Kinjo Lab

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My research centers on improving perioperative outcomes and patient satisfaction. I have a particular interest in the area of pain management. For the past several years, my work has focused on the association of perioperative pain and cognitive dysfunction in older adult patients. More recently, I’ve expanded that focus to include perioperative cognitive changes in patients who have sleep apnea. I am collaborating with colleagues at UCSF to implement a care pathway for surgical patients with sleep apnea in UCSF Hospitals. In all of these efforts, integration of cutting-edge technology in the perioperative setting plays a key role. 

Current Research Projects

The Use of Virtual Reality to Reduce Anxiety and Pain in Perioperative Settings (Principal Investigator)

Virtual Reality (VR) is a powerful and inexpensive technology that has been effectively used in healthcare settings to treat anxiety and pain, with minimal side effects. In the last two decades, opioid abuse and deaths related to opioids have increased, and opioid-naive patients are at increased risk of opioid abuse when opioids are used during their surgical procedures. In addition, anesthetics, anxiolytics and analgesics, namely opioids, have myriad side effects that worsen patient experience, and lead to complications and increased costs. There are limited studies on the use of VR in the perioperative setting. Our study is a randomized controlled trial to investigate the use of VR to treat anxiety and pain in perioperative settings. We will recruit 56 patients, 28 in the control group and 28 in the VR group, undergoing short (<2 hrs) hand or upper extremity surgeries under local anesthesia and monitored anesthesia care (MAC). The control group will receive standard anesthetic management and the VR group will be exposed to VR in the preoperative setting and during the surgical procedure, using the clinically validated AppliedVR software. The data collected will include satisfaction questionnaires and pain scores for anxiety/pain pre- and post- procedure, vital signs trends to assess sympathetic response during surgery, and amounts of anesthetics used. We hypothesize that the VR group will show decreased anxiety and pain, increased satisfaction, and decreased use of anesthetics during the procedure. 

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Outcome Analysis of Perioperative Obstructive Sleep Apnea Pathway(Principal Co-Investigator) 

This study will evaluate the implementation of the new care pathway in adult surgical patients with moderate to severe Obstructive Sleep Apnea (OSA) at Moffitt/Long and Mission Bay hospitals. The pathway includes a protocol to appropriately triage, monitor, and treat patients at risk for hypoxic events. The pathway protocol includes: 1) routine screening of OSA to identify patients at risk for hypoxic events in perioperative period, 2) use of protocolized anesthesia methods, and 3) treatment of patients using perioperative Positive Airway Pressure (PAP) therapy when indicated. At the end of implementation period, we will measure the effectiveness of this new protocol using 1) incidence of postoperative hypoxic and cardiovascular events, 2) incidence of unexpected ICU admissions, and 3) length of hospital stay.

Advancing the Multimodal Pathway: Investigating the Use of Sleep and Zolpidem in the Recovery After Shoulder Arthroplasty (Co-investigator)

Shoulder pain at night is a common symptom of glenohumeral arthritis and likely contributes to sleep disturbances. Recent evidence has shown that non-pharmacological sleep interventions can optimize athletic peak performance, fatigue, and recovery. In addition, the use of zolpidem in orthopedic postoperative patients has suggested improved pain control, reduced opioid usage, and higher patient satisfaction. To investigate the efficacy of sleep medicine in the recovery of orthopedic surgery patients we hypothesize that a multimodal sleep pathway including non-pharmacological interventions and the use of zolpidem can improve patients’ analgesia, sleep, and subsequent recovery after undergoing total shoulder arthroplasty. We propose a prospective randomized control trial in adult patients 18 years old and greater who are undergoing elective total shoulder arthroplasty. The aim will be to compare a control cohort of our current standard of care (sleep aid use on an as needed/patient requested basis) to an interventional cohort with evening inpatient zolpidem administration to improve sleep latency and non-pharmacological interventions to improve sleep hygiene, quality, and duration. To assess these outcomes, we will assess inpatient pain scores, opioid consumption, length of stay, sleep diaries, the Leeds sleep evaluation scales, and overall satisfaction.

 

 

 

    People

    Sakura Kinjo, MD, Principal Investigator

    Clinical Professor, Department of Anesthesia, UCSF
    Anesthesia Medical Director, UCSF Orthopedic Institute

    Dr. Kinjo is an anesthesiologist and pain management physician. She graduated from the Ryukyu University, Faculty of Medicine, Nishihara Cho and Okinawa, Japan in 1994. In 2001, she completed residency at University of Texas Medical Center and went on to a fellowship in Pain Medicine at UC Davis Medical Center in 2002. Since joining UCSF in 2005, she’s been actively involved in research focused on acute pain management, postoperative cognition and regional anesthesia

    Ling-Chu (Mae) Yap, MBBS

    Assistant Professor, Department of Anesthesia, UCSF
    Dr. Yap is a board-certified anesthesiologist with particular interests in acute pain management and regional anesthesia. In her current role as an Assistant Professor of Anesthesia, she plays a large part in resident education and planning regional workshops. Dr. Yap is especially interested in virtual reality's potential to improve the surgical experience for patients. 

    Valeria Carcamo-Cavazos, MD

    Resident

    Valeria Carcamo-Cavazos MD is an anesthesia resident at UCSF, who will graduate in 2019. She obtained her medical degree from UCSF. Valeria’s research experience includes research on the interaction of the immune system with breast cancer at Stanford University where she worked before starting medical school. She has also been involved in multiple short-term research projects as an undergraduate and during medical school. Valeria will pursue a fellowship in regional anesthesia and acute pain management, and she is interested in devising innovative techniques to treat pain and anxiety perioperatively, that have few or no adverse effects. Valeria startedcollaborating with Dr. Kinjo and other members of her research team during her CA1 year to design and implement Dr. Kinjo’s current clinical trial that investigates the use of Virtual Reality (VR) in perioperative settings. Valeria believes there is great potential for VR technology to help relieve pain and anxiety, reducing the use of medications that have multiple side effect, and ultimately improve patient care.

    Emily May

    Research Coordinator

    Emily graduated from the University of Montana in 2011 with a degree in Political Science and a minor in International Development. The first four years of her career were spent teaching special education in Bay Area Public Schools. Working with children and families inspired a curiosity in medicine. She wanted to understand how technology, research, and cooperative care could come together to improve outcomes for patients of all ages. That curiosity took her to a post-baccalaureate program at San Francisco State and, eventually, to UCSF. For the last year and a half, she's worked as a research coordinator in the Department of Anesthesia and Perioperative Care. In that time, she has had the opportunity to work on a variety of projects, including her current role with the Kinjo Lab. These experiences have helped her cultivate a diverse skill set, but she most enjoys the chance to help patients understand and participate in research. 

    Samuel Froines

    Research Volunteer

    Samuel started working with Dr. Kinjo in January of 2017. He discovered Dr. Kinjo’s SOSA research study through the biology department at University of San Francisco. He is a second semester Junior at The University of San Francisco majoring in biology with a minor in physics and economics. He changed courses early in his undergrad switching from business administration to Biology and hasn’t looked back since! He was lucky enough to attend a medical trip to nicaragua in which he was able to observe general/thoracic surgeons, anesthesiologists, and gynecologists interact with patients and preform operations. This experience fueled his interests in medicine and ultimately lead him to find Dr. Kinjo’s research study. He is very greatful that he is able to interact with doctors, nurses, and patients at USCF, and would highly  recommend this position to anyone interested in the medical field!

    Alexander Yu

    Research Volunteer

    Alexander graduated from the University of California, Santa Cruz in 2016 with a BS in Molecular, Cell, and Developmental Biology and a Minor in Chemistry. He joined the Kinjo Lab as a volunteer research assistant in December 2017 assisting with the Postoperative Sleep and Cognition in Obstructive Sleep Apnea Patients (SOSA) study. His interests and career goals lie in medicine and he believes clinical studies are an integral component in advancing modern medicine. He is currently studying for the MCAT and will be applying for medical school in 2019. Outside of healthcare, He enjoys weightlifting, golfing, and exploring new places with his family and friends.

    Alumni Lab Members
    • Maria Victoria (Avic) Magsaysay
    • Azul Galvez
    • Alejandra (Alex) Sepulveda
    • Haojun (Michael) Feng
    • Edward Oliva
    Collaborators

    Eunjung Lim, PhD
    Assistant Professor, Biostatistics Core Facility, Department of Complementary & Integrative Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii

    Andrew Schober, MD
    Assistant Professor, Department of Anesthesia, UCSF
    Department of Orthopaedic Surgery

    Department of Orthopaedic Surgery

    • Lisa Lattanza, MD
    • Igor Immerman, MD
    • Aenor Sawyer, MD
    • C. Benjamin Ma, MD
    • Brain T. Feeley, MD
    • Alan L. Zhang, MD
    • Drew Lansdown, MD
    • Jonathan W. Cheah, MD
    • Cheri D. Mah, MS
    Publications
    1. Kinjo S, Lim E, Magsaysay MV, Sands LP, Leung JM. Volatile anaesthetics and postoperative delirium in older surgical patients-A secondary analysis of prospective cohort studies. Acta Anaesthesiol Scand. 2018 Jul 27. PMID: 30051465.
      PubMed

    2. Behrends M, Yap EN, Zhang AL, Kolodzie K, Kinjo S, Harbell MW, Aleshi P. Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial. Anesthesiology. 2018 Jul 03. PMID: 29975203.
      PubMed 

    3. Lim S, Kinjo S. Exacerbation of chronic pain after dental extractions in a patient with post-treatment Lyme disease syndrome. Saudi J Anaesth. 2018 Jan-Mar; 12(1):112-114. PMID: 29416466.
      PubMed 

    4. Leung JM, Sands LP, Chen N, Ames C, Berven S, Bozic K, Burch S, Chou D, Covinsky K, Deviren V, Kinjo S, Kramer JH, Ries M, Tay B, Vail T, Weinstein P, Chang S, Meckler G, Newman S, Tsai T, Voss V, Youngblom E. Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial. Anesthesiology. 2017 10; 127(4):633-644. PMID: 28727581.
      PubMed 

    5. Harbell MW, Cohen JM, Kolodzie K, Behrends M, Braehler MR, Kinjo S, Feeley BT, Aleshi P. Combined preoperative femoral and sciatic nerve blockade improves analgesia after anterior cruciate ligament reconstruction: a randomized controlled clinical trial. J Clin Anesth. 2016 Sep; 33:68-74. PMID: 27555136.
      PubMed

    6. Moon TS, Lim E, Kinjo S. A survey of education and confidence level among graduating anesthesia residents with regard to selected peripheral nerve blocks. BMC Anesthesiol. 2013 Jul 17; 13(1):16. PMID: 23865456; PMCID: PMC3737120.
      PubMedPubMed Central

    7. Leung JM, Sands LP, Lim E, Tsai TL, Kinjo S. Does preoperative risk for delirium moderate the effects of postoperative pain and opiate use on postoperative delirium? Am J Geriatr Psychiatry. 2013 Oct; 21(10):946-56. PMID: 23659900; PMCID: PMC3742555.
      PubMedPubMed Central 

    8. Kinjo S, Lim E, Sands LP, Bozic KJ, Leung JM. Does using a femoral nerve block for total knee replacement decrease postoperative delirium? BMC Anesthesiol. 2012 Mar 10; 12:4. PMID: 22405052; PMCID: PMC3364862.
      PubMedPubMed Central 

    9. Kinjo S, Sands LP, Lim E, Paul S, Leung JM. Prediction of postoperative pain using path analysis in older patients. J Anesth. 2012 Feb; 26(1):1-8. PMID: 22012171; PMCID: PMC3720127.
      PubMedPubMed Central 

    10. Kinjo S, Frankel A. Failure of supraclavicular block under ultrasound guidance: clinical relevance of anatomical variation of cervical vessels. J Anesth. 2012 Feb; 26(1):100-2. PMID: 22002342.
      PubMed

    11. Leung JM, Sands LP, Paul S, Joseph T, Kinjo S, Tsai T. Does postoperative delirium limit the use of patient-controlled analgesia in older surgical patients? Anesthesiology. 2009 Sep; 111(3):625-31. PMID: 19672166; PMCID: PMC2762324.
      PubMedPubMed Central 

    12. Kinjo S, Tokumine J, Sugahara K, Kakinohana M, Iha K, Matsuda H, Akasaki M, Yamashiro S. Unexpected hemodynamic deterioration and mitral regurgitation due to a tissue stabilizer during left anterior descending coronary anastomosis in off-pump coronary artery bypass graft surgery. Ann Thorac Cardiovasc Surg. 2005 Oct; 11(5):324-8. PMID: 16299461.
      PubMed

    13. Nakamura S, Kakinohana M, Sugahara K, Kinjo S, Miyata Y. Intrathecal morphine, but not buprenorphine or pentazocine, can induce spastic paraparesis after a noninjurious interval of spinal cord ischemia in the rat. Anesth Analg. 2004 Nov; 99(5):1528-31; table of contents. PMID: 15502059.
      PubMed