Department of Neurological Sciences

LABORATORY SCIENCE

Blood Pressure, Blood Flow, and Organ Perfusion In Anesthetized Children and Adults

The primary focus of the Whitaker Lab is basic in nature. Our overall goal is to understand:

• How the vasculature differs in the young when compared to the old, and how vascular responses to anesthetics change across the lifespan
• How adverse pregnancy (e.g., preeclampsia) affects vascular development, structure, and function in offspring
• How fundamental differences in vascular biology can affect blood pressure and organ perfusion in anesthetized children
• How vascular dysfunction can cause hypoperfusion of critical organs during surgery, and how this affects organ function postoperatively

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CLINICAL RESEARCH

Cerebrovascular Responses to Anesthesia in Infants from Adverse Pregnancies

Fundamental differences exist in vascular structure and function across different species. Because of this, we use our findings in the laboratory to inform well-designed clinical studies in the operating room. For instance, we are using transcranial Doppler (TCD) imaging to assess the size and reactivity of intracranial arteries in anesthetized children. In collaboration with the UVM Department of Neurological Sciences, we have designed a custom headset that will allow us to take sequential measurements from the same blood vessel in a consistent way as intraoperative conditions change.

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Electrophysiologic Correlates of Infant Spinal Anesthesia

Over the past 20 years, concerns have arisen that general anesthesia (GA) exposure in infants may lead to neurocognitive deficits later in life. Infant spinal anesthesia (SA) allows the child to remain awake during surgery, avoiding the need for GA. In most cases, babies do not even receive sedative medications because they fall asleep on their own. We utilize non-invasive, continuous electroencephalography (EEG) to study this phenomenon. The initial findings of this study were presented at the International Anesthesia Research Society in 2019, where it won the prize for best abstract.
Ongoing studies will investigate how the EEG changes with different drug combinations, ages, and other modalities of regional anesthesia..

READ OUR PAPER IN PEDIATRIC ANESTHESIA

Objective Measurement of Regional Anesthesia in Infants and Children Using Electromyography (EMG)

Local anesthetics, such as lidocaine, have been used in medicine for centuries to numb an area of the body to prevent pain. However, despite significant progress in medical technology, our ability to objectively measure the effectiveness of local anesthetics is largely subjective in nature.
We have partnered with Blocksynop and Nihon Kohden America to leverage EMG technology in an effort to develop a way to measure regional blockade in pediatric patients undergoing surgery. We use EMG to monitor basal muscle tone before and after regional blockade (for example, during infant spinal anesthesia). Our exciting initial findings have already provided new insights into how these techniques truly work in the youngest of patients. Our goal is to identify the most effective, safest regional block medications regimens for children who require regional anesthesia.

Safety and Efficacy of Infant Spinal Anesthesia

The University of Vermont has an Infant Spinal Anesthesia program that dates back to the 1970s. To date, our pediatric anesthesiologists have cared for thousands of infants without the need for general anesthesia or airway management. As a result of this, UVM has the largest database of infant spinal anesthesia in the world. We use this powerful resource to ask questions about outcomes in patients that received spinal anesthesia when compared to general anesthesia.