Dr Graeme McLeod

Obstetric anaesthesia

Led 10 studies and received grants from the Obstetric Anaesthetists Association (2004, 2005, 2008), Tenovus (2005), Chief Scientists Office (2005) and pharmaceutical industry (1998-2000) for the investigation of new chiral local anaesthetics, pharmacodynamics of neuraxial local anaesthetics and haemodynamic changes during and after caesarean section. Currently undertaking 180 patient RCT investigating the epidural: intrathecal molar potency ratios for bupivacaine, levobupivacaine and ropivacaine, and a 1,000 patient prospective survey, modelling anaesthetic predictors/covariates on fetal H+ at caesarean section.

Mechanisms of actions of local anaesthetics

Completed 8 studies since 1999 with vascular research team investigating the molecular modes of action of local anaesthetics. This work was funded by grants from the Association of Anaesthetists and pharmaceutical industry - Abbott International .

Postoperative pain relief

Developed ultra-low dose femoral perineural catheter infusions to enhance mobility on the first postoperative day after total knee replacement, with potential to improve rehabilitation and shorten hospital stay. Currently leading research to determine the minimum local anaesthetic molar dose of levobupivacaine and ropivacaine when given as a femoral perineural infusion after total knee arthroplasty. These studies are also measuring pyschological, functional and health economic outcomes, and are being undertaken with aid of psychologists (Aberdeen and Stirling) and biomechanical engineers (Dundee).

Expansion of thoracic epidural dataset from 1993-2001 - which formed the basis of MD thesis on the “patterns and predictors of post laparotomy pain” - to 2,800 patients in the interval 1993- 2007 has enabled the development of clinical nomograms. Mathematical modelling uses a statistical language called S-Plus and allows prediction of pain in recovery, time to first experience of pain, and circadian rhythmicity of respiratory rate and blood pressure.

Ultrasound

Clinical member of an NHS/University engineering team investigating novel methods of visualising deep structures such as the lumbar plexus, sciatic nerves and epidural space. Research includes ultrasound imaging studies, software manipulation, elastography and needle developments. Funded by Anaesthetic Research Society grant 2009

Lecture 2nd year and 3rd year medical students as part of the neuroscience and endocrine blocks, and lecture on local anaesthetics on the BSc final year pharmacology course. Supervise medical students on 4th year projects and teach on weekly orthopaedic list. Examiner for the 4th year OSCE exam and the 5th year final examination.

Supervised research fellows (1995 to 2003), clinical lecturers (1995 onwards), regional anaesthesia fellows (2004 onwards). Co-director of the biannual Regional Anatomy & Ultrasound training course at the Cuschieri Skills Unit, Dundee.

McLeod GA, Dale J, Columb MO, Robinson D, Checketts M J, Luck J, Wideritz C, Rowley D Minimum local analgesic concentrations of levobupivacaine for femoral and sciatic perineural blocks after knee arthroplasty. Brit J Anaesth 2009; 4: 528-33

Murphy DJ, MacGregor H, Munishankar B, McLeod G. A randomised controlled trial of oxytocin 5iu versus oxytocin 5iu and 30iu infusion for the control of blood loss at elective caesarean section – pilot study Eur J Obstet Gynecol Reprod Biol 2009; 142: 30-3

Dias M, Newton D McLeod GA, Khan F, Belch JJ The inhibitory effect of local anaesthetics on the flare response to Bradykinin and Substance P. Anaesthesia 2008; 63: 151-5

Munishankar B, Fettes P, Moore C, McLeod GA. A double blind, randomised, controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section Int J Obstet Anesth 2008; 17:9-14.

McLeod GA, Munishankar B, Columb MO An isobolographic analysis of diamorphine and levobupivacaine for epidural analgesia in early labour. Br J Anaesth 2007; 98: 497-502

McLeod GA, Dell K, Smith C, Wildsmith JAW. Measuring the quality of thoracic epidural block Br J Anaesth 2006; 96: 633-9

Book Chapters

McLeod GA Preoperative airway assessment in: Raising the Standard - A compendium of audit recipes for continuous quality improvement in anaesthesia The Royal College of Anaesthetists 2000.

Mcleod G, B Gennery, N Brennan Levobupivacine Improved Safety for Obstetric Anaesthesia In: Lake C, Rice L, Sperry R, eds Advances in Anaesthesia Volume 18 St Louis: Mosby; 2001: 55-89

McLeod G New Local Anaesthetics in Vol 22 Eds Adams, Casham, Grounds Update in Anaesthesia, Analgesia and Intensive Care London Greenwich Medical, 2002: 65-93

Connolly D, McLeod G Pain and Audit in Regional Anaesthesia In: Wildsmith, Armitage and McClure Eds Principles and Practice of Regional Anaesthesia 3rd Ed Edinburgh Churchill Livingston, 2003; 283-292

McLeod G Local anaesthetics p369-399; Regional techniques p370-470; Spinal anaesthesia intradural; extradural p471-536 In: Davies, Cashman eds . Lee’s synopsis of Anaesthesia London, Butterworth Heinemann 2005

McLeod GA Preoperative airway assessment in: Raising the Standard - A compendium of audit recipes for continuous quality improvement in anaesthesia The Royal College of Anaesthetists 2007

McLeod GA , Butterworth J, Wildsmith JAW Systemic toxicity In; Cousins, Bridenbaugh, Carr and Horleker