Making An Impact for the Most Vulnerable Patients

An Interview with Abstract Presenter and 2022 Kosaka Top Scholar Finalist – Dr. Laura A. Santa Cruz Mercado

Abstract Title:

The influence of intraoperative opioid administration on postoperative pain and opioid requirements

Category: Perioperative Anesthesia

Poster #: 79

Poster Presentation:

Poster Session G, Saturday, April 15, 11:00 am – 12:00 pm MT, Centennial A-D, The Hyatt Regency Denver at Colorado Convention Center

Oral Presentation:

Kosaka Best Abstracts Awards Session, Sunday, April 16, 2023, 9:30 am – 11:00 am, Centennial E-H, The Hyatt Regency Denver at Colorado Convention Center

Laura A. Santa Cruz Mercado, MD, initially arrived in Boston as an exchange medical student from Bolivia with a broad goal of building her knowledge in research and science. However, when she stumbled upon a group of strong mentors who believed in her, her purpose became focused on the specialty of anesthesiology, specifically the intersection of neuroscience and anesthesia. As an international medical graduate coming from a developing country like Bolivia, giving back is important to Dr. Santa Cruz Mercado and she realized early on how anesthesiologists can make a major difference in a patient’s life. Now a PGY-1 Anesthesiology Resident at Beth Israel Deaconess Medical Center, she has observed the powerful role that anesthesiologists can play in giving patients a sense of comfort and confidence in an exceptionally stressful and vulnerable time. Her journey in anesthesia research has landed her in a unique position to help some of the most vulnerable patients, particularly those experiencing chronic pain, to find better postoperative pain outcomes. Dr. Santa Cruz Mercado has been recognized as a Top Scholar Finalist for her most recent research project, The influence of intraoperative opioid administration on postoperative pain and opioid requirements. This investigation aims to understand if there is indeed a causal relationship between intraoperative opioid administration and long-term outcomes. Below, she shares some of the important questions this study has raised, her passion for neuroscience and anesthesia and the insights and resources she hopes to bring back to her home country.

1. For this research, you are…

Clinical Investigator and first author

2. What drew you to the anesthesiology specialty?

Anesthesiology is fascinating and intellectually rewarding. It is science in action, requiring vigilance, problem-solving, teamwork, and technical skill. Moreover, as a medical student, I saw how anesthesiologists can have a powerful impact by giving patients a sense of comfort and confidence during a uniquely stressful and vulnerable time.

3. What drew you to this area of research?

I am a naturally curious individual. As I learned the basics of the field, I started to learn more about the amazing research being done in many areas of anesthesia. Particularly, the natural crossroad of neuroscience and anesthesia was captivating. Most of what we do in this field directly or indirectly affects the nervous system. Incidentally, coming from a different environment where there is limited opioid use, learning about the challenges that the opioid epidemic has caused was interesting. Especially intriguing to me were questions related to nociception and pain.

4. What are the goals you most want to accomplish in your work with this research project (or projects)?

The primary response to the opioid epidemic has been focused on reducing or eliminating opioid use as much as possible. This has been especially true in surgery and anesthesia as the field has been working on developing strategies to minimize opioid use. The goal of our study was to understand how those strategies have impacted patient outcomes, especially those related to opioid use and chronic pain. We code-named our study “prelude,” which refers to the start or introduction of something, peeling back the layers of existing practice to answer key questions such as: Should we always aim to minimize opioids in anesthesia or is there a role for opioids intraoperatively? Does the type of opioid and time of administration matter?

5. What is the potential impact of your research on the field of anesthesia and patient care?

Initiatives promoting opioid-free or opioid-sparing modalities in perioperative pain management have led to reduced opioid administration in the operating room. However, the findings of our study point to possible unforeseen consequences that may be detrimental for postoperative pain outcomes. Postoperative opioid administration to treat postsurgical pain is a major contributor to the opioid crisis. Adequate intraoperative opioid administration may be necessary to control postoperative pain and reduce postoperative opioid consumption. Though more research is needed to understand if there is indeed a causal relationship between intraoperative opioid administration and long-term outcomes, our study raises important questions that are yet to be studied and could lead to a shift in practice.

6. What are the benefits of presenting your research during poster sessions at the IARS Annual Meeting?

IARS provides a perfect venue to share our study and get real-time feedback from experts in the field. Furthermore, the ability to present a poster enables organic scientific discussions with like-minded scientists and the hardest critics, both of which are invaluable to help advance research.

7. How do you feel about being recognized as one of the top scholar finalists for the Kosaka Best Abstracts at the IARS 2023 Annual Meeting?

I am extremely humbled to have been recognized as one of the top scholars of such a prestigious meeting. Moreover, I am humbled to have the opportunity to represent all the people on my team who have made this study possible. This recognition is very special to me. I started as an exchange medical student from Bolivia who wanted to learn science and research. I was blessed to have encountered people who believed in me and gave me a chance. This recognition acknowledges their support. Without my invaluable mentors who nurtured and encouraged my growth this research would not have been possible. Thank you.

8. How do you envision this opportunity to present your research orally at the awards session will affect your research and professional trajectory?

The IARS Annual Meeting is a great platform, and having the opportunity to present at this meeting I am sure will have an impact on my research and professional trajectory. The exposure provided by this presentation will enrich my research as I will be able to hear directly from experts in the field and other researchers, and clinicians from whom I am looking forward to learning their insights. I am a young, female physician and researcher from an underrepresented minority with high hopes and dreams; this opportunity can only enhance my professional career. I envision a future where I can say “When I started my research career, I was honored to have one of my first studies be recognized as a top abstract and nominated for the Kosaka award…” and where I can share how many doors were opened, the mentors I met and how this ultimately led to an impact not only in my career but most importantly in patient care.

9. Outside of your research, what might someone be surprised to learn about you?

As an international medical graduate coming from a third-world country like Bolivia, giving back is important to me. Thanks to the great support of my mentors and institution, I am working on multiple projects focused on providing support to Bolivian physicians in education and research. For a population of roughly 12 million, there are only about 350 critical care physicians in Bolivia and as you can imagine during the pandemic this deficit was heightened. During the pandemic, my mentors supported education by providing lectures for ICU physicians on key topics and we recently had the opportunity to provide in-person training this past November. One of the projects we are currently working on is the creation of a critical care fellowship for anesthesia in Bolivia. These projects are close to my heart. I look forward to being able to share more in the future.

10. Is there anyone else you wish to acknowledge as part of this research team?

Yes, the team that made this study possible. I feel privileged to have been able to work with such a brilliant group of individuals. Every single person in our team was key.

Ran Liu, Kishore M. Bharadwaj, Jasmine Johnson, Rodrigo Gutierrez, Proloy Das, Gustavo Balanza, Hao Deng, Akriti Pandit, Tom A.D. Stone, Teresa Macdonald, Caroline Horgan and Jenny Tou. Also, all the clinical, technical staff, and other consultants. They were patient enough to answer our questions and were instrumental guides to build the structure of the database. I also want to take this opportunity to thank my mentors Timothy T. Houle, Edward Bittner and Patrick L. Purdon. Thank you for upholding such high standards with your patience, direction, insightful advice and your trust.