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New anaesthetic agents: Anaesthesia has been revolutionised over the past 50 years by the development of new anaesthetic agents. In 1957, the volatile agent halothane supplanted ether as the anaesthetic of choice. It is more pleasant for patients, potent and non-flammable. Later refinements were isoflurane and sevoflurane, the latter being particularly useful in children. Another key change was the introduction, in 1952, of the first short-acting, depolarising muscle relaxant, suxamethonium, while in 1967 pancuronium replaced d-tubocurarine as the main long-acting, non-depolarising muscle relaxant. The intravenous induction agent propofol (1986) was a major improvement on thiopentone, while the local anaesthetic bupivacaine (1963) provides longer duration of action for regional anaesthesia.

Monitoring of anaesthetic deaths: Australia has led the world in the quality and safety of anaesthesia. In 1960, Ross Holland (Director of Anaesthesia at Lidcombe Hospital, Sydney) pioneered investigation of deaths associated with anaesthesia and education of anaesthetists to reduce anaesthesia-related mortality in New South Wales. Other States followed, and national data have been published triennially since 1985, documenting the safety of anaesthesia in Australia.

Faculty of Anaesthetists: In 1952, postgraduate training in anaesthesia was formalised with the formation of the Faculty of Anaesthetists within the Royal Australasian College of Surgeons. In 1992, the Faculty became the Australian and New Zealand College of Anaesthetists. It has accredited training programs in Australia, New Zealand, Hong Kong, Malaysia and Singapore.

Anaesthesia as an academic discipline: Anaesthesia advanced as an academic discipline in Australia with the appointment in 1962 of Douglas Joseph to the first chair in anaesthetics -- the Nuffield Chair at the University of Sydney. Subsequently, other chairs in anaesthesia were established in Brisbane, Melbourne, Sydney, Newcastle, Adelaide and Perth.

Launch of Anaesthesia and Intensive Care: The journal Anaesthesia and Intensive Care was launched by the Australian Society of Anaesthetists in 1972.

Specific training in intensive care: The world's first training and examination system in intensive care was established by the Faculty of Anaesthetists in 1976. After formation of the College of Anaesthetists, a Faculty of Intensive Care was inaugurated in 1993, with Geoff Clarke (Head of Intensive Care, Royal Perth Hospital) as the first Dean.

Specific training in pain medicine: Training in pain medicine was begun by the College of Anaesthetists in 1996, and in 1998 a multidisciplinary Faculty of Pain Medicine was formed, with Michael Cousins (Head of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney) as the first Dean. Board members are drawn from the Australian and New Zealand College of Anaesthetists, the Royal Australasian College of Physicians and its Faculty of Rehabilitation Medicine, the Royal Australasian College of Surgeons and the Royal Australian and New Zealand College of Psychiatrists.

Minimum standards for anaesthesia: Minimum standards for anaesthesia have been developed progressively and published over the past 50 years by the Faculty, and later College, of Anaesthetists. They have had a major impact on development of standards in hospitals throughout Australia, New Zealand and South-East Asia.

Improved patient monitoring: Equipment that allows beat-by-beat monitoring of oxyhaemoglobin levels by pulse oximetry and breath-by-breath monitoring of end-tidal carbon dioxide levels by capnometry has significantly improved the safety of anaesthesia. Both became widely available in the 1980s and were required to meet Australian and other countries' standards.

Laryngeal mask: Described by Archie Brain (Reading, UK) in 1983, this mask is an airway device that provides a hands-free method of maintaining the airway without intubation. It has become popular with many anaesthetists and is useful in situations when intubation is difficult.

Medical retrieval of the critically ill: From the 1960s onwards, medical retrieval of the critically ill has provided intensive care and safe transport to major centres from anywhere in Australia. These multidisciplinary, multimodal services have extended the vision of John Flynn (founder of the Royal Flying Doctor Service) in an extraordinary way. J E (Fred) Gilligan (Director of Retrieval and Resuscitation, Royal Adelaide Hospital) is one of the longest-serving leaders in this field.

Malignant hyperthermia: In 1960, the familial disease malignant hyperthermia, which is triggered by some anaesthetic agents in susceptible individuals, was first described by Michael Denborough and colleagues from Royal Melbourne Hospital. Recognition of the genetic nature of this disease has allowed members of affected families to be screened, while awareness of the early changes and appropriate management, including dantrolene and intensive care, has reduced mortality from around 80% to less than 10%.

Continuing medical education: CME in anaesthetics has developed and expanded in Australia from its beginnings at section meetings of the Australasian Medical Congress (British Medical Association) in the 1950s. Indeed, in 1996, the Australian Society of Anaesthetists hosted the World Congress of Anaesthesiology in Sydney, with nearly 6000 delegates. Furthermore, Australian anaesthetists have conducted education and examinations in the South Pacific region, Papua New Guinea, Hong Kong, Malaysia and Singapore.

Garry D Phillips
Professor of Anaesthesia and Intensive Care
Flinders Medical Centre, Adelaide, SA

Above photograph of surgeons, 1959. (Courtesy of Wolfgang Sievers)

©MJA 2001
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