Anesthesia

Research 

Faculty actively pursue both clinical and laboratory research projects in the Department of Anesthesia at Children's Hospital Boston. Clinical research is performed throughout the operating rooms, intensive care units and wards. Laboratory research is performed in the Anesthesia and Critical Care Laboratory at the John F. Enders Pediatric Research Laboratories. Fellows in all programs are encouraged to participate.

The faculty of the main operating rooms pursue a wide variety of research interests, including:

• the role of bispectral index in the pediatric patient
• the clinical pharmacology of local anesthetics in infants and children
• the prevention of post-operative nausea and vomiting
• novel anesthetic techniques for microlaryngeal surgery

Neurosurgical research

A very active neurosurgical research program centers on:

• intraoperative EEG monitoring of children undergoing pial synangiosis
• the role of soluble adhesion molecules in children with moyamoya syndrome
• coagulation defects in patients undergoing craniotomies
• adhesion molecules and cerebral ischemia
• the role of chemokines in the evolution of stroke injury
• toxicity of NMDA-blocking agents in the developing brain

Additionally, research in clinical and theoretical ethics focuses on the role of the family in decision making, end-of-life care in the operating rooms and ICUs, professionalism in anesthesiology and informed consent for pediatric patients.

Pain treatment service research

Research includes study in:

• the clinical pharmacology of analgesics and local anesthetics in infants and children
• autonomic regulation in infants undergoing anesthesia
• neonatal pain management
• reflex sympathetic dystrophy in adolescents
• the safety and efficacy of tricyclic antidepressants and other newer medications for control of chronic pain

In the pain treatment research laboratory, investigators also study how tachyphylaxis to local anesthetic agents occurs and how it is altered in the developing nervous system. Other projects include the role of endothelin-1 in mediation of pain and the development of timed-release systems for local anesthetics that can provide prolonged analgesia for days or weeks following injection or implantation.

Cardiac anesthesia service research

Research in Cardiac Anesthesia Service is involved with a number of active clinical research protocols. In addition, there is close collaboration with cardiology and cardiac surgery research efforts within the Cardiovascular Program. Current clinical investigations include:

• evaluation of coagulation following cardiopulmonary bypass
• assessment of cerebral blood flow velocity and risk for air emboli using transcranial Doppler sonography
• evaluation of depth of anesthesia during moderate hypothermic bypass and specifically the utility of BIS monitoring to ensure adequate depth of anesthesia during cardiopulmonary bypass
• studies of anesthesia technique and modification of the stress response in infants and neonates during deep hypothermic cardiopulmonary bypass

Laboratory and bench research also includes:

• developing experimental models of cardiopulmonary bypass in neonatal animals
• exploring the role of white cell/endothelial adhesion molecules in the pathophysiology of extracorporeal circulation and ischemia/reperfusion injury
• defining cellular signaling pathways in ischemia/reperfusion and inflammation
• determining the electrophysiologic, morphologic and molecular determinants of atrial dysrhythmias
• studying molecular mechanisms of myocyte cell death and repair

  

Critical care research  

The Division's research spans the range of intensive care medicine, from novel modes of gas exchange to ethics.

Ongoing projects include:

• investigation of perfluorocarbon-mediated gas exchange in pediatric respiratory failure
• novel modes of ventilation in pediatric respiratory failure utilizing a large animal model
• bench work on metabolic and nutritional derangements in the critically pediatric patient
• efficacy of procedures used in neonatal and pediatric transport
• use of simulator technology to teach crisis management through observational studies in the field

PALICI network

In addition, the Division is very active in the Pediatric Acute Lung Injury Clinical Investigation (PALICI Network). This is a consortium of 10 large pediatric intensive care units across North America whose objective is to collaborate on the design and implementation of multimember, randomized controlled trials to examine the management of acute lung injury in critically ill children.

ICU

Both theoretical and empirical work is being done on ethical aspects of ICU care, such as:

• withholding and withdrawal of life-sustaining therapy
• brain death and organ transplantation
• the ethics of randomized clinical trials

The Division vigorously participates in clinical trials conducted at Harvard Medical School to examine end-of-life decision-making in the intensive care unit. This ongoing clinical trial is examining the impact of an intervention designed to reduce conflict in decision-making around end-of-life care in the adult (medical and surgical) and pediatric intensive care units at the Harvard teaching hospitals.

Upcoming anesthesia study
Mary Ellen McCann, MD, an anesthesiologist at Children's has initiated a study to compare regional (localized) anesthesia with general anesthesia in young children.