2003 APSF Grant Recipients Named

Sorin J. Brull, MD

This year two grants were selected for funding by the APSF Scientific Evaluation Committee (for names of committee members, please see page 67). As in previous years, the maximum award amount is $65,000, and the APSF continues to attract outstanding applicants. The major objective of the APSF grant program is to stimulate the performance of studies that lead to prevention of mortality and morbidity from anesthesia mishaps. A particular priority continues to be given to studies that address anesthetic problems in healthy patients, and to those studies that are broadly applicable and promise improved methods of patient safety with a defined and direct path to implementation into clinical care. The areas of outcome-based research in clinical settings that are particularly prone to untoward events continue to be emphasized. New this year is the specific emphasis that the APSF is placing on education. To recognize the patriarch of patient safety in the United States and internationally, the APSF has just inaugurated the Ellison C. Pierce, Jr., MD, Research Award. The APSF Scientific Evaluation Committee will designate one of the funded proposals as the recipient of this honor, which carries with it an additional, unrestricted award of $5,000.

We were pleased to note that the committee reviewed 20 first-round applications, of which 9 were eligible for final review at the ASA Annual Meeting in Orlando. The applications this year covered a variety of topics including patient comfort during peripheral nerve stimulation, heads-up displays for monitoring, safety of local anesthetics during labor, the effect of surgical case volume on the safety of pediatric anesthesia, simulators in anesthesia education, pre-anesthesia evaluation, prevention of postoperative hyperthermia after cardiac surgery, safety of acute pain management in pediatric anesthesia, potency and toxicity of long-acting local anesthetics, prevention of dental trauma from laryngoscopy, and web-based patient education.

Of the 9 finalists, the members of the APSF committee selected two awardees:

Ken B. Johnson, MD is Assistant Professor of Anesthesiology in the Department of Anesthesiology at the University of Utah in Salt Lake City. His grant proposal is entitled “Exploration of Partial Task and Variable Priority Training to Improve Management of Adverse Respiratory Events: An Enhanced Approach to Didactic and Simulation-Based Training for Anesthesia Residents.” The objective of this proposal is to assess how enhanced didactic and simulator-based training incorporating both part task and variable priority training will impact first-year anesthesia residents’ ability to manage life-threatening adult and pediatric respiratory events. Part task training is defined as the break-down of large, multi-component tasks into a set of components that can become highly automated, reducing the processing demands. Variable priority training is a method of teaching residents to distribute attention over multiple aspects of a task. The study will compare standard training for first-year anesthesia residents with enhanced training over a 12-month period. Standard training consists of resident participation in weekly didactic sessions (grand rounds, case conferences, chapter reviews, and visiting professor lectures), daily hands-on training in the operating room, and 6 simulation-based training sessions throughout the year. Part task and variable priority training consists of participation in the same activities as the control group, except that 1 of the weekly didactic sessions per month will employ part task training, and all 6 of the simulation-based training sessions will employ variable priority training. Each resident’s performance in managing 6 simulated respiratory events will be measured at the beginning and at the end of the 12-month study period. Metrics of comparison between training groups will include the time required to reach diagnosis and the time required to properly treat the simulated respiratory events.

This proposal has significant patient safety implications, as it may offer objective evidence of improved training methods for anesthesia residents in managing life-threatening adult and pediatric respiratory events. Other personnel listed in Dr. Johnson’s proposal include Noah Syroid, MS, who will provide the programming support for the simulator; Diane Tyler, RN, MS, who will serve as the study coordinator; and Holly Dockstader, who will serve as the training assistant. Dr. Johnson’s consultants include David Strayer, PhD, Frank Drews, PhD, and Dwayne Westenskow, PhD.

In addition to receiving the requested funding of $65,000 for this project, Dr Johnson is also the recipient of the inaugural “Ellison C. Pierce, Jr., MD, Research Award,” which consists of an additional, unrestricted grant of $5,000.

Nyamkhishig Sambuughin, PhD, is Assistant Staff Scientist of Neurology Research at the Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center in Phoenix, Arizona. Her grant proposal is entitled “Development of Molecular Diagnosis for Malignant Hyperthermia.” The objective of this proposal is to screen an entire ryanodine type 1 receptor (RYR1) gene using new molecular genetic technology, and eventually to establish the complete spectrum of RYR1 mutations. The proposal is based on the hypothesis that RYR1 mutations are dispersed throughout the gene, causing malignant hyperthermia (MH) susceptibility in 80% of affected families. Individuals with MH are usually clinically normal, but they are prone to life-threatening hypermetabolic crises following exposure to inhalational anesthetics or depolarizing muscle relaxants. In the majority of cases, MH results from a defect in the regulation of calcium release in skeletal muscle due to mutations in the calcium-release channel of the sarcoplasmic reticulum receptor (RYR1). MH is inherited as an autosomal dominant trait, and when MH susceptibility is diagnosed in an individual, his or her family members are considered at risk for the disease. Currently, MH susceptibility can only be determined by caffeine-halothane contracture test, an invasive procedure that is expensive, less than 100% reliable, difficult to perform in children, and only available in 4 diagnostic centers in the United States. The proposal seeks to develop a molecular screening test for MH susceptibility, based on the mutation analysis of the RYR1 gene. Genetic diagnosis for MH susceptibility in at-risk individuals will enhance patient safety significantly, and will be far less invasive, highly specific, and relatively inexpensive.

Dr. Sambuughin’s co-investigators include: Kumaraswamy Sivakumar, MD, Sheila Muldoon, MD, Yoshitatsu Sei, MD, PhD, Denise Wedel, MD, Tom Nelson, PhD, and Paul Iaizzo, PhD. Lev Goldfarb, MD, will be the consultant for this proposal.

The members of the APSF Scientific Evaluation Committee wish to congratulate all of the investigators who submitted their work to APSF this year, whether or not their proposals were funded. We hope that the high quality of the accepted proposals and the important findings that will undoubtedly result will serve as a stimulus for others to submit research grants that will benefit all patients and our specialty.

Dr. Brull is Clinical Professor at the University of Florida-Gainsville, President of Atlantic Anesthesia, LLC, and Chair of the APSF Committee on Scientific Evaluation.