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Dr Peter Amoroso

Dr Peter Amoroso
Consultant Anaesthetist

Dr Peter Amoroso

Pre-registration posts (Aug 83 - Aug 84)

As a house physician I worked on the Renal Unit at Dulwich Hospital and took an early interest in the care of the critically ill patient on the intensive care unit. My house surgeon post provided a wide range of general surgical experience in a district general hospital environment. Here I became involved in caring for patients on a high dependency unit for the first time.

S.H.O. Ear Nose and Throat Surgery (Aug 84 - Feb 85)

This was an excellent opportunity to learn about the management of airway problems and the anatomy of the head and neck. During this post I developed a keen interest in the administration of anaesthesia, intubation and the problem of the shared airway in this population which confirmed my aim to pursue a career in anaesthetics.

S.H.O. General Medicine and Nephrology (Feb 86 - Feb 87)

Having completed my SHO posts in anaesthetics, I decided to add to my experience by taking up a medical post for a year at St Bartholomew's Hospital London EC1. This busy post involved a considerable time on the intensive care unit where I acquired experience in fluid and electrolyte balance and became expert in the techniques of renal replacement. The exposure to general medical practice and the opportunity to take a different perspective on the patients we treat has added considerably to my understanding of the care of the critically ill.

Anaesthetic Experience

S.H.O. St James' Hospital, London SW12 (Feb 85 - Aug 85)

I spent 6 months as an SHO in anaesthetics at St James' Hospital, Balham. Now closed, this was an extremely busy hospital providing an excellent environment in which to begin a training in anaesthetics. Many types of surgery were pursued including a special interest in hepatobiliary, vascular and gastrointestinal surgery. I worked in a busy day care unit and a 6 bedded intensive care unit.

S.H.O. St George's Hospital, London SW17 (Aug 85 - Feb 86)

I rotated to St George's Hospital, Tooting for a further 6 months where in a teaching hospital setting I gained further experience in anaesthesia for orthopaedics, eye surgery, laser procedures, ear nose and throat, gynaecological and maxillofacial surgery. I was introduced to cardiothoracic and obstetric anaesthesia.

Registrar, Royal Free Hospital Rotation (Feb 87 - May 89)

As a registrar on the Royal Free Hospital rotation I developed my experience in all branches of anaesthesia. In particular my time on the intensive care unit at the Royal Free was very rewarding after a year in a medical post. This ITU cares for many long term ventilatory problems and under the guidance of Dr Browne, I learnt a great deal about the problems of weaning. In addition I have cared for several liver transplant patients in the immediate post operative period. I consolidated my obstetric experience and was introduced to thoracic and neuro-anaesthesia. All surgical specialties were served and on rotation to the National Heart Hospital my experience of cardiothoracic anaesthesia was widened. The Eastman Dental Hospital provided a fine example of day care, chair dental and inpatient maxillofacial procedures.

Registrar Barnet/Edgware General Hospitals (Mar 88 - Mar 89)

Whilst on rotation to Barnet and Edgware General Hospitals I worked on a busy day care unit and was able to acquire the principles of outpatient anaesthesia. There was also an excellent theatre-ITU-HDU complex where I was able to use the wealth of clinical experience to pursue a research project. On returning to the Royal Free Hospital as a post fellowship registrar I was exposed to more neuro, thoracic and paediatric anaesthesia. I also became very interested in the teaching of anaesthesia and felt that a lecturer's post would best afford me time in clinical anaesthesia, teaching and research.

Senior Registrar / Lecturer, King's College Hospital (May 89 - Apr 92)

As a lecturer within the Department of Anaesthetics I have been responsible for organising and conducting teaching for junior members of the department preparing for parts I, II and III of the fellowship examination. This has included tutorials, examination practice and formal lectures. A component of my time as lecturer has also been spent in teaching other groups within the hospital. These include an introduction to anaesthesia in obstetric practice for midwives, tutorials for anaesthetic course nurses, and a regular commitment to the intravenous drug administration study day for nurses, intensive care nursing course and physiotherapy teaching.

In particular I have enjoyed joint responsibility for planning and running our three week anaesthetic firm for medical students and, as a result of this, have brought the teaching of Pharmacology and Therapeutics for final year students under the wing of the Anaesthetic Department. I have sat on the curriculum committee of the medical school for the past 2 years. I have also become involved in teaching Pharmacology and the principles of sedation and anaesthesia to dental students at King's.

Administration

This has involved making contingency plans to provide staff for unexpected cases throughout the day in addition to the routine lists. Whilst having to gain the trust and confidence of colleagues one must also establish the cooperation of the various surgical teams whose demands on the anaesthetic services can outstrip supply. Another task is to ensure that juniors are adequately supervised and assigned responsibility appropriates with their progress and training.

Intensive care

King's has a busy intensive care unit with some 900 admissions per year. Duties include supervising the registrar in day to day patient care and to periodically lead the daily ITU ward round. This management commitment is extended during the emergency hours and there is an increasing referral rate from other hospitals, both from within and outside the region. The range of patients admitted include acute medical emergencies (adult and paediatric), severe trauma, cardiothoracic and neurosurgical cases. Further experience has been gained in managing difficult ventilation and weaning problems and in performing a wide range of therapeutic and monitoring procedures such as pulmonary artery catheterisation, parenteral nutrition, renal replacement and intracerebral pressure monitoring.

Cardiothoracic

I have had a regular commitment to a cardiothoracic list every week usually performing two cases per day and often three. These are typically coronary artery grafts, valve replacements, atrio-septal defect and aortic coarctation repair. I also anaesthetised patients for bronchoscopic and thoracic procedures.

Obstetrics

There are some 5000 deliveries per year at Kings and many are complicated. I attended a morning obstetric ward round once per week and enjoyed a regular obstetric list for 18 months at Kings. This was a consultant list and typically comprised of 3 caesarian sections for patients with medical or obstetric problems such as sickle cell disease, diabetes, neurological or cardiac complications. The list also included special procedures such as cervical suture. In addition to this formal commitment, the duty senior registrar has a considerable input on the labour ward since obstetric care at Kings is delegated to senior house officers in anaesthetics.

Neurosurgical

Neurosurgical anaesthesia at the Maudsley Hospital is a shared responsibility between King's and Guy's Hospitals. At nights and weekends it is part of the role of the senior registrar to cover all neurosurgical emergencies. The catchment area for the Maudsley includes most of south east London and the whole of Kent. The patient population varies from small babies for shunt insertion to the elderly with intracranial pathology. I have enjoyed responsibility for a regular neurosurgical list at the Maudsley Hospital for several months.

Pain

The pain-relief team is an integral part of the Anaesthetic Department. There is a research unit attached with a Director and several full time workers. The work includes outpatient clinics, ward rounds, and sessions in the x-ray department performing a wide range of therapeutic nerve blocks. In-patients are referred by other specialties, particularly radiotherapy and oncology, and the pain relief unit has beds to which patients may be admitted. There is thus a well established facility for both the investigation and treatment of chronic pain problems.

Transplantation

King's is both a regional unit for renal transplantation and a national centre for liver transplantation. Exposure to this type of anaesthesia has been wide and varied. I have taken an active part in the perioperative management of patients with major organ failure and I have been fortunate in experiencing anaesthesia for liver transplantation both at the Royal Free and King's College Hospitals. I was acting consultant anaesthetist on the liver unit for three months before taking up my post at Barts, during which time I performed 16 liver transplants (adult and paediatric).

Paediatric Anaesthesia

There has been ample opportunity to further ones confidence in handling anaesthesia for children, infants and neonates. This has included ENT lists as well as day-case dental anaesthesia in the School of Dentistry. There are paediatric lists in general surgery and the children's wards have an adjoining theatre suite and recovery area. I have also had experience in anaesthesia for children with liver failure who are referred to Kings because of the national hepatic failure unit. As the senior registrar on call, one is often called upon to assist with problems on the busy neonatal special care ward and the newly set up paediatric intensive care unit. The liver transplant program at King's includes children so that transfer to Cambridge is no longer necessary. I have cared for several neonatal surgical problems such as gastroschisis and necrotising enterocolitis. There are three paediatric consultant surgeons at King's College Hospital for such emergencies.

Urology

My year as a medical SHO in Nephrology at St Bartholomew's has provided an excellent background on which to base my anaesthetic practice in these often frail patients. There is a busy renal unit at Dulwich Hospital and I have spent considerable time caring for urological patients.

Senior Registrar, Bromley Hospital

The rotation to Bromley Hospital provides an opportunity to be an integral member of the anaesthetic team covering acute services on three sites at Bromley, Farnborough and Orpington hospitals with 800 beds serving a population of 300,000 people. This challenges one's administrative ability as there are three ITU's on the different sites, with a major accident centre and a maternity unit at either end of the district. The clinical work of the senior registrar is varied involving ENT, dental and orthopaedic lists, as well as two sessions per week in the pain clinic, performing therapeutic blocks. The on call commitment involves acting as a "group senior registrar" covering the 3 sites where a more junior member of staff may need advice, assistance or instruction. In particular, I welcomed the involvement in teaching, which is organised for one morning each week. Whilst at Bromley, I continued my undergraduate teaching commitments by holding a weekly tutorial group in Pharmacology and Therapeutics for final year medical students.

Consultant, Barts & Homerton (Apr 92 - )

My special interests at Barts have been maxillofacial and vascular surgery. I have enjoyed the opportunity to develop my expertise with consultant surgical colleagues. For 5 years I have had a full day commitment in oral surgery with Mr Hutchison who has a particular interest in cancer work. I am, therefore, very experienced in major head and neck surgery. Until recently, I have also enjoyed a regular dental session at Barts.

Currently I have enjoyed setting up and running an oncology vascular access service at Barts and I hope to continue to assist in this service in the future. My other area of interest has been acute pain. I have run the multidisciplinary acute pain service at the Homerton Hospital since 1993 and am proud of the developments that have occurred. We now have a full time H grade clinical nurse specialist together with a part time F grade who look after parenteral opiate administration, epidural and regional blocks, Entonox, TENS and some complementary forms of pain relief on the wards. . We are conducting regular audits and commencing research at the Homerton. I hope that this will continue to develop in to a peri-operative medical acute care team.

I have concentrated a great deal of effort on education and teaching for both parts of the FRCA whilst at Barts/London and have joined several courses in London, including the Part 2 FRCA Royal College Courses in Russell Square in addition to the Part 1 North London Course (UCL Hospitals) and the Part 1 Course run at Whipps Cross Hospital. I have traveled to Sri Lanka for 3 consecutive years to teach on behalf of the World Health Organisation .

I have regularly sat on appointments committees for both SHOs and registrars and taken a great interest in the new developments in training in anaesthesia. I am a n approved College Assessor for consultant appointments committees in anaesthesia and enjoy this activity very much.

My research interests have been maintained at Barts with a multi-disciplinary team approach between the departments of Plastic Surgery, Medical Electronics and Anaesthesia to develop a new pulse oximetry probe small enough to monitor free flap viability in the post operative period. This forms part of a PhD thesis for a research worker (Mr John Pickett) from the Medical Electronics department. He is currently writing up his thesis.

Other research projects have included the measurement of expired carbon monoxide levels in smokers presenting for day case anaesthesia and a new technique for post operative analgesia using epidural catheters to irrigate surgical incisions.

I was approached by Penlon to assess a new device (SCOTI) for safe tracheal intubation using sonar waves, and we investigated this equipment for potential marketing in the UK.

More recently ,since the introduction of Calman (1996) and the Merger of Barts and the Royal London hospitals (1994) I have been concentrating my efforts on training. I have been involved in education since 1993 and took the first post of Training Program Director up in 1996 for the combined Barts London School of Anaesthesia. I have now taken on the role of Deputy Regional Advisor in Anaesthesia for North Thames (East) and regularly perform RITAs (record of in training assessment), appraisals and sit on advisory appointments committees four times per year for SpR recruitment.

Together with Dr J Krapez, I helped to set up and run the Barts London Trust appraisal and assessment course for consultants and senior SpRs twice per year. I also lecture on the Barts London Management course on how to obtain a consultant post (twice per year).

I am the Association of Anaesthetists Linkman for Barts and attend the Association meetings whenever possible.

I have been CEPD (Continuing Educational and Professional Development) Coordinator for the Royal College of Anaesthetists for our Trust since 1995. We are currently collecting our first 5 years of data.

Founder and Director of The Prostate Centre Wimpole St London W1 July 2004

The Prostate Centre (TPC) was set up by Roger Kirby and myself to allow a holistic “one stop shop” approach to the care of men with prostatic disease. This ranges from benign hypertrophy to cancer. We offer all range of treatments including robotic surgery. My own role has focused on mens health and the preparation of men for surgery. I have enjoyed working with men to increase their fitness and wellness plus reducing their co morbidity during their treatment.

I also sit on the MAC of the London Clinic together with the Clinical Governance Committee and Drug & Therapeutics Committee of the London Clinic . other roles are that I sit on the Transfusion Committee there and the Resuscitation Committee of the King Edward 7th Hospital

Membership of Learned Societies
  • Anaesthetic Research Society
  • The Royal Institution of Great Britain
  • History of Anaesthesia Society
  • John Snow Society
  • Association of Anaesthetists
Meetings Presented

"Is the dental chair dead?"
Association of Dental Anaesthetists, January 1990, King's College Hospital London.

"Posture and central venous pressure measurement."
South East Thames Society of Anaesthetists, March 1990, King's College Hospital London.

"The Management of acute renal failure on the ITU in England and Wales."
Intensive Care Workshop at the Royal Society of Medicine, July 1990, London.

"The effect of inhaled salbutamol on oxygen consumption."
European Academy of Anaesthesiology. September 1990, Cardiff.

"Resting energy expenditure in paediatric liver disease."
The Nutrition Society of Great Britain, November 1990, University of Manchester.

"Metabolic rate in paediatric liver disease."
The Eastman Dental Hospital, March 1991, London.

"The effect of salbutamol on resting metabolic rate."
Anaesthetic Research Society, March 1991, Exeter.

Anaesthetic Department, Chest Unit, Paediatric and Liver Unit meetings at King's College and Dulwich Hospitals London.

Salbutamol and resting metabolic rate.
American Thoracic Society, Anaheim California. May 1991

Nasal positive pressure ventilation in patients with chronic airways limitation.
American Thoracic Society, Anaheim California, May 1991.

" Am I Asleep or Am I Anaesthetised ?"
The Royal Institution of Great Britain, February 1992 & December 1994.

Day Care Surgery - The Barts Model.
BPAS National Meeting, October 1994 Royal Society of Medicine, London

Anaesthesia for Revision Major Joint Surgery
National Orthopaedic Conference, NE Thames December 1994.

I regularly teach at meetings within the Barts London Trust and the Homerton hospital Trust. (See CEPD log).

Abstracts
  • The effect of salbutamol on oxygen consumption,
    P Amoroso, S Wilson, J Moxham, J Ponte European Academy of Anaesthesiology September 1990
  • Resting energy expenditure in children with liver disease.
    Wilson S, Amoroso P, Ponte J, Baker A, Ball C.
  • The Nutrition Society, Manchester November 1990 The effects of inhaled salbutamol on resting oxygen consumption;
    Amoroso P, Wilson S, Ponte J, Ginsburg R, Moxham J.
  • British Journal of Anaesthesia; 67 210P, 1991 Resting energy expenditure in children with liver disease.
    Wilson S, Amoroso P, Ponte J, Ball C.
  • British Journal of Anaesthesia; 67 216-217P, 1991 Increased resting energy expenditure: A cause of undernutrition in paediatric liver disease.  
    Baker A, Amoroso P, Wilson S, Ely J, Ball C, Ponte J, Mowat A
  • British Paediatric Association, May 1991. Salbutamol and resting metabolic rate.
    Amoroso P, Wilson SR, Ponte J, Moxham J. 
  • American Review of Respiratory Disease; 143 (4) A 748 Oxygen consumption during nasal positive pressure ventilation in chronic obstructive pulmonary disease.
    Wilson SR, Elliot M, Amoroso P, Ponte J. 
  • American Review of Respiratory Disease; 143 (4) A 84 Metabolic changes in children with liver disease.
    S Wilson, P Amoroso, A Baker, C Ball, J Ponte. Proceedings of the Nutrition Society 1992
Publications

Traumatic nasotracheal intubation.
DC Harvey, P Amoroso, Anaesthesia, 41, p442, 1986.

Paralytic ileus and ketamine.
P Amoroso, CJ Best, Anaesthesia, 44, p74, 1989.

Posture and central venous pressure measurement in circulatory volume depletion.
P Amoroso, RN Greenwood, The Lancet, ii p258-260, 1989.
Axillary block anaesthesia in acute and elective hand surgery,
P Amoroso, S Wilson, Annals of the Royal College of Surgeons 1990 p 72 (3).

Indications for mechanical ventilation.
J Ponte with acknowledgement P Amoroso Thorax 45 p885-890 1990

The Dental Chair.
P Amoroso, Proceedings of the Association of Dental Anaesthetists, 8 p6-7, 1990.

Dangerous repairs
H Daly, P Amoroso
Anaesthesia, 46 p997, 1991

Measurement of central venous pressure
British Medical Journal, 303 p994, 1991

Scavenging in theatre.
P Amoroso, JP Sale. Anaesthesia, 46 p159, 1991.

Harm minimisation for drug misusers
N Payne , P Amoroso
British Medical Journal, 304 p1441, 1992

Acute renal failure: Management in the critically ill in
England and Wales.
P Amoroso, M Brunner, RN Greenwood.
British Journal of Intensive Care, 2 p92-94, 1992.

Acute effects of inhaled salbutamol inhalation on metabolic rate of normal subjects.
P Amoroso, S Wilson, J Moxham, J Ponte.*
Thorax, 48 (9) p882-886, 1993

Modification of the thermogenic effect of acutely inhaled salbutamol by chronic inhalation in normal subjects.
S Wilson, P Amoroso, J Moxham, J Ponte.*
Thorax, 48 (9) p886-890, 1993

"Anaesthesia in the 1980's"
P Amoroso, M Brunner
Anaesthesia Review 12, Kaufman & Ginsberg
Churchill Livingstone 1994

"Smoking & Anaesthesia"
P Amoroso
Handbook of Clinical Anaesthesia (in press)

"Anaesthesia for maxillofacial surgery"
British Medical Journal ABC series on oral surgery
P Amoroso (accepted)

NSAIDs and Anaesthesia
A Shukla, P Amoroso
Current Medical Literature: Anaesthesiology 9 (1) p3-5, 1995

Renal Dysfunction and Anaesthesia
P Amoroso, C Lanigan
Current Opinions in Anaesthesiology 1995, 8 267-270

Day Care Abortion: The St Bartholomew's Model
P Amoroso The British Journal of Family Planning 1995 21: 75-76

NSAIDs and Anaesthesia
A Shukla, P Amoroso
Current Medical Literature: International Hospital Pharmacy
1996 6(3): 63-65

A Pulse Oximeter system for use in plastic surgery
J Pickett P Amoroso D Nield D Jones
Proceedings of the first annual conference of the institute of physics and engineering in medicine and biology

Optical technique for continuous monitoring of flap viability in plastic surgery
J Pickett P Amoroso D Nield D Jones
Proceedings of 18th annual international conference of the IEEE engineering in medicine and biology society, Amsterdam (IEEE Piscataway, NJ, USA) Abstract p46, CDROM paper no 520,1996.

Pulse oximetry and PPG measurements in plastic surgery
J Pickett P Amoroso D Nield D Jones
Proceedings of 19th annual international conference of the IEEE engineering in medicine and biology society, Chicago IL,USA (IEEE Piscataway, NJ, USA) Abstract p126, CDROM pp 2330-2332 1997

Stop Those Antiplatelet Drugs Before Surgery!
BJU international 2003-May; vol 91 (issue 7) : pp 593-4
Mak, S); Amoroso, P

The point is…… Article on acupuncture in Prostate UK Charity publication
Peter Amoroso
Update - Issue 17 - April 2004

Bladder neck contracture after radical retropubic prostatectomy
Dler Besarani, Peter Amoroso and Roger Kirby
The London Clinic, London, UK and
St George's Hospital NHS Trust, London, UK

Major Newspaper article (5 page spread) on Our Prostate Practice
Gland on the run Simon Garfield The Observer, Sunday 8 May 2005

Steps by which better overall health for men could be achieved.
Roger S Kirby, Mike G Kirby, Peter Amoroso, John Dean, Duncan Gould
The Prostate Centre, London and The Surgery, Letchworth, UK.
BJU Int. Aug ;98 (2):285-8 2006

Hypertension and the role of the urologist.
Jeetesh M Bhardwa, Mike G Kirby, Peter Amoroso, Roger S Kirby
The Prostate Centre, 32 Wimpole St, London, UK. XXXXX

Prostate-specific antigen testing in hypogonadism: implications for the safety of testosterone-replacement therapy. Hypoandrogen-metabolic syndrome: a significant issue for men's health.
Duncan Gould Peter Amoroso Roger S Kirby Mark R Feneley BJU Int. 2006 Sep;98(3):494 6.

Radical Prostatectomy: From Open to Robotic - Google Books Result
by Roger S. Kirby - 2007 - Medical - 302 pages
CHAPTER 6 Anesthesiological care during and after radical prostatectomy Miles A Goldstraw and Peter Amoroso

Steps by which better overall health for men could be achieved (p 285-288)
ROGER S. KIRBY, MIKE G. KIRBY, PETER AMOROSO, JOHN DEAN, DUNCAN GOULD
Published Online: Jul 4 2006 Volume 98 Issue 2 , Pages 249 - 486 (August 2006)

Is Obesity A Risk Factor For Prostate Cancer?
Miles A. Goldstraw, Dler Besrani, Peter Amoroso, Roger S. Kirby
BJU International 100 (4), 2007, p.726

Radical Prostatectomy: From Open to Robotic (Book) 2007
Radical prostatectomy involves the surgical removal of the entire prostate gland and the seminal vesicles. Recently the open operation has been challenged by laparoscopic and robotic techniques. However, making the transition to this new technology is not an easy option. Avoiding surgical complications such as incontinence and ensuring continued erectile function following the procedure requires good surgical technique by whatever means. The editors and their distinguished team of contributors from around the world offer the reader their guidance based on personal experience and best surgical practice. Radical Prostatectomy is required reading for all those performing radical prostatectomy by open, laparoscopic or robotic techniques.
Chapter “Anesthesiological care during and after radical prostatectomy” Miles A Goldstraw Peter Amoroso

Radical Prostatectomy: Making The Transition From Open To Robotic Surgery Roger S Kirby Miles A Goldstraw Prokar Dasgupta Chris Anderson Krishna Patil Peter Amoroso Jim Peabody
Journal of Robotic Surgery Volume 1, Number 2 / July, 2007 145-149

More Pro-Activity Is Required In The Battle Against Obesity In Men
Pp. 1019-1020(2)
Authors: Kirby, Roger; Amoroso, Peter; Kirby, Michael BJUI Volume 103, Number 8, April 2009
Kirby R, Holmes K, Amoroso P: Supporting the supporter: helping the partner of patients newly diagnosed with prostate cancer. BJU Int; 2010 Jun;105(11):1489-90

AVOIDING AND DEALING WITH THE COMPLICATIONS OF ROBOTASSISTED
RADICAL PROSTATECTOMY Roger Kirby, Krishna Patil, Peter Amoroso, Ben Challacombe and Prokar Dasgupta BJUI 106 December 2010 1567-1575

Diagnosis and Management of Bowel Injury during Laparoscopic Surgery
Roger Kirby, Frank Arnold, Ben Challacombe, Krishna Patil, Peter Amoroso, and Prokar Dasgupta
Trends in Urology March 2011

Prevention and Management of Haematomata after Minimally Invasive Radical Prostatectomy
Roger Kirby, Ben Challacombe, Krishna Patil, Peter Amoroso, Prokar Dasgupta and John Fitzpatrick.
March 2011 BJUI

Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use.Patel U, Dasgupta P, Amoroso P, Challacombe B, Pilcher J, Kirby R. BJU Int. 2011 Oct 31

Wrong side/site surgery Ben Challacombe Prokar dasgupta Peter Amoroso Roger Kirby
Trends in Urology and Mens Health September/October 2011 P32-34