The Anaesthesia June Newsletter 2021
Dr Orna Ní Choileain, SHO, Cork University Hospital
Dear all, I’d like to thank Dr Oonagh Hickey for the invitation to write the introduction to the second newsletter. It’s an intimidating task to follow on from the prolific Dr Brian O’Brien, so I will play to my strengths and keep it brief.
I am writing on behalf of this year’s crop of beginners. We started our careers in anaesthesia at the height of a global pandemic and have finished the year in the midst of a ransomware attack. I’m sure I’m not alone in hoping these events will be once in a career occurrences. I had been warned that the learning curve of the first six months would be steep, but no one expected the many conversations discussing our favourite FFP masks or that we would have gone so long without seeing one another’s faces. I also definitely did more cycling than I ever had before!
I’m sure that I can speak for all the beginners in saying we wouldn’t have managed without the patience, support and good humour of our colleagues in the department. I’d like to take this opportunity to thank all of you for welcoming us into the profession and for all the help this year. I’m hoping our paths will cross again in the not too distant future. We were given great advice at the departmental induction - including ‘never say no to a coffee break’. We will take that first lesson and the many others we have learned with us as we journey on in our careers. (Photo: Orna is the one with the sunglasses).
The College of Anaesthesiologists of Ireland and Faculty of Pain Medicine Congress 20th - 21st May: we would like to congratulate all who organised, facilitated, and presented at the on-line Annual Congress of Anaesthesiology 2021.
Cork University Hospital Departmental Members Dr Dorothy Breen, Dr Parvaiz Hafeez, Dr Brian O’Brien, Dr Barry Kelly and Professor George Shorten contributed as Faculty. This was the first time that the Congress was delivered virtually and had more registrants than ever before. Although the face-to-face element was sorely missed, the feedback suggests that the quality of the meeting overall was excellent.
President of the College of Anaesthesiologists of Ireland: Professor George Shorten has been appointed as the incoming President of the CAI. This is a well-deserved honour. He has made significant clinical and academic contributions to the CUH, to UCC, and to the field Anaesthesia in general. We wish Professor George Shorten well in his new role and we know that he will approach it with his usual brand of enthusiasm and ingenuity.
CAI Consultant Trainer of the Year: we congratulate Dr Paudie Delaney, Consultant Anaesthetist, CUH, who was awarded the CAI Consultant Trainer of the Year.
Prehabilitation Project CUH: the CUH Colorectal Prehabilitation Pilot Project, under the joint leadership of Marie Sheahan (Clinical Nutrition) and Dr Murray Connolly (Anaesthesia SpR), has been shortlisted for a 2021 Public Service Innovation Fund Award. This project is a multidisciplinary endeavour involving colleagues in anaesthesia, surgery, clinical nutrition and dietetics, physiotherapy, occupational therapy, clinical nurse specialists and the smoking cessation service. The mission of this group is to enhance the physical and psychological wellbeing of selected high-risk patients with colorectal cancer prior to surgery. Prehabilitation is achieved following individualised patient assessment through a structured programme of nutrition, exercise, and lifestyle modification in the weeks prior to major cancer surgery. The prehabilitation group's vision is to provide prehabilitation campus wide at the CUH for all patients undergoing major cancer surgery as a central element of quality improvement in perioperative care.
Cork University Maternity Hospital Epidural Information Leaflets: Dr Eanna O’Sullivan has updated the Epidural Information Leaflets in the CUMH. Laminated copies of these leaflets, endorsed by the OAA, RCOG and the Royal College of Midwifery, are be found in each delivery room and in the Induction Unit of the CUMH.
Marchathon Step Challenge, Theatre CUH: The Irish Kidney association and Autism Assistance Dogs Ireland wrote to thank all who were involved in the CUH Theatre Marchathon Step Challenge. Ms May Barry (CNM II) devised a league table for teams from the CUH Main Theatre Complex. Sixteen theatre teams were formed, including three from the Anaesthetic Department, and it soon became quite competitive. This was a healthy and fun team building activity which raised 1270 euros for two very good causes.
CUH Farewell party: there will be a socially distanced party on Friday 11 June as we say farewell to Dr Emmi Ylikoski, Consultant Anaesthetist, who is returning to her native Finland. She has been a valuable addition to the CUH Anaesthetic Department over the last 2 years. Näkemiin ja onnea tulevaango; goodbye and good luck in the future!
Congratulations: we congratulate Dr Carolyn Hayes who finished in second place at the World Cup Triathalon in Lisbon on 23rd May, hopefully bringing her closer to qualifying for the Tokyo Olympics. Dr Hayes is joining the CUH Anaesthetic Department in July.
Research funding: congratulations to Dr Gabriella Iohom whose team was awarded EU 88,000 by the UCC Foundation through the College of Medicine and Health, to study the feasibility and usefulness of employing mixed reality to teach clinical skills. The device the team will use is the Microsoft Hololens II which enables clinical encounters to be broadcast to students who log on remotely through teams. One of the advantages of this approach is that learning “artefacts” such as schematics or patient specific images and displayed beside (or even overlaid on) the patient which might enable physiology, anatomy and pathophysiology to be explained in an effective way.
PNB Fellows: the Department of Anaesthesia at CUH is delighted to announce the appointment of Dr Paschalitsa Serchan and Dr Murray Connolly to the PNB Fellow posts for 2021/2. Both are experienced anaesthesiologists who will undergo higher subspeciality training in Peripheral Nerve Blockade and conduct research studies related to regional anaesthesia and acute pain management. Murray has been a central figure in the Department throughout the pandemic and the Department looks forward to welcoming Litsa back from her home in Greece.
The College of Anaesthesiologists of Ireland Graduation Ceremony: this on-line ceremony was held on the 19th of May. We would like to congratulate all those who were awarded the MCAI, FCAI, CST, Pain Medicine and Intensive Care Medicine certificates. We also congratulate their tutors and those who contributed to the various teaching programs throughout the country. Anaesthesia in Ireland is in safe hands.
Included are current and past members of our various departments:
MCAI: Sean Farrelly, Aoife O’Driscoll, Gilly De Loughrey, Ian Geraghty, Kevin MacSweeney, Sarah Galea, Orna Ní Choilean, Jemima Nilan, Kim O’B, Gillian O’Keeffe, Michael O’Sullivan, Alti Quereishi.
FCAI: Wael Alhalabi, Ciaran Costello, Kieran Crowley, Rachel Cusack, Oscar Duffy, Marwa ElMahi, Ian Kelly, Conor Gormley, Ciara Hayden, Alan Horan, Noelle Healy, Kirsten Joyce, Cathal MacDonnacha, Anna Horgan, Daniel Lehane, David Lorrigan, Rory Linehan, Ruth Mooney, Lauren O’Callaghan, Eoin Ó Rathallaigh, John o’Keeffe, Mai O’Sullivan, Irena Popinceanu, Shaz Ramly, Kyran Reddy, Rana Sadiq, Paul Stewart, Gulnaz Virani, Mirela Fratita and Dan Mulligan.
CST: Joao Vinaigre, Karen Sheehan, Gráinne Rooney, Aoghán O'Muircheartaigh, Aoife O’Loughlin, Dafalla Mohammed, Rania Hayder, John McNamara, Tim Keady, Darragh Gogarty, Ruth Fenton, Kevin Doody, Paudie Delaney, Anne Marie Crowe, Damian Barry, Niamh Barnwell and Marton Deli.
Pain Medicine Diploma: Sandeep Migliani, Kirk Levins.
JFICMI: Eamon Dempsey, Ahmed Elsaka, Carrie Murphy and David Roche.
We also congratulate JR Sheehan on his success in the recent FJFICMI examination.
College of Anaesthesiologist Simulation Training (CAST) Courses: the faculty of the CAST courses based at the ASSERT High-Fidelity Simulation Centre at UCC are delighted that the SICC (Simulation in Intensive and Critical Care) and COAST (Crisis in Obstetric Anaesthesiology Simulation Training) courses held in May were a great success. The ARREST (Anaesthesiology Related Rare Emergencies Simulation Training) and AE (Anaesthesiology Emergencies) courses will be held in early June. These courses had been deferred from earlier in the year due to the pandemic. We are grateful to the staff at the ASSERT Centre for facilitating these courses in a professional and safe manner. As always, we thank the candidates and the faculty for their engagement in the learning process. Our faculty consists of senior clinicians from six hospitals across the Cork, Kerry and Limerick region. If interested in becoming involved, please contact Dr Oonagh Hickey, Consultant Anaesthetist, CUH.
CUH PNB Foundation Course: on May 22nd, Dr Agatha Biculescu, Dr Corina Soare and Dr Gabriella Iohom trained 12 attendees in Foundation Level Peripheral Nerve Blockade (photo). This was the second interactive workshop in this current course, with two more planned for June.
Dr Patrick Seigne, Consultant Anaesthetist, CUH
Facing Africa is an international charity which, prior to the current pandemic, twice a year funded a volunteer team of Anaesthetists, Surgeons and Nurses to travel to Addis Ababa in Ethiopia where they have performed reconstructive surgery. The photograph shows the founders of the Charity (Facing Africa) Chris and Terry Lawrence with Consultant Anaesthetists Dr. Patrick Seigne (CUH), Dr. Dan Mullane (Bons Secours, Cork) and Dr. Peter Lee (Bons Secours, Cork) who were on the May 2017 mission.
Over a 2-week period, the team performed up to 40 operations. Most patients are survivors of Noma, however in recent years we have managed a variety of other conditions including some giant benign jaw tumours and severe facial hyena bites. In 2008, the charity cooperated in creation of BBC documentary “Make Me a New Face: Hope for Africa’s Hidden Children” initiated by presenter Ben Fogle. In 2017, Channel 5 created two documentaries entitled “Critical Surgery, Changing Lives”. The type of operations performed vary and include nasal reconstructions, sub-mental flaps, geneoplasties, ankylosis releases, commisuroplasties and multiple types of free flap surgeries. The jaw tumours involved difficult dissections and removal of the tumours, with free fibular flap to fashion new jaws. A significant percentage of the patients present extremely difficult airway and anaesthetic management issues in a very challenging clinical environment.
Noma is an acute, rapidly progressive, necrotising infection of the mouth. It begins as a small, gingival ulcer and results in gangrenous necrosis of the surrounding facial tissues. It is seen in severely malnourished and debilitated people, especially children. In 1998, the WHO estimated the annual global incidence at 140,000 with a mortality of 70 to 80% in the absence of treatment. Survivors of acute Noma usually have severe disfigurement and functional impairment including trismus, oral incontinence, difficulties eating and speech problems. They are also often shunned by society. It is likely that no more than 10% of affected persons seek medical care as the disease is frequently hidden by families. Facing Africa seeks out these patients in very remote, rural areas of Ethiopia, Sudan and Somalia and brings them to Addis Ababa for nutritional and medical care prior to performing complex and frequently multi-stage operations (often over several trips and years) before helping to integrate them back into their homes. More information is available on their website www.facingafrica.com
In recent years, both the Royal College of Anaesthetists and the College of Anaesthesiologists in Ireland have sponsored senior anaesthetic trainees to join the teams. These have proven hugely successful and there are plans to continue this development. Various research projects and publications about Noma and the anaesthetic and surgical management have been supported by the charity and have added to the knowledge of this disfiguring disease affecting some of the poorest people in sub-Saharan Africa and the world.
Due to the recent Coronavirus Pandemic and the current civil war in Ethiopia, the October 2020, May 2021 and October 2021 trips were suspended but it is hoped to restart going again in May 2022. Anyone interested in becoming involved may contact Dr Patrick Seigne, Department of Anaesthesiology/ICU, CUH.
Dr Eanna O’Sullivan, SpR, CUH
CAI Congress Fun Run: rather than holding the usual 5km fun run as part of the CAI Congress this year, groups throughout the country were encouraged to organise their own in a socially distanced manner. Thanks to Ciara Hayden for organising the 5km fun run/walk at The Marina on May 20th and for setting a challenging pace. There was a good turnout despite the ominous weather forecast and we luckily avoided the rain. The pizzas were certainly good motivators and a number of people set new personally best times. Many members were sporting bluetooth bone-conducting headphones which you may recognise have become an essential part of the departmental uniform (often modelled by a certain trend-setting consultant).
Bantry to Mizen Head Cycle: anaesthetists from the CUH, MUH and SIVUH gathered for a socially distanced cycling trip from Bantry to Mizen on May 29th. Thanks to Dr Frank Loughnane for organising and for finding another way to trick us into exercising. For the second cycling excursion in a row, he picked a day with perfect weather so, clearly, he should organise all future department social days.
Thanks to Dr Sinead Ahern and her husband for operating as support crew and as bicycle valet during the lunch break. As far as I know, nobody needed to be rescued but her shouts of encouragement were well received as they drove past and she was certainly prepared for all eventualities.
Everyone made it back in one piece and had an enjoyable day. Some adventurous members even went off plan and added in a swim in the sea. I’m also told that Dr Brian O’Donnell, Dr Padraig Mahon, Murray Connolly and Ciaran Costelloe had a nice leisurely cycle and were definitely not competitive at all. Rumours that Ciaran Costello even cycled out to the Fastnett Lighthouse have yet to be validated (photo).
Art in the ICU: thanks to Dr Robert Plant for providing this extraordinary drawing of Dr Sean Underwood, SHO Anaesthesia, which was sketched in the CUH ICU by a patient within an hour of undergoing a whipples procedure. The drawing is reproduced here with the permission of the patient and we are delighted to report that he is making a good recovery following his surgery.
The Lusitania Museum and Signal Tower:
Dr Oonagh Hickey, Consultant Anaesthetist, CUH
One of my favourite places for a coffee and a homemade brownie is at the outdoor café by the Lusitania Museum and Signal Tower, especially if I have made the journey up those hills on the trusty bike. The view of The Old Head of Kinsale peninsula is spectacular from here. Some of the buildings are said to date back to the 3rd century and the current lighthouse was built in 1853. The cliffs can be dangerous but are a haven for sea birds including puffins, choughs, guillemots and peregrine falcons. The peninsula itself is home to the exclusive Old Head of Kinsale Golf Links where Tiger Woods has teed off.
If you have time, do consider popping into the Lusitania Museum and Signal Tower. It is hard to imagine on a glorious summer’s day but the sea before you hold secrets of piracy, war and shipwreck. This area was a haven for pirates and smugglers, and Anne Bonney (the notorious Caribbean pirate) was born nearby. Standing here in September 1601, you would have seen a fleet of 28 Spanish ships sail into Kinsale Harbour to your left, at the invitation of the Irish Earls, carrying 3,330 soldiers to engage with the might of the British Military. The Battle of Kinsale would be a crushing defeat for the Spanish and Irish armies, and led to “The Flight of the Earls”- and the reason why many fine French wineries carry Irish surnames. The Signal Tower was one of 81 built around Ireland over 200 years ago during the Napoleonic Wars, to provide an early warning system if French ships were spotted approaching the coast. Displays within the tower outline the flag and ball system used. On April 11th, 1912, you might have seen the Titanic heading west on her ill-fated maiden voyage, having just left Queenstown (Cobh).
Many shipwrecks litter the seabed before you, but the most famous occurred as The Great War (WWI) raged in Europe. On May 7th, 1915 the Lusitania was 11 miles South of the Old Head of Kinsale. She was travelling from New York to Liverpool, carrying 1,962 crew and passengers. She was the fastest liner afloat, hence her nickname “The Greyhound of the Sea”, but she had slowed due to fog- making her an easy target for German submarine U-20 which was stalking her. Having already claimed 3 ships, U-20 was running low on fuel and only had 3 torpedoes left when the huge liner was spotted. At about 2pm, the Lusitania was hit by a torpedo on the starboard side. A second, larger explosion ripped the ship apart- this may have been due to the ignition of some of 173 tons of war munitions and ammunition which she carried, although this was denied at the time. The vessel sank within 18 minutes, with the loss of 1,198 lives. The crew of the Courtmacsherry Lifeboat rowed from the Seven Heads (across the bay to the west) across 11 miles of ocean to assist, a feat that was replicated in 2015 by the current lifeboat crew as a mark of respect. The loss of the Lusitania was instrumental in the USA entering WWI. The Lusitania Museum tells the story and displays artifacts from the ship.
At the top of the tower, you can enjoy spectacular views of the Lusitania Memorial Garden and the surrounding coast. Then it is time to freewheel towards the lovely blue flag Garrylucas and Garrettstown beaches for a paddle and to watch the kite-surfers.
Dr Hanin Hamza, SHO, CUH
Answers to appear in the July Newsletter