David Silverman, MD
Professor Emeritus of AnesthesiologyCards
Contact Info
Anesthesiology
PO Box 208051, 333 Cedar Street, TMP 3
New Haven, CT 06520-8051
United States
About
Titles
Professor Emeritus of Anesthesiology
Biography
After graduating Cornell Medical School, I completed my internship at Albert Einstein College of Medicine and my residency/fellowship in Anesthesiology at the University of Pennsylvania. I remained on U Penn faculty from 1980-1983 and then joined the Dept of Anesthesiology at Yale. My main research interests currently involve: 1) noninvasive monitoring of blood flow in patients and healthy volunteers, with special focus on autonomic influences on microvascular regulation and the assessment of volume loss; 2) improved assessment of patients with a uniform scale for assessing specific disorders and systemic disturbances; and 3) noninvasive monitoring of brain temperature.
Appointments
Departments & Organizations
- Ambulatory Anesthesiology
- Perioperative & Adult Anesthesiology
- Pre-Admission Testing
- Yale Ventures
Education & Training
- Fellow
- University of Pennsylvania (1979)
- Resident
- University of Pennsylvania (1978)
- Intern
- Albert Eistein College of Medicine (1976)
- MD
- Cornell University (1975)
- BA
- Hofstra University (1971)
Board Certifications
Anesthesiology
- Certification Organization
- AB of Anesthesiology
- Original Certification Date
- 1980
Research
Overview
1. Using a multi-dimensional computerized data acquisition system, we are integrating input from arterioles and capillaries (laser Doppler flowmetry), arteries and veins (plethysmography), with continuous monitors of blood pressure and heart rate to gain insight into two major areas of cardiovascular physiology: a) the regulation of microvascular perfusion, with a focus on autonomically-mediated autoregulatory processes; b) the assessment of the cardiovascular responses to volume loss intraoperatively and in healthy volunteers (withdrawal and reinfusion of two units of blood; simulated hypovolemia with the use of lower body negative pressure). These studies involve time-domain and spectral-domain analytical techniques in collaborative efforts with Cardiology, Emergency Medicine, Pulmonary Medicine, and Physiology at Yale and the J.B. Pierce Foundation as well as with Chairman of Biomedical Engineering at another institution. The work has led to intellectual property that has been transferred to Yale University School of Medicine.
2. As Co-Director of the BTT Interdisciplinary Research Group, I am the senior investigator on a series of multidisciplinary, multicenter studies monitoring brain and core temperature noninvasively. In collaboration with Dr. Marc Abreu, the discoverer of the brain thermal tunnel (BTT) and inventor of related technology, I h ave been determining the ability to continuously monitor core and, more specifically, brain temperature, with a noninvasive surface sensor applied beneath the medial brow ridge. Our initial studies have focused on whether BTT is an accurate measure of brain temperature and a reliable detector of brain/core discordance. We thereby haveidentified (and quantified) changes in brain temperature during anesthesia and throughout the perioperative period. For example, we identified otherwise unseen brain hyperthermia (with the potential for neuronal injury) during recovery from cardiopulmonary bypass surgery. In the emergency setting, we documented otherwise undetected ipsilateral hypothermia during incipient ischemic stroke, leading to likely application of BTT as a harbinger of brain loss. Monitoring via the BTT has enabled us to delineate changes during sleep, including delta and REM sleep and abnormalities thereof. We similarly have isolated changes in brain temperature during seizures, craniotomy, mental effort, ischemic stroke and exercise. Preliminary evidence suggests that monitoring BTT may enable us to more effectively identify incipient heat stroke. Such monitoring thus provides previously unattainable insight into brain thermodynamics in health and disease, constituting a hinge moment for brain as well as core thermometry -- and hence patient safety. Upon publication of our initial manuscripts (in prep), I anticipate that BTT will become required monitoring during major surgery and prove to be invaluable in myriad other hospital and nonhospital settings. The sensitivity of monitoring via the BTT to temperature channels at the level of the hypothalamus (body’s thermostat) may make it particularly valuable in detecting prodromal phases of a disorder (such as the flu) as well as active and recovery phases.
3. I have introduced a new way for uniform scoring of bodily systems and the disorders affecting them and integrating this with the anticipated risks associated with anesthesia and surgery. I am exploring ways of adapting my new method of assessment to improve the utility and workability of the electronic health record.
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Medical Subject Headings (MeSH)
Research at a Glance
Yale Co-Authors
Publications Timeline
Research Interests
Hossam Tantawy, MD
Microcirculation
Publications
2009
Integrated Assessment and Consultation for the Preoperative Patient
Silverman DG, Rosenbaum SH. Integrated Assessment and Consultation for the Preoperative Patient. Anesthesiology Clinics 2009, 27: 617-631. PMID: 19942170, DOI: 10.1016/j.anclin.2009.09.001.Peer-Reviewed Original ResearchCitations
2008
Comparing the effect of arginine vasopressin on ear and finger photoplethysmography
Jablonka DH, Awad AA, Stout RG, Silverman DG, Shelley KH. Comparing the effect of arginine vasopressin on ear and finger photoplethysmography. Journal Of Clinical Anesthesia 2008, 20: 90-93. PMID: 18410861, DOI: 10.1016/j.jclinane.2007.09.008.Peer-Reviewed Original ResearchCitationsMeSH Keywords and ConceptsConceptsArginine vasopressin injectionArginine vasopressinVasopressin injectionASA physical status IArginine-vasopressin effectPhysical status IObservational human studiesArginine vasopressin administrationMyomectomy surgeryPlethysmographic amplitudeStatus IIntrauterine injectionUniversity HospitalGreater vasoconstrictionVasopressin administrationFinger photoplethysmographyPhotoplethysmographic amplitudeAdrenergic activationBlood flowHuman studiesFinger signalsVasopressin effectVasopressinInjectionEar
2007
The relationship between the photoplethysmographic waveform and systemic vascular resistance
Awad AA, Haddadin AS, Tantawy H, Badr TM, Stout RG, Silverman DG, Shelley KH. The relationship between the photoplethysmographic waveform and systemic vascular resistance. Journal Of Clinical Monitoring And Computing 2007, 21: 365-372. PMID: 17940842, DOI: 10.1007/s10877-007-9097-5.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsSystemic vascular resistancePlethysmographic amplitudeVascular resistanceLow systemic vascular resistanceCoronary artery bypassPeripheral vascular toneContinuous cardiac outputPulse oximeter waveformPlethysmographic tracingsArtery bypassAdult patientsVascular toneCardiac outputThermodilution catheterBland-Altman analysisCorrelation r valuesMultiple regression analysisRegression analysisPhotoplethysmographic waveformCharacteristic analysisFingerAppreciation of changesMethodsPatientsPhotoplethysmographic measurementsLinear regression
2006
Modeling Perioperative Risk: Can Numbers Speak Louder Than Words?
Holt NF, Silverman DG. Modeling Perioperative Risk: Can Numbers Speak Louder Than Words? Anesthesiology Clinics 2006, 24: 427-459. PMID: 17240601, DOI: 10.1016/j.atc.2006.05.007.Peer-Reviewed Original ResearchCitationsMeSH Keywords and Concepts
2002
Distinction between Atropine-Sensitive Control of Microvascular and Cardiac Oscillatory Activity
Silverman DG, Stout RG. Distinction between Atropine-Sensitive Control of Microvascular and Cardiac Oscillatory Activity. Microvascular Research 2002, 63: 196-208. PMID: 11866543, DOI: 10.1006/mvre.2001.2385.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsPhenylephrine infusionHeart rateOscillatory activityLaser Doppler flowmetryR wave intervalsAdrenergic predominanceProximal vasculatureIntravenous atropineBlood pressureCholinergic responsesSystemic infusionDoppler flowmetrySystemic flowHealthy volunteersMicrovascular flowSystemic pressureRespiratory frequencyRespiratory rateMicrovascular bedInfusionR wavePhenylephrineMicrovasculatureOscillatory powerBaseline
1999
Comparison of ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in volunteers.
Hartmannsgruber M, Silverman D, Halaszynski T, Bobart V, Brull S, Wilkerson C, Loepke A, Atanassoff P. Comparison of ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in volunteers. Anesthesia & Analgesia 1999, 89: 727-31. PMID: 10475314, DOI: 10.1097/00000539-199909000-00037.Peer-Reviewed Original ResearchCitationsMeSH Keywords and ConceptsConceptsIV regional anesthesiaSystemic side effectsRegional anesthesiaSide effectsResponse to tetanic stimuliCentral nervous system side effectsTourniquet releaseNervous system side effectsDouble-cuff techniqueOnset time of anesthesiaAdministration of ropivacaineProlonged sensory blockadeIntravenous regional anesthesiaNumeric scoring scaleTime of anesthesiaTourniquet painDistal tourniquetNo significant differenceSensory blockadePinprick sensationProlonged analgesiaMotor blockadeLight-headednessRopivacaineSurgical conditions
1994
Peripheral assessment of phenylephrine-induced vasoconstriction by laser Doppler flowmetry and its potential relevance to homeostatic mechanisms.
Silverman DG, Jotkowitz AB, Freemer M, Gutter V, O'Connor TZ, Braverman IM. Peripheral assessment of phenylephrine-induced vasoconstriction by laser Doppler flowmetry and its potential relevance to homeostatic mechanisms. Circulation 1994, 90: 23-26. PMID: 8026002, DOI: 10.1161/01.cir.90.1.23.Peer-Reviewed Original ResearchCitationsMeSH Keywords and ConceptsConceptsLaser Doppler flowmetryBlood pressureDoppler flowmetrySkin perfusionPressure cuffHeart rateBrachial blood pressure cuffBlood cellsCutaneous laser-Doppler flowmetryDiastolic blood pressurePhenylephrine-induced vasoconstrictionBlood pressure cuffLaser Doppler flowmeter probeRed cell fluxLaser Doppler readingsForearm vasodilationPeripheral assessmentVasoconstrictive stimuliBaroreceptor activityRed blood cellsForearm vesselsIntravenous infusionSystemic infusionVasoactive stimuliHealthy volunteers
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Anesthesiology
PO Box 208051, 333 Cedar Street, TMP 3
New Haven, CT 06520-8051
United States