• Accuracy of identification of the cricothyroid membrane in female subjects using palpation: an observational study.

      Aslani, Anastasia; Ng, Su-Cheen; Hurley, Michael; McCarthy, Kevin F; McNicholas, Michelle; McCaul, Conan Liam; Department of Anaesthesia, The Rotunda Hospital, Dublin 1, Ireland. (2012-05)
      The cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyroidotomy to provide emergency oxygenation. Despite the apparent simplicity of the technique, this rescue maneuver frequently fails to achieve its goals and complications are numerous. The reasons for this failure are unclear. We sought to determine the ability of physicians to correctly identify the CTM in female patients.
    • The accuracy of locating the cricothyroid membrane by palpation - an intergender study

      Campbell, Mark; Shanahan, Hilary; Ash, Simon; Royds, Jonathan; Husarova, Viera; McCaul, Conan; Rotunda Hospital Dublin (2015-07-14)
    • Accuracy of sonographic chorionicity classification in twin gestations.

      Blumenfeld, Yair J; Momirova, Valerija; Rouse, Dwight J; Caritis, Steve N; Sciscione, Anthony; Peaceman, Alan M; Reddy, Uma M; Varner, Michael W; Malone, Fergal D; Iams, Jay D; et al. (2014-12)
      To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy.
    • Accuracy of sonographic determination of placental cord insertion site in twin pregnancies

      Kent, E; McAuliffe, F; Geary, M; Daly, S; Higgins, JR; Dornan, J; Morrison, J J; Burke, G; Higgins, S; Carroll, S; et al. (2010)
    • Activated factor X signaling via protease-activated receptor 2 suppresses pro-inflammatory cytokine production from LPS-stimulated myeloid cells.

      Gleeson, Eimear M; O'Donnell, James S; Hams, Emily; Ni Ainle, Fionnuala; Kenny, Bridget-Ann; Fallon, Padraic G; Preston, Roger J S; Ireland. (2013-07-19)
      Vitamin K-dependent proteases generated in response to vascular injury and infection enable fibrin clot formation, but also trigger distinct immuno-regulatory signaling pathways on myeloid cells. Factor Xa, a protease crucial for blood coagulation, also induces protease-activated receptor-dependent cell signaling. Factor Xa can bind both monocytes and macrophages, but whether factor Xa-dependent signaling stimulates or suppresses myeloid cell cytokine production in response to Toll-like receptor activation is not known. In this study, exposure to factor Xa significantly impaired pro-inflammatory cytokine production from lipopolysaccharide-treated peripheral blood mononuclear cells, THP-1 monocytic cells and murine macrophages. Furthermore, factor Xa inhibited nuclear factor-kappa B activation in THP-1 reporter cells, requiring phosphatidylinositide 3-kinase activity for its anti-inflammatory effect. Active-site blockade, γ-carboxyglutamic acid domain truncation and a peptide mimic of the factor Xa inter-epidermal growth factor-like region prevented factor Xa inhibition of lipopolysaccharide-induced tumour necrosis factor-α release. In addition, factor Xa anti-inflammatory activity was markedly attenuated by the presence of an antagonist of protease-activated receptor 2, but not protease-activated receptor 1. The key role of protease-activated receptor 2 in eliciting factor Xa-dependent anti-inflammatory signaling on macrophages was further underscored by the inability of factor Xa to mediate inhibition of tumour necrosis factor-α and interleukin-6 release from murine bone marrow-derived protease-activated receptor 2-deficient macrophages. We also show for the first time that, in addition to protease-activated receptor 2, factor Xa requires a receptor-associated protein-sensitive low-density lipoprotein receptor to inhibit lipopolysaccharide-induced cytokine production. Collectively, this study supports a novel function for factor Xa as an endogenous, receptor-associated protein-sensitive, protease-activated receptor 2-dependent regulator of myeloid cell pro-inflammatory cytokine production.
    • Adrenal function in preterm infants undergoing patent ductus arteriosus ligation.

      El-Khuffash, Afif; McNamara, Patrick J; Lapointe, Anie; Jain, Amish; Department of Paediatrics, Rotunda Hospital, Dublin, Ireland. (2013)
      Targeted milrinone treatment for low left ventricular output (LVO) reduces the incidence of acute cardiorespiratory instability following ligation of patent ductus arteriosus (PDA) in preterm infants. Despite this, some infants continue to experience postoperative deterioration. Adrenal insufficiency related to prematurity has been postulated as a possible mechanism.
    • Advanced maternal age and assisted reproductive technologies in an Irish population

      O’Shea, L; Hughes, C; Mocanu, EV (Irish Medical Journal, 2015-09)
      In recent decades the amount of women over 40 seeking assisted reproductive technology (ART) interventions in order to become pregnant has dramatically increased, both in Ireland and worldwide. This is due to an increase in the average age at which women are choosing to have their first child while additionally, many couples are choosing to have a second family later in life. However, as with natural conception, ART success rates decrease with maternal age. In the present study, we perform a 16 year retrospective analysis on our clinical data of women between 40 and 45 years of age, who have undergone ART at a tertiary referral ART clinic. The percentage of patients in this age group was analysed over time, in order to determine follicle recruitment, % oocyte yield, embryonic quality, positive hCG (pregnancy rate), clinical pregnancy rate and rate of preclinical pregnancy loss. Results from our clinic show that women greater than 43 years of age have a significantly reduced reproductive potential compared to women in the 40 to 42 years age group. Woman in the 43-45 age group showed reduced fertilization rates (53.73% versus 58.82%), reduced positive hCG rates (11.51% versus 19.03%) and clinical pregnancy rates (5.04% versus 12.52%) and increased rates of preclinical pregnancy loss (56.23% versus 34.23%), compared to women in the 40-42 age group. With the age at which couples are choosing to have children constantly increasing, novel ART treatment strategies need to be developed.
    • Air travel in pregnancy

      Breathnach FM; Rotunda Hospital (2009-10)
    • Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites.

      Salah, Nazar; El Saigh, Ismat; Hayes, Niamh; McCaul, Conan; Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland. (2009-12)
      Oxygenation via the cricothyroid membrane (CTM) may be required in emergencies, but inadvertent tracheal cannulation may occur. In this study, we compared airway injury between the tracheal and CTM sites using different techniques for airway access.
    • All azoospermic males should be screened for cystic fibrosis mutations before intracytoplasmic sperm injection.

      Mocanu, Edgar; Shattock, Richard; Barton, David; Rogers, Melissa; Conroy, Ronan; Sheils, Orla; Collins, Claire; Martin, Cara; Harrison, Robert; O'Leary, John; et al. (2012-02-01)
      We assessed the frequency of CFTR mutations in groups with varying degrees of sub-fertility and compared these groups to a fertile male group with proven paternity. Screening for CFTR mutations should be routine for all azoospermic males, irrespective of obstructive or non-obstructive etiology, prior to proposing ICSI treatment. CFTR testing has no value in the investigation of non-azoospermic infertile males.
    • All azoospermic males should be screened for cystic fibrosis mutations before intracytoplasmic sperm injection.

      Mocanu, Edgar; Shattock, Richard; Barton, David; Rogers, Melissa; Conroy, Ronan; Sheils, Orla; Collins, Claire; Martin, Cara; Harrison, Robert; O'Leary, John; et al. (2010-11)
      We assessed the frequency of CFTR mutations in groups with varying degrees of sub-fertility and compared these groups to a fertile male group with proven paternity. Screening for CFTR mutations should be routine for all azoospermic males, irrespective of obstructive or non-obstructive etiology, prior to proposing ICSI treatment. CFTR testing has no value in the investigation of non-azoospermic infertile males.
    • Altered hemodynamics and hyperuricemia accompany an elevated sFlt-1/PlGF ratio before the onset of early severe preeclampsia.

      Doherty, Anne; Carvalho, Jose C A; Drewlo, Sascha; El-Khuffash, Afif; Downey, Kristi; Dodds, Madelaine; Kingdom, John; Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto ON. (2014-08)
      Early identification of women at risk of developing early-onset severe preeclampsia (sPE) is a key objective in obstetrics. An elevated ratio of serum soluble fms-like tyrosine kinase (sFlt-1) to placenta-like growth factor (PlGF) (sFlt-1/PlGF ratio) precedes overt hypertension. The longitudinal relationship between this biomarker, maternal hemodynamics, and maternal serum uric acid during the pre-clinical phase is unknown.
    • Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.

      Tadrous, R; Ni Mhuirchteagh, R; McCaul, C; Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland. (Elsevier, 2011-07)
      Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.
    • Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.

      Tadrous, R; Ni Mhuirchteagh, R; McCaul, C; Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland. (2012-02-01)
      Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.
    • Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

      Hayes, N E; Aslani, A; McCaul, C L; Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland. nihayes@rotunda.ie (2012-02-01)
      We describe the anaesthetic management of a patient with Liddle's syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle's syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle's syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.
    • Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

      Hayes, N E; Aslani, A; McCaul, C L; Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland. nihayes@rotunda.ie (2011-04)
      We describe the anaesthetic management of a patient with Liddle's syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle's syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle's syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.
    • Anaesthetic outcomes in obese parturients: the effect of assessment in the high-risk clinic.

      Aslani, A; Husarova, V; Ecimovic, P; Loughrey, J; McCaul, C; Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland. (2012-03)
      Obese parturients are at high risk of complications during anaesthesia and early use of epidural analgesia in labour has been recommended for obese patients during labour.
    • Anatomical characterisation of the cricothyroid membrane in females of childbearing age using computed tomography.

      Long, N; Ng, S; Donnelly, G; Owens, M; McNicholas, M; McCarthy, K; McCaul, C; Department of Radiology, The Mater Misericordiae University Hospital, Dublin, Ireland. (2014-02)
      In the event of failure to secure the airway by conventional means, it may be necessary to perform invasive airway access via the cricothyroid membrane. No studies have addressed anatomy of this structure in the obstetric population. We aimed to review the anatomical variation of this structure in a population of childbearing age.
    • Antenatal care in the Rotunda

      McDonnell, E; Hanrahan, F; Rotunda Hospital (2009-02)