Research in Anesthesiology and Perioperative Medicine

Dr. Zheng-Ming Ding’s laboratory utilizes rat models to investigate neurobiological mechanisms underlying the development of drug abuse and addiction. A combination of behavioral, neurochemical, molecular biological techniques are employed to identify drug-induced neuro-adaptations that can drive the progression of addiction. Distinct neuro-circuits critical to the drug-taking and -seeking behaviors are also a focus of Dr. Ding’s research.

Dr. Megan Fox’s laboratory aims to identify neural mechanisms that drive the development of substance use and stress disorders with an emphasis on opioid use and dependence. Dr. Fox uses multidisciplinary approaches that bridge complex behaviors, cell-type-specific transcriptomics, in vivo neurochemistry, and circuit-specific genetic manipulations.

Dr. Nicholas Graziane’s laboratory looks to identify the molecular and cellular substrates that mediate a number of devastating brain diseases, including drug addiction and chronic pain. With established animal models for these diseases, Dr. Graziane uses electrophysiology and optogenetic approaches to examine changes in synaptic transmission and in intrinsic membrane excitability of neurons and circuits that are thought to control motivation, reward, and affective states.

Dr. Patrick Randall’s laboratory focuses on the role of neuroimmune function in drug addiction. Much of his work is focused on pathogen detecting toll-like receptors and their role in the initiation and maintenance of alcohol and nicotine use and dependence. In addition, the Randall lab is interested in the effects of nicotine vaping on the brain and peripheral organ systems. He utilizes a combination of rodent behavioral models, chemogenetics and comprehensive molecular analysis to better understand the underlying neurobiology of drug addiction.

Dr. Victor Ruiz-Velasco’s laboratory focuses on the modulation of Ca2+ and K+ channels by G proteins and other nucleotides, which has been the focus of his research career. Recently, his laboratory has started to investigate the modulation of acid-sensing ion channel (ASIC) currents by opioid peptides, as well as examining the role of single nucleotide polymorphisms in voltage-gated channels, NaV1.8 and NaV1.9 and pain. Over the years, he has employed a wide variety of techniques that have allowed him to study this biophysical transduction system in excitable cells, including neurons and smooth muscle cells.

Sanjib Adhikary, MD: The Regional Anesthesia and Acute Pain Medicine (RAAPM) research component is involved with multiple clinical studies and quality improvement initiatives and is led by Dr. Sanjib Adhikary. A core focus for this team is orthopedic surgery, assessing both time-based cost analysis involving total joint arthroplasties as well as the efficacy of adductor canal catheters during physical rehabilitation post total knee replacement. Current initiatives also include Enhanced Recovery After Surgery protocols for breast surgery, traumatic rib fracture patients and the use of ketamine infusions for acute pain management. Other areas of interest consist of simulation-based training for resident and fellow education. The RAAPM team has contributed to multiple high-quality publications, textbook chapters and both internal and external grant applications. One of the team’s collective goals is to advance this specialty within the medical field.

Dr. Anthony Bonavia’s work focuses on the mechanisms of innate immune dysfunction caused by septic shock and associated acute kidney injury. Both of these diseases result in very high systemic levels of resistin, a pro-inflammatory cytokine impairing chemotaxis, reactive oxygen species production, and bacterial killing by neutrophils. By using cell-based and animal models, he investigates whether resistin is responsible for immunosuppression in these disease states. The translational implications of his research are to aid better understanding of whether cytokine adsorption therapy may have a role in mitigating the secondary infectious complications that develop in critically ill patients following sepsis and acute kidney injury.

New opportunities to investigate and improve how perioperative care is actually delivered are afforded by electronic medical records registries which can integrate perioperative records across many academic institutions (e.g., Multicenter Clinical Outcomes Group [MPOG]), while still allowing examination of granular detail down to individual anesthesia provider behavior. Dr. Elie Sarraf is researching how to leverage statistical tools, including machine learning, to use these large data sets in order to build models that can predict perioperative outcomes in order to guide patient care.

The Pediatric Anesthesia Research component, led by Dr. Priti Dalal, involves multiple projects. One of the major projects is assessment of post-operative pain using skin conductance measurements. Several other research projects that are ongoing include efficacy of an infra-red vein visualization device, music therapy in children at anesthesia induction, and multiple quality research projects including handoff communications with children’s ICU, outcomes in cases of NICU bedside procedures under anesthesia, unplanned extubations and unplanned ICU admissions.

The Intensive Care Clinical Research Team is led by Dr. Anthony Bonavia, an NIH-funded clinician-scientist whose research focuses on mechanisms and subtypes of sepsis. Given the complex nature of sepsis and critical illness, the team is involved in several multidisciplinary collaborations with other intensivists throughout the Penn State Health system. This has facilitated projects that utilize tools such as bioinformatics, machine learning and multimodal immune-phenotyping to answer complex questions regarding acute sepsis and the chronic critical illness phase that often follows it.

The Cardiac Anesthesia Division, led by Dr. Shayne “Mike” Roberts, has a number of interesting projects. One of the endeavors has been an echocardiographic study comparing different measures of RV function using TEE and TTE. The goal is to help determine what parameters should be used for intraoperative decision-making. Other interests include the use of three-dimensional echocardiography to predict certain conditions after valve surgery. The group is also focused on different methods of teaching residents and is currently collaborating with other institutions on a novel curriculum for perioperative ultrasound. One of the division’s other research interests involves vasoplegia, a condition that is characterized by low blood pressure in the setting of cardiac surgery.

The Clinical Simulation Center provides support for research related to education, system assessment, product development, quality/safety issues and human factors. Large grants can include support for use of Simulation Center resources and small grants are available to support research projects from the endowment. Investigators can contact Sim Center leadership to discuss options for research projects — they would be happy to help.

The Regional Anesthesia and Acute Pain Medicine (RAAPM) research component is involved with multiple clinical studies and quality improvement initiatives and is led by Dr. Sanjib Adhikary. A core focus for this team is orthopedic surgery, assessing both time-based cost analysis involving total joint arthroplasties as well as the efficacy of adductor canal catheters during physical rehabilitation post total knee replacement. Current initiatives also include Enhanced Recovery After Surgery protocols for breast surgery, traumatic rib fracture patients and the use of ketamine infusions for acute pain management. Other areas of interest consist of simulation-based training for resident and fellow education. The RAAPM team has contributed to multiple high-quality publications, textbook chapters and both internal and external grant applications. One of the team’s collective goals is to advance this specialty within the medical field.