Anesthesia Techniques and Areas of Expertise

Dr. Griffiths, a highly skilled anaesthetist, specializes in employing a range of advanced anaesthesia techniques to optimise patient care, particularly for procedures such as breast reconstructive surgery. He tailors the anaesthesia techniques to meet the unique needs of each patient and surgical procedure, ensuring the highest level of safety and effective post-operative recovery. 

Dr. Griffiths is adept at administering general anaesthesia, which induces a reversible state of unconsciousness, allowing patients to undergo surgery comfortably and safely. In addition, he provides regional and local anaesthesia techniques that target specific areas of the body for pain control, minimizing the need for general anaesthesia. 

Before procedures, Dr. Griffiths conducts thorough preoperative assessments, including cardiopulmonary exercise testing, to evaluate each patient's health status. Throughout the surgical procedures, he closely monitors patients' vital signs, adjusting medications as needed to maintain optimal levels of sedation, analgesia, and muscle relaxation. He collaborates with his surgical consultant colleagues to ensure seamless coordination between anaesthesia and the required surgical or medical intervention, including sedation services.

Dr. Griffiths is a Pre-operative Exercise Testing and Evaluation accredited physician specializing in preoperative assessment for patients, including those considering breast reconstructive surgery. A key component of this assessment is cardiopulmonary exercise testing (CPET), a specialized diagnostic tool that offers valuable insights into your cardiovascular and respiratory fitness. During CPET, you will engage in an exercise regimen while your heart rate, oxygen consumption, and other vital parameters are closely monitored. Recognized as the gold standard risk assessment tool, CPET is essential for patients undergoing higher risk surgery, particularly in the context of sedation services. 

The following is a link to the Perioperative Exercise Testing and Training Society of the United Kingdom.

https://ipoetts.org

Preoperative assessment is a crucial step in the surgical journey, ensuring that patients are well-prepared for their upcoming procedure, including those undergoing breast reconstructive surgery. Dr. Griffiths served as the pre-operative lead for the OUH NHS Trust from 2012 to 2017, during which he founded a high-risk anaesthetic clinic at the Churchill Hospital. This clinic has thrived under his successors, significantly reducing peri and post-operative complications, and ultimately improving surgical outcomes for patients, including those needing sedation services within the OUH Trust. This important work was highlighted in a local news article: https://www.oxfordmail.co.uk/news/11438698.pre-op-test-gets-heart-matter/.

Drawing from his extensive experience in preoperative assessment gained in the NHS, Dr. Griffiths was appointed as the National Medical Lead for Nuffield Health from 2018 to 2019. In this role, he collaborated closely with the Nuffield Health Nursing Lead for Pre-operative Assessment to modernise and standardise assessment processes in the private sector, including cardiopulmonary exercise testing for patients evaluated for higher risk surgery.

Dr. Griffiths is a highly experienced consultant anaesthetist specializing in the provision of anaesthesia for major breast reconstructive surgery procedures. He has a special interest in enhanced recovery after surgery (ERAS) pathways and has been instrumental in developing and implementing an ERAS pathway specifically for patients undergoing breast reconstruction surgery. This ERAS Pathway, evolving over 10 years, is designed to optimize the preoperative assessment, intra-operative, and post-operative care of women undergoing this complex surgery, which began with a national survey of anaesthetic practice in 2014.

Overview of the ERAS Pathway

The primary goal of the ERAS Pathway is to streamline the surgical and anaesthetic processes for breast reconstruction, ensuring that the patient experience is as efficient and evidence-based as possible. The pathway emphasizes thorough preparation of patients before surgery, focusing on pain management through multimodal analgesia (primarily administered orally), and ensuring a swift recovery process.

Since its inception, nearly 100 patients have undergone breast reconstructive surgery using the ERAS Pathway, resulting in excellent outcomes.

Key improvements include:

• Enhanced post-operative pain management using a multimodal analgesia approach.

• Reduced length of hospital stay, averaging 3-4 days.

• Improved patient experience throughout the surgical journey.

Key Achievements

The success of the ERAS Pathway is evident in its recent adoption at Mater Dei University Hospital in Malta. Under Dr. Griffiths and Mr. Peter Kalu's leadership, the pathway was utilized for the first two breast reconstruction surgeries in the country since the past-COVID hiatus. Both patients had successful outcomes, with hospital discharge occurring on post-operative day 5 and 6, respectively. This international implementation underscores the effectiveness of the pathway, highlighting Dr. Griffiths' contribution to improving surgical care, his expertise in anaesthetics, and his commitment to patient-centered care, while also including cardiopulmonary exercise testing as part of the preoperative assessment to further enhance patient outcomes.

Relevant Publications:

Sadideen, H., Fiddes, R., Birch, J., Griffiths J. The national variation in peri-operative anaesthetic technique for breast free flap reconstruction in the UK: is it time to define best practice?

Eur J Plast Surg 37, 653–660 (2014). https://doi.org/10.1007/s00238-014-1011-z

Relevant Presentations:

“Anaesthesia for abdominal Based Breast Reconstructions - The Oxford Experience: Past, Present & Future”

BAPRAS National Congress, Newcastle October 2023

Dr. Griffiths has been providing intravenous sedation services at the Endoscopy Unit at Welbeck Health Partners in London, where he has gained firsthand experience in state-of-the-art endoscopy practice and patient care. His expertise is complemented by his understanding of preoperative assessment, which is essential for procedures such as breast reconstructive surgery and the importance of cardiopulmonary exercise testing.

Dr. Griffiths offers sedation services, including intravenous sedation, at the Oxford Endoscopy Unit practice. This approach helps ensure the best patient experience during procedures such as breast reconstructive surgery and cardiopulmonary exercise testing, as well as during preoperative assessments.

Dr. Griffiths has a specific interest in hernia surgery under local anaesthesia and carefully titrated sedation services. As an anaesthetist, he is equipped to assist with inguinal, epigastric, umbilical, and femoral hernia repair under local anaesthetic and carefully titrated intravenous sedation. Additionally, he understands the importance of cardiopulmonary exercise testing and thorough preoperative assessment, ensuring comprehensive care for patients undergoing procedures, including breast reconstructive surgery.