Anesthesiology/Intensive Care

The research within our LUMC departments is conducted within departmental research programmes. The research programme below is embedded within the department of Anesthesiology.

Aim and focus 

To improve the outcome of acute and perioperative care in a population of patients that is increasingly gaining complexity; to improve outcome in chronic pain patients with special emphasis to traumatic and neuropathic pain patients.

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 four themes: translational pain research, perioperative care, intensive care and cardiovascular research.

1. Translational Pain Research

In this line of research prof. Dahan (Anesthesiology) and prof. Malessy (Neurosurgery) participate. Dahan focuses on human (clinical) research, while Malessy’s research is focused on experimental (animal) work. 

1.1 Clinical research into pain and pain treatment

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. 

Researchers (PI and postdoc): Dr. Marieke Niesters (PI) and Dr. Monique van Velzen (postdoc),

Important cooperations: 

  • Prof. David Yarnitsky, Technion, Haifa; 
  • Prof. Frank Overdyk (Hofstra North Shore-LIJ University School of Medicine);
  • Prof. dr. Asbjørn Drewes Aalborg University; 
  • Prof. Anthony Cerami, Araim Pharmaceuticals; 
  • Prof. Joop van Gerven/dr. Koos Burggraaf/dr. Geert Jan Groeneveld, Centre for Human Drug Research;
  • Prof. Dr. Andrea Evers, Faculty of Social Sciences;

1.2 Experimental research

This line of research was added to 1.01.01 in 2017 and is aimed at diagnosing and treating neuropathic pain due to traumatic nerve injury. The dorsal root ganglion  (DRG) is the main focus of research. The DRG is the first relay station between the damaged nerve and the central nervous system and therefore the evident site for treatment. New innovative imaging-guided techniques are being developed to identify the affected DRG. New therapeutic techniques such as DRG stimulation and gene therapy will be developed, first in animal models and later applied in patients. This research line fully fits into the existing research line of 1.01.01 and will lead to synergistic cooperation.

Important cooperations: 

  • Prof. Joost Verhaagen, Dutch Institute for Neurosciences (Instituut voor Neurowetenschappen), Amsterdam; 
  • Prof. Paul Breedveld, Department of BioMechanical Engineering , Technical University Delft.

2. Perioperative care: optimizing outcome 

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 cooperation 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. 

Researchers: Dr. Chris Martini and Dr. Eveline van Dorp

Important cooperations: 

  • Dr. Dingeman Swank, bariatric surgeon, Nederlandse Obesitas Kliniek West;
  • Prof. Rob Nelissen, Dept. Orthopedics, LUMC;
  • Dr. Michiel Warlé, vascular surgeon, RadboudMC;
  • Dr. Rob Bevers, Dept. of Urology, LUMC;
  • Dr. Bert Bonsing, Dept. of Surgery, LUMC
  • Dr. Annemiek Middeldorp, Dept. of Gynaecology, LUMC
  • Prof. Evan Kharasch, Dept. of Anesthesiology, Washington University, St. Louis
  • Prof. Thomas Henthorn, Dept. of Anesthesiology, Denver University

3. Intensive Care: optimizing outcome. 

3.1 Pulmonary Inflammation and damage. 

Mechanical ventilation and oxygen therapy are the cornerstones of contemporary therapy of critical ill patients. This line of research is aimed at optimizing ventilation and oxygen therapy while preventing oxygen-related and ventilator-related tissue damage.

Researchers:  Dr. D. van Westerloo and Dr. M.S. Arbous

3.2 Infection and inflammation. 

The following topics are studied, all in the ICU patient population: selective intestinal decontamination, prevention of gram negative resistant organisms, prevention of cross-infection, inflammatory pathways following cardiac surgery in adult and pediatric populations, inflammation related to blood donation. 

Researchers: Dr. M.S. Arbous and Dr. D. van Westerloo

4. Cardiovascular research

This line of research will in the near future closely cooperate with program 2.03.01 (cardiology). The research addresses the effects of (regional) anesthesia and opioids on the physiological changes with the cardio-vascular system and is strongly aimed at the translation of experimental work into the clinical realm (from bench-to-bedside). 

Researchers:  Prof. dr. L. Aarts, Prof. dr. A. Dahan, Prof. dr. E. de Jonge, dr. E van Dorp and dr. M.S. Arbous

Important cooperations: 

  • Prof. P. Steendijk, Dept. of Cardiology, LUMC

Position in international context

The research is well embedded within the international anesthesia, ICU and pain community with numerous contacts, shared projects, guideline developments and invitations to hold prestigious lectures (see below).

Content / highlights / achievements

The research has three main fields that are closely interconnected and work together: Anesthesia, acute/intensive care and pain treatment. Recently the departments of Anesthesiology, Intensive care and Neurosurgery joined forces to come to one strong research group. This merger took place in mid/end 2016. Major achievements of individual groups relate to (1) the new innovative techniques that have been developed such as novel anesthesia techniques (deep neuromuscular block coupled to nociception monitored anesthesia); (2) the development of cornea confocal microscopy in the detection of small fibre neuropathy in DM and sarcoidosis, (3) the development of novel non-opioid treatments in chronic pain.

Future themes

We will focus on specific main themes: Pain, Anesthesia and Acute/Intensive Care. Examples of topics that are addressed in these themes are (1) improvement of pain therapy; (2) development of monitor- or parameter-guided anesthesia; (3) Improvement of mechanical ventilation and oxygen therapy; (4) Infection and inflammation (incl. selective intestinal decontamination) and (5) cardiovascular research (in cooperation with the department of cardiology). These topics are well interconnected and are multidisciplinary. 

Cohesion within LUMC 

Cohesion is strong as three individual departments work closely together in this one research program. Other cooperations exist with the department of neurology, urology, orthopaedics, surgery, radiology, gynaecology and faculty of social sciences.