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This issue of CPD Anaesthesia contains several articles that I hope will be of significant educational interest to all and I recommend thorough reading as some of the details may be somewhat contrary to expectation. For example the critical care of the elderly article emphasises the often excellent outcome in the extreme elderly admitted to critical care, as long as pathology is reversible, the patients have good physiological reserve and duration of ventilation is short. The tenuous link for the front cover photographs, which I would be stunned if anyone recognises, are extreme old age. The bust of is of Methuselah, who according to the bible was the oldest man recorded, reputedly at 969 years old, dying the day before the great f lood. The tree pictured is the oldest actual living thing on the earth, the Methuselah pine, living up to 5000 years old. The oldest actual person in history, easily confirmed was Jeanne Calment, who died in France in 1997 at the age of 122. She put her long life down to olive oil, red wine and garlic. The oldest person to be admitted to Intensive Care became newsworthy recently when at the age of 113, he was transferred to ITU postoperatively after having a fractured neck of femur fixed and was discharged home shortly thereafter. It is accepted that the population is aging, and this includes the oldest of the old. Only approximately seventy people in human history have been documented as reaching the age of 114 and only about twenty people reached the age of 115. These figures are predicted to double in the next decade and there is no doubt we will be treating a much older population in both anaesthesia and Intensive Care. We need to address the issues now and evaluate the evidence in outcome for specific treatments, e.g. surgical vs conservative outcomes, admission to Intensive Care, radical versus limited surgery etc. Age alone as a factor is a poor predictor of outcome and physiological reserve is more important, and the spreading of CPx testing to predict outcome for major surgery will be a growth area that we need to all understand over the next decade.

The other articles in this issue equally impart important up to date information on techniques for ophthalmic anaesthesia, anaesthesia for head and neck surgery and Transthoracic Endoscopic Sympathectomy. The article on Ultrasound emphasises its use now extending beyond central venous access or drainage of collections, into that of nerve blockade and its use in optimising the performance of nerve blocks. This is a technique that I have yet to learn, but shows great promise and deserves to become more widespread. As the technology improves, so do the uses, I discovered one of our registrars successfully using ultrasound to locate and cannulate a peripheral vein in one of the longstanding ITU patients, in whom we had regularly failed cannulation and were considering cvp access again. Another technique to learn and hopefully use to the patients benefit, emphasising the usefulness of both journals and registrars in keeping us up to date!

Dr Stephen Bonner
April 2008
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