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The Newsletter
of the
Association ISSN 0959-2962 No. 371
of Anaesthetists
of Great Britain JUNE 2018
and Ireland
GAT ISSUE
SPA time for trainees
Knowing your payslip
A Day in the Life of

an…On-call Consultant
Anaesthetist
A Day in the Life

of a…College Tutor
A Night in the Life

of an…On-call
Obstetric Trainee
GAT
ANNUAL
SCIENTIFIC
MEETINg
in Scotland
Location: Hilton Glasgow
4-6 JULY 2018
Trainees, medical
students and first
year consultants,
BOOK NOW!
www.gatasm.org
Editorial Contents 07 03 Editorial
05 A Night in the Life of an…

On-call Obstetric Trainee
07 A Day in the Life of a…

Consultant Obstetric Anaesthetist
08 A Day in the Life of a…

Training Programme Director
09 A Day in the Life of a...

Clinical Director
Welcome to this annual trainee issue of Anaesthesia News. The Group 15 10 A Day in the Life of an…
of Anaesthetists in Training (GAT) Committee is committed to the On-call Consultant Anaesthetist
welfare of all our members. We recognise that morale has remained low
within the whole healthcare environment; reasons for which are complex 18 12 A Day in the Life of an…
and multifactorial. However, within this Special Issue of Anaesthesia Anaesthetic Registrar
News we wanted our readers to remember why we practice this great
specialty by publishing a series of short, witty articles about the lives of 13 A Day in the Life of a…
anaesthetists with differing roles. College Tutor
Presented within the issue are eight humorous ‘A day/night in the life 14 A Day in the Life of an…
of…’ articles. I would like to take the opportunity to thank every author On-call ICU Registrar
for their contribution. Some authors have chosen to remain anonymous,
their contribution is equally acknowledged. 15 Winter Scientific Meeting
I would also draw your attention to the article titled ‘Knowing your 17 Particles
payslip’ by Tom Wojcikiewicz (GAT Committee Elected Member). I know
Tom has worked tirelessly to research and make clear the sometimes 18 Knowing your payslip
22
confusing topic of what all the information on our payslips really means.
21 Anaesthesia Digested
Additionally, Mohammed Akuji and Bernadette Lomas explain an SPA
time initiative in the North-West deanery. I would be interested to know if 22 SPA time for trainees
similar initiatives are taking place elsewhere.
24 Your letters
Finally, I would like to personally thank Eoin Kelleher (GAT Committee
Elected Member) for illustrating this issue. Eoin is immensely talented
and his illustrations capture the content of an article visually. I am 24
pleased that his work appears on the front cover.
The Association of Anaesthetists of Great Britain and Ireland
The content and style of this issue is different from the usual style of 21 Portland Place, London W1B 1PY
Anaesthesia News. I encourage readers to send in their views on any of Telephone: 020 7631 1650
Email: anaenews@aagbi.org
the articles published. Website: www.aagbi.org
Anaesthesia News
I hope you enjoy reading this issue as much as I have. I also hope as Managing Editor: Gerry Keenan
many of you as possible will make your way to Glasgow for the GAT Editors: Satinder Dalay (GAT), Nancy Redfern, Rachel Collis, Craig Bailey,
Tim Meek, Mathew Patteril and Matthew Davies
Annual Scientific Meeting, from 4–6 July. See you there! Address for all correspondence, advertising or submissions:
Website: www.aagbi.org/publications/anaesthesia-news
Satinder Dalay
Elected Member, GAT Committee Editorial Assistant: Rona Gloag
Design: Chris Steer

AAGBI Website & Publications Officer
Telephone: 020 7631 8803
Email: chris@aagbi.org
Printing: Portland Print
Copyright 2018 The Association of Anaesthetists of Great Britain and Ireland
The Association cannot be responsible for the statements or views of the contributors.
No part of this newsletter may be reproduced without prior permission.
Advertisements are accepted in good faith. Readers are reminded that

Anaesthesia News cannot be held responsible in any way for the quality
Anaesthesia News June 2018 • Issue 371 or correctness of products or services offered in advertisements. 33
Undergraduate
elective funding 2018 EVELYN BAKER
Up to £750 MEDAL
Applications are invited from medical students studying
in Great Britain and Ireland (subject to confirmation of
eligibility) to apply to the AAGBI Foundation for funding
towards a medical student elective period taking place
between October 2018 and March 2019. A further round
of funding will be advertised in the Autumn for electives
AN AWARD FOR OUTSTANDING
taking place from April 2019 onwards. Overseas CLINICAL COMPETENCE
students should ensure that they are permitted to apply
for charitable funding. Grants will only be awarded to
applicants who intend to spend time away from their base
academic institution and whose travel, accommodation The Evelyn Baker award was instigated by
and subsistence costs are increased as a result.
Dr Margaret Branthwaite in 1998, dedicated
Preference will be given to those applicants who to the memory of one of her former patients
can show the relevance of their intended elective to
anaesthesia, intensive care or pain relief. A key focus at the Royal Brompton Hospital. The award
of the AAGBI is support for projects in the developing is made for outstanding clinical competence,
world, hence elective placements supporting work in low
and low-resource income countries are given priority. recognising the ‘unsung heroes’ of clinical
anaesthesia and related practice. The defining
For further information and to apply please visit our
website: www.aagbi.org/undergraduate-awards, email characteristics of clinical competence are
secretariat@aagbi.org or telephone 020 7631 1650 deemed to be technical proficiency, consistently
(option 3)
reliable clinical judgement and wisdom and skill
Closing date: 13 July 2018 in communicating with patients, their relatives
for consideration at the Sept 2018 and colleagues. The ability to train and enthuse
Research & Grants Committee meeting
trainee colleagues is seen as an integral part of
communication skill, extending beyond formal
teaching of academic presentation.
Nominations are now invited for the award, which

will be presented at WSM London in January
Travel grants/IRC funding 2019. Members of the AAGBI can nominate any
practising anaesthetist who is also a member of
the Association. Nominees should normally still
be in clinical practice. The award is unlikely to
The International Relations Committee be given to someone in their first ten years as
(IRC) offers travel grants to anaesthetists a consultant or an SAS doctor, and the nominee
who are seeking funding to work, or to
deliver educational training courses or should not be in possession of a national award.
conferences, in low and middle-income Nominations should include an indication that
countries. the nominee has broad support within their
department.
Please note that grants will not normally be
considered for attendance at congresses or
meetings of learned societies. Exceptionally, Last year the award was won by Dr Michelle
they may be granted for extension of travel Soskin. Details of previous award winners
in association with such a post or meeting.
Applicants should indicate their level of and further information can be found on the
experience and expected benefits to be website www.aagbi.org/about-us/awards/
gained from their visits, over and above evelyn-baker-medal
the educational value to the applicants
themselves.
To check eligible travel dates and apply please visit: The nomination, accompanied by a
www.aagbi.org/international/irc-fundingtravel-grants citation of up to 1000 words, should
or email secretariat@aagbi.org or telephone
020 7631 1650 (option 3) be sent to the Honorary Secretary at
HonSecretary@aagbi.org by 17:00
Closing date: 24 August 2018
on Friday 31 July 2018.
A Night in the Life of an…
On-call Obstetric Trainee
And so it begins. I arrive at 2000 for handover and there’s an
epidural to do in room one. The day person was asked at 1955
so plays the relay epidural trick. As soon as I am scrubbed, get
the epidural trolley set up, and start to paint the chlorhexidine
on her back, there’s that announcement, ‘I need to push’. Still, I
suppose that’s one less dural tap.
A few minutes later I gatecrash the evening Labour Ward ward

round. The obs reg knows me well and has already gone to
the mess so he can present me with a large latte on my arrival;
before proudly announcing what he has lined up. It appears that
every high-risk lady in the region has decided to appear tonight.
It’s okay though. I breathe a sigh of relief as I am told they have
all visited the obstetric anaesthetic clinic. I go to the clinic letter
folder to have a read as I am sure it will tell me what to do.
Unfortunately, they only attended last week so the letters haven’t
been filed yet. It’s okay though because as the first patient is
wheeled in they start waving a very detailed six-page clinic letter
detailing exactly what I should do. Bloods, two big cannulae,
an art line and an early epidural. They seem to be missing the
final page of the letter as I can’t find the bit that tells me what
to do at 0300 when their epidural stops working, they’re going
to theatre, declining any further attempt at regional anaesthesia
and demanding a general.
Six hours, four epidurals and five sections later, I am called by

the Labour Ward midwife in charge, ‘we may or may not be
going to theatre, not just yet but possibly at some point in the
next six hours, can you hang around just in case’.
Eventually, we get to theatre with our next patient and position

perfectly for the spinal, but while I set my trolley up there’s a
contraction. ‘Okay, okay, so if you just sit up straight for me.
Okay, maybe need to tilt right again, okay, okay, a bit left, okay
just a bit right again, oh, you’ve got another contraction have
you…’
After 30 minutes of doing the spinal position boogie and several It's 0700, nearly time for handover, the end is in sight, the
spinal needles later, we mutually agree that I will swap the midwives have been rewarding me for every bleep with a shot
hyperbaric levobupivicaine for some isobaric thiopentone and of espresso. I start to feel a bit funny and decide to check my
suxamethonium, with an endotracheal tube chaser. heart rate on my iPhone; 300 bpm and regular. Allergic to Labour
Ward? Over-caffeinated? Has to be the former, surely, quick fetch
As per the norm, we end up with back to back sections. Thankfully the adrenaline. I am a self-respecting anaesthetist after all.
my spinal this time is slick. I look like a pro, beautiful block and
great chat with the parents. All of a sudden panic ensues within Twelve hours later: 11 double espressos, 10 trial of forceps, 9
the room ‘Catch the baby! Catch the baby! Catch the baby!!’ caesareans, 8 spontaneous vaginal deliveries, 7 epidurals, 6
is all that can be heard. Followed by ‘T-I-M-B-E-RRRRRRRR...’ fully and pushing, 5 third-degree tears, 4 general anaesthetics, 3
Dad has hit the floor. Luckily I catch the baby. In the meantime, ‘tricky veins’, 2 dural taps and an anaesthetist in SVT.
the student midwife has called 2222 and in charges the medical
registrar, the medical F1, the ICU CT2 and a CCU nurse, all Lyndsey Forbes
confused as to what exactly they should do in obstetric theatre. Fellow in Paediatric Anaesthesia, Royal Manchester Children’s
Immediately, they are informed by the theatre sister that they are Hospital
not wearing a hat and sent on their way.
Anaesthesia News June 2018 • Issue 371 5

AAGBI Wellbeing
The Edinburgh Fibre Optic and Support
Intubation Course
A two day course aimed at ST3+, SAS and consultants
seeking to update their skills in fibre optic intubation
19th - 20th September 2018 Including

Manikin Practice, Interactive Workshops, Lectures
mentoring
and Asleep Fibre Optic Intubation of a Patient
Course Fee £350

RCOA CME approved 10 points
For more information please contact:

Course secretary: Hazel Cherrie
Telephone: 0131 242 3151
Email: hazel.cherrie@nhslothian.scot.nhs.uk
https://www.ed.ac.uk/clinical-sciences/divisionpgdi/anaesthesia/
events/workshop-on-fibre-optic-intubation-sep-2018 Assisting and supporting
anaesthetists throughout
Department of Anaesthesia, Royal Infirmary
51 Little France Crescent, Edinburgh, EH16 4SA
Supported by
their careers…
www.aagbi.org/wellbeing
Difficult Airway Society,

Annual Scientific Meeting 2018
Registration opens 1st June 2018
To register visit www.das2018.co.uk
28-30 November, Edinburgh, Scotland
das2018@abbey.ie www.das2018.co.uk @dasedinburgh18

A Day in the Life of a…
Consultant Obstetric Anaesthetist
0800: Receive SAFERR (SAFER + Rest?) handover from 1430: Leap into action as the emergency alert sounds while
overnight resident. Congratulate/commiserate after another crazy teaching medical students. Race to attend an arrested parturient,
night, check they’re safe to get home. before practically fainting with relief on seeing a manikin. Hold it
together for the rest of the drill. Try to convince the team during
0810: Jostle for position seeing elective sections with multiple debrief that it wasn’t panic on one’s face.
other professionals. Realise consultant privilege is a thing of the
past. 1500: Rush to theatre with a real postpartum haemorrhage. Briefly
marvel again at the improved laryngeal view with roc rather than
0835: Because of previous lack of privilege, appear five minutes sux before launching into resuscitation mode and coordinating
late to theatre brief clutching illicit cup of coffee, incurring successful multidisciplinary obstetric haemorrhage management.
considerable wrath of theatre sister.
1600: Confirm resuscitation endpoints using Point Of Care testing
0836: Recognise ‘TUBAL LIGATION’ missing from theatre list, before waking patient up. Congratulate and praise our team
again. Ask for a reprint. during debrief while sensitively discussing learning points for
future cases.
0837: ‘TUBAL LIGATION’ now appears as leading surgeon.
Request reprint. 1615: Cup of tea and a handful of Heroes.
0838: Patient now listed for ‘CAESAREAN SECTION and 1630: Attempt follow-ups, find half have gone home.
NOITAGIL LABUT’. Reprint.
1745: Category 3 section for unsuccessful induction in 5ft
0845: Attend multidisciplinary risk management in attempt to tall patient. Agonise over height-related, utterly insignificant
temper natural surgical tendencies. modification of spinal Marcain dose. Momentarily also consider
adjusting universal 300 mcg spinal diamorphine; dismiss out of
0900: Supervise new CT2 performing first ever obstetrics spinal. hand.
Share delight when CSF appears on first pass.
1800: Open two theatres as cord prolapse is rushed through just
1000: Supervise CT2 doing second ever obstetrics spinal. as Category 3 section started. Induce anaesthesia, thrill as baby
Sympathise and empathise over repeat passes while scrubbing cries on delivery. Wake patient after quadratus lumborum blocks.
hands, secretly suspecting one would have had it long ago. Familiar prickle of eyelids as mother is emotionally hugely relieved
to meet a healthy baby.
1030: Realise through tears of frustration that one definitely would
not have had it long ago. Call senior colleague. 2000: Join evening obstetric ward round.
1045: Recognise senior colleague would have had it hours 2100: Sign off for the night, leaving labour ward in the capable
ago. Thank senior colleague profusely and apologise to patient hands of the night resident and pray for a quiet on-call.
effusively, while silently fuming and despairing of own ineptitude.
0600: Check phone is not on mute after alarm signals another day
1100: Regain composure after sending trainee for coffee. on labour ward.
1130: Greet familiar patient from clinic. Recap anaesthetic and Postscript
delivery strategy, carefully crafted with multidisciplinary team and I genuinely love my job as an obstetric anaesthetist. It can be
patient collaboration over preceding weeks. easy to be sniffy about obstetric anaesthesia but I personally
find the combination of technical proficiency, multidisciplinary
1215: Masterly execute complex anaesthetic with minimal fuss cooperation, patient collaboration and high drama extremely
and remember this is what it’s all about. gratifying.
1230: Briefly turn away because of ‘something in my eye’ when Come and give us a go!
complex anaesthetic and delivery plan produces gorgeous,
bawling baby to the delight of everyone in the room. Remember Danny Morland
this really is what it’s all about. Consultant Anaesthetist, Royal Victoria Infirmary, Newcastle
1300: Consume a lunch consisting entirely of Delivery Suite

chocolates.

Training Programme Director
I’m awake before the alarm goes off. I listen to the news headlines take it. It’s an opportunity to gain experience and training to shape
while having a quick look at my emails. their CV for the consultant post they want and they bring back a
new take on ways to do things.
Good news: a trainee is 16 weeks pregnant after several rounds of
IVF. I am delighted for her and her husband. Bad news: fiddle with my multicoloured rotation plot (Joseph’s
Amazing Technicolour Dreamcoat has nothing on my Excel
Bad news: there’ll be a gap in the rotation plot when she goes on spreadsheet) and sort out the next job changeover. There are
maternity leave. gaps. We will cope. I would much rather have the right trainee in
the right job at the right time for their life and their training rather
Cycle to work. than just having a bum on a seat.
Good news: get a green light roll most of the way there and only
encounter one red light. Stick my head in the admin office.
Good news: our admin staff are superb and support the consultants
Bad news: it’s raining. and trainees so well.
Head to the changing room. Bad news: no biscuits.

Good news: I’m early, it’s empty and I don’t have to make polite
conversation. Back to theatre.
Good news: only one more case to do before handing over to the
Bad news: the scrub machine has been filled in a random on-call team.
fashion and my scrub top is a different colour to the trousers (my
anaesthetic OCD kicks in). Bad news: it’s going to be smelly…
Review the emergency list. Cycle home.

Good news: there are some interesting cases on it and I’m on with Good news: it’s stopped raining
an enthusiastic and knowledgeable trainee.
Bad news: every traffic light on the way home is red.
Bad news: the list is a complete work of fiction and will change at
least three times before 0830. Check my email:
Good news: the ARCP panels have been filled. I enjoy ARCPs
Head to the coffee room. and seeing the trainees face to face is so valuable. It’s a chance
Good news: there’s an empty chair and my can of Diet Coke is to review the year, both the highs and lows. I like to celebrate
really cold. excellence and give encouragement where change is needed.
The panel reviews the CV and makes suggestions and we can
Bad news: the night staff look absolutely frazzled. It’s been a plan the next couple of years of training.
monster of a night and they’ve had two theatres, obs, neuro and
the cath lab running overnight. The on-call consultants have been Bad news: HEE want to move to in absentia ARCPs.
in and there are lists that will need covering as they head home to
recover. We have a chat and a quick debrief as they hand over the That’s me done for the day. I’ll leave you with my three things to
patients on the emergency list. remember for life as an anaesthetist:
Get on with the emergency list. 1. ‘No’ is a complete sentence.

Good news: I love my job, I really do. 2. Always know when your next lot of annual leave is.
3. No one ever said on his or her deathbed ‘I wish I’d spent
Bad news: lots of interruptions. more time at work’.
Pop down to the office. Name and address supplied

Good news: I have my own desk in the office.
Bad news: my colleague’s paperwork is metastasising across my

desk from hers.
Look at the programme plot.

Good news: I’ve got lots of folk coming back from OOPT/E/R. I
think time out of programme is so important for those who wish to
8 Anaesthesia News June 2018 • Issue 371

A Day in the Life of a...
Clinical Director
In strict chronological order, Friday morning begins at 0600 – like The best bits now, plotting a project with a pal over a coffee,
Ken Dodd said, I do all the exercises – up, down, up down, then squeezing baby Gwyneth (that’s enough mat leave surely though
the other eyelid. Some of my colleagues clearly have the time now mum!), sorting a job plan to make Tuesday at home easier for
management schtick sorted, read the book etc – ‘Look at your somebody, chatting and listening to someone having a hard time,
email only once a day, set aside 30 minutes in the morning’ – the hopefully leaving them feeling better, smiling with my ITU friends
phone is pinging by 0630 from this crowd – I feel the smugness who now think they’re architects.
radiate from these messages as the inbox levee once more
threatens to break. No problem – ‘you’re always behind the curve, I have a proper job too though don’t forget – into the hubbub of
never in front, if you think you’re on top of it you’ve forgotten theatre for the afternoon and the pride and pleasure of working
something massive’ – this from the surgical CD during his gentle with such fantastic colleagues. I slip into the anaesthetic room
induction when I started a year ago. Big slug of coffee and we’re for the familiarity of the checklist, the cannula, the white medicine
on the bike, wind behind me, across the town moor to the big and the scope. Away from email for a bit and thoughts of that
hospital in toon in the shadow of the Gallowgate. pint waiting later in The Trent. A proper Friday hospital pub for a
proper great department.
You would think that 74 consultants, six specialty docs and 38
trainees should be enough to get the work done but this is a bums Gus Vincent
on seats game – and we have not enough posteriors for the chairs Clinical Director, Peri-Ops and Critical Care, Consultant
of anaesthesia. This week we have 300 lists to cover and have in ITU/Anaesthesia, Royal Victoria Infirmary, Newcastle
15 empty sessions staring at us next week, the
shame of an anaesthetic cancellation implicit
in their stare. I have weapons at my disposal
to cajole my colleagues into the extra work –
cash, charm and threat – but I am mostly good
at the first two. The ‘in-house waiting list’ is
our euphemism for the overtime payments –
good for the ski holiday for many, bad for the
work-life balance of a few – I am grateful my
colleagues stick their hands up.
OK – some morning problems to see off;

that study leave payment is NOT WHAT
WE AGREED, the locum payment hasn’t
arrived, there is a new car parking machine
and ParkingEye is now going to charge us
£2 for an on-call shift (oh no you’re not), the
commissioners WILL NOT PAY for those facet
injections any more, the awkward colleague
has looked at a trainee funny overnight, HR are
hassling for the retire and return irregularity,
‘can I see you for a job I might want in two
years?’, the grumbling orthopod whose list
went down for an organ retrieval bleating
from the ethical low ground, the computerised
expense system to swear at. A text from the
MD saying well done for something; nice,
wherever you are on the food chain we all like
a stroke.
In our stride now, it's meeting time, ideally titled

by acronym to confuse those not invited –
CPG, SIRM, DCGM, AMSC. Choose a strategy
– the quiet man to pay attention to when they
speak or the bossing alpha – don’t worry I’ve
done this course – seek the win-win position,
which in your head is really I win you lose.

A Day in the Life of an…
On-call Consultant Anaesthetist
0530: Tap on the shoulder ‘Daddy – wake up! I’ve got an we’ll pretend it took forever and there’s now blood in the patient’s
important question’. At this dreadful hour on a Saturday, I already airway and I have done my back in. I worry about bullying and
know that my four-year-old daughter and I will disagree on the harassment claim.
definition of ‘important’. ‘What’s the fastest thing in the world’,
she is wondering, ‘Is it a bullet train, the fastest car in the world, 1315: The gall bladder has been identified but remains resolutely
or Ed Sheeran?’ As my mind boggles, I remember that I am intra-abdominal when the doors between the anaesthetic room
on-call from 0800 and could have done with at least another 90 and theatres suddenly swing open like a Western saloon. The
minutes sleep. outline of the on-call vascular surgeon is framed in the doorway.
The general surgeons pause, the image on the stack system
24 hours on-call – a complete lottery. A nightmare for the control pauses, even the ventilator pauses mid-inflation…
freak inside every anaesthetist who wants to be able to plan
everything to the last detail, but also (I’m pleased to realise after ‘The paramedics have called ahead to resus – there’s a query
six years as a consultant) still a source of excitement – who knows leaking AAA on the way in’.
when you might get to do some properly good, consultant-level
life-saving stuff? I wonder whether I should point out that it’s a patient with a query
leaking AAA but he’s already gone.
0800: Booked – a peri-anal abscess in an obese, bearded
chap, an appendix in an eight-year-old girl and a ‘hot’ lap chole. Cue an uncertain 20 minutes where it’s not yet clear if we’ll need
Possibly not consultant-level life-saving stuff, but I have a CT1 to open a second theatre, which scrub team will need to be called
on-call with me for theatres and there’s nothing that I can fairly in, and who will anaesthetise this potential AAA. Can I leave the
let them do entirely on their own. I need to balance allowing them CT1 to finish the lap chole so that I can start off? Maybe, but I
develop their own skills and confidence, the provision of training, will still need a second pair of hands. Is my ICU colleague in the
and patient safety. building? Yes, but still doing the ward round while the registrar
is seeing some referrals. Will I have to ‘phone a friend’ who’s not
0900: Sent for ‘the abscess’. Wondering why we don’t say on-call?
‘the patient with the abscess’, I wander up to the labour ward
to review the patients on the obstetric HDU and to ensure the Luckily it becomes clear that the lap chole is coming to an
locum has arrived. Like many departments, we are carrying gaps end, and there’s no news yet about the AAA. I tell the trainee to
in the trainee on-call rota. Regular locums who know the unit are beware of ‘phantom’ cases on emergency lists and to consider
a real help, but a locum doing their first shift who is not familiar ignoring pretty much all cases until booked. Before that, they are
with local processes can really add to the consultant’s workload. just rumours.
Today’s one is a regular, but I’ve not met him before.
1400: The lap chole is extubated and I still haven’t heard about
A chap in scrubs with a non-Trust ID badge has his feet up in the the AAA. I wander to ED resus. The patient has already gone
handover room. ‘Are you the obstetric anaesthetist?’ I ask. He to SAU. They’ve had a CT abdo. I look at the images with the
looks at me. I haven’t got changed yet, and am wearing jeans radiologist, pretending I can interpret them. Yes, they do have an
and a leather jacket (because I am cool). ‘Yes. And who are aneurysm. No it’s not leaking, but yes, they do really, really need
you?’ comes his airy reply. I tell him I’m the on-call consultant a poo (the patient, not the radiologist). Maybe I’ll wait a bit longer
anaesthetist. His spine straightens and his feet return to the floor. for lunch. The vascular surgeon calls me to let me know that the
I ask a midwife if she think the jacket makes me look younger aneurysm is not coming to theatre.
and am disappointed with the answer.
1500: Although I live just a few miles from where I work, I cannot
1200: Abscess and appendix are done and we have induced the reliably get back across town to the hospital in the stipulated 30
(patient who needs a) lap chole. The CT1 is engaged in some minutes on a Saturday afternoon. Therefore, I am imprisoned. A
rather vigorous mask ventilation. I remind him that we should good opportunity to make progress with the endless amount of
minimise the pressure as much as possible to avoid insufflating admin that comes with being a consultant.
the stomach before laparoscopy. ‘Don’t worry’, he tells me, ‘I’m
getting the hang of this now’. 1930: I walk to the canteen to get some dinner. The shutters are
down. Opening times ‘Saturday 0800 – 1900’. Sigh.
1215: ‘Can we have a nasogastric tube please’ asks the general
surgeon. The CT1 has the good grace to look sheepish. I tell him 2015: Home. Eating.
not to worry and suggest he goes for lunch while I attempt the
most challenging procedure in anaesthesia – siting a nasogastric 0400: Ring ring. Ring ring. ‘Hello doctor, it’s switchboard, I have
tube after a patient is intubated. Luckily it goes straight in, but the theatre anaesthetist on the phone for you’.
the whole theatre team agree that when the trainee comes back,

0430: I’m back in. A young lad, after an extremely refreshing 0700: We’re coming to an end, and it dawns on me just how tired
volume of alcohol, got bored of waiting for a taxi and decided I am; the adrenaline surge of the emergency has gone. I get a
to drive himself home. This went well until his progress was text from the incoming consultant anaesthetist, asking what is
impeded by several parked cars and a rather immovable booked and saying that they’ll come in for 0800 if I’m in theatre. I
brick wall. Because he had managed to climb out through gratefully take her up on her offer and reflect how glad I am that
the shattered windscreen and his vital signs were stable, the we split on-call weekends to ensure that none of us work more
ambulance has brought him to our Trauma Unit, rather than than 24 hours straight.
taking him directly to the nearest Major Trauma Centre. However,
in the three hours that he’s been in ED, his lactate has risen, his 0830: Home again for a rest. A fairly typical on-call, I suppose.
blood pressure has fallen and he’s becoming less responsive Some major stuff, some minor stuff, some rest, some stress,
to fluids. The consultant surgeon is in and wants to take him some plate-spinning, some really impressive trainees and some
for an emergency laparotomy. The ICU and theatre trainees good humoured team working. I have mostly enjoyed it, but I’m
have assumed he is bleeding, cross matched blood, repeated also glad that, by definition, it’s the longest possible time before
gases overnight and prepared drugs for RSI and haemodynamic my next weekend on-call. Maybe I’ll go to bed for a quick nap,
support. I meet everyone in the anaesthetic room, including the but what is this small figure running towards me? ‘Daddy, I’ve got
patient who remains strongly self pre-medicated. Judging by his another important question…Is 20 a big number?’
age, I wonder if he was out celebrating passing his driving test.
Maybe not!
The case goes well, but we do need to replace blood after a
couple of litres of his own is removed from his peritoneal cavity, Name and address supplied
having oozed out of some ruptured mesenteric vessels. It appears
clotted, so we agree that running a TEG is not necessary.

Anaesthetic Registrar
The alarm wakes me at 0600. I lie there contemplating whether I patient arrives. She is grey, pale and asystolic. The team set
really need this job. Maybe I can save enough money by living off about their roles like clockwork. I intubate, the others site venous
the land Good Life style, cancelling Netflix and sewing my own access, give adrenaline and time cycles of CPR as a scribe writes
clothes from hemp? it all down. This one we do not win. The team leader asks if
anyone objects to stopping and thanks us all. Like always we pick
I get up and put the kettle on. ourselves up and head on to the next job.
Long day today, starting with a big elective vascular case. No The consultant and I crack on with a toe amputation. It takes me
need to worry about that though because I stayed last night to three attempts to get the spinal in and I start to question my own
see the patient and spent a good hour swotting up on the finer existence. Once the patient is on the table the consultant sends
details of complex open aneurysms. I’m ready. me for a much-needed coffee. The customer in front of me orders
a small, decaf latte. I ponder what the point of that is and chug
After parking in the next county and walking in from the pouring down my flat white with an extra shot.
rain, I grab my scrubs. Today’s selection is the same as
yesterday. One size fits none. I decide that I can style out pink At 1700 I collect the on-call bleep. For a while things plod along.
bottoms and an orange top with sleek to the cleavage area and There’s a PCA to refill, an epidural to review on the ward and a
head to theatre four. patient with difficult veins needs a cannula. The CT2 and I decide
to divide and conquer. I always feel the absolute business when I
‘Bad news, no ITU beds. Aneurysm is off.’ bang a Venflon in on the ward so I volunteer. Unjustified when it’s
purely all down to practice, but I’ll take these small victories. As
Noooo!!! This was going to be my CBD extraordinaire. Mr Jones I’m popping the Tegaderm on my bleep goes off.
is such a lovely patient too.
‘PROCEED IMMEDIATELY TO RESUS’.
‘No beds for non-urgent electives either. We are helping with
CEPOD’. I hate these calls! I’m running now, imagining the airway from
hell or a sick baby…it’s a ruptured AAA. This I’ve done before. I
This isn’t terrible news. I love the emergency work. It’s why we know the drill. My junior colleague is there already and I see the
came into anaesthetics, isn’t it? The thrill of the thio-sux-tube (or look of relief in her eyes. Your first one is always memorable and
propofol-roc for those born this side of 1985). terrifying. I forget to tell her she’s doing a great job and ask her to
phone blood bank while I call the consultant.
First up is a six-year-old boy for an appendicectomy. The bread
and butter of anaesthesia. I visit him on the ward, chat to mum The patient arrives in theatre at the same time as the boss. I realise
and dad, and explain about the hedgehog milk (it prickles!). I I’m giving her the same look of relief that I’d witnessed in A&E. In
even remember to prescribe EMLA. a couple of years that will be me. That’s a scary thought. The
patient has an unexpected difficult airway. I put my hand out to
‘Have you got any questions for me Joshua?’ the right and the ODP (which I believe is Latin for guardian angel)
hands me the video laryngoscope needed for the job. As a rule of
‘Yes. Why have you got hands like skeleton’s hands?’ thumb, if you’re ever unsure of which bit of equipment you need,
it’s usually the one in the ODP’s hand.
I love kids.
This one we do win. At least, we get them as far as ITU and hand
With Josh safely in recovery it’s off to see the next. A lovely elderly over the reins. I apologise to the nurse about how tangled all the
chap with an incarcerated hernia. He lives alone, he tells me, patient’s lines are for the 4276th time this week. She smiles and
since his wife passed away. He describes to me how he cared for says she will sort it.
her and how her favourite flowers were peonies. I smile and tell
him I will see him soon. It’s now past the end of my shift and time to go. I’m dog-tired
climbing into my clapped out old Golf GTI (#Moet medics!). An
‘Thank you, nurse!’ he calls after me. That’ll do. exhausting but great day is done and I think the team did some
good things today. If only we could do it all again tomorrow.
At the lunchtime meeting I’m presenting a case. I ram a pork
pie from the kindly drug rep into my mouth, listen respectfully What’s that? We can?
to her chat about the latest in transdermal analgesia and hit the
PowerPoint. It goes ok, I think. No one seems to have noticed that Marvellous.
I’m not the world leading expert on Brugada syndrome. As long
as no one asks any questions. Natalie Mincher
ST6, Royal Gwent Hospital, Newport, Wales
Returning from lunch I’m asked to go down to resus. An out of (All cases included are fictitious).
hospital arrest is en route. I get there and set up, writing ‘GAS’
across my plastic gown in marker pen. Two minutes later our
College Tutor
The day dawns bright and the predictable tussle with two
uncooperative children, an equally uncooperative husband and
the dog, ensues. They all seem surprised that once again we have
to leave on time for school/work/walk (delete as appropriate).
Work starts with a morning list and I have one of the more senior
trainees with me. It’s a relief when they inform me they don’t want
(need?) to do any workplace-based assessments and so we have
a lovely morning with a bit of teaching and a bit of a catch up.
The time, however, is punctuated with visits and calls. A visit from
a Clinical Supervisor asking for advice about some documentation
they are preparing to support delivery of their unit of training locally.
A telephone call from the Deanery to see how I’m getting on with
the tasks I was given at the last Training Committee meeting. (I’m
not getting on very well. I bluff it. I think she falls for it). A visit from
a senior trainee to ask if I will act as a referee for their forthcoming
consultant job application. I’ve been their College Tutor for a
significant part of their training and am delighted. It always feels
like an absolute honour to be asked to support an application for
any post.
After lunch I head to my office to begin reviewing my trainees’

portfolios ahead of the forthcoming ARCPs. I say office. It’s
actually a glorified, windowless, broom cupboard I share with one
of my colleagues. We have to be careful not to push our chairs
back from our desks at the same time or we could end up in a very
compromising position.
I log onto the e-Portfolio but not long afterwards there is a knock
at the door; one of the Educational Supervisors wants to discuss
a trainee’s progress with me. Then the Regional Advisor arrives to
see how I’m getting on with my Training Committee tasks. (I’m not.
I bluff it. They don’t fall for it and give me a deadline).
Then a trainee pops in to discuss their portfolio ahead of the

forthcoming ST interviews. Their portfolio is excellent, but the
real reason for the visit soon becomes clear. The trainee explains
they are married to a doctor and both of them are applying for ST
jobs. Clearly upset, they tell me that to complicate things further
one of them is entering the lottery of dual training and limited job
availability in their preferred region. I sit and listen; having worked Text-nagging. I shoot out of my office back to my other life, but as
away from my husband for almost three years during my training I shut the door I catch sight of a bright A4 lever arch folder in the
I really sympathise but it felt like we had a bit more control back corner. My RITA file. Eight years of training evidence in one file.
in my day. I offer vague suggestions interspersed with clichés. Those were the days.
‘Everything happens for a reason.’ The trainee leaves looking
slightly happier. Back at home, after tea, I have a look at my emails and see one
from the trainee I spoke to earlier. ‘Thank you. We both feel so
Back to the portfolios. I review and make notes on them to present much better.’ I reflect on this. (Something else new to me. Should
at the ARCP, to help both my ailing memory and the summary we I be writing it up for my appraisal?). All I really did was listen, but
produce afterwards. As ever I’m amazed at just how much trainees sometimes that’s all that’s needed.
do these days. Then the ‘bing’ of a text.
Name and address supplied
‘Mum, where are you?’ (1709)
‘Mum?’ (1710)
‘MUM?’ (1711)
‘MUM??’ (1711)

On-call ICU Registrar
The identity of a dual trainee in anaesthesia and intensive care Communication, as ever, is key, and as the day goes on you
can at times feel quite conflicted. How do you describe yourself find you have communicated with relatives, colleagues, visiting
when asked? Which role do you say first and in front of whom? specialties, a variety of surgeons, often a radiologist, and the daily
Which conference should you attend with your limited budget update from microbiology on a new unpronounceable and highly
(GAT ASM of course!)? And which e-Portfolio are you filling in resistant bacterium your patient has cultured. But one of the great
today! oddities of intensive care is the one person we communicate with
least is often the patient themselves; for some, the talking ICU
It can feel like trying to please two parents, who are sometimes patient is unfamiliar and the more difficult one to manage.
not exactly experiencing marital bliss. However, through adversity
comes strength! It is these discussions and endless variety, though, that
intensive care is at its most rewarding. Having the expertise in
The day of an ICU registrar begins not unlike those of many other communicating, discussing, re-reviewing and actually having
registrars; the pain of exiting a warm bed, the infusion of caffeine the time to properly assess and make the decisions the patients’
and the donning of ill-fitting, and on occasion, paper-based need is where the skill in intensivism lies.
scrubs. Work begins with the handover, a cathartic process for
those on overnight and the time to plan the day’s likely activities. As the day draws on, prophetic discussions can continue. One
I currently work in a relatively large unit, meaning this can take such discussion I had with a fellow dual trainee one evening
some time; by patient no. 20 some of us have started to nod off broached the topic of how ICU may have changed us as people.
a little, or are lost when trying to remember if the patients are
still on vasopressors, sedation or even ventilated. However, this Yes, being a medical doctor is certainly, for most, quite a defining
is the point in the day when it can all go wrong…the worst thing part of our psyche and how others see us, but how your choice
that can happen to an ICU trainee’s day is when at this precise in specialty has altered your personality wasn’t something I had
moment the medical registrar decides the patient they have sat thought about. The breath between life and death seen, discussed
on all night has now reached the point of referral! That or the early and decided upon daily in ICU does change one’s perspective
morning stabbing has turned up in the ED, just to ruin the plans and thought processes as well as the emotional toll of being
you had started to make. involved in these discussions. These aren’t necessarily always
negative experiences and making difficult decisions is what ICU is
Arriving on a medical ward to review a patient can go two ways, all about. But making these decisions, and increasingly becoming
either you are greeted by an eager trainee keen to tell you all responsible for them, well, I had to agree with my colleague; yes,
about the patient and show you every chart possible. Perhaps it has changed me, but undoubtedly for the better.
they have a secret desire to become an intensivist, that or they
think I am taking away their nightmare patient. The other way Alastair Hurry
is equivalent to discovering a castaway on an abandoned atoll, ST6 ICM & Anaesthesia, Queen Elizabeth University Hospital,
often starved, wearing rags and who has had little to no human Glasgow and GAT ASM 2018 Local Organiser
contact for several days. Written notes are often particularly
sparse, apart from the ubiquitous, ‘for full active treatment’ after
the previous consultant review.
After rescuing the castaway who has now had the requisite lines
placed, latest bundles prescribed and the tome of admission
paperwork completed, you can rightly reward yourself with
a circular discussion on the ward round about the innermost
workings of your long stay patient’s bowel movements and
debate the latest contradictory paper released on an intensive
care topic.
For many non-ICU trainees, the removal of the ward round

from their daily activity is one of the great joys of anaesthesia
and the return to the wander round at the end of the bed is a
chore. So for those who feel like this, remember you can play
games with those of us who specialise in the vague, throw away
mentions of ‘should we try some steroids?’. Or the simple one
liner of ‘levosimendan?’ will simultaneously generate rage and
inquisition and allow you to deflect any unwanted questions.

QEII Centre, Westminster, 09-11 January 2019
AAGBI welcomes the international

anaesthesia community to London
Over 1000 delegates from the anaesthetic specialty
in the UK, Ireland and internationally
High-profile key note speakers to inspire your

learning
Prof David Oliver, Oxford

Prof Bruce Biccard, Capetown
Prof Richard Griffiths, Peterborough
Special Core Topics day, offering clinical and

non-clinical subjects
Practical workshops and dedicated trade exhibition
Abstracts presentations, NELA Prize, Innovation and

other awards
Fun social programme Your time to shine

Be recognised and rewarded for your work. All accepted
“Thank you @AAGBI WSM London for submissions will be published online the journal Anaesthesia.
a great three days - thought provoking Abstract for poster presentation
conference and feeling very inspired
back at work today.” @Ramai23
NELA trainee poster prize
Book today Innovation Award

and save money
AAGBI members benefit from early booking rates. Kindly sponsored by:
Visit the WSM London 2019 website to plan your visit

and book your place.
www.wsmlondon.org
Obstetric Anaesthetists’ Association
Promoting the highest standards of anaesthetic practice in the care of mother and baby
Three Day Course

in Obstetric Anaesthesia
Monday 5 – Wednesday 7 November 2018
4 October 2018 Venue: Church House Conference Centre, Westminster, London
Obstetric Anaesthesia Update

Royal College of Physicians, London BOOK The OAA’s annual state
of the art course, held
TOPICS INCLUDE: Labour analgesia, caesarean
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and a section on new/topical issues
NOW over three days in the
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of Church House,
Westminster
5 October 2018
Management and Critical
Care topics for the Obstetric
Anaesthetist
Royal College of Physicians, London
Expert panel
An interactive day discussing quality improvement in discussion and
obstetric anaesthesia and maternity critical care topics complimentary
networking drinks
BOOKING NOW OPEN

reception
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Postgraduate courses in Anaesthesia and Perioperative Medicine

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Particles
Frykholm P, Schindler E, Sümpelmann R, Walker R, Weiss M
Preoperative fasting in children: review of existing guidelines and recent

developments
British Journal of Anaesthesia 2018; 120: 469–74.
Background
Pawa A, Wright J, Oncwochei DN, et al. It is nearly 20 years since the ASA published guidelines for the minimum periods of pre-
operative fasting at 6-4-2 hours for food, breast milk and clear fluids, respectively; replacing
Combined thoracic paravertebral and pectoral nerve the ‘nil by mouth from midnight’ mantra. Despite this, children are still often subjected to
blocks for breast surgery under sedation: a prospective excessive fasting times. The recorded incidence of pulmonary aspiration associated with
observational case series anaesthesia in children is low and some centres already have experience of using a more
lenient approach to pre-operative clear fluids without adverse long term outcomes.
Anaesthesia 2018; 73: 438–43.
Methods
Introduction This is a review of the evidence supporting current pre-operative fasting guidelines for children
With the use of ultrasound, precision and reproducibility of peripheral and includes a summary of the physiological, epidemiological, and practical aspects of pre-
regional anaesthesia for awake surgery is continuously improving operative fasting with regards to providing safe anaesthesia for children.
and is becoming a more acceptable way to provide anaesthesia [1].
The authors’ aim for this case series was to share their experience Results
of how they provided adequate anaesthesia for breast surgery with The authors reviewed the literature related to several aspects of pre-operative fasting in
good patient and surgeon satisfaction. paediatric practice.
Method A systematic review of the evidence supporting current pre-operative fasting guidelines found
Sixteen patients from one centre between August 2016 and that high-level evidence only exists for minimising peri-operative fasting, 2 hours fasting after
September 2017 underwent breast surgery under regional block clear fluids and restarting oral intake early postoperatively.
plus sedation either by choice or it was clinically indicated. Prior
to the blocks they were given midazolam and fentanyl; they then They discuss the evidence enumerating the incidence of pulmonary aspiration in children
received a thoracic paravertebral block at T2/3 or T3/4 followed by a under current pre-operative fasting guidelines. A multicentre study of UK specialist paediatric
pectoral nerve (PECS-2) block [2], with 20 ml and 30 ml of a 50:50 centres found this to be 2 and 2.2 per 10 000 cases for elective and emergency cases,
mixture of levobupivicaine 0.5% and lidocaine 2% with 1:200000 respectively [1]. Two older studies suggested it may be higher at 4.7 and 10.2 per 10 000
adrenaline, respectively. The maximum dose of local anaesthesia cases, respectively [2,3]. In the large multicentre study, APRICOT, where incidence of bronchial
was not exceeded. Patients were then given a propofol target-control aspiration was 9.3 per 10000, this did not appear to have any long term consequences [4].
infusion, fentanyl boluses, paracetamol and dexamethasone, unless
contra-indicated. The authors discuss important risk factors for pulmonary aspiration, citing a large multicentre
trial in children where the incidence of aspiration was similar whether the children were fasted
Results or not [5]. They also give an overview of the physiology of gastric emptying, the association
Procedures included wide local excision, axillary node clearance, between fasting intervals and gastric residual contents and possible consequences of
sentinel node biopsy, mastectomy and exchange of implant. Fifteen prolonged pre-operative fasting.
out of sixteen cases were completed under regional block plus
sedation. One patient was converted to a general anaesthetic as Lastly, they discuss a study which successfully reduced excessive fasting times [6], a
the block did not cover the medial chest wall. Thirteen patients had centre with 15 years’ experience of not limiting clear fluids in children, which maintained a
no pain, 2 had mild pain and 1 had moderate pain. One patient low incidence of pulmonary aspiration [7] and a QI programme that achieved both with a 1
did not have cover over the inframammary fold but additional hour fasting limit for clear fluids [8]. The authors suggest revising guidelines for pre-operative
local anaesthesia from the surgeon provided adequate cover. All fasting in children based on the current literature.
patients said they would have this type of anaesthetic again. The
surgeons were extremely satisfied in 13/15 cases and satisfied in Discussion
the remaining 2. The authors make four main points based on evidence they reviewed: i) That children are
often fasted for too long; ii) that this may have detrimental metabolic and behavioural effects in
Discussion small children; iii) that evidence exists to support questioning the 6-4-2 hour limits; and iv) that
This technique is a useful way of delivering anaesthesia for breast it may be possible to safely reduce fasting intervals within or even beyond the current 2 hour
surgery, especially for patients who are at high risk under general limit. They note that some centres have reduced or mitigated the requirements for clear fluid
anaesthetic. The authors put forward the benefits of reduced opioid fasting. The authors conclude that, based on the current evidence, other paediatric surgical
requirements, faster ambulation, avoiding volatiles and possibly centres should consider doing the same, ideally, as part of a large multicentre audit.
improving cancer survival [3], as well as the reduction of chronic
pain. Limitations included a small sample size and the inability to Andrew Selman
comment on outcomes and complications; large doses of local ST6 Peri-operative Medicine Fellow, UCLH, London
anaesthesia, and failure to cover the medial chest wall.
References
Conclusion 1. Walker RWM. Pulmonary aspiration in pediatric anesthetic practice in the UK: a
This paper gives an insight into how regional anaesthesia can work prospective survey of specialist pediatric centers over a one-year period. Pediatric
well. Key to any regional technique is the communication between Anesthesia 2013; 23: 702–11.
the surgeon and the anaesthetist, along with an awareness of its 2. Olsson GL, Hallen B, Hambraeus-Jonzon K. Aspiration during anaesthesia: a
limitations. Pawa et al. describe their experience with this technique computer-aided study of 185,358 anaesthetics. Acta Anaesthesiologica Scandinavica
and the issues that occurred. This technique is certainly worth 1986; 30: 84–92.
considering for breast surgery. 3. Borland LM, Sereika SM, Woelfel SK, et al. Pulmonary aspiration in pediatric patients
during general anesthesia: incidence and outcome. Journal of Clinical Anesthesia
Stephen Sarno1, Mruthunjaya D. Hulgar2 1998; 10: 95–102.
1
ST6 Anaesthesia, 2Consultant Anaesthetist, Wrightington Hospital 4. Habre W, Disma N, Virag K, et al. Incidence of severe critical events in paediatric
anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals
in Europe. Lancet Respiratory Medicine 2017; 5: 412–25.
References 5. Beach ML, Cohen DM, Gallagher SM, Cravero JP. Major adverse events and
1. Wahal C, Kumar A, Pyati S. Advances in regional relationship to nil per os status in pediatric sedation/anesthesia outside the operating
anaesthesia: A review of current practice, newer techniques room. Anesthesiology 2016; 124: 80–8.
and outcomes. Indian Journal of Anaesthesia 2018; 62: 6. Dennhardt N, Beck C, Huber D, et al. Optimized preoperative fasting times decrease
94–102. ketone body concentration and stabilize mean arterial blood pressure during induction
2. Blanco R, Fajardo M, Parras T. Ultrasound description of of anesthesia in children younger than 36 months: a prospective observational cohort
Pecs II (modified Pecs I): A novel approach to breast surgery. study. Pediatric Anesthesia 2016; 26: 838–43.
Revista Española de Anestesiología y Reanimación 2012; 59: 7. Andersson H, Zarén B, Frykholm P. Low incidence of pulmonary aspiration in children
470–5. allowed intake of clear fluids until called to the operating suite. Pediatric Anesthesia
3. Wigmore TJ, Mohammed K, Jhanji S. Long-term Survival for 2015; 25: 770–7.
Patients Undergoing Volatile versus IV Anesthesia for Cancer 8. Orlay G, Smith K. A new approach to avoid unnecessary fluid-fasting in healthy
Surgery. Anesthesiology 2016; 124: 69–79. children. Anaesthesia and Intensive Care 2015; 43: 535.

Knowing
your payslip
In August 2017, anaesthetic trainees in England moved to the new 2016 junior
doctor contract. The new terms and conditions of service are now adopted by all
trainees, but those who were ST3 and above on 2 August 2016 continue to be
paid under the ‘old system’ of increments and banding [1].
Changing posts and rotating to new Trusts always cause underpaid for months without realising, being incorrectly taxed or
problems, but this training year seemed to be exceptional with only realising errors when they finally decide to open the backlog
anecdotal reports of many anaesthetic trainees being paid of payslips that have been gathering dust in their pigeon hole.
incorrectly, late or not at all. The BMA reported a 26% increase
in queries regarding pay from junior doctors in August 2017 This article aims to explain what all the numbers on that little piece
compared to 2016 [2]. of paper mean and where you can find the correct information if
you spot any errors. It focuses on the England and Wales payslips
In response to these problems, the AAGBI, in collaboration with 2002 and 2016 (England and Wales share a common payslip
the RCoA, conducted a trainee survey to gather information about but only trainees in England are on the 2016 contract). There
the problem. The results are yet to be analysed but will be released are differences for trainees in Scotland and Northern Ireland and
in due course. In addition, the AAGBI and RCoA released a joint information is accessible using the references provided [4–7].
statement that recognises the problems caused [3].
Disclaimer: I am by no means a financial expert, nor do I have any
What has also become apparent is that doctors, in general, are not formal financial training. I have just learnt the hard way after 11

the most financially savvy bunch! I have heard of colleagues being years of rotating through Trusts and many incorrect payslips!

Payslip 2002
1.ASSIGNMENT NUMBER EMPLOYEE NAME LOCATION
DEPARTMENT JOB TITLE 5.PAYSCALE DESCRIPTION
NHS 3.SAL/WAGE 4.INC. DATE STANDARD PT SAL/WAGE
HRS
TAX OFFICE TAX OFFICE REF 6.TAX CODE 2.NI NUMBER
NAME
7.PAY AND ALLOWANCE (-‐ = MINUS AMOUNT) 8.DEDUCTIONS (R INDICATES REFUND)
DESCRIPTION WKD/EARNED PAID/DUE RATE AMOUNT DESCRIPTION AMOUNT BALANCE C/F

9.Year to date balances (This employment only) This Payslip Summary
GROSS PAY TAXABLE PAY PENSIONABLE TAXABLE PAY
NI LETTER TAX PAID PAY NON-‐TAXABLE PAY
NI PAY OTHER NI PAY PREVIOUS TAXABLE PAY TAX PERIOD TOTAL PAYMENTS
NI CONTS OTHER NI PREVIOUS TAX PAID FREQUENCY TOTAL DEDUCTIONS
CONTS PENSION CONTS PERIOD END
PENSIONABLE PAY EMPLOYEE NO. DATE 10.NET PAY
PAY DATE
PAY METHOD

1. Assignment number
18 This is specific to the Trust you are working in; it's your own unique 'ID number' while employed by this
Anaesthesia News Trust.
JuneH2018
MRC •hIssue
ave 371
access to th
hospital’s ‘Bank’ then you may have another separate assignment number. Often it's the same as your main one but ends in -‐2 or -‐3 et
Your payslip explained
1. Assignment number Pay scale description
This is specific to the Trust you are working in; it's your own unique This is commonly ‘Specialty Registrar’, for those in training, or
'ID number' while employed by this Trust. HMRC has access to this Specialty Doctor, depending on whether you are in or out of training.
too. If you have joined the hospital’s ‘Bank’ then you may have
another separate assignment number. Often it's the same as your 5. Tax code
main one but ends in -2 or -3 etc. Your tax code is important. It tells your employer how much tax to
deduct from your pay. If it’s wrong you could end up paying too little
2. NI number or too much tax. The numbers in your tax code refer to how much
Your National Insurance number. Pretty obvious but worth checking tax-free income you get in that tax year (April to April) [11].
it's correct.
Currently, as of April 2018, you do not pay any income tax on the first
3. Salary/wage £11,850 of earnings. This value is set by the Government through
Your basic salary is based on 40 hours of work (or the hours specified HMRC and is referred to as your ‘personal allowance’ [12].
in the 'Standard Hrs' box) at your ‘pay point’ (the level of the pay
scale you have reached), and excludes banding supplements or any Tax is then paid at 20% on earnings between £11,501 and £45,000,
other allowances (e.g. London allowance). It's not uncommon for 40% on earnings between £45,001 and £150,000 and 45% on any
doctors to unknowingly be paid the incorrect basic salary. It's worth earnings above £150,000 [12]. For example, if you earn £50,000,
checking that what you see on your payslip is what you should be you pay 20% tax on your earnings from £11,501–£45,000 and 40%
receiving. You can refer to the BMA pay scales to do this [8, 9]. Pay on £45,001–£50,000.
and conditions circulars for medical and dental staff are published
by NHS Employers every year [10]. These tell you of any changes Your personal allowance decreases when you earn over £100,000
to basic pay that have been made. Increases have most recently and is removed completely when you earn more than £123,000.
been either frozen or increased by just 1%. This year’s increase was Details of how much tax you’ve paid in the tax year are found on the
as per the Doctors’ and Dentists’ Review Body’s recommendation. P60 form sent to you in the Spring.
Pay scales for Specialty and Associate Specialist doctors are also
accessible within the pay circular. A personal allowance of £11,850 equates to a tax code of 1185L
(L meaning you are entitled to the standard tax-free allowance), and
4. Inc. Date this is what most junior doctors will have as their tax code, although
This refers to the Increment Date, i.e. the date that you go up the it can vary if you have not been working in the UK for a period
pay scale or the date you reached the maximum point (for those recently, for example. The ‘emergency tax code’ is often given to
long-serving registrars and speciality doctors out there!). This is employees when they change employment as the new employer
commonly August but depends on your date of entry into the pay will not have the details of their previous tax code. This emergency
scale. Another reason for incorrect pay is not having received your tax code usually has W1 or M1 at the end, for example ‘1150L W1’
increment, so it's important to check this. or ‘1150L M1’.

A common scenario is being on an emergency tax code for the first Description
month of employment and then reverting to your proper tax code in Under this heading you will see a breakdown of how much you get
the next month. This is either because you yourself have contacted paid for the work you do. As anaesthetists, you are likely to see:
HMRC to inform them of an incorrect code or Medical Staffing has
updated your records via HMRC. Being on the emergency tax Basic pay: this is calculated based on an average of 40 hours of
code, even for just a month, may well mean you didn’t pay the work per week and corresponds to the relevant nodal pay point for
right amount of tax for that period and will need to reconcile this your grade. CT1 = nodal point 3, ST3 = nodal point 4 [8]. Try not
with HMRC at some point (best spotted and fixed sooner rather to get too depressed when you see what your basic hourly rate is!
than later!).
Additional rostered hours: any additional contracted hours over
Your personal allowance can be increased by claiming for tax 40 (most commonly, up to a maximum of 48 in total)
relief on ‘Professional Fees and Subscriptions’ [13] meaning you
can claim if you have used your own money to buy things which Night duty: unfortunately (fortunately?!), the majority of us do night
are needed for your job. Common relevant subscriptions include: duty, and night-time hours are paid at an enhanced rate of 137% of
GMC, BMA, RCoA, AAGBI, MDU and MPS. There are others listed your hourly basic pay.
but these are the most common among anaesthetists.
Weekend allowance: this is a set percentage of your basic salary
Totals of up to £2,500 can be reflected in your tax code thereby for the weekend work that you do, spread evenly over the year’s 12
increasing your personal allowance. Above this, which isn't that pay slips. On the sliding scale used, most trainees will get 7.5% on
common for fees and subscriptions, the completion of a tax return a standard trainee rota. This equates to < 1:2 weekends worked,
is required which does involve more effort. up to and including 1:4 weekends worked. You should see this
breakdown clearly. The maximum is an additional 10% for working
Claiming is actually very straightforward and can be done by either 1:2 weekends.
phoning HMRC or completing a P87 form. You can also claim for
the previous four tax years. It’s important to have all the fees to Cash floor protection: your protected cash floor amount,
hand. Most organisations will readily provide you with a receipt for calculated as your basic salary the day before you transitioned
recent years’ subscriptions. The AAGBI has previously produced a onto the new terms and conditions of service, plus a banding
tax-relief guide which summarises the ways to claim [14]. supplement for the rota you were working the day before transition.
6. Pay and allowances Conclusion

These are the payments you receive. Often seen are your basic pay, The problems that have surrounded pay have only added to the
banding, additional hours, study leave reimbursement, mileage frustrations and low morale that is felt by a large proportion of junior
and London allowance (if applicable). ‘Wkd/earned’ refers to the doctors. Unfortunately, the current guidance regarding exception
hours you’ve worked, ‘Paid/due’ show the hours you have been reporting does not include the reporting of pay problems [15],
paid for and ‘Rate’ is the hourly rate you receive. but in-house advice and support should come from departments
in the form of clinical leads, educational supervisors and college
7. Deductions tutors. The BMA also offers employment advice and support for
Statutory and other deductions are listed here. PAYE (Pay As You its members, and trainees should seek out this service if required.
Earn – income tax), NI (National Insurance) and pension are all Failure to pay you properly is essentially a breach of contract and
seen. Additionally, student loan, car parking permit and mess fees can be pursued for you through formal channels by the BMA on
might also be listed. The presence of an 'R' indicates a refund from your behalf if need be, but early intervention by the local Industrial
a previous amendment, you lucky thing! Deductions (that aren’t Relations Officer normally resolves things promptly. Change is
taxes) made here without your permission are unlawful and you often difficult without the evidence. I would encourage discussions
can challenge them, for example if you did not request or agree to with both your departments and Medical Staffing and follow up any
the cost of a car parking permit being deducted from your payslip. conversations with a quick email.
8. Year to date balances When someone has been significantly underpaid or not paid at
This refers to the totals in this tax year to date and shows your total all, Payroll will sometimes say that they can’t do anything about
gross pay (money earned before tax), NI contributions, pension it until the next month’s payslip – this is simply not the case, and
contributions and tax paid. all Payroll departments are quite capable of paying people weekly
(many non-clinical staff are paid in this way) and they can also
And finally… make ‘emergency’ payments if they are sufficiently motivated, for
example by the BMA getting involved! Don’t let yourself be fobbed
9. Net Pay off ‘until next month’. Being paid correctly should not be viewed as
What you get in your bank at the end of the month. Happy spending! being ‘lucky’, it’s a something we have a right to and therefore any
problems should be escalated accordingly. Many doctors don’t like
Payslip 2016 to think about money very much, but we work hard and do our best
The skeleton of the new payslip is essentially the same as the 2002 for our patients and deserve to be paid correctly.
one but with differences when it comes to the way your pay is broken
down using the 2016 contract’s pay calculations. What is essential
is to meticulously go through all the same elements outlined and
numbered in the 2002 payslip example. Payroll departments have
Tom Wojcikiewicz
struggled to get the calculations right for large numbers of doctors
GAT Committee member
this training year, and it’s in your interests to check their working!
References available online at: www.aagbi.org/anewsjunerefs

Digested
June 2018
Analysis of the distribution and scholarly output from National Institute of Academic
Anaesthesia (NIAA) research grants
El-Boghdadly K, Docherty AB, Klein AA.
This important article is accompanied by two editorials, to mark the 10th show for it; others appear to produce considerable outputs with relatively
anniversary of the National Institute of Academic Anaesthesia (NIAA). little funding. (Interested readers should peruse the online supplementary
While no doubt this will be marked by some celebrations within the data for the geographical location of these respective units). Reassuringly,
national organisations, El-Boghadly et al. have conducted a dispassionate there was no bias towards any particular research group(s) or any gender
analysis of the grants awarded by the NIAA. Since awarding research bias: generally awards were granted in proportion to the number of
grant support is the major (if not only) function of the NIAA, it seems applications. The accompanying editorials expand on themes raised by
reasonable to expect there already to exist a comprehensive database this paper. One of these deals with the concept of ‘research waste’. This
as to what scholarly output resulted from the support given. Perhaps is the concern that if precious funding is not used strategically to support
surprisingly (or disappointingly) the authors discovered that the NIAA developing careers in targeted ways, the research capacity of the specialty
does not formally track research outputs, focused as it is on inputs. A will inevitably shrink. The NIAA does an excellent job in distributing
second result of this paper is that, once outputs are tracked, there is research grants by a traditional competitive mechanism. It might need
considerable variation in the apparent ‘cost-effectiveness’ of different to think about more innovative ways of supporting research groups and
research groups. Some appear very well funded with relatively little to researchers before they are irrevocably lost to the specialty.
Associations of postoperative mortality with the time of day, week and year
Kork F, Spies C, Conrad T, et al.
Famously, it was a bizarre and twisted logic that led to the most damaging same as during the week. The mortality odds ratio after operations started
event in recent years in UK healthcare. A small study suggested a in the morning (08:00–11:00) were lowest and highest for operations
‘weekend effect’ in hospital mortality; Jeremy Hunt, the UK Secretary started in the afternoon (13:00–17:00). There was no seasonal variation
of State for Health, concluded that this was due to fewer consultants in mortality. Longer term analyses showed higher mortality odds ratio
available at weekends, so to promote his ideal of ‘7-day services’ he in winter and lower mortality in spring. The authors conclude that their
sought to change the contracts of…junior doctors who responded by data might help plan capacity for hospitals over the longer term. They
going on strike. Regardless of political views on the matter, the train of do not directly address the question of whether their lack of weekend
logic rests on whether a ‘weekend effect’ exists or not. Other papers from effect might be explained by differences in employment contracts in their
the UK have subsequently questioned that it exists. Now this paper from hospital vs. the NHS.
Germany finds that, in their setting, mortality at the weekend was the
Editorial: Big data: breaking new ground in airway research

Greenland KB.
This editorial accompanies a fascinating article about an airway app an anonymous database, from which different researchers can extract
designed to capture information, at international level, on emergency what they need to try and answer important questions. However, let me
front of neck access (eFONA) in airway management. The editorial leave you with two thoughts. First, in relation to FONA, it may not be
touches on wider issues, such as ethical considerations and the technology the details of patients undergoing FONA that matter, but the details of
required to create large datasets. There is every reason to suppose that those that did not receive FONA, and these will not be captured. Second,
large datasets are useful: the National Audit Projects (NAPs) are after ‘science’ consists of stating a hypothesis and designing an experiment to
all really nothing other than intermittently created datasets around a test that hypothesis. A big dataset is not an experiment; so big data is not
specific condition or question. The ideal is surely that the data of every ‘science’. We may need a new word (and underlying philosophy) for what
patient undergoing anaesthesia or a surgical procedure are entered into is going on.
N.B. the articles referred to can be found in either the latest issue of Anaesthesia or on Early View (ePub ahead of print)
J. J. Pandit, Editor Anaesthesia
SPA time
for trainees
Supporting Professional Activities (SPA) are Our solution
defined as activities that underpin direct To help address this, the specialty trainee committee in the North-
clinical care. Many of these are required West deanery has introduced 16 SPA sessions for senior trainees
per year. These are evenly distributed throughout the year with
for revalidation and the time taken to a maximum of four sessions to be taken per three-month block
undertake them has long been recognised (pro rata for less than full-time trainees). Pre-fellowship trainees
utilise the majority of their study leave for exam-related purposes
within the consultant and SAS contracts. and for this reason they are currently not entitled to SPA time.
The terms and conditions of the consultant Trainees must request SPA sessions in a similar manner to study
contract outline the many activities that leave arrangements. This ensures the approval of the educational
supervisor and rota coordinator locally and allows the training
may be undertaken during SPA time, many programme director to monitor its use. Trainees are expected to
discuss their plans for SPA time with their educational supervisor
of which are also carried out by junior at the initial supervisor meeting and the request can be refused
doctors during their training. if it is deemed unreasonable or it is felt to be at the expense of
achieving core learning outcomes.
The Annual Review of Competence Below are some examples of what SPA time may be used
for. This is not an exhaustive list and approval remains at the
Progression (ARCP) requires trainees to discretion of the educational supervisor. There may be some
overlap with activities that may also be requested as study leave.
show evidence of continuing professional
development as well as involvement
with audit and quality improvement. The
curriculum for advanced trainees includes
Examples of SPA activity
management and leadership, innovation
• Audit and quality improvement projects
and education. It is anticipated that much
• Development of Trust guidelines
of this can be achieved within training • Research including online GCP Training
hours and planned study leave. A recent • Publications (with appropriate senior guidance)
• Preparation for regional/national posters/presentations
report on trainee morale and welfare from • Management – e.g. shadowing senior management
the RCoA highlighted that anaesthetists in and attending board meetings
• Organising and running simulation sessions
training reported overwhelming pressure to • Organising and running local teaching for medical
undertake these activities, with almost all students/junior trainees
• Attending to previously missed training opportunities
done in their personal time [1]. • Working towards MSc/PgDip/PgCert

Alternative Models Conclusion
Allocation of non-clinical time for trainees will vary depending This simple intervention has been universally welcomed by
upon local rota pressures and stage of training. SPA time can trainees as recognition of the contribution they make outside of
be allocated in advance alongside the on-call rota, reducing the clinical setting. The use of SPA time will be monitored from
flexibility for the trainee but allowing departments to plan ahead. the trainee and departmental perspective and the terms adapted
Trainees on advanced modules may require one session a week as needed prospectively. We hope it enables more flexibility for
to meet their non-clinical commitments but this would have to be trainees in terms of the pressures of achieving required non-
negotiated at a local level. clinical work outside of work time, and consequently has an
impact on their wellbeing and training experience.
Potential Problems
There have been concerns voiced regarding the loss of training
time with many senior trainees not achieving the minimum of the Mohammed Akuji
three supervised sessions per week recommended by the RCoA. ST6 Anaesthesia, Bolton NHS Foundation Trust
It is unclear whether this has historically ever been achieved but
there is no doubt that the average number of cases performed by
a trainee prior to becoming a consultant has fallen significantly
[2]. The current study leave allowance within our region is 30
days per annum, which is rarely fully utilised post-fellowship. Bernadette Lomas
We therefore appropriated SPA time from within the study leave ST6 Anaesthesia, Manchester University
budget on an optional basis, preventing a reduction in time within NHS Foundation Trust
the clinical environment.
References
1. Royal College of Anaesthetists. A report on the welfare, morale and experiences of anaesthetists in training: the need to listen. RCoA. December 2017.
https://www.rcoa.ac.uk/system/files/Welfare-Morale2017.pdf (accessed 08/04/2018).
2. England AJ, Jenkins BJ. Time spent in the clinical environment is the most important aspect of medical education – we need to protect it. Anaesthesia
2017; 17: 1306–11.

Dear Editor
While extubating a patient in theatre, I noticed a potential for harm that I had
not anticipated, and which could easily go unnoticed. It is routine to check
for the degree of reversal by using a nerve stimulator at the end of any case
where the patient has received a non-depolarising muscle relaxant. The ECG
dots used to connect the nerve stimulator are commonly produced stuck
to small, transparent and annoyingly static pieces of plastic (Fig. 1). In this
instance, I found a piece of plastic sitting on the inside of the face mask that
was about to be used (Figs. 2, 3). Although no harm came to this patient, it
had the potential to partially or completely obstruct either the breathing circuit
or the patient’s oropharynx.
Many cases have been reported of blocked anaesthetic circuits due to rubber
bungs, caps, wrapping and cleaning rods lodged in angle pieces, circuits and
reusable laryngeal masks, and have resulted in serious harm [1–5]. In 2001, a
Fig. 1 case resulted in death of a 9-year-old boy when a transparent cap completely
occluded an angle piece. Lessons from that case included using single-use
equipment appropriately and not unwrapping until needed, dissemination of
safety information (a similar incident had recently happened), and amendment
of the AAGBI’s checklist to include checking the patency of all parts of the
circuit that will be used [6, 7].
In my case, the face mask and ECG dot plastic were single-use pieces of
equipment that although opened appropriately and not faulty, shouldn’t
come into contact with each other. As safety checking of the breathing circuit
and anaesthetic machine routinely happens at the beginning of a case, we
should be vigilant at checking our equipment at times when altering the
circuit during the case. This case also highlights the importance of having a
tidy workspace and disposing of rubbish appropriately. Changes that have
occurred in previous cases include bright colouring of disposable plastics to
Fig. 2 aid detection, and introduction of a hole in the centre of the plastic to reduce
the chance of complete obstruction.
Roisin Flanagan
CT3 in Anaesthesia, Royal Gwent Hospital
References
1. Dutton CS. A bizarre cause of obstruction in an Oxford non-kink endotracheal tube.
Anaesthesia 1962; 17: 395–6.
2. Ross EDT. Misuse of the plug of Cobb's suction union. Anaesthesia 1974; 29: 66.
3. Thorpe CM. Plastic in the anaesthetic circuit. Anaesthesia 2002; 57: 85–6.
4. Cameron D, Onslow J. Obstruction of airway equipment. Anaesthesia 2002; 57: 188–9.
5. Srikanth K. Yet another foreign body in a laryngeal mask airway. Anaesthesia 2002; 57:
189–90.
6. Carter JA. Checking Anaesthetic Equipment and the Expert Group on Blocked
Anaesthetic Tubing (EGBAT). Anaesthesia 2004; 59: 105–7.
7. Department of Health. Protecting the Breathing Circuit in Anaesthesia. Report to the Chief
Medical Officer of an Expert Group on blocked anaesthetic tubing. 2004.
Fig. 3
For those who are happy to get their AAGBI

news via Twitter, the official President’s Twitter
account is @AAGBI_President and the blog is at
www.aagbipresidentsblog.wordpress.com.
I hope you will follow both.

your Letters
SEND YOUR LETTERS TO:
The Editor, Anaesthesia News at anaenews.editor@aagbi.org

Please see instructions for authors on the AAGBI website
Dear Editor Dear Editor

#FightFatigue 'Lazarus come forth!' before confirmation of death
We would like to congratulate Rob Charles Jesus supposedly resurrected Lazarus four days after his death and burial (Gospel of John,
et al. on their audit regarding fatigue and Chapter 11: 1–44). Lazarus phenomenon is the delayed unassisted return of spontaneous
commend the authors on highlighting such an circulation after its cessation, either after termination of cardiopulmonary resuscitation or
important issue [1]. Was the response rate of withdrawal of life sustaining therapy [1, 2]. Fifty percent of French emergency physicians
37% indicative of attitudes about fatigue in the claim to have encountered it [3] and one-third of Canadian intensivists have seen it at least
workplace as a profession, or itself an ironic once [4]. In a comprehensive review from 2010, 32 cases of Lazarus phenomenon were
product of ‘survey fatigue’? identified from 16 different countries over a 26-year period (1982–2008) [1].
Like many NHS Trusts, clinical and

administrative space is a premium. Despite
this pressure, and ostensible concerns of
‘sleep inertia’ impairing the first few minutes
of performance once woken, our department
has always strongly advocated suitable and
dignified rest facilities for our anaesthetists.
We genuinely believe that fatigued doctors are
a great threat to both patient and staff safety,
and education for clinicians and managers on
effective fatigue management is fundamental
to provision of high quality care and system
resilience.
We are lucky to be a forward thinking Trust with

patient and staff safety advocates throughout
the organisation. Thus we have ensured a
modest but private bedroom, close to the
maternity unit, for our obstetric anaesthetists. According to ALS guidelines, a patient must be observed for a minimum of 5 min before
confirming death [5]. Since most cases of Lazarus phenomenon occur within 10–15 min,
It is widely held that the medical profession consideration should be given to extending this period to 15 min with ECG monitoring
lags behind other safety-critical industries before certifying death or informing the family [2, 6, 7]. While anaesthetists will usually
with regards to fatigue management. encounter death confirmation in a continuously monitored environment (A&E, ITU or
Anaesthetists appear at the forefront of theatre), it is reasonable to delay examination for confirmation of death to 15 min post
specialties addressing this issue, and should cessation of circulation (spontaneous or artificial).
relish the challenge in leading the way. We
fully support the AAGBI, RCoA and FICM Eid Hussien
campaign to #FightFatigue and hope other Specialty registrar Anaesthetics, South Tyneside NHS Foundation Trust
Trusts follow our example.
References
William Birts and Richard Kaye Consultant 1. Hornby K, Hornby L, Shemie SD. A systematic review of autoresuscitation after cardiac arrest. Critical
obstetric anaesthetists Buckinghamshire Care Medicine 2010; 38: 1246–53.
2. Adhiyaman V, Adhiyaman S, Sundaram R. The Lazarus phenomenon. Journal of the Royal Society of
Healthcare NHS Trust Medicine 2007; 100: 552–7.
3. Gerard D, Vaux J, Boche T, Chollet-Xemard C, Marty J. Lazarus phenomenon: knowledge, attitude and
Reference practice. Resuscitation 2013; 84: E153.
1. Charles R, Carrick M, Marriott A. An audit of 4. Dhanani S, Ward R, Hornby L, Barrowman NJ, Hornby K, Shemie SD. Survey of determination of death
trainee fatigue and wellbeing in the Yorkshire and after cardiac arrest by intensive care physicians. Critical Care Medicine 2012; 40: 1449–55.
Humber Deanery. Anaesthesia News 2018: 368: 5. Deakin CC, Nolan JP, Soar J, et al., European resuscitation council guidelines for resuscitation 2010.
10–2 . Section 4. Adult advanced life support. Resuscitation 2010; 81: 1305–52.
6. Linko K, Honkavaara P, Salmenpera M. Recovery after discontinued cardiopulmonary resuscitation.
Lancet 1982; 1: 106–7.
7. Adhiyaman V, Sundaram R. The Lazarus phenomenon. Journal of the Royal College of Physicians of
Edinburgh 2002; 32: 9–13.

Anaesthesia Heritage
21st Anaesthesia,
Museum in London
ANAESTHESIA
HERITAGE
CENTRE Critical Care and Pain Forum
Free
entry
Da Balaia, The Algarve
A unique medical 1 - 4 October 2018
science museum
devoted to the history
of anaesthesia
and pain relief.
Brave Exhibition open until November 2018
Faces
Powerful
stories of facial
reconstructive
surgery during
World War I
Opening hours: Monday to Friday 10am-4pm (last admission

3:30pm). Closed on Bank Holidays. Booking recommended.
Visit www.aagbi.org/heritage
Find us at: The Anaesthesia Heritage
Centre, AAGBI Foundation,
21 Portland Place, London W1B 1PY
Registered as a charity in England and Wales no. 293575 and in Scotland no. SC040697.
www.doctorsupdates.com
education in a perfect location®
ANews_Quarter_advert.indd 1 16/02/2018 15:23
Keep an eye
on the website for
more webinars as
SAS Webinar for SAS doctors they are added
– Safety, survival and sleep

Tuesday 19 June at 16:00
National Safety Standards for Invasive Procedures

(NatSSIPs) and other patient safety issues
Friday 16 November at 13:00
Recordings or previous webinars are also available

www.aagbi.org/webinars
New
EBPOM 2018: Annual London
London Peri-Operative Medicine Congress
Venue
IET Savoy Place, London, 4-6 July 2018
6th July - POETTS Annual Meeting
6th July - TRIPOM Annual Meeting
Key Speaker’s include:
Sir Bruce Keogh Padma Gulur Linda Denehy Rupert Pearse

Birmingham, UK NC, USA Melbourne, Australia London, UK
www.ebpom.org
Current Controversies in Anaesthesia

and Peri-Operative Medicine
Dingle, County Kerry, Ireland
Monday 8th to Friday 12th October 2018
8th -11th October - UCL & Southampton 20th Annual Congress
12th October - ICSI & SIAA Joint Annual Congress New
Call for Abstracts - €1000 in Prizes - Deadline 20th July Format:
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ANNUAL CONGRESS
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Knowing your payslip

Article · June 2018

Thomas Tom George Wojcikiewicz

The user has requested enhancement of the downloaded file.

Knowing your payslip

A Day in the Life of

A Day in the Life

A Night in the Life

05 A Night in the Life of an…

07 A Day in the Life of a…

08 A Day in the Life of a…

09 A Day in the Life of a...

Design: Chris Steer

Copyright 2018 The Association of Anaesthetists of Great Britain and Ireland

Advertisements are accepted in good faith. Readers are reminded that

Nominations are now invited for the award, which

A few minutes later I gatecrash the evening Labour Ward ward

Six hours, four epidurals and five sections later, I am called by

Eventually, we get to theatre with our next patient and position

Anaesthesia News June 2018 • Issue 371 5

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For more information please contact:

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das2018@abbey.ie www.das2018.co.uk @dasedinburgh18

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Anaesthesia News June 2018 • Issue 371 7

Head to the changing room. Bad news: no biscuits.

Review the emergency list. Cycle home.

Get on with the emergency list. 1. ‘No’ is a complete sentence.

Pop down to the office. Name and address supplied

Bad news: my colleague’s paperwork is metastasising across my

Look at the programme plot.

8 Anaesthesia News June 2018 • Issue 371

OK – some morning problems to see off;

In our stride now, it's meeting time, ideally titled

Anaesthesia News June 2018 • Issue 371 9

10 Anaesthesia News June 2018 • Issue 371

Anaesthesia News June 2018 • Issue 371 11

After lunch I head to my office to begin reviewing my trainees’

Then a trainee pops in to discuss their portfolio ahead of the

Anaesthesia News June 2018 • Issue 371 13

For many non-ICU trainees, the removal of the ward round

14 Anaesthesia News June 2018 • Issue 371

AAGBI welcomes the international

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