OK, maybe there’s very little interest amongst you in the latest developments in anaesthesia, particularly for the Russian bots I’m guessing. On the other hand, it’s your taxes that have helped fund my trip, so you deserve a report whether you want it or not.
I’ll just discuss a few of the highlights before I forget them.
There’s been a move to use propofol for end of life care instead of benzodiazepines and opioids, because doctors seem at times unwilling to escalate doses appropriately. Patients on a propofol infusion (AKA Jackson Juice or milk of amnesia), tend to look quite serene. However, it’s widely used for sedation in ICU, and it turns out that ICU survivors will tell you of awful experiences they have while on it, with very real seeming hallucinations and nightmares. So, best to just teach the doctors to be more generous with the other drugs that we know are at least pleasant, for when they’re looking after your old gran in her final days.
There was another session by some young anaesthetists called “off the beaten path” which was inspiring although also rather intimidating. They are all doing extra curricular things like starring on TV shows, being expedition doctors, or looking after famous football teams. They argued that anaesthetic training gives us a huge amount of transferrable skills that help us thrive in difficult situations. I’d like to think it’s true.
The session on brains was also fascinating, and is my particular area of interest. The brainwave monitor (EEG) we use nowadays to make sure people are getting enough anaesthetic can also tell us a lot about how healthy the brain is or isn’t, and how it’s coping with an acute insult such as a head injury or brain bleed. It’s just a matter of pattern recognition which is something we’re very good at.
The talk on functional disorders, meaning illnesses that don’t have an organic basis, was really interesting. This includes things like functional seizures that aren’t epilepsy. Of note, the patients definitely aren’t just “putting it on”. We used to say it was a diagnosis of exclusion, that you had to make sure they weren’t having “real” seizures, but actually that approach can be quite risky, because the drugs that you give can make it worse and are dangerous in their own right. It turns out functional seizures are quite characteristic and easy to spot if you have experience. I had a patient with it last year, and in retrospect we could have done a better job of managing it, mostly with de escalation measures.
The last talk in that section was about clot retrievals in acute stroke. This is when you Hoover out the blood clot from an artery in a patients brain that’s causing the blockage to blood flow. They have way more centres doing it over here than at home, which fits with their higher population, but they still have inequality in access, leading to a postcode lottery for timely care. Unfortunately time is brain so your chances of a good outcome are way better in central London than rural Wales. We have the same problem in NZ.
The peri operative medicine section was the classical sort of thing you expect from medical conferences. They presented a paper that was published on the day they were giving the talk – you can’t be more hot off the press than that! It was on the very effective new weight loss drugs, the GLP-1 agonists like Wegovy. Due to poor stomach emptying it does seem to increase the risk of vomiting under anaesthetic. Perhaps of more interest, less than half of patients who were on them had them prescribed by their GP or hospital doctor. Most just “got them off the internet” somehow. The presenter talked about the last patient she had who was on them, she’d got them from the lady who did her eyebrows. Yikes.
The “outcomes that matter” talk essentially said that what people care about after their surgery and anaesthetic isn’t necessarily what we might expect. Success could look very different to a patient or a doctor. Hence the importance of good communication about expectations, ahead of time.
A talk on caring for autistic patients was a real eye opener too. So much of what we might think is good care is essentially an assault on the senses of an autistic patient. Calmer, quieter, less stimulating environments are important. It’s not a “one size fits all” situation, but rather “horses for courses”, and incidentally that sort of figurative language is also surprisingly unhelpful for concrete thinkers. All adults hate surprises, but this population in particular, so full explanations of the peri operative journey, or even better, a visit of the theatre suite in the days before hand, can be very useful. Premeds such as clonidine are also helpful (that note is for me).
This morning the session on research included some very thorough work debunking the myth that labour epidurals are associated with learning difficulties in children. I’d never even heard of this idea I must say, but I’m pleased to hear it’s all rubbish since I had epidurals for both labours.
The last session was on burnout, which was terrific. I was very pleased to hear it’s not a personal failing, which of course we’re all afraid that it is.
As pressures on us increase, we tend to cut back on the very things that are helping to sustain us.
The presenter had very useful tips on what to do if we recognise the signs in ourselves or in colleagues, and how to prevent it happening in the first place. Surprisingly, the Americans are way ahead in recognising the important role that workplaces provide, and the benefits that accrue not just to staff but to the organisation as a whole when people are thriving. I suspect NZ is way behind in this.
Well, I think that’s about it. Sorry to bore you.