AAGBI/Anaesthesia & BJA/RCoA Small Project Grant
The successful applicants for the AAGBI/Anaesthesia & BJA / RCoA Small Project Grant were:
Principal Applicant
Dr Daniel Conway
Consultant Anaesthetist, Manchester Royal Infirmary
Title
A comparison of minimally and non-invasive cardiac output during abdominal surgery
Amount
£3,995. This award was funded by the Anaesthetic Research Society (ARS)
Scientific Abstract
Background: Oesophageal Doppler (ODM) guides fluid for major surgery and reduces complications for patients by improving fluid balance. However there are significant challenges in using ODM - it cannot be used in awake patients or those having head and neck surgery. Non-invasive NICOM Cheetah may eliminate these challenges yet equivalence with ODM is not established.
Trial Aims: to compare non-invasive CO estimation with ODM
Methods: 25 patients undergoing abdominal surgery for whom ODM is a standard of care. Cheetah Bioimpedance electrodes will be placed on the chest and attached to a monitor. As the Anaesthetist administers iv fluid guided by ODM, the researchers will simultaneously record haemodynamic variables from ODM and Cheetah.
Statistics: Correlation, bias and variability of the differences (Bland Altman technique) and mean error determined.
Further Work: The results from this study will allow us to design a RCT of ODM versus Cheetah. This will establish whether NICOM Cheetah is a viable non-invasive alternative to oesophageal Doppler. If this is proved then many more patients will be able to benefit from improved fluid balance and reduced complications following surgery.
Final Report from Dr D Conway (110 KB)
Progress Report from Dr Daniel Conway (319 KB)
Principal Applicant
Dr Roman Cregg
Academic Clinical Fellow in Anaesthesia, University College London
Title
Contribution of non-nociceptive neurons to pain signalling and phenotype
Amount
£13,691. This award was funded by AAGBI/Anaesthesia
Scientific Abstract
The sequence of the human genome is now known. It is proving extremely useful to look at the association of particular mutations and genomic variants with human disease states to find the genes that contribute to the underlying pathology. Recently, a number of families that are completely insensitive to pain have been found to have lost the functional expression of a gene SCN9A which encodes Nav 1.7 sodium channel. We will use transgenic mouse models of human disease to analyse molecular mechanisms underlying pain perception. Global deletion of Nav1.7 leads to perinatal death in mice, whilst nociceptor-specific deletion (using Advillin Cre vehicle) leads to viable animals with a loss of acute and inflammatory pain. We will use the Wnt-1 Cre line to check contribution to pain signalling of Nav 1.7 in all sensory and autonomic neurons. We can excise these genes in a spatially controlled manner by deleting this gene in nerve tissues leaving the rest of the body intact. We have available to us mice expressing Cre recombinase in all DRG neurons including large diameter cells. We intend to cross this colony with a mouse containing 'floxed' SCN9A gene and study the involvement of these cells in pain signalling.
Final abstract from Dr R Cregg (73 KB)
Please see the NIAA's position statement on the use of animals in medical research.
Principal Applicant
Dr Simon James Davies
Consultant Anaesthetist,York Teaching Hospitals NHS Foundation Trust
Title
Prognostic markers of outcome in infra-inguinal revascularisation: a prospective observational pilot study
Amount
£13,099. This award was funded by the BJA/RCoA
Scientific Abstract
Surgery for infra inguinal revascularisation is associated with a mortality of 5% and an even higher incidence of major adverse cardiac events (MACE). Work from our group has shown that through cardiopulmonary exercise testing (CPET) a high-risk patient group can be identified in those undergoing major abdominal surgery, however CPET has not been evaluated in patients undergoing surgery for peripheral vascular disease. CPET in this group of patients is complex, as many may not be able to exercise to maximal exertion due to claudication, and the ankle brachial pressure index may indicate who will be unable to complete this assessment. In addition to cycle CPET, the test can be performed using an arm ergonometer, and we aim to compare the two methods of assessment. We also propose to use a combination of preoperative biomarkers (BNP and highly sensitive CRP) and CPET to try and identify those patients who have adverse post operative outcomes both short and long term.
First year progress report from Dr S Davies.pdf (37 KB)
Principal Applicant
Dr Ahilanandan Dushianthan
Research Fellow at General Intensive Care Unit, Southampton University Hospital NHS Trust
Title
Pulmonary surfactant in adult patients with acute respiratory distress syndrome
Amount
£15,000. This award was funded by the BJA/RCoA
Scientific Abstract
ARDS imposes a significant health burden. The mortality still remains high despite advances in knowledge of the pathophysiology and management of this disease. Pulmonary surfactant is a complex mixture of lipoproteins, which reduces alveolar surface tension thereby preventing alveolar collapse. Abnormal surfactant levels and composition is well recognised in patients with ARDS. The mechanisms leading to these changes in surfactant composition are not well established, but may be due to reduced synthesis or increased breakdown.
Clinical trials of exogenous surfactant replacement have not demonstrated an outcome benefit. Limitations in understanding of surfactant metabolism and the heterogeneous nature of ARDS may contribute to these disappointing results.
Choline is an essential nutrient, and a precursor and constituent of pulmonary surfactant. Deuteriated (Trimethyl D9) Choline Chloride is a stable, non-radioactive, non-toxic isotope, which has been used successfully in human adult volunteers and in children with ARDS to study surfactant synthesis and metabolism.
This aim of this pilot study is to identify the mechanisms responsible for alterations in surfactant composition and turnover by using Trimethyl D9 choline chloride for the first time in adult patients with ARDS. This may provide valuable information to guide targeted therapies in the future.
First year progress report from Dr Dushianthan.pdf (12 KB)
Principal Applicant
Dr Roger Eltringham
Gloucestershire Royal Hospital
Title
Suitability of oxygen concentrators for use with the Diamedica Portable Anaesthesia system (DPA 01)
Amount
£14,854. This award was funded by the AAGBI/Anaesthesia
Scientific Abstract
The proposal is for a short study to test the performance of various low cost oxygen concentrators for the conditions they may encounter in the harsh conditions of middle and low income countries. These tests are intended to evaluate the suitability of selected, low cost oxygen concentrators for use with the Diamedica portable anaesthetic machine (DPA 01) by measuring their performance to the manufacturer's specifications and the requirements of ISO 8359. The results will provide guidance on the key technical specifications that need to be considered when purchasing oxygen concentrators for use in developing countries and may highlight potential problems with the performance of some oxygen concentrators, which anaesthetists need to be aware of.
First Year Progress Report from Dr R Eltringham (263 KB)
Final Report from Dr R Eltringham (328 KB)
Principal Applicant
Dr Nandor Marczin
Senior Lecturer in Anaesthesia, Imperial College London
Title
Preliminary assessment of frailty in cardiac surgery (definition, prevalence and impact on neutrophil activation)
Amount
£15,000. This award was funded by the BJA/RCoA
Scientific Abstract
The geriatric syndrome of frailty is a concept focusing on biological status rather than chronological age. It is characterised by global impairment of physiological reserves affecting multiple organ systems that clinically translates to increased vulnerability and impaired capability to withstand intrinsic and environmental stressors, and to maintain physiological and psychosocial homeostasis in stress situations.
Clinical impression and recent investigations suggest that frailty is relevant to perioperative medicine and it may be an independent risk factor for increased perioperative complications. However, there are various operational definitions of frailty that impact on estimated prevalence and the reported relationship between frailty and health outcomes.
The current pilot study is primarily designed to better define frailty in the setting of cardiac surgery and to establish the early postoperative clinical course of these patients. We also wish to utilise this framework to begin exploring biological mechanisms that potentially contribute to the increased postoperative risks of these frail patients. Based on current immunological concepts of ageing and frailty recognising the importance of a chronic inflammatory state (inflamm-ageing) in these conditions, we hypothesise that frail patients present for surgery with "primed" neutrophils, which respond to surgical stresses with enhanced activation and augmented release of inflammatory mediators.
