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Volume 4 Number 2 ISSN 1472-8820

World Anaesthesia
news
In this issue Clinical Investigations
Manpower in Pre-op tests
West Africa Epidurals in Mali
– Which way
Case Reports
forward? CS Gas induction
Heroin condom ingestion
Challenges in the
developing world News from
around the world
– Albania, Ethiopia, Eritrea
The mature and Zambia
anaesthetist
WA & WFSA News

Welcome to World Anaesthesia News
“Anaesthesia Worldwide” has now metamorphosed into “World Anaesthesia News” with
a new look and a new international editorial board. It is no longer the journal of the
World Federation of Societies of Anaesthesiologists (WFSA) but is supported by a
Contents
generous grant from the Federation. Feature articles
Anaesthesiologists are often confused by the relationship between the WFSA. and World
Anaesthetic manpower in West
Anaesthesia. I hope that the articles in this issue on each of these organisations will make
Africa 1
matters clear. Essentially, the WFSA is a federation of societies of anaesthesiologists as its name Challenges in the developing
suggests whilst World Anaesthesia is a group of individuals with similar aims, namely “to make world 2
available the highest standards of anaesthesia to all the peoples of the world.” Naturally, the two The mature anaesthetist 4
organisations work closely together and try to support each other’s endeavours.
This issue of World Anaesthesia News continues the tradition of publishing articles from News from around the world
individuals and societies in developing countries. At the end of these articles (from Ethiopia,
A message from Albania 6
Eritrea and Zambia) I have added a few statistics on gross domestic product (GDP), infant
mortality and life expectancy. The figures are all too familiar: GDP is under US $1000 per A history of anaesthesia services
capita, infant mortality approaches 100/1,000 and life expectancy is less than 50 years. In the in Eritrea 7
developed western world, comparable figures are GDP $20-30,000, infant mortality 5-6/1,000 A letter from Ethiopia 8
and life expectancy 70-80 years. The figures for parts of Eastern Europe and the former USSR
The WFSA in Zambia 9
lie somewhere in between. With so little available to be spent on health, it is easy to be
pessimistic but all the authors remain optimistic about the future in their countries
Clinical investigations
I would also commend to you Prof. Thara Tritrakarn’s essay, based on a talk he delivered
at the World Congress in Montreal in June. He concludes that if we in the West can help train Epidural anaesthetic practice
a single anaesthetist who returns to his or her home country, we will have made an
in Mali 11
immeasurable contribution to the improvement in health care in that country. There is our Pre-anaesthetic tests in
challenge for the new millennium. ASA I and ASA II patients 12
The editorial board and I look forward to hearing your thoughts, critical or otherwise of
our efforts and of receiving your contributions to future editions of World Anaesthesia News. Case Histories
Anaesthetic consideration of
William F Casey Heroin condom ingestion
CS Gas induction of anaesthesia
14
15

Useful information 16
The editor of World Anaesthesia Dr Rob McDougal (Australia) Anaesthetic websites to try 18
News is: Email:
Dr W F Casey mcdougal@cryptic.rch.unimelb.edu.au Feature Extra
Popes Cottage Gassing in Guinea
Cheltenham Rd Dr Tom Ruttmann (S.Africa) – on and off ship 19
Gloucester GL6 6TS, UK Email: ruttmann@samiot.uct.ac.za A detached retina in the land
Tel: (+44) 01452 814229 of yaks and yetis 21
Fax: (+44) 01452 812162 Dr Iain Wilson (UK) Pigs might fly! 22
Email: wfcasey@doctors@org.uk Email: iain.wilson5@virgin.ne
The WFSA 23
Editorial Board Editor Emeritus The constitution of World
Dr Dixon Tembo (Zambia) Dr Roger Eltringham (UK) Anaesthesia 24
Email: dctembo@zamnet.zm Email: 106147.2366@compuserve.com A letter from Dr Iain Wilson 25

Prof. Rebecca Jacob (India) Submissions to World Anaesthesia
Book Review 12
Email: rebeccajacob@hotmail.com News may be sent to any of the above.

In their ratio of 1:49. However. problems such as post-operative fluid and created in Oxford. anaesthesia in the developed countries has 2. Obstetrics and Gynaecology. candidates at Part 1. continued. only one in Anaesthesia. The end point of the Intensive Care. Anaesthesia had only 9 to 27 diseases occur in 65% of surgical patients in 1948 with the introduction of the candidates at Part 1. Department of Anaesthesia early years. however. over the same period was also obtained and population being at least 1:300. who in 15 states of Nigeria. on a par with other Surgery producing 16 to 39 Fellows per difficult airways and intercurrent medical medical and surgical specialties. who generally administration of anaesthesia. commenced in 1967 with the creation of candidates sat the anaesthetic primary. nurse anaesthetists popularised the use of chloroform.000 in developed anaesthesia were surgeons like James programme was determined. Ophthalmology the specialty and their lack of adequate anaesthetists locally to Diploma level and Otorhinolaryngology. whilst the first examination for the survey. surveys have shown that the same year that a chair in anaesthesia was and 16 to 40 Fellows produced per year. We have looked at Surgeons. and zero to 2 Fellows per year. The records with vigour since the early 60s by experts in and monitoring equipment for the safe were reviewed to establish the number of all specialties. advances determined. By virtue Results provide service with physician anaesthetists of their eminent position in the medical The Faculty of Obstetrics and in 50% of hospitals and were the sole world. the impact of the West African Postgraduate African Post-graduate Medical College Email: wemimak@infoweb. countries. but only 93 exposure to it during their training. The number of anaesthetists anaesthetists has. septicaemic shock. the areas where anaesthetists the first autonomous Department of produces a ratio of 32 prospective surgeons are primary care providers such as in Anaesthesia at the University of Lagos.000 Many of the early pioneers of the number that proceed to the Fellowship compared to 1:10. The ratios colleagues locally at reduced cost to provide demanding surgical procedures and patients’ of anaesthetist to surgical graduates were improved medical services. Thus. There were between 91 and 101 necessary to ensure the safety of patients. equipment and The number of candidates who registered for the examination of the West African College of Surgeons Fellowship in programme. with in surgery have been possible largely due to trained through the Diploma programme the ratio of anaesthetists to the general modem anaesthesia. Discussion techniques used. Dental Surgery. 17 to 26 at Part 2 and require the expertise of physician National Health Service. increase in the number of candidates Although nurse anaesthetists provide useful The Association of Anaesthetists of attempting the examinations from 275 to assistance to physician anaesthetists in many Great Britain and Ireland was founded in 312 candidates over the five years of the parts of the world. This manpower development. both colleges produced a total of The Diploma in Anaesthesia University College Hospital 75 fellows in Medicine and Surgery but programme of the West African College of Ibadan. The Schimmelbusch mask. These teachers. This Unfortunately. a Dr O A Soyannwo & Prof. become very safe and examination of the various surgical to both medical students and interns thus allowing advances in surgery. The dearth of varying medical conditions. Resuscitation. was secured year.Anaesthetic Manpower in West Africa Feature Stories – which way forward? commenced in 1970 and at the West years with only 6 Fellows of Anaesthesia.abs. to l anaesthetist. A total of anaesthetists if outcome is to be improved. and Pain graduate fellowship training in Nigeria training produced 292 Surgical Fellows in 5 Therapy Clinics are poorly developed or 1 . strict guidelines are 1932. training of Surgery. In a recent survey of 52 hospitals Simpson. they advocated and championed the Gynaecology attracted the highest number providers of anaesthesia in 20% of the use of anaesthesia. In Diploma in Anaesthesia was held in 1935. Post. physician to Queen Victoria. The status of anaesthesia This was closely followed by the Faculty of electrolyte imbalance. specialties viz. Anaesthesia from April 1992 – October Postgraduate medical education based in the EMO and standard Boyles machine have 1995 was collected from the West African West African sub-region has been pursued been replaced with computerised anaesthetic Postgraduate Medical College. in Great Britain. considerable opposition.963 candidates sat for the primary Anaesthesia as a career is unattractive advanced very rapidly. programme yielded 56 diplomats within the 5 years studied. Since then. because of the “behind the scene” nature of In West Africa. E O Elegbe African Medical College in 1979. 22 to 58 at Part 2 the Gambia. 30 (53%) of these Introduction Methods and Material diplomats were also pursuing the Fellowship S ince the introduction of ether in 1846. anaesthesia has witnessed many innovations in the drugs.ne Medical College training on anaesthetic (WAPMC) was commenced in 1990. a constituent College of the West Nigeria. The wider candidates that actually attempted and those had their training in overseas institutions. sometimes against of postgraduate trainees with a steady hospitals including some teaching hospitals. range of drugs available allows a flexibility of who passed examinations of the College in were determined to train their junior techniques suitable for novel and April and October of each year.

th patients to each anaesthesiologist. needs of the community. would-be patients have gross national product (GNP) or earnings per anaesthetists at all. The situation anaesthetists are under pressure to provide require adequate anaesthetic and resuscitative is being made worse as few undergraduates services for sicker patients undergoing an facilities in the hospital. Even our locally trained improved services at the secondary level of possible largely due to innovations in Diplomats have found favour with the health care delivery but will reduce the drift modem anaesthesia. At the tertiary level. Of the six. the few doctors that join the specialty interesting and fulfiling as a potential only a few are interested in anaesthesia. in many parts of the In Table 1. In countries with lower GNPs. government hospitals before they would be secondary level of health care. ten anaesthesiologists serve respected and highly paid members of the influence the priority given to health care and a population of 5. tertiary institutions. was initially thought that one year’s training they are presented with poorly prepared The Diploma in Anaesthesia to Diploma level might ease the manpower patients. Email:sitti@mahidol. whilst there Nigerian Government’s technical assistance of trained anaesthetists into urban private are enough anaesthetists in most scheme and they are sent to work in other hospitals. Challenges in the Developing World Prof. 20 medical profession its various specialties including anaesthesia. low patient Siriraj Hospital. Countries with a lives are lost because surgery and high GNP have plenty of doctors. accreditation specialisation there is profound shortage of What then is the way forward when criteria for surgical departments should anaesthetists in West Africa. However. 2 were from Guinea allocated solely to anaesthesia in the provide it are financially adequately and 1 from Gabon. 146 new fellows were admitted surgeons in the sub-region. Anaesthesiology is the developed world. Many of the few locally trained anaesthetists eligible for further sponsorship for the quickly migrate from West Africa to more Fellowship programme if that is what they Conclusion attractive areas where there is a shortage of wish. Feature stories Thus. Secretary. not surprising that sponsored during their training and then be programme and this reduces the number of despite the efforts of many within the sub. usually given to primary health care to reduce the incidence of infectious diseases. thirteen countries are listed by the and in Bhutan. There is a great shortage of rates. Further. the specialty remains unattractive. the time all levels of health care and that those who three were Nigerians. West African or new medical graduates are willing to increasing range of surgical procedures? countries with compulsory National Service consider anaesthesia as a future career. anaesthesiologists are Economic. their families. to advances made by all branches of surgery. Guinea numbers of trained anaesthetists and manpower shortages. political and social factors ignored. six of whom were education should respond to the health the safe practice of anaesthesia be provided at anaesthetists. anaesthetists in every developing country number of patients per doctor and the infant Thailand with ratios as high as 1 million potential mortality rises. priority is I on October 16th 1846 when ether was first used. have a restricted range of programme should be re-structured and shortage but since the training is based at anaesthetic agents with little monitoring supported by Governments. developed countries to allow sub- countries. medical students curriculum should not be remunerated. Without In countries with a low per capita GNP t is 154 years since the birth of anaesthesia adequate anaesthesia. Anaesthesia has contributed to the progress and the health and welfare of millions of people suffers. reduce maternal and infant mortality and to intensive care and pain management and. For example. surgery cannot (below US $1. West African Postgraduate Medical graduates should have an opportunity for This study has further confirmed that College for his invaluable assistance in data locum appointments in anaesthesia and despite the large number of doctors seeking collection. anaesthesiologists seek to serve 10 million On the other hand.000 per annum).3 million. It is. in Cambodia. These measures will not only less than eight weeks and the specialty promote the growth of anaesthesia in the Acknowledgement should form one of the options for intern sub-region but also improve standards in We wish to thank Professor Kayode Odusote. anaesthesia are inaccessible to patients and per doctor ratios and low infant mortality Mahidol University. What few anaesthetists 2 . Since medical be made to ensure that essential facilities for to the College. the Bangkok.ac. in Economics and Anaesthesia reduce malnutrition. Thara Tritrakarn little access to anaesthetic services. they then may find the specialty postgraduate training in surgical specialties. there are no physician developing world. made to serve for a specified period in clinical anaesthetists working in the region. Such a move will not only provide Advances in surgery have been anaesthetists. It find the work unrewarding especially when career. efforts must in 1999. a ratio of 1:24. New surgery and critical care medicine. In Laos. Many capita in US dollars in 1999. At a Only a combination of strategies can Schemes should allow the year to be spent in recent meeting of the West African redress the widening gap between the anaesthesia and other specialties with chronic College of Surgeons in Conakry. most of the trainees equipment and inadequate resuscitation medical officers already in service could be decide to continue to the Fellowship faculties. training before full registration. therefore. non-existent in most African hospitals.

In smaller cities. developing countries it and priorities change. Research is difficult or anaesthesia for all.500 Yes Japan 30. The mix of the workforce need. value as the sole monitor than an ECG. Like other health professionals they should be made explicit: whether all enjoy good working conditions and have Politics and health care. equipment and being responsible for the the most appropriate monitors for them. more money is anaesthetics. In the larger centres.400 273m 7 387 23. despite having a limited range of drugs and cost? Anaesthetists are in high demand but few in equipment.477 250 88. even within a given politicians and the community at large and to nurse anaesthetists are vital and county.000 80 287. responsible for patient care in Intensive down if not properly maintained and they are Only in countries with a high GNP are there Care Units.000 No Laos 258 5m 94 4.000 No Thailand 1. nurses administer 70-90% of budgets. purchasing drugs and developing countries must decide what are be very expensive. In and their social status. maintenance and repair of equipment. often Electronic monitors frequently break number and rarely work outside large cities. fewer drugs and less patient care. nurses or technicians is often administered by nurses or another challenge for anaesthesiologist who administer anaesthesia.700 6m 5 772 150 40.000 No Hong Kong 24.Table 1: Relationship of economy to health care indices and anaesthesia manpower Feature stories Country GNP/US$ Pop. equipment and support facilities they enough to support their families. for supervising nurse costly to repair.850 62m 26 2.000 Yes Indonesia 460 207m 60 6. Appropriate and concurrent teaching hospitals and private clinics are anaesthesia to public health if they are to plans for their development have to take usually well equipped.000 No Singapore 21. Anaesthetic practice anaesthetists to win the support of anaesthetic work force is inappropriate and can vary considerably. 3 . In smaller towns and cities.000 Yes Nepal 225 23m 88 12.786 350 591. medically qualified anaesthetists or is there a sufficient income to maintain their families In the developing world. They strive to thiopentone and halothane. The ultimate goal of anaesthesiologists is the either at home or abroad.000 Yes Cambodia 270 10m 110 9.500 200 650. Their status and income is Human resource development. are few and far capnograph or oxygen analyser.” It is much easier to impossible. same worldwide: “the provision of safe between. They are. Indonesia and the-art drugs and equipment.000 No Vietnam 310 79m 34 2.300 400 197. Surgical mortality is technicians working under the supervision of have trained in western or developed high and the risks of anaesthesia often medical doctors or entirely unsupervised. With limited In countries with a moderate per capita China.0000 No there are. achieve this goal in rich and developed often lower then that of surgeons and Many developing countries do not know how countries where anaesthesiologists are not physicians and many anaesthesiologists many anaesthetists they need but should only equipped with knowledge but have the have to undertake several jobs to earn implement a realistic human resource plan drugs.300 126m 5 522 4.300 10 500. an entirely medically qualified is a greater challenge. Propofol and available to be spent on health and Anaesthesiologists in developing sevoflurane cost 20-30 times more than secondary and tertiary care receive some countries work very hard. cost benefit ratios have to be GNP (US $1. Pulse oximeters detect hypoxia before clinical Anaesthesia in the developing Journals and textbooks are scarce and signs are evident and are probably of greater world opportunities for post-graduate education. In countries and grown used to using state-of- exceed those of surgery. when governments continuing need for nurse anaesthetists.000 No Bangladesh 289 130m 90 12.000 20 500.100 22m 12 1. per anaesthetist Nurse anaesthetists USA 31. Public hospitals often make any substantial improvements in place alongside those for physician have poorer facilities. for anaesthesia. surgeons the community. anaesthetists Pt. It is essential for doctors. Is a slightly priority. Infant mortality Pt. in addition. anaesthetists.300 11. change everything including health budgets countries where there is a shortage of In less affluent.000-10. carefully considered.800 4m 5 667 130 26. impress on them the importance of indispensable.000 No Malaysia 3. per doctor No. medical schools. work in teaching hospitals in large equipment and serve the poorer sections of Drugs and equipment cities.000 Yes Pakistan 492 136m 88 2.200 20. Anaesthesiologists in sufficient anaesthetists but their services can anaesthetists.000 400 340. Hospitals are better equipped and offer safe anaesthesia to their patients shorter awakening time worth that extra staffed and specialisation is encouraged. countries such as Thailand. anaesthesia Selecting appropriate drugs and equipment is or general practitioners.461 500 124.000).

Many in the developed world who can help their and have not got immunised ourselves? doctors completed the course and then colleagues assist these people. But be careful. profession because of domestic pressures. So. preparing 4 . train a single anaesthetist from a a stress is also a major element of maturity. government and health providers is essential. Some. It ran a one very limited access to anaesthetic services anaesthetists have encouraged our junior year training course for anaesthetists from but there are a large number of anaesthetists colleagues to get immunised against hepatitis developing countries until 1973. damage will be done to medical education in Sometimes though. have children. If only 1% of them helped and to work as part of a team. Universities. Foreign graduates to the United States. skill and United States and in developing countries is Email: rebeccajacob@hotmail.000 (US $25. immeasurable become the norm. We External help may take unnecessary risks such as not In 1950. anaesthesia remains an To prevent and influx of foreign medical unattractive profession. trauma management. author’s (Ed) attending parent/teacher meetings. How many of us ‘mature’ centre in Copenhagen. low Australia in the Pacific and France in The Mature Feature stories professional status and a perceived lower francophone Africa. gained specialist qualifications development of anaesthesia not only at professional skills. Montral live-in maids is also a great help. physiology and study medicine and anaesthesia. helped elsewhere: Canada in Nepal. If changes do not occur Anticipation and the prevention of problems of pain and saves lives from trauma and in the USA and the UK. In my country. knowledge. Anaesthesia makes gradually change that of the stingy. and an ability and decided to stay in the West and enjoy a home but also at a regional and world to maintain good interpersonal relationships more affluent life-style than would be community level. Coping with possible at home. Vietnam) who countrymen. gain them recognition and win them dramatically increased in the 1990s to Maturity and chronological age do not professional esteem. graduates are able to enter the United States Rebecca Jacob and they often find themselves involved in Professor & Head. When been active in establishing training courses anaesthesia in their respective countries we are young. We associate youth medical students and young doctors that to increase by 10% per year. go hand in hand with common sense. experience doesn’t the developing world. increasingly difficult and expensive examination hurdles have been introduced (ECFMG & USMLE). Conversely. In the United Kingdom. critical illness. thus This essay is based on a talk given at the out and the ready availability of dependable raising standards in their respective World Congress of Anaesthesiolgoy. Anaesthesiologists in the developing world practice of medicine in their home countries. Their contributions to Intensive Care. the World Health Organisation Give a helping hand wearing gloves when obtaining intravenous (WHO) established an anaesthesia training More than half the world’s population has access. Support for its development from politicians. not the worries of having a sick child at home. The image sense and hope that. would rise immeasurably. resuscitation and pain management will becoming wider by the day. Encourage them and family responsibilities. surgery possible and safe. Because of low income. as we mature. They must show £17. what are the qualities associated returned home to become the pioneers of national societies and organisations and with maturity? I would suggest they include anaesthesia in their homelands. confidence. Other developed countries have 2000. It is human nature resume our professional careers there is WFSA and the Royal College of to seek to emigrate to where one can enjoy inevitably conflict between our professional Anaesthesiologists of Thailand (RCAT) to a higher standard of living. niggardly for our slowing motor function. we intellectually satisfying branch of medicine preventing students travelling to the UK to associate age with experience and common combining anatomy. the World Federation of developing country who then returned home Managing a family and having a Societies of Anaesthesiologists (WFSA) has to train their juniors. India must constantly prove to their surgical The gap between clinical medicine in the colleagues their ability. More recently. quality of life. The bold print above is mine. and perhaps drop The Bangkok Anaesthesia Training Center not give them internationally recognised and out of “the system “ for a while. Cambodia. individuals can play an active role in the a lot of common sense coupled with however. relives patients and selfish profiteer. Denmark. would then return home and become the The joint or extended family usually helps future trainers in anaesthesiology. When we (BARTC) was established in 1995 by the marketable qualifications.com professionalism. These with quick motor function but a certain anaesthesia is an interesting and exorbitant fees are an effective barrier amount of ineptitude. do a partner.000) per year and continue necessarily go together. the fees charged to foreign students were A mong the definitions of the word “mature” given in Chambers Dictionary are “full development” or “perfection”. the standard of fulltime job can be extremely stressful. Yet the countries. Dept of Anaesthesia Improve professional esteem sophisticated basic research divorced from The Christian Medical College and Hospital and popularity clinical medicine and irrelevant to the actual Vellore. train anaesthesiologists from similar to go home and help their fellow very rarely does a woman give up her countries (Laos. pharmacology with a clinical knowledge of of the generous British gentleman experience and common sense added to our medicine and surgery and technical encouraging learning and scholarship will basic knowledge will more than compensate anaesthetic skills. we make the decision to find for anaesthetic personnel around the world. Anaesthetist support may also be initially needed to start Only the most determined foreign medical and develop suitable training programmes.

we can post you the same all the administrative load that finds its way help put the stresses of life in their proper material on floppy disk with instructions on to your desk. respond appropriately to verbal aggression. nurses. back issues is now available – you can read Having to work with a variety of When in a position of responsibility. to accept those you cannot and a sense of unfairness in their male change and to have the wisdom to know the ● You do not need the latest and most colleagues. friend or schedules and the inevitable disruption of colleague to whom you can unload your Anaesthesia” sleep also becomes increasingly difficult. (N.uk to ride this out’ but more often than not. for destructive. menopause? Only those who have gone Develop skills of control. anger change them.for school examinations or handling woman as they are to a man. 2000 Internet site. of course. technical staff and back your staff and colleagues. on our colleagues. assertiveness and through a stormy peri-menopausal period diplomacy. but it is very challenging as “Update in and remember to take a handful of tablets well. and the sudden feeling of “I good reason. estic or professional the two often interact Publication of The older anaesthetist may often has causing profound consequences to both. However. Oxford. This is invaluable. When one is young. We also see their influence on our Department of Anaesthetics.. when women are It is important to recognise the things countries. Find ways of dealing with the every night Living with busy on-call associated stress. ischaemic heart disease or arthritis the top: it is. It is important that all members ● If you have an Internet connection you can more stressful if one has reached a position of a department support each other as access “Update” at of responsibility. for knowing all demands. UK. ● “Update in Anaesthesia” is an education the inability to react rapidly in a situation Non-verbal behaviour and body language are journal produced by “World Anaesthesia”. it on your computer screen (using suitable people: surgeons. we see our influence on the please write to Dr Mike Dobson. Loss of a beloved partner at Worldwide”) including back issues in similar this stage is also very traumatic. experience.) successful in their careers. in our close working environment for down: their trust and faith in you is difficult interpersonal relationships. lord. Preserve personal time. can’t carry on”. Hospital. pursue the answers to a postgraduate’s questions hobbies.ac.ac. expensive computer to make use of have a partner who is self assured and planning and an understanding of one’s Electronic Update: a 286-PC should be confident in his own right rather than one limitations are signs of a mature anaesthetist. for providing a shoulder for a cannot be expanded infinitely to meet only browser such as Lynx. It is a tremendous advantage to difference. A husband who feels threatened by work we do. “Lord give me love and common sense one feels the inadequacies of old age And standards that are high. indulge in regular physical exercise ● If you don’t have Internet access but do and. to cope with intercurrent illness such as It has been said that it is very lonely at diabetes.nda. adequate. the embarrassment of and received. and download and/or print other anaesthetists can be pleasant and to conclusions. If you need technical advice. lives and on our outlook on life. there is also the potential minimise successes. collaboration with colleagues and students.B. 5 . junior consultant to cry on.ox. Irrespective of Electronic Feature stories recalcitrant teenagers are all part of the whether the primary cause of stress is dom- process of maturing and learning to cope. Do not jump free software). establish rapport and are conducive to better ● An electronic version of “Update” including ogen can lead to so much emotional trauma. Let these time-outs have a computer. Montreal. pre. Do not magnify mistakes or fulfiling. viewed with either a graphical browser being diplomatic when there is a confront. Time management is also important (looks prettier) such as Netscape or a text- ation between a surgeon/nurse and a fellow and it should be understood that time anaesthetist. one aggressive and appearing co-operative help never imagines that declining levels of oestr. use.” one’s patients. Financial This essay is based on a talk given at the World format is also now available at the same security and independence are as vital to a Congress of Anaesthesiology. which was formerly considered a challenge important in the way messages are conveyed but easy to handle. students and his wife’s success can prove to be very friends. This only applies to developing In addition. Find a partner. Learning how to say ‘No’ for widely distributed and acclaimed in many “hot flushes”. Knowledge.ox. John Radcliffe difficult to live with. or send an Fear of the future is very real. You are responsible for the factions within departments are extremely http://www. troubles and frustrations without fear of it What about the “normal’ business of being misconstrued or repeated elsewhere. ● An electronic version of “World Anaesthesia advancing and can’t help wondering whether Give me calm and confidence Newsletter” (incorporating “Anaesthesia one’s deteriorating skills will adversely affect And please. a twinkle in my eye. Nuffield himself.uk/wfsa It can be smooth running of the operating rooms. Some The prayer of the mature anaesthetist Email request to: may be blasé with a feeling of ‘I will be able could be: michaeldobson@ndm. Never let your staff all or part of it for reference. being assertive without being developing countries. who feels inadequate and is unsure of As time goes on. It is important to learn to can understand the feeling of inadequacy. OX3 9DU. they can that can be changed and have the courage to unwittingly arouse feelings of jealousy. for finding time to deal with and remember to relax. prospective.

paediatric. plastic and other turmoil in our large neighbour. a city of approximately 500. Among them pancuronium. therefore. The Tirana Trauma Centre has a 14- In the last ten years. ether and regional anaesthesia in the Civil old. operation with the University of Tirana. He also established the orthopaedic. Adriatic Sea.2366@compuserve. We common with other European languages. again by surgeons. an doctors trained in Eastern Europe and the available: thiopentone. In the Tirana mid-1960’s he was joined by Albania Dr Besim Elezi who was the Email: 106147. Intensive Care will be held in the Albanian Tirana. suxamethonium. He country of 28. 10 operating theatres. In the and only a very limited range of books over five hundred years until independence late 1970’s and early 1980’s. the first specialist Albanian knowledge into practice and it is impractical would be more than happy to answer any anaesthetist. Drrasa and Mihal Kerci helped me prepare in the 1950’s. A Message from Albania Dr Aposotol Vaso practice and used what were Anaesthesiology Department then the most modern Trauma Centre general and regional Central Military Hospital anaesthetic techniques. the trainees have only whenever they can. our country has undergone became the first Professor of Anaesthesia anaesthesiologists and about 60 general. Dr Mihallaq Prifti. oximeters and capnographs and we supplied us with “Update” and to my surgeons who trained in Austria and Italy.000. ten years later.00 sq. Dr Shiroka. I In 1961.com first Albanian to be trained in anaesthesia in Western A lbania is an often forgotten Europe. bedded ITU. until 1990. as did other Albanian monitors. 13 communism. Historically. Indo-European language that has little in Peoples Republic of China. contacts me at the above address. because of adverse surgical specialties are practised at the other Republic of Yugoslavia. although still under state The training of anaesthetists is above. Maksut Endotracheal anaesthesia was introduced pressure manually. From the end of the World War II of Tirana started to enter practice and only textbooks or journal written in Albanian. Albanian anaesthesiologists control. now has an insurance-based and a organised by the Ministry of Health in co. km (a little subsequently left anaesthesia bigger than Israel) on the west to become the spiritual and coast of the Balkan peninsula. There are no anaesthetic Empire.3 million The 1970’s saw a generation of We have a limited range of drugs and the official language is Albanian. They try to keep up to date School was founded in 1952. 6 . a conference on Anaesthesia and Today. neuro. since the fall of Dr Tritan Shehu who. comprehensive anaesthetic service for the Kerci. as A Department of Anaesthesia was Trauma Centre in Tirana in September the capital. massive social and economic changes that in Albania. Dr Maksut Drrasa. it was part of the Turkish Ottoman anaesthesiologist trained at the University university library. the former in 1993 but. Most intensive Turchetta from Italy who has helped us pioneer of modern surgery in Albania used care units lack basic equipment such as ECG make contact with the WFSA and these methods. it was one of the most extreme then was it possible to introduce a Through the initiative of Dr Mihal and isolated communist states in the world. For anaesthesia into routine practice. a cohort of and journals can be found in the in 1912. it is a parliamentary democracy with whole country. it is yet to organise a affiliated university hospitals in Tirana. The population is 3. provide anaesthesia for a wide range of private sector. and by western standards. have little opportunity to put their theoretical this article on anaesthesia in our country. in Denmark. Despite the difficulties outlined changes and. the equipment at their disposal. fentanyl and morphine. Unfortunately. entered research. Our trainees. system has not been immune to these conference or publish a journal. The health care circumstances. Albania was part of the who was the first to introduce epidural Medical textbooks are also in short supply Roman and then the Byzantine Empire.and vascular surgeons. north of scientific leader of surgery in Greece and separated from Italy by the Albania. surgical procedures and have a heavy Although Albania’s only Medical Training lasts four years and encompasses workload. established at Tirana University headed by 2000. very out-dated I wish to express my thanks to Dr Hospital in Tirana. also have nitrous oxide and halothane. the practice theoretical and practical aspects of anaesthesia with progress in the specialty and apply of anaesthesia dates back to the 1920’s and is undertaken in the central hospitals of modern methods and techniques when Austrian and Italian surgeons used Tirana. who had for them to attempt to undertake scientific questions or correspond with anyone who trained in St Petersburg in Russia. have been made more difficult by the Albanian Association of Anaesthesiology Cardiac. was another surgeon. can only monitor the pulse and blood colleagues Drs Mihallaq Prifiti.

Leonardo Silla overthrew the Ethiopian emperor and the the first batch of 15 students in September who was trained in Italy. Simon Haile and survey. from the Philip- pines. the Ministry of Health of Ethiopia course in anaesthesia at the then Princess decided to gather all those who were working Tsehai Haileselasse Hospital in Addis Ababa as anaesthesia assistants through out the Kessete Teweldebrhan and two nurses from Eritrea. health services were little later. Health Eighteen nurses were enrolled in the initial Ghebrebrhan Haile in 1996. those who had received at of Italy). the only qualified because of the Marxist revolution that was officially opened with the enrolment of anaesthetist in Eritrea was Dr. Sudan and also some from Ethiopia itself and the Italian At the same time. a service remained based on the Italian colonial course including the author. namely Mengistu country and gave them a six month intensive Health Science Institution Iasu and Bekit Hagheray completed the course training course to try and increase the number PO Box 4947 and returned to work in Asmara. now nurse anaesthetists) soon left their Resources Development of the Ministry of the Asmara School of Nursing which was assignments in northern Ethiopia and joined Health of Eritrea. train others in the liberation army in prepare a curriculum for a two-year course in In 1962. the Ministry of Health of Ethiopia and anaesthesia training in the field during the care for the civilian population through catholic the World Health Organisation (WHO) jointly Liberation Struggle were given up-grading mission clinics and hospitals. namely. In the 10 years that followed. together with their indigenous assistants G/Mariam were on the initial course. incorporated existing services run by Italians Anaesthetists continued to be in very After Eritrea gained its independence who stayed behind in Eritrea (after the defeat short supply in both Eritrea and Ethiopia so in from Ethiopia in 1993. she was asked (by the Eritrean Health Authorities) to train her own anaesthesia assistants. They would and quality of practising anaesthetists. Eritrea Harar Hospital (now Tikur Anbessa Hospital) in anaesthetists. 8 nurses ran all health services. Eritrea. The latter provided most health 1974. . doctors. The WHO-sponsored school of anaesthesia for nurses. Following this. 7 . A short 1982. Three Asmara also take it in turn to work in the hospital in of the participants were from Eritrea and Eritrea Massawa for a week or a month at a time. The most significant thing that Nekemt (Western Ethiopia). 1996 run jointly by Simon Haile and within a Federation with Ethiopia. opened a School of Anaesthesia at the Duke of courses and were licensed as nurse When the British left in 1952.A History of Anaesthesia Services in Eritrea hospitals in Asmara moving from one to another. a workshop was organised in took place during this period was the opening Habte Hailemelekot (two of my fellow Eritrean December 1998 by the Department of Human of the Itegue Menen School of Nursing. I was not allowed to anaesthesia services in Eritrea was undertaken employed from Germany and the European return to Eritrea but was assigned to work in in late 1998. They were replaced by doctors who came from the socialist block of Eastern Europe. I was selected by the Minister of Health to establish the school of anaesthesia and the Italians. In he history of anaesthesia in the emerging Later. This was done and the Ethiopian Ministry of Health ran the Eritrean anaesthesia in Addis Ababa closed soon after new nurse anaesthetist training programme Health Service. Araya joined the Eritrean Liberation but the remainder are currently working in run by the British Colonial Administration but Struggle to fight for Eritrean independence. 1998. Italian health personnel were systematically marginalised and finally worked only in hospitals caring for the Italian community. Ethiopia annexed Eritrea and the anaesthesia. Dr. Egypt. Italy occupied Eritrea for 50 years up and until 1942 employed and in 1969. nurses and catholic Yosief Michael. open its own school of anaesthesia for nurses in the capital. at the national survey on the quality and range legacy although additional doctors were end of the course in 1976. However. Based on the results of this socialist block. anaesthetists was increasing and three years In 1963. the demand for nuns were mostly replaced by Eritrean nurses. the government of Ethiopia decided to T state of Eritrea is inextricably linked with the history of its colonial occupation. Three nurses. Araya G/Tensae and Asmelash and became its first director in September nuns. A further group of 16 nurses became a Trust Federation with its own Addis Ababa under the directorship of Dr. As Ethiopia increased its control over Eritrea. from Eritrea trained in anaesthesia. was given a one-year course in anaesthesia in government administering internal affairs Hermann Waldvogel from Switzerland. time after they completed of the course. At this workshop. Gose started a nine – month later in 1969. returned there at the end of their course. At this time. He worked in three descent of the country into civil war. a Bulgarian anaesthesiologist was addition. Two of During the British occupation which Asmelash was taken to Addis Ababa and a them subsequently died and one went abroad followed (1942 – 1952). Israel. it was opened in collaboration with the American the Eritrean Liberation Struggle and started to decided that Ghebrebrhan Haile and myself “Point – 4” Aid programme in 1955.

It is one of nurse. Asmara. I was born to a small farming family in children. I would like to thank those labour and those with foetal distress were of “safe anaesthesia for all” by conscientiously hospitals in Addis that understood my diffi- frequently referred to our hospital from places discharging our professional responsibilities culties and helped by donating drugs. Switzerland or who and children in particular. coffee. I was forced to leave my wife and upper respiratory tract infections.000. I colleagues. be able to Ethiopia WFSA Refresher Course in Nairobi. It is a fertile low-lying area where may ask what am I doing in Eritrea and why I was suddenly ordered to take leave and on tea. sugar cane. I transcends ethnic origins and political be done about the absence of anaesthetic was the first nurse and nurse midwife to be boundaries and believe that we in the health drugs. agent for change by continuing to educate PO Box 37 Some of you who know me from the first nurse anaesthetists and by so doing. However. the theatre was cleaned and we assign all graduating male nurses to other have no resentment towards Ethiopia as I have started to discuss with the hospital Medical provinces of Ethiopia. resolved to try and obtain the necessary province.000 and the administrative value. I capital. I was assigned to the worked in the Ethiopian Health Services for Director and through him with the Nekonen Haileselassie Hospital in Harar. The main tinal parasites and tropical skin infections graduated from the School of Nursing in reason for this was the border conflict are the most common health problems. On my return. collecting blood for transfusion we anaesthetists can organise ourselves at a decided to make the long journey to Addis whenever it was necessary and undertaking regional level. 8 . I am sure that we will achieve much expectation that I could continue to be an Debremarcos Hospital in the near future. due to ruptured uterus or sustained permanent Editorial Note: Most of these are on pregnant women or for injuries such as vesico-vaginal fistulae. We are all on duty instrumental in resurrecting the Ethiopian and Eritrea in June 2000. no medically qualified anaesthetists in the Herman Waldvogel in 1976 but was dissolved Ethiopia country. north of Addis Ababa. I was also agreed in the border war between Ethiopia assist me when necessary. as a Nurse and between Ethiopia and Eritrea and I am of The district hospital was built 26 years Nurse Midwife in 1967. I have a vision that Ministry of Health in our region what could (Eastern Ethiopia). With the help of Imperial Government of Ethiopia decided to Despite what has happened to me. It was assigned to the biggest hospital in the professions should remember that bacteria. I joined the WHO-sponsored and a population of 3. 24 hours/day. At this time Eritrea Eritrean ethnic origin. I was sent to the U. A cease-fire and truce was finally trained to apply cricoid pressure and can held for almost 17 years. The population of the reg- Ethiopia. All are School of Anaesthesia for Nurses. My wife and youngest ago but for the last 24 years the operating had been annexed by Ethiopia and the then son were finally deported four months later. likely to take many months. there is a strong In 1989. maize and a range of have abandoned my plans for anaesthesia in August 21 1998. in June 1998. to try and obtain administrative duties. Kenya or decrease the mortality and morbidity of the I the first Symposium for Nurse Anaesthetists surgical population in general and of women am a nurse anaesthetist and work at a which was held in Lucerne. It has an area of 121. one trained In 1974. Mothers in obstructed Symposia and work towards the WFSA goals what we needed. I another child of 3 years behind. theatre has not been used. sq km (approximately half the size of the UK) provided by MSF for one year. intes- Eritrea in 1946 and was brought up there. A little biographical detail may be of documents were confiscated and I was ional is over 200. A letter from At present Eritrea still has a major Association of Nurse Anaesthetists in 1984.S. I Eritrea regained its independence from bowel obstruction or appendicitis. host Regional Scientific Ababa. therefore decided to study anaesthesia and be Ethiopia in 1993. I was able to capita GDP of $660. I worked day and night as the nurse protozoa and viruses recognise no such drugs and equipment although this was in charge of the surgical and maternity wards. some 400km. a position I 76/1. part of the solution. one health assistant acts as a surgical found and become the director of the Ethiopian approximately 55 years and infant mortality is assistant and the other as a runner. we was no one with anaesthetic skills in the and beyond. boundaries. Malaria. equipment and medical gases. When we operate the nurse years later in September 1982. books and 1991. I deliveries. more than 30 years. two health assistants and me.300 Our staff consists of one surgeon. Consequently there is a mismatch by the Marxist Regime in 1978. a nurse School of Anaesthesia in Addis Ababa and six the poorest countries in the world with a per anaesthetist. Other then the matron. airways which were 70 – 12O km. deported from Ethiopia with two of my language of the region is Amharic. for determination to solve this problem although further training and after getting my degree in Testahun Fetene Desta we still lack basic teaching aids. district hospital in the Bahir Dar region have read what I have previously written about After my colleagues and I had trained of Ethiopia. Many of the mothers died 15-20 emergency operations each month. TB. I was between the increasing demands of an privileged to serve as president of the society expanding health service and the anaesthesia for four terms. the capital of Eritrea. were able to start surgery and now perform referring hospitals. away because there like our colleagues in other regions of Africa and endotracheal tubes. the my long-term plans for anaesthesia in Ethiopia over 180 nurse anaesthetists. I returned to the school of Anaesthesia East Gojjam journals and need more teaching staff.9 million. Life expectancy is scrubs. with an American professional license and an Region 3 However. as an operating room assistant to the surgeons My ultimate wish is to see peace and As I was determined to make the and obstetricians as well as attending difficult harmony return to the Horn of Africa. so that theatre operational as soon as possible. my passport and other fruits are grown.A. work force. shortage of nurse anaesthetists and there are The association was originally founded by Dr.

I check the pulse and anything to me. minutes before starting to induce became restless. clinical officers and a urinary catheter. neostigmine and 5% suxamethonium was in the main theatre so can make the teaching of anaesthesia a little lignocaine for spinal anaesthesia and an I sent my health assistant for it. laryngeal spasm persisted. suspected that he had total laryngeal spasm. anaesthetic machine and suction apparatus finished. all the theatre staff assist in 25mg and this abolished all spasm and practising in the country. halothane.000. gastric tube to avoid Mendelson’s syndrome operation was uneventful and after 20 As in Malawi. the but nearly all have language difficulties that gallamine.5 million. last long.000 sq km. Anaesthesiologists is open to all practising 9 . All the anaesthetists The procedure was carried out in our small anaesthetic. He was a 30-year. anaesthetists in the country were sponsored sometimes I do have problems. atropine. with suxamethonium. which blood pressure again and insert a cannula in forceps and thus precipitated a major is run by the University Teaching Hospital a vein. the remainder are positioning and monitoring our patients made ventilation easy. I turned off the halothane and Some of these are very experienced and are and prepare my drugs and intubation started to wake the patient. I also check my minutes the surgeon told me he had administer most anaesthetics in Zambia. administered mask anaesthesia. that there is no such thing as a “simple” hospital system. Unfortunately. After I a popular option amongst medical students paralysed patients by hand. The WFSA in Zambia Dr Dixon Tembo Nkana Mine Hospital Kitwe Zambia Email: dctembo@zamnet. I left it in the main theatre. Africa. the patient subsequently made a full planet. I pre-oxygenate my patient for 5 problem for me. Immediately. Life expectancy is The membership of the Zambian Society of ketamine and maintained it with halothane 40 years and infant mortality is 124/1. insert a naso. difficult when I also have to draw up more was able to ventilate the patient but there were six indigenous Zambian physician drugs or check the pulse and blood pressure. Acoma anaesthetic machine but no I increased the oxygen flow and tried to Anaesthesia has a very low profile and is not ventilator so that I have to ventilate obtain a good seal with my mask. I am delighted to say working as expatriates elsewhere on the until they recover. It is true expatriates on contract. only three of whom are Post-operatively. Eastern Europe I have a basic range of drugs: I did not panic. The the practice of anaesthesia in this country. working for the mining industry are in the one minor operating room next to the main Editorial Note: northern province where there are mining theatre. it is a poor country with a anaesthetists. as I knew how to treat it and former Soviet states. I in the three central hospitals in the country. I induced anaesthesia with neighbour Eritrea. suxamethonium. The majority have been operating theatre. Most of these are from Cuba. to be found practising anaesthesia even in equipment. The other 8 million souls in After my usual assessment and pre. the surgeon re-inserted his trained at the School of Anaesthesia. diazepam and per capita GDP of $560. Some are very good ketamine. to keep suxamethonium immediately to have four other physician anaesthetists. the patient in Lusaka for the Ministry of Health. Like its the country depend on clinical officer oxygenation. old male who came to theatre at 1. When the patient comes to the Unfortunately. without saying the private sector. As I did not expect the procedure to to understand just how important the a typical patient. developed Physician anaesthetists are to be found only anaesthesia and my assistant applies cricoid facial spasm and became deeply cyanosed. The population is 59 million. This can be had injected 25mg of suxamethonium. The mining companies and date of his operation. I did not intubate the patient but contribution being made by the WFSA is to operatively and if necessary. Meanwhile.zm ambia is one of the many countries from Z the developing world that has benefited greatly from the activities of the WFSA Education Committee. I gave a further anaesthetists. As there was not room for my usual Ethiopia is the oldest independent country in operations and they serve a population of drug container. The three Zambian physician Anaesthesia is usually uneventful but recovery and is now well and healthy again.127. At the last count. pressure for all emergency operations.5%. started to cough. working in their 4 January 1999 for a haemorrhoidectomy. It is important to have some knowledge of the situation in Zambia I would like to describe how I manage 1. I as a field of specialisation. difficult. and has an area of 1. One patent I am now wary of giving even the at undergraduate and post-graduate level by in particular sticks in my mind: I don’t shortest anaesthetic by mask alone without the country’s mining industry for which they think I will ever forget his name or the day securing the airway and am also determined are currently working. I assess the patient pre. about 2.50pm on hand during all my anaesthetics. intravenous atropine.

drugs and Changes in modern anaesthetic practice are Consultant Anaesthetist equipment and care of the critically ill. by the current harsh economic climate in the greatly raised by these persons as we have Editorial Note: country. Nigel Webster. straightforward and easy to read and covers of the use of the Glasgow Coma Scale is a a wide spectrum including basic principles. we have managed publication which I have to hold Refresher Courses every year for the been distributing to past 5 years. Draw over anaesthesia and the sometimes only after 40 autoclavings). Ray Sinclair. this made to the text. manual has led to a closing of the loop and anaesthetists as well as those planning to Many excellent features of the original improvement of the sections on intubation work in or visit locations with limited edition have been retained. continue to strive for first world anaesthesia activities have been greatly hampered of late The profile of anaesthesia has been in our third world setting. New specialist. The use and benefits of the Book Review laryngeal mask airway are appropriately discussed given its value as an adjunct to airway management and its increasing availability in developing countries (if Anaesthesia at the District drawings. The Society’s near future. UK) but with a population of only 9. Aimed at non-specialist relevance to anaesthesia and surgery. welcome addition to the section on trauma. A attendant equipment including oxygen section on propofol is now included in Hospital (Second Edition) concentrators are well covered.000 sq. These anaesthetists in the country get together to contributions by the WFSA renew their knowledge and get up to date have supplemented the information on current anaesthetic practice.6 unable to support the Society’s subscription away from the main course. The per capita GDP is $880. Paediatric and obstetric emphasis has been placed on the safe and anaesthesia are well detailed and a useful appropriate use of blood products in More than 10 years after it first appeared.000. have trauma. km (three times the size of the are all in dire economic straits and are even students to them. The text is and rapid sequence induction. Tony Rocke to mention but a few. as is response to its increasing availability and M B Dobson. accordance with WHO guidelines. likely future reductions in cost. efforts of the Society in The WFSA. which are up to date recent years life expectancy has fallen because gloom. anaesthesia: clinical officers and the three Prof. Haydn Perndt in particular. Mal greater appreciation of the Morgan. of the AIDS epidemic and is now only 37 Committee of the WFSA. Peter Curry. as Care Society have contributed to these has our participation in the activities by sending eminent persons in teaching of trauma world anaesthesia as lecturers and resource management led to a persons. A description anaesthetic facilities. The reflected with updated advice on pre. In to the WFSA. participated in our Refresher Courses. ketamine – often the saviour of the non. Bill “ golden hour “ after Casey. Roger Eltringham. and are invaluable resource materials. We We appreciate the look forward to the participation of Prof. chapter describes the management of co. With the help of the Education texts. Henry Bukwirwa from Uganda in the draw on the Federation’s support as we active physician anaesthetists. Andrew Longmate anaesthetic techniques. These are important meetings medical officers and for us as they are the only time that interns. Bill Casey and “Anaesthesia Update” is a much sought after years. It is also well worth a read for book provides clear and concise testing throughout the world of the original both medical students and trainee information on how to do it. Stirling Royal Infirmary text is illustrated with the superb line operative fasting and resuscitation Scotland 10 . practical asset to those non-specialists medical officers practising anaesthesia in Important changes however have been providing anaesthetic services throughout hospitals with limited resources. a revised second edition of this book has existing medical conditions and their This book will continue to be a been published. Infant mortality is 91/1. The WFSA has million. The pharmaceutical companies who taken advantage of their presence during the Zambia is a large country with an area of donated generously to the Society in the past Refresher Courses to expose medical 752. User feedback and field the world. the Association of Anaesthetists Zambia to promote safe of Great Britain and Ireland and the Intensive anaesthetic practice. WFSA/WHO publication. in small group tutorials. assistance of the WFSA Adrian Bosenberg from South African and and we will continue to guidelines. But it is not all doom and also donated books.

43%).1 classical contra-indications to spinal anaesthesia such as Urology 703 33.3 All the patients in the study had a lumbar epidural. patients undergoing sub-umbilical surgery at three centres in Indication Number of patients Percentage Bamako (Point G Hospital.6% 64.1% and it was 14.8 coagulopathies. The aim Epidural anaesthesia has grown more popular over the years of of this study was to evaluate the technique after it started to become the study: in 1992. All patients undergoing sub-umbilical surgery who Gynaecology consented to epidural anaesthesia were included. Total 2078 100 No major complications occurred and the expected side effects were recorded: major hypotension (0. anaesthetics administered.2 ● any adverse incidents or complications Bupivacaine 0. The epidural was ASA II 587 29.9 Summary Total 2078 100 In spite of its many advantages. Total 2078 100 11 . Patients and Method Prospectively. Point G Hospital.8% 100% of providing anaesthesia for sub-umbilical surgery.25% 84 4. followed by lidocaine ASA IV 196 10.2 ● quality of sensory.2% 461 22.2 (461) and ropivacaine (172). The majority were female (1395 versus 683 male) and their ages ranged from 15 to 107 years. motor and sympathetic block Lidocaine 0.28%).0 Bupivacaine was used on 1043 occasions. ASA III 319 16. Hogan and Farako Medical Centres) were studied. Delivery 68 3. Those with the & obstetrics 916 44.7 excluded. were Orthopaedics 45 2.2%. headache (0.179 last century and offers a relatively simple and cost-effective method 14.6% 20.3 Results Bupivacaine 0.95%) and post-operative carried out at the three participating hospitals.2 assessed pre. a total of 14. local infection or patient unwillingness were General surgery 346 16. it was been little used in developing countries such as Mali.Epidural Anaesthetic Practice in Mali Clinical Investigations Prof. 1999 in Bamako. the majority of whom were female. By 1997. moderate hypotension During the time of the study. Bamako.5% + Lidocaine 0.9 in obstetrics/gynaecology (916) and urology (703). it was 2. ASA class Number of patients Percentage Patients underwent a variety of surgical procedures principally ASA I 976 43. Because of its many advantages.576 Hogon 183 19 634 836 Introduction Farako 159 52 556 767 Epidural anaesthesia has been practised since the early days of the Total 2078 2919 9182 14.38%).6% in 1999.1 Male 683 32.1% of all popular in anaesthetic practice the early 1990s in Bamako.and post-operatively and the following information was Total 2078 100 recorded: ● identification The average duration of the epidural block was 192 minutes and ● place of recruitment the range was from 130 to 315 minutes.5% 1043 50. In 1993. epidural anaesthetics should Centre Epidural Spinal General Total be considered for all surgery below the umbilicus in developing Anaesthetic countries. 2078 Epidural anaesthesia by specialty. inadequate anaesthesia (3. it accounted for only 0. Nevertheless. this had grown to 7.2 average age was 46 years and the range from 15 to 107 years.179 operations were (8.7 2078 patients were studied. Point G 1736 2848 7992 12. epidural anaesthesia has hitherto been little used in Mali. The Ropivacaine 1% 172 8.9 most commonly performed at the L3-L4 interspace (1418). ● name and quantity of drug used Agent Number of patients Percentage ● level and time of epidural puncture (with or without catheter) Bupivacaine 0. between May 1993 and December 1999. This paper reviews 2. Mali. Abdoulaye Diallo Sex Number of patients Percentage Chief of Anaesthesia and Intensive Care.078 patients who Three quarters of the patients were ASA classes I or II but a received epidural anaesthesia between May 1993 and December significant number were ASA III and IV. ● clinical and laboratory data ● anaesthetist’s qualifications Local anaesthetic used. Mali Female 1395 67.2% 318 15.

basic coagulation screening tests.1%). full blood counts (FBC) for haemoglobin. Values of p< 0. the groups. haemoglobin levels (26.1 %) and chest X. developed countries where these recommendations have been Means. Cameroon between May – December 1998.cm.org hospital caters for the health needs of patients of all origins and social classes. booked for pre-anaesthetic consultation in the Yaounde Military and ****Department of Internal Medicine.5% of The tests performed as part of the pre-anaesthetic ASA I & II patients). Yaounde. nature and severity of recorded adverse events. Thus The impact of abnormal test results in ASA I & II patients was patients in groups I & II of the American Society of Anaesthesiologists compared with that in ASA III patients by studying their association (ASA) classification should only have tests that are clinically indicated. However. This prospective and descriptive study was carried out in **Department of Haematology. there is no occurring during anaesthetic care were also recorded. difficult conditions under which much surgery is performed. undertake more than 50% of all surgery in the city and the Central Email:binam@syfed. Cameroon. haematocrit and platelet Complications were significantly more frequent in patients with estimations. pre-anaesthetic tests performed on ASA I & II patients undergoing past medical history and current clinical state. the epidemiological basis for such selection has not yet been established. The sex ratio was 1. fasting blood sugar. then evaluated. 15. In with the incidence. frequencies and proportions were used implemented. Mbanya DN**. prevention of adverse events in the peri-operative period.2:1 complications. blood electrolytes.7 ASA II: a patient with mild systemic disease tests was performed on each patient (range 1 – 8 tests). ASA I: a normal healthy patient The mean age of these patients was 39 years and an average of 4. Summary All data was recorded using a structured questionnaires The aim of this prospective and descriptive study was to evaluate the designed to obtain information on each patient’s surgical pathology. 12 . threat to life Abnormal results were found in 45% ASA I & II patients. The immediate post- Pre-operative laboratory tests may have an important role in the operative period was defined as the first few minutes after surgery. These tests included had the highest incidence (44%). therefore. Haemodynamic and haematological complications assessment and their results were recorded. to express results while the chi square test was used to compare In Africa. no adverse effects on patient outcome have been reported. The progress of patients during surgery and in the first 24 Introduction hours following surgery was closely monitored. Patients ***Department of Surgery.8% of these tests yielded abnormal results. justification in performing tests in the latter two categories.8%). ABO and Rhesus blood levels remains indispensable for asymptomatic patients in this grouping as well as electrocardiograms (ECG) and chest X-rays. Their mean age tests performed on our patients and their effect on peri-operative was 39 years (range 3 months to 83 years). the operation Complications occurred in 60% of the patients assessed (57. Such tests the recovery time as the first two post-operative hours.refer. Takongmo S*** Kingue S*”* and Beyiha G* Patients and methods *Department of Anaesthesiology. These hospitals University of Yaounde. Four hundred grouped according to a modified ASA classification as follows: patients were evaluated in this study of whom 91 % were ASA I or II. This study showed that the measurement of haemoglobin renal function tests. All incidents can be divided into three groups: or deaths that occurred and their time of occurrence were recorded. Technical incidents In populations where abnormal results are uncommon. undertaken to review the pre-anaesthetic A total of 400 patients were enrolled in the study. in favour of females. Patients were routine surgical procedures in Yaounde. Central hospitals were recruited for the study. Cameroon.05 were considered to show statistical in view of the pathological conditions common in Africa and the significance.rays (21%). Results This study was. The other tests had no discriminative value and should impact of these tests on the patients’ peri-operative course was only be performed when clinically indicated. mainly ECGs ASA V: a moribund patient who is not expected to survive without (36. anaemia. Incidents were classified as major if they affected a patient’s ● those performed to provide a reference value and recovery or prolonged the hospital stay or minor if they had no ● tests for the pre-operative detection of asymptomatic conditions impact on the patient’s expected recovery. The environment. standard deviations. These were ASA III: a patient with severe systemic disease mainly full blood counts (99%) and prothrombin and whole blood ASA IV: a patient with severe systemic disease that is a constant clotting times (89. similar selective testing has been advocated. ● those performed to evaluate the impact of an existing problem. Pre-anaesthetic tests in ASA I and ASA II patients Clinical Investigations before routine surgical procedures: what is necessary in Africa? Binam F*.

not normally expected in ASA I & II patients but may be related to the large number of haematological abnormalities we detected. A high incidence of adverse incidents is negative. other authors of similar studies anaesthesia (72 spinal and one epidural). rising ASA I & II patients. ECGs and surgery was 116 minutes (range 45 – 276 minutes). Measuring the haemoglobin level is. Adverse incidents were seen to occur patients undergoing surgery. The most frequently requested tests were FBCs (99% of patients.8% in France. therefore.3% of which were abnormal haematological indices. Among the ASA I & II patients with abnormal test results.75%) were abnormal.3%).8% of these tests were difference between the African and French data is probably due to requested by the surgical staff prior to anaesthetic assessment and endemic parasitic infections such as malaria and intestinal worms as the remaining 28.2% in children aged 0-1 year and 1-5 years old showed most abnormalities. In a previous study.7 tests was carried out per patient (range We recorded a high incidence of anaemia (26. It mainly consisted of cardiovascular diseases such as The patients in this study were mainly young.6% of ASA I & II patients. a those in ASA I & II (p<0.3% of graded ASA I & and managing these problems. 71. 8 As in those studies. in whom blood grouping was requested (48. major Conclusion complications were found in 4. frequent after surgical procedures that lasted for more than 60 minutes. two of which followed anaesthesia with ketamine. asthma. fatalities in our environment.9% of them compared to 7.1%) in ASA I & II 1-8). rate between the patients in groups ASA I & II and group ASA III who There were 15 major incidents reported in 12 patients (4. A significant past history was recorded in 77 patients (19. but comparable past medical history. 57. This incidents). haemoglobin levels and chest X-rays to 62% and 48. all the tests we performed in this study. therefore. Of the 193 cases to that recorded in the peri-operative period in some European studies.1 % of Only the haemoglobin level should be measured routinely in all African those in ASA group III group. This should be considered when Adverse incidents occurred in 129 patients with abnormal test selecting appropriate pre-operative tests.5%). One groups I & II. chest X-rays were considered abnormal in 31% and 21% of instances respectively. found a Three hundred and one tests (15.7% of all had haematological abnormalities detected on screening. 263 patients (65. as abnormal results in other tests were more frequently in patients with anaemia than in those with a normal not directly correlated with adverse outcomes. most of the complications that occurred were due patients (2%) were of rarer groups (O and AB) or were rhesus to haemodynamic problems.3% of all cases). p=0. well as malnutrition in Africa. 17. healthy people in ASA hypertension. not have requested case of sickle cell anaemia was noted. Binam et al. No abnormalities were observed in the respectively. The mean duration of in Africa have found a much lower incidence. A significantly greater number of test and highly sensitive method of detecting anaemia.0038). Whereas abnormalities were recorded in 45% of anaesthesia (81. the prothrombin (PT) and whole blood clotting times (WBCT) whilst Haberer reported an incidence of only 1.7%). In the prevalence of severe anaemia in 21.3%) as Abnormal tests results were significantly more frequent in ASA ASA II. Two major incidents (convulsions) occurred in this study that There was a significantly higher incidence of adverse incidents in were attributed to ketamine which had been used as it was the only ASA III patients compared to those in ASA groups I & II (82. Most that is the best indicator of potential problems and indeed. and pulmonary and upper airway disorders. The remaining (10%) were classified as ASA III.25% Discussion of the sample). In our study.0005). In ASA I & II patients with a significant much higher incidence than in other African studies.8%) and fasting blood sugar (77. major incidents were recorded in 4. There was no correlation between be requested when indicated by the patient’s condition. ECGs.7%) were classified as ASA I and 97 (24. but there was no significant difference in the complication those studied). Other tests should only haemoglobin level (p< 0. Minor technical problems were common.0005). 13 . abnormal results: 70% of ASA I & II with significant past medical history Surgery was performed in 327 patients under general had normal results. Complications A higher still incidence of complications occurred in ASA III A total of 316 complications were recorded in 240 patients (60% of patients. abnormalities were found in the ASA III patients (90%) compared to Complications were recorded in 60% of the patients studied. these minor incidents can lead to II (including two cardiac arrests) compared to 9. performed. one of the incidents occurred peri-operatively (55% of cases) and were more deaths recorded was in an ASA II patient with severe anaemia. a much higher rate than in other studies. This is probably a Laboratory test results refection of the subjective nature of many of the abnormalities seen and A total of 1921 tests were requested but only 1910 were actually confirms the poor sensitivity of these tests. group III.5% respectively. An average of 4. a simple clotting screens (WBCT & BT). 33% had abnormal test results.7%) and in the remaining 18. General surgery involving the digestive tract and the abdominal other abnormal test results and adverse incidents Clinical Investigations wall (29%) and gynaecological and obstetrical surgery including Two deaths occurred (0.5% in the ASA III group. including 3 cardiac arrests.8% had a significant past medical history compared to history without clinical repercussions did not influence the incidence of 32. as should the likely length of results. Among the patients with any Due to a lack of trained staff and adequate equipment for monitoring complication. Most authorities would. A study in Côte d’Ivoire noted a similar incidence of 22% patients). Of the ASA I group III than in groups I & II as might be expected but a past medical & II group.1 % in the ASA III group. 44. one from acute hypovolaemic shock hysterectomies (28. This (89. 3 post neurosurgical comas and 5 suggests that it is the degree of anaemia rather than the ASA status convulsions.5% and anaesthetic agent available. However.5% of cases) was most frequently performed in an ASA I & II and the other from a post-operative coma.2% by anaesthetic staff. followed by orthopaedic surgery (19.3% using regional ASA I & II patients in the present study. there was no statistical difference in the number of surgery as the incidence of complications increase if surgery lasts incidents occurring between those in ASA groups I & II and those ASA longer than 60 minutes.

euphoric. 14 . It should be remembered that the Diacetylmorphine) is a weakly basic monoacetylmorphine. addiction as morphine and its manufacture should be performed Once the patient has been resuscitated. The triad of coma. obstruction or because of manifestations of achieved acute narcotic poisoning. ● Gastric lavage if there is oral ingestion intestinal tract.83. Anaesthetic Considerations of Heroin Case Histories Condom Ingestion Dr V Mwafongo Absorption.1) The drug packets vary in size from considered more potent due to its greater Before surgery such patients should be 10mgs to 4gms and are very susceptible to solubility. (Fig. It was Patients with obstruction should be treated whilst that of heroin is 3-4 hours. half-life of Naloxone is 20-30 minutes compound with a pKa of 7. it Introduction undergoes extensive first Recently many countries have seen an pass metabolism and increase in the number of young men and only morphine is women smuggling drugs. If any of the narcotic packages have analgesics are unlikely to be needed. poisoning may be evident such as essential and the patients should be cared for monoacetylmorphine in the urine unresponsiveness or coma. 6. practice has become common in Dar Es Its high solubility Salaam. Heroin shares the analgesic. treated by rupture. It is Centre after being arrested at the airport approximately 40% suspected of smuggling ingested drugs. An anti. a popular drug of misuse and its use ruptured. the main port of Tanzania. the classical signs of narcotic post-operative monitoring of vital signs is can be detected by finding its metabolite.ac. However. If time and ● Antibiotic prophylaxis to prevent Pharmacology of Heroin circumstances permit. The patients passed their drugs per rectum but “recreational” dose and two needed emergency laparotomy for acute the toxic dose vary obstruction. bradycardia or The drugs are usually concealed in excreted in the urine as free and conjugated hypothermia. It is also. 6.1mg/kg repeated as packets of drugs can cause acute intestinal present for surgery because of pure outlet necessary until adequate respiration is obstruction. slow or shallow in an Intensive Care Unit. pinpoint condoms and swallowed a few hours before morphine. The as an analgesic particularly in palliative care ● Standard monitoring should be used induction dose of anaesthetic should be where its high solubility is considered a per-operatively and post-operatively. be necessary to give repeated a remedy for cough and as a treatment for ● No premedication is necessary doses or an infusion of Naloxone as the morphine dependence. It was found shortly ● A rapid sequence induction with patient may appear to recover but then lapse thereafter to be as potent a cause of Suxamethonium and cricoid pressure into coma again after some hours. This after oral administration. six individuals brain more rapidly than were admitted to Muhimbili Medical morphine. widely depending on tolerance. detectable in the blood hidden within their body cavity. the urine can be aspiration pneumonia Heroin (Diamorphine or 3.6 tested for the heroin metabolite. protein bound and its They were aged from 22-50 years and had psychotropic effects can swallowed 30-80 packets of drugs. the courier may develop Anaesthetic Considerations ● Tracheal intubation and ventilation acute narcotic poisoning. cautiously titrated and narcotics or other particular advantage. pupils and respiratory depression in a checking-in for their flights. It is mainly respiration. Four last up to 6 hours. Muhimbili Medical Centre Distribution and Dar Es Salaam Excretion Tanzania Heroin is better Email: hdna@muchs.tz absorbed orally than is morphine. It may. It ● Narcotic analgesics should be used if anaesthesia can be induced as for patients is still widely used in the United Kingdom there is no evidence of poisoning with obstruction as outlined above. Careful ately. introduced into clinical practice in 1898 as in the standard manner: therefore. the Patients ingesting heroin condoms can ● Naloxone 0. unfortun. If this happens in the gastro. was banned in the United States in 1924. miosis. Alternatively. often heroin. Between enables it to enter the January 1997-July 1999. sedative and respiratory patient suspected of ingesting heroin can be diarrhoeal is usually taken at the same time. depressant effects of morphine but is regarded as diagnostic.

As small bowel was protruding through the Chlorocetophenone (CN gas) and there not been two anaesthetists present. he had a heart rate of 110 per minute. the symptoms experienced by the authors ii) Decontaminate the patient as much as completely disappeared. S. appropriately to questions. ketone (MIBK) with nitrogen and after being Cardiff CF4 4XW blood pressure of 120/78 mm Hg and arterial sprayed. Following pre-oxygenation. dyspnoea. the admitted to the Accident and Emergency Unit Immediately after laryngoscopy. confirmed by capnography. laryngoscopy. emergency laparotomy b) The anaesthetist may be affected by CS iv) Have a fan blowing over the gas being expired by the patient during patient and stay upwind of the patient was arranged. Morton arranged. abdomen. CS gas (named Dr. After our experience with this patient. Consultant in Anaesthesia (approximately two hours after exposure to CS dissolved as 5% w/v in Methylisobutyl University Hospital Of Wales gas). CS gas. less toxic. bronchospasm. nose. We report anaesthetist after ability to generate bradykinin both in vivo and vitro. gloves. obese (110 kg) man was 100mg whilst cricoid pressure was applied. The patient was transferred from the after Carson and Stoughton) is 10 times more Specialist Registrars in Anaesthesia Accident and Emergency unit to theatre potent as a lacrimator than CN gas but Dr. His past medical transferred to the ward where he made an i) Have two anaesthetists present history included hypertension treated by uneventful recovery. which The most common teargases are O. He Intensive Care Unit postoperatively and later to CS gas. coughing and pain in the eyes but salivation. anaesthesia ketone and symptoms develop immediately was induced with etomidate 20mg and muscle after exposure to atmospheric concentration as Case History relaxation obtained with suxamethonium low as 0. been restrained by the police with the help of managed to pass the tracheal tube between laryngospasm. Clyburn uneventfully. per minute. It was twelve hours before throughout the procedure. pulmonary danger to himself and others. wipe the anaesthetist after exposure to CS gas. atenolol. the problems we encountered whilst exposure to CS gas. P. tract and skin symptoms predominate. It can cause tissue injury Introduction This case highlights the and necrosis probably from the biochemical inhibition of important enzymes such as Anaesthetising a patient who has been potential risks to the pyruvic decarboxylase and it also has the sprayed with CS gas is a rare event that can be associated with unusual difficulties. didn’t have any other injuries. off excess CS crystals and keep the protruding through the a) Excretion of gas from the respiratory patient in a well ventilated room. possible before inducing anaesthesia As small bowel was This case highlights the potential risks to i. the patient but also experienced the same oedema and even fatal respiratory arrest have the patient was conscious and responding symptoms while trying to insert a nasogastric been reported. Aerosols used by the police deliver a 5% anaesthetising such a patient and suggest solution of CS dissolved in Methylisobutyl guidelines for future management. Balachandran stab wound. v) Inform the recovery and ward staff of After taking appropriate precautions to c) Exposure of attending staff to CS possible ill effects of CS gas and prevent secondary exposure of staff to CS gas. conjunctival oedema. Wales oxygen saturation of 96%.e. respiratory A 53 year old. examination of the airway including whenever possible.inflicted stab injury to the author experienced intense lacrimation. remove contaminated clothes. Two 14g intravenous In conclusion. tachypnoea. 1. It reacts with sulfhydryl groups and other nucleophilic sites. The haemoptysis. mouth. His heart rate 120 tube with the help of a laryngoscope. it is not hard to imagine how patient increased the blood pressure to 110/74 mm Chlorobenzylidene malononitrile (CS gas). gas may be sufficient to render them ensure the patient is nursed in a well- his clothes were removed and put in a plastic incapacitated and potentially compromise ventilated area and breathing bag and he was given humidified oxygen patient safety. apron and stab wound. cough. O-Chlorobenzylidene malononitrile (CS gas) the vocal cords. humidified oxygen. rhinorrheoa. tract continues for several hours after iii) Wear a facemask.CS Gas Induction of Anaesthesia! Case Histories Dr. an exposure of the victim to CS gas. Inhalation pneumonitis. it solidifies on the skin and clothes. On admission. Immediately before induction otherwise. safety could have been compromised had Hg. Eye.G. the second most common being ocular burning and pain. One hour prior to admission he had sneezing. an emergency laparotomy was Dibenzoxazepine (CR gas). with a self. haemetemesis and contact because he was violent and deemed to be a first author immediately took over the care of dermatitis. through a facemask. 15 .0026%. CS is a crystalline solid. blood pressure 80/50 mm Hg and The patient underwent a small bowel we suggest the following guidelines when his arterial oxygen saturation on 15 litres of resection and was electively admitted to the managing patients who have been exposed oxygen through a facemask was 95%. lacrimation. although no serious cannulae were sited and one litre of Discussion problems occurred from this encounter with Hartmann’s solution was transfused. goggles when close to the patient.

attempting to E-mail: 106147. Email: http://www. Each project is Fax: (+1) 212 548 4600. Applications should be made to the The following titles are available at £5 UK Minister of Health of the host developing each: Tel: (+44) 01865 221589.A. and pay a subsistence allowance ($90/day). 333 Cedar Street UK New Haven Tel: (+44) 020 7637 4104 CT 06510.ch Ms Isobel McConnan 185 Walnut Street (Floor 22) 8-10.uk vaporisers. 400 West 59th Street Courses in Anaesthesia for the New York developing world. Contact: Carelift International Inc.ac. Applications should be United Kingdom Tel: (+44) 020 7733 3577 made in advance to the branch office of Tel: (+44) 020 7836 5652 The organisation is interested in receiving their country of origin whose address may Fax: (+44) 020 7836 5616 recent complete sets of journals and be obtained from: Email: wfsa@compuserve. Recruitment Division developing world Coulsdon 19 Ave. These are collected free The Soros Foundation and distributed by Rotarians. The Manley multivent/Glostavent Contact: Dr.com Yale University School of Medicine London WC] B 4JX. (TALC) 3.com Contact: ensure implementation of humanitarian ECHO rules restricting armed violence.icrc. 19103 Overseas Doctors Training Scheme (UK) London WC2E 9NA USA Anaesthetists seeking recognised training UK Tel: (+1) 215 535 3590. Servicing the EMO & Tri-Service E-mail: michael. Dr.2366@compuserve. Useful Information Useful Information World Federation of Societies of Book Aid International The SOROS Foundation Anaesthesiologists (WFSA) 39-41 Coldharbour Lane will consider applications from 8th Floor. Expatriate nationals returning to their USA Contact: Dr. Claire Jewkes Contact: David Moreley 4. 1. Imperial house Camberwell anaesthetists in Eastern and Central 15-19 Kingsway London SE5 9NR Europe for support for limited periods of London WC2B 6TH UK study in the UK. Teaching Videos: Oxford OX3 9DU. Dobson country of origin are invited to apply for Tel: (+1) 212 548 0600 Department of Anaesthesia the post of project expert. nation. Gloucester GLI 3NN The International Committee of UK Equipment collection and the Red Cross (ICRC) Tel: (+44) 01452 394786/394194 distribution to the developing The ICRC acts to help all victims of war Fax: (+44) 01452 394485 world and internal violence. William Rosenblatt Bemard Johnson Adviser Fax: (+44)020 7379 1239 REMEDY Royal College of Anaesthetists E-mail: Dept. M.dobson@ndm. Technical Assistance at Low Cost 2. The oxygen concentrator Bristol: December (annually). posts in the UK should apply to the Tel: (+44) 020 7836 5833 Dr. John Radcliffe Hospital sponsored by the United Nations who E-mail: osnews@sorosny. Tel: (+44) 020 8660 2220 Switzerland or your local society. Job opportunities in the Ullswater Crescent Contact: ICRC. CH-1202 produced by the International Health UK Geneva Exchange. of Anaesthesia 8 Russell Square health exchange@compuserve.com newish text books. Dryden Street Philadelphia P. R Eltringham UK UK Gloucestershire Royal Hospital Tel: (+44) 01179 701212.ox. The TOKTEN Project NY 10019 Oxford: July (annually). de la Paix These are listed in a bimonthly magazine Surrey CR3 2HR. USA 16 .org Headley Way would meet the cost of international travel Headington. Servicing the anaesthetic machine Department of Anaesthesia Institute of Child Health Frenchay Hospital Guilford Street Contact: Bristol BS16 ILE London WCIN 1EH.

org.stanford. 41 Crayford Way Suite 1904 Crayford Courses on Anaesthetic Equipment New York NY 10010 Kent DA1 4JY Maintenance USA One week residential courses for Tel: (+1) 212 679 6800.GLI2 8DA UK.edu Committee Chair Overseas Teaching Program Commonwealth Medical Awards If you wish to advertise your American Society of Anesthesiologists Available to citizens of Commonwealth 520 N. In conjunction with the WFSA. it UK produces two publications.A. If you are interested Fax: (+44) 01452 812162 Contact: in obtaining more information. For further disasters and to victims of armed conflict.ac.Ray Sinclair them at: Email: Dept of Anaesthesia MSF wfcasey@doctors. World Cheltenham Rd Anaesthesia News and Update in Medecins Sans Frontieres (MSF) Painswick Anaesthesia* (an add-on textbook) offers assistance to populations in distress. Fax: (+1) 415 723 8544.dobson@ndm. Email: Samuels@Ieland.msf.D. Glos. USA Applications should be addressed to the please contact: Medical Awards Administrator World Anaesthesia Commonwealth Scholarship Commission The Editor This organisation works to improve 36 Gordon Square Dr W F Casey standards of anaesthesia throughout the London WC1H IPE Popes Cottage world. or Media House * also available on: http://www. Northwest Highway countries for limited periods of organisation on this page (free- Park Ridge.I.uk/wfsa 11 East 26th St. contact Dr.) Nuffield Department of Anaesthetics Contact: Contact: The John Radcliffe Hospital Dr. UK anaesthetic technicians are organised at the Email: http://www. Tel: (+1) 415 723 6411.ox. E-mail: michael. IL 60068-2573 postgraduate study within the UK.ac.com Conference Centre Wotton under Edge Glos.dwb. Useful Information US volunteers wishing to spend Association for International WHO Liaison Officer periods working in developing Development of Anaesthesia Dr M Dobson countries (A.nda.ox.org Fax: (+44) 01322 558524 Applications should be sent to: Geoffrey Dillow E-mail: MediaPublishers@aol. The annual to victims of natural and man-made subscription is £10. 17 . UK information They require volunteers for both long and Tel: (+44) 01452 814229 short-term projects. Fax: (+44) 020 7713 5004.uk Royal Truro Hospital (Treliske) 124-132 Clerkenwell Road Truro London ECIR 5DL Cornwall TR1 3LJ UK Produced and Distributed by: UK Tel: (+44) 020 7713 5600 Media Publishing Company Tel: (+44) 01872 274242. Tel: (+1) 202 296 0928. Lena Dohlman Professor Stanley Samuels Headley Way Health Volunteers Overseas Department of Anesthesia Headington c/o Washington Station Stanford University Medical Centre Oxford OX3 9DU PO. Box 65157 Stanford UK Washington DC 20035-5157 California Tel: (+44) 01865 221589/741166 USA USA Fax: (+44) 01865 221593/453266.uk Fax: (+1) 202 296 8018. GL6 6TS published twice-yearly. of-charge). http://www.org or Tel: (+44) 01322 558029 NHS training and conference centre.

edu/aha/vma Journals: Anaesthesia http://www.html Society for Education in Anesthesia http://anesthesia.uk/ Society for Ambulatory Anaesthesia http://www.edu International Anesthesia Research Society http://www.nih.ac.org JAMA http://www.uchicago.org GASNet Anesthesiology Home Page http://gasnet.ml.html The National Library of Medicine http://www.org International Trauma Anaesthesia & Critical Care Society http://www.html Virtual Museum of Anesthesiology http://umdas.org/public/joumals/jama/jamahome-html NEJM http://www.trauma.sccm.org/ University of Chicago http://www.au/home.u.nda.airway.mwsearch.com The American Society of Anesthesiologists (ASA) http://asahq.com/journals/ja.uk/wfsa The Editor would be delighted to hear of other sites that might be of interest and to learn of any site addresses that are incorrect or no longer function 18 .iars.nejm-org/content/index.ox.bsd.ccf.gov/Omim/ Primary Internet resources for anaesthetists http:/gasnet.orh.ucsf.miami.com/ana Anaesthesia and Analgesia http:/anaesthesia.org Society for Paediatric Anaesthesia http://www.ars.au/su/anaes/VAT/VAT.washington.edu/webdocs/aa/ Anaesthesia and Intensive Care http://www.gov/PubMed/ The Trauma Organisation http://www.halcyon.org Society for Computing and Technology in Anaesthesia http://www.edu.edu/~aelizaga/regional/welcome Medical World Search http:/.uk/programs/list.uk Association of Anaesthetists of Great Britain & Ireland http://www.ispub.anesthesiology.vale.uams.ncbi.html Anesthesiology http://www.nih.nsbi.sasaweb.scata.nlm.org Society for Critical Care Medicine http://www.htm Society for Obstetric Anesthesia & Perinatology (SOAP) http://www.ac.com/ Online Mendelian Inhertitance In Man http://www3.org Illustrated regional anesthesia http://weber.pl Anesthesia Web http://www.org:8080/sea/index.med.org Bandolier (Evidence-based medicine) http://www.med.com/ Audio Digest Foundation http://www.com Royal College of Anaesthetists http://www.sambahq.aaic.org/ The Internet Journal of Anaesthesia http://www.jr2.sciencemag.ama-assn.ac.blackwell-science.nlm.nl/cgi-bin/accri.org British Journal of Anaesthesia http://bja.oupjournals.aagbi.ac.soap.edu Virtual Anaesthesia Textbook http://www-usvd.itaccs.html Gaseous anomaly http://www.ac.umdnj.edu/shindler/echo.com/iasp World Anaesthesia Online http://www. Anaesthetic web sites to try Useful Information Miscellaneous Anaesthesia & Critical Care Resources on the Internet (AACRI) http://www.org The International Society for the Study of Pain http://www.trauma.anesthesiaweb.anaesthesia.dundee.edu/spa South African Society of Anaesthesiologists http://www.eur.htm Associations: Anaesthetic Research Society http://www.uk/Bandolier Echocardiography http://www2.rcoa.audio-digest.net.asp Science http://www.uk:1081/mirror/vat/MajRes.

We also had to sevoflurane and remifentanyl. Life expectancy for males is 43. the capital. equipment one was likely to need from a connecting them to our oxygen source. plastic and mandibular joint and minimal mouth opening. are efficient allowing low ventilate patients overnight in a High reduced and so I suspect the vaporiser had flow anaesthesia and the ventilation of Dependency Unit with a Siemens 900 never been serviced and was rather children weighing 10kg or more. Surgery setting of 1. Although possessing considerable mineral resources. Whilst we worked in one theatre. Our second patient had limited Comprehensive monitoring equipment was sedation. ventilator using midazolam and alfentanil for inaccurate. runs out-reach and dental clinics and who had taught me awake fibre-optic Our first anaesthetic proceeded provides health education. to Donka. It is caused by a machine to the cylinder with a variety of equipped operating theatres. rocuronium. We all latter normally performed his own head and contained only a bed where they had to be had to spend some time initially getting used neck blocks as there were no facilities for cared for by their relatives. ventricular extra-systoles on a vaporiser All three theatres are equipped with thyroid block with 2% lignocaine. The patents were taken to a recovery area that and an American nurse anaesthetist. it remains one of the poorest countries in the world. ENT. to unfamiliar equipment and brand names intubation or ventilation in the hospital. anaesthetise an elderly lady with bowel 19 .5% halothane. the main state-run hospital in and ketamine sedation. After surgery. Guinea-Conakry is a small West African state between Guinea-Bissau and Sierra Leone that has recently provided a safe haven for thousands of refugees from the civil war in the latter country. They Drager AV1 anaesthetic machines. local Guinean anaesthetic technician had ophthalmic but the all volunteer crew also I was extremely grateful to those consultants to use. a The 522-foot Anastasis (Fig. We did not therefore. had to bring everything we were watched the local anaesthetic technician have trained anaesthetic assistants or likely to need from the ship. one of which was ship and is operated by Mercy Ships. I didn’t expect to bump into Dr Keith Thomson who persuaded me to go to Guinea to spend some time on the ship MV Anastasis. anaesthesia for three maxillo-facial operations but had brought torches and our monitors My fellow anaesthetists were a that were to be performed jointly by one of our had battery back up. inefficient Mapleson C circuit that the on board is maxillo-facial. Most of the surgery performed ulceration with ankylosis of the temoro.com ife is full of surprises: when I went to an L anaesthetic conference in a ski resort in the French Alps. mixed bacterial infection when there is poor tubes and connectors and add our laboratory and X-ray facilities and a 35. the Cancrum oris (Fig 2 Overleaf) was not broken. and two manometers.5years anaesthetic induction rooms so it was In the theatre. there were two and 48. a dental clinic. we went intubation using a bougie and midazolam drugs such as propofol.1) is the central store before heading for the operating large oxygen cylinder with a reducing valve world’s largest non-governmental hospital theatre.5 years for females and infant necessary to collect all the drugs and anaesthetic machines but no way of mortality is 29 per 1000 live births. On board are three fully anaesthetic challenge. all donated by Conakry. We were eventually able to nautical arm of a Christian charity “Youth uncommon and presented a significant connect an old and rusty anaesthetic with a Mission”. to provide general contend with an electrical power failure their manufacturers. with ketamine and midazolam and a crico. our recently arrived Lithuanian anaesthesiologist surgeons and with his local counterpart. mouth opening but I was able to perform also available as were modern anaesthetic After two weeks on board ship. we and planning ahead for our lists.Gassing in Guinea – on and off ship Feature Extra Dr Aleksandra Bojarska FCARCSI Department of Anaesthesia Diana Princess of Wales Hospital Grimsby UK Email: alexbojar@hotmail. dental hygiene and results in major facial Humphrey (ADE) circuit rather than use the bedded ward. All care is intubation which I performed after sedation uneventfully until our patient developed provided free of charge. could be lengthy but we were able to disappeared when the concentration was although bulky. We. which.

countries and one can but admire the local induction and maintained anaesthesia with Realistically. impact on the lives of individuals and We discovered a number of fairly It is easy to be pessimistic about the perhaps through them. The be able to afford ketamine and halothane the overall situation in a country such as technique appeared to work satisfactorily and survive with nursing care provided by Guinea. He used ketamine for functional for lack of tubing and cables. If they are lucky. The such as Guinea: patients could never afford with minimal resources. have a dramatic and was also used for Caesarean sections.und.Feature Extra obstruction for a laparotomy in an hospitals three theatres but none were anaesthesia in particular in developing adjoining theatre. The Second All African Anaesthetic Congress 23rd-26th September 2001 at the International Conference Centre. however. modern anaesthetic drugs and surgeons and anaesthetic technicians who halothane in oxygen with the patient equipment are inappropriate to countries are doing their best to provide a service breathing spontaneously on a mask.za 20 . South Africa For further information please contact Professor Tony Rocke Email: mailiti@med. Durban. they may such as ours can have negligible impact on manually but no records were kept. change the world a modern anaesthetic machines in the state of medicine in general and little for the better. Visits from a ship blood pressure and pulse were monitored to pay for them. It can.ac. their relatives.

a woman had to be very sharp and Arrive Kathmandu. At the time of writing.782 km drove to California. 21 . for further conversation. Bumpy methodical and thorough. Thai chicken. My Seen by ophthalmologist and retinal was a highly skilled and competent doctor anaesthesiologist was a female. reserved and concluded that in this male-dominated Friday 10 September 1990.A Detached Retina in the land of Yaks Feature Extra and Yetis Dr Jay Chapman anaesthesia. my major concern was with anaesthesia are performed at TUTH the anaesthesia. unsuccessful attempt at laser surgery. Her mentor. Fluid attentive and helpful. vegetable table and had disappeared into the never- Tuesday 14 September 1999. offers quality treatment of which every building. All procedures under general competent. Nepalese friend for a “last meal”. cards and visitors treatment in Nepal was both unexpected Ophthalmic Studies Is situated opposite arrive in the evening. extreme eye problems since patients rarely person in the operating room. beer. formed the impression that Dr Shrestha As it turned out. confirmed this impression. It is a small. Sneaked out of hospital in the and come to work in Nepal. the Background: The Centre sees and treats many anaesthesiologist is the most important Monday 30 August 1999. I ate monologue until I was on the operating momos. No treatment recommended. It has an operating theatre for out. Kathmandu. Monday 13 September 1999. had been bringing students to Nepal for a supervise the anaesthesia. Large superior Wednesday 15 September 1999. The B P Koirala built when Dr Koirala’s uncle. hoping that the procedure will be entirely Ophthalmic surgery and general Procedure lasted three hours: longer than successful. responsible Okalahoma City. performed under general anaesthesia. The care I the Emergency Room of Tribhuvan received was as good as I could have University Teaching Hospital (TUTH). reassuring and relaxing Jeevan Shrestha. The Eye Centre awakening. After I had decided that the Reprinted from the Kathmandu Post June patient procedure performed under local ophthalmologist was qualified and 27. She had retired from Examined by Dr Koirala. straightforward and his approach society. Obviously. Dr Shrestha has just phoned to anaesthesia in Nepal? You must be crazy! anticipated because of difficulty placing enquire how I am and to book a follow up buckle beneath ocular muscles. USA. beer. flashes of light develop in my right eye. retinal detachments as most present with Country? I have confidence in few of California. jokes and beer. I quickly them in the United States. His with whom I instantly fell in love. the staff were interested in examining my How competent would the eye since they saw few patients with early anaesthesiologist be in this Third World Friday 3 September 1999. who would develops. Many of for one’s survival from the procedure. Discharged from Lions Centre for Ophthalmic Studies was Prime Minister. 2. two day. Laser Admitted to TUTH and comprehensively facial and ophthalmic surgery in Sussex treatment attempted but unsuccessful due examined. Peripheral visual field defect A New Zealand optometrist who medical school. Nepalese citizen can be justly proud. The physicians were is probably no coincidence that it was Bandages removed from right eye. with 20 years experience in his field. modern hospital. Referred to Dr evening to go to Bakery Café with a delightful. expected elsewhere. I found this reassuring as I demeanour was mild. we met another friend and returned pushed me. She Tribhuvan University. Giant floaters and present early in the Third World. with state-of. Dr specialist. a real grandmother type. Nepal. good at her studies to win a place in landing. was a visiting month each year for twenty years English professor. the-art equipment and highly competent Anaesthesia staff. Deliver pronouncement that Dr Shrestha was oozed confidence with her gentle manner lecture on Forensic Medicine then go to “excellent” greatly reassured me. delighted to be alive and free This unexpected foray into medical The B P Koirala Lions Eye Centre for of nausea. Flowers. spotlessly clean. 2000. and surprisingly satisfactory. two days post- prevent further tear and more retinal Surgery including laser and cryo-therapy surgery. administering anaesthesia for maxillo- temporal retinal tear diagnosed. G P Koirala gone from retina. Further café. the eye under general anaesthesia to Thursday 16 September 1999. It Friday 17 September 1999. sizzler and beer. Symptoms continue during extensive or total detachments. disappeared. and my apprehension instantly Koirala Centre for Ophthalmic Studies. As we were leaving the never land where so expertly and gently Examined by Dr Shrestha. Decision made that a buckle be placed on Conclusion. On appointment in Monday. I sit with a swollen right orbit detachment. She kept up a to fluid beneath retina. His Shumati.

another Executive pig and he was travelling flipped a sign saying. But not in Africa. them down with free Coca-Cola to cool off or There are 10 transit. The only information a another. in my customary pseudo-jovial flying mood. Our flight was late but reason why or given any other information. wonder I rejoiced that. gloriously empty. surely. Pigs Might Fly! Almost all flights take off after the a connection at Nairobi from Ugandan to Kenyan Feature Extra advertised time. it was machine of the skies was there for all to see on the Kampala. As though meekly them more? Please send answers on a postcard. the Nairobi-based herders had not heeded the Sometimes they will be told. soon became apparent to our panicking herd that where they work. shops. Was he visually challenged or around your truffles or slurp noisily from your “Glad to have you with us this evening. the right place. a guard armed with an AK 47 and a did not bother to look at the card. like the obedient baton appeared and herded the pigs back into a triumphantly. and we all stared fingering our tickets and making pigs would get on. stamp or make a bad smell in the departure unauthorised information area: it is a general An airport resembles a kind of special farm lounge. sir” came the desk.e. They are plane was not full? No. Gin and tonics wore being loaded. security man thought I was an Executive Pig and he herders. The guard had been posted to The wearing of a tie should not be over- “I’m-in-a-queue” motions. airport Blantyre experience. pig con be told is that the plane is travelling at an waiting for the stun gun. differing only machine if told to do so. Paul Fenton address system operated by someone with a There was no one to herd us into the waiting Department of Anaesthesia speech impediment or reading difficulty that the Kenyan plane. altitude of 37. to doing the same thing. The dangerous inmates the floor. This pig-author was trying to make dry response. There were numerous. its confusion. without the need for a guided tour through a large human being: they handle the people who want to etc. a shirt with epaulettes. In 1999. nibble the furniture or leave droppings on observation that a flying pig is not supposed to for delinquent humans. the tall pig ponders a modern Business Class. at 6. crash on the runway. when the you take away the veneer of fancy entrance halls enough pigs are of the snorting type. I charged through the gate and down little porcines that we were. these pigs wait in line for signed with a trotter print). we all lined up at one closed waiting area. A seasoned WHO traveller the mouth. As we entered the plane’s hushed then sat down with his chin on his hands and paradox: the porcine race is getting taller yet the interior for our night flight to London. pig herders are used to such things. But. the Club stared into space looking neither to right nor to left. (Are cannot got on to an aircraft. Incontinence was imminent. Prof. stamped and snorted and made a mess they would hungry and it was only a 2-hour flight. But the ober-pig-fuehrer head off an expected stampede. prevails? Not so. there was a problem: there were not enough airport and deplores the state of an old one. The Nation prides itself on a new If the pigs start snorting excessively. if something may happen.000 feet. sir. If the one in front wants to started on the same routine with me but stopped sit at nearer desks. luxury. Only one or two will (Now. Never. it was not the lack of stalls and the glitz of over-priced. pigs but only 5 packets Can these pigs also fly? Amazing to relate. the man wearing the them malevolently through the glass. It transpired waving their tickets and protesting their full bellies. Yet. it is essential to have such a is their stock in trade. gleaming. in customer service” we moved to snort at the right stressful for a pig: he is in-coming and out-going at “Just follow the aisle to your right. Also deaf? recline. His smile faded. There were several transit pigs but it fly in aeroplanes. we had inadvertently broken into an in the numbers of passengers they handle. you cannot snort Class steward smiled warmly and greeted him: He didn’t see us. while the herders were distracted with no one in charge and chaos immediately ensued as employees go Pig-class these days) once told me him. We were waiting to check-in for Brazzaville. Yet there are the common reasons why flights building). like cattle or pigs. In fact. I was in a herd that had (the UN is very politically correct. “Are you not glad to have me?” I other past signs announcing “unrivalled excellence Being in transit at an airport can be doubly asked. friend. yet the pigs are rarely told the Airways onward to Lusaka. I grabbed a blank boarding pass from a pile on we pathetically tried to organise ourselves to be in that he was waiting for a plane to escape from the desk and made a rush for the security gate. that safety is the number the airport farmers to conduct security and other Snorting pigs cannot make a plane take off one priority and that he fastens his seat belt by formalities which. actually trot unaided from one plane to another People who work in airports are a special breed of incompetence. throw in some free swill. “closed” to read “open. No response. could we be told that there was a herders will wake up to the fact that a pig can Malawi mechanical failure. The rest just quietly await the know how many seats there are or why you can or are confined to discrete compartments. we 5 unfortunates argued we are not millions do everyday. arrived that the plane was overbooked and none of these The lesson is: be a smart pig when flying. The glorious. The problem is that not places on the plane for us all. my tarmac. when examined in retrospect are any sooner but often the airport herders may hose putting the little bit into the big bit. fenced or instructions if their herdsman or herdswomen.g. all airport are much the same. Suddenly. however. in the far distant future. he there would he other super-beings coming later.” was it a bad hangover? One pig ventured to ask if trough of orange juice if the pig in front is not Assuming that I was with the gentleman. It Come back tomorrow!” One pig started to foam at where to go. then all you can do in look at his seat back. the same time. (One day. porciphobia).99% pointless. you know. Perhaps if enough pigs of swill. so.00am that morning in an early morning flight from of Cape Town. I had decided to wear a tie. Airports are the curious places are delayed. it is a glassed in. in. wore adamant: “You cannot fly! Go in to Nairobi! tell the mindless porcine herd what to do and Here. After about 30 minutes. parked right next to us on the Queen Elizabeth Central Hospital plane is late because it arrived late. Clearly the so early that we pigs had arrived before the runway. half way through when he saw my economy pass. rated. I once fell into conversation with went straight to a desk at the other end and Once in the plane. In fact. Jostling with each About 3 inches from your mucus drooling hooter. stalls are getting shorter. Squealing check-in desks to snort at.” He These days. or moved under close supervision by women naturally ruder then men or is it just that Standard Part 1 order of All Airlines to give no trained keepers from one secure enclosure to there are more of them in airports and you notice useful information at all. In the person: on one occasion. But why. There was nothing else for it. The herders Usually there is someone at the airport to get their way. on an inaudible public advance call from our pilot to expedite the transfer. 22 . so-called “duty-free” mostly docile and would happily trot into a bacon but a deficiency of troughs. laziness. staff problem (e. locked the doors and stared at the steps leaving my lesser porcine brothers still end.) 99. magic clothes i.

Botswana. Mauritius. Asia (China and the succeeding four years. Benin.ox. the Americas (Paraguay. based on the WFSA.000 hits from over 100 decisions concerning many on-going maintaining an active training countries.25 per year. published in six languages (English. activities are delegated to specialist programme for anaesthetists from Donations of teaching material committees. Burkina an Executive Committee. As well as the printed constraints of the available space) if you $150. Russian. Policy is laid down by a obtained from WFSA investments. fax and post. Update contains articles on is conducted during the World Federation. re-launch its website societies. within a fixed budget. nurse anaesthetists during each Congress.50. Ethiopia. Chile (in customised.ac. Publications. The practical Argentina. sending delegates in and the income enables the federation to educational material. Honduras and Nicaragua). It has been run in the Pacific. reflecting the Faso. Each package is undertake their important functions. The chairmen Vietnam). educational material. Tanzania. The WFSA is posed to geographical spread of member Nigeria. Secretary and Treasurer and Africa (Uganda. therefore.000 each year. Mozambique.wfsa. Ghana.000 per year. $1. Additional income is practical anaesthetic procedures and the Congress. Society or Association and your society is “to make available the Recently. then you are part of the highest standards of Trauma Care course.nda. Fiji. You are fulfil its educational objectives. journals and videos are Publications Committees have Regional Training Centres are made on request to centres that lack substantial budgets that they use to supported in Thailand. This has funded for teaching visits that are of anaesthesiologists. to manage the Federation for Malawi and Togo). highest standards of anaesthesia and Usually the WFSA provides airfares and resuscitation to all peoples in the world. Visiting Professorships are one hundred and seven national societies full member of $1. hosted and organised anaesthesia and programme. including books. The theory that underlies them. specialist chat Statutes and Bylaws also sit on the Europe (Russia.org. A course for anaesthetists The Executive Committee gives on the technical care of equipment has information effect to the agreed policies of the been held in Uganda (sponsored by Federation. UK) has developed a Primary a member. Spanish. One was held in resuscitation to all countries. The General Assembly elects a funded Refresher Course in sub-Saharan President. Sudan. well received. The next Congress peoples in the world”. The WFSA holds a World Congress Advanced Trauma Life Support every four years. It is aimed at General Assembly which meets twice capital for these investments has been practitioners (doctors. The subscription is intended to publishes “Update in Anaesthesia” twice Much of the business of the WFSA cover the administrative costs of the a year. Vietnam. Nepal. Its principal not been increased since 1980 but at the expected to include practical teaching in objective is: “to make available the Montreal Congress it was resolved to theatres as well as formal lectures. It is currently proportion to their size. the Education. meeting in alternative years Penlon) and paediatric fibreoptic can be downloaded from the Internet but otherwise conducting business by workshops have been held in Chile and (www. It by the French Society.” Its principal objective is: the host society provides board and If you are a member of a National lodging. for use in developing by a member society. CD and so wish. Ghana. it is available on disc. The Education and Eastern Europe. to the 23 .uk/wfsa). represented and can also The Education Committee has the French. Finance and Pacific (Fiji and Palau) and Eastern news. Benin.The World Federation of Societies of WA & WFSA News Anaesthesiologists (WFSA) The WFSA is a voluntary association of Your national society pays a paediatrics) and South Africa (in membership subscription for each of its obstetrics). June this year in Montreal organised by India and Africa and has been universally the Canadian Society. Arabic and attend as an observer (within the largest budget and spends some Mandarin). Dr Douglas Wilkinson (Oxford. In recent years it has versions. the Baltic States and rooms and useful Executive Committee. It also assists Israel in received over 11. Macedonia). All member derived from a share of the surpluses and clinical officers) in countries with societies of good standing can generated by previous World Congresses limited resources and poor access to participate. The Publications Committee has a will be held in Paris in 2004 and hosted increase this over the next four years to budget of about $50. Costa (www. The site has email.uk) of the Standing Committees on Rica.

An annual subscription is set oxygen concentrators has been set and a electable for one further term at the AGM but members in developing textbook “Anaesthesia in the District countries are exempt from payment. The request. by the development of and to make Update more widely appropriate training. re-electable The activities of World Anaesthesia are for one further term The current officers of the WFSA are: mainly educational and include: President: ● Annual meeting in UK The executive will work for the Society Dr Kester Brown (Australia) through the Organising Committee. support appropriately trained and experienced people able to assist on WFSA linkman – liases with the WFSA WFSA initiatives by paying the costs of lecturers on Refresher Courses. re. Association linkman – liases with AAGBI WFSA has worked with the Australian Society and the Australian government The Executive is elected by members Adviser for those planning to work to develop a Diploma (and subsequently present at the Annual General Meeting. overseas a Masters) course in Anaesthesia at Fiji in the South Pacific and is now in discussion with the Japanese government Chairman – elected for 3 years. With Dr Michael Dobson. world are being sought.uk) with news. During the past four years. another country Treasurer: Dr Richard Walsh (Australia) Chairman. and sits on editorial board of Update equipment. Currently. World Anaesthesia is a world-wide society composed of the following members (some of he has obtained grants from the UK whose aims include: whom perform 2 or more tasks): Department for International Meetings co-ordinator – organiser of Development to conduct a trial of the ● Support for colleagues in developing regular World Anaesthesia meetings Glostavent in Mozambique and Zambia countries. Liaison member – liases with Specialist governments. of anaesthesia. Dr Michael Rosen has obtained funds from the Soros Foundation to provide training for World Anaesthesia anaesthetists from Eastern Europe in Palliative Medicine. materials. a standard for Honorary Secretary elected for 3 years. The ● Overseas meetings with other Societies Executive will appoint members to the ● Preparation and distribution of Secretary: organising committee.org. re-electable to further develop the Bangkok Training for one further term Membership of World Anaesthesia is open to anyone involved with the provision Centre. if you organising publicity at major meetings look up WFSA on the Internet you are ● Liaison with the many other agencies more likely to get information about the whose activities may impinge on Linkman member – responsible for Welsh Football Supporters Association anaesthesia & resuscitation maintaining links between members in than about anaesthesia! different countries and organising a database Collaborations enable the WFSA to ● Provision of a network of of information about different locations achieve more than it can alone. The membership of educational materials Dr Anneke Meursing the committee is listed below but other ● Preparation and publication of Newsletter (Netherlands/Malawi) members may be co-opted at the discretion ● Advice for those planning to work in of the Chairman. Hospital” has been published and revised. non-governmental specialist chat rooms and useful Societies organisations. by The WFSA is posed to re-launch its speaking on their behalf to web site (www. Many national societies. and when requested. for example. WA & WFSA News About thirty packages are dispatched each year. equipment manufacturers regular contributors from throughout the Publicity member – responsible for and others. David Bevan (Canada) and resuscitation to all peoples in the world”. the The Constitution of retiring Treasurer. 24 . pharmaceutical information. With the WHO. A web editor-in-chief and companies. individual requirements of the recipients. and Publications member – edits Newsletter available on CD and via the Internet. Executive Committee: “to make available the highest standards of anaesthesia Prof.wfsa. Treasurer elected for 3 years. the WFSA’s liaison officer with Aims and Objectives The Organising Committee is the World Health Organisation (WHO).

.......................................................... (free of charge) the educational journal “Update in Anaesthesia” to members E-mail address: ........................ We shall then contact you ................................................................................................................................ costs of Update are met by WFSA (printing and distribution) and WA Grade: ............................... The Speciality: ..................................................................................... equivalent.uk/wfsa/.................................................................................. 25 ............................................................... ............... working in developing countries.................................. depending on where you live..................................... Area of War/Conflict..................... support for World Anaesthesia – it is greatly appreciated! ............................ 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Disaster Relief............................................................................................................................... started World Anaesthesia (WA) some 12 years ago.......................................................................................................... supports colleagues providing anaesthesia overseas................................................................................... Currently the membership of Institution: ......................................................................................... Anaesthesia Member.................................................................................... One of its activities is to send Fax: ................................................ recipients.......... electronic versions)............................A letter from World Anaesthesia Database World Anaesthesia Database Dr Iain Wilson Name: ...................................................................................... Many thanks for your continued ........................................... to arrange collection of your subscription...................................................................................................................................................... Secretary (Charlie Collins) and I have Experience overseas: been bringing our membership and subscription records up to date.......................................................................................................................................................................... complete the new database of members .......................................................................... please .......................................................................................................................................................................... Our Treasurer (Douglas Wilkinson)............................................ Other Job Title: ......................................................................................................... copies are required and the address for delivery.............................................................. AGM it was decided that the Annual Please add: the places in those countries........................................................ At the World Anaesthesia meeting on 1 ....................................................... ................... the dates and the type of work you were Membership should be increased to £20 or engaged in.......... As you are aware........................................................ 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Chairman.........................................................................................................................ox................................................................g....................................................................................... If you wish to receive copies of ...........................................................................net ................................................................................................................. October 99 I was delighted to be elected Chairman to follow Mike Dobson who ......................................ac................................................................................................ .............................. Update in Anaesthesia to send overseas please let me know by email how many .............................................. 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........................................................................................................................................................ ✃ World Anaesthesia Database continued Particular interests: (e........................................................................ ................................................... Secretary.............................. ....................................................................................................................................................................................................................................................................................... Anaesthesia................ World Anaesthesia Dept................................................................................................. ......................................................................................................................................................................................................................................................................................................................................................................................... education....... Languages spoken: ........................................................................................ ......................................................... ................................................................... Devon EX2 5DW United Kingdom ....................................................................................................... ............................................................................ Availability: Are you happy to answer enquiries relevant to your experience/expertise? ■ Yes ■ No Are you able to write for WA publications? ■ Yes ■ No Are you available for working visits abroad? ■ < 1 month ■ 1 to 6 months How much notice do you require? ■ 2 weeks ■ 2 months ■ 6 months ■ >6 Any comments: .................................................................................................................................................................................................................................... ........ ........................ ....................................... conflict situations................ .............................. Please complete this form as accurately as possible and return to: Dr................................................................................................................................................................................................ Collins.............................................................................................................................................................................................................................................................................................................................................................. Barrack Road......... long term secular: ...................................................................................................................................................................................................................................................................................................... C..... Royal Devon and Exeter Hospital (Wonford)....................................................................................... ............... ............................................ ....................................... disaster relief.........g..................................... appropriate research writing........................................................ subspecialities of anaesthesia/care of the critically ill.................... medical missionary...................................................................................................................................................................................................................... Exeter............................................................................................................................................................................................................................................................................................................................ ....... ... distance learning...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................