By Alan R. Tait, Ph.D.
Given the recent rapid changes in health policy, it is becoming harder for individual clinical faculty to get sufficient time out of the operating room to pursue their research interests. Realizing this, the faculty at C.S. Mott Children's Hospital have, with the support of Dr. Tremper, formalized a pediatric anesthesia research group. The purpose of this group is to provide a cohesive team to identify research questions, design appropriate study protocols, seek funding and get published. It is hoped that the team, with the combined skills and experience of its members, will be more efficient than individual enterprise and provide a stimulating and mutually beneficial research environment. It is also hoped that more faculty will become involved and, as a consequence, more residents and fellows.
Leading this group are Drs. Paul Reynolds, Jay Shayevitz, and Shobha Malviya. Dr. Alan Tait serves as a resource for help with study design, data analysis, funding opportunities and preparation of manuscripts. In addition, Sandy Merkel, RN offers an important nursing perspective. Two research positions have also been created to provide assistance with study design, data collection and analysis. Terri Voepel-Lewis, formerly head nurse of the Mott recovery room, has taken the position of Research Nurse and Monica Siewert as Research Assistant. The pediatric anesthesia group is also utilizing the services of the UROP program that provides undergraduate students to assist in research projects. To date, there are 15 UROP students working at Mott. This program provides an opportunity for undergraduates to experience research first hand while obtaining credit towards their degree.
The success of such a research group is heavily dependent on good communication and collaboration. At present, the group meets once a week to evaluate progress, discuss any difficulties and to review new ideas or proposals. This forum provides a continual assessment of progress and a plethora of ideas. For example, Dr. Shayevitz, who is director of research for the Mott group, is presently involved with several studies including one examining the local and systemic cytokine response to cardiopulmonary bypass in neonates. In addition, he has been involved in several studies comparing the Hepcon hemostasis management system with empirical methods in managing anticoagulation and heparin reversal in open-heart surgery. Two manuscripts pertaining to these studies have recently been accepted for publication with Drs. Celia D'Errico and Sarah Martindale as principal authors. Dr. Shayevitz is involved with Drs. Sean O'Kelly and Ken Massey in a study to evaluate the effects of Vitamin E on cytokine response and outcome among children undergoing cardio-pulmonary bypass surgery. Drs. D'Errico and Shayevitz are involved with a multicenter study evaluating the efficacy and safety of aprotinin in reducing blood loss in children following cardiopulmonary bypass.
Dr. Paul Reynolds, despite the rigors of being section chief at Mott, has found time to be involved in a study to examine factors that predispose children to nausea and vomiting in the postoperative period. Dr. Malviya is presently involved in a retrospective study with Dr. Margaret Cosio to examine the relationship between the existence of a preoperative URI and outcome in patients following open heart surgery. This study has spawned the development of a prospective study and has been incorporated as part of a NIH proposal with Dr. Tait. Dr. Malviya is also involved with studies comparing fentanyl Oralet to placebo as a premedicant in children and in the evaluation of the efficacy of preoperative pregnancy testing in adolescent girls. In addition, together with Dr. Uma Pandit, Dr. Malviya is comparing epidural to patient controlled analgesia in rhizotomy patients.
Drs. Hamish Munro and Jeff Marshall are involved with a study comparing ondansetron with placebo on the incidence of postoperative nausea and vomiting. Dr. John Huntington recently presented and won first place at the MARC meeting for his study examining the effect of cardio-pulmonary shunt on the rate of rise of expired to inspired NO2 concentration in children. Sandy Merkel and Terri Voepel-Lewis have been busy developing a pediatric pain assessment tool (FLACC) which they have validated against existing methods. This study was well received at the last ASA meeting in San Francisco. Dr. Gutstein continues his FAER funded work on the behavioral and neural correlates of pain and analgesia and has recently been awarded NIH funding to continue his work.
Although, given the limitations of space afforded here, it is impossible to relate all the research activities that are presently underway at Mott, it is easy to see that the formation of a cooperative research group has provided a stimulating forum for research ideas. Coupled with the enthusiasm of the faculty and the involvement of the fellows, it is not difficult to envision a productive and successful future for the group and for the Anesthesiology Department as a whole.