Description

It is often easy to think about your professional ability and realise what areas of your practice need attention. Those areas where you might cover on call, but have no clinical input in practice, this is often Obstetric Anaesthesia for the Intensivists who often only visit labour ward in a crisis or Intensive care for many Anaesthetists. For me this was being called for an Obstetric epidural as a consultant in a 150 kg woman in whom the registrar and then the Senior Registrar both did dural taps. The realisation dawns that you must get back down to insert more routine epidurals in labour from time to time and experience some complex obstetric cases. This issue contains an excellent article on the management of the Critically Ill Obstetric Patient and this should be of interest to all Anaesthetists regardless of special area of interest.

However what about areas of practice where we feel very comfortable and do not realise that there is still lots to learn of clinical relevance. Such an area is low flow anaesthesia. Most of use it daily and it is so familiar that we automatically think that there is little additional to learn. This is far from the truth as the postgraduate article in this issue reveals. There is still much for all of us to learn and much more research remains to be done in this field which is familiar to us all in common practice. This is worthy of careful reading by all who use or intend to use low flow anaesthesia or are facing postgraduate examinations! The front cover photograph is of a variety of early CO2 absorbers including a to and fro system and an early canister similar to that invented by Waters. Although credit is usually given to Ralph Waters for the invention of the Waters soda lime absorber in the 1920s, this was on a long historical background going back to the Reverend Stephen Hales who published a recognisable circuit system in 1727 in which he could breathe for 8 minutes, before the discovery of either oxygen or carbon dioxide.¹ His prediction of the potential use of such a system being used in areas where breathing was not possible because of noxious deadly vapours went unnoticed until a firedamp explosion in Belgium in 1852 leading to a re-evaluation of closed breathing systems.

This issue also contains an article on military medical services, the start of a series of articles describing the problems faced by the military anaesthetic services of which many of us are all too unaware but involve significant challenges of management of the critically ill with limited resources and transport of acutely sick patients under adverse conditions. The More Than an Abstract section reviews the SAFE study on the use of Albumin in critical illness, which recruited 7000 patients in 16 tertiary referral ITUs demonstrating that important well conducted multicentre studies can be performed and important questions answered if the will exists. In addition the role of high frequency jet ventilation, the principle of double effect and management of gas embolus as well as make this an interesting and educational issue.

If anyone is still interested, I did get the epidural in to the relief of the patient, the embarrassment of the Senior Registrar and my surprise!

Reference 

1. White DC. The History of Closed Circuit Anaesthesia. The Association for Low Flow Anaesthesia, Abstract Manchester 1994.