Brit J Hosp Med
-
Head and neck cancer surgery presents significant challenges for the anaesthetist. A thorough multidisciplinary preoperative assessment and optimisation of the patient is essential, including nutritional and psychological evaluation. The incidence of a difficult airway is high, and the anaesthetist must be skilled in advanced airway techniques. ⋯ The Enhanced Recovery after Surgery Society and the Society for Head and Neck Anaesthesia consensus recommendations provide guidance on current best practice. Despite continued debate, it now appears that this constitutes goal-directed fluid therapy, coupled with judicious vasopressor therapy sufficient to achieve an adequate mean arterial pressure. Emerging techniques such as prehabilitation and postoperative near-infrared spectroscopy flap monitoring provide hope of improved outcomes going forward.
-
The choice of anaesthesia technique for neurosurgical procedures has always been debatable. Despite the well-known effects of volatile anaesthetics on intracranial pressure, these are still widely used. This article explores the advantages and disadvantages of using volatile or total intravenous anaesthesia in patients undergoing neurosurgery.
-
Aneurysms are associated with significant complications if not diagnosed and managed appropriately. Popliteal arterial aneurysms are the most common peripheral aneurysm, and can cause pain, nerve compression, ischaemia and limb loss. Vascular surgery is an emerging specialty under the remit of general surgery, with the primary objectives of preventing death and limb loss. This article summarises the epidemiology, investigation and management of popliteal arterial aneurysms for vascular and non-vascular trainees.
-
Faculty development is key to ensuring quality clinical teaching, but standardising teaching practices in multiple settings is a challenge. This article presents an example of a 3-year faculty development programme for teaching clinical reasoning skills, implemented by the Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada for its faculty members at multiple teaching sites. A follow-up study 1-5 months after the final workshop, using a self-assessment questionnaire, indicates that almost half of the participants transferred some of their newly acquired knowledge into their teaching practices. This article discusses factors to consider when developing a faculty development culture, at both a programme and faculty level, to support quality teaching and learning.