Department of Anesthesiology & Perioperative Care: School of Medicine: University of California, Irvine

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Clinical Research

Clinical Anesthesia Research with research team

Clinical research conducted within the Department of Anesthesiology & Perioperative Care includes a wide range of areas of interests in anesthesiology, perioperative medicine and pain medicine. Our research teams lead projects that are funded with departmental, public, private and industry funds.

Areas of Interests

Perioperative Process Improvement and Patient Outcomes

Through initiatives like the Perioperative Surgical Home (PSH), we are actively seeking to improve patient safety, outcomes and experience through the use of standardization of care pathways using the best available evidence-based approaches. The PSH effort is a collaborative project between anesthesiologists, surgeons, nursing, physical and occupational therapists, nutritionists and more. It has demonstrated a sustained reduction in both complications of surgery and shortened length of stay for patients in the hospital.

In addition to the PSH, our Department has active research ongoing that studies critical events and emergencies in the perioperative environment, post-surgical projects following patients after they leave the hospital (when 50% of surgical complications occur) and pre-operatively (when there is an opportunity to optimize patient status before surgery occurs). The ultimate goal is to improve patient outcomes and experience whenever surgery is needed and to ensure that we are consistently delivering the highest possible level of care to our patients.

Publications

  • Alem, N., and Z. Kain. Evolving Healthcare Delivery Paradigms and the Optimization of 'Value' in Anesthesiology. Curr Opin Anaesthesiol (Jan 23 2017).
  • Cyriac, J., L. Garson, R. Schwarzkopf, K. Ahn, J. Rinehart, S. Vakharia, M. Cannesson, and Z. Kain. "Total Joint Replacement Perioperative Surgical Home Program: 2-Year Follow-Up. Anesth Analg 123, no. 1 (Jul 2016): 51-62.
  • Garson, L. M., S. Vakharia, A. F. Edwards, and M. Maze. A Time of Opportunity: Patient Safety and the Perioperative Surgical Home. Anesth Analg 123, no. 6 (Dec 2016): 1348-50.
  • Qiu, C., M. Cannesson, A. Morkos, V. T. Nguyen, D. LaPlace, N. S. Trivedi, A. Khachatourians, J. Rinehart, and Z. N. Kain. Practice and Outcomes of the Perioperative Surgical Home in a California Integrated Delivery System. Anesth Analg 123, no. 3 (Sep 2016): 597-606.
  • Rinehart, J. B., T. C. Lee, K. Kaneshiro, M. H. Tran, C. Sun, and Z. N. Kain. Perioperative Blood Ordering Optimization Process Using Information from an Anesthesia Information Management System. Transfusion 56, no. 4 (Apr 2016): 938-45.

Innovation in Clinical Anesthesiology

Investigators within the Department are leading both single-center and multi-centered studies to optimize patient care using hemodynamic monitoring, novel techniques and systems, and deeper analysis of existing data sets. Areas of interest include goal-directed fluid therapy, development of novel devices and monitoring through collaborations with UCI R&D centers like the Beckman Laser Institute and through joint projects with Industry partners. In some cases these efforts have led to start-up companies and ultimately commercial devices based on technologies developed in the Department.

A prime example is the development of sophisticated computer-assisted fluid-management algorithms for helping anesthesiologists provide goal-directed fluid therapy in the operating room. After development under Dr. Joseph Rinehart and Dr. Maxime Cannesson and extensive bench-to-bedside testing, this technology was licensed out and is now the integral component of Edward Lifescience’s Assisted Fluid Management Technology. With multiple members of the department actively involved with UCI Applied Innovation, we hope to continue to contribute new ideas and new discoveries to the field.

Publications

  • Nair, B. G., E. Gabel, I. Hofer, H. A. Schwid, and M. Cannesson. Intraoperative Clinical Decision Support for Anesthesia: A Narrative Review of Available Systems. Anesth Analg 124, no. 2 (Feb 2017): 603-17.
  • Cannesson, M., H. Schwid, J. Rinehart, and Z. Kain. Technology, Social Engineering, and Clinical Anesthesiology: Present and Future. Anesth Analg 121, no. 3 (Sep 2015): 591-3.
  • Desebbe, O., A. Joosten, K. Suehiro, S. Lahham, M. Essiet, J. Rinehart, and M. Cannesson. A Novel Mobile Phone Application for Pulse Pressure Variation Monitoring Based on Feature Extraction Technology: A Method Comparison Study in a Simulated Environment. Anesth Analg 123, no. 1 (Jul 2016): 105-13.
  • Joosten, A., A. Delaporte, M. Cannesson, J. Rinehart, J. P. Dewilde, L. Van Obbergh, and L. Barvais. Fully Automated Anesthesia and Fluid Management Using Multiple Physiologic Closed-Loop Systems in a Patient Undergoing High-Risk Surgery. A A Case Rep 7, no. 12 (Dec 15 2016): 260-65.
  • Rinehart, J., M. Lilot, C. Lee, A. Joosten, T. Huynh, C. Canales, D. Imagawa, A. Demirjian, and M. Cannesson. Closed-Loop Assisted Versus Manual Goal-Directed Fluid Therapy During High-Risk Abdominal Surgery: A Case-Control Study with Propensity Matching. Crit Care 19 (2015): 94.

Right Ventricular Dysfunction and Its Implication on Perioperative Outcomes in Noncardiac Surgical Cohort

It is known that right ventricular dysfunction (RVD) has important prognostic value for both medical and surgical setting. Specifically, the presence of RVD is associated with worse morbidity and mortality for patients undergoing cardiac surgery. Whether RVD has predictive value for non-cardiac surgery is unknown. We have retrospectively investigated this topic, and have found that RVD is in fact independently associated with higher incidence of postoperative major adverse cardiac events (MACE), higher length of stay (LOS), and in-hospital mortality among patients undergoing major non-cardiac surgery. Our current primary goal is to validate these findings using prospective study design.

In addition, to better understand the predictive value of RVD in non-cardiac surgery, we are also interested in better defining RVD. RVD can involve either systolic, diastolic, or both. Currently, RVD is predominately understood as systolic dysfunction. However, prior studies have suggested that diastolic dysfunction in the RV is common. There is a need to understand the pathophysiology of RV diastolic dysfunction, its clinical implications, and predictive value. We aim to better understand RV diastolic dysfunction through our prospective study.

While there are various known echocardiographic parameters defining RV systolic and diastolic dysfunction, none have been investigated for their predictive value in regards to outcomes after non-cardiac surgery. We are interested in elucidating these echo parameters in terms of their value in predicting outcomes in patients undergoing non-cardiac surgery. It is possible that the echo cutoffs for defining RVD suggested by current guidelines do not correlate with outcomes and that different cutoffs should be investigated.

Finally, our ultimate research goals are to improve the perioperative care of patients with RVD undergoing general surgery. Understanding the prevalence of RVD in this surgical cohort and its clinical implications will be the first critical step before any specific intervention can be further investigated. We plan to study specific intervention using models once we are able to better define this disease in the perioperative setting

Publications

  • Chou J. J Cardiothorac Vasc Anesth. 2019 May;33(5):1482-1483. doi: 10.1053/j.jvca.2019.01.028. Epub 2019 Jan 10. No abstract available.
  • Chou J, Ma M, Gylys M, Seong J, Salvatierra N, Kim R, Jiang L, Barseghian A, Rinehart J. Preexisting Right Ventricular Dysfunction Is Associated With Higher Postoperative CardiacComplications and Longer Hospital Stay in High-Risk Patients Undergoing Nonemergent MajorVascular Surgery. J Cardiothorac Vasc Anesth. 2018 Oct 13. pii: S1053-0770(18)30937-6. doi: 10.1053/j.jvca.2018.10.011.
  • Chou J, Rinehart JB. Computer simulated modeling of healthy and diseased right ventricular and pulmonary circulation. J Clin Monit Comput. 2018 Jan 12. doi: 10.1007/s10877-018-0099-2.

Education and Simulation Research

Research in simulation and educational innovations look towards new ways of training our medical students, residents, faculty and nurses, to improve patient care, reduce the amount of time to knowledge acquisition and mastery difficult skills. Many of these activities take place both at the UCI Medical Education Simulation Center and within the medical center itself.

Ongoing projects include in-situ team training simulations between surgical specialties and anesthesiology to improve performance in critical events, our innovative residency education curriculum and utilizing simulation to increase skill acquisition.

Publications

  • Alem, N., N. Cohen, M. Cannesson, and Z. Kain. Transforming Perioperative Care: The Case for a Novel Curriculum for Anesthesiology Resident Training. A A Case Rep 6, no. 12 (Jun 15 2016): 373-9.
  • Beissel, A., M. Lilot, C. Bauer, K. Beaulieu, C. Hanacek, O. Desebbe, M. Cannesson, J. J. Lehot, and C. Ricks. A Trans-Atlantic High-Fidelity Mannequin Based Telesimulation Experience." Anaesth Crit Care Pain Med (Oct 06 2016).
  • Ramsingh, D., B. Alexander, K. Le, W. Williams, C. Canales, and M. Cannesson. Comparison of the Didactic Lecture with the Simulation/Model Approach for the Teaching of a Novel Perioperative Ultrasound Curriculum to Anesthesiology Residents. J Clin Anesth 26, no. 6 (Sep 2014): 443-54.
  • Ramsingh, D., J. Rinehart, Z. Kain, S. Strom, C. Canales, B. Alexander, A. Capatina, et al. Impact Assessment of Perioperative Point-of-Care Ultrasound Training on Anesthesiology Residents. Anesthesiology 123, no. 3 (Sep 2015): 670-82.
  • Schwid, H. A., and K. J. Souter. Resident Perceptions and Cost Analysis of a Virtual Patient Application for Anesthesia-Related Critical Incidents. J Educ Perioper Med 16, no. 11 (Jul-Dec 2014): E077.

Point-of-Care Ultrasonography

Point-of-care ultrasonography is brought to the patient and performed by the provider in real time. This allows the clinician to interpret findings simultaneous with the patient’s current signs and symptoms. This comprehensive whole-body perioperative ultrasound exam have been abbreviated as the F.O.R.E.S.I.G.H.T. exam (Focused periOperative Risk Evaluation Sonography Involving Gastro-abdominal Hemodynamic and Transthoracic ultrasound).

The curriculum is designed to help the perioperative physician with their clinical decision making for:

  1. Assessment of volume status
  2. Assistance with vascular access
  3. Determination of mechanisms of hypotension
  4. Assessment of cardiopulmonary function
  5. Other issues relevant to the perioperative physician

This is an expanding area of research and quality improvement projects. Our current research in this area includes evaluating teaching straggles to help educate residents on point-of-care ultrasound as well as evaluating the benefit of point-of-care ultrasound for assessing patients in the perioperative setting.

Publications

  • Ramsingh, D., J. C. Fox, and W. C. Wilson. Perioperative Point-of-Care Ultrasonography: An Emerging Technology to Be Embraced by Anesthesiologists. Anesth Analg 120, no. 5 (May 2015): 990-2.
  • Ramsingh, D., E. Frank, R. Haughton, J. Schilling, K. M. Gimenez, E. Banh, J. Rinehart, and M. Cannesson. Auscultation Versus Point-of-Care Ultrasound to Determine Endotracheal Versus Bronchial Intubation: A Diagnostic Accuracy Study. Anesthesiology 124, no. 5 (May 2016): 1012-20.
  • Ramsingh, D., J. Rinehart, Z. Kain, S. Strom, C. Canales, B. Alexander, A. Capatina, et al. Impact Assessment of Perioperative Point-of-Care Ultrasound Training on Anesthesiology Residents. Anesthesiology 123, no. 3 (Sep 2015): 670-82.