Differential Anesthetic Effects on Human Natural Killer Cell Activity and Toxicity
Principal Investigator: Keith A. (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.

Hormonal Effects on Pain Perception
Principal Investigator: Michael Froelich, M.D., M.S.
The purpose of this study is to investigate if labor pain is affected by the mother's hormonal levels.

Laryngeal Airway Ultrasound and Reintubation Assessment Trial
Principal Investigator: Phillip J. McArdle, M.D.
This study aims to a) compare the use of bedside laryngeal ultrasound to the cuff leak test in predicting post-extubation stridor and re-intubation; b) determine the prevalence of laryngeal edema in the neurologically insulted critical care patient as compared to the surgical critical care population; and c) determine an intraclass correlation coefficient for the identification of laryngeal edema using bedside ultrasound by anesthesiologists. Our hypotheses are that laryngeal ultrasound will have a higher positive predictive value than the cuff leak test for post-extubation stridor and that there will be a higher incidence of laryngeal edema in those with pathologic neuroanatomy. Objectives: To compare the positive predictive value of the detection of laryngeal edema as defined by bedside ultrasound as compared to the cuff leak test in predicting post-extubation stridor. To establish the positive predictive value of ultrasound-detected laryngeal edema in the prediction of re-intubation of critically ill patients. To define the prevalence of laryngeal edema in neurologically injured critical care (NICC) patients as compared to surgical critical care (SCC) patients. To evaluate the intra-class consistency correlation (ICC) amongst anesthesiologists with a variety of training evaluating laryngeal edema on ultrasound images.

Mortality associated with massive transfusion
Principal Investigator: Ronald Roan, M.D.
A retrospective analysis of mortality by subgroups for subjects transfused more than 20 units of blood products in 24 hours.  

Oxytocin and Maternal Temperature
Principal Investigator: Michael Froelich, M.D., M.S.
This study tests whether there is an association of oxytocin use and maternal temperature elevation

Phenotype Identification in Pain Populations 
Principal Investigators: Laurence Bradley, Ph.D. and Georg Deutsch, Ph.D. (Adjunct Faculty)
NIH-funded researcher, Dr. Bradley (Medicine-Rheumatology/Immunology) with collaborators Drs. Deutsch (Radiology-Nuclear Medicine), Ness and Froelich (Anesthesiology), have expanded current studies of patients with fibromyalgia and/or irritable bowel syndrome to include patients with the diagnosis of painful bladder syndrome. Parallel quantitative sensory testing studies and regional cerebral bloodflow studies using Continuous Arterial Spin-Label functional MRI technologies are probing whether there exist phenotypic subtypes within these clinical populations based on alterations in sensory testing and altered baseline and evoked regional cerebral bloodflow measures. It is notable that animal studies by Randich (in projects noted above) have identified subpopulations within preclinical models of bladder pain.

Racial Differences in Sleep and Pain Sensitivity Across the Adult Lifespan
Principal Investigator: Burel Goodin, Ph.D.
The risk of developing persistent pain and sleep deficits increases with age, and this appears to be particularly relevant for older African Americans. The goals of this are: 1) increase the scientific understanding of the effects of minority aging on pain sensitivity, and 2) address the impact of minority aging on sleep quality and determine whether sleep mediates the effects of minority aging on pain sensitivity. These data will pave the way for future research to address whether interventions that improve the sleep of older African Americans also meaningfully impact experiences of pain in everyday life by exerting positive influences on pain sensitivity.

Remote Ischemic Preconditioning Living Donor Renal Transplant Protocol
Principal Investigator: Mali Mathru, M.D.
Remote ischemic preconditioning (RIPC), a phenotype of ischemic preconditioning, has been found to provide protection from I/R in humans. Several proof of concept clinical trials have shown that transient ischemia reperfusion of lower extremities confers protection to kidneys in patients undergoing endovascular or open surgical repair of an abdominal aortic aneurysm and in patients undergoing cardiac surgery. Furthermore, a randomized pilot clinical trial demonstrated that application of RIPC in high risk patients with kidney dysfunction undergoing coronary angioplasty reduced the incidence of procedure related contrast media induced AKI. To date the efficacy of RIPC in protecting renal allografts from I/R injury during renal transplantation has not been systematically investigated. In this current proof of concept proposal we will test the central hypothesis that application of RIPC in donors and recipients during live donor kidney transplantation will reduce the severity of graft injury and improve outcome. We propose the following specific aim: To examine the effect of RIPC on clinical and biochemical markers of graft function in patients undergoing live donor kidney transplantation. 

Risk Factors for Failed Conversion of a Labor Epidural to a Surgical Block for Postpartum Tubal Ligation
Principal Investigator: Mark Powell, M.D.
Reactivation of the patient's labor epidural for surgical anesthesia is routine for patients undergoing postpartum tubal ligation. However, not all epidurals are successfully reactivated. Failure to reactivate the epidural has been shown to increase costs and resource consumption in the OR. The only risk factor that has been studied so far is the time from delivery to reactivation of epidural for tubal ligation. We are trying to identify the overall failure rate of reactivation at UAB and other risk factors that may affect the reactivation of the labor epidural. The two major risk factors we are investigating are the patient's BMI and her satisfaction with the epidural during labor as we think patients with higher BMIs and/or lower satisfaction of the epidural during labor may lead to a higher failure rate of reactivation. Patient satisfaction is determined by a Likert score of 1–10 and by the number of extra local anesthetic required during labor and delivery.

The Effect of Sedation on Pain Perception
Principal Investigator: Michael Froelich, M.D., M.S.
The purpose of this study is to define the effect of sedation on pain perception. We obtain pain self-report as subjective outcome and, in a separate study session, BOLD fMRI as an objective outcome measure. 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.

The Identification of Specific Strains of Pseudomonas aeruginosa in Lung Infection and their Relation to Patient Outcomes
Principal Investigators: Jean-Francois Pittet, M.D.; Brant Wagener, M.D., Ph.D.
In this study, we are collecting sputum samples from all patients diagnosed with Pseudomonas aeruginosa at a UAB ICU. The samples are then tested for their expression of various components of the Type III secretion system which is responsible for pathogen virulence. We then compare this bacterial data with clinical data and outcomes in patients to determine the relationship between bacterial virulence and pneumonia definitions/patient outcome/ARDS/etc.
Key Collaborator: Troy Stevens, Ph.D. (University of South Alabama)

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 prevalence 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 Role of Coagulopathy in Pediatric Trauma
Principal Investigators: Jean-Francois Pittet, M.D.; Brant Wagener, M.D., Ph.D.
Coagulopathy after trauma in adults is a common phenomenon, although not well understood.  There is less known in children and we seek to determine first the relationship between coagulopathy and mortality after trauma in children.  We are currently looking into the roles of aPC and syndecan-1 in this process.
Key Collaborators: Robert Russell, M.D. (Children’s Hospital)Steven J. Lisco, M.D., FCCM, FCCP (University of Nebraska at Omaha); Amy L. Duhachek-Stapelman, M.D., (University of Nebraska at Omaha)

The Role of the Parasympathetic and Sympathetic Nervous System in Noscomial Lung Infection after Trauma
Principal Investigators: Jean-Francois Pittet, M.D.; Brant Wagener, M.D., Ph.D.
After trauma, there is intense vagal stimulation that may be a contributor to ARDS and nosocomial lung infection. We are performing a study in which we will look at sympathetic and parasympathetic nervous system patterns in patients who have undergone trauma (using special monitoring equipment) and will relate this to their outcomes in the ICU.
Key Collaborators: Vinod Singh, M.D.; Nicole P. Juffermans, M.D., Ph.D.  University of Amsterdam, Netherlands.

The Role of Vitamins C and E in Prevention of Nosocomial Lung Infection
Principal Investigators: Jean-Francois Pittet, M.D.; Brant Wagener, M.D., Ph.D.
In this project, we are giving patients who have undergone trauma prophylactic doses of Vitamin E to determine whether this will decrease the incidence of nosocomial pneumonia. This project is occurring in conjunction with our in vitro study.
Key Collaborators: Albert Pierce, M.D.