Anaesthesia and Intensive Care’s May issue available now!

Date: 10 May 2017

Anaesthesia and Intensive Care
’s May issue is another scintillating read for those interested in anaesthesia and intensive care alike! Our Correspondence is getting interesting with replies all around; and Chief Editor, Neville Gibbs, has written a fascinating Editorial on NFRs and shared decision-making.

We also acknowledge the passing of Professor Ross Holland, who was a significant contributor to the Journal. He will be sadly missed.

Our Original Papers range from the patient’s perspective of cardiopulmonary resuscitation by Wee et al, to the relationship between functional status prior to onset of critical illness and mortality by Rivera-Lopez et al; and the effect of RRS revision on standard and specific ICU outcomes in a regional hospital by Ohashi-Fukuda et al.

In addition to the array of Original Papers, there is also an in-depth Point of view – Coming full circle: thirty years of paediatric fluid resuscitation – by Glassford et al, and a Review of Endothelial glycocalyx by Pillinger et al.

For more information please visit:

Epidemiology of Critical Care provision after Surgery (EpiCCS)
Date: 26 April 2017

EpiCCS will describe the epidemiology of perioperative risk and outcome and critical care referral after inpatient surgery in Australia. It also aims to examine whether planned postoperative critical care admission is effective as an intervention to reduce postoperative morbidity.

EpiCCS is supported by the Australian Society of Anaesthetists (ASA) and the Australian and New Zealand College of Anaesthetists Clinical Trials Network (ANZCA CTN).

The principle investigator is Professor Paul Myles (Alfred Hospital, Melbourne) and the National Trainee Lead is Dr Scott Popham (ASA Trainee Member Group Chair, based at Gold Coast University Hospital).

Date of study: Patient recruitment will commence at 0700 on Wednesday the 21st June and end at 0659 on Wednesday the 28th June. There is a 7-day and 60-day follow up.

Inclusion: Patients included are all patients aged 18 years and over undergoing any surgery or procedure requiring the support of an anaesthetist and who are expected to require an overnight stay.

Data collection methods: CRFs will be distributed by the site lead at the participating hospital. The site leads are anaesthetic registrars who have liaised with their departments prior to the data collection date, and should be known to each department.

Aside from the main patient data CRF there is a Clinician Perception CRF which requires completion. The questions on these forms explore clinician approach to risk stratification and decision making around postoperative care. The clinicians invited to complete them are

  • - Anaesthetists
  • - Intensivists
  • - Surgeons

Nurses in charge of ICU/HDU within the participating hospitals will be approached twice a day to survey critical care occupancy status.

If you have any further questions please contact the site lead at your hospital or Scott Popham.

Shortage of Dantrium powder

Date: 19 April 2017
Update: Information about Ryanodex (dantrolene sodium), temporary substitute to Dantrium, available here

7 April 2017 
Shortage of Dantrium powder for injection 20 mg (for intravenous injection) vials and alternative supply arrangement under Section 19A of the Therapeutic Goods Act.

The ASA has received communication from Pfizer regarding the following:
- DANTRIUM® powder for injection 20 mg (for intravenous injection) AUST R 14435 sponsored by Pfizer Australia Pty Ltd is unavailable due to an unexpected third party manufacturing issue.
- It is expected to be back in stock by late December 2017.
- Pfizer has arranged a supply of an alternative product, RYANODEX® (dantrolene sodium) for injectable suspension (250mg) on a temporary basis.
- This product is NOT registered in Australia and supply is authorised under an exemption granted by the Therapeutic Goods Administration (TGA) under section 19A of the Therapeutic Goods Act 1989 until late May 2017.

For more information please see here

Date: 7 April 2017

Due to an overwhelming response applications for the Real World Anaesthesia Course have now closed. 
You are welcome to send an email enquiry if you would like information about the next course, please contact Sally Gelton Smith.
The aim of RWAC is to prepare anaesthetists for work in low and middle income countries (“the real world”) and a variety of humanitarian and civil disaster situations. The course consists of a series of interactive lectures, problem discussions, practical equipment sessions and in-theatre teaching of drawover anaesthesia. A simulation session is also planned.

Topics will include:

• Drawover equipment
• Ketamine
• Oxygen concentrators
• Equipment maintenance
• Obstetric and paediatric challenges
• Teaching – who, how and what
• Psychology of adaptation
• Ethical dilemmas
• Tropical medicine
• Trip preparation

The number of participants is limited to 18 to maximise interaction and hands-on learning. The course has previously been oversubscribed and places are allocated on a “first in, first on” basis.

Medical specialists - maintaining a high standard and duty of care.

Date: 23 March 2017

In recent times, several articles have appeared in the print and electronic media about the alleged ‘high fees’ and ‘poor accountability’ of medical specialists. A few weeks ago on his ‘Pearls and Irritations’ blog, John Menadue posted one such piece titled ‘Medical specialists – high fees and poor accountability. The ASA believes that some of John Menadue’s strongly asserted claims merit a measured response, and wishes to address some misconceptions that have arisen. There are almost 5,000 specialist anaesthetists in Australia, and they comprise approximately 4.5% of the nation’s medical workforce. To read the full article please click here.

President's Letter to the West Australian's Editor 

Date: 09 March 2017

Re: ‘WA’s Specialist Fees Verge on greed’ article by Cathy O’Leary Medical Editor 

Dear Editor

I write following your article ‘WA’s Specialist Fees Verge on greed’ by Cathy O’Leary Medical Editor (West Australian 8 March, 2017). It is disappointing that this article confuses increasing medical costs and an ongoing eight-year freeze on Medicare and Health Insurance benefits with greed. The report in the MJA highlights that although the costs associated with running medical practices continue to be subject to inflation, income from Medicare has been continually cut by successive governments and is now in the middle of an eight-year freeze. Yet during this time secretarial wages and nursing wages have increased, rents have gone up, as have electricity costs. Doctors must meet the cost of running a practice to ensure they provide the highest quality service to their patients. There is no desire to disadvantage their patients, but without the support of their staff and the ability to cover the costs of doing business there would be no service at all.

The author then discussed the case of their relative who had a ‘bit of a toothache’. If this were the case then a simple visit to the dentist should have solved the problem. Clearly the need to go to a surgeon and have general anaesthesia indicated something far from trivial. From the information in the article it would appear that the health insurer did not provide a full level of benefit cover for this patient. Unfortunately, many health funds have a myriad of technical rules that allow them to reduce the level of benefit paid to their policy holders. This is often not clear to them. It appears likely the insurer’s arbitrary fee was inadequate, and in this case of was well under half of the AMA fee.

As the freeze on Medicare rebates continues your readers should know that 76% of services for anaesthesia attract no out of pocket expenses at all. Of those services that do have out of pocket cost the average is about $85 per service.

Specialist doctors and General Practitioners will continue to charge patients for the work they do. Costs will continue to rise. If the Medicare freeze and lack of indexation of health insurance benefits continues then it will be the patient who pays more out of their own pocket. It is important that our patients are aware of this. It is also important that doctors should ensure that our patients are not surprised by these costs and that their ability to pay be considered when setting fees that will result in out of pocket payments.

Kind Regards

Associate Professor David M Scott
Australian Society of Anaesthetists

2017 VIC Annual General Meeting & Annual Dinner


DAY:     Sunday, 5th March 2017
TIME:    7.00 pm to 10.00 pm
VENUE:  Kooyong Lawn Tennis Club, 489 Glenferrie Road, Kooyong VIC 3144

We will be honoured and proud to welcome our guest speaker, Dr Tony Atkinson.
Tony, a retired anaesthetist, has published a book about his memoirs called A Prescribed Life. While he forged a successful career as an anaesthetist, his greatest gift may be for telling rousing tales. Listen to Tony tell incredible true stories from his life in England and Australia, providing a behind-the-scenes glimpse of England’s royal family.
Please advise of any special dietary requirements along with RSVP to Mary Vassilacos by Sunday, 26th February 2017.

Please download papers for the 2017 AGM:
1.    AGM Notice
2.    AGM Agenda
3.    AGM Minutes 2016
4.    Appointing a Proxy Form
5.    Request for Notice of Motions Form
6.    Office Bearer’s Nomination Form

Letter to The Australian's Editor

Date:  25 January 2016

Our President Associate Professor David M Scott wrote a letter to The Australian's Editor in response to the recent article “Specialists’ fees drive up out of pocket costs for patients” (The Australian, published on 23 Jan 2017).
Please click here to read the letter.

Anaesthesia and Intensive Care Junior Research Award


Date: 12 January 2017

Applications are invited from ASA, NZSA, or ANZICS members who are in training or within five years of their specialist qualification for the Anaesthesia and Intensive Care Junior Research Award.
To be eligible, applicants must be the first author of a paper published in ‘Anaesthesia and Intensive Care’ in 2016. Ideally the paper would describe work conducted in Australia or New Zealand.
The award will be made on the basis of the scientific merit and originality of the paper. The award will be made separately to the ‘Jeanette Thirlwell Anaesthesia and Intensive Care Best Paper Award’.
The prize consists of AUD $2,000 plus expenses to attend the annual ASA National Scientific Congress to receive the award.
Applications in the form of a letter indicating the name of the paper and the date published should be addressed to the Chief Editor, Anaesthesia and Intensive Care via email by 30 April 2017.

AIC Journal 45.1 now available!

Date: 12 January 2017

The January issue of Anaesthesia and Intensive Care discusses the use of strychnine for the treatment of shock in the cover note, while the editorial Correctly name your poison by L.S. Weber reports on the use of new drug names as decreed by the Therapeutic Goods Administration.

Abstracts of the recent Australian Society of Anaesthetists 75th National Scientific Congress held in Melbourne, are also featured in this issue. For more information please update the AIC App or visit


Call for Nominations for ASA Trainee Members Group  - Committee Chair 2017 - closes 13 February 2017
Date: January 2017

All ASA Trainee Members are eligible to nominate themselves for this position. 
Please contact Maxine Wade, ASA TMG Secretariat on for information.

ASA Trainee Members – International Scholarship Guidelines 2017
Date: January 2017

The ASA has developed close relationships with other international anaesthetic associations under the banner of the Common Interest Group (CIG). This includes a broad scope to the advancement of anaesthesia, patient safety, workforce issues, training and development.As part of this, the ASA understands the value of trainees attending these conferences - learning and sharing experiences and common issues. The ASA is offering three scholarships each year valued at $4,000 to assist trainees with the travel costs to attend one of these international meetings.

Canadian Anesthesiologists Society Annual Meeting
Ontario, 23-26 June 2017

 Association of Anaesthetists of Great Britain and Ireland Annual Scientific Meeting
Cardiff, 5-7 July 2017

American Society of Anesthesiologists Annual Meeting
Boston, 21-25 October 2017

Please click and download Guidelines and Application form.

Relative Value Guide (RVG)
 - History and Advantages
Date: 6 December 2016

In light of the current Medical Benefits Schedule review, I believed it timely to provide a brief history of the origins of the Relative Value Guide and its advantages over the previous system. Please read below:

Dear Colleague,

Some information about the Relative Value Guide (RVG) for anaesthesia.

History and Introduction

  • Introduced into the Medicare Benefits Schedule (MBS) in 2001 after a 30-year campaign by the ASA. It had been first devised in 1951 and then adopted by the American Society of Anesthesiologists in 1961. It has been developed and improved by anaesthetists over 70 years and accurately reflects the relative value of anaesthesia work for every anaesthetic.
  • The previous (bundled) MBS system was tied to the work said to be done by the surgeon. This meant that the anaesthetist could wait weeks or months to obtain the surgeon’s item numbers before an account could be sent. Payment was calculated on a time estimate which was nearly always incorrect, and there were no modifiers for age, physical status nor emergencies.
  • The RVG was introduced in 2001 after a 5-year planning process with the Government, on a cost neutral basis. (Government had agreed in 1996 that it was a vastly superior system for determining fees and rebates however insisted it be introduced at no extra cost)
  • New items such as modifiers and emergency loadings meant the then unit value was reduced to keep cost neutrality, and that it was subsequently frozen for two years to achieve this.

Advantages of the RVG over “bundled billing” (previous MBS system)

  • Fees and rebates are based on the anaesthesia performed, not the surgery. Through its design, the RVG as a limited number of base items which automatically accommodate new surgical techniques, (e.g. “Anaesthesia for cardiac surgery” covers any new heart surgery that the surgeons develop.)
  • The use of real time means every anaesthesia fee and rebate accurately reflect the actual time taken, and as procedures become quicker or slower the fees and rebates change accordingly. 
  • The RVG in that sense is virtually always “up to date” (unlike almost every other part of the MBS)
  • Modifiers for age, physical status and emergencies acknowledge the increase in anaesthesia risk and complexity associated with these patients.
  • Items such as for insertion and monitoring of arterial or central venous catheters and blood transfusions had been in the MBS for all doctors since the MBS was first introduced, acknowledging the risks and skills required for these procedures. When the RVG was introduced  these items were given a unit value and incorporated on a cost neutral basis. These procedures are done by a wide range of doctors other than anaesthetists, particularly 
  • The RVG is regarded as simple to use and understand by insurers as well as anaesthetists and their patients. If an insurer wishes to increase or decrease their total anaesthesia expenditure they simply adjust the unit value up or down. 

In summary

The Relative Value Guide is a simple, elegant system for determining anaesthesia fees and rebates which accurately reflects the relativity of different anaesthesia services and automatically adjusts to changes in medical practice.

A/Professor David M Scott
ASA President