65 Years of Anaesthesia in the NHS

Anaesthesia: Art and Science
65 years in the NHS

The introduction of the National Health Service on 5 July 1948, introduced major changes in both the way doctors worked and how healthcare was delivered to patients.  At the beginning of our film, Dr John Sprigge tells us about the bill his parents received for his mother’s hospital stay from the date of his birth until 4 July 1948. The remainder of the stay was covered by the NHS.

As the National Health Service marks its 65th Anniversary, in many ways so does the specialty of anaesthesia.  Anaesthetics were being given as early as the 1840s, but they were generally administered by General Practitioners as a sideline.  Dr Aileen K Adams and Dr Tom Boulton discuss the impact of the creation of the NHS on anaesthesia.  The NHS agreed to give anaesthetists pay and status equal to other hospital doctors, provided that a Faculty of Anaesthetists was developed.  This decision, in essence, created the specialty of anaesthesia, as it greatly increased the number of people who were giving anaesthetics as a full time job.  Many of these people had been involved in giving anaesthetics during the war and were encouraged to continue doing so because of the equal status given to anaesthetists following the creation of the NHS.

For more information on the creation of the Faculty of Anaesthetists, how it developed into a College and subsequently a Royal College, please click here.

An important part of the creation of the Faculty of Anaesthetists was the development of a two part fellowship exam.  Previous to this, most training for anaesthetists had been experience-based, with doctors observing just a few anaesthetics being delivered before giving one themselves.  Dr Roger Eltringham and Dr Colin McLaren speak about their introductions to anaesthesia, while Dr Aileen K Adams and Dr Jean Mary Horton speak about the apprenticeship style of training, with little emphasis on teaching.  Dr John Sprigge tells us about the developments while he was in training; where he and his peers were given time off to attend lectures leading to a high pass rate of both the Primary and Final FRCA (Fellowship of the Royal College of Anaesthetists) Exams.  Today, doctors undergo a comprehensive seven year highly specialised training programme to become a Consultant Anaesthetist.

For more information on the training of anaesthetists today, please click here.

For information on the examinations that Trainee Anaesthetists undertake today, please click here.

With more full time anaesthetists working in the NHS, there was a dramatic increase in the amount of research that was carried out within the specialty.  This led to rapid improvements in the way that anaesthetics were delivered.  As Dr Peter Venn states, in 1948, many of the techniques and practices used by anaesthetists were the same as those of their Victorian colleagues.  Ether and chloroform were the standard anaesthetic agents at the time.  Dr Jean Mary Horton tells us about the simplicity of using ether as an anaesthetic, while Dr Roger Eltringham speaks about the introduction of halothane (an anaesthetic agent that was widely used in the late 1950s; it was regarded as the first safe volatile agent, but wasn’t recommended for use with particular groups of patients).  Professor David Hatch recalls the changes in anaesthetic agents during his career.  The first anaesthetic he administered was chloroform but he was also involved in the testing of a modern inhalational agent called sevoflurane.  Sevoflurane is now widely used in anaesthetic practice internationally. 

A major development in anaesthesia was the use of new muscle-relaxant drugs based on curare, which allowed surgeons to work inside the abdomen.  This agent paralysed the patient allowing the surgeon to operate, but it meant that the anaesthetist had to then manually ventilate the patient to maintain their breathing.  At this point in time, not much was known about respiratory physiology, but this changed over the course of the next few years.  Dr Aileen K Adams and Professor Rajinder Mirakhur explain the developments in respiratory physiology and the need to improve patient safety.  They list Professor. Cecil Gray, Dr John Nunn and Professor Keith Sykes as being instrumental in these developments.

For further information on Professor Cecil Gray, please click here.

For an interview with Dr John Nunn, please click here.

For an interview with Professor Keith Sykes, please click here.

During this time, not only were there major developments in general anaesthesia but there were also considerable developments in regional anaesthesia.  As Dr Anthony Rubin and Dr Griselda Cooper explain, epidurals began to become an important part of an anaesthetist’s toolkit.  Dr Anthony Rubin further explains the use of regional anaesthesia as both a standalone procedure and when used in conjunction with general anaesthesia.

For further information on local, regional and general anaesthesia, please see this patient information leaflet.

In the early 1990s a new drug called propofol was introduced, as Dr Hugh Seeley and Dr Andrew Morley explain, it reduced the ‘hangover effect’ from anaesthesia, allowing for greater use of day surgery.   Dr Gillian Farnsworth tells us about the impact the Laryngeal Mask Airway (LMA) had on surgery.  The LMA is a device that allows for airway support, which is less invasive than inserting an endotracheal tube, but more reliable than the traditional face-mask.

The major developments in the drugs and equipment used in giving anaesthetics since the inception of the NHS, improved the safety of anaesthesia and reduced the side effects for patients.  Changes in monitoring also meant patients were much safer while under anaesthesia.   Professor David Hatch tells us about the very basic early methods of monitoring, such as checking a patient’s pulse, looking at their eyes for pupil reaction or feeling their skin for temperature variation.  Dr Tom Clutton Brock then tells us about the developments in blood pressure monitoring, and the introduction of the pulse oximeter and electrocardiogram (ECG).  Blood pressure is measured non -invasively by inflating a cuff around a patient’s arm and pulse oximeters check how much oxygen is in a patient’s blood through a clip – typically on their finger. ECG machines monitor the electrical activity of the heart.  Dr John Sprigge tells us about the implementation of the standards of monitoring during anaesthesia. 

For more information on monitoring during anaesthesia, please click here.

Since anaesthesia became a hospital specialty, anaesthetists have diversified their skills and have found themselves in demand in a variety of areas across the hospital. As such, anaesthetists have been essential to the development of Intensive Care Medicine and played an important role in the development of Intensive Care Units.  Dr Hugh Seeley and Dr Paul Lawler tell us about the developments in Intensive Care Medicine.

For more information on Intensive Care Medicine, please click here.

Anaesthesia has now grown to be the largest hospital specialty in the UK and it continues to expand.  Professor Mike Grocott and Dr Ramani Moonesinghe tell us about future developments in anaesthesia, such as the ability to predict individual outcomes based on genetic characteristics and the development of perioperative medicine; the concept of the anaesthetist looking after the patient before, during and after an operation.