Current List of VADA Research (Nov 2021)
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Adequacy Of Heparin Reversal After Standard Protamine Dosing: A Quality Assurance Project (HRAP)
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Use of Paravertebral Catheters for Minimally Invasive Cardiac Surgery
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Efficacy of Ultrasound-Guided Single-Shot ESP Block for Thoracoscopic Wedge Resection
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Postoperative Nausea and Vomiting in Neurosurgical Patients: A Retrospective Analysis
COP-AF multicentre trial
VGH site lead: Dr. McLean
Brief overview:
Evaluating the efficacy of colchicine for the prevention of perioperative atrial fibrillation in patients undergoing thoracic surgery
Albumin Utilization for Intravascular Volume Replacement Across Canadian
Cardiac Surgical Centres: A Prospective Observational Study
VGH site lead: Dr. Mullane
Brief overview:
Quantifying the type of albumin and crystalloid given perioperatively and looking at 28 day outcomes.
Bfree multicentre trial
VGH site leads: Drs. Klein, Atherstone, Mullane
Brief overview:
Evaluating the effect of benzodiazepine free cardiac anesthesia on the rates of postoperative delirium.
Adequacy Of Heparin Reversal After Standard Protamine Dosing: A Quality Assurance Project (HRAP)
PI: Drs. Trudeau, Mullane, Atherstone, Klein
Brief overview:
Cardiac surgery is performed worldwide with the aid of a cardiopulmonary bypass circuit (CPB). Blood is removed from the heart, oxygenated, and then returned to the arterial side of the patient by means of a mechanical pump. Heparin, a potent anticoagulant agent, is given prior to initiation of CPB. This prevents blood from clotting when in contact with the CPB circuit. On separation from CPB, heparin must be reversed to allow normal coagulation to occur. Protamine Sulphate is the agent of choice for this reversal. Protamine however, is not a benign medication and in excess it can inhibit platelet action and cause more bleeding. Current practice in VGH cardiac surgery is to give a 400mg dose of Protamine to reverse heparin. This may be excessive in patients who have received lower heparin doses. ROTEM has been used to show protamine reversal and indicate when too much is given. We aim to investigate 40 patients and identify if we are correct in our dosing or are indeed giving too much.
Dexmedetomidine use in ICU sedation and postoperative recovery in elderly patients
post-cardiac surgery (DIRECT)
PI: Drs. Klein, Mullane
Brief overview:
Due to advances in surgical and anaesthetic techniques, increasing numbers of elderly patients are undergoing cardiac surgery. Elderly patients with multiple comorbidities undergoing cardiac surgery may have prolonged recovery following cardiac surgery when compared to other groups of patients, and are at higher risk of postoperative delirium, postoperative neurocognitive decline and reduced quality of life following hospital discharge. The goals of sedation and analgesia for patients following cardiac surgery are multifold and include postoperative pain relief, the facilitation of ventilation, resolution of hypothermia and normalization of electrolyte balances. The choice of sedative agent however can impact postoperative outcomes. Dexmedetomidine has been associated with improved quality of recovery in patients undergoing major spine surgery and with a reduced incidence of delirium, both of which can impact a patient’s quality of life following surgery. We hypothesized that the use of dexmedetomidine as a sedative agent immediately following cardiac surgery in elderly patients would result in improved quality of recovery and a reduced incidence of delirium in the postoperative period, when compared to propofol. We were also interested as to whether there was an associated improvement in neurocognitive outcomes in this population.
Use of Paravertebral Catheters for Minimally Invasive Cardiac Surgery
PI: Drs. Schisler, Cook
Brief overview:
A retrospective cohort analysis of clinical outcomes following minimally invasive cardiac surgery. Groups receiving paravertebral catheters are being compared to those not receiving this analgesic modality in terms of pain scores, opioid use and hospital length of stay.
HIPEC and Inflammatory Markers: Review
PI: Dr. Wilson
Brief overview:
HIPEC surgeries, compared to other surgeries, have a significant potential for stress and inflammation secondary to long and extensive surgical resections followed by the rapid temperature changes and intra-peritoneal chemotherapy. Given that many of these patients already have experienced metastasis of bowel related malignancies, they are already a high-risk population for cancer recurrence, immune modulation and opioid requirements.4,5 HIPEC surgery has been shown to have significant increases in inflammatory mediators known to be involved with tumour progression and metastasis.1,25,6 We want to characterize this level of inflammation and identify patient, anesthetic and surgical variables associated with inflammatory mediators. This will inform future research into potentially-modifiable factors to reduce inflammation in the future. This information can be obtained from previously collected blood sample results and from a chart review. Overall, collection of this data will allow us to look at our outcomes with a plan to improves and disseminate information to other centres regarding the management of HIPEC cases.
Efficacy of Ultrasound-Guided Single-Shot ESP Block for Thoracoscopic Wedge Resection
PI: Drs. Wilson, Klaibert, Lohser, Tang
Brief overview:
In this prospective, single center, randomized, placebo-controlled blinded pilot study, we hypothesize that the addition of ultrasound-guided single-shot ESP blocks with ropivacaine versus saline to the current standard of care will improve postoperative recovery of patients undergoing VATS wedge resections. Our primary outcome measure was the 40-point Quality of Recovery (QoR-40) assessment in addition to pain level metrics as secondary outcomes using the visual analogue pain scale (VAS), and oral morphine equivalent (OME) consumption in the 24-hour postoperative period. Proof of improved patient recovery and analgesic efficacy in this setting may allow a future head-to-head comparison with more invasive analgesic techniques currently used for thoracic surgery such as epidural and paravertebral blocks
Reducing day-of-surgery cancellations at UBC Hospital
PI: Dr. Klaibert
Brief overview:
Surgical cancellations on the day of surgery lead to lost surgical time, patient dissatisfaction, and practitioner frustration. With a geographically dispersed and medically complex surgical population, growing waitlists, and stretched resources, the occurrence of such cancellations is more likely. Preliminary data collected from November 2020 to April 2021 at UBC Hospital shows 32 instances of same-day surgical cancellations. This represents a significant financial loss related directly to wasted operating time, personnel, and resources, but also indirectly from progression of surgical disease and financial costs to patients.
As anesthesiologists and perioperative medical specialists, we play a pivotal role in optimizing and preparing patients for their operations, yet we currently have an incomplete understanding of the reasons for, and etiology behind day-of-surgery cancellations. Attaining this knowledge is an important step towards understanding how our pre-surgical processes and practices contribute to these cancellations.
Guided by this knowledge, we are undertaking a QI initiative with the aim of reducing same-day surgical cancellations by addressing the contributing factors in our pre-operative practices and processes.
Prehabilitation
PI: Dr. Mayson and prehab working group
Brief overview:
Aim is to identify patients with predefined health conditions—anemia, diabetes, frailty, smoking, malnutrition, chronic pain, poor physical activity and engage and activate them to optimize these conditions prior to surgery so to improve surgical outcomes such as LOS and postoperative morbidity
Postoperative Nausea and Vomiting in Neurosurgical Patients: A Retrospective Analysis
PI: Dr. Rieley
Brief overview
Postoperative nausea and vomiting (PONV) is a common adverse effect of Anesthesia causing decreased patient satisfaction, increased hospital length of stay, higher costs and increased patient morbidity. The use of Aprepitant has been proposed to decrease the incidence of PONV in Neurosurgical patients, in particular those undergoing Posterior Fossa Surgery.
We hypothesize that the incidence of PONV will be higher in patients who received no anti-emetics during Neurosurgical procedures compared to those who received anti-emetics. Furthermore it is likely that those who received combination therapy will have had lower incidence of PONV and those who received Aprepitant will be in the lowest incidence group.
We also hypothesize that PONV will be related to postoperative surgical complications. In addition, decreasing incidence of complications will be seen in decreasing order in those who received Aprepitant as part of their combination prophylaxis; those who received combination prophylaxis; those who received single agent prophylaxis and; those who received no prophylaxis.