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At the end of January 2024, the GMC published an updated version of Good Medical Practice, the core guidance for all registered doctors. This has been accompanied by guidance on a number of other areas, including confidentiality, consent and research, and legal and regulatory proceedings, all of which can be seen on the GMC website.

The opportunity has been taken to conduct a major review of the College’s supporting information for appraisal and revalidation.

On 27 August 2011, The Times alerted readers to a craze originating in Spain: a drink high in alcohol was vaporised in a hand-held inhaler that contained a heater and a supply of oxygen. 

The alcohol rapidly reached the bloodstream via the lungs, quickly producing intoxication. A local newspaper reported:‘Oxy shots – the latest madness of the British in Majorca’. One of us (AD) recounted the story to an anaesthetist friend, Keith Pooley, who announced that once in his career he had actually anaesthetised a patient with ethyl alcohol vapour. He told me the full story which I later wrote up in The Times as an addendum to the oxy shots’ article. He was visiting a local cottage hospital on a weekly basis to prepare patients for minor surgery, mainly using halothane. On this occasion the induction was slow, with the patient resisting, spluttering and coughing. ‘But’ said Keith ‘I eventually got him down and he had his operation’. Recovery was atypical of that from halothane, and some detective work was called for. Keith unscrewed the vaporiser bottle and sniffed the contents – surgical spirits (typically 70–99% ethyl alcohol). It seems that the previous week he had discarded an empty 250 ml bottle of halothane. Someone else, keen on recycling, later retrieved the bottle from the bin and used it to store the surgical spirits. Unlabelled, it had wandered around the hospital until eventually finding its way back into the anaesthetics’ cupboard….

At Nottingham University Hospitals (NUH), it was felt that for our patients with cardiovascular disease, obtaining a preoperative cardiology assessment and perioperative management strategy was prolonging non-cardiac surgery waiting times. 

This was especially compounded by the surgical backlog and increased demand on preoperative services following the COVID-19 pandemic. In order to streamline the assessment process and facilitate safer surgery, a joint cardiology-anaesthesia multidisciplinary team (MDT) meeting was established.

The global problem

It is no surprise that underlying cardiovascular disease can contribute significantly to perioperative morbidity and mortality, with cardiac events being the leading cause of such.¹ Almost half of adults aged over 45 years undergoing major non-cardiac surgery have at least two cardiovascular risk factors, and conditions such as coronary heart disease, heart failure and arrhythmias put patients at increased risk of cardio- and cerebrovascular events in the immediate postoperative period.²