Current Projects
Obstructive sleep apnea in children
Obstructive sleep apnea (OSA) has become a major public health concern as its incidence and severity have increased in tandem with the obesity epidemic. In children, OSA is now recognized as a common disorder and can be associated with significant morbidity. The safe anesthetic management of a child with OSA requires an anesthetic technique tailored to the underlying etiology and severity of OSA and the surgical procedure. Patients with OSA are at risk for airway obstruction (during sedation and anesthesia. Our research also studies the effects of anesthetics, including dexmedetomidine on the upper airway of children, adolescents, and young adults with OSA.
Dr. Mahmoud collaborated with colleagues from the Departments of Pulmonary and Sleep Medicine, Aerospace Engineering, Radiology, and Otolaryngology department to examine using three-dimensional computational simulations from dynamic cine magnetic resonance imaging and sleep study in predicting surgical outcomes in children with obstructive sleep apnea.
Project Goal: Safe anesthetic management of children with OSA
Funding National Institutes of Health - $3,917,068
Dexmedetomidine in pediatric sedation
Dexmedetomidine is an off-label adjunctive agent for sedation and analgesia in pediatric patients in the critical care unit and for sedation during non-invasive procedures in radiology. Because of its minimal respiratory effects, dexmedetomidine has also been used as a single agent for sedation during non-invasive procedures such as MRI. However, additional studies in pediatric patients are needed to evaluate its safety and efficacy. This research includes obtaining FDA IND approval to investigate. Our clinical research has guided the evolution of the Radiology Sedation Program at Cincinnati Children’s, enabling changes based on outcomes data. We have introduced dexmedetomidine as a sedative to replace pentobarbital in radiology. Dr. Kandil and were chosen as a primary site in a multicenter evaluation of dosing and efficacy when dexmedetomidine is used as a sole anesthetic in MRI.
Project Goal to investigate dexmedetomidine in the pediatric population in our institution in order to identify safest and most efficacious dosing and improve outcomes in children.
Funding: Pfizer: Dexmedetomidine utility in MRI
Effects of anesthetic agents on upper airway morphology in children
During sedation and recovery the airway of children with obstructive sleep apnea is vulnerable to collapse. This vulnerability arises from both an inherent collapsibility of the pharyngeal airway in these children and a heightened sensitivity to sedative and anesthetic agents. Pharmacologic and non- pharmacologic support may be required to maintain pharyngeal airway patency in children with obstructive sleep apnea both during sedation and recovery.
Project Goal: Examine the effect of dexmedetomidine, propofol and ketamine administration on airway configuration in children with and without history of obstructive sleep apnea.
Funding: Support is provided from institutional and departmental sources.
Auditory brainstem responses under anesthesia
Auditory brainstem response (ABR) is a useful neurophysiologic modality to identify extent of hearing impairment. It has long been believed that inhaled anesthetic agents have negligible effects on these responses. Based on anecdote from our Audiology colleagues, Dr. Kandil designed a study to investigate whether our inhaled agent, sevoflurane compromises the interpretability and quality of the ABR testing in children when compared to propofol. We have changed our practice since the inception of this study to request total intravenous anesthetic with just propofol when conducting ABR testing in children. This results and analyses have been established and our findings are pending publication
Project Goal: Investigate the previously held notion that ABR testing is resistant to inhaled anesthetic agents and compare the quality and interpretability of the ABR results when using sevoflurane versus propofol.
Funding: Support is provided from departmental funding
