Ventilator-induced lung injury

William G. Tharp, MD, PhD, is a general anesthesiologist with an extensive and varied scientific background in the pathophysiology of obesity and metabolic disease.  In partnership with researchers at the highly respected Vermont Lung Center, Dr. Tharp has several current studies focused on improving the perioperative pulmonary care of patients with obesity. His research program focuses on the biomechanical and molecular mechanisms underlying intraoperative ventilator-associated lung injury, and has an ultimate goal of designing and testing individualized ventilation strategies to reduce or prevent lung damage. His work to quantify the impact of obesity and surgical positioning on lung mechanics during robotic-assisted laparoscopic surgery was published as a cover article in Anesthesiology in 2020.

Resident education

Melissa Davidson, MD, a pediatric anesthesiologist, serves as associate dean for graduate medical education at the UVM Larner College of Medicine and as the designated institutional official for UVM Medical Center, which in English means that she oversees all residency programs at the center. Her expertise is resident education, a field in which she has conducted numerous workshops, designed evaluation programs for both residents and faculty, instituted a leadership program for chief residents, and co-authored a multi-center study on whether emotional intelligence correlates with resident performance. Her current project is a comparison of perceptions: How do anesthesia residents’ perception of their autonomy in training compare to the faculty’s views of resident autonomy? This question stems from self-determination theory, a concept that three universal, innate psychological needs (competence, autonomy, relatedness) must be met in order for individuals to become more self-determined and intrinsically motivated. Anesthesiology residents often complain they are not afforded enough autonomy during training, which according to SDT potentially thwarts their intrinsic motivation to learn. Dr. Davidson’s single-center study will be a prelude to a national study.

Obstetric anesthesia

Jennifer Gage MD’s work revolves around quality improvement in obstetric anesthesia. She has studied the implementation of Enhanced Recovery after Cesarean Delivery (ERAC) protocols and their effect on patient outcomes such as urinary retention, opioid use, and breastfeeding success. Her work makes use of data from the electronic health records and collaboration with clinicians from the UVM Department of Obstetrics, Gynecology, and Reproductive Sciences. Recent work has aimed at determining how modifications to the ERAC protocol can improve care for opioid dependent patients. Dr. Gage’s work aims to enhance obstetric anesthesia care for specific sub-populations and communicate related outcome improvements to other institutions.

Interventional pain management

Alyssa Zhu MD’s research aims to assess utilization of interventional pain modalities and their benefit on chronic pain conditions. Her current work uses data from administrative datasets along with electronic health records to determine the utilization of interventional pain therapies for chronic low back pain in Vermont, with a focus on older adults. This work will provide currently missing information on delivery of interventional pain care in Vermont and form the basis of further inquiry regarding the exclusion of interventional pain therapies in chronic low back pain algorithms at national and international levels.

Biomedical informatics

The UVM Department of Anesthesiology engages in a wide array of health informatics and data analytics, with project areas ranging from lung mechanics and pain management to quality of care and equity in medicine. The aim of these research projects is to leverage existing health record data and multicenter datasets like the Multicenter Perioperative Outcomes Group dataset to inform clinical decisions, improve treatment, and build a more equitable medical system. The use of data science to improve the clinical landscape is an ever-evolving environment at UVMMC where we have the potential to leverage the electronic health record to provide all clinicians with feedback on their care and develop the department’s understanding of areas of systemic quality improvement.

Infant spinal anesthesia

Brian Waldschmidt MD, a pediatric anesthesiologist, is the department’s vice chair for anesthesia Informatics, as well as an Epic^TM Physician Builder. His interests in the electronic health record and technology led him to trial a novel smartphone app for fine-grained timekeeping of physician tasks during surgical cases. The accompanying study was published in the Journal of Medical Systems in 2022. Dr. Waldschmidt conducted a national survey of pediatric anesthesiologists to determine why spinal anesthesia is widely under-utilized in most of the U.S., while it is a commonly used technique at UVM Medical Center; that study was published in Pediatric Anesthesia in 2023. Dr. Waldschmidt’s next projects include studies of continuous caudal anesthesia as an alternative to spinal anesthesia, as well as a comparison of lateral vs. sitting positions for the spinal anesthesia technique in infants.

Non-invasive monitoring

Borzoo Farhang DO, MS, MSHS, a general anesthesiologist, has conducted a number of studies of development-stage non-invasive monitoring devices in the OR, including two different devices for monitoring anti-nociceptive state, or receptivity to pain signals. One of his current projects is of a non-invasive blood pressure monitoring device that provides continuous BP data. That work began as a three-center pilot study, and the device is now in the FDA validation phase. Dr. Farhang also has expertise in additive manufacturing for developing new assistive devices for OR anesthesia, and has extensive experience in rapid prototyping. He holds a patent for a laryngoscope as well as numerous open-source licenses for monitoring modalities, automated respirators and other robotic applications.

Perioperative management

Mitchell Tsai, MD, MMM, is a general anesthesiologist with special training in systems management, and a research program investigating the economics and efficiencies of perioperative clinical care delivery.  He has a number of ongoing lines of interest, including exploring the cost saving and impact on outcomes by limiting preoperative testing before low-risk surgery, how residents around the country are educated in the principles of OR management, and efficacy of operating room governance strategies in Vermont and other states. In another project, in conjunction with faculty from the UVM College of Engineering and Mathematics, Dr. Tsai is exploring the use of techniques such as multi-objective optimization to understand how perioperative services behave as complex adaptive systems, and to ascertain the size at which the ability to scale operational efficiencies becomes limited in complex adaptive systems. He has expanded this analysis of performance frontiers across several institutions around the country, and his published research has shown that as perioperative services get larger, the performance frontier becomes less optimal.  In short, as health care systems increase the number of ORs, there is a limit to the efficiency and the ability to scale resources.  He is the current editor of Perioperative Care and Operating Room Management and serves on the editorial boards for Anesthesia and Analgesia and the Journal of Clinical Anesthesia.