SAMBA Distinguished Service Awards The Committee on Awards has issued a call for nominations for the Distinguished Service Award for presentation at the SAMBA 2006 Annual Meeting in Washington, D.C. The SAMBA Distinguished Service Award is presented to an individual for outstanding achievement in ambulatory anesthesia and is the highest honor which the Society can bestow. Members are invited to submit nominations for the award. Nominations must include a cover letter, a copy of the nominee's curriculum vitae and no more than four letters of support of the nomination. Nominations must be received at the SAMBA office by no later than August 18, 2006. Previous Distinguished Service Award winners are: Marie-Louise Levy, M.D. (1994) Bernard V. Wetchler, M.D. (1995) Stanley Bresticker, M.D.* (1996) Harry C. Wong, M.D. (1997) Burton S. Epstein, M.D. (1998) Surinder K. Kallar, M.D. (1999) Wallace A. Reed, M.D. (2000) Paul F. White, M.D., Ph.D. (2001) Herbert D. Weintraub, M.D. (2002) Raafat S. Hannallah, M.D. (2003) Beverly K. Philip, M.D. (2004) Rebecca S. Twersky, M.D.(2005) *Deceased For a nominating form, please contact the Committee on Awards, SAMBA, 520 N. Northwest Highway, Park Ridge, Illinois 60068-2573; or call (847) 825-5586.

Resident Travel Awards - TOP
The Society encourages residents in anesthesiology training programs to become more involved in SAMBA. Each year, the Society will issues a limited number of travel awards to anesthesiology residents whose scientific abstracts are accepted for poser presentation at the SAMBA Annual Meeting. These travel awards support residents in training with a grant of $1,000 each to attend the meeting. Those who receive travel grants for their abstracts are also eligible for Ambulatory Anesthesia Research Foundation Awards. Case reports are not acceptable. Papers presented at the SAMBA Annual Meeting are eligible for presentation at subsequent meetings of the American Society of Anesthesiologists or the International Anesthesia Research Society. Abstracts are submitted electronically through the Society's Web site. Interested individuals should check the SAMBA Web site in January for information on abstract submissions for the current Annual Meeting.

Outcomes Research Award - TOP
The Society for Ambulatory Anesthesia (SAMBA) from time to time issues requests for proposals to establish the requirements for outcomes-oriented research for the purpose of elevating the quality of patient care in ambulatory anesthesiology catalyzing high-quality research in ambulatory anesthesia. The Society makes available the sum of $150,000 over a two-year period to the selected proposal.

2004 - Winner of the Outcomes Research Award - TOP

Title:
The Role of Dexamethasone and Anesthesia Depth in the Incidence of Postoperative Cognitive Dysfunction: A Factorial Randomized Controlled Trial

Principal Investigator:
Karen C. Nielsen, M.D.
Co-Investigators:
Ricardo Pietrobon, M.D., Ph.D., Susan M. Steele, M.D., Christian C. Apfel, M.D., Daniel I. Sessler, M.D.

Postoperative cognitive dysfunction (POCD) is a common event after surgery and general anesthesia in the elderly,¹ carrying a burden of suffering brought by decreased quality of life. POCD may be manifested as postoperative confusion, which has been reported in up to 44 percent of all elderly patients undergoing surgical fixation of a fractured neck of the femur.² When POCD is evaluated across multiple surgical procedures, the incidence of cognitive deficits has been found to be about 26 percent one week after surgery and approximately 10 percent three months after surgery.³

In spite of its high prevalence, causal mechanisms are poorly understood, and few (if any) preventive therapies are available. POCD has been previously postulated to result from the inflammatory or metabolic stress response associated with surgery.⁴ This association leads to a hypothesis that a decrease in stress response would lead to a decrease in the incidence of POCD, a phenomenon that can be accomplished by preoperative steroids.^5-6 The same rationale can be applied to other causes of POCD, including postoperative pain and postoperative fatigue.⁷ In addition, preoperative steroids reduce the duration of convalescence leading to early mobilization and potentially fewer incidences of POCD.⁷

In relation to monitoring of anesthesia depth, previous studies have pointed to anesthesia duration and continued exposure of the central nervous system to anesthetic drugs3 as a direct cause of short-term POCD.⁴ Although no previous study has been conducted to evaluate the role of anesthesia depth on POCD, it is plausible that keeping patients at a higher consciousness level and less exposed to anesthetic drugs would potentially decrease the incidence of POCD.

Although the use of preoperative steroids and monitoring of anesthesia depth (determined by the bispectral index monitor, or BIS) during anesthesia have been previously shown to reduce adverse outcomes that are commonly associated with POCD, the direct effect of these interventions in the reduction of POCD has not been evaluated. Therefore the aim of this multicenter factorial randomized controlled trial is to determine whether combinations of two different levels of depth of consciousness during anesthesia and preoperative intravenous dexamethasone can decrease the incidence of POCD.

Three hundred people above the age of 60 undergoing ambulatory surgery under general anesthesia will be enrolled in this study. The incidence of POCD in young patients is not significant, and they will not be studied. Participants will be randomized to one of four arms: light anesthesia (BIS 50-60) plus dexamethasone (8 mg I.V. two hours prior to surgery), deep anesthesia (BIS 30-40) plus dexamethasone, light anesthesia plus placebo or deep anesthesia plus placebo. Anesthetic management will be standardized.

Prior to surgery, baseline cognitive function will be evaluated using validated tests (Telephone Cognitive Assessment Battery, Blessed Telephone Information- Memory-Concentration Test). Participants also will be evaluated using a battery of validated cognitive tests measured by telephone and/or the Internet applied at baseline and closely monitored at postoperative 1, 3, 7, 21, 60 and 180 days. Extensive information on potential confounders will be obtained. Additional patient outcomes will be collected, including postoperative pain (Visual Analogue Scale), postoperative nausea and vomiting (Visual Analogue Scale), postoperative fatigue (The Fatigue Self Rating Scale), depression (Center for Epidemiological Studies Depression Scale-CES-D), quality of life (Sabin-Feldman-36), and social support given by family, friends or significant other (Multidimensional Scale of Perceived Social Support). Evaluation of the role of dexamethasone and level of consciousness during anesthesia on POCD will allow for the assessment of factors that can potentially increase the safety of ambulatory anesthesia improving patient outcomes.

References are available on the SAMBA Web site.