Scientist | Brigham and Women's Hospital
Professor of Anaesthesia | Harvard Medical School
Dr. Kissin’s research interests are multifaceted: general anesthetic action, postoperative analgesia, chronic pain, local anesthesia.
1. Depth of anesthesia
The concept that general anesthesia is based not on a single general anesthetic action but on a spectrum of separate pharmacological actions, even if only one drug is used. As a result of the development of this concept, we came to the view that the characteristics of an anesthetic agent should depend on the relative strength of various independent actions that constitute the components of anesthesia (unconsciousness, absence of movement in response to noxious stimulation, attenuation of autonomic responses, etc.). This has led to the conclusion that the search for a reliable index of anesthetic depth should be focused on separate indices of the distinct components of anesthesia. In addition, even the type of interaction (supra-additive, additive, infra-additive) for a combination of agents in relation to one anesthetic action might be different from that for another action of the same combination.
2. Preemptive analgesia
An intervention which prevents establishment of the altered sensory processing that amplifies postoperative pain. We identified the most important condition for maximizing the preemptive effect: the treatment should cover the entire duration of high-intensity noxious stimulation that can lead to establishment of sensitization including the initial postoperative period. As a result, we suggested the adoption of a different term – “preventative analgesia.”
3. Acute tolerance to opioid analgesia
Tolerance to opioid analgesia is profound even in the presence of nociceptive input. We demonstrated that it develops very rapidly, especially with short-acting opioids such as remifentanil.
4. Nerve block with vanilloid agonist resiniferatoxin (RTX)
RTX is an ultrapotent capsaicin analog with unique spectrum of activities. We have found that perineural administration of RTX prevents hyperalgesia in a rat model of postoperative pain. An electron microscopy study in rats also demonstrated that RTX-induced sciatic nerve blockade may produce morphological changes in C fibers, but to a much smaller degree than that with local anesthetics. This result opens a new avenue in the treatment of pain: to use nerve blockade for selective analgesia, analgesia without suppressing motor or sensory functions unrelated to pain.
5. History of recent transformation in direction of progress in anesthesiology
From pharmacology of anesthetics to anesthesia management. Quantitative measurement of publication-based academic interest of anesthesiologists (databases of journal articles, patents, and approved drugs) demonstrated that interest in pharmacological basis of anesthesia is declining, it is mostly concentrating on progressively decreasing number of drugs. At the same time, interest in anesthesia management is increasing, especially during the past 30 years.
Kissin I. What can big data on academic interest reveal about a drug? Reflections in three major U.S. databases. Trends Pharmacol Sci 2018;39:248-257.
Kissin I, Vlassakov KV. Pharmacological basis of anesthesia: How to overcome stagnation? Anesth Analg 2018;127:1268-1270.
Correll DJ, Vlassakov KV, Kissin I. Recent history of publication-based academic interest in general anesthetics. J Anesth Hist 2018;4:109-114.
Kissin I. Academic journals assessed as springboards for new developments: a study of leading anesthesia journals over past 50 years. J Anesth Hist 2019;5:7-12.
Correll DJ, Kissin I. Problems with developments of breakthrough analgesics: Recent history via scientometric analysis. J Aneasth Hist 2019;5:49-57.
Correll DJ, Kissin I. Academic interest in pain: Comparison of four specialties with long-standing involvement in pain medicine. J Anesth Hist 2019 (In press: doi.org/10.1016/j.janh.2019.08.003).