The University of Tennessee Graduate School of Medicine, Knoxville

The Department of Anesthesiology Research | The University of Tennessee Graduate School of Medicine, Knoxville

The Department of Anesthesiology

Anesthesiology Research Division

The mission of the Anesthesiology Research Division is to advance basic and clinical research aiming to enhance understanding of anesthetic mechanisms and improve clinical care. The Anesthesiology Research Division invites active interaction with the clinical faculty and residents in the Department of Anesthesiology, the medical center, the main campus and Oak Ridge National Laboratory. The division provides the bench laboratory skills and equipment to facilitate clinical research projects.

Blood and Blood Coagulation

Anesthesiologists know blood, inside and out. They administer more blood to patients than any other group of medical specialists. For a decade, anesthesiologists at the UT Graduate School of Medicine have researched platelet and whole blood functions to find better care for their patients. Recently, a collaborative team led by Robert M. Craft, M.D., Professor and Residency Program Director in the Department of Anesthesiology, has been investigating blood coagulation in a variety of clinical situations.
"Traditional tests examine the coagulation properties of blood's individual components but not how they work together," Craft says. "The coagulation cascade cannot be adequately assessed by isolating the parts." The team, which also includes Russell Langdon M.D., is utilizing a process called thromboelastography (TEG) that determines the rigidity of whole blood during coagulation. "TEG can tell us which aspect of the coagulation cascade is at fault and allows us to get these assessments in real time," Craft explains. Specifically, TEG is currently being utilized by the Anesthesiology lab to study coagulation disorders in stroke and trauma patients.

Why This Matters

"Our care affects all branches of medicine, so our research reflects this," Craft says of the collaborative spirit evident in the diversity of research in his department.

Physicians must understand the actions and reactions of blood during medical procedures, and collaborative research led by anesthesiologists will bolster that understanding to bring about improved patient safety, better care and more promising outcomes. Specifically, the current projects are designed to help predict and prevent complications from stroke, as well as better treat the bleeding disorders associated with traumatic injury.

These research endeavors assist in the training of tomorrow's clinician researchers as well as maintaining the state of the art knowledge of the clinical staff. The projects also provide training for pre and post-doctoral students interested in careers in biomedical research. Support for these research projects is funded by the T.K. Beene Anesthesiology Gift Fund.

Perioperative Outcomes Research

Anesthesiology as a specialty has seen dramatic increases in patient safety. Mortality rates following general anesthesia have fallen from about 1 in 10,000 in the 1980’s to 1 in 250,000 in 2015. Likewise, complications associated with the perioperative period such as myocardial infarction or acute kidney injuries are rare events. Anesthesiologists still strive to improve patient care and their subsequent outcomes despite the low frequency of complications.

MPOGOne way to combat the difficulties associated with the investigation of rare complications is to combine data from like-minded investigators from across the world. The advent of electronic medical records has enabled perioperative data to be readily pooled from multiple centers. In 2009 under the direction of Jerry L. Epps. M.D., The University of Tennessee Graduate School of Medicine's Department of Anesthesiology became the 7th member of the Multicenter Perioperative Outcomes Group (MPOG). MPOG is a consortium of 47 anesthesiology and surgical departments of institutions with perioperative information systems. Each uses a structured electronic anesthesia information management system that replaces the paper pre-, intra- and post-operative anesthesia records. Research centered on perioperative outcomes focuses primarily on observational studies that evaluate the relative benefits and risks of different therapeutic treatments or interventions to advance knowledge and improve patient care.

Why This Matters

As an example, one of the greatest concerns of an anesthesiologist is to anesthetize a patient only to find out that oxygen cannot be provided through the use of a face mask or placement of a breathing tube due to unforeseen patient abnormalities. Research regarding difficult mask ventilation combined with difficult laryngoscopy is extremely limited even though each technique serves as a rescue for one another. As one of four tertiary care centers participating in a Multicenter Perioperative Outcomes Group study, the Department of Anesthesiology analyzed 492,239 adult cases and identified independent predictors of both difficult mask ventilation and difficult laryngoscopy. An easy to use risk scale was established. As a result, other anesthesia providers can use this information to predict which patients would be difficult to both mask ventilate and intubate thus avoiding a life-threatening condition.




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