British Oxygen Company (BOC) Grant: 2015 Award

In 1958 the British Oxygen Company (BOC) funded the foundation of a Chair of Anaesthesia. The BOC Chair was last held by Professor Leo Strunin in 1958 at the Royal London Hospital. Inflation, improved salaries and the requirement by university employers for overhead costs means that in the 21st Century there is no longer sufficient funding to found and support a new Chair of Anaesthesia.

Instead, the Royal College of Anaesthetists has reinterpreted the resource as the BOC Grant, given as a four year resource to a promising academic who is close to promotion to professorial status. In 2011 the BOC Grant was awarded to Dr Mike Grocott whose Fit 4 Surgery research project aimed to address the association between fitness and surgical outcomes. Now a full Professor, Mike remains actively involved in UK anaesthesia through his role as founding Director of the NIAA Health Services Research Centre (HSRC), Chair of the National Emergency Laparotomy Audit (NELA) and he serves as a NIAA Board member.

This year the BOC Award received nineteen applications from across the UK. Research proposals included anaesthesia and critical care medicine. Methodologies included cell, animal, patient and population studies.

Each application was read and scored by 7 clinical reviewers and 1 lay reviewer, taking into account any conflicts of interest. The scoring process considered the applicant's academic achievements, the scientific quality of the proposal and the likelihood of it being carried out with the available resources, as well as the impact of the award to the selected individual on British anaesthesia as a whole. Once scored, the applications were then ranked from which a short list of 5 candidates was selected for panel interview.

Interviews took place at the RCoA on Thursday 11 February 2016. Decision making was structured, democratic and difficult given such a strong field of candidates. Eventually after due deliberation the panel made the decision to fund two candidates: Dr Gareth Ackland and Dr Daqing Ma.

Dr Ackland is a Senior Lecturer in Perioperative Medicine at Queen Mary University, London. He is also an Honorary Consultant in Anaesthesia at the Royal London Hospital, and an Honorary Senior Lecturer at University College London. His research interests include improving surgical outcomes through an understanding of the mechanisms underlying perioperative organ dysfunction, and perioperative myocardial injury.

His BOC Award research proposal will investigate whether stopping blood pressure drugs in patients before surgery results in damage to the heart after surgery. ACE-I/ARB are frequently stopped before surgery in the widely-held belief that this prevents intraoperative hypotension, although robust evidence for this is lacking. UK practice and international guidelines reflect clinical uncertainty regarding ACE-I/ARB withdrawal. However, a strong association exists between stopping ACE-I/ARB and an increased risk of mortality. These epidemiologic data suggest that acute withdrawal of ACE-I/ARB, coupled with upregulation of the angiotensin receptor as a result of chronic ACE-I/ARB therapy and substantial elevations in angiotensin-2 could be directly injurious, leading to excess postoperative morbidity and mortality.

This hypothesis is highly plausible since the use of ACE-I/ARB reduces cardiovascular morbidity and inflammation, particularly in patients with established cardiovascular and chronic kidney disease.

Dr Ma is Reader and Head of Anaesthesia Research of Section of Anaesthetics, Pain Medicine and Intensive Care in the Department of Surgery and Cancer at Imperial College, London. He is also a Board member of the BJA and the International Chinese Academy of Anaesthesiology, as well as a Council member of the Anaesthetic Research Society UK and the current President of Chinese Life Scientist Society UK. His research interests include the effects of anaesthetics on cancer cell biology and behaviours, post-operative cognitive decline with Alzheimer's disease and organoprotection including kidney transplant.

His BOC Award research proposal aims to investigate whether the anaesthetics exposure promotes cancer cell growth, whether it enhances cancer cells spreading away from the original site, and whether it decreases the sensitivity of cancer cells to chemotherapy. Despite the increasing efficacy of chemotherapy and the development of more selectively targeted therapies to treat cancer over recent decades, post-operative cancer recurrence remains high. It has been accepted that surgery itself can cause distant secondary tumour metastasis through trauma to the tumour and immunosuppressive effects hindering curative efforts through non-surgical therapies.

However the role of anaesthetics, a key component to surgery, on post-operative cancer outcome has not been thoroughly investigated. Given the high rates of post-operative recurrence of many cancers, it is important to dissect out the role of any contributing factors that may arise in the perioperative period, including anaesthesia and/or anaesthetic techniques.

We congratulate both Dr Ackland and Dr Ma on their outstanding proposals and interview presentations and wish them every success with these projects.