CONGRESS OVERVIEW
For the fourth consecutive year, the most prestigious event in the Irish Anaesthesia calendar will be held in the landmark Convention Centre Dublin, with stunning views of the city and its surrounds. CCD is Ireland’s world class, purpose-built international conference and event venue. It was designed by Pritzker Prize winning Irish–born architect, Kevin Roche. This year’s programme includes presentations, a wide range of clinically relevant workshops and a selection of smaller question and answer events and award presentations. There is a full lecture programme in the main auditorium as well as a parallel set of workshops and seminars in the breakout rooms. Speakers this year come from the USA, Hong Kong, Canada and Europe, as well as the UK and Ireland. There will also be four key-note addresses from internationally renowned speakers in what promises to be a truly global and informative congress.
CONTENTS
WELCOME FROM THE PRESIDENT
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WELCOME FROM THE CHAIRMAN OF THE EDUCATION COMMITTEE 6 IRISH CONGRESS OF ANAESTHESIA PROGRAMME OVERVIEW
7
FLOOR PLAN
12
AWARDS
13
SPEAKERS
15
ORAL PRESENTATIONS
37
ACKNOWLEDGEMENT OF EXHIBITORS
44
Don’t forget to download our Congress Phone app!
CAI ANNUAL CONGRESS OF ANAESTHESIA 2015
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PRESIDENT’S LETTER
4
College of Anaesthetists of Ireland
WELCOME FROM THE PRESIDENT
O
n behalf of the Council and the Education
with the Congress. Trainees have been very active in the
Committee I am pleased to welcome all
College in the past year and the committee members are
delegates, speakers, guests and partners in
making a strong contribution to College business. I would
industry to the Dublin Convention Centre
encourage all Fellows of the College in good standing
for the 2014 Irish Congress of Anaesthesia. In line with
to attend the College Annual General Meeting at 13.35
the College’s key mission to promote excellence in medical
on Friday. In addition this year we are holding a session
education and training this year’s event fulfils this aim.
entitled “Meet the College Council” which will give everyone
Many of you participated in last year’s congress and would
an opportunity to interact with the college executive in
agree it was a great success. On behalf of the Council we
an informal setting. The Gala Dinner is being held in the
would like to thank all of you for your continuing support
Four Seasons Hotel. It was a very successful and enjoyable
and ongoing engagement and interest. Under the leadership
evening last year. Hopefully, this will be repeated again this
of Dr Brian Kinirons and the Education Committee another
year and I look forward to seeing as many of you as possible
stimulating programme has been prepared for the 2014
at this very pleasant event. This year’s Industry display
Congress. We received overwhelming good feedback from
is again substantial and I would encourage all delegates
last year’s congress and have worked hard to keep that
to visit the stands and meet the representatives. I would
momentum going and have made changes based on the
like to acknowledge the support from industry for College
feedback. There is no need to say that this year’s programme
educational and research events and warmly welcome all
will comprise state-of-the-art educational and scientific
participants in this year’s Congress. We have had a large
content. Key elements will comprise contributions from
number of submissions of free papers and posters. Please
ISRA and the ICSI and a number of satellite events. I am
support our trainees and colleagues by viewing the poster
delighted to welcome our overseas speakers to Dublin, some
displays and attending the Free Paper session. I hope
for the first time and some old friends. We hope they enjoy
that you will find this years’s programme educationally
their stay with us. The traditional Sir Ivan Magill Lecture,
beneficial, challenging and helpful in shaping your practice.
now in its third year, will be delivered by Prof Kathryn McGoldrick, Professor and Chairman, New York Medical College, Valhalla, New York. I particularly want to welcome the Committee of Trainees in Anaesthesia, chaired by Dr
Ellen O’Sullivan
Mort Kelleher which will be holding its AGM in association
May 2014
CAI ANNUAL CONGRESS OF ANAESTHESIA 2015
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CHAIRMAN’S LETTER
WELCOME FROM THE CHAIRMAN OF THE EDUCATION COMMITTEE
I am delighted to welcome all our delegates to the annual
section. I would encourage all to view the posters and attend
Irish Congress of Anaesthesia 2014 which is being held
the free paper session. Earlier this year, we also held the
for the fourth successive year at the award winning
second Undergraduate Essay competition and we were
Convention Centre Dublin (CCD). This two day meeting
very pleased to receive 26 excellent applications. The three
is the most prestigious and important in the College’s
worthy winners will be presented with their prizes after the
academic calendar and goes from strength to strength
final keynote lecture on Saturday afternoon. Ultimately we
each year. This year we are again extremely proud to
hope that the educational programme will have something
announce a faculty of world class international speakers
for everyone and will contribute to each individual attendee
from the USA, Canada, Asia, France, as well as the UK
obtaining high quality CME/CPD.This congress has
and Ireland. There are a number of highlights this year
attracted enormous support from the trade companies so
but I would particularly like to mention the keynote
I would encourage all to take time to visit them during
address on Saturday morning which will be given by Dr
the coffee and lunch breaks. We are indebted to all our
William Harrop-Griffiths on “Guideleines Spell the Death
sponsors from industry for their continuing support of
of Professionalism”. I would also like to mention that
educational activities run by The College of Anaesthetists
Prof Kathryn McGoldrick, Professor and Chairman, New
of Ireland. Running a congress is very labour intensive and
York Medical College will give this year’s Sir Ivan Magill
places huge demands on the staff of the college. I would
lecture on Friday, titled “Substance Abuse and Anaesthesia
like to thank them for all their hard work and in particular
Providers – An Occupational Hazard”. Again the Intensive
Denise Johnston who has been the lead organiser and very
Care Society have organised a stimulating session and the
ably supported by Ms Margaret Jenkinson, Ms Orla Doran
Irish Society of Regional Anaesthesia are hosting their very
and Ms Sinead Byrne. This is my second year to organise
popular workshop. I would also encourage you to attend
this event as Chairman of the Education Committee. I am
the Friday session titled “HSE – Vision to the future”.
very grateful for the support and guidance of the President
Speakers here will include Mr Ian Carter, HSE and Dr
and colleagues in putting together what I hope you will find
Colm Henry, National Lead, Clinical Director Programmes,
is an educationally stimulating programme. I would also
HSE. At this Congress we have again been overwhelmed
like to thank the members of the Education Committee for
by the quantity and quality of the abstracts submitted. A
their support throughout the year.
number of papers have been selected for oral presentation on Saturday afternoon and prizes will be awarded to the
I hope you will enjoy the Congress and welcome your
authors of the best free paper. The posters will be divided
feedback.
into three categories, Original Research, Audit and Case Reports and Regional. Prizes will be awarded in each
Brian Kinirons, Chairman Education Committee
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College of Anaesthetists of Ireland
THURSDAY ST
21 MAY, 2015
FRIDAY ND
22 MAY, 2015
PR OG ME
RA M OV ERV IE W
KEY NO T NA E LEC TIO TU AAG NAL & RES GMM INT ERN GA ATI LA ON DIN AL PRE NE SPE R SEN A KE TAT RS ION OF PRI ZES
THURSDAY 21ST MAY, 2015 8.00–9.00am 9.00–9.15am
REGISTRATION, TEA AND COFFEE WELCOME BY PRESIDENT, DR ELLEN O’SULLIVAN
LECTURE ROOM A
LECTURE ROOM C
09.15-10.45
CHAIR
OBSTETRICS
SPEAKERS
SESSION 1
09.15-12.30
John Loughrey
PARALLEL SESSION 1
ISRA WORKSHOP
Scott Segal Epidural Analgesia and Maternal fever
WORKSHOP LEADER Harry Frizelle
GUEST FACULTY Patrick Narchi
Mark Van de Velde Post C section analgesia: towards an opiate free strategy Why sweat? Niamh Hayes General Anaesthesia in Obstetric Practice. Key and current issues
10.45-11.15 am COFFEE AND TRADE EXHIBITION
LECTURE ROOM A
SPEAKERS
11.15-12.45
Eilzabeth Behringer ( USA) Hazards of airway managemnent outside the OR
PARALLEL SESSION 2
ACADEMIC
Scott Segall (USA) Modern Airway Evuation from Mallampati to computerized facial analysis
CHAIR
Donal Buggy Can our Mechanical Ventilation strategies in anesthesia and intensive care influence post hoc outcomes?
SPEAKERS
Paolo Pelosi Protective mechanical ventilation during surgery improves postoperative outcome
NATIONAL SPEAKER
Gary Mills Respiratory mechanics
Conan McCaul [TBC]
Peter Speith Protective ventilation in ICU
12.50-13.30 Keynote Lecture 1 ROBERT DEEGAN Electronic Medical Records : Impact on management of perioperative services A
AIRWAY
Ellen O’ Sullivan
ER OO M
SESSION 2
(Lunch and Trade Exhibition Room)
CHAIR
LEC TUR
11.15-12.45
LECTURE ROOM B
13.30-14.30 13.35-14.15
LUNCH AND TRADE EXHIBITION (Lunch and Trade Exhibition Room) CAI ANNUAL GENERAL MEETING (Lecture Room B)
LECTURE ROOM A
LECTURE ROOM B
14.30-16.00
CHAIR
REGIONAL ANAESTHESIA
SPEAKERS
14.30-16.00
Brian Kinirons
SESSION 3
PARALLEL SESSION 3
POLITICS
Peter Marhofer (Austria) Peripheral nerve bockade-‐ Outcome data from the last 10 years
Ellen O’ Sullivan
SPEAKERS
JP Van Bestow RCOA Minister Varadker [TBC]
Patrick Narchi ( France) What we should abandon in RA in 2015
Genevive Goulding President of Australian College IMO [TBC]
Malachy Columb (UK) Clinical pharmacology of local anaesthetic agents : responding to dosing
16.00-16.30 16.00-16.30
CHAIR
COFFEE AND TRADE EXHIBITION (Lunch and Trade Exhibition Room) MEET THE COUNCIL; Q&A SESSION (Lecture Room B)
17.15-18.00 16.30-17.15 Keynote Lecture 2
ANNUAL GENERAL MEETING CAT (Committee of Anaesthetists in Training)
LEC TUR
ER OO
MA
MARK WARNER Positioning problems you hope to never encounter
20.00 Gala Dinner FOUR SEASONS HOTEL, BALLSBRIDGE (BLACK TIE)
FRIDAY 22ND MAY, 2015 09.15-10.00 Keynote Lecture 3
MA
MARK VAN DE VELDE Post C Section -‐ towards an opiate free stratgey ER OO
LECTURE ROOM A
LEC TUR
LECTURE ROOM B
10.00-11.00
CHAIR
MEDICOLEGAL
SPEAKERS
SESSION 1
[TBC] Tom Hayes [TBC]
10.00-11.00
PARALLEL SESSION 1
CAT
CHAIR
Rachel Jooste Simulation in Anaesthesia Training
SPEAKERS
Dr.Karl Knapman A Trainees Experience of Simulation (10 mins)
Ciaran Breen [TBC] Simon Kayhall MPS [TBC]
Dr Crina Burlacu Simulation -‐ effects on training outcome (20 mins) Prof Anthony G Gallagher Profiency based progression for ‘outcome’ rather than ‘process’ based training
11.00-11.30 am COFFEE AND TRADE EXHIBITION
LECTURE ROOM A
11.15-12.45
CHAIR
SESSION 2
Donal Buggy [TBC]
MOST IMPORATANT PAPERS
SPEAKERS Scott Segal [TBC]
Elizabeth Beheringer [TBC] Mary Ellen Warner? [TBC]
(Lunch and Trade Exhibition Room)
11.15-12.45
PARALLEL SESSION 2
ICSI
LECTURE ROOM B
CHAIR
Rory Dwyer ( UK) Monthy Mythen “Fluids in Critical Care; which and how much?”
SPEAKERS
Patrick Murray (Irl.) “Acute Kidney Injury; prevention, treatment options and longterm outcomes”. Maria Donnnelly (Irl) “Critical Outreach
12.45-13.45
LUNCH AND TRADE EXHIBITION (Lunch and Trade Exhibition Room)
LECTURE ROOM A
13.45-14.45
SESSION 3
LECTURE ROOM B
13.45-14.45
SPEAKERS
Robert Deegan Ventricular Assist Devices
CHAIR
PARALLEL SESSION 3
FREE PAPER SESSION
CAT
JUDGES [TBC]
14.50-15.30 Keynote Lecture 24 ELIZABETH BERINGER [TBC]
SESSION 3
PATIENT SAFETY
John Eichorn Intra-‐Op to Peri-‐Op: Anaesthesia Patient Safety Then and now David Whitaker Mark Warner How future technology will impact patient safety
ER OO
SPEAKERS
LEC TUR
15.30-17.00
MA
LECTURE ROOM A
15.50 Close of session and presentation of prizes DR ELLEN O’SULLIVAN
MAP to come
AWARDS
All Prize Winners and Presentations will be announced during close of session at 15.50 in Lecture Room A on Saturday 17th May
ABBVIE SCHOLARSHIP 2014 Dr Anne Doherty Apelin, Placental Growth Factor and Soluble fms-like tyrosine kinase-1 at 14-16 weeks gestation in Pregnancies Complicated by early Preeclampsia and/or Fetal Growth Restriction’.
UNDER GRADUATE ESSAY COMPETITION PRIZE 2014 1st Prize
2nd Prize
3rd Prize
Aine Varley, UCD
Emma Fanning, UCD
Ross Bowe, UCD
CONGRESS RESEARCH MEDAL 2014 Winner of the Free Paper Presentations and Poster Presentations will be announced
CAI ANNUAL CONGRESS OF ANAESTHESIA 2015
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SPEAKERS
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College of Anaesthetists of Ireland
CAI ANNUAL CONGRESS OF ANAESTHESIA 2015
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SPEAKERS
Dr Wouter Jonker is a Consultant in Sligo Regional Hospital and has a special interest in Peadiatrics and Intensive Care. He was born and raised in Pretoria, South Africa and received his MBChB from the University of Pretoria in 2001. After completing his Internship he worked for two years in emergency medicine and anaesthetics before moving to Ireland in 2005. He obtained his FCARCSI in 2009, a Fellowship of the Joint Faculty of in Intensive Care
DR WOUTER JONKER
Medicine of Ireland in 2012 and completed his training in Anaesthesia, Intensive Care and Pain Medicine through the College of Anaesthetists of Ireland in 2013. He is currently the national coordinator for NAP5, a national audit in Ireland and United Kingdom which is investigating accidental awareness during general anaesthesia.
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College of Anaesthetists of Ireland
Originally from Dublin and educated in Belvedere College, Emmet graduated from University College Dublin in 1994. He represented UCD in rugby and boxing winning three British & Irish University boxing titles as well as a Dublin Hospitals Cup Medal for St Vincent’s Hospital. After internship he completed the Basic Surgical Training Scheme in Belfast, acquiring the FRCS (Eng) and FRCSI. Emmet returned to Ireland for further surgical training followed by full time research in Cork University Hospital where he completed an MD in UCC. Following Higher Surgical Training with rotations in Galway, Cork and Dublin, Emmet
DR EMMET NAME
undertook a Fellowship in Laparoscopic Colorectal Surgery in Melbourne Australia. He returned to replace Professor Liam Kirwan in 2010 as Consultant General & Colorectal Surgeon in CUH and Senior Lecturer in Surgery in UCC. His special interests are laparoscopic colorectal surgery (including familial and screen detected cancers), pelvic floor disorders (faecal incontinence, prolapse, constipation), and laparoscopic general surgery including inguinal and incisional hernia repair. Emmet also provides a service in elective general paediatric surgery in Cork University Hospital. He lives in Cork city with his wife and three children.
CAI ANNUAL CONGRESS OF ANAESTHESIA 2015
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SPEAKERS
LOCAL ANAESTHETIC IN PERIPHERAL NERVE BLOCKS: VOLUME, CONCENTRATION, ADJUVANTS WHAT’S NEW WITH ULTRASOUND? Ultrasound guidance facilitates needle positioning and injectate placement, increasing nerve block success rates, reducing onset time, and permitting local anesthetic dose reduction. Some studies have estimated the minimum effective anesthetic volume of local anesthestic required
DR ALAIN DELBOS
to accomplish successful blockade. Successful ultrasoundguided axillary brachial plexus block may be performed with 1 ml of 2% lidocaine-epinephrine per nerve [1]. In the lower limb, the minimal local anaesthetic volume for sciatic nerve block has been found to be 0.10 ml mm(2) cross-sectional nerve area[2] . Concentration of local anesthetics can also be reduced. Perineural injection of 15 ml of lidocaine 0.93% under ultrasound guidance could provide successful femoral nerve block in 90% of patients [3]. Successful combined sciatic and femoral nerve block with bupivacaine 0.25% on diabetic patients can also be
1. O’Donnell, B.D. and G. Iohom, An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology, 2009. 111(1): p. 25-9. 2. Latzke, D., et al., Minimal local anaesthetic volumes for sciatic nerve block: evaluation of ED 99 in volunteers. Br J Anaesth, 2010. 104(2): p. 239-44. 3. Taha, A.M. and A.M. Abd-Elmaksoud, Lidocaine use in ultrasound-guided femoral nerve block: what is the minimum effective anaesthetic concentration (MEAC90)? Br J Anaesth, 2013. 4. Kocum, A., et al., Femoral and sciatic nerve block with 0.25% bupivacaine for surgical management of diabetic foot syndrome: an anesthetic technique for high-risk patients with diabetic nephropathy. J Clin Anesth, 2010. 22(5): p. 363-6. 5. Fredrickson, M.J., A. Abeysekera, and R. White, Randomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade. Reg Anesth Pain Med, 2012. 37(5): p. 495-501.
6. Nader, A., et al., A dose-ranging study of 0.5% bupivacaine or ropivacaine on the success and duration of the ultrasoundguided, nerve-stimulator-assisted sciatic nerve block: a doubleblind, randomized clinical trial. Reg Anesth Pain Med, 2013. 38(6): p. 492-502. 7. Vieira, P.A., et al., Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesthesiol, 2010. 27(3): p. 285-8. 8. Desmet, M., et al., I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a singleshot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. Br J Anaesth, 2013. 111(3): p. 445-52. 9. Rahangdale, R., et al., The Effects of Perineural Versus Intravenous Dexamethasone on Sciatic Nerve Blockade Outcomes: A Randomized, Double-Blind, Placebo-Controlled Study. Anesth Analg, 2014.
performed [4]. Thus, ultrasound guidance contributed to the reduction in total dose of local anesthetics but it is unclear whether this decrease can affect block duration. Block duration is influenced by both local anesthetic volume and concentration, a finding of increasing relevance with the current trend to lower volumes for ultrasound-guided regional anesthesia [5]. In sciatic nerve, when the dose of local anesthetic is optimal to achieve a successful block (10ml of 0,5% bupivacaine), a large injection volume (30ml bupivacaine 0,5%) does not extend the duration of the sensory or motor block. At the opposite, injection of very small dose (2,5 to 5ml bupivacaine 0,5%) is associated with delayed onset and decreased block duration [6]. The main postoperative challenge after painful orthopedic surgery is to provide effective pain relief beyond 24 hours. Recently, a number of studies have clearly shown that when a low-dose of dexamethasone is added to a long-acting local anesthetic in peripheral nerve block, analgesia duration achieved 26-32 hours[7]. Interestingly, recent studies showed that whether dexamethasone is injected perineurally or intravenously, the prolongation of postoperative analgesia is comparable [8]. At this stage, further studies are needed to confirm such an hypothesis. Finally, some issues regarding the potential risk of neurotoxicity when dexamethasone is used perineurally are still debated, and human clinical datas are still lacking [9].
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College of Anaesthetists of Ireland
Capt. John Flanagan has been involved in the aviation industry for over 40 years. Currently a Senior Captain for Hong Kong based Cathay Pacific Airways; his experience is varied and includes tenures in Irish Military, European, and Asian cival aviation. John is a fully qualified Air Accident Investigator, and a member of the International Society of Air Investigators. John’s expertise lies in the area of Flight Safety and Human Factors, an expertise that has allowed him to collaborate with the world’s largest aerospace manufacturers and commercial airlines. A noted educator and leader, John has been training and
CAPTAIN JOHN FLANAGAN
assessing pilots since 1977 and finished his miltary career as Officer Commanding and Chief Instructor of the Irish Air Corps Flying Training School. John is currently a Check and Training Captain for Cathay Pacific, in which role he pays close attention to the positive influence of appropriate and measured instructions and collaboration. In his role as the Confidential Human Factors Program Manager for Cathay Pacific, a founding member of the OneWorld Alliance, John designed, developed and managed the flight crew Confidential Human Factors Reporting Program, which was instigated in 1999. He was also a Flight Safety Officer with the airline’s Corporate Safety Department until 2003. A true advocate for Human Factors Management, John seeks to facilitate improved personnel management in all industries in which decision making and teamwork are crucial to organisational success.
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SPEAKERS
SAFETY CULTURE This presentation will aim to clarify the definition of safety culture, its theoretical basis, measurement of safety culture in healthcare settings, and how can it be improved. The dimensions of safety culture will be explored alongside what makes it difficult to change the culture. A positive Safety Culture in a healthcare setting incorporates ‘open culture’, ‘just culture’, and ‘learning culture’. It is underpinned by
PROFESSOR RAVI MAHAJAN
the belief that the adverse events result from combinations of latent factors and human factors; and that the latent factors can be removed by systematic improvements, and that team working, networking, and learning from safety incidents improve human factors. The improvement in safety culture can be engineered when implementation of safety initiatives, and standardization of the processes and procedures, are addressed alongside enhancing group
Editor-in-Chief British Journal of Anaesthesia Council Member Royal College of Anaesthetists, UK Member Expert Group on Patient Safety, NHS England Chairman Subcommittee of Patient Safety, European Society of Anaesthesiolgy Chairman Data Intelligence Group, Safe Anaesthesia Liaison Group, Royal College of Anaesthetists UK Lead Final Clinical Phase, School of Medicine, Nottingham
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identity and self-esteem of the individuals. A multifaceted approach is required in which more than one dimensions of safety culture are addressed simultaneously. To achieve this, a number of tools can be used, which include safety culture assessments, team training, leadership roles, education programmes, safety audits, incident reporting, and communication through networks and newsletters.
College of Anaesthetists of Ireland
Paul O’Connor started as a Lecturer in Primary Care in January 2013 after coming to NUI Galway as a Research Methodologist in July 2010. He is also an Associate Director of the Whitaker Institute. His research is concerned with improving human performance and safety in high risk work environments. He has carried out research in a wide range of high risk industries (e.g. civil aviation, offshore oil production), and the military (e.g. aviation, special forces). More recently he has been carrying out research
DR PAUL O’CONNOR
in healthcare with the aim of improving patient safety and quality of care through addressing the human factors that contribute to poor performance.He was awarded a Ph.D. in Psychology from the University of Aberdeen in 2002. Prior to coming to NUIG he was an officer in the U.S. Navy for eight years. He served as an Assistant Professor in the Operations Research Department at the Naval Postgraduate School, Monterey, California, Instructor in Aviation Psychology at the Navy/Marine Corps School of Aviation Safety, and Research Psychologist and Experimental Diver at the Navy Experimental Diving Unit. He has authored more than 80 publications, including two books (Safety at the Sharp End, and Human Performance Enhancements in High-risk Environments).
REDUCING RISK IN HEALTHCARE: ONE SIZE DOES NOT FIT AL Human factors and poor team working are the major contributors to poor performance in high risk industries such as aviation, the maritime industry, and offshore oil production. Similarly, in healthcare, breakdowns in communication, poor team working, lack of leadership, and ineffectual decision making by individuals and teams have all been shown to be major contributors to deficiencies in patient safety and quality of care. In order to address these human factors issues there have been many attempts to apply an aviation model of safety to the healthcare industry. The application of this model has resulted in the introduction of safety intervention such as team training and checklists. However, the success of these interventions has been less than universal, and there is evidence to show that effectiveness can decay over time. This presentation will identify why a single model of safety is not appropriate for healthcare, and why there is a need to consider a number of different safety models. The ramifications of these different models for the design and implementation of successful safety interventions will then be discussed.
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SPEAKERS
Donal J. Buggy is Professor of Anaesthesia at the School of Medicine & Medical Science, University College Dublin. He is also a Consultant in Anaesthesia at the Mater Misericordiae University Hospital & Eccles Unit, National Cancer Control Programme, Dublin. His other current appointments include Clinician Investigator at MaterUCD Clinical Research Centre & Conway Institute for Biomedical Science, University College Dublin, Ireland.
PROFESSOR DONAL BUGGY
He is an Honorary Research Ethics Committee Member at the Mater University Hospital and was Honorary Medical Doctor to the Dublin Senior Football Team 2012. His research interests include longer term outcomes after anaesthesia & perioperative medicine, anaesthesia & cancer outcome, regional anaesthesia & acute pain and developing biomarkers for assessing the toxicity of anaesthetics in the developing fetus. Professor Buggy has 120 publications to his name, including 88 PubMed, Book Chapters, Thesis, & Peer-Reviewed Correspondence. He has received forty international invitations as a visiting Professor or Lecturer by the Australian, Japanese & Canadian Societies.
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College of Anaesthetists of Ireland
Lesley Colvin is a Consultant/Reader in Pain Medicine in the Dept of Anaesthesia & Pain Medicine, Western General Hospital, Edinburgh. She works full time in the Lothian Chronic Pain Service and the University of Edinburgh. She has a particular interest in translational research in pain and has several collaborations with the aim of rapidly translating exciting basic science findings into clinical developments. Her current research interests include cancer pain, cancer induced bone pain, acute and chronic
DR LESLEY COLVIN
neuropathic pain, phantom limb pain, opioids in chronic pain, pain and drug dependency and pain assessment. She is an Editor for the British Journal of Anaesthesia and has produced 2 postgraduate issues on advances in pain medicine. She is on the Professional Standards Committee of the Faculty of Pain Medicine of the Royal College of Anaesthetists. She is a member of the Scottish Executive Steering Group in Chronic Pain and the Research sub-group. She chaired the development of the new SIGN Guideline for Chronic Pain and is the SIGN representative on the Scottish Board of the Royal College of Anaesthetists.
ACUTE PAIN MANAGEMENT FOR OPIOID DEPENDENT PATIENTS Acute pain in the hospital setting remains an ongoing challenge, and can be particularly difficult in patients who are opioid dependent. These fall into two broad categories - patients with chronic pain who require long term opioids, and who are physically dependent; and those who have problems with substance misuse (who may have pre-existing chronic pain). This session will focus mainly on the second group of patients: the challenges of acute pain management, how to avoid problems and minimise future harm. While it is often apparent from the history when a patients has a current or previous problem with street drugs, such as heroin, patients may also be dependent on prescription opioids. The use of opioids for chronic pain has increased dramatically over recent years, with potential for drug diversion. Figures from SAMHSA show that in young adults (age 18-25) nonmedical use of painkillers increased from 4% in 1998 to 12% in 2010. ~80% of these were obtained from a friend or relative. Key to successful acute pain management of these patients is a full assessment and clear plan for in-patient management and discharge arrangements. Strategies to address these points will be discussed.
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SPEAKERS
Dr Vincent is Professor of intensive care at University of Brussels and Head of the Department of Intensive Care at the Erasme University Hospital in Brussels. Specialist in Internal Medicine, he spent two years training at the University of Southern California with Prof Max Harry Weil. Dr Vincent has signed more than 800 original articles, some 300 book chapters and review articles, and 850 original abstracts, and has edited 86 books. He is co-
PROFESSOR JEANLOUIS VINCENT
editor of the Textbook of Critical Care (Elsevier Saunders, 5th Edition) and the “Encyclopedia of Intensive Care Medicine” (Springer). Dr Vincent is the editor-in-chief of “Critical Care”, “Current Opinion in Critical Care”, and “ICU Management”. He is member of the Editorial Boards of about 30 journals including “Critical Care Medicine” (senior editor), American Journal of Respiratory and Critical Care Medicine (AJRCCM), “PLoS Medicine”, “Lancet Infectious Diseases”, “Anesthesiology”, “Intensive Care Medicine”, “Shock”, and “Journal of Critical Care”.
THE FUTURE OF THE INTENSIVE CARE DOCTOR?
Dr Vincent is presently President of the World Federation
The specialty of intensive care medicine has grown
of Societies of Intensive and Critical Care Medicine
exponentially since its early days in the 1950s and the
(WFSICCM). He is a Past-President of the Belgian Society
intensive care unit (ICU) is becoming an increasingly
of Intensive Care Medicine (SIZ), the European Society of
important (in terms of size and expenditure) part of
Intensive Care Medicine (ESICM), the European Shock
healthcare systems worldwide. There are many reasons for
Society (ESS), and the International Sepsis Forum (ISF).
the increasing need for ICU beds, but they are primarily
For 33 years he has organised an International Symposium
related to the progress in medicine: Improved trauma care
on Intensive Care and Emergency Medicine which is held
and field resuscitation mean that more patients survive
every March in Brussels. He has received the Distinguished
acute events, there are more immunosuppressed patients
Investigator Award of the Society of Critical Care Medicine,
who develop infections, and we treat more elderly patients
the College Medalist Award of the American College
- already more than half of all ICU days are attributable
of Chest Physicians, was the Recipient of the “Society
to patients over the age of 65. Intensive care medicine will
Medal”(lifetime award) of the European Society of Intensive
continue to grow despite resource limitations. A big issue
Care Medicine and has received the prestigious Belgian
will be in the harmonisation of progress in technology,
scientific award of the FRS-FNRS (Prix Scientifique Joseph
which seems increasingly to be replacing human input.
Maisin-Sciences biomédicales cliniques).
The latest developments in terms of communication, information processing and storage, computerised monitoring, data management systems, will certainly help streamline the processes of care delivery and may reduce the impact of predicted staff shortages. But, good bedside medical practice will remain essential and technology must
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College of Anaesthetists of Ireland
Alistair is a Consultant Anaesthetist and Intensivist at the St Vincent’s University Hospital, Dublin and Chair of Critical Care, University College Dublin. In addition, he is an Associate Professor in the Australian and New Zealand Intensive Care-Research Centre in the School of Public Health and Preventive Medicine, Monash University, Australia and an Honorary Intensivist at the Alfred Hospital, Melbourne, Australia. Research interests include ARDS, sepsis, blood transfusion medicine, clinical trials and traumatic brain injury in the critically ill.
PROF ALISTAIR NICHOL
Dr Colm Henry is the National Lead for the Clinical Director Programme in HSE since 2012. Before that he was Clinical Director in the Mercy University Hospital in Cork from 2009-2012. He is a Consultant Geriatrician, working in the Mercy University Hospital since 2002.
DR COLM HENRY
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SPEAKERS
Danny McAuley is a Consultant and Professor in Intensive Care Medicine at the Regional Intensive Care Unit at the Royal Victoria Hospital and Queen’s University of Belfast. He graduated from Queen’s University of Belfast in 1992. He undertook his training in Belfast, Birmingham, London and San Francisco. He is Co-Director of Research for the UK Intensive Care Society and Chair of the Irish Critical Care Trials group. He has 2 main research interests; acute
PROF DANNY MCCAULEY
lung injury and clinical trials.
THE POTENTIAL ROLE OF STATINS IN ARDS ARDS is a common, devastating, clinical syndrome characterised by respiratory failure requiring mechanical ventilation and is associated with high mortality and morbidity. ALI is caused by inflammatory-mediated damage to the alveolar epithelium and endothelium. Despite many large clinical trials being undertaken, a Cochrane systematic review concluded that there was no effective pharmacotherapy for ARDS. It is increasingly recognised that often such large trials are based on inadequate pilot studies with insufficient data to provide a sound scientific rationale to undertake a clinical trial. Hydroxylmethylglutaryl coenzyme A reductase inhibition with statins is a promising potential new therapeutic option since statins References Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in Acute lung injury to Reduce Pulmonary dysfunction (HARP-2) trial: study protocol for a randomized controlled trial (2012). McAuley DF et al. Trials 13:170. Effect of simvastatin on physiological and biological outcomes in patients undergoing oesophagectomy: a randomised placebo controlled trial (2014). Shyamsundar M et al. Annals of Surgery 259: 26–31. A randomized clinical trial of hydroxymethylglutaryl-CoA reductase inhibition for acute lung
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injury (The HARP study) (2011). Craig et al. American Journal of Respiratory and Critical Care 183:620-626.
modulate a number of the underlying processes described in
Reduction of pulmonary and systemic inflammation by simvastatin after inhalation of lipopolysaccharide by healthy volunteers (2009). Shyamsundar M at al. American Journal of Respiratory and Critical Care Medicine 179:1107-1114.
a potential treatment for ARDS will be reviewed.
ARDS. Statins have diverse anti-inflammatory properties. Statins attenuate lung injury in vivo in animal models. The clinical data which supports the concept that statins may be
Acute lung injury and the acute respiratory distress syndrome in Ireland; a prospective audit of epidemiology and management (2008). The Irish Critical Care Trials Group*. Critical Care 12: R30
College of Anaesthetists of Ireland
Gerard Curley completed clinical training in anesthesia and intensive care in Ireland, and a PhD as a Molecular Medicine Ireland Clinician Scientist Fellow under the supervision of John Laffey at NUI, Galway. His doctoral thesis focused on the development of stem cell therapies for repair of the injured lung. He has completed postdoctoral studies with Michael Matthay’s group at University of California, San Francisco and in the Departments of Experimental Physiology and Anesthesia at University of Toronto, where he has examined ways to optimise cell therapy for use in patients with ARDS and sepsis. He
DR GERARD CURLEY
completed a clinical fellowship in Critical Care in the Interdepartmental Division of Critical Care, University of Toronto, and is currently Assistant Professor/Staff Anesthesiologist at St Michael’s Hospital Department of Anesthesia and University of Toronto.
CELL THERAPY FOR ARDS: IS IT READY FOR CLINICAL TRANSLATION? Over the last twenty years, despite numerous randomised clinical trials aimed at regulating the lung inflammatory response in ARDS, the only proven therapy to consistently reduce mortality is a protective ventilation strategy (1). Stem cell therapy aimed at diminishing inflammation and restoring lung function is one of the most exciting and promising frontiers of medical research. Mesenchymal stem/stromal cells, a population of plastic adherant cells in bone marrow, appear closest to clinical translation, given the evidence that they may favourably modulate the immune response to reduce lung injury, while maintaining host immune-competence and also facilitating lung regeneration and repair (2, 3). A growing number of preclinical studies in ARDS, and clinical trials in other conditions, have demonstrated the safety and efficacy of MSCs (4). As a result, two early phase trials of MSCs in patients with ARDS are underway, in the United States and China respectively. However, questions remain on how best to implement cell
based interventions in ARDS.
Some have argued that more basic research is required because we do not yet have enough understanding of the underlying mechanisms of MSC therapeutic effect in ARDS. Given the on-going high incidence and mortality of ARDS, and given the high cost of developing potential new therapies such as mesenchymal stem cells, the thought that a therapy should fail to be approved simply because it was inadequately studied is devastating. In this talk, I will focus on what is known about MSC mechanism of action in ARDS, as well as on the design of a cell therapy clinical trial, including patient identification and choice of endpoints. I will conclude with a short discussion of the ongong pre-clinical and clinical evaluation of MSCs, which will reduce the likelihood of erroneously dismissing this potentially valuable therapy.
1. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome network. The New England journal of medicine 2000;342:1301-1308. 2. Curley GF, Ansari B, Hayes M, et al. Effects of intratracheal mesenchymal stromal cell therapy during recovery and resolution after ventilatorinduced lung injury. Anesthesiology 2013. 3. Curley GF, Hayes M, Ansari B, et al. Mesenchymal stem cells enhance recovery and repair following ventilatorinduced lung injury in the rat. Thorax 2012;67:496-501. 4. McAuley DF, Curley GF, Hamid UI, et al. Clinical grade allogeneic human mesenchymal stem cells restore alveolar fluid clearance in human lungs rejected for transplantation. American journal of physiology Lung cellular and molecular physiology 2014.
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SPEAKERS
Mr Carter is the National Director of Acute Hospitals, HSE and former Chief Executive Officer of St. James’s Hospital (2006-2012) Prior to taking up his new role of National Director of Acute Hospitals Ian was on secondment to the HSE as Special Projects Manager. Ian has also held the position of Assistant CEO (Acute Hospitals) Mid Western Health Board (1997) and General Manager (Acute Hospitals) Mid Western Health Board (1993 - 1997). Ian
MR IAN CARTER
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Carter is adjunct associate Professor in Health Services Management at Trinity College Dublin
College of Anaesthetists of Ireland
Dr McGoldrick, a graduate of Cornell University Medical College, is Professor and Chair of Anesthesiology at New York Medical College, where she also serves as Residency Program Director. She completed residency training in Anesthesiology at Brigham and Women’s Hospital in Boston. She has authored 85 book chapters and more than 75 journal articles. Dr McGoldrick also has authored or edited 17 books. She has served as President of multiple organizations, including the Wood Library Museum of Anesthesiology, the Connecticut State Society of Anesthesiologists,
PROFESSOR KATHRYN MCGOLDRICK
the Society for Ambulatory Anesthesia (SAMBA), and The Academy of Anesthesiology. A member of Alpha Omega Alpha honor medical society, Dr McGoldrick was the 2013 recipient of the SAMBA Distinguished Service Award and was recently awarded Honorary Fellowship of the College of Anaesthetists of Ireland. Dr McGoldrick currently serves on the Board of the Foundation for Anesthesia Education and Research (FAER) and on the Board of the Anesthesia Foundation. She served from 2009 to 2013 on the Executive Committee of the International Association for Ambulatory Surgery (IAAS). She is Chief Editor of Survey of Anesthesiology and serves on the Editorial Board of Current Reviews in Clinical Anesthesia.® Dr McGoldrick’s interest outside medicine include travel, photography, volunteer work, and writing essays and poetry.
SUBSTANCE ABUSE AND ANESTHESIA PROVIDERS: AN OCCUPATIONAL HAZARD Substance abuse is the most prevalent disabling illness for physicians, with a lifetime prevalence approaching 15%. Substance use disorder (SUD) among anesthesiologists and other physicians produces serious risks to both physicians and their patients. Anesthesiologists are particularly vulnerable to opioid abuse, while other physicians appear to be more likely to abuse alcohol. Although genetics, vulnerable brain chemistry, and environmental triggers are thought to play important roles in substance abuse/addiction, lack of data concerning epidemiology and outcomes has impeded our understanding of this potentially life-threatening condition. Recreational use of mind-altering substances dates at least as far back as 3400 BCE, when the Sumerians cultivated opium poppies (the “joy plant”) for food, analgesia, and rituals. Since the 1970s, the American Board of Anesthesiology has waged a vigorous educational campaign about SUD, mandating that all accredited Anesthesiology residency programs in the United States hold regular educational sessions on the topic. In addition to educating residents and faculty about the dangers of SUD, programs have also emphasized stress management, introduced deterrents (video surveillance, satellite pharmacies), and enhanced accountability (electronic data analysis, random drug testing). Yet, recent data suggest that the incidence of SUD, at least among Anesthesiology residents, is actually increasing. Importantly, even after intensive inpatient rehabilitation, relapse rates are high and, not infrequently, the presenting sign of relapse is death. Possible strategies to improve this bleak situation will be discussed.
References Collins GB et al. Chemical dependency treatment outcomes of residents in anesthesiology: results of a survey. Anesth Analg 2005;101:1457-1462. Tetzlaff J et al. A strategy to prevent substance abuse in an academic anesthesiology department. J Clin Anesth 2010;22:143-150. Warner DO et al. Substance use disorder among anesthesiology residents, 1975-2009. JAMA 2013;310(21):2289-2296.
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SPEAKERS
William Harrop-Griffiths is a Consultant Anaesthetist and Honorary Senior Lecturer at Imperial College Healthcare NHS Trust, London, UK. He graduated in 1981 from Oxford University and St Thomas’s Hospital, London and trained mainly in the London area, apart from a year spent in Seattle, where he was exposed to regional anaesthesia, became hooked and is now a life-long addict. He is the President of the Association of Anaesthetists of Great
DR WILLIAM HARROPGRIFFITHS
Britain & Ireland (AAGBI), Chair of the Board of Trustees of its charity, the AAGBI Foundation, Chair of the Editorial Board of the journal Anaesthesia, a co-opted member of the Council of the Royal College of Anaesthetists, and a number of other things that take him away from clinical anaesthesia more than he would wish at present. He is fond of speaking in public, and his lectures have often been described as “a victory of style over content”. He takes this as a compliment. His clinical interests are orthopaedic, obstetric and vascular anaesthesia. His non-clinical interests include riding horses, bicycles and motorcycles. His passions are his family, English grammar and not falling off horses, bicycles or motorcycles.
GOAL-DIRECTED FLUID THERAPY – SMOKE AND MIRRORS OR MAGIC BULLET? With more than 30 years of continuous practice in anaesthesia and a natural propensity to severe scepticism, Dr Harrop-Griffiths will ask whether GDFT is a valuable weapon in the armamentarium of the thoughtful and skilled anaesthetist or just another clinical craze that rises, flourishes and falls as have many fads over the last three decades – and more. The presentation used in this talk will be available to any registrant who emails harropg@mac.
GUIDELINES SPELL THE DEATH OF PROFESSIONALISM In what is hoped will be a lively and at times controversial session, Dr Harrop-Griffiths will both chair and take part in a debate on whether guidelines and protocols that aim to standardise and regularise medical treatment in fact sound the death knell of true medical professionalism as we know it. The two presentations used in this debate will be available in a variety of formats to any registrant who emails harropg@mac.com after the conference.
com after the conference.
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College of Anaesthetists of Ireland
Barry Lyons graduated in medicine from University College Dublin in 1989, and has a BA degree in philosophy & history (Dublin City University, 2007) and a PhD in medical jurisprudence (University of Manchester, 2011). He practices as a consultant in the Dept. of Anaesthesia and
DR BARRY LYONS
Critical Care Medicine at Our Lady’s Children’s Hospital, Dublin, and lectures in Bioethics at Trinity College Dublin. He is an invited member of the Irish Medical Council’s Ethics & Professionalism Committee, and has recently been a visiting scholar at the School of Law, University of Manchester. ETHICS SESSION – THE LAW AND THE ANAESTHETIST Section 4(2) of the Assisted Decision-Making (Capacity) Bill 2013 implies, perhaps inadvertently, that in all cases where the withdrawal of life-sustaining treatment is proposed, prior High Court approval will be required. This process would represent a significant shift in current practice, but is this problematic? Clearly, such an approach would impact upon workload and expenditure. It might also be proposed that the withholding or withdrawal of life-sustaining interventions are medical matters; that engagement with the patient’s and his/her family’s wishes is an important relational aspect of proper medical treatment that is best carried out by those entrusted with that individual’s care; and that interference by the courts with this relationship represents an unwarranted intrusion that would not be welcomed by patients, families or healthcare professionals. This argument, perhaps, could be taken as an indication that all is well in the world of ICU treatment withdrawal, that the process is scientifically and procedurally sound and based on agreed principles and parameters, that there is a general consensus on this, and minimal variability in practice. International data, however, indicates that none of this is true, and that there are significant difficulties in end-of-life care in the ICU. This paper discusses some of the problems encountered in practice, and a number of possible mechansms aimed at resolving these complex issues.
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SPEAKERS
Dr Mary Donnelly is a Senior Lecturer at the Law Faculty, University College Cork. She is the author of Consent: Bridging the Gap Between Doctor and Patient (Cork: Cork University Press, 2002) and Healthcare DecisionMaking and the Law: Autonomy, Capacity and the Limits of Liberalism (Cambridge: Cambridge University Press, 2010) and co-author of End-of-Life Care: Ethics and Law (Cork University Press, 2011) as well as articles/essays on medical
DR MARY DONNELLY
and mental health law in a range of Irish and international journals/books. She has collaborated on projects on endof-life care, funded by the Irish Hospice Foundation and children and medical treatment funded by the National Children’s Office. She is a member of the Expert Group to review the Mental Health Act 2001 and was a member of the National Consent Advisory Group for the development of the HSE National Consent Policy. She has been a visiting fellow at Monash University, Melbourne, Australia (2002) and at the London School of Economics (2009).
PREGNANCY AND THE LAW - WHAT THE ANAESTHETIST NEEDS TO KNOW This paper will examine a range of issues of relevance to anaesthetists in dealing with pregnant patients. The focus will be practical although, because of uncertainties in the underlying legal framework, it will not be possible to provide legally certain answers in all cases. The issues to be discussed include the following: Legal issues in respect of termination of pregnancy. This will include discussion of the Protection of Life During Pregnancy Act 2013, with a particular focus on issues of consent and conscientious objection and the notification procedures under the Protection of Life During Pregnancy Act Regulations 2013 A consideration of relevant issues of consent and capacity in respect of young people and adults with capacity difficulties. This will include discussion of the age of consent to treatment and the possible different legal treatment of consent and refusal in respect of young people. There will also be a discussion of the proposed changes in the Assisted Decision-Making Capacity Bill 2013 of relevance to anaesthetists in treating pregnant women The legal issues, including possible duties to the ‘unborn’, which arise in respect of the brain death of the woman in situations where the foetus is/may be viable The limits and scope for coercive procedures in the context of refusal of intervention. This includes discussion of the role of capacity and the possible role of foetal interests in the context of the protection of the right to life of the ‘unborn’ in Article 40.3.3 of the Constitution of Ireland.
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College of Anaesthetists of Ireland
Deirdre graduated from the Royal College of Surgeons in Ireland. After internship and medical senior house office posts in Connolly Hospital she went on to train in occupational medicine. During her training she worked in Medmark Occupational Healthcare, Tallaght Hospital Occupational Health Department and the Office of the Chief Medical Officer for the Civil Service. She now works for Medmark Occupational Healthcare, working in Cork and Waterford. Aside from her clinical work she was the medical secretary for the EMI committee, a subcommittee of the Scientific Advisory Committee in the HPSC, which produced guidelines
DR DEIRDRE FITZGERALD
for the management of blood and body fluid exposures. She has also published research regarding violence experienced in community pharmacies, supports for older professionals with cognitive disorders and a Cochrane review examining the evidence behind scabies prophylaxis. Most recently, she has been assisting Dr Blanaid Hayes with a project in the Royal College of Physicians in Ireland, examining physician wellbeing in hospital in Ireland.
THE IMPLEMENATION OF THE EUROPEAN WORKING TIME DIRECTIVE WILL HAVE A DETRIMENTAL EFFECT ON TRAINING IN IRELAND I will be talking about the positive aspects of the European Working Time Directive for doctors undergoing anaesthetic training in Ireland. It is easy to criticise the directive and to expect that training will be compromised by limiting work hours, thereby limiting clinical exposure. One must not forget, however the impact of working long hours on wellbeing, cognition, error potential and overall quality of life. The primary objective of the directive was to protect the health and safety of workers. I hope that trainees will appreciate the benefits for them following my talk.
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SPEAKERS
Glyn Williams is a Consultant in Paediatric Anaesthesia and Pain Medicine at Great Ormond Street Hospital, London.
DR GLYN WILLIAMS
He has published in a number of areas on the subject of Paediatric Pain including developmental and genetic factors affecting the use of opioids, treatment of postoperative pain in children and the treatment of medically related pain in children. He is also currently part of APA sponsored groups devising guidelines on the treatment of pain in children and studying prevalence and consequences of pain at home in children following surgery. ‘MANAGING PAEDIATRIC POST SURGICAL, POST DISCHARGE PAIN – OUT OF SIGHT SHOULD NOT BE OUT OF MIND’ The potential for pain at home in children following surgery is well recognised. Pain is also a significant factor in the occurrence of behavioural disturbances and sleep disruption in children following surgery. Poorly managed postoperative pain may also have a negative impact on recovery, increase complications and healthcare use, decrease parental and patient satisfaction, disrupt normal family life and have an economic cost both individually within the family and on a national scale. There is limited evidence on the incidence, severity and pattern of pain following discharge in children following surgery. Studies from the UK, US and Australia suggest children are experiencing significant pain at home for an extended period which is associated with an increased incidence of behavioral disturbances and high rates of attendance to General Practioners or Accident and Emergency departments.The APAGBI commissioned a study to look at the prevelance of pain at home in children and its consequences. In this talk I will discuss the results from this study and look at the factors affecting the outcomes. I will also highlight that further study and improvement projects are urgently needed to help alleviate what has now been recognised as a serious and common clinical failing.
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College of Anaesthetists of Ireland
Anthony Dickenson, BSc, PhD, FmedSci, FBPharmcolS is Professor of Neuropharmacology in the Department of Neuroscience, Physiology and Pharmacology at University College, London, United Kingdom. He gained his PhD at the National Institute for Medical Research, London, and has held
PROF ANTHONY DICKENSON
posts in Paris, California and Sweden. His research interests are pharmacology of the brain, including the mechanisms of pain and how pain can be controlled in both normal and pathophysiological conditions, and how to translate basic science to the patient.Prof Dickenson is an Honorary Member of the British Pain Society and was a member of the Council of the International Association for the Study of Pain for 6 years and is Section Editor for the journal Pain. He has authored more than 300 refereed publications and has an h index of 63, all due to his motivated and brilliant research team; he
drives in neuropathic pain and some of these peripheral
is a founding and continuing member of the Wellcome Trust
sensors and channels are implicated in human familial
funded London Pain Consortium. Prof Dickenson has given
pain disorders. Nerve trauma causes abnormal impulse
plenary lectures at the World Congress on Pain, the American
propagation towards the spinal cord and marked changes
Pain Society, the European Pain Congress, the Canadian Pain
in calcium channels that now release more transmitter
Society, the Belgium Pain Society, ASEAPs, the Scandinavian
which acts to favour central spinal hypersensitivity.
Pain Society, the British Pain Society, the Thailand Pain
In the spinal cord, the release of transmitters causes
Society, the Irish Pain Society, the Singapore Pain Society, the
activation of receptors such as the NMDA receptor that
Australian Pain Society, the New Zealand Pain Society and
generates wind-up and long term potentiation, plausible
many other international and national meetings. He has also
mechanisms for enhanced and prolonged pain states.
spoken at the Royal Institution, to GPs and schools on pain.
Memory related genes are also activated. Recent work has revealed a hitherto spinal cord –brain –spinal cord
WHAT MAKES UP THE PAIN EXPERIENCE?
loop that involves centres of the brain important in
A.H. Dickenson Dept. NPP Pharmacology, University College
emotional and aversive responses to pain. These centres
London, WC1E 6BT UK
in the brain will be activated not only by pain but also by
Many of the pain signalling and modulatiory mechanisms
“top-down” processes such as fear, anxiety and other life-
in the CNS change following physiopathological events
events that start to dominate in chronic pain states. These
such as the two broad major types of pain, neuropathic and
pathways then descend to facilitate spinal mechanisms
inflammatory pain. Low back pain and cancer pain can be one
of pain showing the key interplay between sensory and
or the other or a combination. The peripheral mechanisms
psychological events in pain processing. In this regard,
of these types of pain are very different yet within the central
a number of drugs are able to harness peripheral, spinal
nervous system the signalling systems appear to be more
and/or supraspinal sites of action to subdue aberrant
common. Finally, in pains such as fibromyalgia the underlying
transmitter or channel function and so can have efficacy
mechanisms are more likely to be central than peripheral. Pain
in different pain states. Understanding mechanisms for
sensors in the periphery are likely to be continually activated
pain enhancement should help to explain these altered
when tissue is damaged. Changes in ion channels, in particular
pain states in patients but also could lead to better use of
sodium channels are thought to cause abnormal peripheral
treatments.
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SPEAKERS
Dr Patrick Neligan is Consultant Anaesthetist in Galway University Hospital. He has a special interest in Intensive Care. He graduated from UCD Medical School in 1991 and trained in medicine and anaesthesia. He did fellowship training in Critical Care at Duke University, North Carolina, and in Trauma Critical Care and Neuroanasthesia at the Hospital of University of Pennsylvania (HUP), Philadelphia PA. He was a consultant in Anesthesiology and Critical
DR PAT NELIGAN
Care at HUP between 2002 and 2008. His wide-ranging academic interests include bariatric medicine and metabolic syndrome, fluids, electrolytes and acid base chemistry and mechanical ventilation. He recently co-edited the textbook “An Evidence Based Practice of Critical Care� (Elservier 2010).
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College of Anaesthetists of Ireland
FREE PAPERS & CAI ANNUAL CONGRESS OF ANAESTHESIA 2015
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FREE PAPER/ABSTRACT
TITLE
An Audit of Surgical Antibiotic Prophylaxis in Cardiac Theatre in Mater Misericordiae University Hospital
BACKGROUND Surgical site infection (SSI) is an uncommon but significant complication following cardiac surgery, with an incidence ranging from 0.23 to 5.67 per 100 operations in chest-only incisions and 0.35 to 8.49 per 100 when donor sites are included. Procedure-related risk factors include the timing of administration of antibiotic prophylaxis relative to time of incision. For vancomycin, the recommended interval is 30 to 60 minutes between completion of infusion and incision. Earlier incision may increase the risk of SSI. METHODS An audit of antibiotic prophylaxis practices in patients presenting for cardiac surgery in MMUH was conducted over a 12-month period. Data was collected on fixed risk factors for SSI as well as modifiable practices, including the timing of vancomycin administration. RESULTS
AUTHOR(S) Dr Kathryn Byrne, Dr Fauzia Bano, Nuala Scanlon, Dr Margaret Hannon, Dr Roísín Ní Mhuircheartaigh
The overall rate of SSI after cardiac surgery was 13 %. In
PRESENTER Dr Kathryn Byrne
incidence of SSI was not higher in those patients in whom
81% the infusion was incomplete at the time of incision and in only 7.2% was the infusion completed 30-60 minutes prior to incision. SSI was more common in diabetic patients, those with a BMI over 25, impaired left ventricular function or peripheral vascular disease. However, the vancomycin infusion was incomplete at the time of skin incision.
NAME & ADDRESS OF INSTITUTION Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7
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DISCUSSION Our findings indicate an incidence of SSI higher than accepted international norms and suboptimal adherence to best practice guidelines in relation to the timing of antibiotic prophylaxis. However, this shortcoming was not itself associated with an increased SSI rate.
College of Anaesthetists of Ireland
TITLE
OBJECTIVE The aim of this preliminary prospective cohort study is to evaluate the role of TIVA and continuous wound infiltration (CWI)-based multimodal analgesia on acute pain, PONV and on the attainment of milestones of recovery following
Clinical outcome in major breast surgery under combined TIVA, multimodal analgesia and continuous wound infiltration. A prospective cohort study
major breast cancer surgery. METHOD A standardised propofol total intravenous anaesthesia (TIVA) technique was used, combined with systemically administered multimodal analgesics. At the end of surgery, wounds were soaked with 40 ml of bupivacaine 0.25%. Two multiported wound inflitration catheters were placed and connected to an elastomeric infusion pump delivering bupivacaine 0.25% at a rate of 5 ml/h for 48 h. Pain, postoperative nausea and vomiting and both PACU and hospital discharge readiness were assessed post-operatively. RESULT To date 47 women completed the study protocol [age (56 ± 9); weight (72 kg ± 16) (mean ± SD)]. The median pain score [NRS (Median; IQR)] on both PACU admission and discharge was 0 (0; 2). Acute pain was present in 28% on PACU admission, 40% at PACU discharge and 26% at 8 AM (0; 1). Only 2 women had PONV on admission and 1 prior to discharge. 95% of women fulfilled PACU discharge criteria [Aldrete Score (Median; IQR)] (10; 1) within 25 min; 70% attained hospital discharge criteria [PADS scores (Median; IQR)] (9; 2) at 8 PM of the same day. CONCLUSION CWI and multimodal analgesia combined with TIVA reduce the incidence of post-op pain and PONV, thus facilitate the early attainment of PACU and hospital discharge readiness
AUTHOR(S) Fleck A., Treanor N., Lavelle A., O’Donnell B. PRESENTER Aurelia Fleck NAME & ADDRESS OF INSTITUTION Department of Anaesthesia and Intensive Care, Cork University Hospital, Wilton, Cork
following major breast cancer surgery.
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FREE PAPER/ABSTRACT
TITLE
Determination of the initial minimum effective dose of 0.5% bupivacaine with 20mcg of fentanyl administered via a spinal catheter for an operative fixation of fractured neck of femur.
BACKGROUND Elderly patients with fractured neck of femur have multiple co-morbidities and a high risk perioperative morbidity and mortality requiring a high standard of perioperative care. Continuous spinal anaesthesia is evolving as a safe and effective technique for management of high risk orthopaedic patients. However, the optimum dose of local anaesthetic with intrathecal opiate required to initiate spinal anaesthesia for emergency hip surgery is unknown. We designed a study to determine the initial minimum effective dose of 0.5% bupivacaine with 20mcg of fentanyl required to start an operative fixation of fractured neck of femur. METHODS 18 patients scheduled for emergency hip surgery were recruited until the study stopping rule of six independent crossovers (success/failure pairs) was triggered. The first patient received a dose of 0.5ml. The doses for consecutive patients were determined by the response of the previous patient using an up-and-down method with incremental increase or decrease of 0.1ml. Dixon and Massey model was used to calculate ED50. Probit analysis was employed to verify ED50 and estimate ED95.
AUTHOR(S) Dr Tomas Hitka, Dr Szillard Szucs, Dr Gabriella Iohom
RESULTS ED50 calculated by Dixon and Massey method was 0.29ml (1.45mg) (95% CI 0.23-0.35). Probit analysis confirmed ED50 as 0.29ml (95% CI 0.288-0.294) and estimated ED95
PRESENTER Dr Tomas Hitka NAME & ADDRESS OF INSTITUTION Department of Anaesthesia, Intensive Care and Pain medicine, Cork University Hospital, Wilton, Cork
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as 0.34ml (1.7mg) (95% CI 0.33-0.35). CONCLUSION The dose of local anaesthetic combined with intrathecal opiate required to start an operative fixation of fractured neck of femur is significantly smaller than doses previously used with a spinal catheter technique for a hip replacement surgery.
College of Anaesthetists of Ireland
TITLE
INTRODUCTION Local infilteration analgesia (LIA) is considered acceptable after total knee replacements (TKR) in terms of analgesia, ease of performance, early mobilisation and early hospital discharge. OBJECTIVE
Does Saphenous nerve block improve analgesia after Total Knee Replacement whenused in combination with Local Infiltration Analgesia: A Prospective RandomisedDouble Blinded Controlled Trial
We hypothesise that preoperative saphenous nerve block (SNB) in combination with periarticular local infiltration provides better analgesia profile as compared to local infilteration alone. METHODOLOGY With institutional ethics approval and having obtained written informed consent 20 ASA 1 – 3 scheduled to undergo TKR under spinal anaesthesia +/- sedation patients were randomly allocated to either Group (SNB): patients receiving SNB or Group (NSNB): patients not receiving SNB. All patients received LIA perioperatively. Post operatively patients were assessed for pain at rest and movement and degree of ambulation 0, 6, 12 and 24 hour. Cumulative opiod consumption and time to discharge were recorded. RESULTS 20 patients were assessed for the study. Our primary outcome was pain on movement at 24 hours. There was significant difference between the two groups 5.5 +/- 1.7 (NSNB) vs 3.9 +/-2.2 (SNB) p= 0.04. Our study also showed significant difference in pain at rest at 24 hour time point 3.8 +/- 2 (NSNB) vs 2.1 +/-2 (SNB) p= 0.04. Cumulative opioid consumption in 24 hours 24 +/- 9.6 (NSNB) vs 18 +/- 10 (SNB) and till discharge 38 +/- 18 (NSNB) vs 32 +/- 18 (SNB), and time to discharge 4 +/- 1.4 (SNB) vs 5 +/- 1.4 (NSNB) were found to be statistically in significant. CONCLUSION We conclude that SNB does improve analgesia after TKR when combined with LIA.
AUTHOR(S) Rauf J, Pascu C, Georgescu S, Harty J, Loughnane F, Iohom G, Shorten G. PRESENTER Jassim Rauf NAME & ADDRESS OF INSTITUTION Department of Anaesthesia/ICU Cork University Hospital, University College Cork, Cork, Ireland.
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FREE PAPER/ABSTRACT
TITLE
Acute and Persistent pain after Laparoscopic Cholecystectomy
INTRODUCTION Persistent post-surgical pain (PPSP) was first recognised as a complication in 1992 but was not defined until 2001. Laparoscopic cholecystectomy is among the most commonly performed surgical procedures but there are reports of high rates of PPSP thereafter. Presently little published evidence exists as to the incidence of, and factors contributing to PPSP following laparoscopic cholecystectomy. OBJECTIVES 1) To investigate the incidence of PPSP. 2) To characterise acute pain 3) to seek factors (demographic, psychosocial and clinical) associated with the development of PPSP following laparoscopic cholecystectomy. METHODS 13 patients undergoing laparoscopic cholecystectomy at Cork University Hospital were recruited consecutively between July and August 2013. Having obtained informed consent, demographic data, Pain Catastrophizing Scale scores, Hospital Anxiety and Depression scores, intraoperative and post-operative analgesic use and verbal
AUTHOR(S) Rory D Linehan, Dr Peter J. Lee
rating scale scores for pain in the post anaesthesia care unit and for 24 hours following surgery were obtained. A telephone interview was conducted 2 months following surgery to determine the presence or absence of PPSP.
PRESENTER Dr Rory Linehan
RESULTS 3 of 13 (23%) patients reported PPSP. 1 of 3 (33%) patients
NAME & ADDRESS OF INSTITUTION Cork University Hospital, Wilton Cork
reported pain at a level that would prohibit discharge from a theatre recovery unit. Verbal rating scales for pain on discharge from post anaesthesia care unit had an association with PPSP that tended towards the significant. (p=0.067)
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TITLE
AIM To find out any significant difference in patient outcome depending on the source of admission in our intensive care unit after implementation of early warning score (EWS) in
Does source of admission affect the outcome of ICU patients after implementation of early warning score?
our hospital. METHOD Retrospective collection of data from 1st August, 2012 to 31st January, 2013 (total 6 months). RESULT A total of 282 patients were admitted in our ICU (5 bedded ICU and 4 bedded high dependency unit) in the audited period of 6 months. 158 (56.02%) patients were admitted from the accident and emergency (A&E) department, and 132 (83.54%) of them had good outcome (either discharged home or transferred to ward or other hospitals). Only 26 (16.45%) of these died in the ICU which was seen to be worst among all sources of admission. Sixty one (21.63%) patients were admitted from the operation theatre, out of them only 4 (6.55%) patients died and the rest had good outcome. Fifty (17.73%) patients were admitted from wards, among which 8 (16%) patients died in our care (more or less similar to A&E department), the remaining 42 (84%) had good outcome. Only 13 (4.6%) patients were admitted from other hospitals, 1 (7.69%) patient died and the other 12 (92.3%) had favourable outcomes. DISCUSSION We have conducted this re-audit after implementation of EWS at the end of June 2012 in our hospital to evaluate whether it is beneficial or not. Our previous audit before the implementation of EWS showed that ICU admission from
AUTHOR(S) Vikash Singh, Rajesh Kumar Jain, Pradipta Bhakta. PRESENTER Vikash Singh NAME & ADDRESS OF INSTITUTION Our Lady Of Lourdes Hospital, Windmill Road, Drogheda.
wards had the worst outcomes in terms of mortality. It is shown that implementation of EWS in our hospital made a major improvement in reducing mortality in this group (16% compared to 37% from previous audit). This is likely due to patients being assessed and referred earlier to ICU
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ACKNOWLEDGEMENTS
The College of Aneasthesists of Ireland would like to acknowledge and thank all participating companies who have helped make the College’s Irish Congress of Anaesthesia 2014 a success.
Aquilant Medical
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College of Anaesthetists of Ireland
COLLEGE OF ANAESTHETISTS OF IRELAND 22 Merrion Square North, Dublin 2, Ireland www.anaesthesia.ie
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