My research interests span several broad themes.
Oxygen sensing, respiratory control and anaesthetics
I study how anaesthetic agents suppress the hypoxic ventilatory response, to try and understand how better to preserve this important protective reflex in anaesthesia and post-surgery. I use a range of techniques, from studies in human volunteers to experiments in isolated carotid body cells (using intracellular calcium imaging and patch clamping electrophysiology). I have also studied the problem using transgenic (knockout) mice using plethysmography.
Management of the difficult airway and difficult tracheal intubation
Clinically connected to the theme of oxygen sensing and hypoxia, I undertake clinical investigations into the problem presented by patients (often with anatomical abnormalities) who are difficult to intubate using conventional techniques. I have helped develop a range of methods and application of equipment better to manage this problem: hypoxia during tracheal intubation remains the most important cause of anaesthetic-related mortalilty and morbidity.
Mechanisms of anaesthesia and depth of anaesthesia monitoring
I led the largest ever study into the problem of 'accidental awareness during general anaesthesia' and arising from that is a workstream that broadly addresses the question of 'mechanisms' of anaesthesia (including its monitoring). I am using a range of methods, from observations in patients to (with collaborators) studies of electrical activity in rodent brain slices. Other aspects of this work involve better understanding issues of consent, medicolegal analysis of cases, and improving the psychological support for affected patients.
Operating theatre management
I have published widely on the topic of 'surgical operating theatre efficiency', defining quantitative measures that are now adopted by several NHS Trusts across the UK, and by companies that produce software to monitor theatre performance. I am myself supplicating for a doctoral degree (DM) based on this work.
Regional anaesthesia for carotid endarterectomy surgery
I am interested in clinical studies assessing the utility of various regional techniques used during this type of surgery, to make it safer. This has resulted in definition of a new block (the intermediate) and anatomical discoveries that have led to a co-written chapter in the iconic Gray's Anatomy.
- Fellow of St John's College
- Associate Professor
Research in oxygen sensing
I am Consultant Anaesthetist at the Oxford University Hospitals. I trained in Medicine at Oxford (Corpus Christi College) where I obtained a First in Physiology, and university prizes in Medicine, Cardiology and Clinical Pharmacology. After a Wellcome Trust Research Fellowship to support a DPhil in Respiratory Physiology, I undertook anaesthetic training in the Oxford region, whilst continuing teaching through a lectureship at Corpus Christi College. I was Assistant Professor of Anesthesiology at the University of Michigan, Ann Arbor, USA (1998-9), appointed to my NHS Consultant post at the John Radcliffe in 1999 and elected to St John’s 2000.
I was the Academic Strategy Officer of the Royal College of Anaesthetists (2005-7), publishing the National Strategy for Academic Anaesthesia – a policy document commissioned to help prepare the specialty nationally for changes in academic medical training. I was a member of the Court of Examiners of the Royal College of Surgeons of England (until 2010), examining the MRCS exams. For 2015-16 I serve as external Examiner to the University of Kent. I am Editor of Anaesthesia. I sit on the Research Council of the National Institute of Academic Anaesthesia and am Scientific Officer of the national Difficult Airway Society (the largest specialist society in anaesthetics in the UK). In 2010 I was elected Chairman of the John Radcliffe Medical Staff Committee (chairman of consultants) for a 4-year term and the first consultant re-elected to a second term 2014. In 2014 I published the international report (NAP5, UK and Ireland) on ‘Accidental Awareness during General Anaesthesia’, culmination of a 4-year Royal College project making over 60 recommendations for clinical practice.
At the University I have been Chairman of Examiners, Graduate-Entry Medical Exams and served as Assessor and then examiner for Final Honour School until 2009. I am Training Program Director for over 400 NHS consultants, supervising their specialist registration as trainers with the General Medical Council.
National and international awards include the Royal College Gold (Jubilee) Medal (2000), Humphry Davy Medal (2006), Macintosh Professorship (2012), and the Spring Silver Medal (2012) of the College of Anaesthetists of Ireland. In 2013 I was elected Faculty Professor of the International Societies of Anaesthesia (UK, USA and Europe) and from 2014, Visiting Professor of the US Society of Anesthesiologists’ Foundation for Education & Research. I am Visiting Professor 2015 to US centres (Anesthesia at Mayo Clinic Jacksonville, Florida; Neurology at University of Texas Southwestern) and appointed Associate Professor, Nuffield Department of Clinical Neurosciences, University of Oxford. I delivered the Victor Horsley Lecture of the British Medical Association 2015.