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
It is known that about 10% of patients over the age of 55 have difficulty with cognition and thinking 3 months after surgery and anaesthesia. Over 2 million operations involving anaesthesia are administered in Australia every year and increasingly the patients are elderly and thus exposed to the risk of cognitive decline after surgery. We have preliminary data showing that people who have mild changes in cognitive function before the surgery (known as mild cognitive impairment) are susceptible t ....It is known that about 10% of patients over the age of 55 have difficulty with cognition and thinking 3 months after surgery and anaesthesia. Over 2 million operations involving anaesthesia are administered in Australia every year and increasingly the patients are elderly and thus exposed to the risk of cognitive decline after surgery. We have preliminary data showing that people who have mild changes in cognitive function before the surgery (known as mild cognitive impairment) are susceptible to further cognitive decline after anaesthesia and surgery. In order to explore the relationship between preoperative cognitive function and postoperative cognitive decline we plan to measure cognition in patients scheduled for elective hip replacement surgery. This is done by asking patients to complete a standard battery of cognitive tests. We will be then able to identify those patients who already have mild cognitive impairment before surgery and by repeated testing after the operation will be able to demonstrate if preoperative cognitive status is a determinant of postoperative cognitive dysfunction. The primary aim of the research is to test whether cognitive impairment before surgery leads to cognitive deficit after surgery in patients over the age of 65 undergoing total hip replacement surgery. The study will also establish the prevalence of pre-operative mild cognitive impairment and the magnitude of postoperative cognitive dysfunction after surgery in this patient group. The study will explore the relationship between preoperative cognitive status and postoperative cognitive deficit , providing information about the incidence, natural history and risk factors of postoperative cognitive deficit. This work will enable further research to isolate specific causative factors and identify therapeutic and prophylactic strategies.Read moreRead less
Are Healthcare Interventions Exacerbating Alzheimer's Disease (AHEAD)
Funder
National Health and Medical Research Council
Funding Amount
$709,803.00
Summary
The AHEAD Study will assess the impact of anaesthesia and surgery on cognitive function in patients with Mild Cognitive Impairment or mild Alzheimer's Disease. Such effects have not been established. With an ageing population being increasingly exposed to healthcare procedures requiring anaesthesia or sedation, any negative impact needs to be identified so that therapeutic decisions may be informed and future research appropriately targeted.
The Influence Of Anaesthetic Depth On Patient Outcome After Major Surgery
Funder
National Health and Medical Research Council
Funding Amount
$2,893,795.00
Summary
Millions of high-risk patients have general anaesthesia for major surgery worldwide every year, but the optimal depth of anaesthesia for these patients is not known. The aim of this large randomised trial is to determine the impact of light versus deep general anaesthesia on survival at one year postoperatively in 6,500 older patients. If light anaesthesia is associated with better survival, this result will be immediately implementable, will save lives and will reduce the costs of care.
Cognitive changes after surgery occur in the elderly, yet the cause remains unknown. We plan to study cognition in patients having hip surgery in which general and spinal anaesthesia are used together. This allows us to sample spinal fluid which will be analysed for substances which identify a predisposition to Alzheimer’s disease. By comparing the results to a group of subjects who have not undergone surgery, we hope to identify if anaesthesia and surgery exacerbate this predisposition.
‘Granny was never the same after her operation’ is a strong public perception. These reports of persistent memory and concentration loss following surgery are now supported by a body of scientific research recording an incidence of ‘postoperative cognitive decline’ (POCD) as high as 75% in cardiac surgery patients. At present the cause is unknown but recently anaesthesia has been implicated. Our research team will investigate these claims.
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.
Outcomes From A Multi-site Randomised Controlled Trial Comparing Regional And General Anaesthesia For Effects On Neurodevelopmental Outcome And Apnoea In Infants
Funder
National Health and Medical Research Council
Funding Amount
$757,831.00
Summary
Animal studies suggest general anaesthetics harm the developing brain. It is unclear if these findings are relevant to humans. The aim of this international randomised controlled trial is to determine whether children exposed to general anaesthesia as an infant have a poorer neurodevelopmental outcome. A previous NHMRC grant funded the first phase of the trial along with substantial funding from overseas. The trial will tell us if general anaesthetics affect the developing brain in children.
Cardiac Intervention, Surgery And Cognitive Outcome (CISCO) Study
Funder
National Health and Medical Research Council
Funding Amount
$367,739.00
Summary
We propose to investigate the association between the presence of coronary artery disease and changes in brain function after therapeutic interventions. Patients undergoing surgery for coronary heart disease are prone to experience changes in mental function and higher level thought processes (cognition) after surgery, especially if they are elderly. As the population ages this is becoming a more significant problem. There is some limited evidence that this particular group of patients has a hig ....We propose to investigate the association between the presence of coronary artery disease and changes in brain function after therapeutic interventions. Patients undergoing surgery for coronary heart disease are prone to experience changes in mental function and higher level thought processes (cognition) after surgery, especially if they are elderly. As the population ages this is becoming a more significant problem. There is some limited evidence that this particular group of patients has a higher incidence of cognitive impairment than the normal population even before they present for surgery, because cardiovascular disease has also been shown to be associated with changes in cognition. To investigate this, we will measure cognitive status in patients over the age of 55 who have coronary artery disease and are being investigated with coronary angiography. This will provide an indication of the baseline cognitive status in patients presenting with coronary vascular disease. We will use validated neuropsychological tests that have been used to assess potsoperative cognitive decline. These tests are sufficiently sensitive to detect subtle changes in a number of areas of thought processing (cognitive domains) and thus identify those subjects who have cognitive impairment. Patients will then go on to be treated by surgery or angioplasty. We will continue to test these patients at time intervals for 3 months in order to track the changes in cognition in each treatment group. Thus we will be in the position to compare how these modalities of treatment for heart disease impact on patients mental function and cognition. In addition we will be able to tell whether a 'recovery' period might be of benefit following coronary angiography. If we are able to demonstrate different cognitive outcomes from different treatments and also an association with pre-existing cognition, this will guide clinical decision making to minimise harm to the brain.Read moreRead less
The Genetics Of Cognitive Deficits In Attention Deficit Hyperactivity Disorder (ADHD)
Funder
National Health and Medical Research Council
Funding Amount
$675,512.00
Summary
Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder of childhood that is marked by age-inappropriate levels of inattention and-or hyperactivity-impulsivity. The disorder appears genetic with a number of different genes likely contributing risk for ADHD. This project takes an innovative approach by asking whether there are different genetic profiles associated with children with ADHD who do or do not have neurocognitive deficits.