Co-Founders, The Society of Bariatric Anaesthetists
Q: Tell us a little about your medical backgrounds and where you now work?
A: NK: I have been a Consultant Anaesthetist and Intensivist in Taunton since 1998. Prior to that I trained in Southampton and London and two years in Australia, and St Bartholomew’s Hospital Medical School. Qualifications MBBS FRCA. Taunton is the Regional Centre for the South West for Bariatric Surgery. We have an NHA practice doing 250 cases per year, mainly gastric bypass surgery. In addition we have a comprehensive medical weight management service. I am Lead Bariatric Anaesthetist for the service, and have led development of anaesthesia, critical care and preoperative assessment arm of the service, since inception in 2003. JC: I am a Consultant Anaesthetist at Imperial College hospitals, where I am the lead for the bariatric service and anaesthesia. I trained in weight loss surgery by visiting and attending courses in 9 different bariatric centres across Europe and the UK. Prior to this I worked to provide anaesthesia for all the malignant and benign upper GI work at Charing Cross. Combining this training with broad experience I have created a tailored anaesthetic package to allow the most rapid return to full mobility and respiratory function in patients with an increased BMI. All of our surgical cases are monitored with Entropy (a brain wave monitor) to ensure the perfect depth of anaesthesia to this challenging group of patients. I personally set up and run a dedicated pre-assessment service prior to surgery for obese cases to ensure safety and minimise the risk of complications and potential cancellation. I am currently performing research into peri-operative thrombosis in weight loss surgery at Imperial Healthcare and am responsible for post-operative shared care pathways.
Q: What made you set up the Society of Bariatric Anaesthetists?
A: NK: All anaesthetists are dealing with larger patients, and clinically they are challenging group of patients. Bariatric surgery is relatively new in the U.K., and when we started working in this field it was clear that there was no forum within the specialty for dissemination of knowledge, exchange of ideas, research, discussion, teaching, promotion of quality standards etc. We decided that this was needed and have set up SOBA. JC: SOBA is explicitly not only for those specializing in bariatric anaesthesia, but we want it to be a voice and forum for all those who deal with morbidly obese patients either in operating theatre or critical care. We anticipate interest from experts working in fields such as obstetric anaesthesia. NK: SOBA is a non-profit making society, with offices at 21 Portland Place, the headquarters of The Association of Anaesthetists of Great Britain & Ireland. The AAGBI will provide both administrative and professional advice to the society. Anaesthetists interested in this field of anaesthesia are encouraged to become members. We want the members to decide the direction of SOBA, as we take the society forward, and those who become involved early will undoubtedly be able to have more influence.
Q: What are your biggest research influences?
A: NK: In many ways the lack of it. We hope that colleagues with a research interest will get involved in SOBA. High quality research is best conducted as part of a wide network. We will encourage formation of research networks, and liaise with industry in research projects. JC: Part of our initial plan for SOBA is to promote a wide discussion about what research is needed in the field of obesity/bariatric anaesthesia, and to target research projects on the basis of this. Much like the intensive Care Society have done.
Q: Tell us more about the Society of Bariatric Anaesthetists and what you do?
A: NK: We are new Society, still developing, and are in the process of actively recruiting members. We already have an online closed discussion group, hosted by doctors.net, and open only to members. We have a website (www.sobauk.co.uk), and are planning to publish a regular newsletter for members. SOBA is hosting a scientific meeting in London on March 4th 2009. SOBA is in negotiation with the developing national surgical bariatric database and want to include anaesthetic data on this. SOBA will need input from members as to what data is required for research, and more importantly quality and outcome data. Funding for developing the anaesthetic part of the database has not yet been identified, and we would welcome suggestions or offers of help. At this stage we are unable to fund this through subscriptions. SOBA will act as a vehicle for dissemination of information about educational and training opportunities. We are planning to set up a course for teaching bariatric anaesthesia, and would welcome input from members and non-members. SOBA also has close links with BOSPA (British Obesity Surgery Patients Association), and we are planning to furnish them with patient information about anaesthesia for dissemination. We would also like to be able to provide them with quality assurance and standards for practice in future.
Q: Are you currently involved in any research projects?
A: NK: SOBA itself is not yet involved, but both founder members have projects ongoing in their own institutions. What projects to develop is one of the priorities for SOBA and its members. JC: I would the early role of SOBA acting as a support system for research and providing the basis for a research network.
Q: What are your perspectives regarding academic anaesthesia in the UK?
A: JC: I am thrilled with the creation of the National Institute of Academic Anaesthesia. The basic science of anaesthesia is so difficult for individual departments to study, however clinical anaesthesia and our impact on morbidity and mortality is definitely the area we envisage a lot of publication and research from our membership.
Q: What do you think are the most important changes to anaesthesia over the last decade?
A: NK: Clinically, the continuing push to accommodate shorter inpatient stays, and the drive to speed recovery from anaesthesia and to facilitate day case/early discharge. The increase in use of short acting anaesthesia and regional/local anaesthesia continues. Also important is the recognition of the role of the anaesthetist in preoperative assessement, which is an area in which anaesthetists must play an increasingly critical role. JC: Depth of anaesthesia monitoring when TIVA models may not reflect our clinical experience. Patients are getting older, more obese, and sicker on average, all of which increases demands for specialist anaesthetic skills. NK: The increasing emphasis on safety and quality. Outcome measurement is going to be a vital part of medical practice in future, as both regulators and patients focus more and more on individuals practice, experience and outcomes. Bariatric surgery and anaesthesia is still relatively new in this country, and patients are in general very well informed about it. It is going to be a requirement that teams practice and outcomes are published. Using the proposed database, we hope that this information can be provided, and contribute to improving standards of care for our patients.
Q: How much further can things be developed?
A: NK: We would like SOBA to lead the promotion of anaesthesia for obese patients as part of the core training for anaesthetists. All anaesthetists will be increasingly dealing with morbidly obese patients, and I would draw parallels with obstetric anaesthesia. Both are potentially high risk, little margin for error, with serious problems that develop very rapidly. But good teaching, experience and attention to detail mean both can be performed extremely safely, and the fear and mystique for the non-specialist is reduced. JC: SOBA can help promote the already mooted idea of each department having a local obesity lead clinician/expert, experts to advise on anaesthesia for the morbidly obese.
Please visit www.sobauk.co.uk to download a membership application.