Purpose of this Project

The Connect to Science Collaborative is designed to allow our student participants to have firsthand access to real scientists, researchers, doctors, and engineers. Students can directly ask questions of our practitioner participants through this collaboration. And from time to time, as their busy schedules permit, these real world scientists, researchers, doctors, and engineers will log in and answer our students' questions. They may even post about their day-to-day, life-in-their-field-of-expertise challenges, routines, accomplishments, or issues.

Student participants, and anyone else in the world who wishes to merely follow the collaborative, will want to subscribe to each scientist, researcher, doctor, or engineer's RSS feed. In this way students can monitor the project without having to visit it every day. When new questions or answers to questions are posted, the RSS will notify the student. More information on setting up an RSS Aggregator are available at this link.

So How Does This Work for Mabry Student Participants?
Students who wish to participate must contact one of the teacher's sponsoring the project and give the teacher the Parent Permission to Participate form. General participation guidelines are available at this link. The teacher sponsors are listed below. Once approved, the teacher assigns approved student authors a UserID and a Password and gives them the URL to be used for logging in. Students may then submit their carefully thought-out and well-written questions by logging in to the collaborative using the information provided to them.

All questions submitted by approved student authors are reviewed by the teachers supervising the project. If a given question is considered appropriate, well-crafted, and significant, the question is then posted to the collaborative by the teachers. From time to time the participating scientists, researchers, doctors, and engineers will log in and answer the questions.

All questions and answers may also receive comments from anyone in the world. Only comments that fall within the purpose of the project will be considered for publication by the teachers working with the project.

So How Does This Work for Non-Mabry Student Participants?
Students who do not attend Mabry Middle School are also welcomed to participate until the project is closed for participation. Students who attend other schools must have a certified educator from their school agree to help sponsor the project. The guidelines for non-Mabry student participation are available at this link. General participation guidelines are available at this link.

Teacher Sponsors for the Connect2Science Collaborative
This project is presently sponsored by two of our 7th grade Life Sciences teachers: Mrs. Kulkarni, and Ms. Larkin. To contact either collaborative sponsor, just click on their name.

October 31, 2006

Response to Questions-10/31/06

I'm a bit new to the workings of the blog site, so I apologize for missing your questions in response to my first posting. Let me make up for that by answering each of the questions.

1. When you mentioned taking care of seven patients over the weekend, I wondered what is the largest amount of patients an anesthesiologist can handle in one day?

The number of patients that I care for in any given day depends on the length of the surgeries and the help that I have. Let me explain. Anesthesiologists often work as the director of an "anesthesia team". The anesthesiologist (who is a physician, a doctor) may supervise residents (physicians who are learning to be anesthesiologists), nurse anesthetists (nurses trained to perform anesthesia), and anesthesiologist assistants (a physician assistant trained to perform anesthesia). We are permitted to supervise up to 4 anesthetists or 2 residents at one time, but this depends on the complexity of the surgery and the medical condition of the patient. Sometimes the operation is so difficult and the patient is extremely ill. In this situation, I would work together with a resident or an anesthetist on only the one patient. When caring for healthy patients having relatively basic surgical procedures, I may be responsible for 4 patients having surgery at the same time (in 4 different operating rooms). When this is the case, I am constantly available to help if there is an unexpected problem and am always present for the most difficult parts of the anesthesia.
Some operations, like brain surgery or a liver transplant, are very complex and may take 10 to 18 hours to complete. Others can last only 10 or 15 minutes.
Therefore, on some days, I may care for only 1 patient, while on others, there may be many.

2. What other techniques are involved in anesthesiology, because you mentioned anesthesiologists use medications and other techniques?

When most people think of anesthesia, they only think about "going to sleep" for the surgery. This is called general anesthesia. But, there are other possible kinds of anesthesia that can be used for some procedures. Many women have epidural anesthesia when they deliver their baby. This anesthetic technique numbs the lower portion of the body so that the women does not have pain during childbirth, and this allows the mother to be awake to experience the delivery. Local anesthesia may be used for small procedures such as sewing up a cut or taking out a small tumor in the skin. With this form of anesthesia, a local anesthetic, a drug that blocks the pain sensation from traveling through nerves, is injected into the skin around the incision or cut. In the area where the local anesthetic was injected, there is no pain when the area is cut or sewed up. During this kind of anesthesia, the patient can be awake or may be sedated (made sleepy) by giving other medications. Another form of pain relief for surgery is a regional anesthetic. With this, a local anesthetic is injected with a needle near a nerve. The local anesthetic blocks the nerve from working and the area of the body supplied by the nerve feels no pain. This technique can be used for surgery on an arm or leg. Again, the patient may be awake during the surgery or could choose to receive sedation.
One of the benefits of the techniques that use local anesthesia is that there is relief of pain for several hours after surgery. There are many different local anesthetic drugs that can be used and some can relieve pain for up to 12 hours after surgery.

3. Why is it that the anesthesia does not shut down the whole body since it is injected into the blood stream?

First, I must tell you that we don't completely understand how general anesthetic drugs produce their effect, that is, anesthesia. There are many types of drugs that can produce general anesthesia. Some are liquids that are injected into the bloodstream while others are gases that are breathed into the lungs and enter the bloodstream through the air in the lungs. Because there are many different kinds of drugs that produce anesthesia, scientists are trying to find a unifying mechanism that is similar with all of these drugs.
One important concept with all drugs or medications is that they all have many effects on the body. Some of these are the desired effects (general anesthesia in this case) while some are "side effects" that may be hazardous. In developing anesthetic drugs, scientists find chemical substances that produce the desired effect (anesthesia) and have little risk for unwanted or dangerous effects. General anesthetics produce "sleep" by working mainly on the cells of the brain (neurons) and spinal cord. When the anesthetic drug combines with special parts of the neurons (receptors), the brain and spinal cord neurons temporarily stop working and the result is general anesthesia. When the anesthetic drug is allowed to go away ( be removed or inactivated by the body), the neurons begin to function normally again and the patient wakes up.

4. You mentioned using anesthesia to keep people from feeling pain. How do you know the right dosage?

Since all people are different (age, sizes, weight, general health), each patient will require a different amount of anesthesia. There are some rough guidelines for dosage, but that is only a starting point. Many people don't realize that general anesthetic drugs are continuously administered during surgery to keep the patient asleep. The drugs only work for a short time, so that if we didn't keep giving them, the patient would quickly wake up. (That's the secret as to how we can wake the patient up at the end of sugery, that is, we turn off, stop administering, the anesthetic drug.)
As anesthesiologists, we have a three year residency training program, and it is during that time that we learn to give the right amount of anesthetic drug to each patient. Someone from the anesthesia care team (see above) is always with the patient during anesthesia and surgery, and he/she is continuously giving the anesthetic drug. When we see that the patient needs more, we can give a larger dose. It is a process of "titration" or finding the right amount based on the individual patient's need at the time.

5. What is the longest time anybody has ever been under anesthesia, and what is the longest suggested amount of time they could safely be under?

The longest anesthetic and surgical procedure that I have participated in was 24 hours. One of the main problems with these extremely long surgeries is not from the anesthesia but relates to the patient being immobile (lying still) for such a long time. General anesthesia is not the same as being asleep. When you sleep at night, every few minutes you move and change position. Under general anesthesia, when the patient is completely still, there is a constant pressure on the skin and muscles that are being pushed against the bed. Over a long period of time, the pressure prevents blood from easily flowing into the areas with pressure on them, and the cells may begin to die. We try to prevent the pressure injuries by placing soft padding on these at risk areas.
Anesthesia has been continuously administered to patients for several days, not for surgery, but to treat some specific medical problems. Unfortunately, I could not find any information regarding a record for the longest anesthetic.

Till next time,
Dr Berry

October 2, 2006

Hello from Mabry students!

Dear Dr. Berry,
Thankyou for taking the time to read and hopefully answer some of the questions written by our 7th grade life science class.
1. When you mentioned taking care of seven patients over the weekend, I wondered what is the largest amount of patients an anesthesiologist can handle in one day?
2. What other techniques are involved in anesthesiology, because you mentioned anesthesiologists use medications and other techniques?
3. Why is it that the anesthesia does not shut down the whole body since it is injected into the blood stream?
4. You mentioned using anesthesia to keep people from feeling pain. How do you know the right dosage?
5. What is the longest time anybody has ever been under anesthesia, and what is the longest suggested amount of time they could safely be under?
We are anxious to know your answers to our questions and look forward to asking more.
Thanks again,
Mabry Middle School Connected Student

October 1, 2006

Response from Dr Berry to First Entry

The techniques involved for preserving organs for transplantation have improved significantly over the past 30 years. Many types of tissues and organs can now be transplanted, and the length of time that they remain viable (alive) while waiting to be transplanted varies from a few hours to many months. The length of time that an organ or tissue can remain in storage depends on the organ and the method of preservation.
The following tissues and organs have been successfully transplanted in humans: heart, lung, liver, kidney, intestine, pancreas (secretes insulin to cure diabetics), bone [can be used in some spine (back) and orthopedic operations], cornea (the clear part of the eye), tendon (used in joint repairs for athletes that injure their knees), and blood vessel.

We don't often think about it, but a blood transfusion is also a transplant since blood cells are taken from one person and given to another. Thousands of transfusions of red blood cells and platelets are used every day in the United States. Blood for transfusion can be stored for about a month while platelets can be stored only for a couple of days.

Once an organ or tissue is taken from a donor, the cells begin to die unless something is done to stop the process. The cells making up the organs require oxygen and nutrients to live, but preservative solutions or other techniques are used to stop or slow the cells' death long enough until the organ can be transplanted. For organs like liver, kidneys, and pancreas, this includes pumping special perservative solutions through the blood vessels of the organ and cooling it with ice. The cold temperature reduces the metabolism (activity) of the cells, and the preservative solution keeps the cells from dying and breaking down. Before these organs are transplanted, the preservative solutions are flushed out (removed). Once the organ is transplanted, it will warm up and the cells will start to function again. Even with current methods of preservation, cells of organs like lung and pancreas can survive only a few hours before they must be transplanted. Other tissues like bone and tendons are preserved using other methods such that they can be stored for many months before use.
Medical researchers are continuing to work on developing better techniques to preserve organs for transplantation to lenghten the time that an organ can be stored and to improve the chances that the organs will survive after transplantation.
Till next time,
Dr. Berry

September 20, 2006

First Posting: An Anesthesiologist's Day on Call

I want to thank Dr. Tyson and Mrs. Abrams for inviting me to participate in this project. I hope to share some aspects of my work with you and answer your questions about anesthesia and medicine. I'm looking forward to a good year working with you. ajb

I am an anesthesiologist working at Emory University Hospital. An anesthesiologist is a physician who has received specialized training to care for patients having surgery or painful diagnostic or treatment procedures. Anesthesiologists use medications and other techniques to make patients comfortable during surgery, unaware of what is going on, and insensible to pain. Anesthesia is temporary so that at the end of the procedure, the patient recovers back to their preoperative state.

(Physicians have their own vocabulary of words to allow them to precisely communicate with each other. I will sometimes use these scientific terms in my postings and will try to explain them as I go along. If there are terms that you don't understand, let me know.)

I was on call over the weekend and took care of seven patients. Two of them received renal (kidney) transplants. Patients whose kidneys have stopped working (renal failure) can live for many years but they must undergo dialysis three times a week. This involves having their blood flow through a machine that filters out the impurities. Dialysis takes about 4 hours and often causes the patient to feel bad the rest of the day. By getting a transplanted kidney, the patient no longer would require dialysis and can pursue a more normal life.

The first successful kidney transplant was performed in Boston in 1954. A kidney was transplanted from one identical twin to the other. The body normally would reject tissue or an organ, in this case the kidney, from another individual. This immune process keeps bacteria and other foreign tissue (sometimes cancer) from taking over the body, but since the genetics of the identical twins was the same, the recipient twin did not reject the new kidney from the brother.
Now we know more about the genetics of transplantation and can better match organs with recipient patients. Now there are also drugs to suppress the immune system (turn it off) to allow the transplanted organs to survive. (What might be the bad side effects of the drugs that stop the body's immune system from functioning?)

One of the kidneys that was transplanted over the weekend was flown in all the way from Florida because it was a perfect match to the patient in Atlanta. Kidneys and other organs for transplant are very limited in number so there has been a system devised to allocate (decide who will get it) organs as they become available. (What do you think would be the factors involved in deciding who gets an organ for transplant? How could you make it fair for all patients waiting?) An organ can only survive for a few hours outside of the body, even with preservation techniques, so this limits the distance that the organs can be transported.

Both kidney transplant patients were doing well after surgery. They will remain in the hospital for about a week, but they will have to continue taking medication forever to prevent their body from rejecting the transplanted kidney. If all goes well, they will not need dialysis again and their lives can become more normal.

Till next time.
Dr. Berry

September 19, 2006

Introducing Dr. Berry

MGLC Welcomes Dr. BerryArnoldberry Photo 0905
Arnold J. Berry, MD, MPH is Professor of Anesthesiology at Emory University School of Medicine. We are honored that he has generously agreed to connect our students to real world of medical practice by participating in the Mabry Global Learning Collaborative's Connect to Science Student/Practitioner Collaboration. From time to time Dr. Berry will answer questions posted to the collaborative by our student authors. He may also share with our learning community information about his work as a physician and a professor at Emory.

A Brief Biography about Dr. Berry

  • Undergraduate degree at Emory University
  • Medical degree at the University of Pennsylvania
  • Anesthesia residency and fellowship at the Hospital of the University of Pennsylvania
  • Joined the faculty at Emory in 1978.
  • Masters of Public Health in Epidemiology from Emory University‚Äôs Rollins School of Public Health, 1997

Dr. Berry's Work

  • Published in several areas of occupational health including fatigue and prevention of occupationally acquired infections in anesthesia personnel
  • A member of the Board of Directors of the Accreditation Council for Continuing Medical Education
  • A member of the Board of Directors of the Foundation for Anesthesia Education and Research
  • Senior oral examiner for the American Board of Anesthesiology
  • The immediate Past Chair of the American Society of Anesthesiologists Committee on Occupational Health

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