OHSU Research Ideas

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• Does epidural increase gastric emptying in labor?
• Does change in PPV/CO after SCD activation predict fluid responsiveness and how does it compare to SLR?
• Does precedex delay emergence?
• Fentanyl patch instead of remifentanil infusion? What other anesthetics could you deliver via patch? Could you do a patch induction for Peds?
• Which findings on the preop note predict pressors use during the case?
• Does sugammadex interfere with HRT in post-menopausal women?
• Reversible chemical/optical/electromagnetic knockdown/inhibition/interference of pain nuclei/DRG/dorsal column/STT activity in rodents/primates
• EEG/MEP/SSEP patterns in monkeys/humans taking THC vs controls
• Quantification of Hgb mass loss vs. qBL in C-section.

• Wearable clinical alarms (2 relevant results, 1 highly relevant result)
• VR for IV placement peds (6 articles spanning 2020-2022, 5 RCTs, and a systematic-review and meta-analysis)
• NIBP monitoring from head/neck
• Better way of determining fluid status
• EPIC timeline builder
• Ultrasound vs blind A-line first attempt success rate and complications?
• Novel reversal agents (e.g. volatile anesthetics, propofol, precedex)

Resources

• Schnell lab
• Leimer/Lo lab (THC, NHPs)
• Saugstad lab (EVs)
• Schennings (Gas vs. TIVA risk of post-op delirium, assessed via CAM)
• Schulman (interrogate ICDs for EMI after surgery)
• Austin Peters
• Selva Balkan
• Dale Hodges
• Liz Moss
• Jeff Davis
• Brandon Togioka

Neuraxial Labor Analgesia and Gastric Emptying

Reference	Population	Intervention	Comparator	Outcome
Weiniger et al Eur J of Anaes 2022	80 non-fasted pregnant women, age 18+, GA 37+ weeks, singleton, cephalad, dilated <= 5 cm, 63 had empty stomachs and 17 had full stomachs at baseline	Double-blind single center RCT with women randomized to low-dose (50) or high-dose (100) epidural fentanyl.	Stomach antrum cross-sectional area (CSA) was measured with gastric US before and 2 hrs after fentanyl administration	No differences between low-dose and high-dose fentanyl groups.
Chassard et al Anes 2022	40 women	Prospective cohort study. Gastric ultrasound (gUS) was used to verify an empty stomach, then participants ate 125 g of yogurt within 5 min. For the epidural group, the meal was consumed within one hour of epidural placement.	10 parturients with labor epidural were compared with 10 pregnant women at term, 10 non-pregnant women, and 10 parturiants with no labor epidural. Serial gUS was performed at 15, 60, 90, and 120 minutes after a light meal and fraction of gastric emptying was calculated as [Area_Antral_90 / Area_Antral_15 - 1]*100.	Gastric emptying fraction (higher is better) was 52% (non-pregnant), 45% (pregnant), 7% (parturiants w/o epidural), and 31% (parturiants w/ epidural). Parturiants had delayed gastric emptying compared to non-parturiants, and epidural analgesia actually sped up gastric emptying.
Bonnet et al BJA 2014	60 spontaneously laboring parturients with ropivacaine/sufentanil PCEA analgesia	CSA measured with binary outcome of "full" or "not full" based on cutoff CSA value of >320 determined in small pilot study of 6 pregnant women.	gUS compared CSA when the anesthesiologist was called for epidural placement (beginning of labor) and at full cervical dilation.	50% had full stomachs at epidural placement compared to 13% at full cervical dilation.
Inada et al J of Anes 2009	16 ASA 1-2 term parturients undergoing elective cesarean delivery	CSE w/ 10 mg Bupivacaine and 10 mcg Fentanyl	Four channel electrogastrography was performed for 10 min at 5 interval time points.	Frequency of gastric contractions increased after spinal anesthetic, during the surgery, and returned to the (presumed) non-pregnant normal values by POD7.

SCD hemodynamic effects

Caption text

Reference	Population	Intervention	Comparator	Outcome
Moady et al IMAJ 2019	Healthy volunteers and HFrEF patients	Pneumatic sleeve (PS) compression devices applied to both legs from toe to thigh and inflated to a pressure of 50 or 80 mmHg. the same method does not exacerbate symptoms and increases CO via an increase in SV, decreases SVR, and has no effect on HR (see ref 17).	Example	In healthy volunteers, there was increased CO, decrease SVR, and have no effect on HR (see ref 16). HFrEF patients who were medically optimized had no change in any hemodynamic parameter after 60 minutes of PS application, and that they tolerated it well without any increase in their BNP.
Bickel et al J of Card Failure 2014	Patients with HFrEF (mean LVEF 30%)	ISPC devices applied to both legs and cycled every 2 min for 40 min.	Example	Increased CO, SV, and decreased SVR w/o any effect on HR and without causing signs or symptoms of heart failure exacerbation. CVP and atrial size increased during ISPC activation.
Gibbons et al Experimental Physiology 2019	14 healthy university students	Four 3 minute trials of orthostatic maneuvers (stand-to-squat or thigh cuff compression/release) were done in random order with half of the trials involving ISPC (5 cuffs, peristaltic motion, applied over 200 ms, 65 mmHg, timed to local diastolic phase) of the lower extremity timed to counteract orthostatic changes (return to standing or after thigh-cuff release). Hemodynamic parameters (superficial femoral artery, MAP, Doppler ultrasound cardiac output, total peripheral resistance, middle cerebral artery blood velocity (MCAv), and cerebral tissue saturation index) were measured non-invasively before, during, and after	Example	Decreased TPR, heart rate; increased CO (via increased SV), TSI, and MCAv
Helmi et al Future Cardiology 2013	Example	Example	Example	Example
Kiefer et al Anesthesiology 2011	Example	Example	Example	Example
Kwak et al J of Neurosurgical Anesthesiology 2011	Example	Example	Example	Example
Kwak et al Arthroscopy 2010	Example	Example	Example	Example
Fanelli et al J of Clin Anesthesia 2008	Example	Example	Example	Example
Sohn et al Circulation J 2008	Example	Example	Example	Example