Loma Linda University


  1. Snake venom pretreatment to prevent surgical brain injury: The potential benefit of pretreatment with a variety of snake venoms in studies of surgical bleeding and post-surgery edema is promising. A number of projects are underway that involve department members and trainees. These projects are supported by an R01 NIH Grant (“Crotalus Snake Venom Preconditioning to Prevent Surgical Brain Injury”).
  2. Neurologic function after cardiac arrest: Interventions to improve neurologic outcome following cardiac arrest are being studied using a rat model of sudden cardiac arrest and resuscitation by researcher Dr. Lei Helen Huang. Working with other members of the Zhang lab this study of post-resuscitation interventions could provide treatments to improve outcome after cardiac arrest. This work is partially supported by a $25,000 grant from the Floyd S. Brauer Anesthesiology Research Endowment.
  3. Vasovagal syncope: The potential benefit provided by remote ischemic pre-conditioning for vasovagal syncope is being studied by a team led by Dr. Jiping Tang. This work is partially supported by a $75,000 Grant to Promote Translational and Collaborative Research (GCAT) from Loma Linda University School of Medicine.

Presentations and Publications
IARS Annual Meeting 2014 Barnhart M, Raval R, Applegate R, Zhang J: Identification Of Potential Target Proteins Leading To Reduced Surgical Bleeding From Pretreatment Of Sprague Dawley Rats With C. Atrox Venom S-142
ASA Annual Meeting 2013 Raval R, Kim C, Hay K, Zhang J, Bull B, Applegate II RL: Decreased Surgical Bleeding in Sprague Dawley Rats Pretreated With Crotalus Atrox Venom, A1047
Soliman S, McBride D, Tang J, Applegate II R: Remote Ischemic Pre-Conditioning Can Modulate the Systemic Response to VVS and Decreases Syncopal Episodes. S-482

Drunalini Perera PN, Hu Q, Tang J, Li L, Barnhart M, Doycheva DM, Zhang JH, Tang J:Â Delayed remote ischemic postconditioning improves long term sensory motor deficits in a neonatal hypoxic ischemic rat model. PLoS One. 2014 28;9(2):e90258
Doycheva DM, Hadley T, Li L, Applegate II RL, Zhang JH, Tang J: Anti-neutrophil antibody enhances the neuroprotective effects of G-CSF by decreasing neutrophil mobilization in hypoxic ischemic neonatal rat model. Neurobiol Dis. 2014 Sep;69:192-9
Manaenko A, Lekic T, Barnhart M, Hartman R, Zhang JH: Inhibition of Transforming Growth Factor-β Attenuates Brain Injury and Neurological Deficits in a Rat Model of Germinal Matrix Hemorrhage. Stroke. 2014;45(3):828-34
Fujii M, Sherchan P, Krafft PR, Rolland WB, Soejima Y, Zhang JH. Cannabinoid type 2 receptor stimulation attenuates brain edema by reducing cerebral leukocyte infiltration following subarachnoid hemorrhage in rats. Journal of the Neurological Sciences 2014;342:101-6.
Fujii M, Sherchan P, Soejima Y, Hasegawa Y, Flores J, Doycheva D, Zhang JH. Cannabinoid receptor type 2 agonist attenuates apoptosis by activation of phosphorylated CREB-Bcl-2 pathway after subarachnoid hemorrhage in rats. Clinical and Experimental Neurology 2014;261:396-403.
Benggon M, Chen H, Applegate R, Zhang JH: Thrombin preconditioning in surgical brain injury in rats. IARS Annual Meeting 2014 Resident Oral Abstract Competition; Benggon M, Chen H, Applegate II RL, Zhang JH: Thrombin preconditioning in surgical brain injury in rats. Acta Neurochirurgica Supplement 2015
Komanapalli ES, Sherchan P, Rolland II W, Khatibi N, Applegate II RL, Martin RD, Tang J, Zhang JH: Epsilon Aminocaproic Acid Pre-Treatment Provides Neuroprotection Following Surgically Induced Brain Injury In A Rat Model. Acta Neurochirurgica Supplement 2015
Huang L, Woo W, Sherchan P, Khatibi NH, Krafft P, Rolland II W, Applegate II RL, Martin RD, Zhang JH: Valproic acid pretreatment reduces brain edema in a rat model of surgical brain injury. Acta Neurochirurgica Supplement 2015
Pakkianathan C, Benggon M, Khatibi NH, Chen H, Marcantonio S, Applegate II RL, Tang J, Zhang JH: Propofol Pre-Treatment Fails to Provide Neuroprotection Following a Surgically Induced Brain Injury Rat Model. Acta Neurochirurgica Supplement 2015
Meineke M, Applegate II RL, Rasmussen T, Anderson D, Azer S, Mehdizadeh A, Kim A, Allard M.: Cognitive dysfunction following desflurane versus sevoflurane general anesthesia in elderly patients: a randomized controlled trial. Â Medical Gas Research 2014; 4:6

Program Project Grant

Program Project Grant to establish the Center for Brain Hemorrhage Research: $7.7 million NIH award to the Zhang Neuroscience Laboratories. We anticipate a number of important findings to come from this Center. It is our hope that based on results from basic science projects we will be able to carry out translational research on interventions that show promise to improve outcomes after hemorrhagic stroke.

Pediatric Anesthesia Research

  1. Analgesia following surgery in children can be challenging. A team of LLU researchers investigated the impact of acetaminophen following cleft palate repair, finding a decrease in opioid use (Nour C, Ratsiu J, Singh N, Mason L, Ray A, Martin M, Hassanian M, Uhler J, Applegate II RL: Analgesic Effectiveness of Acetaminophen for Primary Cleft Palate Repair in Young Children: A Randomized Placebo Controlled Trial. Pediatric Anesthesia 2014; 24:574-58)
  2. Finding optimum methods to control pain in pediatric urologic surgery patients is being studied by a team led by Dr. Shannon Mulder: Preemptive analgesia in children using caudal epidural ropivacaine: A prospective, randomized, controlled study NCT01494272
  3. Premedication for pediatric patients is being studied by a group led by Dr. Amgad Hanna NCT02096900

Presentations and Publications
Vadi M, Roddy KJ, Ghazal EA, Um M, Neiheisel AJ, Applegate II RL: Comparison of the GlideScope Cobalt® and Storz DCI® Video Laryngoscopes in Children Younger Than Two Years of Age During Manual In-Line Stabilization: A Randomized Trainee Evaluation Study,  Pediatric Emergency Care 2015
Applegate R, Kumar G, Hanna A, Hassanian M, Um M, Davis P, Daum C, Romanu R, Stoelk R, Tagge E: The Impact of Systemic Illness on Postoperative Pain in Children Undergoing Laparoscopic Appendectomy. A4292, ASA Annual Meeting, 2014

Education research at LLU

  1. Decision making in critical events was reported on by a collaborative group that includes Dr. Marissa Vadi: Vadi MG, Patel N, Stiegler MP: Case Scenario: Local Anesthetic Systemic Toxicity after Combined Psoas Compartment–Sciatic Nerve Block Analysis of Decision Factors and Diagnostic Delay. Anesthesiology 2014; 120 (4):987-96
  2. Use of video interviews for resident selection is being studied by a group that includes Dr. Robert Martin, Dr. Marissa Vadi, Dr. Mathew Malkin, Dr. Gary Stier, Dr. John Lenart, Dr. Jason Gatling and Dr. Richard Applegate. An abstract based on preliminary analysis of this work has been submitted to the 2015 ASA Annual Meeting.

Perioperative Surgical Home

  1. Anesthesiology resident training in the Perioperative Surgical Home is being implemented and studied by a group led by Dr. Gary Stier and others. These results are being shared with the ASA PSH Collaborative. The Department’s perioperative care coordination project has targeted the care of patients undergoing major urologic surgery. Efforts to date focus on redesigning the entire perioperative episode of care for the patient, including the use of enhanced preoperative risk assessment and optimization tools, early discharge planning, improved patient education, intraoperative pain, fluid, and glucose management protocols, early ambulation, nutritional supplementation, postoperative medical management, and efficient transitional care planning. Preliminary data indicate reductions in hospital resource utilization and length of stay, along with greater overall patient satisfaction with the implementation of this model of care.
  2. Multimodal analgesia was associated with significantly less IV opioid administration and fewer adverse events following total knee arthroplasty in a study led by Dr. Mohamed Nour (ASA Annual Meeting 2014 Nour M, Applegate IIR, Herra D, Kuman G, Uhler J: Adverse Events Before and After the Implementation of a Multimodal Peri-Operative Pain Control Regimen for Total Knee Arthroplasty. A1303)