By Drs. Henry Gonzalez, Rita Agarwal, Ronald George, Mark Singleton, and Jane Moon
By Henry Gonzalez, MD
The weather was almost perfect; there were over 7,000 people at the ASA annual meeting held in San Diego in October and it felt great.
Virtual meetings have their place; they have utility, they are efficient and cost-effective, and they build community. But virtual meetings lack an atmosphere of genuine interpersonal communion. When a person is passively watching TV, or, “zooming” a meeting with their camera “off” and voice “muted”, participation and interaction with others is really limited. I heard that there were about half the number of people at this meeting when compared to the number who usually attend the annual ASA meeting, prior to COVID. But thousands still came; it was refreshing, it was vibrant, it was good to see and to be part of.
If this was your first time at an ASA annual meeting, you got a decent glimpse of what the meeting is all about. For the intellectually curious, there was much fodder to use in this meeting. The span of lectures and topics was excellent, the space seemed abundant, and the ability to pick one’s focus of review and study was very good. For those of you who rarely attend the annual ASA meeting, I highly recommend going to one, you already helped pay for it with your dues.
Now back to the weather. It is always a hope of the ASA leadership, I would imagine, to have an annual meeting without foul weather. I had to leave for most of Monday, but all the other days were just immaculate. There was enough sunshine to help us with our vitamin D levels, enough shade for those who are weary of sunshine, and the ambient temperature was very comfortable.
One of the benefits of attending the annual meeting, is that ASA tries to always meet in a city that many people, from around the country and world, wouldn’t mind seeing and experiencing. We only live once, we think. So “kudos” goes to the planning folks of the ASA. The San Diego meeting went very well.
There were people at all levels of training and experience at the meeting, from medical students, residents, fellows, old guys like me, young anesthesiologists, professors, and students alike had come to enjoy some serious education along with some serious fine dining. Yes, the annual meeting is not all work! The exhibit hall was huge, enough room to wonder from exhibit to exhibit, from gadget to gadget, and from old friends to new acquaintances and remain socially distanced. That part of the ASA annual meeting was good to experience. The ability to see, touch, and learn about new techniques and aids to the “craft” of administering medications and device usage was excellent. The exhibitors were there to help support our practice of medicine within the field of perioperative medicine. Whether it be pre-operative evaluations, intraoperative diagnosis and treatments, or other related activities, there was an exhibitor there to help.
Amongst the thousands of attendees, there were several ASA members who were involved within the ASA’s governance. There were executive committee meetings, House of Delegate meetings, regional caucus meetings, and meetings of various sorts related to the mission and goals of our society. Many of our colleagues have given their time to volunteer for the society. There was ample opportunity and time for many ASA members to interact with the leadership of our society. This work is incredibly important to the running of the ASA and the State Component Societies including the CSA.
Below are a few summaries of some of the notable lectures and events at the ASA.
Keynote Lecture: Doris Kearns Goodwin - Leadership in Turbulent Times
By Rita Agarwal, MD, FAAP, FASA
The keynote lecture this year was a fascinating discussion between ASA President Beverly Phillips and Pulitzer Prize winning presidential scholar Doris Kearns Goodwin.
Dr. Phillips started by asking how the country’s turbulent times are now compared to the past. Ms. Kearns Goodwin replied, “We have lived through really, really tough times before and somehow our country has emerged with greater strengths … Think about Abraham Lincoln, Teddy Roosevelt and Franklin Delano Roosevelt, they had terrible challenges and somehow they were able to lead the country through … It gives you perspective and it gives you hope.”
Dr. Phillips asked the most intriguing question of the evening: Are great leaders born or made? Ms. Goodwin responded that she thought great leaders are made. They have certain gifts that they are born with; for example, Teddy Roosevelt had a photographic memory and immense curiosity while Lincoln had a gift for language and empathy. Circumstances lead to the need to use and develop those skills. Teddy Roosevelt stated that most people’s success comes from “using ordinary quality to extraordinary degree through the application of a lot of hard work.”
Ms. Goodwin went on to talk about how the key to success is the ability to grow, to have empathy, to be able to successfully pivot, and to be accessible. An example of a successful pivot was during World War 2, when Franklin Delano Roosevelt who had alienated many business owners with the New Deal, had to reach across to them and do everything he could to allow them to be successful. As a result, they were able to make an airplane every four minutes and ships, which had previously taken 250 days to make, in a day.
The talk was full of delightful anecdotes and stories and interspersed with practical nuggets of advice for future leaders.
The talk is still available virtually until October 27 for those who went to the in-person meeting but were unable to attend the Keynote lecture.
SOAP / Gertie Marx Plenary Lecture: Cynthia A. Wong, MD - One third of a century of Learning: The Contributions of Anesthesiologists to Obstetric Care
By Ronald George, MD
Highlights of the 2021 ASA Annual Meeting in San Diego, California included the Society for Obstetric Anesthesia and Perinatology (SOAP) Gertie Marx plenary lecture. This year’s lecture was delivered by the amazing Dr. Cynthia Wong, Chair and Department Executive Officer of the Department of Anesthesia at the University of Iowa. Dr. Wong shared with us the evolution of obstetric anesthesia over the past three decades of her career. This was fitting as Dr. Wong was also awarded the SOAP Distinguished Service Award to recognize the outstanding achievements and service to SOAP. Through the lens of Dr. Wong’s experience, attendees were reminded of the large strides taken in the past 30 years. Informed by evidence that Dr. Wong helped contribute to, labor analgesia went from single epidural bolus of high concentration local anesthetic through a reusable epidural needle to programmed intermittent boluses with patient controlled epidural analgesia with extremely low concentration anesthesia with opioids.
None of this would have been possible if not for a systematic approach to dose finding studies to evaluate minimal local anesthesia concentrations and the impact of adding opioids to these solutions. At the same time, Dr. Wong and her Obstetric Anesthesia trailblazing friends and colleagues shined the light on the safety of regional anesthesia in childbirth and regularly stomped out epidural myths. Epidurals lead to cesarean delivery - nope; epidurals should not be placed early in labor – nope. Myths were busted, and patient safety was at the forefront. Spinal anesthesia for cesarean delivery with vasopressor infusions proved to be safe and became standard of care. Dr. Wong and colleagues shepherded in an era of national practice guidelines, multidisciplinary partnerships, and patient centered labor analgesia. Because of her 30 years of high-quality research, truth telling, and patient advocacy coupled with an army of young faculty she had mentored, Dr. Wong has certainly carved a distinguished career following in the footsteps of Dr. Gertie Marx.
Emery A Rovenstine Lecture: Steven Shafer - Ever Eger: My Love Affair with Anesthesia
By Mark Singleton, MD, FASA
Monday morning began for many of us in the large main lecture hall at the San Diego
Conference Center, with the “main event”, the Emery A Rovenstine Lecture. Special awards are also presented at this time just prior to the lecture, and this year the most prestigious Distinguished Service Award was presented to our own Dan Cole. The Rovenstine Lecture was given this year by Stanford Emeritus Professor Steve Shafer, MD; it will long be remembered as a uniquely artful and imaginative performance that brought to life an inspiring resurrection of one of the most beloved and legendary figures in the history of anesthesiology. As a close and long-time friend of Ted Eger, Dr. Shafer was his collaborator and editor on the recently published Autobiography of a Persistent Anesthesiologist, begun in the year before Dr. Eger’s passing in 2017. Thus, it was our treat to witness Steve, with the donning of a baggy sweater and cabbie cap (Eger trademarks), transform himself into his old friend, and becoming him for a short while on stage, tell us in his own words some of the amusing, startling, and groundbreaking events of a remarkable life. This was a truly captivating one-man-show.
This year the Monday evening Presidents Reception was, for the first time, open to all conference registrants who wished to purchase a ticket, rather than an invitation-only event as in previous years. As always, this was a formal gala, held at the Air and Space Museum in nearby Balboa Park with transportation to and from the conference center. Despite the requirements for masks, proof of vaccination, and clearances that applied to the entire ASA 2021 generally, it was clear that attendees where glad for a chance to eat, drink, dance, and socialize in a way that has been missing from most of our lives over the past year and a half. It is only fair to say that by the time the festivities were in full swing, many masks were set aside until the bus ride back, which may have caused concern to some. Those folks were probably not on the crowded dance floor where the excellent band was hard to resist. All in all, it was a wonderful farewell to ASA President Beverly Philip.
John W. Severinghaus Lecture: James C. Eisenach - Gadgeteering for Pain Relief
By Jane Moon, MD
This year’s breathtaking John W. Severinghaus Lecture on Translational Science was given by James C. Eisenach, MD, the Francis M. James, III Professor of Anesthesiology and Physiology & Pharmacology at Wake Forest School of Medicine, President of the Foundation for Anesthesia Education and Research (FAER), and Past Editor-in-Chief of Anesthesiology. Dr. Eisenach's presentation was titled “Gadgeteering for Pain Relief,” an intentional reference to Dr. Severinghaus’ inaugural namesake lecture “Gadgeteering for Health Care." Ingeniously structured, it paralleled the arc of Dr. Severinghaus’ incredible research career with Dr. Eisenach’s very own, while grouping both journeys into the “three acts” of “the hero’s journey”—a term described by Joseph Campbell, scholar of the foundational myths of human civilization. By organizing his lecture in this way, Dr. Eisenach paid homage to the great physician scientist Dr. Severinghaus in this year of his death while also discussing in clear and honest detail the ups, downs, and overall progression of his own prolific research career. Dr. Eisenach traced the results and lessons learned from his early-career studies on epidural administration of clonidine, described his numerous years spent examining the pharmacokinetics and pharmacodynamics of various spinal injections for analgesia, and discussed his current focus on oxytocin neurobiology and the broad, multidisciplinary question of inter-individual variability in recovery from postoperative pain. In his lecture, Dr. Eisenach went beyond compelling scientific exposition, historical narrative, and autobiography to inspire and challenge his audience with timeless life wisdom, a commitment to research ethics, and a call for active mentorship of budding physician scientists. He closed his lecture with a moving encouragement from Joseph Campbell: “Follow your bliss and don’t be afraid, and doors will open where you didn’t know they were going to be.”