Sir Humphry Davy Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol BS2 8HW Tel: 0117 342 2163
Anaesthesia at University Hospitals Bristol NHS Foundation Trust covers a wide range of specialist surgical procedures. We are the regional centre for many tertiary specialties as detailed below and ST3&4 trainees spend 12-15 months here. Trainees in ST5-7 also return for their higher modules, and we offer advanced training in many areas. We also welcome clinical fellows as both pre-final FRCA and post-CCT fellowships, and have a good track record of offering educational opportunities to these doctors along with trainees.
We are a very active friendly department with active research, quality improvement and education for trainees and fellows alike. There are approximately 100 Consultant anaesthetists across all specialties, who supervise trainees, clinical fellows, ACCPs and specialty doctors.
Specialties within UHBristol:
Adult anaesthesia:
Anaesthesia is provided for adults in all specialties except vascular, neurosurgery and urology. The Bristol Royal Infirmary (BRI) is the regional centre for head and neck surgery, hepatobiliary and pancreatic surgery, thoracic, oesophagogastric and gynaecology including major oncology resections. We also provide colorectal surgery with a high proportion of ELAPE and major abdominal wall reconstruction surgery in the region. Some orthopaedic surgery is provided including specialist limb reconstruction surgery and a high proportion of geriatric (silver) trauma.
The BRI is one of the most active thoracic centres in the country having dedicated thoracic anaesthetists and surgeons. There is at least one dedicated thoracic surgery list each day.
Head and neck anaesthesia supports dental, OMFS and ENT surgery. We have a full range of advanced airway management equipment available including regular lists requiring jet ventilation, major head and neck resections with free flap reconstruction and laryngectomies. The department also manages the Difficult Airway Rescue Team, combining skills from anaesthesia with OMFS and ENT. Trainees will often complete their advanced airway modules here, and the post-CCT fellowship post is also popular.
The obstetric anaesthesia team run delivery suite in St Michaels hospital and see approximately 5000 deliveries each year. It is the regional centre for complex maternal and neonatal patients, especially cardiac defects. There is dedicated Consultant cover for elective and emergency operative deliveries.
We also offer a wide range of major surgery including liver resections, pancreatic surgery (malignant and pancreatitis), oesophageal resections and other major abdominal resections.
Day surgery in UHBristol in colorectal, OMFS, ENT, gynaecology and upper GI surgery is usually done in dedicated suites in St Michaels Hospitals and South Bristol Community Hospital.
Ophthalmic anaesthesia is generally done in the Bristol Eye Hospital for both adults and paediatrics. There are 4 elective lists per day and an emergency list 6 days per week, using both regional and general anaesthesia.
There are also opportunities for teaching in pain management (acute and chronic), vascular access lists, brachytherapy and ECT.
Cardiac anaesthesia and critical care:
The BRI also hosts the regional cardiology centre, including 3 cardiac catheter labs providing primary and elective PCI, tertiary cardiac electrophysiology and imaging (echocardiography and cardiac CT/MRI) services. The BRI hosts the regional centre for out-of-hospital cardiac arrests receiving approximately 130 admissions per year, with excellent outcomes.
Cardiac surgery is delivered via 3 dedicated theatres and a hybrid theatre. There are approximately 1200 valve or graft procedures per year, plus a large regional TAVI service. Cardiac critical care is provided in conjunction by cardiac anaesthesia and general intensive care, and ECMO/ prolonged cardiopulmonary bypass is occasionally provided for short periods before transfer to quaternary services. We have good links with quaternary centres in London for retrieval of our patients.
We also have the regional grown-up congenital heart disease (GUCH) service with an increasing number of patients requiring anaesthesia and critical care for cardiac and non-cardiac procedures. ST3/4 trainees and ST6 trainees will do their intermediate and higher modules in the BRI and BHI, and we also offer a post-CCT fellowship in cardiac anaesthesia and critical care.
Paediatric anaesthesia:
Paediatric anaesthesia in Bristol is now provided entirely via the Bristol Royal Hospital for Children. ST3/4 trainees spend 3 months in paediatric anaesthesia, with higher trainees spending time in paediatric anaesthesia, PICU and WATCH – the regional paediatric critical care and transport service. Advanced training in paediatric anaesthesia is offered here with good feedback from previous trainees.
The BRHC is the regional paediatric centre and offers surgery for all specialties including neuro and cardiac surgery. Anaesthesia trainees have many opportunities to see a wide range of paediatric surgery, critical care and pain management and are well supervised during on call sessions. The BRHC is the regional major paediatric trauma centre.
Intensive Care:
The general intensive care unit is one of the busiest in the region, admitting 1300 patients per year into 20 beds. Approximately 30-40% of admissions are after major elective surgery, with the remainder being emergency cardiology (post-cardiac arrest or specialist PCI or EP requirements), emergency surgery or medical admissions. We support the Bristol Haematology and Oncology centre and frequently admit patients after complications of chemotherapy or bone marrow transplantation. All forms of organ support are provided with advanced cardiac monitoring and therapy, echocardiography and critical care ultrasound, and good links to the regional ECMO quaternary service in London.
Specific teaching in intensive care medicine is delivered by the Consultants at weekly dedicated teaching sessions, journal club or via M&M or quality improvement meetings. There is an MDT simulation programme in the unit.
Peri-operative medicine:
UHBristol has a dedicated pre-operative department which is responsible for pre-operative assessment of all elective patients. Direct Consultant review is available for any complex or high-risk patients, and rapid pulmonary function, echo or CPET testing is routine for many patients. There is a post-CCT fellowship post provided with an interest in peri-operative medicine, and the department runs a regional course in peri-operative medicine.
Teaching provided in UHBristol:
Every trainee is allocated an Educational Supervisor and College Tutor which they keep and meet regularly with for the duration of their time in UHBristol. Dedicated teaching is offered in the ICM, obstetric, paediatric, cardiac and general modules. The department also has a weekly meeting which often delivers excellent CPD for everybody and provides an opportunity to meet with others.
The department houses an airway laboratory which is freely available to trainees to practice videolaryngoscopy, fibre-optic intubation or front-of-neck access on mannequins or challenging models. We run an annual head and neck study day and the Difficult Airway study day.
There is an active simulation programme, jointly delivered with the Bristol Medical Simulation Centre. We also run introduction courses to cardiac (One heart) and thoracic (One lung) anaesthesia, as well as MEPA (emergency paediatric anaesthesia), ALS, ATLS and APLS courses. Our ICU also runs a national FFICM revision course at the RCoA in London.
The trainee group have also initiated regular trainee forums open to all, supported by a College Tutor and aim to improve trainee wellbeing and feedback during each module in an informal forum. The department has a strong focus on wellbeing, with rest facilities for on-call anaesthetists, continuous coffee facilities, a lounge with internet access and a library for meetings with AV facilities. We offer return to training systems for those requiring extended time away from clinical duties for whatever reason.
In addition, we have a wide range of opportunities in research, quality improvement and medical education available to those who wish to develop their skills in these areas.
The current College Tutors are Dr Kathryn Jackson and Dr Kaj Kamalanathan@uhbw.nhs.uk, who are happy to be contacted regarding any training or fellowship opportunities within UHBristol
Kajan.kamalanathan@uhbw.nhs.uk