Atul Gaur, MD
Consultant Anaesthetist
University Hospitals of Leicester NHS Trust
Glenfield Hospital
Leicester, LE3 9QP, UK
Founder Director of the Society for Ultrasound in Anaesthesia
Tel: (+44) 0116 2502315
e-mail: atul.gaur@uhl-tr.nhs.uk

NICE guidance in 2002 on the use of ultrasound locating devices for placing central venous catheters sparked off the use of ultrasound in Anaesthesia in UK. But many anaesthetists had their doubts if this was the right guidance and how it would work. Nevertheless, several professionals started attending workshops and courses to improve their knowledge and learn the skills involved in ultrasound guided vascular access. Read on.......

Ultrasound is a domain of Radiologists. Ultrasound guided interventions involves more than just a few techniques to learn. It is a sub-speciality on its own. There is a requirement to understand the technology, human anatomy and to master dexterity. I was fortunate to have the guidance and active support of Dr Vandana Gaur, a consultant radiologist, who helped me in understanding the subject at every step. It did not take me long to realize the big gap in teaching programmes and a need for appropriate courses to avoid the abuse of ultrasound in perioperative care. Undoubtedly, ultrasound is emerging as a strong tool to improve patient care and safety as it takes us beyond our capabilities. But it may prove disastrous if not learnt and applied properly. Indeed! This is not a see one, do one, teach one pursuit.
I started using the ultrasound in clinical practice in 2004 at Leicester. We had one portable ultrasound machine in General Intensive Care Unit of Glenfield Hospital. Dr Sanjay Agarwal, Consultant Intensivist, allowed it to be taken into the operation theatres and this was the starting point of our journey. Mr Marcus Pigeon, ODP took pains to organize the transfer and the upkeep of the machine at that time when others were not happy to see this gadget in the anaesthetic room. Marcus also helped with the recording of the images and movie clips, a few of these are still being used in our teaching programmes. Gradually, other staff came along and we started rolling.
The next task was to start a regular teaching programme for the use of ultrasound in Anaesthesia. I discussed my plan with a few of my colleagues who, though supported me, but were a bit unsure about its importance. A few enthusiastic trainee anaesthetists Dr Rishi Diwan, Dr Pascal Boddy and Dr Vijay Kumar; could foresee the future of ultrasound in the perioperative care and joined in. Dr Adrian Searle, Consultant Anaesthetist, DRI, Derby, Professor J Dias and Dr NA Moore played an important role and supported the workshop programmes. We conducted our first workshop ‘Ultrasound for Vascular Access and Intensive Care Unit’ in 2004. This encouraged a few other colleagues to join, learn and contribute. We started from scratch e.g. many learnt to insert the ultrasound images and movie clips into power point presentations for the first time. Here my experience of working as an Additional Professor at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) Lucknow came to our rescue.
Today we have an excellent faculty who deliver top-notch lectures and demonstrations. Our faculty include: Drs NA Moore, R Laenage, P Ali, MJ Jones, A Ahmed, S Francis, F Fombon, V Gaur, P Martinovsky, P Boddy, P Ganty, J Dedhia, S Kuchi and a few more besides Dr Adrian Searle. Renowned professionals like Dr Barry Nicholas participated as faculty on our courses and provided a tremendous boost to our desire to improve further. Recently, Dr TH Bhatti and Dr Tony Sutherland have joined our faculty team.                                                                                                 
We organise workshops at Royal College of Anaesthetists, Association of Anaesthetists of Great Britain and Ireland and University Hospitals of Leicester NHS Trust. These are very popular and more than 700 consultant and trainees from across UK and Europe have benefited by attending these events. We also organize overseas workshops and CMEs at BMHRC, Bhopal and SGPGIMS, Lucknow, India.
The ultrasound workshops and courses are a bit different from other courses because the ultrasound images and movie clips make important part of the course material. I knew the value of computers and internet as a teaching tool, as I had established a computer school at SGPGIMS in the past. Therefore the website www.usganaesthesia.com was launched in September 2007 to help with our workshops and courses. Ms Farha Abidi agreed to help us with the development of the website. We placed most of our lectures, ultrasound images and video clips on this website. Another distinguishing feature of ultrasound workshops is that delegates want more hands-on experience. The availability of the lectures on the web site in advance of workshop helped a great deal in providing more time for hands-on experience and increased the popularity of our workshops. The web space and facilities on www.usganaesthesia.com started falling short of expectations; hence I replaced it with www.usgain.com in December 2007 and with www.suaglobal.com in January 2015.
The www.suaglobal.com is being designed to keep future demands and developments in mind e.g. e-journal, Ask an Expert, Ultrasound library, e-book, Newsletters, workshops and conferences etc. There is a very strong and versatile admin section which would help us in the management of the web site once it starts expanding. This work is quite time consuming and needs future planning. I have a reasonably strong team who is trying to deliver its best like Dr Sridevi Kuchi for Ask an Expert, Dr Satya Jakkampudi for Ultrasound library, Drs Namita Kapila, Anthony Joseph and Mamta Chauhan for Newsletters. Dr Praveen Ganty and Dr Vandana Gaur provide over all general support and strategies to build the web site.
The use of ultrasound in perioperative care is spreading fast due to the enhanced quality and safety of patient care. Numerous professionals will be using this tool in day to day clinical practice. We are witnessing an upsurge in interest to know about this modality amongst medical students. It would be pertinent to have an association where all like-minded professionals can come together to share ideas, experiences, challenges, research etc. This idea prompted me to think about starting a society. A few of my colleagues liked the idea and together we launched a registered (England and Wales) not for profit society ‘The Society for Ultrasound in Anaesthesia’ (SUA) in June 2008. There are eight directors of the ‘Society for Ultrasound in Anaesthesia’: Prof J Dias, Drs NA Moore, E Lin, W Butt, V Gaur, R Diwan and A Ahmed and myself.  
All societies do require a working committee and so did the SUA. It was not possible to hold elections so soon as members had just started joining in and we did not have any supporting infrastructure. Hence, based on recommendations and nominations the following appointments were made for one year or till the first annual scientific meeting: President, Dr M J Jones; Vice Presidents, Dr A Searle and Dr P Ali; Secretary, Dr A Gaur; Joint Secretary, Dr P Ravi; Treasurer, Dr A Ahmed; Joint Treasurer, Dr F Fombon. The following members were nominated as Chairpersons for various sub-committees:

  1. Ultrasound in Obstetric anaesthesia: Dr Satya Francis                     
  2. Ultrasound in Intensive Care: Dr Sunil Pooboni and Dr Peter Martinovsky
  3. Echocardiography: Dr Ranjit Laenage
  4. Ultrasound and Medico legal issues: Dr Ian McLellan
  5. Audit, Research and Grants: Dr Edward Lin and Dr NA Moore
  6. Trainee committee: Dr Pascal Boddy and Dr Praveen Ganty
  7. Training and Accreditation: Dr M W Butt
  8. Advisory committee: Professor Joseph Dias and Dr Vandana Gaur

Presently the SUA has two international chapters:

  1. Italian Chapter: Dr Dario Galante, President
  2. Indian Chapter: Professor Anil Agarwal, President
The Society for Ultrasound in Anaesthesia has made good progress in its first year. Over 600 members have joined the society. We are looking forward to organize the first Annual Scientific Meeting SUA 2010 on 29th April 2010 at RCoA, London, UK.