From EEG Bispectral Monitoring to Perioperative Medicine: Enhancing Recovery after Surgery and Improving Patient Care

Profile of Dr. Tong Joo “TJ” Gan, MD, MHS, FRCA, MBA – Recipient of the Clinical Scholar Research Award in 1999

The IARS established its grants and awards program in 1983 to further the scientific advancement of the anesthesiology specialty. To date, the IARS has funded more than 200 projects, contributing more than $14 million to the anesthesia community – nearly $1 million annually.

Tong Joo “TJ” Gan, MD, MHS, FRCA, MBA was an early recipient of the IARS Clinical Scholars Research Award (CSRA). The CSRA was created in 1994 by IARS to further the understanding of anesthesiology and related sciences in clinical practice through clinical investigations. After awarding almost $5 million to 62 recipients from 1994 until 2011, this award became the IARS Mentored Research Award (IMRA). The IMRA grants are intended to help create future anesthesiology leaders and prepare applicants to apply for independent research funding. Since its inception in 2013, the IMRA has awarded over $4 million to 28 outstanding investigators. With the help of the IARS, both CSRA and IMRA recipients have succeeded in advancing the science of anesthesiology.

Twenty years ago, when Dr. TJ Gan1 received his Clinical Scholar Research Award, CSRA, for research on the use of EEG Bispectral Index monitoring, this was a novel concept and untested, particularly in the elderly. “There was little being done on how the elderly recover and what we can do to enhance their recovery,” Dr. Gan acknowledges. “Today, neuromonitoring during anesthesia is mainstream and part of everyday practice. Thinking back, my award and early study, while quite a long time ago, shaped my path in anesthesia research and aligns with what I do today.”

Dr. Gan credits his early success to outstanding mentors, including Dr. Joseph “Jerry” Reves,2 a pioneer in geriatric research, and Dr. Peter Glass,3 his direct mentor. “They were interested in the elderly and EEG Bispectral Index monitoring.  I was influenced by their enthusiasm and dedication,” adds Gan. Their early papers, still widely quoted, showing the utility of the EEG Bispectral Index, which results in 25% less anesthesia use and earlier recovery, led to FDA approval for the monitor and its widespread use today. “My advice to anyone starting out in research is to find a good mentor, someone with similar interests who is willing to spend time with you and advocate for you. Mentors can change and if one doesn’t work, find another.”

The CSRA Award has been instrumental in Dr. Gan’s distinguished career. “It helped me meet other investigators in the field, build collaborations, and exchange ideas, particularly in the areas of overall recovery from surgery, including management of pain and post op nausea, bowel recovery, and renewed mobilization,” says Gan. What’s the best thing about the award? “You begin to be more interested in a particular topic, find unknowns, and ideas for future studies. There’s a snowball effect—it’s a tremendous opportunity for young investigators who want to launch their careers in clinical research.”

Today, Dr. Gan’s focus is clinical pharmacology and building enhanced recovery from surgery (ERAS) programs. “I’ve started them in orthopedics, obstetrics and gynecology, and colorectal surgery, and founded the American Society for Enhanced Recovery,” Gan acknowledges with pride. Concurrently, he advocates for teamwork in perioperative care as a way to deliver better care and improve long-term outcomes. “Perioperative medicine is a new field and I’m a pioneer in it.  Using a team concept in perioperative management versus having individual players is a complete change—it’s a better strategy for managing anesthesia and watching opioid use.”

Anesthesiologists, Gan believes, are in a unique position to enhance recovery and perioperative care, given their pivotal role in the OR with patients and professionals from many specialties. “I see anesthesiologists as leaders of the perioperative care team because what we do in the OR has a tremendous impact on recovery,” highlights Gan. “We have multiple studies on this right now at Stonybrook.”

On the personal side, Dr. Gan has watched friends and relatives go through surgery with tremendous pain. “I see how people are affected and where recovery could be better, particularly in the area of pain management,” laments Gan. He looks at non-opioid pain reduction and the value to the patient of not having the side effects versus not having the pain. “It’s a difficult conundrum…to lower side effects and have pain or to lower pain and have side effects. Fortunately, in anesthesia, we are still discovering many pharmacologic options.”

For those considering a career in anesthesiology, Dr. Gan is enthusiastic. “It’s the best specialty with excellent work-life balance and endless opportunities. You can work in clinical care, research, and in drug development, including clinical pharmacology in anesthesia,” suggests Gan. The potential for leadership is high, given the anesthesiologist’s pivotal role in the OR, and their interactions with many specialties. “If you want to do research, the operating room is a great testing arena–you can study the effectiveness of monitors, as we have.”

When asked about what drew him to anesthesiology, Dr. Gan has a simple answer: “I love working in anesthesiology because of the people in it. Anesthesiologists are very optimistic in general and I just enjoy being around them.”

 

  1. Tong Joo (TJ) Gan, MD, MHS, FRCA, MBA, is Professor and Chairman of the Department of Anesthesiology at Stony Brook’s Renaissance School of Medicine and Chair of the Section on Perioperative Medicine for the International Anesthesia Research Society. He has served as the principal investigator or co-investigator for over 100 clinical trials, with total awarded grant funding of more than $23 million. 

    Dr. Gan received the IARS Clinical Scholar Research Award in 1999 for his study, “Enhancing recovery outcomes in elderly ambulatory patients.”
  1. Dr. Joseph Reves is the former Dean of the Medical University of South Carolina and Chairman of the Department of Anesthesiology at Duke University Medical Center.
  1. Dr. Peter Glass is the former Professor and Chairman of the Department of Anesthesiology at the State University of New York at Stonybrook, Professor at Duke, and President of the Society for Ambulatory Anesthesia, SAMBA.

Encourage, stimulate, and fund ongoing anesthesia-related research projects that will enhance and advance the specialty, and to disseminate current, state-of-the-art, basic and clinical research data in all areas of clinical anesthesia, including perioperative medicine, critical care, and pain management. The IARS is focused solely on the advancement and support of education and scientific research related to anesthesiology.

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IMRA Awards

This award is intended to support investigations that will further the understanding of clinical practice in anesthesiology and related sciences. Up to four research projects are selected annually, with a maximum award of $175,000 each, payable over two years.

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