In collaboration with the Anesthesia Clinical Research Unit (ACRU) group and Mayo Epidemiology and Translational Research in Critical Care (METRIC) group, our researchers are focused on the following questions:
- Can mode of ventilation be associated with acute lung injury?
Through characterization of ventilator settings during anesthesia and its relation to subsequent adverse pulmonary outcomes, we are studying association between ventilatory modes and pulmonary complications. We are identifying subsequent patients who did not have clinically significant respiratory disease preoperatively, but developed postoperative acute lung injury. We are studying factors that may have led to pulmonary complications, with special emphasis on intraoperative ventilator management, fluid status and hemodynamics. In another study we are examining whether the protective ventilatory strategy (recruitment maneuvers, low tidal volume and high positive end-expiratory pressure) decreases the postoperative pulmonary inflammatory response and complications in elderly patients undergoing major abdominal surgery. In addition to preoperative and intraoperative pulmonary variables, we are measuring the release of serum inflammatory cytokines (IL-6 and IL-8) in response to the type of ventilation used (protective vs. conventional ventilation).
- Does lung recruitment affect uptake of desflurane?
Increase in pulmonary shunt (due to atelectasis) may negatively affect uptake of insoluble anesthetic gas such as desflurane. Since the recruitment maneuver reopens the atelectatic lung and decreases pulmonary shunt, the patients who are ventilated with open lung have improved oxygenation and may achieve higher serum desflurane concentrations at identical vaporizer settings. Since bariatric patients exhibit a high degree of reduction of mean lung volume during anesthesia, they are an ideal model for examining these fundamental rinciples of anesthesia practice.
Other Perioperative Outcomes
- Does nasal nicotine decrease postoperative nausea and vomiting (PONV)?
The incidence of PONV is lower in smokers. It is not known which smoke component may be responsible for the antiemetic effect. Furthermore, it is not clear if this is an acute effect or rather an effect that develops during chronic exposure to substances present in cigarette smoke, which is then carried throughout the perioperative period. Nicotine has been shown to inhibit serotonin 5-HT3 receptors, the same receptors blocked with today’s most potent antiemetic medications. That is why we elected to prospectively study whether acute nasal administration of nicotine may reduce the PONV in surgical patients who are high risk for PONV.
- Clinical pharmacology studies:
Our clinical pharmacology research is focused on finding improved pharmacologic solutions that improve the care of our patients. To find solutions, we study new drug entities or new uses of drugs currently approved for use. Often we work in partnership with industry to gain access to the newest agents available. With the ability to gather pharmacokinetic or pharmacodynamic data in our specialized anesthesiology settings, our contributions to clinical trials assist in finding new therapeutic options for our patients who are currently participating in industry sponsored clinical trials.
- Outcome Studies: Review of Anesthesia Performance Improvement Database
We use Institutional and Departmental data sources to conduct various retrospective outcome studies in large surgical populations. Some rare clinical events (e.g., cardiac arrests, pulmonary embolism) are less amenable to evaluation in prospective studies, and so far we reported these clinical outcomes, which are available on PubMed. We are evaluating the role of intraoperative ECMO on mortality in children undergoing repair of complex congenital anomalies. We also retrospectively study other perioperative adverse events: pediatric laryngospasm and transfusion (hyperkalemia) related cardiac arrests. We are now in preparatory stages for studying the role of exposure to anesthesia during the first three years of life regarding the incidence of learning disabilities, attention deficit/hyperactivity disorder and/or developmental delay. Finally, we are investigating the possible association between preoperative hemoglobin levels and intraoperative transfusions on postoperative outcomes (myocardial infarction rae, death etc) in patients undergoing total joint replacement.