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Ultrasound for central venous access

The ASA has published its guidelines for central venous access (see link below).  I am regularly amused by the slavish credence given by trainees to use of ultrasound as ‘mandatory’ for central  venous access.  Why I ask?  That ‘s what the NICE guideline says, they reply.  Do you work in the NHS I ask? Yes … Continue reading

Anaesthesia Ireland – present tense, future – bright but scary

Run through training at last – this will guarantee a bright future for our specialty and correct the wrongs of a previous generation. But some questions must be asked. This process may open a Pandora’s box regarding anaesthesia staffing around the country and may ultimately hasten the implementation of a sub consultant grade. In the … Continue reading

Anaesthesia Trainees Reject Subconsultant Grade

Trainees in Anaesthesia in Ireland have given the thumbs down to the Minister of Health’s proposal for a “specialist” or “sub consultant grade”. These findings are contained in an impressive survey carried out by the group of anesthetists in training. What might be more worrying for Dr Reilly, is the sheer number of trainees planning … Continue reading

College Announces Run-Through Training

The College of Anaesthetists of Ireland have announced the greatest shakeup in training structure ever. Anaesthesia will now become a 6 year categorical programme with semi-automatic progression from year to year. The final year is a fellowship year in Ireland or abroad. This is an effective 2-3 year reduction in training duration. The Western Anaesthesia … Continue reading

Flotrac-Vigileo – useful tool or toy?

The Flotrac-Vigileo system appears to have become the first line haemodynamic monitor in Galway. How did this happen, and is it just a toy? Over the past 2 decades there have been considerable advances in minimally invasive cardiovascular monitoring. This results from a greater acceptance of the flow-model approach to fluid resuscitation,1 a cultural shift … Continue reading

Hyperoxia and Surgical Site Infections: is oxygen beneficial?

Using high inspired concentrations of oxygen in the perioperative period may reduce the risk of surgical site infections for patients undergoing colo-rectal surgery. It does not appear to confer benefit for other patient groups. We live side by side with an element that both feeds us and damages us simultaneously: oxygen. Reactive oxygen species cause … Continue reading

Symposium 2013: What would you like to hear?

The proposed date for the Western Anaesthesia Symposium 2013 is April 26/27.  Once more it will be held in the Radisson Blu Hotel Galway.  The program is already in evolution but we warmly invite submissions for suggested topics.  Are there areas of your anesthesia or intensive care practice that have intrigued, confused or challenged you? … Continue reading

Ultrasound for Neuraxial Anaesthesia

Most of the time that we palpate the spine (70%) we are incorrect at assessing the level of the spine that we are palpating blindly. In the future ultrasound guidance will be standard of care for spinal anesthesia, according to Jose Carvlho, from Toronto at the Western Anaesthesia Symposium. Does the line drawn across the … Continue reading

Difficult Airway in the Obstetric Population

Is there anything more scary than a difficult intubation in a patient undergoing emergency Caesarian delivery? The subject was discussed by Conan McCaul at the Western Anaesthesia Symposium. The vast majority of women in the 3rd trimester have a Mallampati score of 3 or 4. The MP grade may actually become worse during the course … Continue reading

Analgesia Following Caesarian Delivery

Jose Carvalho discussed pain following Caesarian Delivery at the Western Anaesthesia Symposium. 12-15% of patients have chronic pain 10 months following Caesarian section. This is not related to previous surgery, vertical incision, obesity or infection. The more pain a patient has postpartum, the more likely they are to have chronic pain and it is associated … Continue reading