Stanford

Stanford University School of Medicine

Stanford University School of Medicine represents a rich mix of faculty and trainees at all levels (medical students, graduate students, and postdoctoral fellows). There are currently approximately 1700 fulltime faculty members in the School of Medicine, including 100 in 10 basic science departments and 600 in 16 clinical departments. Also, more than 3,000 part-time voluntary clinical faculty participate in the teaching programs of the school. There are 34 active NIH training grants at the School of Medicine. Stanford University received a Clinical and Translational Science Award (CTSA) called the Stanford Center for Clinical and Translational Education and Research, which will further support and coordinate translational efforts across departments and schools.

The Stanford Department of Anesthesiology, Perioperative & Pain Medicine at the School of Medicine is highly regarded for its clinical work and research and is currently the second most funded Anesthesia Department in the country. Last year the Department of Anesthesiology spent $12.8 million on sponsored research with 42 grants, 18 clinical trials and 7 contracts. Stanford Dept. of Anesthesia has approximately 8600 sq. ft. of lab space, and an adjacent animal facility. It also has access to many core facilities such as the Cognitive Neuroscience Facility, and Lucas Center of Magnetic Resonance Spectroscopy. Some faculty are located at the Palo Alto VA HCS that also has fully equipped research facilities.

The Stanford Anesthesia Research is an important part of the field of anesthesia—it is what has allowed anesthesiologists to continuously improve the vital task of rendering patients unconscious for surgery. This is a broad field of study from subcellular mechanisms of anesthesia, research at the organ level, and clinical studies directly related to patient care, health policy and economics related to anesthesia, and the education of the next generation of anesthesiologists.

There are weekly Grand Rounds meeting and a research meeting, at which researchers present data from ongoing projects or plans for new projects to get feedback and ideas. This is a casual venue which would be available for a medical student to present their results. Depending on the interest of the student, there are also journal clubs in Neuroscience, Pediatrics, etc. that the student could attend and participate in.

Faculty members within the department have diverse interests that range from the molecular to clinical research.

Basic Science Overview

A major focus within the department is pain research from the basic level to clinical studies. Many laboratories investigate the cellular and molecular mechanisms of acute and chronic pain, its control by opioids and the creation of a hyperalgesic state by opioids, and the role of central nervous system microglia in the development of pain states. Others are interested in personalized medicine for common genetic polymorphisms that alter anesthetic and analgesic effects of the medications used in anesthesia, and also the linkage between nociceptive and cardioprotective signaling pathways.

Some faculty are interested in finding new strategies to promote neuronal survival and improve functional outcome following brain injury.

Many members of the faculty are investigating the basic mechanisms of anesthesia by investigating their cellular, synaptic and molecular mechanisms of action using electrophysiological recording techniques. Others are using computational chemistry to design new selective intravenous anesthetics potentially with minimal hemodynamic side effects.

The advent of high dimensional flow cytometry has revolutionized the ability to study and visualize the human immune system and team of faculty combines high parameter mass cytometry (a.k.a Cytometry by Time of Flight Mass Spectrometry, CyTOF), with advanced bio-computational methods to study how the human immune system responds and adapts to perturbations such as surgical trauma and pregnancy.

A member of the department are developing novel methods for analyzing changes in cellular metabolites caused by drug treatment or in disease. The metabolomic results are integrated with the genetic data to identify new disease mechanisms and to develop new diagnostics.

There is an effort within the department to create mice with human livers. This is a novel experimental in vivo platform that replaces mouse liver with functioning human liver tissue derived from adipose tissue stem cells. The humanized mice are being used to develop a novel platform for predicting human drug metabolism and human drug responses; for understanding stem cell development, and to develop a new method for liver transplantation that uses the patient’s own cells without immunosuppression.

Clinical and Translational Studies

Stanford Anesthesia conducts adult and pediatric clinical trial and studies on drug and device efficacy for use in the perioperative period and during intensive care. The department also has laboratory facilities for clinical studies that are equipped with the ability to process and bank various tissue samples.

Stanford Anesthesia also has a long history of investigating the methods of the pharmacokinetics and pharmacodynamics of commonly used anesthetic drugs in adults and children.

Adult Pain Research

The SNAPL lab is focused on using powerful research methods and state of the art neuroimaging tools to investigate the emotional and cognitive factors that influence pain as well as the neural plastic changes that occur in chronic pain. They use neuropsychology, pharmacology, clinical research, and/or neuroimaging approaches to investigate normal pain processing, pain disorders, and treatment options for all types of pain including lower back pain, migraines and fibromyalgia.

They also perform studies looking at the use of real-time fMRI feedback to improve control over pain, and Transcranial Magnetic Stimulation (TMS) to study how various brain regions impact pain processing. They are studying various treatments, such as Botox for scar pain, Gabapentin to prevent post-surgical pain, and acupuncture for pain relief.

Big Data Studies and Health Policy

Some faculty are also interested in health policy such as looking into the opiate crisis in the veteran population using big data techniques. Others are interested in the economics of treatments for chronic pain and of perioperative surgical home programs, and the tradeoffs between costs and outcomes for patients having surgery and anesthesia.

Regional Anesthesia

Regional anesthesiology is the science and practice of modulating nerve transmission in the central neuraxis or within peripheral nerves, to produce target-specific and opioid-sparing pain relief and to enhance recovery. Faculty that specialize in regional anesthesia are developing techniques and patient care pathways to improve postoperative pain control and other surgical outcomes for patients of adults and children.

Obstetric Anesthesia Research

This group addresses a wide variety of questions related to the field of obstetric anesthesia and analgesia, how anesthetics interact with hemostatic changes in pregnancy, postpartum pain management and spinal anesthesia for cesarean delivery. In addition, this group has done research on the economics of obstetric anesthesia, patient perception of risk, experimental pain, and the use of nitroglycerin for preterm labor and external cephalic version.

Pediatric Anesthesia Research Clinical Trials

A clinical trial is being conducted to determine if giving acupuncture can reduce nausea and vomiting in pediatric patients undergoing chemotherapy. There are multiple studies being conducted on the pharmacokinetic/pharmacodynamics and pharmacogenetics of opiates, sedatives and ketamine in the neonate and pediatric surgical population.

Biobehavioral Pediatric Pain Lab

This group is investigating the role of learning and memory on pain outcomes in youth with chronic pain, the goal of the current study is to examine the process of aversive learning in adolescents with pain in comparison to healthy controls using brain imaging (fMRI) and psychophysical (skin conductance) measures to assess functional circuit and physiological changes associated with altered learning and memory patterns.

They also seek to better understand the daily functioning of children with chronic pain using daily diaries filled out by the parent and child that ask about the child's emotional and physical functioning throughout their participation.

Educational Research

Stanford Anesthesia is at the frontier in the development of innovative techniques and training tools to improve the educational experience of anesthesiology residents. Stanford Anesthesia faculty are also pioneers in the use of simulation to improve the crisis handling skills of residents and anesthesiologists. Particular research interest centers on the effects of sleepiness and fatigue in medical personnel and the effects of sleep deprivation on clinical performance using a realistic simulator.

Members of the AIM lab are re reshaping resident education to better match the learning styles of millennial learners and have used this knowledge to build blended and online learning for anesthesiology residents. These groups are actively involved in research related to their educational work.

Research during Residency

The department runs a well-respected residency program and 14 different subspecialty fellowship training programs, including one dedicated to academic research.

The Stanford Fellowship in Anesthesia Research and Medicine (or Stanford FARM Scholars) is designed for residency applicants who want to pursue careers as researchers and academic anesthesiologists. The FARM program requires a minimum of one research fellowship year in addition to the 3 years of traditional residency. Additional funding to support research costs during the fellowship year is available through the departmental small grants program.

Further details on research within the department can be found at: http://med.stanford.edu/anesthesia/research.html