American Society of Regional Anesthesia and Pain Medicine February 2015 - (Page 22)
Scientist Spotlight-Dr. Guy Weinberg, Trailblazer in
Patient Safety
Colin J. McCartney, MBChB,
FCARCSI, FRCA, FRCPC
Chair, ASRA Research
Committee
Kathleen Nelligan, BSc
MD Candidate 2016
Schulich School of Medicine
and Dentistry
University of Western Ontario
1990s, Dr. Weinberg was investigating mitochondrial metabolism of
local anesthetics and, in his own words, was "hoping to understand
why a patient with isovaleric acidemia and carnitine deficiency was
super-sensitive to bupivacaine. She developed severe arrhythmias
after receiving only 22 mg of bupivacaine in tumescence solution."
In attempting to recreate the biochemical picture of carnitine
deficiency at the cellular level, Dr. Weinberg infused lipid emulsion
in a rat expecting a similar elevated sensitivity to bupivacaine but
found exactly the opposite: "After lipids, a normally toxic dose of
bupivacaine had no adverse effect."
A
nesthesiology and pain medicine is a field rich in history
and discovery. Marked by the likes of Carl Koller, Virginia
Apgar, and John Snow,
the field has contributed not only
to perioperative medicine but
also epidemiology, neonatology,
and intensive care. ASRA aims
to continue this tradition by
supporting physicians and
scientists working within the
subspecialty. Through awards
such as the Carl Koller Memorial
Research Grant, ASRA carries on
this tradition. Now approaching its 29th year, it is time to shine the
spotlight on some of the most notable research accomplishments
achieved through ASRA's support.
This discovery led to the first study of the mechanism of lipid
rescue for local anesthetic systemic toxicity (LAST). Funded by the
Koller Award in 2004, Dr. Weinberg investigated whether or not lipid
infusion accelerated bupivacaine removal from a rat heart model.
It did.
Fast forward 10 years-not only
have Dr. Weinberg's original
results been replicated in an
intact animal model, but there
have also been countless case
reports of successful lipid rescue,
ranging from LAST to overdoses
from many other drugs. However,
improving care in rare events has
been challenging. "The greatest
challenge of rare events is convincing your potential audience
of their clinical relevance," says Weinberg. "That audience could
be physicians who don't see an event occurring at a rate of 1 in
1,000 as presenting a real danger to their practice. It could also
be a grant reviewing agency that won't fund a project studying
an event with that low an incidence. However, the reality of LAST
is that while we would like it to be a 'never event,' 1 in 1,000
"Like many seminal discoveries
in medicine, a chance
observation was the trigger for
an important discovery."
Like many seminal discoveries in medicine, a chance observation
was the trigger for an important discovery. Enter Dr. Guy Weinberg,
anesthesiologist and scientist at the University of Illinois. In the late
22
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American Society of Regional Anesthesia and Pain Medicine
2015
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine February 2015
In Memoriam : Alon Palm Winnie, M.D., ASRA Founding Father
President’s Message
Editorial
40th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
Resident and Fellow Events at the 2015 Spring Meeting
How We Do It: Managing an Acute and Perioperative Pain Medicine (APPM) Service at the University of Florida
Ketamine—an Old Drug with New Tricks
Optimal Postcesarean Delivery Pain Management
Palliative Care and Pain Medicine—Beyond Intrathecal Pumps and Opioids
Scientist Spotlight—Dr. Guy Weinberg, Trailblazer in Patient Safety
American Society of Regional Anesthesia and Pain Medicine February 2015
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