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THE MAGAZINE OF THE NEW ZEALAND SOCIETY OF ANAESTHETISTS • APRIL 2022
LIFEBOX -
Saving Lives
NZSA membership
survey results
PLUS:
Combined Scientific Congress 2022
Babies and anaesthesia training
Global Health Commit tee opportunities
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PAGE 2 | APRIL 2022 ADVOCACY, COMMUNITY AND EDUCATION
APRIL 2022 | ISSUE 62
CONTENTS
REGULARS
4 President’s column
10
Global Health
6 News in brief Committee
8 NZSA trainee column
10 NZSA Global Health Committee
S P E C I A L F E AT U R E S
14 NZSA Executive Member profile
24 NZATS column
25 webAIRS news
12
FEATURES
9 A rich and fulfilling life through
mindfulness
11 UK anaesthetist and comedian LIFEBOX - saving lives
finds his wellness in humour through safer surgery
12 LIFEBOX – Saving lives through and anaesthesia
safer surgery and anaesthesia
16 NZSA membership survey –
key results
18 What are we going to do about
nitrous oxide?
20 Combined Scientific Congress 2022
22
26
Active approach to investing
Book reviews 16
NZSA membership
survey results
Publication dates and deadlines Connect with your audience - advertise with
Copy due by: Published: New Zealand Anaesthesia!
11 July 2022 August 2022 Our advertising rates are very competitive. Find out more by
8 November 2022 December 2022 contacting Pam Chin: pam@valleyprint.co.nz
10 March 2023 April 2023
Magazine advertising is available on both standard and
premium pages. Options include full page, half page and
Contributions and feedback
quarter page. Complimentary advertising is also included in
We welcome your comments on the magazine. If you would our E-Newsletter (E-Zine) – conditions apply.
like to contribute ideas and/or an article please contact editor:
comms@anaesthesia.nz Magazine content may be reproduced only with the express permission
of the NZSA Executive. Opinions expressed in New Zealand Anaesthesia
do not necessarily represent those of the NZSA.
Level 1, Central House
26 Brandon Street, Wellington 6011
PO Box 10691, The Terrace, Wellington, 6143 @theNZSA New Zealand Society of Anaesthetists
Phone: +64 4 494 0124 | Fa x: +64 4 494 0125 w w w.anaesthesia.nz
REPRESENTING, SUPPORTING AND PROMOTING NZ ANAESTHETISTS SINCE 1948 APRIL 2022 | PAGE 3
PRESIDENT’S COLUMN
At the time of writing this conditions, clinician patient ratios, fast-tracking and simplifying
column we are arguably registration, residency, and immigration pathways to boost the
close to reaching the peak of numbers of foreign-trained healthcare workers, training more
Omicron cases and will soon doctors, nurses and other healthcare staff, and working with
see case numbers level off. clinical leaders at both hospital and community levels.
It has been an arduous and
The narrative of industrial negotiations is that we are valued,
very challenging time for our
and that our wellbeing is important. The rhetoric sounds
health system. Staff safety
laudable but protracted battles over pay and working conditions
and wellbeing, along with
are demoralising and the antithesis of feeling valued.
the ability to meet the health
needs of our patients, were This segues well into delving more into the topic of staff
already under pressure from exhaustion and burnout – entrenched in our health workforce.
longstanding staff shortages The 2020 survey by ASMS showed more than half of New
and underinvestment in Zealand’s doctors are burnt out, and there has been no
health before the omicron improvement in the last five years.
outbreak. The high number
We often hear about the need to build resilience to prevent
of omicron cases has compounded the vulnerability of our
burnout, however this can veer too much towards “physician
system, with frontline teams having to work even longer
heal thyself” and place the onus for not being resilient enough
hours to cover staff absences due to COVID infections
onto the doctor. Our health system must change so that it does
or being household contacts. As expected, at some DHBs
not make it an uphill battle to achieve personal resilience and
elective surgeries have had to be deferred. And as we know
work fulfilment. It is not good enough to just be surviving or
from when COVID first hit in 2020, there are ongoing delays
coping – surely the aim should be to be thriving: that will bring
in specialist appointments, diagnostics, and treatment.
the best care to our patients.
There has been mounting anxiety among my colleagues and
You may have read an article published in STUFF in February
others I have spoken to in the health workforce at the lack
in which Auckland anaesthetist and NZSA member Dr Jo
of a national health workforce plan, despite years of knowing
Sinclair (who is also the clinical wellbeing lead at Middlemore
the shortages we faced. Workforce shortages have a negative
Hospital) spoke about her personal experience of burnout.
impact on the wellbeing of staff. Health organisations have
The key message in this article was that a doctor’s wellbeing
advocated for many years that we need strategic workforce
is inextricably linked to their being able to provide quality care
modelling and planning, but successive governments ignored
to patients and to improve the system from within for better
these calls. We have not had the central leadership needed
population health outcomes.
and now find ourselves in an even more precarious position as
we valiantly work to meet the additional health needs caused Burnout does not lend itself to good patient care (it can affect
by a pandemic. your ability to connect with patients and build rapport, it can
make you less communicative etc) or the ability to advocate for
We were reassured by the Government that
systemic improvements (including the current health reforms.)
advance planning was in place to help
hospitals cope with the pressures So while personal resilience should be a goal and we
“Strong of omicron, however information should continue to raise awareness of and offer strategies
engagement sharing about this has been poor. such as mentoring, peer supervision and debriefs, we also
The issues I highlight reflect a need urgent systemic reform in parallel. In terms of health
and input from reform, the NZSA provided comprehensive feedback to the
wider problem, which the NZSA,
clinical leaders at as well as other organisations Government on the Pae Ora Bill last year and sought answers
such as ASMS and NZMA have to bridge information gaps. To date we do not feel there
both hospital and
been pushing for as part of has been sufficient engagement and would have expected
community levels the health and disability system detailed briefings. We did however have a positive meeting
is essential” reforms: the necessity of clinicians with a group, led by Dr David Galler, who are assisting the
having meaningful input into planning Transition Unit to develop the Health Charter (a key feature of
health services, including workforce the Pae Ora Bill). In our health reform submission, we called
planning. We are at the frontlines of patient for clinical governance and improving the wellness of our
care and best placed to help shape policy direction. Strong health workforce as key to ensuring meaningful change. We
engagement and input from clinical leaders at both hospital expressed the need for our health workforce to feel engaged
and community levels is essential. The time is now as we work and for employers to make their wellness a priority to create
to shape a new health system with the reforms well underway. a positive workplace environment.
Core to workforce planning is the need for the Government The Charter team advised us that they are focusing on
to prioritise staff retention and recruitment: this requires a workforce wellness and on forging genuine connections
multipronged plan of action – addressing sustainable working between hospital and community health services to offer a
PAGE 4 | APRIL 2022 ADVOCACY, COMMUNITY AND EDUCATION
“It is not
good enough
to just be
surviving or
coping”
Sheila on biking holiday.
seamless service to patients. They said that the Charter must Caldwell share their thoughts on why this is a not to be missed
recognise the whakapapa of our health workforce, and that event. We are excited to welcome our Australian colleagues to
we work in the presence of those that have come before us. the capital and remain optimistic that by the time of the CSC
Essentially, the Charter will be the foundation of how health (21-24 October) we will be connecting in person!
workers are treated and building constructive relationships
And last but by no means least, this issue highlights some
in the health sector. They reassured us that the Charter’s
of the great work by our member volunteers via the NZSA
point of difference is that health workers are being widely
Global Health Committee, our obstetrics network NOA and
consulted and that an engagement tool will be released soon.
our Environmental and Sustainability Network. Our survey
It was exciting to hear the team talk about how important it is
showed members are greatly appreciative of this work and
to value our workforce, and that this is key to a sustainable
we received very positive comments on the difference our
health service. Of course, the proof will be in the pudding; will
networks are making to strengthen advocacy.
it just be talk and ideas with no action? Or another restructure
with no meaningful change?1 I sincerely hope not.
Personal wellbeing
Magazine issue highlights I have just had the pleasure of taking three weeks off work.
The timing disastrous or perfect depending on your view!
Thank you to members who completed our member survey –
I began a cycling adventure on 1 March starting at Ships Cove
these are very busy times, so we were particularly grateful. As
in Queen Charlotte Sound and finishing at Milford Sound. It
always, we received considered feedback. We only conduct
was a fabulous trip, and although I felt a little conflicted to
this survey every two years and it is invaluable to enable us to
be going on leave as the Omicron surge hit, I am conscious
glean member views of our broad, diverse work program and
of the need to take annual leave when you can as part of
member satisfaction with how we deliver member services.
maintaining your personal wellbeing. Having a few weeks
It also keeps us apprised of the issues that you consider
away from work and disconnecting completely has allowed
priorities so we can better represent you across our key
me to recharge and for that I’m thankful. I hope many of you
pillars of work: advocacy, education, and community. Our CEO
can achieve the same over the coming year.
Michele Thomas provides an overview of survey results on pp.
16-17. The Executive is looking closely at the results to inform
the NZSA’s strategic direction. We always welcome your
feedback and I encourage you to contact me at president@
anaesthesia.nz
Some other key features in the magazine: we showcase the
Combined Scientific Congress 2022 (to be held in Wellington
and virtually), co-hosted by NZSA and the Australian Society of Sheila Hart, NZSA President
Anaesthetists. Co-convenors Dr Mark Featherston and Dr Cathy
1 https://www.nzherald.co.nz/nz/health-system-reform-
dhb-board-members-gone-by-july-without-compensation/
PAA4PWVUZID2SYTENP5Q6ZB6ZY/
REPRESENTING, SUPPORTING AND PROMOTING NZ ANAESTHETISTS SINCE 1948 APRIL 2022 | PAGE 5
NEWS IN BRIEF
Private practice resources for NZSA members The Fiji National University will recognise her time in Samoa if
NZSA is able to provide a FANZCA to locum/do a sabbatical in
New to private practice or contemplating working in private
Samoa who could provide supervision for Cecilia. Even short
practice? The NZSA has an introductory guide to assist
time locums will be helpful. To discuss this opportunity and
members to work in the private health sector. We also have
express your interest in working as a locum to support Cecilia
other private practice resources, including the Relative Value
please contact NZSA Global Health Committee Member Dr
Join over
Guide and a document we produced with ACC to answer
Indu Kapoor: kapoor.indu@gmail.com
frequently asked member questions in relation to ACC. Find
our private practice resources in the members’ only section of
Free mindfulness course for NZSA members
the NZSA website (please log in to access).
30,000
The NZSA is committed to supporting the wellness of our
NZSA private practice advocacy members and has teamed up with the organisation Ovio to
offer members free access to their online mindfulness course.
We need more member voices to assist the NZSA to advocate
We interview Cheryl Strawbridge, the founder and driving
Research Review
on issues facing private practice. Last year we expanded our
force behind Ovio Mindfulness, on page 9. We launched this
Private Practice Network, which discusses issues affecting
new member benefit late last year. Members can access the
subscribers
anaesthetists working in private practice. Discussion and brief
course on the NZSA website, in the members only section.
meetings are via our IT platforms. We are keen to have more
Join over
members join so that we can hear about private practice issues
Visiting Lectureships
that are specific to your region in the private hospitals. It is
Heads of anaesthesia departments and practices are invited
30,000
not an onerous time commitment and would be of significant
value for the NZSA’s private practice advocacy, for example to nominate a member of their staff who has given an
Anaesthesia and Pain Management outstanding presentation at a CME session. A New Zealand
with ACC and private hospitals. The network also assists the
RESEARCH REVIEW
office with member inquiries relating to privateResearch
practice issues. Review
Anaesthesia Visiting Lecturer is an anaesthetist who will give
with experts Dr John Barnard and a stimulating, informative and well-delivered presentation.
subscribers
If you would like to be involved and/or have any questions,
Associate Professor Gwyn Lewis
Join over
email ceo@anaesthesia.nz Lectureships will be in a webinar format (following on from last
covers critical research with commentary
year's successful event).
on the impact to local practice.
Locum support for PACT fellow The Lectureship was established in 2008 by the Aotearoa
30,000
Anaesthesia and Pain Management
NZSA’s Pacific Anaesthesia
Anaesthesia Anaesthesia Education Committee (ANZAEC) New Zealand
andCollaborative Training (PACT)REVIEW
RESEARCH
Pain Management
fellow Dr Cecilia Vaai-Bartley is continuing her with experts Dr John Barnard
studies in to and
share knowledge and experience through outstanding
RESEARCH REVIEW Associate Professor Gwyn Lewis
™
Samoa. However, she requires appropriate supervision, for
Making Education Easy covers critical research with presentations
commentary amongst anaesthetic departments and practices. Issue 23 – 2020
Welcome
Research Review
In this issue: on the impact to local practice.
Details and nomination form on the ANZAEC website. https://
to issue 23 of Anaesthesia and Pain Management Research Review.
her time in Samoa to be counted towards her training. No
Low- vs. high-dose
intraoperative opioids
This issue begins with a systematic review with meta- and trial sequential analyses reporting, albeit with low
certainty of evidence, that high-dose intraoperative opioids are associated with higher postoperative pain
scores than low-dose regimens of the same opioid. There is also a narrative review article outlining important
considerations for anaesthesiologists when managing patients who are being or have been treated with
Complications from
www.anaesthesiaeducation.org.nz/visiting-lectureship
immunotherapy with immune checkpoint inhibitors.
appropriate local supervision is currently availableAnaesthesia
perioperative transoesophageal
echocardiography
in Samoa.
The pain management research begins with a paper reporting that young adult women who have experienced
childhood maltreatment, particularly if they have also experienced post-traumatic stress as adolescents,
and
subscribers
Prediction of hospitalisation are more likely to report pain conditions. To conclude this issue, we have an interesting article on how the
mainstream media outlets in NZ portray chronic pain and if best practice is being accurately broadcast to the
Pain Management
length and complications by
frailty assessments NZ public.
She has already missed much of her training due to COVID.
Brief pre-anaesthetic jaw/
neck exercise for improving
intubation
We hope you find the selected research helpful in your everyday practice, and we encourage you to keep
sending us your comments and feedback.
Kind regards,
Dr John Barnard Nominations close 30 Sept 2022.
Assoc Prof Gwyn Lewis
RESEARCH REVIEW
Making Education Easy
™
Issue 23 – 2020
johnbarnard@researchreview.co.nz gwynlewis@researchreview.co.nz
Immune checkpoint
inhibitors: considerations for In this issue: Welcome to issue 23 of Anaesthesia and Pain Management Research Review.
This issue begins with a systematic review with meta- and trial sequential analyses reporting, albeit with low
anaesthesiologists Low- vs. high-dose certainty of evidence, that high-dose intraoperative opioids are associated with higher postoperative pain
Low- versus high-dose intraoperative opioids intraoperative opioids scores than low-dose regimens of the same opioid. There is also a narrative review article outlining important
Heightened pain risk after Complications from
considerations for anaesthesiologists when managing patients who are being or have been treated with
Authors: Albrecht E et al. immunotherapy with immune checkpoint inhibitors.
childhood maltreatment perioperative transoesophageal The pain management research begins with a paper reporting that young adult women who have experienced
Summary: This was a systematic review with meta-analyses and trial sequential analyses of 27 RCTs echocardiography childhood maltreatment, particularly if they have also experienced post-traumatic stress as adolescents,
Mind-body therapies (n=1630) comparing high and low doses of the same intraoperative opioid in patients receiving general Prediction of hospitalisation are more likely to report pain conditions. To conclude this issue, we have an interesting article on how the
for opioid-treated pain anaesthesia, and reporting pain outcomes. There was low-certainty evidence that compared with low doses, length and complications by mainstream media outlets in NZ portray chronic pain and if best practice is being accurately broadcast to the
NZ public.
frailty assessments
high doses of the same opioid were associated with higher at-rest 10-point pain scores at postoperative hours We hope you find the selected research helpful in your everyday practice, and we encourage you to keep
Pre-emptive and preventative 24 (primary outcome) and 2 (respective mean differences, –0.2 [95% CI –0.4, –0.1] and –0.4 points [–0.6, Brief pre-anaesthetic jaw/ sending us your comments and feedback.
pain psychoeducation for –0.2]), greater cumulative consumption of intravenous morphine equivalents (–1.6mg [–2.6, –0.7]) and a
neck exercise for improving Kind regards,
intubation
perioperative pain control significantly lower pressure threshold for mechanical pain (3.8 g/mm2 [1.8, 5.8]).
Dr John Barnard
johnbarnard@researchreview.co.nz
Assoc Prof Gwyn Lewis
gwynlewis@researchreview.co.nz
Immune checkpoint
Alterations in pronociceptive inhibitors: considerations for
Comment (JB): The take-home message for any budding researchers with a yearning to perform a anaesthesiologists
and antinociceptive meta-analysis is pick a subject that lends itself to narrow search terms. The two authors assessing the Low- versus high-dose intraoperative opioids
Heightened pain risk after
mechanisms in LBP search results for this meta-analysis failed in this regard, and they had to review 4922 abstracts in order childhood maltreatment Authors: Albrecht E et al.
Summary: This was a systematic review with meta-analyses and trial sequential analyses of 27 RCTs
to filter out the 27 trials that provided the data for the meta-analysis. Sadly, this Olympic-level dedication
Anaesthesia and Pain Management
Media representation of Mind-body therapies (n=1630) comparing high and low doses of the same intraoperative opioid in patients receiving general
was not rewarded with gold-medal results; statistical significance for the primary outcome, that higher for opioid-treated pain anaesthesia, and reporting pain outcomes. There was low-certainty evidence that compared with low doses,
chronic pain in NZ high doses of the same opioid were associated with higher at-rest 10-point pain scores at postoperative hours
intra-operative opioid doses lead to higher pain scores at rest 24 hours postoperatively, but the actual Pre-emptive and preventative 24 (primary outcome) and 2 (respective mean differences, –0.2 [95% CI –0.4, –0.1] and –0.4 points [–0.6,
pain psychoeducation for
difference in pain score was small and the result came with a low level of certainty. As a demonstration of perioperative pain control
–0.2]), greater cumulative consumption of intravenous morphine equivalents (–1.6mg [–2.6, –0.7]) and a
significantly lower pressure threshold for mechanical pain (3.8 g/mm2 [1.8, 5.8]).
how thinking has changed over the last 25 years, the oldest studies included in the analysis were designed
Alterations in pronociceptive
RESEARCH REVIEW
Abbreviations used in this issue to demonstrate a positive pre-emptive analgesic effect of high-dose intra-operative opioids. The overall low and antinociceptive
Comment (JB): The take-home message for any budding researchers with a yearning to perform a
meta-analysis is pick a subject that lends itself to narrow search terms. The two authors assessing the
CBT = cognitive behavioural therapy certainty reflects issues with bias in the trial designs and the marked heterogeneity in dose regimens. The mechanisms in LBP search results for this meta-analysis failed in this regard, and they had to review 4922 abstracts in order
CPM = conditioned pain modulation ratio between low and high dose varied between 1:15 and 1:1.5, and what was a high dose in some studies Media representation of to filter out the 27 trials that provided the data for the meta-analysis. Sadly, this Olympic-level dedication
LBP = low back pain chronic pain in NZ was not rewarded with gold-medal results; statistical significance for the primary outcome, that higher
was a low dose in others. When attempting to generalise this work to the clinical context, possibly the most intra-operative opioid doses lead to higher pain scores at rest 24 hours postoperatively, but the actual
RCT = randomised clinical trial difficult aspect to account for was the low usage of multimodal analgesia. Only two of the trials included difference in pain score was small and the result came with a low level of certainty. As a demonstration of
TSP = temporal summation of pain how thinking has changed over the last 25 years, the oldest studies included in the analysis were designed
regular paracetamol (acetaminophen) and only five included an NSAID (nonsteroidal anti-inflammatory
with experts Dr John Barnard and
Abbreviations used in this issue to demonstrate a positive pre-emptive analgesic effect of high-dose intra-operative opioids. The overall low
drug). As you have probably surmised, the authors concluding remark was a plea for more research and CBT = cognitive behavioural therapy certainty reflects issues with bias in the trial designs and the marked heterogeneity in dose regimens. The
CPM = conditioned pain modulation ratio between low and high dose varied between 1:15 and 1:1.5, and what was a high dose in some studies
better data.
Covid-19 Response: LBP = low back pain
RCT = randomised clinical trial
was a low dose in others. When attempting to generalise this work to the clinical context, possibly the most
difficult aspect to account for was the low usage of multimodal analgesia. Only two of the trials included
Our heartfelt thanks Reference: Acta Anaesthesiol Scand 2020;64:6–22 TSP = temporal summation of pain
regular paracetamol (acetaminophen) and only five included an NSAID (nonsteroidal anti-inflammatory
Associate Professor Gwyn Lewis
drug). As you have probably surmised, the authors concluding remark was a plea for more research and
All of us at Research Review want to Abstract better data.
thank you for the part you are playing in Covid-19 Response:
the Covid-19 crisis. Our hats go off to you, Our heartfelt thanks Reference: Acta Anaesthesiol Scand 2020;64:6–22
All of us at Research Review want to Abstract
and we are proud to be associated with thank you for the part you are playing in
Independent commentary by Dr John Barnard
covers critical research with commentary
you. Our role in all of this is to support you the Covid-19 crisis. Our hats go off to you,
and we are proud to be associated with
by keeping you informed and up to date as you. Our role in all of this is to support you Independent commentary by Dr John Barnard
much as we possibly can. Dr John Barnard works as an anaesthetist at Waikato Hospital with a part time academic by keeping you informed and up to date as
much as we possibly can. Dr John Barnard works as an anaesthetist at Waikato Hospital with a part time academic
component. In addition to his role in the operating theatres, four years ago he became the component. In addition to his role in the operating theatres, four years ago he became the
Clinical Director of the Hospital Pharmacy and Chairman of the hospital’s Medicines and Clinical Director of the Hospital Pharmacy and Chairman of the hospital’s Medicines and
on the impact to local practice.
Therapeutics Committee.
Therapeutics Committee.
www.researchreview.co.nz a RESEARCH REVIEW™ publication
www.researchreview.co.nz a RESEARCH REVIEW™ publication 1
1
Anaesthesia and
Pain Management
RESEARCH REVIEW ™
Making Education Easy Issue 23 – 2020
Sign up at no cost online at In this issue:
Low- vs. high-dose
intraoperative opioids
Welcome to issue 23 of Anaesthesia and Pain Management Research Review.
This issue begins with a systematic review with meta- and trial sequential analyses reporting, albeit with low
certainty of evidence, that high-dose intraoperative opioids are associated with higher postoperative pain
scores than low-dose regimens of the same opioid. There is also a narrative review article outlining important
considerations for anaesthesiologists when managing patients who are being or have been treated with
www.researchreview.co.nz
Complications from immunotherapy with immune checkpoint inhibitors.
perioperative transoesophageal The pain management research begins with a paper reporting that young adult women who have experienced
echocardiography childhood maltreatment, particularly if they have also experienced post-traumatic stress as adolescents,
are more likely to report pain conditions. To conclude this issue, we have an interesting article on how the
Sign up at no cost onlineDelivered
at by email to your inbox
Prediction of hospitalisation
length and complications by mainstream media outlets in NZ portray chronic pain and if best practice is being accurately broadcast to the
frailty assessments NZ public.
We hope you find the selected research helpful in your everyday practice, and we encourage you to keep
Brief pre-anaesthetic jaw/ sending us your comments and feedback.
neck exercise for improving Kind regards,
intubation Dr John Barnard Assoc Prof Gwyn Lewis
Immune checkpoint johnbarnard@researchreview.co.nz gwynlewis@researchreview.co.nz
inhibitors: considerations for
anaesthesiologists
www.researchreview.co.nz
Low- versus high-dose intraoperative opioids
Heightened pain risk after
Authors: Albrecht E et al.
childhood maltreatment
Summary: This was a systematic review with meta-analyses and trial sequential analyses of 27 RCTs
Mind-body therapies (n=1630) comparing high and low doses of the same intraoperative opioid in patients receiving general
for opioid-treated pain anaesthesia, and reporting pain outcomes. There was low-certainty evidence that compared with low doses,
high doses of the same opioid were associated with higher at-rest 10-point pain scores at postoperative hours
Pre-emptive and preventative 24 (primary outcome) and 2 (respective mean differences, –0.2 [95% CI –0.4, –0.1] and –0.4 points [–0.6,
pain psychoeducation for –0.2]), greater cumulative consumption of intravenous morphine equivalents (–1.6mg [–2.6, –0.7]) and a
perioperative pain control significantly lower pressure threshold for mechanical pain (3.8 g/mm2 [1.8, 5.8]).
Alterations in pronociceptive Comment (JB): The take-home message for any budding researchers with a yearning to perform a
and antinociceptive meta-analysis is pick a subject that lends itself to narrow search terms. The two authors assessing the
mechanisms in LBP search results for this meta-analysis failed in this regard, and they had to review 4922 abstracts in order
Delivered by email to your inbox
Media representation of to filter out the 27 trials that provided the data for the meta-analysis. Sadly, this Olympic-level dedication
chronic pain in NZ was not rewarded with gold-medal results; statistical significance for the primary outcome, that higher
intra-operative opioid doses lead to higher pain scores at rest 24 hours postoperatively, but the actual
difference in pain score was small and the result came with a low level of certainty. As a demonstration of
how thinking has changed over the last 25 years, the oldest studies included in the analysis were designed
Abbreviations used in this issue to demonstrate a positive pre-emptive analgesic effect of high-dose intra-operative opioids. The overall low
CBT = cognitive behavioural therapy certainty reflects issues with bias in the trial designs and the marked heterogeneity in dose regimens. The
CPM = conditioned pain modulation ratio between low and high dose varied between 1:15 and 1:1.5, and what was a high dose in some studies
LBP = low back pain was a low dose in others. When attempting to generalise this work to the clinical context, possibly the most
RCT = randomised clinical trial difficult aspect to account for was the low usage of multimodal analgesia. Only two of the trials included
TSP = temporal summation of pain
regular paracetamol (acetaminophen) and only five included an NSAID (nonsteroidal anti-inflammatory
drug). As you have probably surmised, the authors concluding remark was a plea for more research and
better data.
Covid-19 Response:
Our heartfelt thanks Reference: Acta Anaesthesiol Scand 2020;64:6–22
All of us at Research Review want to Abstract
thank you for the part you are playing in
the Covid-19 crisis. Our hats go off to you,
and we are proud to be associated with
you. Our role in all of this is to support you Independent commentary by Dr John Barnard
by keeping you informed and up to date as
much as we possibly can. Dr John Barnard works as an anaesthetist at Waikato Hospital with a part time academic
component. In addition to his role in the operating theatres, four years ago he became the
Clinical Director of the Hospital Pharmacy and Chairman of the hospital’s Medicines and
Therapeutics Committee.
www.researchreview.co.nz a RESEARCH REVIEW™ publication
1
PAGE 6 | APRIL 2022 ADVOCACY, COMMUNITY AND EDUCATION
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REPRESENTING,
Teleflex Medical SUPPORTING
New Zealand · 300AND PROMOTING
Richmond NZ ANAESTHETISTS
Road · Grey Lynn, SINCE 1948
Auckland 1021 · New Zealand APRIL 2022 | PAGE 7
Customer Service Tel. 0800 601 100 · nzcs@teleflex.com · www.teleflexmedical.co.nz
NZSA TRAINEE COLUMN
Babies, anaesthesia training
and words of wisdom
Hi everyone. Today I write from
a different place, at home on
parental leave with my three-
month-old baby girl, Lucy
(likes milk and naps, don't ask
for photos as I have too many
of the same pose on different
Dr Mikaela Garland days and have recently updated
NZSA Trainee
Representative
my photo storage space).
I still feel in somewhat of a haze with
the days merging into one. Given this is
my first baby and first parental leave, I will write
about my experience so far and the most useful advice from
colleagues that have travelled this path before me.
When is the best time? What happens with training?
It’s a cliche because it’s true – there isn’t a best time. The Simply, you go into interrupted training. It requires a form that
best time is the time you have your baby. As anaesthetists- is signed off by the Supervisor of Training, which is submitted
in-training, we like to make plans and stick to them. A baby to ANZCA.
doesn’t have a plan other than to have no plan, and the
Complexity – there will be a delay in your training time, and
same is true for becoming pregnant. Personally, I had seen
this will affect everyone in different ways. I have yet to return
a few friends struggle with fertility and despite having some
to work and when I do, Lucy will be five months old. I am
understanding of statistics, this still resulted in my husband
returning as a Fellow part way through the year, and I will have
and I trying earlier rather than later. You will know what is right
four months of Post Fellowship Training to complete at the end
for you, so trust yourself.
of the training year. I could have taken 14 months off to keep
it “clean” and stick to the training year, however, this sounded
like too much time off for me.
Words of wisdom
I’m scared! I haven't given an anaesthetic since August last
year (ICU prior to leave). I now constantly think about a tiny
human, and I have all these new things to do and think about
while still trying to be “the old me” at work. Here is some
invaluable advice I received:
• Make sure your baby is somewhere you trust and are happy
with to remove that mental load during your workday.
• Enjoy your time off – you will still be able to give a safe
anaesthetic on your return.
• Outsource what you can (unless your hobby is cleaning,
I would find someone else to do it).
• Ask for help from your co-parent, family, friends, or whoever
is willing. When you go back to work will you need help
with childcare, pickups/drop-offs, meals, sleep? You are
not supposed to do it all yourself!
Final words
I remember that on one of my last shifts at work I was asked
if I wanted to go home early as I was heavily pregnant and I
said, “no thanks, I’m about to go on holiday for six months, you
should go early”’ I regret saying that. It's not a holiday. It's hard.
We are used to instant gratification at work and Lucy is
teaching me the art of patience. Coming out the other side of
the fourth trimester, it's worth it.
PAGE 8 | APRIL 2022 ADVOCACY, COMMUNITY AND EDUCATION
A rich and fulfilling life through
mindfulness
Mindfulness has been She chose to do the trainers program with Ovio, spending
“transformational” for two days at the Taurua Retreat Centre at Lake Taupo with a
accredited life coach and group learning the deep dive and accreditation program. “The
mindfulness consultant course taught me the skills needed to teach and helped me
Cheryl Strawbridge, who has to remember to pause and be mindful, one day at a time. The
experienced its profound skills I learnt from Ovio helped me through some very difficult
impact in her own life and times as I was better able to deal with the challenges life threw
the lives of her clients. at me with greater awareness and resilience.”
Cheryl’s scientific background “Mindfulness and meditation are a lifelong personal journey,
(with degrees in biochemistry, and Ovio has been a great partner in that journey.” She
physiology, and psychology) describes the course as inspiring, practical, and backed up by
and time spent working in the science-backed techniques.
healthcare sector, held her in
Cheryl, who has run her program at medical and healthcare
good stead to create her own unique mindfulness brand “Ovio
facilities, says mindfulness teaches you how to be more
Mindfulness Solutions.” Founded in 2013, demand for her
conscious and deliberate about how you live.
services grew quickly as people sought solutions to achieve
greater purpose and balance in their lives. “When I was younger, I advocated for change any way I could
to make the world a better place. Now I feel the most effective
Today, Cheryl supports and coordinates a global team of
thing is to work one heart at a time. There is so much potential
experienced Mindfulness consultants who teach people how
for positive change in each person, which ripples out into
to “cut through the noise in their heads.”
organisations, communities, and wider society.”
This is a world away from her initial career, working for
Residing in the Wellington suburb of Karori with her husband,
multinational companies.
three teenage children, a cat, and a dog, Cheryl says her top
Cheryl says she saw first-hand the harmful impacts of a fast- personal wellbeing activities are spending time in nature and
paced and stressful lifestyle on friends and colleagues. She regularly connecting with family and friends.
also experienced the power of mindfulness in her own life,
The Ovio mindfulness course is free for NZSA members. To
following a diving accident which left her paralysed. While she
was very grateful to recover the ability to walk after intensive begin your mindfulness journey, you can access the course
treatment in a dive recompression chamber, she had intense on the NZSA website via the members’ only section once
headaches and other health issues. logged in.
“This chronic pain catapulted me into depression and led We would love to hear your feedback once you’ve completed
to the recognition that not everything could be healed with the course ceo@anaesthesia.nz
allopathic medicine. Mindfulness was a powerful
ally that eased my chronic pain and freed me
from the grips of depression. I was excited to see
that published studies confirmed my belief in the
effectiveness of mindfulness.”
The NZSA has teamed up with Cheryl to
offer members free access to the Ovio online
mindfulness course, which aims to counter the
effects of our busy, digitised, and demanding
world. The benefits of putting mindfulness into
practice include better sleep and increased
energy, improved concentration, increased
productivity and performance, a greater sense
of calmness and reduced anxiety. Feeling more
engaged and present in your life also helps to
enhance personal and professional relationships,
says Cheryl.
NZSA CEO Michele Thomas first became aware
of Ovio when she was asked to do mindfulness
training while employed at QE Hospital in Rotorua.
REPRESENTING, SUPPORTING AND PROMOTING NZ ANAESTHETISTS SINCE 1948 APRIL 2022 | PAGE 9
NZSA Global Health Committee
opportunities
Locums needed for Pacific Societ y of overseas work in low and middle-income countries (if any; not
essential) as well as whether you will be happy to supervise
Anaesthetist’s Conference 2022
Provisional Fellows (post FANZCAs).
This year’s PSA Conference will be held 26-30 September at
the Hotel Warwick Fiji, Coral Coast, Sigatoka. The NZSA Global The NZSA GHC and PSA thank you for considering providing
Health Committee is looking for Consultant Anaesthetists and anaesthesia services in the Pacific during the PSA meeting.
Post-FANZCA Provisional Fellows who would be interested in
providing locum cover during the PSA conference. NZSA Trainee Grant for Pacific Society of
Anaesthetist’s Conference
NZSA GHC Chair Dr James Dalby-Ball says that working as a
locum will enable Pacific trainees and colleagues to attend the New Zealand anaesthetic trainees, who are members of
annual PSA meeting – their only opportunity for CME and to the NZSA, are invited to apply for the 2022 NZSA Global
meet and network with their Pacific colleagues. These locum Health Committee Grant (NZ $1000.00) to pay towards
positions are suitable for post FANZCA advanced trainees, the costs of attending the Pacific Society of Anaesthetist’s
Provisional Fellows, and Senior Medical Officers. annual Conference in Fiji from 26-30 September 2022. The
conference theme is “Resilience and Recovery” with faculty
This year locums are required for: Lautoka Hospital, Fiji (4), from Australia, New Zealand, ANZCA and the Pacific.
Labasa Hospital, Fiji (2), Colonial War Memorial Hospital, Suva,
Fiji (4 Anaesthesia and 1 ICU), Samoa (2), and Tonga (3). The grant provides New Zealand trainees who are
interested in global health and development an opportunity
The NZSA GHC provides support with information about host to gain a broad perspective of anaesthesia services in the
hospitals, registration, and the PSA, as well as suggestions Pacific. It is also an excellent opportunity for networking
for accommodation. The NZSA also provides a certificate of with our Pacific anaesthesia colleagues and to assist with
participation for CME reimbursement and ANZCA CPD on the meeting, if required.
completion of the Locum Feedback form.
The selected trainee will be required to provide a short
The locum is a recognised CPD activity under the knowledge report to the NZSA after their experience attending the PSA
and skills section of the ANZCA CPD program. Conference, which will be published in the NZSA magazine,
Overseas aid work: The broadening of knowledge and skills and will be eligible to be nominated as trainee representative
via contribution to aid efforts. on the NZSA Global Health Committee.
Credits: 1 credit per hour, maximum cap of 10 credits per year.
Evidence: Correspondence confirming participation in NZSA trainee membership is free and interested trainees can
overseas aid commitment. become a member at the time of applying for this grant. (Visit
NZSA’s website www.anaesthesia.nz)
If you are interested in offering support as a locum, please
email Dr Indu Kapoor kapoor.indu@gmail.com and Dr Petra To apply contact Dr Indu Kapoor, NZSA GHC Member, with a
Van der Linden Ross petra.vdlr@gmail.com. Please include letter expressing interest and reason(s) for wanting to attend,
your current place of work and position, details of past along with a short CV at kapoor.indu@gmail.com no later
than 31 May 2022.
Delegates at the 2019 PSA annual conference. Due to COVID disruptions, the PSA Conference was unable to go ahead in 2020 and 2021.
PAGE 10 | APRIL 2022 ADVOCACY, COMMUNITY AND EDUCATIONUK anaesthetist and comedian finds
his wellness in humour
It’s not every day that you meet an anaesthetist with a of our role like obstetrics, ICU, pain etc, or really impressed by
successful, thriving comedic career, but Dr Ed Patrick is the drugs that we use!”
doing just that. He has also released a memoir, “Catch Your
He says writing the book was a privilege and he wanted every
Breath – the Secret Life of an Anaesthetist” writing about
reader to take something from it, whether in the “bubble of
his anaesthesia training, patient interactions, and the UK’s
anaesthetics or not.”
experience with the first COVID wave. NZSA CEO Michele
Thomas and NZSA Communications Manager Daphne We turn to the topic of health workforce shortages in the UK,
Atkinson had the pleasure of chatting to Ed. which are similar to New Zealand’s. “There’s going to be a
boom of anaesthetists retiring in the next few years and not
Dr Ed Patrick takes anaesthesia and the care of his patients
enough training places to fill the gaps. There’s no give in the
very seriously, but also sees the lighter side of life. He describes
system and anaesthetists often pick up ICU roles due to staff
comedy as a much needed creative and wellness outlet to
shortages.”
survive the pressures of the job. And never more so than when
the first COVID wave hit in the UK. But taking a step back, how He says the level of ICU work required of anaesthetists during
did a doctor embark on a comedy career, which has turned out the height of the pandemic had a personal impact. “I lost my
to be so successful, with gigs at the Edinburgh Fringe Festival identity as an anaesthetist. I was used to building up rapport
and hosting the “Comedians’ Surgery” podcast? with patients, helping them through the process of surgery,
being there for them post-surgery.”
Ed began performing stand up at university. He concedes that
his “side career” was a bit of a secret as he often heard that “You couldn’t reassure people in the same way about
doctors had to commit themselves 100% recovery. It was difficult not being able
to medicine, with no room for anything to give patients a straight answer to their
else. In fact, when he’d leave the hospital questions. There was a huge divide –
to perform a comedy show, he would some people pulling through and others
say he was catching up on “admin” as not. Some healthy people who got sick
he feared being told off. The turning with COVID unexpectedly declined, and
point was when a consultant spotted the others with various conditions recovered.”
mention of comedy in his CV. Expecting to
When asked how he coped, he says the
be chastised, Ed was surprised when the
survival instinct kicked in – it was only
consultant encouraged him to pursue his
later that he reflected on how difficult it
interest and step it up. Soon afterwards
had been, especially at the start of the
he got his first Edinburgh booking.
pandemic when so much was unknown,
Humorous incidents from his anaesthesia and anaesthetists had to quickly adapt
training and patient consults became to their new roles in ICU. One of the
a part of his comedy routines. With his biggest challenges was no longer having
collection of anecdotes, writing a book comedy as a release. “The dynamic of a
felt like a natural progression, but he was particularly spurred bad day in medicine and then having a great day in comedy
on to write after his creative outlet took a hit as comedy to balance it out was gone. It was full on, 13-hour days with no
bookings were cancelled due to COVID. time to process what was happening. At the time you think
you’re okay, but then when you look back realise you weren’t.”
He had a strong vision for the memoir, wanting to raise public
awareness about the role of anaesthetists and anaesthesia The pandemic forged bonds within healthcare teams,
“the magical, dark mystery.” He often encountered people who especially doctors and ICU nurses: “My philosophy is to do
didn’t know that anaesthetists are doctors, and even when what the nurses tell you!”
they did, had a narrow view of an anaesthetist’s role as “just
Ed believes that comedy is more important than ever as we
putting people to sleep.” He wanted to write a book to provide
continue to cope with the pandemic. “We need to laugh.
insight about the breadth and depth of the specialty’s scope.
Humour keeps us sane, it’s like therapy.”
The frontline role of anaesthetists in the pandemic response
began to shift attitudes, as media coverage showed the integral Ed is keen to visit New Zealand again and was impressed when
role of anaesthetists looking after COVID patients in ICU. he saw the work life balance of his doctor friends. “They
“And there was this growing recognition that anaesthetists would finish work for the day, and head off for a surf or hike,
are part of emergencies, dealing with airways etc.” whereas in the UK, you just go to Tesco to pick up a sandwich
or something.”
“It’s a fascinating specialty and we have our fingers in every
pie. It’s interesting when you speak to people about being an You can read Michele’s review of Ed’s book in this issue of
anaesthetist; they’re either really interested in the broad scope the magazine.
REPRESENTING, SUPPORTING AND PROMOTING NZ ANAESTHETISTS SINCE 1948 APRIL 2022 | PAGE 11LIFEBOX – Saving lives through
safer surgery and anaesthesia
Lifebox Communications Manager Lifebox ANZ has supported Lifebox to respond to COVID-19
Kitty Jenkin provides an update on with pulse oximeters for frontline providers across eight
Lifebox activities, and an overview countries in the Asia Pacific region including 50 oximeters
of its expansive work program. to Fiji and 100 to Papua New Guinea during their respective
COVID surges.
Lifebox was founded to tackle the global crisis of unsafe
surgery. By investing in tools, training, and partnerships, Lifebox, alongside Smile Train and the World Federation of
Lifebox addresses the critical gaps in surgical systems to Societies of Anaesthesiologists, also developed the COVID-19
make surgery and anaesthesia safer worldwide. Since 2011, Surgical Patient Checklist to keep surgical teams and patients
Lifebox has expanded its global network across 116 countries, safe from infection. The COVID Checklist is a simple tool to
trained 11,000 healthcare providers, and made surgery safer promote teamwork and communication in the operating
for 35 million patients. room and offers prompts to perform key infection prevention
strategies during surgery. In collaboration with Jhpiego, Lifebox
This work has been supported by The New Zealand Society
developed an online Train-the-Trainer workshop. Available in
of Anaesthetists (NZSA) since Lifebox’s founding days, with
English, French, and Spanish, more than 23 workshops have
Professor Alan Merry a founding board member of Lifebox.
been held to train over 130 perioperative providers as trainers.
NZSA’s support continues today through Lifebox Australia and
Lifebox continues to provide online training workshops at the
New Zealand (Lifebox ANZ) – a consortium of partners that also
request of hospitals around the world.
includes Interplast Australia and New Zealand, the Australian
and New Zealand College of Anaesthetists (ANZCA) and the
Australian Society of Anaesthetists (ASA). The consortium
Innovating to Protect Healthcare Providers
aims to strengthen anaesthesia and surgical safety. COVID-19 caused worldwide shortages in PPE, particularly
N95 masks, leaving healthcare providers at-risk. A global
In 2021, Lifebox launched an ambitious new strategic plan survey by Lifebox, published in the Annals of Surgery, found
to make every surgery safer. The Strategic Plan (2021-2024) 37% of healthcare providers surveyed in low-income and
targets the most critical moments in the end-to-end surgical lower-middle-income countries did not have routine access
patient journey by increasing the quality and impact of Lifebox to N95 masks and clinicians reported having to purchase
programs across three focus areas – safe anaesthesia, their own PPE (when available) and reusing it – sometimes
teamwork, and surgical safety. The plan’s theme is Stronger without decontamination. To respond to this challenge,
Teams, Safer Surgery and puts multidisciplinary teamwork Lifebox took part in a global pilot with a coalition of optical
at the heart of Lifebox’s approach by strengthening the engineers, physicists, and clinicians to design a low-cost,
professions and processes both within and beyond the easy-to-construct cabinet that decontaminated N95 masks
operating room. with ultraviolet-C (UV-C) irradiation – boosting mask supply by
five times.
Global COVID-19 Response
The pilot involved 21 hospitals in low- and middle-income
Since the onset of the COVID-19 pandemic, Lifebox has
countries and to date, has resulted in the decontamination
prioritised supporting its global network of anaesthesia
of 930,000 masks, with savings to the clinical sites of $3.7
providers, nurses, surgeons, and critical care specialists
million. In Ethiopia, where Lifebox is a registered non-profit,
with tools and resources for safe surgical, anaesthesia,
and COVID-19 care. This global response included the
development of technical guidance and the distribution of
personal protective equipment (PPE) and oxygen resources,
including 10,000 pulse oximeters across 49 countries.
Pulse oximeters are an essential device in COVID-19 care,
enabling healthcare providers to assess the oxygen saturation
of a patient – a critical component of patient triage, clinical
decision making, as well as ongoing monitoring of COVID
patients. In low-income countries that often lack intensive
care resources, the early identification of COVID-19 patients is
essential for the best outcomes.
COVID-19 has demonstrated that many health systems lack
robust oxygen ecosystems – such as pulse oximeters and
sustainable oxygen supplies. Investing in oximeters pays
tremendous dividends: They are low-cost, durable, highly
valued, and can be rapidly used across clinical units. Lifebox PulseOximetry Training at Redemption Hospital, Liberia.
PAGE 12 | APRIL 2022 ADVOCACY, COMMUNITY AND EDUCATIONLifebox worked with the Addis Ababa Institute of Technology improved patient monitoring during surgery in resource-
(AAiT) and St. Peter’s Specialized Hospital to build eight UV-C limited settings.
cabinets. The results of this pilot were recently published in
Despite being listed as an “essential” safety monitoring device
the New England Journal of Medicine (NEJM) Catalyst.
by the WHO-WFSA International Standards for a Safe Practice
of Anaesthesia, there is a lack of capnography availability
Strengthening Anaesthesia Safet y in Laos throughout many low- and middle-income countries, due
and Liberia primarily to its technical requirements and cost.
A cornerstone of Lifebox’s work is improving anaesthesia
The Initiative has developed specifications for a capnography
safety. Last year, Lifebox, in partnership with the Laos Society
device specifically designed for the intraoperative care of
of Anaesthesiologists and Lifebox ANZ, organised the first
children, including those having cleft surgery, in low-resource
online pulse oximetry Training-of-Trainers. The workshop was
settings, and launched a Request for Proposals. Smile Train
attended by anaesthesiologists and biomedical professionals,
and Lifebox are working to launch a robust, easy to use, and
and was led by Dr Rob McDougall, Dr Tom Mohler, and Dr
affordable capnography device at the end of this year to
Simon Hackett. This workshop was followed by the distribution
improve anaesthesia safety for children around the world.
of 110 pulse oximeters to support the country in its response
to COVID-19.
In Liberia, Lifebox is working to support the country’s 80 nurse
anaesthesia providers. As lead Lifebox pulse oximetry trainer,
anaesthesiologist Dr Musa Kallamu Suleiman explained,
“Some of the centers in Liberia do not even have a nurse
anaesthesia provider to monitor the patient during surgery.
The doctor gives the anaesthesia then goes back to scrub,
and also operates. This is not safe. We advise these centres
that even if the person isn’t formally trained, they should have
someone who is dedicated to anaesthesia monitoring. The
training that we are doing with Lifebox will help these types of
providers enormously.”
With support from partners like NZSA, Lifebox has distributed
more than 35,000 pulse oximeters to anaesthesia providers
across the world alongside pulse oximetry training. There is
still much work to do to ensure oximetry availability across the Lifebox Yashodhara Multispeciality Hospital & Research Center, Solapur,
Maharashtra, India.
perioperative process, including recovery.
Smile Train-Lifebox Safe Surger y and
Anaesthesia Initiative
Lifebox’s safer surgery and anaesthesia work is built on
partnerships. In December 2020, Lifebox launched the Smile
Train-Lifebox Safe Surgery and Anaesthesia Initiative with
the world’s leading cleft-lip and palate organisation – Smile
Train. This ground-breaking initiative is a multi-year strategic
partnership to elevate the quality and safety of cleft and
paediatric surgery in more than 70 countries.
Last year the Initiative launched The Smile Train-Lifebox
Capnography Project which seeks to find a “capnography
solution” to provide comprehensive, safe cleft care through
Lifebox Patient Monitoring, Madagascar.
Support Lifebox
At the time of writing this article, only 14% of people in low-income countries have received at least one dose of a COVID-19
vaccination. Lifebox is enormously concerned for the health of its partners as vaccine inequity leaves many healthcare
providers on the COVID frontlines unprotected across the world. Lifebox’s work to minimise the risks for providers and
patients is more critical than ever. This work is only made possible with the generous support of Lifebox donors.
The NZSA has been a steadfast supporter of Lifebox through Lifebox ANZ. To continue supporting this lifesaving work and
provide healthcare workers with essential tools and resources visit https://www.interplast.org.au/donate/donate-now/ and
select Lifebox.
Find out more about saving lives through safer surgery and anaesthesia at lifebox.org
REPRESENTING, SUPPORTING AND PROMOTING NZ ANAESTHETISTS SINCE 1948 APRIL 2022 | PAGE 13You can also read
