Biomedical subjects
Publications and source records attributed to R M Towey.
A survey of the anaesthetic services in rural Tanzania was carried out in an area of 67500 km2 and population of 4 million in order to assess the quality of anaesthesia and the major obstacles to good practice. Lack of draw-over vaporizers, Ayre's T-pieces, and a supply of oxygen were found to be the major obstacles to safe practice in this area of Africa.
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A patient with a permanent pacemaker underwent radical neck dissection. After induction of anaesthesia, a magnetic surgical instrument mat was placed over the patient's chest. This caused the pacemaker to go into a threshold test which included a 2.5-s period of asystole. Surgery had to be abandoned temporarily. We suggest that magnetic instrument mats should not be used with pacemaker patients; not all pacemakers are converted to a fixed magnetic rate by application of a magnet. The anaesthetist should check to see if the patient has a pacemaker with a threshold test and, if possible, this should be rendered inactive.
An anaesthetic technique suitable for training in fibreoptic intubation is described. It uses a capped oropharyngeal airway which leaves the nose free for fibreoptic intubation and allows the airway to be maintained and ventilation to be controlled if necessary. An assessment is made of the technique after 50 fibreoptic intubations with the Olympus LF-1 fibrescope. There were no failed intubations and no serious complications.
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To compare two anaesthetic techniques, morbidity following day-case gynaecological surgery in 170 patients was assessed by means of a questionnaire at the time of leaving hospital. A further questionnaire sought information for the evening of the operation, and the 1st and 2nd days after operation. Ninety-four per cent of patients returned the latter questionnaire. There was a high frequency of morbidity extending into the 2nd day after operation. An anaesthetic technique using Althesin and nitrous oxide in oxygen offered no advantage over a technique with thiopentone and nitrous oxide in oxygen and halothane.
Anaesthesia for separation of thoracopagus twins is described. One twin died 10 hr postoperatively and was found to have an undiagnosed coarctation of the aorta. The second twin required long term respiratory support and survived. The anaesthetic management and postoperative care are discussed.
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The efficiency of the Oxford Inflating Bellows for intermittent positive pressure ventilation using a partially closed Heidbrink expiratory valve has been assessed by measuring the arterial carbon dioxide tension (PaCO2) after various intervals of IPPV on eight patients. It was found that satisfactory alveolar ventilation was achieved if a degree of hyperventilation was employed.
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The results of 458 prolonged nasotracheal intubations are described in 435 infants and young children up to 5 years of age after open heart surgery, in whom the upper airway was normal. No deaths occurred which could be attributed to the technique, and no tubes became obstructed. Sub-glottic stenosis did not occur when a loose-fitting endotracheal tube was used, and stridor after extubation was rare. If necessary, the technique can be used with safety for several weeks.
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The competence of the laryngeal-closure reflex was assessed in a group of patients having ketamine anaesthesia and found to be depressed. All patients in a control group of conscious volunteers had a competent reflex. The possible dangers of ketamine anaesthesia without endotracheal intubation are discussed.