Dr Michael E. Tunstall
1987-1990 - President
1990 - Gold medal winner
I entered general medical practice (GP) in 1956 as a trainee. I had under my belt two house jobs, two years National Service as a regimental medical officer, one year as an SHO in anaesthetics, a diploma in obstetrics and a diploma in anaesthetics.
There were rapid changes taking place in the National Health Service and I could see that I would not be able to realise my ambition of being a GP with anaesthetic and obstetric duties in the local cottage hospital.
Following the year as a GP trainee I became a registrar in anaesthetics at St. Mary's Hospital, Portsmouth. It was there that Dr. Hamer-Hodges encouraged the juniors to participate in his obstetric anaesthetic research. His landmark paper "General Anaesthesia for Operative Obstetrics", which was published in the British Journal of Anaesthesia in 1959, promulgated the use of thiopentone, suxamethonium and 60-70% nitrous oxide in oxygen only, until delivery of the baby. In the 1950's this was revolutionary.
My next post was as an anaesthetic registrar at the Middlesex Hospital, London W1. There the junior anaesthetists were absolutely forbidden to use the above technique for obstetric forceps deliveries. Pudendal blocks were not used. We were confined to using nitrous oxide, oxygen and ether only, via the Magill circuit and face-mask. "They had not had a death from this technique for over 50 years." Retching and vomiting was par for the course during induction. On one occasion when all the consultants were busy I was asked to take the Bentley car of one of them, with a portable anaesthetic machine in the boot, to give an anaesthetic for a forceps delivery in a private nursing home in Wimpole Street. I still remember feeling the heat on my back from the recently extinguished gas fire in that pokey room as the ether was bubbling through the Boyle's bottle.
The next move was back to Portsmouth for the first part of a joint senior registrar's post on the Portsmouth and United Oxford Hospitals rotation. Once again I became fully involved with the audit of obstetric anaesthesia and resuscitation of the newly born. Paediatricians did not come into the obstetric operating theatre and it was the anaesthetist's responsibility to resuscitate the baby if required.
It was my experience of inhalation anaesthesia without endotracheal intubation in obstetrics that led to its inclusion in the failed intubation drill that was first devised in Aberdeen. It followed a maternal death shortly after Caesarean section because the anaesthetist was unable to intubate the trachea and had not been taught any alternative.
My appointment as a consultant in Aberdeen in 1962 was made because the Professor of Obstetrics and Gynaecology, the late Sir Dugald Baird, wanted an anaesthetist who would give most of his time to work in the Aberdeen Hospital. Early on in the appointment I asked Sir Dugald if I could research the use of methoxyflurane as an inhalation analgesic in the labour ward. His reply was "get on with it boy, that is what you are here for". The freedom and the privilege of "getting on with it" remained until my retirement in 1992. MET
Mike is in my view by far the most important contributor to obstetric anaesthesia that the UK has produced writes Felicity Reynolds . His own account of his career gives no glimmer of this.
He is a true original thinker and made no fewer than three ground breaking advances. Who else could claim such an achievement?
1. Entonox. While we were taught that nitrous oxide and oxygen, stored as a liquid and a gas respectively, could only be given from four cumbersome cylinders (two plus two spares), he set about showing that they could be mixed, and so created Entonox, to this day the most widely used method of labour analgesia in this country.
2. Isolated forearm technique. Concerned about awareness when light anaesthesia with muscle relaxation came into fashion, he invented the isolated forearm technique, allowing strength to be preserved in one arm after giving suxamethonium, to make it possible to detect awareness and even, as he pointed out, amnesic wakefulness.
3. Failed intubation drill. An obsession with the need to intubate obstetric patients led to terrifying failure to intubate/failure to ventilate situations, panic and sometimes maternal death. Mike Tunstall said in essence, “Don’t panic – plan” and developed the first failed intubation drill.
Although regional anaesthesia may now seem dominant, systemic techniques are still needed and their safety, so greatly enhanced by Mike Tunstall, remains a concern.
Mike Tunstall died peacefully at home in Newtonhill (south of Aberdeen) on 21 April 2011.
