Mayo Clinic College of Medicine - Rochester

Mayo Clinic: Department of Anesthesiology and Perioperative Medicine

The Department of Anesthesiology and Perioperative Medicine-Research at Mayo Clinic conducts a wide range of research related to anesthetic techniques, perioperative medicine and pain management.

Investigators in the department have diverse research interests, ranging from very basic investigations of anesthetic effects on subcellular function to advanced clinical projects that have a direct impact on patient care, such as reducing the need for perioperative transfusions and improving the management of chronic pain.

With an extensive multidisciplinary faculty, the Department of Anesthesiology and Perioperative Medicine-Research is developing cutting-edge technologies in anesthesiology, including the use of gene therapy to treat cardiovascular disease in the perioperative period. The department engages in collaborative research with numerous Mayo Clinic physicians and scientists on a broad spectrum of conditions that benefit from improved anesthetic techniques and pain management or that require specialized care, including anesthesiology use in obstetrics and pediatrics.

The Department of Anesthesiology and Perioperative Medicine-Research seeks a better understanding of genomics, proteomics, lung biology, pharmacology and other basic science related to anesthesia to ultimately improve outcomes for patients in need of anesthesia and pain management.


RESIDENT TRAINING/ORIENTATION

Huang J, Licatino LK, Long TR. Methods of Orienting New Anesthesiology Residents to the Operating Room Environment: A National Survey of Residency Program Directors. J Educ Perioper Med. 2020;22(3):E645. Published 2020 Jul 1. doi:10.46374/volxxii-issue3-Licatino

The initial weeks of clinical anesthesiology are a formative period for new residents. The rapid acquisition of clinical knowledge and technical skills during the transition into the operating room can be challenging and stressful for trainees. Orientation methods vary across the United States. A survey was distributed to all US anesthesiology residency program directors through the SAAAPM email newsletter as well as direct email in order to gather information on orientation practices. We hope this information will assist program directors in comparing their orientation practices to other programs and identifying best practices and potentially useful variations.


CARDIOVASULAR ANESTHESIOLOGY

D'Souza RS, Sims CR 3rd, Andrijasevic N, Stewart TM, Curry TB, Hannon JA, Blackmon S, Cassivi SD, Shen RK, Reisenauer J, Wigle D, Brown MJ. Pulmonary Complications in Esophagectomy Based on Intraoperative Fluid Rate: A Single-Center Study. J Cardiothorac Vasc Anesth. 2021 Jan 12:S1053-0770(21)00008-2. doi: 10.1053/j.jvca.2021.01.006. PMID: 33546968.

Esophageal surgery as a curative option for esophageal cancer remains a procedure of high morbidity and mortality. Postoperative pulmonary complications contribute significantly to poor patient outcomes, with a reported incidence as high as 40% for esophagectomy including re-intubation (12.2%), pneumonia (12.2%), and ventilation beyond 48 hours (3.5%). In this cohort study comprising 1,040 patients, we assessed the relationship between intraoperative fluid (IOF) administration and postoperative pulmonary outcomes in patients undergoing a transthoracic, transhiatal, or tri-incisional esophagectomy from year 2007-2017. Regression analysis revealed a higher IOF rate was associated with greater ARDS within 10 days (adjusted OR=1.03, P=0.01). For secondary outcomes, a higher IOF rate was associated with greater hospital mortality (adjusted OR=1.05, P=0.002), although no significant association with 30-day hospital mortality was identified. Tri-incisional esophagectomy was associated with a higher hospital mortality rate (7.8%) compared to transthoracic esophagectomy (2.6%, P = 0.03), or transhiatal esophagectomy (0.7%, P = 0.01). We concluded that Increased IOF administration during esophagectomy may be associated with worse postoperative pulmonary complications, specifically ARDS.

Diaz Soto JC, Mauermann WJ, Lahr BD, Schaff HV, Luis SA, Smith MM. MELD and MELD XI Scores as Predictors of Mortality After Pericardiectomy for Constrictive Pericarditis. Mayo Clin Proc. 2021 Mar;96(3):619-635. PMID: 33673914.

Clinical outcomes after pericardiectomy for constrictive pericarditis are constrained by a relatively high perioperative mortality. Because advanced cases have worse prognosis with surgical delay, preoperative risk stratification is important in guiding surgical decision making and optimal timing for intervention. In this retrospective cohort study, we analyzed 226 patients who underwent pericardiectomy for constrictive pericarditis. After adjusting for relevant covariates both MELD and MELD-XI scores were associated with increased postoperative morbidity and mortality. These findings suggest that both scores can serve as a simple yet robust risk stratification tool for patients undergoing pericardiectomy for constrictive pericarditis.

PATIENT OUTCOMES

Pulos BP, Johnson RL, Laughlin RS, Njathi-Ori CW, Kor TM, Schroeder DR, Warner ME, Habermann EB, Warner MA. Perioperative Ulnar Neuropathy: A Contemporary Estimate of Incidence and Risk Factors. Anesth Analg. 2021 Feb 19. doi: 10.1213/ANE.0000000000005407. Epub ahead of print. PMID: 33617180.

Perioperative neuropathies are often transient and resolve spontaneously, but can be severe and associated with permanent disability for patients. Ulnar neuropathy is the most commonly reported perioperative neuropathy, however recent incidence data and contemporary risk factors were not known. Our team performed a retrospective incidence and case-control study of patients undergoing non-cardiac procedures over a 4 year time period. The incidence of perioperative ulnar neuropathy was found to be much lower in our current study than the incidence reported 2 decades earlier from our institution. This decrease is likely due to practice changes such as shorter hospital stays and earlier ambulation of post-surgical patients, although further study is needed to determine the exact cause. Perioperative ulnar neuropathy was found to be most common in men ages 50-70 and in those with higher BMI, similar to the results from the earlier study. A history of cancer, longer procedure length, and tucked arm positioning during surgery were also found to be associated with the development of ulnar neuropathy. The tucked arm position is potentially modifiable and may be of particular relevance in patients with other risk factors for perioperative ulnar neuropathy. Although the exact cause of perioperative ulnar neuropathy remains unknown in most cases, the results of this study can be used to help guide preoperative counseling, particularly with high-risk patients, and hopefully further decrease it’s incidence.