The UK defence anaesthesia experience with the Zambia Anaesthesia Development Programme.

For 18 months UK military anaesthetic trainees have been travelling to Zambia for a 3-month fellowship under the auspices of the Zambia Anaesthesia Development Programme. In this article we will discuss the history, current state and future intent of the fellowship in order to better inform the anaesthetic cadre and wider UK Defence Medical Services.

Penetrating paediatric thoracic injury.

Paediatric penetrating chest trauma is common in conflict, but rarely seen in peacetime. We describe the successful hospital management of a five year old female civilian casualty with life threatening penetrating thoracic trauma caused by a fragment from an explosive device.

The incidence of seizures following Deep Brain Stimulating electrode implantation for movement disorders, pain and psychiatric conditions.

Deep Brain Stimulation (DBS) for neuromodulation is now commonplace. However little is known about the incidence of either procedural related seizures or epilepsy following chronic DBS. This study aims to provide estimates of these complications for movement disorders, pain and psychiatric conditions. A literature review was performed. Because searches using the terms seizure, epilepsy, and deep brain stimulation revealed only papers dealing with experimental and clinical application of DBS to treat chronic seizures disorders, a search strategy trawling through papers that described clinical case series of DBS was used. Thirty-two papers were reviewed that described stereotactic placement of DBS electrodes for movement disorders, pain syndromes and psychiatric conditions with cohorts of n > 5. Sixteen of these papers describing at least 1418 DBS electrode placements in 1254 patients did not mention seizures as a complication (i.e., it was not possible to know whether seizures had or had not occurred). In 16 papers, describing at least 2101 electrode placements in 1555 patients, seizures were described in 42 patients (incidence 2.7%). The range of seizure incidence varied from 0% (three series encompassing 317 patients and 576 electrode placements) up to 10% (n = 130) and 13% (n = 15). The reasons for this variance were not obvious. At least 74% of seizures occurred around the time of electrode implantation and many of these patients also suffered intracranial hemorrhage. Follow up times were variable (range 6 mths to 5 years). The analysis was complicated by multiple publications from some centres with duplication of some data. The quality of literature on seizures following DBS insertion for neuromodulation is highly variable. Analysis of the available data, after making corrections for publication of duplicate data, suggests strongly that the risk of seizures associated with DBS placement is probably lower than 2.4% (95% CI 1.7 to 3.3 %). The risk of postprocedural seizures associated with chronic deep brain stimulation is even lower with best estimates around 0.5% (95% CI .02 to 1.0%).

Defence Anaesthesia transition from the Tri-Service Anaesthetic Apparatus to the Diamedica Portable Anaesthesia Machine 02.

Defence Anaesthesia is changing its draw-over anaesthetic capability from the Tri-Service Anaesthetic Apparatus (TSAA) to the Diamedica Portable Anaesthesia Machine 02 (DPA02). The DPA02 will provide a portable, robust, lightweight and simple method for delivering draw-over volatile anaesthesia with the option of positive pressure ventilation through manual or mechanical operation for paediatric and adult patients. The UK Defence Medical Services uses a modified configuration of the DPA02; this paper seeks to explain the rationale for the differing configurations and illustrates alternative assemblies to support integration with other Defence Anaesthesia equipment. High-fidelity simulation training using the DPA02 will continue to be delivered on the Defence Anaesthesia Simulation Course (DASC). Conformité Européenne accreditation of DPA02 supports future UK live patient training in centres of excellence supervised by subject matter experts; this was not possible with the TSAA. This article is intended to be a key reference for all members of the Defence Anaesthesia team. Alongside other resources, it will be given as precourse learning prior to attending the DASC and the Military Operational Surgical Training. This article will also be issued with all Defence DPA02 units, supporting ease of access for review during future clinical exercises (including validation), prior to supervised live training and on operational deployments.