6^th International Conference on Surgery and Anaesthesia April 13-14, 2020 London, UK

Biography:

Dr. Harry Mc Grath completed his Medical Degree at UCC, in Ireland, and has worked in Melbourne Australia in numerous Hospitals including Monash. He is currently working in University Hospital Limerick in the Anaesthetics Department. He has active research interests with University of Limerick, UESTC China, and Peking University in the field of AI and anaesthestics

Abstract:

Artificial Intelligence(AI) and Data Analytics will change our lives beyond recognition, and they will have a far more significant impact than the internet or mobile technology. We are now at the threshold where machine intelligence is comparable with human intelligence, in certain limited aspects, for the first time in history. Enhancements in technology, both software and hardware, have resulted in some human decision-making being inferior to and more erratic than AI in many fields, including medicine. However, it is widely accepted that rather than compete with machines, using AI to support and help make better-informed decisions is the key to future medicine. In areas like anaesthesia, data analytics can be used to develop useful advanced clinical decision support tools based on machine learning. 

Keywords

Anaesthesiology, Machine Learning, Big Data, Data analytics, Pain Management,

Data analytics and AI technology have the potential to transform medicine to a level never seen before, in terms of efficiency and accuracy but also creating insecurity and allowing the transfer of expert domain knowledge to machines. However, applying AI to all areas of medicine such as anaesthetics cannot automatically be assumed to achieve improvements beyond human experts. It is often forgotten that it is "Artificial" intelligence that is being considered. Monitoring of depth of anaesthesia during surgery is subjective and depends on the patient’s ASA classification and the surgery type to allow accurate drug administration against the measured state of arousal of the patient. The patient’s sensitivity may vary throughout the surgical procedure, and the haemodynamic effects of the drugs may limit the amount that can be given safely. 

Anaesthetics is a complex medical discipline that involves much cognitive and dexterity based work, and assuming AI can easily replace experienced, and knowledgeable medical practitioners is a very unreasonable expectation. 

Technological advancement has made robots an integral part of several fields, including surgery. Pharmacological robots are closed-loop systems, able to precisely titrate the dose of anaesthetic drugs to a preset value, concerning hypnosis, analgesia and neuromuscular block. Mechanical robots automatically reproduce manual tasks, showing promising performance. Decision support systems can improve clinical practice. The use of robots in anaesthesia shows the advantage of eliminating the repetitive part of the workload, allowing the anaesthesiologist to focus on patient care.

A major issue with current deep learning systems is "opacity." Although a machine may be trained to perform a specific input-output mapping, it is often unclear as to which part of the training network is responsible for any specific outcome. This is undesirable, as physicians need to understand and trust the operation of any autonomous anaesthesia system. In particular, A physician needs to be sure that the machine Will not generate "wild" responses in unforeseen operating conditions. Currently, acceptable methods solve this by increasing the training sets and more complex levels of processing, without a precise analysis of cognitive bias that may occur. Decision making for use in anaesthetics cannot be a nondeterministic closed process, and clinicians need to have full control and understanding of the decisions developed by these rule-based algorithms. Anaesthetics involves much cognitive and dexterity based work. Technology is increasingly encroaching on both of these areas. AI Systems using Machine based Learning tools and software can be very useful in some aspects of clinical decisions within anaesthetics. 

This paper focuses on the complexity of both AI and data analytics developments and opportunities of AI in anaesthetics for the future. It will review current advances in AI and Data analytic tools and hardware technologies as well as outlining how these can be used in the field of anaesthetics

Biography:

Dr. Manpreet Singh MBBS MD Anaesthesia EDAIC  is a Speciality Doctor working in the department of Anaesthesia and Intensive care in Northwick Park Hospital associated with London Northwest University since January 2019. Before that, he was working in the department of Intensive Care in the Indraprastha Apollo Hospitals, New delhi, India. He has published 2 papers in reputed journals and  wants to pursue further research and training in the field of Anaesthesia.

 

Abstract:

Introduction: Esophageal atresia (EA) with or without trachea-esophageal fistula is a common neonatal emergency which may be associated with major life incompatible cardiac abnormalities¹. Survival of such neonate depends on stabilization and proper resuscitation followed by postoperative care.

Case Report: We came across a 4 days old male baby, with diagnosis of EA and distal TEF, posted for right thoracotomy with primary repair under GA. On preoperative evaluation baby had respiratory distress, frothing from mouth & was hemodynamically unstable on dopamine with oxygen saturation (Spo2) of 85% on room air. Intraoperatively surgery was uneventful but baby not able to maintain Spo2 even after ligation of fistula. At time of reversal of neuromuscular blockade, he had active movements, was maintaining SpO2 of 88% with 100% O₂ & on dopamine. After extubation he maintained SpO2 of 85% on nasal prongs when shifted to PACU. But after 3 hours of surgery, his Spo2 started falling & developed persistent cyanosis, so trachea was intubated with chest tube insertion on right side done suspecting  pneumothorax or hemothorax or pleural effusion which were subsequently ruled out, emergency 2 D echocardiography showed large VSD, pulmonary atresia, PDA, single ventricle with Tetrology of Fallot. He was started on PGE₁, Alprostadil & dobutamine because of worsening hemodynamic instability shifted to NICU but was not able to maintain Spo2>75% with mechanical ventilation. His general physical condition deteriorated over next 2 days and died due to respiratory failure and cardiac arrest.

Discussion and Conclusion: EA- TEF is a major congenital anomaly and when it is associated with life incompatible anomalies like single ventricle along with PDA, VSD and Pulmonary atresia, it becomes a night mare and a real challenge to both pediatric surgeon and anaesthesiologis^1,4. Success in survival of neonate with EA-TEF is attributed to improved neonatal care, anesthesia and better understanding of neonatal physiology. But unfortunately our institution is not well equipped with emergency cardiac back up which if would have been there, then after successful ligation of trachea-esophageal fistula, our 4 day old neonate could have been saved, who died of respiratory failure and cardiac arrest. 

Keywords- Esophageal atresia, trachea-esophageal fistula, single ventricle, PDA, VSD

 

Biography:

Dr. Shagun Bhatia Shah is a motivated and dedicated anaesthesiologist with eighteen years of experience in anaesthesia and over 60 publications in various international peer reviewed journals. Her interest in oncoanaesthesia drove her to practice as a consultant at RGCI&RC. Her specific interests include recent advances in anaesthesia like USG-guided nerve blocks,difficult airway and anaesthesia for robotic surgery. She is certified in TOE (Transoesophageal echocardiography) use and utilizes it for managing cardiac patients undergoing noncardiac oncosurgery. She has successfully conducted clinical trials like “Optic Nerve Sheath Diameter guided noninvasive ICP measurement in patients undergoing robotic surgery in steep Trendelenberg position”and “TOE for intraoperative goal directed fluid therapy in cardiac patients undergoing non cardiac oncosurgery” among others and is a core member in framing CRS –HIPEC consensus guidelines 2019. She is ready to walk that extra mile with post- operative and terminally ill cancer patients to alleviate their pain and suffering

Abstract:

Statement of the problem: It is alarming to note that 28% of all anaesthesia related deaths are secondary to cannot intubate, cannot ventilate (CICV) situations. Prime step in circumventing CICV is to detect potential problems with oxygenation and ventilation and maintaining airway patency. Airway assessment gives the diagnosis. Airway plan is the treatment. Anticipated difficult airway is not a race against time. We shall learn how to pause, plan, prepare and proceed to success.

Methodology: Nine core airway assessment considerations shall be addressed here, illustrated with pictures of real-life clinical situations 1.Any history of airway difficulties? 2.Any altered cardiorespiratory physiology? 3.Any impact of surgery on the airway? 4.Bag-mask ventilation difficulty? 5.SAD placement difficulty? 6.Intubation difficulty? 7. Infraglottic airway difficulty? 8.Risk of aspiration? 9.How easy will it be to extubate safely? Utility of ultrasonography in airway assessment shall be discussed. We shall see how fiberoptic bronchoscopy (FOB), though the gold standard, is not a blanket solution for all difficult airways. Case scenarios where potential CICV situations have been tackled with awake retrograde intubation, videolaryngoscopy and elective tracheostomy shall be described. Difficult airway in remote locations and the Vortex approach shall also be addressed.

Difficult Airway: pause, plan, prepare and proceed

Biography:

Dr. Chaitya Desai has completed his MBChB at the University of Liverpool. He intercalated in a master’s in medical law and ethics, graduating with a distinction from the University of Liverpool. He is currently a foundation year trainee at City Hospital in Birmingham, UK

Abstract:

Introduction

Maximilian Stern introduced the first resectoscope and performed the first transurethral resection of the prostate (TURP) in 1926.¹ The design was advanced in 1931 by Joseph McCarthy with the addition of an effective panendoscope. The Stern-McCarthy resectoscope and the TURP procedure was initially advocated in the UK by urologists such as Canny Ryall and Terrence Millin; and soon became the global gold-standard treatment for symptomatic prostate enlargement.² In the subsequent decades, concerns were raised regarding the procedure’s need for general anaesthesia, risk of retrograde ejaculation, and invasive method.³ In 1993, Thomas Stamey, a noted urologist, stated that TURP was ‘now a therapy of history’.⁴ In the last two decades, a novel minimally invasive non-ablative surgical technique to treat symptomatic benign prostatic hypertension (BPH) has been developed. The procedure is called prostatic urethral lift (PUL), trademark: ‘UroLift’,⁵ and this paper aims to highlight its modern progression.

Methods

A systematic review of the literature was conducted via searching online databases such as the Cochrane Library and Pubmed. Relevant articles which included the keywords: ‘TURP’, ‘prostatic urethral lift’ and ‘UroLift’, were collated.

Results

PUL was designed by Theodore Lamson and a team of engineers at the American-based start-up Neotract Inc. The procedure and delivery device were formally presented in 2004, after extensive animal testing and research and development costs of approximately 30 million dollars. Initial pilot studies in 2011 showed promise,⁵ and a randomized multicentre sham comparison trial in 2013 demonstrated the IPSS, QoL score, Q_max, and another validated questionnaire known as the BPHII score were all improved with PUL.⁶ Furthermore, the 2015 BPH-6 study which was a randomized European multicentre trial showed that PUL yielded viable improvements in operative results while sustaining a robust safety profile and causing a negligible effect to sexual functioning when compared to TURP.⁷ This build-up of positive evidence led to regulatory approval by the USA Food and Drug Administration in 2013, and the UK National Institute of Clinical Excellence in 2014. In October 2018, the UK Government acknowledged the PUL as one of only seven Accelerated Access Collaborative ‘Rapid Uptake Products’, leading to rapid uptake in the NHS. In December 2018, the MedLift 12-months study was published and showed that even prostates with middle lobe obstruction can be treated with the PUL procedure safely and effectively.⁸

Conclusion

PUL reached a milestone of 100,000 patients treated worldwide in June 2019. Research and urological practice in the 20^th century has shaped the minimally invasive future of this dynamic field, and PUL is at the forefront

Biography:

Dr J Khera is from Charing Cross Hospital, Imperial College Healthcare NHS Trust, UK

 

Abstract:

Introduction: The 2017 AAGBI Consent for Anaesthesia Guidance states that “Anaesthetists should record details of the elements of a discussion in the patient record, noting the risks, benefits and alternatives (including no treatment) that were explained.” The importance of this stems from changes in ethical and legal frameworks with new case law and an increased emphasis on patient-centered care.1,2 ï‚· Our audit in January 2018 found poor documentation of consent for anaesthesia with only 35% of charts having a documented plan. 

Objectives: To improve the quality of anaesthetic consent documentation with an electronic anaesthetic record. 

Methods: Retrospective audit of patients who underwent surgery between 15^th-19^th July 2019
Analysis of the Cerner electronic records

Results :
76 patient records assessed. 15 patients excluded due to no electronic Cerner record (n = 61). ï‚· Anaesthetic plan documented in 100% of Cerner records, compared to 35% pre-Cerner.  ï‚· Comparing documentation on post-Cerner records to pre: alternative plan 33% vs  8%, common General Anaesthetic (GA) side effects 80% records vs 32%, serious risks or opportunity to discuss with patient 33% vs 14%, risks of invasive monitoring 80% vs 50%, risks of Regional Anaesthesia (RA) 70% vs 33% and risks of combined GA + RA 67% vs 17%. (Figure 1) ï‚· However, specific risks for RA were better documented using Cerner such as failure (60% vs 0%); post dural puncture headache (50% vs 0%) and backache (60% vs 0%).(Figure 2)

Conclusion:
The introduction of the electronic Cerner record has improved the documentation of anaesthetic consent particularly in: documentation of anaesthetic plans; alternatives; serious risks and opportunities of them being discussed; as well as risks associated specifically with invasive monitoring, RA and combined GA + RA.  ï‚· However, further work is needed to improve documentation of anaesthetic consent – this may be implemented with pre-formed checklists on the electronic record. 

 

Biography:

Harry Lobb is a final year medical students at the University of Liverpool, UK

Abstract:

Given the average cost of a NHS operating theatre is £1,200 per hour, it is essential that optimal utilisation is achieved. There are no standard guidelines for plastic surgery theatre utilisation. UK governmental institutions have suggested that operating departments should aim for 90% utilisation but there has been little research to validate the target of 90%. In 2018, the NHS Benchmarking Network’s Operating Theatres project suggested a minimum of 83% utilisation should be achieved by general surgery theatres. In this study, the database ‘Opera’ was accessed to retrospectively analyse plastic surgery theatre times. Theatre utilisation was calculated as a percentage of total scheduled theatre time used by operative time. This audit aimed to assess the utilisation of plastic surgery theatres in one NHS hospital. In this study, the overall theatre utilisation rate was 76.7% with 7.5% of time lost due to late starts (median 20 minutes), 6.5% of time was used for patient turnover (median 14 minutes) and 12.1% of time was wasted by early finishes (median 36 minutes). Theatre utilisation in this study is below the recommended level. Recommendations: 1. Aim to perform the ‘huddle’ in theatre half an hour before the list begins; 2. Communication of a 30-minute and 15-minute warning so patients can be sent for earlier to decreased turnover time; 3. Re-audit after changes have been made. If start times and turnover times are improved, there is the potential to add extra patients to theatre lists, increasing theatre utilisation.

 

Biography:

Youssef Beshier MB. Bch, MSc, MRCS is the surgical registrar at Wexford General Hospital, Ireland

Abstract:

Acute Appendicitis is one of the most common surgical emergency procedures in Ireland. Clinical assessment is the corner stone in diagnosis. However, Recent Imaging modalities can significantly decrease the number of negative appendectomy with subsequent decline in patient’s morbidity, recovery and hospital stay^[1,2]. The percentage of  negative appendicectomy  is consider a quality indicator in the management of acute appendicitis.    There is no clear definition for the appropriate acceptable rate of negative appendectomy in Level 3 hospital in Ireland, thus some patient will still have a completely normal appendix excised.

All data were collected retrospectively from the electronic medical record system including all emergency appendectomy that were performed from 1^st of July 2018 till 30^th of June 2019 in Wexford general hospital. Also, all the radiological workup and histopathology report for these patients were reviewed using the hospital electronic laboratory and radiology system.

We conducted  this study to clarify the percentage of negative appendectomy in Wexford general hospital in Ireland to analyze our current practice and identify the areas that need to be improved.

 

Biography:

Francesk Mulita is a Resident General Surgeon at the Department of Surgery at the General University Hospital of Patras. He has taken a Master degree studying post-operative analgetics after most common surgical operations. Since 2019 he is PhD candidate studying post-operative infectious complications after colorectal operations

Abstract:

The purpose of this study was to compare the analgesic effect of paracetamol and the paracetamol / parecoxib and paracetamol/pethidine combinations in patients undergoing open inguinal hernia repair.The study was performed on 259 patients hospitalized at the Department of Surgery at the General University Hospital of Patras from February 1, 2017 to May 10, 2019. These patients had inguinal hernia. Patients were divided into three different groups (Group A, B and C) based on their postoperative analgesic treatment. Group A patients received paracetamol and pethidine, group B patients received paracetamol and parecoxib and group C received paracetamol monotherapy. NRS (Numerical Rating Scale) pain assessment was performed at 45 minutes, 2 hours, 6 hours, 12 hours and 24 hours after taking the first analgesic drug. Statistical processing of the data was done using the stata 13 program. Statistical processing of our data revealed a statistically significant difference between patients in group A who reported less pain than patients in group C (P = 0.00) and between patients in group B who reported less pain than patients in group C (P = 0.00). No statistically significant difference was found between patients in group B and A (P = 1.00). The combination of postoperative analgesic paracetamol and parecoxib is equivalent to the combination of paracetamol and pethidine. These two combinations of postoperative analgesic therapy outweigh the paracetamol monotherapy and are therefore indicated in open inguinal hernia repair

Biography:

Dr. Sorcha Coleman graduated last year from National University of Ireland, Galway. She is currently employed as an Anaesthesiology Senior House Officer at University Hospital Limerick, which serves a catchment of just under 400,000 in Ireland’s Midwest 

Abstract:

The World Health Organisation defines anaemia as a haemoglobin of <13g dl^-1 in males, and <12g dL^-1 in females, at sea level. Moreover, as the WHO definition of anaemia is based on standard deviations from the mean haemoglobin, one could postulate that a Hb of <13 g dL^-1 would be a more appropriate target for preoperative Hb optimisation among both genders. 

One hundred consecutive pre-operative haemoglobins were analysed retrospectively. Emergency and orthopaedic cases were excluded. Of the cases examined, 55 were male and 45 female. In the male cohort, 27 patients were anaemic - with haemoglobins of less than 13g dL. In the female surgical patients, 13 individuals had haemoglobins’ of less than 12. 10 per cent of patients examined had no preoperative bloods done. These were exclusively otolaryngological procedures. Of the cohort, 5 patients had haemoglobin of less than 9g/dL. i.e. severe anaemia. These patients were all male and predominantly had gastrointestinal surgeries.

Preoperative anaemia is independently associated with worse clinical outcome and is a strong predictor of a patient’s requirement for allogenic blood transfusion, which itself increases the risk of post-operative morbidity and mortality. It has been proven that chronic anaemia can be a marker for other comorbidities. Non-emergent surgeries may be postponed in order to diagnose the cause of lowered haemoglobin, and correct it - depending on its cause, severity, the urgency of the procedure and its expected blood loss. This can be alleviated by oral or intravenous iron in iron deficiency anaemia. Supplemental erythropoeitin can also increase patients’ haemoglobin levels but is advised to be used in conjunction with supplemental iron. 

Biography:

Dr Dalal Almghairbi has completed her PhD at the age of 35 years from Nottingham University and postdoctoral studies from the same University School of Medicine. She is a lecturer at University of Zawia Libya, a course director of research methadology module. She has published 7 papers in reputed journals

Abstract:

Background Conflict is a significant and recurrent problem in most modern healthcare systems. Given its ubiquity, effective techniques to manage or resolve conflict safely are required.

Objective This review focuses on conflict resolution interventions for improvement of patient safety through understanding and applying/teaching conflict resolution skills that critically depend on communication and improvement of staff members’ ability to voice their concerns.

Methods We used the Population-Intervention-Comparator-Outcome model to outline our methodology. Relevant English language sources for both published and unpublished papers up to February 2018 were sourced across five electronic databases: the Cochrane Library, EMBASE, MEDLINE, SCOPUS and Web of Science.

Results After removal of duplicates, 1485 studies were screened. Six articles met the inclusion criteria with a total sample size of 286 healthcare worker participants. Three training programmes were identified among the included studies: (A) crisis resource management training; (B) the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training; and (C) the two-challenge rule (a component of TeamSTEPPS), and two studies manipulating wider team

behaviours. Outcomes reported included participant reaction and observer rating of conflict resolution, speaking up or advocacy-inquiry behaviours. Study results were inconsistent in showing benefits of interventions.

Conclusion The evidence for training to improve conflict resolution in the clinical environment is sparse. Novel methods that seek to influence wider team behaviours may complement traditional interventions directed at individuals.