Dr. Brian KINIRONS
President, College of Anaesthesiologists of Ireland, Ireland
Current clinical position:
Consultant in Anaesthesiology and Intensive Care, Galway University Hospital,
Clinical Lecturer in Anaesthesia, National University of Ireland, Galway,
Clinical Co-Lead Regional Anaesthesia Programme, Galway University Hospitals.
Leadership experience in medical education and training:
Chairman, Education Committee, College of Anaesthetists of Ireland 2011-2012.
Examiner, MCAI, College of Anaesthesiologists of Ireland
Consultant Trainer and Tutor, National Specialist Anaesthesiology Training Programme
Honorary Secretary, College of Anaesthetists of Ireland 2015 – 2018.
Honorary Secretary, European Board of Anaesthesiology 2016 – 2018.
Vice President, Irish Society of Regional Anaesthesia 2016 – 2018.
Past President, Irish Society of Regional Anaesthesia
European Society of Regional Anaesthesia Council – Irish Representative
Council Member, College of Anaesthetists of Ireland, 2012- 2017.
Re-elected Council member, College of Anaesthetists of Ireland, 2017 to date
Current leadership positions:
President, College of Anaesthesiologists of Ireland 2018 – to date
Chair, International Academy of Colleges of Anaesthesiologists 2019- to date
Member of Consultant Appointment Advisory Committee
Executive Member of Forum of Postgraduate Training Bodies of Ireland
I am currently completing a diploma in Quality Improvement and Leadership in RCPI.
“Don’t block the next patient. We are concerned about compartment syndrome”
Anyone working in the field of orthopaedic trauma will be familiar with the above sentiment. The use of regional in the setting of trauma patients with a high risk of compartment syndrome remains controversial. Given that a delay in diagnosis of compartment syndrome is associated with potential acute kidney injury, limb and indeed life loss, the consequences of a delay are significant. Analysis of closed claims suggests that decompressive fasciotomy within 8 hours from the onset of symptoms is associated with a successful defence of a claim. Conversely, a delay of 12 hours increases the risk of amputation and death. Making the diagnosis remains challenging and requires identifying an at risk population, a high index of suspicion, regular repeated examination and ultimately measurements of compartment pressure. Compartment syndrome remains a clinical diagnosis. Much of current practice is based around the fear of delaying the diagnosis of compartment syndrome due to the patient and medio-legal consequences of such a delay. The questions that arises therefore, is it ethical to withhold analgesia in order to facilitate an early diagnosis of compartment syndrome? Furthermore, is it ethical to withhold regional anaesthesia in a cohort of patients who would benefit from excellent analgesia?
The speaker will assess the evidence from both the orthopaedic and anaesthesiology literature and will separate the facts from the fiction.
1. Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. British Journal of Anaesthesia 2009;102(1):3-11.
2. Cometa MA, Esch AT, Boezaart AP. Did continuous femoral and sciatic nerve block obscure the diagnosis or delay the treatment of acute lower leg compartment syndrome? A case report. Pain Med 2011;12(5):823-8.
3. Kucera TJ, Boezaart AP. Case Report Regional Anesthesia Does Not Consistently Block Ischemic Pain: Two Further Cases and a Review of the Literature. Pain Medicine 2014;15(2):316-9.
4. Rauf J, Iohom G, O’Donnell B. Acute compartment syndrome and regional anaesthesia – a case report. Rom J Anaesth Int Care 2015;22(1):51-54.
5. Walker BJ, Noonan KJ, Bosenberg AT. Evolving compartment syndrome not masked by a continuous peripheral nerve block: Evidence-based case management. Reg Anesth Pain Med 2012;37(4):393-7.
6. Aguirre JA, Gresch D, Popovici A, Bernhard J, Borgeat A. Case Scenario: Compartment Syndrome of the Forearm in Patient with an Infraclavicular Catheter. Anesthesiology 2013; 118(5):1198-205.