Graeme McLeod

+44 (0)1382 740525
Consultant Anaesthetist & Honorary Professor

Biography

Graeme McLeod qualified from the University of Edinburgh in 1983 and trained in General Practice, gaining MRCGP in 1987. He switched to Anesthesia training first at Monklands Hospital, Lanarkshire, rotating into Glasgow then came to Ninewells Hospital in 1991 after obtained FRCA. He was appointed NHS consultant in 1995 and on arrival of Professor JAW Wildsmith was appointed to Honorary Senior Lecturer. His thesis “The patterns and predictors of thoracic epidural analgesia” was awarded MD (Dundee) 2005. He gained PGCertMedEd (Dundee) 2006 and FFPMRCA in 2007.

Awards

  1. With two co-authors he won the BMA book award, First prize, Anaesthesia & Critical Care, 2013 for Principles and Practice of Regional Anaesthesia, Eds, McLeod, McCartney, Wildsmith, 4th Ed, Oxford University Press.
  2. The Innovation in Anaesthesia award, Association of Anaesthetists, GB&I, 2012 for invention of new bi-array ultrasound probe.
  3. Payne-Stafford-Tan award for Excellence in Clinical Practice, Teaching & Research, Royal College of Anaesthetists



Research

Technical failure still occurs in 25% of epidural blocks and in 7% of regional techniques. Regional blocks are conducted using ultrasound, although epidural block remains a blind technique dependant on operator skill. Ultrasound scanning is estricted to identification of the mid-line and measurement of distance to the epidural space. For both epidural and regional block, resolution of tissue targets and needle tips is hampered by increasing depth. For example tissue resolution using 5MHz to 10MHz transducers varies between 600mm and 300mm due to attenuation of acoustic energy. Needle visibility is further impaired by increasing needle angle and out-of-plane needle alignment, even using echogenic or textured needles.

The objective of my research is to develop new needle technologies that improve both image presentation and operator interpretation of ultrasound images particularly in the obese population where skin landmarks are difficult to feel and palpation much more prone to error.

Visible vibrating needle project We have invented an ultrasound actuator that vibrates needles between 14g and 25g at 20,000 Hertz, patent No. GB 1304798.0, 2013. The licensing agreement for this technology was sold to Active Needle technologies, Buckinghamshire, UK by the University of Dundee in December 2015. Vibration shows needles in colour using doppler ultrasound, is less likely to deflect and, using the reverse peizo-electric effect, measures needle tip force, electrical impedance and resonant frequency in real-time.

Ultrasound at Tip of Needle Project The logical key innovative step in future ultrasound technology is to narrow the distance between the ultrasound transducer and anatomical region of interest by building a needle incorporating ultrasound elements at its tip. The advantage of such a device would be two-fold: not only would energy be attenuated less because the distance between transducer and target was considerably reduced, but close proximity would necessitate the use of transducers with much higher frequencies with shorter focal points, and by inference much higher resolution and better discrimination between tissue not just outwith but also within nerves. I am a member of multi-disciplinary, multi-centre research group consisting of clinicians and engineres from the Universities of Dundee, Edinburgh, Glasgow, Heriot-Watt and Birmingham. My PhD student, Anu Chandra, is funded by a Br J Anaesth/RCoA grant

Impact

Patents
EP2747664A1, WO2013030556A1 CA2847015A1 Bi-array ultrasound probe. 2014. Inventors: S Cochran, R Habershaw, J Marsh, G Corner, G McLeod. Licensing sold to Zonare, Palo Alto by
University of Dundee

GB 1304798.0, 2013. Visible vibrating needle. Inventors: M Sadiq, Z Huang, S Cochran, G Corner, G McLeod. Licensing agreement to Active Needle Technologies, Chesham, Buckinghamshire

Teaching

Mastery learning of UGRA on the Thiel soft embalmed simulator using eye tracking metrics
Mastery learning is a new paradigm for medical education used to gain maximum learning outcomes when teaching simulator based technical skills. We conducted a study sponsored by Optomize, a spin-out psychology company of the University of Strathclyde, Glasgow. Using eye tracking technology we generated learning response curves for each trainee; identified crucial time periods before and during needle intervention; retention of competency after 4 months and differences between trainees and experts.

Publications

Book

McLeod G, McCartney C, Wildsmith JAW Principles and Practice of Regional anaesthesia, 4th Edition, 2013, OUP, Oxford.

Original papers

  1. Munirama S, Eisma R, Corner G, Cochran S, McLeod G. An Evaluation Of The Physical and Functional Fidelity Of The Soft Embalmed Thiel Human Cadaver as a Simulator For Ultrasound Guided Regional Anesthesia – Accepted Br J Anaesth 2016
  2. Wallace CD, Foulds LT, McLeod GA, Younger RA, McGuire BE. A comparison of the ease of tracheal intubation using a McGrath MAC((R)) laryngoscope and a standard Macintosh laryngoscope. Anaesthesia 2015; 70: 1281-5
  3. Munirama S, McLeod G. A systematic review and meta-analysis of ultrasound versus electrical stimulation for peripheral nerve location and blockade. Anaesthesia 2015; 70: 1084-91
  4. Munirama S, McLeod G. 'Stratified' approach to individualized anaesthetic care. Br J Anaesth 2015; 114: 543-5
  5. Munirama S, Joy J, Columb M, et al. A randomised, single-blind technical study comparing the ultrasonic visibility of smooth-surfaced and textured needles in a soft embalmed cadaver model. Anaesthesia 2015; 70: 537-42
  6. Joy J, McLeod G, Lee N, et al. Quantitative assessment of Thiel soft-embalmed human cadavers using shear wave elastography. Ann Anat 2015; 202: 52-6
  7. Munirama S, Joy J, Eisma R, Corner G, Cochran S, McLeod G. Images in anesthesiology: shear wave elastography: novel technology for ultrasound-guided regional anesthesia. Anesthesiology 2013; 119: 698
  8. Eisma R, Gueorguieva M, Immel E, et al. Liver displacement during ventilation in Thiel embalmed human cadavers - a possible model for research and training in minimally invasive therapies. Minim Invasive Ther Allied Technol 2013; 22: 291-6
  9. Munirama S, Satapathy AR, Schwab A, et al. Translation of sonoelastography from Thiel cadaver to patients for peripheral nerve blocks. Anaesthesia 2012; 67: 721-8
  10. Guo S, Schwab A, McLeod G, et al. Echogenic regional anaesthesia needles: a comparison study in Thiel cadavers. Ultrasound Med Biol 2012; 38: 702-7

Book Chapters

  1. McLeod G. Future Ultrasound Technologies for the Perioperative Physician Perioperative Medicine Current Controversies, Editor: Karen Stuart-Smith. Springer International Publishing Switzerland, 2016
  2. McLeod G. Evidence-based use of ultrasound and/or nerve stimulation. In Decision Making in Orthopedic and Regional Anesthesiology, Editors: Anderson M, Wilson S, Rosenblatt M. Cambridge University Press, Cambridge, 2015
  3. McLeod GA. Practical Procedures, Regional Anaesthesia and Pain Management. In Oxford Textbook of Vascular Anaesthesia, Editors: Thompson J, Telford R, Howell S, OUP, Oxford, 2014.
  4. McLeod G, Hales T. Local anaesthetic agents. In: Smith and Aitkenhead’s Textbook of Anaesthesia 6th Edition, Elsevier, Philapedelphia, 2013