OR in the News

University of Louisville Medicine, January 2001

January 20, 2001 By Randi Hansen

Picture a quiet Berkeley, Calif., neighborhood early on a Sunday morning in 1972: peaceful houses, tree-lined streets and well-manicured lawns. Suddenly, the sleeping residents are jolted awake by an enormous explosion that rattles windows as much as a block from the epicenter.Ground zero is, of course, the home of the Sessler boys, who have developed quite a reputation for their myriad—and mostly explosive—chemistry experiments.

“My brother Jon and I, working in our back yard, pulverized a large rock,” recalls Dr. Daniel I. Sessler, now 45 and barely able to suppress a grin beneath his dark beard and mustache. “We were seriously interested in pyrotechnics.” The director of an international clinical research group called Outcomes Research, Sessler came to the University of Louisville in May to assume the post of assistant vice president for health affairs and associate dean for research at the school’s Health Sciences Center. He also is the Lolita S. and Samuel D. Weakley professor of anesthesiology.

Sessler arrived in Louisville more quietly than he lived in Berkeley, but he’ll import every bit as much excitement. His charge is to unify and streamline the clinical research process at the University of Louisville.

He first visited Louisville last year as a candidate for chair of the anesthesiology department. That appointment went to Dr. Carol Lake, but Dr. Joel Kaplan, vice president for health affairs and dean of the medical school, later called him back. “He said, ‘How would you like to direct the university’s clinical research program?’” Sessler recalls. “I was intrigued.” U of L sets high standards for research and follows complex regulatory frameworks when it comes to clinical research, Sessler says.

“For example, before a clinical project can even start, numerous steps are required, such as providing oversight through the proposal clearance process and conflict-of-interest evaluation, negotiating a contract between the university and the sponsor, obtaining Institutional Review Board approval, and so on,” he notes.

“The goal is to maintain high standards and make it easy for investigators to do research. “My goal, and that of the university’s research office, is to make this process as simple, transparent and parallel as possible.” Sessler’s relocation to Louisville also brings the headquarters of Outcomes Research to U of L. The nonprofit group, which was founded by Sessler, is composed of 80 investigators in 10 countries.

Powered by more than $4 million in research funding since its inception, Outcomes Research works on a broad array of projects, typically keeping about 60 studies in progress at any given time, Sessler says. Its members are especially interested in testing simple interventions that may markedly improve how patients fare. For example, Outcomes Research has a long-standing interest in patient temperature regulation during and after surgery. When the group began studying the topic 15 years ago, little information was available and patient temperature variations were not considered a serious clinical problem.

In a remarkable series of nearly 200 papers, the group determined the extent to which anesthetics impair temperature control and how hypothermia develops during surgery. They also evaluated the consequences of hypothermia. To everyone’s surprise, including Sessler’s, the consequences of this easily preventable complication turned out to be severe. A 2-degree Centigrade reduction in patient temperature, which is typical in unwarmed surgical patients, halves the body’s ability to metabolize drugs, provokes post-surgical shivering, prolongs patient recovery from anesthesia and increases blood loss and transfusion requirements. And as if that weren’t enough, the group reported in the New England Journal of Medicine that even a slight decrease in patient temperature triples the risk of surgical infection and significantly extends hospital stays.

Outcomes Research remains the most prolific anesthesia research group in the world. However, its members now run the gamut of medical specialties, Sessler says. Less than half the group’s work currently is related to temperature regulation, and its efforts now extend into surgery, physiology, pharmacology, and half a dozen other specialties. For example, the group’s researchers performed a series of studies in 1999 showing that simply giving supplemental oxygen during and immediately following surgery (a mixture containing 80 percent oxygen rather than the routine 30 percent) halves the incidence of postoperative nausea and vomiting.

More importantly, the team found that extra oxygen also halves the risk of surgical wound infection. This study, also published in the New England Journal of Medicine, brought the group international acclaim.

Now based in Louisville, Outcomes Research will be able to offer scientific support to U of L clinicians who seek assistance setting up studies. “When clinical research projects fail,” Sessler explains, “the difficulties are usually scientific, not administrative. “It might be that the researchers didn’t know how to design a protocol, or how to get funding, or how to do the study, manage the data, analyze the results or write the manuscript. “One of the group’s goals is to help clinicians who have questions or ideas translate them into published manuscripts that can then serve as the basis for grant applications and future work. Research is one of the core academic missions of the university. We want to encourage participation by providing tools and assistance.”

Terms like “academic mission” have nearly always been a part of Sessler’s vocabulary. Both parents are physicists, and Sessler’s father is a member of the National Academy of Sciences and immediate past president of the American Physical Society. Sessler tactfully refers to his upbringing, in a house with a fully equipped chemistry laboratory but no television, as “non-standard.” “Starting when I was in grade school, my father would pose problems at dinner. A typical one might be, ‘How would you determine the diameter of the earth?’ We would come up with some ways that it might be done and then he would give us the values that we’d have obtained from the proposed measurements. “We would then calculate the results in our heads. We did that every night.”

It certainly didn’t do them any harm. Sessler’s younger brother, Jon, is a chemist at the University of Texas—Austin and was the youngest person ever appointed as a full professor at that institution. Jon also is the founder of the drug company Pharmacyclics. His sister, Ruth Bernstein, is a geologist. Sessler, like his brother, studied chemistry at the University of California—Berkeley, despite his father’s oft-repeated adage that “chemists are constantly trying to blow themselves up—and the really good ones succeed.” (“A little physics bias there,” Sessler adds wryly.)

He stayed near the top of his class for three years and was then accepted to the Columbia University College of Physicians and Surgeons. “I don’t have an undergraduate degree,” Sessler confesses. “Turns out not to be required. Certain courses are prerequisite for medical school, but a degree is not actually necessary.” He later returned to California to do pediatric and anesthesia residencies at the University of California—Los Angeles. During his residency he kept a “pretty good” photography business—mostly fashion photography—going on the side. “My parents enjoyed art, music and literature, and they taught me to appreciate them,” Sessler notes. “My mother, for example, got me interested in modern dance while I was in high school. In college, I danced as much as the dance majors.”

After finishing his residencies, Sessler took a faculty position at the University of California—San Francisco and was rapidly promoted to full professor. In 1997, he also was appointed professor and vice-chair at the Ludwig Boltzmann Institute in Vienna, Austria—an appointment he still holds. “I used to go to Vienna every month” Sessler says, “but obviously can’t go so often now.” He and his wife, Ximena Valdes, a pediatrician at Kossair’s Children’s Hospital, made the move from San Francisco to Louisville “with great trepidation.” “San Francisco is arguably one of the greatest cities of the world, and we were understandably nervous about leaving. “However, we love it in Louisville. We’re building a house here, and quite enjoying the friendly people and the lush countryside.