Anesthesia
Clinical investigation
Active clinical investigations are being carried out in the various clinical services of the Anesthesia Department at Boston Children's Hospital.
Main operating rooms
Investigations include the study of:
- the cardiovascular effects of sevoflurane in children performed using noninvasive echocardiographic indices of cardiac function
- the role of local anesthetics applied directly to the skin for analgesia for venipuncture
- the role of new drugs in decreasing nausea and vomiting
- the efficacy of ketorolac for pain relief in outpatient procedures
In the neuroanesthesia area, many active studies are being performed using transcranial Doppler and other noninvasive techniques to better understand the effects of anesthetics on cerebral function.
Pain treatment services
Investigations include the study of:
- the clinical pharmacology of analgesics and local anesthetics in infants and children
- autonomic regulation in infants undergoing anesthesia
- reflex sympathetic dystrophy in adolescents
- the safety and efficacy of tricyclic antidepressants and other newer medications for control of chronic pain
Cardiac anesthesia services
Investigations include the study of:
- factors affecting neurologic injury associated with cardiac surgery in infants, one of which is an NIH-funded clinical trial. These studies use advanced noninvasive techniques of transcranial Doppler and near infrared spectroscopy to assess cerebral blood flow, emboli and cerebral tissue oxygenation levels.
- the utility of transesophageal echocardiography in intraoperative diagnosis of residual cardiac defects after repair
- the role of magnesium in dysrhythmias following cardiac surgery in infants
- anesthetics and stress response to surgery among infants.
MICU
In the MICU, ongoing clinical studies of the physiology of ECMO in neonates are conducted, along with organization of a trial of ECMO for pediatric adult respiratory distress syndrome. Other clinical investigations include:
- the role of nitric oxide in pediatric pulmonary diseases
- the use of new methods of ventilatory support as alternatives to ECMO
- the development of computer-based expert systems to monitor clinical patient care parameters on line in real time and to control therapy such as mechanical support of ventilation
Finally, both theoretical and empirical work is being done on ethical aspects of ICU care, such as issues surrounding the withholding and withdrawal of life-sustaining therapy, brain death and organ transplantation, and the ethics of randomized clinical trials.
