Gordon Jackson Rees (1918 – 2001) was a British anaesthetist
Jackson Rees laid down the foundations for paediatric anaesthesia. Renowned for his development of the Jackson Rees technique and modification of the Ayre T-piece system to ensure safe and efficient paediatric ventilation during anaesthesia.
He published over 20 papers and was a self-confessed ‘reluctant writer’ preferring to teach in the operating theatre. He was a member of multiple prominent societies and recipient of many awards; remembered by a colleague as the ‘First paediatric anaesthetist in Europe’
- Born on December 8, 1918 in Oswestry, England
- His father was a marine engineer; Ayres would frequently visit various ships with his father and assist in maintenance of many mechanical devices. This made him very familiar with the measurement of pressure-volume loops which would hold particular value in his later career
- 1937 – enters University of Liverpool to study medicine after leaving school with grades considered “satisfactory”
- 1942 – graduates from medicine at University of Liverpool and is drafted into the Royal Airforce; marries fellow medical student Miss Elisabeth Schofield
- 1943 – works in the Royal Air Force medical branch as a station medical officer
- 1945 – returns to UK and is offered a postgraduate course in anaesthetics at Radcliffe Infirmary, Oxford under Professor Robert Macintosh and William Mushin
- 1946 – passes diploma in anaesthetics
- 1947 – invited to the University of Liverpool Anaesthetic department as a demonstrator by Cecil Gray and introduces the revolutionary concept of the ‘triad of anaesthesia’ where conventional methods at the time used only a single anaesthetic agent
- Becomes a full time anaesthetist (reluctantly) at Royal Liverpool Hospital under the insistence of formidable Paediatric surgeon Isabella Forshall
- Later is known as the ‘first paediatric anaesthetist in Europe’ by Forshall’s successor Peter Rickham
- 1949 – becomes a Consultant Anaesthetist at Royal Liverpool Hospital
- 1950 – develops the ‘Jackson-Rees technique’ of paediatric anaesthesia and adapts a modified Ayres’ T-piece with the addition of an open-ended bag and high frequency ventilation. A seminal paper is published in the British Medical Journal and becomes the yardstick of successful and safe paediatric anaesthesia
- 1966-8 – appointed President of the Liverpool Society of Anaesthetists
- 1976-9 – Founder member and second President of Association of Paediatric Anaesthetists
- 1981-2 – appointed President of the Section of Anaesthetists of the Royal Society of Medicine
- 1983 – retires from anaesthetic practice and becomes a guest Professor of Paediatric Anaesthesia in the Erasmus University of Rotterdam for a year
- 1986 – appointed as first President of the Federation of European Associations of Paediatric Anaesthesia
- Died on January 19, 2001
- Awards: Hon FFARACS (1964); Frederick Hewitt Medal, FARCSEng (1967); Hon FFARCSI (1980); Hon MD Uruguay (1983); Hickman Medal, RSM (1990); John Snow Medal, AAGBI (1992); Robert M Smith Award, American Academy of Pediatrics (1993); FRCP by Election (1994); Hon FRCPCH (1994).
Jackson Rees Technique
The newborn infant differs so greatly from the adult in his anatomy and physiology that the approach to anaesthesia in the two groups must be quite different. In the past there has been a tendency to adapt to infants those methods of anaesthesia which have proved to be of value in adults. The time has come to consider the problem of anaesthetizing the newborn in relation to their peculiar physiologyBMJ,1950; 2: 1419
Rees research into the physiological differences between adults and paediatric patients led to the development of the so-called Jackson Rees technique. His experiences in adult anaesthesia provided a model for his paediatric patients where the principles of light narcosis and a muscle relaxant ensured good surgical conditions and a rapid recovery.
Initially, Rees employed ether anaesthesia with his modified T piece system during controlled ventilation. He would alternatively turn the ether off at regular 20minute intervals and restart it when the child just started to move. The use of hand ventilation with his modified system allowed high ventilatory rates with sustained low levels of expiratory pressure. This pattern of ventilation was later shown to improve gas exchange and maintain lung volume.
Rees noticed that with this technique:
Babies appear to be in much better condition post-operatively than those in whom spontaneous ventilation was allowed to continue throughout the operation, or in whom deeper levels of anaesthesia were attained.
This technique was able to be further perfected with the use of nitrous oxide and d-tubocurarine in neonates and infants. Jackson Rees taught this method to generation of trainees and became dubbed the Jackson Rees technique.
Jackson Rees T-piece
The first mention of the modified Ayre T-piece system was in 1950 and published in a seminal paper in the British Journal of Anaesthesia.
Simply, the Jackson-Rees T piece consists of a T-piece fitted to the endotracheal tube with one limb connected to a tube delivering fresh gas flow and the other limb connected to a small reservoir bag. The bag has a hole in the tail that can be occluded by the anaesthetist and the bag squeezed to gently provide intermittent positive pressure ventilation.
It is a modification of the Mapleson E system and is known as the Jackson Rees modification or Mapleson F. High flow rates of 2.5-3 times the minute volume are required to prevent rebreathing during spontaneous ventilation and 1.5-2times minute volume for controlled ventilation. It is the circuit of choice for paediatric patients.
Artificial ventilation may be carried out by attaching a double ended bag to the exhaust tube, the open end of which is fitted with a vulcanite tap. This tap can be adjusted so that the intermittent pressure applied to the bag expels the amount of gas required to maintain the equilibrium of the systemRees GJ. BMJ 1950
Jackson Rees Tube
In 1966, Jackson Rees described a new T-shaped plastic naso-endotracheal tube “facilitate prolonged intermittent positive pressure ventilation of the lungs in infants and children“.
The long limb of the tube would be inserted by way of the patient’s nose. Additional tubes would connect one end of the crosspiece to an inspiratory valve and the other to an expiratory valve. The short limb of the tube enabled the removal of secretions by suction, without having to disconnect from the ventilator.
The nasotracheal tube, when used for intermittent positive pressure ventilation, has certain disadvantages in that the connexion to a ventilator is sometimes difficult to arrange in the smaller infant. In order to overcome these difficulties a special tube has been devised consisting of a standard Portex endotracheal tube to which, at right angles at its distal end, is welded a second wider-bore tube. This is done in such a way that (1) the lumina of both tubes are in continuity and (2) the union of the smaller to the large tube is eccentric, so that there is no protrusion of the latter towards the patient’s nose when the tube is in situ
- Rees GJ, Howar DD. Buccal support for administration of anaesthetics to the edentulous. Lancet. 1948 Feb 21;1(6495):289.
- Rees GJ. Anaesthesia in the newborn. Br Med J. 1950 Dec 23;2(4694):1419-22.
- Rees GJ. Neonatal respiration. Br J Anaesth. 1954 May;26(3):154-63
- Rees GJ. The training of anaesthetists. Med J Aust. 1964 Apr 11;1:570-1
- Rees GJ, Owen-Thomas JB. A technique of pulmonary ventilation with a nasotracheal tube. Br J Anaesth. 1966 Nov;38(11):901-6.
- Rees GJ, Stead AL, Bush GH, Jones RS. Intensive therapy in pediatrics. Br Med J. 1966 Dec 31;2(5530):1611-6
- Rees GJ. The indications for intermittent positive pressure breathing. Prog Pediatr Surg. 1971;3:93-7
- Dr Gordon Jackson Rees. Royal College of Anaesthetists
- Obituary. Dr Gordon Jackson Rees; Pioneer of Paediatric Anaesthesia
- Maltby JR. Gordon Jackson Rees. In: Notable Names in Anaesthesia. The Choir Press 2013: 170-172
- Kaul TK, Mittal G. Mapleson’s Breathing Systems. Indian J Anaesth. 2013 Sep;57(5):507-15.
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