AAGBI/Anaesthesia Research Grants

Southmead Hospital, North Bristol NHS Trust

Title
General, Local, and Regional Anaesthesia in Emergency Surgery (GALORE)
A project to develop mode of anaesthesia as an intervention in emergency surgery and inform future trials

Amount
£28,092

Scientific Abstract
Worldwide the burden of emergency surgery is considerable and there is a need for interventions to improve outcomes in this high-risk patient group.

The association between general anaesthesia (GA) and worse patient outcomes has been investigated in observational studies of emergency inguinal hernia repair, endovascular stroke thrombectomy, hip fracture surgery and endovascular repair of ruptured abdominal aortic aneurysms (rEVAR). While delivering an alternative mode of anaesthesia for suitable emergency surgery procedures is potentially beneficial to patients, it is a complex intervention to evaluate and very little is known about the clinician and patient perspectives and preferences for different modes of anaesthesia in emergency surgery. There is also no consensus about the definitions of anaesthesia for use in clinical trials. This collaborative project aims to:
1. Conduct a systematic review
2. Understand the perspectives of clinicians performing emergency surgery on the use of different modes of anaesthesia
3. Explore patient experience of modes of anaesthesia and preference in the context of emergency surgery
4. Reach consensus about the description of different modes of anaesthesia as an intervention

The results will be synthesised to inform the design of a multicentre trial to evaluate mode of anaesthesia as an intervention in emergency surgery.

University Hospitals Plymouth NHS Trust

Title
AFAR - Accelerometers for Assessing Recovery. Can an accelerometer be used as an objective patientcentred endpoint tool for measuring recovery from anaesthesia in the natural environment ? A pilot study for SWARM (South West Anaesthesia Research Matrix)

Amount
£5,142

Scientific Abstract
Measurement of the "success" of anaesthesia and perioperative care is a research priority; objective measurement of patient recovery is challenging, particularly after discharge. Wearable movement sensors ("accelerometers") are a novel technology that may have utility to measure patient-centred endpoints such as activity levels.

This SWARM feasibility study is a clinical collaboration with the Open Lab computer science research group, developers of the AX3 accelerometer and software.

We aim to investigate the feasibility of using accelerometers to track recovery, to gain experience with this technology, and test a methodology that could be deployed at scale across our trainee research network.

We will recruit 50 adult day surgery patients to wear the AX3 accelerometer device for three "Wear Periods": immediately before and after their operation (i.e. baseline and recovery) and at three months postoperatively. The activity data will be analysed alongside demographics, clinical details and the QoR-15 to assess the reliability and responsiveness of the accelerometer as a tool to measure recovery.

"Acceptability" will be explored with feedback questionnaires and a PPI group. Feasibility for future study will be informed by recruitment rate, wear time (compliance), device return rate, and proportion of usable data.

Imperial College, London

Title
Novel Monitoring Tools in Vascular Surgery: Can transcranial magnetic stimulation be used to monitor spinal cord function during open and endovascular repair of thoraco-abdominal aortic aneurysms?

Amount
£22,236

Scientific Abstract
Spinal cord ischaemia (SCI) is a devastating complication of thoraco-abdominal aortic aneurysm (TAAA) surgery. It affects up to 22% of patients, depending on type and method of repair. Electrical stimulation of the motor cortex during surgery produces motor evoked potentials (MEPs) and is a form of neuromonitoring designed to diagnose SCI and guide remedial interventions. It is, however, not widely utilised and the intense pain from this invasive technique restricts its use to anaesthetised patients. Endovascular techniques are increasingly being used to repair TAAAs, in which up to 19% of patients develop SCI post-operatively. Thus, there is a need for an alternative monitoring method.

Transcranial magnetic stimulation (TMS) induces currents within the motor cortex to produce MEPs; it is non-invasive and painless. To our knowledge, it has not been used in patients with peripheral vascular disease (PVD), the most likely cohort of patients to undergo TAAA repair, or during TAAA surgery itself.

We will use TMS to characterise MEPs in PVD patients and in those with prolonged ischaemia undergoing lower limb vascular surgery; an essential prerequisite to interpreting the MEPs. Successful completion of this work will lead to the development of a perioperative monitor to detect and prevent SCI.

University of Glasgow

Title
PROFILES: bnP for pRediction of Outcome Following Lung rEsection Surgery

Amount
£25,239

Scientific Abstract
Background
Lung cancer is the leading cause of cancer death in the UK. Evidence favours increased surgical resection but this has a risk of postoperative dyspnoea for which current prediction models are poor. Based on pilot data where we demonstrate association between BNP and both postoperative cardiac dysfunction and dyspnoea, we propose a novel scoring tool incorporating B-Type Natriuretic Peptide (BNP) alongside routine measurements to improve predictive power.

Methods
Multicentre prospective observational study of 250 patients presenting for anatomic lobectomy by open or thoracoscopic surgery. Patients will undergo BNP measurement preoperatively and days 2 and 3 postoperatively. Logistic regression (risk prediction) models will be constructed with and without the inclusion of preoperative BNP alongside conventional clinical predictors and their relative ability to predict postoperative outcomes assessed by ROC analysis. Secondary outcomes, informed by patient involvement include assessment of functional outcome and health related quality of life.

Improved prediction of patients at increased risk of breathlessness could: better inform the consent process; allow patients previously considered excessively high-risk access to potentially curative surgery; and allow development of targeted preventative therapies aiming to ameliorate disabling postoperative dyspnoea.