RESEARCH TRACK CURRICULUM
MISSION: The research track in anesthesiology allows for in depth exposure to academic research and scientific investigation with clinical and basic science researchers. As such, residents
enrolled in this program will have guidance and supervision in areas of scientific research as it relates to the practice of anesthesiology and critical care.
Goals and Objectives for Fellows and Residents Pursuing the Research Track
The resident or fellow is expected to achieve the following:
A. Develop an understanding of the scientific principles of clinical or laboratory research as they apply to anesthesiology or critical care.
B. Learn to read, analyze, and discuss peer-reviewed literature in a specific research area of interest.
C. Develop an in-depth understanding of a specific area of anesthesiology or critical care beyond that expected of a general anesthesia practitioner.
D. Learn to prepare, submit, and follow research proposals based upon institutional guidelines and policies for human or animal experimentation.
E. Complete a focused research project including developing specific aims and hypotheses, acquiring necessary technical skills, generating and collecting data,
analyzing data, and writing an abstract (as a minimum) or paper based upon study.
F. Prepare and deliver an in-depth slide presentation pertaining to an area of scientific research to a group of physician peers.
Resident/Fellow Activities and Responsibilities
CA-3 Research Track:
The resident will commit to a six-month period of clinical or laboratory research in a suitable discipline as approved by the residency director and education committee.
The resident and research mentor will develop a research proposal that will satisfy the following general requirements:
1. A project will be designed that can be completed in a six month period.
2. All studies must conform to the standards of human research (as outlined by the Institutional Review Board of UTMB) or animal research (Animal Care and Use Committee) with
current, approved protocols.
3. A written outline of the study including scientific justification for the propose of the study and appropriate bibliography must be prepared. The outline will conform to the general criteria for preparing grant
proposals for submission to the National Institutes of Health. Specific sections will include:
► Hypotheses and Specific Aims,
► Background and Significance
► Preliminary Studies (if applicable)
► Experimental Design and Methods
4. The proposal should be no longer than 10 double spaced, typed pages.
5. In order to prepare an adequate proposal, the resident should choose and meet with a faculty mentor at least six months prior to beginning the research rotation. The research proposal must be
submitted to the Education Committee by December of the CA-2 year and approved prior to beginning the research rotation.
6. The resident must have a satisfactory rating from the Clinical Competency Committee for the six-month clinical period preceding the Research Track.
The research will be conducted under the direct supervision of the research mentor, who will provide the education committee and residency director a written overview of the research progress
at three-month intervals. Within each written review, the mentor will assign a grade of satisfactory or unsatisfactory.
For grades of unsatisfactory, a review by the mentor, residency director, and education committee will be held to determine the appropriateness of the project and whether or not the rotation should continue.
Residents receiving an unsatisfactory grade will also have an interview with the residency director and education committee as part of the review process. A high level of achievement is expected.
Standards that are applicable to persons pursuing graduate or postdoctoral research training will be applied.
Residents and research mentors will spend a minimum of 1 hour per week discussing peer-reviewed literature in the area of research being examined. At the completion of the research rotation, the
resident and mentor will summit an abstract of the work to the education committee and residency director as minimum. The resident will be strongly encouraged to write up the research and submit
it to a peer-reviewed journal for publication. The resident will be expected to complete the bulk of the research, statistical analysis, and writing of any paper or abstract submitted for publication. The
resident will provide a minimum of a 30-minute oral presentation to the anesthesia residents and faculty about the scientific background, research protocol, results, and conclusions of the research
after its completion.
Research Fellowships (PGY-5 level):
Research fellowships are available to individuals that have completed an accredited residency training program in Anesthesiology. These fellowships are designed for individuals possessing
a desire to pursue a career in academic anesthesiology. Research fellowships of 1 or 2 years duration are available and may be extended based on the goals of the trainee in conjunction
with guidance from the research mentor. As for resident research programs, research will be undertaken under the supervision of a research mentor. A research plan will be developed as follows:
1. A project will be designed that can be completed within the proposed duration of the research fellowship.
2. All studies must conform to the standards of human research (as outlined by the Institutional Review Board of UTMB) or animal research (Animal Care and Use Committee) with current,
approved protocols.
3. A written outline of the study including scientific justification for the proposed study and appropriate bibliography must be prepared. The outline will conform to the general criteria for preparing
grant proposals for submission to the National Institutes of Health. Specific sections will include:
a. Hypotheses and Specific Aims
b. Background and Significance
c. Preliminary Studies (if applicable)
d. Experimental Design and Methods.
4. The proposal should be no longer than 10 double spaced, typed pages. In order to prepare an adequate proposal, the fellow should choose and meet with a faculty mentor at least 3 months prior to
beginning the research rotation. Although not absolutely required, fellows are strongly encouraged to identify a faculty research mentor as early as possible in order to investigate the possibility of
submitting a proposal for extramural funding.
Facilities
The Department of Anesthesiology has research laboratories located in the Old Shriners Burns Hospital and the Shriners Hospital for Children. The entire first floor and much of the second and fourth
floors of the Old Shriners Burns Hospital are dedicated to the Department of Anesthesiology for basic science research; the laboratories occupy 5,000 square feet (sf) of actual floor space. The intensive
care research laboratory consists of 3,300 sf of laboratory space. It has 900 sf contained in three laboratories dedicated to the housing and care of chronically instrumented large animals; currently there
are 12 sheep under study. These laboratories also have infusion pumps, physiologic monitors, and cardiac output computers available at each animal station. Two of these laboratories have a blood
gas analyzer and one has a co-oximeter.
A 250 sf fully equipped operating suite is available to prepare large animals for study. The surgery suite has an anesthesia machine, electrocautery unit, physiologic monitor, and adjustable operating room table.
A study area of approximately 400 sf is used for non-sterile experiments and postmortem examinations. The area contains a large stainless steel table in a “cold room”. A 50 sf walk-in cooler is available for
cadaver storage.
The analytical laboratories consist of 1,200 sf dedicated to the analysis of samples generated during animal experiments. These five laboratories contain two ultra-cold freezers, normal freezers, two
centrifuges, refrigerated ultra-centrifuge, Coulter Counter, two fume hoods, gamma counter, colloid osmometer, drying oven, analytical balance, oxygen evaporator, speedovac concentrator, and light
spectrophotometer. One laboratory (450 sf) is used entirely for radioimmunoassay preparation. Another labora-tory is dedicated to gravimetric determination of tissue water content. A third laboratory
is used for microsphere analysis. The fourth and fifth laboratories are used for cell counts and cell preparations.
The cerebrovascular research laboratories consist of two laboratories totaling 500 sf. The experimental laboratory has a fluid coupled trauma device for producing brain injury in rodents, anesthesia
machine, pial arteriolar diameter measurement system, microcapnometer, two stereo microscopes, water bath, two precision balances, fume hood, and a computerized data acquisition system with
sixteen-channel analog to digital converter. An adjacent equipment room is shared with the cardiopulmonary bypass research laboratories and has a blood gas analyzer, blood gas co-oximeter,
gamma counter (microsphere blood flow determinations), precision balance, icemaker, and an ultracold freezer.
The cardiopulmonary bypass research laboratory is used to study gas emboli during cardiopulmonary bypass. The lab has 700 sf of floor space in two laboratories. One laboratory has cardiopulmonary
bypass pumps with flow meter, color scan ultrasonic bubble detector, saturation/hematocrit monitor, physiologic monitor, cardiac output computer, sonomocrometer, electrocautery unit, defibrillator,
surgery lights and table infusion pumps, vapor pressure osometer, and a computerized data acquisition system.
The anesthesia equipment laboratory (500sf) contains both a museum for demonstrating historical yet functional, anesthesia equipment for educational purposes and a laboratory for evaluation and
testing new anesthetic equipment. The isolated heart research laboratories are 300 sf each. These laboratories are for studying isolated, perfused hearts (Langendorf Preparation) and have a
four-channel strip chart recorder with pressure transducers, and cardiac output computers.
The inflammation and immunology laboratories are housed on the 8th floor of the Shriners Hospital for Children. The mission of this research group is to study the mechanisms of injury and immune
dysfunction caused by sepsis, tissue ischemia and burn trauma. The laboratory is involved in both basic science and clinical research. A well equipped cell and molecular biology laboratory has been
established and is housed in two laboratories with a combined area of approximately 1000 sf.
Facilities include a tissue culture laboratory containing incubators, microscopes and laminar flow hoods. The laboratories are fully equipped to perform, and investigators are actively utilizing, molecular
techniques including reverse transcription polymerase-chain reaction (RT-PCR), RNAse protection assays, Western blotting, immunoprecipitation, flow cytometry, immunohistochemistry, electrophoretic
mobility shift assays, gene microarrays and immunoassays such as ELISA. Most molecular studies are being performed in mouse models of sepsis and trauma. This laboratory is also actively involved
in several local and national clinical studies aimed at understanding the effects of burn trauma on the immune system.
In addition to the formal research laboratories, several investigators in the department are conducting research in the General Clinical Research Center (GCRC). The GCRC has a long history of NIH
support and provides an excellent setting for conducting clinical investigations. Currently departmental researchers are performing research aimed at understanding fluid kinetics in patients and volunteers.
All monitoring and analytical equipment as well as research nursing support is provided by the GCRC in conjunction with the principal investigators.
Faculty Participants
Donald S. Prough, M.D., Rebecca Terry White Distinguished Professor and Chairman. Dr. Prough and colleagues are actively investigating several factors and their role in the
pathogenesis of traumatic brain injury. His studies include determination of the roles of zinc and vascular function in the pathogenesis of brain injury in rats. Dr. Prough is also active in
studies aimed at determining the effect of aging on the host response to head trauma. In addition, he is active in fluid kinetics research. Specifically, he is studying volume kinetic and
mass balance analysis of responses to fluid infusion. Dr. Prough also serves as co-investigator on studies designed to assess noninvasive optoacoustic monitoring of blood oxygenation
and hemoglobin concentration.
Daniel L. Traber, Ph.D., Charles R. Allen Professor and Director of the Investigational Intensive Care Unit. The major emphasis of our research is directed to two forms of acute
respiratory distress syndrome (ARDS). In both cases we use sheep that are surgically prepared for chronic study. These animals are studied in an area similar to an intensive care unit.
The first form of lung injury is ARDS secondary to airway injury and multiple trauma. We injure the airway with smoke from burning cotton and create a 40% 3rd degree burn. We have
established that this injury is associated with the deposition of neutrophils in the pulmonary microcirculation. One of our studies evaluates the role of the selectin family of adherence molecules.
We use a combination of cell biology and immunohistochemical techniques to establish the presence of selectins and then try to block the response by the administration of antibodies to the selectins.
The second model of ARDS that we are evaluating is one associated with sepsis. Injuring the airway with smoke and placing Pseudomonas aeruginosa bacteria into the lung creates this injury.
This model shows all of the characteristics of sepsis Low systemic vascular resistance, high cardiac output, very low PaO2/FiO2 ratio. We are evaluating protease activated receptors in this model.
In both of these models we have also identified the fact that nitric oxide synthase is active. We are in the process of identifying which of the synthases is active on at what times post injury. We
are testing several inhibitors of the various forms of nitric oxide synthase in these two models.
Daneshvari R. Solanki, M.D., Professor. Dr. Solanki is studying ischemia reperfusion injury. Specifically, she is involved in studies designed to evaluate the effects of restoration of blood
flow on muscle tissue and blood following a period of infrarenal or suprarenal aortic cross clamping. They are enrolling patients undergoing total knee arthroplasty and vascular surgery. In
addition, she is studying the efficacy and safety of encapsulated long acting morphine administered as a single dose in the epidural space for postoperative pain control.
George C. Kramer, Ph.D., Professor and Director, Resuscitation Research Laboratory. The research performed in the Resuscitation Research Laboratory primarily involves the
study of perioperative fluid therapy and their application to the resuscitation of critically injured patients. Specifically, we are studying the use of hypertonic crystalloids and colloids, novel
solutions with metabolic substrates and new blood substitutes for treatment of trauma and hypovolemia using a sheep model. In addition, we are involved in ICU and OR clinical trials of an
automated resuscitation system and new blood pressure monitors. Student researchers with a computer science or engineering background are a plus, but not a requirement.
Douglas S. DeWitt, Ph.D., Professor and Director, Charles R. Allen Research Laboratories. The research in my laboratories focuses on the study of the effects of traumatic brain
injury on the brain and its blood supply and on the effects of secondary insults such as hemorrhagic hypotension on brain function. We are studying the mechanisms that cause cerebral
vascular dysfunction after brain injury. In addition, we are working to develop and test resuscitation drugs and solutions to improve brain perfusion and survival after brain trauma and
hemorrhage. We primarily utilize a rat model of traumatic brain injury to study a variety of parameters including neurological function and behavior, brain inflammation and apoptosis
in order to assess the effectiveness of low volume resuscitation with hypertonic fluids in our model.
Joachin Cortiella, M.D., Associate Professor. My research interests center around tissue engineering and tissue/organ development. Both of these disciplines involve engineering,
cell biology and material science principles. Currently my research focus has been on tissue engineered trachea and stem cell research in lung development (regeneration). Future research
will focus on organ development using synthetic polymers for the pancreas, liver, heart, kidney, skin and brain.
Christer Svensen, M.D., Ph.D., Associate Professor. Intravenous fluid therapy is important for maintaining circulation during trauma and surgery. Initial therapy is aimed at restoring the
circulating volume in order to prevent end-organ damage due to ischemia. We devised models for the behavior of fluids in one- and two-compartment models.
We also recently developed a three-volume model. To date, studies designed to understand the kinetic behavior of fluids have been conducted mainly on animals and conscious volunteers.
Over the past four years, the model has been refined and more clearly understood. The administration of intravenous fluids according to volume kinetic principles is clearly a major step forward
towards a more appropriate use of intravenous fluids. There is an obvious need for clinical use of this model. We recently analyzed data for sheep under isoflurane anesthesia and found that
anesthesia conditions involve major changes in the volume kinetic handling of fluids. The objective of this study was to correlate the dilution profiles of infused fluids with hemodynamic performance
to improve fluid therapy. The more appropriate use of infusion therapy will thus reduce the problems of postoperative pulmonary edema and hypovolemia.
Asle Aarsland, M.D., Associate Professor. The liver plays a central role in the coordinated utilization of energy substrates at the whole-body level. A surplus of energy substrates can temporarily
be stored in the organ or alternatively be converted into substrates that are subsequently secreted to serve the energy needs of other tissues. Fatty acids provided by adipose tissue lipolysis can
be stored as hepatic triglycerides, be converted into ketone bodies or alternatively be resecreted as VLDL bound triglycerides. An imbalance between hepatic uptake and secretion of fatty acids
leads to hepatic steatosis and subsequent cirrhosis. Burn patients have an increased rate of lipolysis and develop a profound hepatic steatosis during recovery. Using substrates labeled with
stable isotopes our research has focused on the in vivo lipid metabolism in healthy volunteers and in burn patients with particular emphasize on the fatty acid metabolism of the liver.
Helen Hellmich, Ph.D., Assistant Professor. I am currently investigating the temporal patterns of gene expression in the brains of rats that have been subject to fluid percussion brain injury. I am
using cDNA microarrays containing over a thousand genes to monitor the gene expression profiles. I have chosen a few of the genes that change following brain injury and am examining their expression
in the brain using in situ hybridization techniques. The transcriptional profile of the brain undergoes rapid and dramatic changes in response to trauma. These gene expression changes can lead to
apoptosis and neurodegeneration.
Understanding the secondary injury cascades at the molecular level will ultimately aid in development of therapeutic interventions for traumatic brain injured patients. I am presently studying the
effects of TBI in three age groups, young, adult and aged rats to determine what is the molecular basis of the difference in outcome for the age groups. As a molecular neurobiologist, I also have
an interest in how the developing and aging brains respond to trauma. In addition to these lines of investigation, I am developing a series of retroviral vectors to deliver neurotrophic factor genes
to the rat CNS as a means of gene therapy. Neurotrophic factors have been shown by several investigators to ameliorate the secondary damage in ischemic and traumatic brain injury.
Edward R. Sherwood, M.D., Ph.D., Professor. The major research interests in my laboratory address altered antimicrobial immunity in experimental models of sepsis and thermal
injury. Similar changes in immune function occur during the post septic period and following major trauma. Specifically, we have observed suppressed production of key immunomodulatory cytokines
such as interferon-? (IFN-?) and interleukin (IL)-12 as well as MHC class II, a central factor in antigen presentation. In the post-septic state, alterations in macrophage and dendritic cell function result in
impaired antimicrobial immunity. In models of thermal and smoke inhalation injury we have observed changes in the function of antigen presenting cells (macrophages and dendritic cells) as well as
natural killer cells and T lymphocytes. Our goal is to identify the cellular and molecular changes that result in altered antimicrobial immunity in these models and to develop treatment approaches to
decrease infectious complications in these patient populations. We are also studying the roles of natural killer cells and cytotoxic T cells in mediating host injury during acute intraabdominal sepsis.
These studies are designed to advance our understanding of the factors contributing to organ injury and death in the septic host.
Ronald S. Levy, M.D., Professor. My main research interest is the development of simulator technology as a teaching tool for medical students and postgraduate physicians.
Our department has recently obtained a pediatric and adult simulator. I will be developing protocols for recreating routine and emergency scenarios. These protocols will be used to train personnel in
critical incident management. Studies will be performed to determine whether simulator training will improve emergency management skills.
Revised 7/2004