Travel funding from the College of Health Sciences Mary Weston Fund made it possible for Dr Bruce Biccard, a Senior Academic in UKZN’s Department of Anesthetics, to attend an All Africa Anaesthesiology Congress in Cairo, Egypt, where he presented three papers.

Attended by about 1 500 registered delegates, Biccard says that the Conference was not only a success with regards to growing the anaesthesiology profession but also provided a platform for international research collaboration.

Biccard managed to successfully formalise an Africa Anesthesiology Collaborative group. The group was established to promote medical education, programme development, health outcomes auditing and clinical research.

Biccard’s paper titled: “The role of BNP in perioperative risk stratification in noncardiac surgery”, focused on determining the utility of B-type natriuretic peptide (BNP) perioperative risk stratification and its role in vascular and nonvascular noncardiac surgery as well as the perioperative timing of B-type natriuretic peptide serum evaluation.

BNP is a substance secreted from the ventricles or lower chambers of the heart in response to changes in pressure that occur when heart failure develops and worsens. The level of BNP in the blood increases when heart failure symptoms worsen, and decreases when the heart failure condition is stable. According to a recent study published in the January Journal of the American College of Cardiology, BNP accurately detected heart failure 83 percent of the time and reduced clinical indecision from 43 percent to 11 percent.

Biccard’s study found that BNP’s were associated with improved cardiac risk stratification in non-cardiac surgery, however whether they improved patient outcome by integrating them into management algorithms still needed to be determined.

Biccard’s second paper was titled: “Intraoperative predictors of adverse cardiac outcomes in noncardiac surgery”. Preoperative cardiac risk is commonly determined by preoperative risk scores and risk stratification tools. However, recent studies have suggested that intra-operative factors modify the risk of cardiac complications following noncardiac surgery. Therefore, this study aimed to determine where it was important to identify independent intraoperative predictors of perioperative cardiac risk.

The study is a large ongoing international prospective observational project known as the Vascular Events In Noncardiac Surgery PatIents cOhort evaluatioN (VISION) Study. Data from the meta-analysis suggested that the only independent intra-operative predictor of postoperative cardiac events with sufficient evidence, was the need for perioperative blood transfusion.

However, Biccard said the size of the VISION study, which will involve 40 000 patients worldwide when completed, will present a unique opportunity to explore whether the intraoperative physiological and surgical risk predictors in single small studies were in fact independent predictors of postoperative cardiac events, even in the presence of perioperative blood transfusion.

The VISION study hopes to clarify a number of limitations of the current understanding of which risk factors are independently predictive of postoperative cardiac events.

Biccard’s third paper: “Myocardial Injury after Noncardiac Surgery - a Proposed New Clinical Entity”, focused on developing new diagnostic criteria for patients who have myocardial complications during noncardiac surgery. The presentation of myocardial injury in surgical patients is different to that of medical patients with myocardial infarction.

The data, also part of the VISION study, will be published in the near future, and it is hoped they will help in identifying and managing these patients in the future.

The Perioperative Research Group based within UKZN’s Department of Anaesthetics and in collaboration with the Departments of Cardiology, Radiology and Chemical Pathology, is the only African site participating in the VISION study.

Biccard stated that attending the Conference was useful. ‘I believe the funding succeeded in providing an impetus for academic development, collaboration and contributed to successful exposure for the University. Thank you for supporting me.’

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