Description

Welcome to what I hope you will find to be a fascinating and thought provoking issue of CPD Anaesthesia. I think I can assume that all readers will find items of interest in this issue that will add to their knowledge base, even if it does not instantly change their own practice. This issue in many ways hints at things to come, in particular the article on anaesthesia for robotic surgery is a fascinating insight into the future if not for most of us, maybe for a select few in large specialist centres. Surgery would appear to be prolonged, but with fewer postoperative complications, at some financial cost. Anaesthesia for such cases must be technically challenging in terms not only of duration, positioning and access, but of communication with potentially a distant surgeon. Having said that I think many of us have probably worked with surgeons who barely said good morning and this might be an improvement for many! Perhaps in 20 years, most surgery will be done robotically, operator independent and only the anaesthesia will be delivered by people, I wonder who will move the operating light?

In addition to this we have an excellent review on TIVA in children, a new technique to me and probably to many, but again with significant possible advantages. A technique whose usefulness and applicability may have been undermined by the propofol infusion syndrome problems reported in paediatric intensive care in the 1990s, which is not applicable to the healthy child undergoing surgery, an excellent and informative review. Following on from USS guided vascular access in the last issue, we review USS nerve blocks in this issue, an excellent and recommended development in enabling us to achieve higher success rates of nerve blockade. This thorough practical review is still detailed and enables translation of theory into practice for us all, particularly now that high definition USS machines are almost universally available. Following this a very practical piece reviews the fascia iliaca block and again details the smooth translation of this very useful block into clinical practice. A thorough review of heat illness and its treatment in ITU is fascinating and although predominantly military in its application for many of us, is increasingly becoming a condition requiring treatment in long and hot summers throughout the Mediterranean as well as the rest of the world, again a potential problem of the future, though I have to say not the north east of England where it has rained almost every day for the last 2 years.

Finally I am delighted to be able to publish an excellent review of Examination techniques in anaesthesia for the final exams by an acknowledged international figure in this field. This should be regarded as essential reading for those undertaking final exams and I would recommend all readers of this issue to keep this article and direct it towards those about to take any postgraduate exam in anaesthesia and college tutors and educational supervisors to keep on file, it gives excellent clear cut advice for all approaching a significant challenge in their careers. I hope you enjoy this issue and reflect on the ways in which you may be able to apply some of the reviews into daily practice and feel free to disseminate to many.

Dr Stephen Bonner

Editor