The Department of Anesthesiology at NYU School of Medicine holds research and academic activities among its primary missions. That commitment and the availability of enthusiastic mentors is present in our Department for the purpose of strengthening both basic and clinical research. Research opportunities for residents and fellows are available. Residents are encouraged to become involved early in their training to begin to define an area of interest upon which they can build an academic career.
Active protocols exist for both investigator initiated and sponsor initiated research. Alex Bekker MD, PhD, the Vice-Chair of Research, is examining the phenomenon of post-operative cognitive dysfunction in the elderly, particularly those with mild cognitive impairment, who have an increased risk of developing dementia. It is a multi-year study involving serial neuro-cognitive assessments and determination of the role of inflammation in cognitive dysfunction. That research is sponsored by a National Institute of Aging grant administered by the Alzheimer’s disease Center. Our department is an active participant in the newly established Center of Excellence on Brain Aging at NYU Langone Medical Center. Potential treatments to improve cognitive recovery after surgery in the elderly are also being investigated with the drug rivastigmine in a trial supported by Empire Clinical Research Investigator Program.
Marc Bloom, MD, PhD of the neuro-anesthesiology group has participated in the development of the BIS monitor, a device to measure depth of sedation, and its potential expansion in the determination of anesthetic requirements for pain. Jeanna Blitz, MD has been active with several sponsored trials and most recently investigation of the uses of palonosetron for long term control of nausea and vomiting after surgery. Patrick Linton, MD is leading an effort to investigate the role of isoproterenol in BIS changes during electro-physiologic studies in cooperation with NYU cardiologists. The cardiovascular group’s Marc Kanchuger, MD is involved with multi-centered industry trials whose aim is to improve the practice and outcome of cardiac anesthesiology and surgery. Jinny Kim, MD initiated a trial to examine the efficacy of clevidipine in the treatment of hypertension in neurosurgery patients.
The Director of Clinical Research, Michael Haile, MD and the staff of coordinators and fellows continually aid in the development of trials, submit new investigations for IRB approval and help to manage trials. Residents are encouraged to participate in the process of protocol development and submission along with a faculty mentor.
At present several main areas of basic investigation are ongoing in the Department of Anesthesiology at NYU and we encourage the participation of residents and fellows to help us understand and solve these interesting problems. Faculty, fellows and residents routinely contribute to national Anesthesiology meetings and have manuscripts published in peer reviewed professional and scientific journals.
One area of research deals with the underlying pathophysiology of Barth's syndrome. Barth's syndrome consists of the triad of cardiomyopathy, skeletal myopathy, and neutropenia in children and teenagers. The primary defect consists of an abnormality in the processing of the mitochondrial phospholipid, cardiolipin. Cardiolipin is essential for the structural integrity of mitochondria. Michael Schlame, MD PhD, also the Director of the cardio-vascular group, has described this abnormality and is now determining the genetic and enzymatic aberration leading to the defect in cardiolipin supported by a multi-year grant from the National Institutes of Health.
Another area of basic and translational investigation involves study of the neuronal and cognitive dysfunction caused by the serial events of energy depletion, membrane depolarization, reperfusion injury, oxidative stress, and inflammation. Transient cognitive deficits associated with the consolidation and retrieval of memory have been induced by low flow states associated with hypotension, hypoxia and induced inflammation associated with elevated cytokine levels. Those deficits have been found to be reversible by manipulations aimed directly at the neurotransmitter milieu and Ca2+ homeostasis as well as anti-inflammatory treatments. Other studies involve the role of depression and nitric oxide treatment in cognitive dysfunction. Co-investigations with the Departments of Neurology, Radiology and Psychiatry are ongoing. The laboratory is supported by two PhD’s, Richard Kline and Samuel Galoyan, two MD’s, Michael Haile and Yong-Sheng Li, and an MD, PhD, Alex Bekker.
The final area of basic investigation involves an understanding of the mechanisms of anesthetic action, with a particular focus on the alteration by volatile anesthetics of calcium homeostasis in the central nervous system and the heart. Our laboratory has determined along with investigators at other institutions that the depression of cardiac contractility by volatile anesthetics is due to interference with delivery of calcium through voltage-dependent calcium channels to the contractile proteins. In the neuron the volatile anesthetics similarly interfere with the delivery and recognition of calcium leading to changes cell signaling, neurotransmitter release and excitability. The alterations in calcium homeostasis are intrinsic to the process of anesthesia. The alteration by anesthetics of Ca2+ homeostasis has also lead to investigations in our laboratory of the role of anesthetics as neuroprotective agents specifically directed against global cerebral ischemia, and the mechanisms of local anesthetic toxicity. Investigations of these problems require basic biochemical, electrophysiological, and molecular techniques.
Electrophysiological techniques are used to characterize the contribution of channels/proteins and/or lipids at the plasma membrane (whole cell, patch clamp) and at intracellular compartments (incorporation of isolated proteins and/or lipids into planar lipid bilayers). Flourometric techniques are used to measure Ca2+ changes in various cellular compartments (cytoplasmic and organelles). Finally, immunohistochemistry is used to identify the type and determine the intracellular location of various proteins involved in Ca2+ regulation. The laboratory is supported by two PhD's, Esperanza Recio-Pinto, a pharmacologist and electrophysiologist, Fang Xu, a neurochemist, an MD, Kevin Gingrich, two MD PhD's, Michael Schlame and Thomas Blanck, and several MD's and pre- and postdoctoral students who are devoted to understanding basic mechanisms of anesthesia.