Anesthesiology Research and Clinical Trials

The Division of Pediatric Anesthesiology focuses on three areas of research:

• Perioperative care to make the overall experience of the children and their families as safe and as pleasant as possible
• Pain management – acute
• Sedation for diagnostic and radiological procedures

Clinical trials are under way to determine how we can improve our management techniques to make children less anxious, more comfortable and free from the side effects of surgery and anesthesia.

We have been studying the effectiveness of pharmacological and psychological techniques in reducing preoperative anxiety. Studies are also under way with different analgesic and anesthetic drugs given during the intraoperative period to reduce adverse postoperative behavior such as emergence delirium.

In addition, we have focused on the measurement of postoperative nausea and vomiting in children to find ways to reduce this complication that occurs in more than 30 percent of children undergoing surgery. We feel there is an absence of data for most drugs in the pediatric patient population and aim to provide such information for the more rational choice of drugs and doses in children.

With the increasing incidence of obesity in the U.S. population, we have been faced with an increasing number of obese children. We have been performing research studies to determine if anesthetic drug pharmacokinetics and pharmacodynamics differ in obese children compared to normal children to make recommendations for drug doses for the obese children.

Another area of interest to us is the incidence of intraoperative awareness with recall in children undergoing general anesthesia. There is evidence that this incidence is higher in children than in adults. There are no data to show if processed EEG-based (Bispectral Index) titration of anesthetics will reduce this incidence.

Postoperative pain is a source of distress to patients and their families. As most surgical procedures in children are done on an ambulatory or outpatient basis, post-discharge pain management is important. We have studies underway to determine if the intraoperative administration of certain drugs is associated with less postoperative pain without increasing drowsiness and delaying recovery from anesthesia.

There is a dearth of information about commonly used drugs in the pediatric and neonatal population. We have been performing pharmacokinetic and pharmacodynamic studies on drugs such as hydrocodone and buprenorphine in these patients.

We also have an interest and specialize in the treatment of complex regional pain syndrome in children. There is evidence that genetic factors may play a role in the development of a chronic pain state. We are enrolling patients with complex regional pain syndrome in a study in which blood samples are obtained for genetic analyses such as mutation testing and association analyses. We hope to use this research sample resource in future studies of constitutional variation in the development of a neuropathic pain disorder.

The Department of Anesthesiology provides supervision for sedation for all diagnostic procedures. We have been performing system analysis studies to determine the effect of our endeavors on patient safety, operational efficiency and costs in this area.