Optimal general anaesthesis

name removed 23 Oct 2012 (Ataliwyd y cyfrif) made this Rhyddid Gwybodaeth request to Royal College of Anaesthetists
This authority is not subject to FOI law, so is not legally obliged to respond (manylion).


This request has been closed to new correspondence from the public body. Contact us if you think it ought be re-opened.

Roedd y cais yn rhannol lwyddiannus.

name removed 23 Oct 2012 (Ataliwyd y cyfrif)

Dear Royal College of Anaesthetists,

I have just found your link:

http://www.rcoa.ac.uk/docs/Risk_7confusi...

on confusion following an operation where general anaesthesia has been used.

You state that the information may be used and quoted so long as the source is stated to be the Royal College of Anaesthetits.

I wish to ask specific questions which relate to what has been stated in this document.

"Post-Operative Cognitive Dysfunction" is stated to be common after an operation and that the effects can last a few days but can last as long as 3 months, and that if there is associated infection this might complicate recovery.

What is the longest period of "post-operative cognitive dysfunction" known? Or maybe you can say if there has been any scientific documentation which shows that the effects of general anaesthesia might still be present several months, not just 3 months, after the original operation.

My concern is that the leaflet refers to doctors understanding that this is a common reaction whereas I query whether all doctors, nurses, physiotherapists, occupational therapists and psychiatric social workers, psychiatric nurses, psychiatrists and other health professionals actually recognise this in ALL cases, and whether there are some people who are MISTAKENLY believed to be psychiatrically ill when in fact they are not.

This would be a tragedy of epic proportions if a person was to go in to hospital, say, with a broken leg or broken arm or broken back, and end up in a mental health unit under Section 2 or 3 of the Mental Health Act or be subjected to the Mental Capacity Act 2005.

What safeguards are there to protect such patients? Do any exist?

What protection is there for patients who believe themselves to be normal but who have experienced auditory hallucinations after the operation, who may have acted bizarrely and even "inappropriately" and been "disinhibited" in their behaviour such as nakedness, exposing their breasts, or trying to take out drips, tubes and pins? I note that your leaflet does mention similar instances.

What clinical evidence and data are used to assist the friends and relatives of the patients who are thus affected?

What support mechanisms are in place to help the patients return to their "normal" behaviour?

Which anaesthetic drugs cause the worst "post operative cognitive dysfunction" in middle age patients presenting with a spiral fracture of the tibia and fibula with a BMI suspected to be between 30 and 33?

How do anaesthetists measure a patient to ensure that correct amounts of anaesthesia are given if the patient has not been weighed on account of having a broken leg? And also not measured, and therefore have to rely on guesstimate based on the patient or patient's relative saying what is believed to be the weight and height?

For I am concerned about the equipment that hospitals have to use in order to ensure that such patients are properly measured as it could it not be a matter of life and death not to have the appropriate information?

Do anaesthetists have special equipment to weigh such patients? And if so, what specifically? And is such equipment in all acute hospitals in the UK? Similarly with the measuring of height in non-ambulatory patients, how is this done accurately? Do you use laser or computer technology? Or what?

I would be most grateful for any information that can enlighten me.

Thank you very much for your help

Yours sincerely,

[first name removed] [last name removed]

name removed 23 Oct 2012 (Ataliwyd y cyfrif)

Dear Royal College of Anaesthetists,

I made this Freedom of Information Request on 3 January 2012.

Do you have an "automated" response email system or do you rely upon human interaction to process your emails?

May I please ask you to check your inbox to see if there is an email from WhatDoTheyKnow charity website with my request?

Thank you very much for your kind help

Yours sincerely,

[first name removed] [last name removed]

Reception, Royal College of Anaesthetists

Dear [first name removed],

I am so sorry, I have rechecked the inbox for the 03 January 2012 and I have no record of your e-mail.
Is it possible you could resend to [Royal College of Anaesthetists request email].

Once again I apologise for this.

Kind Regards
Sonia

dangos adrannau a ddyfynnir

name removed 23 Oct 2012 (Ataliwyd y cyfrif)

Dear Sonia,

Thank you very much for your response, and I am resending my application which is dated 3 January 2012.

I did wonder when I had not had an acknowledgement, which is why I wrote my follow-up.

I am most grateful to you

With best wishes

[first name removed]

3 January 2012
Dear Royal College of Anaesthetists,

I have just found your link:

http://www.rcoa.ac.uk/docs/Risk_7confusi...

on confusion following an operation where general anaesthesia hasbeen used.

You state that the information may be used and quoted so long as the source is stated to be the Royal College of Anaesthetits.

I wish to ask specific questions which relate to what has been stated in this document.

"Post-Operative Cognitive Dysfunction" is stated to be common after an operation and that the effects can last a few days but can last as long as 3 months, and that if there is associated infection this might complicate recovery.

What is the longest period of "post-operative cognitive
dysfunction" known? Or maybe you can say if there has been any scientific documentation which shows that the effects of general anaesthesia might still be present several months, not just 3 months, after the original operation.

My concern is that the leaflet refers to doctors understanding that this is a common reaction whereas I query whether all doctors, nurses, physiotherapists, occupational therapists and psychiatric social workers, psychiatric nurses, psychiatrists and other health professionals actually recognise this in ALL cases, and whether there are some people who are MISTAKENLY believed to be psychiatrically ill when in fact they are not.

This would be a tragedy of epic proportions if a person was to go in to hospital, say, with a broken leg or broken arm or broken back, and end up in a mental health unit under Section 2 or 3 of the Mental Health Act or be subjected to the Mental Capacity Act
2005.

What safeguards are there to protect such patients? Do any exist?

What protection is there for patients who believe themselves to be normal but who have experienced auditory hallucinations after the operation, who may have acted bizarrely and even "inappropriately"
and been "disinhibited" in their behaviour such as nakedness, exposing their breasts, or trying to take out drips, tubes and pins? I note that your leaflet does mention similar instances.

What clinical evidence and data are used to assist the friends and relatives of the patients who are thus affected?

What support mechanisms are in place to help the patients return to their "normal" behaviour?

Which anaesthetic drugs cause the worst "post operative cognitive dysfunction" in middle age patients presenting with a spiral fracture of the tibia and fibula with a BMI suspected to be between 30 and 33?

How do anaesthetists measure a patient to ensure that correct amounts of anaesthesia are given if the patient has not been weighed on account of having a broken leg? And also not measured, and therefore have to rely on guesstimate based on the patient or
patient's relative saying what is believed to be the weight and height?

For I am concerned about the equipment that hospitals have to use in order to ensure that such patients are properly measured as it could it not be a matter of life and death not to have the appropriate information?

Do anaesthetists have special equipment to weigh such patients? And if so, what specifically? And is such equipment in all acute hospitals in the UK? Similarly with the measuring of height in non-ambulatory patients, how is this done accurately? Do you use
laser or computer technology? Or what?

I would be most grateful for any information that can enlighten me.

Thank you very much for your help

Yours sincerely,

[first name removed] [last name removed]

Yours sincerely,

[first name removed] [last name removed]

Shirani Nadarajah, Royal College of Anaesthetists

Dear Ms [last name removed],

Thank you for your email. Which I have passed on to my senior colleagues for comment. I will get back to you as soon as I have some information for you.

Regards,

Shirani Nadarajah
Professional Standards Administrator

Professional Standards Directorate | Royal College of Anaesthetists | Churchill House | 35 Red Lion Square | London WC1R 4SG www.rcoa.ac.uk | Registered Charity No: 1013887 | Registered Charity in Scotland No:  SCO37737  | VAT Registration No:  GB 927 2364 18

dangos adrannau a ddyfynnir

name removed 23 Oct 2012 (Ataliwyd y cyfrif)

Dear mS Nadarajah,

Thank you very much for your speedy reply, and I look forward to receiving your data via this website WhatDoTheyKnow.

With best wishes,

Yours sincerely,

[first name removed] [last name removed]

Shirani Nadarajah, Royal College of Anaesthetists

16 Atodiad

Dear Ms [last name removed]

Thank you for your enquiry. The questions you ask are very complex, and there are, at present, few clearcut answers. The subject of postoperative cognitive dysfunction is the subject of much ongoing research, and I have attached a number of published papers which should be helpful.

Yours sincerely,

Shirani Nadarajah
Professional Standards Administrator

Professional Standards Directorate | Royal College of Anaesthetists | Churchill House | 35 Red Lion Square | London WC1R 4SG
www.rcoa.ac.uk | Registered Charity No: 1013887 | Registered Charity in Scotland No:  SCO37737  | VAT Registration No:  GB 927 2364 18

dangos adrannau a ddyfynnir

name removed 23 Oct 2012 (Ataliwyd y cyfrif)

Dear Ms Nadarajah,

I am most grateful to you and your colleagues for accessing this information. It is most useful and helps me and my family enormously.

Thank you so much

Yours sincerely,

[first name removed] [last name removed]

name removed 23 Oct 2012 (Ataliwyd y cyfrif)

Dear Royal College of Anaesthetists,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Royal College of Anaesthetists's handling of my FOI request 'Optimal general anaesthesis'.

I have expressed my gratitude already for being given very helpful links regarding anaesthesia but I am now requesting an Internal Review because I realise that my original Request for Information has not actually been answered in full.

Whilst I accept that you may or may not have representatives in each and every acute hospital in the United Kingdom, I would like to ask how you disseminate your knowledge and information to the people who are to have major surgery with general anaesthesia or even regional anaesthesia.

I ask this as a matter of grave importance because your excellent leaflet about Post-Surgical Cognitive Dysfunction would help many patients and their families and friends to understand why a patient may become so confused after surgery that they literally behave bizarrely such as pulling out surgical pins and equipment and that the staff of the hospital then consider that these patients have gone mad and maybe exhbiting schizophrenic type symptoms and behaviour of hallucinations, bizarreness such as walking around naked, "telepathy", "thought broadcasting", self-exposure, fiddling with a catheter and trying to take it out because it irritates them and then being considered to be bizarre and at risk for so doing, calling out, playing with their own faecal matter when constipated as the after-effect of surgery where anaesthetics have been used in tibia and fibula fracture surgery to emplace an os calcis pin, for example.

My true worry is that people might be found to be "schizophrenic" but when they are NOT actually schizophrenic.

It is of grave concern to me that you cannot give me the answers to my original questions, and therefore I would like to ask whether you SPECIFICALLY supplied all Healthcare Trusts in England including Acute and Mental Health Trusts with your documentation, including the one on Post-operative confusion?

I am very worried for patient safety that misdiagnoses may occur unless the hospitals treating patients are made FULLY AWARE - indeed a major campaign is required in my opinion to make the whole world aware - that people can be labelled with schizophrenia when actually there is something else wrong - and that a person with, say, long-standing depression and latterly PTSD, might be at much greater risk than the general population, irrespective of age, especially if that person is then found to have atrophied frontal lobes.

Your very helpful links do not apparently address such a person - such as a middle-aged person - with such a status and I would be most grateful to know how safe antipsychotic drugs such as Haloperidol, Olanzapine, Sertraline, Amisulpride and Clozapine are in relation to a person who has long-standing effects of post-operative confusion who then develops a sinus tachycardia and requires bisoprolol on top.

To me this needs to be investigated for patient safety if you have not already been informed of any such incident please take this as a hypothetical scenario.

A full history of my FOI request and all correspondence is available on the Internet at this address:
http://www.whatdotheyknow.com/request/op...

Yours sincerely,

[first name removed] [last name removed]

Campaigner for Liberty, Truth and Justice

Shirani Nadarajah, Royal College of Anaesthetists

Dear Ms [last name removed]

 

Thank you for your further correspondence on this matter.  All of our
patient information leaflets and professional guideline documents are
available free of charge to all users and providers of NHS and independent
healthcare services; however, we cannot direct their use by compulsion or
legislation; we are neither a regulator nor government body and we offer
all of our material as a beneficial service.  We are delighted to say that
professionals and patients inform us most UK healthcare institutions are
aware of our material and many make use of the various forms of literature
and electronic material we provide, but this is all through local choice
and we do not monitor who is, or is not, making use of it.  In addition,
you should be aware that there are other providers of anaesthesia
information to hospitals and some may choose one of these over this
College's material.

 

Finally, I should clarify that although the Freedom of Information Act
does not apply to this organisation, as we are not a public authority, we
endeavour to make all of our material on anaesthetic training, education
and standards of practice freely available with the obvious exception of
that related to named individuals.

 

I hope that helps clarify our position.

 

 

Charlie McLaughlan  MBA, MSc, MIoD
Director of Professional Standards
Royal College of Anaesthetists

 

 

 

dangos adrannau a ddyfynnir

name removed 23 Oct 2012 (Ataliwyd y cyfrif)

25 February 2012

Dear Mr Laughlan, Mr Turner MP for the Isle of Wight, Mr Cameron Prime Minister, Mr Lansley Secretary of State for Health,

Thank you very much for the excellent information you have provided to me already - and I do believe that all hospitals should be in receipt of your brilliant leaflet about post-operative cognitive dysfunction which really helped me.

Thank you so much,

Yours sincerely,

[first name removed] [last name removed]