Aspiring clinician-scientists are encouraged to complete 6-18 months of research in addition to six months of clinical training. Research opportunities are available in a variety of areas, either working in concert with a faculty member on an ongoing project or undertaking a new investigation. The research interests of some of the current faculty are described below.
Residents may undertake the accompanying clinical training at the beginning or end of the research training period, and may choose from a number of options available to those electing one of the clinical tracks. The Department is proud of its contributions to academic research; such rotations supplement sound clinical rotations, as we believe that a sound clinical foundation is essential to both the academic and private practice of anesthesia.
The Department of Anesthesia and Critical Care offers a joint Anesthesiology/Clinical Pharmacology Training Program (ACPTP). The goal of this program is to provide superior training in clinical anesthesiology and to extend this training to include an in-depth knowledge of the principles, practice and research methods of clinical pharmacology.
The latter is integrated throughout the clinical anesthesia training period and in an additional fellowship year. The successful candidate will be eligible to sit for the examinations of the American Board Anesthesiology and the American Board of Clinical Pharmacology at the conclusion of training.
The program consists of a continuum, adding didactic training in clinical pharmacology during the CA-1 and CA-2 years. The second two years of training consist of a combined program designed to meet the requirements of the American Board of Clinical Pharmacology.
At least six months of this period will be clinical as described by the American Board of Anesthesiology, but this time may be used in conjunction with ongoing work in clinical pharmacology. The candidate, under the direction of a mentor, will design and complete a research program focused on the principles of clinical pharmacology as they apply to the practice of anesthesia and critical care.
Project Title: Role of Pre-eclampsia in Cardiovascular Disease
Faculty: Sajid Shahul, MD
Description: The project investigates mechanisms of cardiac dysfunction in preeclampsia. Women with a history of preeclampsia (PE) are at increased risk of death from cardiovascular disease. I use a translational approach combining advanced echocardiography with biochemical signatures to detect subclinical cardiac changes in women with preeclampsia. This work is complemented by the use of large databases like the National Inpatient Sample (NIS) to uncover the epidemiology of preeclampsia.
Project Title: Pulmonary Arterial Hypertension and Pregnancy
Faculty: Jennifer Banayan, MD
Description: The primary purpose of the study is to report the current incidence of pulmonary arterial hypertension during pregnancy at our institution. We aim to evaluate both maternal and fetal outcomes and trends: maternal mortality, neonatal prematurity, intra-uterine growth restriction, and peripartum mortality.
Project Title: General Anesthetics for Cesarean Section
Faculty: Jennifer Banayan, MD
Description: The rate of use of general anesthetics for cesarean delivery in the United States and factors associated with its use remain unknown. We propose to determine the rate and to identify factors associated with variability in the rates from three large administrative databases. One of them is the National Anesthesia Clinical Outcomes Registry, a sample representing over 22 million anesthetics from a variety of practice settings across the United States.
Project Title: Pain and Analgesic Choices for Previable Vaginal Delivery
Faculty: Barbara Scavone, MD
Description: Little data exist regarding pain and analgesia for previable vaginal delivery. Ours is a unique prospective study gathering data on pain scores and analgesic choices for this procedure.
Project Title: Obstetric Management of Super-Obese Patients
Faculty: Barbara Scavone, MD
Description: We compare outcomes among super-obese (BMI >/= 50), obese, and non-obese cohorts. Ours will be the largest sample describing anesthetic management of super-obese patients in the literature. We are prospectively assessing traditional palpation versus ultrasound guidance for obstetric neuraxial anesthetic techniques.
Project Title: Microparticle Release and Obstetric Hemorrhage
Faculty: Barbara Scavone, MD
Description: This is a pilot study measuring the pattern of microparticle release over time during normal deliveries. We are using these data to plan for a study comparing microparticle patterns in patients who hemorrhage versus those who do not.
Project Title: Comparison of the LMA Flexible and Endotracheal Intubation for Adenotonsillectomy in Pediatric Patients.
Faculty: Wendy Binstock, MD
Description: The use of the LMA Flexible has the potential to enhance positive outcomes and decrease the incidence of extubation-related complications in pediatric patients undergoing adenotonsillectomy, the most common surgical procedure in children. Alternative airway management and anesthesia techniques that may prove to be as safe and effective as current practice and could save time and decrease the cost of this procedure.
Project Title: Pediatric Craniofacial Surgery Perioperative Registry.
Faculty: Wendy Binstock, MD
Description: In this study we collect multicenter data about the medical care of children undergoing craniofacial surgical procedures. The information is stored in a common database, and the data are available to all centers for research and quality improvement.
Project Title: PeDI Registry
Faculty: Alina Lazar, MD
Description: The objective of the study is to input data into the PeDI Registry, a multi-center repository that documents intubation methods, techniques, personnel, and intubation-related adverse events after difficult direct laryngoscopy in children during anesthesia management. With benchmarking data from participating sites, difficult airway management practices can be compared. The registry will continually analyze and plot trends in practice, such as evolution in the types of techniques and equipment employed.
Project Title: Comparison of Two Sedation Regimens for Awake Fiberoptic Intubation
Faculty: David Glick, MD, MBA
Description: There are a number of methods for intubating patients with airways too difficult to manage using direct laryngoscopy. The most frequently used method is intubation with a fiberoptic bronchoscope. This method is well described, but significant work remains to optimize the technique, identify its pitfalls, and select the best drugs for patients undergoing “awake” fiberoptic intubations.
Project Title: The Incidence of Perioperative Deep Venous Thromboses of the Lower Extremities
Faculty: David Glick, MD, MBA
Description: The development of postoperative Deep Venous Thromboses (DVTs) is a great concern both clinically and administratively. Prevention of DVTs is one of the quality standards by which hospitals are ranked. This study will determine the incidence of DVTs immediately before surgery and examine the impact of various anesthetic techniques on the rate of intraoperative development of DVTs.
Project Title: The Use of Digital Recording of Family Members to Improve Emergence from Anesthesia
Faculty: David Glick, MD, MBA
Description: As patients awaken from general anesthetics they may experience periods of confusion and disorientation. Disorientation is especially difficult for patients who do not speak English or for whom English is a second language. Our project is an ongoing effort to identify phrases and instructions used by an anesthesiologist at emergence and to translate them into the patient’s native tongue. The project has grown to encompass the post-anesthetic care of our patients and to identify and translate the necessary phrases in that venue as well. Recorded messages from parents also have been played back for pediatric patients (English-speaking and non-English-speaking) at emergence.
Project Title: Use of the BIS Monitor To Decrease the Incidence of Intraoperative Awareness
Faculty: David Glick, MD, MBA
Description: This project evaluates the effects of various perioperative medications on the ability to form memories and the simultaneous effects these mediations have on the bispectral index, a processed EEG algorithm that determines depth of anesthesia.
Project Title: Protective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in Obese Patients - The PROBESE Randomized, Controlled Trial
Faculty: Aalok Kacha, MD, PhD
Description: Postoperative respiratory failure, particularly after surgery under general anesthesia, adds to the morbidity and mortality of patients. The optimal ventilatory strategy for the care of patients with BMI > 35 is not known. This international multicenter randomized, controlled trial is designed to compare a ventilation strategy using higher levels of PEEP with recruitment maneuvers (transient increases in transpulmonary pressure) with one using lower levels of PEEP without recruitment maneuvers in obese patients at an intermediate–to–high risk for postoperative pulmonary complications (PPCs). The primary endpoint is the proportion of patients with PPCs. Secondary endpoints include intraoperative complications, need for postoperative ventilatory support (invasive or non–invasive ventilation), need for unexpected ICU admission or ICU readmission, the number of hospital–free days and 90-day survival or mortality.
Project Title: The Economic Impact of the Preoperative Clinic
Faculty: David Glick, MD, MBA
Description: Over the past several years we have examined the causes of day-of-surgery case cancellations and delays. At first the impact of the anesthesia preoperative clinic on case cancellations and delays was studied. Subsequently, we evaluated the demographic characteristics that place a patient at higher risk for a day-of-surgery case cancellation. The long-term goal of the project is to create a model for predicting case cancellations and delays.
Project Title: Correlation of Hemoglobin Point-of-Care Testing and Serum Hemoglobin
Faculty: Allison Dalton, MD
Description: We seek to determine the correlation between the point-of-care measures of hemoglobin in the ORs and serum hemoglobin run in the lab at hemoglobin concentrations around the transfusion threshold. We will also consider how time from collection to running the sample changes the concentration of the hemoglobin measured by point-of-care devices.
Project Title: Argatroban Dose Requirements in Critically Ill Patients with Heart Failure
Faculty: Allison Dalton, MD
Description: The primary outcome is to study the dose of argatroban at the time of the first two consecutive therapeutic activated partial thromboplast in times (aPTTs) in patients with heart failure and reduced ejection fractions compared to those without heart failure. Secondary outcomes are the percentage of aPTTs that are therapeutic, time to therapeutic aPTT, incidence of bleeding on or within the first 24 hours of discontinuation of argatroban, and the incidence of mortality associated with bleeding/thromboembolism or with other causes.
Project Title: Observational Study Evaluating the Hemodynamic Relationship Between Volume Removal and Pulse Pressure Variation During Renal Replacement Therapy
Faculty: Aalok Kacha, MD
Description: Assessing the intravascular volume status of ICU patients is a continuous challenge in the management of their fluid balance. Despite the importance of this evaluation, there is no single objective measure to guide the clinician. Traditionally, fluid balance has been guided blood pressure, heart rate, pulmonary examinations, skin turgor, capillary refill, urine output, and chest radiograph. Dynamic indices of volume responsiveness are vastly superior to invasive pressure measurements (central venous pressure, pulmonary capillary wedge pressure) for the management of hypovolemic shock in mechanically ventilated patients. Pulse pressure variation (PPV) reflects the slope of the Starling curve at the patient’s current intravascular volume. We hypothesized that PPV may also guide volume removal during continuous venovenous hemofiltration or intermittent hemodialysis. We are conducting an observational study of patients undergoing renal replacement therapy to evaluate the utility of PPV in predicting negative fluid balance.
Project Title: Characterizing the Postsurgical Pain Experience
Faculty: David Dickerson, MD
Description: This study was conducted in part with the Pritzker Summer Research Program. We sought to build an automated, electronic health record-driven database for tracking the patient the pain experience after surgery. The study tracks intraoperative and postoperative pain on a numeric rating scale of pain scores. We are hoping to identify trends in the patient experience related to treatment, surgery type, and preoperative comorbidities. We use manual chart review to identify data fidelity within the electronic record to improve data management and patient assessment. We hope to develop an automated tool for institutional quality improvement and various research initiatives. Several residents and fellows are currently participating in this project.
Project Title: Comparison of Quality of Pain: Open Tip Single-Terminal Hole with Close Tip Multi-Hole Epidural Catheter in Postsurgical Adult Patients.
Faculty: Tariq Malik, MD
Description: This is a prospective, randomized trial to compare the efficiency of two different epidural catheters. Similar catheters have been tested at the lumbar level; this study is meant to evaluate their efficacy at the thoracic level. Over 600 subjects have been enrolled. (The primary end-point is a comparison between one-sided block vs bilateral block in each group.)
Project Title: Analgesia for Patients for Mediate Arcuate Ligament Syndrome Release
Faculty: Magdalena Anitescu, MD
Description: Mediate arcuate ligament syndrome (MALS) is a condition that produces postprandial abdominal pain of various intensities. In select cases, surgery is indicated to release fibrous bands that encase the celiac artery. Our center is one of the pioneers of this treatment. In close collaboration with vascular and pediatric surgery, we initiated a study to identify the best perioperative analgesic plan for patients with MALS undergoing surgery for release.
Project Title: Use of Imaging for Bone Marrow Biopsy and Patient Satisfaction
Faculty: Magdalena Anitescu, MD
Description: Bone marrow biopsy is one procedure to evalutate hematologic disorders. In most cases the biopsy is taken from the iliac crest. Landmarks are identified by palpation. The procedure is associated with pain because of multiple needle adjustments or multiple punctures. If the biopsied specimen is suboptimal, another biopsy must be taken. Together with the section of hematology-oncology, we initiated a study to evaluate the quality of a specimen and patient satisfaction when a bone marrow biopsy is performed using imaging techniques (ultrasound and fluoroscopy).
Project Title: Prospective, Randomized, Controlled Study of Continuous Adductor Canal Blockade for Total Knee Arthroplasty Outcomes.
Faculty: David Dickerson, MD
Description: In this study, we are prospectively examining the impact of a postoperatively placed adductor canal catheter for total knee replacement (TKA). The adductor canal contains the distal femoral nerve which, when infiltrated with local anesthetic, creates a sensory block. Residents and fellows are actively participating in patient enrollment, treatment, and data collection. The study examines a comprehensive preventive analgesic method for TKA, tracking postoperative physical function, acute pain control, analgesic consumption, and incidence of chronic postsurgical pain.
Project Title: Comparison of Pain Relief after Ultrasound-guided Non-stimulating Interscalene Catheter Placement vs. Stimulating Catheter Placement in Total Shoulder Arthroplasty; a Randomized Study.
Faculty: Tariq Malik, MD
Description: Total shoulder replacement is the third most common joint replacement surgery. The recovery process is painful. This study is meant to evaluate the effectiveness of pain relief after total shoulder arthroplasty when a catheter is placed in one of two different ways.
Project Title: Thoracic Epidural Catheter Placement Using Chest Computed Tomography
Faculty: Tariq Malik, MD
Description: Thoracic epidural catheter placement is a technically challenging procedure because of the anatomy of the thoracic spine. We will use computed tomography to guide replacement. Over 200 subjects are being enrolled in this randomized prospective study.
Project Title: Comparison of Ultrasound-guided L5/S1 Epidural Catheter Placement with Standard Epidural Catheter placement: A Randomized Trial.
Faculty: Tariq Malik, MD
Description: We will place an epidural catheter at the Ls/S1 level to improve pain relief in the third stage of labor. Pain relief will be compared after catheter placement at a higher level. The study will also show the value of ultrasound a in labor epidural.