Oxygen sensing, respiratory control and anaesthetics
I study how anaesthetic agents suppress the hypoxic ventilatory response, to understand how better to preserve this important protective reflex 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. We have made the important discovery that anaesthetic agents compete infra-additively at a single receptor (TASK channel), challenging the paradigm that these drugs act via non-receptor (additive-only) mechanisms.
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 (the fascinating isolated forearm technique wherein patients under anaesthesia move to command), 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
My book ‘Practical Operating Theatre Efficiency’ received the Emerald/EDRF International Prize in Healthcare Management, and I have been awarded a Doctor of Medicine DM) degree, with extensive publications in the field of 'surgical operating theatre efficiency'. I advise the NHS and Deloitte plc on improving theatre performance.
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
- Professor of Anaesthesia
Research in oxygen sensing
I am Consultant Anaesthetist at the Oxford University Hospitals NHS Foundation Trust. I trained in Medicine at the University of 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, while 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 Hospital in 1999 and elected to a Fellowship at St John’s College, 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 am elected Member of Council, Royal College of Anaesthetists, where as Chair of the Safe Anaesthesia Liaison Group (SALG) I am national director for patient safety. I instituted a SALG Safety Fellowship at Harvard University, where I hold a visiting professorship, in partnership with the Beth Israel Deaconess Medical Center, Boston, where I have a clinical faculty appointment. In 2014, commissioned by the Royal College 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. This work received numerous awards including the British Medical Journal’s Book Award and the Irish Excellence in Healthcare award.
In the NHS, I have served for several years (until 2018) as Chair/Vice Chair of Medical Staff Council (chair of consultants); I was Training Program Director for Educational Supervisors in Oxford; I was seconded as Director of Medical Education at Worcester; I sat on development boards of two emerging medical schools (Aston and Three Counties); and I am currently Clinical Director, Operating Theatres, NOTSSCAN Division. I served for 3 years as National Clinical Advisor to the NHS New Care Models program, and have advised the Medicines and Healthcare Regulatory Agency (MHRA), the National Institute of Clinical Excellence (NICE) and the Home Office on drugs policy in relation to abuse of anaesthetic drugs.
I have received several national and international awards include the Royal College Gold (Jubilee) Medal (2000), Humphry Davy Medal (2006), the Spring Silver Medal (2012) of the College of Anaesthetists of Ireland, Rowling Medal of the Royal College of Anaesthetists (for my work in patient safety). I have held visiting and other professorial appointments at several centres, including at the Royal College of Anaesthetists, London (Macintosh Professorship), at Mayo Clinic (Jacksonville, Florida), University of Texas Southwestern, University of Sydney (Jobson Professor), University of Michigan (inaugural USP Professor), Karolinska Institute Stockholm (Besokande Professor). I have delivered the Victor Horsley Lecture of the British Medical Association 2015, and the Spyros Makris Lecture of the Greek Society of Anaesthesia 2018.