The Daily Dose • Saturday, May 15, 2021

What’s New in Anesthesiology Research?

Hana Nadeem

The Foundation for Anesthesia Education and Research (FAER) and Medical Student Anesthesia Research Fellowship (MSARF) program provided medical students with opportunities to pursue a mentored research experience last summer. On the evening of May 14, Harriet Hopf, MD, led a successful virtual poster presentation session as a follow-up during the AUA 2021 Annual Meeting. In the hope of enriching anesthesiology as a specialty and broadening the areas of clinical anesthesia, today’s panel included brief presentations by seven students who participated in the summer experience, followed by a Q&A session.

Former recipients of FAER funding, Loren Smith, MD, PhD, from Vanderbilt University, and Bradley Fritz, MD, MSCI, from University of Washington in St. Louis, moderated the engaging presentation session.

Christine Shen, a student at Albert Einstein College of Medicine, worked on “Assessing the Clinical Impact of Postoperative Temperature on Infants Returning to NICU Following Surgery” and started off the presentations. Even though her impressive and hard work showed no difference in 30-day mortality between immediate postop hypothermic and nonhypothermic patients who were admitted or returned to the NICU after surgery, it was discovered that hypothermic patients have a higher surgical site infection risk. This conclusion attracted the participants’ attention and will lead to an interesting new project for further investigation.

Stephanie L. Ong, a student at University of Toledo School of Medicine and Life Sciences, presented her research project on “Combined Use of ECMO, Prone Positioning and APRV in the Management of Severe COVID-19 Patients.” The ongoing COVID-19 pandemic has placed a significant burden on healthcare systems around the world and resulted in an increased number of ICU admissions. Discovering acute respiratory distress syndrome (ARDS) as one of the complications of COVID-19, this study’s results showed that this subset of patients treated with extracorporeal membrane oxygenation (ECMO) had an improved oxygenation compared to other groups placed on prone position or a combination of both. The outcome of this study still showed an increase in mortality overall, but this outcome is attributed to the severity of the disease.

Praveen Rajaguru, a Brown University student, discussed his advances on “Anesthesia Modality Utilization for Common Extremity Fracture Fixation in Northern Tanzania: A Retrospective Analysis.” This interesting topic displayed some clinical variation in frequency of use of different anesthesia modalities based on the anatomical location and the acuity of care. After reviewing the patients’ charts, the choice of performing spinal anesthesia to fix lower extremity fracture vs general anesthesia for upper extremity fractures was noted. General and spinal anesthesia were the most common modalities chosen in emergency procedures and these results were consistent with the hospitals in the US.

“Ryanodine Receptors Mediate Store-operated Calcium Entry in Dorsal Root Ganglion Neurons” was the next poster, presented by Isis Zhang, a student at Rutgers New Jersey Medical School and the second-place winner. Studies showed that modulation of SOCE in the peripheral nervous system can control nociception and inhibiting this pathway can cause reduction in acute and inflammatory pain, as well as attenuation in thermal and mechanical sensitivity after the establishment of inflammatory pain. Using this pathway in the hope of treating conditions like chronic and neuropathic pain, it has been discovered that caffeine treatment induced Ca2+ influx in 42% of DRG neurons. When inhibitors of SOC (ML-9 and YM) were applied, caffeine induced Ca2+ entry was significantly diminished, suggesting RYR calcium stores contribute to SOC entry in DRG neurons. She ended her presentation by suggesting further studies to elucidate functional significance of RYR-mediated SOC activation in animal pain.

Monica Taneja followed next, presenting her project on “Anemia, Sex and Race as Predictors of Morbidity and Mortality after Knee Arthroplasty Surgery.” She is a student at University of Maryland School of Medicine and was granted the first-place winner on her magnificent and extensive work. Her study showed that morbidity or mortality rates increased as the rate of severity of anemia went up. A positive correlation was established between anemia and risks of severity of complications. However, the other determinants, race and sex, were not statistically significant effect modifiers. Since anemia is a risk factor for postoperative complications, she ended her presentation with a suggestion to consider anemia in patient blood management controls and outcome management.

Rosalyn Chen, a student at Boston University School of Medicine, exhibited a topic on “Receptor and Molecular Targets for the Development of Novel Analgesic Therapies.” She discussed the effect of modifying different kinds of receptors involved in the nociception, like of κ-opioid, σ-opioid, NMDA and cannabinoid receptors, on chronic pain and hyperalgesia. Although improving selectivity and minimalizing side effects is still a challenge, she notes that some of the therapeutic medication on the market are being studied for potential analgesic effects. Those therapeutics include: 1) intrathecal resiniferatoxin is in clinical trial for severe pain secondary to advanced cancer; 2) phase III trials of tanezumab showed improved joint pain and function on moderate to severe osteoarthritis; and 3) tocilizumab has demonstrated some pain reduction in moderate to severe rheumatoid arthritis. However, long-term safety and efficacy of the data remains limited.

Finally, Varun Yarabarla, receiving the third place award, was the last presenter in the session. He is a student at Philadelphia College of Osteopathic Medicine and described his project on “Gender and Pathways to Leadership in Academic Anesthesiology: A Qualitative Content Analysis of the United States Chairpersons CV.” Since women are underrepresented in academic anesthesiology, Varun collected data and CVs, allowing him to identify and categorize the personal details into four phenotypes of academic chairpersons: the clinician-administrator, the educator, the investigator, and the well-rounded scholar. His data noted that women were underrepresented in academic anesthesiology and leadership in medicine, specifically chairperson roles. Nonetheless, no gender related differences in achievement patterns are evident above the chairperson position. Even though he encountered some limitation while gathering data (sample size, CV format, etc.), he reveals that the future step for this ongoing project is to look into other leadership positions (program director, deans, etc.).

Towards the end of this panel, Mary Dale Peterson, MD, MSHCA, FACHE, FASA, ASA Past President, highlighted the students’ success and perseverance despite the difficulties and obstacles encountered during this past year. And, before wrapping up the MSARF/FAER panel, she had the opportunity to announce the winners of the event: Monica Taneja 1st,  followed by Isis Zhang 2nd,  and Varun Yarabarla in 3rd.