Medical Specialist Group

- Anaesthetics, Intensive Care and Pain Medicine -

The Department of Anaesthetics is a Consultant only service provided by eight specialist anaesthetists. Approximately 9000 anaesthetics per year are performed in Guernsey.

The Intensive Care Unit has been substantially upgraded in recent years with modern state of the art equipment for the care of some of the sickest patients in the hospital. An ongoing audit of all patients allows us to compare our outcomes with other Intensive Care Units. Guernsey's performance profile is extremely good with patient outcomes following Intensive Care treatment being better than most UK centres. Intensive Care facilities are constantly being upgraded and a new combined Intensive Care / High Dependency Unit is planned for the future.

Pain Medicine has also evolved greatly in recent years and the Department now offers regular review and advice through the Pain Clinic at Alexandra House as well as Outpatient / Inpatient procedures at the Princess Elizabeth Hospital. There are close links with Le Bourgs Hospice and other Pain Clinics in the UK.

Personnel:

Consultants	Dr G. Beck FRCA Dr. A.S. Boyle FRCA Dr J A Chandler FRCA Dr H F Holland FRCA Dr. C. McClymont MB BS FRCA FANZCA FFPMRCA Dr N. van Heerden FFA (SA) FRCA Dr. M.J. Wolfe FRCA Dr. G.D. Yarwood FRCA
Secretarial Staff	Mrs Nancy Renouf - PA to Drs Boyle, Chandler and Wolfe Mrs Justine Quesnel - PA to Drs McClymont and Yarwood Mrs Steph Miller - PA to Drs Beck, Holland and Van Heerden

Services provided by the Department of Anaesthetic Intensive Care and Pain Medicine

Anaesthetics

Patients are seen at Preoperative Anaesthetic Assessment Clinics to assess their suitability and fitness for their operation and anaesthetic. The aim is that patients should be as fit as possible prior to their anaesthetic. Patients are given a form to complete and bring to the clinic that provides us with a brief medical history.

Anaesthetic services are provided for General Surgery including Breast and Vascular, Orthopaedics, ENT, Gynaecology, Urology, Endoscopy, Hospital Dental (a non-Contract service), Cardioversions, Obstetrics and Ophthalmology.

Emergency cover is provided for each of the above specialities including a 24-hour Epidural service and a transfer service for critically ill patients off the Island. There are two Consultants on-call at all times for emergencies.

Anaesthetic assistance is provided by Operating Department Assistants and Anaesthetic Nurses with Mr Graham Cooper as Chief ODA. Guernsey now has its own training programme for ODA's.

Intensive Care Medicine

Five morning sessions per week are used solely for ICU. Dr. Yarwood covers Monday to Wednesday. Dr. McClymont Thursday and Friday. Each covers the other when absent. Both Surgical and Medical patients from all disciplines are cared for.
We have facilities for invasive monitoring to a high standard and can Haemofilter patients using our Prisma Haemofiltration Unit, which has been in use for one year. Our ventilators allow us to use an increasing number of modes of ventilation including non-invasive ventilation via a facemask.

Pain Medicine

This service is run by Drs McClymont and Boyle.
Chronic Pain Clinics are held at Alexandra House on Wednesday and Friday afternoons and include acupuncture by Dr Boyle.
Pain block session's are performed on Monday, Tuesday and Thursday afternoons.
Procedures performed include Epidurals (caudal, lumbar, thoracic, cervical), facet joint injections, intravenous local anaesthetic blocks with physiotherapy, stellate ganglion blocks, coeliac plexus blocks, lumbar sympathectomies, various nerve blocks including cryoanalgesia and radiofrequency lesioning of nerves.

A fast-track epidural service is offered where patients with lumbar nerve root entrapment are offered a direct appointment to have an epidural steroid injection followed two weeks later by an appointment to see one of the orthopaedic surgeons to guide further management.

TENS machines are given to patients with instruction in their use by the Practice Nurses.

Dr McClymont attends Le Bourgs Hospice on a Thursday at 12.30 to advise and assist with the management of patients there.

Each consultant anaesthetist reviews the acute pain needs of his own patients. In addition the on-call anaesthetist is available for advice on acute pain. A dedicated Acute Pain Service for inpatients is currently being planned.

Chronic Pain rarely presents as an emergency problem though patients can be seen at short notice if required.

Services for Private Patients

With the exception of Dental Anaesthetics (a non-Contract service only), all of the above services are provided for both Contract and Private Patients.