Three grants were again selected for funding by the APSF for the year 2002. The funded topics included a proposal to develop a microdialysis procedure to aid in the diagnosis of malignant hyperthermia susceptibility, an examination of the effect of apolipoprotein E and aging on cerebral blood flow responsiveness to a mu opiod, and an analysis of skill acquisition determining expertise in laryngoscopy. The grant recipients were selected by 13 members of the APSF Committee on Scientific Evaluation (listed on page 63), and announced on October 13 at the APSF Board of Directors Meeting in New Orleans. The committee reported that there were 31 applications, 12 of which made it to the final selection process. The applications were felt to be of high quality, making the selection of the 3 grant winners quite difficult. The major objective of the APSF is to stimulate and support studies that lead to prevention of mortality and morbidity from anesthetic mishaps. Priority is given to studies that apply to healthy patients or studies that have broad applicability to improving patient safety. Information on the application process for next year’s awards also appears in this issue. A summary of the three selected proposals is presented below and includes the amount of the award and the duration of the study. As in the recent years, the maximum award is $65,000.
Microdialysis Assisted Diagnosis of MH Susceptibility
Saiid Bina, PhD, Assistant Professor of Anesthesiology at the Uniformed Services University of the Health Sciences in Bethesda, MD, was selected for his grant proposal entitled “Development of a microdialysis procedure for the diagnosis of malignant hyperthermia susceptibility.” The grant is for $49,400 and its duration is 18 months. The long-term objective of this proposal is to develop a simple, relatively inexpensive, reliable, less invasive, and readily available diagnostic test for malignant hyperthermia (MH) susceptibility. The development of such a diagnostic test has obvious and significant safety implications for patient safety: malignant hyperthermia is a genetic, potentially lethal disorder of skeletal muscle. The currently available standard test for MH susceptibility (caffeine-halothane contracture test) is invasive, requiring surgical removal of muscle specimen (biopsy); once obtained, the biopsy specimen can only be tested in only 11 North American centers, and the testing must be done within 5 hours of biopsy to ensure consistency. The proposed project will test the hypothesis that microdialysis testing is effective, reproducible, and inexpensive, while being far less invasive than the current tests.
Apolipoprotein, Aging, and Opiods
W. Andrew Kofke, MD, MBA, Professor of Anesthesiology at the University of Pennsylvania School of Medicine in Philadelphia, PA, was awarded a 24-month, $65,000 grant for his proposal entitled “Effect of apolipoprotein E polymorphism and aging on cerebral blood flow response to mu opioid.” The objective of this study is to determine whether brain (limbic system) hypermetabolism, manifest as hyperemia, occurs in healthy humans receiving an opioid (remifentanil), and whether this hypermetabolism varies with age and apolipoprotein E status. The significant patient safety implications of this proposal are that up to 10% of elderly patients undergoing surgery sustain permanent postoperative cognitive dysfunction. Specifically, the occurrence of cognitive deficits after cardiac surgery in patients who receive high doses of opioids has been correlated with the presence of the apolipoprotein E4 allele. Since preliminary data in both animals and humans support the contention that opioids produce limbic system activation, this study proposes to determine whether the use of opioids in genetically susceptible individuals may have deleterious neurotoxic effects.
Improving Laryngoscopy Expertise
Nathan J. Delson, PhD, Director of the Mechanical Engineering Design Center, the Department of Mechanical and Aerospace Engineering, University of California at San Diego in San Diego, CA, was the third recipient. His proposal entitled “Expert skill acquisition for improved laryngoscopy training” was selected for a 12-month grant in the amount of $64,773. In this proposed study, a multidisciplinary team of engineers and anesthesiologists will use a sophisticated “instrumented laryngoscope” to measure the factors that define expertise and cause difficulty attaining successful oral endotracheal intubation. The patient safety issues are significant, as failure of airway management remains a major cause of anesthetic morbidity or during emergency situations. While experienced anesthesiologists can perform laryngoscopy successfully and intubate the trachea reliably, less experienced clinicians or paramedical personnel may have failure rates of up to 33%. The identification of the components of laryngoscopic technique that define expertise and that are critical to the success of tracheal intubation is of paramount importance in perfecting training techniques and developing training aids. The results of this study are likely to improve the efficacy of laryngoscopy training, and provide the technical data necessary to guide the construction of physiologically accurate and realistic airway management trainers.
The members of the APSF Scientific Evaluation Committee wish to congratulate all of the applicants who submitted their proposals to the APSF for consideration during this cycle, whether or not they were selected for funding. We hope that the high quality of the funded proposals will serve as a stimulus for others to submit research grant applications that will enhance patient safety and benefit future patients.
Dr. Brull, Professor in the Department of Anesthesiology at the University of Arkansas College of Medicine in Little Rock, is Chair of the APSF Committee on Scientific Evaluation and a member of the APSF Editorial Board.