DAS 2002

DAS
2002 London 21-22 November 2002­

Took place at the Commonwealth Conference and Events Centre at the Commonwealth Institute.

Organising Committee

Dr Ravi Bhagrath, Dr Ian Calder, Dr Bernie
Liban, Dr Viki Mitchell, Dr Anil Patel, Dr Adrian Pearce, Dr Tim
Vorster, Dr Steve Yentis

Programme


Thursday 21st
November

The
College View on Airway Training 		Dr Paul Cartwright Royal
College of Anaesthetists
Airway
Skills Teaching in the Netherlands – lessons for the UK		 Dr
Pieter Borg		 University Hospital of
Maastricht, The Netherlands
Laryngeal
Tube		 Dr Don Miller Guy’s
and St Thomas’Hospital, London
Airway
Management Device		 Dr Mark Stacey Llandough
Hospital
Proseal Laryngeal Mask Dr
Tim Cook		 Bath
A new
mirrored
laryngoscope for difficult intubation		 R.C.N. McMorrow, R.K.
Mirakhur		 The Belfast City
Hospital
Evaluation of the
Bullard laryngoscope		 E. Zadrobilek Empress
Elisabeth Hospital, Vienna, Austria
Clinical
experience with the Bonfils intubating fibrescope		 M.
Halligan, P. Charters		 University Hospital
Aintree, Liverpool
Comparison of the
laryngeal tube and the laryngeal mask		 T M. Cook, B.
McCormick, T. Asai		 Royal United Hospital,
Bath
A Realistic manikin for
airway training		 J.P.H. Fee, J.M.
Murray, A. McBride, T. Edgar		 The Queen’s University
of Belfast
Ventilation of a model
lung through various cricothyrotomy devices		 R.M. Craven, R.G. Vanner Frenchay
Hospital, Bristol
Diagnosing a ‘Lions
Roar’ and intubating a ‘Spaceman’		 O. Ross, U. McLachlan Southampton
General Hospital
Potassium permanganate
poisoning and airway management		 U. Timperley, I.
Odutoye, O. Rodney		 Ninewells Hospital,
Dundee
Negative pressure
pulmonary oedema following thyroidectomy		 N. Beckett Ulster
Hospital, Northern Ireland
Airway
Care in the Resuscitation Room – who should do it?		 Dr
Mike Clancy		 Southampton
The
Trachlight - a core
skill?		 Dr Bert Dercksen Assen,
Netherlands

 

Friday

The use of simulators
in airway training		 Dr Ravi Bhagrath St Bartholomew’s
Hospital, London
An Australian
perspective		 Dr Sonya Bajenov Sydney
Medical Simulation Centre
False
hope?		 Dr Ronnie Glavin Scottish
Clinical Simulation Centre, Stirling
An
algorithm for tracheal intubation		 Dr Thomas Heidegger St
Gallen, Switzerland
Fibreoptic intubation
through the ILMA		 Dr Michael Avidan King’s
College Hospital, London
Are
trainees safely managing the obstetric airway?		 T. Addei, M. Razzaque,
H. Drewery		 The Royal London
Hospital, London
Instruction in awake
fibreoptic intubation using the trainees as subjects		 N.M.
Woodall, CL. Barker, R.J. Harwood		 The Norfolk and Norwich
University NHS Trust
Evaluation of a model
for surgical airway training		 S.C. Clarke, SM. Yentis Chelsea
and Westminster Hospital, London
Tracheal
intubation in simulated grade III difficult laryngoscopy		 K.G.
Hames, A.G. Marlin, J.J.Pandit, M.Popat, S.M. Yentis		 The
John Radcliffe Hospital, Oxford
Look
up to open wide: head position affects mouth opening		 U.
Picard, C. O’Sullivan, M. Chapman, A. Crockard, I. Calder		 Northwick
Park Hospital, Middlesex
Use
of bite guards and critical incidents involving the laryngeal mask
airway		 J.P. Blackburn, J.P.
Con, C. Moore		 Moorfields Eye
Hospital, London
A difficult airway due
to shotgun pellets		 C.J. Loew, H. Matthew,
A. Dark		 Wycombe Hospital,
Buckinghamshire
Bronchospasm or blocked
tracheal tube?		 J. Dick, M. Newton National
Hospital for Neurology and Neurosurgery, London

 

The
Difficult Airway Society Annual Meeting, London,
21-22nd November 2002

This was my third DAS Annual Meeting and, having thoroughly enjoyed my previous two meetings, I was looking forward to this year. It did not disappoint. The entrance to the Commonwealth Institute, this year’s venue, was heralded by a host of international flags billowing in the crisp November wind, quite
appropriate for the international nature of the meeting with speakers who had travelled from as far afield as The Netherlands, Switzerland and even Australia. The main lecture theatre was state-of-the-art and the two days of presentations, lectures and workshops were attended by yet another record number of delegates. It was nice to see familiar faces and even nicer to see the growing numbers of trainees taking an interest.

The meeting opened with a warm welcome from the outgoing chairman Dr Adrian Pearce, followed by Dr Paul Cartwright presenting the College view on airway training. Faced with a reduction in working hours, changes in working patterns and the growing demands of the service outside of theatres (e.g. in ITU and Obstetrics), he pointed out that trainees were
spending less time learning the traditional skills of airway management in theatre. To tackle this problem he emphasised the continual need to improve basic airway teaching using methods such as simulators, CD ROMs, videos and personal training with the need for competency assessments.

Our first guest speaker, Dr Pieter Borg, from Maastricht, gave an account of airway training in The Netherlands, including the Access to the Airway course run by his hospital to improve airway skills for all anaesthetists. He also presented a survey on current practice in airway management and
the use of the ASA algorithm amongst Dutch anaesthetists, making recommendations that the algorithm should be adapted according to local practice, equipment and training.

The next session analysed three relatively new supraglottic devices, the laryngeal tube (LT), the airway management device (AMD) and the Proseal LMA. There were horrified gasps from the audience as they were shown the macroscopic presence of proteins on reused, cleaned and sterilised LMAs. I am sure we all look forward to seeing a single-use device available in the future after seeing those pictures. Unfortunately some of the data presented on the LT and the AMD is already out of date as VBM and Nagor, the manufacturers of the devices, have since brought out newer (?)improved versions which are currently undergoing trials. This led to an interesting impromptu debate from the floor about the rules
and regulations governing the safety of introducing such devices into clinical practice.

During the splendid lunch there was time enough to wander around the large trade exhibition and the first-rate poster presentations. The afternoon session then commenced with the presentations of free papers on equipment and clinical cases. The standard, as usual, was of exceedingly high quality. This was particularly ‘mirrored’ in the presentation by Dr R McMorrow who won the KeyMed prize of an Olympus
digital cameras for his invention of a new mirrored laryngoscope (read more in the Abstracts from the AAGBI Annual Scientific Meeting, December 2002 Anaesthesia). As Dr Anil ‘Mc’Patel pointed out, it seems
that Dr ‘Mc’Morrow certainly has the right name for inventing a laryngoscope!

The last session
of the day was an extremely brave presentation by Dr Mike Clancy. I say brave as Dr Clancy, an Emergency Physician, was addressing a hall full of anaesthetists to advocate the rather contentious issue of A & E doctors performing emergency airway care up to the first 30
minutes (in conjunction with anaesthetists of course). It is enlightening to have our colleagues from different departments come and share their thoughts and different perspectives. The talk was generally
well received, although I am sure everyone has their own opinions on the matter. The session closed with our second guest speaker, Dr Bert Dercksen, also from The Netherlands, discussing the merits of the Trachlight and suggesting its re-introduction as a core skill.

After tea, the Annual General Meeting took place with a reshuffle of the cabinet. Dr Mansukh Popat was voted in as the new chairman, with Dr John Henderson being appointed Honorary Secretary and Dr Chris Frerk the new Treasurer. We wish them well in their new roles. This was swiftly followed by the Society Dinner. An enormous amount of behind-the scenes organisation by Dr Viki Mitchell and Dr Anil Patel led to an incredibly sumptuous meal at the Royal Garden Hotel in Kensington. Great food and a great venue were enjoyed by all.

The second day kicked off on a high fidelity note with animated talks on simulators and their usefulness as adjuncts in teaching, training and management of critical incidents. Dr Ravi Bhagrath described his experience of simulated airway scenarios at the Bart’s and the London simulator and our third guest speaker, Dr Sonya Bajenov, travelled from Sydney to give her presentation on the theory and practice of simulation from an Australian perspective. Two passionate simulator-friendly talks required counter-balancing and Dr Ronnie Glavin from the Scottish Simulation Centre described well its limitations.

The morning coffee breaks allowed more people to attend the excellent smooth running workshops. Our last guest speaker, Dr Thomas Heidegger from Switzerland, then spoke about quality issues and outcome measures. Dr Steve Yentis and Dr Mansukh Popat rounded off the session with a summary of the working group recommendations on issues of consent regarding advanced airway techniques.

The day ended with the final session of free papers covering issues of training and more fascinating case presentations. There followed brief comments from the Chairman, who informed us of the healthy state of the DAS bank balance, and Dr Henderson gave a progress report on the DAS failed intubation
guidelines. The meeting was drawn to a close with the presentation of the prize for best paper (well done Dr McMorrow!) and people made tracks back to their own neck of the woods up and down the country,
enthused, educationally refreshed and brimming with yet more ideas on how to tackle that difficult airway. Bring on next year’s meeting in Glasgow www.das2003.com!

Dr Farah Ahmed,
SpR 4,
Moorfields Eye Hospital, London.

»