Some kind words from June 2018 attendees at Boot Camp….

The next Boot Camp is planned for February 2019.

I will also be conducting a workshop at the Adelaide National Scientific Congress in October. 

Dr. Vida,

Good day and a beautiful morning here in Hobart. Thank you so much for the lovely boot camp which was very useful for me. As an IMG with English not being my first language it is most often difficult for me to come up with the correct words and an excellent opening statement. What I saw and felt in the last two days was a thoroughly enriching experience and also the kindness and dedication from you to make sure that everyone should pass this exam. 

I am giving my exam in the first sitting next year and would love to attend this course again and pass. I want to make my family and teachers happy and proud of me. Thanks again and sorry for the long mail.

K

A boot camper Fan.

I hope they took out as much as I did. Best money I ever spent in my 10 years of anaesthetics

Dear Vida,

The Boot Camp course was a very motivating and useful course and the best way to make a weekend more productive. I really admire your interest and motivation in teaching and helping the registrars in one of the most stressful time of their training. I am sure organizing such a course is a time and energy-consuming activity and I really appreciate your kindness.

Please pass my regards to your husband and also all examiner/consultants who dedicated their time to us.

I hope to be able to send you an email with the good news and all my recalls this October! 😉

As we talked, I would like to ask if there would be a chance to take your time for a VIVA and have your feedback about my performance, please.

Warmest regards, MF

The option to “opt out” is available until October – the website is here

or paste this link

https://www.myhealthrecord.gov.au/for-you-your-family/opt-out-my-health-record

Save the date and register: 2+3 June 2018.

In response to demand for a second Boot Camp for the second sitting of the final exam – we’re doing it again. This two day workshop is aimed at performance and technique for the final exam.

REGISTRATION is via ADVANCED PROFESSIONAL EDUCATION (APE). Click HERE to be redirected.

If you have any questions, please feel free to get in touch with me.

The program will be available soon – please go to Boot Camp posts under the BOOT CAMP tab for indicative content. SAT 9 to 5, SUN 9 to 3

VENUE

Anaesthesia final exam candidates have completed their written and medical vivas – proving that it is a survivable experience.

Waiting to be invited to the next round of anaesthesia vivas can be trying. Don’t wait until the results to resume your preparations with enthusiasm. Knowledge and training are never wasted! Welcome the experience.

Evidence shows that rest and exercise are important elements to effective and improved learning…. There are also a couple of new videos to help you refresh your efforts for the next phase of preparation – watch the trainee space!

Best wishes to you all!

Boot Camp 2018 was the biggest and (I would say) best yet.

With administrative support from ASA’s Jade Melville, Jo and Rod Katz – the program and the all-important breaks flowed very smoothly1 78 delegates and 6 faculty represent a lot of looking after – thank you all.

The John James Foundation kindly supported Boot Camp with their outstanding facility for the weekend.

Drs Steve Davies, Nicola Meares, Carmel McInerney, Linda Weber and Sally Wharton were a very hard-working part of the program: myth-busting isn’t easy!

Thank you to all of the delegates – there was an infectious buzz in the room. Best wishes to you all for effective preparation and outstanding performances for March-May!

Vida Viliunas – Convenor

Here’s an idea for gift giving:

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Anaesthetist Dr Kara Allen of Monash Simulation reviewed “Anaesthesia: the gift of oblivion and the mystery of consciousness”  – a new work by Kate Cole-Adams. Dr Allen’s review was written for theconversation.com.

The French refer to the emergence from general anaesthesia as “réanimation” – literally to restore consciousness. This is a crucial attribute – that consciousness will return following the desired period of oblivion. This is skilfully explored in Kate Cole-Adams’ book Anaesthesia.

Cole-Adams delves into questions about consciousness and self. Are we restored fully to self or does the experience of anaesthesia change us in a way that may not be measurable? The result is a nuanced, powerful book, grounded in Cole-Adams’ decision to undergo scoliosis surgery, and developed around the analogy of submerging in a bottomless sea and breaking into wakefulness like a swimmer surfacing from the depths.

Anaesthetists have a short time to establish rapport with a patient who is quite literally putting their life in our hands. We know our purpose is to provide unconsciousness and analgesia, so short-term harm can take place for long-term gain. Cole-Adams writes eloquently:

It is a form of denial that enables them to act upon us in ways that would otherwise be unthinkable. To ignore the ghostly griefs and joys and hopes that trail each of us into the operating rooms, and to get on with the vital business of slicing, splicing and excision.

Occasionally the book strays into the sensational, particularly with reference to studies investigating situations where people have become aware while under anaesthesia, but don’t have a memory of this happening. But predominantly, Cole-Adams writes compassionately and competently about the art and science of anaesthesia, and of practitioner and patient.

As a practitioner, it’s fascinating and beautifully written. Some 50% of the population of Australia and New Zealand are not sure that anaesthetists are doctors, so a book that outlines the contribution of a specialist anaesthetist is very welcome.

Much of Cole-Adams’ focus is on two of the biggest aims of anaethesia: rendering the person unaware of what is happening, and ensuring they don’t remember it later. She also explores the complex question of consciousness – if we don’t form memories of an experience, and have no detectable conscious perception at the time, does the experience cause us harm?

Awareness and recall under the knife

Cole-Adams explores the phenomenon where people become aware during surgery, and can remember it. This is known as “awareness with recall”. There’s no doubt awareness with recall is an important problem with profound implications for the patient.

A large study found the number of patients aware during surgery was extremely low (measured by validated questionnaires administered after the operation), although some procedures (such as those with very large volumes of blood lost) and patients (such as those with severe heart or lung disease) were at higher risk than others.

Most cases were brief and not associated with distress or pain. Compassionate, timely disclosure of the events leading to the awareness and psychological support decreased long-term implications such as post-traumatic stress disorder, which could otherwise be severe.

She examines several “spooky little studies” that found people were aware under anaesthetic, but spends less time on the studies that failed to find evidence these things occur. The popular press like to focus on graphic and shocking stories, but it’s important to remember these are rare and extreme cases.

She also explores “perception under anaesthesia” – where a person may show a preference for certain words or images they heard or saw under anaesthesia. Studies have shown the overwhelming majority of patients have no detectable memories or evidence of consciousness under general anaesthesia.

And does it matter if someone perceives they’re in surgery while under anaesthetic if they don’t remember it afterwards? We don’t have enough information to say perception while undergoing surgery won’t affect someone psychologically if they don’t remember it. The process of surgery and post-operative recovery can all take a psychological and physical toll. It’s an interesting question, but almost impossible to answer.

Awareness is a rare but real problem that should be examined, whereas we’re not really sure perception under anaesthesia exists. And if it does, we don’t know if it would affect the patient at all since they have no memory of it.

Consciousness

Consciousness is a continuum – from drowsy through to completely inert. In situations where sedation is required, anaesthetists will administer drugs to cause amnesia, reduce pain and occasionally cause brief periods of unconsciousness. There are no hard and fast barriers between sedation and general anaesthesia – “deep sedation” often looks very much like general anaesthetic.

As consciousness recedes, harm to heart and lung function are more likely. This is particularly concerning when sedation is administered by health professionals without specialty training or indeed medical training. Only the term “specialist anaesthestist” is protected, so a less qualified person may administer anaesthesia or sedation, for example by the proceduralist in cosmetic surgery or dentistry. It’s one thing to put a patient to sleep; it may be a more difficult task to wake them up again.

This is fundamentally a story, not a scientific text, and has the potential to be slightly alarming for the uninitiated. We are fortunate in Australia that anaesthesia is extremely safe and highly reliable, but often there is emphasis on complications in the media. Cole-Adams has thought deeply about these topics, resulting in a book that is an exploration of the psychological, physiological and at times philosophical roles of anaesthesia and the implications for modern surgery.

For the interested reader, it’s an outline of the science, with an emphasis on the unknown. For the practitioner, it’s a patient experience, eloquently expressed. There’s much more to anaesthesia than meets the eye, and this book provides a glimpse into the depths.