SmartTots Investigator Interview: Rita Saynhalath, MD, FAAP, FASA

Short-term Outcomes in Infants Following General Anesthesia with Low-dose Sevoflurane/Dexmedetomidine/Remifentanil Versus Standard Dose Sevoflurane (The TREX Trial)

Abstract Presentation:

Oral Abstract Session: Late-Breaking Abstracts, Saturday, May 18, 2024, 6:25 pm – 6:33 pm, Elwha B, Hyatt Regency Seattle

During her fellowship, Rita Saynhalath, MD, FAAP, FASA, was first exposed to pediatric anesthesiology clinical research, marking the beginning of her journey to play a part in changing the anesthetic management of children and potentially making a meaningful difference on their long-term outcomes. Now an Associate Professor of Anesthesiology and Pain Management at The University of Texas Southwestern Medical Center and Children’s Health, Dr. Saynhalath became involved early with the initial pilot TREX project and then later with the TREX trial. The TREX trial evaluates anesthesia exposure of 2 hours or longer on children at the age of 3 and will provide the strongest evidence to date on the effects of anesthesia on the developing brain. During an Oral Abstract Session on Saturday, May 18, at the 2024 Annual Meeting, presented by IARS and SOCCA, Dr. Saynhalath is excited to share the short-term outcomes of this important trial. Below, she reflects on what drew her to this area of research and the potential impacts of the TREX trial on the outcomes of our most vulnerable patients.

1. For this research, you are…

Co-investigator

2. What drew you to this area of research? Has it evolved since your initial research project? 

My first experience with pediatric anesthesiology clinical research happened during my pediatric anesthesiology fellowship year, under the mentorship of Dr. Peter Szmuk. I was involved with the initial pilot TREX project and later had the opportunity to also be a part of the TREX trial, helping our institution achieve the highest enrollment numbers of the clinical trial. Neurodevelopmental outcomes in pediatric patients undergoing general anesthesia have captivated my attention because it was one of the main controversial issues during my training. After becoming more involved with the TREX consortium, I became invested in the issue because a change in anesthetic management could potentially make a meaningful difference on the long-term outcomes of our youngest patients. Once enrollment for TREX was completed, I was excited to lead the manuscript writing for the short-term outcomes of the TREX trial under the mentorship of Professors Justin Skowno and Andrew Davidson.

3. What are the goals you most want to accomplish in your work with this research project?

The primary goal of this research project is to compare the composite cognitive score of the Wechsler Preschool and Primary School Intelligence Scale at 3 years of age between 2 arms: one who received low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia versus one who received standard-dose sevoflurane. For the short-term-outcomes manuscript, our goals were to compare the perioperative outcomes between the 2 arms including: the incidence of intraoperative hypotension, bradycardia, and light anesthesia events, postoperative pain scores, time to recovery, and morbidity and mortality outcomes at 5 days postoperatively.

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

Previously published clinical trials (GAS, PANDA, and MASK) concluded that a single, short anesthetic is not neurotoxic. The TREX trial evaluated anesthesia exposure of 2 hours or longer and will provide the strongest evidence to date on the effects of anesthesia on the developing brain.

5. What are the benefits of presenting your research at the IARS Annual Meeting?

The benefit of presenting our research at the IARS Annual Meeting is to increase exposure, invite discussion especially over the alternative anesthetic regimen (low-dose sevoflurane/dexmedetomidine/remifentanil), and hopefully intensify interest for the results of the clinical trial.

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

I am one part of a huge project. TREX is a collaborative effort that would not have been possible without the leadership of Professor Andrew Davidson from Murdoch Children’s Research Institute. For this project on the short-term outcomes of the TREX trial, I had the honor of working under the amazing mentorship of Professor Justin Skowno. I would also like to acknowledge the wonderful mentorship from Professors Britta von Ungern-Sternberg, Fiona Taverner, Peter Szmuk, and Andrew Davidson. I would also like to recognize the authorship group for this manuscript: Nicola Disma, MD, Fiona J. Taverner, MBBS, Britta S. von Ungern-Sternberg, PhD, Dean Andropoulos, MD, Ann S. Ng, MD, Benjamin B. Shields, MD, PhD, Francesca Izzo, MD, Paul Lee-Archer, PhD, Mary Ellen McCann, MD, Luigi Montagnini, MD, Beate Kuppers, MD, Elena Lenares, MD, Suzette Sheppard, BSc (Hons), Jurgen C. de Graaff, MD, PhD, Katherine J. Lee, PhD, Xiaofang Wang, PhD, Peter Szmuk, MD, Andrew J. Davidson, MD, and Justin J. Skowno, PhD.

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

I am a devoted fan of the Backstreet Boys and have been since 1999 when I moved to the United States during their peak popularity with “I Want It That Way.”