Innovators and co-curators: The researchers shaping medicine’s future and our new exhibition | Association of Anaesthetists
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Innovators and co-curators: The researchers shaping medicine’s future and our new exhibition

News and advocacyNews Innovators and co-curators: The researchers shaping medicine’s future and our new exhibition

Innovators and co-curators: The researchers shaping medicine’s future and our new exhibition

What technology do you picture in the hospital of the future?

You might imagine robots giving regional anaesthetics or artificial intelligence (AI) apps calculating drug and genome compatibility. Perhaps you envision using virtual reality (VR) headsets for remote consultations or wearable devices for patient monitoring.

These impressive concepts are no longer examples of elaborate science fiction as researchers are developing exactly this technology on a mission to engineer safer and more precise anaesthesia. With the help of 2025 Award for Innovation in Critical Care and Pain runners-up Prateek Verma and Thomas Craven, the Heritage Centre has curated a new exhibition exploring landmark innovations in anaesthesia since the 19th century and, with new equipment and drugs, what lies ahead in the coming decades. In this article, Verma and Craven discuss their own innovations and how they fit into the future of pain medicine and critical care.

Remote support in Emergency Assistance, Clinical Healthcare Transfer Services

If you fell ill with smallpox in 1867, you may have been taken to hospital in an ambulance that looked like this:

Horse ambulance. 1975-7061 Science Museum Group Collection Online.

Despite ambulance traditionally meaning ‘walking hospital’ (ambulo is Latin for ‘I walk’), as you can imagine, England’s 19th century ambulances had very limited resources for treating patients on-the-go and being a medical taxi service was essentially all they were good for.

Fast forward to the 20th century and things started to change. London’s first motorised ambulance was introduced in 1930 and by the 1960s, two-way radios were built into emergency medical service vehicles.

With better technology and more secure vehicles, ambulances slowly started to live up to their name, becoming sites for remote treatment. Today’s physicians and paramedics use mobile phones and tablets to consult senior physicians for advice on out-of-hospital care. But it doesn’t stop here. Researchers continue to pioneer new tools that are changing the landscape of remote care, like the Adult Critical Care Transfer Service (ACCTS) Cymru VR360 Remote Support system.




 

 

Above: Spinal injection and Oskar Kreis, Family Collection

Spinal anaesthesia has its origins in the late 19th century. Almost immediately after the introduction of cocaine as local anaesthetic in 1884, physicians around the world began to experiment with the new agent.

In 1885, American J. Leonard Corning investigated its effects on a dog’s peripheral nervous system before German surgeon August Bier eventually achieved what is considered the first ‘true’ spinal anaesthesia in 1898. Using Heinrich Quincke’s lumbar puncture technique, introduced some years earlier, Bier performed spinals in six patients.

Inspired by Bier, Swiss obstetrician Oskar Kreis introduced spinal anaesthetics for women in labour, whose pain relief until then had been ether or chloroform. In 1900, Kreis performed spinals on six women in their second stage of labour and observed that, while they remained completely pain-free until several hours following delivery, uterine contractions were unaffected. Even though Kreis’s pioneering efforts were not recognised for a long time, this undoubtedly was an important advance in anaesthetic care.

Adult Critical Care Transfer Service (ACCTS) Cymru is dedicated to the safe and efficient transport of critically ill adult patients between Intensive Care Units across Wales and beyond. This often involves high-pressure emergency situations where clinical teams must make rapid, informed, lifesaving or life-changing decisions. However, variations in background and experience of team members can potentially create differences in the care provided. While a remote support team consisting of a consultant and a nurse is always available to support the clinical team, reliance on conventional methods of communication like phones can lead to subjectivity in interpretation of the situation and variability in the advice provided.

Now imagine a world where we can deliver uninterrupted, high-quality, equitable and patient-centered critical care regardless of whether the patient is in ITU or being transferred in an ambulance – because critical care is a #ProcessNotLocation.

ACCTS Cymru have designed a VR360 Remote Support system that enables this and more, removing barriers like geography and the composition and skill set of clinical teams to accessing specialist healthcare. Virtual reality headsets provide remote clinical support teams with 360-degree livestream views inside ambulances and the ability to interact with on-site clinical teams, enabling them to be virtually present and fully immersed in the clinical situation. It even allows livestreaming of procedures like ultrasound and bronchoscopy. This significantly improves the quality of advice and support given, particularly under complex and stressful situations, reducing miscommunications and enhancing clinical decision making. This innovation benefits both patients and clinicians, with applications extending across a range of scenarios, including pre-hospital medicine, rural hospitals facing staff shortages, community healthcare, and beyond. It also promises to revolutionise medical education, offering immersive, hands-on learning opportunities in real-world scenarios.

As healthcare services become more centralised and workforce shortages persist, remote clinical support is critical for sustainable service delivery. The ease of use, cost-effectiveness and potential for widespread impact position our innovation as a game-changer for the future of healthcare.

 

999 R.E.A.C.H. - System Workflow.

Prateek Verma
Senior Clinical Fellow in Adult Critical Care Retrieval and Transfer Medicine, Adult Critical Care Transfer Service (ACCTS) Cymru, UK
Specialist Registrar (ST9) Intensive Care Medicine and Anaesthetics, Sheffield Teaching Hospitals, Yorkshire and Humber Deanery, UK
Honorary Senior Lecturer, Bangor University, UK
Bevan Exemplar, Bevan Commission, UK

Digital tool for early detection of neuraxial complications in the maternity population

Today, around 320,000 epidurals, spinals or a combination of both are performed annually for maternity patients in the UK [1]. The risk of serious complications such as epidural haematoma are very low; however, these may result in permanent nerve damage. Given the sheer number of procedures performed, screening for serious complications is warranted.

The Association-recommended screening assesses motor power via straight leg raise, four hours after a spinal is performed or an epidural removed [2]. Some trusts use patient wristbands to remind the patient and staff to check leg power at four hours. At Croydon University Hospital, we won the runner-up prize for the Innovation Award at the Association’s 2025 Winter Scientific Meeting for developing a completely novel digital solution: an automatic pop-up at four hours for the EPR, alerting midwives to check leg power, record the results, and escalate concerns to the anaesthetist early.

 

Digital innovation: timed pop-up for EPR.

Straight leg raise assessment sequence.

Our system’s advantages include:

  • An automated timing function unburdening staff and new mothers from remembering timings 
  • Avoids information overload/pressure on the new mother 
  • Avoids delays for mothers who are asleep or unwell 
  • Automatic data collection for audits 
  • Environmentally friendly 
  • Self-instructing pop-up that supports preceptee and agency midwives with no additional training required.

Looking into the future, as patient integration with the EPR becomes more ubiquitous, there is potential for the screening process to occur via the patient’s mobile phone. This may include a timed audio reminder and provision of video instructions on how to perform a straight leg raise, requesting the patient does so and alerts staff of any concerns. The result could be automatically recorded on the EPR from the patient’s response. If abnormal, immediate attention would be sought. If normal motor function, the midwifery pop-up may be automatically cancelled, thus freeing staff to concentrate on alternative care.

Thomas Craven
Core Anaesthetics CT3, Croydon University Hospital, London

Masa Zdravkovic
FY1, Croydon University Hospital, London

Samuel Hird
Consultant Anaesthetist, Croydon University Hospital, London

References

  1. RCOA. (2009) Major complications of central neuraxial block in the United Kingdom, NAP 3 - The 3rd National Audit Project of The Royal College of Anaesthetists. Available at: https://www.rcoa.ac.uk/sites/default/files/documents/2019-09/NAP3%20report.pdf (Accessed: 21 November 2024). 
  2. Yentis, S.M. et al. (2020) ‘Safety guideline: Neurological monitoring associated with obstetric neuraxial block 2020’, Anaesthesia, 75(7), pp. 913–919. doi:10.1111/anae.14993.

From ether to AI: The evolution of anaesthesia

From the first simple anaesthetic inhalers, to Henry Boyle’s anaesthetic machines and Archie Brain’s laryngeal mask airway: over the last 180 years, doctors have designed equipment and techniques that have made pain treatment easier and more comfortable for patient and practitioner. Today’s doctors continue to pioneer new drugs and equipment that could change medicine for the better. To discover more about the innovations that have shaped anaesthesia and what the future of medicine holds, visit the new exhibition at the Anaesthesia Heritage Centre. From ether to AI: The evolution of anaesthesia is running from May 2025 to April 2026.

Award for Innovation in Anaesthesia, Critical Care and Pain

The Association invites applications for the 2026 prize for innovation in anaesthesia, critical care and pain. This prize is open to all anaesthetists, intensivists and pain specialists based in Great Britain and Ireland. The emphasis is on new ideas contributing to patient safety, high quality clinical care and improvements in the working environment.