ANZCTR search results

Laparoscopic surgery continues to cause specific pathophysiological changes particularly due to intraabdominal pressure (IAP) and positioning. Cardiovascular changes include hyperand hypotension, prolonged QT dispersion, arrhythmias and rarely cardiac arrest. Splanchnic perfusion changes with changes in organ function are mainly due to the increased intraabdominal pressures and the resultant reduction in abdominal perfusion pressure. Pulmonary changes like hypercarbia, hypoxemia and barotraumas are usually avoided through adaptations in ventilation settings. Although other causes like CO2 absorption, ventilation strategy, surgical technique, the nature and duration of the procedure, and intrinsic patient factors (intravascular volume, preexisting cardiopulmonary status and neurohormonal status) have been identified, the intraabdominal pressure caused by the CO2 pneumoperitoneum combined with the patient’s position remain the main drivers behind these pathophysiological change. Commonly IAP is around 12 mm Hg for most laparoscopic procedures. Pressures above 15 mm Hg lead to increased systemic and pulmonary vascular resistance and a reduction in cardiac index. Lowering insufflation pressures even more leads to a further reduction in postoperative pain and a better quality of life 5 days after surgery. The primary reason for insufflation is to create good view of the surgical field and enough room to manoeuvre with the surgical instrumentation. Determining factors will be the proceduretype dependent extent of the relevant surgical field, the patient habitus, and the abdominal wall elasticity. One would assume that a neuromuscular block (NMB) would facilitate the extension of the abdominal wall and produce more space at lower insufflation pressures. However, only very limited evidence exists, both suggesting that ongoing NMB may or may not provide any benefit. Clinical practice varies between ongoing NMB, intermittent NMB or no NMB at all after induction. With the advent of the reliable NMB reversal agent Sugammadex, we are now in a position to offer continuous deep NMB (CDNMB) until the end of the procedure without compromising our ability to timely and fully reverse the NMB. This enabled us to design this prospective observational pilot study to investigate if the IAP can be reduced to lower values with a CDNMB with Rocuronium compared to no ongoing neuromuscular block under a standardized anaesthetic technique. The outcome of this study will help us determine the power and study size requirements for a randomized controlled trial looking at the lowest IAP in patients with and without continuous deep NMB.

Dosing study of sustained release Ocular System for treatment of Anterior Segment Eye Disease to determine Safety and Efficacy of the ForSight V501 Product.

Sitting for long periods of time each day is detrimental to health and has been linked with increased risk of cardiovascular disease and death. Stroke survivors are among the most sedentary members of society and face significant barriers to maintaining recommended levels of physical activity. This project aims to investigate the safety and feasibility of an intervention aimed at encouraging stroke survivors to 'sit less and move more' each day.

This study will investigate the use of a drug called Exenatide in patients with acute ischaemic stroke. Exenatide is a drug currently approved for use in patients with type 2 diabetes to help control glucose levels. Research in animals and other laboratory studies suggests that exenatide may have a protective effect on brain cells by protecting cells that are at risk of dying in ischaemic stroke, as well as controlling glucose levels. Exenatide has also been shown to reduce the area of brain damaged by stroke. In this study we aim to have two groups of 25 patients – an exenatide treatment group and a control group. One group will receive an exenatide injection twice daily for 5 days after stroke, with the first dose given within 9 hours of the onset of stroke symptoms. These patients will also receive either metoclopramide 10 mg or ondansetron 4 mg twice daily intravenously to prevent nausea and vomiting for the first 3 days. The control group will have standard stroke care without exenatide treatment. Patients in both groups are also eligible to receive tPA therapy. Blood tests will be taken on days 0,1, 3, 5, 7 and 14 to assess glucose levels and other blood markers. Standard imaging for stroke patients will be done for participants in the study, including a CT scan before starting the trial and CT or MRI 3-5 days after the stroke. All the patients will also have continuous glucose monitoring done in the first 72 hours. This will be done by equipment called Guardian real-time CGM system (Medtronic), which has a sensor with a subcutaneous needle. We aim to look for any significant differences between the two groups for blood sugar control, clinical outcome and size of stroke on CT/MRI. We will also monitor participants closely for adverse events that may be linked to exenatide treatment.

Ageing is associated with a physiological reduction of appetite and energy intake, which has been called the “anorexia of ageing”. Dietary supplementation with liquid protein preparations is now used frequently to increase energy and protein intake in older adults in both institutionalized and community-dwelling populations. Although the latter would appear a logical approach, evidence for success of increased energy intake in older individuals is limited. It is well established that the ingestion of nutrients induce a number of changes in gastrointestinal (GI) function, which are associated with the modulation of appetite and energy intake. These changes include the slowing of gastric emptying, which sustains gastric distension and is associated with proximal gastric relaxation. In addition to the effects of healthy ageing, there is evidence of differences between undernourished and well-nourished older people, which may potentially result from being undernourished and/or contribute to the undernourished state. Urgent investigation is warranted to determine the effects of oral protein intake, so that protein can be incorporated into their diet to assist in sparing muscle mass without reducing their appetite. The study aims to characterise in older individuals, the effect of undernutrition on energy intake, appetite, antral area, gastric emptying, plasma concentrations of amino acids, hormones (i.e. CCK, PYY, ghrelin, GLP-1, GIP, glucagon and insulin) and glucose.

This study tests the short and medium term efficacy of the online UniWellbeing Course with students with symptoms of anxiety or low mood, when administered by staff from the Macquarie University Campus Wellbeing Service.

By conducting this project we hope to explore the short and long term benefits of a self-guided treatment for obsessive-compulsive disorder. We also hope to find out how acceptable the program is to consumers and how we can improve the program. The results will inform us about who is likely to benefit from this treatment protocol and how best to administer this program.

This study investigates whether using a new pain monitoring device, the ANI monitor, can better predict how much pain-killing medication patients having keyhole gallbladder surgery need. During gallbladder removal patients are asleep and unaware but still need pain-killing medication such as morphine or fentanyl to make sure they are not in severe pain when you wake up. Anaesthetist currently estimate how much pain-killing medication is needed based on factors including patient age, body weight, thepatients response to the surgery judged by blood pressure/heart rate monitoring and the anaesthetists clinical experience. Using these methods, patients sometimes wake up after surgery with severe pain because the prediction of dose for pain-killing medicine during surgery was incorrect. In this study, we will be testing a new pain monitor which may be able to more accurately predict a patients analgesia requirements during surgery. This monitor requires two gel electrodes to be placed on your chest, alongside the gel electrodes that are put on by the anaesthetist for standard heart monitoring. It records heart rate with great accuracy and using complex mathematical formulas, generates a number (the acute nociception index) which may better predict the pain levels while the patient is anaesthetized. This study compares the comfort of patients waking up after gallbladder surgery when the monitor is used compared with standard care.

Gamma glutamylcysteine (GGC) is commonly found in many foods, such as garlic and whey, which are anecdotally associated with numerous health benefits. GGC can potentially be used by the body to synthesise the commonly termed “master antioxidant” glutathione, which is responsible for protecting our cells from oxidative stress and for the elimination of toxins. As we age our body’s capacity to produce sufficient glutathione progressively declines leaving us vulnerable to many age related diseases and disorders. In this study, we will investigate whether oral administered GGC can be of benefit in increasing the glutathione content in blood cells in young. mature and aged populations.

This study has been designed to test the efficacy and safety of an 8 week regimen of subcutaneous teriparatide. A prospective randomised double-blinded placebo-controlled study design will be used. There will be a one-year follow up period. During the intervention and follow up phases, participants will undergo dental examinations, biochemical and radiological investigations, as well as a quality of life questionnaire.