Dr. Mandy CHU
Pamela Youde Nethersole Eastern Hospital
Dr Mandy Chu is a Consultant Anaesthesiologist in Pamela Youde Nethersole Eastern Hospital in Hong Kong. After completing specialty training in HKCA and ANZCA, she continued to explore further in the field of Neuroanaesthesia. With the inspirations from literatures and many other expertize, she recognized the importance of neuroprotection during perioperative period, especially in the susceptible elderly group. She participated in a few projects regarding perioperative cognitive protection and published articles related to perioperative stroke and cognitive disorders. The practices in neuro-cognitive assessment, monitoring and neuro-protection in perioperative period are still lacking in the current medical system in Hong Kong. Dr Mandy Chu is still working with her colleagues on the feasibility in building a multidisciplinary team in her hospital, trying to make perioperative brain protection as a routine.
Perioperative stroke has been one of the most devastating complications after operation. We were told to discuss this complication with our patients since the very first day of our training. However, we seem still know little about this disease entity despite its destructive impact to our patients and their families. Sometimes we might even falsely reassure our patients having very low risk of stroke. This is partially due to the complex nature of the disease and also the diverging diagnostic criteria used over the years. There were indeed obstacles in the studies in perioperative stroke. The actual practices in minimizing the risks were even more challenging. Despite the hardship, many international expertise and investigators were trying very hard to get consensus on the definition and risk factors of perioperative stroke. Neurological assessment has been promoted these years to be included as part of the routine postoperative assessment.Challenges still persist. Choice of Anaesthetics, intraoperative targets of parameters and the threshold for transfusion are by far lacking evidences. Moreover, studies found the perioperative strokes seriously under-estimated. Diagnosis might be missed as perioperative neurological assessment is still not universally practiced, the presence of covert stroke is the main cause of the under-estimation. Covert stroke shares lots of common characteristics of postoperative neurocognitive disorder and also a cause to POCD. Would the promotion of neurocognitive assessment help in the recognition of covert stroke? How much more should we do to improve our patients’ outcome? It is time that we have to start to make changes happen to our patients.