CSA Online First

CSA Online First is a weekly blog featuring insights from CSA members themselves.

Edited by Rita Agarwal, MD, FAAP, with contributions from CSA’s Committee on Professional and Public Communications, Online First is a place where knowledge and opinion from any one of our 3200 plus physician-anesthesiologist members can be shared, discussed and deliberated to advance the specialty of anesthesiology, the practice of medicine and society in general.

"Better solutions to difficult problems are usually made when all sides are heard."

Steven Goldfien, MD

 

Fall Conference Overview: Flying balls of molten lava! Vast clouds of sulfuric acid! A pair of category 5 hurricanes! Ten-foot storm surges!

by
  • Shafer, Steven, MD
| Jan 22, 2019

BALLISTIC MISSILE THREAT INBOUND TO HAWAII. SEEK IMMEDIATE SHELTER. THIS IS NOT A DRILL!

shaferThis year’s Fall CSA Meeting on the Big Island of Hawaii offered attendees a potential once-in-a-lifetime experience in natural and man-made disasters. However, geographic and temporal luck conspired to keep these misfortunates remote from the Fairmont Orchid Resort on the Big Island. Instead, intrepid attendees found clear blue skies, manicured beaches, exquisite accommodations, and turtles swimming ashore to bask in the sunlight.

The 2018 Fall CSA Meeting showcased of seven internationally renowned speakers. Presentations differed from typical CME programs, intentionally featuring timely yet controversial clinical topics. Every day included general lectures to bring new perspectives of science, society, and technology. The program revolved around the unifying credo of physicians and allied healthcare providers: Patients come first.

Pamela Flood, MD, MA, Professor of Anesthesiology, Perioperative and Pain Medicine PM Fall Meeting at Stanford University opened the program with a problem-based learning discussion Don’t Give Up on Mom! She described a parturient who had modest hemorrhage during an otherwise unremarkable vaginal delivery. Six hours after delivery the patient arrested from retroperitoneal hemorrhage. Spontaneous circulation returned following massive transfusion, stat hysterectomy, and one hour of CPR!  The new mother left the hospital three weeks later, returning to work with no neurologic sequelae. Her infant daughter will never know how physicians, nurses, and healthcare providers refused to let her mother die. In subsequent lectures, Dr. Flood spoke on Oy, My Aching Back: Management of Chronic Back Pain (spoiler alert: surgery is a last resort). She explained how anesthesiologists should approach her pain patients in Waking Up Happy: General Anesthesia for Patients with Chronic Pain. In her final lecture Can Someone with a Frog Heart Have a Baby?, Dr. Flood explored the challenges of caring for parturients whose own congenital cardiac defects were corrected as children. Amazingly, a single, highly-motivated ventricle can delivery enough oxygen for two people!

Jerold Levy, MD, Professor of Anesthesiology, Associate Professor in Surgery, and Co-Director of the  Cardiothoracic ICU at Duke University seamlessly segued after Dr. Flood’s epic resuscitation tale into Managing the Hemodynamically Unstable Patient: Shock Jock. His first shock lecture explored maintaining blood pressure and tissue perfusion, while his subsequent resuscitation lecture Keep it Tickin’ explained how to keep patients with life-threatening arrhythmias alive. Reflecting his diverse interests, Dr. Levy’s problem-based learning discussion reviewed allergy management: Red with a Wheeze, as if Stung by Bees, Hey, Could it Be What I Gave IV? The only speaker to quote Jesse Ventura, Dr. Levy also reviewed the challenges of the nearly incomprehensible new generation of anti-platelet and anti-thrombotic drugs in his lecture I Ain’t Got Time to Bleed.

Samuel Wald, MD, MBA, FASA, Vice President of Perioperative and Interventional Services and Associate Chief Medical Office at Stanford Health Care, Clinical Professor of Anesthesiology, Perioperative and Pain Medicine at Stanford University, and President of the California Society of Anesthesiologists offered perspectives from two of his many roles. Sharing his perspective as a senior executive at Stanford Health Care, Dr. Wald reviewed Leadership Qualities and How to Promote Them in Yourself. Eschewing platitudes, Dr. Wald offered concrete, thoughtful, and validated approaches to developing personal leadership. I found his suggestions on dealing with difficult individuals particularly noteworthy, as Dr. Wald accurately described how he manages. For those of us who would rather anesthetize an iguana than a child, Dr. Wald’s problem-based learning discussion took the attendees through Pediatric Anesthesia for the Occasional Pediatric Anesthesiologist. It was an excellent discussion, but I would still rather anesthetize an iguana.

Pres reception FallEugenia Ayrian, MD, Associate Professor of Clinical Anesthesiology and Chief of Neuroanesthesiology at the Keck School of Medicine, University of Southern California also tackled a challenging clinical scenario: Anesthetic Management of Patients with Cerebral Aneurysms and Moyamoya Disease. Dr. Ayrian addressed some of the controversial and conflicting recent findings about Postoperative Cognitive Dysfunction. She drew from her years of managing complex neurosurgical patients to describe the Perioperative Management for Complex Spine Procedures. Finally, Dr. Ayrian’s problem-based learning discussion reviewed the Perioperative Management of Patients during Awake Craniotomy.

Christine Stock, MD, Professor of Anesthesiology at the Feinberg School of Medicine at Northwestern University drew from her years of experience as an anesthesiologist and critical care physician in her problem-based learning discussion Anesthesia Years after Spinal Cord Injury. Her clinical PBLD was followed by three uncomfortably moving lectures informed by her years as Department Chair at Northwestern: Burnout: Our Colleagues and the Care of their Souls Therein, Aging Anesthesiologists: the Dilemma of our Elders, and Re-Entry of the Recovering Anesthesiologist into Clinical Practice. I felt as if all three talks were directed towards me: a 64-year-old anesthesiologist, struggling to balance increasing clinical workload against a decreasing window of opportunity for making significant contributions to our field, and still reconciling the loss of colleagues to drug addiction. Sustained applause after of these incredible lectures suggested that many others were also deeply moved by her presentations.

Therese T. Horlocker, MD, Professor of Anesthesiology and Perioperative Medicine at the Mayo Clinic used her opening presentation, Life is Painful: Balancing Philosophy with the Joint Commission’s Fifth Vital Sign, to address the laudable goals and subsequent clinical nightmare unleashed by efforts to improve pain management. Dovetailing with Dr. Levy’s lecture on the new anticoagulants, Dr. Horlocker explained how The New Anticoagulants are Making My Day a Bloody Mess: the Updated ASRA Guidelines. She also explored the risk of infection during regional anesthesia, explaining that You’re Not as Clean as You Think! Reducing the Risk of Infectious Complications of Regional Anesthesia. Evidently it takes more than handwashing to safely send patients home with catheters.

Most days concluded with my lectures. Offering little practical utility, my talks gave everyone an excuse to leave early for their Hawaiian adventures. My first lecture, Propofol: Murder, Mayhem, and Mercy, explored the use of propofol in two murders, one rape, and the death of Michael Jackson. The final story described the case of a woman whose anesthesiologist father discovered that propofol was an effective treatment of last resort for her 10/10, 24x7 chronic pain. My second lecture, Exparel is No More Effective than Plain Bupivacaine, needs no further explanation. My third lecture, Drug Shortages: Anesthesia Without Fentanyl, Morphine, and Hydromorphone, addressed the challenges caused by Hurricane Maria’s destruction of pharmaceutical plants in Puerto Rico. My final lecture, Cognitive Computing and Disruptive Innovation, explored parallels in the evolution of human and machine intelligence. While artificial intelligence can beat our cognitive abilities, no technology can compete with human dexterity. Technology turns to trash without us. Because biology endlessly renews, biology will prevail.

The meeting attendees uniformly found the lectures instructive, practice-changing, and entertaining. The meeting survey revealed uniform affirmation that attendees would change their practice based on what they learned at the meeting. Many attendees traveled from abroad, flying nearly half-way around the world for the opportunity to attend the CSA Fall Conference. They affirmed, both in person and in their evaluations, that it was well worth the trip.

The CSA Fall Conference alternates between the Big Island and Kauai, the “Garden NashvilleIsle.” The 2019 Fall Conference will be held at the Grand Hyatt on Kauai from November 4 – 8. Those who don’t want to wait a year for an outstanding Hawaiian CME meeting can sign up for the 2019 Winter Anesthesia Conference at the Westin Maui, which will run from January 26 until February 1. For further information on these conferences, or other educational opportunities from the California Society of Anesthesiologists, please visit the CSA website. 

2019 Annual Meeting  graphicCSA is also holding their Annual Meeting at the beautiful Paradise Point in San Diego from March 7-10. They are continuing their highly successful and well received Practice Management sessions. These discussions will highlight updates in leadership, business administration, and practice performance  issues that are of critical importance in today’s anesthesiology practice environments. The early registration has been extended to February 8, so I encourage you to register today. 

I want to acknowledge the outstanding speakers, who responded enthusiastically to my request for “completely different” presentations. I want to thank Rachel Hickerson, the talented CSA leadership and staff, and the exhibitors who shared their innovations and insights over the course of the meeting.

Finally, I want to thank the attendees. They enthusiastically participated in the problem-based learning discussions, stayed awake through the lectures, and built rapport with new friends and acquaintances throughout the week. Despite volcanic and atmospheric disturbances in the months before the conference, and unintentional broadcasting of a missile alert in early 2018, the Big Island treated everyone to Hawaii’s uniquely tropical paradise.


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