The Daily Dose • Wednesday, May 12, 2021

Rapid Fire Showcase of Emerging Anesthesiology Investigators

Cameron Bosinski, MD, MS

The Rapid Fire Showcase on May 8 at Scholars’ Program Day 2021 highlighted the diverse research interests of early-stage anesthesiology researchers from across the country. Speakers discussed updates from clinical, translational and basic science projects that range from new imaging modalities for monitoring patients poststroke to novel therapeutics to prevent postoperative kidney injury.

Illuminating Ischemic Stroke
Dr. Broc Burke is an Instructor in Anesthesiology at Washington University and gave a talk titled, “Illuminating Ischemic Stroke.” Currently, functional connectivity magnetic resonance imaging (fcMRI) is used to assess the loss of brain function that can result after a stroke. Unfortunately, this technique is expensive, time-consuming and can only be used intermittently. Dr. Burke has worked to adapt diffuse optical tomography so that it can assess functional connectivity in the brain (fcDOT). FcDOT is less expensive than fcMRI and can be used continuously at the bedside, potentially replacing and improving upon regular neuro checks. Dr. Burke was able to demonstrate that the degree of decreased bilateral functional connectivity correlates with NIH stroke scale severity. This project is likely to lead to increased adoption of fcDOT for the early detection of reinfarction and improvement of post-stroke care.

Opioid Prescribing Patterns for Surgical Patients
Dr. Erica Langnas is a CA-4 at the University of California San Francisco and gave a talk titled, “Opioid Prescribing Patterns for Surgical Patients.” Dr. Langnas noted that the number and amount of opioids prescribed after surgery have been on the decline in recent years, in part due to the increased use of acetaminophen, NSAIDs and gabapentin. Although these results are encouraging signs, the opioid epidemic persists. Dr. Langnas discovered that patients were often discharged with a dose of opioids that far exceeded their daily dose of opioids while in the hospital. Twenty-five percent of patients who did not receive any opioids during their hospital stay were nonetheless discharged with opioids. This disconnect between dose needed for pain control and dose prescribed at discharge leads to an excess supply of opioids in the community, which can lead to accidental overdoses and illicit use. This project highlights the need to carefully consider whether patients need opioids after surgery and to tailor the dose to the patient’s need.

High-Density Lipoproteins: A Potential Novel Therapeutic for Postoperative Acute Kidney Injury
Dr. Loren Smith is an Assistant Professor at Vanderbilt University and presented about, “High-Density Lipoproteins: A Potential Novel Therapeutic for Postoperative Acute Kidney Injury.” Postoperative acute kidney injury (AKI) is due to multiple factors, including ischemia and inflammation. Prior studies have shown that higher baseline levels of high-density lipoproteins (HDL) are associated with a lower incidence of postoperative AKI. Although treatment with atorvastatin does increase HDL concentration, it did not reduce the incidence of postoperative AKI. Dr. Smith investigated this problem more thoroughly and found that small HDL particles were associated with a reduced isoflurane concentration postoperatively. Via activation of ATF3 and ABCA1 receptors, HDL is able to inhibit the release of proinflammatory mediators from macrophages. This study is a precursor for developing novel pharmacological therapeutics that mimic the anti-inflammatory effects of HDL and prevent postoperative kidney injury.

The SANDMAN Study: Sleep Apnea, Neuroinflammation, and Dysfuntional Cognition Manifesting after Noncardiac Surgery
Dr. Michael Devinney, Jr. is an Assistant Professor at Duke University and presented on, “The SANDMAN Study: Sleep Apnea, Neuroinflammation, and Dysfunctional Cognition Manifesting After Noncardiac Surgery.” Although postoperative delirium is an important risk factor for morbidity after surgery, little is known about how to prevent it from developing after surgery. Previous studies have shown that post-op delirium is associated with Alzheimer disease and neuroinflammation, but the causes are unknown. Building on prior data collected during the INTUIT study, Dr. Devinney investigated whether obstructive sleep apnea (OSA) might be a cause of postoperative cognitive dysfunction by administering the Epworth sleepiness scale and analyzing cerebrospinal fluid cytokines. Preliminary data showed that many patients with postoperative cognitive dysfunction also have undiagnosed sleep apnea. Continuing this work will be important to determine whether the treatment of sleep apnea can prevent postoperative cognitive dysfunction.

Wake Me Up Happy: Neural Circuits in Emergence
Dr. Mitra Heshmati is a CA-3 at the University of Washington and gave a talk about, “Wake Me Up Happy: Neural Circuits in Emergence.” For some patients, emergence from anesthesia is associated with disorientation and agitation. Dr. Heshmati is interested in studying how to reduce the negative emotions produced by emergence. Previously, it has been demonstrated that optogenetic and direct electrical stimulation of the ventral tegmental area (VTA) can promote emergence from sleep, isoflurane and propofol. Dr. Heshmati used optogenetic stimulation of the GABAergic neurons in the VTA of a mouse and was able to show that an increase in GABAergic tone was associated with emergence from anesthesia. In addition, it was shown that an increase in dopamine signaling in the nucleus accumbens occurs immediately preceding emergence. This study will be important for describing the neural circuits that lead to emergence and ensuring that all patients remain comfortable after anesthesia.

Prospective Pragmatic Clinical Trials
Dr. Allison Janda is a Clinical Lecturer at the University of Michigan and is interested in developing prospective pragmatic clinical trials by analyzing the data collected from the Multicenter Perioperative Outcomes Group (MPOG). MPOG is a consortium of multiple hospital systems across the United States that have agreed to share perioperative datasets collected at each institution. Dr. Janda described a multicenter review that sought to determine the factors that influence benzodiazepine use after cardiac surgery. The data collected suggests that most of the variation in benzodiazepine use is largely attributable to individual prescribers and individual institutions, rather than patient factors. In the future, Dr. Janda will use the MPOG dataset to explore inotrope and LVAD practice patterns across institutions. Further investigation of the data collected by MPOG will lead to insights that could not be obtained by any single institution.

Persistent Pain after Breast Cancer Surgery
Dr. James Khan is an Assistant Professor at Mount Sinai Hospital in Toronto and presented on, “Persistent Pain after Breast Cancer Surgery.” Previous studies have shown that even 2 years after surgery for breast cancer, 38% of patients still experience pain with an average intensity of 4/10. Dr. Kahn is leading the PLAN trial, which will assess the efficacy of an intraoperative lidocaine infusion on pain caused by breast cancer surgery. Preliminary results demonstrated a 32% reduction in persistent pain. This study presents a novel pharmacological treatment for a major cause of postoperative pain. Recruitment of new subjects in the PLAN trial is currently ongoing. Intraoperative infusion of lidocaine may be an important option for other surgeries that are associated with persistent postoperative pain.

If you missed this session, you’ll have a second chance to check it out at the IARS 2021 Annual Meeting. This session will be presented one more time on Sunday, May 16, 1:10 pm 2:10 pm ET.