Description

There cannot always be fresh fields of conquest by the knife; there must be portions of the human frame that will ever remain sacred from its intrusions, at least in the surgeon’s hands. That we have already, if not quite, reached these final limits, there can be little question. The abdomen, the chest, and the brain will be forever shut from the intrusion of the wise and humane surgeon.” (Sir John Erichsen, 1873)

Whilst some of us may still feel a great deal of sympathy with Sir John Erichson’s comments from the 19th Century, it remains an interesting reminder of the pace of change in medical advances. What changes will occur within our own working lifetimes and how will we cope and adapt to them? Will we close our eyes and refuse to adapt whilst pretending that the newer techniques do not work or will we embrace them and continue to adapt and develop our own skills?

However, where does keeping practice up to date in line with clinical governance become mere experimentation to try something new to no benefit to the patient. How many hours have many of us spent watching aortic stents being inserted over the last few years only to now have doubt cast on their long term worth in preventing aneurysm rupture? In this issue of CPD Anaesthesia we review several new techniques that may become of great clinical benefit in the near future.

In this issue, we present a novel midhumeral approach to brachial plexus blockade which avoids many of the characteristic complications of the usual approaches. Bispectral Index technology is reviewed. It may be new to many anaesthetists but which is increasing in popularity, and appears to be the user friendly product of many years of research looking for ways to measure depth of anaesthesia and sedation.

We present 2 articles on risk. Early warning scoring is becoming increasingly useful in clinical practice in identifying sick patients on the wards and this is reviewed in detail in all it’s many forms. Again trials are ongoing and if successful in decreasing mortality rates, some form of early warning scoring may become expected practice in the near future. The second article on risk is presented helping all of us to analyse the risk associated with what we do and how to communicate this to our patients. Eye blocks are a typical example of areas of practice with which we become unfamiliar very quickly if we do not regularly perform them. Alwitry compares practice and the advantages and disadvantages of different eye blocks.

All these issues reflect the changing nature of what we do, how we do it and how we weigh up the risks and benefits and assess our practice. Self-assessment and audit is now expected of us and in the first article in the this issue Professor David Hatch succinctly and clearly draws together the issues surrounding revalidation and in particular what will be expected by the GMC in the future. What is obvious is not only that we will need to keep up to date, but that we will need to show that we have kept up to date and then audited our work to demonstrate our outcomes. One wonders whether Sir John Erichson was ever persuaded to operate on the brain, abdomen or chest in his lifetime and whether he was encouraged or subsequently changed his opinions. Our own practice should certainly be open to change according to the prevailing evidence.