ANZCA Bulletin June 2012 - final.pdf - Australian and New Zealand ...

TO FIND OUT MORE ABOUT ANZCA 2013 ASM, REGISTER YOUR INTEREST AT:WWW.ANZCA2013.COM E: ANZCA2013@WSM.COM.AU1

20 Curriculum updateThe primary examination willtake on a new format underthe revised curriculum.24 Still inventingRobert Orton medalrecipient, Dr DuncanCampbell is stillinnovating.12 Perth ASM a great successMore than 1500 Fellows and traineesattended the Perth meeting.ANZCA BulletinThe Australian and New Zealand College of Anaesthetists(ANZCA) is the professional medical body in Australiaand New Zealand that conducts education, training andcontinuing professional development of anaesthetistsand pain medicine specialists. ANZCA comprises about5000 Fellows and 2000 trainees across Australia andNew Zealand and serves the community by upholdingthe highest standards of patient safety.Medical editor: Dr Michelle MulliganEditor: Clea HincksProduction editor: Liane ReynoldsSub editors: Kylie Miller and Meaghan ShawDesign: Christian LangstoneAdvertising manager: Mardi MasonSubmitting letters and other materialWe encourage the submission of letters, news andfeature stories. Please contact ANZCA Bulletin Editor,Clea Hincks at chincks@anzca.edu.au if you would liketo contribute. Letters should be no more that 300 wordsand must contain your full name, address and a daytimetelephone number.Advertising inquiriesTo advertise in the ANZCA Bulletin please contactMardi Mason, ANZCA Marketing and SponsorshipManager, on +61 3 9510 6299 or emailmmason@anzca.edu.au.ContactsHead office630 St Kilda Road, MelbourneVictoria 3004, AustraliaTelephone +61 3 9510 6299Facsimile +61 3 9510 6786communications@anzca.edu.auwww.anzca.edu.auFaculty of Pain MedicineTelephone +61 3 8517 5337painmed@anzca.edu.auCopyright: Copyright © 2012 by the Australianand New Zealand College of Anaesthetists, all rightsreserved. None of the contents of this publication maybe reproduced, stored in a retrieval system or transmittedin any form, by any means without the prior writtenpermission of the publisher.Please note that any views or opinions expressed inthis publication are solely those of the author and donot necessarily represent those of ANZCA.2 ANZCA Bulletin June 2012

32 Titanic challengeVictorian anaesthetist Dr Ashley Webbexplains the effectiveness of a quitsmoking program at Peninsula Health.54 Museum treasuresThe Geoffrey Kaye Museum ofAnaesthetic History has three newitems of historical significance.28 Teaching in PNGThe Overseas Aid Committee is doinga lot of work in Papua New Guinea.Contents4 President’s message5 Chief Executive Officer’s message6 Acknowledging Professor Kate Leslie8 Letters to the editor9 Awards11 News12 Perth ASM wrap up19 New Fellows’ Conference20 ANZCA’s revised training program24 A mad idea – or several – is justwhat the doctor ordered28 ANZCA contribution helps improvepatient care in Papua New Guinea32 Tobacco and surgery: Issues ofTitanic importance34 Lessons abound on a Dili adventure37 NZ Anaesthesia ASM38 ANZCA and government:building relationships40 Quality and safety45 The dangers of self-inflatingresuscitation bags46 ANZCA Trials Group meets at theannual scientific meeting in Perth50 Successful candidates54 Anaesthetic history: Museumreceives valuable historical giftsfrom South America55 ANZCA history and heritage update56 The early development of anaesthesiapractice in Queensland60 ANZCA in the news62 The Anaesthesia andPain Medicine Foundation64 New Zealand news67 People and events68 Australian news78 ANZCA Council meeting report80 Faculty of Pain Medicine86 Library update88 Obituary89 Future meetings Australiaand New Zealand91 life&leisure: “Savvy professionalscan reap tax rewards”, “Crossingthe South Island the hard way” and“Rug up and explore with a wintryEuropean adventure”3

President’smessageDr Lindy RobertsPresident, ANZCAThere are two particularly special aspects forme in taking over as president of the Collegeat this time. The first is that the handoveroccurred at the recent successful ASM in myhometown, Perth. The second is that thisyear marks the 20th anniversary of ANZCAand it is also 20 years since I first joined theCollege as a trainee.As the incoming president, I am likeall our Fellows, driven by the notions ofexcellence, care and collaboration. Anexample of this is through leadership of thecurriculum review process where we useda coalface-up approach, seeking the viewsof Fellows and trainees about the existingtraining program, to build a world-classcurriculum that is nearly ready to be rolledout. We have another opportunity at thistime as the College and its Faculty of PainMedicine define the plans and direction forthe five years from 2013 to 2017.It is important that College leaders seekthe views of Fellows and trainees and usethat feedback wisely – the best leaders Ihave known have forged the directions oftheir organisations from listening to theirconstituents. As part of the planning for thenext five years, there has been a series ofways in which Fellows and trainees havehad a voice. These include the consultationprocess and hospital visits being undertakenby ANZCA Chief Executive Officer LindaSorrell, the outcomes of the 2010 Fellowshipsurvey, the 2011 New Zealand roadshowundertaken by Dr Vanessa Beavis, and the2012 curriculum survey targeting heads ofdepartment, regional/national educationofficers, supervisors of training and trainees.Thank you to all who have shared their views.So what are you saying? These are someof the key messages:• Our core purposes remain training,education, accreditation, standards ofclinical service delivery for all sectionsof our communities; services for Fellowssuch as continuing education, continuingprofessional development, the libraryand other resources; advocacy to thewider community and government in theinterests of high quality patient care andsafety; and promotion and support forevidence-based practice through researchand education.• As a College we have many strengths.These include the training program andthe quality of our graduates, our growingeducational resources, and publications.We are a credible, professionalorganisation that has the tremendousbenefit of Fellows’ capabilities andcontributions; along with staff knowledgeand resources.• We can improve in a number of areas,particularly in our relationships withand services to our Fellows and trainees,including acknowledgement of andsupport for their contributions. Our mainchallenges over the next few years willbe those of health sector and workforcereform; implementing the revisedcurriculum; ensuring that we remain anorganisation that continues to deliveroptimal value to its members; and fosteringrelationships with important partners. Insome quarters, we need to strengthen ourprofile and role.I am inspired by the call from Fellows forthe College to remain a world leader, anorganisation committed to excellence witha profile and membership services to match,using new technologies and communicationsto best effect. All these aspirations ultimatelyunderpin the high standards of care weprovide our patients.Past presidents, deans and councils aswell as the many Fellows and trainees whohave contributed so much up to this pointhave given us all a solid foundation on whichto continue building. I know we can respondto challenges and we will aspire towardsan even stronger organisation over the nextfive years. We need to promote and maintainstrong standards through successfulrollout of the revised curriculum, and growsupport for innovative research and ongoingdevelopment of resources for Fellows.We need to work on building a sense ofunity and ownership in our College throughstrengthening relationships between theANZCA Council and the regions, ensuring aservice-oriented approach throughout theCollege, and seizing ongoing opportunitiesfor collaboration between the College and theFaculty of Pain Medicine. We must continueto foster strong relationships and strategiccollaborations with governments, othercolleges and the societies, and with trainingorganisations in Hong Kong, Singaporeand Malaysia. And we must ensure ourorganisation is sustainable into the futureby continually developing efficiencies,relevance and effectiveness, the best staffand the best systems. I am confident that wewill move from strength to strength.Of course, there would be no Collegewithout the efforts of the many Fellows,trainees and staff who contribute at somany levels. The past 20 years has beenmarked by many significant achievementsfor the professions of anaesthesia andpain medicine, and I feel privileged to betaking over as the leader of a college thatis in excellent shape. I have a great senseof optimism about our next 20 yearsand beyond.4 ANZCA Bulletin June 2012

Chief ExecutiveOfficer’s messageThe development of our ANZCA StrategicPlan for 2013-2017 is continuing apace.Much feedback has been obtainedthrough high-level consultation withinternal stakeholders, including councillors,committees (including regional) and staff;and with external stakeholders such asother colleges, departments of health,universities and relevant governmentagencies.Other sources of information haveincluded recent fellowship and traineesurveys, the New Zealand hospital roadshow by former New Zealand NationalCommittee chair and new ANZCA councillor,Dr Vanessa Beavis, and key pointsraised during my recent visits to hospitalanaesthesia departments in Australia.A total of 58 separate sets of feedbackwere received to six questions used toguide discussions and help inform ANZCA’sstrategic priorities for the five years fromnext year. Of these, 43 came from groupsand individuals within ANZCA and 15 fromexternal agencies, including from withindepartments of health, universities, andother colleges.Following are the questions and thethemes resulting from the responses.What is ANZCA’s core business? Training,education, standards; advocacy; research;communication.What are ANZCA’s strengths? Quality ofservices and graduates; communicationsand profile; Fellows’ capacity andcapability; organisational capacity andways of working.What are ANZCA’s weaknesses?Relationships with and services to Fellowsand trainees; reliance on pro bono work ofFellows; profile and perceptions of ANZCA;organisational structure and ways ofworking.Where should ANZCA be in five years’time? The leader in anaesthesia training,recognised expert agency; a capable andinnovative user of IT and communicationstechnologies; provider of excellent servicesto members; good communicator witha strong profile.What are ANZCA’s main challenges in thenext five years? Engagement with Fellowsand trainees; good business practice in atough environment; managing externalinfluences (other providers, politicalchange); curriculum implementation andcontinuing medical education/continuingprofessional development services;improving structure and ways of working.There were also a number of themes thatappeared across most or all of thequestions including:• The revised curriculum: An essentialcomponent in ongoing core business;a strength; a challenge, and critical towhere ANZCA will be in 2017.• Workforce: Mal-distribution ofanaesthetists; training places, numberof trainees, projected increase in demand,and funding changes for training.• A need for support for rural anaesthetistsand GP anaesthetists.The ANZCA Council held a workshop inApril and will be discussing the strategicplan again this month.History and heritageAt the recent Perth annual scientificmeeting, we filmed the first of severalinterviews with key College figures. Thesewill form a collection of oral histories thatwill be available to the wider fellowshipvia the website.This is part of our commitment to historyunder our History and Heritage Strategy,which was signed off by the ANZCACouncil earlier this year. The strategy aimsto meet 10 objectives over the next fewyears including actively capturing anddocumenting the history of the College andusing information technology to improveaccessibility.We also have plans for a strong historicpresence at next year’s ANZCA annualscientific meeting in Melbourne and arecommitted to a new “anaesthetic history”section in each edition of the ANZCA Bulletin.Other activities being undertaken includeupdating a booklet about the historicANZCA-owned building, Ulimaroa, andother publications that highlight the historyof the College.For further information about the Historyand Heritage Strategy please see page 55.Ms Linda SorrellChief Executive Officer, ANZCA5

AcknowledgingProfessor Kate LeslieIt is my pleasure to acknowledge ourimmediate past president Kate Leslieand her work as the leader of the Collegefrom May 2010 to May 2012. Kate’spresidency has been marked by a clearvision, exceptional attention to processand outcomes, coupled with strong anddecisive leadership.Kate’s efforts have been tireless andher style courageous. Through the visionof ENGAGE she urged us to embrace,negotiate and influence, get involved,advocate, give our support and educate.There have been many achievementsunder Kate’s leadership:• Delivering a plan with our formerCEO Mike Richards to strengthen ourcapability in areas such as educationdevelopment, fellowship affairs, policyand communications.• Recruiting our new CEO, Linda Sorrell,and putting in place a forward-lookingrelational and collaborative agenda.• Leading the organisation to be ready forthe rollout of the revised curriculum,ANZCA Curriculum Revision 2013.• In collaboration with others, achievinga critical Medicare schedule change tofund trainees in private.• Building activities and collaborationsin overseas aid.• Setting new standards of clarity forFellows and trainee participating inCollege activities through terms ofreference for ANZCA committees andleaders.• Leading the charge for improving ourapproach to indigenous health.• Confirming and codifying the crucialrelationship between ANZCA andthe Faculty of Pain Medicine byconstitutional review.• Strengthening relationships withour important partners notably theCollege of Intensive Care Medicine, theCollege of Surgeons and the Society forPaediatric Anaesthesia in New Zealandand Australia.• Overseeing two highly successfulannual scientific meetings – in 2011held jointly with the Hong Kong Collegeof Anaesthesiologists and this year inPerth.• Reinforcing the College’s commitment topreserving our history and heritage.Through her ENGAGE strategy, Kate hasachieved much. I, along with the ANZCACouncil, am committed to continuingto work in all of these areas, as they arestrengths for our College that are worthbuilding upon.Kate, on behalf of all Fellows, traineesand staff, thank you. We wish you well inyour future endeavours.Dr Lindy RobertsANZCA President6 ANZCA Bulletin June 2012

Director of ProfessionalAffairs (IMGS)ANZCA is seeking to engage a senior anaesthetist of highstanding to the position of Director of Professional Affairs(International Medical Graduate Specialists). This positionreports to the Chief Executive Officer and works closely withthe Dean of Education/Executive Director of ProfessionalAffairs and other Directors of Professional Affairs and withANZCA Council members.This position advises on clinical and professional issuesof importance to the College, particularly in relation tointernational medical graduate specialists and may be askedto represent the College at external meetings. The positioninvolves working closely with College staff.ANZCA is seeking expressions of interest from Fellowsincluding former councillors of the College who have hadclinical experience in the past two years. An attractiveremuneration package will be negotiated with the successfulcandidate.For information on key selection criteria or a positiondescription please contact Linda Sorrell, Chief ExecutiveOfficer, ANZCA by telephoning +61 3 9510 6299 or emaillsorrell@anzca.edu.au. The closing date for applicationsis July 9, 2012.ANZCA TrainingScholarships for 2013ANZCA makes available 20 scholarships each year toassist anaesthesia trainees who are suffering severefinancial hardship. Each scholarship will be awarded inthe form of a 50 per cent reduction in the annual trainingfee for the following year. Applicants must be registeredtrainees of ANZCA.Applications must be submitted on the prescribed2013 ANZCA training scholarship application form,copies of which are available from the College.Please contact:Janelle TaltyPhone: +61 3 9093 4913Email: jtalty@anzca.edu.auThe closing date for applications for 2013 is FridayAugust 10, 2012. Successful applicants will be notifiedin November 2012.Please note: If your financial circumstances improve duringthe training year for which the ANZCA Training Scholarshipis awarded, you must notify the College. Your applicationwill be reviewed and you may be asked to relinquish allor part of your scholarship.7

Originally the mace was developed duringmedieval times as a weapon wielded byone arm from horseback. Therefore theshaft was long with a heavily studdedhead, and such maces developed afearsome reputation, which made theman excellent symbol for power.Following the introduction ofgunpowder the usefulness of the maceas a weapon declined but its symbolismfor power and authority survived.Ceremonial maces became larger withmore decoration and were made ofprecious metals such as silver and gold.The ANZCA mace was gifted to the geographical region and the domicile The Duke of Norfolk as Earl Marshall ofCollege by the Royal Australasian College of its headquarters; its derivation from Her Majesty’s College of Arms authorisedof Surgeons (RACS) at our College’s first the Faculty of Anaesthetists, Royal the armorial bearings on December 1,annual scientific meeting in 1994, when Australasian College of Surgeons, and 1992, and they were officially grantedtheir then president, Dr David Theile said, the links particularly in intensive care on May 10, 1994. The subcommittee“as a demonstration of our part in your with the Royal Australasian College of members were very pleased to behistory and a permanent expression of Physicians; its closeness to the basic notified that, because of the designour good wishes for your future”. The sciences of anatomy, physiology and and its detailed justification, thesedesign of the mace was greatly assisted pharmacology; and the relationships arms were granted in the minimum timeby Joan Sheales, the then College which exist between the new and old – an exceedingly rare occurrence.Registrar (now titled chief executive worlds.The armorial bearings consist of theofficer), and is based around a lily to The armorial bearings were“supporters”, which were chosen assymbolise the creation of the new college designed by a College’s Coat of Arms famous historical figures whose workof anaesthetists, as the lily in Greek lore Subcommittee, which met between was vitally important in changing not onlysymbolises birth.September 1991 and September 1992 medical knowledge, but the way in whichThe mace design also incorporates and consisted of Barry Baker (chair), people thought about that knowledge.much of the symbolism from thePeter Livingstone (dean/president), DavidCollege’s armorial bearings which were McConnel (councillor), Peter Jonesdesigned to represent the Australian and (RACS) and Joan Sheales (registrar/CEO),New Zealand origins of the College; its and later Michael Hodgson (president).2003Anaesthetists inManagement SpecialInterest Group establishedOnline journals availableto Fellows2004Curriculum 2004commencesMichael Cousins appointedANZCA PresidentOne Grand Chain(volume two) publishedJack Havill appointed Dean,Joint Faculty of IntensiveCare MedicineMilton Cohen appointedDean, Faculty of PainMedicineClinical Teacher CoursepilotedANZCA website createdANZCA Trainee Committeeestablished18 ANZCA Bulletin March 2012 ANZCA CELEBRATING 20 YEARS 1992-20122005Mike Richards appointedANZCA CEOAcute Pain Management:Scientific Evidence (secondedition) publishedANZCA Trials Group formedAndreas Vesalius is on the left. Hepublished his seminal work De HumaniCorporis Fabrica in 1543 from Padua,Italy. This publication changed anatomybecause it overthrew, after 1400years, Galen’s dogma (largely basedon the anatomy of apes and monkeys)with human cadaver dissection, andby instituting the scientific approachof challenging dogma with directexperience. Vesalius also was the firstto show that an animal that had ceasedto breathe could be resuscitated byusing artificial respiration through areed inserted into the windpipe – in thecoat of arms he is holding a bellows tosignify this act. The bellows also signifiesthe experimental scientific basis ofthe specialty following Vesalius’ lead.His view is outward looking to signifyhis broad academic outlook, and toindicate the widespread place of artificialventilation in anaesthesia and intensivecare.William Harvey, who lived in Englandbut who had studied in Padua, is theother supporter and is depicted holdinga book with a heart etched on thecover. The heart and book represent thecontribution made by Harvey in 1628when he published De Motu Cordis,which for the first time described thecirculation of blood through the lungsand around the body. The book alsosymbolises the College’s respect foracademic learning.Harvey looks towards Vesaliusto explain that the discovery of thecirculation depended on prior anatomicaldescription by Vesalius and others (thatis physiology followed anatomy), and alsobecause Harvey studied in the Italianmedical schools.These two supporters represent theheritage of the specialty based as it is onrespiratory and cardiovascular physiologytogether with anatomy.2006Walter Thompsonappointed ANZCA PresidentRoger Goucke appointedDean, Faculty of PainMedicineRichard Lee appointedDean, Joint Faculty ofIntensive Care MedicineRegional AnaesthesiaSpecial Interest GroupestablishedNew Fellow first electedto CouncilIn 2008, ANZCA commissioned the design of a contemporary corporate logo tocomplement the College coat of arms on ANZCA livery. The logo is now used,along with the crest, on all ANZCA hard-copy and electronic documents, andon our website. The two symbols presented together signify the historical andcontemporary values of ANZCA and the confidence of our organisation as wemove forward.The logo was inspired by the triangular board room table at ANZCA House inMelbourne, but the overall design is abstract and open to wide interpretation.The designers, Streamer, commented that the overall effect of the overlappinggeometrical shapes is one of precision and exactitude, reflecting the sciencesthat underpin the profession. The two sets of overlapping forms may reflect ourtwo countries and the three sets the foundations of our College - anaesthesia,intensive care medicine and pain medicine. The multiple and connecting triangularelements pointing in different directions allude to the multidisciplinary nature ofthe College.The “triangles” remind me of a high mountain range reflected in a deep ocean,requiring us to be courageous, intrepid and visionary in all the things we do. Theyevoke a journey where the summit will be reached through careful steps and bydogged persistence. The rich burgundy colour denotes quality, authority and a linkto the traditions of our past, but in essence the logo is modern and forward-lookingand that’s what I like about it!Professor Kate LesliePresident, ANZCAThe place of pharmacology, which isworld of Europe (and the not-so-old worldthe third scientific base for the specialty,of North America where anaesthesia wasis addressed by use of the botanicalfirst demonstrated and broadcast to thespecimens in the “charges of the shield”.world in the mid-19th century).The supporters stand on land separatedThe sea also indicates the significanceby water, which forms the “compartmentof sea travel in the transmission of theof the arms”.introductory news about anaesthesiaThese separate lands signify notfrom North America to Europe andonly the countries of Australia and Neweventually to Australia and finallyZealand, but also the separation of theNew Zealand.new world of Australasia from the old(continued next page)2007ANZCA Foundation officiallylaunchedAirway ManagementSpecial Interest GroupestablishedTrauma Special InterestGroup establishedANZCA Code of Conductintroduced2008Leona Wilson appointedANZCA PresidentPenelope Briscoeappointed Dean,Faculty of Pain MedicineVernon Van Heerdenappointed Dean, Joint Facultyof Intensive Care MedicineReview of the curriculumcommenced19The Cootamundra wattle (Acacia of Anaesthetists of the Royal Australasianbaileyana) illustrated on the land on College of Surgeons. The College ofwhich Vesalius stands representsSurgeons has the torch of glory in itsAustralia and the silver fern or ponga arms and has also the motto Fax mentis(Cyathea dealbata) on the land on which incendium gloriae – “The torch thatHarvey stands represents New Zealand. illuminates the mind is the fire thatThe shield contains two parts. The consumes vainglory”.“chief of the shield” contains theThe charges in the four quadrantsSouthern Cross indicating the College’s symbolise the plants that togethergeographical place in the Southern form the basis for the pharmacologyHemisphere because the constellation fundamental to anaesthesia. In theis at 600 S and therefore not visible upper left quadrant is the opiumfrom most of the Northern Hemisphere. poppy (Papaver somniferum) signifyingThe five stars are represented with the analgesia, and in the upper rightnumber of points representing their real quadrant is the mandrake plantbrightness in the night sky starting at (Mandragora officinarum) signifyingthe base of the cross with the brightest sedation and anaesthesia.star and moving clockwise: alpha – eight These charges also symbolise the oldpoints; beta – seven points; gamma – world plants. The new world plants areseven points; delta – six points; epsilon depicted in the lower charges. In the– five points.lower left quadrant is the curare vineThis representation is also that taken (Chondrodendron tomentosum) signifyingby the state of Victoria and is not taken neuromuscular paralysis, and in theby any other state or country using the lower right quadrant the cocaine leaf andSouthern Cross. Thus this representation fruit (Erythroxylum coca) signifying local into the wreath on the helmet andsymbolises the College’s founding and anaesthesia.its lambrequin (or cape). The risingheadquarters in Victoria.The crest consists of the helmet, sun behind the helmet indicates theThe lower part of the shield contains which is unusually affronté (or facing geographical place of the College in thethe Cross of St George indicating the forward) with a closed visor to indicate east next to the international date line;links between the College and itsalertness and readiness for any urgent and also symbolises links with the RoyalBritish counterpart, the Royal College of action. This type and position of helmet Australasian College of Surgeons and theAnaesthetists, as well as the Christian is similar to the Royal College ofRoyal Australasian College of Physiciansheritage of the College.Anaesthetists again linking the College to both of which have similar rising suns forThe “torch of glory” imprinted on the this fraternal organisation.the same symbolic reason.upright of the cross symbolises the direct The colours of the College gownderivation of the College from the Faculty (black and gold) are incorporated2008 (continued)Continuing ProfessionalDevelopment ProgramintroducedDr Ray Hader Trainee Awardfor Compassion establishedFirst ANZCA E-Newsletterdistributed2009Continuing ProfessionalDevelopment Programbecame mandatoryANZCA begins producingpodcasts20 ANZCA Bulletin March 2012 ANZCA CELEBRATING 20 YEARS 1992-20122010Independent College ofIntensive Care Medicine(CICM) formed replacingJFICM. Vernon VanHeerden inaugural CICMPresidentKate Leslie appointedANZCA PresidentDavid Jones appointedDean, Faculty of PainMedicineThe “hand of the carer” (physician) sterling silver when the RACS offered to lip is engraved “Presented by the Royalrising from the Lord’s cloud representing gift the mace to ANZCA. The aspects of Australasian College of Surgeons 1994”.Almighty guidance links the College back the armorial bearings that have been The mace is 960 millimetres long,to the Parisian medical influence and to translated into the design for theweighs approximately 2.75 kilograms,the foundations of the modern European mace are:and was cast in 19 separate piecesmedical tradition in 12th century Paris, The butt: This is now the larger end at Flynn Silver’s workshop in Kyneton,and symbolises the Fellow’s hand guided of the mace and is in the shape of a Victoria, using the lost wax technique.by the Lord caring for the patient’s life. half opened lily containing the motto Dan and John Flynn commented at theThe hand holds an ankh, the Egyptian “Corpus curare spiritumque” engraved on time (May 17, 1994) that “we considerhieroglyph for life, which links the major the inner lip. Within the open lily cusp, it to be the most significant commissionresponsibility of College Fellows – the like a stamen, the crest is reproduced in undertaken by ourselves to date”. Thepreservation of life – to the roots of full with the torch of glory placed below cost of the mace was $A34,500.western medicine in Egypt in the 5th the crest in a sense holding the crest Every council meeting is conductedto 3rd millennia BCE.aloft.with the mace on its jarrah rest in openThe snake of Asclepius (Aesculapius) This repositioning of the torch was display to symbolise the authority ofentwines the Ankh to symbolise the links deliberately designed to represent the gift council, and again at the College annualwith the heritage of Greek medicine and of the mace by the RACS to the College, general meeting.the ethics of doctor-patient relationships, and to symbolise the growth of theThe mace is also ceremonially carriedwhich derive from that time.College of Anaesthetists from the Faculty in the procession of the president andThe motto reads Corpus curare of Anaesthetists.council to the opening of each annualspiritumque which translates as “To care The shaft: Embossed on the shaft scientific meeting.for the body and its breath of life” and (stem of the lily) is a representationIf you have not looked closely at eitherwhich aptly summarises the main aim of the shield containing the fourthe coat of arms or the mace, you shouldfor Fellows of the College. There is an quadrants and with the chief containing do so, as they are each rich in a heritageintended pun in the motto, which uses the Victorian Southern Cross stars that you share with your colleagues,the Latin word curare (to care). This is represented by Argyle champagne-colour not only in anaesthesia but more widelyalso a word, derived differently from diamonds sized in proportion to the stars’ across the breadth of medicine andMacusi Indians in Guyana (wurari), used brightness (1x20pt, 2x16pt, 1x11pt, science.daily in the specialty for the drug curare and 1x6pt). The charges are representedor its analogues, which cause the state of more boldly and larger than in the arms Professor Barry Bakerneuromuscular paralysis or curarisation. to emphasise their differences, and for Dean of Education and Executive DirectorOriginally the College mace had been artistic relief on the shaft.of Professional Affairsdesigned to have a timber shaft made The head – Australia and New Zealandfrom Australian jarrah and an unspecified are represented in the head (anotherNew Zealand timber, but this timber half open but smaller lily) by a wattle inshaft was replaced with gold plated silver-gilt and a fern in silver. Around the2010Acute Pain Management:Scientific Evidence (thirdedition) publishedPerioperative MedicineSpecial Interest GroupestablishedOnline in-trainingassessments start2011Linda Sorrell appointedANZCA CEOOnline Clinical TeacherCourse piloted1992-20122012 (to March)Lindy Roberts announcedPresident-elect, ANZCABrendan Moore announcedDean-elect, Faculty of PainMedicineNumber of Fellows – 5300and 2000 traineesANZCA Curriculum Revision2013 learning outcomesapproved21The first honorary secretary’s reportof the WA State Committee includedthe following:“In a country the size of ours it isimpossible for the Board of Facultyto maintain satisfactory contact withFellows and Members in the variousstates of the Commonwealth and theDominion of New Zealand. The Boardtherefore exercised the powers given toit under additional Regulations (1955)and appointed State and DominionCommittees whose functions are tocarry out duties delegated by theBoard, to convene at least one scientificmeeting each year and to advise theBoard of any matters which may concernthe interests of the Faculty.“In July last year the Board appointedDrs G.R. Troup, Douglas Wilson andL.G.B. Cumpston to constitute theWestern Australian State Committee. On8th September 1955 this committee heldits first meeting at which Dr Troup wasappointed Chairman and Dr CumpstonHonorary Secretary. The committee hasmet on five subsequent occasions.” 2The inaugural meeting lasted 30minutes and took place at Dr Troup’srooms in Yorkshire House, 194 StGeorges Terrace, Perth. The first matterdiscussed was the Faculty scientificmeeting. Were these meetings to beexclusively for Fellows and members,or did the committee have the rightto invite the profession at large? Thecommittee was keen to involve Fellowsof the Faculty of Anaesthetists of theRoyal College of Surgeons in Englandand sought advice from the board as towhether these professionals would firstseek membership of the AustralasianFaculty or would be entitled tofellowship outright.With only nine members andFellows in WA there was insufficienttime and resources to organise ascientific meeting during 1955 and itwas suggested at the second committeemeeting in October that March or April1956 would be regarded as the earliestpossible date. In fact the committeedid not meet again until March 1,1956, and at this time planning for thescientific meeting began in earnest.It was decided to hold the meeting onan evening in June at approximatelythe same time as the College (RoyalAustralasian College of Surgeons –RACS) scientific meeting. The meetingwas to take the form of a symposiumentitled “Controlled respiration inanaesthesia and in medical conditionswith respiratory embarrassmentor paralysis” and anticipatedthe presentation of papers by ananaesthetist, a physiologist, a physicianand a surgeon. Three more meetingsof the WA committee were held beforethe annual scientific meeting on June 7,1956.The Faculty symposium commencedat 8pm and was now titled “Themanagement of respiratory paralysis inanaesthesia and disease”. The meetingopened with a short address by Dr LSouef, chair of the State Committee ofRACS. Dr Douglas Wilson presentedthe subject from the anaesthetic aspectand Dr Beech, also a foundation Fellowof the Faculty of Anaesthetists, RACS,from the medical angle. Discussion wasopened by Dr Thorburn (by invitation),from the physician’s point of view, andDr Peter Gibson discussed the thoracicsurgical approach. The meeting closedat 10.30pm.The honorary secretary’s reportof June 9, 1956, concluded with thefollowing: “College Meeting – Perth –1958. It is anticipated that the AnnualMeeting of the College will take placehere in 1958. This will undoubtedlyinclude the Faculty and will be afunction of great importance to us all.”Gilbert Troup was one of the outstandingfigures in anaesthesia practice inAustralia. He led a rich career inmedicine prior to his work during theearly 1950s in helping to establish theFaculty of Anaesthetists, RACS. 3Born in Christchurch, New Zealandin 1896, he was educated in Melbourneand graduated in medicine from theUniversity of Melbourne in 1922. Hesettled in Perth in the same year,working first at the Children’s Hospitaland then at the Perth Hospital, becominga junior honorary physician in 1924while maintaining a private practicein Subiaco.A long and distinguished career inanaesthesia began when Dr Troup wasappointed honorary anaesthetist to thePerth Hospital in 1927. He followed inthe footsteps of William Nelson (whoserved from 1918 to 1926) and BruceBurnside (served 1918 to 1923), whowere the first honorary anaesthetistsappointed to the hospital.Dr Troup was a member of theFaculty’s WA Committee from 1955 until1959, serving twice as chair, from 1955 toOctober 1956, and from November 1957until June 1959. He died in August 1962.Dr D R C Wilson(ASA) Executive Committee stateD R C “Bunny” Wilson was perhaps best representative for WA from 1947 to 1951.known for his contribution to paediatric Dr Wilson died in January 1970.and neonatal anaesthesia, particularlyDr Ernest Beechhis pioneering work in WA. 4Ernest Beech was born in AdelaideBorn in 1906 in Perth, he graduatedin 1908 and studied medicine at theMBBS at Melbourne University in 1931.University of Adelaide, gaining hisAfter a year as a resident medical officerMBBS there in 1932. He relocated toat Perth Hospital he entered generalWestern Australia in 1933 to becomepractice in Dowerin, which continueda resident medical officer at Perthuntil 1939. He served with distinction inHospital. Dr Beech was appointedWorld War II and was awarded an MBE,medical registrar in 1934. He then spentMilitary Division, for his service in Syriatwo years in postgraduate studies inin 1941.England at the Royal Chest HospitalDr Donald Stewart wrote in 2010and the Queen’s Square Hospital.that it was Gilbert Troup who nurturedDr Beech obtained his MRCP inBunny Wilson’s interest in anaesthesia1936 and, on his return to Perth,after the period of hostilities ended,was appointed honorary outpatientand he soon became the first full-timephysician and honorary anaesthetistanaesthetist in Western Australia,to the Perth Hospital in 1938. Hewith posts at Royal Perth Hospital,maintained this dual role until 1950, andHollywood Repatriation Hospital andwas also in general practice until 1946.Princess Margaret Hospital, where heDr Beech also served as anaesthetistwas director of anaesthesia from 1945to the neurosurgery unit at Perthuntil 1956. 5Hospital. He contributed to postgraduateDr Wilson served on the WAeducation in Western Australia as theCommittee of the Faculty ofsecretary of the ASA PostgraduateAnaesthestists, RACS, from 1955 to 1966.Committee for two years. 6He was chair twice, from November1956 to September 1957 and from June1960 to August 1961. He also served Above from left: Dr Gilbert Troup,as Australian Society of Anaesthetists Dr D R C Wilson, Dr Ernest Beech.70 ANZCA Bulletin December 2011ANZCA Bulletin December 2011 71Letters to the editorRich history ofanaesthesiadepicted“ The Duke of Norfolkas Earl Marshall of HerMajesty’s College of Armsauthorised the armorialbearings on December 1,1992.”Corporate logo – “the Triangles”“ Vesalius also was the firstto show that an animal...could be resuscitated byusing artificial respirationthrough a reed insertedinto the windpipe.”“ The motto reads Corpuscurare spiritumque whichtranslates as “To care forthe body and its breathof life”.”ANZCACELEBRATING20YEARSWestern Australia’s foundation Fellowsand the establishment of the WesternAustralian State CommitteeThe first annual businessmeeting of the WesternAustralian State Committeetook place at the BritishMedical Associationcouncil room on June 9,1956. Members of thecommittee could reviewthe achievements of thepast year with satisfaction.At this time the committeecomprised two foundationFellows of the Facultyof Anaesthetists, DrsGilbert Troup and D R C(Bunny) Wilson, and Dr LG B (Graham) Cumpston,a foundation member ofthe Faculty who had beenelevated to fellowship inJanuary 1956. 1Heading SampleThe men who made it happenDr Gilbert TroupCelebrating our Coat of ArmsIt is no exaggeration to say I was thrilledto see Professor Baker’s exposition of theCollege Coat of Arms (ANZCA Bulletin,March 2012). Every feature rich with historyand significance; their appearance, colour,position, shape, size, all telling the story ofthe College and our traditions of anaesthesiaand intensive care in a spectacularsymphony of colour and images. As thelogo for a learned college I believe our Coatof Arms stands head and shoulders aboveevery other Australian and Australasianprofessional college and is something ofwhich every Fellow can be proud.I turn to the article about the triangles.What contrived symbolism that is. Thetriangles have no soul and the many FellowsI have spoken to appear to have a similarview and are baffled by the supposedsymbolism of the triangles.Can I appeal to the new Council to reviewthe decision to adopt the triangle logo? Letus make the most of what we have, our trulymagnificent and inspiring Coat of Arms.Let us use the coloured version at everyopportunity. Trainees should be made awareof its nature and design so they can drawinspiration from it.Let us proudly display our inspirationalArms whenever and wherever possible.Dr John Paull MB BS, Dip Ed, FANZCAConsultant Anaesthetist (Retired)Honorary Research AssociateSchool of History and Classics,University of Tasmania,Launceston, Tasmania.Why does the College need two logos?I was intrigued to read the descriptionsof the armorial bearings or “crest”, andthe corporate logo, “the triangles”, in theMarch 2012 ANZCA Bulletin. Barry Baker’sexemplary article should be compulsoryreading for all current and aspiring Fellowsof the College.The description of the logo, however,leaves a number of questions unanswered.That the logo design is “abstract and opento wide interpretation” reminded me ofan occasion when I met with a senior staffmember at Melbourne University. Withoutprompting, she commented on a Collegebusiness card that depicted the corporatelogo, saying that it appeared to representan organisation that was unsure ofits direction!Why did the ANZCA Council feel theneed to commission a new logo in 2008 inaddition to one that was widely recognisedand had been developed through a rigorousand well established process? Contemporaryvalues are not obtained through theacquisition of a pretty design; they areobtained by action and achievements,thereby bestowing integrity on the nameand reputation of the organisation.We now have the confusion of twologos. The original armorial bearings, withso much embodied meaning, has beendeliberately downgraded by the impositionof an abstract design of uncertainfoundation.The “rich burgundy colour” of thecorporate logo supposedly denotes “quality,authority and a link to the traditions of thepast”. I find it difficult to ascribe such arange of attributes to a colour, more so asthe logo appears in a range of colours in thesame issue of the Bulletin.Other Australian and New Zealandmedical colleges use a single crest or shield,and display it proudly. It is timefor the council to reconsider the meritsof having two logos.Dr Rod Westhorpe OAM, FRCA, FANZCAHonorary Curator, Geoffrey Kaye Museum ofAnaesthetic HistoryPerth Hospital recordsThanks to Fraser Faithfull and ProfessorGarry Phillips for the article on the earlydays of the Faculty of Anaesthetistsin Western Australia (ANZCA Bulletin,December 2011).For the sake of the historical record I offersome minor corrections. The records of thePerth Hospital contradict the statement in theBulletin that Dr B Burnside and Dr WH Nelsonwere the first honorary anaesthetists appointedto the hospital, commencing in 1918.Although the record is incomplete,the minutes of the Perth Hospital Board 1as early as 1906 record the nominationof a Dr Thurston to the post of honoraryanaesthetist. In 1924 Gilbert Troup wasappointed as an honorary assistantphysician (not junior physician) to the PerthHospital, and he was first appointed as anhonorary anaesthetist in 1930 (not 1927) 2 .It is not clear when Dr Troup firstworked at the Perth Children’s Hospital;his own “personal information” held by theAustralian Society of Anaesthetists givesthe date as 1922 (the year of his graduationfrom Melbourne University), but accordingto the records of the hospital, his initialappointment there was in 1924 3 .Dr Toby NicholsDepartment of AnaesthesiaRoyal Perth HospitalReferences:1. Minutes of board meetings of the Perth Hospital(held by Royal Perth Hospital Museum).2. Annual reports of the Perth Hospital (held by RoyalPerth Hospital Medical Library).3. Jeanette Robertson, archives facilitator, PrincessMargaret Hospital (personal communication).8 ANZCA Bulletin June 2012

Cathay Pacific use Medlink, which isa 24-hour service based at the TraumaCentre of Banner Hospital, Phoenix inArizona, US. The doctors on board areto follow the instruction of the groundmedical support and to communicatepatient information to them. Thedecision for diversion ultimately restswith the captain of the aircraft in liaisonthe leader of the medical response team.A decision for flight diversion was madein both scenarios.mber 2011“ In-flight medical emergenciesare relatively common occurringat approximately one per 10,000– 40,000 passengers.”procedures together with memoryitems in an emergency. We discussedhow we can adapt these principlesto anaesthesia.We received many encouragingcomments on the way back in thecoach. I heard a number of times thatthis was the highlight of the CSM forsome participants. This workshop wasthe result of collaboration with CathayPacific and they generously providedtheir simulation facilities, aviationmedical specialists, flight instructorsand flight attendant trainers. They alsolearned a great deal from the encounter.Dr Tim Brake, FANZCAAbove from left: Dr Phillipa Hore and DrUnited Christian Hospital, Hong KongMichelle Mulligan in the cockpit; the flightsimulator controls; the Flight Training CenterDr Tim Brake was the “Is there a doctor at Cathay Pacific, Hong Kong; anaesthetistson board?” workshop co-ordinator at taking part in the in-flight medical emergencythe 2011 Hong Kong Combined Scientific simulation workshop.Meeting.ANZCA Bulletin September 2011 41A funny thing happened onthe way back from the HongKong Combined ScientificMeeting (CSM).On one flight, an asthmaticinadvertently took somepeanut snacks and developedanaphylactic shock. Hissister was frantic and calledfor the flight attendant. Theflight attendant responded,informed the cockpit and“ In-flight medical emergenciestheir ground medical supportare relatively common occurringwhile putting out a call onat approximately one per 10,000the intercom: “Is there a– 40,000 passengers.”doctor on board?”Fortunately there were six anaesthetistsIt is likely that doctors who travel Table 1. Example of aviationOne of the main issues raised inDuring debriefing, the leader of the Referencesreturning from the CSM, and theregularly will receive a call for helppatient responded to treatment that wasemergency medical kitthe debriefing is who had authority medical response team disagreed with 1. Cocks R., Liew M. Commercial aviationduring their careers. In-flight medicalin the emergency. According to the the decision for diversion but was notavailable in the emergency medical kit.in-flight emergencies and the physician.involved in the decision. One of theEmergency Medicine Australasia (2007)Soon after, on another flight a young emergencies are relatively common Kit Specification – European JointCathay Pacific protocols, the cabinobservers was involved in another19, 1–8man had a grand mal convulsion,occurring at approximately one per Aviation Authoritiescrew retains control and will run theground support medical service and 2. Gardelof B. Inflight medical emergencies.10,000 -40,000 passengers, with oneanother group of anaesthetists(JAA) Regulation: JAR-OPS 1.755emergency within their abilities. CabinAmerican and European viewpointsdeath per 3-5 million passengers andcrew personnel are trained in first aid, noted that there may be communicationissues during an emergency.on the duties of health care personnel.responded to the call “Is there a doctor– Emergency Medical Kitcardiopulmonary resuscitation and theuse of the AED. They will be guidedThe cockpit simulations showed howLakartidningen 2002; 99 (37): 3596–9.on board?” Meanwhile, in the cockpitmedically related diversion of aircraft Contents:in 7-13 per cent of cases 1 . There will be a3. DeJohn C, Veronneau S, Wolbrink A,things were not much better with takeoffaborted due to windshear and themedical support.before and after takeoff and landing, of in-flight medical care aboard selectedby the medical advice of their ground the aviation industry uses checklistsmedical person on board in 83 per cent - SphygmomanometerLarcher J, Smith D, Garrett JS. Evaluationof flights 2 . The most common diagnose - Syringes and needles“fire engine one” alarm occurringCathay Pacific use Medlink, which is and the use of standard operatingUS air carriers. Cabin Crew Safety 2000;are vasovagal syncope (22.4 per cent),four times.- Oropharyngeal airways (two sizes)a 24-hour service based at the Trauma procedures together with memory35 (2): 1–19.cardiac (19.5 per cent) and neurologicalThese scenarios took place at- TourniquetCentre of Banner Hospital, Phoenix in items in an emergency. We discussed(11.8%) 3 .the Flight Training Center at CathayResuscitating a patient in the- Disposable glovesArizona, US. The doctors on board are how we can adapt these principlesPacific in Hong Kong as an offsiteto follow the instruction of the ground to anaesthesia.workshop of the CSM. We ran in-flight confined space of an economy seat- Needle disposal boxmedical support and to communicate We received many encouragingmedical emergency simulations for 24may be difficult. The seats will not lie - Urinary catheterpatient information to them. Thecomments on the way back in theflat and there will be other passengersdecision for diversion ultimately rests coach. I heard a number of times thatparticipants to familiarise them with- A list of contents in at least twothe emergency medical equipment crowded around who may need thewith the captain of the aircraft in liaison this was the highlight of the CSM forlanguages (English and one other)available on board, to appreciate theflight attendant. In this scenario thewith the flight control. This surprised a some participants. This workshop wasmannequin was moved from theDrugs: Adrenocortical steroid,number of the anaesthetists on board the result of collaboration with Cathayunfamiliar and confined environmenteconomy seat to the galley area. We antiemetic, antihistamine,who assumed they had autonomy in Pacific and they generously providedand to understand the airline protocolshad been briefed on the contents of antispasmodic, atropine, bronchialin medical emergencies.decision-making for patients under their simulation facilities, aviationthe emergency medical kit by Cathay dilator (inhalation and injectabletheir care. However, the cabin crew medical specialists, flight instructorsWe used a mockup of the BoeingPacific’s aviation chief medical officer forms), coronary vasodilator, digoxin,withheld the medical responders from and flight attendant trainers. They also777 cabin, a Sim-man 3G high fidelitybut it was still difficult in the emergency diuretic, adrenaline (epinephrine)administering medications until it was learned a great deal from the encounter.mannequin, actors and a team of flightto find the correct drugs and equipment. 1:1000, major analgesic, medicationapproved by Medlink.attendant trainers to set up the scenarioAn oxygen cylinder was used and for hypoglycaemia, sedative/Communication with MedlinkDr Tim Brake, FANZCAfor in-flight medical emergencies.the automated external defibrillator anticonvulsant, uterine contractant.is by satellite phone, which may beinterrupted. We noted during bothUnited Christian Hospital, Hong Kong Above from left: Dr Phillipa Hore and DrCockpit simulation was done with a flatMichelle Mulligan in the cockpit; the flight(AED) was available but not used. Thesimulator controls; the Flight Training Centerscreen simulator with flight instructorscontents of emergency medical kitsscenarios that the participant whoNote that there is no requirement for anDr Tim Brake was the “Is there a doctor at Cathay Pacific, Hong Kong; anaesthetistsfrom Cathay Pacific.may vary between airlines but is being IV kit, although some carriers includingcommunicated with Medlink was notthe leader of the medical response team.on board?” workshop co-ordinator at taking part in the in-flight medical emergencystandardised in the aviation industry. Qantas will have IV fluid. There isA decision for flight diversion was madethe 2011 Hong Kong Combined Scientific simulation workshop.Meeting.Table 1 gives an example.no intubation equipment althoughin both scenarios.a laryngeal mask may be included.40 ANZCA Bulletin September 2011ANZCA Bulletin September 2011 41AwardstotorOne of the main issues raised inthe debriefing is who had authorityin the emergency. According to theCathay Pacific protocols, the cabincrew retains control and will run theemergency within their abilities. Cabincrew personnel are trained in first aid,cardiopulmonary resuscitation and theuse of the AED. They will be guidedby the medical advice of their groundmedical support.with the flight control. This surprised anumber of the anaesthetists on boardwho assumed they had autonomy indecision-making for patients undertheir care. However, the cabin crewwithheld the medical responders fromadministering medications until it wasapproved by Medlink.Communication with Medlinkis by satellite phone, which may beinterrupted. We noted during bothscenarios that the participant whocommunicated with Medlink was notDuring debriefing, the leader of themedical response team disagreed withthe decision for diversion but was notinvolved in the decision. One of theobservers was involved in anotherground support medical service andnoted that there may be communicationissues during an emergency.The cockpit simulations showed howthe aviation industry uses checklistsbefore and after takeoff and landing,and the use of standard operatingReferences1. Cocks R., Liew M. Commercial aviationin-flight emergencies and the physician.Emergency Medicine Australasia (2007)19, 1–82. Gardelof B. Inflight medical emergencies.American and European viewpointson the duties of health care personnel.Lakartidningen 2002; 99 (37): 3596–9.3. DeJohn C, Veronneau S, Wolbrink A,Larcher J, Smith D, Garrett JS. Evaluationof in-flight medical care aboard selectedUS air carriers. Cabin Crew Safety 2000;35 (2): 1–19.on board?on in-flighttraining at theprompts me to relayened only a monthat happens in theflight from Fiji,thalmic surgicalere was a calls system of theoctor. The fourd been working withed at me and firmlymade myself knownwas ushered to thee a man was lyingry narrow corridoro rear toilets.n from his wifeman in his mid-50sidities including, liver cancer and ad been on holidaywell for the past fewinal pain, nauseabeen unable to keepn.ifficult but he wasHe looked pale,ulse and his systolicpation, (there was nom.Hg. I concludedas a result ofry to dehydration.dical kit wasgh somewhat oldlitre of Hartmann’sset.Letters to the editorI managed to cannulate a vein, althoughthere was no tape available and we hadto secure it with Band-Aids. His conditionimproved somewhat with the fluid andwhen the captain called to ask if he neededto divert the plane I informed him thatthis would not be necessary. However, Irequested that an ambulance be ready atthe arrival of the plane and that a stretcherbe waiting as soon as we disembarked as Iconsidered that he needed urgent hospitalcare. I was assured that this wouldbe done.On arrival in Sydney all the passengers Re: NZ anaesthetic technicians canwere let off before us but when I got to now register as health professionalsthe door I found that there was neither (September 2011)stretcher nor any thought of one. Finally I was delighted to read the article byan airport employee arrived with aSusan Ewart, describing the “11-yearwheelchair and all we could do wasprocess” that has resulted in anaestheticbundle the patient into this. No one in technicians in New Zealand nowsight was aware of a medical emergency, Editor’s being note able to register under the Healthnor seemed to care much. We wheeled In the December Practitioners Competence edition of Assurance the ANZCAthe patient to passport control where Act. I congratulate all those involved inBulletin, weachieving a quote this in important a letter professional submitted bydid get some priority in the queue butthen had to wait for bags to be collected Associate goal Professor for our operating Michael room colleagues. Davis onbefore he was finally wheeled out to New Zealand Throughout my anaesthetic technicians career, I wasthe concourse where I expected thevalued highly the support of the manyinadvertently fine men and left women out. This who have is the worked letter,ambulance to be waiting. No one knewanything about it and the patient, his republished alongside in me full in this with capacity. the missing,wife and myself were dumped rather slightly abridged, However, the quote process included.of developingunceremoniously in the cold and draughty the professional role of anaestheticarrivals hall. I inquired about the medical technicians to where it is today is, in fact,NZ anaesthetic much longer than technicianscentre at the airport but it was midday on athe 11 years since theSaturday and it was closed. I was delighted NZ Anaesthetics to read Technicians the article Society by SusanFinally, in desperation, I phoned 000 Ewart, expressed describing “their the wish “11-year to be covered process” by thatand spoke to the NSW ambulance who this legislation”. The first anaesthetichas said resulted in anaesthetic technicians inno call or arrangement had been made. technicians training course in NewNew Zealand was now developed being by able myself to in registerNonetheless they sent an ambulance andthree quarters of an hour later the patient 1978, 33 years ago, soon after I arrivedwas finally on his way to hospital.in Christchurch as a full-time specialistAviation is often held up to wefor the then North Canterbury Hospitalanaesthetists as model of practice but Board. In order to complete the earlyin this instance a serious breakdown Is there history a doctor of technician training in NZ, it isof communication between the air and on board? worth quoting from a 1990 Departmentthe ground led to sub-optimal care ofthis patient.Dr Terry ClarkeDirector, Department of Anaestheticsand Pain ManagementNepean Hospital, Penrith, NSWunder the Health Practitioners CompetenceAssurance Act. I congratulate all thoseinvolved in achieving this importantprofessional goal for our operating roomcolleagues. Throughout my anaestheticcareer, I valued highly the support of themany fine men and women who haveworked alongside me in this capacity.However, the process of developingthe professional role of anaesthetictechnicians to where it is today is, in fact,much longer than the 11 years since theNZ Anaesthetics Technicians Societyexpressed “their wish to be covered bythis legislation”. I developed the firstanaesthetic technicians training course inNew Zealand in 1978, 33 years ago, soonafter I arrived in Christchurch as a full-timespecialist for the then North CanterburyHospital Board. In order to complete theearly history of technician training in NZ,it is worth quoting from a 1990 Departmentof Anaesthesia internal publication thatcovered the history of anaesthesia inChristchurch from 1974 to 1990. 1“In the late 1970s...a nationaltraining committee was formed under theauspices of the Department of Health, on“Oh, you can’t; they’re the men whobring the stairs to the plane,” was the reply.In-cabin phone communicationwhich Doug Chisholm [Medical Director,Anaesthesia Services, CAHB] was invitedto sit. Anticipating the establishmentof proper training programmes, a pilotcourse was commenced...in Christchurchmodelled on the anaesthetic and basicsciences components of the UK OperatingDepartment Assistants training programme.This Christchurch course became the basisfor the development of the NZ programme.[Dr] Jim Clayton from Dunedin was the firstexaminer.”As far as I know, at least two of thoseoriginal five graduates were still workingas anaesthetic technicians in Christchurchuntil recently.Associate Professor (retired)Michael Davis, MB, BChir, MA (Cantab.),FRCA(Eng.), FANZCA, MD(Otago),DipDHM, CertDHM(ANZCA)Reference:1. Davis FM, editor. Department of Anaesthesia1974–1990. The changing face of anaesthesiain the public health system. Christchurch:Canterbury Area Health Board; 1990.to Launceston and thence to on-airfieldLaunceston Airport Fire Response.After what seemed like 24 hours, the fireof Anaesthesia internal publication thatcovered history of anaesthesia into the front of the plane achieved two truck arrived and Deo Gratias, along withChristchurch from 1974 to 1990.Anaesthetic technicians in New Zealand1important objectives: the pilot requested the senior medical emergencies instructorAs far as I know, at least two of thosestairs urgently and the senior cabin crew for Tasmania, and oxygen.original five graduates were still workingas anaesthetic technicians in Christchurch announced my imminent urgent egress.[When he offered to take over holdinguntil very recently.I now know how a sheep dog feels as it the face mask I said something like, “Sure,runs along the backs of a flock of sheep all I’ve been practising for about 35 years if youFor Associate Professor sake (retired) Michael of accuracy, trying to flee the barking dog! I wish could just to help with expandthe other bits.” He wasDavis, MB, BChir, MA (Cantab.),FRCA(Eng.), FANZCA, MD(Otago),I was off the plane as soon as the stairs so calm, “Okay”, and proceeded with theRe: “Is DipDHM, there a CertDHM(ANZCA)doctor on board?”hit the fuselage, to find the gent had been other bits.](ANZCA Christchurch Bulletin, September 2011), and the rolled into an unconscious-patient position. Meanwhile, the patient was respondingon subsequent what letter from Dr Dr Clarke (ANZCA MichaelTo my seriousDavisconsternation, hehasandwrittenI could hear Ambulance TasmaniaReferenceBulletin, 1. Davis December FM, editor. 2011) Department prompts of Anaesthesia me to exhibited no response, deepest cyanosis wailing up the highway. Never was I so gladrelate an 1974–1990. account The of changing my own. face of anaesthesia and no palpable pulses. My silent private to greet ETT, and skilled paramedics.in the public health system. Christchurch:aboutI was seated atearlythe window in theanaestheticendCanterbury Area Health Board; 1990.response could be summed up technicianin one word. A young plastics surgeon kept shakingrow on board an A330-220, which hadWith an earnest request for formal help my hand with congratulatory exuberancejust nosed into park on the tarmac into the man in the yellow jacket with the and a local ED RMO was delegated to briefLaunceston.secret service device in his ear, I proceeded them.training Looking out the window, in I notice New three with Zealand expired air mouth-to-mouth (ANZCA and aThe next day Bulletin,the intensive caremen in yellow and, as I watch, one of them thump that should have woken something. unit [as a retrievalist/hanger on in ICU]gracefully slides from walking to prone-onconcreteposition.assuming that they would arrive with “K…. I’ve kissed you once and I’m not doing“Get the fire-ies” was my catch cry, I expressed to the gentleman patient,March Oddly, my first thought 2012). was, “Must be Efforts to instituteit again …formalflashing lights and oxygen, at least.Give up the fags!”difficult for that person working aroundAs I learned at an informal debriefing, Lesson: Smash the closest fire alarmaircraft with epilepsy …”the man with the secret service device in for oxygen-to-go at airport!trainingAs I watched, he did notbeganmove from the his in ear could communicate 1960s with only the and beganassumed prone-on-concrete position as his pilot of the aircraft to which his device was Dr George Waters FFARCStwo comrades rallied. The more I watched attached. [I thought that he could talk to Acting Director, Anaestheticsthe less he moved.the world].and Intensive Careat Christchurch I indicated to the cabin crew that I Hospital Nevertheless that instigated a chain andMountGreenIsa, Queenslandwished to offer assistance.of communication from him to aircraftcockpit to Melbourne, to Hobart finallyLane Hospital, Auckland, April 1977.Submitting lettersWe encourage the submission of letters to the editor of ANZCA Bulletin. They should be sent to communication@anzca.edu.au.Letters should be no more than 300 words and may be edited for clarity and length.The first examination for the Certificate10 ANZCA Bulletin March 2012 ANZCA CELEBRATING 20 YEARS 1992-2012of Proficiency was held in March 1979.Six candidates presented, four fromChristchurch and two from Auckland.All passed. Training extended to othercentres after that.Dr Basil Hutchinson, FANZCA, Auckland(Former chair, Anaesthetic Technicians’Board, NZ)Submitting lettersWe encourage the submission of lettersto the editor of ANZCA Bulletin. Theyshould be sent to communications@anzca.edu.au. Letters should be nomore than 300 words and may beedited for clarity and length.Dudley Buxton Medalof the Royal Collegeof AnaesthetistsProfessor Teik Oh has been awardedthe Dudley Buxton Medal of the RoyalCollege of Anaesthetists in recognitionof his estimable services to the specialty.The medal was established in 1967 toprovide an annual award of a prize formeritorious work in anaesthesia or in ascience contributing to the progress ofanaesthesia.Australia Day HonoursDr Andrew Kenneth Bacon has beenawarded the Ambulance Service Medal(ASM), Victorian Ambulance Service, inthe 2012 Australia Day Honours List.Australian Queen’sBirthday HonoursAssociate Professor Malcolm Wrighthas been appointed a Member of theOrder of Australia in the General Division,for service to intensive care medicine, asa clinician, teacher and administrator,and through advanced medical trainingprograms in developing countries.Dr David Henry McConnel has beenawarded the Medal of the Order ofAustralia in the General Division, forservice to medicine, particularly as ananaesthetist, through a range of executiveand professional roles.Dr Drew James Wenck has been awardedthe Medal of the Order of Australia in theGeneral Division, for service to intensivecare medicine through advisory roles,and to the community.New Zealand Queen’sBirthday HonoursSir Roderick Deane has been made aKnight Companion of the New ZealandOrder of Merit (KNZM) for his contributionto business and policymaking, and forsupporting the arts and disability sectorfor more than 30 years. Sir Roderick is onthe board of ANZCA’s Anaesthesia andPain Medicine Foundation.Dr James Judson, FANZCA, FCICM,received an MNZM (Member of the NewZealand Order of Merit) for services tointensive care medicine. Dr Judsonworks as an intensive care specialistat Auckland City Hospital’s IntensiveCare Unit.Would you like a2013 ANZCA Diary?If you did not receive an ANZCAdiary last year and would like a2013 ANZCA Diary, please emailcommunications@anzca.edu.auwith your name and ANZCAID number.PLEASE NOTE: If you received a2012 ANZCA Diary last year, you willautomatically receive a 2013 diary.9

Heading SampleThe Dr Ray HaderTrainee Award forCompassionNominations are sought from ANZCAtrainees and Fellows within threeyears of fellowship by examinationfor the Dr Ray Hader Trainee Awardfor Compassion. The deadline fornominations is October 11, 2012.Dr Ray Hader was an ANZCA trainee who grewup and lived in Victoria. He died in 1998 of anaccidental drug overdose after a long strugglewith drug addiction. To mark the 10-yearanniversary of his death, a friend, Dr BrandonCarp, established an award that promotesa compassionate approach to the welfareof anaesthetists, their colleagues, patientsand the community.Details of the AwardEligibilityAt the deadline for submissions, the nomineewill be an accredited ANZCA trainee resident inany ANZCA training region or an ANZCA Fellowwithin three years of admission to fellowshipby examination.The nominee will have made a significantcontribution to the welfare of an individual,a group or a system that promotes welfare andcompassion. The individual, group or systemwill be preferentially related to anaesthesia,but may alternatively be related to othercolleagues, patients or the community(locally or internationally).NominationNominees will be nominated and secondedby accredited ANZCA trainees resident in anyANZCA training region or ANZCA Fellowswithin three years of admission to fellowshipby examination.The nominator will describe in 1000 words orless how the candidate has made a significantcontribution. The description will beaccompanied by a covering letter signed bythe nominator and seconder.DeadlineNominations must be received by ANZCA ChiefExecutive Officer Linda Sorrell by 5pm onOctober 11, 2012.PrizeThe winner will receive $A2000 to be usedfor training or educational purposes, anda certificate.If you are concerned about yourselfor a colleague contactThe Doctors’ HealthAdvisory ServiceHotlinenearest to youAustralia:New South Wales/Northern Territory+61 2 9437 6552Australian Capital Territory +61 407 265 414Queensland +61 7 3833 4352Victoria +61 3 9495 6011Western Australia +61 8 9321 3098Tasmania 1300 853 338South Australia +61 8 8273 4111New Zealand: 0800 471 2654Professional documents – updateThe professional documents of ANZCAand the Faculty of Pain Medicine arean important resource for promotingthe quality and safety of patient carefor those undergoing anaesthesia forsurgical and other procedures, andfor patients with pain. They define therequirements for training and for hospitalsproviding such training, provide guidanceto trainees and Fellows on standards ofanaesthetic and pain medicine practice,define policies, and serve other purposesthat the College deems appropriate.Professional documents are also referredto by government and other bodies,particularly with regard to accreditationof healthcare facilities.Professional documents are subjectto regular review and are amended inaccordance with changes in knowledge,practice and technology.PS31 Guidelines on CheckingAnaesthesia Delivery Systems and PS37Guidelines for Health PractitionersAdministering Local Anaesthesia havebeen revised.These documents and newly developedbackground papers are now being piloted.Queries or feedback regardingprofessional documents can be directedto profdocs@anzca.edu.au.The complete range of ANZCAprofessional documentsis available via the ANZCA website,www.anzca.edu.au.Faculty of Pain Medicine professionaldocuments can be accessed via theFPM website, www.fpm.anzca.edu.au.10 ANZCA Bulletin June 2012

NewsNew College office-bearersDr Genevieve Goulding has beenappointed ANZCA Vice-President andProfessor Ted Shipton has been appointedFPM Vice-Dean. Dr Goulding has beenChair of the Education and TrainingCommittee since 2010. She is a deputydirector in quality and safety for thedepartment of anaesthesia at the RoyalBrisbane and Women’s Hospital. Heranaesthesia interests include obstetricanaesthesia, medical education, welfareissues and patient safety. ProfessorShipton is Chair of the FPM Trainee AffairsPortfolio and Education Committee. He isClinical Director of the Pain ManagementCentre at the Canterbury District HealthBoard in Christchurch and AcademicChair of the Department of Anaesthesia,Christchurch School of Medicine at theUniversity of Otago.ANZCA accreditationANZCA representatives met theAustralian Medical Council (AMC)Assessment Committee in Melbourneon June 1 for a preliminary meetingto clarify key issues arising from boththe ANZCA and FPM submissions foraccreditation with the AMC and MedicalCouncil of New Zealand. The assessmentcommittee were satisfied with theoverall quality of the documentationand discussion centred on theimplementation of the revised curriculum,among other issues. The assessment isscheduled to begin on October 8 withsite visits to representative hospitalsacross the two countries followed bymeetings at ANZCA House during theweek beginning October 15.Overseas aid traineescholarshipDr Steven Smith, from the MaterMothers Hospital in Brisbane, has beenawarded the 2012 ANZCA Overseas AidTrainee Scholarship. Dr Smith will travelto the Vila Central Hospital in Vanuatu inAugust and September to help provideclinical anaesthesia services while localanaesthetists attend the Pacific Societyof Anaesthetists Conference. He also willhelp teach junior healthcare providersabout obstetric anaesthesia and theinvestigation of obstetric anaesthesiareferral of high-risk patients and auditprocesses. For more information aboutthe work of the Overseas Aid Committee,see page 28.An introductionto anaesthesiaNew Zealand ANZCA Fellow Dr AidanO’Donnell has written a book calledAnaesthesia: A Very Short Introduction.The book is a short introduction toanaesthesia for the lay reader and isexpected to be valuable for new-starttrainees, medical students, nurses,technicians, midwives and the generalpublic. It covers the whole spectrumof modern anaesthetic practice,including general and local anesthesia,anaesthesia for childbirth and intensivecare, as well as equipment and agents.It also provides a detailed breakdownof anaesthetic risks, side effects andcomplications. It is published by OxfordUniversity Press. More information canbe found at: http://ukcatalogue.oup.com.Vic Callanan awardThe inaugural Townsville Hospital VicCallanan Award, named after one of thepioneers of anaesthetics in Australia,has been awarded to resident medicalofficer Dr Ben Shepherd for his skillsin resuscitation. Dr Callinan steppeddown last year as the hospital’s directorof anaesthetics after 36 years in therole. The award is presented to thehospital’s best performer in simulatedresuscitation. The award was reported inthe local newspaper, the Townsville Sun.Australasian Anaesthesia(the Blue Book)The 2011 edition of the AustralasianAnaesthesia publication, more commonlyknown as the Blue Book, is now availableto download via the ANZCA website in anelectronic flipbook format. The flipbookformat enables downloading of the BlueBook direct to PC, laptop, smartphoneand tablet. The flipbook featuresnavigation and search functions to helpfind topics of interest faster, and includeszoom and full-screen modes for easeof reading.For Fellows and trainees who prefera hard copy of the publication, pleaseemail the ANZCA Continuing ProfessionalDevelopment (CPD) team at cpd@anzca.edu.au, citing your ANZCA College IDnumber and full name, and a copy willbe sent to you. Any queries, pleasecontact the ANZCA CPD team oncpd@anzca.edu.au or + 61 3 9510 6299.Lifebox donationsFellows and trainees raised $46,142 atthe Perth annual scientific meeting forLifebox to provide developing countrieswith about 200 pulse oximeters. For$US250, Lifebox provides a robust pulseoximeter and educational material tohospitals in developing countries thatwill ensure safe anaesthesia and savethe lives of patients undergoing surgery.The first of the ANZCA-donated pulseoximeters will go to Papua New Guinea.For more information, see page 16.11

Perth ASMMore than 1500 Fellows and trainees attended the PerthAnnual Perth Annual Scientific Scientific Meeting Meeting May. in The May. scientific The scientific programincluded program included 13 plenary 13 sessions, plenary sessions, 195 concurrent 178 concurrent sessionpresentations, session presentations, 56 workshops, 47 workshops, 42 small 42 group small discussionsgroupand discussions 59 ePoster and presentations quality assurance and sessions, was complementedand 59 ePosterby presentations an excellent and social was program complemented and other by importantexcellentANZCA social program events, such and other as important College Ceremony. ANZCA events,such as the College Ceremony.wrap upPerth12 ANZCA Bulletin June 2012

Counting the many successesof the ANZCA ASMThe College has much to celebrate asthe curtain goes down on an innovativeand interesting annual scientific meetingin Perth.We have put our glad rags in to be drycleaned, filed away another conferencehandbook and reacquainted ourselveswith our children. Now there is a chance toreflect upon the product of so many hoursof planning; the days from May 12-16 duringwhich the ANZCA Annual Scientific Meeting2012 was held.We selected the theme “Evolution: Grow,Develop, Thrive” a little over two yearsago driven by the desire of the RegionalOrganising Committee to put together ameeting that had elements of old and new,in addition to practical aspects that wouldappeal to clinicians looking to develop andrefine their practice.Delegates were treated to the relaxing jazzytones of songstress Nicki Pelecanos as themeeting kicked off with welcome drinks inthe Riverview foyer of the Perth Conventionand Exhibition Centre overlooking theSwan River. The welcome drinks are alwaysa great way to reconnect with friends andcolleagues and this year was no exception.Beautiful blue skies greeted us on theopening day of the meeting, and wewere welcomed by a representativeof the Whadjuk Noongar people, MsIngrid Cumming, in a moving ceremonyacknowledging the traditional ownersof the land.The academic program blasted off withinteresting and thought-provoking plenarylectures delivered by the first female ASMVisitor, Professor Ruth Landau, and FPMVisitor Dr Daniel Bennett. They set the tonefor the excellent plenary sessions overensuing days. As the first session came toa close, a gasp of delight arose from the1500 delegates as the curtain at the back ofthe stage drew back to reveal a healthcareindustry exhibition, allowing access fordelegates over the stage into the pavilionwhere morning tea was served.Trainee delegates were joined by councillorsand members of the academic fraternityfrom ANZCA and the Faculty of PainMedicine at the Trainees’ Luncheon at theMetro bar and bistro. The casual, relaxedmood gave a perfect opportunity to mingle.Saturday night saw 177 new Fellowswelcomed into the specialties whilewatched by family and friends at the CollegeCeremony. Always a special occasion, the2012 ceremony will stand out in the mindsof those present as they recall the personaland touching oration delivered by Australia’sfirst indigenous surgeon, AssociateProfessor Kelvin Kong, who emphasised theimportance of kinship within our professionby recounting the stories of three influentialwomen in his life. The College CeremonyReception, which followed, was a fittingway to congratulate the graduands, andshowcased the exceptional food and winethat Western Australia has to offer.Sunday started bright and early with a runinto King’s Park for about 40 fit and eagerdelegates and heralded another sunny daychock full of concurrent sessions, workshopsand small group discussions, including thefinal day of the FPM program.Plenary sessions by Professor PatrickWouters exploring the wonders of the rightventricle and renowned pain expert andperioperative physician Professor HenrikKehlet on the troublesome transitionfrom acute to chronic pain set the scene.Internationally renowned communicationexperts, TRIAD, commenced a series ofsold-out workshops focusing on difficultconversations and negotiation, whichwere well received by the attendees.(continued next page)13

Several heavily pregnant friends andfamily members gave up part of theirMother’s Day to volunteer for the specialistechocardiography workshop by ProfessorAlicia Dennis, and Dr Alex Swann and hisgroup ran a successful difficult airwayworkshop with true to life road-traffictrauma scenarios.The healthcare industry was welcomedand thanked with a cocktail reception thatevening as we mingled among our 61exhibitors. We were entertained by localacoustic musicians 2fiveSoul as delegatessocialised and browsed the exhibition.The artworks displayed in the rear of thearea provided a pleasant diversion froman entertaining and informative exhibitionhall. Special thanks go to Philips and alldelegates for their patience as we awaitedthe untimely arrival of the USB keyscontaining the abstracts!The short academic program on Mondayincluded presentations by the Gilbert BrownPrize contenders and was followed by aplethora of choices for the delegates toexperience some of the local Perth culture.A round of golf, a swim with the dolphins,a ride around the river or a day at RottnestIsland were enjoyed by families andpartners.Our delegates were able to recoup, plan forthe next couple of days and enjoy some thelocal attractions during an afternoon andevening of unplanned time. This also gavesome of the Regional Organising Committeea chance to debrief and troubleshoot anyissues for the final days of the conferenceand others to enjoy the fabulous winedinner at Chez Pierre with 50 delegatesand partners.The last full day of the meeting presented afinal opportunity to soak up the innovationsof the meeting. The moderated ePostersessions concluded in the morning andthe Masterclass series reached a finale withexcellent sessions on airways, coagulationand regional anaesthesia.Anticipation mounted with the promiseof glamour, mystery and Bond filling thetwilight skies with the commencementof the gala dinner. Attended by 1000delegates and their partners, socialconvenors Dr Charlotte Jorgensen and DrPriya Thalayasingam outdid themselves inproviding a night to remember; highlightsinclude Professor Landau’s movie-inspiredtoast and Dr Alan (Evil) Millard’s entertainingmastering of the ceremonies.We were feeling a little nostalgic by thetime the final morning rolled around. Themeeting concluded in great style (and witha great turnout) with TRIAD’s StevensonCarlebach delivering a session on the“neuroscience of negotiation” followedby a thought-provoking hypotheticalsession, chaired by medico-legal expertDr Andrew Miller.The closing ceremony saw the Collegepresidency handed over by Professor KateLeslie to Dr Lindy Roberts, both of whomepitomise Dr Robert’s message of ourCollege moving “from strength to strength”.Now, a few weeks later, the dust has settledand we haven’t had to allocate rooms forany business meetings, troubleshoot menudisasters, or massage any budget figures.We have had a chance to reflect on whata privilege it has been to help co-ordinatesuch an extraordinary event; how luckywe’ve been to have enjoyed the tremendoussupport and goodwill of attendees,facilitators, volunteers and exhibitors; andwhat a fantastic team of people we havehad the pleasure to work with over the lastfew years. A huge and sincere thank youto you all.Dr Tanya Farrell and Dr David Vyse,Co-convenors, Perth ASMThis page Clockwise from top: Perth ASM signage; Perth ASM Co-convenors Dr David Vyse and Dr Tanya Farrell; lunch in the healthcare industry area; the Opening Ceremony audience;view of the Opening Ceremony from the audio visual control area. Opposite page Clockwise from top: Question time in a plenary session; participants in the laryngoscope workshop;viewing an ePoster; Retired Fellows Lunch attendees.14 ANZCA Bulletin June 2012

“ Our aviator had asimple answer forthe problem offatigue – ‘Getmore sleep!’Scientific program hits the markwith interest and innovationThe largest anaesthesia conference yet tobe held in Perth, the 2012 ANZCA AnnualScientific Meeting offered 13 plenarypresentations, 178 concurrent sessionpresentations, 47 workshops, 42 smallgroup discussions and QA sessions and59 ePoster presentations.It was gratifying to receive a great deal ofpositive feedback about the scope andquality of the scientific program fromboth the overseas invited speakers anddelegates, the few complaints from thelatter relating to the fact that they could notattend all the sessions that attracted them!Much of the success resulted from thediversity of the program, which deliberatelyincluded many speakers from other medicalspecialties and non-medical disciplines,including intensivists, cardiologists,haematologists, microbiologists, surgeons,maternal and fetal medicine specialists,paediatricians, scientists and pilots.The Masterclass series met the needs ofthose wishing to update or learn aboutcurrent best practice; the Patient BloodManagement sessions covered bothnew science and the successful WesternAustralian initiative into improvedperioperative care of anaemia andevidence-based blood transfusion practices;and the Harvard-based TRIAD groupchallenged and enriched our thinking indealing with difficult conversations andthe complexities of human behaviouralresponses.The other key factor lay in the exceptionalquality of the presentations. All credit isdue to the more than 250 presenters andfacilitators, starting with our featuredinvited speakers – Professor Ruth Landau,Professor Patrick Wouters, Professor HenrikKehlet, Professor Joseph Neal, AssociateProfessor Andrew Davidson and Dr DanBennett – and finishing with a outstandinghypothetical session hosted by Dr AndrewMiller, the medical equivalent of GeoffreyRobertson and Billy Connolly.In line with the theme of our meeting– Evolution: Grow, Develop, Thrive – wesought contributions from our invitedspeakers that covered new and developingareas of practice: pharmocogenetics,point-of-care monitoring, the applicationof ultrasound and echocardiography andadvances in the management of acute andchronic pain.The program emphasised the importanceof our training and non-technical skills,with lectures and workshops devotedto the new ANZCA curriculum, research,communication skills, simulation andwelfare. Our aviator had a simple answer forthe problem of fatigue – “Get more sleep”!and our negotiation counsellor had a similarmessage – “Listen”!The ANZCA ASM plays an importantrole in showcasing the growth of ourunderstanding and knowledge throughscientific endeavour. To this end, theLennard Travers Professor, AssociateProfessor Andrew Davidson, clarifiedwhat is meant by “translation research”and the Gilbert Brown Prize sessionshowcased our young achievers. Thesewere complemented by the ANZCAFormal Project session, the Open Posterand Trainee Poster prizes; and the FPMDean’s Prize and Free Paper session.Congratulations to respective ANZCAprize winners Dr Mary Hegarty, Dr RohanMahendran, Dr Paul Stewart and Dr StanleyTay; and to the FPM Best Free Paper winner,Dr Sarika Kumar.The introduction of ePosters appearedwell received and offers greater scopeto presenters than the traditional posterformat.Finally, we thank our colleagues whoworked tirelessly to run a smoothmeeting bursting with information andentertainment. Special mention goes to ouramazing convenors, Dr Tanya Farrell andDr David Vyse, and organising committeemembers Dr Soo Im Lim, Dr LiezelBredenkamp, Dr Markus Schmidt and Dr EdO’Loughlin, who were heavily involved inorganising the scientific program.Clinical Professor Tomas Corcoranand Professor Michael Paech,Scientific Program Co-convenors15

Pain medicine meeting shapesevolution of healthcareIn a world where we are bombarded bynegativity in the form of phrases suchas “terrorism”, “global financial crisis”,“massacre”, “religious extremism”, “armsrace”, “global warming”, “conflicts” and“power struggle”, one can take solace inoccasions such as the recent 2012 ANZCAAnnual Scientific Meeting, where the focuswas “evolution”.Evolution encapsulates the very purposesof existence and unites all living things,including human beings, irrespective ofgenetic background, upbringing socioeconomicstatus, beliefs and occupation.Conceived by Charles Darwin andpopularised by Richard Dawkins, theconcept of evolution challenges us to thinkrather than to believe and to never cease toquestion.Pain medicine lends itself to the foundationof evolution, as all creatures will adapt totheir environment to avoid and overcomepain. Pain, in an essence, drives us tobetter ourselves.In the 2012 ASM, the pain component wasdesigned to introduce new concept and toask the hard questions – What are we doingnow? Is it working? How do we decide whatdirection we need to take? – by focusing onoutcomes.The concepts were spearheaded byindividuals who are the champions ofasking these hard questions, includingour invited speakers Dr Dan Bennett andProfessor Henrick Kehlet. Such gatheringsof dedicated scientists and visionariesalike represent a common ground of thedesire to better ourselves and to engagein exchange of ideas without prodigiousand bias, engaging in purposeful debate,to shape the future of pain medicineand the propagation and evolutionof healthcare.Dr Max MajediFPM Scientific ConvenorDelegates raise $50,000 for LifeboxDelegates at the ASM raised $A46,142,including $A35,654 at the Gala Dinner, forthe Lifebox charity through the ANZCAASM Global Lifebox Initiative that ranthroughout the meeting,Delegates were given a pledge form intheir satchels that could be used to makedonations and at the Gala Dinner, eachtable was given a pledge envelope andguests were encouraged throughout theevening to donate to the cause.The money will be used to buy pulseoximeters and education kits worth $US250.Each year, tens of thousands of lives are lostduring surgery because operating roomsin many hospitals around the world don’thave this simple piece of equipment that isstandard in Australia and New Zealand.An estimated 77,000 operating rooms indeveloping countries around the worlddon’t have access to pulse oximeters,putting at risk about 35 million patientseach year.“ Delegates atthe ASM raised$A46,142,including$A35,654 atthe Gala Dinner,for the LifeboxcharityThis page Clockwise from top: Dr David Jones with invited speaker, Dr Daniel Bennett; FPM new Fellows; Professor Henrik Kehlet presenting at an FPM session; (top) Dr Jones with FPMFree Paper winner Dr Sarika Kumar; (bottom) Immediate past Dean Dr David Jones with new Dean, Associate Professor Brendan Moore; Dr David Jones with invited speaker ProfessorHenrik Kehlet. Opposite page Clockwise from top: The College Ceremony; the College mace; a new Fellow is photographed; Robert Orton Medal winner, Dr Duncan Campbell; Orator,Associate Professor Kelvin Kong.16 ANZCA Bulletin June 2012

SnapshotFull registrants: 1125Day registrants: 68Total attendees: 1782New Fellows: 177Sessions: 58ePoster sessions: 6Masterclass sessions: 12Workshops: 47Small groupdiscussions (SGDs): 38Quality assurancesessions: 4Prize winnersRobert Orton MedalDr Duncan Campbell – For positivelyaffecting the professional life of thousandsof anaesthetists and the care of millionsof patients by the invention of a fluidicventilator that is widely known as“The Campbell Ventilator”.Gilbert Brown PrizeDr Mary Katherina Hegarty – “Does takehomeanalgesia improve post-operativepain after elective day case surgery? Acomparison of hospital versus parentsuppliedanalgesia”ANZCA Formal Project PrizeDr Rohan David Mahendran – “Measuringcardiac output in the setting of differentintra-abdominal and positive endexpiratorypressures: Comparison oftrans-cardiac and trans-pulmonarythermodilution in a porcine model”ASM 2012 Open Poster PrizeDr Paul Anthony Stewart – “Ipsilateralcomparison of acceleromyography andelectromyography during recovery fromnon-depolarising neuromuscular blockadeunder general anaesthesia in humans”ASM 2012 Trainee Poster PrizeDr Stanley Tay – “Reduce volatile agentusage following introduction of Et-controlsystem”Renton PrizeDr Katrina Pamela Pirie, May 2011Dr On Yat Wong, September 2011Cecil Gray PrizeDr Jai Nair LePoer Darvall, May 2011Dr Stuart Lachlan Hastings, September 20112012 named lecturesMary Burnell LectureProfessor Ruth Landau (ANZCA ASM Visitor),Seattle, US – “Pharmacogenetics andanaesthesia: not yet ready for prime time?”Michael Cousins LectureDr Daniel Bennett (FPM ASM Visitor),Colorado, US – “Opiophobia, regulation andrisk management: developmentsin the USA, a cautionary tale”Ellis Gillespie LectureProfessor Patrick Wouters (ANZCA WAVisitor), Ghent, Belgium – “The rightventricle: more than a passive conduit?”FPM WA Visitor LectureProfessor Henrik Kehlet (FPM WA Visitor),Copenhagen, Denmark – “Progression fromacute to chronic pain: what do we knowand need to know?”Australasian Visitors LectureAssociate Professor Andrew Davidson(Lennard Travers Professor), Victoria,Australia – “Translational research inanaesthesia”Regional Organising CommitteeVisitor’s LectureProfessor Joseph Neal (Western AustralianOrganising Committee Visitor), Seattle,US – “Ultrasound – guided regionalanaesthesia: a game-changer or juststeady progress?”17

Spreading the ASM wordMedia activities occurred both internallyand externally at the annual scientificmeeting – via daily multimedia ASME-Newsletters sent to meeting delegates andFellows and trainees not at the ASM andthrough a very successful media program,which resulted in widespread coverage inprint, on radio and TV in Australia and NewZealand.The ASM E-Newsletter was distributedon the Friday before the ASM started (onthe FPM Refresher Course Day) and eachday of the meeting including Wednesday,the final day.It featured a video interview with everykeynote speaker plus audio recordings ofeach plenary lecture. Additional interviewswith selected speakers also ran as well asphoto galleries and media updates. All ASME-Newsletters can be found on the ANZCAwebsite under “Events/ANZCA annualscientific meetings”.A total of 347 ASM-related media reportsmentioned ANZCA, reaching a potentialcumulative audience of more than sixmillion in Australia and New Zealand with avalue of more than $700,000 in equivalentadvertising dollars, according to a reportfrom our media monitoring service, MediaMonitors.Nine media releases were issued, resultingin interviews with 17 speakers. Highlightsincluded coverage of neurotoxicityfor newborns, a possible genetic linkto anaesthesia awareness, an updateon oxytocin, new data on pregnancycomplications associated with extremelyobese women, the use of hypnosis inpain management, and developmentsin artificial blood.The attendance of medical reporters fromThe Australian (News Ltd), The Age (FairfaxMedia) and the Australian Associated Presswire service at the meeting resulted in18 reports that were widely syndicatedthroughout Australia and New Zealand. Thisproved invaluable in terms of building ourrelationships with key media organisationsnot to mention raising the College’s profile– and that of anaesthesia and pain medicine– in the community.For more details, please see “ANZCA in thenews” on page 60..Clea HincksGeneral Manager, CommunicationsANZCA“ 347 ASM-relatedmedia reportsmentionedANZCA, reachinga potentialcumulativeaudience ofmore than sixmillionClockwise from top: Gala Dinner pre-dinner drinks; dancing at the Gala Dinner; more scenes from the Gala Dinner; the WA Regional Organising Committee.18 ANZCA Bulletin June 2012

New Fellows’ConferenceLeaders – born or made?Leadership earned or learned?These were just some ofthe questions we wanted toexplore during the 2012 NewFellows’ Conference (NFC).“Team Leadership in Anaesthesia” tookplace on May 9-11, prior to the Perth ASM.Our aim was to put together a thoughtprovokingprogram, showcasing aspectsof anaesthetic leadership outside theusual theatre setting and, in the process,providing delegates with some newskills and ideas about leadership.After gathering at the Perth Conventionand Exhibition Centre, we had a threehour bus ride in the rain to the beautifulsurrounds of Caves House in Yallingup,Western Australia.To get tired legs moving, and to get toknow each other, our first session was aseries of team challenges. Figuring out thestrengths and weaknesses in our teams tosolve the various puzzles culminated inthe teams having to cross an imaginarycrocodile-infested ravine with two shortplanks, two milk crates and an iron bar.Everyone made it out alive to the otherside. The “time machine challenge”record time previously set by the AFLEagles team was well and truly smashedby our anaesthetists, a feat to rememberby all.This was followed by a relaxedsundowner, which included a winetasting run by Howard Park Winery,before an informal sit-down dinner infront of a roaring fireplace strengtheningnew acquaintances.Our second day commenced with earlymorning jogging and swimming for thesuperfit. The next workshop, presentedby Anveeta Shrivastava and WynandHamman from Deloitte Consulting, tookus through understanding cognitivetypes, and how individuals respond todifferent motivators and inspirations.We were able to type ourselves into thefour categories of the Hermann-BrainDominance Instrument, which werecolour-coded, resulting in the groupreferring themselves by their “colour”for the remainder of the conference.After a scenario role play, we learnt aboutleadership and followership archetypes,and how an understanding of theseallows for successful team interactions.This stimulating workshop wasfollowed in the afternoon by aninteractive panel discussion session,with the aim of debating issues requiringanaesthesia leadership outside thetheatre environment. Our esteemedpanel consisted of Dr Mary Pinder, FICMExaminations Chair, Dr Justin Burke, NewFellows’ Councillor, Dr Prani Shrivastava,Welfare SIG Chair, Dr David Scott, ANZCAcouncillor and councillor in residence atthe 2012 NFC and Dr Emily Wilcox, therepresentative from the 2011 NFC.Topics covered included how we dealwith being a role model, a position ofunconscious and unchosen leadership(leading to a discussion thread on theneed to improve mentoring of newFellows); how we deal with ethical issuesarising from our responsibilities to actin our patients’ best interest and be niceto our surgical colleagues; and whetherwe have created unrealistic expectationsin the community regarding the role ofthe anaesthetist. This was successful instimulating debate and discussion, whichcontinued after David Scott’s talk relatingthe journey of his involvement in theCollege, into the Conference Dinner heldat Cullen’s Winery.Cullen’s Winery is a renownedorganic winery in the region, with a longassociation with the medical community.Dinner was one of the highlights of themeeting, with a short talk from VanyaCullen, Chief Winemaker at Cullen’s,showcasing leadership in the winemakingindustry with their sustainable biodynamiccultivation. A special tasting of someof their premium wines pre-empted afantastic meal showcasing local produce.Nearly everyone made it out of bed intime the next morning for Mary Pinder’sworkshop on debriefing after medicaldisaster. This involved small groupsworking together on various hypotheticalscenarios to identify issues and learninghow to design a debriefing plan.After concluding the conference withthe election of a representative for nextyear’s NFC, we embarked on the bustrip back to Perth, with many noisy andexcited conversations taking place amongnew friends and associates across theAustralasian regions.Dr Angeline LeeDr Irina KurowskiNew Fellows Conference Co-convenorsAbove from left: New Fellows Conferencedelegates; Teamwork was needed to crossthe (imaginary) “crocodile-infested ravine”.19

ANZCA’s revisedtraining programHow the new primaryexamination will workGeneral overviewThe broad aim of the new primaryexamination is to provide an integratedapproach to learning.While the candidate will still belearning about individual topics viathe reference texts, the examinationprocess, especially with regard to the oralexamination, will not specifically aimto examine individual subject areas inisolation.Rather the examination will aim topresent candidates with a broad rangeof questions covering the scope of thevarious major topics. The exam can nolonger be thought of as being distinctsubject areas that will be examinedindividually. Subsequently, there will beno “passing” of individual subject areaspossible in the new exam. A satisfactoryperformance in the examination overallis needed to ensure a pass in the primaryexamination. The allocation of markswill remain as it is now with the writtenand oral sections each worth 50 per centtoward the final mark.Eligibility to sitOne of the crucial changes will be thatonly trainees occupying accreditedtraining posts, who have completed sixmonths of anaesthetic training, will beallowed to sit the primary examination.This will make the exam process muchmore relevant for candidates since, in thepast, no experience in anaesthesia wasrequired. This meant examiners had tobe very cautious in framing questionsso they did not have a specific clinicalanaesthetic focus to ensure no candidatewas disadvantaged.Now that has changed and questionswill tend to have a more clinical focuswherever possible. That does not meanthe examination is changing focus – itis not – it will remain an assessmentof basic sciences applicable to theconduct of clinical anaesthesia and painmanagement.Syllabus in generalThe examination team has been throughthe new learning objectives, which arecollected together in appendix threeof the master curriculum document(found at www.anzca.edu.au/trainees/curriculum-revision-2013) and matchedthem to the old primary examinationsyllabus. Statistics have been removedfrom the new curriculum, although theformat in which they are to be assessedis still to be determined. There have beenother minor changes but, in general terms,most of the other components of theold primary examination syllabus havebeen translated into the new learningobjectives.There has been additional materialadded in the form of about 30 learningobjectives dealing with anatomy,equipment and safety. These havebeen transferred, as it were, from thefinal examination program and are allappropriate for early year trainees. Whilethis extra material may at first seemdaunting, it is all very applicable to theconduct of anaesthesia and mirrors manyof the procedures that basic trainees willbe involved in.WrittenThe written component, consisting ofa multiple-choice question paper anda short-answer question paper, willremain. However, the format will changeto bring it in line with the style of thefinal examination and consist of a singlemultiple-choice question paper of 150items, and a single short-answer questionpaper of 15 questions. Each of these willcover physiology, pharmacology, clinicalmeasurement, safety, anatomy andequipment. In order to be invited to theoral examination, the candidate mustachieve a minimum of 40 per cent ineach paper.OralThis is where the major changes willoccur. To start, there will be three vivas,each with two examiners lasting 20minutes each. While this may appear tocandidates as making life even harderthan before, in fact, the opposite is thecase. By having three vivas, each ofwhich will cover four subject areas, thecandidate will have a chance to talk about12 different topics.This change is necessary in order toassess the additional material that hasbeen added to the learning objectiveswhile, at the same time, maintaining thedepth of knowledge needed. It also meansthat if a candidate performs poorly inone, or even two topic areas, there is stilla good chance of being able to pass thevivas overall. Each viva will be integratedin format. The material being covered inthe vivas will be examined in detail eachday to ensure that candidates are beingassessed on a wide range of topics and thecandidate is not being re-assessed on thesame material during the different vivasessions.Each of the vivas will differ incontent. While the vivas will indeedbe “integrated”, there should be noexpectation that each viva will containequal amounts of material from all partsof the syllabus. Indeed some vivas mayhave a leaning towards one broad aspect,such as physiology with some questionson other learning objectives includedthroughout, while others may be broader,for example covering pharmacology,physiology and anatomy topics in theone viva.Resources and feedbackOne of the strengths of the primaryexamination has been that examinablematerial has always been based on theobjectives provided in a syllabus (or whatare now learning objectives) coupled witha prescribed set of recommended texts.Every question asked in the primaryexamination must have a direct referenceback to one of the recommended texts.This will continue into the new primaryexamination. The list of recommendedtexts will soon be published on theCollege website, once approval has beenobtained. It is also our intention to poston the website a selection of integratedviva questions, written by the currentexamination panel, which can be usedfor practise in trial viva settings, socandidates can get a feel for the new oralexamination format.Lastly, the Primary ExaminationSub-Committee is aware that the Collegehas placed a limit on the number ofattempts that may be made to sit theprimary examination. We are looking atways to provide high quality feedbackto unsuccessful candidates so they canimprove their performance in subsequentattempts.Associate Professor Ross MacPhersonChairman, Primary ExaminationSub-Committee20 ANZCA Bulletin June 2012

ANZCACurriculumRevision2013Sample vivaquestions for thenew format primaryexaminationA number of sample viva questionshave been written by members of thePrimary Examination Sub-Committee.These questions are available on theCollege website in the CurriculumRevision 2013 section - www.anzca.edu.au/trainees/curriculumrevision-2013.The viva questions are designed togive candidates some practice in thetype of integrated vivas that will beused in the new primary examination.The best way to utilise the samplequestions when preparing for theexamination is outlined online.The College aims to increase thenumber of sample questions over time.Fundamental toanaesthesia: theANZCA ClinicalFundamentalsAmong a number of innovations inANZCA Curriculum Revision 2013 will bethe introduction of seven ANZCA ClinicalFundamentals.These fundamentals have beendeveloped to define the range of clinicalknowledge and skills required forspecialist anaesthetic practice, and willbe taught and experienced throughout thecurriculum, particularly within the firstfour years of training, in parallel with theANZCA Roles in Practice.The seven ANZCA Clinical Fundamentalsconsist of:• General anaesthesia and sedation.• Airway management.• Regional and local anaesthesia.• Perioperative medicine.• Pain medicine.• Resuscitation, trauma and crisismanagement.• Safety and quality in anaestheticpractice.These areas define the fundamentalaspects of anaesthetic practice, andclearly indicate the major areas ofexpertise that are required by allanaesthetists for specialist practice asan anaesthetist regardless of the clinicalareas in which they work.The specific learning outcomes,expected to be achieved for these ANZCAClinical Fundamentals, have beendefined and grouped to the variousperiods of training (introductory, basicand advanced training) where they buildfrom basic knowledge and skills to moreadvanced levels as the trainee progresses.Log on to the ANZCA website to read moreabout these learning outcomes:www.anzca.edu.au/trainees/curriculumrevision-2013/pdfs/anaesthesia-trainingprogram-curriculum.pdf.The development of the ANZCA ClinicalFundamentals derived from a desire todefine more accurately the core elementsthat make up and distinguish the practiceof anaesthesia regardless of the areas inwhich anaesthetists work.“No longer is (pain medicine)a subject to be ticked asModule 10 and forgotten!”Past emphasis on surgeryPreviously, considerable emphasis hadbeen placed on describing anaesthesiaaccording to the surgery for which it isused. This has under-emphasised manyimportant expert contributions made byanaesthetists to other areas of medicine,as well as failing to recognise theuniversal application of many aspectsof anaesthetic knowledge and skills.Airway managementAirway management is a good exampleof where all branches of medicinereadily acknowledge the pre-eminenceof anaesthetic skills and knowledge.Training and education in airwaymanagement in the revised curriculumwill no longer be somewhat haphazardby “association” with anaesthesia forsurgery. As a clinical fundamental it willbecome the focus of the training itself.The curriculum review undertakenin 2008-10 recommended that there beimproved emphasis on other core areasof anaesthesia, including perioperativemedicine, pain medicine and regionalanaesthesia. These areas were perceivedto be under-represented in the trainingprogram. This particularly applies toperioperative medicine and to painmedicine.Pain medicineIn the existing ANZCA curriculum, painmedicine was included as a specificmodule (10), which could be experiencedas a single block of activity, as well asa component of another module (1). Itwas commonly not perceived by traineesas being integral to their training asanaesthetists.By incorporating pain medicine asan ANZCA Clinical Fundamental, therevised curriculum emphasises theintrinsic importance of pain medicine toall activities undertaken by anaesthetists.It thus demonstrates that the knowledgeand skills of pain management arelearned and applied across the wholetraining period and cannot be studiedin isolation.(continued next page)21

ANZCA’s revisedtraining programcontinuedNo longer is it a subject to be tickedas Module 10 and forgotten! Theimportance of early, adequate andongoing management of acute pain tominimise the development of chronicpain syndromes must be integral to everyanaesthetic; and the ability to provide thebest clinical care for chronic pain patientswho need concurrent therapy through theperioperative period is essential.Perioperative medicineSimilarly, perioperative medicine isemphasised throughout training toenable the whole patient to be managedas part of the perioperative process, andnot just to be swotted up for the finalexamination! This ability to assess andmedically manage patients throughoutthe perioperative period is what providesthe most compelling argument as to whyanaesthesia is best managed by medicalgraduates.Regional anaesthesiaPatients will benefit from recognitionin the revised curriculum that regionalanaesthesia is a very importantalternative or adjunct to generalanaesthesia in many areas of practice.The advent of good compact ultrasoundimaging has improved the safeapplication of regional anaesthesia,and this technology has helped in theresurgence of this form of anaesthesia,which has considerable benefits for theperioperative care of patients.Crisis managementAnaesthetists have been integral to thedevelopment of the team managementof the critically ill, especially inadvanced life support and trauma teams.Anaesthesia itself can be associatedwith the management of life-threateningcrises such as anaphylaxis and malignanthyperthermia. The knowledge and skillsrequired of anaesthetists to manage thecrises that may occur in their practice,and to contribute to the team managementof the critically ill have been definedin the resuscitation, trauma and crisismanagement fundamental.Safety and quality inanaesthetic practiceThe issues of safety and quality inanaesthetic practice have not previouslybeen gathered together and highlightedfor training, though anaesthetists have forover 60 years led the medical professionin these aspects of practice. Anaesthetistswere the first to systematically investigatedeaths that may have been due totheir own clinical management of thepatients; anaesthetists were also thefirst to introduce knowledge generatedfrom aviation experience to improvecrisis management and implement safetyalgorithms; and similarly anaesthetistswere the first within the medicalprofession to use high fidelity teamsimulation exercises to improve the safetyand high quality of anaesthetic delivery.It is appropriate to acknowledge this rolein anaesthetic practice by introducing thesafety and quality in anaesthetic practicefundamental.Thus the ANZCA ClinicalFundamentals were developed to expandon areas where there were perceiveddeficiencies in the 2004 curriculum. Mostimportantly, they focus the attentionof trainees, supervisors, Fellows andother Colleges on the main areas whereanaesthetists are trained and educatedto be clinical leaders.TutorsTo implement these clinicalfundamentals, the College plans tohave clinical fundamental tutorswithin teaching departments for eachANZCA Clinical Fundamental. In smalldepartments, some Fellows may needto tutor more than one fundamental.We hope that there are enthusiasticanaesthetists with particular interests andexpertise for each of the ANZCA ClinicalFundamentals in each department. Thesetutors will lead the way in making thelearning experience for trainees satisfyingand educational. Above all, they willsupport their trainees so that they obtainthe best possible clinical experience todevelop essential knowledge and skillsin these clinical fundamentals. Thissupport may require greater opportunityfor regional anaesthesia in hospitalswhere this activity is not strong; thedevelopment of simulation situations,for example, for specific rare airwaymanagement scenarios; improvedperioperative assessment proceduresprior to and following anaesthesia; andcarefully supervised acute pain roundswith strengthened links to services forpatients with persisting pain.Enhanced curriculumThere are many challenges in developingthe full potential of these ANZCA ClinicalFundamentals, but the enthusiasm thatFellows have displayed for this conceptmeans we are confident this initiative willconsiderably enhance the curriculum.The ANZCA Council is extremely proudand excited to be part of the deliveryof ANZCA Curriculum Revision 2013with its innovative ANZCA ClinicalFundamentals. We believe it will enhanceconsiderably the training and educationof our trainees.Professor Barry BakerDean of Education, ANZCA22 ANZCA Bulletin June 2012

OTSAN Supporting anaesthetists from abroad to achieve fellowship in AustraliaThe Overseas Trained Specialist Anaesthetists’ Network (OTSAN) assists international medical graduatespecialist (IMGS) anaesthetists in their quest to start a successful life in Australia.OTSAN was established by Fellows who have passed ANZCA’s professional accreditation process.It supports international medical graduate specialists through many facets of the process, includingeducation and social networking as well as liaising with national and local structures and industrial relations.Join us in Melbourne on 14 & 15 July for our first ever ‘Exam Boot Camp’. During this 2-day workshopyou will learn ‘correct exam technique’ as well as participate in mock medical clinical and anaesthesiavivas. For information see our website www.otsan.org or contact Renee McNamara (imgs@anzca.edu.au).Our website also offers a virtual meeting place to help IMGS anaesthetists overcome social andeducational isolation. It supplements OTSAN activities such as meetings and workshops.The Australian and New Zealand College of Anaesthetists has received Australian Government funding under the SpecialistTraining Program. This funding will be used to support the activities of OTSAN.Chair of the ScholarRole PanelAn exciting opportunity is available for an ANZCA Fellow of highstanding to take a leadership role in the development of researchand teaching within the ANZCA Training Program.The Chair of the Scholar Role Panel will lead a key committeeof 20 Fellows appointed to develop, assess and evaluate thescholar role activities in the revised 2013 ANZCA curriculum.The scholar role activities include teaching skills: criticalappraisal and evidence-based practice; audit researchmanuscripts; and relevant post-graduate programs. TheScholar Role Panel will make assessment decisions on formalaudit reports, research manuscripts and on the suitability ofpostgraduate study proposals. The panel will have at leastone face-to-face meeting per year and three teleconferencemeetings.The Chair will sit on the Assessments Committee and contributeto the overall assessment strategy of ANZCA. The AssessmentsCommittee meets three times a year in Melbourne and reportsto the Education and Training Committee.The Chair will fulfil the following criteria:• Hold a FANZCA or equivalent.• Be appropriately qualified and experienced to assess thelearning outcomes of the scholar role activities.• Have enthusiasm, credibility and commitment.• Demonstrate leadership abilities.For an outline of scholar role activities, the terms of referenceof the Scholar Role Panel and the roles and responsibilities ofANZCA chairs of committees and subcommittees please contactDaniela Doblanovic (ddoblanovic@anzca.edu.au).For any other inquiries please contact Associate ProfessorJennifer Weller (j.weller@auckland.ac.nz).23

A mad idea – orseveral – is just whatthe doctor orderedDr Duncan Campbell provesageing is no barrier to alifetime of medical innovation.He spoke to Meaghan Shaw.Remarkably, Dr Duncan Campbell, 81,who nearly 40 years ago invented theCampbell ventilator which became thestandard for hospitals around Australiaand New Zealand, is still inventing.In January this year, he took out apatent for a non-invasive cardiac outputmonitor that can determine cardiacoutput using optical sensors.It’s the latest in a stream of inventionsby the indefatigable octogenarian,who last month was presented withthe Robert Orton Medal at the ANZCAAnnual Scientific Meeting in Perth for hiscontribution to anaesthesia, in particularfor the invention of his eponymousventilator.“I thought they had forgotten about melong ago!” was his initial response whenlearning he was to be honoured.With a wry sense of humour andturn of phrase, Dr Campbell recountsa remarkable life from a childhood inIran and India, to serving in the armyduring the Malayan Emergency, workingwith IVF and laparoscopy pioneer DrPatrick Steptoe, and creating a series ofanaesthetic-related innovations.An interest in the wireless at a youngage, and a desire to take things apart tosee how they worked, perhaps can beseen as the spark that set off his passionfor invention.He was conceived in India, born inBritain, and spent his infancy in Indiaand early years in Iran, where his Scottishfather was the vice consul.Incredibly, he knows the date of hisconception because his mother, fromYorkshire, was quite the correspondentand wrote to a friend the day he wasconceived saying: “Today, I startedDuncan”.His earliest memories are fromZahedan, Iran, near the border ofPakistan and Afghanistan, where hisfather once fired a revolver into the airto frighten an intruder in the dead ofthe night.“ The anaesthetists werewandering aroundhaving a whale ofa time, chatting toeverybody and laughing.And I thought perhapsthat’s the life!”He recalls the intruder tearing aroundthe compound in distress because hisaccomplice, waiting on the consular wallto pull him up with a rope, disappearedat the sound of gunshots, taking the ropewith him.By the beginning of World War II,Dr Campbell was back in Britain andeducated in London, the Lake Districtand the Kings School in Canterbury,before delaying national service bystudying for an intermediate bachelor ofscience degree in agriculture – an interestprompted by his parents running a farm.His agricultural studies led to adesire to study medicine – his fatherwas delighted – and his first job afterqualifying was as a house surgeonat Charing Cross Hospital, where hecontemplated his future.“I didn’t really relish the idea of goinginto general practice,” he recalls. “Ithought something hospital orientatedwould be more interesting. And I wasalways intrigued by the fact that while Iwas stuck holding retractors and thingsfor the surgeons, the anaesthetists werewandering around having a whale of atime, chatting to everybody and laughing.And I thought perhaps that’s the life!”At his second house job at theMetropolitan Hospital, London, DrCampbell became friendly with theregistrar anaesthetist who took himunder his wing until the registrar hada confrontation with the night porterand was dismissed.“He was marched in front of theadministrator who said, ‘Good nightporters are far more difficult to get thananaesthetists. Goodbye!’” Dr Campbellsays, saddened at the memory.His second attempt to defer nationalservice failed when he told thearmy board the reason was to studyanaesthetics.“They laughed and laughed andsaid, ‘The army’s short of anaesthetists.You’ll have no trouble at all getting ananaesthetic job in the army. Off you go.’”Doubtful he’d be posted as a traineeanaesthetist anywhere more exoticthan the north of Scotland, Dr Campbellsuggested the Far East and ended up inSingapore, where he was also appointedblood transfusion officer. His ploy toencourage commanding officers andadjutants to set an example and giveblood proved highly effective as well asentertaining for the troops.After only a year’s training, he waspromoted to captain, graded clinicalofficer in anaesthetics and sent as thesole anaesthetist to the Kluang militaryhospital in (then) Malaya, about 120kilometres north of Singapore.24 ANZCA Bulletin June 2012

“The parting words were, ‘We’re onlya phone call away’, which wasn’t muchhelp,” he says.In Kluang, Dr Campbell met his wife,Mary, who was a nursing sister at themilitary hospital. They subsequently hadtwo sons – one of whom is an anaesthetistand the other a dentist.Kluang was also where he played hispart in a hospital-inspired truce betweenthe British and communist terrorists,which perhaps led to a cessation ofhostilities in that area.At that time, injured terrorists whowere sent to the civilian hospital didn’tsurvive the night because the localsdetested them so much they slit theirthroats.As part of a goodwill gesture, themilitary hospital started taking problemcases from the civilian hospital, includingthe terrorists.The first time this happened, only DrCampbell and the surgeon were on duty.Short of staff and wards, they patchedup the unarmed terrorists, and sent themto share the ward where the British wererecovering.The terrorists were astonished to wakeup as they expected to be given a lethalinjection and were discovered the nextday by the returning commanding officerplaying a card game, pontoon, with theinjured British soldiers.Dr Campbell says the terrorists werereluctant to return to their jungle unitsafter their recovery and apparently toldtheir comrades they didn’t want to fightthe British, who had become their friends.“And do you know, there was oneother skirmish when another lot ofterrorists came in and after that, none.Absolutely nothing. We never had anymore terrorists,” he says. “And I wondervery much whether it was to a large extentassociated with the fact that we actuallydemoralised them with our treatment.”Returning to England, Dr Campbelldid his formal anaesthetic training afterwhich, for interview practice, he appliedfor a job as an anaesthetist in charge ofthe anaesthetic services for the Oldhamgroup of hospitals on the outskirts ofManchester.“So absolutely blasé, I went up for thisinterview,” Dr Campbell recalls, expectingto be roasted for wasting the interviewpanel’s time by applying for such a seniorjob when he wasn’t even a consultant.At the interview, he was asked bypanelist Dr Patrick Steptoe what he knewabout pneumoperitoneum and if he, likeother anaesthetists, would be worriedabout pushing gas into the peritonealcavity.“I said, ‘Well I’d be worried if it was air,but if it was carbon dioxide or oxygen, I’dbe quite happy because you wouldn’t getan air embolus with that,’” he replied.(continued next page)“ An interest in the wireless ata young age, and a desire totake things apart to see howthey worked, perhaps can beseen as the spark that set offhis passion for invention.”Opposite page from left: Dr Duncan Campbell;Dr Campbell and his son, Dr David Campbell,who was presented as a Fellow at the PerthASM; and Dr Campbell inspecting the latestventilators at the Ulco stand at the Perth ASM.25

A mad idea – orseveral – is just whatthe doctor orderedcontinuedAstonished to get the job, he workedalongside Dr Steptoe as the specialistdeveloped the technique of laparoscopy.Dr Campbell was still working at thehospital as Dr Steptoe began procuringhuman eggs from ovaries using alaparoscope, a precursor to IVF treatment,but moved to Australia nearly a decadebefore the first live birth in 1978.Living along the Pennines, where itgets cold, wet and windy, Dr Campbellgot fed up with the miserable weather.One day, having dug out the snow thathad blocked his driveway and garage,only to have the wind fill it up again, heturned to his wife and said: “Mary, wherecan we go where it doesn’t snow?” Herresponse was “What about Australia?”and a glance through the British MedicalJournal revealed an anaesthetic staffspecialist job advertised at the RoyalPrince Alfred Hospital in Sydney.He got the job and moved in 1969.One of his first duties was to design ananaesthetic tray that could store thedaily supply of anaesthetic ampoules.Flicking through the Yellow Pages,he found an advertisement for UlcoEngineering, which made specials toorder and was willing to do medicalwork. They took on the productionof the anaesthetic tray, and so beganDr Campbell’s long and productiveassociation with the company and itsmanaging director, John Uhlir.His next invention was a pneumaticlifting trolley, operated by two carbondioxide cylinders, which could liftpatients off the bed, transport them, andlower them onto the operating table. Itcould tilt patients up and down, and alsohad a radiotranslucent sheet to enableX-rays to be taken.Ulco made a prototype, trials wereconducted and a few were sold toAustralian hospitals, but demand andprofit margins were low and productionceased.But his next invention hit the jackpot.For some time, even before he cameto Australia, Dr Campbell had beenfrustrated with the ventilators availableand wanted to design a robust andversatile ventilator for theatre use thatcould be used on all ages, with theparameters – pressure, volume, flow andtime – all controlled by the anaesthetist.First he needed to find an alternativeMcKrScan LRto an electronic control system as, at thattime, there was considerable concernabout the dangers of micro and macroshock in the operating theatre, as wellas possible explosive hazards fromflammable anaesthetics.His breakthrough came when, literallyinspired by rocket science, he learnt thatlong-range rockets used a system of fluidiccontrols to withstand severe vibrationsand magnetic forces.Having sourced through Ulco someminiature fluidic control modules, in 1973Dr Campbell made his first prototype.“It took up a lot of space with a massof spaghetti-like tubing connecting thevarious components, but it worked,”he says.He crammed all the workings intoa plastic lunch box and took it to Ulcoand various manufacturing companiesto gauge their interest. CommonwealthIndustrial Gases (CIG) was tempted andsaid they’d get back to him. He’s stillwaiting.The main obstacle to production wasthat the mass of tubes made assembly toocomplicated. But inspired by transistorradios, where all the wiring was replacedby circuit boards, he designed a templateso that channels could be engraved on aboard for mounting the fluidic elements.The channels could then be sealed with aback plate to eliminate connecting errors.He returned to Ulco and Mr Uhlirwas hesitant but said he would make26 ANZCA Bulletin June 2012

a prototype for $1100 – a substantialamount of money – during the company’squieter periods.“I scratched my head and thoughtabout it, and said, ‘Ok’,” Dr Campbellrecalls.With the manufacture of the firstmachine under way, he went to theAustralian Society of Anaesthetists’ (ASA)meeting in Hobart in 1974 to present apaper on the ventilator.On the plane back to Sydney, hesat beside Dr John Keneally, who wasworking at the Children’s Hospital, thenat Camperdown. He was interested ina ventilator that was suitable for bothchildren and adults.“I said, ‘We’re making it so that it’llventilate anything from a mouse up to anelephant’,” Dr Campbell says.Unknown to him, Ulco was capturedby his enthusiasm and made a secondmachine at the same time as the first,which was completed in April 1975.The first was used by Dr Campbell andhas since been donated to the ASA’s HarryDaly Museum. The second was trialed andthen sold to the Children’s Hospital.Associate Professor Greg Knoblanchewas then a registrar at the Children’sHospital and the Royal North Shore.He told Royal North Shore’s director ofanaesthetics Dr Ted Morgan about theventilator, and the hospital promptlyordered four. The Children’s Hospitalbought another, and the soon-to-beopenedBaulkham Hills Private Hospitalalso bought four.“All without any advertising at all,”Dr Campbell proudly explains.His description of the ventilator waspublished in Anaesthesia and IntensiveCare in February 1976.Improvements were made to theventilator over the years: negativeexpiratory pressure was eliminated as itwas never used; the bellows configurationwas changed from hanging to rising;a disconnect alarm was incorporated;and the fluidic controls were replacedby improved and more manageableelectronics with a visual display.The absence of mechanical movingparts, precision engineering and attentionto detail resulted in a ventilator with longtermreliability and legendary success.By the time Mr Uhlir retired and soldthe company in 2003, more than 3400 ofthe ventilators, including the updatedelectronically controlled EV500, whichis still affectionately known as theCampbell ventilator, had been made andsold. A recent inquiry to the companyrevealed the figure is now more than 4000and, despite a trend toward integratedanaesthesia machines and ventilators,they’re still being sold, with more than1000 units still in use in Australia, NewZealand, throughout the Asia Pacific,the Middle East, Africa and Greece.Spin-offs included a horse ventilator;an anti-DVT system using an inflatablesleeve to perfuse legs, which was notcommercially viable; a kidney perfusingsystem, which was successful untilresearch showed kidneys left on ice didbetter than perfused kidneys; a systemfor measuring airways resistance; a newventilator alarm giving almost immediateindication of a disconnect; and a projectfor recycling volatile anaesthetics forhospitals.His last project with Ulco was for asystem of working out cardiac output,but Mr Uhlir reluctantly pulled the plugon the proposal because he was sellingthe company and the project would takea further two-to-three years to get tomarket.Dr Campbell sold the patent for thesystem to Edwards Laboratories in the US.But he kept thinking about it. “Atthe back of my mind I was always a bitworried about the fact that this was aninvasive procedure requiring arterialcannulation in order to get cardiac output.And I suddenly realised that it could bedone entirely non-invasively. You coulddo it optically, with optical sensors.I tried it out, and it worked.”He took out a new patent in Januaryand the project is in the pipeline, buthe’s wary about talking about it becausehe thinks people will say he’s mad –although he’s used to that.“They told me I was pretty mad aboutthe ventilator,” he recounts. “I said, ‘I’mgoing to have a ventilator with no movingparts whatsoever’. They said, ‘Oh, you’remad’. I said, ‘No. There will be not a singlemechanical moving part’. They said,‘How will it work?’ I said, ‘Very nicely!’”Meaghan ShawMedia Manager, ANZCA“ The absence of mechanicalmoving parts, precisionengineering and attention todetail resulted in a ventilatorwith long-term reliability andlegendary success.”Opposite page: A younger Dr Duncan Campbellwith a Campbell ventilator. This page:Dr Campbell taking possession of the firstCampbell ventilator.27

ANZCA contributionhelps improve patientcare in Papua New GuineaThe Overseas Aid Committee isworking to assist the deliveryand quality of anaestheticservices in Papua New Guinea(PNG), writes Meaghan Shaw.Papua New Guinea has so few anaesthetistsyou can count them. There are only 15consultant anaesthetists working ingovernment hospitals, for a populationof seven million.In addition, there are about 100 nonmedicaltrained anaesthetic scientificofficers providing the rest of the country’sanaesthetic services.Coupled with health spending of about$A50 per person and a paucity of basicanaesthetic equipment and drugs, thecontrast with Australia and New Zealandcouldn’t be starker.For Dr Lisa Akelisi-Yockopua, one ofPNG’s few consultant anaesthetists, arecent visit to Perth’s annual scientificmeeting was an “eye opener”, givingher an insight into the latest anaestheticadvances and exposing her to an array ofnew equipment in the healthcare industryexhibition area.“Obviously we do need a lot ofequipment up in Port Moresby,” she saysat the Perth meeting. “Seeing the displayof different equipment here, it’s like,‘Oh, wow. It’s so different’.”Dr Akelisi-Yockopua is in her secondyear out of training and came to Australiaas a guest of ANZCA’s Overseas AidCommittee. She has been selected for theANZCA International Scholarship and ishoping to pass her English language testsoon so she can come back to Australiaand work with Adelaide anaesthetist,Dr Chris Acott, who specialises in headand neck surgery.She also wants to specialise inanaesthesia for head and neck surgery –an area of need in PNG, which has a highincidence of head and neck cancer dueto betel nut chewing and smoking. PNGalso has other developing country healthproblems such as chronic tuberculosis,leprosy and HIV.The sessions Dr Akelisi-Yockopuaattended at the ASM – including aresuscitation update, difficult airwaysession, updates on opioids and reversaldrugs, and a fibreoptic intubationworkshop – were incredibly useful.“I just can’t express how appreciative Iam,” she says. “This is a great opportunityfor any of us who haven’t been to sucha conference. It will be very nice for myother colleagues who (can learn fromme). I’m very fortunate to come to thisconference where I’m exposed to so manythings which I didn’t expect, and alsomeeting up with the other consultantsfrom overseas.”Since 1993, ANZCA has been involvedwith training in PNG through the effortsof Professor Garry Phillips and a PNGsenior lecturer in anaesthesia, Dr HarryAigeeleng. This has included funding twoeducational visits to PNG each year, at theinvitation of the University of PNG.Dr Michael Stone, from the RoyalPrince Alfred and St Vincent’s hospitals inSydney, went to PNG earlier this year fora week to train the anaesthetic scientificofficers and anaesthetic registrars.The anaesthetic scientific officerstypically start their careers organisingequipment for anaesthetists anddoing general cleaning duties beforeundertaking a one-year diploma inanaesthetic science. Often they have anursing background. They provide thebulk of the anaesthetic services in thecountry, especially in the provincialhospitals.The anaesthetic registrars undertakea four-year masters in medicine course tobecome consultant anaesthetists.Dr Stone provided tutorials andlectures on subjects such as airwayskills, rapid sequence induction, failedintubation, defibrillation, advanced lifesupport, paediatric syndromes and crisismanagement, aided by mannequinsdonated by the College.It’s the second trip to PNG for Dr Stone,who was encouraged to do the teachingvisit by new Overseas Aid Committee28 ANZCA Bulletin June 2012

Chair, Dr Michael Cooper, who hadpreviously taken part. Both were partlyinspired to work in PNG having been toschool with native Papua New Guineans.Dr Stone says of the 100 kina (about$A50) per capita spent on health each yearby the PNG government, only a minisculeamount ends up in the anaestheticbudget.“Consequently, there is a shortageof simple things like drugs such assuxamethonium and analgesics;halothane is the only volatile anaestheticagent; there’s shortages of simpleequipment like spinal needles, so spinalanaesthesia is provided using a standardcannula to give a spinal injection; and thegas supply runs out frequently,” he says.Coupled with this, the standard ofsecondary school education in PNG islower than Australia, mortality rates arehigh, and any death can potentially leadto the risk of payback from disgruntledrelatives due to the country’s strongwantok system of allegiance andobligation to extended family.Given this, Dr Stone is impressedwith the students who he finds to beconscientious, motivated and hardworking.“They make up for educational andresource deficits through enthusiasm,”he says. “I take my hat off to them that,despite working under incredibly difficultcircumstances and often having highanaesthetic morbidity and mortality,they still come back to work each day andcontinue to work hard for their patientsand the community.”A former chairman of the OverseasAid Committee, Dr Wayne Morriss, saysANZCA supports a range of initiativesfor PNG, with the other annualeducational trip to PNG undertaken byfellow committee member Dr Roni Krieser,who provides basic science teaching fortrainee medical anaesthetists.In addition, ANZCA helps organisean anaesthetic refresher course in PortMoresby in September every second year,when a large proportion of anaestheticstaff from PNG can gather in one place.At the upcoming course this year,the committee will distribute about 40Lifebox pulse oximeters provided througha $10,000 ANZCA donation to the Lifeboxinitiative, which provides low-costoxygen monitors to developing countries,alongside associated resources andtraining to raise the safety of surgery.ANZCA also will provide about40 packs of textbooks and electroniclearning resources sourced by Dr Cooperas part of ANZCA’s educational initiative.A further 10 packs will be distributed toother developing countries supported byANZCA.“ For a small investment,we can make quite largechanges in anaestheticpractice, patient safety,all these things.”Above from left: Dr Lisa Akelisi-Yockopua,from Port Moresby, who came to Australia andattended the ASM as a guest of the OverseasAid Committee; Port Moresby General Hospital;Training in PNG; A tray of drugs.29

ANZCA contributionhelps improve patientcare in Papua New GuineacontinuedDr Morriss says small donations of thiskind can help reduce the gap betweenanaesthetic practice in Australia and NewZealand, and our closest neighbours, suchas PNG.“For relatively little expenditure or littleresource, we can make a huge benefit,” hesays. “We work very hard to get maximumbang for buck. So for a small investment,we can make quite large changes inanaesthetic practice, patient safety, allthese things.”Beyond PNG, the committee isalso looking at overseas developmentopportunities in other countries.This includes a new initiative, theinaugural ANZCA Overseas Aid TraineeScholarship, which was recently awardedto Dr Steven Smith from the Mater Mothers’Hospital in Brisbane.This scholarship provides support fora final year ANZCA trainee to accompanya visiting team to a developing countryand improve their knowledge andunderstanding of the challenges ofproviding anaesthesia and pain medicinein the developing world. Dr Smith plans tovisit Vanuatu later this year.The committee also supports theteaching of the Essential Pain Managementcourse, which aims to improve knowledgeof pain in developing countries, provide asimple framework for managing pain, andexplore ways of overcoming local barrierswhich include lack of staff, inadequatepain knowledge and the scarcity orabsence of analgesic drugs.The course was developed and pilotedby former Faculty of Pain Medicine deanDr Roger Goucke and Dr Morriss in PNGin 2010, and has been taught in Fiji, theSolomon Islands, Vanuatu, Micronesia,Cook Islands, Mongolia, Vietnam, Rwandaand Tanzania, with plans to introduceit to Spanish-speaking Central Americalater this year and other parts of Asia.It has been translated into Mongolian,Vietnamese and Spanish.Dr Morriss says the Essential PainManagement course is an example ofstarting with important principles andbuilding on the basics of practice.“The message of the course is extremelysimple so that facilitates early hand-overto local instructors,” he says. “But thecourse is also very flexible so people canlayer on as much complexity as they like.”Overall, he says the Overseas AidCommittee has achieved a lot in its twoyears of operation, ensuring ANZCA is“an outward-looking rather than inwardlookingCollege” and providing benefitsfor all areas of the College.“It increases the relevance andprofile of the College internationally andensures people are gaining skills from ananaesthetic and teaching point of view,”Dr Morriss says. “From an individual pointof view, people often do it for altruisticreasons. And, from a regional point ofview, we think that it’s also good to begood neighbours.”Meaghan ShawMedia Manager, ANZCA“ We work very hard to getmaximum bang for buck.So for a small investment,we can make quite largechanges in anaestheticpractice, patient safety,all these things.”Above from left: Learning to use equipment;An emergency trolley.30 ANZCA Bulletin June 2012

advertisementBefore prescribing, please refer to Product Information and to State and Federalregulations. Product Information is available from Mundipharma Pty Limited.PBS1 st DECEMBER201131

TOBACCO AND SuRGERy:ISSuES OF TITANIC IMPORTANCEOn April 15, 1912, the RMSTitanic sank with loss of morethan 1500 lives 1 . A centurylater, it remains one of theworst peacetime maritimedisasters, caused by failingsthat continue to both shockand fascinate the world 1 .In Australia and New Zealand, 20,000people die annually from tobacco-relateddisease, equivalent to the RMS Titanicsinking in the Tasman Sea every month 2 .Like the Titanic disaster, regulatoryfailure contributes to this tobacco deathtoll. For example, some tobacco productscontain additives, such as ammonia, thatincrease the addictiveness of nicotine (byincreasing its unionised fraction) withoutthe manufacturers being required to statethis on the packaging 3,4 .Gender and class inequity occurred inthe Titanic death toll. Ninety two per centof second-class male passengers diedcompared to 3 per cent of the femalepassengers in first class 1 .Class and gender inequity occurs withthe tobacco death toll too. The poorest20 per cent of Australian men are 1.8times more likely to face premature deathcompared with the wealthiest 20 percent. This is due largely to socio-economicdifferences in smoking prevalence 5 .Many patients quit smoking beforesurgery, particularly those having cardiacsurgery, cancer surgery and other majoroperations 6 . Surgery can promote quittingand quitting itself improves surgicaloutcome, including significant reductionsin wound infection and cardiovascularcomplications 7 . Despite this, evidencesuggests that preoperative clinics do notsystematically provide adequate smokingcessation care to patients having electivesurgery 8,9 . Such organisational failuresmay be costing lives in the same way thatsystemic failings led to unnecessary deathsin the icy Atlantic waters more than100 years ago.Clinicians dropping the ball onsmoking cessationPrior to August 2011, Peninsula Healthprovided little organisational support toencourage smokers to quit before electivesurgery. A survey of pre-admission servicesin Victoria, NSW and the ACT showedwe were not unusual in this regard 9 . Ourwaiting-list patients were sent a brochureentitled “About your anaesthetic”, whichincluded just two lines about smokingon page three:“Give up smoking at least six weeksbefore your surgery to give your lungs andheart a chance to improve. You need tolet the surgeon and anaesthetist know ifyou smoke.”32 ANZCA Bulletin June 2012

The “chance” for cardiovascularimprovement appeared not to motivatemost patients, who continued to smokeuntil the day of surgery. Perhaps manybelieved their lungs and heart were fine.Perhaps others would be motivated iftold their chance was increased by 30to 100 per cent for a range of majormorbidity including surgical site infection,pneumonia, myocardial infarction, strokeand septic shock 10 . Whether patients“need to let the...anaesthetist know”about their smoking or whether it is ourresponsibility to ask is a point that could beargued. However an audit of preoperativeassessments in the UK showed smokingstatus was documented in less than 25 percent of cases so perhaps there is a needfor smokers to volunteer the information 11 .The existing brochure was weak and 50per cent of surgical patients who smokedid not recall receiving this limited advice 12 .Fewer than 40 per cent of smokers wereaware that smoking increased anaestheticcomplications or made wound infectionsmore likely 13 . Clinicians were not talkingto their patients about smoking either.Only 9 per cent of smokers were told tostop by an anaesthetist and 25 per centby a surgeon 12 . Surgeons advised quittingsmoking in only 6.5 per cent of patients ina previous study at a Melbourne teachinghospital 14 . Clinician behaviour in thisregard may be influenced by concerns thatcessation just prior to surgery increasedrespiratory complications, although thisis increasingly recognised as medicalmyth that has persisted far too long 2,7,15 .In taking advantage of the “teachablemoment” that surgery provided for smokingcessation, it appeared that clinicians haddropped the ball.Stop before the opFrom August 2011, all smokers enteringthe Peninsula Health waiting list weresent a locally developed quit pack, whichaddressed the deficiencies identifiedabove. This was marketed as the “Stopbefore the op” program.It consisted of a colour brochuredetailing how quitting before surgerycould reduce postoperative morbidity/mortality and improve long-term healthif staying quit. A referral form for Quitlinewas included together with a reply-paidenvelope to our anaesthetic department.The brochure advised signing and postingthis form, which would be faxed to Quitline.It advised that Quitline is staffedby smoking cessation specialists whooffered a standard service of six freetelephone counselling sessions that wouldat least double the chances of long-termabstinence compared with trying alone 2 .Quitlines in all Australian states and NewZealand offer a similar service. Prior to“Stop before the op” less than 2 percent of smokers having surgery had usedQuitline in the past year.The new brochure included links forother support options such as face-to-facecounselling offered by Peninsula HealthCommunity Health.During the six-month pilot program,650 quit packs were posted to smokersentering the waiting list, resulting in 83requests (12.8 per cent) for Quitlineservices. Other patients contacted theanaesthetic department to say they hadquit without Quitline or saw a GP for help.Data was collected prior to the pilot showsthat although some patients did quit whileon the waiting list, this mostly occurredwithin a few weeks of surgery when theremay be little benefit (see figure below).“Stop before the op” increased Quitline usemore than fivefold and transformed quittingto clinically meaningful times of a month ormore. Following this success, the programis now permanent with a slightly modifiedquit pack being sent to every waitinglistpatient (smokers and non-smokers)as identification of smokers was timeconsumingand sometimes difficult.More lifeboats on the TitanicSince 1944, there have been more than300 papers showing the adverse effectsof smoking on surgical outcome, includingincreased risks of perioperative myocardialinfarction 10,16 . While it is appropriate toexplore risk reduction strategies throughresearch on beta-blockers (POISE),clonidine/aspirin (POISE-2) or nitrous oxideavoidance (ENIGMA-2), smoking cessationis a life-boat that is here and now.Our responsibility is to ensure thatall patients are offered the chance toget in the lifeboat if they choose.Dr Ashley WebbFrankston Hospital, VictoriaDistribution of quit durations before surgeryfollowing implementation of “stop beforethe op” quit pack: increased % of clinicallymeaningful quit times (>1 month)6 months31.8 27.3 29.5 11.4 11.1 16.7 72.2 5.6Before quit packsAfter quit packsReferences:Links: Australian Quitline referral form: www.quitnow.gov.au/internet/quitnow/publishing.nsfNew Zealand Quitline referral form:www.quit.org.nz/94/helping-others-quit/healthprofessionals1. Spignesi SJ. The Titanic For Dummies. Hoboken:John Wiley & Sons; 2012.2. Webb A. Smoking and surgery: time to clear theair. In: Riley R, ed. Australasian Anaesthesia 2011.Melbourne: ANZCA; 2012:115-124.3. Henningfield J, Pankow J, Garrett B. Ammonia andother chemical base tobacco additives and cigarettenicotine delivery: issues and research needs.Nicotine Tob Res. Apr 2004;6(2):199-205.4. Heydon NJ, Kennington KS, Jalleh G, Lin C. WesternAustralian smokers strongly support regulations onthe use of chemicals and additives in cigarettes. TobControl. May 2012;21(3):381-382.5. AIHW. Australia’s Health 2010. Australia’s healthseries No. 12. In: Welfare AIoHa, ed. Vol Cat. No122. Canberra: AIHW; 2010.6. Shi Y, Warner DO. Surgery as a teachable momentfor smoking cessation. Anesthesiology. Jan2010;112(1):102-107.7. Myers K, Hajek P, Hinds C, McRobbie H. StoppingSmoking Shortly Before Surgery and PostoperativeComplications: A Systematic Review and Metaanalysis.Arch Intern Med. Jun 2011;171(11):983-989.8. Wolfenden L, Wiggers J, Knight J, et al. Increasingsmoking cessation care in a preoperative clinic:a randomized controlled trial. Prev Med. Jul2005;41(1):284-290.9. Lee B, Webb A. Smoking cessation strategies atpublic hospital preadmission clinics in Victoria, NSWand ACT. ANZCA Annual Scientific Meeting 2012;www.anzca.edu.au/events/ANZCA per cent20annualper cent20scientific per cent20meetings/2012-anzca-annual-scientific-meeting/epostersessions-2012/asm-2012_435.pdf.10. Turan A, Mascha EJ, Roberman D, et al. Smokingand perioperative outcomes. Anesthesiology. Apr2011;114(4):837-846.11. Simmonds M, Petterson J. Anaesthetists’ records ofpre-operative assessment. Clin Perform Qual HealthCare. 2000;8(1):22-27.12. Webb A, Robertson N, Sparrow M, McCormackM, Connell G. Smoking cessation before electivesurgery: who is telling patients to stop beforethe operation? ANZCA ASM 2012; www.anzca.edu.au/events/ANZCA per cent20annual percent20scientific per cent20meetings/2012-anzcaannual-scientific-meeting/eposter-sessions-2012/asm-2012_382.pdf.13. Webb A, Robertson N, Sparrow M, McCormack M,Connell G. Elective surgical patients who smokehave low awareness of their increased perioperativerisks. ANZCA ASM 2012; www.anzca.edu.au/events/ANZCA per cent20annual per cent20scientific percent20meetings/2012-anzca-annual-scientificmeeting/eposter-sessions-2012/asm-2012_381.pdf.14. Myles PS, Iacono GA, Hunt JO, et al. Risk ofrespiratory complications and wound infectionin patients undergoing ambulatory surgery:smokers versus nonsmokers. Anesthesiology.Oct 2002;97(4):842-847.15. Shi Y, Warner DO. Brief preoperative smokingabstinence: is there a dilemma? Anesth Analg.Dec 2011;113(6):1348-1351.16. Peters MJ, Morgan LC, Gluch L. Smoking cessationand elective surgery: the cleanest cut. Med J Aust.Apr 2004;180(7):317-318.33

Lessons aboundon a Dili adventureVolunteer anaesthetist,Dr Jane McDonald,in Timor LesteI flew into Dili from Darwinat 8am on Saturday. Whenwe landed, a blast of warmand humid air hit me as Istepped off the plane. I noticedimmediately the smell ofburning wood from hundredsof outdoor cooking fires,reminding me of bushfiresback in Australia.This was my first trip to Timor Lesteand I was travelling with ear nose andthroat surgeon Dr John Curotta and nurseDanielle Doughty. We were volunteerscoming to provide specialist ear noseand throat surgery through the RoyalAustralasian College of Surgeons (RACS).I carried a large padlocked bright orangecase with me, containing a smorgasbordof anaesthetic drugs provided by RACS.We were cleared through customs andthen met by Dr Eric Vreede, a specialistanaesthetist and team leader of theAustralia-Timor Leste Assistance forSpecialised Services (ATLASS) program,which is funded by AusAID.Timor Leste is a small country only640 kilometres north-west of Darwin, andis one of Australia’s nearest neighbours.Colonised by the Portuguese in the 16thcentury, the predominantly Catholicpopulation is made up of people ofMalayo-Polynesian and Papuan descent.The population is just over one million,though a high birth rate means it isincreasing rapidly. In 1974 Timor Lestewas invaded by Indonesia and yearsof violence followed, culminating in amassacre of Timorese in 1991. This wasa turning point, and an internationalpeacekeeping force was sent in untilorder was restored.In May 2002, Timor Leste becamean independent sovereign state. Yearsof fighting have destroyed much ofthe country’s infrastructure. The newpresident was military-fatigues-wearingand bearded ex-Fretilin guerrilla leaderJose Xanana Gusmao. In 2003, Gusmaomet Fidel Castro at a non-alignednations meeting in Kuala Lumpur andon hearing of the young nation’s poorsocial indicators of life expectancyand infant mortality, Castro offered “athousand doctors”. Timorese studentshave since been training in Cuba onscholarships and more than 200 doctorshave graduated and returned to Timor.Also the Cuban Government has set up afaculty of medicine within the Universityof Dili, which has been running since2005. This has been the biggest Cubanhealth assistance program outside LatinAmerica.Since 2001 RACS has been providingsurgical services through the AustralianEast Timor Specialist Services Project(AETSSP). This has included facilitatinga continuous surgical service at Dili’sHospital Nacional Guido Valadares(HNGV) through the provision of along-term general surgeon, anaesthetistand emergency medicine physician.Local doctors have had their trainingstrengthened in areas of generalsurgical practice and there has been thedevelopment and implementation of acertified 12-month training course for 1534 ANZCA Bulletin June 2012

nurse anaesthetists. ATLASS is buildingon these achievements.After arrival, Dr Vreede looked afterour team. We collected a hire car andheaded towards our hotel. The roads werechaotic and crowded with tooting cars,buses, motor scooters, pedestrians anddogs, competing with each other for rightof way over the narrow and rough roads.We left our bags at our accommodationand made our way to Dili’s hospital tofind a large crowd of almost 500 patientswaiting to be seen by the ear, nose andthroat team from Australia.Communication is difficult in Timor.The official languages are Portugueseand Tetum though few people speakPortuguese. Many people also speakBahasa Indonesian. There are manyCuban-trained doctors who speakSpanish, and some Chinese doctors whospeak only Mandarin. An interpreterhelped us with the patients at the ear,nose and throat clinic.Mr Samento Faus Correia, the localco-ordinator and interpreter for RACS,wore a bright red Mao cap, which gavehim an appropriate air of authority. Hecontrolled the crowd and organised thepatients efficiently so Dr Curotta couldsee as many as possible. I became an“acting ear, nose and throat registrar”making notes and writing prescriptions.Australian volunteer and ear-care nurseJulie Sousness was able to triage patientswith the help of a surgical registrartrained in Fiji who worked at the hospital.There was a high incidence ofchronic ear infection and associatedcomplications. There were also patientswith chronic sinusitis, various untreatedcongenital abnormalities, sensorineuraldeafness, vocal cord problems andallergic rhinitis. Several patients hadoropharyngeal cancers caused bychewing betel nut, and one patient hadjuvenile nasopharyngeal angiofibromacausing severe epistaxis.We managed to see 280 of the patientsand identified 65 that would benefit fromsurgery. Unfortunately, we could notsee the rest. Prioritisation is difficult.We chose to concentrate on ear surgeryand gave priority to younger patients,those with bilateral tympanic membraneperforations, and those needingmastoidectomies.(continued next page)“ Several patients hadoropharyngeal cancerscaused by chewingbetel nut.”From top left: A view of Dili Harbour; Dr JaneMcDonald (left) puts a patient to sleep with thehelp of local Ear Care Nurse Julie Sousnessacting as interpreter; Halothane vapouriser;Dr John Curotta reviews a patient on the wardpost-operatively.35

Lessons aboundon a Dili adventurecontinuedWe operated on 20 patients over thenext week, aged from two to 32 years,performing mostly mastoidectomies forcholesteatoma, and myringoplasties.The average age of patients treatedwith surgery was 14 years. All surgicalpatients were in otherwise good health,though they were notably small in staturecompared with the Australian population.The heaviest patient was a man of 30 whoweighed just 52kg.Oxygen and halothane were available,but no other gases or volatile agents.Suction was provided by means of aportable electric pump. Drugs and someanaesthetic airway equipment came withus, provided by RACS.Nearly all patients I left to breathespontaneously. The available monitoringwas pulse oximetry, ECG and BP. Therewas no capnography. My anaestheticassistants were Timorese trained, but didnot speak English, so communication wasa problem. Medical students attendedmany of the sessions, though teachingwas also handicapped by languagedifficulties.The cost of our trip was assisted bythe generous efforts of the Rotary Clubof Balwyn Victoria. We hope we haveimproved the lives of a few Timoresepeople by our visit. It has definitelyprovided an opportunity to mentorTimorese trainees.Dr Jane McDonaldWestmead Hospital and Children’sHospital at Westmead“ All surgical patients werein otherwise good health,though they were notablysmall in stature comparedwith the Australianpopulation. The heaviestpatient was a man of 30who weighed just 52kg.”Above from left: Final year Timor Lestemedical students, trained in Cuba, watchingAustralian ENT surgeon Dr John Curotta do amastoidectomy. Danielle Doughty (volunteerwith the ENT team) is scrub nurse; Dr JohnCurotta (back to camera) examining patients atthe ENT clinic. To the left is Danielle Doughty.A patient who had surgery on a previous trip,in the green shirt, named Colito, acts asinterpreter.36 ANZCA Bulletin June 2012

NZ Anaesthesisia AnnualScientific MeetingBy combining with a specialistinternational conference, thisyear’s NZ Anaesthesia AnnualScientific Meeting is able tooffer an exceptional line up ofabout 100 international speakerscovering a wide range ofgeneralist and specialist topics.Scientific Co-Convenor Professor AlanMerry says the combined conference hasattracted the best anaesthesia facultyyet seen in New Zealand – and one thatmeans there will be something of interestfor all anaesthetists and trainees.The usual NZ Anaesthesia ASM is beingheld in Auckland between November14-17 along with the 2012 InternationalCongress of Cardiothoracic and VascularAnesthesia (ICCVA).“Combining with ICCVA has enabledus to attract an excellent internationaland Australasian faculty,” ProfessorMerry says. “I consider it the best we haveever had for a New Zealand conference,and they will be providing a first-classgeneralist stream.” Speakers in thegeneral stream come from the US, NewZealand, Australia, Germany and Canada.Professor Merry is one of a team ofscientific program advisors who have puttogether a comprehensive program underthe theme “What becomes of the brokenhearted? Outcomes and how to changethem”. It has a broad-ranging generalstream, a specialist ICCVA stream anda third stream that straddles the two.Registrants are able to attend any sessionin any stream.The combined conference is beinghosted by ANZCA and the New ZealandSociety of Anaesthetists in associationwith the Society of CardiovascularAnesthesiology (SCA), which is US-basedbut with an international membership ofover 6000 cardiac, thoracic and vascularanaesthesiologists. Its ICCVA congress isheld in different venues around the worldevery two years. This is the first time ithas been held in Australasia.Topics in the general stream includeperioperative management of stents,transthoracic echo for non-cardiacanaesthetists, dynamic monitoringfor non-cardiac surgery, goal-directedtherapy in non-cardiac surgery, and fasttrack anaesthesia and outcome. Someof the other subjects covered includeairway management, trauma, obstetrics,paediatrics, acute and high risk patients,risks in older patients, operating roomefficiency, simulation and outcome,intubation skills and perioperativeassessment.Professor Merry says the quality ofthe faculty overall is exemplified by thekeynote speakers – Dr Richard Duttonfrom the US, Professor Scott Beattie fromCanada and the NZSA Visiting Speaker,Dr Paul Baker, from Auckland.Dr Dutton is an attendinganaesthesiologist at the Universityof Chicago and the newly-appointedExecutive Director of the AnaesthesiaQuality Institute, which runs the NationalAnesthesia Clinical Outcomes Registry.Dr Dutton has been involved in myriadresearch endeavours for the past twodecades and has shared his professionalexpertise at more than 200 grandrounds and national and internationalsymposiums, specifically addressingsuch issues as haemostatic resuscitation,massive transfusion and factor VIIain civilian practice.Dr Dutton will present a Saturdaymorning plenary session on “Outcomes:how to measure them and changethem: perspectives from AQI”, as wellas speaking on “Trauma – anaesthesiaand outcomes” in one of the concurrentsessions.In his plenary session, Professor ScottBeattie from Canada will present on“What becomes of the broken hearted– angina: stents, coronary surgery andmodern medical management”. In ahuman factors concurrent session, he willspeak to “Perioperative assessment– how does it change outcome?”Dr Beattie is a professor in theDepartment of Anesthesia, University ofToronto, Faculty of Medicine and worksin the Department of Anesthesia andPain Management at the Toronto GeneralHospital, University Health Network .He is recognised internationally as anexpert in the area of cardiac anaesthesia.The NZSA Visiting Speaker, Dr PaulBaker, has 25 years’ experience as aconsultant anaesthetist at StarshipChildren’s Health in Auckland. He is alsoa senior lecturer in the Department ofAnaesthesiology, University of Auckland.His research interest and MD thesis is“Improving the safety and managementof the difficult airway”.In 1996, Dr Baker founded theAirwaySkills course, which has taughthundreds of anaesthetists, intensivistsand emergency physicians in New Zealandand Australia. He is also the developerof the Orsim bronchoscopy simulator.Dr Baker will present a plenary sessionon “Education in airway management”and a paper on the “Quality and safetyof airway equipment”.The combined NZ Anaesthesia ASM/ICCVA conference begins on WednesdayNovember 14 with various satellitesymposiums covering general and cardiactopics during the day, and the welcomereception in the evening. It opens formallyon Thursday morning, with the conferencedinner held on Friday evening.For the full program and other speakerdetails, and to register, go to www.iccva2012.com. Early bird registrationis open until September 5. Abstractsubmission for the moderated postersession, NZSA Ritchie Prize and NZSATrainee Prize is open until July 31.The NZ Anaesthetic TechniciansSociety conference is running in parallelwith the NZ Anaesthesia ASM/ICCVAconference.Susan EwartNZ Communications Manager, ANZCA37

ANZCA and government:building relationshipsANZCA continues to workwith the Australian andNew Zealand governmentswhich both handed downtheir budgets in May.AustraliaAged-care boost in budgetThe Australian government’s 2012-13budget, released in May, was consistentwith previous commitments made to thehealthcare system. The biggest ticket itemin the recent budget was a $3.7 billiondollar aged-care package, with additionalsupport for dental health, the NationalBowel Cancer Screening Program, healthinfrastructure projects, as well as ehealth.The government’s commitment toehealth was expanded with additionalfunding to support the roll out of thePersonally Controlled Electronic HealthRecord (PCEHR) over the next two years.Health Minister Tanya Plibersek has takena number of opportunities to promotethe PCEHR as a cost-effective methodfor managing the health information ofAustralians, in the lead up to the system’slaunch on July 1.Recent ANZCA submissionsANZCA continues to advocate on behalfof Fellows, providing submissions togovernment and health stakeholders ina variety of areas. ANZCA has recentlymade submissions to the:• Medical Board of Australia’sconsultation on the board fundingexternal doctors’ health programs.• The Australian Institute of Health andWelfare’s consultation on Nationaldefinitions for elective surgery urgencycategories.• The Australian Health WorkforceMinisterial Council’s Development ofNational Criteria under the NationalRegistration and Accreditation Scheme.• Health Workforce Australia in responseto its proposed Health ProfessionalsPrescribing Pathway in Australia.ANZCA’s past submissions, including theCollege’s accreditation submission to theAustralian Medical Council, can be foundat www.anzca.edu.au/communications/submissions.ANZCA recently met withrepresentatives from Health WorkforceAustralia regarding the ongoing healthworkforce 2025 study into the supply anddemand of medical practitioners witha focus on the data on the anaesthesiaworkforce. The College is providinginput into a report for Australian healthministers due later in the year.Specialist Training ProgramThe Specialist Training Program (STP) hasmade significant achievements over thepast four months. All funding agreementswith hospitals have been finalised, mosthospital reports have been received, andpayments have been made to supportthe training positions. ANZCA has beendeveloping systems to streamline theprocesses involved in managing the 37training positions across anaesthesia,pain medicine and intensive caremedicine.The College has made it a priorityto develop networks with STP stafffrom other colleges, in order to shareknowledge and experience, in additionto continuing to engage with governmenton training in expanded settings. The2013 STP application round has recentlyclosed. ANZCA, including the Faculty ofPain Medicine, received 23 applications,which were assessed for funding.The Australian Department of Healthand Ageing will assess the College’sassessment, as well as those made by therelevant health jurisdictions. The resultsof the application round are expectedlater this year.ANZCA is working with regional/rural/remote area sites through the RuralSupport Loading Grant (RSL) to assistthese sites to meet costs of supportingtrainees. All inquiries regarding theRSL and the 2013 STP application roundshould be directed to the STP projectmanager at stp@anzca.edu.au.38 ANZCA Bulletin June 2012

New ZealandHealth in the 2012/13 budgetThe New Zealand government’s 2012-13 budget was delivered on May 23.Health Minister Tony Ryall announcedan increase of $101 million for electivesurgery and cancer services. One ofthe goals of the funding is an increasein 4000 elective surgeries per year.Other areas of interest include directingfunding to reduce the waiting time forimaging and diagnostic tests, and ITimprovements to support faster access toresults. The government also earmarkedan additional $143 million for disabilityservices. In a so-called “zero budget”,the reallocation of funding still favoursVote:Health.Physician assistantsHealth Workforce New Zealand (HWNZ)has released the summative evaluationfrom its demonstration of the physicianassistant (PA) role at MiddlemoreHospital, where two PAs trained in theUnited States joined surgical teams forone year. Based on the results of thatdemonstration, HWNZ is now progressingwith the trial of the PA role in primarycare. The New Zealand office is workingwith HWNZ to ensure that the College iskept up-to-date with the PA project, andis providing advice to HWNZ on the newrole from an anaesthesia perspective.This project is an example of HWNZ’sapproach of rapid project developmentand implementation.ANZCA is developing a positionstatement on physician assistants andother alternative providers. The results ofthe Middlemore Hospital trial and othertrials will be used to inform this process.CPD for general registrantsThe Medical Council of New Zealand(MCNZ) has developed a continuingprofessional development (CPD) programfor doctors who are not vocationallyregistered or who are not participatingin a vocational training program, knownas “general registrants”. The programis designed to strengthen the CPDrequirements and monitoring of generalregistrants’ ongoing education.The Chair of the New Zealand NationalCommittee, Geoff Long, ANZCA’s ChiefExecutive Officer, Linda Sorrell, and theNew Zealand General Manager, HeatherAnn Moodie, met with MCNZ to proposethat general registrants working only ina specialist area (such as anaesthesia)and participating in an accreditedcollege program are able to fulfil MCNZ’srequirements. Following agreementby MCNZ, work is now underway toensure the CPD program meets MCNZ’srequirements by March 2014.SubmissionsNew Zealand’s drug purchasing agency,Pharmac, has sought the input of the NewZealand National Committee into thedevelopment of its Preferred MedicinesList. Submissions have been compiledon anaesthetic, analgesic and antiemeticagents, and on fluids and electrolytes.Recent submissions also includeadvice to the Health Quality and SafetyCommission, the Ministry of Health,and Health Workforce New Zealandon technical workforce planning anddevelopment, including anaesthetictechnicians.John BivianoGeneral Manager, PolicyANZCA39

Quality and safetyAustralian andNew ZealandAnaestheticAllergy GroupAnaesthetists know that anaphylaxisduring anaesthesia is a potentiallylife-threatening crisis. The event isoften traumatic both for patient andanaesthetist.It is also clear that anaesthesia isincreasingly delivered in a wide varietyof settings.Busy anaesthetists need readilyavailable information regardingmanagement and referral centres forthese patients to ensure subsequentanaesthesia is safe.Furthermore, anaesthetists involvedin subsequent care need clear guidelinesabout which anaesthetic agents can safelybe used.The Australian and New ZealandAnaesthetic Allergy Group (ANZAAG)was established in response to thesechallenges. ANZAAG members arespecialists with an interest in themanagement and diagnosis of allergy toanaesthetic agents.Members have been recruited throughthe network of specialists regularlyworking in this area. ANZAAG comprises68 members, including 50 anaesthetists,15 immunologists, one technical specialistand one perioperative physician, to date.The group represents 28 testing centresthroughout Australia, New Zealand andHong Kong.ANZAAG arose from a conceptdeveloped by New Zealand anaesthetistsinvolved in the management andinvestigation of patients who experiencedanaphylaxis during anaesthesia.The New Zealand group first met inthe early 1990s and rapidly demonstratedthe benefits of a network of specialistsincluding anaesthetists, immunologistsand technical/laboratory specialistsinvolved in this area of care. It wasapparent that a similar Australasiangroup could deliver benefits throughoutthe region.ANZAAG has since developed astructure to reflect the inter-collegiatenature of the members of the group. Theexecutive members of ANZAAG will forma sub-committee of ANZCA’s Qualityand Safety Committee to ensure a closeworking relationship between the twobodies.The current executive of ANZAAGincludes the chair, Dr Michael Rose(specialist anaesthetist, Sydney),ANZAAG co-ordinator Dr Helen Crilly(specialist anaesthetist, Gold Coast),immunologist representative Dr KatherineNichols (consultant immunologist andpathologist, Melbourne) and anaesthetistrepresentative Dr Peter Cooke (specialistanaesthetist, Auckland).The group first met in May 2010 andhas met twice a year since. ANZAAGmeetings focus on education anddeveloping resources to aid colleagues inthe event of allergic reactions associatedwith anaesthesia.ANZAAG is finalising a number of draftdocuments that will be available froma website that will launch at the ANZCAannual scientific meeting in Melbournenext year.The aims for ANZAAG are:1. To work towards best practice andsafety in relation to the treatment,investigation and prevention ofanaesthesia related anaphylaxis,working with other agencies nationallyand internationally.2. To foster information exchange,standardisation of practice andgood working relationships betweenanaesthetists, immunologists, allergistsand technologists involved in the followup and investigation of patients whoexperience perioperative anaphylaxisin Australasia.3. To foster critical inquiry and otherresearch in the area of perioperativeallergy and in the long term, to supportthese endeavours by establishing aresearch database of anaestheticrelatedallergy within Australasia.4. To provide and maintain web basedresources including Australasianguidelines for the management andinvestigation of anaesthesia relatedanaphylaxis and to advise on referraland investigations after such an event.5. To seek opportunities to keepanaesthetists, immunologists andallergists updated regarding the subjectof anaesthesia related anaphylaxis.ANZAAG will hold its annual generalmeeting and educational symposiumfrom March 16-17, 2013 at the PrincessAlexandra Hospital in Brisbane. Theeducational component will be open toall anaesthetists and immunologistsand will focus on areas of interest inanaesthetic drug allergy.Anaesthetists with a special interestin anaesthetic drug allergy managementare invited to join the group. For furtherinformation please contact Dr Helen Crillyat hcrilly@onthenet.com.au.Dr Helen CrillyANZAAG Co-ordinator40 ANZCA Bulletin June 2012

Anaphylaxis to drugsduring anaesthesiaFrom January 1993 to December 2011,the Victorian Consultative Council onAnaesthetic Mortality and Morbidity(VCCAMM) reviewed 164 cases of adversedrug reaction. The actual number of casesmay be higher and the true frequency forany drug is unknown in the absence ofaccurate denominator data.1. Reactions to neuromuscular blockers:• Life threatening anaphylactic reactionsto muscle relaxants comprises thehighest risk. It is suggested thatwhenever unexpected hypotension isencountered during induction, it is wiseto consider anaphylaxis and institutetreatment with adrenaline, even ifthe diagnosis is in doubt.• Hypotension may be the only clinicalfeature but cutaneous signs (rash,blanching, pallor) coughing orbronchoconstriction (increased airwaypressure, difficulty with ventilation,hypoxia) may also occur.• All anaesthetists should be preparedto initiate an emergency call to obtainimmediate support for co-ordinatedcrisis management in any case ofsuspected anaphylaxis.• Review of these cases revealed thatdelayed diagnosis, failure to rapidlyescalate adrenaline dose and co-existentcardiac disease were associated withincreased risk of mortality.2. Reactions to intravenous antibioticscan also be severe and life-threatening.In the case of cephazolin, carefulinquiry should be made aboutprevious hypersensitivity reactionsto cephalosporins and penicillin. Ahistory of major allergy to penicillinshould be a contraindication to theuse of cephalosporins as there is someevidence of cross reactivity.Associate Professor Larry McNicolChair, VCCAMMFigure 1: Intraoperative Drug Anaphylaxis 1993-201141

Quality and safetycontinuedComment on VCCAMM Reporton Anaphylaxis• The total number of cases investigatedis almost certainly a fraction of thoseoccurring over the period 1993-2011.This number of cases would be seenby a single busy anaesthetic allergyinvestigation clinic in approximately18 months rather than 18 years. This isprobably due to the lack of mandatoryreporting of anaesthetic anaphylaxis.• There is no doubt that muscle relaxantanaphylaxis has been and remainsthe principle cause of anaestheticanaphylaxis. The proportion ofreactions to each relaxant is dynamicand will have changed during theinvestigation period. It is unusualthat all muscle relaxants (for examplevecuronium and pancuronium) are notlisted here, presumably due to imperfectreporting of these events although by1993 many anaesthetists had changedto rocuronium in preference to olderagents. Thus it is important that thistable is not seen as a true reflectionof the relative risk for perioperativeanaphylaxis.• The statement that “it is wise to consideranaphylaxis and institute treatmentwith adrenaline, even if the diagnosisis in doubt” is excellent, and couldeasily be bolded.• Hypotension may be the only feature,but it is also worth noting thatbronchospasm may be the only feature.Anaphylaxis should be consideredin cases of severe and/or unexpectedhypotension, bronchospasm, aswell as when one or more of theseis present with skin signs (rash,erythema, urticaria) or angioedema.In cases when the diagnosis is unclear,treatment should be instituted andmast cell tryptase assays taken to helpinvestigations later.• The statement “All anaesthetists shouldbe prepared to initiate an emergencycall to obtain immediate support forco-ordinated crisis management inany case of suspected anaphylaxis”is excellent. Training/drills foranaphylaxis management shouldbe routinely practised.• It should be noted that it is the treatinganaesthetist’s responsibility to arrangefollow-up testing by an expert inanaesthetic allergy investigation.Significant morbidity, including furtherepisodes of anaphylaxis, have occurredwith failure of referral and investigationof perioperative anaestheticanaphylactic reactions.• Cross-reactivity between cephalosporinsand penicillins has been the subjectof great misunderstanding over theyears. While cross-reactivity doesexist (particularly between penicillinsand first generation cephalosporins)it is uncommon. Cross-reactivity isrelated more to similarities betweenthe side chains of antibiotics than thebeta lactam ring itself. It should beremembered that there is potentialmorbidity involved with the avoidanceof the most appropriate antibiotic. Thebest approach in patients with allergyto penicillins or cephalosporins is toobtain clarification of exact antibioticsensitivity by an immunologist withexpertise in this area of testing. Ina setting where such an opinion isunavailable and delay inappropriate,cross reactivity should be assumedif the reaction to the penicillin orcephalosporin was anaphylactic,involved evidence of angioedema,or significant cardiovascular orrespiratory compromise.Dr Michael RoseChair, Australia and New ZealandAnaphylaxis Allergy Group42 ANZCA Bulletin June 2012

Methylene blue andserotonin reuptakeinhibitors – an updateMixing methylene blue and SRIstriggers severe toxicityAn informed understanding of serotonintoxicity with methylene blue has notchanged since my previous comment in2008 1 . The seriousness and accuracy ofthe previous warning has been borneout by subsequent international reportsof severe reactions and a few deaths. Forthose who wish to refresh their memoryabout methylene blue and serotonintoxicity there is a summary in my mostrecent review 2 , as well as updatedinformation on my website (Google“Gillman methylene blue”).The story of interactions betweenmonoamine oxidase inhibitors (MAOIs),which includes methylene blue, anddrugs that possess significant serotoninreuptake inhibitor (SRI) capacity, mostlyantidepressants, 3 has confused not onlythe profession, but also the regulatoryauthorities. For instance, various sourcesincorrectly warn against mirtazapine,nortriptyline, bupropion etc, which donot have any SRI action and pose no risk.That is confusing and may precipitateunnecessary disruption or reschedulingof operations.One particular aspect of the (usuallypostoperative) presentation of serotonintoxicity warrants attention. Anaesthesiaitself is not only an effective treatmentfor the central nervous system and corehyperthermia of serotonin toxicity,but also tends to modify and disguisesigns and symptoms in the immediatepostoperative period. Body temperaturetends not to be elevated for a few hourspostoperatively, but can then rapidlyrise. In one recent case such a patientdied of hyperthermia, despite energeticcooling efforts 4 . Monitoring of core tempis essential, and judicious use of 5-HT2Aantagonists to treat hyperthermia maysometimes be required as a life-savingmeasure.There is no firm evidence as to whichof the available 2A antagonist candidatesis best. The choice may depend on thehistory and condition of the patient, therequired speed of onset (sub-lingual, IMIor IV) and the experience of the doctor.The possibilities are cyproheptadine(PO only), chlorpromazine (IMI/IV),risperidone (IM), olanzapine (sublingual),droperidol (IMI/IV), but notziprasidone, because it has significantSRI potency). As a guide, all these drugswould be expected to produce significantblockade at the 5-HT2A receptor in “usualclinical” doses 5 .Evidence supports the propositionthat in Australia, in contrast to othercountries, we have been successful inavoiding the toxic drug interaction ofserotonin toxicity.No cases have been reported to theTherapeutic Goods Administration(personal communication, March 2012),and all inquiries to me about methyleneblue toxicity have been from Europeand USA. There have been none fromAustralia.I would like to think that it is at leastpartly because of the attention thatAustralian anaesthetists have given tothe evidence that has been presented.Congratulations are due not only tothe medical profession, but also tothe manufacturers of methylene bluein Australia (Phebra), who included aspecific warning about serotonin toxicityon my advice. In contrast, warnings fromnational agencies (US Food and DrugAdministration and the British Medicineand Healthcare Products Agency), and inthe package inserts, are either absent orimprecise.ConclusionsMixing methylene blue with serotoninreuptake inhibitors predictably andfrequently causes severe and potentiallyfatal serotonin toxicity: discontinuationof SRIs, with appropriate washout periodsbefore using intravenous methylene blue,is a high priority and should probablybe considered mandatory. The situationwith smaller doses of methylene blue viaother routes is uncertain. Oral absorbencyis good and proposed uses of methyleneblue, such as chromo-endoscopy, maygenerate blood levels sufficient to provokeserotonin toxicity 6 .Dr P Ken Gillman, MRC PsychDr Gillman is a retired clinicalpsychiatrist with a special interestin neuropharmacology.References1. Gillman, PK, Methylene Blue: A Risk forSerotonin Toxicity. ANZCA Bull, 2008.17: p. 36.2. Gillman, PK, CNS toxicity involvingmethylene blue: the exemplar forunderstanding and predicting druginteractions that precipitate serotonintoxicity. J Psychopharmacol (Oxf), 2011.25(3): p. 429-3.3. Gillman, PK, Monoamine oxidase inhibitors,opioid analgesics and serotonin toxicity.Br. J. Anaesth., 2005. 95: p. 434-441.4. Top, W, Gillman, PK, de Langen, C, andKooy, A, Fatal methylene blue associatedserotonin toxicity. 2012: p. [in preparation].5. Kapur, S, Zipursky, RB, Remington, G, Jones,C, et al., 5-HT2 and D2 receptor occupancyof olanzapine in schizophrenia: a PETinvestigation. Am J Psychiatry, 1998. 155:p. 921-928.6. Repici, A, Di Stefanob, AFD, Radicionib,MM, Jasc, V, et al., Methylene blue MMX®tablets for chromoendoscopy. Safetytolerability and bioavailability in healthyvolunteers. Contemporary Clinical Trials,2011. 33: p. 260–267.43

Quality and safetycontinuedECRI alertsThe ECRI Institute is a non-profitorganisation that issues alerts fromfour sources: the ECRI InternationalProblem Reporting System, productmanufacturers, government agenciesincluding the US Food and DrugAdministration (FDA) and agencies inAustralasia, Europe and the UK as wellas reports from client hospitals.Some alerts may only involve singleor small numbers of cases, there is nodenominator to provide incidence andthere is not always certainty about theregions where the equipment is supplied.This section can only highlight someof the alerts that may be relevant. It is theresponsibility of the hospitals to follow upwith the manufacturer’s representativesif they have not already been contacted.Flow rate inaccuracy in Bayer MRtubing sets used with Continuumpumps (designed for use in MRIenvironments)Bayer MEDRAD Continuum MR infusionsystem tubing may exhibit variations inflow when used with Continuum infusionpumps. There has been a recall of thetubing and continuum pumps that havebeen calibrated with the tubing.Accurate delivery of criticalmedications in the MR environment isdifficult without appropriate pumps.Although it is possible to the use“regular” volume or syringe pumps sittingoutside the field and to connect to thepatient with several extension tubing sets,the compliance and length of tubing mayaffect rate accuracy and responsivenessto rate changes. Other MR conditionalpumps are available.Cassette test failure alarm on loadingof Hospira PlumSet Administration Setonto pumpHospira has recalled its 104-inch LifeshieldPrimary PlumSet Administration Sets.A cassette failure alarm may occur whenthese sets are loaded onto the pump,possibly due to failure in welding of thecassettes. The cassette cannot and shouldnot be used. The main potential adverseoutcome is a delay in administration ofthe required therapy.Luer connection leak in COBE spectrablood warmer systems (Caridian BCT)If specific directions are not followed,a leak may occur at the return luerconnection to an elevated blood warmerpotentially resulting in air entrainmentinto the system.Caridian BCT has inserted anaddendum to the labelling: “Whenconnecting a blood warmer tubingset to the return line, ensure that thetubing connection is tight. Put the luerconnection no higher than 50cm abovethe return access to prevent the possibilityof air entering the tubing”.Dr Phillipa HoreCommunications and Liaison PortfolioQuality and Safety CommitteeGeneral alertsCoronial alertAn Australian coroner investigating thedeath of a patient undergoing repair of aclavicle recently highlighted his findingsthat a screw had been inadvertentlyinserted into the right subclavian vein.There was considerable haemorrhage,which was aggressively managed, butthe patient did not improve and couldnot be resuscitated. The possibilityof concomitant air embolism was alate diagnosis, probably due to theconcentration of the surgical andanaesthetic team on managing thehaemorrhage.While not critical of the team, thecoroner sought to highlight the possibilitythat whenever a large vessel is perforated,other causes of refractory resuscitationsuch as air embolism should beconsidered as well as the hypovolaemiathat results from massive haemorrhage.Dr Patricia MackayCommunications and Liaison PortfolioQuality and Safety CommitteeGreen armbands in ophthalmicsurgeryAustralian anaesthetists should be awarepatients who have vitreo-retinal surgeryget a green wristband if they have had gasinstilled in the globe of the eye.The band remains on until the surgeonconsiders the gas has completely gone,usually 4-6 weeks. The administration ofnitrous oxide under these circumstancesmay be a potential risk to the eye andshould be avoided.Safety of Anaesthesialatest reportANZCA’s Safety of Anaesthesia, a reviewof anaesthesia-related mortality reportingin Australia and New Zealand 2006-2008is now available on ANZCA’s websiteunder resources. A web booklet versionwill be available soon and publicised inan upcoming ANZCA E-Newsletter. Forqueries please contact ANZCA’s Qualityand Safety Officer on qs@anzca.edu.au.44 ANZCA Bulletin June 2012

The dangers ofself-inflatingresuscitation bagsSelf-inflating resuscitation bagsare essential but rarely usedadjuncts to the anaesthesiamachine, a vital back upwhen the oxygen supply oranaesthesia machine fails.They are also essential itemsof equipment in the postanaesthesiacare unit (PACU),on cardiac arrest trolleys andin emergency departments.However, a number of hazards areassociated with the use of these bags, bothre-usable and disposable models, many ofwhich will be well known to anaesthetistsand intensivists.Dr Jane Torrie, the Director of theSimulation Centre for Patient Safety inAuckland, has identified an issue with oneparticular bag and reports:“Our usual bag valve mask productstocked in our university medicalsimulation centre was recently replacedwith the L670 BVM single use productmade by Allied Healthcare, Missouri, andimported by Care Medical.”“During teamwork research over threedays in late February 2012, we videoed25 teams (anaesthetist, post-operativecare nurse and anaesthetic assistant)managing highly-realistic simulated casesof deteriorating patients in a post-operativecare area. All team members wereclinically experienced and work in largelocal medical institutions where similarbag valve mask systems are stockedand used.“The research team observing the casesnoticed that in 11 out of 25 cases (44 percent), a member of the team disconnectedoxygen tubing from the manikin’soxygen face mask and connected it tothe manometer port of the L670 BVMafter removing the white port cap. Inall 11 cases, none of the team membersdetected the error during the remainder ofthe simulated case, and the oxygen wasdelivered at maximum flow rate (12-15 lpm)into the port for several minutes.“The research team felt that barotraumawas a possibility in these cases, so atthe end of the research simulations weconnected a two-litre test lung bag to theL670 BVM, connected oxygen tubing tothe manometer port and turned gas flowsto 12 lpm.“It was apparent that the test lungbag expanded alarmingly to a volumeof several litres and that there was nopressure relief system functioning toprotect patient lungs from O2 supplypressure in this device configuration.A photo is attached. This behaviourcould also be reproduced using a brandnew L670 BVM found in an operatingroom at Auckland City Hospital, but notconsistently. There is no visible differencebetween the two BVMs.“Patients whose lungs are ventilated viaa closed system (endotracheal tube) wouldbe at high risk of life-threatening lungbarotrauma if the L670 manometer portwas connected to oxygen tubing.“It is obvious that this connection errorwill also reduce the inspired O2 in mostcases, as the reservoir bag does not filldespite high O2 flow rates. A secondphoto is attached demonstrating this.“While we are aware that this is notthe intended configuration of the L670, weobserved a large proportion of experiencedhealthcare professional teams, who wereusing it for the intended purpose, actuallyassemble it in a hazardous configuration.Even more concerning, the error wasnot apparent to them and thus was notcorrected.”The problem was reported to Medsafe(the authority responsible for regulatingtherapeutic products in New Zealand),which did not think it appropriate totake formal action as it understood thisparticular product had already beenwithdrawn from the market; the issue wasone of incorrect use rather than devicefailure; and there had been no adverseevents arising from such incorrect useof this or similar products.Despite this, MedSafe is keen thatword of this potential hazard is distributedto all anaesthetists.This is a timely reminder that thereare many hazards associated with thesebags. Some hazards – such as the facilityfor incorrect assembly rendering themuseless and foreign material such as vomitaccumulating in the old black Ambu bags– have largely been eliminated, or at leastreduced by improved design.A further series of problems is associatedwith the use of a filter between the bag andthe patient. This is, of course, unnecessaryif a disposable bag is used but severalbrands of re-usable bag are still available.This is not the forum to discuss the prosand cons of disposable devices but someof the hazards are as follows:• High pressure oxygen could be connectedto the CO2 monitoring port of the filterresulting in exactly the same issues thatDr Torrie had in the simulation centre.• The same port can be left open or evenbroken off, resulting in a large leak andtotally inadequate ventilation.• The filter can be blocked by patientsecretions.• There are other disposable devices withports between the bag and the patient.All anaesthetists should be aware of theseproblems and take the following actions:• Check the self-inflating resuscitationbags in your clinical area frequently.• Never use a filter with a disposabledevice.• Make sure the O2 tube is connected tothe end of the bag away from the patient.(It should be stored in this configuration,which will prevent the last minuteincorrect assembly experienced byDr Torrie’s subjects.)• Educate nursing and other staff atevery opportunity on the safe useof these devices.Dr Joe Sherriff, FANZCAANZCA’s National Quality and SafetyOfficer, New Zealand45

ANZCA Trials Group meetsat the annual scientificmeeting in PerthPerth meetingOne of the important core activities forthe ANZCA Trials Group is the annualscientific meeting. This year, the Perthmeeting included two trials groupscientific sessions, the annual trials grouplunchtime meeting and a trials groupexecutive committee meeting.For the first time since the 2011 PalmCove research workshop, the newlyformed ANZCA Research Co-ordinators’– Special Interest Group (ARC-SIG) metat lunchtime on May 12 at the PerthExhibition and Conference Centre. The 11participants, led by Sofia Sidiropoulos,discussed terms of reference for futuremeetings and a program for the breakoutsessions for the forthcoming ANZCA TrialsGroup Strategic Research Workshop inPalm Cove on August 10-12.All co-ordinators were partiallysupported to attend by the NationalHealth and Medical Research Councilgrant for the Peri-operative IschaemicEvaluation-2 Trial (POISE-2 trial).Associate Professor David Storychaired the first ANZCA Trials Groupscientific session on Saturday morning.Professor Steve Webb, the chair of theAustralian and New Zealand IntensiveCare Society-Clinical Trials Group(ANZICS-CTG), opened the sessionwith a talk on what is new in intensivecare research. Professor Matthew Chanfollowed with a presentation on hiswork with the neuro-vision pilot study.Professor Julia Fleming wrapped up thesession with a presentation on intraguanethidinefor Raynaud’s syndrome:a pilot study. Both Professors Chan andFleming were recipients of the ANZCATrials Group Pilot Grant Scheme, andwere awarded grants of $5000 last year.The chair of the ANZCA Trials Group,Associate Professor Tim Short, chairedthe second session, “Methods andmadness in clinical trials”, on Tuesdayafternoon. Professor Paul Myles gave aninformative talk on equipoise in clinicalresearch. Professor Myles was followedby Dr Nolan Mc Donnell, who demystifiedthe mysterious with a presentationon superiority, non-inferiority andequivalence trials.The ANZCA Trials Group sessionsat the annual scientific meeting followan update/methodology/results formatand Professor Stephen Schug finishedthe session with a presentation onmeasurement tools in acute pain research:is there room for improvement?The annual ANZCA Trials Grouplunchtime meeting followed and wasattended by more than 30 participantsfrom Australia, New Zealand and HongKong, including research co-ordinatorsassociated with trials group research.Professor Tim Short chaired the meeting.Professor Myles opened the discussionon how future research could be betterfunded especially for investigatorinitiatedresearch, as well as updating theattendees on research activity associatedwith ANZCA multicentre research.Most of the lunchtime meeting wasassigned to a POISE-2 investigatormeeting, chaired by the national coordinatorfor Australia and New Zealand,Professor Kate Leslie. She informed themeeting that POISE-2 is engaged with 33sites across Australia, 10 are activated and27 patients have been recruited to date.Professor Leslie thanked the investigatorsand co-ordinators at the meeting fortheir hard work and persistence ingetting POISE-2 up and running in adifficult research environment. TheRoyal Adelaide Hospital (Dr TomPainter and Sue Lang, and colleagues)was identified as having made anoutstanding contribution to POISE-2,with 16 patients recruited to date. Thissite is also the largest contributor to theAspirin and Tranexamic Acid for CoronaryArtery Surgery Trial (ATACAS Trial).Congratulations to Tom and Sue andtheir colleagues!Pilot grantsThe ANZCA Trials Group is pleased toannounce that the first pilot grant of$A5000 for 2012 has been awarded toDr Ben Olesnicky, Royal North ShoreHospital, NSW, for his project “Effectof Analgesic Regime on OutcomesFollowing Major Hepatobiliary Surgery– A Comparison of Epidural Analgesiaand Intrathecal Morphine”.For more information of the ANZCAPilot Grant Scheme, which is open toapplicants all year, see: www.anzca.edu.au/fellows/Research/trials-group/pilotgrant-scheme.htmlPublicationsLeslie K, Myles PS, Chan MTV, Forbes A,Paech M, Peyton P, Silbert BS, WilliamsonE. Nitrous oxide and long-term morbidityand mortality in the ENIGMA Trial.Anesth Analg 2011; 112:387-393.Graham AM, Myles PS, Leslie K, Chan MT,Paech MJ, Peyton P, E I Dawlatly AA. Acost-benefit analysis of the ENIGMA trial.Anesthesiology 2011 Aug;115(2):265-72Myles PS; the ENIGMA Trial Investigators.Correspondence. Anesthesiology. 2012Mar; 116(3):736Leslie K. Myles P.S. Halliwell R. PaechM.J. Short T.G. Walker S. Beta-blockermanagement in high-risk patientspresenting for non-cardiac surgery: Beforeand after the POISE Trial. Anaesthesiaand Intensive Care 2012; 40(2): 319-327.46 ANZCA Bulletin June 2012

Events4th Annual Strategic ResearchWorkshop, Sea Temple, Palm Cove,Qld, August 10-12.Following a very successful workshopmeeting in Palm Cove in 2011, the ANZCATrials Group is returning to Palm Covefor its 4th annual consecutive meetingthis year. The workshops bring togetherexperienced researchers as well as newand emerging researchers from Australia,New Zealand and Hong Kong. Thesemeetings aim to present, mentor andencourage new ideas for multicentreresearch in anaesthesia, perioperativeand pain medicine. Participants receiveupdates about existing research and areencouraged to engage in multicentretrials.We also encourage anaesthesiaresearch nurses and co-ordinators toattend.ANZCA Research Co-ordinators’ –Special Interest Group (ARC-SIG) hasinvited the Australian and New ZealandIntensive Care Society-Clinical TrialsGroup (ANZICS-CTG) Research Coordinators– Special Interest Group chair,Rachael Parke, from Auckland, to presentat one of the breakout sessions.Associate Professor Steve Webb, thechair of the ANZICS-CTG, is a guestspeaker along with biostatisticianDr Katherine Lee from the ClinicalEpidemiology and Biostatistical Unit,Murdoch Children’s Research InstituteMelbourne. There will also be a POISE-2trial investigators’ meeting.Participants are encouraged to bringalong their ideas for future multicentreresearch. Please contact spoustie@anzca.edu.au prior to the workshop with thetitle and a one-page summary of yourproposal(s).More information can be found at:www.anzca.edu.au/fellows/Research/anzca-trials-group-events.htmlStephanie PoustieANZCA Trials GroupResearch Fellow and Co-ordinator8th ISHA 2013ISHA 2013History Matters!‘The Anaesthetist’ by HaroldCazneaux 19338th International Symposium onthe History of Anaesthesia,22–25 January 2013, University of Sydney, AustraliaSatellite meeting, Melbourne, January 29-30Geoffrey Kaye Museum of Anaesthetic History, Australian& New Zealand College of AnaesthetistsThe University of Sydneywww.isha2013.comisha2013@asa.org.au47

Welcome to the Melbourne 2013 Annual Scientific Meeting of theAustralian and New Zealand College of Anaesthetists and Facultyof Pain Medicine. Taking place from May 4 to 8, 2013, the regionalorganising committee has planned a scientific program in a venue withan international green star rating that prides itself on high quality foodand wine, complemented by an engaging social program. All in one ofthe best cities in the world – which combines refined culture with cuttingedge cool! With its leafy boulevards, intimate laneways, cultural precinctsand known for its dining-out scene, Melbourne is the perfect setting toreconnect with colleagues and to meet new ones.The theme ‘Superstition, dogma and science’ is an opportunity for eachof us to critically examine our practice and reflect on these elements in allthat we do.Are we creatures of habit? Are we as open to change as we think? Canwe justify and explain the choices we make every day?We have embraced this theme by developing a diverse scientific programto be delivered by an exceptional group of world-renowned anaesthetistsand pain specialists, in conjunction with many other outstanding medicalspecialists, scientists and non-medical professionals. We will showcasethe strengths of our specialty through these highly respected championsand support their teaching with dynamic workshops and small groupdiscussions. The flexibility and scheduling of the program will allow youto choose your own adventure and create the conference experiencethat you seek. We invite you to bring an open mind and look forward towelcoming you to Melbourne in 2013.Dr Debra Devonshire, ConvenorDr Mark Hurley, Deputy ConvenorDr David Bramley, Scientific Co-ConvenorDr Rowan Thomas, Scientific Co-convenorDr Michael Vagg, FPM Scientific Convenor48 ANZCA Bulletin June 2012

ConFIrmed keynote SPEAKERSProfessor Kevin TremperMD, PhD (ANZCA ASM Visitor, USA), University of Michiganand head of the Multicenter Perioperative OutcomesGroup, whose plenary lecture will address the translationof large population outcome study results into decisions forindividual patients under our care.Associate Professor Timothy ShortMB, ChB, MD Otago, FANZCA, FHKCA (Australasian Visitor,New Zealand), current chair of the ANZCA Clinical TrialsGroup, an expert in pharmacological interactions asreflected in response surfaces, as well as the associationbetween depth of anaesthesia and outcomes.Professor Edzard ErnstMD, PhD, F Med Sci, FRCP, FRCP(Ed) (FPM ASM Visitor,UK), the first full professor of complementary medicinein the UK, who has vast experience in bringing scienceand evidence to this often unscientific and largelyunregulated field.Professor Paul WhitePhD, MD, FANZCA (ANZCA Victorian Visitor, USA) fromCedar Sinai Medical Centre, a widely published expert inanaesthesia for ambulatory surgery and section editor forAnaesthesia & Analgesia, who will focus particularly onsome of the myths and science behind anaesthesia for ouraging population.Professor Fabrizio Benedetti,MD (FPM Victorian Visitor, Italy), internationally recognisedfor his research in the neuroscience of placebo and for hisbook The patient’s brain: the neuroscience of the doctorpatientrelationship.Professor Colin Royse,MBBS MD FANZCA (Organising Committee Visitor, Australia),known for his research in cardiac anaesthesia, ultrasoundand echocardiography, who will address the outcomesthat really matter to patients.Register your interestat www.anzca2013.com or via emailat anzca2013@wsm.com.auComing soon...The regional organising committeerecommendations on the top FIVEcoffee houses, bars, bike routesand kick back venues.KeY datesCall for AbstractsOpen September 2012RegistrationOpens November 2012Call for AbstractsClose February 2013Notification to AuthorsEarly March 2013Early Bird RegistrationCloses March 2013ANZCA ASM 2013May 4-8, 201349

SuccessfulcandidatesPrimary examinationFebruary/April 2012One hundred and sixty four candidatessuccessfully completed the PrimaryFellowship Examination and arelisted below:Nathan Mark OatesRoss Ingle HanrahanAdam Mark HillAdelene Su-Chen OngAlison Beth MainAlyson Patricia McGrathAman Bamra Deep SinghAmardeep SinghAnanth KumarAndrew Mena NikolaAshokkumar MurugesanChristopher Michael MasonDaniel HernandezDavid Jack ZalcbergDavid Sai-Wo ChengJang Cheu ChamJessie LyJoseph Peter WilbersKaren Ann HungerfordKarina Simone BerzinsLara RybakLeonid PinskiLucy Rebecca KellyMahsa MirkazemiMarcin Felix TeisseyreMichael Patrick ReidNathan Andrew MooreNathan Roy ThompsonNeil Lawrence PillingerPenelope Gaye TaylorPeter Alexander BairdPhui Leng ChanRebecca Jade McNamaraRebecca ScottSheung Hei Anthony WanShirin JamshidiSimon Christopher McLaughlinSunshine Kaya AustinTrylon Matthew TsangAbigail Ngar-Yee WongBehruz Mohammad JamshidiCatherine Ann Abi-FaresChristian Van NieuwenhuysenChristopher John GortonClaire Margaret Amy ManningClinton John PatricksACTACTNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWQldQldQldQldQldQldQldCraig Andrew McDonaldDaniel James RobertsonDavid Gutierrez-BernaysDavid LiuDesiree Vanguardia PerezJacqueline YungJoanne Lyn CumminsJolyon Jay BondKarl James GaddKellie Maree BirdLinh Tien NguyenMichael John SabaOhmar AungPaul Robert MillsPeter Francis CorreaRajdev ToorRebecca Helen KampSamuel Michael BongersSim-Wei HowSorcha Eibhlin EvansStephen Chi-Wei FungThomas Michael WalshVictor Khi LeeWai-Mee FoongYee-Jen Jane ChiaAdam Richard StoreyAlexandra Alison BullAnn-MareeBarnesJames Arthur LondonLaura Jane WillingtonMarni CalvertRichard Peter ChampionRichard Samuel LumbJohn James CarneyAlireza ShangarffamAmandeep Singh SaraiBishoy MoussaBronwyn Calire ScarrCarolyn Sarah VarneyClara Anamaria CotaruDamien ElsworthDaniel Knox JoyceDarragh Eoiw O’BrienDorothy Wai-Lin ChanFazian ZiaGordana UkalovicGregory Michael BulmanHarriet Clare BeevorJames Austin McGuireJenny Clare HewlettJoshua Anthony SzentalJulia KuchinskyJulie Yin Mei ChanQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldSASASASASASASASATasVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicKacey Nicole WilliamsMarissa FergusonMelinda Neroli MilesMurthi SangeethaNathalie Mei GomesNoam Benjamin WinterPeter DoukasRyan Basil McMullanSophia Cotton BerminghamThomas Peter SullivanVanita Mohan BodhankarVerity Rachel SuttonVina MelianaVincent Andrew Kun-Sai YuenYing ChenAndrew Jin-Meng LeeAnna CarterChristine Siang-Yin OngDaniel Eric AndersonIng-Kye SimJan David JanmaatJen Aik TanMumtaz Anwar KhanNathan Jon CurrPaul Anthony CosentinoPaul Matthew RicciardoRenuka AlakesonRohan David MahendranWilliam Henry FellinghamKa-Hei ChongMaggie Wai Ying TsuiSen Yin Stevienne TamWai-Naam Wales ChanWoon-Lai LimAbhishek JainAlison JacksonBeau Curby KlaibertChen Seong OngDavid Samuel PriorEmily Claire RowbothamErica Ting-Yi HsuGemma Anne MalpasGraham Clifford WesleyHeidi Joanna Mary NelsonJeremy Stephen YoungJoesph Raoul McKerrasJulia Kate TaylorKatia Vanya HayesMadison Rosanna Elaine GouldenMichael Richard TanRochelle Amanda BarronRuth Elizabeth BrownSallie Elizabeth MalpasVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicWAWAWAWAWAWAWAWAWAWAWAWAWAWAHKHKHKHKMalNZNZNZNZNZNZNZNZNZNZNZNZNZNZNZNZNZNZNZ50 ANZCA Bulletin June 2012

Sathish KrishnanScott Yu-Chun WuSiew Ting ChinSophie Caroline Van OudenaarenYiyi ZhangDesmond Yu Mun HoFung Chen TsaiLik Han TeeSelene Yan Ling TanStella Lin AngXian’en Hope AngZhi-Xiang TanNZNZNZNZNZSingSingSingSingSingSingSingRenton PrizeThe Court of Examiners recommendedthat the Renton Prize for the half yearended June 30, 2012, be awarded to:Ing-Kye SimWAMerit CertificatesMerit Certificates were awarded to:Jacqueline YungJen Aik TanJulie Yin Mei ChanAndrew Mena NikolaEmily Claire RowbothamYiyi ZhangJeremy Stephen YoungJulia KuchinskySelene Yan Ling TanDaniel Eric AndersonGregory Michael BulmanAdam Richard StoreyThomas Peter SullivanJolyon Jay BondSangeetha MurthiAlexandra Alison BullQldWAVicNSWNZNZNZVicSingWAVicSAVicQldVicSAFinal examinationMarch/May 2012One hundred and thirty five candidatessuccessfully completed the FinalFellowship Examination and arelisted below:Hon Earn SimAdrian BoynAlexander DuthieAndrew Alexander LovettAngela SuenArjun NagendraBrendan Alexander IrvineCaroline Anne JacksonCaroline Liana FungChristopher Charles StoneDinesh Harkishin ThadaniElizabeth Mei-Ying SymonsEmily Ching-Ying YeohJia Jia YeJonathan Douglas MintonMarie Christiane HadassinPaul Mark HealeyRachel RuffRagu NathanRobert Patrick HeavenerStanley L. YuStephanie Wei Yin FongStephen Jonathan SmithThananchayan ElalingamTimothy SuhartoWajdi Hadi MohamadAhmad Al-SalhiYasmin Vivian Celeste ZarebskiAlistair Grant KanBradley John SmithBrooke Jean VickermanColin Thomas BrodieEmma Lucinda WaltersFrancesca Lee RawlinsJacqueline Annette EvansJeremy Luke BrammerJoshua Surian DalyKellie Anne OvendenLisa DeeckeLynda Glenys Veronica AllchurchMinka GrenierMitchell MorseNurul Shamsidar Mohamed BakriPaul Francis WiganPaul Joseph BennettACTNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWNSWQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldQldPaul Robert NicholasPeter David KoudosPhilip Lloyd StaggTorben Neal WentrupWendy Julia MorrisWilliam Thomas MeadeYasmin WhatelyAndy Sisnata SiswojoArvinder GroverBenjamin Philip JonesChuan-Whei LeeDaniel Hsin-Kai LiuGareth Iain SymonsGauri Sangeeta ReschGrace Mei Ling SeowHerman LimIan Thomas ChaoJamahal Maeng-Ho LuxfordJames Stuart ClarkJoseph IsacJosephine Agnes MorrisonKirsten Alice BakyewLahiru Nipun AmaratungeLakmini Kamithri De SilvaLi Ann TengMark Joseph HeynesMartin N-H Hoai NguyenMatthew Garry RichardsonMelinda Kelly SameMichelle Sue-Lin ChiaNam Van LeNerida Frances TelecRachel DilerniaSina MahjoobSuet-Ling GohSuzanne Claire WhittakerTimothy James ByrneTrung Thien DuAndrew FahAndrew Norman Richard WingJeremy Thomas SuttonKuan Lee NgMichael Douglas SchurgottNathan Trent JuddVicki Anne CohenDaniel John ArasMark Michael AlcockByrne Erik RedgraveClaire Louise HintonDavid Andrew KingsburyDavid Edward BridgmanDavid William Hoppe(continued next page)QldQldQldQldQldQldQldVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicVicSASASASASASASATasTasWAWAWAWAWA51

SuccessfulcandidatescontinuedHamish Stuart MaceWAMarlene Louise JohnsonWAMiles EarlWANatasha Kamala EpariWARiyad Adul Aziz DawoodWAVanessa Greta PercivalWAWong Yoke MooiWAAlastair James InesonNZAndrew Lynn Hamiliton Childs NZBenjamin Thomas Hayes Greenwood NZChing Wan WuNZConrad EngelbrechtNZDavid Heather LaurenceNZGeoffrey Paul CardenNZJaime Leigh O’LoughlinNZJames Edward MooreNZJeffrey Ian ReddyNZJennifer Anne WrightNZJeremy James ArcherNZJin Hyuk KangNZJonathan Colin Kersley Taylor NZJoseph Charles Luke Taylor NZKathryn Frances DawsonNZLucy Rebekah StoneNZMarsha Kim HeusNZNicolas William RogersNZOwen CallenderNZPhillip John QuinnNZPo Che YipNZRachel Clair DempseyNZSamuel Morrow GrummittNZVictoria Yien FreemanNZKu Ying WaiHKLing Wai YipHKMak Wai YinHKOr Yin LingHKTse King Yan CatherineHKTsui Sin Yui CindyHKWong Tak YeeHKFifteen candidates successfully completedthe International Medical GraduateSpecialist Exam and are listed below:Namita RakhejaNSWMahesh GanjiNTCaroline CollardQldSibi KurianQldKajari RoySANitin NairSATharapriya RamkumarSATilo Willy KlingerTasArnold BeetonVicAdly Ariff AbasWAAndreas Rassamy Manopas WACristina Revenga CillaWAJesco KompardtWARaymond SinnaduraiWACecil Gray PrizeThe Court of Examiners recommendedthat the Cecil Gray Prize for the half yearended June 30, 2012, be awarded to:Hon Earn SimACTMerit certificatesMerit certificates were awarded to:Andrew Norman Richard WingChuan-Whei LeeIan Thomas ChaoJamahal Maeng-Ho LuxfordLahiru Nipin AmaratungeMarlene Louise JohnsonSAVicVicVicVicWA52 ANZCA Bulletin June 2012

Combined Education,Management,Simulation andWelfare SIG Meeting“Workforce: future force”September 21-23, 2012Hyatt Regency Sanctuary Cove, QldFor further information:Hannah Burnell, SIG CoordinatorT: +61 3 8517 5392E: hburnell@anzca.edu.auwww.anzca.edu.au/events/sig-eventsThe Perioperative MedicineSpecial Interest Group inconjunction with the AcutePain Special Interest Grouppresents: “When worlds collide:Perioperative medicine – thenew specialty on the block?”The Byron at Byron Resort,Byron Bay, NSWJuly 27-28, 2012For further information, pleasecontact the conference organiser:Kirsty O’ConnorT: +61 3 8517 5318E: koconnor@anzca.edu.auwww.anzca.edu.au/events/sig-events53

Anaesthetic history: Museumreceives valuable historicalgifts from South AmericaThree items of historicalsignificance, including aTakaoka ventilator and aTakaoka universal vaporiser,have been donated to theGeoffrey Kaye Museum ofAnaesthetic History at apresentation in BuenosAires, Argentina.At the recent World Congress ofAnaesthesiologists, the honorarycurators of the Geoffrey Kaye Museum,Rod Westhorpe and Christine Ball, wereguests at a historians lunch, hosted bythe Asociación de Anestesia, Analgesia yReanimación de Buenos Aires.The association, whose headquartersare in a suburb of the great city of 14million inhabitants, proudly showed ustheir museum, with its own street frontageand display window.Two of the items donated to themuseum were invented by Braziliananaesthetist and engineer Dr KentaroTakaoka in the 1950s. The Takaokaventilator and the Takaoka universalvaporiser were enormously popular inLatin America, and elsewhere in theworld. The ventilator is particularlyinteresting because of its compact size.The third gift was a copy – one of onlytwo known to remain in existence – ofthe first edition of the journal RevistaArgentina, Anestesia y Analgesia, April,1939. This is one of the earliest anaesthesiajournals ever published and, after beingbrought home very carefully, it is now inthe proud possession of the Geoffrey KayeMuseum.The Geoffrey Kaye Museumof Anaesthetic History enjoys aninternational reputation as one of themajor collections in the world and manyinternational historians admire andenvy the role the museum has playedin furthering professional and publicknowledge of the history and practiceof anaesthesia.The visit to the World Congressof Anaesthesiologists gave us theopportunity to renew the many closerelationships that the museum maintainswith international anaesthesia historians.Christine Ball presented at one of thehistorical sessions. The Buenos Airesassociation presented a fascinatingdisplay throughout the congress,including what is believed to be the oldestfilm of an anaesthetic. Taken in 1899,the film shows the surgical removal ofa hydatid lung cyst. The anaesthetic,believed to be chloroform, is administeredby open drop by a medical student whilethe surgeon, without gloves, mask orheadwear, removes the cyst. The GeoffreyKaye Museum now has a copy of the filmon DVD.The Geoffrey Kaye Museum ofAnaesthetic History and ANZCA areproud supporters of the forthcomingInternational Symposium on the Historyof Anaesthesia, to be held in Sydney inJanuary. A two-day satellite symposiumin Melbourne will follow a few dayslater, when we expect to host manyinternational guests at the College.Dr Rod Westhorpe, Honorary Curator,Geoffrey Kaye Museum of AnaestheticHistoryDr Christine Ball, Honorary AssistantCurator, Geoffrey Kaye Museum ofAnaesthetic History54 ANZCA Bulletin June 2012

ANZCA historyand heritageupdateANZCA’s history is highlyvalued among many Fellowsand trainees who identifyhistory and heritage as atangible reminder of the highstandards and achievementsof previous generations.Consequently, the ANZCA Council signedoff on a history and heritage strategy in2011 that aims to meet 10 key objectives incapturing and documenting the history ofthe College while enhancing the GeoffreyKaye Museum of Anaesthetic History,an internationally significant collection.The 10 objectives are focused aroundpreservation, engagement, accessibilityand relevance to Fellows and trainees.In 2012, key activities to date haveincluded the filming of three interviewswith key College figures – ProfessorEmeritus Tess Cramond, Dr DuncanCampbell and Dr Nerida Dilworth.Dr Dilworth is a well-known retiredpaediatric anaesthetist from WesternAustralia, Dr Campbell designed theCampbell ventilator and was awarded theOrton Medal at the Perth annual scientificmeeting and Professor Cramond is asignificant historic figure in Australasiananaesthesia.These engaging oral histories will beavailable to all Fellows via the ANZCAwebsite during the second half of 2012,forming part of an ongoing series.Other activities have focused on theimplementation of robust historicalcollection and archiving policies thatwill provide guidance on the collectionand maintenance of items of historicalimportance.Work has also commenced onimproving accessibility to the collectionheld by the College through the use ofinformation technology. This is focusedon providing a rich and interactiveexperience of material via the ANZCAwebsite.Also under way are plans for a stronghistoric presence at next year’s ANZCAannual scientific meeting in Melbourneand the development of materials thathighlight the history of the College.Mark HarrisonGeneral Manager, Fellowship AffairsOpposite page clockwise from top left:Group photo outside the Anaesthesia Museumof the Buenos Aires Anesthesia Association.From left: Dr Enrico Buffa, Dr Hector Venturini(Curator), Dr Rod Westhorpe, Dr ChristineBall, Dr David Wilkinson (WFSA President), DrDouglas Bacon (Wood Library Laureate), DrAlberto Varela (Director), and Dr George Bause(Curator, Wood Library Museum); Dr ChristineBall being presented with the Takaoka ventilatorby Dr Enrico Buffa, Dr Alberto Varela (Director),and Dr Hector Venturini (Curator); A copy of thefirst issue of the Argentinian journal Anestesia yAnalgesia, 1939.This page from left: Filming oral histories areDr Nerida Dilworth and Dr Wally Thompson;Dr Duncan Campbell and Dr Christine Ball.55

The early developmentof anaesthesia practicein QueenslandThis is the fifth articlein a series about thefoundation Fellowsof the Faculty ofAnaesthetists, RoyalAustralasian Collegeof Surgeons. ProfessorTess Cramond takes upthe story as it unfoldedin Queensland 1 .The first practitioner with a higher degreein anaesthetics to practice in Brisbanewas Dr “Doggie” David Aubrey Davis, MBChM (Syd) 1923, Diploma in Anaesthetics(DA), Royal Colleges of Physiciansand Surgeons (RCP&S) 1939. There is arecord of his having an appointment atthe Brisbane Hospital as an HonoraryPhysician (1932-38).Dr Horace Johnson completedphysician training in Edinburgh as wellas special training in anaesthetics andis also recognised as one of the founderpractitioners in Queensland. He workedas honorary anaesthetist to the MaterChildren’s Hospital in Brisbane from 1935until the wartime period. As his residentin 1952, my interest in anaesthetics wasnurtured by him. When Dr Johnsonvolunteered for the Australian ImperialForce (AIF), his anaesthetic practicewas taken over by Dr Vera Madden(married name Watson) MBBS (Melb)1935, who provided yeoman service toan overworked surgical community.She was the first full-time appointmentin anaesthetics at Brisbane Hospital(1938-41). She went into private practicewhen Dr Horace Johnson volunteered forthe AIF, remaining in practice until herhusband, Dr Donald Watson (orthopaedicsurgeon), returned from active servicein 1946.Dr Madden was followed (1941-45) byDr Agnes Coates Earl, MBBS (Syd) 1939and, when she resigned, from 1945-49by Dr Ray Robinson, MBBS (Qld) 1943,who obtained the two-part DA (Syd)1951. Dr Robinson was to play a pivotalrole not only as one of the “QueenslandGirls”, but also in the development ofpaediatric anaesthesia at the Hospitalfor Sick Children and in thoracicanaesthesia at the Brisbane Hospitaland later at the Princess AlexandraHospital. She anaesthetised the firstneonate to have surgery for repair ofa tracheo-oesophageal fistula by DrMorgan Windsor, and it was a memorableexperience for me to have been theanaesthetic registrar helping her thatnight in 1954.Dr Robinson was joined in 1947-49by Dr Joan Dunn, MBBS (Qld) 1944.She completed her training in Oxford,obtaining the two-part DA,RCP&S(1951) – the first Queensland graduate toobtain a higher degree in anaesthetics.She was appointed the first anaestheticssupervisor (later called director), at theBrisbane Hospital (1951-53). A superb,quietly efficient administrator, she hadthe unenviable task of providing clinicalcare, supervising and training juniorstaff and organising a new department.There was limited finance, facilities wereprimitive and the administration lessthan supportive. For Dr Dunn, there “wereno problems, only solutions”. There were20 operating theatres in eight areas of thethree hospitals – the Brisbane Hospital,the Women’s and the Hospital forSick Children.Another woman whose re-entry tomedicine after 21 years was to havea marked impact on the future ofanaesthetics in Queensland was DrIsabel McLelland, MB ChM (Syd) 1918.She was almost 50 before she retrainedin medicine to give anaesthetics forher husband, gynaecologist Dr HughMcLelland. Mrs McLelland, as shewas always known, established thepartnership which was later knownas “The Queensland Girls”, interstateand overseas. She did much to fosterthe role of the specialist anaesthetist56 ANZCA Bulletin June 2012

“ She managed even the most irritable surgeonssuperbly telling them to get on with the surgeryfor which they were trained – and giving them ascore on her ‘grizzle graph’!”providing excellent service for electiveand emergency surgery. She waselected to membership of the faculty ofanaesthetists but later declined election tofellowship on the grounds that fellowshipwas the accolade for those who did formaltraining and successfully fulfilled theexamination requirements. It was myprivilege to be invited to join the group– with Mrs McLelland, Dr Robinson,Dr Dunn and Judith Foote.Dr Ruth Molphy, MBBS (Qld) 1947,was appointed registrar 1948-1950 andthen proceeded to the UK, obtaining thetwo-part DA in 1952 before returningto the Brisbane Hospital as director ofanaesthetics 1953-1963, and later asfoundation director at the Prince CharlesHospital 1963-1983. Dr Molphy was aninnovator. She built on Dr Dunn’s firmfoundation and introduced the recoveryroom and the respiratory unit, theforerunner of the modern intensive careunit. She managed even the most irritablesurgeons superbly telling them to geton with the surgery for which they weretrained – and giving them a score on her“grizzle graph”!The input of three remarkablewomen – Dr Dunn, Dr Robinson andDr Molphy – moulded anaestheticpractice in Queensland. They wereexceptionally competent clinicians,gentle and technically dextrous, readyto be innovative with new drugs andtechniques. Importantly, they related wellto patients, surgeons, nurses and otherhealth professionals. So the precedentwas set – women doctors make goodanaesthetists! Appointment of women asanaesthetic registrars was accepted.On the other side of the river, thefirst anaesthetics registrar at the Materwas Dr Patricia O’Hara (Lady Brennan)MBBS (Qld) 1950, in 1952, followed byDr Gavan Carroll MBBS (Qld) 1952, whoserved in the position from 1954 to 1955.He undertook all the teaching of medicalstudents until the appointment of DrSheila Power MRCS LRCP (Sheffield) 1957,DA 1959 as the first director, from 1963to 1973.The last two-part DA,RCP&S washeld in 1953 and it was replaced by thetwo-part FFARCS. Both Dr Dunn andDr Molphy were admitted to FARCS in1954. The Faculty of Anaesthetists of theRoyal Australasian College of Surgeonswas established in 1952 and Dr Dunnand her colleagues, including Dr AverilEarnshaw MBBS (Qld) 1950, DA 1953, weredisappointed to miss out on early offersof foundation membership of the newfaculty although many did in factbecome foundation members.It is apparent that many ex-servicemenhad learnt anaesthetics under fieldconditions, working with surgicalcolleagues who were now in privatepractice and important in medicalpolitics. It is not surprising that prominentex-servicemen – Dr Arnold RobertsonMBBS (Syd) 1936, Dr Hec Willson, MBBS(Syd) 1939, Dr Hugh Connolly MBBS (Qld)1941, Dr Edward Muller MBBS (Qld) 1940,and Dr John Woodley MRCS LRCP 1940– were sponsored for admission to thefledgling Faculty of Anaesthetists, RACS.Dr Robertson and Dr Willson wereadmitted as foundation Fellows and DrConnolly, Dr Dunn, Dr Win Fowles MBBS(Syd) 1939, Dr Molphy, Dr Muller, DrRobinson and Dr Woodley, who graduatedfrom the University College HospitalLondon, as foundation members 2 .(continued next page)From left: Dr Arnold Robertson; Dr Joan Dunn;Professor Tess Cramond.57

The early developmentof anaesthesia practicein QueenslandcontinuedDr Robertson was the son of adistinguished ear, nose and throatsurgeon and had a privileged education– the Armidale School, St Andrew’sCollege and the University of Sydney. Hehad blues for rowing and rugby. Initiallya general practitioner in Queensland, hedrifted into full-time anaesthetics practicebecause “he enjoyed it and was good atit”. He was appointed visiting specialist atthe Mater and could be described as thefounder of the specialty in Queensland.His war service was equally outstanding.He retired with the rank of LieutenantColonel, an OBE and several mentions indispatches. He served on the Council ofthe British Medical Association and wasits secretary in 1948. He became staterepresentative to the federal executive ofthe Australian Society of Anaesethetists,and then its federal president in1950-51, when he was convenor of theanaesthetics section of the AustralianMedical Conference. In 1952 he decided tomigrate to the United Kingdom, where heremained for 20 years.Dr John Hector “Hec” Willsonenjoyed a long successful career as aclinical anaesthetist, which includeda post as Special Lecturer in GeneralAnaesthesia, Faculty of Medicine andDentistry, University of Queensland, andsenior roles at the Mater and BrisbaneGeneral hospitals as well as visitingand consultant roles at GreenslopesRepatriation Hospital and YerongaMilitary Hospital.With the establishment of the regionalcommittees of the faculty in 1956, DrWillson, Dr Connolly and Dr Muller allaccepted a role for a short period, but thedriving forces were Dr Dunn, Dr Robinsonand Dr Molphy, later supported byDr Roger Bennett MBBS (Qld) 1945.References:1. Professor Cramond served as Dean of theFaculty of Anaesthetists, RACS, from 1972to 1974 and has published a number ofprevious articles in the ANZCA Bulletinabout outstanding women anaesthetists,including:Obituary article - Dr Lillian Joan Dunn,published in the March 2002 edition,pp. 26-27Obituary article – Dr Margaret Smith, March2008 edition, pp. 16-17Obituary article – Dr Agnes Mary Daly,March 2010 edition, pp. 98-99Obituary article – Dr Ruth Molphy, June 2011edition, pp. 106-1072. Three doctors were added to the listof foundation members in June 1953:Dr William Ackland-Horman of SouthAustralia, Dr Isabella McLelland ofQueensland, and Dr Stewart Peddie ofNew Zealand. Please refer to the Registerof Fellows and Members of the Faculty ofAnaesthetists, Royal Australasian College ofSurgeons, page 43 [held in ANZCA Archives].“ The input of threeremarkable women– Dr Dunn, DrRobinson and DrMolphy – mouldedanaesthetic practicein Queensland.”58 ANZCA Bulletin June 2012

advertisementPostoperative pain reliefthat’s fast, and lasts1 **DYNASTAT is indicated as a single perioperative dose for the management of postoperativepain. Before prescribing, please review Product Information.(parecoxib sodium for injection)PBS Information: This product is not listed on the PBS.BEFORE PRESCRIBING, PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE FROM PFIZER AUSTRALIA PTY LTD.MINIMUM PRODUCT INFORMATIONDYNASTAT Injection (parecoxib) 40 mg Powder and Diluent for Injection. Indications: single peri-operative dose for post-operative pain. Contraindications:CABG or other major vascular surgery; unstable or significant established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease;hypersensitivity to ingredients; allergic-type reactions to sulfonamides, aspirin, NSAIDs or COX-2 inhibitors; severe hepatic impairment (Child-Pugh score ≥10).Precautions: assess patient’s overall risks before prescribing; use lowest effective dose & do not exceed 40 mg; significant and multiple risk factors for CV events(hypertension, hyperlipidaemia, diabetes, smoking); signs of serious skin reactions (rash, mucosal lesions) or hypersensitivity; may mask fevers; monitor incisionsfor infection; history of GI ulcer disease or bleeding; asthma; renal or hepatic impairment or disease; dehydration; †hypertension; fluid retention, †compromisedcardiac function, †pre-existing oedema, †diuretic treatment, †risk of hypovolemia; pregnancy and lactation; children, elderly; concomitant use with ACE inhibitors orangiotensin receptor antagonists and thiazide diuretics. See full PI for details. Adverse events: nausea, vomiting, hypertension, hypotension, dizziness, dyspepsia,constipation, hypokalaemia, ecchymosis, agitation, insomnia, postoperative anaemia, respiratory insufficiency, wound infection, gastroduodenal ulceration, bradycardia,hyperglycaemia, thrombocytopenia, cerebrovascular disorders. Rarely: acute renal failure, aseptic meningitis, CHF, anaphylaxis, angioedema, erythema multiforme,hepatic failure, hepatomegaly, jaundice, Stevens-Johnson syndrome. Myocardial infarction (very rare), exfoliative dermatitis, toxic epidermalnecrolysis (rarely) have been reported for valdecoxib (parecoxib is converted to valdecoxib in the body). See full PI for details. Dosage andadministration: single 40 mg IV or IM dose. Based on TGA approved Product Information of 6 July 2006 and amended 16 December 2009.†Please note changes to Product Information.Reference: 1. DYNASTAT Approved Product Information. Pfizer Australia Pty Ltd, ABN 50 008 422 348. 38–42 Wharf Road, West Ryde,NSW 2114, Australia. Pfizer Medical Information: 1800 675 229. www.pfizer.com.au. Trademark. 03/10 H&T PPU0363.59

ANZCAin the newsMedia coverage of ANZCA and the Facultyof Pain Medicine has reached a potentialcumulative audience of nearly 10 millionpeople (9,452,995 people) over the pastfew months, mainly due to media reportsgenerated from the annual scientificmeeting (ASM) in Perth.Highlights of the ASM media coverageincluded outgoing president ProfessorKate Leslie appearing on the new nationalChannel 10 breakfast show promoting theconference and talking about key topics,and the new ANZCA President, Dr LindyRoberts, taking talkback calls on ABC 720Perth’s Drive program with host RussellWoolf.Nine media releases were issuedpromoting the ASM, the Faculty of PainMedicine Refresher Course Day andthe Joint Trauma and Anaesthesia andCritical Care in Unusual and TransportEnvironments (ACCUTE) Special InterestGroup meeting, which focused on masscasualties and burns.Topics that generated the largestamount of media interest included DrBob Large from the Auckland RegionalPain Service talking about the usesof hypnosis in analgesia and painmanagement; Professor Geoffrey Dobsonfrom James Cook University explaininghow he is developing a resuscitationfluid for injured soldiers inspired byhibernating hummingbirds; AssociateProfessor Andrew Davidson fromMelbourne’s Royal Children’s Hospitaltalking about the increased risks ofanaesthesia for newborns; ProfessorJamie Sleigh from New Zealand’s WaikatoHospital explaining a possible geneticlink to anaesthetic awareness; Dr NolanMcDonnell from Perth’s King EdwardMemorial Hospital for Women outliningincreased complications associatedwith extremely obese pregnant women;Professor Amy Tsai from the Universityof California, San Diego, explaining howworms are being used to develop artificialblood; and visiting US Professor RuthLandau talking about the “love hormone”oxytocin.Seventeen speakers from theconference and associated meetingswere interviewed and ANZCA greatlyappreciates their contribution. Fullcoverage from the meeting can be foundon the ANZCA website under “Events”.Apart from the ASM, ANZCA alsocontributed to a 4000-word feature onchronic pain in the Weekend Australian(circulation 300,000) quoting AssociateProfessor Milton Cohen and ProfessorMichael Cousins, and a pain medicinecareer special in the MJA Careers sectionfeaturing FPM spokesmen. Also in thepain area, former FPM Dean, Dr DavidJones, was interviewed by a NZ wireservice about the need for New Zealandto follow Australia’s lead on prescriptionopioid tracking.A media release promoting publicationof the Safety of Anaesthesia: A review ofanaesthesia-related mortality reportingin Australia and New Zealand 2006-08received coverage, as did one about theSpecialist Training Program fundingsecured by ANZCA, which was widelyreported in regional and rural areas.Meaghan ShawMedia Manager, ANZCA60 ANZCA Bulletin June 2012

Media releases distributed by ANZCA since March this year$50,000 raised to save lives in developing countries (May 16)Perth anaesthetist and pain expert new ANZCA president (May 16)Oxytocin: the love hormone’s new role in pain relief (May 14)Primordial species could be the key to artificial blood (May 13)Post-operative nausea and vomiting: is there a genetic link (May 12)Hypnosis in pain management (May 11)Revolutionary pain service leads the way on pain relief (May 10)Hibernating hummingbirds inspire new resuscitation fluid (May 10)More than 1300 anaesthetists to attend key meeting in Perth (May 8)Anaesthesia remains extremely safe (April 23)Boost for rural health with extra specialists trained (April 12)ANZCA Bulletin out now: ANZCA turns 20; NZ urged to adopt prescription opioidmonitoring; Christchurch one year on – NZ release (March 30)ANZCA Bulletin out now: ANZCA turns 20; training Mongolian skeptics;NZ urged to adopt prescription opioid monitoring – Australian release (March 30)Since March this year,ANZCA has generated…67 print stories85 online stories170 radio reports44 television reports14 - 17 November 2012Auckland, New Zealandwww.iccva2012.comRegister nowwww.iccva2012.comNew ZealandAnaesthesia AnnualScientific Meetingcombined with the13th InternationalCongress ofCardiothoracic andVascular AnesthesiaHosted byIn association with61

The Anaesthesia andPain Medicine FoundationDr Roderick Deaneappointed KnightCompanionAnaesthesia and Pain MedicineFoundation Board member Dr RoderickDeane, who joined the board in October2011, has received the honour ofappointment to the New Zealand Order ofMerit as a Knight Companion. Sir Roderickwas appointed by Her Majesty the Queenon the occasion of the celebration of theQueen’s Birthday and Diamond Jubileethis year.The significance of this honour isreflected in the fact it is one of just fourKnight Companion appointments madeto the New Zealand Order of Merit in thisyear’s Queens Birthday and DiamondJubilee Honours List.Sir Roderick’s senior levelcontributions to New Zealand in corporateand business leadership, public sectorreform and central banking, particularlythrough his leadership during thecurrency crisis of 1984, are widelyrecognised for having significantlyimproved economic opportunities forall New Zealanders.The appointment also reflects SirRoderick’s long-term commitment tothe arts and his provision of assistanceand leadership to charitable causesand organisations. Along with hisparticipation on ANZCA’s Anaesthesiaand Pain Medicine Foundation Board,Sir Roderick’s contributions have been astrong example of personal communityservice that helps to improve the qualityof life through expanding economic,cultural, creative, and health and wellbeingopportunities.Sir Roderick’s contribution to the boardof the Anaesthesia and Pain MedicineFoundation comes at a time of renewedeffort to increase the foundation’sfundraising, to increase support forscientific research, overseas aid andindigenous health. Improving support inthese areas is vital for delivering betterhealth outcomes to millions of NewZealanders, Australians and peoplein developing countries.Give to the foundation’s researchfunding appealAs part of its fundraising program, thefoundation recently sent an appeal toFellows and the public in Australiaand, pending the response, is planninga similar appeal in New Zealand. Ifyou haven’t responded already, pleaseconsider sending a contribution. Previousresearch by ANZCA Fellows has producedresults and further grants far outweighthe small initial costs. Making a gift tothe foundation is one of the best andmost relevant philanthropic investmentsavailable!Thank you to all Fellows who havealready given generously. Gifts can bemade by mail or by calling Rob Packerat the foundation on +61 3 8517 5306.Robert PackerGeneral Manager,Anaesthesia and Pain MedicineFoundation, ANZCATo donate, or for more informationon supporting the foundation,please contact Robert Packer,General Manager, Anaesthesia andPain Medicine Foundation on+61 3 8517 5306 or emailrpacker@anzca.edu.au.62 ANZCA Bulletin June 2012

advertisementHeading SampleMetaVision ® Proven AnaesthesiaInformation Management SystemsEase the burden of documentationImprove compliance with protocols & best practicesCreate accurate, complete anaesthesia recordsIn today’s perioperative environment, clinicians need to plan and administer care while simultaneously documentingand responding to vast amounts of information. Anaesthesiologists must comply with numerous clinical protocolswhile capturing the administrative information necessary for maximum and speedy reimbursement. The MetaVisionAnaesthesia Information Management System (AIMS) by iMDsoft is uniquely positioned to address these challenges,delivering measurable outcomes such as:> 40% increase in timely delivery of PONV drugs. OLVG, The Netherlands> 100% billable anaesthesia procedures. Massachusetts General Hospital, US> 30% reduction of perioperative hypothermia. Lehigh Valley Hospital, PA, USContact us:Vision Software Solutions Pty Ltd, an iMDsoft company16/99 Musgrave Road, Red Hill, QLD 4059 | 1800 240 919sales@imd-soft.com | www.imd-soft.com© Copyright 2012 iMDsoft ® .iMDsoft ® and MetaVision ® are trademarks of iMDsoft. m-AD-017-ANZCA12-(Ver1.0)63

New Zealand newsNew ZealandNational Committee(NZNC) newsNZNC 2012-13 membershipThe ANZCA Council has ratified thefollowing as the 2012-13 New ZealandNational Committee (NZNC): Dr VanessaBeavis, Dr Kerry Gunn, Dr Gary Hopgood,Dr Indu Kapoor, Dr Geoff Long, Dr SabinePecher, Dr Nigel Robertson, Dr JoeSherriff, Dr Malcolm Stuart, Dr JenniferWoods and Dr Sally Ure. The NZNC hasco-opted Dr Geoff Laney from DunedinHospital to make up the 12 and Dr JohnSmithells of Hamilton as the New Fellows’Representative.Since the nominations were declared,Dr Vanessa Beavis (pictured above) hasbeen confirmed as having been elected tothe ANZCA Council. She will now sit on theNZNC ex officio as a councillor so at theJune meeting the NZNC will consider cooptinga further member in her stead.Internal elections for officers will beheld at the June meeting.Dr Vanessa Beavis has been appointedchair of the NZ Panel for VocationalRegistration.Next meetingThe NZNC meets on June 22-23, withthe 2011 ANZCA Media Award winner,health reporter for TVNZ Lorelei Mason,as the guest speaker. She will talk to thecommittee about how the media worksand what they are looking for when puttingtogether a story.This meeting is preceded on the Fridayby the NZNC’s annual joint meeting withthe New Zealand Society of Anaesthetists’Executive.ANZCA CEO Linda Sorrell and ANZCAPresident Dr Lindy Roberts will attendboth meetings.General newsNon-specialists practisinganaesthesiaThe Medical Council of New Zealand(MCNZ) has revised the recertificationrequirements for general registrant doctorswho are not vocationally registered or ina specialty training program. The MCNZhas contracted with Bpac (Best PracticeAdvocacy Centre – a joint venture betweensome primary care organisations and theUniversity of Otago) to offer the requiredrecertification training program.About 20 of these general registrantsare already registered in ANZCA’s CPDprogram and in March the NZNC raisedwith the MCNZ and Bpac the issue of howto avoid these doctors having to undertaketwo CPD programs. The MCNZ has sinceadvised that those registered in the ANZCACPD program as at March 14, 2012 willnot also have to undertake the Bpacprogram, provided that within two years,the ANZCA program is meeting all theMCNZ’s administrative requirements forgeneral registrant recertification.Registration for anaesthetictechniciansThe new registration regime foranaesthetic technicians, bringingthem under the Health PractitionersCompetence Assurance Act 2003(HPCAA), came into full effect as atApril 1. Now only those registered asan anaesthetic technician can holdthemselves out to be anaesthetictechnicians or practising anaesthetictechnology. Their registration isadministered by the Medical SciencesCouncil of New Zealand (MSCNZ), formerlythe Medical Laboratory Sciences Board(MLSB). Under the new regime, healthpractitioners who undertake anaesthetictechnology duties for a minimum of 384hours in one year are expected to beregistered in the scope of practice of ananaesthetic technician. While traineetechnicians do not need to be registered,they are required to work under thesupervision of a registered anaesthetictechnician. As at May 31, 620 anaesthetictechnicians had registered.Anaesthetic nurses without theanaesthetic technician qualification butrelevant experience have the option ofregistering as an anaesthetic technicianthrough a process that includes aworkplace-based assessment. Several aregoing through this process. Alternatively,such nurses may choose to continueperforming an anaesthetic nursing rolebut then may not use the title ‘anaesthetictechnician’. The MSCNZ is consideringallowing nurses until 2014 to registeras an anaesthetic technician.40th anniversary celebrations nownext FebruaryOngoing repairs to the University of Otago,Christchurch’s main building (damagedin the earthquakes) has seen a furtherpostponement of the 40th anniversarycelebrations of the ChristchurchMedical School. The damage forced outresearchers and students and repairshave prompted postponement of thecelebrations twice – firstly from February2012 and now from September 2012.However, the building is being repairedrapidly and on February 20-22, 2013the University of Otago, Christchurch, willcelebrate both a return to these premisesand 40 years of research and teachingin Christchurch. Those who have workedor studied at the school are invited toparticipate. Celebrations include ananniversary dinner on February 22 and aday of scientific sessions as well as toursthrough refurbished laboratories. Registeryour interest by completing an online formaccessible via a 40th anniversary buttonon http://www.otago.ac.nz/christchurch, oremail kim.thomas@otago.ac.nz.64 ANZCA Bulletin June 2012

Council of Medical Colleges (CMC)At its March meeting, it was agreedthat the Council of Medical Colleges(CMC) would continue with its enlargedsecretariat, which will involve a 36 percent increase in subscriptions phasedin over two years. A CMC website isbeing developed to provide a conduitfor information sharing and to progressmatters between meetings.At the May meeting, Professor AlanMerry, as Chair of New Zealand’s HealthQuality & Safety Commission, and DrLeona Wilson, as Chair of the PerioperativeMortality Review Committee (POMRC),each gave updates on the work of theHQSC and POMRC, and outlined howcolleges can help with this work,especially disseminating information arisingfrom their reports.HWNZ Executive Chair Professor DesGorman (pictured above) spoke to thegroup about health workforce issues, notingthat a shortage of nurses is a larger andmore pressing problem than the shortageof doctors.Professor Gorman said HWNZ wasfocusing on ways of improving whatalready exists, for example productivityimprovements, addressing mal-distribution,and looking at the impact of models ofcare on the demand for doctors and otherhealthcare practitioners. The best mix ofgeneralist and specialist skills remainson the HWNZ agenda, as does thedevelopment of a ‘flexible, redeployableworkforce”. A document on prioritisationof funding for medical disciplines has beenreleased to district health boards andProfessor Gorman said it would be sent tocolleges in the near future.Anaesthesia researchARGONZ (Anaesthetic Research Group ofNew Zealand) is an informal association forNew Zealand anaesthetists and traineesinterested in furthering scientific andclinical research in anaesthesia. The groupwould like to collect information aboutcurrent and planned research so that itcan be made available to the anaesthesiacommunity in case others can usefullycontribute to that research. ANZCA hasagreed to assist with this. As a first step,anyone who has a current research project(or an idea for a future project) is asked toemail ANZCA’s New Zealand office (anzca@anzca.org.nz) with the title of their researchand a few lines explaining where they areup to and any difficulties they face.NZ government newsMore operating theatres forMiddlemore HospitalThe Counties Manukau District HealthBoard, which administers MiddlemoreHospital in South Auckland (picturedabove), has received government approvalfor three new operating theatres andthe replacement of 11 existing agedtheatres. The new clinical services blockwill also include a 42-bed assessment andplanning unit, an 18-bed high dependencyunit, and replace the clinical sterile supplydepartment.New trauma networkThe government has established a MajorTrauma National Clinical Network todevelop a national, strategic approach tothe provision of major trauma services,from pre-hospital emergency care torehabilitation and injury preventionservices, and to co-ordinate major traumaservice improvements.The network’s clinical leader is surgeonMr Ian Civil, Director of Surgery at theAuckland District Health Board and theimmediate past president of the RoyalAustralasian College of Surgeons (picturedabove).Faster broadband for rural hospitalsUnder the second phase of ruralbroadband initiative contracts, 37rural hospitals, including Thames andTaumarunui, as well as 10 health centres,will receive ultra-fast broadband. Thefaster links will allow rural staff to takepart in training sessions being run inurban centres and enable clinicians toview immediately electronic informationrecorded across the country, rather thanhaving to wait for reports or films tobe sent.Tobacco plain packagingCabinet has agreed in principle tointroduce plain packaging for tobaccoproducts in alignment with Australia.However, this is subject to the outcomeof a public consultation process to beundertaken later this year.65

The Australian Society of Anaesthetists invites you to jointhem at their 71st National Scientific Congress in Hobartfrom 29 September to 2 October 2012For further information please visit www.asa2012.comAnaesthesiaand Intensive CareWant to access the latest research anddevelopments in Australasian anaesthesia?Read original papers, reviews, case reports,correspondence and more!For more information or to subscribeplease go to our website.66 ANZCA Bulletin June 2012Sign Sign up up for for e-Table of of Contents alerts alerts and and RSS RSS feeds feedswww.aaic.net.au

People and eventsAirway Management SIG MeetingObstetric Anaesthesia SpecialInterest Group meetingThe third Airway Management SIG Meeting was held at the MantraErskine Beach Resort in Lorne, Victoria from March 9-11. Thetheme of the meeting was “Everything airways: Airway problemsoutside the OT” and the international guest speakers wereDr Josef Holzki (Germany) and Dr Paul Phrampus (US). Theconvenor was Dr Chris Acott and the co-convenors were Dr ZoeLagana and Dr Louisa Heard. More than 250 delegates attendedlecture sessions and workshops with 20 companies from thehealthcare industry supporting the meeting. The next AirwayManagement SIG meeting will be held in 2014.Trauma & ACCuTE SpecialInterest Group ConferenceThe joint one day Trauma and Anaesthesia and Critical Care inUnusual and Transport Environments (ACCUTE) SIG Meetingwas held at the Parmelia Hilton Perth on Friday May 11, 2012.The meeting was well attended and covered a wide variety oftopics under the general theme of “Mass casualty- burns”. Guestspeakers included Professor Fiona Wood, Mr John Kelleher,Professor Geoffrey Dobson and Lieutenant Colonel Michael Reade.The next meeting of the Trauma SIG will be held in conjunction withthe Airway Management SIG in Melbourne, June 2013.Associate Professor John MoloneyDr Allan MacKillopJoint ConvenorsThe 3rd Quadrennial Obstetric Anaesthesia Special InterestGroup meeting was held at the Quay West Resort, BunkerBay, following the 2012 ANZCA Annual Scientific Meeting.The location was on the edge of the renowned Margaret RiverWine region and gave the delegates the opportunity to unwindafter the ASM.The theme of the meeting was ‘high risk obstetricanaesthesia’ and speakers included well-known anaesthetistsfrom around Australia and New Zealand. Invited speakersincluded Dr Luke Torre (intensivist), Dr Nicole Staples(haematologist), Dr Andrew Miller (lawyer and anaesthetist)and Professor Yee Leung (gynaeoncologist). The programincluded a number of interactive sessions, workshops andPBLDs, which included practical tips and tricks for delegates.There was a welcome reception at the resort and a winetour, which visited well-known vineyards in the Margaret River.The social program also included a conference dinner at theWise Vineyard.Meeting delegates raised more than $1000 for the Lifeboxproject through a series of raffles supported by the sponsors,adding to the success of this initiative from the ASM.The meeting attracted 120 delegates and six healthcareindustry representatives, all of whom took away new ideas andnew friends and colleagues.Thank you to all the delegates, speakers and workshop andPBLD facilitators for attending and contributing to the successof the meeting, a number of whom travelled a long way. Aspecial thank you to Kirsty O’Connor from ANZCA, for her helpwith organising the meeting.Dr Nolan McDonnellConvenerAbove clockwise from top left: Dr Paul Phrampus (US) and Dr JosefHolzki (Germany); Dr Andrew Heard, Dr Pierre Bradley and Dr RichardSemenov; Delegates at the 3rd Quadrennial Obstetric AnaesthesiaSpecial Interest Group meeting; Professor Fiona Wood and Dr KylieHall; Lieutenant Colonel Michael Reade and Co-Convenor AssociateProfessor John Moloney.67

Australian newsQueenslandQueensland Regional ReportActivity in Queensland continues at a high level and in the lastthree months has included:• A week-long final exam preparation course.• Primary and final practice viva sessions.• Written and clinical exams.• Two primary lectures.• Two webinars and recording of four podcasts.• A three-day foundation teacher course.• The directors of anaesthetics meeting.• The 15th Annual Registrars’ meeting.Once again, the Queensland Regional Committee would liketo acknowledge the work of the dedicated and capable courseconvenors, lecturers and mock examiners who have offeredtrainees these valuable learning opportunities.Committees have been elected for 2012-14. Office bearerswill be advised in the next edition of the ANZCA Bulletin.The selection and allocation process for 2013 hospitalrotations has been reviewed and applications for placementsclosed June 4. Assessment is in full swing.OPAL: Obstetrics,Paediatrics and LawDr Ben van der Griend is the keynote speakerat the Queensland combined ANZCA/AustralianSociety of Anaesthetists annual conferencebeing held on Saturday July 7. Dr van derGriend is a paediatric anaesthetist at theChristchurch Hospital. He has a strong interest in training andhas set up a successful education program called PAT:CH– Paediatric Anaesthesia Teaching: Christchurch.Dr van der Griend’s presentation, “Is it safe to anaesthetisechildren?”, will address the likelihood of a child dying or beingharmed by anaesthesia and whether anaesthesia damagesthe developing brain.The full conference program is available at on ANZCA’sQueensland regional office website: http://qld.anzca.edu.au.Opposite page from left: Adjudicators Dr Helmut Schoengen and Dr BrianLewer; Dr Peter Moran and the formal projects officer for Queensland,Dr Kerstin Wyssusek; Dr Yasmin Whately receiving the Tess CrammondAward from Professor Tess Crammond; Formal project presenters DrConrad Macrokanis and Dr Satnam Solanki; Adjudicators Dr HelmutSchoengen, Dr Sanjiv Sawhney and Dr Brain Lewer; Dr David Goldsmithreceiving the lucky draw prize from Stefan Dooney of Pert & Associates;Brian Pert of Pert & Associates with Dr Michael Steyn; Dr Chris Turnbull,Dr Robert Miskeljin and Dr Andrew Wilke; Dr Conrad Macrokanisreceiving the Axxon Health Award from Dr Patrick See.The 36th annual Queensland combined ANZCA/Australian Societyof Anaesthetists conference focuses on obstetric and paediatricanaesthesia, as well as medico-legal principles relevant foranaesthetists. The day will comprise a series of lectures and amedico-legal panel discussion in the morning, followed by anultrasound workshop, a paediatric resuscitation workshop andproblem-based learning discussions in the afternoon.Workshop 1 is led by Dr Phil Cowlishaw and will focus on ultrasoundfor obstetric anaesthesia. Workshop 2 is led by Dr Amanda Harvey andoffers an update in paediatric resuscitation. This workshop will focus onthe current paediatric advanced life support guidelines. The workshopwill cover changes to the Australian Resuscitation Council guidelinespublished in 2010, and paediatric anaesthetic emergencies includinganaphylaxis and local anaesthetic toxicity.Problem-based learning discussions will include: ‘The headache ofproviding safe, effective labour analgesia’ and ‘Paediatrics: the snifflingsnorer’.Program and registration details are available on the ANZCA websiteQueensland home page. We hope you join us at this significantQueensland event.We thank our conference sponsors for their support:Avant, MDA National, Sonosite, AstraZeneca,Abbott Australia, MSD, Pfizer, Medfin, Ferring Pharmaceuticals,Hospira, LMA PacMed, Ultimate Medical, B Braun.68 ANZCA Bulletin June 2012

15th Annual QueenslandRegistrars’ MeetingThe registrars’ scientific meeting for the presentation ofcompleted formal projects was held at the West End premisesof ANZCA’s Queensland office on Saturday April 28. This is a keyannual event in the training of anaesthetists and offers registrarsthe opportunity to present their original research for their FormalProject at a meeting of their peers.The standard of presentations was high and the winner, DrYasmin Whately, was commended by the adjudicators for thesignificant development to her skills, required to collect andanalyse the pathology data needed to examine the contractilefunction of cardiac tissue. Other prize winners included DrConrad Macrokanis, who received the Axxon Health Award forwork on irukandji syndrome and Dr Brett Segal, who received theAustralian Society of Anaesthetists Chairman’s Choice Award forhis analysis of single-shot anaesthesia.Professor Tess Crammond presented Dr Whately with firstprize, the Tess Crammond Award, and provided some sage wordsof encouragement and advice for trainees.We thank our major sponsor, Pert & Associates, who made astrong case for the importance of sound financial managementfor consultants.69

Australian newscontinuedQueensland continuedFoundation Teacher’s CourseA Foundation Teacher’s Course was held at the West Endpremises of ANZCA on April 18-20. Maurice Hennesseyfacilitated the course, assisted by Dr Kersi Taraporewalla,our resident educator of international specialist graduates.A total of 16 supervisors attended and were put to the testthrough lively discussions and problem-based learning activities.The main focus of these discussions and activities was howto give relevant feedback that enhances the acquisition ofknowledge and skills, particularly in relation to the soon to beimplemented workplace-based assessments (WBAs).The course also provided participants with an opportunity toengage with colleagues who were able to offer different viewsand opinions on the practice of assessment.Clockwise from top left: Dr Rudolf van der Westhhuizen sharing hisexperience with newly appointed supervisor Dr Aled Hapgood; ANZCA’sMaurice Hennessey observes the activities during a session on deliveringtraining at the Queensland Foundation Teacher’s Course; Dr MareeBurke, Dr Julie Sherwin and Dr David Law practice the art of givingfeedback; Dr Helen Davies with Dr Tim Scholz at the QueenslandFoundation Teacher’s Course.70 ANZCA Bulletin June 2012

South Australia and Northern TerritoryCurrent medico legalanaesthetic controversiesOn April 3, the SA & NT Continuing Medical Education Committeeheld “Current medico legal anaesthetic controversies” presentedby Dr Andrew Miller. Dr Miller was an excellent speaker andreceived very positive feedback from the 40 or so attendees. Hottopics included information on mandatory reporting, anaestheticcase studies, epidural disaster case and the proposed NationalDisability Scheme. This initiated much discussion among theattendees and many stayed after the presentation to networkand discuss.South Australia and Northern TerritoryCombined ANZCA/ASA SouthAustralian & Northern Territory ASMAbove clockwise from top left: Dr Douglas Fahlbusch, Helena Manis,Dr Andrew Miller and Megan Sheldon; Dr Lynne Rainey and Dr JohnHughes; Speaker Dr Andrew Miller; WCH Queen Vic Theatre.November 3Theme: “Anaesthesia and the Failing Organ”Venue: The Sanctuary, Adelaide ZooContact: Kerri ThomasPh: +61 8 8239 2822Email: kthomas@anzca.edu.au71

Australian newscontinuedWestern AustraliaNews from PerthA medical careers expo was held on March 27 at the Burswoodon Swan. The aim of the expo was to provide interns, residents,service registrars, international medical graduates and seniormedical students with information regarding vocational trainingprograms and career pathways. The evening was very busyand was attended by more than 200 junior doctors and seniormedical students. Thank you to Dr Suzanne Myles, Dr MichaelVeltman, Dr Joel Adams, Dr Jim Miller, Dr Bree Maciejewski andDr Melissa Haque who helped out with inquiries regarding theanaesthetic training program in WA.A supervisors of training workshop was held on the eveningof April 26 at the WA regional office. The workshop focused onthe workplace-based assessments (WBAs), which form partof the revised curriculum, and was presented by the WA WBAchampions Dr Paul Kwei and Dr Ange Lee. Dr Jodi Graham alsoassisted with the workshop. Supervisors of training will nowreturn to their departments and start teaching and recruitingassessors.On May 11, the WA regional office hosted an ANZCATeachers Course-Foundation level. The course was attended by11 Fellows, some of whom were in Perth to attend the annualscientific meeting, which was held at the Perth Convention andExhibition Centre from May 12 to 16. Maurice Hennessy fromthe ANZCA Education Development Unit convened the courseand covered the following areas: planning effective teachingand learning, teaching in context and effective feedback. Thefeedback from the course was very positive.The ANZCA WA annual general meeting was held at the PerthConvention and Exhibition Centre on May 14. Thank you to thosewho attended.On the evening of May 14, Oliver Jones, ANZCA GeneralManager, Education Development, gave a presentation at theWA regional office about the transition of existing trainees to thenew curriculum in 2013. About 25 WA trainees attended. WA’sregional education officer, Dr Jodi Graham, was also on hand toanswer questions. Thank you Oliver and Jodi.Above clockwise from top left: ANZCA General Manager, EducationDevelopment Oliver Jones and WA Trainees; Attendees at the WA ANZCATeachers Workshop; Maurice Hennessey and attendees at the workshop.72 ANZCA Bulletin June 2012

TasmaniaNew South WalesTasmanian Joint ANZCA/ASAMeeting in 2013The 2013 Tasmanian Joint ANZCA/ASA Meeting will be held fromFebruary 22-23 at The Tramsheds Function Centre, Launceston.For further enquiries, please contact: tas@anzca.edu.auAustralian Capital TerritoryWBA workshopThe ACT regional office held a workplace-based assessmentworkshop on June 9, which was attended by delegates fromhospitals in the ACT, Dubbo and Wagga Wagga.As well as providing a valuable opportunity to learn about theassessment tools required as part of the new ANZCA curriculum,the workshop gave participants a welcome opportunity to meetwith colleagues.Preparations are underway for a difficult airways workshopto be held at the Hyatt Hotel, Canberra, on August 4.Further information and registration forms will be availableon the ACT website soon.Part Zero: An Induction toAnaesthesia takes offThe 2012 Part Zero: An Induction to Anaesthesia course onMarch 10 proved a popular way to spend a quiet Saturdayafternoon. Despite clear sunny skies outside, more than 100interns, residents and registrars flocked to the Royal PrinceAlfred’s Education Centre to learn more about the excitinglife of an anaesthetic registrar.After a welcome by the NSW Regional Trainee Committee, theday kicked off with doctors Katherine Jeffrey, Simon Martel andAnand Pudipeddi reminding us what being an anaesthetic traineeis all about, and the various prestigious organisations a buddinganaesthetic trainee can join. This was followed by Dr Pat Farrellcovering “What is the College?”, Dr Simon Martel highlightingthe structure of training and the new ANZCA curriculum and DrMichael Stone’s famous exam tricks and tips lecture.Afternoon tea was followed by a presentation by Dr MichaelBonning, of Beyondblue, who covered the topic of mental healthand happiness. Dr Greg Downey discussed mentorship and DrKen Harrison, of Careflight, gave a guide to career choice (as wellas his family photo album!) Dr Greg Knoblanche rounded off theafternoon with his presentation on the ins and outs of medicolegaldefence.Despite squeezing a lifetime’s worth of information into fivehours, morale remained high thanks to the entertaining andinformative lectures. The day was rounded off with a questionand answer session followed by drinks at the local. Thanks go toall the presenters, the 2011 Regional Trainee Committee, andto Tina Papadopoulos and Warren O’Harae from the NSW ANZCAoffice for all their work behind the scenes.73

Australian newscontinuedNew South WalesNSW Regional CommitteeThere is a significant and exciting “changing of guard” at the NSWRegional Committee this year. Six members are leavingthe committee, including three former chairs, Jo Sutherland,Michael Amos and Richard Halliwell.I thank these three dedicated people, who have more than 30years of experience at regional committee level. They have giventheir time and experience to the College in many roles on thecommittee.Also leaving is Tracey Tay, who has made a great contributionto the committee including as regional educational officer. Thanksalso to Michael Rose and Kar Soon Lim, who have contributedparticularly with formal projects and education over the past fouryears. I sincerely thank all these retiring members of the statecommittee for all the excellent work they have done.This year presents the exciting challenge of the revisedANZCA curriculum. The NSW region also has a large numberof hospital accreditation inspections ahead.To help lighten the load, I welcome Andrew Armstrong, MichelleMoyle, Nicole Phillips, Michael Stone, Suyin Tan, Emily Wilcox tothe committee. Please feel free to speak to any members of thecommittee about any issues or concerns.Simon Martel and Carl D’Souza will represent the new Fellows,while we welcome Michael Wirth as Chair of the NSW TraineeCommittee. Thanks to Lewis Holford who has handed over toGavin Patullo representing the Faculty of Pain Medicine on thecommittee.The NSW Regional Committee as always has the support ofthe NSW representatives at the ANZCA Council, Frank Moloney,Patrick Farrell and Michelle Mulligan, and this continues.The committee welcomes the continued input of CarmelMcInerney (ACT) and Michael Farr (Australian Society ofAnaesthetists).To conclude, ANZCA Curriculum Revision 2013 presents anexciting change to education within the College and this, combinedwith the usual workforce and accreditation requirements, willpresent some challenges to the new NSW Regional Committee.I look forward to the contributions of all members as I thankthose who have contributed greatly in the past.Dr Greg O’Sullivan, DirectorAnaesthetic DepartmentSt Vincent’s HospitalAustralian Medical AssociationCareers DayMembers of the ANZCA NSW Regional Committee and NSWTrainee Committee attended the NSW Australian MedicalAssociation Careers Day on May 5 at Sydney Olympic Park.The day was designed to introduce the various career optionsavailable to junior doctors. Approximately 300 junior doctors andmedical students attended the event.The NSW ANZCA table was well attended and questionsranged from “How do I become an anaesthetist?” to “How doI pass the primary exam?” and “How do I get a trainee job?”.There were also many questions about the curriculum changeand how it will affect training.A highlight of the day was a retrieval demonstration byCareflight, who flew in to extricate an injured child from a mockupplayground accident. This generated great interest amongattendees when it was revealed that anaesthetists are part ofthe retrieval team.Many thanks to NSW ANZCA staff and doctors who gave uptheir Saturday to talk about anaesthetics.Above clockwise from top left: Dr Richard Halliwell and Dr Greg O’Sullivan;Mock retrieval at the Australian Medical Association Careers Day; TheANZCA table.74 ANZCA Bulletin June 2012

Anatomy for AnaesthetistsSaturday 24 November 2012The University of SydneyFor more information please contactNSW ACE Ph: +61 2 9966 9085 Fax: +61 2 9966 9087Email: nswevents@anzca.edu.auWeb: www.nsw.anzca.edu.au/eventsNSW Part II Refresher CourseThe NSW Regional Committee again conducted a very successfulPart II Refresher Course in Anaesthesia at Royal Prince AlfredHospital from February 20 to March 2.The course enabled candidates sitting for the final fellowshipexaminations a greater understanding of anaesthesia. It includedseminars, panel sessions, demonstrations, lecturers andinformal tutorial. A highlight on the last day of the course wasthe anatomical workshop held at Department of Anatomy andHistology, University of Sydney, which enlists the help of sevenlecturers in a hands-on workshop.A special thanks to all the speakers who devoted a hugeamount of time and effort in assisting the candidates to preparefor their final examinations, and especially to Dr Tim McCullochand Associate Professor Gregory Knoblanche.ANAESTHESIA CONTINUINGEDUCATION COORDINATINGCOMMITTEENSW REGIONAL COMMITTEEAUSTRALIAN AND NEW ZEALANDCOLLEGE OF ANAESTHETISTSAUSTRALIAN AND NEW ZEALANDCOLLEGE OF ANAESTHETISTSNEW SOUTH WALES SECTIONTHE AUSTRALIAN SOCIETYOF ANAESTHETISTSCONTINUING EDUCATION Seminar No 78NEW SOUTH WALES SECTIONTHE AUSTRALIAN SOCIETYOF ANAESTHETISTSSee one, Do one, Teach onehow to GaiN aNd maiNtaiN SkillS3 - 4 November 2012, Shoal baywww.nsw.anzca.edu.au/events1/2 page adNew South WalesPrimary refresher coursein anaesthesiaThe course is a full-time revision course, run on a lecture/tutorial basisand is suitable for candidates presenting for their primary examinationin the first part of 2013. The first week will cover mainly physiologytopics and the second week pharmacology topics.Date: Monday October 15 – Friday October 19 (physiology)Monday October 22 – Friday October 26 (pharmacology)Venue: Large Conference Room, Kerry Packer Education CentreRoyal Prince Alfred Hospital, Missenden RoadCamperdown NSW 2050Fee: A$880 (incl gst) (two weeks)A$440 (incl gst) (one week)A comprehensive set of supplementary notes, lectures notesand USB will be given to each participant at the start of the course.APPLICATIONS CLOSE on Friday September 28 (if not filled prior)The number of participants for the course will be limited and lateapplications will be considered only if vacancies exist.For information contact: Tina PapadopoulosANZCA New South Wales Regional Committee117 Alexander Street, Crows Nest NSW 2065Email: nswcourses@anzca.edu.auPhone: +61 2 9966 9085 Fax: +61 2 9966 908775

Australian newscontinuedVictoriaVictoriaAnnual Victorian Registrars’Scientific Meeting 2012Friday November 9, 2012ANZCA HouseMelbourne 3004Calling all traineesEnhance your presentation skillsDraw attention to your researchSubmit an abstract and be part of this annual eventMembers of the ANZCA Trials Group will moderate the researchpresentationsFor information please contact:Daphne ErlerVictorian Regional CoordinatorAustralian and New Zealand College of Anaesthetists630 St Kilda RoadMelbourne VIC 3004VictoriaRegister and join us at the33rd Annual Victorian ANZCA/ASAcombined CME Meeting“The ultra Meeting”Saturday July 28, 2012Sofitel Melbourne on Collins25 Collins Street, MelbourneRegistrationFellowsTraineesRetireesDinner$330 including GST$217 including GST$110 including GST$120 including GSTRegistration form and flyer at: www.vic.anzca.edu.au/eventsFor information please contact:Daphne ErlerVictorian Regional CoordinatorEmail: vic@anzca.edu.auTelephone: +61 3 8517 5313Full-time Primary FANZCA CourseOur Course Coordinator, Minh Lam, has efficiently organisedand run the Victorian Full-time Primary FANZCA Course fromMay 28 to June 8 at which we had a record attendance of 60candidates.As there was a change in some lecturers, the program waschallenging but resulted in a very successful course.I thank our participating lecturers and the mock vivaexaminers, both new and established, whose assistance andcooperation we could not do without. Their efforts are greatlyappreciated and we look forward to their continued input.As convenor, I thank the College for the use of their facilitiesand the staff for their cooperation and understanding in theevent that the course caused any inconvenience or disturbance.Dr Adam SkinnerPrimary FANZCA Course ConvenorFrom top: Statistics lecturer Dr Craig Noonan (second from left) withtrainees; Course convenor Dr Adam Skinner (second from left) withtrainees.76 ANZCA Bulletin June 2012

advertisementRoyal Melbourne HospitalRoyal Department Melbourne of Anaesthesia Hospitaland Department Pain Management of Anaesthesiaand Pain ManagementAnnual Refresher CourseTheme: Complex Patients,Theme: Complex Patients,Practical SolutionsPractical SolutionsThis year’s program revolves around lectures andThis workshops year’s program showcasing revolves Royal around Melbourne’s lectures expertise andworkshops in a range of showcasing anaesthetic Royal topicsMelbourne’s expertisein a range of anaesthetic topicsVenue : Royal Melbourne HospitalVenue Date : Royal Friday Melbourne 2 Nov 2012 HospitalDate : 1230 Friday – 21830 Nov hr 20121230 – 1830 hrFurther information, please contactFurther ARC@mh.org.au information, please contactARC@mh.org.auTel : (+61) 3 9342 7540Tel : (+61) 3 9342 7540On-line registration : www.anaesthesia.mh.org.auOn-line registration : www.anaesthesia.mh.org.auadvertisement6 th th International HokkaidoTrauma ConferenceRusutsu Ski ResortRusutsu Ski ResortJapanJapanJanuary 13January 13 th th - 18 18 th th 20132013Topics include :• Topics Airway include Management : in Trauma• Maxillo-Facial Airway Management Traumain Trauma• Maxillo-Facial Damage Control Trauma Surgery• Damage Paediatric Control Trauma Surgery• Paediatric Pain Management Traumain Trauma• Pain Ortho-Trauma Management in Trauma• Neuro-TraumaOrtho-Trauma• Neuro-TraumaEarly bird registration now open tillEarly 17 August bird registration 2012 now open tillRegistration 17 August 2012 close 2 November 2012Registration Tel : (+61) 3 9342 close 7540 2 November 2012Tel : (+61) 3 9342 7540www.hokkaidotrauma.comwww.hokkaidotrauma.com77

ANZCA Councilmeeting reportApril 2012Report following the Council meetingof the Australian and New ZealandCollege of Anaesthetists held onApril 21, 2012Death of FellowsCouncil noted with regret the deathof the following Fellows:• Dr Harold John White (NSW)FANZCA 1992, FFARACS 1967• Dr Maurice John Brookes (NSW)FANZCA 1992, FFARACS 1968• Dr Ronald Ernest Thiel (Qld)FANZCA 1992, FFARACS 1966College honours and awards• Dr Leona Wilson has been appointedchair of the New Zealand PerioperativeMortality Review Committee.• Dr Andrew Kenneth Bacon has beenawarded the Ambulance Service Medal(ASM), Victorian Ambulance Service,in the 2012 Australia Day Honours List.Education and TrainingANZCA curriculum project: Councilapproved in principle a preliminary draftof the ANZCA Handbook for Trainingand Accreditation, which will now becirculated for wider consultation. Afurther draft of Regulation 37 “Trainingin anaesthesia leading to FANZCA, andaccreditation of facilities to deliver thiscurriculum” was also approved. Copies ofboth documents will be presented to Junemeetings of the Education and TrainingCommittee and the council for approval.Training program in Hong Kong,Malaysia and Singapore: In light ofthe achievement of the original purposefor training in Hong Kong, Malaysiaand Singapore being fulfilled withthe development of internationallyrecognised training programs andqualifications in each country, the ANZCACouncil decided not to implement the 2013curriculum in Hong Kong, Malaysia andSingapore.Trainees registered on April 21, 2012,will be supported to complete the currenttraining program within a reasonabletimeframe, with provisions for thesetrainees to be developed in consultationwith the regional training committeesof Hong Kong, Singapore and Malaysia.Support for and privileges of existingFellows will continue. The council willwork with anaesthesia leaders in HongKong, Singapore and Malaysia to shapea new collaboration that builds on ourshared history and supports our sharedobjectives over coming decades. Moreinformation is available as a link fromthe front page of the College website.EMAC Course Subcommittee: Councilapproved the formation of an EMACCourse Subcommittee, which willoversee the accreditation of simulationcentres for EMAC and provide advice tothe Education and Training Committeeand the ANZCA Council on traineeaccess to EMAC courses. In line with thisdecision, terms of reference have beendeveloped for the subcommittee andRegulation 2 will be amended to reflectthe disbandment of the CoursesWorking Group.Training Accreditation Inspectors:Council supported the development ofa formal process for the appointment oftraining accreditation inspectors whoare not councillors or members of theTraining Accreditation Committee. Theywill be appointed for three-year termsand eligible for re-appointment threetimes (a maximum of 12 years). Theprocess for appointments is outlined inthe terms of reference for ANZCA TrainingAccreditation Inspectors.Training Accreditation Committee(TAC) 2013 Working Group: Councilapproved the establishment of anadvisory body to review the changes andthe implications for accreditation and tomake recommendations to the TrainingAccreditation Committee about necessarychanges. Terms of reference have beendeveloped to assist in this process.Time limits for recognition ofoutstanding AVT forms: A time limit ofMay 31, 2012 has been placed on receiptof outstanding approved vocationaltraining forms for training completedin 2009 or before. Trainees who do notsubmit relevant documentation by thisdate will lose accredited time for therelevant training terms. This is beingcommunicated to individual traineesand their supervisors of training.Dr Lisa Akelisi-Yockopua was supportedto attend the 2012 ASM in Perth from theANZCA scholarship fund.Papua New Guinea: ANZCA will providethe best medical student with a certificateand $100, the best diploma of anaesthesiawith a certificate and $400, and the bestMMed student with the Professor GarryPhillips Prize in the form of a medaland $500.Fellowship AffairsNew Fellows Conference: Councilapproved the following resolutions:(a) That new Fellows who attend theNew Fellows Conference are eligiblewithin five years of fellowship.(b) New Fellows will receive financialsupport to present at one annualscientific meeting only.(c) That the above recommendations areimplemented from 2013 onwards.(d) That new Fellow representativeswill be required to report back totheir respective regional/nationalcommittees, by writing a report onthe New Fellows Conference andpresenting it to the regional ornational committee.Annual scientific meetings2018 ASM: Canberra will host the 2018Annual Scientific Meeting, to take placeat the National Convention Centre fromFriday May 4 to Wednesday May 9, 2018.2014 ASM: Due to the redevelopment ofthe Sydney Convention Centre, the 2014ASM will be relocated to Singapore andwill be a co-located meeting with theRoyal Australasian College of SurgeonsAnnual Scientific Congress from MondayMay 5 to Friday May 9, 2014. Dr NicolePhillips will be the convenor of the 2014Annual Scientific Meeting and Dr TimothyMcCulloch the scientific convenor.Internal AffairsAppointment of externalrepresentatives: Council approved thefollowing appointments:• Dr Rowan Thomas – ANZCArepresentative to the StandardsAustralia IT-014-13 Clinical DecisionSupport Sub-Committee.• Dr Phoebe Mainland – ANZCArepresentative to the StandardsAustralia mirror committee for ISOTC 210 (Quality Management andcorresponding general aspects formedical devices).• Professor Kate Leslie – Health WorkforceAustralia – Expert reference groupfor the expanding workforce scopeinitiative: advanced practitioners inendoscopy nursing78 ANZCA Bulletin June 2012

Indigenous Health Committee: Inseeking to determine and monitor thenumbers of indigenous trainees andFellows in Australia and New Zealand andin line with a request from the Committeeof Presidents of Medical CollegesIndigenous Subcommittee, questionsderived from the census of both Australiaand New Zealand will be included in thetraining application and subscriptionnotices.Terms of reference: Council approvedthe following terms of reference forFellows and trainees occupyingleadership roles within ANZCA: President;vice-president; honorary treasurer;councillors; committee, subcommitteeand working group chairs; committee,subcommittee and working groupmembers; chair of examinations; finaland primary examiners; TrainingAccreditation Committee inspectors;international medical graduate specialistpanel members; international medicalgraduate specialist workplace-basedassessment assessors; and the annualscientific meeting officer. Copies of thesedocuments will be made available onthe ANZCA website shortly.Australian federal not-for-profitsector reform: The CEO provided theANZCA Council information aboutthe establishment of an independentregulator, the Australian Charities andNot-for-profits Commission (ACNC), a newdefinition of ‘charity’ and other changes.The college will ensure it is prepared forthese changes.Regulations: Amendments have beenmade as follows with copies to be madeavailable on the ANZCA website shortly:• Regulation 2 – ‘Committees of theCouncil’ to include the EMAC CourseSubcommittee and the Anaesthesia andPain Medicine Foundation (regulation34 was withdrawn).• Regulation 4 – ‘ExaminationSubcommittees and Courts’ (thisregulation will be withdrawn from thestart of the 2013 Hospital EmploymentYear, with content to be distributed toregulations 2 and 37 and the terms ofreference).• Regulation 6.4 – ‘Admission toFellowship by Assessment’.• Regulation 30 – ‘Reconsideration andReview’ to include a time limit of 3months from the date of the decisionto applications for reconsiderationand review.Quality and SafetyRecategorisation of ‘T’ documentsto ‘PS’ documentsDuring the work of the TE-DocumentDevelopment Group, it became evidentthat the College’s professional documentscould be rationalised by reclassifyingall documents in the “technical (“T”)”category as “professional standards(“PS”)”. The proposed change incategorisation would apply to:• T01 Recommendations on MinimumFacilities for Safe Administration ofAnaesthesia in Operating Suites andOther Anaesthetising Locations.• T03 Minimum Safety Requirementsfor Anaesthetic Machines for ClinicalPractice.• T04 Guidelines on Equipment toManage a Difficult Airway DuringAnaesthesia.PS42 Recommendations for Staffingof Departments of AnaesthesiaA document development group will beestablished to review the document anddevelop an accompanying backgroundpaper. The following individuals havebeen appointed to the group: Dr MarkReeves (lead; Tas), Dr Vanessa Beavis(NZ), Dr Kerry Brandis (Qld), Dr PeterRoessler (Vic) and Associate ProfessorDaryl Williams (Vic).TE09 Guidelines on Quality Assurancein AnaesthesiaA document development group willbe established to review the TE09 and,develop it into a professional standardand accompanied by a background paper.The Quality and Safety Committee willput forward to council the documentdevelopment group’s composition forapproval.PS16 Statement on the Standards ofPractice of a Specialist Anaesthetistand TE06 Guidelines on the Duties ofan AnaesthetistA document development group willbe established to amalgamate bothdocuments into one professionalstandard and prepare an accompanyingbackground paper. The followingindividuals have been appointed tothe document development group: DrRod Mitchell (lead; SA), Dr Justin Burke(Vic), Dr Alison Corbett (WA RegionalCommittee Vice-Chair), Dr VaughanLaurenson (NZ) and Dr Peter Roessler(Director of Professional Affairs).Retiring CouncillorsThis was the last council meeting forCouncillor Dr Leona Wilson, the Facultyof Pain Medicine Dean Dr David Jones,and New Fellow Councillor Dr JustinBurke. The president thanked them fortheir contributions and wished themwell for their future endeavours.Dr Roberts acknowledged the manysignificant contributions made byProfessor Leslie as the ANZCA presidentand wished her well for the future.Professor Leslie will remain on theANZCA Council for the next two yearsas a councillor.Dr Lindy Roberts will take office as theANZCA President from the annual generalmeeting to be held at the Perth ASM inMay 2012.Professor Kate LesliePresidentDr Lindy RobertsVice-President79

Dr David Jones’farewellAs ANZCA celebrates its 20th birthday, theFaculty of Pain Medicine reached its teens.I have been privileged to be there since itsconception and gestation via an ANZCA JointAdvisory Committee on Pain Management(JACPM, 1994-1998) then continue to serveon the Faculty Board as inaugural censor(subsequently assessor) since the Faculty’sbirth late in 1999 and through to being thesixth Dean. Now it is necessary for me to stepaside.I would like to acknowledge many finepeople who have also been dedicated to seeingthe Faculty grow from a good idea, thenevolve and thrive into the peak training andassessment organisation that it is today.In particular I pay tribute to AssociateProfessor Leigh Atkinson and Dr PennyBriscoe, both former deans who also nowleave the board having completed maximum12-year terms, and former dean AssociateProfessor Milton Cohen, who continues hisvaluable input as the Faculty’s first director ofprofessional affairs.From the founding dean, ProfessorMichael Cousins, together with all otherboard members, these people have made amajor contribution to this early genesis ofthe Faculty. In addition I acknowledge thestrengthening relationship with ANZCA asthe host College, which has made the venturepossible. I would not like to belittle in anyway all the other contributing specialists, butat the same time note that anaesthetists arepresent during the genesis of many long-termpain conditions, and have a very significantcontributory role in working towardsreduction of chronicity.A new board with five new members hasbeen empanelled led by Associate ProfessorBrendan Moore. This happens at an excitingtime – especially to continue developinga realigned curriculum flowing from theblueprinting project, and also the time ofsettling the strategy directions for the next fiveyears.The priority directions include maturing ofthe project for outcome data collection and itsevaluation, and development of future leadersand increased advocacy.Since pain traverses most areas of healthpractice, it is important to have all healthprofessionals better educated, as well as thepublic in general. To that end, the Facultyis continuing to build new relationships.Primary care and gynaecology are twomajor fields where much persistent pain isencountered, and through the efforts of aformer dean of Faculty, a new section on painwithin Royal Australasian College of Surgeonsconnects to another large source of clinicalcases.It is significant that the Faculty’s VisitingSpeaker, Professor Henrik Kehlet, a worldauthority on persistent post-surgical pain,delivered his plenary on the transition fromacute to chronic pain at the recent ANZCAASM. The Faculty is multidisciplinary, andthese examples illustrate the cross-specialtycollaboration that is necessary to get all on thesame page regarding persistent pain.In partnership with the pain societies andPainaustralia, the task of improving access toservices looms larger than most. Growing askilled workforce is inextricably linked to thisin that increased places for training arealso needed.There is growing unrest in Australiaand New Zealand over what is appropriateregarding opioid prescribing, with much ofwhat reaches the headlines lacking balance byonly highlighting what is bad. Rarely, if ever,is there a mention of positive outcomes, whichI can assert from experience do exist. Havingthe wisdom to know the difference comes tomind.Much of what has been presented atscientific meetings recently (for example, fMRIstudies, graded motor imagery, placebo andnocebo research) tell me that the organ of painis … the brain!If I had to select a single theme abouthelping pain sufferers to cope and improvetheir lot, I would choose the relationship wemust form with them as being paramount.We do not cure long-term pain, we frequentlycontrol some of it, but always we need to striveto provide comfort. That comfort requires ahuge range of tools, including active listening,believing and acknowledging the person hasa problem – although not an unsurmountableone – reducing the perceived threat from apain condition, reassurance, and providingrealistic expectations from health interactionsfor pain.Stressors, such as the effects of not beingbelieved, or uncertainty about the meaning ofa particular pain regarding the patient’s futureand even life expectancy, are consistent withrecent research on creating nocebo effects.Dealing with these factors usuallytakes more than one interaction (that is,a relationship), and I ask whether we asspecialists should be treating doctors (whodo it) or consultant doctors (who tell otherpeople what to do)? There may be someimportant style differences that alter outcomes– something for Faculty members to considerwhen it comes to evaluating outcomes data.None of those arts of medicine methodsexonerate us from having top-notchknowledge about all the scientific aspects ofour specialty. But the art of communicatingthat meaningfully to the patient needsmuch thought and practice. It should be nosurprise then that experienced practitionersare questioning within Faculty circles theduration we allocate for training. How muchis enough?Briefly I would like to mention somethingabout the environment in which we operate.It is increasingly more politically correct, anda normal expectation, to provide informationand gain informed consent. It certainlyfeels right to inform patients well – and iseven expected by the law. But each monthI encounter an example of another healthprofessional undermining some aspect ofwhat I thought was a job well done, usuallyan act by someone thinking they are doingtheir job well. For example, in a dispensinglocation reading to a patient each the sideand adverse effects of a medication fromthe drug catalogue, or printing it from thecomputer and giving it to the patient. On thesurface it may seem like the right thing to do,notwithstanding we (patient plus prescriber)might have discussed the most likely sideand adverse effects before they departed theconsultation. Patients return with reports like“it freaked me out”. It may increase their fearof taking anything.Research proves that active medicationsinclude placebo responses (a real response)contributing to their beneficial effects 1 .Similarly pairing of dire/negative messageswith effective agents undermines theirefficacy (nocebo effect). And that happensfor even the safest of medicines we use.What can you as readers contribute on howwe can remain ethical, comply with legalrequirements but also not undermine theefficacy of our tools? The science is therealready.I have learned innumerable lessons fromthose around me – practitioners of all types,patients and even a few politicians. I thankall those who have shared their wisdom,guidance, stories, secrets and tricks ofpractice, and those who entrusted me withstewardship of the Faculty and its board overmy time as dean.To conclude, as I wish the Faculty and itsFellows an even brighter future, I would like toleave you with a modified version of the plea(from Niebuhr): “Give us Grace to accept withserenity what we cannot change, Courageto change what must be changed, and theWisdom to distinguish between them”.Dr David JonesImmediate past Dean, FPMReference:Tracey I. Getting the pain you expect: mechanisms ofplacebo, nocebo and reappraisal effects in humans.Nature Medicine (2010): 16;1277-1283.81

Faculty of Pain MedicineNewsFPM Boardmeeting report2012 ExaminationExamination datesNovember 23-25, 2012 (Friday to Sunday)The Auckland Regional Pain Service,Auckland NZClosing Date for Registration:Friday October 5, 2012Pre-Examination Short CourseThe 2012 Pre-Examamination ShortCourse will be held from September 14-16,2012 at ANZCA/FPM Brisbane RegionalOffice, West End Corporate Park, RiverTower, 20 Pidgeon Close, West End,Queensland.Closing date for registration:Friday September 9, 2012.Admission toFellowship of theFaculty of PainMedicineBy examination:Dr Simon Aaron Cohen, FRACP(New South Wales)Dr Cornelis Abraham De Neef,FACRRM (Victoria)Dr Louise Kathleen Brennan,FANZCA (Victoria)Dr Brett Chandler, FANZCA (Victoria)Dr Roderick Kenneth Grant, FANZCA(Queensland)Dr Jason Suk Hyun Kwon, FANZCA(Queensland)Dr James Chor Hoaw Yu, FANZCA(New South Wales)Dr Mohammed Saleem Khan,FAFRM(RACP) (Victoria)Dr Gopinathan Raju, MA (Malaysia)Honorary Fellowship:Professor Henrik Kehlet, PhD(Denmark)Training UnitAccreditationFollowing successful reviews, ConcordRepatriation General Hospital, The RoyalChildren’s Hospital and Flinders MedicalCentre has been re-accredited for training.After its initial review, Gold CoastInterdisciplinary Persistent Pain Centrehas become an accredited training unit,bringing the number of accredited painunits to 28.Dr Timothy Brake has been confirmedas the Supervisor of Training at theKowloon East Cluster Pain ManagementCentre.May 2012Report following the Faculty of PainMedicine Board meetings held onMay 10 and May 13.The Faculty of Pain Medicine Board meton May 10 in Perth and the new boardmet on May 13 to appoint office bearersand committee chairs. The chairs willconfirm committee membership withinthe coming weeks.At the new board meeting, Professor TedShipton (NZ) was elected FPM Vice-Dean, Professor Stephan Schug and DrKieran Davis were co-opted for a secondterm representing Western Australiaand the North Island New Zealandrespectively. Associate Professor DavidA Scott, FANZCA, FFPMANZCA (Vic) wasconfirmed as the co-opted ANZCA Councilrepresentative to the board. The boardnow comprises:Associate Professor Brendan MooreDeanProfessor Edward ShiptonVice-Dean, Chair, Education CommitteeDr Meredith CraigieChair, Examination CommitteeDr Kieran DavisCo-opted member North Islandof New ZealandDr Ray GarrickRoyal Australasian College of PhysiciansrepresentativeDr Chris HayesChair, Research CommitteeDr Dilip KapurTreasurerDr Frank NewAssessorProfessor Stephan SchugCo-opted member, Western AustraliaDr Michael VaggChair, Continuing ProfessionalDevelopment CommitteeDr Melissa VineyChair, Training Unit AccreditationCommitteeDr Andrew ZacestRoyal Australasian Collegeof Surgeons representativeAssociate Professor David A ScottCo-opted member of ANZCA Council82 ANZCA Bulletin June 2012

The board congratulated Dr FrankMoloney (NSW) and Dr Michelle Mulliganon their re-election to ANZCA Council,and to Dr Vanessa Beavis (NZ) and DrGabriel Snyder (New Fellow councillor) ontheir election to ANZCA Council.Dr David Jones, Professor Leigh Atkinson,Dr Penny Briscoe, Dr Carolyn Arnold andDr Guy Bashford were farewelled at theFPM Annual Dinner on Friday May 11.The Faculty Board will next meet inMelbourne on August 13.FPM strategic planning 2013-17The board, including new boardmembers, held a second strategicplanningworkshop in conjunction withthe May 10 board meeting to continuedeveloping a five-year strategy. Asummary of responses from consultationwith key stakeholders helped identifystrategic goals for FPM to 2017.Arising from the workshop, the Faculty’sdriving aim for 2013-17 is “Buildingstrength”. Key pillars of the strategywill be:• Build the fellowship and the Faculty.• Build curriculum and knowledge.• Build advocacy and access.FellowshipTwo new Fellows were admitted in March,six in April and two in May, including theaward of honorary fellowship to ProfessorHenrik Kehlet at the College Ceremonyin Perth. This takes the total numberof admissions to 328.Associate fellowshipThe board resolved to rescind FPMRegulation 3.5: Admission to AssociateFellowship by Training and Examination.The board agreed that a singleregisterable qualification, FFPMANZCA,will be awarded to persons who meetall Faculty training and assessmentcriteria. A prior specialist qualification“acceptable to the board” is one of thecriteria. International medical graduatespecialists applying for FPM training willbe assessed on a case-by-case basis todetermine the quantum of recognitionof prior learning to be credited towardsthe Faculty’s training time requirements.Regulation 3.1.1.6 will be amended toremove reference to a requirement foran Australian or New Zealand specialistqualification acceptable to the board.International medical graduatespecialists (IMGS)The board approved the formation ofan FPM IMGS Working Group to reviewANZCA Regulation 23 with a view toadopting this regulation and to followclosely ANZCA’s IMGS assessmentprocesses adapted to pain medicine asthe subject matter. The FPM workinggroup will include representation fromthe ANZCA IMGS Committee and ANZCA’smanager IMGS and accreditation. Theboard resolved that FPM IMGS assessmentfees will align with ANZCA’s.RelationshipsANZCAThe following Fellows were nominatedto represent the Faculty on ANZCAcommittees:Dr Meredith CraigieExaminations Committee/Chair,ExaminationsPrimary Examination Sub-Committee/Chair, ExaminationsFinal ExaminationSub-Committee/Chair, ExaminationsProfessor Ted ShiptonEducation and TrainingCommittee/Chair, EducationCommitteeDr Chris HayesResearch Committee/Chair, ResearchDr Penny BriscoeFellowship Affairs Committee/ASM officerDr Frank NewIMGS Committee/AssessorDr Jane TrincaQuality and Safety CommitteeAssociate Professor Roger GouckeOverseas Aid CommitteeDr Melissa VineyTraining Accreditation CommitteeProfessor Stephan SchugANZCA Trials Group ExecutiveDr Penny Briscoe/Professor Ted ShiptonANZCA Terms of ReferenceWorking GroupRepresentation on ANZCA regionalcommittees is to be confirmed followingconsultation with regional chairs.Royal Australian College of GeneralPractitioners (RACGP)A steering group meeting for the jointFPM/RACGP GP online-learning projectwas held on April 27 in Sydney. Followingdevelopment of the online contentinvolving a number of Fellows, the projecthas now entered the review process andremains on track for a launch of a moduleat the FPM Spring Meeting in Coolum onSeptember 29. The full active-learningmodule will be launched at the GP12meeting on October 26.Australian Pain Society/New ZealandPain Society/FPM/ANZCA boardsbreakfast meetingFaculty representatives attended aninformal combined boards breakfastmeeting during the Australian PainSociety Annual Scientific Meeting, whichbrought together key representatives ofthe Australian Pain Society, New ZealandPain Society, Painaustralia, FPM andANZCA. Another meeting of the group willbe convened later in the year to discussopportunities for closer collaboration toachieve the next steps to implement theNational Pain Strategy.EducationFPM curriculum revisionDuring April and May, research wasdone into educational approaches usedby fields relevant to pain medicine. Thefindings of the research and a secondversion of the proposed curriculumframework were presented to members ofthe Curriculum Revision Sub-committeein a workshop in Perth on May 14. Twocurrent trainees have joined the subcommitteeand were present at theworkshop. The latest version of theproposed framework includes two streamsof learning and assessment: Stream A –Understanding of theory and Stream B– Clinical skills development. Additionalworkshops are planned throughoutthe year. Implementation of the newcurriculum is planned for 2015.(continued next page)83

Faculty of Pain MedicineFPM Boardmeeting reportcontinuedRetrospective credit of prior trainingThe board approved the establishmentof a working party to develop criteriaupon which to base decisions regardingthe awarding of retrospective credit forprior training and experience in a mannerthat is reliable, available to relevantstakeholders, and based on the currentunderstanding of the requirements of aspecialist pain medicine physician. Therewill be collaboration with the plannedIMGS Working Group.Training unit accreditationThe Gold Coast InterdisciplinaryPersistent Pain Centre has beenaccredited for pain medicine training.Concord Repatriation General Hospital,Royal Children’s Hospital and FlindersMedical Centre have been re-accredited.The board approved the revised Facultyprofessional document PM2 (2012)Guidelines for Units Offering Trainingin Multidisciplinary Pain Medicine. Therevised document includes criteria forTier 2 accreditation for units deemed bythe Faculty Training Unit AccreditationCommittee to have significant strengthsin some areas of pain medicine practice,but not the breadth of practice required tosatisfactorily meet the requirements of acomprehensive (Tier 1) training facility (asstipulated in PM2).Continuing professional development2012 ASM and Refresher CourseDay – PerthThe Faculty’s Refresher Course Day andASM programs were a great success.The refresher course attracted morethan 130 delegates and strong supportfrom healthcare industry sponsorsand exhibitors. The program providedinsights into the importance of outcomemeasurement in pain management. Theday was completed with a dinner at theOld Brewery overlooking the magnificentSwan River. The meetings attractedwidespread media coverage and the ASME-newsletter was well received. Thanksgo to all who contributed in bringing thisevent to fruition.The Best Free Paper Award was awardedto Dr Sarika Kumar for her papertitled “Total and free ropivacaine druglevels during continuous TransversusAbdominis Plane (TAP) block forpostoperative analgesia after abdominalsurgery: A pilot study”.The Dean’s Prize was not awarded.2014 ASM and Refresher CourseDay – SingaporeFollowing the change of venue fromSydney to Singapore, the Faculty hasappointed a Co-FPM Scientific Convenor,Dr Kian Hian Tan (Singapore), to workwith Dr Lewis Holford. The Faculty isinvestigating potential venues for theRefresher Course Day in Singapore andopportunities for collaboration with theRoyal Australasian College of Surgeonspain medicine section.ProfessionalElectronic Persistent Pain OutcomesCentre (ePPOC)The project to develop a nationalbenchmarking system for chronicpain has now been provisionally titled‘Electronic Persistent Pain OutcomeCentre’ (ePPOC). Development is plannedin three stages; a funded planning stage;an initial pilot; larger roll out. Stage oneis aimed at developing a sustainablebusiness model for ePPOC. Once anapproved business plan is developedand a funding module is secured, a pilotroll out involving six to eight centresis anticipated. This will enable initialimplementation and system development.Once the benchmarking system is refined,a larger roll out will be launched.SubmissionsThe Faculty’s submission to theAustralian Medical Council for ongoingaccreditation was submitted March 2012and can be viewed on the FPM website atwww.fpm.anzca.edu.au/communications/accreditation-submissions.The Faculty has recently contributedto the following submissions, whichcan be viewed at www.anzca.edu.au/communications/submissions/government-submissions-2012• Health Workforce Principal Committee– Development of national criteriaunder the National Registration andAccreditation Scheme (NRAS)– April 2012• Medical Board of Australia –Consultation on the board fundingexternal doctors’ health programs– April 2012• Department of Health and Ageing –Evidence requirements for assessmentof applications for the prostheses list:A discussion paper – February 2012• Deputy Director General, Governance,Workforce and Corporate – Request forinformation to support NSW medicalspecialist modelling – March 2012FinanceAt the end of April, the Faculty remainedin a positive position against budget.2012 calendarDates for future board meetings:August 13 (Melbourne)October 29 (Melbourne)84 ANZCA Bulletin June 2012

SpRiNgmeetiNg2012RiSiNgtideSFACultY oF pAiN mediCiNeAuStRAliAN ANd New ZeAlANdCollege oF ANAeSthetiStSFRom A Ripple to A wAve– the RiSiNg tideS iN pAiN mediCiNeSeptembeR 28-30, 2012pAlmeR Coolum ReSoRt,SuNShiNe CoASt, QueeNSlANdOn behalf of the Faculty of Pain Medicine and the organisingcommittee of the 2012 Spring Meeting, we would like to invite youto this exciting three day event at the beautiful Palmer Coolum Resortin the Noosa Shire of the Queensland Sunshine Coast.The meeting will focus on new and interesting developments inmedications, education and initiatives of our own Faculty. We will takea closer look at these “rising tides” of Pain Medicine as these newideas develop from ripples to waves in our area of medicine.Please join as at this beautiful beach location with an internationalstandard golf course and exquisite resort facilities.Associate professor leigh Atkinson, ConvenorAssociate professor brendan moore,Convenor and Dean, Faculty of Pain MedicineFor further information, please contact:Conference Secretariat Kirsty O’Connor, Faculty of Pain Medicine630 St Kilda Rd, Melbourne VIC 3004T: +61 3 8517 5318 F: +61 3 9510 6786 E: koconnor@anzca.edu.au85

Library updateNew titlesBooks can be requested viathe ANZCA Library cataloguewww.anzca.edu.au/resources/library/book-catalogue.htmlAAGBI core topicsin anaesthesia 2012/ Johnston, Ian [ed];Harrop-Griffiths,William [ed]; Gemmell,Leslie [ed]. / Associationof Anaesthetists of GreatBritain and Ireland.-- Oxford, UK: Wiley-Blackwell, 2012.Alfred Hospital faces and places.Volume IV / Alfred Hospital; AlfredHealthcare Group Heritage Committee.-- Prahran, Victoria: The Alfred, 2010.Kindly donated by the Alfred HospitalHeritage CommitteeAustralasiananaesthesia 2011:Invited papers andselected continuingeducation lectures /Riley, Richard [ed]. --Melbourne: Australianand New ZealandCollegeof Anaesthetists, 2012.Also available onlinethrough the ANZCAwebsiteBasic and clinicalpharmacology /Katzung, Bertram G [ed];Masters, Susan B. [ed];Trevor, Anthony J. [ed].-- 12th ed -- New York:McGraw-Hill, 2012.Essentials of painmedicine / Benzon,Honorio T [ed]; Raja,Srinivasa N. [ed];Fishman, Scott M. [ed];Liu, Spencer [ed]; Cohen,Steven P. [ed]. -- 3rd ed-- New York: ElsevierSaunders, 2011.More e-booksavailable to Fellowsand traineesThe ANZCA Library now providesaccess to over 25 online textbooksthrough Cambridge University Press,as detailed below:• Anaesthetic and PerioperativeComplications.• Evidence-based Anaesthesia andIntensive Care.• Basic Science for Anaesthetists, 2ndEdition.• The Anaesthesia Science Viva Book,2nd Edition.• Anesthesia in Cosmetic Surgery.• Core Topics in Airway Management,2nd Edition.• The Clinical Anaesthesia Viva Book,2nd Edition.• MCQs for the Primary FRCA.• Core Topics in Neuroanaesthesiaand Neurointensive Care.• Anesthetic Pharmacology: BasicPrinciples and Clinical Practice,2nd Edition.• Core Topics in Endocrinology inAnaesthesia and Critical Care.• Controversies in Obstetric Anesthesiaand Analgesia.• Physics, Pharmacology and Physiologyfor Anaesthetists: Key Concepts forthe FRCA.• Ultrasound-Guided RegionalAnesthesia: A Practical Approachto Peripheral Nerve Blocks andPerineural Catheters.• SBAs for the Final FRCA.• Anesthesia Oral Board Review:Knocking Out the Boards.• Anesthetic Management of theObese Surgical Patient.• Case Studies in Neuroanesthesiaand Neurocritical Care.• Clinical Ethics in Anesthesiology:A Case-Based Textbook.• Positioning Patients for Surgery.• Pharmacology for Anaesthesiaand Intensive Care, 3rd Edition.• Core Clinical Competencies inAnesthesiology: A Case-basedApproach.• SAQs for the Final FRCA.• Morbid Obesity: Peri-operativeManagement, 2nd Edition.• Anesthesia for the High-Risk Patient,2nd Edition.These e-books and many more can beaccessed through the ANZCA Libraryonline textbooks list or library catalogue:www.anzca.edu.au/resources/library/online-textbooksNew ECRI publicationsHealth Devices, Vol. 40, No. 9,September 2011• Best vital signs monitors.Health Devices, Vol. 40, No. 12,December 2011• Evaluation of 10 intensive careventilators.86 ANZCA Bulletin June 2012

Hadzic’s peripheralnerve blocksand anatomy forultrasound-guidedregional anesthesia/ Hadzic, Admir [ed].-- 2nd ed -- New York:McGraw-Hill, 2012.Also available onlinethrough ANZCA Libraryonline textbooks listMonitoring thenervous system foranesthesiologistsand other health careprofessionals / Koht,Antoun [ed]; Sloan,Tod B. [ed]; Toleikis,J. Richard [ed]. -- NewYork: Springer, 2012.Ophthalmicanaesthesia / Kumar,Chandra M [ed]; Dodds,Chris [ed]; Gayer, Steven[ed]. -- Oxford: OxfordUniversity Press, 2012.History of anaesthesia VII: proceedings(7th : 2009 Oct. 1-3 : Crete): proceedings ofthe 7th International symposium on thehistory of anaesthesia / Askitopoulou, Helen[ed]. -- Herakleion: Crete University Press, 2012.Neuroscientificfoundations ofanesthesiology /Mashour, George A.[ed]; Lydic, Ralph [ed].-- 1st ed -- Oxford: OxfordUniversity Press, 2011.Stoelting’s anesthesia and co-existingdisease / Hines, Robert L. [ed]; Marschall,Katherine E. [ed]. -- 6th ed -- Philadelphia,PA: Churchill Livingstone, 2012.Available online through ANZCA Library OnlineTextbooks list• Ventilator alarms and safety alerts.Health Devices, Vol. 41, No. 4, April 2012.• Making connections: integratingmedical devices with electronic medicalrecordsHealth Devices, Vol. 41, No. 5, May 2012.• Interfacing monitoring systems withventilators.• Advanced ventilation features.Operating Room Risk Managementupdates.• Basic Patient Monitoring duringAnesthesia.• Pre-Use Checklist for Anesthesia Units.• Social Media in Healthcare.Evidence-basedpractice cornerHines S, Steels E, Chang A, GibbonsK. Aromatherapy for treatment ofpostoperative nausea and vomiting.Cochrane Database of Systematic Reviews2012, Issue 4. Art. No.: CD007598.Liakopoulos OJ, Kuhn EW, SlottoschI, Wassmer G, Wahlers T. Preoperativestatin therapy for patients undergoingcardiac surgery. Cochrane Database ofSystematic Reviews 2012, Issue 4. Art. No.:CD008493.Derry S, Moore RA. Single dose oralcelecoxib for acute postoperative pain inadults. Cochrane Database of SystematicReviews 2012, Issue 3. Art. No.: CD004233.Jones L, Othman M, Dowswell T, AlfirevicZ, Gates S, Newburn M, Jordan S,Lavender T, Neilson JP. Pain managementfor women in labour: an overview ofsystematic reviews. Cochrane Databaseof Systematic Reviews 2012, Issue 3. Art.No.: CD009234.Calvache JA, Delgado-Noguera MF,Lesaffre E, Stolker RJ. Anaesthesia forevacuation of incomplete miscarriage.Cochrane Database of Systematic Reviews2012, Issue 4. Art. No.: CD008681.Keay L, Lindsley K, Tielsch J, Katz J,Schein O. Routine preoperative medicaltesting for cataract surgery. CochraneDatabase of Systematic Reviews 2012,Issue 3. Art. No.: CD007293.Rutherford JS, Flin R, Mitchell, L. Nontechnicalskills of anaesthetic assistantsin the perioperative period: a literaturereview. British Journal of Anaesthesia,first published online May 11, 2012doi:10.1093/bja/aes125Contact the ANZCA Librarywww.anzca.edu.au/resources/libraryPhone: +61 3 8517 5305Fax: +61 3 8517 5381Email: library@anzca.edu.au87

ObituaryDr Ronald E Thiel1934 – 2012Ron Thiel was born and raised inToowoomba, Queensland. He attendedToowoomba Grammar School from 1942-52 where he excelled both academicallyand on the sporting field. In his senioryear, he was school captain, captain ofschool cadets, captain of the athleticteam, president of school dramatic societyand runner-up dux.He commenced medical studies at theQueensland University School of Medicinein 1953. He was offered one of five statescholarships during his first year, butdeclined, perhaps because a scholarshiprequired a seven-year commitment to thestate health department after graduation.He later took up an army scholarship toassist with his education expenses.After graduation he was posted toSingleton and other bases for hisrequisite two years.On returning to Brisbane, Ronworked as an anaesthetic registrar atGreenslopes Repatriation Hospital andthe Royal Brisbane Hospital. He obtainedhis anaesthetic fellowship in 1966. (Hewas Fellow no. 303, which amused himconsidering his army background). Hewas awarded the prestigious AustralianSociety of Anaesthetists Gilbert Troupprize for his paper “The MyotonicResponse to Suxamethonium”, whichwas published in the British Journal ofAnaesthesia in October 1967.Ron and his family moved to Cairnswhere he was the sole specialistanaesthetist for six years. Ron was themainstay of anaesthetic practice, bothpublic and private, during this period,with some GP anaesthetists to supporthim. Because of his enthusiasm andteaching ability, he was instrumental inencouraging many residents to undertakepost-graduate anaesthetic training.Ron was a perfectionist and thisinevitably led to professional altercations(especially with surgeons), and accountsof these confrontations are now folklore.He developed a large dental surgeryanaesthetic practice and was one offoremost practitioners in this field.In the early 1970s, Ron developed whatwas probably the first day-surgery unitin Queensland approved for Medicarerebates. For many years this facility atSolander Medical Centre provided alow-cost alternative to inpatient stays,prior to the establishment of hospitalday surgery units.As the Cairns Anaesthetic Groupexpanded, Ron moderated his workloadand in 1987 undertook a “tree change” toMalanda on the Atherton Tablelands. Hecommuted to Cairns several times a weekand worked sessions at Atherton BaseHospital, again undertaking teachingduties with nursing and medical staff.Ron retired from anaesthetic practicein 1998 and relocated to Brisbane, thento Kooralbyn Valley and finally to theSunshine Coast. His retirement wasmarred by the onset of Alzheimer’sdisease that, with his usual tenacity andstubbornness, he fought for 12 years, faroutlasting his initial prognosis.Ron had a very active life outsideanaesthetics, with the emphasis onsailing and water sports. He will beremembered for his wicked sense ofhumour, a ready grin and sometimesquestionablejokes!Ron is survived by his devoted wifeGaye, his children William, Carey andGillian and their families.Dr Robert J Shield88 ANZCA Bulletin June 2012

Future meetingsAustralia and New ZealandJuly 7Brisbane, Qld36th Annual QueenslandANZCA/ASA Combined ContinuingMedical Education ConferenceTheme: “Medic-legal issues,paediatrics and obstetrics”Venue: Brisbane Convention andExhibition Centre, Brisbane, QueenslandWebsite: www.qld.anzca.edu.au/eventsAugust 10-12 Palm Cove, QldANZCA Trials Group AnnualStrategic Research WorkshopVenue: Sea Temple Resort,Palm Cove, QueenslandWebsite: www.anzca.edu.au/fellows/Research/anzca-trials-group-events.htmlNovember 3Adelaide, SACombined ANZCA/ASA SouthAustralian & Northern Territory ASMTheme: “Anaesthesia and thefailing organ”Venue: The Sanctuary, Adelaide ZooEmail: sa@anzca.edu.auJuly 27-28 Byron Bay, NSWPerioperative Medicine and Acute PainSpecial Interest Group MeetingTheme: “When worlds collide:Perioperative medicine – The newspecialty on the block?”Venue: Byron at Byron, Byron BayWebsite: www.anzca.edu.au/events/sig-eventsSeptember 21-23 Sanctuary Cove,QldThe Combined Education, Management,Simulation and Welfare SpecialInterest Group ConferenceTheme: “Workforce: Future force”Hyatt Regency Sanctuary Cove,QueenslandWebsite: www.anzca.edu.au/events/sig-eventsNovember 3-4 Shoal Bay, NSWNSW Spring CMEVenue: Shoal Bay ResortWebsite: www.nsw.anzca.edu.au/eventsJuly 28Melbourne, Vic33rd Annual ANZCA/ASACombined CME MeetingTheme: “The ultra meeting”Venue: Sofitel Melbourne on Collins,Melbourne, VictoriaWebsite: www.vic.anzca.edu.au/eventsSeptember 28-30 Coolum, Qld2012 Faculty of Pain MedicineSpring MeetingTheme: “From a ripple to a wave– the rising tides in pain medicine”Venue: Palmer Resort Coolum, SunshineCoast, QueenslandWebsite: www.fpm.anzca.edu.au/events/2012-spring-meetingThe meetings in this listing are ANZCAor ANZCA-affiliated meetings.Non-ANZCA meetings are listed in theevents calendar on the ANZCA website:www.anzca.edu.au/eventsPlease check with conference organisersto confirm dates before arranging travel.89

Future meetingsAustralia and New ZealandcontinuedNovember 14-17 Auckland, NZ13th ICCVA/NZ AnaesthesiaASM 2012Theme: “What becomes of thebroken-hearted? Outcomesand how to change them”Venue: Skycity Convention Centre,Auckland New ZealandWebsite: www.iccva2012.comJanuary 29-30 Melbourne, VicGeoffrey Kaye SymposiumVenue: ANZCA and Universityof MelbourneWebsite: www.anzca.edu.au/resources/geoffrey-kaye-museum/geoffrey-kaye-symposium.htmlJuly 19-21 Queenstown, NZNeuroanaesthesia SIG ConferenceVenue: Millennium Hotel Queenstown,New ZealandEmail: events@anzca.edu.auNovember 24Sydney, NSWAnatomy for AnaesthetistsVenue: University of Sydney, Sydney,New South WalesWebsite: www.nsw.anzca.edu.au/eventsMay 4-8Melbourne, VicANZCA ASM 2013Theme: “Superstition, dogma & science”Venue: Melbourne Conventionand Exhibition Centre, Melbourne,VictoriaWebsite: www.anzca2013.com2013January 22-25 Sydney, NSWISHA 2013Theme: “History matters”Venue: University of Sydney, Sydney,New South WalesWebsite: www.isha2013.comJune 30 – July 5 Port Douglas, QldCardiothoracic, Vascular and PerfusionSIG MeetingVenue: Sea Temple Resort & Spa,Port Douglas, QueenslandEmail: events@anzca.edu.auThe meetings in this listing are ANZCAor ANZCA-affiliated meetings.Non-ANZCA meetings are listed in theevents calendar on the ANZCA website:www.anzca.edu.au/eventsPlease check with conference organisersto confirm dates before arranging travel.90 ANZCA Bulletin June 2012

Nobody likes paying tax. But how taxsavvy you are has an effect on howmuch money is in your pocket at theend of the year. Leon Getler reports.x%Australian tax laws allow you to deduct costsof doing business from your gross income.What you are left with is your net businessprofit. This is the amount that gets taxed.Knowing how to maximise your deductiblebusiness expenses lowers your taxableprofit. At the same time, there might be sidebenefits from your expenditure: a good car todrive, a combination business trip-vacationand superannuation.Anaesthetists have a range of deductionsto lower their taxable profit. Medicalpractitioners earn high incomes so a taxstrategy is critical. A tax deduction is anyexpense incurred in producing assessableincome. In other words, if the cost was paidin the practice of your profession you canclaim a tax deduction.Savvy professionals can reap tax rewards Crossing the South Island the hard wayIn New Zealand, anaesthetists in privatepractice will now enjoy a lower tax rate thantheir Australian counterparts. New Zealand’scompany tax rate dropped to 28 per cent lastyear, putting it below the Australian companytax rate. The deductions are the samefor Australia but they need to be careful.The Supreme Court last year found twoChristchurch surgeons used family truststo pay themselves “artificially low salaries”and deliberately avoid tax.The deductions are what attract the mostinterest. Anaesthetists running a practicecan claim medical supplies, medicines,equipment and material. They can alsoclaim professional indemnity insurance.Another source for deductions comes withprofessional subscriptions, accreditations,literature, education and memberships.$200.00 +Rug up and explore with a wintry European adventure$28.46 +$45.68 ++$$798.15 +$239.00 +$145.78 +$895.00 +$45.68 +$798.15 +$239.00 +$145.78 +$895.00 +$45.68 +$798.15 +$239.00 +$145.78 +$895.00 +$239.00Anaesthetists also can claim travel, not+including travel to and from work. Traveldeductions can cover conferences and studytrips,$145.78even if they include a holiday.+Tony Greco, a senior tax advisor withAustralia’s Institute of Public Accountantssays:$895.00“Some people are able to claims trips+abroad further research, as long as theydon’t do too much of the other stuff.”$45.68This means the trip would need to be+documented. There needs to be paperworkfor every activity around research. If, forexample,$798.1560 per cent of the trip was spent+on further research and the rest of thetime on vacation, there would be a 60 percent$239.00deduction. The airfare might be fully+deductible but accommodation and otherexpenses would be apportioned. “It takessome$145.78co-ordinating and apportioning but+that’s not to say you can’t go on a holiday,’’Greco says. “That’s not to say you can’t mixa$895.00bit of pleasure with business.”+(continued next page)$45.68 +$798.15 + 91Savvy professionalscan reap tax rewards

In Australia, superannuation presents abig tax opportunity. If you are self-employedand earn less than 10 per cent of your totalincome as an employee, you can claimyour after-tax super contributions as a taxdeduction. This not only boosts your super,but also your tax position. If you are underage 50, you can claim a deduction of thistype of up to $A25,000 per financial year.A contribution of up to $A25,000 wouldbe taxed at 15 per cent. Until now, if youwere aged 50 or over, you could claim upto $A50,000 and have that taxed at15 per cent.However, Australia’s recent FederalBudget changed that. Under the budget,people aged 50 years and older will beallowed a maximum $A25,000 contributionfor their super fund. That will be taxed at 15per cent. The government has halved theprevious caps for people aged over 50.So what happens if the contributionis above $A25,000? It will be taxed at46.5 per cent. For example, you mightmake a contribution of $A30,000. Thatmeans $A25,000 of that will be taxedat 15 per cent but the extra $A5000 willbe taxed at 46.5 per cent. The move willdisproportionately affect people who arenow entering their 50s.These changes kick in from July 1. Inother words, 2011-12 is the last financialyear before the standard cap for concessioncontributions by members over 50 is halvedfrom $A50,000 to the indexed $A25,000that applies to other fund members. Theyneed to act now – it could give them a lotof money. A $A50,000 deduction for aconcessional contribution could be worthas much $A15,750. At the same time, it’sincreasing the amount the person has setaside for their retirement.Tony Greco says anaesthetists seekingto minimise their tax with a $A50,000contribution into their superannuation shouldact well before the end of June.“They only have until the end of June toget that in order,’’ he says. “Bear in mindthat June 30 is a Saturday and a lot ofpeople think that electronic transfers workon a Saturday, but you can’t do it,’’ Grecosays. “It has to physically hit the super fundaccounts on a business day before June 30.I wouldn’t leave it too late. I wouldn’t leaveit until the Friday.”One of the big changes for small businessthat came in with the new AustralianMinerals Resource Rent Tax is how muchsomeone can claim for small assets.92 ANZCA Bulletin June 2012Until now, small business entities witha turnover of less than $A2 million wereeligible for a range of tax benefits, includingsimplified depreciation, capital gains taxconcessions and exemptions and simplifieddepreciation rules allowing an immediatetax deduction for assets costing less than$A1000.But under changes that come in this July,cash flow will be enhanced with more taxwrite offs. From 2012-13, the value of assetsthat small businesses can instantly writeoff will rise from $A1000 to $A6500. Smallbusinesses also will be able to claim anaccelerated initial deduction of $A5000 formotor vehicles acquired from July 2012.Greco says this means it would beworthwhile deferring the purchase of assetsuntil July. “If you’re in small businessyou could only spend $1000 and get animmediate write off,’’ he says. “Now that’sin place for the current year, but on July 1,it bumps up to $6500.“So if it costs less than $1000, yougo to Officeworks and buy that printerfor under $1000.“But if it costs more than $1000, youshould wait until July 1 because the write-offgoes from $1000 to $6500 if you are asmall business. If you buy it before June 30,you would depreciate that and write it offover its useful life. But come July 1, you canget a 100 per cent tax deduction straightaway.“With a car, you will get a $5000deduction up front. With cars, you depreciate15 per cent in the first year and 30 per centthereafter. But come July 1, you knock fivegrand straight off and then get 15 per centon the balance, which means faster cashflow.”It is best to keep record of every expenseno matter how trivial it might seem. Withan orderly record keeping system, you aremore likely to find tax savings you neverknew existed.Leon Gettler is a former Fairfax seniorbusiness journalist. He is now a freelancebusiness writer.$200.00 +$28.46 +$45.68 +$798.15 +$239.00 +$145.78 +$895.00 +$45.68 +$798.15 +$239.00 +$145.78 +$895.00 +$45.68 +$798.15 +$239.00 +$145.78 +$895.00 +$239.00 +$145.78 +$895.00 +$45.68 ++$$798.15 +$239.00 +$145.78 +$895.00 +$45.68 +“It is best to keep record of everyexpense no matter how trivial it mightseem. With an orderly record keepingsystem, you are more likely to findtax savings you never knew existed.”

Crossingthesouthislandthe hardwayOne of ANZCA’s Fellows,Invercargill anaesthetist DrJoe Sherriff, holds a veryspecial place in the historyof New Zealand’s famousannual Speight’s Coast toCoast race. He won the firstevent in 1983 – and in thisyear’s 30th running of therace, he won the over-60age group class and was theoldest finisher in the onedayevent. Dr Sherriff spoketo ANZCA’s New ZealandCommunications Manager,Susan Ewart, about hisinvolvement in the race.The Speight’s Coast to Coast multi-sportevent traverses New Zealand’s South Islandfrom Kumara Beach on the Tasman Seanear Greymouth, through the Southern Alpsto Sumner Beach on the Pacific Ocean inChristchurch – a total distance of around243 kilometres. Now, the race may beundertaken as either a one- or two-dayevent.The course comprises about 140kilometres of road cycling, 30 kilometresof very rugged off-road running and 70kilometres of kayaking down the WaimakaririRiver.When Dr Sherriff won the two-day 1983event, he had just completed the last yearof his anaesthesia training in Dunedin. Hethen headed off to a consultant anaesthetistpost in the UK before returning to Invercargillin 1991. Pressure of work, family and otherinterests (search and rescue dog training andbeing in the New Zealand orienteering team)prevented further participation in multisportraces for a while. However, in 2002,organiser Mr Robin Judkins coerced him totake part in the 20th Coast to Coast event.Dr Sherriff says that somewhat to hissurprise, he finished the one-day event. Hewas disappointed by his time, however, sostarted training seriously and a couple ofyears later beat his original 1983 time byhalf an hour.This year, Dr Sherriff again came underpressure from Mr Judkins to participate inthe 30th running of the race. He says thatonce again there was a serious trainingdeficiency, but that he was encouraged bya great pre-race write up in the ChristchurchPress, complete with photos of the bike herode in 1983, which Dr Sherriff still usesto commute to work.This saw him lining up with othercompetitors on the beach at Kumara onFriday February 10 for a 6am start and amad three-kilometre dash up the road to thewaiting bikes. Dr Sherriff says he can’t runvery fast these days so did the road bike ridein a slow bunch toward the back of the field.The run that followed was full of interestwith multiple river crossings and car-sizedboulders to circumvent. It goes over thealpine Goat Pass, well above the bush lineand down into the Mingha River valley.Dr Sherriff says conditions for thekayaking section on the Waimakariri Riverwere slow with a strong head wind and a verylow slow flow – his excuse for a slow time,he says.Back on the bike for the last 70kilometres, things weren’t much better, andit was a very tired Dr Sherriff who rolled intoSumner some 16½ hours after starting – butwinner of his class and the oldest finisher inthe one-day race.Dr Sherriff says none of it was possiblewithout the dedicated assistance of hissupport crew, partner Ms Jo Wilson andfriend Mr Andy Clayton, who have helped DrSherriff in all the eight Coast to Coasts hehas done in the past 11 years.That support involves a 4.30am startfollowed by a day of getting the right gear tothe right place with lots of kit to carry fromvan to transition point and back again. Thebike and kayak have to be checked to seethey are in perfect working order and at theend of each stage Ms Wilson and Mr Claytonensure Dr Sherriff is in the right shoes,clothes, etc, and is fed, watered and readyfor the next few hours.This year they found that an addedchallenge was negotiating the thousands ofroad cones and unfamiliar landscape in postearthquakeChristchurch – which saw MsWilson and Mr Clayton get to the finish only afew seconds before Dr Sherriff himself.Hard though the event was, Dr Sherriffreckons it beats a 16-hour day in theatre andhe hasn’t ruled out trying to get fitter andgiving it another go. “This of course dependson the support crew,” he says, “especially Joallowing me to do so.”A specialist anaesthetist at SouthlandHospital in Invercargill, Dr Sherriff is amember of ANZCA’s New Zealand NationalCommittee and is its national Quality andSafety Officer.The photos show Dr Sherriff kayakingand at the transition point from kayak tobike. Photos courtesy of Paul’s CameraShop, Christchurch.93

Rug RUG up UP and ANDExploRE EXPLORE WiTh WITH a AWinTRy WINTRY EuRopEanEUROPEANadvEnTuREADVENTUREThere’s much to enjoy about a northern hemisphere winterprovided you know where to go, writes Kendall hill. Hill.Winter in Europe offers far more than jetset ski resortsand a white Christmas. Take advantage of affordableairfares and hotels and barely there crowds to discoverthe treasures of a cold continent – but whatever you do,don’t pack light.1. Ice dreamsThe Arctic’s greatest architectural folly wasfirst carved from frozen water in the Laplandvillage of Jukkasjärvi 20 years ago. Since then, everyNovember and December the Ice Hotel is built afreshand decorated by invited artists armed with a grand design,a chisel and a hardy constitution. Their ephemeral creationssimply melt back into the earth each spring. Winters can bebleakly bitter and perennially dark in northern Scandinavia butthere are consolations to bedding down in a minus-five-degreeart installation – chief among them the strong probability ofwitnessing the Northern Lights. There are also the uncommonpleasures of sleeping on reindeer furs, steaming cups of hotlingonberry juice and morning saunas.The hotel opens for business in mid-December and closesby the end of April; guests normally combine a night inthe Ice Hotel with a heated stay in nearby Kiruna.Ice Hotel; from 1600 SEK a person a night(about $230); icehotel.com.2. A more sereneSerenissimaIn spring, summer and autumn it’s hard to appreciate thedazzling, cinematic beauty of Venice through the constantthrong of fellow tourists. So go in winter instead, when mistsroll in from the Adriatic to shroud the Gothic canalscapes withyet another layer of wonder and timelessness. (It’s even moresublime with a light icing of snow.) Rain is relatively scarce inDecember and January and the mercury ebbs to single figures– perfect for ice skating in the Campo San Polo or exploring thePalazzo Ducale, the Campanile and the wealth of heavenlylandmarks that are hell to visit in peak season. For thosenot averse to hordes and exorbitant hotel rates, the famedCarnevale will run from January 26 to February 13 in2013 with a host of masked balls, cultural events andfree guided tours of such cultural institutions asthe Peggy Guggenheim Collection.See carnevale.venezia.it for fulldetails. en.turismovenezia.it94 ANZCA Bulletin June 2012

3. A classic whiteChristmasChristmas markets (Christkindlmarkts) are found acrossGerman-speaking Europe but for the complete fairytaleexperience, head to Vienna. The Austrian capital blazeswith bud lights and monumental public spaces, such as theRathausplatz and Schonbrunn Palace, transform into festivemarkets fragrant with spiced apple punch and pine trees,gluhwein and gingerbread, and laden with Christmas decorationsand gifts. Most markets hang out their shingles frommid-November and continue trading until December 23,ahead of the traditional Christmas Eve or HeiligerAbend celebration of tree-trimming, carol-singingand present-giving. Wien.info4. Snow timeAvid skiers will already have their favouritealpine escapes earmarked, and be aware that theminimum booking period at many European resorts canbe up to 10 days (compared with one week in the US).The cheapest time to visit is pre-Christmas, when crowdsare thin on the ground but the powder can be too. One sureway to take the hassle out of alpine highs if if you’re travelling viaLondon: every weekend during the ski season, Eurostar operatesa special Ski Train direct from London St Pancras to French skiresorts such as Courchevel, Méribel and Val d’Isère. The Fridaynight service will have you on the slopes by Saturday, andthere’s also a Saturday morning departure that arrives in timefor the evening’s après-ski. Raileurope.com.au5. XocolateThe Spanish antidote to winter is simple anddelicious – mugs of steaming hot chocolate thathave been enjoyed by the elite since Cortes firstbrought this Aztec delicacy from the New World in the16th century. There’s no more atmospheric place to indulgethan in Barcelona’s Carrer de Petritxol, aka Chocolate Street– a Gothic laneway lined with restored mosaics and art gallerieswhere the aromas of churros and xocolate perfume winter days.Catalans are so mad about the stuff they even make a chocolatesausage – the best is from the superb smallgoods store LaBotifarreria de Santa Maria (labotifarreria.com).In Madrid, join the huddled, happy masses at Chocolateria SanGinés, open till 7am daily (Pasadizo de San Ginés, in the citycentre near Puerta del Sol). Spain.info95

6. AuctionstationsForget Louis Vuitton and Isabel Marant – fora Parisian purchase to really cherish, head to thecity’s most famous auction house, Drouot. Furnituredesigner Nicolas Blandin knows the labyrinthine salons andidiosyncracies of this 9th arondissement landmark better thanmost and can advise visitors on the smartest buys, whether itis Second Empire objets d’art, Mapplethorpe photography orCongolese fetish art. Major sales – the contents of a chateau,for example – tend to be major social events and Blandin is anengaging interlocutor between outsiders and the inner circle.Serious buyers should set aside at least two days, one topreview the sales (there are 21 salons to sift through) andanother for the live auction. Blandin knows the city’s fleamarkets intimately too. His promise to prospective buyersis to explain the art market and flea markets to themand ensure they buy “at the right price andfeel comfortable”. Contact him at nicolas.blandin@yahoo.fr; nicolasblandindesign.blogspot.com.7. In with a showEven in the winter doldrums, London’s culturalcalendar never wanes. The English capital offerssomething for almost everyone in its winter exhibitions,which range from an exhibition of British ballgownsat the V&A Museum (until January 6, vam.ac.uk) to theScience Museum’s centenary show honouring Alan Turing,the computer pioneer and Enigma codebreaker (until June20, 2013, sciencemuseum.co.uk). Tate Britain is exhibitingmore than 150 works by the ever popular Pre-Raphaelites (untilJanuary 13) while Tate Modern looks at the brief, bizarre reignof the Vienna Actionists (until April 13, tate.org.uk). Over atthe National Gallery, Seduced by Art: Photography Past andPresent, explores the influence of Old Masters’ painting onphotography (until January 20, nationalgallery.org.uk).96 ANZCA Bulletin June 2012

The Alfred Intensive CareUpcoming Events ProgramThe profits from courses are 100% allocated to research, education, projectsand equipment for The Alfred ICU.Major Events in 2012Inaugural Renal Support in the Critically Ill ConferenceOur international guest speaker John Kellum will be joined by rinaldoBellomo, Carlos scheinkestel and Ian Baldwin for a full day ofpresentations for all medical and nursing practitioners in intensive carewith an interest in critical care nephrology and renal replacement therapy(rrT). A satellite hands-on practical session for nursing and interestedmedical staff will run concurrent to the afternoon session. This sessionwill focus on the equipment, skills, troubleshooting and practical issuesrequired for setting up and running rrT within the ICU.17 July 2012 registration $330 – 7004th Alfred International Symposium on ECMO & VADSupport in Critical CareThe 2 day symposium will examine the latest device developments in thefield of ECLs support and include contributions from leading Internationalspeakers marco ranieri (Italy) daniel Brodie, John Kellum & steven Conrad(UsA) and speakers from across Australia. This meeting is being held inconjunction with the Extracorporeal Life support Organisation (ELsO).An optional hands on session with live models is available for physicianswanting to develop competency in percutaneous ECmO cannulation.nurses workshop day will be held at The Alfred on Friday 20 July & is freefor all nurses attending this symposium.Two day symposium 18 & 19 July 2012 registration $850 – $1600symposium plus Cannulation 18 & 19 plus 20 July 2012 registration $31003rd Alfred ICU Nutrition in the Critically Ill SymposiumTwo days of keynote lectures, up-to-date reviews, recent research and casepresentations. For doctors, nurses and dietitians who deal with the sickestpatients in our hospitals. International guest speaker: Pierre singer - Israel9 & 10 november 2012. registration $600 - $750 Early bird $500 - $650by 14 september 2012Advanced Life Support (ALS) Provider CourseTwo day Australian resuscitation Council accredited adult life supportprovider training in advanced cardiac arrest and medical emergencymanagement for doctors, nurses and paramedics.27 & 28 August, 11 & 12 October, 3 & 4 december 2012registration $770 - $1550Basic Assessment & Support in Intensive CareTwo day introduction course for medical staff new to intensive careand care of the critically ill.6 & 7 August, 7 & 8 november 2012 registration $650Bronchoscopy for Critical CareAll you need to know about fibre optic intubation, massive pulmonaryhaemorrhage, bronchial lavage, foreign body removal and safebronchoscopy in critically ill patients. Interactive and simulationbased course.7 september 2012 the Friday prior to Echocardiographyregistration $800 - $990 Early bird $700 - $850 by 29 June 2012The Alfred Critical Care Echocardiography CourseTwo day course covering problem orientated approach toechocardiography in critically ill patients. Emphasis on echo guidedmanagement of the critically ill. Content tailored to suit participant’s echoexperience with a favourable faculty : participant ratio providing amplehands on experience.10 & 11 september 2012 registration $1750ICU & Perfusion Adult ECMO CourseTwo day course for doctors, nurses & perfusionists seeking to provideECmO support to patients with severe forms of cardiac and respiratoryfailure. Optional third day for cannulation training.2 day Course 17 &18 October 2012 registration $800Course and 1 day Cannulation 16 or19 October 2012 registration $2300The HEaRT Course – Haemodynamic Evaluationand Related TherapiesThis two day course is designed for doctors and nurses working inall critical care areas including intensive care, theatres, coronary care& emergency & aims to improve understanding of the physiology,measurement, monitoring & support of the cardiovascular system. Withpractical sessions in small groups, there are only limited places available.23 & 24 August 2012 registration $670 - $1100 Early bird $600 – 990by 21 June 2012For further information or to register online www.alfredicu.org.au/coursesContact: Cathy Oswald Ph: +61 3 9076 5397 E: c.oswald@alfred.org.auALS or BASIC Contact: Kate Pearce Ph: +61 3 9076 5404 E: k.pearce@alfred.org.au Prices are subject to changeAdvErTIsEmEnT

advertisementCYKLOKAPRON solution for injection reduces peri- and postoperativeblood loss and the need for blood transfusion in adult patientsundergoing cardiac surgery, or total hip or total knee arthroplasty. 1,2So your good work won’t go down the drain.BEFORE PRESCRIBING, PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLEFROM PFIZER AUSTRALIA PTY LTD. MINIMUM PRODUCT INFORMATION CYKLOKAPRON ® (tranexamic acid,1000 mg/10 mL Solution for Injection) Indications: reduction of peri - and post-operative blood loss and the need for blood transfusion in adult cardiac surgery,total knee or hip arthroplasty. See full PI for complete list. Contraindications: history or risk of thrombosis, active thromboembolic disease, colour visiondisturbances, subarachnoid haemorrhage, hypersensitivity to tranexamic acid or other ingredients. Precautions: Do not use in haematuria, Concomitantlywith Factor IX Complex Concentrates or Anti-inhibitor Coagulant Concentrates, irregular menstrual bleeding, disseminated intravascular coagulation rapidinjection may cause dizziness and/or hypotension. Pregnancy Category B1, Use with caution in nursing mothers. See full PI for details. Adverse Effects:Common side effects: death, arrhythmia, cardiogenic shock, myocardial infarction, stroke, renal dysfunction/ impairment, renal failure, respiratory failure,DVT Serious but rare side effects: convulsions. See full PI for details. Dosage and Administration: Adult Cardiac Surgery: 15 mg/kg (pre-surgery),4.5 mg/kg/hr (during surgery), 0.6 mg/kg of this infusion dose may be added to heart-lung machine. Adult Total Knee (TKA) or Hip Arthroplasty (THA):15 mg/kg prior to tourniquet release (TKA) or prior to skin incision (THA) & repeated at 8 & 16 hours after fi rst dose. Dosage adjustment in renal impairment,See full Product Information for dosage for other indications. The current Product Information is available at www.Pfi zer.com.au. PFIZER AUSTRALIA PTYLTD. ABN 50 008 422 348. 38-42 Wharf Road, West Ryde, NSW 2114. Pfi zer Medical Information 1800 675 229.®Registered trademark References: 1. CYKLOKAPRON Approved Product Information. 2. Henry DA et al. CochraneDatabase of Systematic Reviews 2011, Issue 3. Art. No. CD001886. McCann Healthcare P5181/CYK0046 11/11.PBS Information: This product is not listed on the PBS.