Dr. Nik Gravenstein’s productive career and quiet leadership support nationally prominent UF anesthesiology department

For anesthesiology Chairman Nikolaus “Nik” Gravenstein, M.D., upholding high standards is a family tradition stretching back 45 years.

In 1958, the UF College of Medicine recruited Gravenstein’s father to begin the department of anesthesiology. Today, Nik, who became chairman in 1997, oversees a thriving department with 70 faculty members at the Health Science Center’s Gainesville and Jacksonville campuses and the Malcom Randall Veterans Affairs Medical Center. The department trains as many as 84 residents and fellows a year and expects to exceed $2 million in grant funding this year.

Gravenstein, who specializes in cardiac and neurological cases, emphasizes the importance of subspecialty training, which the department formally established in 1972. Having faculty “several deep” in each subspecialty is a major strength, Gravenstein said.

“It gives residents a chance to experience a variety of perspectives,” he said. “Not everything in medicine is black and white.”

In 1969, the department began holding special teaching sessions early every morning to maximize learning.

“Our morning didactic session is probably unique among anesthesiology departments,” he said. “It allows us to focus on academics without trying to simultaneously do something clinical, and contributes to the quality and expertise of our residents. It’s part of what enables us to recruit and work side-by-side with the best and brightest residents anywhere.”

Former department Chairman Jerome Modell, M.D., said Gravenstein is known for his low-key approach, supportiveness and behind-the-scenes organization. Recognizing the importance of time for teaching and research is one of Gravenstein’s hallmarks, Modell said.

“Nik is an excellent teacher, a superb clinician and truly has the interests of his faculty and residents at heart, frequently sacrificing himself for their benefit,” he said. “There are times when anesthesiologists have to leave academic pursuits to go into the operating room. Almost invariably Gravenstein will go himself to preserve their academic time, which is extremely important and admirable.”

Gravenstein’s own teaching skills have been lauded since 1977, when he received a UF College of Medicine Student Teacher Award. He also received the anesthesiology department’s Outstanding Teacher Award in 1984-85 and the T.W. Andersen Outstanding Teaching Award in 1994-95. In 1987 he became one of fewer than 400 worldwide invited to join the Association of University Anesthesiologists.

Gravenstein’s work has led to seven patented innovations, including two monitors for carbon dioxide and a noninvasive method for determining hematocrit and blood levels of hemoglobin and oxygen. He has edited or co-edited five textbooks, contributed chapters to 28 books, and has written or contributed to more than 80 articles for refereed publications. Since 1995 he has been named an outstanding specialist by the consumer referral guide “The Best Doctors in America: Southeast Region.”

“In research, Nik has always taken clinical problems and designed studies to work them out, which is key to patient safety,” Modell said. “He also has a knack for getting young people, particularly residents, involved in clinical research. He serves as a role model.”

The department has a strong history of research accomplishments. “Some of our faculty, led by Dr. Terri Monk, are now aggressively investigating cognitive impairment after surgery,” Gravenstein said. In 2001, Monk found about a third of adults ages 18 to 59 and 40 percent of those 60 and older experienced evidence of memory loss and a lack of concentration after surgery involving general anesthesia.

After three months, 2 percent of those ages 18 to 59 and 16 percent of those 60 and older continued to experience cognitive problems. Other department research areas include critical care, pulmonary insufficiency and its treatment, simulator- and Web-based anesthesiology education, obstetric anesthesia, postoperative pain management, nanotechnology and molecular biology. The department also has ongoing translational, collaborative research efforts with UF’s Institute on Aging; the departments of medicine, chemistry, chemical engineering, orthopaedic surgery, and physiology and functional genomics; and the division of thoracic and cardiovascular surgery.

Innovation is key for the department, which has a tradition of developing and embracing new technology. Currently, at least one patent per year is granted to faculty in the department. In the 1990s, a team invented the Human Patient Simulator®, a training system that uses a full-size mannequin and detailed mathematical models of respiratory, cardiovascular and pharmacokinetic systems to simulate patient response to drugs and respiratory ventilation.

During the past fiscal year, the simulator ranked fifth in royalty income for UF. The simulator is currently used worldwide to train physicians, veterinarians, nurses and paramedics.

A little more than a year ago, the department created the Virtual Anesthesia Machine on a Web site that now receives more than 100,000 hits a month from all over the world.

Today, UF anesthesiologists are joining a campuswide, multidisciplinary effort to exploit the potential medical applications of nanotechnology, the cutting-edge science of constructing substances 10,000 times smaller than the diameter of a human hair. Led by Professor Donn Dennis, M.D., the department is exploring the use of infinitesimally small, drug-binding molecules to block the effects of certain drug overdoses on the heart and other internal organs. The nanoparticles developed by this research can attach themselves to toxic substances, reducing their concentration in the bloodstream. Gravenstein, who credits colleagues and support staff for the department’s success, describes his management style as “behind-the-scenes.”

“I try to lead by example, keep an open mind and have an open-door policy,” he said. “A criticism of me has been that I’m not hard-nosed enough, but that’s just my style. I try to build consensus, and I think people ultimately respond to data and common sense.”

Gravenstein said he doesn’t balance his personal life and professional life as well as he could, but he’s an enthusiastic family man.

“I’ve got four great kids, and I’ve been married for more than 20 years,” he said. “I have a great enthusiasm for snowskiing, wakeboarding, golfing and playing tennis, as well as watching my kids grow up and playing their sports. It’s a wild and crazy existence, but that’s what makes it fun.”

As a child, Gravenstein moved to Gainesville in 1958 when UF recruited his father, Joachim Gravenstein, to head anesthesiology. The elder Gravenstein is now a graduate research professor emeritus. Gravenstein’s brother Ruprecht was the first baby to be born at Shands Dec. 10, 1958. Gravenstein received his medical degree from UF in 1980, and his brother Dietrich is a UF associate professor of anesthesiology. Having a personal history so closely blended with college and department milestones gives him a long-reaching perspective.

“Sometimes we get wrapped up in the issues of the moment and lose track of the incredible strides we’ve made,” he said. “This is truly an internationally known institution with internationally known faculty, and the anesthesiology department is proud to be part of it and to be pushing the envelope of our field in this environment.”