Head of Department Professor MFM James
During 2010, the most important completed study was the fluid resuscitation trial in trauma patients. This study had great educational value for all who participated, and the principal investigator (MF James) formed part of a world-wide series of discussions on appropriate perioperative and critical care fluid management. This study, known as the FIRST Trial, was subsequently accepted by the British Journal of Anaesthesia with minimal changes required. The study has also provided data on markers of resuscitation, acid-base and coagulation changes, which will form the basis for at least 3 MMed mini-dissertations for registrars. This study will in all likelihood have a significant influence on future fluid management and help to resolve one of the longest standing and important controversies in the literature. A meta-analysis of the effects and influence of balanced salt solutions against isotonic saline on clinical outcomes has recently been completed and will form the basis of a Cochrane Review. The main authors are from University College London, with collaborators at Duke University and this Department.
A second important area of investigation is Obstetric Anaesthesia. New projects were initiated in the study of spinal anaesthesia in preeclamptic parturients. One study will investigate the effects of vasopressor therapy pre-delivery on neonatal acid-base status in patients with a non-reassuring fetal heart trace. A second study will examine three aspects of spinal anaesthesia, namely stroke volume responsiveness prior to spinal anaesthesia, the haemodynamic effects of the vasopressor therapy prior to delivery, and the effects of various methods of administering oxytocin, including the interaction with an alpha-agonist. For this purpose, a non-invasive cardiac output device will be employed, using an algorithm based upon pulse wave form analysis. As part of these investigations, a collaboration was initiated with the Department of Anaesthesia of the University of Washington. This aspect of the study will examine the population characteristics of the adrenaline β2-haplotype in preeclamptic women. At the same time data would be collected on control healthy women. At least three MMed mini-dissertations will arise from this work. One of the investigators represented the Department at the Obstetric Anaesthetists Association annual 3 day course in London. A further study validating the use of a non-invasive cardiac output device in patients with complicated severe preeclampsia, was accepted by the British Journal of Anaesthesia. In addition, a prospective audit of epidural analgesia was completed and analysed.
The refurbishment of the Red Cross Hospital operating theatre complex continued to create an environment conducive to research, and this was evidenced by the publication of several instructive case reports, and an important study of the pharmacokinetics of ketamine in children, following oral administration, which is in press in Paediatric Anaesthesia. Several new projects are in preparation, including a pharmacokinetic study of the antimicrobial agent cefazolin during cardiopulmonary bypass. Co-operation in these studies has been obtained from the department of pharmacology, including the development of an assay for cefazolin, would should form the basis of several further important clinical trials. Important projects in thromboelastography are ongoing. Valuable guidelines have been published for pain management and sedation in children.
The Department has been accepted as a research site for the international, multicentre POISE-2 trial of aspirin and statins for perioperative protection of high risk patients against perioperative myocardial events. The South African principal investigator is Dr B. Biccard, from the Department of Anaesthesia, UKZN. The local site was initially set up by Prof M. James. The lead author is Dr A. Myburgh, with Dr A Emmanuel as a co-investigator.
The Department was involved in 3 major areas of research. Firstly, there are ongoing studies on coagulation, both clinical, which resulted in a paper in Anaesthesia, and an animal study of coagulation in a porcine model of acute liver failure. Cardiac output measurements were also obtained in the latter study. Secondly, transoesophageal echocardiography is being performed in baboons undergoing valve replacement.
Once again, junior consultants and registrars were encouraged to participate in research activities wherever possible, and scientific writing skills were also improved in this way. International collaboration continues, with the University College London Hospitals, Stanford University, the Rikshospitalet, Oslo, the University of Toronto, and the University of Washington.