None listed
Conditions
Brief summary
There is clear evidence that heart surgery can lead to clinically evident and asymptomatic brain injury. There is some debate as to whether this is due to clots forming in the heart and going to the brain, the need to use heart-lung bypass, anaesthetic factors, or other factors that occur during the operation such as low blood pressure leading to reduced blood flow to the brain. We wish to determine the risk of brain injury following bowel surgery and any factors that may predict this risk. This will be done by performing clinical and cognitive testing before and after surgery and magnetic resonance imaging brain scans in the week following surgery. The results of this study will be compared to those seen in heart surgery patients. The aim is to shed more light on the mechanisms of brain injury following surgery.
Interventions
Post-operative magnetic resonance (MRI) brain imaging with diffusion weighted imaging (DWI) and FLAIR sequences.
The MRI technique of DWI is a simple and non-invasive means of identifying areas of cerebral ischemia with high sensitivity and specificity. Increased DWI signal intensity change occurs within minutes of the ischemic event and remains “positive” for 7-14 days even in the absence of clinical signs of stroke. This allows areas of acute ischemia to be distinguished from old infarction.
Post-operative magnetic resonance (MRI) brain imaging with diffusion weighted imaging (DWI) and FLAIR sequences. The MRI technique of DWI is a simple and non-invasive means of identifying areas of cerebral ischemia with high sensitivity and specificity. Increased DWI signal intensity change occurs within minutes of the ischemic event and remains “positive” for 7-14 days even in the absence of clinical signs of stroke. This allows areas of acute ischemia to be distinguished from old infarction. Each scan is estimated to take 20 minutes in duration. Participants will also undergo clinical and cognitive assessments both pre- and post- operatively. Clinical and cognitive assessments will be performed within the week prior to surgery. The clinical assessment will be repeated between 3-7 days after the operation and then again at 6-8 weeks. Cognitive assessment will be repeated at 6-8 weeks only.
Sponsors
Auckland City Hospital Research Review Committee
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1.Thirty consecutive patients undergoing bowel surgery (right hemicolectomy, anterior resection or abdominoperineal resection) at the Auckland City Hospital. 2.Able to give informed consent. 3.Able to undergo the clinical and cognitive assessments 4.Able to tolerate a post-operative MRI brain scan.
Exclusion criteria
1.Previous neurological disease, including stroke or transient ischemia attack (TIA), or cognitive impairment as determined by Abbreviated Mental Test Score (AMT<7), or past psychiatric disease that would interfere with the interpretation of clinical and radiological data. 2.Contraindications to MRI brain scanning including permanent pacemaker/implantable defibrillator, metallic foreign bodies, claustrophobia. 3.Any patient that the assessing clinician or treating surgeon or anaesthetist does not believe would be an appropriate candidate for the study.
Outcome results
None listed