We will conduct a clinical trial of the effectiveness of a continuous auditory display of an anesthetized patient's respiratory status. Expired carbon dioxide monitoring has helped reduce respiratory incidents since its widespread introduction in the late 1980s, but a continuous auditory display of respiratory status may reduce incidents further. We will conduct a clinical trial with 10 anaesthetists of continuous auditory respiratory monitoring. Successful outcome may lead to commercial uptake.
The MASTER Anaesthesia Trial (or Mulcentre Australian Study of Epidural Anaesthesia) is a large clinical experiment designed to determine whether using epidural techniques to control pain during and after surgery results in fewer complications after major surgery. The Trial involves a comparison of epidural methods, in which some of the anaesthetic and pain-killing drugs are injected into the space in the spinal column surrounding the sac that encloses the spinal cord, with conventional methods, ....The MASTER Anaesthesia Trial (or Mulcentre Australian Study of Epidural Anaesthesia) is a large clinical experiment designed to determine whether using epidural techniques to control pain during and after surgery results in fewer complications after major surgery. The Trial involves a comparison of epidural methods, in which some of the anaesthetic and pain-killing drugs are injected into the space in the spinal column surrounding the sac that encloses the spinal cord, with conventional methods, where the drugs are injected into a vein or muscle. Both approaches are well accepted in clinical practice, but it remains uncertain whether one is superior to the other. At present, nineteen hospitals in Australia, Hong Kong and Malaysia are contributing patients to the project, with others in New Zealand and Asia expected to join soon. If one method of anaesthesia and pain control is found to be significantly better than the other, in terms of avoiding complications, this would have obvious benefits to patients, but would also reduce lengths of stay in hospital and improve efficiency within the health system.Read moreRead less
PREOPERATIVE RISK FACTORS, ADVERSE OUTCOMES AND EFFECTS OF EPIDURAL AND SPINAL ANAESTHESIA
Funder
National Health and Medical Research Council
Funding Amount
$66,110.00
Summary
Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. P ....Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. Providing clear answers to both questions requires careful analysis of large amounts of data in which systematic and random errors have been minimised. Databases from well-designed and supervised clinical trials represent an invaluable resource in this regard because they have been compiled through the rigorous application of unambiguous definitions and protocols during the process of recording, coding and entering the information. By bringing together the resources and expertise of the MASTER Trial group and the Collaborative Overview of Randomised of Trials of Regional Anaesthesia (CORTRA), both of which are major international projects led from the Australasian region, we have a unique opportunity to provide exceptionally robust answers to some of the most challenging issues in anaesthesia. The combined study of two large international databases will provide a more precise quantitative analysis of the components of preoperative risk and their relationship to life threatening post operative complications, and the possible role of epidural and spinal anaesthesia in minimising risk by reducing the frequency of these complications.Read moreRead less
A Multi-site RCT Comparing Spinal And General Anaesthesia On Neurodevelopmental Outcome And Apnoea In Infants
Funder
National Health and Medical Research Council
Funding Amount
$512,072.00
Summary
5% of Australian children have surgery when they are infants. Recent studies have shown that surgery in babies is associated with poorer neurological outcomes. The reason for this is unclear but animal experiments suggest it may be due to some anaesthetic agents. This trial will determine if the anaesthetic is the cause of the problem. 660 babies who need surgery will be randomised to receive a general or local anaesthetic, and then followed for 5 years.
Development Of Novel Methods For Non-invasive Measurement Of Cardiac Output And Lung Volume During Anaesthesia
Funder
National Health and Medical Research Council
Funding Amount
$257,970.00
Summary
In Australia approximately 2 million anaesthetic procedures are performed annually. Approximately one patient in 20,000 dies during or shortly after an anaesthetic from complications related to the anaesthetic itself, and as many as one in 170 suffers severe complications. Mortality and severe morbidity are often ultimately associated with lack of oxygen in the tissues. Oxygen is transported from the lungs to the tissues by the blood. The oxygen content of arterial blood is monitored by pulse ox ....In Australia approximately 2 million anaesthetic procedures are performed annually. Approximately one patient in 20,000 dies during or shortly after an anaesthetic from complications related to the anaesthetic itself, and as many as one in 170 suffers severe complications. Mortality and severe morbidity are often ultimately associated with lack of oxygen in the tissues. Oxygen is transported from the lungs to the tissues by the blood. The oxygen content of arterial blood is monitored by pulse oximetry during every anaesthetic, but blood flow is not. Cardiac output is measured in only a very small proportion of anaesthetised patients using intravenous catheters that pass through the heart to the lungs. This procedure is invasive and is associated with significant morbidity and mortality. At present there is no easy way to monitor cardiac output non-invasively during anaesthesia. Our proposed research project, currently underway in conjunction with an industrial partner, is aimed at the development of a reliable, rapidly repeating, non-invasive method for monitoring total cardiac output and lung volume in every patient who has an anaesthetic. The purpose of the new monitor is to ensure that potential problems with oxygen supply to the tissues are detected and corrected promptly. Our new monitoring technique is computer-controlled, can function without intervention by the anaesthetist and has very few side-effects. It can be added to any anaesthetic machine. Such a measurement technique is likely to have an impact on anaesthesia similar to that of pulse oximetry in the 1980's, and, if suitably adapted, is likely to find applications in other fields, such as intensive care, sports medicine, the respiratory function laboratory and in veterinary medicine.Read moreRead less
ANTIPODES The Australian National Trial Investigating Post-Operative Deficit, Early Extubation And Survival
Funder
National Health and Medical Research Council
Funding Amount
$370,509.00
Summary
Brain damage following cardiac surgery is an unfortunate but common complication occuring variously in 30-80% of patients. Although severe strokes are uncommon (<1%), more subtle effects such as forgetfulness or behaviour changes may persist and make daily living difficult. Many attempts have been made to identify the exact cause of the brain damage, but no answer has been forthcoming. Recently, the introduction of modern anaesthetic techniques, which allow patients to wake up quickly after t ....Brain damage following cardiac surgery is an unfortunate but common complication occuring variously in 30-80% of patients. Although severe strokes are uncommon (<1%), more subtle effects such as forgetfulness or behaviour changes may persist and make daily living difficult. Many attempts have been made to identify the exact cause of the brain damage, but no answer has been forthcoming. Recently, the introduction of modern anaesthetic techniques, which allow patients to wake up quickly after the operation, have given strong indications that they may also cause less brain damage. We plan to test this aspect of modern anaesthesia, by comparing the results of tests for brain damage after anaesthesia that has been given by traditional methods and the recent method which allows patients to wake up quickly.Read moreRead less
Evaluation Of Nitrous Oxide In The Gas Mixture For Anaesthesia: A Randomised Controlled Trial (The ENIGMA Trial)
Funder
National Health and Medical Research Council
Funding Amount
$490,125.00
Summary
There are about 2 million anaesthetics given each year in Australia (1:10 Australians), with more than 1 million Australians being exposed to nitrous oxide (laughing gas). Despite being around for more than 150 years, there has yet to be a large trial of the safety and benefits of nitrous oxide, particularly when compared with newer (safer?) anaesthetic drugs. Nitrous oxide is not a particularly strong anaesthetic and so it must be mixed with other drugs. Current practice in Australia and around ....There are about 2 million anaesthetics given each year in Australia (1:10 Australians), with more than 1 million Australians being exposed to nitrous oxide (laughing gas). Despite being around for more than 150 years, there has yet to be a large trial of the safety and benefits of nitrous oxide, particularly when compared with newer (safer?) anaesthetic drugs. Nitrous oxide is not a particularly strong anaesthetic and so it must be mixed with other drugs. Current practice in Australia and around the world is to give 70% nitrous oxide in oxygen along with another anaesthetic gas in order to produce a depth of anaesthesia sufficient for surgery. This is despite knowledge that nitrous oxide interferes with the production of DNA. DNA is used to programme cell division and function - it is the building block of cell and tisue growth. It is known that nitrous oxide can impair some tissue functions, such that anaemia and, possibly birth defects can occur. Such effects are rare, but recent evidence suggests that milder abnormalities may occur more commonly than previously thought. There is also good evidence that nitrous oxide increases the risk of severe nausea and vomiting after surgery. The adverse effects on DNA production raises the possibility of nitrous oxide causing immune deficiency, heart ischaemia, (angina), nerve and spinal cord damage, and increased cancer risk in hospital staff chronically exposed to low levels of nitrous oxide. The prevailing view is that nitrous oxide is a cheap, relatively safe drug that can reduce the exposure to other anaesthetic drugs. However, the development of many new anaesthetic drugs demands a re-evaluation of the role of nitrous oxide in current anaesthetic practice.Read moreRead less
Linking Of Physiological Models Of Iv Anaesthetic Disposition With Models Of The Cardio- And Cerebro-vascular Systems
Funder
National Health and Medical Research Council
Funding Amount
$227,036.00
Summary
On average, nearly 1 in 10 Australians are anaesthetised each year. Most cases include an injection of either thiopentone or propofol directly into a vein. These drugs quickly produce the desired loss of consciousness, but can also produce significant undesirable effects on the circulatory system. To date, anaesthetists have relied on their accumulated experience to choose doses of these drugs that achieve an appropriate balance between their desirable and undesirable effects. However, the scien ....On average, nearly 1 in 10 Australians are anaesthetised each year. Most cases include an injection of either thiopentone or propofol directly into a vein. These drugs quickly produce the desired loss of consciousness, but can also produce significant undesirable effects on the circulatory system. To date, anaesthetists have relied on their accumulated experience to choose doses of these drugs that achieve an appropriate balance between their desirable and undesirable effects. However, the scientific basis of this process was poorly understood. Consequently, we conducted experiments in sheep in which we showed that the level of unconsciousness produced by these drugs depended on their concentration in the brain. Each sheep was unharmed and could be studied repeatedly. We established the important factors that influenced this brain concentration, and developed a unique computer model of the processes governing the desirable effects of thiopentone and propofol. However, understanding of what influences the undesirable effects of these drugs is less well developed. In this project, we propose a series of experiments in which we inject the thiopentone and propofol in special sites within the sheep so that we achieve low concentrations in some parts of the body, but high concentrations in others, while also measuring their undesirable effects. This will show which sites in the body high concentrations of drug should be avoided to minimise these undesirable effects. Another series of studies will be used to extend our computer model so that it can predict these undesirable effects. This extended model will allow anaesthetists to visualise and understand the fundamental factors influencing both the desirable and undesirable effects of thiopentone and propofol. This in turn will lead to dose strategies that help the anaesthetist maximise the desirable effects, while minimising the undesirable, in individual patients.Read moreRead less