Breakfast Sessions
Thursday Details
Near-Infrared Spectroscopy for the Brain and Beyond: Examining its Value as an Index of End-Organ Integrity
The importance of cerebral oxygenation is reflected in the fact that an organ which makes up only 2% of body mass receives 15% of the cardiac output. Yet even for high-risk surgeries such as coronary artery grafting, standard clinical monitoring tells us more about the oxygen state of the finger than that of the brain. Our experience has shown us that the cerebral oxygenation can be compromised in situations where all standard monitoring values are within acceptable limits. I will describe our local experience and critically examine the clinical evidence supporting the use of near-infrared spectroscopy as an index of end-organ viability of the brain. I will also explore possible future uses of these devices to direct clinical protection of other organs and tissues.
Thursday's Speaker
Dr Dean A. Cowie – MBBS, FANZCA
Staff Specialist, Austin Health, Melbourne, Australia
Clinical subspecialties include neurosurgical, cardiac anaesthesia and echocardiography. Research interest has been in the field cerebral protection, particularly following subarachnoid haemorrhage. ANZCA supervisor of training for Northern Suburbs Rotational Training program.
Friday Details
Friday's Speaker
Professor Colin Royse
Director, Anaesthesia and Pain Management Unit
Department of Pharmacology, University of Melbourne
Colin Royse is a Professor of Anaesthesia at the University of Melbourne, and a visiting cardiac anaesthetist at the Royal Melbourne Hospital. He is the lead author for the PQRS publication and continues as a member of the PQRS scientific committee. His research interests outside of Quality of Recovery research include anaesthetic pharmacology, echocardiography and cardiac surgery outcomes. His main teaching interests are in echocardiography and he is co-director of the Postgraduate Certificate and Diploma of Clinical Ultrasound, run through the University of Melbourne.
Fridays Abstract
In the last 20 years, there has been a lot of focus on mortality and morbidity outcomes in Anaesthesia research. This has lead to an impressive safety record, such that very few patients die directly from anaesthesia causes. However, anaesthesia interventions have a small effect size on morbidity and mortality (10-15%), necessitating very large trials to show any benefit or harm. Smaller trials are likely to lead to type II error and falsely reassure us that no harm exists or falsely disappoint us that no benefit exists. Such large trials are very expensive to perform, take years, and so few are performed.
Despite an impressive safety record with anaesthesia delivery, quality of recovery is far from perfect. Patients frequently experience persisting pain, nausea, anxiety or depression, poor return to prior levels of function, and postoperative cognitive decline. Although these outcomes may not be recorded in a traditional morbidity assessment, they may cause considerable suffering to the patient. Quality of recovery is the next horizon for anaesthetic research as it focuses on patient oriented outcomes, and importantly will identify how what we do in the operating room impacts on longer term recovery. A focus on quality of recovery will also provide us with a feedback loop on how our anaesthetic techniques affect patient recovery and allow opportunity for continual improvement.
Most quality of recovery scales have looked at early recovery time periods, some are subjective rather than objective, and few are designed for repeated measurement over time. In response to these deficiencies, an international collaboration of anaesthetists and neuropsychologists developed and validated the Postoperative Quality of Recovery Scale. It measures quality of recovery in an objective manner with repeated measurements to track early, late and long term recovery in 6 domains (physiological, nociceptive, emotive, activities of daily living, cognitive and overall patient perspective. These tools will be discussed and data from PQRS research presented.