DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

Gerontological Research in
Anesthesia and Surgery
Program (GRASP)
MADAN M. KWATRA, Ph.D.
Associate Professor in Anesthesiology
Assistant Professor of Pharmacology
and Cancer Biology
J.G. REVES, M.D.
Professor and Chairman of
Anesthesiology
AREA OF INTEREST:
Geriatric Research and Education
Focusing on the Special Needs of the
Elderly Patient Undergoing Surgery
FOCUS
GRASP seeks to identify areas of basic
and clinical research that will reduce
the incidence of adverse post-surgical
outcomes that frequently occur in the
elderly. To this end, GRASP holds
monthly meetings, organizes biennial
conferences entitled “Surgery and the
Elderly,” and develops research projects.
MONTHLY GRASP MEETINGS
These meetings, attended by basic
science and clinical faculty, residents,
fellows, and medical students from the
departments of anesthesiology, surgery,
and the center for aging research, discuss
a variety of topics related to the
elderly. Topics covered in GRASP meetings
are listed in the Lectures, Conferences,
and Didactic section of this
report.
BIENNIAL SURGERY AND THE
ELDERLY CONFERENCES
These conferences are held biennially
and focus on specific issues affecting
the elderly surgical patient. The first
Duke conference on surgery and the
elderly was held on September 17,
1997; anesthesiologists, basic scientists,
geratricians, and surgeons from major
medical centers across the country
were in attendance. This conference
highlighted the risks faced by an elderly
patient undergoing surgery and how
age affects the various organ systems. In
addition, this meeting was instrumental
in establishing contacts between the
American Society of Anesthesiology
(ASA) and the American Geriatric
Society (AGS). These meetings were
attended by basic scientists (AGS/the
Hartford Foundation) whose goals are
to introduce geriatrics into the curricula
of various non-primary specialties.
The second Duke conference on
surgery and the elderly was held on
September 30, 1999. The focus of this
conference was on cognitive dysfunction
in the elderly after non-brain
surgery. The conference was divided
into morning and afternoon sessions.
The morning session was devoted to
understanding the incidence of postoperative
cognitive dysfunction after
cardiac, hip fracture, and major noncardiac
surgeries. The afternoon session
focused on two issues: whether regional
anesthesia produces less post-operative
cognitive dysfunction and the cholinergic
hypothesis of post-operative cognitive
dysfunction. A total of 40-50 people
were in attendance including anesthesiologists,
basic scientists, geratricians,
and surgeons from Duke and other
universities.
The third Duke conference on
surgery and the elderly will be held
on September 20, 2001. The theme of
this conference will be “What we know
and need to know about the elderly
from existing databases.”
RESEARCH PROJECTS
A major aim of GRASP is to pursue
research that will lead to better postoperative
outcomes for the elderly. To
this end, we are currently developing
projects devoted to understanding post-
LABORATORY PROGRAMS
operative delirium in the elderly.
Several projects are identified and
include the following:
1) What is the role of pain in postoperative
delirium?
2) Is regional anesthesia accompanied
by a lower incidence of delirium?
3) Are certain combinations of
anesthetics contributing to a higher
incidence of post-operative delirium?
4) What is the molecular basis of
post-operative delirium?
Duke Chapel outdoor walkway
LABORATORY PROGRAMS 127