Interview with 2019 Distinguished Service Award Recipient W. Andrew Kofke, MD, MBA
Christopher Fjotland, MD
|Christopher Fjotland, MD|
|W. Andrew Kofke, MD, MBA|
Dr. Fjotland: What led you to a career in neuroanesthesiology?
Dr. Kofke: It started when I was an ambulance attendant from 1968-1978 witnessing patients not waking up after CPR. This drew me to attend the University of Pittsburgh so I could meet Peter Safar, an EMS icon. While a student at Pittsburgh I was privileged to work in Safar’s lab with Ed Nemoto as my research mentor on various global brain ischemia projects. I had done previous lab work in organic chemistry and biochemistry, but that was my introduction to neuroscience research.
Also at that time I was imprinted clinically by Dr. Maurice Albin, the founder of SNACC. While I was a student, he was actively involved in getting SNACC started, although I was pretty much unaware of all that. As a student I also encountered brain-oriented ICU faculty: Drs. Grenvik, Powner, and Snyder. So I would say that it was the imprinting by Drs. Safar, Nemoto, Albin, Grenvik, Powner, and Snyder who altogether led me to a pathway into neuroanesthesia and neurocritical care.
Dr. Fjotland: What is your favorite neuroanesthesia case to manage and why?
Dr. Kofke: Vascular cases have always interested me the most. Both intracranial and endovascular aneursym cases present interesting challenges related to integrity of the aneurysm and neuroprotection. Occasionally they also present bona fide massive transfusion and fluid resuscitation issues in the context of neural jeopardy and such cases also occasionally present issues with cerebral edema and its management. It has been and continues to be a ripe area for investigation. The whole neuroanesthesia package seems to be presented by a challenging aneurysm case.
Dr. Fjotland: Tell us about a research project (or projects) that you are most proud of and why?
Dr. Kofke: The work I am most proud of is the line of research I was involved in demonstrating neurotoxicity of opioids in preclinical studies with several subsequent studies showing congruent effects in humans. We showed limbic system excitation and injury in physiologically controlled rodents. Studies in humans with remifentanil demonstrated limbic system activation in PET and ASL MRI. Finally, we have recently reported opioid associated amnesia in opioid users. I think in the long run this may be the most impactful work I have done.
However, I have also been privileged at UPenn leading a team who evaluated in neuroICU patients a noninvasive monitor of absolute and relative CBF/OEF/CMRO2. I garnered my first RO1 for this project (at age 62!) and am quite sure it has the potential to totally paradigm shift neuroanesthesia and neurocritical care to focus on CBF and OEF rather than some brain-blind measure such as blood pressure.
Finally, there is some nascent systems biology work I have done on single nucleotide polymorphisms which I think can help guide individualized management using post insult time dependent variations in complex pathophysiology matched to appropriate directed multifaceted therapies to take care of a complicated disease. If I was just starting out I would aim my focus on systems biology.
Dr. Fjotland: When you're not in the OR or the lab, what are you most passionate about? What do you do to unwind and/or have fun?
Dr. Kofke: Spending time with my grandchildren and enjoying nature in northeast Pennsylvania. I was an avid runner (actually a trotter) but have a new hip which may attenuate that activity to simple hiking in the forests of Pennsylvania.
Dr. Fjotland: What new "hot topics" in neuroanesthesia are you most excited about and where do you see them potentially taking the field?
Dr. Kofke: I think systems biology incorporating phenotypes and genotypes is going to be big. We also need to develop proper preoperative tests to quantitate a given patients cerebrovascular reserve to allow for individualized decisions regarding monitoring and therapy. There is also delirium…a real challenge.
From an educational perspective the genesis of the International Council for Perioperative Neuroscience Training (ICPNT) (icpnt.net) is a new vista in neuroanesthesia education presenting a host of novel elements, including international accreditation and the genesis of an international network of neuroanesthesia programs.
Dr. Fjotland: Tell us about your most proud professional achievement and what makes that so special to you?
Dr. Kofke: I am proud of the folks who trained with me and who have gone on to their own success. Most notable are Drs. Lisa Sinz, Peggy Seidman, Garfield Russell, Kane High, Steve Whitehurst, Jen Kosty, Jovany Cruz-Navarro, Sander Schlichter, Ben Scott, Jeremy Hensley, Mark Zapp, Chitra Sivasankar, Dave Wyler, and others seemingly too numerous to count. I was taught by many luminaries and to pass on what I have been taught and learned myself to my trainees, who do the same for their students. I think it’s a geometric relationship, the cycle of life in academics and I have been privileged to be part of it.
Dr. Fjotland: As a recipient of the SNACC Distinguished Service Award, what advice do you have to give to aspiring trainees and junior faculty?
Dr. Kofke: Keep your focus on improving patient care. There is a lot of very distracting chatter about how difficult it is to be in medicine, avoiding burnout, needing to be more efficient, getting those bills in, contributing to the right PAC for your special interest, among other things. Don’t let all this stuff distract you from your real mission: taking excellent care of your current patients, teaching those who will have future patients, and creating knowledge that will improve patient care for many more patients everywhere in the future.