Obituary of David John Steward, MBBS, FRCPC

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David J. Steward. Royal College Lecturer, Canadian Anesthesiologists’ Society Annual Meeting 1999 (Calgary, AB, Canada; photo courtesy of Dr. Mary Lou Steward).

On 31 August 2023, David John Steward, MBBS, FRCPC passed at the age of 89 after a brief illness. Known to most as a world-class lecturer, David was also a superb clinician, a passionate teacher, and a prolific author. He will be sadly missed by Mary Lou and family, as well as his colleagues and friends around the world.

Born in England, David received his MBBS with Honours in medicine from the Royal Free Hospital School of Medicine at the University of London, England as well as his LRCP and MRCS in 1958. After brief stints as a house physician at the Royal Free Hospital and as a house surgeon at the Royal Portsmouth Hospital, he immigrated to Toronto, Canada where he enrolled in the anesthesia residency program at the University of Toronto. Upon graduation in 1968, David received his Diploma in Anesthesia and became a Fellow of the Royal College of Physicians and Surgeons of Canada. He completed his American Boards in Anesthesiology the following year. David accepted his first anesthetic job in the department at the Hospital for Sick Children in 1968. By 1971, he was appointed Anesthetist-in-Chief and by 1976, Professor of Anesthesia at University of Toronto. In 1984, David moved to the BC Children’s Hospital in Vancouver as Anesthetist-in-Chief, where he remained for seven years. Following in the footsteps of Digby Leigh, he moved south to Los Angeles to become Head of the Department of Anesthesiology at the Children’s Hospital Los Angeles where he remained until his retirement in 2001.

Over his 33 years in practice, David’s inquisitive nature and outstanding clinical acumen made him a maverick in our field. He developed a keen interest in anesthesia for congenital heart surgery where he tackled thorny challenges such as optimizing acid-base balance and outcomes in infants undergoing circulatory arrest, an interest that continued until his retirement. He was the first to recognize and publish a tocsin to warn clinicians that ex-premature infants were at risk for postoperative apnea. Long before ambulatory surgery was commonplace, in the mid-70s he developed one of the first efficient outpatient surgery centres as a separate unit within Sick Kids with streamlined admissions, very efficient patient flow to and from the operating rooms, and rapid discharge. Nevertheless, there were no criteria for rapid discharge from surgery, so he set out to develop a recovery score that soon became known as the Steward Recovery Score, a score that continues to be widely used. In the early 80s, he spearheaded the reintroduction of regional anesthesia for urologic and general surgery in infants and children. In total, he authored more than 100 peer-reviewed publications, many of which bear the names of the residents and fellows David trained at the Hospital for Sick Children, BC Children’s Hospital, and Children’s Hospital Los Angeles.

David was passionate about teaching. He initiated daily morning seminars with the anesthesia residents at Sick Kids, covering a different subject each day of their six-month pediatric rotation. He soon realized he had amassed enough material from his seminars to publish a text, which he titled the Manual of Pediatric Anesthesia. First published in 1979, the Manual continues to this day with the seventh edition that still bears his name.

David was also a very skilled lecturer. In Toronto, he finetuned every program at the Pediatric Anesthesia conference infusing current and controversial topics that showcased the “best of the best” lecturers in pediatric anesthesia as well as the local talent. The conference was an instant success, attracting both general anesthesiologists and pediatric specialists. The conference expanded to become one of the most widely attended anesthesia conferences in our subspecialty. David exported his winning formula to the LA Children’s Anesthesia conference, which continues to this day as the longest running pediatric anesthesia conference. Perhaps David is best known as the consummate speaker, who could skillfully deconstruct abstruse concepts and deliver them eloquently, in clear and understandable terms. His riveting presentations were delivered with a cadence that captivated audiences. Often paired up with his dear friend and colleague Frederick (Fritz) Berry, this duo was a powerhouse on the stage, whether they delivered lectures or participated in panels, they never disappointed their audiences.

David was also very committed to pediatric anesthesia globally. As the Chairman on pediatric anesthesia at the World Congress in 1984, he inaugurated the first World Congress on Pediatric Anesthesia in the Philippines that continued for many years to provide a forum where pediatric anesthesia specialists, young and old, could mingle and exchange their thoughts about pediatric anesthesia in an informal and disarming atmosphere. In 1992, David spearheaded the Canada China Child Health Foundation that resulted from his numerous trips to lecture at hospitals and institutions in China as early as 1983. He shared knowledge and taught staff the latest advances in care for infants and children, finding a very warm and receptive audience wherever he travelled.

As we reflect on his rich career, David ranks shoulder-to-shoulder with the giants in our specialty, who together worked tirelessly to ensure the care we provide to infants and children today worldwide is safe and effective. On a personal note, I was incredibly fortunate to have been one of the trainees that David took under his wing and opened the doors to a career in pediatric anesthesia that would never have been possible without his support. How many other anesthesiologists worldwide owe a debt of thanks to David for opening doors and giving them opportunities for their wonderful careers? Their numbers are too many to count.

So, on behalf of your trainees and colleagues worldwide, all the wee patients whose lives were transformed because of your brilliance and expertise, and knowing how proud Mary Lou and your family were of you, may you rest in peace.