Council Elections We have two vacancies on council coming up in the Autumn so if you would like to join the council and help advance paediatric anaesthesia, please keep an eye out for this on the website and in your email.

APAGBI Linkman meeting This year is being held in partnership with SPAN in the beautiful city of Edinburgh on November 4th.

Welcome to the APAGBI 2019 newsletter. There is lots of news to catch up on inside the newsletter including the ongoing reviews of children’s surgery and critical care, paediatric perioperative care and Professor Wolf swimming the channel!! Final preparations for the Annual Scientific Meeting 2019 in Sheffield are well under way with the usual mix of lectures and workshops covering a diverse range of topics. There is the additional attraction of the Difficult Airway education day, which precedes the full meeting.

T Piece

Spring 2019

President’s Report Welcome to this newsletter which I hope will help keep you up to date with some of the activities of the APA. Kester Brown It is with great sadness that we heard that Kester Brown from Melbourne had died not long before Christmas. He was a leading light in Paediatric Anaesthesia and a long-term member and friend to the APAGBI. He will be sadly missed. Council Changes Dr Philip Arnold from Liverpool, has decided to resign from Council because of other work commitments. We have decided to incorporate responsibility for Guidelines to the Education Committee with the idea of being able to look at producing some guidance over the next few years. Phil will continue with his role on the Scientific Committee and as our SALG representative. We have co-opted Hannah Lonsdale from Sheffield as the Newly Appointed Consultant for 2019-20. This role is to form a link between trainees and the more senior members of Council. At the AGM in June, Chris Gildersleve will become President and I wish him well in his new role. We will be all behind him! Mark Thomas will be the next President Elect from June onwards. Congratulations to him. There will be a further election for Home members during the winter period. I would like to encourage as many members as possible to apply for this post. It is a very rewarding and interesting Council to be involved with many various activities and a welcoming and enthusiastic group of individuals. New Membership process Currently new members have to be nominated by an APA member. This seems rather out-dated. Council has agreed that application for membership should be broadened to any doctor who was interested in paediatric anaesthesia: “Membership open to any medically qualified interested practitioners” We will discuss this further at the AGM. APA Sub-Committees During the winter, we have agreed that the Perioperative Care Group and PATRN will both become sub-committees of the APAGBI, the former part of the Professional Standards and the latter part of the Education Committee. This we hope will give both them and the APA advantages There is a full and wide-ranging programme at the ASM this year with excellent social events. I urge you to book your place now.

NHSE Review of Children Surgery and PIC The NHSE process has created two pilot networks to look at the potential impact of their new models of care. Considerable concern has been expressed by PICS to the NHSE about their plans. However, NHS England have been very quiet recently and we are awaiting a report on this work. Anaesthesia and Neurotoxicity Tom Englehardt has led on updating this in light of the recent published evidence and it reads very sensibly with good advice for how to approach questions on this from parents. It will shortly be available via the website. ASM Sheffield There is a full and wide-ranging programme at the ASM this year with excellent social events. I urge you to book your place now. Roddie McNicol Prize One of the recent innovations has been the Roddie McNicol prize for Local Anaesthesia. We had some excellent entries for this inaugural awarding of the prize and a deserved winner, which will be presented during the Free Paper Session on the Friday morning of the ASM. His wife, Prof Ann-Marie McNicol will present the prize. Charles Stack President APAGBI

Green Champion The Association of Anaesthetists has been developing an initiative on sustainability and environmental issues. This includes reducing use of plastic and single use items at meetings, a prize for an abstract on an environmental issue and even a meat free meal during the ASM! The APAGBI support this initiative and created a role as environmental champion for a council member. Karen Bartholomew, the current meetings secretary, has volunteered to take on this role and implement some of these ideas at future APAGBI meetings.

Join us at this years’ ASM in Sheffield, and register quickly! The Early Bird date has already gone by, the Airway Update Session on 5th June is already fully booked, and a waiting list is in operation. The Scientific programme includes sessions focussing on: MAJAX; Managing anxiety in children; Spinal surgery and major orthopaedics; Global Challenges with regard to Children; Haematology issues, paediatric specific; Obesity in Childhood; QI, and what you need to know; Allergy & Anaphylaxis; “How to” and linked ideas. The Jackson Rees lecture is: “What would the World look like without Plastics?”

Professor Anthony Ryan OBE

We look forward to seeing you at our Welcome Reception in The Sheffield Winter Garden on 5th June, and we hope you will join us for dinner in Sheffield Cathedral on 6th June; http://apaconferences.com/Social%20Programme%20APAGBI%20ASM.html Karen Bartholomew, Chair Meetings Committee

ASM 2020 London Date: 13th -15th May Local organiser: Dan Taylor, Evelina Venue: Institute of Engineering & Technology Programme: Planning is well advanced, and will be advertised in

Sheffield this June.

Paediatric Perioperative Care – New Subcommittee Perioperative care of patients has become a high-profile priority for the RCOA and they have invested significant resources to establish a new Centre of Perioperative Care (CPOC), which aims to further lead in improving preparation and outcomes of patients having surgery. Within the new CPOC, paediatrics has been identified as a specific work stream. In order to work closely with the RCOA and harness the work already performed by dedicated leads around the country, the APAGBI has created a new Paediatric Perioperative Care Subcommittee. The new subcommittee met for the first time in February at Birmingham Children’s Hospital and discussed ways of supporting all anaesthetists looking after children to develop their perioperative services and also work with the RCOA to promote paediatrics within CPOC. It is indicative of the drive to develop paediatric perioperative care that both the APAGBI linkman (Nov 4, 2019, Edinburgh) and the APAGBI ASM 2020 (London), have selected it as the theme for their meetings. Keep an eye on the website (www.apagbi.org.uk ) and Twitter (@apagbi ) for further news.

APAGBI Linkman Scheme The APAGBI Linkman Scheme connects paediatric anaesthetists in all hospitals facilitating collaboration and partnership. Our 2018 conference took place in picturesque Bath. Trainee attendance and tweeting at the linkman conferences has been steadily growing. Check out #APAL18 to get a flavour of the meeting. Our ethos ‘Link, learn, connect and collaborate’ takes us to magnificent Edinburgh for the next Linkman Conference. This will be a joint APA Linkman/SPAN meeting and is scheduled for Monday, 4th November 2019 at the King Khalid Building, Royal College of Surgeons of Edinburgh. Highlights include sessions on Paediatric Perioperative medicine, UK paediatric ENT review and emerging research. There will also be the Linkman prize presentation and an optional pre-conference workshop. There are early bird discounts and subsidised rates for non-consultant delegates. Your engagement is central to the success of the Linkman Scheme. Please connect with me via email either on linkman@apagbi.org.uk or on nimrajan@gmail.com

www.apagbi.org.uk We hope you are benefitting from our new website. I would like to highlight a few of our popular areas and mention some forthcoming new projects. Every month we post a new poll on the homepage which links into a Hot Topic written by the Education and Training Committee. Our database of Paediatric Anaesthesia Fellowships is continually updated, listing fellowships both in the UK and abroad. Likewise, our courses section provides an up to date list of all courses and meetings relevant to paediatric anaesthesia in the UK and internationally. If you haven’t had a chance, do listen to our podcasts of past lecturers from our Scientific meetings and follow the links to the videos of selected lectures. I am pleased to say that the PATRN group will also be hosting a section on the new website, posting details of their latest research projects. If you would like to add any material to the website or have any feedback, please drop me a line via email webmaster@apagbi.org.uk or post on our twitter feed @APAGBI Sumit Das, Webmaster

Introducing the “NAC” – The Newly Appointed Consultant on Council

A new co-opted position on Council has been created for consultants within 5 years of appointment. It is hoped that this position will give trainees who have been involved with the Paediatric Anaesthesia Trainee Research Network (PATRN) and those from the wider constituency of newly appointed

consultants, the chance to serve a period of time on Council. It is hoped that ultimately Council might reap the longer-term benefit of a wider age range amongst full Council members and Officers. Hannah Lonsdale is the first holder of this post and attended her first council meeting in January: “I was appointed as consultant anaesthetist at Sheffield Children’s Hospital in 2016 and have clinical interests in orthopaedic and regional anaesthesia. I'm also on faculty at Johns Hopkins All Children’s Hospital in the USA as a data scientist. My projects at Johns Hopkins involve using machine learning and sensor technology to improve children’s health. In the UK, I am developing TeamScreen, an innovative electronic dashboard to support the management of resuscitation in adults and children. Through this project I participate in the NHS Clinical Entrepreneur Programme. I applied to join the APAGBI council to further this aim to introduce the best in technology to the NHS and to be a link between the traditionally very senior and experienced members of the council and the new emerging crop of Millennial trainee and consultant paediatric anaesthetists. We all aspire to excellence in care for our patients and bring new and different experiences to achieve this. I look forward to continuing to work with the APAGBI membership across the country and further afield.”

What is a “CASAP?” The “Children’s Acute Surgical Abdomen Programme” is a national audit looking at the care and outcomes of children between 1 and 18 years of age undergoing emergency abdominal surgery. This research study has been adopted by the NIHR and it is hoped the pilot for 6 months will be starting soon. The APAGBI has donated £40 000 to drive this project forwards. The project, led by Ramani Moonesinghe at UCL, needs the support of >90% of UK centres and we hope that your centre will engage and support this opportunity to create a national database and improve the outcomes of children undergoing these operations. The CASAP team will be present at the ASM in Sheffield so please take the time to find their stand and register your interest. For more information visit: https://www.niaa-hsrc.org.uk/CASAP-Home or register your interest by email casap@rcoa.ac.uk

Update on Peer Review and ACSA The long established system of APA Peer Review has restarted after a change to the process to incorporate the ACSA paediatric standards. The initial request via the linkmen for centres to trial the new process generated interest from a number of people, and the first new Peer Review took place in February 2019. There are a further 3 visits planned for 2019. As you will realise, ACSA has an increasing number of required paediatric standards to meet, drawn from GPAS, and that the RCOA will accept approval by the APAGBI peer review team that a centre has met these standards. In future we hope to do 3 Peer Review visits a year. Information about the Peer Review process and how to arrange a review for your centre is on the APA website. To deliver 3 reviews a year we need to recruit more consultants as reviewers and if you are interested please get in touch with the Peer Review Lead via the website or email peer-review@apagbi.org.uk Stephanie Bew is stepping down as lead for peer review after several years of hard work at redesigning the peer review process. The role is being taken over by Judith Nolan who has recently joined council.

How to Avoid an APA Council Meeting: Swim The English Channel! Prof Andrew Wolf: Immediate Past President APAGBI Last August I chose to swim the English Channel in a pair of swimming trunks, a cap and goggles re-creating the first successful swim of Capt. Mathew Webb in 1875. The rules of the swim laid out by the Channel Swimming Association are very specific: you start at Dover on Samphire Hoe beach and swim without touching the boat or having any assistance until you hopefully land on the French Shore. The Straight distance is 21miles but with the currents you end up swimming around 35 miles. I spent 3 years training for this challenge that involved six to 10-hour training swims in the sea at temperatures between 3C and 15C, something that takes time for your body to get used to. Swimming the Channel is difficult, and many do not succeed. Three times as many people have stood on the top of Everest than have swam solo across the English Channel. I chose to do this partly for the challenge: I spent my years before medicine as a competitive swimmer but had not thought about it for 40 years. I also wished to help to use the swim to raise funds to open a bioprinting unit in Bristol using 3D printing technology for Paediatric Cardiac Surgery. This allows us build accurate 3D models of the heart using MRI and CT scans to help plan the surgery, use tissue-like models to practice the surgery and help us explain to parents and children what needs to be done. In the long term we are developing techniques in Bristol and Chicago to implant individualised biological tissue using the child’s own stem cells as a permanent one-stop repair to avoid repeat operations. The funds I have raised so far from commercial donations and my charity) have allowed us to open the unit last month making my channel swim worthwhile. On a perfect day at 0430am in the morning of 6th August 2018 I set off in the early dawn. My schedule was to swim for an hour and then take a feed and something to drink (and repeat this hourly) until I hit the French Coast. After much practice I found that rice pudding, boiled potatoes and jaffa cakes along with sports gels were my preferred food and warm black tea with honey was perfect for fluids with the occasional warm Coca Cola! The Channel temperature was kind, a balmy 17 C (normal swimming pools are around 30 C !). The bad stuff: jelly fish stings of which I had many. The jelly fish are found in the mid channel where the water is colder and deeper (known as the separation zone). Many swimmers give up here as you are 6-8 hours into the swim and can only see land in the distance, which can be demoralising. My coaches told me not to look forward or backward at this point. Sea sickness is another hazard and while my support crew suffered, I remained Ok. The last couple of hours is hard: in order to get there quickly, you need to land on the Cap Gris Nez in France. If you miss that, the tide turns, and your swim goes up by 4 hours as the French Coast goes away from you. This is the other place where swimmers abandon the challenge. As I approached the Cap Gris Nez, my coaches were urging me to speed up, not easy after 12 hours in the water. Fortunately, I just made the Cap with around 200m to spare.

My official time was 12 hrs 42 minutes and was also delighted to be awarded the Paul O’Clee Trophy by The Channel Swimming Association as the oldest successful swimmer of 2018 at 64 yrs old. I have sort of got the bug for cold water swimming, I am swimming Loch Ness this summer (fresh water and 11C), and I am thinking of swimming the North Channel that’s Ireland to Scotland in 2021(very cold lots of currents and lions mane jelly fish)! You can see a 5-minute film of my channel swim on U-tube. Before the swim I was contacted by a BAFTA award winning film maker, Sasha Snow who himself had cardiac surgery as a child. He has made an amazing film not only of the swim but also of the work we are doing on bioprinting. Enjoy the film: https://bit.ly/ThePrintedHeart Also, if you want to know more or feel moved to donate towards my project on baby hearts, please go to https://www.facebook.com/professorandywolf and http://bit.ly/andywolfjustgiving