Fragile Minds, Frail Bodies: Navigating complexity in Anaesthesia

We have had brilliant feedback on our all day meeting based on navigating complexity in anaesthesia. The day started off with formal proceedings through the AGM. Dr Raymond Ahearn and Dr Pat Mullen have been nominated as new Honorary Members (Life) in recognition of all of their tremendous work and commitment to the society of decades. Dr Nicole Robin formally handed over the presidency to her successor Dr Richard Craig. We all thank Dr Robin for all the hard work that she had put in over the last few years helping the LSA go from strength to strength. Good luck to Dr Richard Craig with the mantel that he takes on.

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The first speaker of the day was local legend Dr Sally Hargreaves informing us on her Don't BE DAFT campaign. If we can ensure patient's listed for surgery have some common co-morbidities optimised, we can really make a difference with the reduction in cancellations, and also in freeing up pre-operative clinic slots. Remember don't Blood pressure >160/100, Elevated BMI >40, Diabetes HbA1C >70, Anaemia/ AF Hb <130, Frailty > 5, Tobacco smoker (stop for 4 weeks pre-op) and ensure optimisation before listing. This was followed by BJA Chair Prof Simon Howell updating us about changes of frailty in the literature. The increase in complications and length of stay is now evident from a clinical frailty score of 4 or more. Almost 80% of frail patients have multi-morbidity. It will be fascinating to see the outcomes of the POPS-Sup project.

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We were entertained by Mr David Atkin who shared his experiences of having delirium on two separate occasions on intensive care and subsequently on a frailty ward. It was insightful to hear how everyday medical occurrences can be interpreted so traumatically during critical illness, and how he has worked through these memories. We shall all need to prioritise ice-cream availability to our patients! Thank you for sharing some difficult memories with us, it was invaluable to hear and learn from you.

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Our 8th Biennial T. Cecil Gray BJA Lecture was delivered by Prof Lis Evered. She educated us about the current proposed pathophysiology behind post-operative neurocognitive disorders. Surprisingly around 30-50% have an undiagnosed form of cognitive impairment, it is important to continue to minimise the risks peri-operatively in all patients regardless of a pre-operative diagnosis. A useful screening tool can be asking a patient if there are any fish in the sea? Delirium or other post-operative neurocognitive disorders cause an increase 12-fold in dementia! Interestingly, there doesn't currently seem to be a difference between a TIVA or volatile anaesthetic.

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In the afternoon, we had Dr Peter Brooks talk to us about delirium in a paediatric population. It is much more challenging to distinguish between pain and delirium post-operatively; the give away is lack of eye contact. We will see more about the use of neurone specific enolase in helping us to diagnose, and monitor delirium in the future. Interestingly the risk of post-operative delirium is significantly increased in those who suffer from pre-operative anxiety either themselves or from exposure to that from their parents/ guardians. The last lecture of the day was delivered by Dr David Bardell where he entertained us with plenty of brilliant videos looking at emergence delirium in animals. The risks that vets and their colleagues place themselves in is quite astounding. Unfortunately, the research is quite far behind that in the human population. Horses are a particular challenge, and there are still high risks of emergence delirium in both cats and dogs. Alpha-2 agonists can provide benefit in its management. Most importantly, we can all become vets for the chilled out donkeys!

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The day was concluded with the Gordon Jackson Rees Prize and Poster Prize. Our shortlisted residents were: Dr Tom Lightburn, Dr Ben Jones, Dr Gareth Allen, Dr Megan Brocken, and Dr Ash Shah. Congratulations to everyone who submitted an abstract, the presentations and posters were evident of all of the brilliant hard work that is going on around the region currently. Well done to the winner of the Gordon Jackson Rees Medal Dr Tom Lightburn. The runner up was Dr Gareth Allen. Well done also to the Poster Prize winner Dr Reanne Jones.​​ You can see our past winners and more information on Jackson Rees here.​