Citation for Chandy VergheseIn his review of 2nd edition of ‘Laryngeal Mask Anaesthesia: Principles and Practice the late Andranik Ovassapian wrote ‘Dr. Brain’s innovation is a gift of life to patients and anesthesiologists alike and has saved an untold number of lives since its introduction’ and indeed with well over 100 million patient uses the LMA and all it’s adaptations have gained a major place in modern anaesthetic practice. What was also acknowledged was the hugely fruitful association between Archie Brain and Chandy Verghese.
Chandy’s story began in Trissur, Kerala where he was born and spent his early years. He then went on to school in Delhi, Mumbai and Madras and following a pre-med year at Loyola College, Madras entered Madras Medical College in 1968. He was following the first member of his family to become a doctor. His grandfather had qualified from there in 1907 and had served in the British Army Medical Service as a general surgeon, operating from head to toe. For those who know Chandy they might be amazed to know that with him as vice-captain the basketball team won the state championship in 1969, for the first time in the history of the competition. But it was not all work and no play, Chandy became an expert snooker player whilst a medical student. Qualifying in 1974 he spent a year on a remote Kerala tea estate as Chief Medical Officer for the plantation hospital before coming to the UK in 1976.
Eighteen months as house officer and senior house officer in medicine in Dover led to the start of his anaesthetic career at the Royal Gwent hospital. After starting as a registrar in Taunton he went on to the Bristol Royal Infirmary where the seeds of academia were sown under the influence of Cedric Prys-Roberts and Peter Baskett. The North London registrar rotation led to jobs at Grays Inn Road and Stanmore and eventually to a senior registrar and lecturer’s post in the academic unit at the Royal London. He recalls that it was there that he first met Archie Brain. To gain ethical approval for a study he had in mind Archie had to prove that the LMA could be inserted under topical anaesthesia alone and Chandy, who happened to be passing, along with Ed Major were to witness this while the process was being photographed. They were to meet many more times when Archie became a locum consultant and Chandy a senior lecturer and honorary consultant, working mainly at the Newham site of the Royal London.
Chandy had become friends with fellow senior registrar Carl Waldmann and was persuaded to go to the Royal Berkshire in Reading in 1987, as consultant anaesthetist, where Carl had started the previous year. It was this appointment that made several things possible. Archie had finally found a backer for his LMA, Robert Gaines-Cooper was going to succeed in providing investment and support where all Archie’s previous attempts had faltered. Robert and his partner Michael Panter were based in Henley-on-Thames and Pangbourne respectively, just along the road from the Royal Berkshire and suddenly both Chandy and Archie had found a home for conducting their clinical research and development of the LMA family.
The period from`1989 onwards was to provide a rich harvest of publications as a steady stream of innovations, in techniques of LMA usage as well as different versions that overcame limitations of the original device for certain applications came from the industrious duo. From the earliest studies we were to see the LMA become the first responder airway of choice in cardio-pulmonary resuscitation. This was first demonstrated in Reading and then in a multi-centre study involving Peter Baskett and Brian Stone. Looking back it is interesting that what we take for granted was fairly controversial at the time, namely that effective oxygenation from the first responder at a cardiac arrest was more important than a fixation on intubation of the trachea. This challenging of dogma continued throughout the years that Archie and Chandy worked together and even today their messages are not uniformly accepted in the anaesthesia community. Archie would make prototypes and repeatedly modify the LMA in an upstairs room in a house just down the road from the hospital and Chandy would test them on patients. Those that looked promising would then enter larger trials with control groups and formal assessments. This was in the days when the theatre sterilising equipment was in theatre and the ethics committee was just down the road.
From this collaboration we have got the intubating laryngeal mask airway (ILMA) and C-TRACH, the Proseal and with the advent of single use devices the Supreme LMA and the Unique LMA. Clearly there have been many others who have been involved in the clinical studies and LMA development but the initial work was done by Archie and Chandy. The focus on advanced airway management and evolution of second generation supraglottic devices, i.e.: those with gastric access ports and higher seal pressures under positive pressure ventilation were one direction of development. The other was demonstrating the feasibility of LMA usage in situations where airway control was paramount but where intubation for a variety of reasons might be particularly difficult. Thus we saw publications from them ranging from use in neonatal resuscitation, pre-hospital usage, intensive care applications and usage in the operating theatre such as the prone patient.
Chandy has been held in high regard as a clinical teacher by trainees moving through the department. His clinical skills are recognised in the ‘Chandy manoeuvre’, an airway adjusting manoeuvre that is crucial in maximising the chances of successful intubation via the ILMA. From the very first time Chandy saw a LMA being inserted awake he was aware of the potential of this technique in difficult airway management. The video of his own awake ILMA insertion and self intubation has gone viral and had more than 25 000 hits on YouTube.
Chandy has travelled the world lecturing and conducting workshops and master-classes in LMA usage. He became the 9th President of the Society of Airway Management in 2007, our sister organisation in the USA. For his life’s work devoted to airway management Chandy is highly deserving of the DAS nomination for the DAS Macewen medal.