The Sir Robert Macintosh Lecture: Perioperative Medicine

Saturday 3 June, 09h45-10h30 – Room B

This year’s Sir Robert Macintosh Lecture will be given at 9:45 AM today, immediately after the opening ceremony. The presenter is a very well-known face at Euroanaesthesia: Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care, University College London, UK.

“The roles and responsibilities of the modern anaesthetist have changed since the last century,” explains Prof Mythen, who is also an Elected Council Member at the Royal College of Anaesthetists and their lead for Perioperative Medicine. “In the UK, the demands on health care are continuing to rise dramatically. Our older population is growing rapidly as the ‘baby boomers’ reach retirement. The older patient is much more likely to have multiple co-morbidities, polypharmacy, frailty, dementia and complex social needs.”

Many children born today in the UK can expect to survive for over 100 years (estimates suggest more than half).  In response to the needs of this demographic that is seen throughout the developed world, the specialty of anaesthesia or anaesthesiology has gradually matured into “perioperative medicine”. This may be defined as the care of patients from the moment of contemplation of surgery to full recovery.

“At the heart of perioperative medicine is the ongoing provision of safer and ever more effective anaesthesia, critical care and pain management,” explains Prof Mythen. “These traditional roles will continue to make up the majority of job plans and portfolio careers for anaesthetists.”

However, he will emphasise that there is a need for a cadre of providers who sub-specialise in perioperative medicine, many of whom will be anaesthetists.  It is critically important that the specialty of anaesthesia clearly defines the core curriculum and training standards for perioperative medicine along with advanced training for sub-specialists. Efficient and effective delivery of the perioperative medical needs of the population will require some reconfiguration of workforces and deployment of digital solutions.

“The main goal of anaesthesia for surgery is unchanged. We want to deliver as many patients as possible back to their community with an improved quality of life following surgical intervention, without iatrogenic harm. We are well placed to identify, communicate, mitigate and manage risk as part of a broad multi-disciplinary team led by the surgeon,” he says.

Prof Mythen will also focus on progress in preoperative services that are continuing to adapt to include assessment that starts in the home, triage based on objective risk criteria, identify the very high risk patient and the use of targeted investigations to help determine risk prior to the first contact with a surgeon —and thus enable truly informed consent. Risk mitigation is becoming normal practice through lifestyle modification (such as exercise, alcohol, smoking), fine-tuning of chronic medical conditions (for example diabetes, anaemia, heart and lung failure), mental resilience training and supported decision making for the most complex cases. He concludes: “One of the greatest challenges remains how to reach the decision that no surgery or less surgery may be the best surgery for some patients.”