The anaesthetist and care of the surgical case
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