The career research interests of Juraj Sprung, M.D., Ph.D., have focused on three primary research areas: pulmonary mechanics, effects of intravenous anesthetics on myocardial contractility, and perioperative and long-term outcomes related to anesthetic management.
Dr. Sprung started his research career by studying the mechanics of breathing and patterns of diaphragm contractility. He conducted research to investigate contractility of the heart in the presence of hypothermia and the effects of various intravenous anesthetics, which were tested on human myocardium explanted from patients with end-stage heart failure undergoing heart transplant.
Dr. Sprung's current interests include studying the short-term and long-term outcomes of patients with rare medical conditions undergoing anesthesia. Due to the large surgical volume at Mayo Clinic, and the availability of detailed medical records, it is possible to evaluate anesthetic and surgical outcomes of a relatively large number of patients with extremely rare diseases such as myotonia congenita, cor triatriatum, DiGeorge syndrome, LEOPARD syndrome, Swyer-James syndrome and the like. The information gathered through these comprehensive reviews of medical records provides insight into the perianesthetic courses of such conditions, which due to their rarity cannot be evaluated in a prospective fashion.
Dr. Sprung's research team studies outcomes of exposure to anesthesia and neurocognitive function. They are currently focusing on the effects of exposure to anesthesia throughout the life span, and are exploring the possibility of an association between single or multiple anesthetic exposures and permanent cognitive deficits — specifically, development of Alzheimer's disease.
Lasting effects of anesthesia exposure through adult life and development of Alzheimer's disease. Dr. Sprung's team is exploring whether general anesthesia administered to adults after age 40 could have a potential role in development of Alzheimer's disease later in life.
Using resources from the Rochester Epidemiology Project and the Mayo Clinic Study of Aging and in collaboration with the Mayo Clinic Department of Neurology, they are examining the role of anesthetic exposure on subsequent development of mild cognitive impairment, a condition that proceeds manifestation of Alzheimer's disease.
This project is significant because it includes a prospectively followed, mentally healthy older adults (at entry into the study) and conducts yearly testing of their cognitive function. Dr. Sprung's team hopes that this study will provide more definitive insight into potential effects of anesthesia exposure on cognition and will reveal whether anesthetic exposure affects speed and severity of the development of existing cognitive deficits.
- Acute lung injury. Dr. Sprung's research team is interested in factors that may be associated with development of acute lung injury after mechanical ventilation. Dr. Sprung explores the role of intraoperative ventilator management including tidal volume, positive end-expiratory pressure and alveolar recruitment with regard to the development of acute lung injury. Special targets of investigation are high-risk surgical populations such as older patients and overweight patients.
- Postoperative ventilation outcomes. An additional area of focus for Dr. Sprung's research is directed toward different modalities of intraoperative managements that may affect the speed of immediate postoperative recoveries. Specifically, Dr. Sprung's team is focused on factors associated with development of immediate postoperative complications, and especially factors associated with adverse respiratory events. This work is aimed at reducing the patient backload in recovery rooms and is geared toward improving the flow of patients from the operating room to regular nursing floors.
Long-term oncologic outcomes related to type of anesthesia. It is well-known that the use of narcotics decreases immune response, and an intact immune system is an especially important factor in regard to tumor progression. The immune system may be suppressed in the perioperative period, which is when tumor manipulation may contribute to dissemination of tumor cells into the circulatory system. Therefore, it is extremely important to maintain the body's defense forces during the perioperative period.
This aspect of Dr. Sprung's research examines whether the use of narcotic-sparing techniques in perioperative settings affects tumor recurrence and spread. Dr. Sprung's research team is currently focusing on urologic oncologic patient populations with prostate and bladder cancers.
Significance to patient care
By studying rare medical conditions and perioperative outcomes, Dr. Sprung aims to identify modifiable factors and thus reduce the number of perioperative complications. Knowledge of potential problems allows anesthesia providers to be better prepared and to be proactive when it comes to rare adverse events. His study of anesthesia and Alzheimer's disease and dementia will help to clarify the extremely important and highly controversial question of whether anesthesia affects cognition in older adults, which is of great interest to patients undergoing surgical procedures. Resolution of this question may affect decision-making when choosing whether to undergo elective surgery.
- U.S. trial coordinator, PROBESE Randomized Controlled Trial, European Society of Anaesthesiology, 2014-present