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SESSION 2004/2005

bullet SEPTEMBER - Joint Symposium with the Royal Society of Medicine Section
                        of Anaesthesia "Management of the difficult airway and anaesthesia
                        for head and neck surgery"
 
bullet OCTOBER -     Presidential Address Dr R G Ghaly
                         "Alternative medicine: friend or foe?"
 
bullet NOVEMBER - Symposium "Regional Anaesthesia"
 
bullet FEBRUARY -   Abbott Trainee's Prize Evening
 
bullet MARCH       -   Joint Meeting with the Liverpool Society of Anaesthetists
 
bullet APRIL          -  Out of Town Meeting with the Yorkshire Society of Anaesthetists
 
bullet MAY             -  Manchester Medal Lecture - Professor R K Mirakhur

SEPTEMBER 2004

The first meeting of the 2004/2005 session for the Section of Anaesthesia, of the Manchester Medical Society, was held on Friday 17th September 2004 jointly with The Royal Society of Medicine, Section of Anaesthesia. The meeting was held at The Manchester Conference Centre, Weston Building, Sackville Street, Manchester and commenced at 9.30 am with registration and coffee half-an-hour before.

The Chairman, Dr C Earlam (President of the Manchester Medical Society’s Section of Anaesthesia) began by welcoming members of the Royal Society of Medicine, Section of Anaesthesia. She then thanked everyone who was present for attending the full day symposium entitled "Management of the difficult airway and anaesthesia for head and neck surgery".

The following speakers presented their lectures in the morning session and were introduced by Dr Earlam as follows:-

Dr Andrew Vickers
(Consultant Anaesthetist, Royal Lancaster Infirmary)

"Carotid surgery under local anaesthesia – a practical guide"

Dr Vickers covered his experiences of managing patients undergoing carotid surgery under local anaesthetic. He then provided some background as to why local anaesthesia may be superior to general anaesthesia. Finally, he focussed mostly on the practical issues relating to this procedure.

Dr Keith Thomson
(Consultant Anaesthetist, North Hampshire Hospitals NHS Trust)

"Airway problems in the developing world"

Dr Thomson talked about the range of maxillofacial surgery on board the Mercy Ship Anastasis in West Africa. These included mandibulectomies for ameloblastoma, maxillectomy usually for fibrous dysplasia, cleft lip and palate surgery and repair of severe facial defects as a result of cancrum oris. The talk was illustrated by many photographs.

Dr Russell Perkins
(Consultant Anaesthetist, Central Manchester and Manchester
Children’s University Hospitals NHS Trust)

"Anaesthesia and the child with cleft lip palate"

Dr Perkins covered:

· Types of cleft
· Associated abnormalities / syndromes
· Common pre-op problems
· Intra-operative management
· Post-op management

Dr Grant McKeating
(Consultant Anaesthetist, Royal Preston Hospital)

"Head injury – from scene to specialist centre"

Dr Keating discussed the management of traumatic brain injury throughout the pathway of care – from the time of the incident and transfer to hospital, time spent in the emergency room, the transfer to the neurosurgical centre, anaesthetic management in the operating theatre, and ongoing treatment within the neuro-critical care unit.

After lunch the meeting continued with a few words from the afternoon’s Chairman, Dr Frank Walters , President, Section of Anaesthsia RSM. He then introduced the afternoon speakers as follows:-

Dr Anil Patel
(Consultant Anaesthetist, Royal National Throat Nose & Ear Hospital)

"The shared airway"

Anaesthesia for the shared airway requires close co-operation and communication between anaesthetist and surgeon, an understanding of each other’s problems and knowledge of specialist equipment.

Patients vary from young individuals with benign vocal cord pathology to elderly patients with advanced glottic carcinoma and different anaesthetic techniques are suitable for different patients.

There is no ideal anaesthetic technique for all endoscopy procedures. The technique depends on the patient’s general condition, the size, mobility and location of a lesion, the use of a laser and the surgical requirements.

Options for the successful anaesthetic management of the shared airway include:-

a. Microlaryngoscopy tubes
b. Laser tubes
c. Supraglottic jet ventilation
d. Subglottic jet ventilation
e. Transtracheal jet ventilation
f. Spontaneous ventilation techniques

Dr Robert Walker
(Consultant Paediatric Anaesthestist, Central Manchester and
Manchester Children’s University Hospitals NHS Trust)

"Management of the compromised paediatric airway"

Anaesthesia for the shared airway requires close co-operation and communication between anaesthetist and surgeon, an understanding of each other’s problems and knowledge of specialist equipment.

Patients vary from young individuals with benign vocal cord pathology to elderly patients with advanced glottic carcinoma and different anaesthetic techniques are suitable for different patients.

There is no ideal anaesthetic technique for all endoscopy procedures. The technique depends on the patient’s general condition, the size, mobility and location of a lesion, the use of a laser and the surgical requirements.

Options for the successful anaesthetic management of the shared airway include:-

a Microlaryngoscopy tubes
b Laser tubes
c Supraglottic jet ventilation
d Subglottic jet ventilation
e Transtracheal jet ventilation
f  Spontaneous ventilation techniques

Dr Stephen Pugh
(Consultant Anaesthetist, University Hospital of Wales)

"Circulating volume measurement"

This talk covered how blood losses and volume replacement during prolonged surgery may be difficult to measure and manage. Dr Pugh also covered some techniques to facilitate volume management and improve outcomes.

Dr Jerry Nolan
(Consultant in Anaesthesia and Lead Clinician in
Intensive Care Medicine, Royal United Hospitals)

"Major trauma and the airway"

The seriously injured patient presents significant challenges for airway management. The nature of the problem was presented and approaches to management at the scene and in the resuscitation room was discussed.

Over 100 delegates attended what proved to be an excellent conference. The delegates showed their appreciation and interest by listening attentively and bestowing prolonged applause after each lecture. Even though we may have great speakers and interesting topics, the smooth running of these events is equally essential for a successful conference and a vote of thanks was given to Fiona Lamb, Administrator of the Manchester Medical Society and her team.

The Section gratefully acknowledges the support of Aspect, Spacelabs Medical, Abbott Laboratories, Nagor, Glaxo Smith Kline, Amdipharm, Pfizer, Draeger and Cook.

A dinner was held the night before the symposium (Thursday 16th September 2004) in the Exhibition Lounge of the Weston Building. Speakers; members of the Council of the Section of Anaesthesia of the Manchester Medical Society; the President of the Royal Society of Medicine, Section of Anaesthesia and the President of the Liverpool Society of Anaesthesia were all invited.

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OCTOBER 2004

The Presidential Address for the Section of Anaesthesia of the Manchester Medical Society for the 2004/2005 session was held on Thursday 14th October 2004 at 7.00 pm in the Manchester Dental Education Centre (MANDEC), University of Manchester.

Prior to the Presidential Address, the Annual General Meeting took place. Formal election of New Office-bearers and Members of Council for 2004/2005 were unanimously accepted.

The incoming President, Dr R G Ghaly (Consultant in Anaesthesia & Chronic Pain Management, and Clinical Director of Anaesthesia, Wrightington, Wigan and Leigh NHS Trust) proudly accepted the Presidential Medallion and praised Dr Earlam, current Immediate Past President, for all her hard work throughout her presidential year.

Dr Ghaly then gave a stimulating lecture entitled:-

"Alternative medicine: friend or foe?"

His address covered the place of complimentary medicine in contemporary clinical practice. Although several different disciplines were outlined, Dr Ghaly concentrated on acupuncture in which art he is an acknowledged expert. He was able to back up the content of his lecture with his own published research. Of particular interest was the fact that acupuncture had been proven (by Dr Ghaly) to be at least as effective, if not more so, than traditional pharmacological approaches to postoperative nausea and vomiting. The lecture was educational, stimulating and entertaining in equal measure .

Immediately afterwards, Dr Earlam gave a vote of thanks to Dr Ghaly and members of the audience (including Professor J C Lowry, President of the Society) endorsed her positive comments by way of prolonged applause.

The section normally holds a dinner before the meeting. However, this session it was agreed that the dinners would be held after the meeting at 8.15 for 8.45 pm. Therefore, Dr Ghaly’s Presidential Dinner was held after his lecture in a private dining room of the University Refectory.

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NOVEMBER 2004

The second meeting for the Section of Anaesthesia of the Manchester Medical Society for the 2004/2005 session was a half-day symposium on the theme of Regional Anaesthesia. The meeting was held on Thursday 11th November 2004 at 8 45 am in the Education Centre, Royal Bolton Hospital. The meeting was sponsored by GSK. It was preceded by a breakfast of coffee and croissants.

This meeting represented a new departure for the Section of Anaesthesia being the first symposium to take place during the regular working hours and replaced the November and December evening meetings. It was therefore extremely gratifying to note the attendance of approximately a hundred members.

Dr Ghaly, the President, welcomed the audience and chaired the morning programme.

The first talk was given by Dr H Hack (Consultant Anaesthetist, Central Manchester & Manchester Children’s University Hospitals NHS Trust) on the subject of paediatric regional anaesthesia. This proved to be most illuminating and interesting. Dr Hack expounded general principles while illustrating his point by concentrating mainly on caudal and ilio-inguinal blocks.

The second talk comprised a lively debate, the motion being: This house believes that epidural and other major nerve blocks should only be inserted in awake patients. Speaking for the motion was professor J Wildsmith (University of Dundee) and against was Dr H Fischer (Consultant Anaesthetist, Worcestershire Acute Hospitals NHS Trust). A preliminary vote on the motion was roughly 50:50 split. After opening statements, the floor was open to questions from the audience which were many and interesting. Finally, after the speakers gave their concluding remarks, another vote was taken which this time showed a 60:40 majority against the motion.

After a break for coffee and a minute of silence in remembrance of those who had given their lives in armed conflict, the final session comprised another debate, the motion being: This house believes that thoracic epidurals should not be routinely used for heart surgery. Speaking for the motion was Dr A Vohra (Consultant Anaesthetist, Central Manchester & Manchester Children’s University Hospitals NHS Trust) and against was Dr P Alston (Consultant Anaesthetist, Royal Edinburgh Infirmary). Although most of the audience did not specifically practise cardiac anaesthesia, the quality of the presentations was such that all were thoroughly interested and involved in the debate. The preliminary vote showed a majority against the motion, although there were many abstentions. After the debate, the house rejected the motion.

Dr Ghaly then thanked all of the speakers for the excellence of the presentations and the audience for attending.

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FEBRUARY 2005

The Trainees’ Prize evening for the Section of Anaesthesia, of the Manchester Medical Society, was held on Thursday 10th February 2005 at 7.00 pm in the Manchester Dental Education Centre (MANDEC), University of Manchester.

The President of the Section, Dr R G Ghaly, welcomed the audience and thanked Abbott Laboratories Limited for supporting the scheme. He then proceeded to introduce the competitors, along with the titles of their lectures as follows:-

Dr N Bhadra
"Audit of work patterns of trainees at Stepping Hill Hospital before and
after the introduction of a European Working Time Directive (EWTD)
compliant rota - is training being compromised"

Dr M Entwistle
"Limited resources need not mean lower quality care: a trainee’s
experience of cleft lip and palate surgery in the developing world"

Dr J Norman
"Emergency Anaesthesia: A Survey of Practice "

The audience and adjudicators listened attentively as the speakers gave their presentations. Each speaker answered questions immediately following their individual lectures and received positive feedback from members of the adjudicating panel.

Following much deliberation, it was agreed that the first prize of £250 would be awarded to Dr Entwistle. The runner-up prize of £100 (donated from the section’s funds) was awarded to Dr Bhadra. It was felt that all papers were of a very high standard and all three presenters will receive a certificate marking the occasion of their presentation.

After the meeting an informal Buffet supper was held at MANDEC in honour of the presenters.

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MARCH 2005

An afternoon Joint Meeting with the Section of Anaesthesia of the Manchester Medical Society and the Liverpool Society of Anaesthetists was held on Thursday 10th March 2005. The meeting commenced at 2.00 pm, with a buffet lunch beforehand between 1.00 and 1.45 pm at the Park Royal Hotel, Warrington.

This year’s joint meeting was organised by Dr D Gray, President of the Liverpool Society of Anaesthetists, who also chaired the meeting.

The speakers for the afternoon were as follows:-

Dr Peter Cartwright
(Chairman RCA Exams Committee)
"Current thinking on the RCA Examinations"

Dr David Saunders
(Vice-President RCA)
"The Anaesthetic Workforce, the EWTD & Beyond"

Mr Rob Halls
(Chief Executive, Winchester & Eastleigh NHS Trust)
"A Chief Executive’s View of Anaesthetists"

An impressively large audience attended and were treated to three fascinating talks. A lively question and answer session followed. This was the first joint half-day symposium between the two societies, replacing as it did the traditional evening meeting. The new format was judged a great success and will be repeated next year.

Dr R G Ghaly, President of the Section of Anaesthesia, of the Manchester Medical Society, gave a vote of thanks to the speakers and also to Dr D Gray for organising a successful meeting.

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APRIL 2005

The ‘Out of Town Meeting’ of the Section of Anaesthesia of the Manchester Medical Society was held on Saturday 16th April 2005 jointly with the Yorkshire Society of Anaesthetists. The meeting took place at the Education Centre, Rochdale Infirmary, Whitehall Street, Rochdale. It commenced at 9.30 am with coffee beforehand at 9.00 am and finished at approximately 4.30 pm.

The President of the Section of Anaesthesia, of the Manchester Medical Society, Dr R G Ghaly opened the meeting and chaired the morning session as follows:-

Dr P Nightingale (South Manchester University Hospitals NHS Trust)
"Sepsis – are we making progress?"

Currently Dr Nightingale sits on the Department of Health’s Critical Care Information Advisory Group and Chairs the Department’s Financial Flows Group on funding for critical care.

Dr I Lieberman (South Manchester University Hospitals NHS Trust)
"Chronic refractory angina"

Dr Lieberman’s specialty interest in medicine is the management of chronic refractory angina and he has recently taken over the chair of the specialist group for this in the Pain Society.

Dr D Conway (Central Manchester and Manchester
Children’sUniversity Hospitals NHS Trust)

"Oral feeding on Intensive Care"

As Professor Mythen’s arrival from London was delayed due to problems with the trains, two of the SpRs now gave their short presentations as follows:

Dr E Kam (Stepping Hill Hospital)
"Effect of emulsion formulation on propofol injection"

Dr M Entwistle (Royal Manchester Children’s Hospital)
"Limited resources need not mean lower quality care: a teacher’s
experience of cleft lip and palate surgery in the developing world"

Each presenter was allocated ten minutes for their presentation followed by a further 5 minutes for questions to be taken from the audience.

Lunch was held at 12.00 noon for approximately 100 members and guests courtesy of the generous support of: GlaxoSmithKline, Keymed) Medical & Industrial Equipment) Ltd, Karl Storz Endoscopy (UK) Ltd, Amdipharm PLC, Intersurgical Ltd, B Braun Medical Ltd, Deltex Medical Ltd.

Dr E Moss, President of the Yorkshire Society of Anaesthetists welcomed back members and guests after lunch and introduced Professor Mythen:

Professor M G Mythen (University College London)
"Modernising the care of the major surgical patient"

The two SpRs from Yorkshire then gave their presentations.

Dr S Holbrook (St James’s University Hospital)
"Pulse oximetry: sympathy for the medic"

Dr S Turner (The General Infirmary, Leeds)
"Effect of perioperative steroids on renal function during
liver transplantation"

The trainee presentations were followed by two excellent, informative lectures as follows:-

Dr I Woods (York Health Services NHS Trust)
"Risk management"

Professor M C Bellamy (St James’s University Hospital)
"Liver transplantation – can the anaesthetist make a difference?"

The talk included some clinical background, practical details, supporting science and extrapolatable lessons. Professor Bellamy hoped to show that the conduct of anaesthesia for the major case does influence outcomes and suggest areas of future interest.

Finally, Dr Vallis gave an excellent finale with an original and informative lecture

Dr C J Vallis (Royal Victoria Infirmary)
"Physiology of Half Marathons and The Great North Run"

The three speakers individually took questions from the floor. Dr Moss gave a vote of thanks, which was closely followed by prolonged applause from the audience for what was not only an excellent informative day but also provided delegates the opportunity to network and form new links.

Both Presidents expressed their gratitude to the Manchester Medical Society Administration team for all their hard work.

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MAY 2005

The Section of Anaesthesia of the Manchester Medical Society held their eighth Manchester Medal Lecture on Thursday 12th May 2005. The meeting commenced at 7.00 pm and was held in the Manchester Dental Education Centre (MANDEC), University of Manchester.

The President of the Section, Dr R G Ghaly, welcomed the audience and introduced the speaker as follows:-

Professor R K Mirakhur
(Professor of Anaesthetics, Queen’s University Belfast)

"Nondepolarizing replacement for succinylcholine:
A reality or a pipedream?"

The audience listened attentively as Professor Mirakhur spoke on his chosen subject. This was of great interest to all the anaesthetists in attendance and was delivered with Professor Mirakhur’s customary panache. Much of the lecture included his own groundbreaking research in this field and gave real hope that we might one day have a suitable substitute for suxamethonium. Although traditionally the Manchester Medal lecturer is not asked questions afterwards, such was the interest generated that Professor Mirakhur kindly agreed to field a number of them. Professor Mirakhur then received a vote of thanks from the President and prolonged applause from the audience.

As is customary, a dinner was held after the meeting in honour of Professor Mirakhur at 8.15 for 8.45 pm in Christie Bistro, University of Manchester. It is also customary to invite the past Manchester Medal Lecturers to attend the evening but unfortunately none were able to accept their invitation.

However, the remaining members and guests enjoyed a pleasant evening in the warm surroundings of Christie Bistro which not only brought the evening but also the session to a delightful close.

The Manchester Medical Society Section of Anaesthesia would like to acknowledge the generous support given by Organon Laboraties Ltd and B Braun Medical Ltd.

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