Humans can tolerate a narrow range of body temperatures. Both hypo- and hyperthermia have potentially life-threatening consequences. As global temperatures rise, heat illness is an increasing concern. We are investigating the mechanism and consequences of epidural hyperthermia, and the impact of personal protective equipment (PPE) use on healthcare workers.

Epidural hyperthermia occurs during 20% of labour epidurals and has a negative impact on both the mother and baby. With the support of the Obstetric Anaesthetists’ Association and Imperial Healthcare Charity, we are investigating the “sympathetic blockade” mechanism; the impact upon neonatal neurological outcome; and the efficacy of a potential solutions.

Use of Personal Protective Equipment (PPE) has increased in healthcare during the COVID-19 pandemic in order to prevent disease transmission. Its use has clear benefits, but it can also cause heat illness in those who wear it. With the support of the BMA foundation, we are investigating the impact of airborne PPE on healthcare workers performance and wellbeing. 

Anaesthesia is mediated through the effects of drugs on the central and peripheral nervous systems. Neurophysiology is a means of quantifying these effects. We are employing neurophysiological methodologies to investigate the concept of patient controlled inhalational sedation and are developing methods of detecting spinal cord injury during vascular surgery.

Use of sedation, rather than general anaesthesia, has benefits for patients, clinicians and healthcare organisations. However, clinician delivered sedation is underutilised, due to concerns about safety and intraoperative awareness. Patient controlled sedation is a potentially superior alternative, but little is known about this technique. Therefore, we are working with Intersurgical Ltd to gain a greater understanding of its safety and efficacy.

The risk of spinal cord injury following endovascular aortic aneurysm repair is up to 10%. Increasingly, spinal cord injury is seen post-operatively, limiting the use of current monitoring modalities. If damage to the spinal cord can be detected perioperatively, strategies can be employed to mitigate it. Therefore, we are investigating the efficacy of transcranial magnetic stimulation and near infrared spectroscopy to detect spinal cord injury in the perioperative period.

• Obstetric Anaesthetists’ Association
• Imperial Healthcare Charity
• BMA foundation
• Association of Anaesthetists

Related centres

• MSk Lab

Industry links

• Intersurgical Ltd

Internal

• Dr Paul Strutton
• Prof Alison McGregor
• Prof William Harrop-Griffiths
• Dr Connor Myant
• Prof Stephen Brett
• Mr Colin Bicknell
• Prof Alun Davies

External

• Dr David Low
• Dr Sam Hughes

Chaudhari N, Strutton PH, Wickham AJ, McGregor AJ, Mullington CJ. Heat stress associated with aerosol PPE and its impact. Occupational Medicine 2022 [online ahead of print].

Gimzewska, M; Berthelot, M; Sarai, P; Geoghegan, L; Onida, S; Strutton, PH; Shalhoub, J; Davies, AH. Evaluation of a novel wireless near infrared spectroscopy (NIRS) device in the detection of tourniquet induced ischaemia. BMJ Innovations2022; 8(1).

Morton, S; Kua, J; Mullington, CJ. A Systematic Review and Meta-Analysis of Epidural Analgesia, Intrapartum Hyperthermia and Neonatal Brain Injury. BJA 2021; 126(2):500-515.

Mullington, CJ; Malhotra, S. Hyperthermia after epidural analgesia in obstetrics. BJA Ed 2021; 21(1):26-31.

Mullington, CJ; Low, DA; Strutton, P; Malhotra, S. A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery. IJOA 2020; 43:56-64.

Mullington, CJ; Low, DA; Strutton, P; Malhotra, S. Body temperature, cutaneous heat loss and skin blood flow during epidural anaesthesia for emergency caesarean section. Anaesthesia 2018; 73(12):1500-1506.

Sarai, P; Bicknell, C; Courtois, N; Strutton, PH. Can Transcranial Magnetic Stimulation be used to detect potential spinal cord injury following thoracic endovascular aortic repair (TEVAR)? A preliminary study to characterise baseline motor evoked potentials in vascular disease patients. European Journal of Vascular and Endovascular Surgery 2018. 56(6):e30.