Three grants were selected for funding by the APSF for the year 2000. Topics funded include two types of anesthesia related injuries (perioperative vision impairment/blindness and new work on ulnar nerve palsy, which is a follow up to a previous APSF-funded study), and enhanced presentation of intraoperative physiologic data.
Selection was made by the APSF Committee on Scientific Evaluation (members listed on Page 51). Committee members were pleased to note that after last year’s nadir in the number of applications of only 16, there was a total of 23 applications for APSF grants to begin in the year 2000. Of particular note for this funding cycle has been the increase in the maximum award from $50,000 to $65,000. As noted in the guidelines for grant application, the major objective of APSF is to stimulate studies that lead to prevention of mortality and morbidity from anesthesia mishaps. A particular priority is given to studies that address problems of anesthesia for healthy patients or those studies that are broadly applicable and that promise improved methods of patient safety with a defined and direct path to implementation into clinical care. See the announcement in this Newsletter for applications for next year’s awards.
Areas of research interest in this year’s applications included risk factors for neuraxial anesthesia; wound infections; myocardial ischemia; functional recovery after anesthesia; anesthesia simulation and its use in training; quality improvement and assessment of patient outcome. The APSF Scientific Evaluation Committee met during the ASA Annual Meeting in October in Dallas.
Three proposals for funding were selected:
“Perioperative Vision Loss and Other Visual Changes”
Mary E. Warner, M.D., Assistant Professor of Anesthesiology and member of the Perioperative Outcomes Group at the Mayo Clinic in Rochester, MN.
This proposal will elucidate the risk factors and the frequency of perioperative visual changes, including vision loss, in patients undergoing surgical procedures. The study is comprised of two parts: Part 1 is a retrospective review of the massive surgical database of the Mayo Medical Center of non-ocular, non-cardiac, and non-neurovascular surgical procedures performed from 1986 to 1999. During these procedures (approximately 480,000 cases), patients received general or major regional (neuraxial) anesthesia. The patients’ records will be reviewed for cases of visual loss that was diagnosed within 30 days of the surgical event.
Part 2 is a prospective study of adult patients (750 patients) who will undergo surgery and general or central neuraxial anesthesia. In these patients, perioperative accommodative visual changes and visual symptoms will be evaluated preoperatively, and postoperatively before dismissal from the 24-hour hospital stay (for ambulatory patients), or within 24 hours of surgery (for hospitalized patients). Tests consist of standard ocular accommodation checks with an AMA reading card, and measurement of pupillary size by standard techniques.
The identification of the risk factors associated with perioperative visual changes touches very important safety issues in anesthetic practice and may have a great impact on clinical care. As a member of the Mayo Perioperative Outcome Group, Dr. Warner’s co-investigators include members of the Department of Anesthesiology (Drs. Mark Warner, David Warner and James Hebl, and Darrell Schroeder, statistician), Department of Ophthalmology (Drs. James Garrity and David Herman), and Department of Health Science Research (Pamela Maxson, RN, MS).
“Effect of Gender on Ulnar Nerve Dysfunction Induced by Stretch, Pressure, Ischemia, or Positioning”
Robert C. Morell, M.D., Associate Professor in the Department of Anesthesiology at Wake Forest University School of Medicine in Winston-Salem, NC.
This proposal is an extension of previous research performed by the investigator and his colleagues in which the mechanisms of human perioperative ulnar neuropathy were examined. Because recent data have demonstrated that 75% of perioperative ulnar nerve injuries occur in male patients, the author proposes to study systematically the possible influence of gender in volunteers whose ulnar nerves are subjected to variations in stretch, pressure, positioning, and ischemia. The identification of the risk factors and the relationship, if any, to gender, are key safety issues in anesthetic practice.
The author proposes to determine ulnar nerve dysfunction that can be induced by 4 separate insults: 1) Stretch (flexion at the elbow between 0-120 degrees); the effect of nerve stretching on development of neuropathy will be measured by neuroselective current perception thresholds (NCPTs), 2) Pressure (by computerized pressure mapping); the effect of pressure will be determined by the use of a flexible pressure-sensing array; ulnar nerve compression will be accomplished by placing a rigid wooden cylinder between the ulnar nerve and the pressure-sensing array for up to 40 minutes (or until paresthesia or changes in NCPTs are reported), 3) Ischemia will be determined by measuring the latency period from inflation of an upper arm tourniquet to 250 mmHg until appearance of NCPT changes, 4) Positioning influence, if any, will be assessed by measuring the pressure on the resting arm when placed in varying degrees of abduction and supination. Understanding of the risk factors for perioperative ulnar nerve injury, and identification of their relationship to gender are mandatory for the development of recommendations for the prevention of perioperative neuropathies. For this project, Dr. Morell’s co-investigators include Drs. Richard Prielipp, John Butterworth and Francis Walker from the Department of Anesthesiology.
“Integration and Visualization of Physiologic Data”
Dwayne Westenskow, Ph.D., Department of Anesthesiology at the University of Utah in Salt Lake City, UT
The aim of this project is to enhance the clinicians’ ability to discover and rapidly respond to critical intraoperative events by developing a display that will help the practitioner visualize the patients’ physiologic state. The development of an object-oriented graphical visual display will: a) increase situation awareness (vigilance) and facilitate faster detection of abnormal physiologic parameters, b) reduce errors associated with medical diagnosis in a high workload environment, and c) shorten treatment time lag. The committee members are happy to announce that Dr. Westenskow’s initial aim, that of securing APSF “seed” funding until obtaining significant NIH and NSF support, has been fulfilled. Since the approval of his proposal, Dr. Westenskow and his co-investigators (Drs. Julio Bermudez, Stefano Foresti, and David Strayer) have already received notification of NIH approval. Thus, Dr. Westenskow has withdrawn his request for APSF funding at this time.
The members of the APSF Scientific Evaluation Committee wish to congratulate all of the investigators who submitted their proposals to APSF this year, whether or not these were funded. We hope that the high quality of the accepted proposals will serve as a stimulus for others to submit research grant applications which will generate new knowledge that will benefit all patients.
Dr. Brull, Professor and Chairman, Department of Anesthesiology, University of Arkansas for Medical Sciences is Vice Chair, APSF Committee on Scientific Evaluation.