• Asepsis in regional anesthesia.

      Jochum, Denis; Iohom, Gabriella; Bouaziz, Hervé; Albert Schweitzer Hospital, Colmar, France. (2010)
    • The associations between severity of early postoperative pain, chronic postsurgical pain and plasma concentration of stable nitric oxide products after breast surgery.

      Iohom, Gabriella; Abdalla, Hamza; O'Brien, James; Szarvas, Szilvia; Larney, Vivienne; Buckley, Elisabeth; Butler, Mark; Shorten, George Declan; Department of Anesthesia & Intensive Care Medicine, Cork University Hospital,, Cork, Ireland. (2012-02-03)
      In this study, we compared the effects of two analgesic regimens on perioperative nitric oxide index (NOx) and the likelihood of subsequent development of chronic postsurgical pain (CPSP) after breast surgery and sought to determine the association among early postoperative pain, NOx, and the likelihood of subsequent development of CPSP. Twenty-nine consecutive ASA I or II patients undergoing breast surgery with axillary clearance were randomly allocated to one of two groups. Patients in group S (n = 15) received a standard intraoperative and postoperative analgesic regimen (morphine sulfate, diclofenac, dextropropoxyphene hydrochloride + acetaminophen prn). Patients in group N (n = 14) received a continuous paravertebral block (for 48 h) and acetaminophen and parecoxib (followed by celecoxib up to 5 days). Visual analog scale pain scores at rest and on arm movement were recorded regularly until the fifth postoperative day. A telephone interview was conducted 10 wk postoperatively. The McGill Pain Questionnaire was used to characterize pain. NOx was estimated preoperatively, at the end of surgery, 30 min and 2, 4, 12, 24, 48 h postoperatively. Twelve (80%) patients in group S and no patient in group N developed CPSP (P = 0.009). Compared with patients with a pain rating index > or =1 (n = 18) 10 wk postoperatively, patients with a pain rating index = 0 (n = 11) had lesser visual analog scale pain scores on movement at each postoperative time point from 30 min until 96 h postoperatively (P < 0.005) and at rest 30 min (0.6 +/- 1.5 versus 30.2 +/- 26.8; P = 0.004), 4 h (2.3 +/- 7.5 versus 19.0 +/- 25.8; P = 0.013), 8 h (4.4 +/- 10.2 versus 21.4 +/- 27.0; P = 0.03) and 12 h (0.7 +/- 1.2 versus 15.4 +/- 27.0; P = 0.035) postoperatively. NOx values were greater in group N compared with group S 48 h postoperatively (40.6 +/- 20.1 versus 26.4 +/- 13.5; P = 0.04).
    • Brief reports: a clinical evaluation of block characteristics using one milliliter 2% lidocaine in ultrasound-guided axillary brachial plexus block.

      O'Donnell, Brian; Riordan, John; Ahmad, Ishtiaq; Iohom, Gabriella; Department of Anaesthesia, Cork University Hospital, Wilton Rd., Cork, Ireland. briodnl@gmail.co (2010-09)
      We report onset and duration of ultrasound-guided axillary brachial plexus block using 1 mL of 2% lidocaine with 1:200,000 epinephrine per nerve (total local anesthetic volume 4 mL). Block performance time, block onset time, duration of surgery, and block duration were measured. Seventeen consecutive patients were recruited. The mean (SD) block performance and onset times were 271 (67.9) seconds and 9.7 (3.7) minutes, respectively. Block duration was 160.8 (30.7) minutes. All operations were performed using regional anesthesia alone. The duration of anesthesia obtained is sufficient for most ambulatory hand surgery.
    • Femoral nerve blockade.

      Szucs, Szilard; Morau, Didier; Iohom, Gabriella; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland. szilard.szucs@yahoo.ie (2010-06)
      Femoral nerve blockade is the most widely performed lower limb block. Methods of femoral nerve blockade are briefly reviewed with particular reference to ultrasound guidance.
    • Local anesthetic dose and volume used in ultrasound-guided peripheral nerve blockade.

      O'Donnell, Brian D; Iohom, Gabriella; Cork University Hospital, University College Cork, Ireland. (2010)
    • Nitric oxide index is not a predictor of cognitive dysfunction following laparotomy.

      Twomey, Ciaran; Corrigan, Mark; Burlacu, Crina; Butler, Mark; Iohom, Gabriella; Shorten, George; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Ireland. ctwomey@ualberta.ca <ctwomey@ualberta.ca> (2010-02)
      To determine the associations between postoperative cognitive dysfunction (POCD) and plasma concentrations of stable nitric oxide products [nitric oxide index (NOi)].
    • Peripheral nerve blockade. Preface.

      Iohom, Gabriella; Shorten, George; Cork University Hospital and University College Cork Cork, Ireland. Gabriella.iohom@hse.ie (2010)
    • Preliminary evaluation of a virtual reality-based simulator for learning spinal anesthesia.

      Kulcsár, Zsuzsanna; O'Mahony, Emer; Lövquist, Erik; Aboulafia, Annette; Sabova, Daša; Ghori, Kamran; Iohom, Gabriella; Shorten, George; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland. Electronic address: zsuzsanna.kulcsar@gmail.com. (2012-12-27)
      STUDY OBJECTIVE: To evaluate the influence of a simulation-based program on the initial performance of dural puncture by medical interns, and to refine the design of simulator-based teaching and competence assessment. DESIGN: Prospective interventional study. SETTING: Academic medical center. SUBJECTS: 27 medical interns inexperienced in the technique of spinal anesthesia or dural puncture and within 12 months of graduating from medical school, were randomly assigned to a conventional or a simulator-based teaching course of spinal anesthesia: 13 were recruited to the Conventional Group (CG) and 14 to the Simulator Group (SG). MEASUREMENTS: A SenseGraphic Immersive workbench and a modified Phantom desktop with shutter glasses were used to create a teaching environment. Outcomes of teaching were assessed in two phases within three weeks of the teaching course: Phase I consisted of a written examination followed by assessment on the simulator. A global rating scale and a task-specific checklist were used. Phase II (for those participants for whom a suitable opportunity arose to perform spinal anesthesia under supervision within three wks of the teaching course) consisted of structured observation of clinical performance of the procedure in the operating room. Participants were assessed by independent, study-blinded experts. Student's two-tailed impaired t-tests were used to compare the parametric outcomes (P < 0.05 was considered significant). MAIN RESULTS: All participants completed the written test successfully with no difference between groups. Ten participants from CG and 13 from SG completed the simulator-based testing performing similarly in terms of the global rating scale. Five participants in CG and 6 in SG proceeded to clinical testing. On the global rating scale, interns in SG scored higher than those in CG. They performed similarly according to the task-specific checklist. CONCLUSIONS: Overall, no difference was measured between those taught with traditional methods and those, by a simulator based program in regard to the performance of spinal anesthesia.
    • Proactive error analysis of ultrasound-guided axillary brachial plexus block performance.

      O'Sullivan, Owen; Aboulafia, Annette; Iohom, Gabriella; O'Donnell, Brian D; Shorten, George D; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton, Ireland. onavillus@gmail.com (2012-07-13)
      Detailed description of the tasks anesthetists undertake during the performance of a complex procedure, such as ultrasound-guided peripheral nerve blockade, allows elements that are vulnerable to human error to be identified. We have applied 3 task analysis tools to one such procedure, namely, ultrasound-guided axillary brachial plexus blockade, with the intention that the results may form a basis to enhance training and performance of the procedure.
    • Regional anesthesia techniques for ambulatory orthopedic surgery.

      O'Donnell, Brian D; Iohom, Gabriella; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, , Cork, Ireland. (2012-02-03)
      PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.
    • Ultrasound guided supraclavicular block.

      Hanumanthaiah, Deepak; Garstka, Maria; Vaidiyanathan, Sabanayagam; Szucs, Szilard; Iohom, Gabriella; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Ireland; Email: gabriella.iohom@hse.ie. (Medical ultrasonography, 2013-09)
      Ultrasound guided regional anaesthesia is becoming increasingly popular. The supraclavicular block has been transformed by ultrasound guidance into a potentially safe superficial block. We reviewed the techniques of performing supraclavicular block with special focus on ultrasound guidance.