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When English chemist Joseph Priestley discovered ‘dephlogisticated nitrous air’, or nitrous oxide in 1772, he unknowingly revolutionised medical practice. What Mr Priestley didn’t know was the significant impact that N₂O would have on the environment.

With a lifetime of 150 years in the atmosphere and a 100-year global warming potential 10 times that of carbon dioxide, N₂O poses a significant problem.

Are we regularly bulk-buying N₂O just to leak it straight into the sky? This is not a new idea. The Nitrous Oxide Project, started in NHS Lothian in 2021 by Alifia Chakera, found that usage of N₂O in the theatre setting was much lower than anticipated, with significant wastage in the supply chain. In fact, hospitals that have undertaken similar analyses report that 95–99% of the N₂O that’s bought is wasted due to leaks in both outdated manifold systems and in piped N₂O supplies.

In Scotland there stands a national gap in clinical governance which results in blind spots and potential risk to patients. This article explores why Scotland is missing out and what needs to be done next.

Our nation is ideally placed to perform and contribute to UK-wide audit. The population size, the uniform governance structure, and the infrastructure and expertise should lend themselves to a world-leading approach to clinical audit and outcomes.

Despite this, Scotland doesn’t participate in an important programme for ensuring standards and safety in anaesthesia in the UK. The Safe Anaesthesia Liaison Group (SALG) is a long-standing collaborative project between the Royal College of Anaesthestists (RCoA) and the Association of Anaesthetists. Established in 2008, it aims to provide a central repository for anaesthesia-related patient-safety incidents. SALG then analyses, prioritises and takes appropriate action on reported incidents.

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.

Healthcare systems account for up to 4.4% of the world’s carbon footprint, and it is well established within hospitals that operating theatres are some of the most energy-intensive spaces. 

The NHS has recognised the impact it makes towards climate change by setting an ambitious target to reach net-zero of carbon emissions by 2045. This means a reduction in current levels of carbon emissions by at least 80% by 2036.

Within North Bristol Trust, we organised a Green Operating Day to implement carbon-saving measures rooted in the Intercollegiate Green Surgical Checklist and the Green Surgery Report to test the feasibility of implementing these measures across three neurosurgical theatres and 10 operative cases.

It’s only the start of meteorological winter, but the recent rhetoric of the newish government does seem to chime for the multidisciplinary team working in critical care services. It is becoming more difficult each day to keep safe services afloat, with bed occupancy well above recommended levels throughout the four nations.

While there’s a definite wish in critical care to accommodate the long list of elective surgical patients and for emergency patients to be located in the best place, be that enhanced or critical care, it will be most welcome to see details forthcoming from government. We hope they lead to the better flow of patients through our ICUs in 2025 and beyond.

Two years ago, the clinical leads census revealed that 50% of responding ICUs have at least one gap on their consultant rota. We continue to seek triangulating information on recruitment challenges, which appear to be in less urban areas and specialist ICUs. FICM continues to engage with relevant stakeholders, including NHS England and the Academy, to make the case for more intensivists in the future.

Returning to work following a prolonged period out of training is daunting, whether that be due to parental leave, sick leave, carer’s leave or for Out-of-Programme time. 

Anaesthetists in training know all too well the stresses that come with frequently rotating between different hospitals and departments, with three- and six-monthly rotations being quite the norm in some deaneries.

Having a child is a life changing experience, and many would hope that their place of work remained constant throughout the beginnings of parenthood. Frequent job rotations with a diverse curriculum to work through means trainees are potentially carrying out their return to work in a new environment while juggling the stresses of childcare and pressures of getting back up-to-speed at work.

Dr Jon Chambers picks up the reins as Editor of the Bulletin and welcomes you to the year's first issue.

As I pick up the reins as Editor of the Bulletin, I do so with an appropriate degree of trepidation. The Bulletin has been a constant throughout my anaesthetic career, and it remains a window into our specialty that combines a mix of news, developments within the specialty, personal stories and guidance. In my short time in the role, I’ve already been humbled by the quality of contributions from the anaesthetic community willing to share their stories and their work with colleagues.

The start of a new year is often a time to look to the future and the new challenges ahead. In the midst of this newness I have always believed that we should also take the time to look back, and to learn from and reflect on the lessons of our past. In the run up to LGBT+ History Month (February) Professor Andrew Hartle does just that, and he writes openly and honestly on the challenges he has faced as an out gay anaesthetist throughout his career in the NHS and the military. His reflections take us through his journey of exclusion and stigmatisation, and then ultimately of acceptance, recognition and celebration. It is an incredible journey and ends with him rightly encouraging us all to feel prouder in 2025.

Dr Claire Shannon, President outlines what's coming up in 2025 and why it's important to support each other and work as part of a great team.

Happy New Year to you all. I know many of you will have been working over the festive period, but I hope you also had some time to catch up with friends and family and take a well-earned break. 

Winter is never an easy time in the NHS. During the more challenging times of the year, I’m always particularly grateful for the support of my colleagues and the benefits of working as part of a great team. I hope that’s true for you too as we look to the year ahead.