AnesthesiaNews · The Essential Role of Nurse Anesthetists “Many patients don’t even know we...

The Essential Role of Nurse Anesthetists

AnesthesiaNewsNewsletter of the Department of Anesthesia and Perioperative Care | University of California, San Francisco

Summer 2011 | Vol. 9.1

A New Era in Pain Management | Tracking Sepsis | Ask the Expert | Peer Reviewed Publications

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There were no anesthesiologists in Waxahachie, Texas where Leigh-Ann Langford grew up. At the region’s small hospital – a satellite of Baylor Medical Center – certified registered nurse anesthetists (CRNAs) were the sole anesthesia providers.

One of the CRNAs, Dale Stevenson, was a close friend of Langford’s father.“For a very long time, my dad didn’t know that anyone other than CRNAs gave

anesthesia,” says Langford, who today is a CRNA at UCSF Medical Center. Waxahachie’s anesthesia story is especially relevant today, because as UCSF Medical

Center – like many of its counterparts – copes with increased demands for anesthesia and mandated cuts in residents’ hours, it is turning to CRNAs to help fill the gap.

A Long History of Qualified Care

In the United States, nurse anesthetists have been providing anesthesia care since the mid-nineteenth century and, today, CRNAs are either masters-prepared or doctoral-prepared in anesthesia care. Their training and history signify that what went on in Waxahachie is hardly unusual, especially in rural areas.

CRNAs Leigh-Ann Langford and Mary Connolly working at Mt. Zion Hospital

Whatever the flaws or merits of health care reform (Patient Protection and Affordable Care Act), the ongoing debate has focused my attention on the concept of health care value: optimally addressing patients’ presenting

complaints, avoiding excess services, seamless transitions amongst care providers, preventing new health concerns, returning patients to functional lives, and averting readmissions. This renewed emphasis on value has powerful implications for

anesthesiologists.Consider the case of a patient

whose arthritic knee has caused her debilitating pain for months to the extent that her shopping tasks are no longer performed without assistance. After entering the hospital, her surgeon completes a terrific knee replacement and she leaves relatively pain-free, with a knee able to move in all the right directions. By traditional measures, that’s high value care in which surrogate markers have been used to measure outcome.

But what if the care plan – from pre-op through post-discharge care – didn’t fully account for a variety of patient risk factors? What if the patient left the hospital cognitively impaired, and became more dependent on others to accomplish the activities of daily living? Is the patient better off than when she entered the hospital? Have costs or efficiency improved if the episode initiated an escalating need for other health care services?

In the hospital, anesthesiologists are the care providers best positioned to enhance value by orchestrating the episode of surgical care and taking a holistic view of the outcome. Many of the articles in this issue of the newsletter make clear why we must assume this responsibility.

Sepsis, pain, and the onset of cognitive dysfunction result from a complex set of factors that are beyond the reach of neat care silos. If anesthesiologists don’t guard against them across the entire hospital stay, no one will. We can work more closely with primary care providers before admission, bring together the plans of other care providers into one comprehensive plan, and communicate more effectively so that all of us are cognizant of the risks that need to be mitigated before, during, and after each surgical procedure. At an academic medical center like UCSF, we also can see that our resources and educational programs are geared towards creating value.

Of course, for many of us, the commitment to value is not new. But if we are to continue to meet that commitment effectively, we have to adapt to an evolving system. For anesthesiologists, that means accepting more responsibility for orchestrating each surgical patient’s entire episode of hospital care and linking these episodes seamlessly to primary care.

Mervyn Maze, MB ChB Professor and Chair

FROM THE CHAIRMANAnesthesiaNews

2 UCSF Department of Anesthesia and Perioperative Care

DEPARTMENT CHAIR EDITOR-IN-CHIEF

Mervyn Maze, MB ChB

EXECUTIVE EDITOR:

Marge O’Halloran

EDITOR:

Morgen Ahearn

DESIGNER:

Laura Myers Design

PRINCIPAL WRITER:

Andrew Schwartz

PHOTOGRAPHERS:

Christine Jegan, Brad Immanuel, Marco Sanchez, Brant Ward

Anesthesia News is published by the UCSF Department of Anesthesia and Perioperative Care

521 Parnassus Avenue Room C 450, Box 0648 San Francisco, CA 94143-0648 415/476-2131

http://anesthesia.ucsf.edu

Send all inquiries to [email protected]

©2011 The Regents of the University of California

Summer 2011 | Vol. 9.1

1 The Essential Role of Nurse Anesthetists

2 From the Chairman

3 Tracking the ICU’s Serial Killer

4 A New Era in Pain Management

6 Resident Voices

7 Profile: Bradley Immanuel

8 Honors, Awards, Appointments

9 Ask the Expert: Jacqueline M. Leung, MD

10 Active Research Grants

12 Peer Reviewed Publications 2010-2011

16 Upcoming Events

In the intensive care unit – where UCSF anesthesiologist Judith Hellman, MD, does her clinical work – sepsis is the

most feared and prolific killer. It’s no surprise then that Hellman spends her research hours tracking how the inter-actions between microorganisms and the body’s innate immune system lead to shock and organ dysfunction in sepsis.

Hellman, the UCSF Department of Anesthesia and Perioperative Care’s Associate Director of Research, is particularly focused on activity in the endothelium, the thin layer of cells that lines the interior of blood vessels. A recipient of an NIH RO1 grant funded through the ARRA program, as of this writing Hellman has a major paper on endothelium and sepsis in the January 2011 issue of the Journal of Immunology.

A Career Spent Homing in on SepsisThough she grew up in New York City, her family’s San Francisco roots eventually drew Hellman to UC Berkeley where she majored in microbiology; she then attended medical school at Columbia. “I thought I wanted to do medical research, but when I walked through the ICU during a medical school surgery rotation, I became excited about what goes on there, and eventually decided to become an ICU physician,” she says.

Tracking the ICU’s Serial KillerThen, she completed residencies

in both internal medicine at Oregon Health Sciences University and anesthesia at Massachusetts General Hospital. At Mass General, her department chair discovered her microbiology background and referred her to the lab of H. Shaw Warren, MD, an infectious disease physician and sepsis researcher.

“It all sort of came together at that point – microbiology, intensive care, sepsis,” says Hellman. After an intensive care fellowship, also at Mass General, Hellman moved on to do post-doctoral work in Warren’s lab on a T-32 training grant.

A Convoluted, Contradictory Disease ProcessAs she began her own research career, Hellman originally focused on lipoproteins that are present in the bacteria that cause sepsis and get released when infections are present.

“Then, in my clinical work, I was struck by the complex bleeding and clotting derangements that occur in patients with sepsis,” says Hellman. “I couldn’t help but think that processes that occur in the endothelium, which is important in coagulation homeostasis and is activated in sepsis, might be

at the heart of sepsis-induced organ failure.”

That insight led to her current projects, where Hellman is studying the role of Toll-like receptor 2 (TLR2) and TLR2

agonists. TLRs are proteins that serve as surface receptors on many cells, including leukocytes and the endothelium; they recognize parts of bacteria – the TLR agonists – and decide how to react. This sets off a complex inflammatory cascade, which leads to coagulopathy, vascular leak, and, eventually, sepsis-induced organ failure.

Defining these cellular and chemical interactions is complicated enough, but the challenge for Hellman is to then make sense of their effects on human health. On the one hand many responses in sepsis have important roles in clearing infection and healing; on the other hand they can initiate fatal shock and organ failure. Hellman hopes to understand the cellular interactions well enough to target the harmful effects, without undermining beneficial effects, such as eradication of the infection.

“You can’t get paralyzed by the complexity,” she says. “You just have to accept it can take many years to achieve the goal.”

“I couldn’t help but think that processes that occur in the endothelium, which is important in coagulation homeostasis and is activated in sepsis, might be at the heart of sepsis-induced organ failure.”

Anesthesia News | Summer 2011 3

Judith Hellman

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Since 2009, California has been an “opt out” state allowing CRNAs to practice without physician supervision. At UCSF, however, hospital policy dictates that they practice under the “medical direction” of an anesthesiologist. At UCSF, CRNAs administer both general and regional anesthesia in the OR as well as in non-OR settings that include MRI, neuro-angiography, the endoscopy suite, the cardiac catheterization lab, and the electrophysiology lab. The ratio of CRNAs to anesthesiologists during a shift is typically 2:1.

The only areas where CRNAs do not practice at UCSF are the intensive care unit, obstetrics, open-heart surgery, liver transplant, and the pain services. “Some of what limits our practice at a teaching hospital is that these other services offer more of the experiences residents need,” says CRNA Ann Crowley.

Pleasures and Challenges

Both Crowley and Langford enjoy their work, but also know they face significant challenges, as any anesthesiologist can attest. “Surgical anesthesia requires that we maintain the patient’s homeostasis in a profoundly altered state. That’s our job, but it can be very stressful,” says Crowley.

“Also, many patients don’t even know we exist,” laughs Langford. “Frequently we have to explain what our profession is, despite it being over a century old. Although, this gets old after awhile, it is an opportunity to educate the community about the CRNA profession.”

But there are many rewards as well. For one, “I think our faculty enjoy working with us,” says Crowley.

“And UCSF is a vibrant university medical center, with a lot to learn – and everyone is interested in teaching,” says Langford. “In that environment, you don’t have to make as big of an effort to seek out cutting edge anesthesia practice. It’s all right here.”

The Essential Role of Nurse Anesthetists

“Many patients don’t even know we exist. Frequently we have to explain what our profession is, despite it being over a century old.”

The past decade has seen signifi-cant advances in the management of both acute and chronic pain,

as physicians scramble to respond to patients’ pain complaints, safety and regulatory demands, and the need to reduce hospital readmissions.

“Effective pain management has come front and center,” says Director of Pain Medicine Mark Schumacher, PhD, MD, from the UCSF Department of Anesthesia and Perioperative Care. “Yet pain management is notoriously complex, often touching on multiple sub-specialty areas across care settings.”

To address that complexity and ensure all patients receive the highest quality care and outpatient follow up, Schumacher and Chair of the Department of Anesthesia and Perioperative Care Mervyn Maze, MB ChB, are working both within Anesthesia and with other departments to craft a unified approach to pain management. The initial effort will include Interventional Radiology, Neurology, Neurosurgery, Obstetrics-Gynecology, Orthopedics, Osher Center for Integrative Medicine, Palliative Care and Pharmacy.

A New Era in Pain Management


“The goal is to create a Pain Medicine Consortium that will coordinate pain management across all medical center services – outpatient, inpatient, and follow-up care – both now, and at the future Women’s, Children’s and Cancer Centers at Mission Bay,” says Schumacher.

More Effective Use of Pain Management ExpertiseAs at many other institutions, UCSF pain management services have grown in response to patient needs. At the Parnassus and Mount Zion hospitals, what began as a post-operative acute pain service now includes inpatient chronic pain management for patients admitted or readmitted due to poorly controlled pain.

In theory, the outpatient UCSF Pain Management Center – with its dedicated, multidisciplinary faculty – complements the two inpatient services but, understandably, the services can overlap. In an effort to more effectively deploy the department’s expertise, Schumacher has refocused the Parnassus and Mount Zion pain services towards acute post-operative care,

while making a team of dedicated faculty from the outpatient Pain Management Center available at both inpatient hospitals for chronic pain management care and consultations.

“The chronic pain team fosters continuous care, either by working with referring physicians on a long-term plan or by following patients back to the Pain Management Center,” says Schumacher. “And as efforts proceed to unify pain medicine at UCSF, the multi-modality Center will continue to provide an important anchor for patients suffering from chronic painful conditions.”

Translating Research, Disseminating Knowledge“Perhaps the most exciting part of forming a Pain Medicine Consortium is how it can help bring the work of the many world-class pain researchers at UCSF directly to patients’ bedsides,” says Schumacher.

That work includes a number of unconventional, non-opioid therapies,

many of them developed or advanced in part at UCSF. Among them: gabapentin for neuropathic and post-operative pain; the use of capsaicin for blocking

pain at its source, including cancer pain; use of low-dose ketamine for patients who have built a resistance to narcotic analgesics; and intravenous lidocaine for post-operative pain reduction.

“Whether through optimizing more established regional and interventional techniques or integration of novel non-narcotic pain

management strategies, we will more safely and effectively manage patients’ pain complaints,” says Schumacher.

To that end, he believes that centralizing pain management expertise will also help disseminate that expertise to others. “There’s no way one physician or team can manage all pain patients at UCSF, but we can now do a better job of working with other physicians, physician trainees, nurses, and pharmacists on emerging pain management strategies.”

A New Era in Pain Management

“Effective pain management has come front and center. Yet pain management is notoriously complex, often touching on multiple sub-specialty areas across care settings.”

Mark Schumacher

The UCSF Department of Anesthesia and Perioperative Care offers a unique educational experience for residents and fellows, with options to pursue a variety of tracks. Below, in their own voices, are two physicians in the Anesthesia Research Scholars program and two enrolled in the UCSF-wide Global Health Clinical Scholars program.

Paul RiegelhauptIntern, Research Scholars Track

I’ve always been a math and science nerd. I went to Albert Einstein College of Medicine for an MD/PhD, more to be a scientist than a doctor, but then fell in

love with being a doctor, and decided I wanted both.

I found anesthesia while studying the GABA receptor for my thesis project. My work was focused on the molecular structure of protein transporters on membranes, which certainly come into play in anesthesia, so it was an easy transition for me.

I came to UCSF because they put it all together here: research, clinical excellence, and a great place to live. They understand what it takes to get started as a clinical scientist and they foster your growth with outstanding people and more long-term support than other residency programs. The depart-ment believes that research matters and they’re dedicated to supporting it.

In my med school essay, I told a story of a guy who keeps jumping into the water to save people from drowning.... I want to be the guy who figures out who’s throwing all the people in the water; I’m really turned on by figuring out the mechanisms of disease and using that to fuel medical innovation.

Catherine ChenIntern, Research Scholars Track

My dad is an oncologist and I always wanted to be a doctor. But in my senior year at Rice (BA in English), I decided not to apply to medical school right away;

instead I went to New York and spent three years doing investment banking. Within the first year, I knew being a physi-cian better matched my gifts and interests.

I wound up getting into Johns Hopkins, where I had a surgeon mentor (Marty Makary, MD, MPH) who does a lot of research on patient safety and outcomes. While I was writing a book chapter for him, I realized that anesthe-siologists have been doing this patient safety/quality of care thing longer than other specialties. Also, I had done my anesthesia rotation early – and loved it.

I was attracted to UCSF Anesthesia because of all the research history and because of the research track. The way the track is integrated throughout your residency lets you develop relationships over time, rather than starting from scratch on day one of a fellowship. And I like that this internship year has been balanced and doable; I really appreciate the thought given to the rotations, electives and schedules.

I would like to focus my research on the perioperative setting – and look at the system as a whole to see what types of things can make patients safer. There are so many subtleties and niches in patient safety that I don’t know where I’ll end up, but one goal is to come up with new ways to measure quality and the impact of the interventions we propose.

Kristine BreyerGlobal Health Scholar

My interest in global health began as an under-graduate at the University of Colorado. Then, I attended medical school at Loyola University in Chicago, which

really promotes working with underserved populations and gave me the opportunity to work at a free clinic on Chicago’s West Side and go on a medical trip to rural Guatemala.

I initially came to UCSF in 2006 as a plastic surgery resident, but made a career change into anesthesia in 2009. The Anesthesia Department has given me the opportunity to take part in the Global Health Scholars Program, a unique program through UCSF’s Institute of Global Health where residents and graduate students participate in course work and develop research projects in the global health sciences.

For my project I want to combine my backgrounds in surgery and anesthesia training to look at perioperative trauma outcomes and create systems changes

to improve those outcomes, because injury from trauma is a leading cause of morbidity and mortality in developing countries. My long-term goals are to investigate and use systems changes and education to improve our ability to care for all perioperative patients in developing countries.

UCSF has a strong relationship with a university hospital in Uganda and we are in touch with a network of people in Uganda who are excited to collaborate with us. We will begin with an observa-tional study and then work together to design systems change that could help improve perioperative trauma outcomes. We are not going to Uganda to impose changes on their medical system, but as collaborative partners. It’s their hospital, their country.

Sarah GebauerGlobal Health Scholar

I grew up in Texas and was a Spanish major at Emory University, in part because I knew I wanted to do global health work. My grandmother had done medical and legal

work in Guatemala, and that made us think about helping people outside of our small bubble. Then I went to Stanford for medical school, where I had some great mentors who took me to Guatemala to work with local health promoters.

I chose anesthesiology, because I really like the people and it offers a good mix of hands-on activities: critical care, pain medicine – there are lots of options, lots of ways for your life to look. I’m looking forward to my palliative care fellowship at San Diego Hospice next year.

I chose UCSF, because I was very impressed by the quality of the clinical training and the interest of the faculty in the projects they were doing. When I came here, I was hoping to continue my interest in global health and the program directors were nice enough to let me apply.

(Before I became pregnant), I was planning a project looking at cleft palate repair in Nepal, with Dr. (George) Gregory, looking at complication rates and other outcomes there. Now I’ll fulfill my require-ments by creating an online education module for the Global Health Education Consortium. I still plan to make global health an important part of my career.


ResidentVoices

Profile: Bradley Immanuel

In challenging economic times, Bradley Immanuel oversaw dramatic change in the Department of Anesthesia and Perioperative Care’s information technology operations. An amateur photographer who takes about 30,000 photos each year – and an avid bicyclist – Immanuel lives in San Francisco with his wife Catherine and his two sons Lucas, 7, and Jonah, 3.

How did you come to be director of IT for the UCSF Department of Anesthesia and Perioperative Care?After graduating from Pepperdine University with a political science degree, I spent five years working for a nonprofit doing economic development in Russia. But it was a small operation and I often found myself acting as the computer fix-it guy. I’ve spent the last nine years in the department’s IT unit and have really enjoyed it. I was given the chance to build on successes and learn from failures; I would not have had that chance in most other organizations.

How does the department’s IT unit currently operate?Our group does everything from helping a faculty member check email to creating programs that facilitate professional fee billing to serving as liaison to other campus IT groups. We’re a kind of IT concierge; we make sure Anesthesia faculty and staff get what they want and need so IT problems don’t take away from their ability to do world-class patient care, research and education…. We spend about 50-60 percent of our time troubleshooting, and the rest creating new systems or electronic workflows.

For example?For example, to help the department more accurately bill, we’ve created a confirmation solution that downloads data from the current EMR system. In our system, areas that often get missed – such as when someone forgets to document an Anesthesia event – bubble to the top. It also helps us see which faculty members worked with which residents, so we can know who is best prepared to do evaluations. There are also things like the no-fault reporting system we set up with Dr. Caldwell; for just a few hours of a programmer’s time the department has received a lot of benefit.

But big changes are on the way?Yes. The Medical Center’s EMR is changing from PICIS and UCare to APeX. This will have a big effect on faculty and residents; our role will largely be to ensure our confirmation system works with APeX and to help faculty when they need to access APeX from their office.

The bigger change for IT is the Chancellor’s Operational Excellence initiative – a response to state budget cuts. Up to now, IT at UCSF has been a series of small businesses and Anesthesia has had gold-plated service…Now we have to figure out how to make excellent service available to others without degrading our department’s ability to set our own IT agenda; we want to be able to continue providing specialized services to our faculty, staff and other department members.

Some samples of Brad’s photography



FACULTY HONORS, AWARDS & APPOINTMENTSJon Matthew Aldrich, MDCAMPUS AWARD:

UCSF Academy of Medical Educators Excellence in Teaching Award, 2010

Pedram Aleshi, MDCAMPUS AWARD:

William K. Hamilton Award for Excellence in Teaching, 2010-2011

Matthias Braehler, MDCAMPUS AWARD:

Ronald D. Miller Award for Excellence in Junior Faculty Advising and Mentoring of Residents, 2010-2011

Lee-Lynn Chen, MDCAMPUS AWARD:


Neal Cohen, MDCAMPUS APPOINTMENT:

Interim Vice Dean for Academic Affairs, 2011

HonorsAwardsAppointmentsing software and hardware. Dr. Collins believes that hospital-based in-situ simulation programs will be a major part of the educational fabric of the UCSF and affiliated hospitals.

Adrian Gelb, MB ChBEXTRAMURAL AWARD:

Distinguished Service Award, Society for Neuroscience in Anesthesiology and Critical Care, 2010

Michael Gropper, MD, PhDCAMPUS APPOINTMENT:

UCSF Department of Anesthesia and Perioperative Care’s Executive Vice Chair, 2011

Jan Hirsch, MDCAMPUS AWARD:


Benjamin Houseman, MD, PhDCAMPUS AWARD:


Eric Lin, MDCAMPUS AWARD:


Errol Lobo, MD, PhDCAMPUS AWARD:

UCSF Exceptional Physician Award, 2011

Mervyn Maze, MB ChBCAMPUS APPOINTMENT:

The William K. Hamilton, MD, Distinguished ProfessorshipThroughout his tenure at UCSF, Bill Hamilton was determined that while many anesthesia departments were held back by the yet undeveloped skills of anesthesiologists, his Department would proceed apace with other more established medical specialties. Not only did he succeed in this endeavor, but he was the force behind research discoveries that were implemented by all fields of medicine.

A Distinguished Professorship within the Department of Anesthesia named for Dr. William K. Hamilton will recognize his past exemplary service, while signaling the promise that continued research, training and clinical care in anesthesiology at UCSF will spur the discoveries of tomorrow.— Text from the William K. Hamilton Distinguished Professorship brochure

J. Renee Navarro, MD, PharmDCAMPUS APPOINTMENT:

UCSF’s first Vice Chancellor for Diversity and Outreach, 2010

Mark Rollins, MD, PhDCAMPUS APPOINTMENT:

Director of Fetal Anesthesia, UCSF Fetal Treatment Center, 2011

Arthur Wallace, MD, PhDCAMPUS APPOINTMENT:

Vice Chair, UCSF Department of Anesthesia and Perioperative Care, 2011Chief, San Francisco Veteran’s Affairs Medical Center, Anesthesiology Service, 2011

Jenson Wong, MDCAMPUS APPOINTMENTS:

Medical Director, Health Information Technology for San Francisco General Hospital and Trauma Center, 2010

RESIDENT AWARDS Michele Arnold, MDCAMPUS AWARD:

Stuart C. Cullen Award for Excellence during Residency, 2010-2011

Brad Cohn, MDCAMPUS AWARD:

Julius R. Krevans Award for Clinical Excellence, SFGH, 2010

Madina Gerasimov, MDCAMPUS AWARD:

Jeffrey A. Katz Award for Work Ethic and Professionalism during Residency, 2010-2011

Anuj Malhotra, MDCAMPUS AWARD:

Mark A. Rosen Award for Scholarshipduring Residency, 2010-2011

POST-DOCTORAL SCHOLAR AWARDNiccolo Terrando, BSC, PhDEXTRAMURAL AWARD:

2nd Place, Best Abstract Prize Competition session at Euroanaesthesia 2010, for “Unraveling the interactions between postoperative infection, surgery, and inflammation in post-operative cognitive dysfunction”

Adam Collins, MD (above) as part of a multidisciplinary team including Leslie Dubbin, RN, and Robert Mackersie, MD

CAMPUS AWARD:

Hearts Grant, SFGH, 2011A Hearts grant for $92,500 was recently awarded to a multidisciplinary team at San Francisco General Hospital to initiate trauma team training and other courses to improve the delivery of patient care to the critically ill at SFGH. The grant awardees are Leslie Dubbin, RN, Robert Mackersie, MD, and Adam Collins, MD. The grant funds will be used to purchase a Laerdal SimMan 3G with accompany-

What can anesthesiologists do to decrease or prevent the occurrence of postoperative delirium?Delirium is currently conceptualized as a geriatric syndrome, which means that rather than the cause being disease in a single organ, a constellation of events likely contributes to delirium’s occurrence.

For example, there are multiple patient-dependent risk factors for postoperative delirium, including: older age, lower educational level, impairment of cognitive status before surgery, and previous history of a central nervous system disorder. In addition, various baseline risk factors, including events that take place during the perioperative period, can be precipitating factors. Among the most important of these factors, studies have identified intraoperative blood loss, medications such as opioids, and postoperative pain.

Risk Identification and Mitigation is CrucialTherefore, decreasing or preventing the occurrence of postoperative delirium begins with rigorous risk identification during the preoperative evaluation. Since cognitive status is not routinely evaluated in the preoperative period, it is probably indicated to add a limited cognitive screen such as the mini-cog (an assessment instrument that combines an uncued 3-item recall test with a clock-drawing test) to exclude pre-existent cognitive impairment. When an at-risk patient is identified, a collaborative, proactive approach is indicated, which can involve nursing, geriatrics, surgery, and pharmacy services. This multi-disciplinary approach might include:

n early orientation upon anesthesia emergence, including having family members present in the post anesthesia recovery unit;

n minimization of sensory deprivation by providing hearing and visual aids;

n aggressive management of postoperative pain; consider the use of regional techniques for postoperative analgesia or the use of narcotic adjuvant to minimize the use of postoperative intravenous opioids;

n and avoidance of multiple drugs, particularly those with central nervous system effects, such as drugs with anti-cholinergic properties and benzodiazepines.

Other tactics can include monitoring for dehydration, bladder distention or ileus, and proactive prevention of falling injury by use of a “sitter.” Frequent checks of oxygen saturation and measurements

of hemoglobin and renal function in the early postoperative period are also indicated for at risk patients since hypoxemia, anemia and uremia are clearly avoidable and potentially reversible precipitating factors for delirium.

The Role of SleepFinally, though we have long suspected that sleep disruption is another major precipitating factor, routine use of sleep aids should be avoided. Instead, consider non-pharmacologic approaches, such as the practice of early mobilization and avoiding sleep disruption by minimizing nighttime vital signs measurements and procedures. Sleep disruption is particu-larly prevalent in the intensive care unit (ICU), and here again, non-pharmacologic interventions designed to aid a good night’s sleep may be essential for ultimately decreasing the occurrence of delirium.

To that end, our department has organized a multi-disciplinary clinical study to address whether sleep disruption directly contributes to postoperative delirium in the ICU. Brain monitors will measure different sleep stages in the patients, and we will use a standardized measure for ICU delirium. We hope that this study will contribute to the understanding of the pathophysiology of delirium in the hospital and allow us to design effective strategies to prevent or minimize its occurrence.

Ask the Expert: Jacqueline M. Leung, MD

References1. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001 May;49(5):516-22.2. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994 Jan 12;271(2):134-9.3. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996 Mar 20;275(11):852-7.4. Vaurio LE, Sands LP, Wang Y, Mullen EA, Leung JM. Postoperative delirium: the importance of pain and pain management. Anesth Analg. 2006 Apr;102(4):1267-73.5. Leung JM, Sands LP, Paul S, Joseph T, Kinjo S, Tsai T. Does postoperative delirium limit the use of patient-controlled analgesia in older surgical patients? Anesthesiology. 2009 Sep;111(3):625-31.



Christian Apfel

Principal InvestigatorAcademic Senate, Individual Grant, 09/01/10–08/31/11Smoking Status as a Risk Factor for Severe Acute Post-Operative Pain After Elective Surgery$34,445

Roland Bainton

Principal InvestigatorNIH/NIGMS, Individual Grant, 08/01/07–05/31/12Physiology and Regulation of Drug Transport Across the Blood Brain Barrier$1,450,670

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11Roland Bainton, 2010 RFA$100,000

Philip Bickler

Principal InvestigatorNIH/NIGMS, Individual Grant, 03/01/07–02/28/12Intracellular Signaling in Anesthetic and Hypoxic Preconditioning of Neurons$1,238,340

Principal InvestigatorVarious Industry Sponsors, Other Clinical Contract, 09/01/86–Present Accuracy of Pulse Oximeters with Profound Hypoxia$200,000

Marek Brzezinski

Principal InvestigatorNorthern California Institute for Research and Education (NCIRE), Individual Grant, 01/11/09–12/31/11Is PTSD a Risk Factor for Medical and Psychiatric Complications in the Perioperative Period?$50,000

Yongmei Chen

Principal InvestigatorNIH/NINDS, Individual Grant, 09/15/09–08/31/11Endothelial Progenitor Cells in Brain Arteriovenous Malformations$154,500

Adrian Gelb

Principal InvestigatorAbratech Corporation, Subcontract-Research, 01/13/11–08/31/11Brain-Activity During Sedation Predicting Post-Sedation Explicit-Memory$138,089

Andrew Gray

Principal InvestigatorCarl Koller Memorial Research Grant/American Society of Regional Anesthesia and Pain Medicine, Individual Grant, 01/01/11–12/31/12Intravascular Contrast for Regional Anesthesia$41,304

Zhonghui Guan

Principal InvestigatorFoundation for Anesthesia Education & Research (FAER), Research Career Award, 07/01/10–06/30/12Contributions of Histone Acetylation Inflammatory Pain$175,000

Principal InvestigatorREAC/Cox J Fund, Individual Grant, 07/01/10–06/30/11Role of Histone Acetylation Inflammatory Pain $30,000

Tomoki Hashimoto

Principal InvestigatorNIH/NINDS, Individual Grant, 02/01/07–01/31/12Intracranial Aneurysm Pathogenesis-Roles of Vascular Remodeling and Inflammation$1,346,491

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11Tomoki Hashimoto, 2010 RFA$34,982

Judith Hellman

Principal Investigator NIH/NIAID, Individual Grant, 06/05/09–05/31/11TLR2 in Sepsis-Induced Coagulopathy, Endothelial Leak, and Pulmonary Dysfunction$687,893

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11Judith Hellman, 2010 RFA$50,000

Principal InvestigatorAcademic Senate, Individual Grant, 01/20/11–06/19/11Purchase of Electrical Cell-Substrate Impedance Sensing (ECIS) System-Shared Instrument Grant$35,000

Jan Hirsch

Principal InvestigatorREAC/Simon E Mem FD, Individual Grant, 06/01/09–05/31/11 Tobacco Smoke Exposure – a Predisposing Factor to Ventilator Induced Lung Injury and Damage to the Alveolar Epithelial Type II Cell?$30,000

Benjamin Houseman

Principal InvestigatorNIH/NIGMS, Research Career Award, 03/01/10–02/28/15Pharmacologic Dissection of the P13-Kinase Pathway in Trauma$598,050

Principal InvestigatorUCSF Academy of Medical Educators–Innovations Funding, Individual Grant, 07/01/10–06/30/11Development of an Interdisciplinary, Web- Based Trauma Education Curriculum at San Francisco General Hospital$30,000

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11Benjamin Houseman, 2010 RFA$50,000

Helen Kim

Principal InvestigatorNIH/NINDS, Research Career Award, 07/01/08–06/30/13Genetic Influences on Clinical Outcome in Brain Arteriovenous Malformations$782,716

Kerstin Kolodzie

Principal InvestigatorREAC/Harris Fnd, Individual Grant, 07/10/10–06/30/11The Effect of General Anesthesia on the Risk for Arrhythmia? A pilot study$29,917

Rondall Lane

Principal InvestigatorUniversity of Pittsburgh, Subcontract-Research, 06/01/09–05/31/11Isolating Mechanisms Underlying Hospital Variation in End-of-Life ICU Use$43,693

Chanhung Lee

Principal InvestigatorAmerican Heart Association (AHA–National Office), Individual Grant, 01/01/07–12/31/11Influence of Matrix Metalloproteinase on Brain Arteriovenous Malformation Hemorrhage$260,000

Jae-Woo Lee

Principal InvestigatorNIH/NHLBI, Research Career Award, 08/04/08–07/31/13Mesenchymal Stem Cells for Treatment of Acute Lung Injury$608,850

Jacqueline Leung

Principal InvestigatorNIH/NIA, Individual Grant, 09/15/09–08/31/14Pathophysiology of Postoperative Delirium in Older Patients$2,176,111

Lawrence Litt

Principal InvestigatorNIH/NIGMS, Individual Grant, 04/01/09–01/31/13Hypothermia, Anesthesia and NMR Metabolomics in Ischemic Neonatal Brain Slices$1,401,093

Bin Liu

Principal InvestigatorNIH/NCI, Individual Grant, 03/07/06–01/31/12Mapping a Clinically Significant Internalizing Tumor Epitope Space$1,582,152

Principal InvestigatorNIH/NCI, Individual Grant, 12/05/08–11/30/11Internalizing Antibody-Targeted Nanosized siRNA Therapeutics$373,890

Principal InvestigatorNIH/NCI, Individual Grant, 02/01/09–01/31/12Selection of Internalizing Human Antibodies Targeting Pancreatic Tumor Cells in Situ by Laser Capture Microdissection$373,890

Principal InvestigatorNIH/NCI, Individual Grant, 03/01/10–12/31/13Identifying Antigens Bound by Novel scFvs Targeting All Subtypes of Mesothelioma$1,250,293

Liu, Bin (continued)

Principal InvestigatorVaxiion Therapeutics, Individual Grant, 11/01/09–11/01/11Human Antibody Targeted Minicell Drug Delivery Platform$127,500

Principal InvestigatorPancreas Cancer Program, Individual Grant, 04/01/10–03/31/11Developing Recombinant Tumor and Tumor Stem Cell Surface Antigens for Pancreatic Tumor Detection and Therapy$26,500

Co-InvestigatorLustgarten Foundation for Pancreatic Cancer, Individual Grant, 03/01/11–02/28/13Developing Targeted Nanoparticles to Interfere with K-ras Expression Using siRNA $200,000

Martin London

Principal InvestigatorAPSF-Anesthesia Patient Safety Foundation, Individual Grant, 01/01/06–12/31/11Perioperative Pharmacologic Prophylaxis for Cardiovascular Events in the Department of Veterans Affairs: A Pharmaco-epidemic Pilot Project$75,000

James Marks

Principal InvestigatorFox Chase Cancer Center, Subcontract-Research, 02/05/07–01/31/12Defining the Role of Affinity in Antibody-Based Tumor Targeting and Therapy$638,122

Principal InvestigatorNIH/NIAID, Individual Grant, 08/15/07–07/31/12Development of botulinum neurotoxin immunotherapy, serotypes C, D, F, and G$3,709,450

Principal InvestigatorXoma, Inc., Subcontract-Research, 02/17/09–09/14/14Production of Monoclonal Antibody-Based Therapeutics for Botulism$1,595,352

Principal InvestigatorUC Irvine, Subcontract-Research, 05/01/09–04/30/14Evolving Diagnostic Antibodies for Botulinum Neurotoxins$1,383,486

ActiveResearchGrants


James Marks (continued)

Principal InvestigatorGeorgetown University, Subcontract-Research, 09/03/08–06/30/11Adaptive Immunity from High Affinity Anti-HER2/neu Monoclonal Antibodies $244,683

Principal InvestigatorGeorgetown University, Subcontract-Research, 02/02/09–12/31/13Determinants of Tumor Sensitivity to EGFR-Targeted Antibodies$384,635

Principal InvestigatorMerrick Pharmaceuticals, URC/Unfunded Research Collaboration, 05/15/09–05/14/11Bispecific Antibodies Targeting Basal Breast Cancers

Principal InvestigatorCenters for Disease Control, Contract, 09/09/09–09/07/11Monoclonal Antibodies for Mass Spectrometry Based Detection of Biothreat Agents$593,898

Principal InvestigatorFunctional Genetics, Inc, Subcontract-Research, 07/01/10–06/30/13Development of Broad Spectrum Host Oriented Therapeutic Antibodies Against Influenza Infection$398,854

Principal InvestigatorFunctional Genetics, Inc, Subcontract-Research, 07/0/1/10–06/30/13Discovery of Critical Host Genes Enabling Resistance to HIV-1 Infection as Therapeutic Targets$400,611

Principal InvestigatorLustgarten Foundation for Pancreatic Cancer, Individual Grant, 08/01/10–07/31/11The Lustgarten Foundation Biomarker Initiative $116,716

Mervyn Maze

Principal InvestigatorFoundation for Anesthesia Education & Research (FAER), Fellowship, 01/01/11–01/31/112011 Medical Student Anesthesia Research Fellowship Program

Rachel McKay

Principal InvestigatorBaxter Healthcare Corp., Contract, 08/05/10–08/04/11Effect of Anesthetic Choice (Sevoflurane versus Desflurane) on Speed and Sustained Nature of Airway Reflex Recovery in the Context of Antagonized Neuromuscular Block$231,014

Principal InvestigatorPopulation Health Research Institute (PHRI), Contract, 10/29/10–04/29/11An International, Placebo-Controlled Factorial Trial to Assess the Impact of Clonidine and Aspirin in Patients Under-going Noncardiac Surgery Who are at Risk of Perioperative Cardiovascular Event$64,000

Claus Niemann

Principal InvestigatorDHHS/Health Resources and Services Administration (HRSA Individual Grant, 09/01/08–08/31/11Intensive Insulin Therapy in Deceased Donors to Improve Renal Allograft Function and Transplanted Allograft Outcomes$821,251

Principal InvestigatorMasimo Corporation, Contract, 02/04/10–07/31/11Pulse Oximeter Parameter Performance During Liver Transplant$13,904

Ludmila Pawlikowska

Principal InvestigatorNIH/NIDDK, Individual Grant, 03/01/09–02/28/13Genetic Analysis of Metabolic Syndrome by Admixture Mapping in African American$1,258,469

Principal InvestigatorNIH/NINDS, Individual Grant, 02/01/10–01/31/12Somatic Mutation Detection in Brain AVM by Massively High-Throughput Sequencing$416,973

Arun Prakash Budde

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11Arun Prakash, 2010 RFA$30,000

Jeffrey Sall

Principal InvestigatorNIH/NIGMS, Research Career Award, 02/01/10–01/31/14Volatile Anesthetic Alteration of Neural Precursor Cell Cycle and Fate Decisions$478,440

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11Jeffrey Sall, 2010 RFA$53,050

Mark Schumacher

Principal InvestigatorNIH/NINDS, Individual Grant, 07/01/09–06/30/13Capsaicin Receptor Subtypes in Pain Transduction$1,195,075

Principal InvestigatorUC San Diego, Subcontract-Research, 07/01/10–02/28/11Pain Management by an Endogenous Antihyperalgesic $136,247

James Sonner

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11James Sonner, 2010 RFA$86,368

Greg Stratmann

Principal InvestigatorInternational Anesthesia Research Society (IARS), Research Career Award, 01/01/09–12/31/11Is Pediatric Anesthesia Associated with Long-Term Hippocampal Dysfunction?$80,000

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11Greg Stratmann, 2010 RFA$62,000

Principal InvestigatorReNu Medical, Inc., Clinical Trial, 02/15/11–02/14/12Accuracy of Pulse Oximeters in Neonates and Children Undergoing Cardiac Surgery$20,000

Hua Su

Principal InvestigatorNIH/NINDS, Individual Grant, 02/01/10–01/31/12Targeted Gene Expression in Ischemic Brain by Intravenous Delivery$386,250

Principal InvestigatorAmerican Heart Association (AHA–WSA), Individual Grant, 07/01/10–06/30/12Induction of Functional Angiogenesis in the Ischemic Brain $140,000

Pekka Talke

Principal InvestigatorHospira, Inc., Clinical Trial, 12/09/10–12/08/12The Pharmacokinetics and Pharmacodynamics of Dexmedetomidine in Patients with Seizure Disorders$31,631

Julin Tang

Principal InvestigatorHospira, Inc., Contract, 09/24/07–12/31/11A Prospective, Randomized, Controlled Study on the Use of Dexmedetomidine to Facilitate Extubation in Surgical Intensive-Care Unit Patients who Failed Previous Weaning Attempts Following Prolonged Mechanical Ventilation$154,966

Binbin Wang

Principal InvestigatorUCSF Anesthesia, Individual Grant, 07/01/10–06/30/11Binbin Wang, 2010 RFA$1,350

William Young

Program DirectorNIH/NIGMS, Training Grant, 07/01/07–06/30/12Comprehensive Anesthesia Research Training$921,700

Principal InvestigatorColumbia University, Subcontract-Research, 01/13/06–07/31/11A Randomized Trial of Unruptured Brain Arteriovenous Malformation (ARUBA)$162,368

Principal InvestigatorNIH/NINDS, Individual Grant, 07/01/08–06/30/13Predictors of Spontaneous Cerebral AVM Hemorrhage$2,047,332

Principal InvestigatorNIH/NINDS, Program Project Grant, 04/01/09–03/31/14Integrative Study of Brain Vascular Malformations$6,657,383

Principal InvestigatorNIH/NINDS, Individual Grant, 01/01/09–12/31/13Hemodynamics of Cerebral Arteriovenous Malformations$1,652,669

Principal InvestigatorNIH/NINDS, Multicenter Project Grant, 09/30/09–06/30/14Brain Vascular Malformation Consortium: Predictors of Clinical Course$6,095,571

Principal InvestigatorThe Leslie Munzer Neurological Institute, Individual Grant, 01/01/09–12/31/11Influence of Bone Marrow Derived Cells in the Development of Abnormal Blood Vessels in a Model of Brain AVM$25,000

Aldrich JM, Gropper MA. Can we predict pulmonary complications after thoracic surgery? Anesth Analg. May 1;110(5):1261-3, 2010.

Anderson A, Eilers H, Yost CS. Anaphylaxis complicating graft reperfusion during orthotopic liver transplantation: a case report. Transplant Proc. Jun;42(5):1967-9, 2010.

Antoine J, Hussain Z, El-Sayed I, Apfel CC. The unrecognised difficult extubation: a call for vigilance. Anaesthesia. Sep;65(9):946-8, 2010.

Apfel CC, Jalota L. Can central antiemetic effects of opioids counter-balance opioid-induced nausea and vomiting? Acta Anaesthesiol Scand. Feb;54(2):129-31, 2010.

Apfel CC, Saxena A, Cakmakkaya OS, Gaiser R, George E, Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth. Sep;105(3):255-63, 2010.

Apfel CC, Cakmakkaya OS, Martin W, Richmond C, Macario A, George E, Schaefer M, Pergolizzi JV. Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study. BMC Musculoskelet Disord. Jul 8;11:155, 2010.

Apfel CC, Zhang K, George E, Shi S, Jalota L, Hornuss C, Fero KE, Heidrich F, Pergolizzi JV, Cakmakkaya OS, Kranke P. Transdermal scopolamine for the prevention of postoperative nausea and vomiting: a systematic review and meta-analysis. Clin Ther. Nov;32(12):1987-2002, 2010.

Ballard PL, Lee JW, Fang X, Chapin C, Allen L, Segal MR, Fischer H, Illek B, Gonzales LW, Kolla V, Matthay MA. Regulated gene expression in cultured type II cells of adult human lung. Am J Physiol Lung Cell Mol Physiol. Jul;299(1):L36-50, 2010.

Behrends M, Martinez-Palli G, Niemann CU, Cohen S, Ramachandran R, Hirose R. Acute hyperglycemia worsens hepatic ischemia/reperfusion injury in rats. J Gastrointest Surg. Mar;14(3):528-35, 2010.

Bickler PE, Fahlman CS. Enhanced hypoxic preconditioning by isoflurane: signaling gene expression and requirement of intracellular Ca2+ and inositol triphosphate receptors. Brain Res. Jun 22;1340:86-95, 2010.

Bickler PE, Fahlman CS, Gray JJ. Hypoxic preconditioning failure in aging hippocampal neurons: impaired gene expression and rescue with intracellular calcium chelation. J Neurosci Res. Dec;88(16):3520-9, 2010.

Bidlingmaier S, Wang Y, Liu Y, Zhang N, Liu B. Comprehensive analysis of yeast surface displayed cDNA library selection outputs by exon microarray to identify novel protein-ligand interactions. Mol Cell Proteomics. Mar;10(3): M110.005116, 2011.

Bidlingmaier S, Liu B. Construction of yeast surface-displayed cDNA libraries. Methods Mol Biol. 729:199-210, 2011.

Bidlingmaier S, Liu B. Identification of protein/target molecule interactions using yeast surface-displayed cDNA libraries. Methods Mol Biol. 729:211-23, 2011.

Blobner M, Eriksson LI, Scholz J, Motsch J, Della Rocca G, Prins ME. Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur J Anaesthesiol. Oct;27(10):874-81, 2010.

Boyd BS, Wanek L, Gray AT, Topp KS. Mechanosensitivity during lower extremity neurodynamic testing is diminished in individuals with Type 2 Diabetes Mellitus and peripheral neuropathy: a cross sectional study. BMC Neurol. Aug 28;10:75, 2010.

Broadhurst MJ, Leung JM, Kashyap V, McCune JM, Mahadevan U, McKerrow JH, Loke P. IL-22+ CD4+ T cells are associated with therapeutic trichuris trichiura infection in an ulcerative colitis patient. Sci Transl Med. Dec 1;2(60):60ra88, 2010.

Brzezinski M, Lee A, Holak EJ, Pagel PS. A simple method for obtaining a “ramped” laryngoscopy position after anesthetic induction. J Cardiothorac Vasc Anesth. Jun;24(3):537-9, 2010.

Brzezinski M, Kukreja J, Mitchell JD, Pagel PS, Tassone RF. Sudden Onset of Atrial Flutter During Continuous Venovenous Hemodialysis. J Cardiothorac Vasc Anesth. Jan 11Jan 11. [Epub ahead of print], 2011.

Carvalho B, Aleshi P, Horstman DJ, Angst MS. Effect of a preemptive femoral nerve block on cytokine release and hyperalgesia in experimentally inflamed skin of human volunteers. Reg Anesth Pain Med. Nov;35(6):514-9, 2010.

Choukalas CG, Walter J, Glick D, O’Connor MF, Tung A, Dinwiddie SH, Nunnally ME. Mask ventilation, hypocapnia, and seizure duration in electroconvulsive therapy. J Clin Anesth. Sep;22(6):415-9, 2010.

Choy DF, Modrek B, Abbas AR, Kummerfeld S, Clark HF, Wu LC, Fedorowicz G, Modrusan Z, Fahy JV, Woodruff PG, Arron JR. Gene expression patterns of Th2 inflammation and intercellular communication in asthmatic airways. J Immunol. Feb 1;186(3):1861-9, 2011. Cohen JM, Gray AT. Functional deficits after intraneural injection during interscalene block. Reg Anesth Pain Med. Jul-Aug;35(4):397-9, 2010. Cohen JM, Gray AT. Reply to drs. Bigeleisen, chelly, and filip. Reg Anesth Pain Med. Jan-Feb;36(1):95-7, 2011. Cohen MJ, Serkova NJ, Wiener-Kronish J, Pittet JF, Niemann CU. 1H-NMR-based metabolic signatures of clinical outcomes in trauma patients – beyond lactate and base deficit. J Trauma. Jul;69(1):31-40, 2010. Cohen NH. Critical care medicine in the United States: what we know, what we do not, and where we go from here. Crit Care Med. Jan;38(1):304-6, 2010. Cohen NH. The real reasons not to rely on severity scores. Crit Care Med. Jan;38(1):334-5, 2010. Coursin DB, Cohen NH, Murray MJ. Refrain from exclusionary training. Crit Care Med. Sep;38(9):1919-20, 2010. Darragh MR, Schneider EL, Lou J, Phojanakong PJ, Farady CJ, Marks JD, Hann BC, Craik CS. Tumor detection by imaging proteolytic activity. Cancer Res. Feb 15;70(4):1505-12, 2010. Delaloy C, Liu L, Lee JA, Su H, Shen F, Yang GY, Young WL, Ivey KN, Gao FB. MicroRNA-9 coordinates proliferation and migration of human embryonic stem cell-derived neural progenitors. Cell Stem Cell. Apr 2;6(4):323-35, 2010. Desalvo MK, Mayer N, Mayer F, Bainton RJ. Physiologic and anatomic characterization of the brain surface glia barrier of Drosophila. Glia. Feb 23. doi: 10.1002/glia.21147. [Epub ahead of print], 2011. Dong J, Thompson AA, Fan Y, Lou J, Conrad F, Ho M, Pires-Alves M, Wilson BA, Stevens RC, Marks JD. A single-domain llama antibody potently inhibits the enzymatic activity of botulinum neurotoxin by binding to the non-catalytic alpha-exosite binding region. J Mol Biol. Apr 9;397(4):1106-18, 2010. Dougherty RH, Sidhu SS, Raman K, Solon M, Solberg OD, Caughey GH, Woodruff PG, Fahy JV. Accumulation of intraepithelial mast cells with a unique protease phenotype in T(H)2-high asthma. J Allergy Clin Immunol. May;125(5):1046-1053.e8, 2010. Drasner K. Anesthetic effects on the developing nervous system: if you aren’t concerned, you haven’t been paying attention. Anesthesiology. Jul;113(1): 10-2, 2010. Drasner K. Local anesthetic systemic toxicity: a historical perspective. Reg Anesth Pain Med. Mar-Apr;35(2):162-6, 2010. Drummond DC, Noble CO, Guo Z, Hayes ME, Connolly-Ingram C, Gabriel BS, Hann B, Liu B, Park JW, Hong K, Benz CC, Marks JD, Kirpotin DB. Development of a highly stable and targetable nanoliposomal formulation of topotecan. J Control Release. Jan 4;141(1):13-21, 2010. Dubowitz G, Detlefs S, McQueen KA. Global anesthesia workforce crisis: a preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World J Surg. Mar;34(3):438-44, 2010. Dubowitz G. Global health and global anesthesia. Int Anesthesiol Clin. Spring;48(2):39-46, 2010. Eberspächer E, Blobner M, Werner C, Ruf S, Eckel B, Engelhard K, Schmahl W, Gelb AW. The long-term effect of four hours of hyperventilation on neurocognitive performance and lesion size after controlled cortical impact in rats. Anesth Analg. Jan 1;110(1):181-7, 2010. Eger EI 2nd. After you, please: the second Annual John W. Severinghaus Lecture on Translational Science. Anesthesiology. Apr;112(4):786-93, 2010. Eger EI 2nd. Cost in several flavors. Anesth Analg. Feb 1;110(2):276-7, 2010. Eilers H, Liu KD, Gruber A, Niemann CU. Chronic kidney disease: implications for the perioperative period. Minerva Anestesiol. Sep;76(9):725-36, 2010. Eilers H, Cattaruzza F, Nassini R, Materazzi S, Andre E, Chu C, Cottrell GS, Schumacher M, Geppetti P, Bunnett NW. Pungent general anesthetics activate transient receptor potential-A1 to produce hyperalgesia and neurogenic bronchoconstriction. Anesthesiology. Jun;112(6):1452-63, 2010. Eilers H, Larson MD. The effect of ketamine and nitrous oxide on the human pupillary light reflex during general anesthesia. Auton Neurosci. Jan 15;152(1-2):108-14, 2010.


PeerReviewedPublications

Erickson SE, Vasilevskis EE, Kuzniewicz MW, Cason BA, Lane RK, Dean ML, Rennie DJ, Dudley RA. The effect of race and ethnicity on outcomes among patients in the intensive care unit: A comprehensive study involving socioeconomic status and resuscitation preferences. Crit Care Med. Mar;39(3):429-435, 2011. Eriksson LI. Advancing medical science and practice in anesthesiology: Karolinska. Anesthesiology. Dec;113(6):1258-9, 2010. Errando CL, Pérez-Caballero P, Gelb AW, Sigl JC. Methodology, human factors, and incidence of intraoperative awareness. Acta Anaesthesiol Scand. Jul;54(6):781-3, 2010. Fagerlund MJ, Kåhlin J, Ebberyd A, Schulte G, Mkrtchian S, Eriksson LI. The human carotid body: expression of oxygen sensing and signaling genes of relevance for anesthesia. Anesthesiology. Dec;113(6):1270-9, 2010. Fahlenkamp AV, Peters D, Biener IA, Billoet C, Apfel CC, Rossaint R, Coburn M. Evaluation of bispectral index and auditory evoked potentials for hypnotic depth monitoring during balanced xenon anaesthesia compared with sevoflurane. Br J Anaesth. Sep;105(3):334-41, 2010. Fan QW, Cheng C, Hackett C, Feldman M, Houseman BT, Nicolaides T, Haas-Kogan D, James CD, Oakes SA, Debnath J, Shokat KM, Weiss WA. Akt and autophagy cooperate to promote survival of drug-resistant glioma. Sci Signal. Nov 9;3(147):ra81, 2010. Fan Y, Shen F, Frenzel T, Zhu W, Ye J, Liu J, Chen Y, Su H, Young WL, Yang GY. Endothelial progenitor cell transplantation improves long-term stroke outcome in mice. Ann Neurol. Apr;67(4):488-97, 2010. Fang X, Neyrinck AP, Matthay MA, Lee JW. Allogeneic human mesenchymal stem cells restore epithelial protein permeability in cultured human alveolar type II cells by secretion of angiopoietin-1. J Biol Chem. Aug 20;285(34):26211-22, 2010. Feiner JR, Bickler PE, Mannheimer PD. Accuracy of methemoglobin detection by pulse CO-oximetry during hypoxia. Anesth Analg. Jul;111(1):143-8, 2010. Feiner JR, Bickler PE. Improved accuracy of methemoglobin detection by pulse CO-oximetry during hypoxia. Anesth Analg. Nov;111(5):1160-7, 2010. Flexman AM, Ng JL, Gelb AW. Acute and chronic pain following craniotomy. Curr Opin Anaesthesiol. Oct;23(5):551-7, 2010. Franck M, Radtke FM, Apfel CC, Kuhly R, Baumeyer A, Brandt C, Wernecke KD, Spies CD. Documentation of post-operative nausea and vomiting in routine clinical practice. J Int Med Res. May-Jun;38(3):1034-41, 2010. Gabarrós A, Young WL, McDermott MW, Lawton MT. Language and motor mapping during resection of brain arteriovenous malformations: indications, feasibility, and utility. Neurosurgery. Mar;68(3):744-52, 2011. Gabriel RA, Kim H, Sidney S, McCulloch CE, Singh V, Johnston SC, Ko NU, Achrol AS, Zaroff JG, Young WL. Ten-year detection rate of brain arteriovenous malforma-tions in a large, multiethnic, defined population. Stroke. Jan;41(1):21-6, 2010. Gao P, Chen Y, Lawton MT, Barbaro NM, Yang GY, Su H, Ling F, Young WL. Evidence of endothelial progenitor cells in the human brain and spinal cord arteriovenous malformations. Neurosurgery. Oct;67(4):1029-35, 2010. Garcia-Rodriguez C, Geren IN, Lou J, Conrad F, Forsyth C, Wen W, Chakraborti S, Zao H, Manzanarez G, Smith TJ, Brown J, Tepp WH, Liu N, Wijesuriya S, Tomic MT, Johnson EA, Smith LA, Marks JD. Neutralizing human monoclonal antibodies binding multiple serotypes of botulinum neurotoxi Protein Eng Des Sel. Mar;24(3):321-31, 2011. George E, Hornuss C, Apfel CC. Neurokinin-1 and novel serotonin antagonists for postoperative and postdischarge nausea and vomiting. Curr Opin Anaesthesiol. Dec;23(6):714-21, 2010. Gomez-Sjoberg R, Leyrat AA, Houseman BT, Shokat K, Quake SR. Biocompatibility and Reduced Drug Absorption of Sol-Gel-Treated Poly(dimethyl siloxane) for Microfluidic Cell Culture Applications. Anal Chem. Oct;82:8954-8960, 2010. Gray AT, Drasner K. Safety of ultrasound-guided regional anesthesia. Anesthesiology. Jun;112(6):1538-9, 2010. Guffey PJ, McKay WR, McKay RE. Case report: epidural hematoma nine days after removal of a labor epidural catheter. Anesth Analg. Oct;111(4):992-5, 2010. Guo L, Gelb AW. False negatives, muscle relaxants, and motor-evoked potentials. J Neurosurg Anesthesiol. Jan;23(1):64, 2011. Guo L, Gelb AW. The use of motor evoked potential monitoring during cerebral aneurysm surgery to predict pure motor deficits due to subcortical ischemia. Clin Neurophysiol. Apr;122(4):648-55, 2011.

Hao Q, Su H, Palmer D, Sun B, Gao P, Yang GY, Young WL. Bone marrow- derived cells contribute to vascular endothelial growth factor-induced angiogenesis in the adult mouse brain by supplying matrix metalloproteinase-9. Stroke. Feb;42(2):453-8, 2011. Hao Q, Zhu Y, Su H, Shen F, Yang GY, Kim H, Young WL. VEGF Induces More Severe Cerebrovascular Dysplasia in Endoglin than in Alk1 Mice. Transl Stroke Res. Sep 1;1(3):197-201, 2010.

Hårdemark Cedborg AI, Bodén K, Witt Hedström H, Kuylenstierna R, Ekberg O, Eriksson LI, Sundman E. Breathing and swallowing in normal man – effects of changes in body position, bolus types, and respiratory drive. Neurogastroenterol Motil. Nov;22(11):1201-8, 2010.

He J, Wang Y, Feng J, Zhu X, Lan X, Iyer AK, Zhang N, Seo Y, VanBrocklin HF, Liu B. Targeting prostate cancer cells in vivo using a rapidly internalizing novel human single-chain antibody fragment. J Nucl Med. Mar;51(3):427-32, 2010.

Heier T, Caldwell JE, Feiner JR, Liu L, Ward T, Wright PM. Relationship between normalized adductor pollicis train-of-four ratio and manifestations of residual neuromuscular block: a study using acceleromyography during near steady-state concentrations of mivacurium. Anesthesiology. Oct;113(4):825-32, 2010.

Hiller DB, Di Gregorio G, Kelly K, Ripper R, Edelman L, Boumendjel R, Drasner K, Weinberg GL. Safety of high volume lipid emulsion infusion: a first approximation of LD50 in rats. Reg Anesth Pain Med. Mar-Apr;35(2):140-4, 2010.

Howard M, Roux J, Lee H, Miyazawa B, Lee JW, Gartland B, Howard AJ, Matthay MA, Carles M, Pittet JF. Activation of the stress protein response inhibits the STAT1 signalling pathway and iNOS function in alveolar macrophages: role of Hsp90 and Hsp70. Thorax. Apr;65(4):346-53, 2010.

Hsieh TC, Schiller NB, Joshi RV. Extensive lipomatous hypertrophy of the interatrial septum with involvement of the right atrium. Anesth Analg. Mar 1;110(3):725-6; discussion 727, 2010.

Hsieh TC, Katz JA. Images in anesthesiology: thyroid cancer invading the trachea. Anesthesiology. Oct;113(4):961, 2010.

Huang JJ, Azakie A, Russell IA. Echo rounds: discrete subvalvular aortic stenosis. Anesth Analg. Apr 1;110(4):1003-5, 2010.

Hyytiä H, Ristiniemi N, Airas L, Pettersson K, Hellman J. Development of an immunoassay for the detection of cystatin C dimers. J Immunol Methods. Apr 15;355(1-2):14-20, 2010.

Innes AL, McGrath KW, Dougherty RH, McCulloch CE, Woodruff PG, Seibold MA, Okamoto KS, Ingmundson KJ, Solon MC, Carrington SD, Fahy JV. The H antigen at epithelial surfaces is associated with susceptibility to asthma exacerbation. Am J Respir Crit Care Med. Jan 15;183(2):189-94, 2011.

Iyer AK, Su Y, Feng J, Lan X, Zhu X, Liu Y, Gao D, Seo Y, Vanbrocklin HF, Courtney Broaddus V, Liu B, He J. The effect of internalizing human single chain antibody fragment on liposome targeting to epithelioid and sarcomatoid mesothelioma. Biomaterials. Apr;32(10):2605-13, 2011.

Jalota L, Apfel CC. Importance of the Spanish Expert Guidelines for the prevention and treatment of postoperative nausea and vomiting. Rev Esp Anestesiol Reanim. Oct;57(8):467-72, 2010.

Josephson SA, Moheet AM, Gropper MA, Nichols AD, Smith WS. Ventilator-associated pneumonia in a neurologic intensive care unit does not lead to increased mortality. Neurocrit Care. Apr;12(2):155-8, 2010.

Kåhlin J, Eriksson LI, Ebberyd A, Fagerlund MJ. Presence of nicotinic, purinergic and dopaminergic receptors and the TASK-1 K+-channel in the mouse carotid body Respir Physiol Neurobiol. Jul 31;172(3):122-8, 2010.

Kanematsu Y, Kanematsu M, Kurihara C, Tada Y, Tsou TL, van Rooijen N, Lawton MT, Young WL, Liang EI, Nuki Y, Hashimoto T. Critical roles of macrophages in the formation of intracranial aneurysm. Stroke. Jan;42(1):173-8, 2011.

Kanematsu Y, Kanematsu M, Kurihara C, Tsou TL, Nuki Y, Liang EI, Makino H, Hashimoto T. Pharmacologically induced thoracic and abdominal aortic aneurysms in mice. Hypertension. May;55(5):1267-74, 2010.

Khachi S, Zhu Y, Yang GY. Preparation and analysis of endothelial progenitor cells associated with angiogenesis. Methods Mol Biol. 621:139-48, 2010.

Kim H, McCulloch CE, Johnston SC, Lawton MT, Sidney S, Young WL. Comparison of 2 approaches for determining the natural history risk of brain arteriovenous malformation rupture. Am J Epidemiol. Jun 15;171(12):1317-22, 2010.


Kong EC, Woo K, Li H, Lebestky T, Mayer N, Sniffen MR, Heberlein U, Bainton RJ, Hirsh J, Wolf FW. A pair of dopamine neurons target the D1-like dopamine receptor DopR in the central complex to promote ethanol-stimulated locomotion in Drosophila. PLoS One. Apr 1;5(4):e9954, 2010.

Koth LL, Cambier CJ, Ellwanger A, Solon M, Hou L, Lanier LL, Abram CL, Hamerman JA, Woodruff PG. DAP12 is required for macrophage recruitment to the lung in response to cigarette smoke and chemotaxis toward CCL2. J Immunol. Jun 1;184(11):6522-8, 2010.

Krasnodembskaya A, Song Y, Fang X, Gupta N, Serikov V, Lee JW, Matthay MA. Antibacterial effect of human mesenchymal stem cells is mediated in part from secretion of the antimicrobial peptide LL-37. Stem Cells. Dec;28(12):2229-38, 2010.

Lawton MT, Kim H, McCulloch CE, Mikhak B, Young WL. A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery. Neurosurgery. Apr;66(4):702-13; discussion 713, 2010.

Leung JM. Postoperative delirium: are there modifiable risk factors? Eur J Anaesthesiol. May;27(5):403-5, 2010.

Little SJ, Van der Heusen F, Thornton KC. Complete intraoperative transesophageal echocardiogram imaging of the extent of an inferior vena cava mass guides surgical management. Anesth Analg. Nov;111(5):1125-7, 2010.

Liu J, Litt L, Segal MR, Kelly MJ, Yoshihara HA, James TL. Outcome-related metabolomic patterns from 1H/31P NMR after mild hypothermia treatments of oxygen-glucose deprivation in a neonatal brain slice model of asphyxia. J Cereb Blood Flow Metab. Feb;31(2):547-59, 2011.

Liu LL, Aldrich JM, Shimabukuro DW, Sullivan KR, Taylor JM, Thornton KC, Gropper MA. Special article: rescue therapies for acute hypoxemic respiratory failure. Anesth Analg. Sep;111(3):693-702, 2010.

Logvinova AV, Litt L, Young WL, Lee CZ. Anesthetic concerns in patients with known cerebrovascular insufficiency. Anesthesiol Clin. Mar;28(1):1-12, 2010.

Lou J, Geren I, Garcia-Rodriguez C, Forsyth CM, Wen W, Knopp K, Brown J, Smith T, Smith LA, Marks JD. Affinity maturation of human botulinum neurotoxin antibodies by light chain shuffling via yeast mating. Protein Eng Des Sel. Apr;23(4):311-9, 2010.

Lu DC, Roeser AC, Mummaneni VP, Mummaneni PV. Nuances of occipitocervical fixation. Neurosurgery. Mar;66(3 Suppl):141-6, 2010.

Lyon R, Gibson A, Burch S, Lieberman J. Increases in voltage may produce false-negatives when using transcranial motor evoked potentials to detect an isolated nerve root injury. J Clin Monit Comput. Dec;24(6):441-8, 2010.

Matthay MA, Goolaerts A, Howard JP, Lee JW. Mesenchymal stem cells for acute lung injury: preclinical evidence. Crit Care Med. Oct;38(10 Suppl):S569-73, 2010.

Matthay MA, Thompson BT, Read EJ, McKenna DH Jr, Liu KD, Calfee CS, Lee JW. Therapeutic potential of mesenchymal stem cells for severe acute lung injury. Chest. Oct;138(4):965-72, 2010.

McKay RE, Malhotra A, Cakmakkaya OS, Hall KT, McKay WR, Apfel CC. Effect of increased body mass index and anaesthetic duration on recovery of protective airway reflexes after sevoflurane vs desflurane. Br J Anaesth. Feb;104(2): 175-82, 2010.

Mikhak B, Weinsheimer S, Pawlikowska L, Poon A, Kwok PY, Lawton MT, Chen Y, Zaroff JG, Sidney S, McCulloch CE, Young WL, Kim H. Angiopoietin-Like 4 (ANGPTL4) Gene Polymorphisms and Risk of Brain Arteriovenous Malformations. Cerebrovasc Dis 31(4):338-45, 2011.

Miller RD, Ward TA, Shiboski SC, Cohen NH. A comparison of three methods of hemoglobin monitoring in patients undergoing spine surgery. Anesth Analg. Apr;112(4):858-63, 2011.

Mummaneni PV, Lu DC, Dhall SS, Mummaneni VP, Chou D. C1 lateral mass fixation: a comparison of constructs. Neurosurgery. Mar;66(3 Suppl):153-60, 2010.

Nakagawa K, Tang JF. Physiologic response of human brain death and the use of vasopressin for successful organ transplantation. J Clin Anesth. Mar;23(2):145-8, 2011.

Nakamura JL, Phong C, Pinarbasi E, Kogan SC, Vandenberg S, Horvai AE, Faddegon BA, Fiedler D, Shokat K, Houseman BT, Chao R, Pieper RO, Shannon K. Dose-dependent effects of focal fractionated irradiation on secondary malignant neoplasms in Nf1 mutant mice. Cancer Res. Jan 1;71(1):106-15, 2011.

Neal JM, Bernards CM, Butterworth JF 4th, Di Gregorio G, Drasner K, Hejtmanek MR, Mulroy MF, Rosenquist RW, Weinberg GL. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. Mar-Apr;35(2):152-61, 2010.

Nguyen HP, Zaroff JG, Bayman EO, Gelb AW, Todd MM, Hindman BJ; IHAST-MIDS and IHAST Investigators. Perioperative hypothermia (33 degrees C) does not increase the occurrence of cardiovascular events in patients undergoing cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial. Anesthesiology. Aug;113(2):327-42, 2010.

Niemann CU, Eilers H. Abdominal organ transplantation. Minerva Anestesiol. Apr;76(4):266-75, 2010.

Niemann CU, Feiner J. Quality improvement in transplant anesthesia: which way forward? Curr Opin Organ Transplant. Jun;15(3):374-6, 2010.

Niemann CU, Xu F, Choi S, Behrends M, Park Y, Hirose R, Maher JJ. Short passive cooling protects rats during hepatectomy by inducing heat shock proteins and limiting the induction of pro-inflammatory cytokines. J Surg Res. Jan;158(1):43-52, 2010.

Osredkar D, Sall JW, Bickler PE, Ferriero DM. Erythropoietin promotes hippocampal neurogenesis in in vitro models of neonatal stroke. Neurobiol Dis. May;38(2):259-65, 2010.

Percie du Sert N, Rudd JA, Apfel CC, Andrews PL. Cisplatin-induced emesis: systematic review and meta-analysis of the ferret model and the effects of 5-HT(3) receptor antagonists. Cancer Chemother Pharmacol. Mar;67(3):667-86, 2011.

Perouansky M, Rau V, Ford T, Oh SI, Perkins M, Eger EI 2nd, Pearce RA. Slowing of the hippocampal θ rhythm correlates with anesthetic-induced amnesia. Anesthesiology. Dec;113(6):1299-309, 2010.

Pinsonneault RL, Mayer N, Mayer F, Tegegn N, Bainton RJ. Novel models for studying the blood-brain and blood-eye barriers in Drosophila. Methods Mol Biol. 686:357-69, 2011.

Politis GD, Schneider WJ, Van Beek AL, Gosain A, Migliori MR, Gregory GA, Fisher QA, Flick R. Guidelines for pediatric perioperative care during short-term plastic reconstructive surgical projects in less developed nations. Anesth Analg. Jan;112(1):183-90, 2011.

Ponomarev I, Rau V, Eger EI, Harris RA, Fanselow MS. Amygdala transcriptome and cellular mechanisms underlying stress-enhanced fear learning in a rat model of posttraumatic stress disorder. Neuropsychopharmacology. May;35(6):1402-11, 2010.

Prakash A, Hellman J. Editorial: Pattern recognition receptors and factor B: “complement”ary pathways converge. J Leukoc Biol. Oct;88(4):605-7, 2010.

Puntillo KA, Arai S, Cohen NH, Gropper MA, Neuhaus J, Paul SM, Miaskowski C. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med. Nov;38(11):2155-60, 2010.

Radke OC, Werth K, Borg-von-Zepelin M, Saur P, Apfel CC. Two serial check valves can prevent cross-contamination through intravenous tubing during total intravenous anesthesia. Anesth Analg. Oct;111(4):925-8, 2010.

Reddy S, Shaller CC, Doss M, Shchaveleva I, Marks JD, Yu JQ, Robinson MK. Evaluation of the Anti-HER2 C6.5 Diabody as a PET Radiotracer to Monitor HER2 status and Predict Response to Trastuzumab Treatment. Clin Cancer Res. Mar 15;17(6):1509-20, 2011.

Roux J, Carles M, Koh H, Goolaerts A, Ganter MT, Chesebro BB, Howard M, Houseman BT, Finkbeiner W, Shokat KM, Paquet AC, Matthay MA, Pittet JF. Transforming growth factor beta1 inhibits cystic fibrosis transmembrane conductance regulator-dependent cAMP-stimulated alveolar epithelial fluid transport via a phosphatidylinositol 3-kinase-dependent mechanism. J Biol Chem. Feb 12;285(7):4278-90, 2010.

Rubinsky L, Raichman N, Lavee J, Frenk H, Ben-Jacob E, Bickler PE. Antifreeze protein suppresses spontaneous neural activity and protects neurons from hypothermia/re-warming injury. Neurosci Res. Jul;67(3):256-9, 2010.

Rudnick SI, Lou J, Shaller CC, Tang Y, Klein-Szanto AJ, Weiner LM, Marks JD, Adams GP. Influence of Affinity and Antigen Internalization on the Uptake and Penetration of Anti-HER2 Antibodies in Solid Tumors. Cancer Res. Mar 15;71(6):2250-9, 2011.

Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. Jul;111(1):92-8, 2010.


PeerReviewedPublications

Sackey PV, Eriksson LI, Martling CR, Radell PJ. Case scenario: tailored sedation to the individual needs of the intensive care unit patient. Anesthesiology. Dec;113(6):1439-46, 2010. Schumacher MA, Eilers H. TRPV1 splice variants: structure and function. Front Biosci. Jun 1;15:872-82, 2010. Schumacher MA. Transient receptor potential channels in pain and inflammation: therapeutic opportunities. Pain Pract. May-Jun;10(3):185-200, 2010. Severinghaus JW. Unfinished physiology. Adv Exp Med Biol. 662:3-5, 2010. Shin HS, Xu F, Bagchi A, Herrup E, Prakash A, Valentine C, Kulkarni H, Wilhelmsen K, Warren S, Hellman J. Bacterial lipoprotein TLR2 agonists broadly modulate endothelial function and coagulation pathways in vitro and in vivo. J Immunol. Jan 15;186(2):1119-30, 2011. Sidhu SS, Yuan S, Innes AL, Kerr S, Woodruff PG, Hou L, Muller SJ, Fahy JV. Roles of epithelial cell-derived periostin in TGF-beta activation, collagen production, and collagen gel elasticity in asthma. Proc Natl Acad Sci U S A. Aug 10;107(32):14170-5, 2010. Siegemund M, van Bommel J, Stegenga ME, Studer W, van Iterson M, Annaheim S, Mebazaa A, Ince C. Aortic cross-clamping and reperfusion in pigs reduces microvascular oxygenation by altered systemic and regional blood flow distribution. Anesth Analg. Aug;111(2):345-53, 2010. Speca DJ, Chihara D, Ashique AM, Bowers MS, Pierce-Shimomura JT, Lee J, Rabbee N, Speed TP, Gularte RJ, Chitwood J, Medrano JF, Liao M, Sonner JM, Eger EI 2nd, Peterson AS, McIntire SL. Conserved role of unc-79 in ethanol responses in lightweight mutant mice. PLoS Genet. Aug 12;6(8), 2010. Starr PA, Martin AJ, Ostrem JL, Talke P, Levesque N, Larson PS. Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. J Neurosurg. Mar;112(3):479-90, 2010. Stechert MM, London MJ. Native aortic root endocarditis with invasion of the right outflow tract. Anesth Analg. Jan 1;110(1):36-8, 2010. Stoop AA, Joshi RV, Eggers CT, Craik CS. Analysis of an engineered plasma kallikrein inhibitor and its effect on contact activation. Biol Chem. Apr;391(4):425-33, 2010. Stratmann G, Sall JW, Bell JS, Alvi RS, May LV, Ku B, Dowlatshahi M, Dai R, Bickler PE, Russell I, Lee MT, Hrubos MW, Chiu C. Isoflurane does not affect brain cell death, hippocampal neurogenesis, or long-term neurocognitive outcome in aged rats. Anesthesiology. Feb;112(2):305-15, 2010. Su H, Kim H, Pawlikowska L, Kitamura H, Shen F, Cambier S, Markovics J, Lawton MT, Sidney S, Bollen AW, Kwok PY, Reichardt L, Young WL, Yang GY, Nishimura SL. Reduced expression of integrin alphavbeta8 is associated with brain arteriovenous malformation pathogenesis. Am J Pathol. Feb;176(2):1018-27, 2010. Su H, Yang GY. Treatment of focal brain ischemia with viral vector-mediated gene transfer. Methods Mol Biol. 686:429-46, 2011. Sun K, Zhang Z, Suzuki T, Wenk JF, Stander N, Einstein DR, Saloner DA, Wallace AW, Guccione JM, Ratcliffe MB Dor procedure for dyskinetic anteroapical myocardial infarction fails to improve contractility in the border zone. J Thorac Cardiovasc Surg. Jul;140(1):233-9, 239.e1-4, 2010. Terrando N, Monaco C, Ma D, Foxwell BM, Feldmann M, Maze M. Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline. Proc Natl Acad Sci U S A. Nov 23;107(47):20518-22, 2010. Thoma MS, Maa J, Schiller NB, Litt L. Cholecystectomy in the presence of a large patent foramen ovale: laparoscopic or open? J Clin Anesth. Nov;22(7):553-6, 2010. Tsai TL, Sands LP, Leung JM. An Update on Postoperative Cognitive Dysfunction. Adv Anesth. 28(1):269-284, 2010. Vagefi PA, Klein I, Gelb B, Hameed B, Moff SL, Simko JP, Fix OK, Eilers H, Feiner JR, Ascher NL, Freise CE, Bass NM. Emergent orthotopic liver transplantation for hemorrhage from a giant cavernous hepatic hemangioma: case report and review. J Gastrointest Surg. Jan;15(1):209-14, 2011. Vasilevskis EE, Kuzniewicz MW, Cason BA, Lane RK, Dean ML, Clay T, Rennie DJ, Dudley RA. Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project. J Crit Care. Feb;26(1):65-75, 2011. Vincenti M, Behrends M, Dang K, Park YH, Hirose R, Blasi-Ibanez A, Liu T, Serkova NJ, Niemann CU. Induction of intestinal ischemia reperfusion injury by portal vein outflow occlusion in rats. J Gastroenterol. Nov;45(11):1103-10, 2010.

Vizcaychipi MP, Xu L, Barreto GE, Ma D, Maze M, Giffard RG. Heat Shock Protein 72 Overexpression Prevents Early Postoperative Memory Decline after Orthopedic Surgery under General Anesthesia in Mice. Anesthesiology. Apr;114(4): 891-900, 2011.

Wallace AW, Au S, Cason BA. Association of the pattern of use of perioperative -blockade and postoperative mortality. Anesthesiology. Oct;113(4):794-805, 2010.

Wallace AW, Au S, Cason BA. Perioperative -Blockade: Atenolol Is Associated with Reduced Mortality When Compared to Metoprolol. Anesthesiology. Apr;114(4):824-36, 2011.

Warren HS, Fitting C, Hoff E, Adib-Conquy M, Beasley-Topliffe L, Tesini B, Liang X, Valentine C, Hellman J, Hayden D, Cavaillon JM. Resilience to bacterial infection: difference between species could be due to proteins in serum. J Infect Dis. Jan 15;201(2):223-32, 2010.

Weng Y, Yang L, Corringer PJ, Sonner JM. Anesthetic sensitivity of the Gloeobacter violaceus proton-gated ion channel. Anesth Analg. Jan 1;110(1): 59-63, 2010.

Wenk JF, Zhang Z, Cheng G, Malhotra D, Acevedo-Bolton G, Burger M, Suzuki T, Saloner DA, Wallace AW, Guccione JM, Ratcliffe MB. First finite element model of the left ventricle with mitral valve: insights into ischemic mitral regurgitation. Ann Thorac Surg. May;89(5):1546-53, 2010.

Wenk JF, Sun K, Zhang Z, Soleimani M, Ge L, Saloner D, Wallace AW, Ratcliffe MB, Guccione JM. Regional left ventricular myocardial contractility and stress in a finite element model of posterobasal myocardial infarction. J Biomech Eng. Apr;133(4):044501, 2011.

Werner DF, Swihart A, Rau V, Jia F, Borghese CM, McCracken ML, Iyer S, Fanselow MS, Oh I, Sonner JM, Eger EI 2nd, Harrison NL, Harris RA, Homanics GE. Inhaled anesthetic responses of recombinant receptors and knockin mice harboring 2(S270H/L277A) GABA(A) receptor subunits that are resistant to isoflurane. J Pharmacol Exp Ther. Jan;336(1):134-44, 2011.

Williams O, Houseman BT, Kunkel EJ, Aizenstein B, Hoffman R, Knight ZA, Shokat KM. Discovery of dual inhibitors of the immune cell PI3Ks p110delta and p110gamma: a prototype for new anti-inflammatory drugs. Chem Biol Feb 26;17(2):123-34, 2010.

Woodruff PG, Albert RK, Bailey WC, Casaburi R, Connett JE, Cooper JA Jr, Criner GJ, Curtis JL, Dransfield MT, Han MK, Harnden SM, Kim V, Marchetti N, Martinez FJ, McEvoy CE, Niewoehner DE, Reilly JJ, Rice K, Scanlon PD, Scharf SM, Sciurba FC, Washko GR, Lazarus SC; Copd Clinical Research Network. Randomized trial of zileuton for treatment of COPD exacerbations requiring hospitalization. COPD. Feb;8(1):21-9, 2011.

Woodruff PG, Wolff M, Hohlfeld JM, Krug N, Dransfield MT, Sutherland ER, Criner GJ, Kim V, Prasse A, Nivens MC, Tetzlaff K, Heilker R, Fahy JV. Safety and efficacy of an inhaled epidermal growth factor receptor inhibitor (BIBW 2948 BS) in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. Mar 1;181(5):438-45, 2010.

Yong CM, Sharma M, Ochoa V, Abnousi F, Roberts J, Bass NM, Niemann CU, Shiboski S, Prasad M, Tavakol M, Ports TA, Gregoratos G, Yeghiazarians Y, Boyle AJ. Multivessel coronary artery disease predicts mortality, length of stay, and pressor requirements after liver transplantation. Liver Transpl. Nov;16(11): 1242-8, 2010.

Young WL. Sapere Aude!: the 2009 Excellence in Research Lecture. Anesthesiology. Apr;112(4):802-9, 2010.

Zhang Y, Guzinski M, Eger EI 2nd, Laster MJ, Sharma M, Harris RA, Hemmings HC Jr. Bidirectional modulation of isoflurane potency by intrathecal tetrodotoxin and veratridine in rats. Br J Pharmacol. Feb;159(4):872-8, 2010.

Zhang Z, Tendulkar A, Sun K, Saloner DA, Wallace AW, Ge L, Guccione JM, Ratcliffe MB. Comparison of the Young-Laplace law and finite element based calculation of ventricular wall stress: implications for postinfarct and surgical ventricular remodeling. Ann Thorac Surg. Jan;91(1):150-6, 2011.

Zhou Y, Zou H, Zhang S, Marks JD. Internalizing cancer antibodies from phage libraries selected on tumor cells and yeast-displayed tumor antigens. J Mol Biol. Nov 19;404(1):88-99, 2010.

Zhu X, Bidlingmaier S, Hashizume R, James CD, Berger MS, Liu B. Identification of internalizing human single-chain antibodies targeting brain tumor sphere cells. Mol Cancer Ther. Jul;9(7):2131-41, 2010.


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AnesthesiaNewsSummer 2011 | Vol. 9.1

Upcoming Events UCSF Center for Cerebrovascular ResearchCCR/PPG SEMINARSPresented by the Center for Cerebrovascular Research Department of Anesthesia and Perioperative Care University of California, San Francisco San Francisco General HospitalFor a list of upcoming seminars: http://avm.ucsf.edu/For a list of past seminars:http://avm.ucsf.edu/research/recent_seminars.html

UCSF Maintenance of Certification in Anesthesia Simulator CourseThe UCSF Department of Anesthesia Simulation Center is endorsed by the American Society of Anesthesiologists for meeting the standards required for conducting ABA MOCA® simulation courses. This center offers eight hour, single day courses for four participants. Each participant will play active roles in all four scenarios, including one scenario as the primary anesthesiologist and one as the secondary anesthesiologist. Each scenario is recorded with sound and video, which is used to guide the debriefing conference that follows.Dec. 16, 2011 / Feb. 10 / Mar. 9 / Apr. 20 / or May 18, 2012

COURSE CHAIR:

Adam Collins, MD Associate Professor of Clinical Anesthesia, Director, UCSF Anesthesia Simulator Center

To reserve a spot, please contact Armando Leiva, course administrator, at [email protected].

The Changing Practice of AnesthesiaSeptember 22-25, 2011Hotel Nikko San Francisco / San Francisco, California

COURSE CHAIRS:

Merlin Larson, MD Professor Emeritus in Residence, Department of Anesthesia and Perioperative Care

Binbin Wang, MDAssistant Clinical Professor, Department of Anesthesia and Perioperative Care

Susan Yoo, MDAssistant Clinical Professor, Department of Anesthesia and Perioperative CareProgram and registration information: www.cme.ucsf.edu

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