Those with specific research interests or projects will be invited to join current on-going clinical investigations in an effort to enhance the overall academic experience. Under the direction of staff anesthesiologists the research fellow will have the opportunity to work closely with an established investigator on clinical projects. Emphasis will be placed on designing hypothesis-driven experiments, writing a complete research and/or grant proposal, reviewing and analyzing the data for statistical accuracy, preparing abstracts and manuscripts for publication, and presenting the findings before an audience of peers and colleagues. In addition, fellows may also be asked for assistance in the writing and preparation of book chapters, review articles, lectures, teaching conferences, and manuscript reviews. During the first month of the first Fellowship year no research time will be given to any new fellow.

Areas of clinical investigation can be divided into studies related to:

1. The use of intraoperative TEE; diastolic function, epiaortic scanning and neurocognitive outcome, and contrast and myocardial perfusion studies.
2. Pain management studies using regional techniques in cardiac anesthesia.
3. The evaluation of new drugs and pharmaceutical agents; oxygen carriers etc.
4. The understanding of the physiological changes that occur with cardiopulmonary bypass (CPB)
5. Cost benefit and clinical outcome analyses; long-term outcomes etc.
6. Evaluation of existing treatment protocols (e.g., drugs, management, etc.) in various patient subgroups (e.g., women, elderly, disease states, etc.).
7. Blood conservation in cardiac surgery.
8. Outcome studies in cardiac surgery.
9. Neurocognitive outcomes in cardiac surgery.
10. Genetics and outcome in cardiac surgery.

Selected Publications:

2006-2008

Selected Publications TGH Department of Anesthesia

Beattie WS, Abdelnaem E, Wijeysundera DN, Buckley DN. Comparison of pre-operative stress echocardiography and nuclear scintigraphy. Anesthesia & Analgesia. 2006;102(1):8-16.

Beique F, Ali M, Hynes M et al and the Canadian Perioperative Echocardiography Group. Canadian Guidelines for training in adult perioperative transesophageal echocardiography. CJA 53: 969-72, 2006.

Borger M, Alam A, Murphy P, Doenst T, David T. Chronic ischemic mitral regurgitation: repair, replace or rethink? Ann Thor Surg 81:1153-61, 2006.

Chamchad D, Djaiani G, Jung HJ, Nakhamchik L, Carroll J, Horrow JC. Nonlinear heart rate variability analysis may predict atrial fibrillation after coronary artery bypass grafting. Anesth Analg 103(5): 1109-12, 2006 (CPA).

Djaiani G, Hynnenen M, Karski J, Cheng DCH. Clinical outcomes in patients undergoing elective coronary artery bypass graft surgery with and without utilization of pulmonary artery catheter generated data. J Cardiothorac Vasc Anesth 20: 307-10, 2006

Daiani G, Fedorko L, Cusimano RJ, Mikulis D, Carroll J, Beattie S, Karski J. Off-pump coronary bypass surgery: risk of ischemic brain lesions in patients with atheromatous aorta. Can J Anesth 53: 795-801, 2006

Djaiani G. Aortic Arch Atheroma: Stroke Reduction in Cardiac Surgical Patients. Semin Cardiothorac Vasc Anesth 10: 143-157, 2006

Djaiani G, Karkouti K, Beattie WS. Low hematocrit during cardiopulmonary bypass is associated with increased risk of stroke in adult cardiac surgery. Reply. Ann Thorac Surg 82: 1166, 2006.

Friedman Z, Katznelson R, Devito I, Siddiqui M, Chan V ” Objective Assessment of manual skills and proficiency in performing epidural anesthesia- video assisted validation” Reg Anesth Pain Med. 2006 Jul-Aug;31(4):304-10.

Robert Garnett, Colin Bands, David Bracco, Wojciech Dobkowski, William Gallacher, Serge Lenis, Stuart McCluskey, Brian Muirhead and Brian Warriner. Hydroxyethyl Starches: Canadian Anesthesiology Consensus for Use in Selected Clinical Situations. Bristol-Myers Squibb Publication, 2006.

Heggie J, Karski J. The Anesthesiologist’s Role in Adult s with Congential Heart Disease. Cardiol Clin 24 (2006) 571-585.

Hemmerling T, Djaiani G, Williams J. The use of epidural analgesia in cardiac surgery should be encouraged. Anesth Analg 103(6): 1, 2006.

Karkouti K, Beattie WS. Aprotinin is useful as a hemostatic agent in cardiopulmonary surgery – No. J Thromb Haemost 2006;4:1879-1881.

Karkouti K, Yau TM, van Rensburg A, McCluskey SA, Callum J, Wijeysundera D, Beattie S. The effects of a treatment protocol on clinical outcomes in cardiac surgical patients with excessive blood loss. Vox Sanguinis 2006;91:148-156.

Karkouti,K.; Wijeysundera,D.N.; Yau,T.M.; Callum,J.L.; Meineri,M.; Wasowicz,M.; McCluskey,S.A.; Beattie,W.S. Platelet transfusions are not associated with increased morbidity or mortality in cardiac surgery. Can J Anesth. 53(3): 279-287, 2006.

Karkouti K, McCluskey SA, Ghannam M, Salpeter MJ, Quirt I, Yau TM. Intravenous iron and erythropoietin for the treatment of postoperative anaemia. Can J. Anesth. 53 (1) 11-19, 2006.

Karkouti K, Riazi S, Wasowicz M, Meineri M, Wijeysundera DN, Beattie WS, McCluskey SA, van Rensburg A, Yau TM. Determinants of complications with recombinant factor VIIa therapy for refractory blood loss after cardiac surgery. Can J Anesth 2006;53:802-809.

Karkouti K, O’Farrell R, Yau TM, Ivanov J, Beattie WS, for the Reducing Bleeding in Cardiac surgery research group. A clinical prediction rule for excessive blood loss in cardiac surgery. Can J Anesth 2006 53: 781-794.

Karkouti K, Shayan C, Hsu J, Carroll J, Wijeysundera DN, Fedorko L, Beattie WS. Prognostic value of proteinuria in cardiac surgery. Can J Anesth 2006;53:500-506.

Karkouti K, Beattie WS, Dattilo KM, McCluskey SA, Ghannam M, Hamdy A, Wijeysundera DN, Fedorko L, Yau TM. Aprotinin is not superior to tranexamic acid in high-transfusion-risk cardiac surgery. Transfusion. 2006;46(3):327-338.

Karkouti K, Shayan S, Wijeysundera DN, McCluskey SA, Ghannam M, Beattie WS. Prognostic value of postoperative proteinuria in cardiac surgery: a pilot study. Canadian Journal of Anesthesia. 2006;53(5):500-506.

Karkouti, K. Beattie, W.S., Dattilo,K.M., McCluskey,S.A., Ghannam,M., Hamdy,A., Wijeysundera, D.N., Fedorko,L., Yau,T.M. A propensity score case-control comparison of aprotinin and tranexamic acid in high-transfusion-risk cardiac surgery. Transfusion 46(3): 327-338, 2006.

Li YL, Wong DT, Wei W, Liu J. A novel acoustic window for trans-oesophageal echocardiography by using a saline-filled endotracheal balloon. BJA 2006; 97: 624-9.

Riazi S, Karkouti K, Heggie J. Management of life-threatening oropharyngeal bleeding with recombinant factor VIIa. Can J Anesth 2006;53:881-884

Li YL, Wong DT, Wei W, Liu J. A new method for detecting the proximal aortic arch and innominate artery by transesophageal echocardiography. Anesthesiology 2006; 105: 226-7. (Contribution: co-principal author).

Stuart A McCluskey, Keyvan Karkouti, Duminda Wijeysundera, Karen Kakizawa, Mohammed Ghannam, Ahmed Hamdy, David Grant and Gary Levy. Derivation of a risk index for massive blood transfusion in liver transplantation. Accepted for publication, Liver Transplantation, 12:1584-1593, 2006.

McCluskey SA, Karkouti K, et al. Derivation of a risk index for prediction of massive blood transfusion in liver transplantation. Liver Transpl 2, 12:1584-1593 2006; Sept 1

Minkovich L, Djaiani J, Katznelson R, Day F, Fedorko L, Tan J, Carroll J, Cheng D, and Karski J. Effects of alveolar recruitment on arterial oxygenation in patients after cardiac surgery: a prospective, randomized, controlled clinical trial. J Cardiothorac Vasc Anesth. 2007 Jun;21(3):375-8.

Minkovich LL, Brister SJ, and Slinger PD. Transesophageal echocardiography in adult-type Bland-White-Garland syndrome. Anesth Analg. 2007. Jun;104(6):1348-9.

Slinger P. Postpneumonectony pulmonary edema: good news, bad news. Anesthesiology 105: 2-5, 2006 (Editorial).

Slinger P. Pro: Low tidal volume is indicated for one-lung ventilation. Anesth Analg 103: 268-70, 2006 (Editorial).

Wijeysundera DN, Karkouti K, Beattie WS, Rao V, Ivanov J. Improving the identification of patients at risk of postoperative renal failure following cardiac surgery. Anesthesiology. 2006;104(1):65-72.

Karski JM. Transesophageal echocardiography in the intensive care unit. [Review] [7 refs] [Journal Article. Review] Seminars in Cardiothoracic & Vascular Anesthesia. 10(2):162-6, 2006 Jun.

Srinivas, C, Collins N, Borger M, Horlick E, Murphy P. Hypoxemia Complicating LVAD Insertion: Novel Application of the Amplatzer PFO Occlusion Device. J Card Surg 22: 156-8, 2007.

Borger, Michael, Murphy, Patricia, Alam, Asim, Fazl, Shafie, Maganti, Manjula, Armstrong, Susan, Rao, Vivek and David, Tirone. Initial results of the chordal-cutting operation for ischemic mitral regurgitation. JTCVS (Journal Thoracic and Cardiovascaulr Surgery) volume 133, no 6 1483-1490, 2007.

Cooper RM. Complications Associated with the Use of the GlideScope Videolaryngoscope. Can J Anesth 54(1), 54-57, 2007.

dePerrot M, Fadel E, McRae K, Tan KT, Slinger P , Paul N, Mak S, Granton JT. Evaluation of persistent pulmonary hypertension after acute pulmonary emboli. Chest. 2007 Mar 30.

Kanellakos GW, Slinger P: Post-operative Analgesia for Thoracic Surgery. US Surgery 2007, Vol.1.

Roscoe A, Kanellakos GW, McRae K, Slinger P. Pressures exerted by endobronchial devices. Anesth Analg. 2007 Mar;104(3):655-8.

Djaiani G. Fedorko L. Borger MA. Green R. Carroll J. Marcon M. Karski J. Continuous-flow cell saver reduces cognitive decline in elderly patients after coronary bypass surgery.[see comment]. [Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't] Circulation. 116(17):1888-95, 2007 Oct 23.

Newcomb AE. Pelenghi S. Karski J. Butany J. David TE. Cardiac papillary muscle hemangioma. [Case Reports. Journal Article] Journal of Thoracic & Cardiovascular Surgery. 134(5):1345-6, 2007 Nov.

Wacker J. Djaiani G. Katznelson R. Karski J. External compression of superior vena cava after the replacement of ascending aorta. [Case Reports. Journal Article] European Journal of Echocardiography. 9(4):589-90, 2008 Jul.

Djaiani G. Ali M. Borger MA. Woo A. Carroll J. Feindel C. Fedorko L. Karski J. Rakowski H. Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery. [Comparative Study. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't] Anesthesia & Analgesia. 106(6):1611-8, 2008 Jun.

Fergusson DA. Hebert PC. Mazer CD. Fremes S. MacAdams C. Murkin JM. Teoh K. Duke PC. Arellano R. Blajchman MA. Bussieres JS. Cote D. Karski J. Martineau R. Robblee JA. Rodger M. Wells G. Clinch J. Pretorius R. BART Investigators. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery.[see comment]. [Comparative Study. Journal Article. Multicenter Study. Randomized Controlled Trial. Research Support, Non-U.S. Gov't] New England Journal of Medicine. 358(22):2319-31, 2008 May 29.