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R Amatya

Publications and source records attributed to R Amatya.

22 records · Page 2Linked to original sources

Anaesthesia training and development in Nepal 1985-1990.

In 1985 a diploma program in anaesthesia was established in Kathmandu, Nepal, as a joint venture between the Institute of Medicine in Kathmandu and the University of Calgary. Development of the program and of the specialty in the capital city of Kathmandu was continuously documented during the next five years by local and visiting faculty. In 1990 teams of two Nepali and one Canadian anaesthetist also conducted a survey of each of the seven 50-100 bed zonal hospitals which did not previously have a trained anaesthetist and which are now staffed by graduates of the diploma program. In 1985 Nepal, with a population of 16 million, had seven trained Nepali anaesthetists all of whom worked in two hospitals in Kathmandu. By the end of 1989, 19 physicians had graduated. Seven of these continue to work in Kathmandu hospitals, nine work in zonal hospitals throughout the country and two are taking higher anaesthesia training in the United Kingdom. Additional Nepali anaesthetists have returned from training abroad, and the Society of Anaesthesiologists of Nepal, which joined the World Federation of Societies of Anaesthesiologists in 1988, now has 34 members. An annual anaesthesiology symposium is held, and weekly clinical meetings are organized in the major hospitals in Kathmandu. Anaesthetists who work in the zonal hospitals have limited supplies of drugs and equipment and opportunities for continuing medical education are virtually nonexistent.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Department, Hospital↗

Re-evaluation of the Farman entrainer in a low-pressure system for field anaesthesia.

The aim of this project was to develop a portable anaesthesia system that was compatible with modern anaesthesia practice under field conditions, when compressed gas supplies are limited. We assembled and evaluated a low-pressure plenum system, based upon the Farman entrainer, which was adaptable to spontaneous, assisted or intermittent positive pressure ventilation (IPPV). The entrainer was tested using a low flow of compressed gas, O2 at 1-3 L.min-1. We measured the fresh gas flow (FGF) and O2 concentrations (F1O2) delivered at various source gas flow rates (O2 flow), and with various breathing circuits. Entrainment ratio, FGF, and F1O2 were highly dependent upon resistance to flow in the different breathing circuits. With a wide bore T-piece the air/O2 entrainment ratio was 6:1, and the F1O2 was 0.3. When circuit resistance was higher, e.g., with the Bain circuit, air entrainment and FGF were reduced, but F1O2 was higher. Because it offered the lowest resistance, the T-piece circuit was selected for a clinical trial.

Anesthesia, Inhalation↗

A low-pressure portable anaesthesia system for field use: clinical trials.

This is a report of our experience with a portable anaesthesia system that was developed for use under field conditions, when compressed gas supplies are limited. We first assembled and bench-tested a low-pressure plenum system, based upon the Farman entrainer. The entrainer required a low flow of compressed gas, O2 at 1-2 L.min-1, and generated a low-pressure mixture of O2 and air which was directed through an Oxford miniature vaporizer, a non-return valve, and a widebore T-piece circuit. With this system we anaesthetized 24 patients with intermittent positive pressure ventilation (IPPV) and nine patients breathing spontaneously. During IPPV, the circuit resembled a T-piece and provided effective gas exchange with a FGF of 1.2 times minute ventilation. Inspiratory and expiratory valves were arranged so that the spontaneous mode was non-rebreathing, and FGF was adjusted to equal minute ventilation. The system was very economical, using 1-2 L.min-1 O2 and 20-25 ml.hr-1 liquid halothane to produce a FGF of 6-10 L.min-1, an FIO2 of 0.33, and FIhal of 1-1.5 per cent. We have demonstrated that this is a versatile, safe, and economical system, compatible with the practice of modern inhalational anaesthesia under field conditions. It can be readily assembled from commercially available components.

Adult↗

Anaesthesia training in Nepal.

The background, organization, problems, and successful implementation of an anaesthesia training program in Nepal are described. Nepali physicians had previously taken their postgraduate anaesthesia training in western countries, especially in Britain. The low pay of anaesthetists, poor maintenance of equipment, and irregular supplies of anaesthetic drugs in their own country has led many of them to stay abroad. In 1985 there were only seven Nepali anaesthetists in Nepal for a population of 16 million. An alternative approach to training is presented in which a series of Canadian anaesthetists, over a three-year period, are supporting the establishment of a one-year Diploma in Anaesthesiology program in Nepal. They are working with Nepali anaesthetists and the Institute of Medicine in Kathmandu, Nepal. The local anaesthetists supervise most of the clinical training while the Canadians give academic leadership and guidance.

Anesthesiology↗