Areas of Expert Witness Practice
Dr Wiltshire accepts instructions across the full spectrum of anaesthetic and perioperative medicine. The following sets out the principal areas in which he provides independent expert opinion on breach of duty, causation, and condition and prognosis.
Pre-operative assessment and risk stratification, including ASA classification and fitness for anaesthesia.
Induction, maintenance, and emergence from general anaesthesia, including drug selection and dosing.
Airway management, including difficult airway assessment, failed intubation, and cannot intubate cannot oxygenate scenarios.
Adverse events and complications: awareness under anaesthesia, anaphylaxis, aspiration, and post-operative cognitive dysfunction.
Spinal and epidural anaesthesia: technique, drug selection, and management of complications including high block and total spinal.
Peripheral nerve blocks: upper and lower limb blocks, truncal blocks, and ultrasound-guided techniques.
Complications: nerve injury, epidural haematoma, epidural abscess, local anaesthetic systemic toxicity, and post-dural puncture headache.
Acute post-operative pain management: adequacy of analgesic prescribing, multimodal analgesia, and patient-controlled analgesia.
Chronic pain: complex regional pain syndrome (CRPS), neuropathic pain, and the sequelae of inadequately treated acute pain.
Opioid prescribing: appropriateness, monitoring, and complications including respiratory depression and opioid-induced hyperalgesia.
Epidural analgesia in labour: insertion, management, and complications including inadequate block, dural puncture, and neurological injury.
Anaesthesia for caesarean section: spinal, epidural top-up, and general anaesthesia; decision-making in emergency situations.
Maternal complications: post-dural puncture headache, epidural blood patch, maternal cardiac arrest, and anaesthetic-related maternal mortality.
Airway management in children: paediatric-specific anatomy, laryngospasm, and management of the difficult paediatric airway.
Drug dosing and pharmacology in children: weight-based dosing, developmental pharmacokinetics, and drug errors.
Paediatric-specific complications: emergence agitation, post-operative nausea and vomiting, and respiratory complications.
Perioperative risk assessment and optimisation: pre-operative investigations, cardiopulmonary exercise testing, and shared decision-making.
ICU management: ventilation, sedation, haemodynamic monitoring, and the management of sepsis and multi-organ failure.
End-of-life care in ICU: withdrawal of treatment, DNACPR decisions, and the standard of care in the dying patient.