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Understanding perioperative brain health with Dr. Alana Flexman

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Thanks to anaesthesiologists like CHÉOS Scientist Dr. Alana Flexman, patients have comfortable, pain-free surgeries. Anaesthesiologists use medications that mute pain nerve signals being sent to the brain during operations. Dr. Flexman specializes in neuroanaesthesia, a sub-specialty focused on optimizing the conditions for surgery in either the brain or the spinal cord. A few of these procedures can actually be performed while the patient is awake!

Possible cognitive impacts of surgery

Dr. Alana Flexman

Although preventing pain during surgery is very important, influencing the brain so profoundly can have an impact that lasts after surgery. Dr. Flexman elaborates, “One of the most common complications is delirium, affecting 20–30% of patients 65 years or older post-surgery. Not only does this cause additional stress for patients and their families, it can also delay hospital discharge or cause other complications.”

There is also the anecdotal experience where a patient after surgery is described by their loved ones as “never being quite the same”. Although this phenomenon has yet to be clinically defined, it can be observed in research using complex psychological testing that identifies cognitive decline in some people after surgery.

Another neuro-related complication that can occur in patients as a result of anaesthesia during surgery is having a perioperative stroke. A perioperative stroke is a stroke that occurs around the time of an operation, including during recovery. Understanding how to recognize and mitigate the risk of a perioperative stroke is a main focus of Dr. Flexman’s research.

Understanding perioperative stroke risk

“Even though there is a low rate of stroke (<1 per cent) after surgery, this risk of getting a stroke in certain individuals goes up significantly. For example, if a patient previously had a stroke, they are at an increased risk for a perioperative stroke. Currently, we can identify those who are at risk for a stroke really well, but there are not many ways to mitigate that risk.”

There are a few reasons why it is harder to detect and prevent perioperative stroke. Largely it’s due to lack of knowledge and awareness. For example, F.A.S.T. (and iterations B.E.F.A.S.T. and F.A.S.T.E.R) are widely shared educational tools to help people recognize when someone is having a stroke outside of a hospital and get them to help fast.

“Patients who have a stroke in the hospital do worse than those who have a stroke on the street. Within a hospital, the patient is already sick or has additional complications that may increase their chance of having a stroke. Additionally, they experience delayed recognition, intervention, and imaging because there is just a lack of awareness around having a stroke while in the hospital, and how the signs differ.”

Recognizing a knowledge gap

Dr. Flexman surveyed fellow anaesthesiologists asking about how often they thought about perioperative stroke and if they have discussed it with others. Even though her colleagues were concerned about it and recognized the lack of information on perioperative stroke, they were unsure what they could do to better care for their patients.

Dr. Jason Sutherland

An important step in improving patient care is understanding which patients are at greatest risk. Dr. Flexman’s research focuses on recognizing risk populations and the importance of identifying stroke during or after surgery. For example, tools can be made available in the surgical environment to help identify patients who may have a stroke, but how is easy is it to use these tools? Are they accurate? Are they acceptable to the patients?

Dr. Flexman’s research aims to answer these questions to “identify patients at risk and put them on a pathway to be screened more frequently for strokes, detect strokes earlier, and apply appropriate interventions to minimize the impact on the patient’s health.” She is working with CHÉOS Scientist Dr. Jason Sutherland, as well as several other collaborators across different departments, to look at patient outcomes after stroke and be able to identify why some patients fair differently than others.

How do we have patients go through surgery, anaesthesia recovery, and pain management while having the best outcome possible from a neurologic standpoint so that patients feel like their brains are protected?” Dr. Flexman asks.

The importance of mentorship

Improving patient care is not just about addressing the knowledge gaps of established expertise, it is also about training the next generation of physicians and scientists. Dr. Flexman is passionate about mentorship and authored a paper discussing the importance of mentorship in her field early on in her academic career.

“One of the rewarding parts of my job is helping others get to where they want to go. This applies to both my patients and my trainees. In the operating room and in academia, I enjoy providing my students with the opportunities to grow and excel so that they can continue improving patient care, both in research and in medicine.”

Dr. Flexman enjoys providing opportunities for her students to grow and will be presenting her work alongside her Master’s student Jaycee Farmer at the upcoming Work in Progress seminar on March 16, 2022. Click here for more information and to register for this event.