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Cardiothoracic anaesthesia

_MG_6297St George’s is the tertiary centre for cardiac, thoracic and vascular surgery and acute cardiology for SW London and Surrey. The department provides subspeciality anaesthesia and critical care for these services. With around 1000 cardiac surgical cases per year and a very busy thoracic and vascular surgical programme, we are one of the leading London teaching centres for cardiothoracic anaesthesia training.

Complex and high risk surgery is undertaken daily in the 3 dedicated operating theatres, providing intensive training opportunities for speciality registrars. There is also a busy programme of challenging cardiology catheter lab procedures including electrophysiology and transcutaneous valve replacement (TAVI).
The intensive care unit admits elective and emergency cardiac surgical patients, vascular surgical patients and an increasing proportion of acute cardiology patients – including primary PCI and out of hospital arrests. It is a 17 bedded unit and our emphasis is on clinical excellence and high quality patient-centred care.

We have a programme of research and education and our junior doctors become valued members of the team, with many staying on to become consultants within the department.

Echocardiography is now an essential skill for anaesthesia and critical care and we provide a comprehensive clinical service and training opportunities. There are a number of training programmes and courses both in the theatres and the intensive care unit.

Department structure

No. Consultant Anaesthetists: 15
No. Cardiac Intensivists: 10
Lead Consultants: Dr Hanif Meeran (cardiac anaesthesia), Dr Frank Schroeder (Cardiothoracic Intensive Care Medicine)

Links

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 Head and neck anaesthesia

The ENT Department at St George’s Healthcare is the ‘hub’ of the South West Thames Network. There are referrals from across south west London for complex surgery including Head and Neck cancer. The Head and Neck Unit is one of the busiest in the UK, supported by a strong multi-disciplinary team. Other ENT specialties include Otology, Rhinology, Facial Plastic Surgery, Paediatric ENT and Neuro-otology.

The Maxillofacial Unit comprises four departments: Maxillofacial Surgery, Restorative Dentistry, Orthodontics and Paediatric (Children’s) Dentistry. It is recognised as a Centre of Excellence, providing specialist services not available at other hospitals e.g. surgery for head and neck cancers, facial trauma, facial deformity, reconstructive surgery of the mouth and jaws and surgical dermatology for face and neck cancers. It also has a department of Restorative Dentistry and an Orthodontic Department.

There is a strong group of Head & Neck anaesthetists who specialise in managing difficult airways; those who require awake fibreoptic intubation, and those who present with airway obstruction. The advanced airway techniques that are used and taught by this group include the use of indirect larygnoscopy and high frequency jet ventilation. They are involved in auditing all their Head and Neck patients, providing Airway Training Days which have proved very popular, and in simulation teaching.

Department structure

No. of Consultants: 6
Lead Consultant Anaesthetist: Dr Karen Light

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Neuroanaesthesia

The St George’s Hospital Atkinson Morley Neurosurgical Unit is a leading UK centre for both adult and paediatric neurosurgery. It is a designated trauma centre with a specific neurosurgery service that manages all head injury patients.

Department structure

No. Consultant Anaesthetists: 13
Lead Consultant Anaesthetist: Dr Argyro Zoumprouli (Neuroanaesthesia), Dr N Burgess (Neuro ICU)

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Obstetric anaesthesia

The St George’s Maternity Unit is a tertiary referral centre for pregnant women with complex and high-risk pregnancies. The Unit comprises both low-risk midwifery and consultant led units with two theatres, an Obstetric HDU and a High Risk Obstetric Anaesthetic Clinic which is closely linked to the highly regarded Fetal Medicine Unit.

The unit booked 5374 women in 2012 and delivered 5128 women as compared to 6193 and 5328, respectively, in 2011. We performed 3323 anaesthesia procedures (1600 labour epidurals and 1723 theatre cases) in 2012. About 31% of women who delivered on the unit received epidural analgesia.

Over 80% of requests for epidural analgesia were attended to within 30 minutes and 97% within 1 hour. At follow up, 96% of women found their epidural analgesia satisfactory / excellent and 97% would have epidural analgesia again.

Please see the latest response times of our obstetric service:
Response Times for Epidural Pain Relief

We run four services together as part of the commitment to obstetric anaesthesia:

    1. A round-the-clock emergency service
    2. A planned caesarean section service on weekdays
      As part of a dedicated operating list Monday – Friday
    3. A High Risk Clinic runs every Thursday morning
    4. Advanced Level training in Obstetric Anaesthesia and Analgesia

Department structure

No of consultant anaesthetists: 12
Advanced level trainees/fellows: 3-4 every 6 months
Lead consultant anaesthetist: Dr Christina Wood

Training/Research 

St George’s has delivered Advanced Obstetric Anaesthesia training since 2007. Each post is designed for an anaesthetist with the final FRCA or equivalent, an interest in developing obstetrics as an ongoing career aim and provides opportunity to work at a senior level in a busy high-risk obstetric unit.

These anaesthetists have two days a week dedicated to Obstetric Anaesthesia and related projects, with one day a week clinical service commitment to theatres and on-call commitment to Obstetrics also.

In addition they have opportunity to attend monthly meetings within the Obstetric Unit on various aspects of Risk Management, Education and High Risk Obstetric Clinics as well as multi-disciplinary Maternal Medicine clinics and excellent daily teaching Obstetric ward rounds.

Fellows will also have opportunity to participate and develop experience in multi-disciplinary Obstetric Simulation through St Georges GAPS simulation centre, ward based simulation skills & drills and involvement in our midwifery mandatory training programme. St George’s is a well-established audit unit; each year trainees successfully present at both national and international meetings on an audit or case-related project during their placement.

in May 2016, our team of consultants and trainees proved to be an outstanding representation for the department and the trust at the Obstetric Association of Anaesthetists (OAA) annual conference in Manchester. Both trainees and consultants were presenting a number of posters on a range of innovative ideas and completed research, and thus rewarded with the first prize which went to one of our senior trainees for work on maternal satisfaction with epidural fixation devices. Click here to see the posters that were presented .

To add to this success Dr Emma Evans was also elected to the OAA Executive Committee for a 3 year term.

Annual Review

Read the Obstetric Anaesthesia Annual Review 2014

Links

Obstetric Anaesthetists’ Association

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Paediatric anaesthesia

The department of paediatric anaesthesia consists of 13 consultant paediatric anaesthetists, providing a 24 hour dedicated paediatric anaesthesia service to the trust.

St. George’s provides surgical services for the local community and tertiary services for South West London and surrounding DGHs. We undertake approximately 5500 paediatric anaesthetics per year across the designated paediatric theatres, day surgery unit and remote sites such as endoscopy and radiology. Lanesborough wing includes a 30 bed neonatal ICU, 12 paediatric critical care beds and the 12 bed Jungle day unit. 

Department structure

No. Consultant Anaesthetists: 13
Lead Consultant Anaesthetist: Dr Darryl Hampson-Evans

Training/Research 

Both junior and senior trainees undertake paediatric modules at St Georges and there is an emphasis on education in the department with regular teaching sessions, audit and a quarterly joint governance meeting with the whole children’s surgery group. 

Senior trainees who are interested in further training in paediatric anaesthesia have an opportunity to spend a year at Great Ormond Street Hospital which is competitively interviewed on an annual basis.

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Preoperative Assessment

The Anaesthetic Assessment Clinic is run by a team of Consultant anaesthetists, preoperative nurses and healthcare assistants. It was established in February 2005 to enable high risk, elective surgical patients with multiple co-morbidities, to benefit from having a thorough anaesthetic assessment before undergoing surgery. We are able to carry out simple functional tests within the clinic, and with the wealth of medical and surgical specialities and facilities on site at St George’s we are able to promptly and directly refer for further advice, formal reviews and specialist investigations.

Advice is also given regarding the appropriate level of post-operative care, ensuring that an HDU or ITU bed is arranged when required.

The consultant anaesthetist will also liaise with the anaesthetist caring for the patient to ensure they are fully appraised of the patient’s history to facilitate the planning of perioperative care. The clinics are also our opportunity to sit and discuss perioperative risk with the patient and their relatives, helping our patients to make informed decisions about proceeding to surgery. We are currently using the American College of Surgeons National Surgical Quality Improvement Programme (ACS NSQIP) risk calculator tool to explain risk numerically to patients. This is the largest pan surgical speciality validated tool developed on US population data.

Currently the clinics run daily in the Preoperative Centre opposite the Atkinson Morley wing. Referrals are usually made by Consultant surgeons or directly from surgical pre-assessment clinic. The Preoperative assessment webpage acn be found here: https://www.stgeorges.nhs.uk/service/anaesthesia/preoperative-assessment/

Lead Consultant anaesthetist: Dr Kanchan Patil

 

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Regional anaesthesia

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As a tertiary referral centre for major hand trauma surgery, St George’s Healthcare is able to provide patients with the choice of having their procedure carried out under regional anaesthetic techniques. We have a number of consultants who specialise in regional anaesthesia and the current lead is Dr Andrzej Krol.

Drs Tredray and Krol have worked together since 2006 to also run a highly successful two day course on regional anaesthesia. The course is held twice a year and consists of lectures, workshops and small group in theatre teaching covering all aspects of regional anaesthesia.

We also collaborate with our colleagues at East Surrey hospital as part of the faculty for their highly successful regional anaesthesia conference held in November every year.

To complement the courses we have prepared a background to regional anaesthesia, equipment used and the basic science around it and a user friendly guide to performing some common blocks.

Department structure

Lead Consultant Anaesthetist: Dr Andrzej Krol

Training/Research 

We have been running a highly successful advanced regional anaesthesia module for our senior trainees since 2008. The module director is Dr Ralph Zumpe. The module is for six months and trainees are appointed following a competitive interview process. Interviews are held twice a year.

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Trauma and orthopaedic anaesthesia

trauma A+ESt George’s Hospital is one of four major trauma centres in London, covering a diverse population in the south west London, Kent, Surrey and Sussex (KSS) areas. We receive over 100 trauma calls per month and exceed our target for “Injury Severity Score >16″ cases.

With the addition of the helipad in 2014, we now receive the majority of Helicopter Emergency Medical Service (HEMS) patients from the KSS area.

The consultant anaesthetists working within the trauma service cover on call commitments dedicated to major trauma care, with a major trauma theatre including state of the art equipment on standby 24hrs. The trauma service is backed by a rigorous governance programme, with biweekly multidisciplinary education and governance meetings attended by all specialities.

Department structure

No. Consultant Anaesthetists: 12
Senior Trauma Fellow: 1 every 6 months
Lead consultant Anaesthetist: Dr Pallavi Waikar

Training/Research 

Opportunities for research and audit are plentiful, we report all data to the national Trauma Audit and Research Network (TARN) and are currently involved in the investigation of pegelated haemoglobin, goal directed therapy in major orthopaedics and have registered for the CRASH 3 trial.

Training courses are run for all grades and specialities from one day trauma care introductions to trauma leadership courses for senior doctors. ED trainees, anaesthetic registrars, ODPs, students and paramedics are all given training in trauma care. We also have high fidelity simulation training within the ED and in the education centre.

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Vascular anaesthesia

St George’s is the leading centre for endovascular aneurysm surgery and is a tertiary referral centre for all areas of vascular surgery. The surgical workload includes 250 EVAR/ TEVARs, 50-60 carotid endarterectomies, in excess of 15 mesenteric revascularisation procedures and 60-70 lower limb revascularisations per year. These figures are predicted to increase substantially.

Department structure

Lead consultant Anaesthetist: Dr Grainne Nicholson (General Group Lead)

Training/research 

Training in vascular anaesthesia aims to ensure the individual becomes competent in the multi-disciplinary management of the major vascular patient. He or she is exposed to the wide variety of anaesthetic techniques used for the management of a challenging patient population undergoing complex major surgery.

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