Stanford School of Medicine
Anesthesia–

Research Fellowships



Pharmacokinetics and Pharmacodynamics

Fellows may undertake clinical research on the pharmacodynamics of drugs used in anesthesia. All fellows receive didactic training in pharmacokinetics, pharmaco- dynamics, statistics and computer programming. Training in analytical chemistry is also offered. Fellows may participate in activities of the Division of Clinical Pharmacology, including rounds, research seminars and consultation service. Research emphasizes the use of the electroencephalogram to quantitate anesthesia depth, the development of pharmacodynamic models for drugs used in anesthesia, the physiological processes that govern drug distribution in man and the interaction between hemodynamics and pharmacokinetics in intravenous agents. Investigations in both humans and animals are available.

Principal Faculty: Steven Shafer M.D., Hendrikus Lemmens M.D., PhD, David Drover M.D.


Neurobiology of Anesthesia and Analgesia

Recognizing the explosive growth of neuroscience and its potential impact in anesthesia, the department has established a strong concentration of research effort in this area. Dr. Bruce MacIver uses patch-clamp electrophysiological recording in isolated brain slices to investigate anesthetic actions on synaptic transmission and nerve cell excitability.

Principal Faculty: Bruce Maciver PhD.


Cerebral Ischemia

Dr. Rona Giffard’s laboratory studies stroke, both trying to find ways to reduce ischemic brain injury, and to better understand the interactions between different brain cell types during injury and recovery. Astrocytes and their response to injury is an important focus in the lab. We have found that astrocyte impairment contributes to neuronal injury in global ischemia. We also study the effects of heat shock proteins, oxidative stress, and changes in mitochondrial function. Studies are performed in animal models and primary cultures.

Principal Faculty: Rona Gifford M.D., PhD.


Systems Neuroscience of Pain and Analgesia

Historically, pain has been considered in relation to its etiologic or disease factors, such as the relationship between surgery and postoperative pain, herpes zoster and postherpetic neuralgia, and arthritis and painful joints. This has had the effect of addressing pain as a symptom of disease, and although much progress has been made in understanding the molecular and cellular mechanisms of disease, the resulting pain has not necessarily been alleviated. What is required, and has been missing from the evaluation, is an understanding of the underlying mechanisms responsible for the pain itself.

Dr. Mackey’s Stanford Systems Neuroscience and Pain Lab (SNAPL) is focused on elucidating and characterizing underlying mechanisms of pain and analgesia. In particular, he has focused his efforts on characterizing the mechanisms of pain from the level of the network to behavior (see figure). Important mechanisms of nociception exist at the level of the gene through the neuron; however, pain is ultimately a subjective experience that does not commonly correspond to the level of tissue injury or nociception that a person experiences. Additionally, while much has been learned from animal models of pain, it is ultimately the human patient that needs to be studied to best understand and treat this terrible condition.
SNAPL uses a combination of sophisticated neurobehavioral, psychophysical and neuroimaging (fMRI, VBM, DTI, effective connectivity) techniques to investigate acute and chronic pain mechanisms and analgesia in the spinal cord and brain in humans. Dr. Mackey has several ongoing NIH, foundation and industry funded projects related to real-time fMRI and learned brain control, cognitive and affective dimensions of pain, pharmacologic fMRI, spinal cord mapping, epidemiology of chronic pain, sodium channel blockers in neuropathic pain and neurotoxins in neuropathic pain. These projects involve interdisciplinary collaborations with multiple departments throughout Stanford and other academic institutions.

Research fellowships are available for qualified candidates. For more information contact:
Andrew Morrow

http://paincenter.stanford.edu
(650) 725-9636

Principal Faculty: Sean Mackey M.D., PhD.


Patient Safety and Human Performance

The Patient Safety Center of Inquiry at the VA Palo Alto Health Care System has 7 major areas of study and fellows participate in all aspects of laboratory activity and are expected to develop their own area of expertise under faculty guidance. The major areas of study include:

  1. Simulation-based training in decision making, crisis management, and teamwork;
  2. Theory of organizational safety applied to health care;
  3. Effects of sleep deprivation and fatigue on patient safety;
  4. Cultures of safety in health care;
  5. Safety-related event reporting and analysis;
  6. Safety of human subjects in research; and human factors issues in medical equipment design and use.

In addition to its internal collaborators within the VA Palo Alto HCS and Veterans Health Administration (VHA), external collaborators include: The Center for Health Policy at Stanford University, the California Collaboration for Improving Patient Safety, and investigators from The Haas School of Business at UC Berkeley and from the Naval Postgraduate School in Monterey, CA.

Principal Faculty: David Gaba M.D., Steven Howard M.D., Kevin Fish M.D., Yasser Sowb, PhD. and Kim Park, RN


Physical Chemistry of Anesthetic Agents

This laboratory studies molecular theories of anesthesia and alcohol. We build molecular models of ligand-gated ion channels and then perform molecular dynamics calculations of anesthetic binding. Training is offered in analytical techniques including mass spectrometry, high pressure liquid chromatography, gas chromatography and radioactive labeling.

Metabolic studies employ cell culture, preparation of cell membrane fractions and reconstituted cytochrome P-450. Research projects can be tailored to suit individual interests and the background of the fellow.

Possible projects include treatment of rat liver hepatocytes in culture with suspected liver necrosis-inducing metabolites, raising antibodies to hepatocyte surface antigens and studying neutrophil-hepatocyte interactions.

Principal Faculty: James R.Trudell PhD.


Clinical Pharmacology of Analgesic Drugs/Interventions

Focus on developing improved methods to measure pain in humans, to assess the efficay of analgesic interventions with greater accuracy and to allow predicting the clinical usefulness of new analgesic compounds/interventions at an early stage of drug/interventional development. Emphasis lies on psychophysical approaches to measure pain and on various experimental pain models used in humans. Data evaluation and analysis is based on concepts used in clinical pharmacology.

Principal Faculty: Martin Angst M.D.

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