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- Pain medicine
I have been a consultant anaesthetist at the Manchester Royal Infirmary (now the Manchester University NHS Foundation Trust) with special interest in cardiac anaesthesia and intensive care since 1993. I was appointed as MAHSC Professor at The University of Manchester in 2018. The cardiac unit has been the regional centre for adult congenital heart surgery patients (ACHD) for the North West (until 2017). I continue to be a lead ACHD anaesthetist for our Trust. I provide anaesthesia and intensive care for the highly specialised group of cardiac surgery patients; and patients with cardiac disease requiring non-cardiac surgery. In 1993 I led the development of cardiac anaesthetic and surgical support for caesarean section patients.
I am a lead anaesthetist for patients undergoing tertiary complex head and neck cancer surgery with reconstruction. During this period, the cardiac maternity service and the head and neck cancer services have been specially commended following external review.
I have a special interest in perioperative management of diabetes and developed protocols for the management of cardiac surgical patients over the past 25 years.
I have been clinical director of the department of anaesthesia 2007-2012 for a department of 66 consultants and 44 trainees, providing anaesthetic and perioperative services for all major types of primary and tertiary surgical services with 25 operating theatres across 7 different sites with >14,500 operating sessions per year. I was in charge of a budget of £11.6 million. I appointed 22 new consultants during this period. I also ensured that the in-vitro fertilisation (IVF) unit was properly developed in its current site (>£1million spent) when the new Trust was developed.
I have a long history of research and teaching. I am involved in teaching, training, assessing and examining medical students and doctors. I am educational supervisor for foundation year and anaesthetic trainees.. I have guided students and trainees with research and had presentations shortlisted for Prize presentations in Monaco, Cambridge and Manchester.
I have been invited to lecture on perioperative management of the patient with cardiac disease (Association of Anaesthetists of Great Britain and Ireland (AAGBI) symposia. I have developed a special interest in thoracic epidural anaesthesia and have been invited to teach and lecture nationally and internationally on this and other topics. These include the UK, Mexico, France, Georgia, India and China. I am an honorary visiting Professor at Nanjing Medical University.
I have organised many meetings and symposia myself and on invitation by the RCOA and AAGBI. I am an invited member of RCOA panels for developing “Appraisal and Clinical Excellence in Anaesthesia”. I am an invited member of the RCOA Anaesthesia Review Team (ART) advising anaesthetic departments in difficulty.
I am accredited with the British Society of Echocardiography (BSE) Adult Transoesophageal Echocardiography (TOE). I am a BSE Adult TOE accreditation examiner and have helped develop the exam. I am also an examiner for the Royal College of Surgeons MRCS exams; appointed to the panel of examiners of the European Diploma of Anaesthesia and Intensive Care (EDAIC). I have helped to develop the Cardiac Surgery Advanced Life Support course (CALS).
My H-Index is 27. I have been Principal Investigator for a collaborative 10-year study on patients undergoing coronary artery surgery with the Ischaemia Research and Education foundation (California); International surgical outcomes study (ISOS); CAVIAR Study). I am part of the UK Perioperative Medicine Clinical Trails network organised by the National Institute of Academic Anaesthesia (NIAA)
Areas of interest
Cardiac disease patients; diabetic patients.
Current NHS consultant posts held
Consultant in Cardiac Anaesthesia and Intensive Care
Manchester Royal Infirmary
Diabetes and anaesthesia
Outcomes after surgery
Honorary Visiting professor Medical University of Nanjing, China 2012
MAHSC Professor The University of Manchester 2018
Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. ICM2017
Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery. BJA,2017
Extracorporeal membrane oxygenation in adult congenital heart disease: a case series and literature review Crit Care Resus2017
Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. BJA 2016
Hybrid right atrial approach for trans-catheter pulmonary valve implantation. Int J of Cardio2015
Novel Immunohistochemical and Structural Features of Subsidiary Atrial Pacemakers in the Goat; Relevance to Potential Sites for Biological Pacemakers. Heart2014
A Sole Abdominal Compression Cardiopulmonary Resuscitation: A Novel Technique in the Management of Cardiac Arrest Following Cardiac Surgery. Analg and Resus2013
Dexmedetomidine protects against renal ischemia and reperfusion injury by inhibiting the JAK/STAT signaling activation. J of Transl Med2013
Impact of hyperglycemia on perioperative mortality after coronary artery bypass graft surgery. JTCVS2011
Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. ICM2011
Remifentanil infusion in association with fentanyl/propofol anaesthesia in patients undergoing cardiac surgery. BJA2005
Thoracic epidural with general anesthesia for combined off-pump coronary artery and aortic aneurysm surgery JCTVA2003
Airway protection during Laryngeal Mask Airway (LMA) use in Nasal surgery. CJA2002
Thoracic Epidural Anaesthesia in Patients with Ankylosing Spondylitis Undergoing Coronary Artery Surgery. JCTVA2002
Use of remifentanil during general anaesthesia for caesarean delivery in two patients with severe heart dysfunction. IJOA2001
Epidural Scoring scale for Arm movements (ESSAM) in patients receiving high thoracic epidural analgesia for coronary artery bypass grafting. Anaes1999
Effect of diabetes mellitus on the cardiovascular responses to induction of anaesthesia and tracheal intubation.BJA1993
Comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate or ranitidine treated intensive care unit patients. CCM1991
Courses offered to GPs
Perioperative management of patients with cardiac disease undergoing non-cardiac surgery.
Management of antiplatelet and anticoagulant drugs in the perioperative period.
Regional anaesthesia for surgery
- MB ChB Manchester University 1983
- DA Faculty 1985
- FRCA Royal College of Anaesthetists 1989
- FFICM Faculty of Intensive care medicine 2011
- Cert HSM Institute of health service managers 1993
- Accreditation in Transthoracic Echocardiography British Society of Echocardiography 2009
Reference number 2819459
Details of entry to specialist register
- Anaesthesia, 1993
Affiliations / memberships
1. Association of Anaesthetists of GBI
2. Manchester Medical Society
3. Royal College of Anaesthetists
4. British Medical Association
5. Anaesthetic Research Society
6. Association of Cardiothoracic and Critical Care
7. Intensive Care Society
8. European Society of Anaesthesiology
9. European Association of Cardiothoracic
10. Difficult Airway Society
11 Society of Vascular Anaesthesia
12 British Society of Echocardiography
Post treatment communication
Following treatment of a Bupa member, I will communicate with GPs in line with Department of Health, GMC and appropriate professional bodies guidelines.
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