Ciarán Twomey | University of Alberta (original) (raw)

Papers by Ciarán Twomey

Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2006

Page 1. 26442 - TARGETED EPIDURAL ANESTHESIA IN A HIGH RISK ORTHOPEDIC PATIENT Ciaran Twomey FCAR... more Page 1. 26442 - TARGETED EPIDURAL ANESTHESIA IN A HIGH RISK ORTHOPEDIC PATIENT Ciaran Twomey FCARCSI, Ban Tsui, FRCP(P); University Of Alberta, Edmonton, ALBERTA, Canada

Complications of Regional Anesthesia, 2007

asa-abstracts.com

Background Apolipoprotein E is important in recovery after neuronal damage. The ε4 allele of the ... more Background Apolipoprotein E is important in recovery after neuronal damage. The ε4 allele of the apolipoprotein E gene (APOE), located on chromosome 19, is risk factor for Alzheimer's disease (1), poor outcome after cerebral injury (2, 3) and early postoperative ...

European Journal of Anaesthesiology, 2005

... Frizelle, HPa1,c1; Curran, E.a1; Twomey, C.a1; MacAdoo, J.a1; Shorten, G.a1. ... Following ho... more ... Frizelle, HPa1,c1; Curran, E.a1; Twomey, C.a1; MacAdoo, J.a1; Shorten, G.a1. ... Following hospital Ethics Committee approval and having given written informed consent, 88 patients, ASA I-III, undergoing elective cataract surgery under general anaesthesia were studied. ...

Journal of Clinical Anesthesia, 2010

Study Objective: To determine the associations between postoperative cognitive dysfunction (POCD)... more Study Objective: To determine the associations between postoperative cognitive dysfunction (POCD) and plasma concentrations of stable nitric oxide products [nitric oxide index (NOi)]. Design: Prospective study. Setting: Academic hospital. Patients: 28 ASA physical status I, II, and III physical status patients undergoing major noncardiac surgery. Interventions: Cognitive assessment was performed preoperatively and postoperatively at 4 days (early) and 6 weeks (late). Measurements: Serial measurements of plasma NOi were recorded. Main Results: Early POCD with a deficit in one cognitive domain was present in 18 patients (64%), and in 8 patients (28%) with deficits in two or more cognitive domains. Late POCD was evident in three patients (20%) who had a deficit in one domain. Eight patients were lost to late follow-up. There was no difference in baseline or subsequent serum concentrations of NOi between those who showed early and late POCD and those who showed no POCD. Conclusion: Factors other than nitric oxide-mediated injury is responsible for POCD following major non-cardiac surgery.

Complications of Regional Anesthesia, 2007

Epidural anesthesia was first reported by Sicard and Cathelin in France, in 1901.1 Whereas contin... more Epidural anesthesia was first reported by Sicard and Cathelin in France, in 1901.1 Whereas continuous techniques were pioneered by Hingson et al.2 and Tuohy,3 Dawkins4 and Bromage5 established lumbar epidural anesthesia as the gold standard for the management of labor pain. As these techniques evolved, undesirable effects became apparent; those that were repeatedly seen were judged to be side effects

Regional Anesthesia and Pain Medicine, 2006

... Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional a... more ... Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 1994;78:507-513. ... 3. De Andres J, Sala-Blanch X. Peripheral nerve stimulation in the practice of brachial plexus anesthesia: A review. ...

Survey of Anesthesiology, 1998

Laparoscopy causes an increase in intraabdominal pressure and may lead to an increase in gastroes... more Laparoscopy causes an increase in intraabdominal pressure and may lead to an increase in gastroesophageal reflux (GER). We designed this study to assess and compare the frequency of GER and tracheal contamination in patients undergoing laparoscopic cholecystectomy (LC) and gynecological laparoscopy (LG). We studied 20 LC and 17 LG patients. The pH was measured using monocrystalline antimony pH electrodes positioned in the middle to upper esophagus and on the posterior wall of the trachea distal to the tip of the endotracheal tube. Acid reflux was defined as a decrease in esophageal pH to 4.0 or less. Alkaline reflux was defined as an abrupt increase in esophageal pH of more than 1.0, not associated with previous acid reflux. More than 80% of all patients at baseline had a gastric pH < or = 2. Overall, acid GER alone occurred in 47% patients in the LG group and in 15% patients in the LC group. During recovery, a larger proportion of patients had acid reflux in the LG group (47%) than in the LC group (10%). In contrast, alkaline reflux occurred in 75% of LC patients and 11.7% of LG patients. After cholecystectomy, there is an acute increase in the incidence of alkaline reflux. This alkaline reflux may be due to duodenogastric reflux resulting in an alkaline gastric shift. We studied the incidence of reflux of stomach contents in patients undergoing laparoscopic (keyhole) surgery for cholecystectomy or gynecology, using pH probes in the esophagus (gullet) and the trachea (windpipe). Acid reflux was very common but did not pass into the trachea. After gallbladder removal, the refluxed material became alkaline.

Anesthesia and Analgesia, 2005

Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significa... more Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel's risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.

Anesthesia and Analgesia, 1995

To test the hypothesis that the laryngeal mask airway (LMA) predisposes patients to gastroesophag... more To test the hypothesis that the laryngeal mask airway (LMA) predisposes patients to gastroesophageal reflux, we randomly assigned 55 patients having elective surgery to receive standardized anesthesia with the LMA or with conventional face mask (FM) plus airway. A pH-sensitive probe with two electrodes, 10 cm apart, was passed nasally into the esophagus 1 h before induction of anesthesia, and recordings were made continuously until 30 min after surgery. At the distal electrode, 30 cm from the anterior nares, there was a significant difference in the incidence of reflux: 53.6% with the LMA versus 22.2% with the FM (P < 0.05). At the level of the proximal electrode, 20 cm from the anterior nares, there was no difference between groups. Multiple reflux events, defined as two or more reflux events before, during, or after anesthesia, were significantly more frequent in the LMA group (P < 0.05). Reflux events continued in the postanesthesia care unit (PACU) in both groups with no significant difference between groups. There was no clinical evidence of aspiration of gastric contents in either group. Use of the LMA appears to result in increased reflux to the level of the mid to upper esophagus, and is associated with a more frequent incidence of multiple reflux events than use of the FM.

Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2006

Page 1. 26442 - TARGETED EPIDURAL ANESTHESIA IN A HIGH RISK ORTHOPEDIC PATIENT Ciaran Twomey FCAR... more Page 1. 26442 - TARGETED EPIDURAL ANESTHESIA IN A HIGH RISK ORTHOPEDIC PATIENT Ciaran Twomey FCARCSI, Ban Tsui, FRCP(P); University Of Alberta, Edmonton, ALBERTA, Canada

Complications of Regional Anesthesia, 2007

asa-abstracts.com

Background Apolipoprotein E is important in recovery after neuronal damage. The ε4 allele of the ... more Background Apolipoprotein E is important in recovery after neuronal damage. The ε4 allele of the apolipoprotein E gene (APOE), located on chromosome 19, is risk factor for Alzheimer's disease (1), poor outcome after cerebral injury (2, 3) and early postoperative ...

European Journal of Anaesthesiology, 2005

... Frizelle, HPa1,c1; Curran, E.a1; Twomey, C.a1; MacAdoo, J.a1; Shorten, G.a1. ... Following ho... more ... Frizelle, HPa1,c1; Curran, E.a1; Twomey, C.a1; MacAdoo, J.a1; Shorten, G.a1. ... Following hospital Ethics Committee approval and having given written informed consent, 88 patients, ASA I-III, undergoing elective cataract surgery under general anaesthesia were studied. ...

Journal of Clinical Anesthesia, 2010

Study Objective: To determine the associations between postoperative cognitive dysfunction (POCD)... more Study Objective: To determine the associations between postoperative cognitive dysfunction (POCD) and plasma concentrations of stable nitric oxide products [nitric oxide index (NOi)]. Design: Prospective study. Setting: Academic hospital. Patients: 28 ASA physical status I, II, and III physical status patients undergoing major noncardiac surgery. Interventions: Cognitive assessment was performed preoperatively and postoperatively at 4 days (early) and 6 weeks (late). Measurements: Serial measurements of plasma NOi were recorded. Main Results: Early POCD with a deficit in one cognitive domain was present in 18 patients (64%), and in 8 patients (28%) with deficits in two or more cognitive domains. Late POCD was evident in three patients (20%) who had a deficit in one domain. Eight patients were lost to late follow-up. There was no difference in baseline or subsequent serum concentrations of NOi between those who showed early and late POCD and those who showed no POCD. Conclusion: Factors other than nitric oxide-mediated injury is responsible for POCD following major non-cardiac surgery.

Complications of Regional Anesthesia, 2007

Epidural anesthesia was first reported by Sicard and Cathelin in France, in 1901.1 Whereas contin... more Epidural anesthesia was first reported by Sicard and Cathelin in France, in 1901.1 Whereas continuous techniques were pioneered by Hingson et al.2 and Tuohy,3 Dawkins4 and Bromage5 established lumbar epidural anesthesia as the gold standard for the management of labor pain. As these techniques evolved, undesirable effects became apparent; those that were repeatedly seen were judged to be side effects

Regional Anesthesia and Pain Medicine, 2006

... Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional a... more ... Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 1994;78:507-513. ... 3. De Andres J, Sala-Blanch X. Peripheral nerve stimulation in the practice of brachial plexus anesthesia: A review. ...

Survey of Anesthesiology, 1998

Laparoscopy causes an increase in intraabdominal pressure and may lead to an increase in gastroes... more Laparoscopy causes an increase in intraabdominal pressure and may lead to an increase in gastroesophageal reflux (GER). We designed this study to assess and compare the frequency of GER and tracheal contamination in patients undergoing laparoscopic cholecystectomy (LC) and gynecological laparoscopy (LG). We studied 20 LC and 17 LG patients. The pH was measured using monocrystalline antimony pH electrodes positioned in the middle to upper esophagus and on the posterior wall of the trachea distal to the tip of the endotracheal tube. Acid reflux was defined as a decrease in esophageal pH to 4.0 or less. Alkaline reflux was defined as an abrupt increase in esophageal pH of more than 1.0, not associated with previous acid reflux. More than 80% of all patients at baseline had a gastric pH < or = 2. Overall, acid GER alone occurred in 47% patients in the LG group and in 15% patients in the LC group. During recovery, a larger proportion of patients had acid reflux in the LG group (47%) than in the LC group (10%). In contrast, alkaline reflux occurred in 75% of LC patients and 11.7% of LG patients. After cholecystectomy, there is an acute increase in the incidence of alkaline reflux. This alkaline reflux may be due to duodenogastric reflux resulting in an alkaline gastric shift. We studied the incidence of reflux of stomach contents in patients undergoing laparoscopic (keyhole) surgery for cholecystectomy or gynecology, using pH probes in the esophagus (gullet) and the trachea (windpipe). Acid reflux was very common but did not pass into the trachea. After gallbladder removal, the refluxed material became alkaline.

Anesthesia and Analgesia, 2005

Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significa... more Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel's risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.

Anesthesia and Analgesia, 1995

To test the hypothesis that the laryngeal mask airway (LMA) predisposes patients to gastroesophag... more To test the hypothesis that the laryngeal mask airway (LMA) predisposes patients to gastroesophageal reflux, we randomly assigned 55 patients having elective surgery to receive standardized anesthesia with the LMA or with conventional face mask (FM) plus airway. A pH-sensitive probe with two electrodes, 10 cm apart, was passed nasally into the esophagus 1 h before induction of anesthesia, and recordings were made continuously until 30 min after surgery. At the distal electrode, 30 cm from the anterior nares, there was a significant difference in the incidence of reflux: 53.6% with the LMA versus 22.2% with the FM (P < 0.05). At the level of the proximal electrode, 20 cm from the anterior nares, there was no difference between groups. Multiple reflux events, defined as two or more reflux events before, during, or after anesthesia, were significantly more frequent in the LMA group (P < 0.05). Reflux events continued in the postanesthesia care unit (PACU) in both groups with no significant difference between groups. There was no clinical evidence of aspiration of gastric contents in either group. Use of the LMA appears to result in increased reflux to the level of the mid to upper esophagus, and is associated with a more frequent incidence of multiple reflux events than use of the FM.