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Research outputs from the Anaesthetics Department at the RD&E.


Recent Submissions

Now showing 1 - 5 of 58
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    Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference
    (Transplantation, 2023-10-01) Chadha, R.; Sakai, T.; Rajakumar, A.; Shingina, A.; Yoon, U.; Patel, D.; Spiro, M.; Bhangui, P.; Sun, L. Y.; Humar, A.; Bezinover, D.; Findlay, J.; Saigal, S.; Singh, S.; Yi, N. J.; Rodriguez-Davalos, M.; Kumar, L.; Kumaran, V.; Agarwal, S.; Berlakovich, G.; Egawa, H.; Lerut, J.; Clemens Broering, D.; Berenguer, M.; Cattral, M.; Clavien, P. A.; Chen, C. L.; Shah, S.; Zhu, Z. J.; Ascher, N.; Bhangui, P.; Rammohan, A.; Emond, J.; Rela, M.
    BACKGROUND: During the perioperative period of living donor liver transplantation, anesthesiologists and intensivists may encounter patients in receipt of small grafts that puts them at risk of developing small for size syndrome (SFSS). METHODS: A scientific committee (106 members from 21 countries) performed an extensive literature review on aspects of SFSS with proposed recommendations. Recommendations underwent a blinded review by an independent expert panel and discussion/voting on the recommendations occurred at a consensus conference organized by the International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplantation Society of India. RESULTS: It was determined that centers with experience in living donor liver transplantation should utilize potential small for size grafts. Higher risk recipients with sarcopenia, cardiopulmonary, and renal dysfunction should receive small for size grafts with caution. In the intraoperative phase, a restrictive fluid strategy should be considered along with routine use of cardiac output monitoring, as well as use of pharmacologic portal flow modulation when appropriate. Postoperatively, these patients can be considered for enhanced recovery and should receive proactive monitoring for SFSS, nutrition optimization, infection prevention, and consideration for early renal replacement therapy for avoidance of graft congestion. CONCLUSIONS: Our recommendations provide a framework for the optimal anesthetic and critical care management in the perioperative period for patients with grafts that put them at risk of developing SFSS. There is a significant limitation in the level of evidence for most recommendations. This statement aims to provide guidance for future research in the perioperative management of SFSS.
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    Anaesthesia and peripartum cardiomyopathy
    (Elsevier, 2023-12-01) Chapman, K.; Njue, F.; Rucklidge, M.
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    Marathon running and cell-cycle arrest biomarkers of acute kidney injury
    (Elsevier, 2022-10-24) Leckie, T.; Fitzpatrick, D.; Richardson, A. J.; Hunter, A.; Bains, S.; Grimaldi, R.; Galloway, R.; Forni, L. G.; Hodgson, L. E.
    OBJECTIVES: Endurance exercise is known to cause a rise in serum creatinine. It is not known to what extent this rise reflects renal stress and a potential acute kidney injury (AKI). Increases in Insulin Like Growth Factor Binding Protein 7 (IGFBP7) and Tissue Inhibitor of Metalloprotinases-2 (TIMP-2), urinary biomarkers of cell cycle arrest and renal stress, are associated with the development of AKI in clinical populations. DESIGN: Repeated measures study. METHODS: Runners were recruited at the 2019 Brighton Marathon (UK) and provided urine and blood samples at baseline, immediately post-race and 24 h post-race. Serum creatinine, urinary creatinine and urinary IGFBP7 and TIMP-2 were analysed from the samples. RESULTS: Seventy nine participants (23 females, 56 males), aged 43 ± 10 yrs. (mean ± SD), finish time 243 ± 40mins were included for analysis. Serum creatinine increased over the race by 40 ± 26% (p < 0.001), TIMP-2 increased by 555 ± 697% (p < 0.001) and IGFBP7 increased by 1094 ± 1491% (p < 0.001) over the race. A subset of twenty-two participants supplied samples 24 h post-race, reporting values similar to baseline for all variables. CONCLUSIONS: This study is the first to report large rises in IGFBP7 and TIMP-2 following marathon running. This suggests that rises in creatinine are not fully explained by changes in production and clearance and marathon running induces a state of kidney stress and potential injury.
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    Frailty in the ICU: what are we doing with all this information?
    (Springer, 2022-09-01) Shah, A.; Gustafson, O.; Swarbrick, C.; King, E.; Shah, K.
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    Evidence-based strategies to reduce the incidence of postoperative delirium: a narrative review
    (Wiley, 2022-01-11) Swarbrick, C. J.; Partridge, J. S. L.
    Delirium is one of the most commonly occurring postoperative complications in older adults. It occurs due to the vulnerability of cerebral functioning to pathophysiological stressors. Identification of those at increased risk of developing delirium early in the surgical pathway provides an opportunity for modification of predisposing and precipitating risk factors and effective shared decision-making. No single delirium prediction tool is used widely in surgical settings. Multi-component interventions to prevent delirium involve structured risk factor modification supported by geriatrician input; these are clinically efficacious and cost effective. Barriers to the widespread implementation of such complex interventions exist, resulting in an 'implementation gap'. There is a lack of evidence for pharmacological prophylaxis for the prevention of delirium. Current evidence suggests that avoidance of peri-operative benzodiazepines, careful titration of anaesthetic depth guided by processed electroencephalogram monitoring and treatment of pain are the most effective strategies to minimise the risk of delirium. Addressing postoperative delirium requires a collaborative, whole pathway approach, beginning with the early identification of those patients who are at risk. The research agenda should continue to examine the potential for pharmacological prophylaxis to prevent delirium while also addressing how successful models of delirium prevention can be translated from one setting to another, underpinned by implementation science methodology.