Papers by J.G. Mc Donnell
Miscellaneous
Background and Aims Chronic otitis media (COM) is an inflammatory disease of the middle ear. The ... more Background and Aims Chronic otitis media (COM) is an inflammatory disease of the middle ear. The symptoms of COM are ear pain, intracranial complication. Skull base osteomyelitis (SBO) may occur by transmission of infection based on COM. In this paper, we present a patient with untreated COM who was diagnosed with SBO. Methods A-67-year-old man visited our clinic with left TMJ pain. He had taken NSAIDs, and his symptoms had been relieved but not disappeared. CT showed no abnormal finding. But he showed familiar pain in the left TMJ. He was diagnosed with left TMJ arthralgia. After medication, the pain in the left TMJ was disappeared. 6 months later, he re-visited clinic and presented with pricking pain in the same area. CT revealed erosive change in left TMJ. He was diagnosed with left TMJ osteoarthritis and prescribed medicines including amoxicillin, ketorolac. However, his severe pain had been persisted. Results CRP is 49.1. A MRI showed heterogeneous enhancement in the left condyle. He was referred to ENT and left mastoidectomy was performed. When the microbial cultures of resected specimens were performed, candida was found, which led to the final diagnosis of SBO.
Anesthesia & Analgesia, 2007
A substantial component of the pain experienced by patients after abdominal surgery is derived fr... more A substantial component of the pain experienced by patients after abdominal surgery is derived from the abdominal wall incision.The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit.The block has been described by McDonnell and colleagues, and can be used for intra and postoperative analgesia in patients having surgery in the lower abdominal region, especially for caesarean section, inguinal hernia repair and laparoscopy. The technique of blind and ultrasound-controlled blockade is described and discussed in detail.
Anaesthesia, 2007
Direct laryngoscopic tracheal intubation using the Macintosh laryngoscope is taught to many healt... more Direct laryngoscopic tracheal intubation using the Macintosh laryngoscope is taught to many healthcare professionals as it is a potentially life-saving procedure. However, it is a difficult skill to acquire and maintain. Several alternative intubation devices exist that may provide a better view of the glottis and require less skill to use. We conducted a prospective, randomised trial of four different laryngoscopes and the ILMA in 30 medical students who had no prior airway management experience. The devices were tested in both normal and cervical immobilisation laryngoscopy scenarios. Following brief didactic instruction, each participant took turns performing laryngoscopy and intubation using each device under direct supervision. Each student was allowed up to three intubation attempts with each device, in each scenario. The Airtraq, McCoy, and the ILMA each demonstrated advantages over the Macintosh laryngoscope. In both the easy and difficult airway scenarios, the Airtraq, McCoy, and the ILMA reduced the number of intubation attempts, and reduced the number of optimisation manoeuvres required. The Airtraq and ILMA reduced the severity of dental trauma in both scenarios. The performance of the other devices studied was more variable. Overall, participants found that only the Airtraq was less difficult to use and they were more confident using it compared to the Macinosh laryngoscope.
Analgesia in Major Abdominal Surgery, 2018
block and Iliiohypogastric/Ilioinguinal blocks are discussed. 2. There are landmark-based and ult... more block and Iliiohypogastric/Ilioinguinal blocks are discussed. 2. There are landmark-based and ultrasound-based insertion techniques described for each block with differences in efficacy and duration of effect. 3. TAP approaches include subcostal oblique (anaesthesia above the umbilicus), mid-axillary (anaesthesia below the umbilicus), posterior (anaesthesia below the umbilicus) and the bilateral dual (complete abdominal wall anaesthesia). 4. The TFP block provide anaesthesia of the L1 and L2 distribution and can provide analgesia for iliac crest bone grafting, open inguinal hernia repair and open appendicectomy. The subcostal nerve T12 will also be anaesthetized. Thus, the TFP block can also be used to anaesthetize the lateral cutaneous branches innervating the skin area from the iliac crest distal to the major trochanter and can be used for analgesia following hip repair. 5. Iliohypogastric/ilioinguinal nerve blocks are primarily used for inguinal hernia repair surgery and can be landmark based as well as ultrasound guided.
Regional Anesthesia and Pain Medicine, 2008
Background and Aims: The analgesic efficacy of continuous wound infiltration with ropivacaine aft... more Background and Aims: The analgesic efficacy of continuous wound infiltration with ropivacaine after minimal invasive hip surgery is unknown. The aim of this investigation was to compare pain management between the ropivacaine (R-group) and the placebo group (P-group with NaCl 0.9%) and to assess ropivacaine plasma concentrations during continuous wound infusion. Methods: After approval by the ethics committee and written informed consent 72 consecutive patients (ASA I-III) for elective minimal invasive hip replacement were prospectively randomized to both groups. Anaesthesia management (spinal anaesthesia and sedation) were standardized. The epicapsular placement of the 15 cm PAINfusor fenestrated catheter (Baxter) was performed by the surgeon. 20ml ropivacaine 0.3% (R-group) or NaCl 0.9% (Pgroup) were applied into the wound as bolus before its closing. Thereafter, continuous infusion of ropivacaine 0.3% or placebo according to the study group were continuously infused at 8 ml/h for 48 hours after surgery by the elastomeric membrane balloon of 2 infusor pumps (Baxter LV10, 300ml). A morphine-PCA and standardized rescue pain medication were offered to all patients. Morphine consumption, pain at rest and with motion, total and unbound ropivacaine plasma concentration, PONV, sedation, mental status and hospitalization time were recorded. A follow up was performed 12 weeks postoperatively. Results: (preliminary data with 30 patients): Demographic and surgical data were similar in both groups. The total morphine consumption and the pain scores with motion were lower in the R-group (p Ͻ 0.05). No difference was found in the other parameters. After 12 weeks there was no difference in hip pain but a slight reduction of wound pain in the R-group (p Ͻ 0.05). Total and unbound ropivacaine plasma concentrations were below toxic levels in the R-group. Conclusions: Continuous wound infusion is a save technique for postoperative analgesia after minimal invasive hip replacement.
Regional Anesthesia and Pain Medicine, 2008
Background and Aims: The analgesic efficacy of continuous wound infiltration with ropivacaine aft... more Background and Aims: The analgesic efficacy of continuous wound infiltration with ropivacaine after minimal invasive hip surgery is unknown. The aim of this investigation was to compare pain management between the ropivacaine (R-group) and the placebo group (P-group with NaCl 0.9%) and to assess ropivacaine plasma concentrations during continuous wound infusion. Methods: After approval by the ethics committee and written informed consent 72 consecutive patients (ASA I-III) for elective minimal invasive hip replacement were prospectively randomized to both groups. Anaesthesia management (spinal anaesthesia and sedation) were standardized. The epicapsular placement of the 15 cm PAINfusor fenestrated catheter (Baxter) was performed by the surgeon. 20ml ropivacaine 0.3% (R-group) or NaCl 0.9% (Pgroup) were applied into the wound as bolus before its closing. Thereafter, continuous infusion of ropivacaine 0.3% or placebo according to the study group were continuously infused at 8 ml/h for 48 hours after surgery by the elastomeric membrane balloon of 2 infusor pumps (Baxter LV10, 300ml). A morphine-PCA and standardized rescue pain medication were offered to all patients. Morphine consumption, pain at rest and with motion, total and unbound ropivacaine plasma concentration, PONV, sedation, mental status and hospitalization time were recorded. A follow up was performed 12 weeks postoperatively. Results: (preliminary data with 30 patients): Demographic and surgical data were similar in both groups. The total morphine consumption and the pain scores with motion were lower in the R-group (p Ͻ 0.05). No difference was found in the other parameters. After 12 weeks there was no difference in hip pain but a slight reduction of wound pain in the R-group (p Ͻ 0.05). Total and unbound ropivacaine plasma concentrations were below toxic levels in the R-group. Conclusions: Continuous wound infusion is a save technique for postoperative analgesia after minimal invasive hip replacement.
Regional Anesthesia and Pain Medicine, 2007
Anesthesia & Analgesia, 2010
BACKGROUND: The transversus abdominis plane (TAP) block provides effective postoperative analgesi... more BACKGROUND: The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial. METHODS: Forty children undergoing appendectomy were randomized to undergo unilateral TAP block with ropivacaine (n ϭ 19) versus placebo (n ϭ 21) in addition to standard postoperative analgesia comprising IV morphine analgesia and regular diclofenac and acetaminophen. All patients received a standard general anesthetic, and after induction of anesthesia, a TAP block was performed using the landmark technique with 2.5 mg ⅐ kg Ϫ1 ropivacaine 0.75% or an equal volume (0.3 mL ⅐ kg Ϫ1) of saline on the ipsilateral side to the incision. RESULTS: The TAP block with ropivacaine reduced mean (ϮSD) morphine requirements in the first 48 postoperative hours (10.3 Ϯ 12.7 vs 22.3 Ϯ 14.7 mg; P Ͻ 0.01) compared with placebo block. The TAP block also reduced postoperative visual analog scale pain scores at rest and on movement compared with placebo. Interval morphine consumption was reduced over the first 24 postoperative hours. There were no between-group differences in the incidence of sedation or nausea and vomiting. There were no complications attributable to the TAP block. CONCLUSIONS: Unilateral TAP block, as a component of a multimodal analgesic regimen, provided superior analgesia compared with placebo in the first 48 postoperative hours after appendectomy in children.
Anesthesia & Analgesia, 2008
BACKGROUND: Patients undergoing total abdominal hysterectomy suffer significant postoperative pai... more BACKGROUND: Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial. METHODS: Fifty females undergoing elective total abdominal hysterectomy were randomized to undergo TAP block with ropivacaine (n ϭ 24) versus placebo (n ϭ 26) in addition to standard postoperative analgesia comprising patient-controlled IV morphine analgesia and regular diclofenac and acetaminophen. All patients received a general anesthetic and, before surgical incision, a bilateral TAP block was performed using 1.5 mg/kg ropivacaine (to a maximal dose of 150 mg) or saline on each side. Each patient was assessed postoperatively by a blinded investigator in the postanesthesia care unit and at 2, 4, 6, 12, 24, 36, 48 h postoperatively. RESULTS: The TAP block with ropivacaine reduced postoperative visual analog scale pain scores compared to placebo block. Mean (Ϯsd) total morphine requirements in the first 48 postoperative hours were also reduced (55 Ϯ 17 mg vs 27 Ϯ 20 mg, P Ͻ 0.001). The incidence of sedation was reduced in patients undergoing TAP blockade. There were no complications attributable to the TAP block. CONCLUSIONS: The TAP block, as a component of a multimodal analgesic regimen, provided superior analgesia when compared to placebo block up to 48 postoperative hours after elective total abdominal hysterectomy.
Anaesthesia, 2011
We report the successful use of a stellate ganglion block as part of a multi-modal postoperative ... more We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.
Anaesthesia, 2013
Introduction: Airway management is an essential component in the rst aid of medical emergencies ... more Introduction: Airway management is an essential component in the rst aid of medical emergencies in the combat medical care. Though Endotracheal tube (ETT) is considered ideal for airway management, supraglottic airway devices (SGA) are gaining popularity as an alternative. We studied the use of a novel SGA device (BASKA® mask) in hospital which can be extended to the combat situation. Methods: In this randomised, clinical study, we compared two airway devices (ETT and Baska® Mask) for ventilation in patients (n=100) undergoing laparoscopic surgery. We evaluated the mean airway seal pressure, ease of insertion, time taken for insertion and the complication rates with the use of airway devices. The data were analyzed using appropriate statistical tests. Results: We found that the mean airway seal pressures were comparable with the two devices. The rst-time success rate for insertion was higher with the Baska® mask than with the ETT (94% vs 70%) respectively (p < 0.001). The overall device insertion success rates were comparable between the two devices (100% vs 96% respectively, p = 0.5412). Conclusion: Baska® mask is comparable on various parameters to the ETT and is easier to insert due to its exible head. This is relevant for airway management during combat medical support in eld situations.
Acta Anaesthesiologica Scandinavica, 2007
Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly... more Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. It has been reported regularly for a long time in numerous and various injuries of the central nervous system in both adults and children, but remains poorly understood because of the complexity of its pathophysiologic mechanisms involving hemodynamic and inflammatory aspects. NPE seems to be under-diagnosed in acute neurologic injuries, partly because the prevention and detection of non-neurologic complications of acute cerebral insults are not at the forefront of the strategy of physicians. The presence of NPE should be high on the list of diagnoses when patients with central neurologic injury suddenly become dyspneic or present with a decreased P a O 2 /F i O 2 ratio. The associated mortality rate is high, but recovery is usually rapid with early and appropriate management. The treatment of NPE should aim to meet the oxygenation needs without impairing cerebral hemodynamics, to avoid pulmonary worsening and to treat possible associated myocardial dysfunction. During brain death, NPE may worsen myocardial dysfunction, preventing heart harvesting.
Regional Anesthesia & Pain Medicine, 2021
BackgroundThere is heterogeneity in the names and anatomical descriptions of regional anesthetic ... more BackgroundThere is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques.MethodsWe conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement.ResultsSixty expert Collaborators parti...
Anesthesia & Analgesia, 2007
The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall n... more The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial. Thirty-two adults undergoing large bowel resection via a midline abdominal incision were randomized to receive standard care, including patient-controlled morphine analgesia and regular nonsteroidal antiinflammatory drugs and acetaminophen (n = 16), or to undergo TAP block (n = 16) in addition to standard care (n = 16). After induction of anesthesia, 20 mL of 0.375% levobupivacaine was deposited into the transversus abdominis neuro-fascial plane via the bilateral lumbar triangles of Petit. Each patient was assessed by a blinded investigator in the postanesthesia care unit and at 2, 4, 6, and 24 h postoperatively. The TAP block reduced visual analog scale pain scores (TAP versus control, mean +/- sd) on emergence (1 +/- 1.4 vs 6.6 +/- 2.8, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), and at all postoperative time points, including at 24 h (1.7 +/- 1.7 vs 3.1 +/- 1.5, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Morphine requirements in the first 24 postoperative hours were also reduced (21.9 +/- 8.9 mg vs 80.4 +/- 19.2 mg, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). There were no complications attributable to the TAP block. All TAP patients reported high levels of satisfaction with their postoperative analgesic regimen. The TAP block provided highly effective postoperative analgesia in the first 24 postoperative hours after major abdominal surgery.
Anesthesia & Analgesia, 2007
Regional Anesthesia and Pain Medicine
The breast journal, Jan 30, 2017
There has been a substantial increase in ambulatory day-case breast surgery in recent decades. Th... more There has been a substantial increase in ambulatory day-case breast surgery in recent decades. This has been largely due to improvements in anesthetic procedures and pre-emptive analgesia. Thoracic paravertebral blockade (TPVB) is increasing in popularity, though concerns over iatrogenic injury remain, especially pneumothorax. The purpose of this study was to conduct a review of the incidence of pneumothorax following TPVB prior to breast surgery. Data from of a consecutive series of patients having TPVB prior to breast surgery between 2009 and 2014 were reviewed. TPVB were used prior to unilateral and bilateral procedures. Medical records were retrospectively assessed for any complication including pleural punctures, pneumothorax, hypotension, bradycardia as well as signs and symptoms of local anesthetic toxicity. 1152 patients underwent a total of 1322 TPVB injections (982 unilateral and 340 bilateral). Clinically significant hypotension and/or bradycardia occurred in 26 patients ...
Regional anesthesia and pain medicine
Abdominal wall blocks rely on the spread of local anesthetic within musculofascial planes to anes... more Abdominal wall blocks rely on the spread of local anesthetic within musculofascial planes to anesthetize multiple small nerves or plexuses, rather than targeting specific nerve structures. Ultrasonography is primarily responsible for the widespread adoption of techniques including transversus abdominis plane and rectus sheath blocks, as well as the introduction of novel techniques such as quadratus lumborum and transversalis fascia blocks. These blocks are technically straightforward and relatively safe and reduce pain and opioid requirements in many clinical settings. The data supporting these outcomes, however, can be inconsistent because of heterogeneity of study design. The extent of sensory blockade is also somewhat variable, because it depends on the achieved spread of local anesthetic and the anatomical course of the nerves being targeted. The blocks mainly provide somatic analgesia and are best used as part of a multimodal analgesic regimen. This review summarizes the anatom...
Anesthesia and Analgesia, 2007
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Papers by J.G. Mc Donnell