Podcasts

The AAGBI has produced a small number of podcasts as part of a pilot project. These are downloadable from this webpage - simply click on the titles below to play or right click on the titles and save the file to your desktop and import into itunes or download to your MP3 Player to listen at your leisure. We will be developing a more extensive collection of educational podcasts in the coming months and years. If you would like to comment on these podcasts or would like to suggest topics for podcasts in the future, please email website@aagbi.org

Management of Severe Local Anaesthetic Toxicity 2 Management of Severe Local Anaesthetic Toxicity 2
Dr John Picard discusses the new version of the LA Toxicity safety guideline.
Pre-operative Assessment and Patient Preparation 2) Pre-operative Assessment and Patient Preparation 2
Dr Ranjit Verma discusses the new version of the Pre-op safety guideline.
Equipment  Equipment
Dr John Carter discusses new guidance on the Safe Management of Anaesthetic Related Equipment coinciding with the launch of the AAGBI's latest safety guideline.
Anaphylaxis  Anaphylaxis
Dr Nigel Harper discusses new guidance on managing potentially fatal anaphylactic reactions during surgery.
Pandemic Flu  Pandemic Flu
Andrew Hartle discusses the implications of pandemic flu for hospitals, intensivists, anaesthetists, trainees and the public.
Difficult airways - what skills and what equipment? (20' 37") Difficult airways - what skills and what equipment? (20' 37")

When Ellen O'Sullivan describes a patient with a dental abscess whose trachea proves difficult to intubate, a discussion is sparked about what airway skills all anaesthetists should have and what airway equipment all hospitals should have. Ellen O'Sullivan, Chandra Kumar, Steve Yentis and Alastair Chambers also discuss problems with maintaining difficult airway skills.

References
Yentis SM, Lee D.
Evaluation of an improved scoring system for grading tracheal intubation. 
Anaesthesia 1998; 53: 1041-4.

Henderson J J, Popat M T, Latto I P, Pearce A C.
Difficult Airway Society guidelines for management of the unanticipated difficult intubation.
Anaesthesia 2004; 59: 675-94

Cormack RS, Lehane J.
Difficult tracheal intubation in obstetrics.
Anaesthesia 1984; 39: 1105-11

Cook TM.
A new practical classification of laryngeal view. 
Anaesthesia 2000; 55: 274-9

Difficult airways - should formal assessment of patients' airways be compulsory? (11' 20") Difficult airways - should formal assessment of patients' airways be compulsory? (11' 20")

When Chandra Kumar describes a patient who presents a potentially difficult tracheal intubation, our panel of experts disagree on whether formal airway assessment is of real value. Steve Yentis, Ellen O'Sullivan, Chandra Kumar and Alastair Chambers address this unresolved dilemma.
 

References
Samson GLT, Young JRB.
Difficult tracheal intubation: a retrospective study.
Anaesthesia 1987; 42: 487-90.

Mallampati SR, GattSP, Gugino LD et al.
A clinical sign to predict difficult tracheal intubation: a prospective study.
Canadian Anaesthetists Society Journal 1985; 32: 429-34.

Yentis SM.
Predicting difficult intubation--worthwhile exercise or pointless ritual?
Anaesthesia 2002; 57:105-9

Obstetric anaesthesia - a quick look at a chest X-ray (20’ 32”) Obstetric anaesthesia - a quick look at a chest X-ray (20’ 32”)
When Dr Valerie Bythell is asked to have a “quick look” at a chest X-ray on the Labour Ward, her suspicions are quite correctly aroused. David Bogod, Mike Wee and Paul Clyburn discuss the management of an acutely septic woman in labour, the use of remifentanil PCA for analgesia, autonomy in decision-making and even the best form of anaesthesia for rescue cervical cerclage.

Reference
Blair JM, Dobson GT, Hill DA, McCracken GR, Fee JPH. Anaesthesia 2005; 60: 22-7

High-risk amputation – 17’ 14” High-risk amputation – 17’ 14”
When an 82-year-old diabetic with severe aortic stenosis and chronic lung disease presents for amputation of a gangrenous leg, no anaesthetic option seems without significant risks. Andrew Hartle, William Harrop-Griffiths, Nick Denny and Chandra Kumar discuss the pros and cons of the various options, coming to a conclusion that may well surprise those who know their passion for regional anaesthesia.
Clinical ethics and anaesthesia – who decides treatment for the patient without capacity? (17’ 09’’) Clinical ethics and anaesthesia – who decides treatment for the patient without capacity? (17’ 09’’)
When a severely demented woman is admitted to hospital with a fractured neck of femur, her estranged daughter intervenes and tries to refuse treatment on her mother’s behalf. Who decides whether surgery should be performed under these circumstances: the demented patient, the estranged daughter, the anaesthetist, the surgeon or an independent mental capacity advocate? David Bogod, Stuart White, Steve Yentis, Les Gemmell and Andrew Hartle discuss this knotty problem.
Obstetric anaesthesia – problems with anticoagulation (16’ 54’’) Obstetric anaesthesia – problems with anticoagulation (16’ 54’’)
Although a plan for the management of a pregnant woman with a mechanical mitral valve replacement is decided in advance by a multidisciplinary team, spontaneous rupture of her membranes and the start of premature labour disrupt the plan, forcing the obstetricians and anaesthetists to contemplate an urgent caesarean section in an anticoagulated patient. How long can the operation be delayed? What tests of coagulation for a patient on low molecular weight heparin would be appropriate? What form of anaesthesia should be used? David Bogod, Paul Clyburn, Valerie Bythell and Mike Wee debate this difficult clinical problem.
Obstetric anaesthesia - lost in translation (17' 18") Obstetric anaesthesia - lost in translation (17' 18")
When a woman who cannot speak English is admitted in labour, those caring for her start to doubt the accuracy of her husband's translation of her wishes. When it becomes evident that she is needlephobic and her labour becomes complicated, matters get even worse. David Bogod, Mike Wee, Paul Clyburn and Val Bythell discuss the problems associated with interpretation and needlephobia in high-risk labour.
Ethics - DNAR problems (16' 32")  Ethics - DNAR problems (16' 32")

David Bogod, Steve Yentis, Les Gemmell, Stuart White and Andrew Hartle discuss the problems associated with providing anaesthetic care for a patient who is the subject of a Do Not Attempt Resuscitation order. Is tracheal intubation resuscitation? Is intravenous fluid therapy resuscitation? How about a milligram or two of ephedrine? Our resident ethical experts unpick this potentially knotty ethical situation.

Reference
McBrien ME. Heyburn G. 'Do not attempt resuscitation' orders in the peri-operative period Anaesthesia 2006; 61: 625-7

Regional anaesthesia and nerve damage Regional anaesthesia and nerve damage

When a 32-year-old man suffers significant nerve damage after plating of the clavicle performed under regional and general anaesthesia, the surgeon is all too ready to blame the interscalene brachial plexus block. How common is significant nerve damage? What can you do to minimise the risks of this feared complication? Do the benefits of this technique outweigh its risks? In this session, four experts in regional anaesthesia - Andrew Hartle, Will Harrop-Griffiths, Nick Denny and Chandra Kumar - explore the controversial topic of regional anaesthesia and nerve damage.

References
Benumof JL. Permanent loss of cervical cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000; 93: 1541-4.

Koff MD, Cohen JA, McIntyre JJ, Carr CF, Sites BD. Severe brachial plexopathy after an ultrasound-guided single-injection nerve block for total shoulder arthroplasty in a patient with multiple sclerosis. Anesthesiology 2008; 108: 325-9.

Clinical ethics and and anaesthesia - the trainee paramedic Clinical ethics and and anaesthesia - the trainee paramedic

You are in an anaesthetic room preparing to anaesthetise a patient when a trainee paramedic enters the room and asks you whether he can intubate the patient's trachea in order to complete the 10 intubations he needs to be "signed off". Should you agree to this because it is in society's interest to have skilled paramedics or refuse on the grounds that the patient is not in a position to give - or refuse to give - informed consent? In this session, five leading experts in clinical ethics - David Bogod, Les Gemmell, Andrew Hartle, Steve Yentis and Stuart White - debate the ethical considerations of this all-too-common situation. 

References
AAGBI. Consent for Anaesthesia 2006.