Emergency anaesthesia under the spotlight
30 March 2020
Emergency surgery is a procedure beset with risks; many of these concern the use of anaesthetics. Dr Lucy Elliott, a medic with the North Bristol NHS Trust, is using the Clinical Primer Scheme from the Elizabeth Blackwell Institute to find ways to minimise the dangers.
Compared to elective surgery, the mortality rate of patients undergoing emergency surgery is disproportionately high. For some emergency surgical procedures, the mortality rate has been quoted at over 25%. But there is evidence to suggest that using local or regional anaesthesia over general anaesthesia could improve outcomes in patients undergoing emergency surgery, although there aren’t sufficient randomised controlled trials (RCT) to investigate.
Protected research time
But research such as this is challenging at the best of times, and it’s made more difficult by the demands of a full on-call rota that medics have to undergo. Here’s where the Clinical Primer Scheme helped. Dr Elliott explained: “One of the most marked benefits of the scheme is the protected research time, which ensured that my time was committed to the research she had elected to undertake.”
Dr Elliot’s research work, in which she is standardising definitions of anaesthesia into formal protocols, forms part of the GALORE (General, Local and Regional Anaesthesia in Emergency Surgery) project, which attempts to optimise anaesthesia administration in emergency surgery settings. She hopes that the work she is doing will contribute to the development of a RCT comparing local and general anaesthesia methods.
“Recent work has shown that often the reporting of interventionist anaesthesia in patients undergoing invasive procedures is inconsistent”, said Dr Elliott. “This makes interpreting evidence of trials difficult. We are looking to assess how anaesthetic is being reported in trials when it is used as an intervention in any patient undergoing an invasive procedure - we’re using a recognised checklist for reporting complex interventions. The aim is for this to guide how anaesthetic interventions are reported, which will improve the validity of outcomes from such trials and give us a yardstick by which we can devise more appropriate emergency treatment paradigms.”
Dr Elliott published her initial scoping review in the British Journal of Surgery, and the full systematic review project, (Systematic review of reporting standards of Anaesthetic Interventions in Randomised Controlled Trials) will be published in British Journal of Anaestheia in the early part of 2020.
A fine fellowship
Dr Elliot said, “These studies will continue to feed into further first author publications. Alongside the continued support and guidance of my academic supervisors within my research group, that have allowed me to successfully apply for the NIHR-funded Anaesthetics Academic Clinical Fellow (ACF) post in Bristol. This is a three-year post including anaesthetics training, which will commence in August 2020. Alongside my clinical training, I will continue my research work through affiliation with the University of Bristol with protected research blocks in both the second and third years of the post, with the aim to formulate a funding application for a PhD following the completion of the post in August 2023.”