Anesthesiology Research

Research drives everything we do at Montefiore Einstein Anesthesiology. We focus our efforts on addressing critical questions in perioperative outcomes, access to care, pain and opioid-free analgesia as well as efforts to understand the effect of anesthesia on the developing brain. We have cultivated a clinically impactful research program dedicated to supporting investigator-initiated research from bench to bedside. We leverage our leading electronic health record database through our work in the Anesthesiology Digital Health Laboratory to analyze and inform decisions in clinical operations, clinical research and quality improvement. Our research extends beyond conventional anesthesiology to include prospective clinical studies, epidemiology and social science investigations—all aimed at advancing perioperative care.

For more than six decades, our research team has transformed the landscape of anesthesiology through groundbreaking discoveries that continue to shape modern medicine. Our legacy of innovation extends from pioneering the use of epidural analgesia for pain management during childbirth—a technique that has since benefited millions of mothers worldwide; to landmark achievements such as introducing game-changing medications that are now cornerstones of anesthesiology practice. We were the first department in the United States to use succinylcholine in clinical practice, and we introduced both naloxone and 2-chloroprocaine into clinical practice. Our early advocacy for balanced anesthesia and development of low-flow nitrous oxide-oxygen techniques revolutionized clinical practices nationwide. The “priming principle” we discovered—which dramatically reduces muscle relaxant onset time—remains a fundamental concept in anesthesia.
 
These historic firsts are matched by our ongoing commitment to advancing the field. Our researchers have unveiled crucial insights into neuromuscular junction pathophysiology and the complex pharmacology of muscle relaxants, narcotics and local anesthetics. We made history by co-designing the first National Institutes of Health (NIH)-funded, anesthesiologist-led, multicenter, randomized control trial designed to understand the pathophysiology of the neuromuscular junction. Most recently, our team developed a machine learning tool that predicts high-risk patients for postoperative respiratory failure—exemplifying our continued dedication to improving patient safety through technological innovation. From the operating room to the research laboratory, our work continues to advance the boundaries of what’s possible in anesthesiology, perioperative medicine and critical care, always with one goal in mind: delivering safer, more effective patient care that also optimizes the comfort and psychological well-being of our patients who are recovering from major surgical procedures or severe trauma.

The Digital Health Laboratory is the cornerstone of clinical and observational research at Montefiore Einstein Anesthesiology and includes a team of physician-scientists, research fellows and data scientists. Our researchers generate and analyze highly granular, pharmacophysiological patient data from more than one million patients who have undergone surgery at Montefiore Einstein or in one of our collaborating healthcare networks to understand the effects of new medications on patients’ recovery from surgery or critical illness. This robust database enables our team to identify rare complications and is the foundation for individualized perioperative treatment. By harnessing Montefiore Einstein’s database of unique patient demographics, we emphasize access to care in our research. 
 
A recent landmark study from our Lab, published in Nature Medicine, exemplifies our impact. Analyzing more than 250,000 noncardiac surgery patients across multiple centers, we demonstrated that new-onset postoperative atrial fibrillation (POAF) occurs predictably and increases ischemic stroke risk. Importantly, we found that postoperative oral anticoagulation reduced stroke risk during the first year after surgery.

Our clinical experience in the operating rooms and intensive care units directly shapes Montefiore Einstein Anesthesiology’s research agenda. Our investigations span the full spectrum of anesthesiology subspecialties with a systematic approach: we identify breakthrough treatments through retrospective analysis and validate these findings through prospective clinical studies.

We are spearheading numerous randomized controlled clinical trials, some of which are funded by the National Institutes of Health (NIH). Through our clinical trials, patients can access emerging technologies and innovative treatments that may otherwise not be available to the general public.

At Montefiore Einstein Anesthesiology, we offer a wide variety of training and educational programs for individuals at all levels of their scientific and biomedical careers. We offer a dynamic and supportive research program for residents interested in becoming physician-scientists, with extensive opportunities to build a research career. In addition to clinical experience, Montefiore Einstein Anesthesiology residents and fellows are offered dedicated non-clinical research time and personalized mentorship. Residents and fellows also engage in clinical trials and project-based research with the help of a dedicated research coordinator to advise on study protocols and Institutional Review Board (IRB) guidelines for human subject research. We are currently offering four residency research tracks, ranging from introductory to advanced and intensive.

We also offer a one-year opportunity for medical students to be full-time research associates in our Digital Health Lab, learning advanced observational research theory and statistics and contributing to multiple peer-reviewed manuscripts. Students are mentored by our senior researchers and have the opportunity to participate in clinical trials, learn Stata coding and present their work at national and international conferences. To learn more about this offering, which is open to both U.S. and international medical students, please contact our Clinical Trials Specialist Rafi Khandaker at rkhandaker@montefiore.org and our Vice Chair of Research Dr. Olubukola Nafiu at onafiu@montefiore.org.