Perioperative medicine: efficacy, safety and outcome

In 2016 the departments of Anesthesiology and Intensive Care merged their research programs into one strong mutual program aimed at the further development of already existing research targets and the inception of novel research goals. Currently the research of the two departments has focused on the following themes: translational pain research, perioperative care, intensive care, cardiovascular research, cardiorespiratory control, epidemiology of opioids.

Perioperative care

The research theme “perioperative care” aims to study the effect of applied anesthesia care on patient outcome. Various indicators (endpoints) are being investigated such as hemodynamic stability, quality of the surgical field (as assessed by the surgeon), postoperative (acute and chronic) pain, postoperative development of pulmonary complications, readmission, and blood replacement therapy. The research is conducted in close collaboration with the surgeon of different specialties. Apart from clinical trials being performed in the operating room complex, big data analyses are an integral part of this research line. Aimed at the improvement of perioperative care various projects are on-going, including (i) the renewal of pain protocols for the treatment of postoperative pain (based on the results of big data analyses); (ii) application of the novel technique of deep neuromuscular block, a technique that that gained world-wide adoption; (iii) the implementation of a pain or nociception monitor to steer opiate administration during general anesthesia. This latest development makes it possible to apply parameter-guided anesthesia, which will reduce hemodynamic instability, the probability of awareness and chronic postoperative pain. LUMC is currently an excellence centre for perioperative nociceptive monitoring.

Pain Research

This research is mechanistic and therapeutic in nature and is aimed at the development and application of novel diagnostic tools (such as Cornea Confocal Microscopy (CCM) and Quantitative Sensory Testing (QST)) in chronic pain. By combining multiple tools specific pain phenotypes are detected that present themselves irrespective of the underlying disease. Each phenotype requires a specific and unique treatment paradigm. In this line of research precision medicine is combined with personalized medicine.

The therapeutic part of this line of research is aimed at optimizing the treatment of acute and chronic pain by maximizing pain relief while simultaneously minimizing toxicity (e.g. respiratory depression, sedation). By creating so called Utility Functions of individual drugs in specific populations, treatment is optimized by choosing those drugs with the most favourable utility functions. This line of research has gained the interest of the laymen’s press and is widely sponsored by the pharma industry. It also has close links to finding a solution to the opioid epidemic that not only occurs in the US but also in the Netherlands.