hen I attended my first Clinical Forum “at the ASA,” I was impressed. Here was a free activity that I could still attend despite bad planning on my part and sold-out refresher courses! Still, I expected the panel of experts at the head of the table to present their topics in PowerPoint, and I was trying to settle into my seat in a position that would make it less than obvious if I nodded off temporarily.

Well, was I in for a surprise! First, we were able to tackle a real clinical situation encountered in everyday practice. The audience offered suggestions on management, asked provocative questions and really set the pace of their own learning! Initially I could not believe this was to go on for the entire forum, but again I was mistaken. The panelists were expertly prepared to answer questions without giving a lecture; if they threatened to fall into a monologue, the moderator quickly extracted them and returned the initiative back to the audience.

What a great venue the Clinical Forum is for adult learning! The format allows one or two cases to be discussed in a lively and thought-provoking manner. Attendees can easily express their opinions and even disagree with or enhance what the expert panelists may propound from the podium! And this also is what makes attending a Clinical Forum so interesting and a great deal of fun.

This year there are 10 forums with topics spanning a wide spectrum of issues and controversies. Are you interested in education, ethics or transplants? The 2006 Clinical Forums are where you need to be, just as the “Forum Romanum” was the place to get the latest political news and to be seen and be heard in ancient Rome!

Clinical Forums are scheduled to occur beginning Saturday, October 14, and ending Wednesday, October 18. The first forum begins every day at 9 a.m., with four forums being held on Saturday, Sunday, Tuesday and Wednesday at 9 a.m., 11 a.m., 1 p.m. or 1:30 p.m., and 3 p.m. or 3:30 p.m. Two forums are scheduled for Monday, October 16, at 9 a.m. and 2 p.m. Below is a schedule of all forum offerings at the 2006 Annual Meeting in Chicago. Your meeting program book will list the topics as well as case vignettes. A more detailed case outline, complete with questions and subtopics, will be available in the meeting room immediately prior to each Clinical Forum presentation.

The Committee on Clinical Forum and the faculty welcome you and hope to see you there for some good professional fun and interesting discourse.

• Airway Clinical Forum: Airway Cases From Hades: Tackling Extraordinary Challenges.
  Moderator: D. John Doyle, M.D., Ph.D., Cleveland Clinic, Cleveland, Ohio.

Intubation of a morbidly obese man in respiratory failure despite high-level CPAP. A 980-pound man receiving CPAP therapy on 100-percent oxygen needs to be intubated to allow a tracheotomy to be performed. Arterial PCO₂ tension is in excess of 100 mm Hg, leading to an obtunded and uncooperative patient. The patient desaturates whenever his CPAP mask is removed. What now? (Real case)

• Airway Clinical Forum: Difficult Airways: Is “Dex-Mex” Appropriate Fare?
  Moderator: Basem B. Abdelmalak, M.D., Cleveland Clinic, Cleveland, Ohio.

An 83-year-old man presents to the preoperative assessment clinic for evaluation concerning his total colectomy for colon cancer. His past medical history includes 30 packs/year of smoking, hypertension, diabetes mellitus type II, peripheral vascular disease, osteoarthritis and chronic renal insufficiency. His activity is limited secondary to his arthritis; however, he is able to take care of himself at home with assistance from his two daughters.

• Education Clinical Forum: Dilemmas for Teaching Anesthesiologists: The Problem Trainee.
  Moderator: Catherine K. Lineberger, M.D., Duke University Medical Center, Durham, North Carolina.

An anesthesiology resident encounters difficulties in his program because of a cognitive performance issue.

• Ethics Clinical Forum: Ethics Issues: Brain Death and Organ Donation.
  Moderator: Gail A. Van Norman, M.D., University of Washington, Seattle, Washington.

You are the anesthesiologist on call at a community hospital. You are informed that there is to be an organ donation. The donor is currently in the ICU, ventilator-dependent and minimally conscious. You are asked to provide I.V. sedation and monitoring while ventilation support is withdrawn. After the patient’s heart stops, you will declare death, and organ donation will proceed five minutes thereafter. The family wishes to be present for withdrawal of life-support. The donor is 33-year-old woman who was admitted to the ICU following surgery to stabilize a cervical fracture sustained during an equestrian accident. Other injuries include a right humeral fracture and cerebral contusion. She is otherwise healthy but is ventilator-dependent. Initial evaluation indicated that prognosis for recovery of ventilatory function is poor. She has left a living will directing that she would not want mechanical ventilation unless there was a “reasonable likelihood” of recovery. Her husband indicates that he wants to have ventilation withdrawn and, in accordance with her wishes, to donate her vital organs.

• Geriatrics Clinical Forum: Cognitive Complications of Anesthesia and Surgery in Elders.
  Moderator: Gregory J. Crosby, M.D., Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts.

An elective total hip repair in an 81-year-old woman with mild forgetfulness and a daughter concerned that anesthesia and surgery will make her mom’s cognition worse.

• Geriatrics Clinical Forum: Protecting the Aging Kidney During Surgery.
  Moderator: Jerome F. O’Hara, M.D., Cleveland Clinic, Cleveland, Ohio.

A 72-year-old female with a past medical/surgical history that includes a 100-pack/year smoking history (quit 10 years ago), type 2 insulin-dependent diabetic and right nephrectomy for renal cancer three years ago. The patient presents for a left partial nephrectomy for renal cancer to avoid dialysis. Fasting serum glucose is 349 gm/dL, and serum creatinine is 2.1 mg/dL.

• Practice Management Clinical Forum: How Do I Use Anesthesia Workforce Information to Position Myself Optimally in the Marketplace?
  Moderator: Armin Schubert, M.D., M.B.A., Cleveland Clinic, Cleveland, Ohio.

A third-year anesthesiology resident contemplates his career choices and wonders whether a fellowship in cardiac anesthesiology will help gain access to the segment of the anesthesiology marketplace in highest demand.

• Practice Management Clinical Forum: Hot Issues in 2006.
  Moderator: Gifford V. Eckhout, M.D., M.B.A., Trinity Mother Frances Health System, Tyler, Texas.

Generational issues: You have been asked to consult for a successful anesthesiology practice that is encountering some growing pains. This 36-person group has a number of senior partners who want to restrict their call and weekend activity. They have always worked hard, have built this large practice and now feel they have earned their day in the sun. On the other hand, the newest physicians in the group, GenXers who are products of the restrictive residency work limitations, are balking at the long hours traditionally worked in this practice. Many of them are insisting on part-time work schedules but wish to continue on a full partnership track. Call, shareholder status, voting and input into leadership are issues of contention between the members. Resolution of these issues is the key to the health of your group, but how?

• Quality Clinical Forum: Clinical Forum on Quality Improvement: Beyond Creating the Anesthetic Record: What Does an Automated Anesthesia Information Management System Mean for Our Patients and Practices?
  Moderator: Warren S. Sandberg, M.D., Ph.D., Massachusetts General Hospital, Boston, Massachusetts.

  A middle-aged person with diabetes is scheduled to undergo right colon resection for tumor. The patient asks you how you plan to manage his blood sugar, whether you will administer preoperative antibiotics and how you plan to maintain normothermia. The patient states that he really dreads the possibility of a post-op wound infection. You chat some more and discover that the patient is actually an executive for a large health insurer. He mentions that some of the most exciting work he’s doing is developing pay-for-performance contracts with providers. He is interested to know how anesthesiologists might participate in such contracts. As you prepare to preoxygenate, he points to your AIMS workstation and says, “There’s a gold-mine of data in there; I’ll bet regulatory and watchdog groups would love to help you develop ways to meet best-practice performance targets!”

• Transplant Clinical Forum: Liver Transplantation With a Wrinkle.
  Moderator: Jacek B. Cywinski, M.D., Cleveland Clinic, Cleveland, Ohio.

A 53-year-old male was evaluated for OLT with a diagnosis of ESLD secondary to both Laennec’s and hepatitis C virus-related cirrhosis. A preoperative transthoracic echocardiogram revealed normal left and right ventricular function, with moderate concentric left ventricle hypertrophy and proximal septal hypertrophy of 1.8 cm measured thickness. Dobutamine stress echo revealed no evidence of inducible ischemia; however, severe systolic anterior motion of both the anterior and posterior mitral valve leaflets was noted, with the development of an intracavitary gradient of 150 to 189 mmHg at peak stress.

Armin Schubert, M.D., M.B.A., is Professor of Anesthesiology, Cleveland Clinic Health Sciences Campus of the Ohio State University, Cleveland, Ohio.