DISTINGUISHED SERVICE AWARD RECIPIENT

An Interview with the SNACC 2020 Distinguished Service Award Recipient, Antoun Koht, MD

Tasha L. Welch, MD

Tasha L. Welch, MD
Assistant Editor, SNACC Newsletter

The Distinguished Service Award is reserved for the SNACC members who have made substantial contributions to the field of Neurosciences in Anesthesiology and Critical Care. This award focuses on accomplishments based in all areas of medicine: clinical practice, research, and mentorship. 

Dr. Antoun Koht has been deservedly named the SNACC 2020 Distinguished Service Award recipient. Dr. Koht is the Chief of Neuroanesthesia in the Department of Anesthesiology at Northwestern Feinberg School of Medicine, Chicago, USA, and has enjoyed a successful career advancing the field of neuroanesthesiology.

Antoun Koht, MD

What attracted you to neuroanesthesia?
During my time as a critical care fellow, I encountered a case of carbon monoxide poisoning for a young medical student in January of 1978. He came with a 39% carbon monoxide level. He was still unconscious after 10 hours, despite the recovery of the carbon monoxide level. Few months before this case, an article published promoted barbiturate coma and hypothermia for brain protection. This article encouraged us to apply such treatment to the patient. We used induced external hypothermia to 30-31°C and phenobarbital infusion. The patient was in such induced coma for 72 hours. Within a month, he was awake and sent to rehabilitation. This case encouraged me to attend my first SNACC sponsored meeting in San Francisco in April 1978. The meeting dealt with brain protection and ICP issues. The coordinators for this meeting were a neurosurgeon (Laurence Marshal) and an anesthesiologist (Harvey Shapiro). The management of that patient and attending this SNACC meeting encouraged me to seek extra training in neuroanesthesia.

Since, at that time, Northwestern did not have a formal fellowship in neuroanesthesia, I was self-taught. I acted as a fellow supervising the resident, and both working under the supervision of an attending. I used to read extensively to learn neuroanesthesia and to teach the resident on rotation. During that time, I passed my board and the FLEX exam to practice in the USA. I started to work as attending April 1979. That month, the resident who was on rotation was John Mulvihill. John was so impressed with the teaching and signed up to be our first fellow on July 1, 1979. As part of his fellowship, I arranged for Dr. Mulvihill to attend the SNACC meeting in Williamsburg, Virginia the fall of 1979.   

The fellowship lasted for ten years, closing in 1989 after Dr. Tod B. Sloan and I left Northwestern University.

Restarting of the fellowship was put in motion soon after my return to Northwestern in May 2006. We got approval in 2007, and on July 1, 2007, we had our first fellow of the second Northwestern fellowship in Neuroanesthesia. Dr. John Bebawy was our first fellow of the second fellowship program. And, as it was with the SNACC of 1979, I encouraged Dr. Bebawy to attend SNACC, ASA, ASNM, ASNACC (Beijing), and Budapest's IOM course during his fellowship year. He presented papers at these meetings. Now, with my retirement approaching at the end of this year, I passed to Dr. Bebawy, the section chief and the fellowship program director positions. I know the program is in good hands. Dr. Bebawy is on the SNACC executive committee and is in line to be the president of SNACC.

Your research appears to be heavily focused on neurophysiologic monitoring.  How have you seen this field evolve, and what do you envision the future of neuromonitoring to be?
First, let me start by giving credit to Dr. Anthony J. Raimondi, chairman of neurosurgery, for starting the neurophysiological monitoring at Northwestern Memorial Hospital. He brought a neurophysiologist and a technologist to establish the service when I was a fellow in 1978. The neurophysiological monitoring service was reorganized in 1982 as part of the anesthesia department. Dr. Tod B. Sloan (who just finished our residency and joined the neuroanesthesia section) was soon joined by Dr. Richard J. Toleikis, PhD, to help the section with intraoperative monitoring.

In 1984 we presented our initial data of 385 patients monitored with SSEP at the second international congress on spinal cord monitoring hosted by Dr. Johannes Schramm (a neurosurgeon) in Erlangen, Germany. During that meeting, Professor Koki Shimoji (anesthesiologist) invited me to be on the educational committee. These meetings were held every two years during that decade. In addition to the congress in Erlangen, I participated in the third international congress on spinal cord monitoring in Annapolis, Maryland, in 1986. The meeting was hosted by Dr. Thomas Ducker (neurosurgeon) and Dr. Richard Brown (neurophysiologist).

The fourth international congress on spinal cord monitoring was held in Niigata, Japan 1989, and hosted by Professor Koki Schimoji (anesthesiologist). The first international congress was born in Tokyo, Japan, and hosted by Dr. Tetsuya Tamaki in 1981.

During the Erlangen meeting, I arranged to spend one-year sabbatical research at the University of Erlangen-Nurenburg with Professor Schramm. My research was on drugs effect on SSEP, and monitoring SSEPs during cerebral aneurysm clipping surgery.

As you see from this short history, neurophysiological monitoring was a multispecialty field, and anesthesiologists were a big part of it. However, gradually anesthesiologists drifted away from monitoring.

As for the future, the medical cost runaway will be curtailed in the future. Fixed payment may force cuts. One of the significant reductions can be in the IOM's interpretation, which is often done from a remote area.  The anesthesiologists with some extra training can make such interpretation at a minimal cost. Since anesthesiologists are in the operating room and are experts in managing body patient’s systems, I can see a significant comeback in the future.

I am glad that our second fellow of 2008 was Dr. Laura Hemmer. She, as Dr. Bebawy, always was involved in ASA, SNACC, ASNACC, and ASNM activities. She will be the president of the ASNM this May 1, 2021, and she is the chair of the educational committee at SNACC. 

Has your research shaped or changed your clinical practice in any way?
No doubt that my research in evoked potentials shaped to a greater degree my clinical career. It allowed me to expand on such monitoring by teaching and writing the book's two editions that I co-edited with Drs. Sloan and Tolekis, "Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals." The book has been translated into Chinese in both editions.  Also, this research enabled me to lecture at national and international meetings on all continents.

Such work was the cause for my triple appointments at Northwestern University in anesthesiology, neurological surgery, and neurology, in addition to my honorary position at the Capital University in Beijing.

Several of your awards and accolades are due to your role as an educator/mentor. How have mentors played a role in your career?  Why do you feel mentoring is an important aspect of your career?
During our lifelong career, we gain a vast amount of information. We should share such knowledge with others, who at one time will carry the flag and move forward. As a medical student, I was impressed and influenced by the teaching style of one of my attendings at Damascus University, Professor Joseph Sayegh, who in turn was influenced by some of his attendings at Case Western University. Teaching young residents and students pleases me, like the pleasure of seeing my children growing up.

Mentorship is an essential part of me and should be part of all of us. It would be a waste to let our knowledge die without transferring it to the next generation. Sharing such an experience will come, one day, to serve us well when we need medical help.

Our long career provides us with critical and vital skills of how to react to life incidents. Passing such gifts to our mentees is an essential piece for advancement.

Aristotle mentored Alexander the Great for seven years. He passed on to young Alexander his wisdom in letters, aimed to shape the future of young Alexander. Aristotle taught Alexander how to fight and how to react to everyday life incidence, both in peace and in war. One thousand years later, the Omayyad Caliphate in Damascus asked staff to translate Aristotle's letters into Arabic. Translating these letters opened the gate for other books to be translated from the Old Greek period to Arabic. Such translation of the mentorship letters, and other books, shaped the 300 years of the Golden Arabic/Islamic period. It produced excellent work, which was later translated into Latin, including the great work of Ibn-Sina (Avicenna).

As you can see, the mentorship letters written around 340 BC influenced the Arabic/Islamic golden ages (one thousand years later), which in turn preserved, improved, and innovated science that later was transferred to Latin Europe. Thanks to Aristotle's letters of mentorship.

This award really focuses on mentorship within a well-rounded career of scholarly activity and clinical practice. What do you feel helped you keep and achieve a successful and balanced career in all these areas?
Focusing on the subject at hand, tabulating priorities, tackling each issue on its merit within its importance, all without sacrificing family obligations.

What has been the most rewarding aspect of your career thus far?
Being able to see my residents and fellows excel and to become leaders in anesthesiology and serving our specialty.

I hope the SNACC members and newsletter readers join me in congratulating Dr. Koht on being honored with the Distinguished Service Award. There is no doubt that Dr. Koht deserves to be honored for his achievements and contributions to anesthesiology, critical care medicine, neurologic surgery, and neurophysiologic monitoring. I hope that we can also congratulate Dr. Koht on a successful career as he plans his retirement for later this year. Thank you to Dr. Antoun Koht for his time and contributions to this article.