The safety of anesthesia care during surgery has come a long way since its introduction in 1846 and the researchers at the Center for Perioperative Medicine at The University of Texas Health Science Center (UTHealth) want to keep the momentum going.
The new research center is finding novel ways to protect vital organs – kidneys, lungs, heart, liver, and intestines – during a surgical intervention.
Housed in the Department of Anesthesiology at McGovern Medical School at UTHealth, the center is a vital part of the university’s continuous quality improvement efforts when it comes to the treatment of injuries or diseases that involve opening the body.
“Perioperative medicine refers to all aspects important to a surgical procedure. It spans from optimizing our patients for surgery, making sure that the operation and anesthesia goes well, and extending into the recovery phase, including critical care medicine and rehabilitation,” said Holger Eltzschig, MD, PhD, the director of the center and the chair of anesthesiology at McGovern Medical School.
When surgeons repair a failing heart or excise a cancerous growth, there is a risk of postoperative organ injury, which can manifest itself in many different forms from stroke to inflammation to respiratory distress.
“Although surgery and anesthesia have become exceptionally safe due to advances in technique and drug development, there are still inherent risks,” Eltzschig said.
Seniors, who are sometimes frail and more prone to complications, are at an increased risk of organ injury. While U.S. Census data showed that in 2006, people over 65 years of age comprised 12.5% of the population, they accounted for 38% of hospitalizations, according to the National Hospital Discharge Survey.
Potentially lifesaving organ transplants also come with elevated risks. Cynthia Ju, PhD, the center’s co-director and vice chair for research in anesthesiology at McGovern Medical School, is working closely with McGovern Medical School faculty members and transplant surgeons Wasim Dar, MD, PhD, and J. Steve Bynon, MD, to make liver transplants safer. Dar and Bynon see patients at Memorial Hermann-Texas Medical Center and UT Physicians, the clinical practice of McGovern Medical School.
“We hope to use our research to develop strategies to reduce mortality and morbidity rates during liver transplantations,” said Ju, the Joseph C. Gabel, MD, Endowed Chair in Anesthesiology at McGovern Medical School. “We are beginning to unravel the molecular mechanisms mediating how a white blood cell known as an eosinophil protects the liver during transplantation.”
Ju’s laboratory is one of more than 20 affiliated with the new perioperative center. Researchers are on the faculty of McGovern Medical School and The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, where both Ju and Eltzschig have appointments.
“Our research in perioperative medicine is focused on what leads to adverse events during surgery and how we can prevent these events from happening,” said Eltzschig, the John P. and Kathrine G. McGovern Distinguished University Chair at McGovern Medical School. “We also want to be better prepared to deal with adverse events when they occur.”
Center members are conducting clinical and preclinical studies to learn more about surgical procedures. For example, Xiaoyi Yuan, PhD, assistant professor of anesthesiology with McGovern Medical School, is working to reduce a health condition sometimes experienced by patients in an intensive care unit or who are being treated for sepsis or pneumonia.
The condition is called acute respiratory distress syndrome (ARDS). According to the American Lung Association, there are about 200,000 cases of ARDS each year in the United States and 30% to 50% percent of those diagnosed with ARDS die of it. Those who recover from ARDS often have a reduced quality of life.
“So far, there is a shortage of effective treatment or prevention strategies for this deadly disease,” Yuan said.
Yuan is studying the process by which genetic information is converted into proteins in the hope of learning more about the roles of a class of molecules called microRNAs during ARDS. MicroRNAs are an integral part of the conversion process but do not become proteins themselves.
“When we increased the levels of a certain microRNA in a mouse model of acute lung injury, there were better outcomes,” she said. “We hypothesize that this microRNA reduces lung inflammation by controlling pro-inflammatory molecules.”
In addition to finding novel therapeutic approaches to make surgery safer, the Center for Perioperative Medicine is also one of the places where the next generation of scientists and physician-scientists is being trained to learn how to do research and to become successful and independent leaders in their fields.
Eltzschig said, “The highly collaborative environment with leaders from different departments and even institutions makes our center the perfect place for junior investigators to train in translational medicine and to start their careers on finding new ways to help our patients and make the hospital stay more pleasant and successful.”
Those scientists include Nathaniel Berg, an MD/PhD student at MD Anderson UTHealth Graduate School.
“As an aspiring physician-scientist, the Center for Perioperative Medicine has been an ideal environment for me to train because I get to work closely with exceptional researchers and clinicians,” Berg said. “Our center also houses a unique set of core equipment and expertise that promotes a collaborative and productive place for students and postdocs to train.”
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