A vital branch of our Acute Care Department, our Anaesthetics Team deliver national and international multi-centre studies in Anaesthetics and related specialities, working to advance the care that we give to our patients.
At North Bristol NHS Trust, we provide safe Anaesthesia and expert Perioperative Care for around 100 surgical procedures a day. We are a regional specialist centre for major trauma, neurosurgery, renal transplant, vascular surgery, urology, plastic & burns. Our research focus on:
- Improving outcomes for patients undergoing emergency surgery
- Improving outcomes for older surgical patients with multiple co-morbidities
- Understanding for which patients regional anaesthesia help to improve outcomes
We run one of the largest preoperative assessment units in the UK and offer preoperative fitness assessment via Cardiopulmonary Exercise Testing (CPET), evidence-based prehabilitation advice and access to research which aims to improve perioperative outcomes.
Please speak to the person treating you to find out if there is a research study that may be able to help you.
We aim to trial a treatment used to guide the dose and timing of fluid administered into the bloodstream to patients during and shortly after surgery. We will trial this treatment, called “goal-directed haemodynamic therapy” (GDHT), in patients undergoing emergency bowel surgery (laparotomy).
Emergency laparotomy is a common major emergency surgical procedure, performed to treat life-threatening conditions caused by cancer, infections or previous surgery. Over 30,000 people in England & Wales undergo this surgery annually at a cost of over £650m. Outcomes from emergency bowel surgery are poor; 14% of patients aged over 50 die within a month of surgery, rising to 20% within three months. As this surgery is so common, treatments that reduce death rates even slightly could save hundreds of lives.
Major surgery and critical illness (both features of emergency bowel surgery) reduce blood flow to vital organs. This can cause serious complications and death after surgery. Fluids are given into the bloodstream to improve blood flow. Giving the right amount of fluid at the right time has a major impact on outcomes after surgery, but is hard to gauge accurately. Clinicians normally use signs such as heart rate and blood pressure to guide them, but these can be unreliable. GDHT aims to address this. It lets clinicians determine the dose and timing of fluid to give patients, guided by a monitor measuring the blood flow pumped by the heart. GDHT may be beneficial in planned surgery, but has not been properly tested in the complex setting of emergency bowel surgery.
We aim to determine whether GDHT given to patients aged 50+ during and for up to six hours after emergency laparotomy reduces the number of deaths within 90 days of surgery. We propose a multicentre clinical trial in 7646 patients recruited from 100 UK hospitals over three years.
Chief Investigator: Dr Christopher Newell
Planned end date: 01/07/2023
Local Ref: 3978
eFONA: Cognitive barriers in emergency front of neck airway study
As anaesthetists, one of our primary roles is maintaining the patient’s airway during anaesthesia. Very rarely (1/50,000 anaesthetics) an anaesthetist is unable to either insert one of these tubes or provide oxygen to the patient in any other way which may result in brain damage due to harmfully low oxygen levels (hypoxia) or death. The solution to these situations, involves accessing the airway through an incision in the front of the neck (emergency Front of Neck Airway).
All anaesthetists are taught the practical steps involved, and the procedure itself is relatively easy to perform. Delay in making this decision is often the most common problem, yet very little research has been done examining the actual decision making required to perform this life saving procedure.
The aims of this study are to:
- Understand the thought process undergone by professionals needing to perform this task
- Identify reasons for any delay in making this decision
An experienced psychologist will carry out confidential semi-structured interviews with individuals whom have performed or attempted this emergency procedure within the past 2 years. It is hoped that the reasons why anaesthetists are reluctant to make this lifesaving decision could be elucidated. In doing so, these factors could be addressed in education and training of the workforce with the ultimate intention of making airway management and therefore anaesthesia safer for all patients.
Chief Investigator: Dr Lawrence Kidd
Planned end date: 01/05/2022
Local Ref: 4675
Perioperative Quality Improvement Programme (PQIP)
PQIP will measure complications after major planned surgery and seek to improve these outcomes through feedback of data to clinicians. A REC/CAG application for the PQIP Database has already received a favourable opinion. This analysis will answer important research questions about variation in quality of care in major surgery. We expect that this substantial collaborative work will lead to valuable insights regarding the ways in which hospitals use data to drive improvements in care.
Chief Investigator: Mrs Sarah Martindale
Planned end date: 31/10/2023
Local Ref: 3952
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