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A Cut Above: Our Minor Surgery Course Receives RCS Ed Accreditation

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  • Dr Mike Smith
We’re delighted to announce that our minor surgery course has recently been accredited by the Royal College of Surgeons of Edinburgh. This milestone isn’t just a testament to our dedication but also a beacon of assurance for all current and prospective participants.

Setting the Standards in Minor Surgery Training

Earning accreditation from the Royal College of Surgeons is no small achievement. It signifies that our course meets the rigorous standards set by one of the world’s most respected surgical bodies. But what does this mean for you?

Firstly, it guarantees that our curriculum is comprehensive, up-to-date, and aligned with the latest advancements in minor surgery. The accreditation process involves a meticulous review of our teaching methods, faculty qualifications, and educational resources. This endorsement ensures that you’re receiving top-tier training that stands on par with international standards.

Precision Meets Excellence

Minor surgery demands not just technical skill but also an artistic touch—a balance of precision, confidence, and empathy. With this accreditation, we’re more committed than ever to fostering these qualities in our participants. Our course delves deep into the nuances of minor surgical procedures, patient care, and post-operative management.

Why This Matters to You

In an ever-evolving medical landscape, continuous professional development is crucial. This accreditation adds significant value to your credentials, signaling to peers and employers alike that you’ve received training vetted by a leading surgical institution. It opens doors to advanced opportunities, networking with esteemed professionals, and staying abreast of the latest surgical techniques and best practices.

Achieving accreditation is not our endpoint but a stepping stone. It fuels our dedication to ongoing enhancement of our course. We’ll continue integrating the latest research, adopting innovative teaching tools, and soliciting feedback to ensure our program remains at the forefront of minor surgical education.
Picture of Dr Mike Smith

Dr Mike Smith

Mike is a GP Partner in Knebworth. He has also held many senior NHS leadership roles across primary, secondary and community care. He has been lecturing for nearly 20 years and having made the switch from plastic surgery to General practice many years ago, continues to perform enhanced minor surgical procedures in his practice.

Learn more about Minor Surgery

Read on to see our full course syllabus

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“Can’t Stop the Feeling”: The Use of Music During Minor Surgery

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  • Dr Mike Smith
Anyone who has been involved in minor surgical procedures for any length of time will likely have considered the use of music in the operating room. I have been playing music in my operating room for over 20 years—not just because I’m a massive Taylor Swift fan (that’s just a coincidence).

Recently, during a surgical list, I wondered whether I was playing music for my own benefit, for the patient, or for my assistant—or whether there was any actual science behind it.

The Sound of Silence (Is Overrated)

The reality is that an operating theatre without music can be as quiet as a library, with the peace broken only by the occasional sound of instruments clattering or a muttering from the surgeon.

Silence can be unnerving for a patient. Background music not only fills awkward silences but also aids in focus and reduces anxiety. A quick review of the literature reveals more evidence on this topic than one might expect.

The conclusion is that music actively reduces patient anxiety and can enhance the surgeon’s focus. Studies like the one by Narayanan and Gray (2018) describe how music has the power to maintain calm and boost concentration during procedures.

All minor operations we perform are under local anesthesia, so the patient is wide awake. Every note of music helps to drown out the unnerving sounds of surgery—a snip, a buzz, a squelch—and provides a psychological barrier for the patient against the stress of the situation.

Choosing Your Tunes

Not every track is appropriate for the operating room. Playing energetic songs like “Mr. Brightside” might set your heart racing and your foot tapping in all the wrong ways, especially if you’re about to remove a delicate cyst.

I suggest that instrumental tunes, without catchy lyrics, keep everyone’s rhythm steady and might be more conducive to a successful (unruptured) cyst removal.

My personal go-to is the “Ibiza Sunset Chill” playlist—nothing says “relax” quite like feeling as if you’re watching a beach sunset instead of being in a GP practice.

Implementing Musical Interventions

Music in the operating theatre has its own set of protocols:

  • Volume: It’s about balance. You want enough volume to drown out the whirr of machines but not so loud that it becomes overwhelming or distracting.
  • Selection: While we might be tempted to listen to “God’s Plan” by Drake or Taylor Swift’s latest hits, instrumental pieces or ambient sounds often make the best playlist candidates. They provide the benefits of music without the risk of lyrical distractions.
  • Consensus: While it’s not a democracy, getting approval from the patient and assistant over the playlist can turn music from a potential irritant into a therapeutic tool. If they’re not fans of my chill-out tracks, I’m ready to switch to something more universally calming, like the sound of ocean waves or the “Best of Enya.”
 

Adhering to Licensing Laws

In the UK, a GP minor surgery operating room doesn’t just need to worry about its playlist—it’s also about adhering to licensing laws. For commercial music, we need to secure permissions through PRS for Music and PPL to ensure everything is legal. This covers us for playing most commercial tracks during procedures. Even if you are by yourself, if you play music in the workplace, you expose yourself to this challenge.

Alternatively, there’s a simpler option available through royalty-free music. Platforms like the Free Music Archive, Jamendo, or the YouTube Audio Library offer a wide selection of tracks that can be used freely without the typical licensing required for commercial songs, making them a straightforward choice for creating a calm atmosphere.

However, it’s worth noting that some people opt to play music without securing a proper license. This approach carries a risk, as it could lead to legal issues or fines. It’s always safest to ensure all music use complies with licensing requirements to avoid any potential problems.

The Prospective Symphony of Surgery

There is a growing consensus that music and surgery go together like the epidermis and dermis. Research, including a systematic review by El Boghdady and Ewalds-Kvist (2020), echoes this sentiment, suggesting music can be as crucial to surgical performance as a steady hand—provided the tracks are chosen as carefully as the surgical instruments.

It’s not just about playing something in the background; it’s about orchestrating an environment that promotes healing. And if we hit the right notes, the operating theatre becomes less daunting, more comforting – a place where the only thing sharper than the scalpel is the playlist.

References

Narayanan, A., & Gray, A. R. (2018). First, do no harmony: An examination of attitudes to music played in operating theatres. ResearchGate. El Boghdady, M., & Ewalds-Kvist, B. M. (2020). The influence of music on the surgical task performance: A systematic review. International Journal of Surgery.
Picture of Dr Mike Smith

Dr Mike Smith

Mike is a GP Partner in Knebworth. He has also held many senior NHS leadership roles across primary, secondary and community care. He has been lecturing for nearly 20 years and having made the switch from plastic surgery to General practice many years ago, continues to perform enhanced minor surgical procedures in his practice.

Learn more about Minor Surgery

Read on to see our full course syllabus

READ MORE
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Lidocaine with Adrenaline: Where to get it?

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  • Dr Duncan Hill

When operating on a conscious patient, screams of agonising pain can be distracting, and so it is generally preferable use a local anaesthetic. 

In primary care minor skin surgery, fast acting lidocaine (1% or 2%) is our local anaesthetic of choice. However, in a hospital setting, it’s routine to use a mix of lidocaine with adrenaline.

Adrenaline is commonly found on the resuscitation trolley, but why is it on the surgical trolley?

Adrenaline acts as a vasoconstrictor, meaning it constricts the superficial blood vessels in the dermis. This keeps the local anaesthetic at the injection site for longer, reducing its systemic absorption.

This has several (theoretical) benefits:

  • it allows the use of more lidocaine before reaching a toxic dose level;
  • it will produce a more effective anaesthetic block;
  • it reduces the amount of bleeding at the operation site;

The toxic dose of lidocaine is 3mg/kg. This doubles to 5-7mg/kg when you add adrenaline. Most minor skin surgery procedures will use a maximum of 3 – 4ml of local anaesthetic, and so reaching a toxic dose is unlikely, with or without adrenaline.

Lidocaine on its own lasts for about 2 hours. Using lidocaine with adrenaline can extend this to around 3 hours. This is not particularly helpful in a 20–30-minute procedure.

In practice, the primary reason most use lidocaine with adrenaline is to reduce the amount of bleeding, and to improve the overall effectiveness of the anaesthetic.

Sounds great. Why can’t I get hold of it?

Over the last 12 months the major medical suppliers have had constant supply problems of pre-mixed 1% lidocaine with adrenaline (commonly sold as Xylocaine 1% with adrenaline, but there are other brands).

There is much speculation: some suggest hospitals are hoarding stock, or manufacturers are producing less due to low profit margins. Indeed, the latter is certainly part of the issue, as two companies have ceased production, leaving Fresenius Kabi and Pfizer as the sole remaining manufacturers.

There has also been a shortage in the supply of adrenaline, with available stocks understandably prioritised for more urgent needs.

What are the alternatives?

If you’re struggling to get hold of lidocaine 1% with adrenaline, our tutors recommend the following alternatives:

Search for another source or brand

Though these alternatives brands may be unlicensed or face the same availability issues. Maintaining a good relationship with your local pharmacist can be beneficial, as they are often adept at tracking down a supply.

Forego the adrenaline

Use only lidocaine at either 1% or 2%, which will still provide an adequate anaesthetic block. Just remember the maximum toxic dose of 3mg/kg.

Use 2%

Some of our tutors have had luck sourcing 2% lidocaine with adrenaline, although this is now also in short supply.

Mix your own

Surprisingly, it’s not that complicated and just requires a bit of preparation. It’s noted that the adrenaline concentration when mixed with local anaesthetic is 1:200,000 (5mg/ml), whereas the concentration used on the resuscitation trolley is 1:10,000 (100mg/ml). One could dilute the 1:10,000 adrenaline to 1:200,000 and then add it to lidocaine. Indeed, this is a common practice in hospitals.

The Leeds Pharmacy Service has provided a very simple guide for this process: just adding 1ml of 1:10,000 adrenaline to 20ml of lidocaine 1% or 2%. Read here.

Copy the dentists

Dentists use a single-use injectable cartridge with a mix of adrenaline and lidocaine. This requires a steel syringe into which a single-use cartridge is placed. The adrenaline concentration in this is slightly different at 1:80,000, which is acceptable for use in a local anaesthetic skin block. Sold here.

The challenge here is the cost implication. The steel syringes are expensive and generally intended for sterilisation/reuse —a capability dentists have, but may not be financially viable in NHS Primary and Community Care.

It has been suggested you could insert a green needle into the dental cartridge and draw up into a normal disposable syringe. The cartridges are not designed for this though, as they require positive pressure to release their contents.

What’s the conclusion?

A lidocaine-adrenaline mix is a superior option in minor skin surgery, as it provides a better anaesthetic block and reduces bleeding.

However, with the current supply issues, we either need a bit of ingenuity, something primary care professionals are very familiar with, or we revert back to humble old lidocaine.

Picture of Dr Duncan Hill

Dr Duncan Hill

Duncan has extensive surgical experience, having trained in general surgery and neurosurgery before becoming a GP. He has interests in muscular-skeletal medicine and is a Minor Surgery GPwSI, performing Carpal Tunnel Decompressions, etc. He is a senior trainer for Medical Skills Courses, and the Clinical Lead for an extended Minor Surgery services in Walsall.​

Learn more about Minor Surgery

Read on to see our full course syllabus

READ MORE