Neuroanesthesia – Clinical Neurophysiology

Neuroanesthesia is devoted to multidisciplinary research efforts with a cluster of highly talented faculty members that have unique scientific expertise and perspectives. The perioperative arena provides a wide, unmet clinical challenge and need for development of novel therapeutics that, if achieved, can shorten the duration of perioperative times and hospital stays. In many respects, the mechanisms that are involved or observed in the surgical arena, can provide us with a wealth of new information. This information could have wide-ranging implications for many medical specialties beyond our own.

Scope of Research in 2012 and Beyond:

The research studies within the neuroanesthesia division take a multidisciplinary team approach to solve unexplained terrain relevant to the central nervous system. The current tools focus on elucidating key components. This provides a unique opportunity for discovery and program development with a balanced training environment.

Mission Statement

“Team Neuro” is a multidisciplinary team of faculty members that are dedicated to clinical research. To accomplish our objective, we have a platform that brings together a group of clinicians who have expertise in different areas.

Clinical Faculty Involved in Perioperative Research
  • Linda S. Aglio, MD, MS – Director
  • Lisa J. Crossley, MD
  • Laverne D. Gugino, MD, PhD
  • Grace Y. Kim, MD
  • Jie Zhou, MD, MS, MBA

Summary of Ongoing Projects

Compare the Effectiveness of Pain Control Between Different Epidural Medication in Patients Undergoing Thoraclumbar Spine Surgery

We are proposing that a single shot epidural injection of local anesthetic and oral opioids given prior to major bony work will result in decreased post-operative pain, better patient satisfaction and less overall oral opioid consumption. Hence, we would like to investigate which combination of medications will result in the best patient satisfaction, quickest increase in post-operive physical therapy participation, earlier return to activities of daily living, and the largest decrease in post-operative oral opioid consumption and concomitant decrease in side effects from oral opioid consumption.

Recording and Analysis of Human Intracranial Neurophysiology During Induction and Emergence.

Patients with intractable epilepsy are routinely implanted with intracranial electrodes to localize seizure activity for later treatment. Implantation and explanation (removal) of these electrodes require surgery under general anesthesia. The anesthetic portion of these procedures presents a remarkable opportunity to study the neural mechanisms of general anesthesia by recording from these electrodes during anesthetic induction and emergence. In this protocol, we describe an experiment that does this using a gradual 10 minute anesthetic induction that will permit a detailed characterization of the full range of brain states under anesthesia linked to auditory processing and behavior. These experiments will provide data of unprecedented novelty and importance, while making efficient use of clinical resources, and presenting minimal additional risk to study subjects who were already scheduled to have surgery under anesthesia.

Comparison of Cardiac Output, Stroke Volume and Stroke Volume Variation Measurements Using Pulse Contour versus Bioreactance Based Monitors in Neurosurgical Operations (current.

Perioperative hemodynamic and fluid optimization is crucial in neuroanesthesia. Stroke volume variation analysis (SVV) has emerged to be an important parameter for fluid optimization and management. Conventional volume stroke monitoring uses central venous pressure or arterial pressure. The Vigleo™ requires invasive arterial or venous catheter placement. This is a retrospective study which seeks to analyze the accuracy of this monitor and will attempt to access postoperative brain edema and length of hospital stay.

Fluid Restriction in Neurosurgical Patients: Does it Make a Difference?

Hemodynamic stability and maintenance of cerebral perfusion pressure are crucial for managing patients with intracranial pathology. While decreased intravascular volume is easily corrected, excessive and even normal fluid replacement may result in brain swelling and longer hospital stays. Neurosurgical patients undergoing tumor resection are evaluated according to the following parameters: a metabolic profile and preoperative and postoperative radiologic study to assess the impact of intraoperative fluid management on cerebral edema. Long term outcome includes time to discharge and length of hospital stay.

Recent Publications, Publications & Workshops

  • 2011 “Intraoperative Neurophysiological Workshop” Society for Neuroscience, Anesthesia and Critical Care, Chicago, IL
  • 2011 “Intraoperative Monitoring” Moderator/Discussant, Society for Neuroscience, Anesthesia and Critical Care, Chicago, IL
  • 2012 “Intraoperative Neurophysiology Workshop – Advanced Level” Society for Neuroscience, Anesthesia and Critical Care, Washington, DC
  • 2012 “Intraoperative Neurophysiology Workshop” American Society of Anesthesiologists, Washington, DC
  • Zhou J, Aglio LS. Abstract: 108 – Comparison of Cardiac Output, Stroke Volume and Stroke Volume Variation Measurements Using Pulse Contour versus Bioreactance Based Monitors in Neurosurgical Operations. SNACC 39th Annual Meeting, Chicago Marriott; Oct 2011.
  • Zhou J, Aglio LS. Abstract: 15 - Comparison of Cardiac Output, Stroke Volume and Stroke Volume Variation Measurements Using Pulse Contour versus Bioreactance Based Monitors in Neurosurgical Operations. Harvard Ansthesia Research Consortium, Harvard Medical School, Boston, MA; Oct 2011.
  • Zhou J, Branam S, Aglio LS. Retrospective Review of Stroke Volume Variation Guided Intraoperative Fluid Individualization and Optimization for Skull Based Operations. American Society of Anesthesiolgoists; October 2012.
  • Zhou J, Lin X, Aglio LS. Cardiac Hemodynamic Measurements Using Arterial Pressure-Based Versus Cardiometry-Based Monitors in Neurosurgical Operations. American Society of Anesthesiolgoists; October 2012.
  • Zhou J, Lin X,, de Luna W, Aglio LS. Comparison of Cardiac Hemodynamic Measurements Using Arterial Based Monitors in Neurosurgical Operations. American Society of Anesthesiolgoists; October 2012.
  • Zhou J, Aglio LS. Comparison of Cardiac Output, Stroke Volume and Stroke Volume Variation Measurements Using Arterial Pressure-Based Versus Biorectance Based Monitors in Neurosurgical Operations. Society for Neuroscience and Critical Care, October 2012.
  • de Luna W, Jiang S, Zhou J, Huang R, Mukundan SW, Aglio LS. Fluid Restriction in Neurosurgery Patients: Does it Make a Difference? American Society of Anesthesiologists, Foundation of Anesthesia, Education and Safety for Medical Research Scholars: October 2012.
  • Zhou J, Branam S, de Luna W, Aglio LS. Retrospective Review of Stroke Volume Variation Guided Intraoperative Fluid Individualization and Optimization for Skull Based Surgery. Brigham and Women’s Hospital Women’s Research Day, September 2012.