The Relative Prevalence and Severity of Autonomic Nervous System Dysfunction in Diabetic Patients Undergoing Retinal Surgery

Principal Investigator:  Gwendolyn Boyd, M.D.

This is a prospective, cross-sectional study of the comparative prevalence and severity of cardiac autonomic neuropathy (CAN), diabetic autonomic neuropathy (DAN), and autonomic nervous system (ANS) dysfunction as well as sympathovagal balance (SB) in two convenience patient samples.  Associated comorbidties, including cardiomyopathy, coronary artery disease, cerebrovascular disease, renal disease, hypertension, chronic lung disease, and obstructive sleep apnea (OSA) will be assessed as predictors of ANS dysfunction in both the diabetic and non-diabetic groups.  It is hypothesized that diabetic patients presenting for surgery to treat vision impairment secondary to diabetic retinopathy will have a higher prevalance of autonomic nervous system dysfunction compared to non-diabetic patients undergoing retinal surgery.  Determination of the severity as well as the relative balance/imbalance of the sympathetic and parasympathetic nervous system tone should allow for more optimal treatment during the perioperative period with the ultimate goal of decreased morbidity and mortality.

The Effect of Intravenous Lidocaine on Allodynia (Carl Koller Grant)

Principal Investigator: Michael Froelich, MD, MS

The drug Lidocaine (given as infusion) improves a chronic pain syndrome called CRPS (Chronic Regional Pain Syndrome). We quantify this effect using established pain rating methods and want to use functional brain imaging to find out whether this treatment effect goes along with a change of brain activity that is caused by pain.

The Effect of Intravenous Lidocaine on Normal Sensation and Healthy Volunteers (Carl Koller Grant) (The Effect of Lidocaine on Allodynia)

Principal Investigator: Michael Froelich, MD, MS

The drug Lidocaine (given as infusion) improves a chronic pain syndrome called CRPS (Chronic Regional Pain Syndrome). We quantify this effect using established pain rating methods and want to use functional brain imaging to find out whether this treatment effect goes along with a change of brain activity that is caused by pain.

The Effect of Sedation on Eye Movements (The Effect of Sedation on Pain Perception)

Principal Investigator: Michael Froelich, MD, MS

The purpose of this project is to define the effect of sedation on eye movements. There are several reports indicating that fast eye movements (saccadic eye movements) may be affected by sedation and some investigators claim that the observation of these eye movements may be the best objective means to quantify the sedative effects of certain drugs.

The Effect of Sedation on Pain Perception

Principal Investigator: Michael Froelich, MD, MS

The purpose of this study is to define the effect of sedation on pain perception.  There are several reports indicating that sedation may change the way painful procedures (stimuli) are experienced. Therefore, we plan to investigate this effect in detail.

Hormonal Effects on Pain Perception

Principal Investigator: Michael Froelich, M.D., MS

The Purpose of this study is to investigate if labor pain is affected by the mother's hormonal levels.

Oxytocin and Maternal Temperature

Principal Investigator: Michael Froelich, M.D., MS

This study tests whether there is an association of oxytocin use and maternal temperature elevation

Differential Anesthetic Effects on Human Natural Killer Cell Activity and Toxicity

Principal Investigator: Tony Jones, M.D.

Intravenous as well as volatile anesthetics have complex actions on virtually every cell type in the human body. There are well documented effects of these agents on a variety of cell types.  However, the effects of anesthetics on the cells of the immune system, including natural killer (NK) cells, are currently not well understood.  Two specific objectives will be pursued:  to determine the effect of isoflurane, a volatile anesthetic, and propofol, an intravenous anesthetic, on normal donor human NK cell function following exposure to anesthetics in vivo; to determine the effect on normal human NK cell activity after exposure to the anesthetics isoflurane and propofol in vitro.

Modulation of Innate Immunity in Lung Transplantation

Principal Investigator: Sadis Matalon, PhD

Alveolar epithelial cells of mammalian lungs actively transport sodium (Na⁺) and chloride (Cl^-) ions and these processes are important in fluid homeostasis.  Sodium ions enter the apical membranes of both type I and type II alveolar epithelial cells through sodium selective, cation and cyclic nucleotide gated ion channels and are extruded across the basolateral membrane by the ouabain-sensitive Na,K-ATPase.  This vectorial transport of Na⁺ ions (and concomitant movement of Cl^- ions to maintain electroneutrality) creates an oncotic force leading to the reabsorption of fluid across both normal and damaged lungs. Nitric oxide and reactive oxygen nitrogen intermediates (formed by the reactions of nitric oxide with partially reduced oxygen species), generated in close proximity of epithelial cell membranes by activated inflammatory cells, modulate the activity of sodium channels via signal transduction mechanisms (such as activating PKG and PKC) or by post-translational oxidative modifications of sodium channel proteins and their chaperons. Channel activity (and vectorial sodium transport) may be either increased or decreased depending on levels of reactive intermediates and length of exposure. 

Quantitative Studies of Urinary Bladder Sensation

Principal Investigator: Timothy Ness, MD

In NIH-funded studies, truly translational studies related to urinary bladder and colorectal sensation are being performed by measuring psychophysical responses in humans and parallel studies in rodents. Dr. Ness with collaborators (Randich, Robbins) have  determined that developmental mechanisms related to visceral hypersensitivity can be initiated by early-in-life inflammatory events that lead to altered neurophysiological processing as adults.  These observations are now supported by epidemiological studies.  The precise interplay between excitatory and inhibitory influences that exist at a spinal level are being dissected out using behavioral, neurophysiological (spinal dorsal horn, medullary and thalamic extracellular neuronal studies) and immunohistochemical (c-fos induction) studies in this programmatic line of research. Psychophysical studies have identified deficiencies in endogenous pain control systems related to counterirritation - similar deficits have been identified in preclinical experimental models.

Effects of Inhaled Nitric Oxide on Ischemia-Reperfusion Injury in Human Liver During Transplantation

Principal Investigator: Rakesh Patel, Ph.D.

The purpose of this prospective study is to further document the efficacy and safety of inhaled nitric oxide (NO) to decrease damage to the transplanted liver caused by the re-initiation of blood flow.

The Application of Performance Improvement Principles to the Patient Throughput Process in an Adult Outpatient Pain Treatment Center

Principal Investigator: Thomas Vetter, MD, MPH

This study's purpose is to assess and to improve the existing patient flow, or so-called throughput process, in an adult outpatient pain treatment clinic.  The well-recognized and widely applied "Six Sigma" approach to performance improvement will be applied. This study will be undertaken primarily both as part of an internal departmental rapid-cycle plan, do, study, act (PDSA) performance improvement effort and for resident educational purposes.  

Airway Management and Vascular Assess Simulation

Principal Investigator: Thomas Vetter, M.D., MPH

This project involves a pre-and post-airway management and vascular access stimulation survery.  The purpose of the survey is to assess the perceived effectiveness of the simulation course on the performance of medical students enrolling in the Anesthesiology rotation during their third and fourth year medical education.

The Predictors and Patient versus Parental Perceptions of Health-Related Quality of Life in Pediatric Chronic Pain

Principal Investigator: Thomas Vetter, M.D., MPH

The primary mission of the Pediatric Chronic Pain Medicine Program is to improve the health-related quality of life of infants, children, and adolescents from Birmingham as well as the entire state of Alabama, by providing a comprehensive spectrum of clinical services that compassionately address the equally important biological, psychological, and social components of their pediatric chronic pain condition, thereby reducing the attendant stress and dysfunction of both the patient and his or her family members. This study is intended to provide additional insight into the factors affecting health-related quality of life with pediatric chronic pain as perceived by the patient versus his or her parents.  In doing so, additional insight into the subjective interperetation the pediatric chronic pain experience will be gained.  The four objectives of this study will be (a) to examine further the relationship between patient self-reported health-related quality of life and parent proxy-reported health-related quality; (b) to identify what biological, psychological, and/or social factors are the strongest predictors of a pediatric chronic pain patient's self-reported pain intensity and self-reported health-related quality of life, in a diverse cohort of patients referred to and subsequently treated by an anesthesiology-based yet, interdisciplinary pediatric chronic pain medicine program; (c) to assess the effect of patient-specific, pain-focused biopsychosocial treatment regimen on pain intensity and health-related quality of life, and (d) to determine the effect of patient/parental satisfaction with on-going health care on their compliance with and uptake of the pain treatment regimen.

Success Rate, Efficiency and Predictors of Reactivation of a Continuous Labor Epidural Catheter for Postpartum Tubal Ligation.

Principal Investigator: Marsha Wakefield, M.D.

Postpartum bilateral tubal ligation (PPBTL) is a common sterilization method in the United States.  Neuraxial anesthesia is the preferred method of providing anesthesia for the procedure.  Frequently a previously placed indwelling epidural catheter for labor analgesia is removed and a de novo spinal anesthetic is placed to provide anesthesia for PPBTL.  We hypothesize that the failure rate of reactivation of in situ epidural catheter is high.  The purpose of the study is to investigate success rate, predictors, efficiency, quality of anesthesia, and patient satisfaction with reactivating an indwelling epidural catheter initially placed for labor and delivery versus discontinuing the labor and delivery epidural and performing a spinal anesthetic for PPBTL.