Journal of Perioperative Practice

The exam question “Who should be held to account for the delivery of safe, effective and compassionate care?”

At a recent AfPP event, during a debating session amongst fellow perioperative practitioners, the role and remit of assistant theatre practitioner (ATP) was raised. The debating panel's views were sought from several quarters and the subject seemed to spark discussion and much ‘harrumphing’ in the audience. A recently qualified ATP, who, having spent an intensive two years studying for a foundation degree, expressed his frustration about on-going role ambiguity and the struggle to have his newly acquired knowledge and skills recognised in practice. As a heated discussion went around the room, polarised views were emergent, in particular themed around concerns about delegation, accountability and scope of practice.

A review by Catchpole et al (2009) into the causes and types of harm experienced by the surgical patient emphasised the high risk nature of the perioperative period. Investigations into recent failures at NHS organisations have emphasised the relevance of non-technical skills education in improving clinical performance and patient outcomes. However, scrub practitioner non-technical skills are often developed on a tacit basis, making assessment of performance difficult. This literature review identifies strategies that facilitate assessment of non-technical skills during surgery. Recommendations are made that will assist scrub practitioners in using a validated scrub practitioner non-technical skills assessment framework reliably.

Type 1 diabetes mellitus (T1DM) is a serious lifelong condition affecting many people in the UK. With the increasing prevalence of T1DM, it is inevitable that more patients will present for anaesthesia and surgery. This article will inform anaesthetic practitioners about the condition, the challenges involved with glycaemic control, complications such as hyperglycaemia and hypoglycaemia, and the importance of maintaining good glycaemic control. It will offer advice about what anaesthetic practitioners can do to help manage and care for their patients.

Rapid sequence induction of general anaesthesia (GA) is the fastest anaesthetic technique in a category-1 caesarean section (C1CS) for foetal distress. Recently rapid sequence spinal anaesthesia (RSS) has been explored as a technique to avoid the potential risks of GA in such cases. Out of hours, trainee anaesthetists are often required to provide anaesthesia for these emergencies. We surveyed their practices when performing a RSS.

The aim of a RSS is to rapidly and safely achieve anaesthesia for C1CS, while optimising foetal oxygenation and preparing for possible GA. It requires anaesthetic skill, team work and communication. Many trainees understood the principles of the RSS, however, a significant number did not. Practice varied widely and no trainee had received any formal RSS training. Training for junior anaesthetists and those working in obstetric theatres, in the conduct of the RSS is crucial, to ensure safe practice, avoid delays in delivery and safely avoid the risks associated with GA in the C1CS.

Today we take for granted the blessing of anaesthesia and it is almost impossible for us to imagine the agonies that surgical patients underwent in the past. This description of a mastectomy, performed in 1720 by Lorenz Heister, Professor of Surgery and Anatomy in Altdorf in the republic of Nurnberg, (now part of Germany), gives a vivid idea of major surgery in those days. In this much shortened abstract from his lengthy report, which appears in the 1775 English edition of his textbook entitled ‘Medical, Chirurgical and Anatomical cases and Observations’ he discusses the preoperative preparation, the mastectomy itself, performed as quickly as possible and the tedious postoperative dressings of the inevitably suppurating wound;-