SNACC’s Distinguished Service Award, 2022 – Karen B. Domino, MD, MPH
This year’s Society of Neuroscience in Anesthesia and Critical Care (SNACC) meeting provided us the pleasure of finally celebrating neuroscience research, neuroanesthesia care, and education together and in person. The excitement of networking and reconnecting with friends and family during this 50th anniversary of SNACC ended on an especially thrilling note with the announcement of SNACC’s Distinguished Service award, which went to Dr. Karen Domino this year. The distinguished service award is reserved for the SNACC member who has made outstanding contributions to the field of Neuroscience in Anesthesia and Critical Care and to SNACC. Dr. Domino’s commitment to the University of Washington’s (UW) Anesthesiology and Pain Medicine department and as a clinician-scientist member of the Division of Neuroanesthesia is exemplary. She has served as Associate Chief of Anesthesiology at the University of Washington – Montlake and Vice Chair of Clinical Research from 2007 until November 2022. Dr. Domino was instrumental in getting the Multicenter Perioperative Outcomes Group (MPOG) at the UW, and she currently serves as the MPOG representative for her department. Dr. Domino also serves as a member of the Washington State Medical Commission and Chair of the ASA Committee on Practice Parameters, which produces ASA advisories and guidelines to help in the safe care of patients. Dr. Domino’s work and leadership at UW, her effort and meaningful contributions to medical societies like SNACC and the ASA, and her work in her state medical societies are a clear testament to this well-deserved award.
Leadership and a spirit of collaboration supported by strong mentorship and a commitment to improving patient outcomes through research, education, and patient safety characterize Dr. Domino’s interest and involvement in SNACC. Dr. Domino became a member of SNACC while a fellow at the University of Pennsylvania. She was successful in utilizing her NIH-funded respiratory physiology research to understand gas exchange and pulmonary physiology alterations in the setting of increased intracranial pressure, hyperventilation, and hemorrhage. After additional training in outcomes research, Dr. Domino directed her research time in prospective clinical studies with attention to patient safety in perioperative care. She began her work in SNACC as the director of the SNACC Bibliography and has lectured on a variety of different topics, from traumatic brain injury and ischemic optic neuropathy to the social determinants of health. Her increasing involvement in this neuroscience society culminated in her membership on the editorial board of JNA, and after 5 years on SNACC’s executive board, Dr. Domino became the 31st president of SNACC (2004-2005). During her time as President, she worked to promote collaboration for outcomes research among SNACC members. She was instrumental in designing the Postoperative Visual Loss (POVL) Registry and in the planning of a case-control study to understand the risk of the rare but nevertheless life-changing visual loss after surgery.1 This group used cases from the POVL registry and controls from many participating centers across the country to understand the risk of ischemic optic neuropathy. Independent risk factors like male sex, obesity, use of the Wilson frame, longer anesthetic duration, greater estimated blood loss, and a lower percentage of colloid administration continue to be important considerations when informing patients preoperatively and planning surgery to optimize patient outcomes. As SNACC’s representative to the American Society of Anesthesiology (ASA) Educational Track Subcommittee on Neuroanesthesia where she later assumed the role of chair, Dr. Domino helped with important educational programming for the ASA. She moved up to the leadership of the ASA Annual Meeting Committee, becoming Section Head /Chair of the ASA Annual Meeting in 2015. With the goal of becoming better equipped to understand the policy in medicine, in 2012-13, Dr. Domino took a leave from the University of Washington to become a Robert Wood Johnson Health Policy Fellow at the National Academy of Medicine. This experience was no doubt invaluable in assuring her effectiveness in helping to set policy as SNACC’s representative to the ASA House of Delegates.
It takes a village…2
This Igbo and Yoruba proverb which reflects the emphasis African cultures place on community and its role in supporting its members for growth and development captures well the support Dr. Domino understands as having been integral to her success in Neuroanesthesia. Her career trajectory begins with family and her love of neuroscience and clinical care, supported by strong mentorship along the way.
After an auto accident involving her grandparents, who were unrestrained, Dr. Domino’s grandfather suffered a lethal cervical spine injury and left her grandmother, who suffered a TBI requiring a year and a half of rehab in a skilled nursing facility followed by time at home with family for another two years before she was miraculously able to return to living independently for over 30 years. Karen Domino reflects on her father, a neuropsychopharmacologist who corrected a nitrous oxide tank that was erroneously placed in lieu of oxygen in the ambulance ride as contributing to the beginning of her understanding of the value of patent safety efforts. Discussions at dinner on research and work as a teen filing pharmacology papers and cleaning glassware in the lab provided her a familiarity with pharmacology which would later support her college interest in neuroscience and biological psychology. The excitement of acute clinical care eclipsed her interest in psychology and her early understanding of the importance of work-life balance would necessarily steer her away from a career in neurosurgery. Dr. Domino attributes her interest in Anesthesiology to discussions she was able to participate in “over the drapes” as a surgical resident and the efforts of Dr. Harry Wolman, one of the founding members of the Neurosurgical Anesthesia Society (later renamed as SNACC) in 1973, and then chair of University of Pennsylvania Dept of Anesthesiology, who granted her an opportunity to train without having completed any rotations in this discipline.
While neuroanesthesia provided Dr. Domino a wonderful opportunity to engage her favorite subjects: physiology, pharmacology, and acute perioperative care, strong mentorship from her village of mentors in college and medical training has been critical to her success. As an undergraduate at Vassar, critical thinking inculcated by strong mentors during the development of her own basic science research projects provided Dr. Domino with the necessary foundation for success as a clinician scientist. Her fellowship program director Dr. David Smith (1991 SNACC president and winner of the Lifetime teaching award, 2005) who suggested that she join SNACC, would provide her inspirational mentorship in teaching. Dr. Domino attributes her continued academic success in neuroanesthesia during her junior faculty years at UW to a multidisciplinary group of mentors: Dr. Phillipa Newfield (SNACC president- 1987), who provided her an opportunity to present at the SNACC meeting, Dr. James Cottrell (SNACC president- 1981) for the opportunity to contribute to a book chapter; Dr. Jane Matjasko (SNACC president- 1982) helped with an opportunity to serve as an oral board examiner; and Dr. Elizabeth Frost, winner of the distinguished service award of SNACC – 2017 who spoke candidly about the barriers faced by women in academic medicine. Additionally, neurosurgeons like Dr. Thomas Langfitt, founder and organizer of the NAS, Dr. Peter Jannetta (SNACC president – 1982), and Dr. Richard Winn provided her outstanding mentorship as faculty at UW.
“I enjoy the diversity of clinical care, research, mentorship, and teaching all types of learners.”
Karen Domino, MD
Dr. Domino’s response to what is the most gratifying aspect of her academic career encompasses the mission of academic medical centers worldwide. She has enjoyed watching residents/fellows rise to become the best that the field of anesthesiology has to offer, and her advice to learners and faculty is to collaborate with colleagues in neurosurgery, education, research, and clinical care. Inducted to the Academy of WINNERs of SNACC, Dr. Domino advises women to “work hard, play hard, and enjoy life and family!” Thank you, Karen, for your work in SNACC, improving the care of our patients, and sharing your path to neuroanesthesia. We are truly fortunate to have a fantastic collaborator, mentor, educator, and dedicated clinical scientist as a member of our neuroanesthesia subspecialty.
- The Postoperative Visual Loss Study Group. Risk Factors associated with ischemic optic neuropathy spinal fusion surgery. 2012;116:15-24