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Volume 4, Number 2
Winter 2014
In This Issue
The North American MH Registry
A Novel System for Monitoring Surgical Hemoglobin Loss
Education News
Faculty Spotlight
Upcoming Conferences
In the News
Recent Awards
Recent Journal Papers
Notable Publications
Faculty on the Road
Marshall W. Webster, MD Interim Chair, Department of Anesthesiology  
Senior Vice President, UPMC  
A Message from the Interim Chair
  

Happy holidays to all of you and thank you again for your interest in the latest news from our department. We've been busy as usual since our last newsletter in the spring.

 

I continue to serve as Interim Chair as the search for a new chair progresses. The search committee is still in the midst of interviewing candidates. Finding a new leader for what many consider the largest anesthesiology department in the country, in terms of number of faculty, has not been a simple or fast process as expected. Nonetheless, we hope to select and inaugurate a new chair soon in 2015. I again would like to commend our team of faculty, CRNAs, and support staff who have stepped up their efforts to adapt during this transitional period as the search continues.

 

The department was again reputably represented at the American Society of Anesthesiologists (ASA) Annual Meeting. The 2014 event was held from October 11-14, 2015 at the Ernest N. Morial Convention Center in New Orleans, LA. Department residents, fellows, and faculty members delivered 57 presentations, which included 17 resident presentations (five original research and 12 medically challenging cases). Additionally, 12 faculty members and one resident served on ASA and ASA-related committees. We held our yearly alumni reception at ASA 2014 on Sunday, October 12th and were happy to see many familiar faces there.

 

In this issue of the newsletter, we feature a research article on the North American Malignant Hyperthermia (MH) Registry from Director Dr. Barbara W. Brandom. This registry provides medical investigators around the world with information to research how MH presents itself, how it is diagnosed, how it is treated, and how it responds to that treatment. Each case that is entered into the registry increases the knowledge available to researchers working on MH treatment and diagnosis. This issue's clinical article by resident Dr. Gerhardt Konig and Dr. Jonathan H. Waters describes their work with a new system that provides more precise blood loss monitoring during surgery. Drs. Waters and Konig served as beta testers of the Gauss Surgical Triton Fluid Management System™ and completed the first ever cases at UPMC using the system. Their work received attention in the press. In addition, this issue proclaims the numerous successes, accolades, and awards achieved by our phenomenal faculty, who continue to shine and bring prominence to the department.

 

We are proud to report that the department continues to generate increasing clinical revenue, even in this era of financial challenges.We earned $30,842,969 in year-to-date net patient revenue through the first quarter of fiscal year (FY) 2015 compared to $30,017,646 in YTD net patient revenue through 1st quarter FY 2014, which translated to a 2.75% increase. Our department is steadfastly committed to improving quality of care and patient safety while continuously improving productivity and efficiency.

 

Thank you to everyone who has kept in touch with us. We are striving towards improving our alumni database so that we don't lose touch with you and can reach out to alumni with whom we are not currently in touch. If you move or start a new job, please make sure that we have both your current e-mail address and postal mailing address on file so that you continue to receive this newsletter as well as invitations to our conferences and events such as the yearly ASA alumni reception. We also ask that you help us get in touch with any alumni who may not be receiving this newsletter by forwarding it to them so that they can provide their contact info. Anyone can update their contact info by completing our alumni database form online. The form also asks for additional details besides contact information, such as whether you were a former resident, fellow, or faculty member and the years you were active in the department, so that we can improve our records.

 

Please continue telling us what you are up to, what you think of our newsletter, and what kind of articles you would like to see. To submit feedback or suggestions, please contact Christine Heiner here in the department.

 

We wish you and your families a very happy and safe holiday season! 

The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States at the University of Pittsburgh/UPMC

Barbara W. Brandom, MD, Professor and Director, NAMHR

Michael C. Young, NAMHR Technical Manager

Kristee Adams, NAMHR Administrative Assistant

 

Barbara W. Brandom, MD

 

Malignant hyperthermia (MH) is a rare, potentially life-threatening, inherited disorder usually associated with the administration of certain general anesthetics, specifically the volatile anesthetic agents and the neuromuscular blocking agent succinylcholine. In susceptible patients, these drugs can induce a drastic and uncontrolled increase in skeletal muscle metabolism, which overwhelms the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if not quickly treated. Mounting evidence suggests that a small number of patients can also develop MH with exercise and/or on exposure to hot environments. Signs of MH include muscle rigidity, rapid heart rate, high body temperature, muscle breakdown, and increased acid content. Immediate treatment with dantrolene sodium usually reverses the signs of MH. Without proper and prompt dantrolene treatment, mortality is extremely high.

 

Changes in the ryanodine receptor type one gene (RYR1) have been associated with MH in the majority of MH-susceptible families. Of the over 400 RYR1 variants that have been observed, fewer than 40 have been strictly proven to be causative of MH. A few MH-susceptible families have changes in other genes. MH-susceptibility has an autosomal dominant inheritance pattern; children and siblings of a MH-susceptible patient have a 50% chance of inheriting a genetic defect for MH, and hence would also be MH-susceptible. However, carriers for susceptibility may be completely unaware of this risk unless they or a family member develop a life-threatening crisis during anesthesia. In addition, not everyone who has a genetic MH defect develops MH upon each exposure to the triggering anesthetics. The caffeine-halothane contracture test (CHCT) is the standard MH diagnostic test used to determine a patient's susceptibility to MH.

 

The sudden unexpected death of a healthy individual undergoing minor surgery is a tragedy almost incomprehensible in this day of modern medical miracles. Yet this still happens to MH-susceptible patients. Even when treated properly, MH can cause death. Survivors might be left with brain damage, failed kidneys, muscle damage, or impaired function of other major organs.

 

Marilyn G. Larach, MD initiated the North American MH Registry (NAMHR) of the MH Association of the United States (MHAUS) in 1987 with support from Pennsylvania State University, her husband David Larach, MD and the MH Diagnostic Biopsy Centers in the USA. The registry's goal is to acquire, analyze, and disseminate case-specific clinical and laboratory information related to MH-susceptibility. The registry has been located at the University of Pittsburgh (Pitt)/UPMC Department of Anesthesiology since 2000.

 

The NAMHR contains anonymized reports of acute MH events [Adverse Metabolic/Muscular Reaction to Anesthesia (AMRA) reports] and several types of reports that include patient-specific historical and diagnostic data. Most of the AMRAs describe anesthetic-induced MH. In 2014, the NAMHR included over 3,500 reports of in vitro testing for MH susceptibility and over 800 AMRAs. Additionally, over 290 reports chronicle the anesthetic experience of individuals who believe they are MH-susceptible or have experienced MH episodes and have not had CHCTs, but may have had RYR1 exams from diagnostic molecular genetics labs in the USA.

 

The most recent publication from the NAMHR (Larach MG, et al., Malignant Hyperthermia Deaths Related to Inadequate Temperature Monitoring, 2007-2012: A Report from the North American Malignant Hyperthermia Registry of the United States) appeared in Anesthesia Analgesia in December 2014. It is based on AMRAs from cases between January 2007 and December 2012. Eight AMRAs reported deaths from fulminant MH during this interval. Known MH causative mutations or variants of uncertain significance in RYR1 were found in all those who died of fulminant MH and had tissue genetically examined. An editorial focusing on the importance of accurate temperature monitoring during anesthesia accompanied this research report. A podcast from Anesthesia Analgesia is also forthcoming on this subject.

 

Medical students, anesthesiology residents, and student nurse anesthetists from Pitt as well as other schools have worked on projects using NAMHR data. Pitt medical student James Wilde recently used NAMHR resources to survey the incidence of muscular pain or weakness in patients with positive versus negative muscle CHCT results. He presented this work, "Pain Reported by MH-Susceptible Subjects," at the 2011 American Society of Anesthesiology meeting and received the Daniel Massik Award from MHAUS for his presentation. His study confirmed that MH-susceptible patients report more pain than those without MH susceptibility, hopefully paving the way for similar larger-scale studies to examine chronic pain in patients with positive CHCT results.

 

Publication of studies using NAMHR resources remains a major focus of our work. Three research reports are currently in stages of preparation for peer-reviewed publication. Past publications are listed on the MHAUS website. The NAMHR maintains both electronic and paper libraries that include publications from the NAMHR and from many other researchers whose work is relevant to MH. In 2014, the most highly-cited such paper was a 1994 study by Larach MG, et al. "A Clinical Grading Scale to Predict MH Susceptibility" (Anesthesiology. 1994 Apr;80(4):771-9). The original purpose of this grading scale was to identify almost-certain MH cases that would define cut off values for the CHCT. The clinical grading scale is now used by researchers around the world as a standardized descriptor of MH events.

 

In 2012, the Global Rare Disease Registry (GRDR), which is supported by the National Center for Advancing Translational Sciences at the National Institutes of Health, selected the NAMHR through a competitive process to be one of 12 existing groups to participate in their open access, de-identified, web-based registry of common data elements from subjects with different rare diseases. The individual registries maintain the confidentiality of their subjects and work with researchers who develop hypotheses based on GRDR data. In 2013, the NAMHR provided data from 2,123 subjects, with 141 fields per subject, to the GRDR.

 

Because of the expertise available at the University of Pittsburgh and in the NAMHR, The Center for Medical Genetics and Genomics at UPMC has integrated the registry with genetic testing for MH-susceptibility and genetic counseling for MH-susceptible families. The counseling framework facilitates testing of appropriate family members, the avoidance of unnecessary testing and its costs, and referral for confirmatory muscle testing if necessary. The coordination of laboratory results with the NAMHR facilitates identification of new disease-associated mutations and genotype/phenotype correlations. Findings from their work were presented at the American Society of Medical Genetics Conferences in 2007 and 2010.  
Information and Resources on Malignant Hyperthermia

Please visit the MHAUS website for more info on MH, as well as:

Visit the GRDS website to learn more about the GRDR.

 

Visit MHAUS's NAMHR webpage to learn more about the North American MH Registry.

 

Dr. Barbara Brandom is happy to speak with health care providers or families who want to learn more about evaluation of their MH risk. She can be reached at 412-232-5679.

 

MHAUS now provides limited financial support for maintenance of the NAMHR. One can donate to the NAMHR directly through United Way by referencing the MHAUS code number on your donation paperwork: #11560596. Donations are tax-deductible.

 

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A Novel System for Monitoring Surgical Hemoglobin Loss

Gerhardt Konig, MD

PGY-3 (CA2) Resident

 

Jonathan H. Waters, MD

Professor, Anesthesiology & Bioengineering

Chief of Anesthesiology, Magee-Womens Hospital of UPMC

Medical Director, Blood Management Division, Biotronics, Inc.

Medical Director, UPMC Patient Blood Management Program


As anesthesiologists, we track surgical blood loss in order to monitor volume status and the need for blood product transfusion. Intraoperative blood loss, however, is difficult to measure objectively. Visual estimates are usually made by observing all of the different places where blood ends up in the operating room: the suction canisters, the surgical field, the surgical drapes, the floor, and soaked up into laparotomy sponges. These visual estimates, not surprisingly, are very inaccurate, and clinicians tend to underestimate high blood loss volumes and overestimate low volumes. [1-4] The accuracy of these estimates can be improved using simulations and didactic training; however, long-term retention is poor, with no association between experience level and providers' estimation accuracy. [5-7] Besides visual estimates, drapes and surgical sponges have been weighed in some cases. A gravimetric estimate of the amount of blood in the sponged is obtained by subtracting the dry weight from the final weight of the substrates. This method, although arguably more accurate than visual estimation, is impractical for day-to-day use as it is labor-intensive and sensitive to the presence of non-sanguineous fluids (e.g., saline, ascites, amniotic fluid) on the substrates. [8] In two recently-published manuscripts in Anesthesia and Analgesia, we reported the accuracy of a new tablet-based system that uses a computer vision algorithm to measure surgical blood loss in laparotomy sponges, which is both more objective and more accurate than both the visual and gravimetric methods of estimation. [9,10] Laparotomy sponges, each of which can hold up to 100 mL of blood, can account for a significant portion of the total surgical blood loss.

 

The Triton System (Gauss Surgical, Inc., Los Altos, CA) combines mobile imaging with computer vision and machine learning algorithms to measure hemoglobin mass absorbed by surgical sponges. Via a camera-enabled mobile application native to the iPad 2 (Apple Inc., Cupertino, CA), the Triton system allows intraoperative scanning of surgical sponges by the circulating nurse as they are removed from the sterile surgical field as part of the routine process of recording sponge count (Fig. 1). Simultaneously, the captured images of blood-soaked sponges are encrypted and transferred wirelessly to a remote server from the mobile application via secure protocol. Once on the server, photographic and geometric information from relevant regions of interest is parsed and used to measure the hemoglobin on the sponge. The algorithm includes fine-grained detection, classification, and thresholding schemes to filter out the effects of extraneous, non-sanguineous fluids and compensate for variability in intraoperative lighting conditions. A cumulative value of the hemoglobin in the sponge is returned to the mobile display within seconds.


 

Figure 1 (click on photo to enlarge)

In extensive testing in both benchtop and intraoperative studies, we found the system to be very accurate. Strong positive linear correlations and narrow limits of agreement in Bland Altman analysis were found, with a 12% mean percent error in hemoglobin measures. With the ability to more accurately and objectively measure surgical blood loss quickly and easily, real-time accurate monitoring of blood loss is possible. This provides more robust data to support volume resuscitation and transfusion decisions, as well as creating the potential for new forms of real-time clinical decision support. If expected bleeding curves - expected blood loss over time - for a given procedure or perioperative period can be established, patients who are bleeding excessively may be able to be identified earlier when they start to fall off of the curve. We are in the process of collecting data to generate such curves. [11] In addition, knowing the volume of blood contained in laparotomy sponges may improve intraoperative blood recovery efficiency. When a large amount of blood is found to be soaked into surgical sponges, this blood can be rinsed out and directed into cell salvage devices and returned to the patient rather than discarded.

 

 

References 

  1. Guinn NR, Broomer BW, White W, Richardson W, Hill SE. Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery.
    Transfusion 2013;53:2790-4
  2. McCullough TC, Roth JV, Ginsberg PC, Harkaway RC. Estimated blood loss underestimates calculated blood loss during radical retropubic prostatectomy. Urol Int 2004;72:13-6
  3. Seruya M, Oh AK, Boyajian MJ, Myseros JS, Yaun AL, Keating RF. Unreliability of intraoperative estimated blood loss in extended sagittal synostectomies. J Neurosurg Pediatr 2011;8:443-9
  4. Seruya M, Oh AK, Rogers GF, Han KD, Boyajian MJ, Myseros JS, Yaun AL, Keating RF. Blood loss estimation during fronto-orbital advancement: implications for blood transfusion practice and hospital length of stay. J Craniofac Surg 2012;23:1314-7
  5. Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006;113:919-24
  6. Dildy GA 3rd, Paine AR, George NC, Velasco C. Estimating blood loss: can teaching significantly improve visual estimation? Obstet Gynecol 2004;104:601-6
  7. Toledo P, Eosakul ST, Goetz K, Wong CA, Grobman WA. Decay in blood loss estimation skills after web-based didactic training. Simul Healthc 2012;7:18-21
  8. Johar RS, Smith RP. Assessing gravimetric estimation of intraoperative blood loss. J Gynecol Surg 1993;9:151-4
  9. Konig G, Holmes AA, Garcia R, Mendoza JM, Javidroozi M, Satish S, Waters JH. In vitro evaluation of a novel system for monitoring surgical hemoglobin loss. Anesth Analg. 2014 Sep;119(3):595-600.
  10. Holmes AA, Konig G, Ting V, Philip B, Puzio T, Satish S, Waters JH. Clinical evaluation of a novel system for monitoring surgical hemoglobin loss. Anesth Analg. 2014 Sep;119(3):588-94.
  11. Konig G, Philip B, Ting V, Abbi G, Adams G, Satish S, Waters JH. Bleeding Curves: Time-course Assessment of Surgical Hemoglobin Loss. American Society of Anesthesiologists Annual Meeting, New Orleans LA, October 13th 2014.

Articles by Drs. Konig and Waters on Blood Loss Monitoring Generate Media Attention

 

The articles "Clinical Evaluation of a Novel System for Monitoring Surgical Hemoglobin Loss" and "In Vitro Evaluation of a Novel System for Monitoring Surgical Hemoglobin Loss" by Drs. Konig and Waters and colleagues were published in the September 2014 issue of Anesthesia & Analgesia. Both papers describe their research team's use of the Gauss Surgical Triton Fluid Management System™ to monitor surgical blood loss, serving as beta testers of the device and completing the first ever cases at UPMC using the system. The publications were featured in two AA2day podcasts on August 26, 2014: "Blood Loss in Sponges Determined Using a New System" and "The Clinical Application of an iPad Device to Measure Blood Lost on Laparotomy Sponges." Gauss surgical also issued a press release, which resulted in publicity in Virtual-Strategy Magazine and MobiHealthNews.
    

Education News

 

Rita M. Patel, MD

Professor and Vice Chair for Education, Department of Anesthesiology

Associate Dean for Graduate 

Medical Education, University of Pittsburgh School of Medicine

Designated Institutional Official,
 UPMC Medical Education





The department continues to excel in the education of medical students, residents, fellows, and faculty. Our educational programs are recognized as among the best in the nation, and we have much to report since the last department newsletter in the spring.

 

Our annual Resident and Fellow Graduation Ceremony was held on June 13, 2014 at the University Club. Nineteen residents and 42 fellows graduated. In the fall, we learned that our 2014 graduating resident class had a 100% pass rate on the American Board of Anesthesiology (ABA) certifying examination. The current CA-2 class also had a 100% pass rate on the new ABA Basic Examination. We began academic year 2014-2015 with 71 residents: 12 new Clinical Base Year (CBY) residents, 20 CA-1 residents (including eight new CA-1 residents), 20 CA-2, and 19 CA-3 residents. Dr.  Keith M. Vogt was elected Chief Resident and Drs. Patrick J. Hackett and Jeffrey G. Moore were chosen to share the Associate Chief role.

 

In September, the Pittsburgh Business Times reported that the physician network Doximity partnered with U.S. News & World Report to release a report evaluating US medical residency programs. The report ranked the UPMC Anesthesiology Residency Program #10 in the nation.
  

 

We recently made several curriculum changes to enhance the resident training experience. The CBY curriculum added a new lecture-based rotation, "Anesthesiology Professional Practice," under the direction of Dr. Ted Sakai. This rotation covers areas not typically taught during clinical residencies such as research principles, presentation skills, leadership, patient safety, and medico-legal concerns. The rotation culminated in a mentored meeting experience at the 2014 ASA meeting.  Also, the CBY, CA-1, CA-2, and CA-3 didactic series, including "Evidenced Based Medicine" sessions, are now recorded using Camtasia and posted to the GME website MedHub for future reference.

 

This fall, we implemented a new Grand Rounds system, with Dr. Charles Boucek as the Director of the Anesthesiology Grand Rounds Series and the newly formed Grand Rounds Advisory Committee. In collaboration with the Center for Continuing Education in the Health Sciences and UPMC Media, Grand Rounds modules are now recorded each month in addition to live audience Journal Clubs and Visiting Professor/Key Note sessions, which are also recorded and posted for web viewing.The Residency Program hosted the ninth annual PARRC conference at UPMC Shadyside on May 10, 2014 under the direction of Course Director Dr. Ted Sakai. PARRC Planning Committee members included Drs. James Ibinson, Keith Vogt, David G. Metro, and Shawn T. Beaman, as well as Barb Novak Chismar (Project Manager) and Sandra Hirsch (Research and Training Coordinator). PARRC is an opportunity for residents and faculty to learn about current, cutting edge research by anesthesiology residents from seven residency programs across the state of Pennsylvania. Both original research and case reports were submitted as oral presentations and posters, representing scholarly activities performed in each institution. Overall, 24 oral presentations and 68 posters were presented by residents from seven anesthesiology residency programs. UPMC was represented by 16 residents who presented posters and six who presented oral presentations.

 

On July 1, 2014, Dr. Ryan Romeo was appointed Associate Program Director for our Obstetric Anesthesiology Fellowship Program, and Dennis P. Phillips, DO was appointed Associate Program Director of our Anesthesiology Critical Care Medicine (CCM) Fellowship Program. The Anesthesiology CCM Fellowship Program also concluded its first match through the San Francisco Match Program. Forty-seven candidates applied for and filled four fellowship positions.

 

The department's Adult Cardiothoracic Anesthesiology Fellowship Program, directed by Dr. Erin A. Sullivan and initially accredited in 2010, recently received continued accreditation status from the Accreditation Council for Graduate Medical Education (ACGME), along with two commendations. The Review Committee commended the program for its "demonstrated substantial compliance with the ACGME's program and/or institutional requirements for graduate medical education without any new citations." The Review Committee also commended the program on its "quality of leadership, organization and record of scholarship, as well as for the dedication of one morning every week for teaching." With this continued accreditation, the program is transitioning into the ACGME's Next Accreditation System (NAS). The NAS is a new outcomes-based accreditation process through which the doctors of tomorrow will be measured for their competency in performing the essential tasks necessary for clinical practice in the 21st century. The program's first Self-Study Visit is scheduled for April 2022 in alignment with the core Anesthesiology Residency Program's visit. 

 

On July 1, 2014, Dr. Scott Brancolini was appointed the new Program Director for the Pain Medicine Fellowship Program. In October 2014, the Pain Medicine Fellowship participated in the National Residency Matching Program for the first time and the fellowship matched nine of nine positions offered. 

 

We also help to shape graduate medical education at the national level. I chair the Academic Home and Scholarship Committee for the American Association of Medical Colleges (AAMC) Group on Resident Affairs. The committee's work culminated in a presentation, "Promoting Scholarship in Graduate Medical Education" at the national AAMC meeting in November 2014. In addition, I also served on the ACGME committees for the development of national milestones for obstetric anesthesiology fellowships and anesthesiology residency programs.

 

Earlier this year, Drs. Shawn T. Beaman and Erin A. Sullivan were selected to serve as an examiner and a senior editor/exam content developer, respectively, for the ABA Part 2 Examination. The ABA examines and certifies physicians who complete an accredited program of anesthesiology training in the United States and voluntarily apply to the Board for certification or maintenance of certification.

 

Finally, Dr. Franklyn P. Cladis, director of our Pediatric Anesthesiology Fellowship, and Dr. A. Murat Kaynar, director of our Anesthesiology CCM Fellowship program, were elected as members of the Association of University Anesthesiologist (AUA) during the AUA Annual Business meeting in April. The AUA's mission is to advance the Art & Science of Anesthesiology by encouraging its members to pursue original investigations in the clinic and in the laboratory, develop the method of teaching anesthesiology, and freely and informally interchange ideas. AUA members are nominated and elected based on excellence in teaching, administration, and research.

   

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Faculty Spotlight: David G. Metro, MD

 

David G. Metro, MD is a Professor of Anesthesiology at the University of Pittsburgh School of Medicine and Director of our department's Anesthesiology Residency Program, which was recently ranked as one of the top residency programs in the nation. He has been a member of the Department of Anesthesiology at the University of Pittsburgh for over fifteen years.

 

Dr. Metro graduated from the University of Pittsburgh with a BS in biological sciences and due to his superior scholastic performance, was granted early admittance to the University of Pittsburgh School of Medicine. He received his MD in 1994, focusing on perioperative medicine; he completed a transitional year program at Mercy Hospital of Pittsburgh (now UPMC Mercy) and subsequently his anesthesiology residency at the University of Pittsburgh.  He joined the faculty in our department in 1998. 

 

Throughout his career in the UPMC/Pitt Department of Anesthesiology, Dr. Metro has proven his excellence in teaching and leading educational programs. As his career has progressed, he has held various positions in education, including Medical Student Director, Chair of the Residency Selection Committee, Chair of Residency Program Review Committee, Associate Residency Program Director, and currently, Residency Program Director.

 

Under his tenure as Associate Program Director of the Anesthesiology Residency Program, he assisted then-Program Director Dr. Rita M. Patel in all aspects of managing the program. In 2006, he aided in the Accreditation Council for Graduate Medical Education (ACGME) review for the residency program, which resulted in a full five-year accreditation. He was then named Residency Program Director and led another review in 2011.  This second review yielded another five-year accreditation and has since been upgraded to a 10-year accreditation in 2013 under the newest ACGME system. 

 

As Program Director of the Anesthesiology Residency Program, Dr. Metro is responsible for all aspects of resident training within the department.  He has been able to expand the curriculum to include new areas of anesthesiology and new technologies such as simulation and increase residents' international exposure. Residents not only train at UPMC hospitals in the US; Dr. Metro has developed and organized international rotations at ISMETT in Palermo, Italy and in third world countries as part of a charitable mission anesthesia initiative. The residency program is considered one of the top programs in the country; residents are selected from some of the top medical students in the world and enter nationally renowned institutions and fellowships upon completion of their training. He has sent graduating residents to programs such as Duke, Harvard, Johns Hopkins, Michigan, Penn, Stanford, Texas Heart, UCLA, UCSD, The University of North Carolina, The University of Washington, and Vanderbilt.

 

Dr. Metro has written 20 published peer-reviewed papers, including 11 as first or senior author. He has edited two published books and written seven book chapters and over 40 abstracts. His book, Avoiding Common Anesthesia Errors (LW&W 2007), which has been translated into five languages, had almost 40 departmental authors and resulted from a collaboration with co-editors from the University of Maryland, Thomas Jefferson University, and the Oregon Health and Science University. It was the first departmental effort on a textbook of this type and has resulted in several similar projects being published by faculty in our department. Dr. Metro's latest textbook, A Case Approach to Perioperative Drug-Drug Interactions (LW&W 2014 - see below) included over 30 departmental authors.  Dr. Metro has donated all proceeds from his textbooks to the Foundation for Anesthesia Education and Research. 

 

Patient safety and quality assurance have also been a major focus for Dr. Metro during his career. He founded the Anesthesiology Resident Patient Safety Committee, the first of its kind at the University of Pittsburgh School of Medicine. The committee is comprised of residents from each level of anesthesiology training with faculty and legal advisors. Their goal is to identify medical errors that occur and use resident input and experience to create improvement. This is accomplished by careful case review, root-cause analysis, policy review, and ultimate determination of factors leading to the error. Once these factors are identified, residents with faculty guidance create educational initiatives. These initiatives are then brought to the rest of the resident trainees by way of didactics, discussions, and other education materials.  The ultimate responsibility of this committee is for all residents to learn from one event and use this knowledge to help prevent future occurrences. Dr. Metro also serves on the UPMC Pain Management Council, System-wide Quality Improvement Committee, and Graduate Medical Education Patient Safety Committee to improve patient outcomes. 

 

He is a member of the American Society of Anesthesiologists, Society of Academic Anesthesiology Associations, Allegheny County Medical Society, Pennsylvania Society of Anesthesiologists, American Medical Association, and the Society for Education in Anesthesia, where he currently serves on the publication committee. 

 

Dr. Metro and his wife Maria and have three children: Luke (age 19), Nicholas (age 16), and Emily (age 14). He is an avid sports fan, especially of Pitt's sports teams; he's held Pitt football and basketball season tickets for 20 years.

 

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Dr. David Metro Co-edits Textbook Including Thirty-Seven Chapters by Department Authors
 


David G. Metro, MD was a co-editor of the recently published textbook A Case Approach to Perioperative Drug-Drug Interactions (Springer, 2014, 668 pages). The book includes an impressive 37 chapters from both current and former physician authors in our department (bolded):

 

 


 

 


 

 

 


 

 

  1. Lovely JA, Esper S, Hutchens M, Wayne T. Nicholson WT, Marcucci C. The Pharmacoepidemiology of Drug Interactions: Why and How They Are Important?
  2. Jernigan JA, Ibinson JW. That Sums It Up: Volatile Anesthetics, Additive MACs
  3. Silipo AT, Planinsic RM, Wittwer ED, Sprung J, Nicholson WT. 1+1+1+1=? Variable Effects of Combined Substances
  4. Gierl B, Gyulai FE. Relax, It's Only Gentamicin: Volatile Anesthetics, Aminoglycoside Antibiotics, Neuromuscular Junction
  5. Jayaraman AL, Gelzinis TA. The Hemodynamic Hole: General Anesthetics, ACE-I, ARBs
  6. Adams P, Rizk NN. Alpha-2 To The Rescue But Beware Bradycardia: Volatile Anesthetics, alpha-2 agents
  7. Manrique AM, Marcucci C, Subramaniam K. Magnesium Mama and the Mad Dad: Magnesium Sulfate, Propofol, Remifentanil, Vecuronium
  8. Yurigan JJ, Oravitz TM. Comfortably Numb: Local Anesthetics
  9. Partyka L, Meng L. Naturally Occurring and Nasty: Cocaine, Propranolol
  10. Webber AM, Cladis FP. The Spinal Countdown: General Anesthesia after Spinal Anesthesia
  11. Peretich KT, Planinsic RM. The Worry That's Always With Us: Now I'm Depressed. Benzodiazepines, Opioids, Propofol
  12. Adams P, Hilmi IA. The Worry That's Always With Us: Tragic But Not Rare. Alprazolam, Clonazepam, and Buprenorphine
  13. Metro DG. Introduction to Part X. Drug-Drug Interactions Involving Neuromuscular Blockade Agents
  14. Feuer MP, Chalifoux TM. Blocked Again: Succinylcholine, Repeated Doses
  15. Shy JC, Metro DG. Irreversibility Sux: Succinylcholine, Neostigmine
  16. Gierl BG, Gyulai FE. Keep an "Ion" The Twitches: Magnesium, Neuromuscular Blockade
  17. Best MW, Beaman ST. An Unexpected Wait: Pancuronium, Mivacurium
  18. Li P, Orebaugh SL. Misusing Mom's Meds: Chronic Amphetamine, Indirect Acting Sympathomimetics
  19. Sniecinski RM, Wittwer ED, Tanaka K, Zaidan J. Seize the Day: Fatal Forty DDI: Tranexamic Acid, Furosemide, Ibuprofen
  20. Cleveland KW, Metro DG. Introduction to Part XVII: Drug-Drug Interactions Involving Foods and Nutrition
  21. Hall Burton DM, Asato M, Boucek C. High Fat Diet (I): No Juice for The Ketotic Kid: Ketosis, Carbohydrates, Seizures
  22. Bane BC, Cain JG. Protein Huffing and Puffing: Theophylline, Dietary Protein, CYP1A2
  23. Lang RS, Meng L. Salty Sam: High Salt Diet, Nitroprusside
  24. McCray J, Orebaugh SL. A Peak Potassium Problem: Salt Substitute, Spironolactone, Lisinopril
  25. Scouras N, Metro DG. Awake? Vitamin C, General Anesthetics
  26. Blasiole B, Beaman ST. Tropical Punch Packing a Real Knockout. Fatal Forty DDI: Grapefruit Juice, Midazolam, CYP3A4
  27. Ball RD, Boretsky K. Peppermint Patty. Fatal Forty DDI: Peppermint, Felodipine, CYP3A4
  28. Webber AM, Dalby PL. From Bleeding Gums to Green Thumbs- A True Story. Fatal Forty DDI: Warfarin, Green Vegetables
  29. Mathai KM, Hutchens M, Krohner RG. I Just Can't Lick This Problem. Fatal Forty DDI: Licorice, Electrolytes, Digoxin
  30. Lin C, Talarico JF. Sommelier's Surprise: Tyramine Rich Foods, MAO-i drugs, Monoamine Oxidase
  31. Ondecko Ligda K, Sullivan EA. Dairy Carefully. Fatal Forty DDI: Dairy, Fluoroquinolone
  32. Kaynar AM, Bhatnagar NK. Cold and Sick, Sick and Cold: Fiber, Thyroxine Replacement, Malabsorption
  33. Kolarcyzk L, Forte PJ. TPN (I): A Review and Two Interactions. TPN Basics and Complications
  34. El-Baghdadi MM, Hilmi IA. Skin and Bones: Starvation, Perioperative Drugs
  35. Hache J, Chalifoux TM. Enough to Make You Sick: Syrup Of Ipecac, General Anesthesia
  36. Gierl B, Romeo R. Caffeine Crash. Fatal Forty DDI: Caffeine, Ethinylestradiol, Ciprofloxacin, CYP1A2
  37. Veneziano G, Mangione M. Caught Yellow-Handed. Fatal Forty DDI: Tumeric, Warfarin, CYP1A2, CYP2C9

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Upcoming Conferences

 

Save the date! The 11th Annual UPMC Regional Anesthesia & Ultrasound Guided Techniques Conference: Update in Acute & Chronic Pain and Liver Transplantation will be held April 18-19, 2015 at Nemacolin Woodlands Resort.  Registration and additional information will be available in January of 2015. Please visit the online registration site in January!



Celebrating 20 Years of WISER: Aiming Beyond Excellence in Healthcare Education

Thursday March 26th, 2015, 6-9pm

Senator John Heinz History Center, 1212 Smallman Street, Pittsburgh, PA 15222. See full details and register online at WISER's website 

 

 

In the News 

 

The Pittsburgh Post-Gazette news story "Eye Color Linked to Pain Tolerance in Pilot Study at Pitt" spotlighted a study presented at the 2014 annual American Pain Society meeting by Inna Belfer, MD, PhD showing that women with different eye colors tolerate pain differently.

 

  

Zongfu Chen, MD was featured in the news story "Radio Waves Knock Out Knee Pain" on ABC in San Antonio.

Zongfu Chen, MD

 

 

PGY4 (CA3) resident Christina H. Lee, MD appeared on Good Morning America with Dr. Andrew-Jaja, the "singing doctor" from Magee Women's Hospital of UPMC, who was featured singing "Happy Birthday" to a baby he delivered via C-section. Christina provided anesthesia care for the patient and can be seen in the video. 

 


 

Michael P. Mangione, MD




 


 KDKA interviewed Michael P. Mangione, MD about a new research study on chronic pain in Veterans.

  

 

An article published in The New York Times focused on research on steroid injections for spinal stenosis that was recently published in The New England Journal of Medicine. Ajay D. Wasan, MD was a co-author on the paper. 


  

Jonathan H. Waters, MD was featured in the article "UPMC is Finding Ways to Squeeze Savings, Prevent Waste," in which he discusses the health system's cost-saving blood salvage efforts.

 

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Recent Honors and Awards

 

(L to R, top row): Shushma Aggarwal, MD; Cheryl Bernstein, MD; 
Barbara W. Brandom, MD; Jacques E. Chelly, MD, PhD, MBA; 
ZongFu Chen, MD 
(L to R, bottom row): Franklyn P. Cladis, MD; Peter J. Davis, MD; 
Andrew Herlich, DMD, MD, FAAP; Jerome Parness MD, PhD; 
Erin A. Sullivan, MD

 

Shushma Aggarwal, MD; Cheryl Bernstein, MD; Barbara W. Brandom, MD; Jacques E. Chelly, MD, PhD, MBA; ZongFu Chen, MD; Franklyn P. Cladis, MD; Peter J. Davis, MD; Andrew Herlich, DMD, MD, FAAP; Jerome Parness MD, PhD; and Erin A. Sullivan, MD were all named in Pittsburgh Magazine's 2014 "Best Doctors" list. More than 450 UPMC physicians were named in 75 areas of expertise. The list was compiled by Best Doctors� and derived from the Best Doctors in America� database, which includes the names and profiles of more than 45,000 of the best doctors in the United States. Physicians are included in the database after an exhaustive peer review. Drs. Aggarwal, Chelly, Chen, Herlich, Parness, and Sullivan were named Best Doctors in the specialty of anesthesiology; Drs. Brandom, Cladis, Davis, Herlich, and Parness were named Best Doctors in the specialty of pediatric anesthesiology; Dr. Sullivan was named in the specialty of pediatric cardiovascular anesthesiology; and Dr. Bernstein was named in the specialty of neurology.
 
 
The scientific exhibit "Auriculotherapy in Anesthesia and Pain" by authors David Alimi, MD; Jacques E. Chelly, MD, PhD, MBA; Mireille Michel-Cherqui, MD; Charles Lin, MD; Touichi Kawabe, MD; and Benjamin Metais won first prize at the 68th PostGraduate Assembly in Anesthesiology in New York NY on December 12-16, 2014.
 
  
Jacques E. Chelly, MD, PhD, MBA was appointed Editor-In-Chief of Journal of Anesthesia and Pain Management.
 

 

Franklyn P. Cladis, MD and A. Murat Kaynar, MD, MPH were elected as members of the Association of University Anesthesiologist (AUA). 

 

 

Franklyn P. Cladis, MD, FAAP was elected to the boards of directors of the Society for Pediatric Anesthesia (SPA) and the Society for Education in Anesthesia (SEA)

Tomas Drabek, MD, PhD

 

 

Tomas Drabek, MD, PhD was awarded a "Best in Category" award for Critical Care, Trauma, and Resuscitation and was selected as a "Best of Meeting" finalist for his abstract "Minocycline Fails to Improve Neurologic and Histologic Outcome after Ventricular Fibrillation Cardiac Arrest in Rats" the International Anesthesia Research Society's (IARS) Annual Meeting and International Science Symposium on May 17-20, 2014.

 

 

Andrew Herlich, DMD, MD, FAAP was voted President-elect of the Pennsylvania Society of Anesthesiologists (PSA) for 2014-2015  

 

 

Gregg E. Homanics, PhD was awarded a five-year extension of his prestigious National Institutes of Health (NIH) MERIT (Method to Extend Research in Time) Award "Ethanol Mechanisms in GABAaR Gene-Targeted Mice." Dr. Homanics' project has been continuously funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the NIH since 1995, first as an R01 award and then as a MERIT award in 2010. This approval will extend funding until 2020. Dr. Homanics is one of three University of Pittsburgh/UPMC Department of Anesthesiology researchers to have held an esteemed MERIT award, making the department the only anesthesiology department in the US to have had three MERIT awardees.

 

 

James Ibinson MD, PhD was honored with a Distinguished Alumnus award from the College of Engineering at The Ohio State University (OSU). Along with the award, he was invited to present a grand rounds lecture for the OSU Department of Anesthesiology and several lectures to the anesthesiology residents and the biomedical engineering students.

Peter Safar, MD


 

The Alliance of Germanic Societies of Pittsburgh and the Austrian-American Cultural Society honored our founding chairman, Peter Safar, MD, on German-Swiss-Austrian-American Day, Saturday, September 13, 2014. A recognition ceremony was held at Teutonia M�nnerchor in the Pittsburgh Northside neighborhood. Dr. Jan D. Smith represented the Safar family in receipt of this great honor. The City of Pittsburgh released a proclamation recognizing the honorees.

 

 

Tetsuro Sakai, MD, PhD was invited as a Visiting Professor to the Yale University School of Medicine Department of Anesthesiology on November 4-5, 2014. Dr. Sakai presented two lectures during his stay:

  • "Complications with Veno-Venous Bypass and Other Monitorings during Liver Transplantation" (lecture for all residents)
  • "Resident Scholarly Activity-The Pittsburgh Experience" (departmental Grand Rounds Lecture)
William Simmons, MD





 

William Simmons, MD received an Exemplary Service Award from the Iota Phi Foundation (Omega Psi Phi Fraternity) for demonstrating superior leadership in the area of medicine on November, 22, 2014. 

 

 

Doreen Soliman, MD was an invited international speaker at the 18th Alexandria Anesthesia & Intensive Care Conference (ASAIC), September 23-25, 2014 in Alexandria, Egypt. She presented two lectures: "Care of the Pediatric Cardiac Patient for Non-cardiac Surgery," and "Foreign Body Aspiration in Children: an Update." She also moderated a case discussion session on challenging pediatric airway scenarios.

 

 

The abstract "The Posterior Insula Reveals Pain vs. Rest Functional Connectivity Differences Not Present with the Anterior Insula" by Keith M. Vogt, MD, PhD (current Chief Resident) and James W. Ibinson MD, PhD (faculty mentor) was selected as the "Best of Category Award" in Pain Mechanisms at the IARS Annual Meeting and International Science Symposium on May 17-20, 2014. This is Dr. Ibinson's lab's second consecutive year winning this distinction at the IARS meeting.

 

 

Brian A. Williams, MD, MBA won several prestigious awards since our last newsletter in the spring:

(L) - RADM Dr. Boris Lushniak, Acting Surgeon General of the United States, congratulates Dr. Williams at the ASMUS awards ceremony; (R) Dr. Carolyn Clancy, VA Undersecretary of Health with Dr. Williams at the ASMUS awards ceremony
  • He was presented with the 2014 Pittsburgh Federal Executive Board Excellence in Government Award in the category "Outstanding Contribution to Medical Science."
  • He received the 2014 Research & Development Award from AMSUS - The Society of Federal Health Professionals on December 2-5, 2014.
  • He was chosen as VA Pittsburgh Healthcare System's (VAPHS) outstanding physician of the year for his innovative work that has significantly improved post-surgery outcomes for veterans.
  • The VAPHS Regional Anesthesiology Team, led by Dr. Williams, received the Platinum Award at the 2014 Fine Foundation Awards for Teamwork Excellence in Health Care on November 12, 2014. This multidisciplinary team award was the highest honor bestowed at the ceremony. The team, comprised of our anesthesiologists and rotating residents, along with VAPHS Staff CRNAs and RN Block Specialists, was recognized for their work with regional anesthesia, including pain prevention and significant reduction of morbidity and mortality after joint replacement surgery. Our department's anesthesiologists who are active block team members include Drs. Arun Bhandari, Catalin Ezaru, Trina Huwe, Jim Ibinson, Hulimangala Rakesh, and Shashank Saxena. Current residents who have contributed as authors to publications originating from the VAPHS Regional Anesthesiology team include Drs. Andrew Gentilin, Patrick Hackett, Pulsar Li, Jeffrey Moore, Nicholas Schott, and Sokpoleak So. The award ceremony was featured in a Pittsburgh Post-Gazette story and a video about the award featuring Dr. Williams and the VAPHS Regional Team is on YouTube. Congratulations to the VAPHS Regional Team for this prestigious honor.Congratulations and thanks also to Chief of VAPHS Anesthesiology Dr. Michael Mangione for his overall support of the program.   

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Recent Journal Papers

Aguayo LG, Castro P, Mariqueo T, Munoz B, Xiong W, Zhang L, Lovinger DM, Homanics GE. Altered Sedative Effects of Ethanol in Mice with alpha1 Glycine Receptor Subunits that are Insensitive to Gbetagamma Modulation. Neuropsychopharmacology. 2014; 7(10):100.

 

Albers KM, Zhang XL, Diges CM, Schwartz ES, Yang CI, Davis BM, Gold MS. Artemin Growth Factor Increases Nicotinic Cholinergic Receptor Subunit Expression and Activity in Nociceptive Sensory Neurons. Mol Pain. 2014; 10(31):1744-8069.

 

Beckel JM, Argall AJ, Lim JC, Xia J, Lu W, Coffey EE, Macarak EJ, Shahidullah M, Delamere NA, Zode GS, Sheffield VC, Shestopalov VI, Laties AM, Mitchell CH. Mechanosensitive Release of Adenosine 5'-triphosphate Through Pannexin Channels and Mechanosensitive Upregulation of Pannexin Channels in Optic Nerve Head Astrocytes: A Mechanism for Purinergic Involvement in Chronic Strain. Glia. 2014; 62(9):1486-501.

 

Badhwar V, Esper S, Brooks M, Mulukutla S, Hardison R, Mallios D, Chu D, Wei L, Subramaniam K. Extubating in the Operating Room after Adult Cardiac Surgery Safely Improves Outcomes And Lowers Costs. The Journal of Thoracic and Cardiovascular Surgery. Published Online: July 31, 2014.

 

Belfer I, Greco CM, Lokshin A, Vulakovich K, Landsittel D, Dai F, Crossett L, Chelly JE. The Design and Methods of Genetic Studies on Acute and Chronic Postoperative Pain in Patients after Total Knee Replacement. Pain Med. 2014; 15(9):1590-602.

 

Belfer I, Young EE, Diatchenko L. Letting the Gene out of the Bottle: OPRM1 Interactions. Anesthesiology. 2014 Oct; 121(4):678-80.

 

Bermudez CA, Shiose A, Esper SA, Shigemura N, D'Cunha J, Bhama JK, Richards TJ, Arlia P, Crespo MM, Pilewski JM. Outcomes of Intraoperative Venoarterial Extracorporeal Membrane Oxygenation versus Cardiopulmonary Bypass during Lung Transplantation. Ann Thorac Surg. 2014; 98(6):1936-43.

 

Boisen ML, Collins RA, Yazer MH, Waters JH. Pretransfusion Testing and Transfusion of Uncrossmatched Erythrocytes. Anesthesiology. Online First: September 11, 2014.

 

Bottiger BA, Esper SA, Stafford-Smith M. Pain Management Strategies for Thoracotomy and Thoracic Pain Syndromes. Semin Cardiothorac Vasc Anesth. 2014; 18(1):45-56.

 

Brandom BW. From the Journal Archives: Masseter Muscle Rigidity: A Dose-Related Drug Effect or an Early Manifestation of a Rare Potentially Fatal Pharmacogenetic Disorder. Can J Anaesth. 2014; 61(8):767-9.

 

Brumovsky PR, La J-H, Gebhart GF. Distribution across Tissue Layers of Extrinsic Nerves Innervating the Mouse Colorectum - An in Vitro Anterograde Tracing Study. Neurogastroenterology & Motility. Article first published online: September 3, 2014.

 

Callahan P, Pinto SJ, Kurland G, Cain JG, Motoyama EK, Weiner DJ. Dexmedetomidine for Infant Pulmonary Function Testing. Pediatr Pulmonol. 2014; 3(10):23100.

 

Cladis F, Kumar A, Grunwaldt L, Otteson T, Ford M, Losee JE. Pierre Robin Sequence: A Perioperative Review. Anesth Analg. 2014; 119(2):400-12.

 

Cramer JM, Zimmerman MW, Thompson T, Homanics GE, Lazo JS, Lagasse E. Deletion of Ptp4a3 Reduces Clonogenicity and Tumor-initiation Ability of Colitis-Associated Cancer Cells in Mice. Stem Cell Res. 2014;13(1):164-71.

 

Dede O, Motoyama EK, Yang CI, Mutich RL, Walczak SA, Bowles AJ, Deeney VF. Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis. J Bone Joint Surg Am. 2014; 96(15):1295-302.

 

Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain. J Manipulative Physiol Ther. 2014; 37(7):449-67.

 

Dolman AJ, Loggia ML, Edwards RR, Gollub RL, Kong J, Napadow V, Wasan AD. Phenotype Matters: The Absence of a Positive Association between Cortical Thinning and Chronic Low Back Pain When Controlling for Salient Clinical Variables. Clin J Pain. 2014; 30(10):839-45.

 

Drabek T, Foley LM, Janata A, Stezoski J, Kevin Hitchens T, Manole MD, Kochanek PM. Global and Regional Differences in Cerebral Blood Flow after Asphyxial Versus Ventricular Fibrillation Cardiac Arrest in Rats Using ASL-MRI. Resuscitation. 2014 July; 85(7):964-71.

 

Drabek T, Janata A, Wilson CD, Stezoski JP, Janesko-Feldman K, Tisherman SA, Foley LM, Verrier JD, Kochanek P. Minocycline Attenuates Brain Tissue Levels of TNF-Produced by Neurons after Prolonged Hypothermic Cardiac Arrest in Rats. Resuscitation. 2014 Feb; 85(5):284-91.

 

Drabek T, Wilson CD, Janata A, Stezoski JP, Janesko-Feldman K, Garman RH, Tisherman SA, Kochanek PM. Unique Brain Region-Dependent Cytokine Signatures After Prolonged Hypothermic Cardiac Arrest in Rats. Therapeutic Hypothermia and Temperature Management. November 25, 2014.

 

Esper SA, Levy JH, Waters JH, Welsby IJ. Extracorporeal Membrane Oxygenation in the Adult: A Review of Anticoagulation Monitoring and Transfusion. Anesthesia & Analgesia. 2014; 118(4):731-43.

 

Esper S, Pinsky M. Arterial Waveform Analysis. Best Pract Res Clin Anaesthesiol. 2014; 28(4):363-80.

 

Esper SA, Subramaniam K, Tanaka KA. Pathophysiology of Cardiopulmonary Bypass: Current Strategies for the Prevention and Treatment of Anemia, Coagulopathy, and Organ Dysfunction. Semin Cardiothorac Vasc Anesth. 2014 May 29; 18(2):161-76.

 

Fang Q, Qian X, An J, Wen H, Wu J, Cope DK, Williams JP. Pre-induction Dexamethasone Does Not Decrease Postoperative Nausea and Vomiting after Microvascular Decompression for Facial Spasm. Chin Med J. 2014; 127(14):2711-2.

 

Fang Q, Gao G, An J, Liu C, Qian X, Wen H, Wu J, Wang Y, Cope DK, Williams JP. Total Intravenous Anesthesia for Cesarean Section in a Pregnant Woman with Spinal Muscular Atrophy. Chin Med J. 2014; 127(18):3350-1.

 

Finegersh A, Homanics GE. Acute Ethanol Alters Multiple Histone Modifications at Model Gene Promoters in the Cerebral Cortex. Alcohol Clin Exp Res. 2014; 38(7):1865-73.

 

Finegersh A, Homanics GE. Paternal Alcohol Exposure Reduces Alcohol Drinking and Increases Behavioral Sensitivity to Alcohol Selectively in Male Offspring. PLoS One. 2014; 9(6).

 

Fisk Z, Luke C. A Case for the Continued Importance of Continuous Peripheral Nerve Block Catheters. ARSA Newsletter. 2014 November.

 

Gelzinis TA. New Insights into Diastolic Dysfunction and Heart Failure with Preserved Ejection Fraction. Seminars in Cardiothoracic and Vascular Anesthesia. 2014 June 1, 2014; 18(2):208-17.

 

Guha S, Coffey EE, Lu W, Lim JC, Beckel JM, Laties AM, Boesze-Battaglia K, Mitchell CH. Approaches for Detecting Lysosomal Alkalinization and Impaired Degradation in Fresh and Cultured RPE Cells: Evidence for a Role in Retinal Degenerations. Exp Eye Res. 2014; 126:68-76.

 

Haas T, Fries D, Tanaka KA, Asmis L, Curry NS, Sch�chl H. Usefulness of Standard Plasma Coagulation Tests in the Management of Perioperative Coagulopathic Bleeding: is There any Evidence? British Journal of Anaesthesia. September 8, 2014.

 

Hachisuka J, Ross SE. Understanding the Switch from Pain-to-itch in Dermatitis. Neurosci Lett. 2014; 579:188-9.

 

Hall Burton DM, Boretsky KR. A Comparison of Paravertebral Nerve Block Catheters and Thoracic Epidural Catheters for Postoperative Analgesia Following the Nuss Procedure for Pectus Excavatum Repair. Paediatr Anaesth. 2014; 24(5):516-20.

 

Henao JP, Peperzak KA, Lichvar AB, Orebaugh SL, Skledar SJ, Pippi MA, Williams BA. Extrapyramidal Symptoms Following Administration of Oral Perphenazine 4 or 8 mg: An 11-year Retrospective Analysis. European Journal of Anaesthesiology. 2014 Apr; 31(4):231-5.

 

Hibbard KM, Orebaugh SL, Kentor ML, Williams BA. Pain Patterns in Anterior Cruciate Ligament Reconstruction, and the Utility of Sciatic Nerve Blockade for Postoperative Analgesia. J J Anes Res. 2014, 1(1): 001.

 

Holmes AA, Konig G, Ting V, Philip B, Puzio T, Satish S, Waters JH. Clinical Evaluation of a Novel System for Monitoring Surgical Hemoglobin Loss. Anesthesia & Analgesia. 2014; 119(3):588-94.

 

Honavar J, Bradley E, Bradley K, Oh JY, Vallejo MO, Kelley EE, Cantu-Medellin N, Doran S, Dell'italia LJ, Matalon S, Patel RP. Chlorine Gas Exposure Disrupts Nitric Oxide Homeostasis in the Pulmonary Vasculature. Toxicology. 2014; 321:96-102.

 

Hudson M, Rietbergen H, Chelly JE. Sugammadex is Effective in Reversing Rocuronium in the Presence of Antibiotics. BMC Anesthesiology. 2014; 14(69).

 

Ibinson J, Ezaru C, Cormican D, Mangione M. GlideScope Use Improves Intubation Success Rates: an Observational Study using Propensity Score Matching. BMC Anesthesiology. 2014; 14:

 

Kander T, Tanaka KA, Norstrom E, Persson J, Schott U. The Effect and Duration of Prophylactic Platelet Transfusions before Insertion of a Central Venous Catheter in Patients with Bone Marrow Failure Evaluated With Point-Of-Care Methods and Flow Cytometry. Anesth Analg. 2014; 119(4):882-90.

 

Kardon AP, Polgar E, Hachisuka J, Snyder LM, Cameron D, Savage S, Cai X, Karnup S, Fan CR, Hemenway GM, Bernard CS, Schwartz ES, Nagase H, Schwarzer C, Watanabe M, Furuta T, Kaneko T, Koerber HR, Todd AJ, Ross SE. Dynorphin Acts as a Neuromodulator to Inhibit Itch in the Dorsal Horn of the Spinal Cord. Neuron. 2014; 82(3):573-86.

 

Kaynar A, Yende S, Zhu L, Frederick DR, Chambers R, Burton CL, Carter M, Stolz D, Agostini B, Gregory AD, Nagarajan S, Shapiro SD, Angus DC. Effects of Intra-Abdominal Sepsis on Atherosclerosis in Mice. Crit Care. 2014; 18(5):469.

 

Kertai MD, Esper SA, Akushevich I, Voora D, Ginsburg GS, Stafford-Smith M, Grichnik K, Newman MF, Fontes ML, Smith P, Podgoreanu MV, Mathew JP. Preoperative CYP2D6 Metabolism-dependent Beta-Blocker Use and Mortality after Coronary Artery Bypass Grafting Surgery. J Thorac Cardiovasc Surg. 2014; 147(4):1368-75.

 

Konig G, Holmes AA, Garcia R, Mendoza JM, Javidroozi M, Satish S, Waters JH. In Vitro Evaluation of a Novel System for Monitoring Surgical Hemoglobin Loss. Anesthesia & Analgesia. 2014; 119(3):595-600.

 

Kotha R, Orebaugh SL. Shoulder Surgery in the Beach Chair Position: Current Anesthetic Concepts and Controversies in Hemodynamic Management and Cerebral Perfusion. Advances in Anesthesia. 2014; 32(1):37-57.

 

La JH, Gebhart GF. Condition-specific Role of Colonic Inflammatory Molecules in Persistent Functional Colorectal Hypersensitivity in the Mouse. Neurogastroenterol Motil. 2014; 26(12):1730-42.

 

Larach MG, Brandom BW, Allen GC, Gronert GA, Lehman EB. Malignant Hyperthermia Deaths Related to Inadequate Temperature Monitoring, 2007-2012: A Report from The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States. Anesthesia & Analgesia. Publish Ahead of Print September 26, 2014.

 

Lu SY, Tanaka KA, Abuelkasem E, Planinsic RM, Sakai T. Clinical Applicability of Rapid Thrombelastography and Functional Fibrinogen Thrombelastography to Adult Liver Transplantation. Liver Transplantation. 2014; 20(9):1097-105.

 

Marcus DA, Bernstein CD, Haq A, Breuer P. Including a Range of Outcome Targets Offers a Broader View of Fibromyalgia Treatment Outcome: Results from a Retrospective Review of Multidisciplinary Treatment. Musculoskeletal Care. 2014; 12(2):74-81.

 

Marcus DA, Blazek-O'Neill B, Kopar JL. Symptom Reduction Identified after Offering Animal-Assisted Activity at a Cancer Infusion Center. Am J Hosp Palliat Care. 2014; 31(4):420-1.

 

Mariqueo TA, Agurto A, Munoz B, San Martin L, Coronado C, Fernandez-Perez EJ, Murath P, Sanchez A, Homanics GE, Aguayo LG. Effects of Ethanol on Glycinergic Synaptic Currents in Mouse Spinal Cord Neurons. J Neurophysiol. 2014; 111(10):1940-8.

 

McHugh RK, Fitzmaurice GM, Carroll KM, Griffin ML, Hill KP, Wasan AD, Weiss RD. Assessing Craving and its Relationship to Subsequent Prescription Opioid Use Among Treatment-Seeking Prescription Opioid Dependent Patients. Drug Alcohol Depend. 2014; 145:121-6.

 

McHugh SM, Shaffer EG, Cormican DS, Beaman ST, Forte PJ, Metro DG. Use of Social Media Resources by Applicants during the Residency Selection Process. Journal of Education in Perioperative Medicine. 2014 January-June; XVI(V).

 

McGowan FXJ, Davis PJ. The Advanced Pediatric Anesthesiology Fellowship: Moving Beyond a Clinical Apprenticeship [Editorial]. Anesthesia & Analgesia. 2014; 118(4):701-3.

 

Mowrey DD, Kinde MN, Xu Y, Tang P. Atomistic Insights into Human Cys-loop Receptors by Solution NMR: Biochim Biophys Acta. 2014 Mar 28. pii: S0005-2736(14)00108-4.

 

Murray AW, Smith JD, Ibinson JW. Diffuse Alveolar Hemorrhage, Anesthesia, and Cannabis. Ann Am Thorac Soc. 2014; 11(8):1338-9.

 

Naito A, Muchhala KH, Asatryan L, Trudell JR, Homanics GE, Perkins DI, Davies DL, Alkana RL. Glycine and GABAA Ultra-Sensitive Ethanol Receptors as Novel Tools for Alcohol and Brain Research. Mol Pharmacol. 2014; 86(6):635-46.

 

Nakayama Y, Nakajima Y, Tanaka KA, Sessler DI, Maeda S, Iida J, Ogawa S, Mizobe T. Thromboelastometry-guided Intraoperative Haemostatic Management Reduces Bleeding and Red Cell Transfusion After Paediatric Cardiac Surgery. Br J Anaesth. 2014; 10.

 

Nates JL, Cattano D, Chelly JE, Doursout MF. Study of Acute Hemocoagulation Changes in a Porcine Endotoxemic Shock Model Using Thrombelastography. Transl Res. 2014; 16(14):00308-9.

 

Ogawa S, Tanaka KA, Nakajima Y, Nakayama Y, Takeshita J, Arai M, Mizobe T. Fibrinogen Measurements in Plasma and Whole Blood: A Performance Evaluation Study of the Dry-Hematology System. Anesthesia & Analgesia. Publish Ahead of Print September 15, 2014.

 

Pizzi LJ, Chelly JE, Marlin V. Nursing Time Study for the Administration of a PRN Oral Analgesic on an Orthopedic Postoperative Unit. Pain Manag Nurs. 2014; 15(3):603-8.

 

Raval JS, Waters JH, Triulzi DJ, Yazer MH. Complications Following an Unnecessary Peri-Operative Plasma Transfusion and Literature Review. Asian J Transfus Sci. 2014; 8(2):139-41.

 

Ross S, Edwards K, McFadden K, Bigeleisein PE, Orebaugh SL. Pressures of Injection in a Cadaver Model of Peripheral Nerve Blockade. Journal of Anesthesia and Clinical Research. 2014; 5(9).

 

Sambuughin N, Zvaritch E, Kraeva N, Sizova O, Sivak E, Dickson K, Weglinski M, Capacchione J, Muldoon S, Riazi S, Hamilton S, Brandom B, MacLennan DH. Exome Analysis Identifies Brody Myopathy in a Family Diagnosed with Malignant Hyperthermia Susceptibility. Molecular Genetics & Genomic Medicine. Article first published online: June 6, 2014.

 

Samuelsson AR, Brandon NR, Tang P, Xu Y. Cellular Registration without Behavioral Recall of Olfactory Sensory Input under General Anesthesia. Anesthesiology. 2014; 120(4):890-905.

 

Saxena S, So S, Williams BA, Mangione MP. The Role of Diagnostic Ultrasound-Guided Selective Common Peroneal Nerve Block in a Patient with Negative Imaging but with Classic Neuropathic Pain after Below Knee Amputation. A&A Case Reports. 2014; 3(2):20-2.

 

Scheff NN, Yilmaz E, Gold MS. The Properties, Distribution and Function of Na+-Ca2+ Exchanger Isoforms in Rat Cutaneous Sensory Neurons. J Physiol. 2014; 592 (Pt 22):4969-93.

 

Schreiber KL, Campbell C, Martel MO, Greenbaum S, Wasan AD, Borsook D, Jamison RN, Edwards RR. Distraction Analgesia in Chronic Pain Patients: The Impact of Catastrophizing. Anesthesiology. 2014; 121(6):1292-301.

 

Shnol H, Paul N, Belfer I. Labor Pain Mechanisms. Int Anesthesiol Clin. 2014; 52(3):1-17.

 

Smith M, Triulzi DJ, Yazer MH, Rollins-Raval MA, Waters JH, Raval JS. Implementation of a Simple Electronic Transfusion Alert System Decreases Inappropriate Ordering of Packed Red Blood Cells and Plasma in a Multi-Hospital Health Care System. Transfus Apher Sci. 2014; 51(3):53-8.

 

Srinath A, Young E, Szigethy E. Pain Management in Patients with Inflammatory Bowel Disease: Translational Approaches from Bench to Bedside. Inflamm Bowel Dis. 2014; 20(12):2433-49.

 

Subramaniam K, Wells CMQ. Intraoperative Transesophageal Echocardiography: A Safeguard for Cardiovascular Surgery [Editorial]. Journal of Perioperative Echocardiography. 2014; 2(2):49-50.

 

Tillman TS, Seyoum E, Mowrey DD, Xu Y, Tang P. ELIC-alpha7 Nicotinic Acetylcholine Receptor (alpha7nAChR) Chimeras Reveal a Prominent Role of the Extracellular-Transmembrane Domain Interface in Allosteric Modulation. J Biol Chem. 2014; 289(20):13851-7.

 

Tress EE, Clark RS, Foley LM, Alexander H, Hickey RW, Drabek T, Kochanek PM, Manole MD. Blood Brain Barrier is Impermeable to Solutes and Permeable to Water after Experimental Pediatric Cardiac Arrest. Neurosci Lett. 2014; 578:17-21.

 

Tsai MH, Hudson ME, Emerick TD, McFadden DW. The True Relevance of First-Case Start Delays. Am J Surg. October 13, 2014.

 

Vallejo MC, Silipo AT, Camann WR. In Memory of Ezzat I. Abouleish, MD. Society for Obstetric Anesthesia and Perinatology (SOAP) Newsletter. 2014 Summer: 25-6.

 

Visoiu M. Outpatient Analgesia via Paravertebral Peripheral Nerve Block Catheter and On-Q Pump-A Case Series. Paediatr Anaesth. 2014; 24(8):875-8.

 

Visoiu M. Usefulness of Beta-2-Transferrin to Detect an Unforeseen Complication Following Paravertebral Nerve Block [Letter to the Editor]. Journal of Clinical Anesthesia. 2014 June; 26(4):336-8.

 

Visoiu M, Cassara A, Yang CI. Bilateral Paravertebral Blockade (T7-10) Versus Incisional Local Anesthetic Administration for Pediatric Laparoscopic Cholecystectomy: A Prospective, Randomized Clinical Study. Anesthesia & Analgesia. Publish Ahead of Print: November 25, 2014.

 

Visoiu M, Hsu S. Where is the Catheter? An Unexpected Complication from a Paravertebral Catheter Placement. J Anesth Crit Care Open Access. 2014; 1(5).

 

Visoiu M, Joy LN, Grudziak JS, Chelly JE. The Effectiveness of Ambulatory Continuous Peripheral Nerve Blocks for Postoperative Pain Management in Children and Adolescents. Pediatric Anesthesia. 2014 Nov; 24(11):1141-8.

 

Visoiu M, Joy LN, Scholz S, Chelly JE. Continuous Paravertebral Nerve Blockade for Postoperative Analgesia after Video-Assisted Thoracoscopic Surgery and Chemical Pleurodesis in Children-A Case Series. Journal of Anesthesia and Critical Care. 2014; 1(3):00016.

 

Wasan AD. Efficacy vs Effectiveness and Explanatory vs Pragmatic: Where is the Balance Point in Pain Medicine Research? Pain Med. 2014 Apr; 15(4):539-40.

 

Waters JH. Patient Blood Management in Obstetrics. Int Anesthesiol Clin. 2014; 52(3):85-100.

 

Waters JH. Role of the massive transfusion protocol in the management of haemorrhagic shock. British Journal of Anaesthesia. 2014 December 1, 2014; 113(suppl 2): ii3-ii8.
 

Weiner DK, Morone NE, Spallek H, Karp JF, Schneider M, Washburn C, Dziabiak MP, Hennon JG, Elnicki DM. E-learning Module on Chronic Low Back Pain in Older Adults: Evidence of Effect on Medical Student Objective Structured Clinical Examination Performance. J Am Geriatr Soc. 2014; 62(6):1161-7.

 

Williams BA, Butt MT, Zeller JR, Coffee S, Pippi MA. Multimodal Perineural Analgesia with Combined Bupivacaine-Clonidine-Buprenorphine-Dexamethasone: Safe in Vivo and Chemically Compatible in Solution. Pain Med. 2014; 23(10):12592.

 

Williams BA, Ibinson JW, Mangione MP, Scanlan RL, Cohen PZ. Clinical Benchmarks Regarding Multimodal Peripheral Nerve Blocks for Postoperative Analgesia: Observations Regarding Combined Perineural Midazolam-Clonidine-Buprenorphine-Dexamethasone. Pain Med. 2014; 28(10):12599.

 

Williams BA, Schott NJ, Mangione MP, Ibinson JW. Perineural Dexamethasone and Multimodal Perineural Analgesia: How Much Is Too Much? [Editorial]. Anesthesia & Analgesia. 2014; 118(5):912-4.

 

Yilmaz E, Hough KA, Gebhart GF, Williams BA, Gold MS. Mechanisms Underlying Midazolam-Induced Peripheral Nerve Block and Neurotoxicity. Reg Anesth Pain Med. 2014; 39(6):525-33.

 

Zhang X, Beckel JM, Daugherty SL, Wang T, Woodcock SR, Freeman BA, de Groat WC. Activation of TRPC Channels Contributes to OA-NO2-induced Responses in Guinea-pig Dorsal Root Ganglion Neurons. J Physiol. 2014; 592(Pt 19):4297-312.

 

Zhang XL, Albers KM, Gold MS. Inflammation-induced Increase in Nicotinic Acetylcholine Receptor Current in Cutaneous Nociceptive DRG Neurons from the Adult Rat. Neuroscience. 2014; 18:483-99.

 

Zhao Q, Huang K, An J, Fang Q, Wen H, Qian X, Cope DK, Williams JP. The Distance from Skin to Cervical and High Thoracic Epidural Space on Chinese Adults as Read from MRI. Pain Physician. 2014; 17(2):163-8. 

 

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Notable Publications


 

Tetsuro Sakai, MD, PhD


 
The paper "Facilitation of resident scholarly activity: Strategy and outcome analyses using historical resident cohorts and a rank-to-match population" by Tetsuro Sakai, MD, PhD; Trent Emerick, MD; David G. Metro, MD; Rita M. Patel, MD; Sandra C. Hirsch, MBA; Daniel G. Winger, MS, and Yan Xu, PhD (Anesthesiology 2014; 120:111-9) sparked some discussion on the future of academic anesthesiology in the August issue of Anesthesiology. The discussion began with the editorial "Avoiding Professional Extinction" by Drs. Michael M. Todd and Lee A. Fleisher, published in the same issue as the Sakai et al. article. The discussion continued with a letter to the editor about that editorial from Drs. Nirav Vikram Kamdarde and Pascal Scemama Gialluly. Drs. Todd and Fleisher responded, defending their point acknowledging our department's Resident Research Program:

 

"What is missing from our profession today? Maybe too many academic departments-and perhaps medical schools-are lead [sic] by individuals who are too closely wedded to past models of success, who do not recognize the winds of change, or have no experience with research or the creative process.4 And part of the problem lies with some members of the younger generation. Too many shun even the concept of "research" (in even its broadest definition, including innovation, invention as well as determining its success). It is so much easier to go to work each day, do something fun (and doing anesthesia is great fun!), and get paid a lot of money. The solution can only come through departments that are willing to fight for support and guidance needed (like the University of Pittsburg [sic]) combined with motivated young people. It is also important that we train these innovative individuals in the methods by which we can determine whether we are achieving our stated goals."
 

   

Faculty on the Road

  

 

Inna Belfer, MD, PhD will present "Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Genetic, Clinical, Demographic, and Psychosocial Factors" at the Study in Multidisciplinary Pain Research (SIMPAR) 7th International Conference, which will be held in Rome, Italy, March 27-28, 2015. Dr. Belfer also serves as a member of the SIMPAR Scientific Committee and encourages attendance at the conference. The target audience is anesthesiologists, pain clinicians, and pain researchers. Please visit the SIMPAR 2015 website for more info.

 Dr. Eric Kelly


 

Eric E. Kelley, PhD will present the seminar "Molecular Mechanisms of Nitrite Reduction to Nitric Oxide in Obesity" at the Jagiellonian Centre for Experimental Therapeutics (JCET) in Krak�w, Poland, on February 6, 2015.

 

Steven L. Orebaugh, MD will lecture and teach in workshops at the 40th Annual American Society of Regional Anesthesia Regional Anesthesiology and Acute Pain Medicine (ARSA) Meeting*, May 14-16, 2015, Las Vegas, Nevada and The New York School of Regional Anesthesia (NYSORA) Symposium, September 19 - 20, 2015, New York, NY.

Dr. Dennis Phillips

 

 

Dennis P. Phillips, DO will give the PulmonaryGrand Rounds Lecture "Transesophageal Echocardiography in the Intensive Care Unit" for the UPMC Division of Pulmonary, Allergy, and Critical Care Medicine (Department of Medicine) on Friday, January 16, 2015, 12pm - 1pm, UPMC Montefiore, conference room NW628.

 

 

Brian A. Williams, MD, MBA will also give two lectures at ARSA 2015*,each followed by their respective panel discussions:

  • Cost-Effective Regional Anesthesia and Pain Medicine: How to Run a Cost-Effective Acute Pain Service
  • Regional Anesthesia and Long-Term Outcomes: Regional Anesthesia Can Decrease the Possibility of 30-Day Hospital Re-Admission


Congratulations to the following department faculty members who have been invited to participate in Pediatric Anesthesiology 2015*, a meeting co-sponsored by the Society for Pediatric Anesthesia (SPA) and the American Academy of Pediatrics Section on Anesthesiology and Pain Medicine (AAP). The event will be held March 13-15, 2015 at the Arizona Biltmore in Phoenix, AZ.

  

Problem-based Learning Discussion: Pediatric Jehovah's Witness Patient with Shone's Complex and Mitral Stenosis and Pulmonary Hypertension Presenting for Posterior Spinal Fusion

Brian Blasiole, MD, PhD; Patrick M. Callahan, MD

Sunday, March 15, 2015, 7:00 - 8:10 am


 

Advanced Ultrasound-guided Regional Anesthesia Workshop

Senior Faculty: Santhanam Suresh, MD; Amod Sawardekar, MD; Adrian T. Bosenberg, MB, ChB, FFA; Arjunan Ganesh, MBBS; Benjamin J. Walker, MD. Junior Faculty: Karen R. Boretsky, MD; Denise M. Hall-Burton, MD; Nishanthi Kandiah, MD; Madhankumar Sathyamoorthy, MD; Nicholas R. Wasson, MDFriday, March 13, 2015, 3:30 - 6:30 pm

 

Research Workshop: Pediatric Anesthesia Research: Raising the Bar

Jerome Parness, MD, PhD, FAAP; Richard J. Levy, MD; Olutoyin A. Olutoye, MD, FAAP; Caleb Ing, MD

Friday, March 13, 2015, 3:30 - 6:30 pm

  

Please note this is all the information currently available about department participation at ARSA 2015 and SPA 2015. Please stay tuned to our website and/or our Facebook page for future announcements about department presentations at the meeting.

supportSupport the Department

 

Please help us continue the tradition of excellence by supporting the department with your tax deductible gift.  Your support will enable us to expand our efforts in teaching, research and clinical care. To learn more about ways to support the department, include the department in your estate plans, or about planned or differed gifts, or gifts of securities, please contact:

 

Mike LaFrankie

Medical and Health Sciences Foundation

Forbes Tower, Suite 8084

3600 Forbes Avenue at Meyran Avenue

Pittsburgh, PA 15213

412-647-9071

Fax: 412-647-8300

lmichael@pmhsf.org

 

Please make checks payable to: 

University of Pittsburgh /Anesthesiology

 

THANK YOU!

 

The University of Pittsburgh Department of Anesthesiology gratefully acknowledges the individuals online who have contributed to the Alumni Fund. Thank you for your generous donations.

 

 

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