Virtual Experience

You want me to do this case!? Anesthetizing the critically ill for non-cardiac surgery

Martin Krause, MD; Erica Wittwer, MD; Gebhard Wagener, MD; Jessica Spellman, MD, FASE; Samuel Gilliland, MD; Sarah Alber, MD

Description

Patients with specific cardiovascular comorbidities who present to the operating room give the Anesthesiologist cause for great concern. While these pathologies are less common, it is critical to understand and manage them appropriately. Critical care physicians often see these conditions on a more frequent basis. A panel of intensivists will discuss the intraoperative management of various pathologies and provide tips and tricks in a fast-paced, lively fashion. This session is designed to give practical information efficiently, leaving the audience with increased confidence.

Objectives

1. Identify and optimize patients with severe aortic stenosis or severe pulmonary hypertension preoperatively, and manage these patients throughout the perioperative period.
2. Obtain pertinent hemodynamic, pharmacologic, and device data in patients with an implanted left ventricular assist device (LVAD) or extracorporeal membrane oxygenation (ECMO), and manage these patients appropriately during non-cardiac surgery.
3. Utilize life-support guidelines combined with a problem-based approach to treat intraoperative cardiac arrest.

The High Risk patient with a Physiologically Difficult Airway- recognition and management

Matteo Parotto, MD, PhD; John Sakles, MD; Sheila Myatra, MD, FCCM

Description

In recent years, the scientific literature has shown the fundamental impact on patient safety of the physiologically difficult airway. Over 40% of critically ill patients experience major peri-intubation cardiovascular instability and severe hypoxia. This can occur in the ED, ICU, and in OR or out of OR anesthesia locations. This forum will provide clinicians with in-depth insights on the significance and recognition of physiological challenges in relation to airway management; strategies to improve patient safety; and the role and application of technological advancements to decrease the risk of critical desaturation in this context.

Objectives

1. Appreciate the significance and recognition of physiological challenges in relation to airway management.
2. Understand strategies to improve patient safety in this context
3. Understand the role and application of technological advancements to decrease the risk of critical desaturation in this context

All About Vasopressors:  Optimizing Support and Minimizing Harm in Vasoplegic Patients

Marguerite Hoyler, MD; James Littlejohn, MD; Alisha Sachdev, MD, FASA; Caroline Gross, MD; Margo Short, MD; Paul Gallo, MD

Description

Although perioperative vasopressor use is commonplace in anesthesiology practice, vasopressor choice, dose, and route of administration may be challenging, especially in the setting of complex patient physiology, an expanding array of pharmacologic options, and treatment-refractory vasoplegia. This fast-paced panel will provide evidence-based, practical strategies for selecting, dosing, and escalating vasopressors in the perioperative setting, as well as essential considerations to help minimize patient harm that may be associated with vasopressor use. Key points include use of novel vasopressors (angiotensin II, IV methylene blue, hydroxocobalamin), and vasopressor use in patients with cardiac disease (valvular heart disease, obstructive hypertrophy, and pulmonary hypertension), septic shock, and treatment-refractory vasoplegia. 

Objectives

1. Summarize evidence-based best practices for vasopressor use, including mode of delivery (peripheral versus central lines) and use in septic shock. Develop a pragmatic approach for escalating vasopressors in the perioperative setting.
2. Review recommendations for use of novel vasopressors, as well as side effects and possible contraindications. Summarize hemodynamic effects, including possible adverse effects, of vasopressors in patients with cardiac disease.
3. Organize a differential diagnosis for hypotension in patients who to fail to respond to vasopressor use. Devise a strategy for managing treatment-refractory vasoplegia

Intraoperative lung protective ventilation: Are we beating a dead horse?

Jonathan Charnin, MD, FASA; Aditi Balakrishna, MD; Milad Sharifpour, MD, MS

Description

Lung protective mechanical ventilation with small tidal volumes (6-8 mL/kg PBW) and moderate amounts of PEEP are the cornerstone of managing patients with ARDS. More recently, a driving pressure of < 15 cm H2O has been shown to improve outcomes in critically ill patients with, or without ARDS. However, it is unclear if any of these interventions improve postoperative outcomes in non-critically ill patients undergoing mechanical ventilation under anesthesia for elective surgical procedures. Our goal is to review the existing body of literature on intraoperative lung protective mechanical ventilation and address some of the existing controversies.

Objectives

1. To review the available data regarding intraoperative use of lung protective mechanical ventilation.
2. To critically analyze individual components of lung protective mechanical ventilation bundles
3. To examine whether newer targets, such as optimizing driving pressure, or reducing mechanical power, will reduce the incidence of postoperative pulmonary complications

The Transplant Recipient Presenting for Elective Surgery: Pearls and Pitfalls for Successful Management

Geraldine Diaz, DO; Brent Boettcher, DO, FASA; Gebhard Wagener, MD; Yong Gang Peng, MD, FASA

Description

The success of solid organ transplantation has generated a ubiquitous population of recipients eligible for non-transplant related elective surgeries. Their demand exceeds the capacity of traditional care within transplant centers. Thus, encounters with this complex patient cohort are becoming increasingly routine. Understanding the unique physiology and techniques to assess and preserve allograft function among solid-organ transplant recipients are now essential to the practicing anesthesiologist. This panel will address: post-transplant allograft physiology, preoperative assessment of allograft function, recipient optimization for elective surgery, as well as perioperative management to optimize recovery.  

Objectives

1. Identify the unique physiology and pre-operative functional assessment of the transplanted allograft.
2. Describe perioperative strategies to preserve allograft function including hemodynamic monitoring, fluid management, pharmacologic therapy, and transfusion practices as well as detection of post-operative organ injury .
3. Recognize subtle indicators of early allograft dysfunction that warrant unique evaluation prior to elective surgery.

Resurgence of interest for using old NMDA antagonists in  pain management 

Ehab Farag, MD, FRCA, FASA; Aleksey Maryansky, DO; Crystal Manohar, MD, MBA, FASA

Description

The new discoveries and studies in the functions and usefulness of old NMDA antagonists such as ketamine, magnesium, and methadone have reignited the interest in their use for perioperative pain management.

Objectives

1. Explain the newly discovered mechanisms of actions for ketamine, magnesium, and methadone for perioperative pain management.
2. Interpret the newly discovered antidepressant effects of ketamine and their important effects for pain management
3. Revise the use of NMDA antagonists in perioperative pain management

Revolutionizing Anesthesia Education: The Integration of AI and VR

Caoimhe Duffy, MB, BCh, MSc, FCAI; George Shorten, MD, FRCA; Niamh Feely, FCAI, FRCA; Noelle Healy, MD

Description

The shortcomings of traditional time-based training in anesthesia are increasingly apparent as the field pivots towards competency-based medical education (CBME). Simulation-based education, a cornerstone of CBME in anesthesia, faces challenges in providing objective standardized assessments and constructive feedback. Recognizing the need for innovation, there is a growing body of evidence supporting the integration of artificial intelligence (AI) and virtual reality (VR) into CBME. In this panel, we will delve into the transformative impact of AI and VR on reshaping anesthesia education and training models, critically evaluating existing evidence and challenges within anesthesia education while exploring how AI technology can be a valuable asset. We will discuss the utilization of learning analytics for personalized learning, the creation of objective metric outcomes through standardized instruments and explore applications of VR in anesthesia, ranging from the development of distance workshop learning to immersive, realistic environments. Drawing on successful implementations and cautionary tales, we will identify opportunities to enhance safe, effective CBME in anesthesiology.

Objectives

1. Discuss the emerging role of AI and technology in advancing anesthesia education.
2. Explore the emerging role of AI and technology in advancing anesthesia education.
3. Evaluate the integration of technology into anesthesiology training.

Why Do They Tolerate This Behavior? A Guide for Trainees and Junior Faculty: Addressing Harassment, Incivility, Disrespect

Scott Markowitz, MD, MSOL; Iyabo Muse, MD, FASA; Molly Kraus, MD, FASA

Description

Clinician shortages and burnout plague our specialty. Harassment, incivility, and disrespect (HID) are rampant, and have a significant negative impact. Data from the AAMC showed that anesthesiology has the highest incidence of all specialties, with 21.3% of men and 52.6% of women faculty having experienced harassment. The ASA created the ad hoc committee on HID to focus attention on understanding and preventing these behaviors as well as addressing the impact. Junior faculty and trainees may be more likely than other department members to encounter HID in daily interactions. Junior faculty and trainees are more likely to be younger, to be women, and to be from underrepresented groups. Junior faculty and trainees may feel more vulnerable to HID and may fear speaking out could lead to further marginalization and retaliation. This panel will offer an understanding of these harmful behaviors, their impact on outcomes, including patient health, anesthesiologist burnout, clinician retention, and gender disparities. The panel will also examine, from the perspective of trainees and junior faculty members, ways to address individuals who engage in HID behaviors and harmful systems.

Objectives

1. Participants will be able to prepare actions that can interrupt and address harassment, incivility, and disrespect.
2. Participants will be able to describe components of harassment, incivility, and disrespect reporting systems for trainees and junior faculty,
3. Participants will be able to appraise local efforts for identifying and addressing harassment, incivility, and disrespect,

Taking a Stand on Respectful Behavior: Leadership Lessons from the AUA, APSF and ASA

Molly Kraus, MD, FASA; Robert Whittington, MD; Della Lin, MD, FASA; Dolores Njoku, MD; Jina Sinskey, MD, FASA

Description

Respectful behavior in the operating room improves teamwork and communication, with implications for patient safety and clinician well-being. The AAMC recently released the results of a survey demonstrating that anesthesiology has the highest percentage of women (52.6%) and men (21.3%) experiencing gender-based harassment. In a recent APSF survey of perioperative team members (anesthesiologists, surgeons, CRNAs, CAAs, PACU RNs, OR RNs), 71.6% of respondents reported experiencing non-physical violence. There is a need for structural changes to create sustainable solutions to combat harassment, incivility, and disrespect. In this panel, we present leadership lessons and actionable strategies to address this issue from the lens of three professional societies: 1) Define the problem (Association of University Anesthesiologists ? defining the scope within anesthesiology using a survey study); 2) Take a stand (American Society of Anesthesiologists ? establishment of an ad hoc Committee on Harassment, Incivility, and Disrespect); and 3) Educate and empower (Anesthesia Patient Safety Foundation ? creating and implementing a training program for frontline clinicians).

Objectives

1. Discuss the need for systems approaches to address harassment, incivility, and disrespect.
2. Define three different approaches to creating structural change.
3. Develop a plan for instituting structural change at the organizational level.

Decoding the ABC’s of MCS: Mechanical Circulatory Support from IABP to ECMO

Kelly Ural, MD, FASA; Adam Dalia, MD, MBA; Agnieszka Trzcinka, MD; Jessica Spellman, MD, FASE; Samhati Mondal, MD, MBBS, FASE

Description

This panel will serve as an introduction and overview of the different types of Mechanical Circulatory Support (MCS) available, clinical scenarios where each is utilized, and the top things to know when these patients come to the OR. There will be something for beginners who are just learning what these devices are, to those who need to use echocardiography to guide placement and troubleshoot misplaced cannulas or malfunctioning devices. Ideally these will be taught using clinical scenarios.

Objectives

1. Differentiate among the different types of mechanical circulatory support and understand appropriate use.
2. Prepare for caring for these patients in the operating room and non-OR setting.
3. Choose appropriate echocardiography windows to guide placement and troubleshoot malfunctioning devices.

Ergonomics and Workplace Injury Prevention for Anesthesiologist

Mary Ann Vann, MD, FASA

Description

Current conditions in the anesthesiologists’ workplace require performance of tasks that may cause physical injury. Twisting, bending, kneeling, lifting and reaching to provide patient care in modern operating rooms are common ergonomic challenges. Poor ergonomics can cause musculoskeletal disorders and other physical maladies. Fixed obstacles in anesthesia locations (especially Non-OR sites), limited ability to access patients in unusual positions, patients with extreme body weights, and use of certain equipment can induce physical injury. This problem became evident in a January 2023 survey of ASA members on workplace injuries. 54.4% of 1501 respondents reported a job associated injury and 24% reported chronic physical conditions that required treatment. Injuries to anesthesiologists impact both patient safety and workforce shortages. Other physical hazards in the workplace that may cause injuries such as boom strikes and falls will also be discussed. This course will describe ergonomic challenges in the anesthesia workplace, increase awareness of the risks, and present actions that can minimize the occurrence of injury and its consequences.

Redefining education in anesthesiology to adapt to the digital era - a paradigm shift

Shobana Rajan, MD, FASA; John Mitchell, MD; McKenzie Hollon, MD, FASE; William Kofke, MD, MBA

Description

Redefining anesthesia education with a new paradigm suggests a fundamental shift in the way anesthesia training is approached to adapt to the digital era of the future. Emerging technologies and artificial intelligence will help to shape the future of training through personalized medical education, simulation, virtual reality, and global collaboration in education. Precision medical education (PME) is an emerging field that aims to tailor medical education to the individual needs of learners using data-driven insights. It is a learner-centric approach to delivering a customized education with the learner at the center of the educational process. Simulation-based mastery learning with deliberate practice and virtual reality results in the highest quality of initial learning and longest durability of training. We will demonstrate approaches to integrate this into training paradigms. All the previously established accredited sub-specialties of anesthesiology, have a USA-based system; however, neuroanesthesiology fellowships are accredited internationally. This Snap-Talk will highlight the potential benefit of international collaboration in education and research.

Objectives

1. Define the core principles of personalized medical education and implement resolutions for anticipated challenges in individual resident training.
2. Integrate simulation and immersive reality into training paradigms in anesthesiology
3. List the advantages of international collaboration and formulate a plan to implement sharing education across international borders.

Professional Liability: Things Every Anesthesiologist Should Know

Vilma Joseph, MD, MPH, FASA; Alan Marco, MD, MMM; Erik Smith, MD; Franklin Chiao, MD, MBA, MS, MSc, FASA

Description

Anesthesiologists are safety leaders who strive to eliminate medical error. Yet we live in a high-risk environment of increasing complexity with sometimes unattainable expectations. Improving safety requires our ability to internally disclose and discuss medical errors and bad outcomes in an effort to improve going forward. Many clinicians are involved in adverse events that may or may not result in a claim being made or a suit filed. How does this affect your report in the National Practitioner Databank? Are there any peer-review protections for physicians? Unfortunately, there is a recent trend of high-profile criminal prosecutions of medical error. Criminalizing error impedes safety by punishing individuals who function in flawed systems, rather than promoting positive change in the systems themselves. This talk will discuss criminal prosecutions of medical error in the setting of patient safety. It will distinguish between criminal and civil avenues for addressing medical error. It will also explore the negative impact that criminalization of medical error has on overall patient safety.

Objectives

1. Recognize effective approaches that reduce medical error and improve patient safety.
2. Differentiate between the civil and criminal systems of law, and how they assess medical error
3. Illustrate ways memory joggers may be developed that are protected from discovery.

Women in Anesthesiology: The Presidents of WIA Reflect on the Past, Evaluate the Present, and Plan for the Future

Kristin Ondecko Ligda, MD, FASA; Amy Pearson, MD, FASA; Elizabeth Malinzak, MD, FASA

Description

Women remain underrepresented in anesthesiology, particularly in leadership, authorship, promotions, and advancement. This panel will evaluate the past, present, and future of women in anesthesiology. We will discuss the relevant issues that women in anesthesiology have faced over the years with particular focus on the barriers to advancement, representation, and leadership. We will review the current research regarding leadership, promotion, burnout, and attrition of women anesthesiologists. We will also evaluate the future needs for women in anesthesiology to maintain the momentum for advancing and empowering our profession. We will also examine the role of intersectionality in fostering a diverse, inclusive workforce that may lead to improved retention of talent and improved patient care in our profession.

Objectives

1. Discuss the issues faced by women in anesthesiology, including the barriers to advancement, representation and leadership.
2. Review the current research regarding leadership, promotion, burnout, and attrition of women anesthesiologists.
3. Examine the future needs for women in anesthesiology and the role of intersectionality in fostering and retaining a diverse, inclusive workforce.

Preparing the next generation of anesthesiologists – from preclinical education to applying into residency

Shyamal Asher, MD, MBA, FASA; Christopher Malgieri, MD; Jean Vo, MD; Jonathan Argo, MD

Description

There are projected workforce shortages within anesthesiology exacerbated by the increase in demand for anesthesia services and an aging anesthesia workforce. Given this mismatch, it is critical for our specialty to recruit the next generation of anesthesiologists beginning early in medical school. There is inadequate exposure to anesthesiology during medical school with 80% of schools not requiring an independent anesthesiology rotation. In addition, 60% of students who matched in anesthesiology had a different specialty preference at the start of medical school. Thus, there is an opportunity for early, structured exposure to anesthesiology for students to allow them to make more informed decisions about their specialty of choice. This session will discuss strategies for implementing a comprehensive medical student anesthesiology curriculum. Including structured exposure to anesthesiology in the preclinical years, a comprehensive clinical anesthesiology experience directed at third- and fourth-year students, structured advising for advising for students interested in applying into anesthesia, and tips for mentoring successful anesthesiology applicants.

Objectives

1. Implement a preclinical anesthesiology curriculum for first- and second-year medical students to promote interest in the field of anesthesiology.
2. Implement a comprehensive clinical anesthesiology experience through structured anesthesiology electives and sub-internships
3. Demonstrate the core tenants of effective medical student advising for a career in anesthesiology and list the new features of anesthesiology eras application and tips for a successful interview and match season.

Trust me, I'm a Doctor: Medical History's Impact on Black American Disparities 

Elizabeth Tetteh, MD, FASA

Description

Health care disparities are woven into the health care system and are encountered daily by anesthesiologists and physicians. As medicine seeks to become more equitable and inclusive, it is vital to be aware of historical events and feelings that may shape patient's understanding of medicine and their trust in the medical system. This historical discussion will analyze ethnic and racial health care disparities that exist in America. It will explore historical events that include mistreatment of enslaved African and Black Americans from the 1800's to present day. It will further examine unconsented medical and surgical experimentation on the enslaved black population, grave robbing to support medical school education, biased radiation experimentation, and legal female sterilization. Finally, the session will review the historical discriminatory events towards Black physicians from the mid-1800's to present day. It will probe into the lasting repercussions of closing a majority of Black medical schools as well as the discriminatory practice of medical associations and the persisting effect to present day.

Objectives

1. Gain awareness of medical history as it pertains to the black population.
2. Distinguish the ethical impact on contemporary medical standards and practices.
3. Determine the prolonged effects of medical history's impact on black patients and physicians.

Post-Cesarean Delivery Pain Management: Enhanced Recovery After Cesarean (ERAC)

Grace Lim, MD, MSc; Amanda Kleiman, MD; Laurent Bollag, MD; Mohamed Tiouririne, MD

Description

Cesarean delivery is the most common surgery performed in the world. Optimal pain management after cesarean is critical to assure new mothers are capable of caring for newborns, mobilizing early, and thereby maximizing maternal and infant health while minimizing risks for associated complications such as thromboembolism from stasis and high doses of opioids for pain control. This session will cover the rationale and specific elements of enhanced recovery after cesarean (ERAC) that are pertinent to post-cesarean pain management. Best practices will be reviewed, and implementation tips for success will be discussed. By the end fo this session, learners will be informed of best practices in ERAC and will have specific implementation tools for practice improvement efforts.

Objectives

1. Explain the rationale for enhanced recover after cesarean, ERAC.
2. Appraise the evidence supporting ERAC best practices.
3. Apply ERAC to individual and group anesthesiology practices

Transforming Anesthesia: The Impact of Large Language Models on Perioperative Care

Seshadri Mudumbai, MD; Philip Chung, MD; Rodney Gabriel, MD; Vesela Kovacheva, MD, PhD

Description

This panel session will focus on large language models (LLMs) like ChatGPT, Bard, Claude, and Perplexity, to explore their fundamental, transformative potential in anesthesia and perioperative care. The session will begin with an introduction to LLMs and their current and emerging applications in the field, from augmenting clinical decision-making to enhancing medical education and research. Panelists will then discuss how these advanced tools can be seamlessly integrated into perioperative workflows, offering insights into how LLMs could improve patient outcomes and operational efficiencies. The session will also critically examine the ethical, legal, and privacy challenges associated with the deployment of LLMs in healthcare, focusing on ensuring patient safety, data security, and maintaining the highest standards of care. Attendees will gain a comprehensive understanding of how LLMs like ChatGPT can transform perioperative care, balancing innovation with ethical responsibility.

Objectives

1. To provide an overview of large language models (LLMs) and their potential applications in anesthesia and perioperative care, focusing on patient management, education, and research.
2. To explore practical strategies for integrating LLMs into perioperative workflows to enhance decision-making, patient communication, and clinical training.
3. To discuss the ethical, legal, and privacy implications of using LLMs in anesthesia, including data security, reliability of AI-generated advice, and impact on patient care standards.

Artificial Intelligence Applications in Perioperative Medicine: What Anesthesiologists Need to Know

Piyush Mathur, MD, FASA; Brandi Sinkfield, MD; Kenneth Cummings, MD, MS, FASA

Description

Artificial Intelligence applications in perioperative medicine continue to be researched at an exponential pace and are now being implemented in clinical practice. With over 600 FDA approved AI applications, more and more devices and digital platforms are using AI to support clinical decision making, ranging from estimation of ejection fraction during echocardiography to ultrasound guidance for performance of peripheral nerve blocks, These applications aim to enhance clinician decision making and support safer practice. With the large language models getting integrated into electronic health records, documentation burden and efficiency of topical search is likely to be better supported to decrease burnout. In this session, we will outline the current state of research and implementation trends related to AI applications in perioperative medicine for anesthesiologists. We will also explore the tremendous opportunity for anesthesiologists from all areas of practice to be engaged with and lead in development and implementation of AI in perioperative medicine.

Objectives

1. Learn basic terminologies related to artificial intelligence.
2. Summarize the current state of AI research and applications in perioperative medicine.
3. Describe how anesthesiologists can start, engage with, and lead in development and implementation of AI in perioperative medicine.

Challenges and Controversies in Trauma Management

Albert Varon, MD, MHPE, FCCM, FASA; Bonnie Milas, MD; Brenda Gentz, MD, FASA; Roman Dudaryk, MD

Description

This panel will entail presentation and discussion of various challenges and controversies in trauma management including decontamination and resuscitation, use of whole blood in traumatic hemorrhage, and opioid overdose resuscitation. The panel includes a very diverse group of speakers from Level 1 Trauma centers across the US.

Objectives

1. Identify current challenges and controversies in trauma management.
2. Critically evaluate literature on trauma and opioid overdose resuscitation.
3. Assess how new trends in trauma management impact anesthesia care.

Gun Violence as a Public Health Issue and the Need for Hospital Mass Casualty Protocols

Ann Stumpf, MD; Erin Stewart, MD, MS; Lanette Stewart, MD, JD, MPH

Description

Almost every patient who survives gun violence long enough to make it to a hospital will see an anesthesiologist. We aim to identify gun violence as a public health problem. We aim to examine the upstream factors and identify ways anesthesiologists can contribute to prevention. We then look at downstream factors and identify ways hospitals of all sizes can and should prepare for mass casualty incidents. Post-session, learners should walk away with tangible steps for public health advocacy and confidence in designing a mass casualty incident response plan for their communities.

Objectives

1. The learner will be able to explain why gun violence is a public health problem.
2. The learner will be able to propose areas for public health advocacy with roles specific to the voice of an anesthesiologist.
3. The learner will be able to see the importance of and create a mass casualty incident plan for their community of any size.