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The anaesthetist and care of the surgical case

The anaesthetist and care of the surgical case

75th logo Anaesthesia journal

Anaesthesia 1946; 1: 25-35 and 1946; 2: 28-31.

J. Beard

This is the first significant peri-operative medicine article in an anaesthetic journal, written in two parts and published in the first and second issues of the journal Anaesthesia. It was actually reprinted from an original publication in the British Medical Bulletin (1946; 4: 114-20), with an editorial note stating that "Since few anæsthetists in Great Britain see this admirable production of the British Council, no apology is made for reproducing Dr Beard's exceptionally interesting paper."

In the 1950s, Dr John Beard was a pioneering cardiothoracic anaesthetist in London at the Brompton, Hammersmith and National Heart Hospitals during the development of cardiopulmonary bypass for open cardiac surgery. He also worked as a GP in Wimbledon until he retired at the age of 70. He was an examiner for 20 years and became the Chairman of the Board of Examiners (Faculty of Anaesthetists of the RCS; then RCoA), President of the Association of Anaesthetists and President of the Anaesthetic Section of the RSM.

The year 1946, recovering from the Second World War while establishing the new NHS, has many parallels to 2021 with our need for a successful NHS reset while also facing the challenge of the massive elective surgery backlog created by the COVID-19 pandemic. There are lines in this paper that are both prophetic and relevant to the current recovery.

The opening paragraph emphasises a key peri-operative aim “Today there is an increasing emphasis on rehabilitation of the patient after operation. The rapid return of the citizen to full activity is of the greatest importance to national economy, to the overcrowded hospital, and to the patient himself. This demands an increasingly high standard of surgical and anæsthetic care.”

Team working is recognised “The teamwork of the operating theatre requires a full co-operation: by extending this outside the theatre, with the anæsthetist taking a larger part in pre- and post-operative care, advantage would be taken of his special training in sedation, in the relief of pain, intravenous techniques, and in the administration of oxygen and other gases.”

Pre-operative care is mentioned including the role of exercise, nutrition and anaemia management alongside early mobilisation after surgery “When, therefore, a patient has been kept in hospital for any length of time he should be as much as possible out of bed, and invaluable help can be provided by the physio-therapy department in arranging and supervising suitable exercises….”

The final paragraph perhaps summarises the combined importance of an understanding of anaesthesia and perioperative medicine for our current roles: “At the outset of his career the attention of the anæsthetist is focussed almost entirely on the actual administration during operation. With increasing experience he should be able not only to provide satisfactory operating conditions for the surgeon, but also to keep constantly in mind the convalescent period and end-result. The application by the anæsthetist of a special knowledge of post-operative complications should benefit the patient, help the surgeon, and bring a wider interest to the specialty.”

This is an amazingly prescient article covering the direction that our speciality is moving. The only jarring note, from our current viewpoint, is the overuse of the male pronoun he/his.

Chris Snowden
Getting it Right First Time joint Clinical Lead for Anaesthesia and Perioperative Medicine
Consultant, Department of Anaesthesia, Freeman Hospital, Newcastle upon Tyne 

Mike Swart
Getting it Right First Time joint Clinical Lead for Anaesthesia and Perioperative Medicine
Consultant, Department of Anaesthesia and Perioperative Medicine, Torbay Hospital, Torquay

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