Professionalisation and specialisation in the practice of anaesthesia in the UK.

The year 2024 marks 70 years since graduation of the first candidates in revised examinations for Fellowship of the Faculty of Anaesthetists of the Royal College of Surgeons (FFARCS). Here we review the progress of specialisation and professionalisation of anaesthesia in the UK.

The seven professorial protégés of John Gillies.

John Gillies was the founding head of the Department of Anaesthetics at the Royal Infirmary of Edinburgh, which began in 1940. An astute educator, he was instrumental in establishing anesthesia as a medical specialty, on equal footing with surgery, from the start of the National Health Service in 1948. Gillies' kudos attracted medical graduates from the UK, USA and Canada to work in his Department. The excellence of his teaching and mentoring may be judged from the fact that no less than seven of his protégés became professors of anesthesia/anesthesiology. This paper identifies these seven professorial protégés and reviews their careers. Reasons for the successful consequences of John Gillies' tutelage are considered.

The Place of Erythroidines in the History of Neuromuscular Blockers.

Between 1938 and 1951 erythroidine derivatives were seriously considered as alternatives to curare for the provision of muscle relaxation. This has been overlooked in the published history of anaesthesia. The first publication on the paralysing effect of an extract of Erythrina americana was in 1877, but this was in a Mexican journal, which was not widely read. Sixty years later erythroidine was isolated, and in 1938 it was first used clinically to treat spastic dystonia, preceding the use of Intocostrin for this purpose. By 1943 dihydro-ß-erythroidine was prepared in crystalline form, which was equipotent with curarine and of acceptable duration; it was used in clinical anaesthesia in 1946. In the 1940s curare was presented in solutions with potency stated in units, determined by bioassay, which was a disadvantage compared with the straightforward mg of dihydro-ß-erythroidine. However, by the early 1950s, improvement in the pharmaceutical presentation of d-tubocurarine and new neuromuscular blockers, displaced the erythroidines.

Anesthetists and Intensivists Who Defied the Cold War.

The term "Iron Curtain" described the barrier between communist East Europe and the capitalist West from 1945. Next the term "cold war" was introduced for the confrontation between these two sides without open warfare, because of the deterrent of atomic weapons. Restriction in collaboration between those on either side extended to the medical profession, including anesthesia, resuscitation and intensive care. Archives and publications from both sides of the Iron Curtain were perused to reveal the important role of those who defied the Cold War to maintain collaboration between anesthesiologists. From 1956 the British doyen of anesthesia, Sir Robert Macintosh began liaison with personnel in the USSR, which led to reciprocal visits. In this liaison a notable Russian anesthesiologist was Igor Zhorov. Then the WHO Copenhagen Anaesthesiology Centre had an impact. Later liaison from the USA came via Emanuel Papper, followed by Peter Safar. Other notable participants included Vladimir Negovsky from the USSR as well as Hugo Keszler and Jiri Pokorny from Czechoslovakia. These efforts in collaboration helped improvement of standards on both sides of the Iron Curtain.

Predictive factors influencing fast track rehabilitation following primary total hip and knee arthroplasty.

BACKGROUND: Fast track rehabilitation after primary total hip (THR) and total knee replacement (TKR) is gaining popularity. We performed a prospective clinical trial to identify predictive factors for successful fast track rehabilitation. METHODS: Between June 2005 and January 2006, 52 THR and 48 TKR were performed on consecutive patients off the local waiting list with no pre-selection or exclusion criteria. Patients underwent a fast track rehabilitation programme within a group-dynamic set-up aiming for discharge day 3 to 5 postoperatively. Demographic, clinical and social factors were analysed. RESULTS: Eighty-four percent (n = 44) of THR patients and 73% (n = 35) following TKR achieved the target discharge. Average discharge after THR was 5.4 and 5.5 days after TKR. Delayed discharge was mostly related to medical, social and organisational reasons. Age, 3 m-get-up-and-go-test (3 m-TGUGT), home situation and preoperative walking distance were the main predictors for the early discharge after THR; age, diagnosis, ASA class and preoperative pain medication were influential for TKR. Perioperative complication rates were within or below the national average. CONCLUSION: Successful fast track rehabilitation is possible without pre-selection and does not seem to compromise clinical safety. However, a good social and physiotherapy community set-up should be available. The identified predictive factors could be helpful to identify candidates for fast track rehabilitation.