Dr. Sprung's Anesthesia Outcomes Lab at Mayo Clinic conducts a wide range of research related to the use of anesthesia in patients with rare conditions, in children, in obesity, in orthopedic surgery and in many other situations.
Intraoperative ventilatory strategies
One focus of our research is the use of intraoperative ventilatory strategies to prevent lung injury. This research includes studies on:
- Recruitment maneuver in older patients undergoing open abdominal surgery
- Ventilator management in patients receiving mechanical ventilation during anesthesia
- Desflurane uptake during recruitment maneuver in patients with morbid obesity
- A randomized, double-blind study to evaluate the efficacy of nasal nicotine spray to prevent postoperative nausea and vomiting in patients who are nonsmokers undergoing elective gynecological surgery
- Outcomes and predictors of perioperative pediatric laryngospasm
- The role of anesthesia in learning disabilities in children
- Predictors of survival after perioperative pulmonary embolism in patients undergoing noncardiac surgery
- Intraoperative use of ECMO in pediatric patients who couldn't be weaned from cardiopulmonary bypass
- Transfusion-associated hyperkalemic cardiac arrests
- Association between preoperative hematocrit and postoperative outcomes after major orthopedic surgery
- A multicenter, open-label, phase IIIa trial to evaluate the efficacy and safety of ORG 25969 when used at the end of a surgical procedure to reverse the neuromuscular block induced by rocuronium after routine surgery
- Awake fiber-optic intubation protocol: a phase III, randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of dexmedetomidine for sedation during fiber-optic intubation
- A phase III randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of dexmedetomidine for sedation during monitored anesthesia care
In collaboration with the Anesthesia Clinical Research Unit and the Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) research group, both at Mayo Clinic, our researchers are addressing these questions related to lung injury in anesthesia:
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 the association between ventilatory modes and pulmonary complications. We're identifying subsequent patients who didn't have clinically significant respiratory disease preoperatively but who developed postoperative acute lung injury. We're studying factors that may have led to pulmonary complications, with special emphasis on intraoperative ventilator management, fluid status and hemodynamics.
We're also 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 older patients undergoing major abdominal surgery. In addition to preoperative and intraoperative pulmonary variables, our lab is 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. Because the recruitment maneuver reopens the atelectatic lung and decreases pulmonary shunt, patients who are ventilated with open lung have improved oxygenation and may achieve higher serum desflurane concentrations at identical vaporizer settings. Because patients with obesity (bariatric patients) exhibit a high degree of reduction of mean lung volume during anesthesia, they are an ideal model for examining these fundamental principles of anesthesia practice.
Other perioperative outcomes
Our lab also is investigating other anesthesia outcomes.
Nasal nicotine and postoperative nausea and vomiting
The incidence of postoperative nausea and vomiting is lower in people who smoke. It's not known which smoke component may be responsible for the anti-emetic effect. It's also not clear if this is an acute effect or 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 anti-emetic medications. Our lab is prospectively studying whether acute nasal administration of nicotine may reduce postoperative nausea and vomiting in patients undergoing surgery who are at high risk of these events.
Clinical pharmacology studies
Our clinical pharmacology research is focused on finding improved pharmacological solutions that improve the care of patients. To find solutions, we study new drug entities or new uses of drugs currently approved for use. Our lab often works 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 patients who are participating in industry-sponsored clinical trials.
Outcome studies: Review of anesthesia performance improvement data
We use institutional and departmental data sources to conduct various retrospective outcome studies in large surgical populations. Some rare clinical events (such as cardiac arrests and pulmonary embolism) are less amenable to evaluation in prospective studies.