Clinical Research

In collaboration with the UCI Susan Samueli Integrative Health Institute and the UCI Institute for the Study of Cannabis, our pain medicine physicians are attempting to clarify the role of cannabis as a therapy for chronic pain. Medical cannabis has been available in California since 1996 and these therapies are only now being subjected to rigorous scientific study. The concentration, dosage and route of cannabis administration for use in pain relief has not been well-described and our investigators are trying to determine what, if any, would be the best recommendations for chronic pain patients, particularly patients who are currently opioid-dependent.

Our research in simulation and educational innovations focuses on advanced practices of training medical students, residents, physicians, post-graduates and nurses, to improve patient care, reduce the amount of time to knowledge acquisition and mastery of difficult skills. Our education and simulation research takes place at the state-of-the-art UCI Medical Education Simulation Center and within the UCI Medical Center. Ongoing projects include in-situ team training simulations between surgical specialties and anesthesiology to improve performance in critical events and projects on residency education curriculum by utilizing simulation to increase skills acquisition.

Our faculty researchers 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 Research and Development Center, other UCI centers 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.

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 Joseph Rinehart, MD and Maxime Cannesson, MD, and extensive bench-to-bedside testing, this technology was licensed out and is now an integral component of Edward Lifesciences Assisted Fluid Management Technology.

This study is to examine the outcomes of pediatric patients receiving Onabotulinumtoxin A (Botox®) for the treatment of chronic migraines. There have been approved studies for treating chronic headaches and migraines in adults, but there is limited scientific literature on the outcomes in pediatric patients.

Pediatric chronic migraines make up nearly 60 percent of all visits to a pediatric headache specialist and result in a negative impact in the overall quality of life for children similar to pediatric cancer, heart disease and rheumatic disease with the lost in school time and with social interactions with family and peers.

The aim of this study was to determine if pediatric patients treated with Botox® reported a statistically significant improvement in the primary features (frequency, intensity, duration and disability scoring) associated with migraines compared with placebo at follow-up visits.

The "Effectiveness of Onabotulinumtoxin A (Botox®) in Pediatric Patients Experiencing Migraines: A Randomized Double Blinded Placebo Crossover Study in the Pediatric Pain Population” was awarded the American Society of Regional Anesthesia and Pain Medicine (ASRA) Chronic Pain Research Grant to principal investigator, Shalini Shah, MD.

Our department is actively seeking to improve patient outcomes and experience whenever surgery is needed through the use of standardization care pathways using the best available evidence-based approaches through the Perioperative Surgical Home (PSH) initiative. 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, we have 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 preoperatively (when there is an opportunity to optimize patient status before surgery occurs).

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).

POCUS includes an expanding area of research and quality improvement projects that includes evaluating teaching lags to help educate residents on utilizing POCUS as well as evaluating the benefit of POCUS for assessing patients in the perioperative setting.

POCUS 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