance.