2007 Annual Scientific Meeting
Report of the VASGBI Annual Scientific Meeting
Durham University Queens Campus, Stockton on Tees, Monday 10th – Tuesday 11th September 2007
The 11 th Annual Scientific Meeting of the VASGBI was hosted by Gerry Danjoux and Simon Baker in Stockton on Tees. The meeting was attended by over 180 delegates and was slightly extended from previous years to include 5 sessions over 2 days. In addition to extending the time available for the meeting, this also allowed delegates who thought they were going to a meeting in Durham time to arrive. The programme encompassed the science and art and practical aspects of vascular anaesthesia from speakers whose backgrounds included anaesthesia, vascular surgery and cardiology. The delegates responded once again by partaking fully in all the scientific and social aspects of the meeting.
The meeting opened with a ‘FAQs’ session comprising four 20-30 minute talks on practically based topics given by a number of eminent individuals. Firstly Richard Telford of Exeter gave an erudite account of the history of endoscopic thoracoscopic sympathectomy, the potential problems and pitfalls for the unwary and an insight as to how his own anaesthetic practice has developed over the years. This was followed by Sean Bennett of Hull who spoke on the use of echocardiography in non-cardiac surgery. Clearly TOE could be valuable in the perioperative management of some of our high-risk vascular cases, and Dr Bennett gave a realistic account of the practicalities of gaining and maintaining expertise in TOE, and of incorporating it into the realms of vascular anaesthesia. He also emphasised the role of preoperative transthoracic echocardiography in preoperative evaluation and risk assessment. Next Dr Steve Murray of Middlesbrough gave a particularly clear update on perioperative management of the patient with a cardiac pacemaker or implantable defibrillator. This is one of the areas of cardiology which has changed significantly over the last decade so that most standard texts are now outdated. Dr Murray’s talk was very well received and was delivered with dry aplomb. The session was concluded by Mark Stoneham of Oxford who described the difficulties of blood pressure management in patients following carotid endarterectomy. Probably all vascular anaesthetists have experienced patients with problematic arterial pressure before and after carotid surgery. It was therefore reassuring to learn that we are not alone in experiencing difficulties, and that the traditional aims of management (observe, monitor appropriately and treat judiciously with conventional drugs) still hold.
The first session after lunch was dedicated to Acute Coronary Syndromes. Dr Jim Hall, a cardiologist from Middlesbrough enlightened us on the Management of ACS, including recent diagnostic classification and implications for management, including the increasing role of primary angioplasty in place of thrombolysis. Patients with recent coronary angioplasty or in particular coronary stents require long-term antiplatelet therapy and may present a difficult problem if they require surgery, because of the high risk of coronary thrombosis if antiplatelet drugs are stopped, and the increased risks of epidural or spinal haematoma if perioperative neuraxial blockade is performed. These topics have received much attention in the last few years and the next talk by Simon Howell of Leeds addressed the subject ‘Implications of coronary interventions for anaesthesia’ very well. In addition to an overview of the scientific data and gaps in our knowledge he gave a good account of the practicalities of perioperative management.
The final session of the first day opened with Professor Nick Cheshire of St Mary’s Hospital London whose talk was entitled ‘Surgical management of thoraco-abdominal aneurysms’. After rightly apologising for being a surgeon he entertained the delegates with multiple slides of the surgical procedure itself and spoke eloquently about the peculiar challenges involved. In addition he expounded with disarming modesty of the difficulties when results are less than anticipated and continued to describe the management options including hybrid, combined open and endovascular procedures for complex cases involving multiple vessels. This talk was complemented by the lecture from our invited international speaker, Ken Davison of Massachusetts General Hospital. Dr Davison pioneered the use of selective epidural cooling to protect the spinal cord from ischaemia during TAAA repair, and he described his technique for management of these patients. Although many of us will not come across elective TAAA repair in our routine practice, his talk was full of gems gained from practical experience over many years. These included the lessons learned as an anaesthetist/intensivist looking after major vascular patients in the postoperative period. A highly fruitful panel discussion followed.
Professor Nick Cheshire and Dr Ken Davison
Dr Simon Lewis of Bristol gave a brief and informative account of his experiences as a post CCT fellow in Australia, which was supported by a travel grant from the VASGBI. Dr Lewis gained valuable experience in vascular and other fields of anaesthesia and members are reminded that these grants are available to be used to fund travel to visit centres of excellence for vascular anaesthesia and surgery in the UK and overseas.
The announcement that the next session would comprise the subcommittee reports and Annual General Meeting prompted the usual stampede for the exits, but those who stayed were treated to a quick and efficient handling of the necessary business.
The conference dinner was held in the dining hall and as usual the wine flowed and the customary late bar followed the meal. No major mishaps have been reported although one delegate complained on the feedback forms about noise from people returning to their rooms after 02:00 am. However, in traditional fashion, no-one was available for comment.
Once again, despite the rigours of socialising the evening before, the first session on Tuesday morning (Free Papers followed by the Debate) was attended by almost all the delegates. It has been said before but undoubtedly this demonstrates the inner fortitude strengths and skills of the VASGBI members, an enduring characteristic of vascular anaesthetists which separates us from the rest. The quality and number of papers submitted to the meeting continues to improve each year; this year we received 25 abstracts of which 15 were selected for poster presentation and 4 for verbal presentation. The posters and verbal abstracts were each judged by members of the Audit and Research Subcommittees. In truly decisive fashion, the judges were unable to separate the winners of the verbal presentations so prizes of £200 each were awarded to Dr E. Kothmann of Middlesbrough for her presentation on ‘The effect of an exercise prescription on fitness of patients with AAA’ and to Dr C. Melikian of the Royal Free Hospital London for her presentation on ‘Point of care assessment of platelet function in the perioperative period’. A further prize of £200 for the best poster was awarded to Dr M.D.Wiles of Nottingham for his study of factors influencing outcome after endovascular repair of ruptured AAA.
One of the most popular aspects of the ASM is the debate, and this year proved no exception. The motion, in a slight change to the advertised programme, was ‘This house believes that all vascular services should be centralised’, proposed by Mr Andrew Parry of Middlesbrough and opposed by the redoubtable Dr David Thomas of Durham. Those delegates expecting a surgeon vs. anaesthetist bunfight Tees-style were not disappointed although the tactics were significantly more civilised than in previous years. Parry opened well, drawing on reserves of eloquence backed by meaningful quotes and statistics, skills hitherto unsuspected in vascular surgeons. Thomas countered with several combinations of logic and humour, keeping facts and figures as a backup. He appeared to have delivered a knockout blow with images of his anaesthetic machine loaded with coffee and a description of how he could take the short walk home through treelined glades for lunch. Parry had no time to make a comeback as he had proposed the motion and the audience were left with baited breath whilst the votes were counted. The pre-debate votes were: 58 for the motion and 47 against. After the debate there were 55 votes for the motion and 38 against. So in contrast to some meaningless statistics, it was decided that no viable conclusions could be made, and the debate was declared an honourable draw.
Mr Andrew Parry v Dr Dave Thomas
In the final session of the meeting Gerry Danjoux of Middlesbrough spoke on the practicalities of ‘Setting up a vascular preoperative assessment clinic’. This area is increasingly important and Dr Danjoux outlined a number of the difficulties that may be encountered as well as strategies for success. Finally, Professor Chris Dodds of Middlesbrough enlightened the audience about ‘The impact of changes in training on vascular anaesthetists of the future’. This was a slight departure for the Society into the medical political arena but was timely in view of recent developments in training, accreditation and revalidation. The talk was very well received and generated much discussion.
Jonathan Thompson as incoming Chairman formally closed the meeting. In his closing remarks, he thanked and made a presentation to Richard Telford who has served the VASGBI as Chairman since 2004 and as committee member before that. He also thanked Jane Heppenstall, Gerry Danjoux and Simon Baker for organising an excellent meeting and closed with a reminder that next year’s meeting is to be held in Norwich on September 8 th-9th 2008. The draft programme already looks impressive and as usual members are advised to book early to avoid disappointment.
