DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

the country. The division added two
active NIH grants during the year, for a
combined total of 8 NIH grants within
the division. The research efforts of the
division are supported by our entire faculty
and eight full-time research coordinators
Aimee Butler, Wayne Cohen,
Kelli Cozart, Bonnie Funk, Vince Gaver,
Malissa Harris, Jason Hawkins and Jerry
Kirchner. Additionally, research technicians
Chonna Campbell, Amanda
Cheek, Mary Currier, E. D. Derilus,
Tanya Kagarise, Satarah (Torie) Latiker,
Erich Lauff, Kenya Lee, Scott Lee, Colin
Macdonnell, Terri Moore, Beverly Perry,
Melanie Tirronen, Erin Ward, and
Jonathan Williams have significantly
extended the capabilities of divisional
research.
Clinical Research
The Neurologic Outcome Research
Group added one National Institutes of
Health grant, for a total of 5 NIH grants
supporting ongoing work as well as
receiving the first American Heart
Association Roundtable grants awarded
at Duke. Under the direction of Drs.
Mark Newman, Jerry Reves, and Jim
Blumenthal, with the assistance of all
cardiac division members, the division
is continuing to investigate neurologic
and neuropsychologic outcome after
cardiac surgery, as well as interventions
to improve these perioperative complications.
The group recently published
studies in the New England Journal of
Medicine and Stroke documenting the
long-term impact of perioperative cognitive
decline on long-term cognitive
function. This is a first hopeful step
in prevention or treatment of these
untoward events. The group has also
continued its investigation of the association
of Apolipoprotein ε4 and cognitive
dysfunction and stroke after cardiac
surgery. This research has led to an
important collaboration with the Department
of Neurology to further assess
a patient's genetic predisposition to
neuronal injury or potential recovery
from neuronal injury.
In conjunction with the Department
of Neurology and Duke Clinical
Research Institute, the newest focus
of the neurologic outcomes research
group is the development of the Multicenter
"Perioperative Organ Protection
Consortium." This is a collection of 25
Academic Sites in the United States and
Canada. The group is submitting two
multicenter interventional NIH grants
in early 2000 evaluating the impact
of clinical practice on neurocognitive
outcome.
Laboratory and
Translational Research
The cardiac anesthesiology division has
spent considerable resources, time, and
energy over the last 5-10 years developing
physician scientists and basic
researchers in areas related to cardiovascular
medicine. Examples of individuals
include Debra Schwinn, M.D.,
Hilary Grocott, M.D., FRCP(C) and
Madan Kwatra, Ph.D. We are now
pleased to report that basic science
projects originating from each of these
investigator's laboratories have resulted
in publications in major scientific journals
and national peer reviewed funding
(NIH, FAER, AHA).
The Molecular Pharmacology
Laboratory, under the direction of Dr.
Debra Schwinn has continued its investigation
of adrenergic receptors, with an
additional NIH RO1 grant awarded this
year. In addition, translational research
has also begun, with investigators bridging
clinical and basic science areas
with new hypothesis-driven research
projects designed to elucidate mechanisms
underlying acute myocardial
beta-adrenergic receptor desensitization,
G protein-coupling in human
heart, and mechanisms underlying
brain injury during cardiopulmonary
bypass.
Dr. Debra Schwinn initiated a NIH
sabbatical in January of 2000 to gather
additional expertise into genetic and
genetic translational research. Our goal
is to develop a perioperative outcome
CLINICAL ACTIVITIES
and genetics database that will be a
resource for the entire world.
A new laboratory initiative was
begun in 1999 in the Cardiothoracic
Anesthesia division. A laboratory
focused on the pathophysiology and
adverse outcomes (particularly neurologic)
after cardiopulmonary bypass
(CPB) was established under the direction
of Dr. Hilary Grocott. This laboratory,
The Anesthesiology Cardiopulmonary
Bypass Laboratory, used a pig CPB
model to investigate intermediate cerebral
outcomes (glial and neuronal
derived proteins released into the CSF
and serum following brain injury) after
CPB. In order to make the most of a relatively
expensive animal preparation as
well as to capitalize on other expertise
in the division and department, the
model was also used to examine issues
related to myocardial (-adrenergic
desensitization and renal ultrasound
imaging employing intravenous contrast.
Concurrent with the pig CPB
model, a second, more economical
CPB model was developed in the rat.
This work, performed with the collaborative
support of cardiothoracic anesthesia
fellow Dr. Burkhard Mackensen,
took place in the neuroanesthesia laboratory
with space generously donated
by Dr. David Warner. This new laboratory
has been unique, thus far in the
field, with its ability to successfully perform
complete CPB in rats with subsequent
recovery. The coming year’s
focus will continue with the further
development of a model of neurocognitive
impairment after CPB in the rat
in order to investigate both the mechanisms
of injury as well as potential pharmacologic
neuroprotection. In conjunction
with Dr. Warner, neurology,
neurosciences and other related fields,
the Duke Multidisciplinary Neuroprotection
Laboratory has been developed to
facilitate these important investigations.
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