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July 2003
Volume 67
Number 7

Emery A. Rovenstine Memorial Lecture:
Terri G. Monk, M.D., to Present ‘Postoperative Cognitive Dysfunction: The Next Challenge in Geriatric Anesthesia’

Arnold J. Berry, M.D., Chair
Section on Annual Meeting


Terri G. Monk, M.D.

Terri G. Monk, M.D., Professor of Anesthesiology at the University of Florida College of Medicine, Gainesville, will present the 2003 Emery A. Rovenstine Memorial Lecture on Monday, October 13, at 11:15 a.m. at the Moscone Center. As one of only two plenary sessions held during the Annual Meeting, this lecture honors Emery A. Rovenstine, M.D., the distinguished anesthesiologist who was Chair of the Department of Anesthesiology at New York University Medical Center and Director of Anesthesia at Bellevue Hospital. Although Dr. Rovenstine served the specialty of anesthesiology in multiple capacities, including as a founding member and president of the American Board of Anesthesiology, ASA President and a recipient of the ASA Distinguished Service Award, he is best known as the teacher and mentor for a generation of anesthesiologists who went on to become leaders of our specialty.

In her presentation, Dr. Monk will focus on one of the most significant trends affecting medical care, an aging U.S. population and the increasing number of elderly patients requiring anesthesia and surgery. Dr. Monk is recognized as one of the leading researchers investigating the recently described phenomena of postoperative cognitive dysfunction in the elderly. As she stated in a recent grant application, “Today, the fastest growing segment of the United States population includes people over the age of 65 years, and it is estimated that more than half of these individuals will require some form of surgery in their lifetime. Improvements in surgical techniques, anesthesia and intensive care units have made surgery in these elderly patients possible. Despite improved operative outcomes in the elderly, a significant percentage of these patients experience postoperative cognitive dysfunction (POCD). The socioeconomic implications of this cognitive decline are profound, and some reports suggest that abrupt declines in cognitive function are precursors of a loss of independence, withdrawal from society and death. While it is now accepted that POCD is a real entity, little is known about the etiology of POCD and the risk factors for this problem in the aging population.”

Dr. Monk began her research in POCD after she joined the Department of Anesthesiology at the University of Florida College of Medicine in 1998. She initially went to Gainesville because her husband, B. Craig Weldon, M.D., had been recruited as a pediatric intensivist and anesthesiologist, but in her new department, she soon found a mentor, J. S. Gravenstein, M.D., whose influence immediately changed her career. Dr. Gravenstein had just concluded his participation in a multicenter study demonstrating that age was a significant risk factor for postoperative cognitive dysfunction. Although Dr. Monk had already reached the midpoint of her professional career, she arrived in Gainesville at a time that she was searching for new areas to pursue.

As a result of the mentoring of Dr. Gravenstein, her research in a new area, geriatric anesthesia, was launched. Through collaborative efforts with neurologists and neuropsychologists at the University of Florida, she received funding from the Anesthesia Patient Safety Foundation to perform a study to determine if POCD occurred in patients younger than 60 years of age. This was the start of the second phase of Dr. Monk’s academic career. She has now received grants from the National Institutes of Health to support additional training in clinical and outcomes research, and in August 2003, she will receive a master’s of science degree from the Advanced Postgraduate Program in Clinical Investigation. After completion of her advanced training, she is planning research to delineate the mechanisms responsible for POCD in the elderly, including the role of pre-existing patient factors and the inflammatory response to surgery. With a better understanding of these processes, it may some day be possible to recognize patients at risk and to prevent unwanted outcomes.

As a result of her recent academic interests, Dr. Monk became a charter member of the Society for the Advancement of Geriatric Anesthesia (SAGA) and currently serves as the president-elect of the Society. She also is an ASA representative to the American Geriatric Society’s Section of Surgical and Related Medical Specialties.

Dr. Monk has followed a circuitous path to reach her current position. After graduating Summa Cum Laude from Wayne State College, Wayne, Nebraska, she attended medical school at the University of Nebraska in Lincoln. Upon completion of her internship at the University of Nebraska, she entered her anesthesiology residency at University of Nebraska but completed her training at Baylor College of Medicine, Houston, Texas, where she served as chief resident in anesthesiology. Initially, she chose to enter the private practice of anesthesiology, but after several years, she joined the Department of Anesthesiology at Washington University School of Medicine, Washington, D.C. Here, she was introduced to clinical research by her first mentor, Paul F. White, M.D., Ph.D. Soon, she had several publications and had sufficiently mastered basic research skills to begin to pursue additional topics independently. Her research interests then shifted to transfusion medicine, including blood conservation strategies, acute normovolemic hemodilution and blood substitutes. She has authored multiple journal publications and chapters on these topics.

Dr. Monk’s academic career has benefited from her anesthesia mentors and from her work with collaborators from other specialties. She now serves as a mentor for medical students, anesthesiology residents and fellows, and neuropsychology postdoctoral students who are interested in pursuing research careers.

The Emery A. Rovenstine Memorial Lecture honors the memory of one of our specialty’s most distinguished leaders and mentors. It is fitting that Dr. Monk, who has benefited from and now serves as a mentor to others in the tradition of Dr. Rovenstine, has been selected to deliver this lecture.




   
Arnold J. Berry, M.D., is Professor of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.
Arnold J. Berry, M.D.

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