Virtual Experience

Professional Liability: Things Every Anesthesiologist Should Know

Description

Anesthesiologists are safety leaders who strive to minimize medical errors. We also participate in social media and utilize artificial intelligence. Anesthesiologists need to understand how to navigate the protect themselves from medical malpractice and civil liability as part of their daily practice. This includes patient management as well as appropriate documentation of occurrences. The practice of apologizing to patients/families will also be discussed. Anesthesiologists need to understand how to mitigate medical malpractice risks due to the use of social media and AI. Many clinicians are involved in adverse events that may or may not result in a claim being made or a suit filed. However, one should be prepared if a claim or suit is filed. In addition, in certain circumstances, anesthesiologists may be reported to the National Practitioner Databank based on the results of a medical malpractice claim. 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 errors.

Objectives

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

Pediatric Trauma: Review of the Initial Management and Perioperative Considerations

David Young MD, MBA, MEd, FASA

Description

This Refresher Course Lecture (RCL) has been developed to review and emphasize several key topics regarding the perioperative management of pediatric trauma patients. The content will be designed for a learner group of non-pediatric anesthesiologists who may or may not be familiar with the management of trauma patients or work in trauma centers. This RCL will focus on six subtopics: epidemiology in pediatric trauma; initial management of the pediatric trauma patient; advanced trauma life support (ATLS) and the value to anesthesiologists; and will conclude with discussions on the preoperative, intraoperative, and postoperative considerations for several typical pediatric traumatic injuries. Cognitive aids including the ATLS guidelines will supplement this RCL. Several principles, such as crisis resource management, will also be integrated into this RCL to provide several strategies for developing life-long learning techniques for delivering effective care to pediatric trauma patients.

Objectives

1. Appreciate the significant epidemiologic impact from pediatric traumatic injuries.
2. Describe the application of advanced trauma life support for the initial management of pediatric trauma patients.
3. Recognize the key perioperative considerations for typical pediatric traumatic injuries. 

The Physiologically Difficult Airway: Understanding and Implementing Evidence-Based Practices

Craig Jabaley MD, FCCM

Description

Anesthesiologists have made laudable strides in improving the safety and reliability of airway management in the operating room (OR), particularly in the identification and approach to anatomically difficult airways. These advances have carried over into out-of-OR settings as well, such as the intensive care unit and emergency department. However, a growing body of literature suggests that work remains to be done on reducing the incidence of adverse physiologic events during airway management in critically ill adults. Such patients can be considered to have a physiologically difficult airway, wherein the patient’s physiological and pathophysiological alterations increase the risk for complications during tracheal intubation and the transition to positive pressure ventilation. A surprisingly robust body of literature now exists to support evidence-based best practices in preventing common physiologic complications during airway management in these at-risk patients. This refresher course lecture will review and synthesize this literature and offer practical takeaways suitable for implementation at the bedside to improve patient safety.

Objectives

1. Review outcomes of tracheal intubation in critically ill adults and distinguish between anatomically and physiologically difficult airways.
2. Identify and review relevant literature to synthesize an integrated approach to tracheal intubation in critically ill adults.
3. Formulate strategies to prevent adverse outcomes before, during, and after tracheal intubation in critically ill adults.

Identification and Treatment of Perioperative Anxiety in Pediatric Patients

Thomas Caruso MD, PhD, FASA, Romy Yun MD

Description

Children often experience perioperative anxiety. Sequalae of untreated anxiety include increased pain and delirium, and long-term consequences include sleep disturbances and enuresis. Effective management of pediatric perioperative anxiety significantly impact patients. Research-based anxiety scales have driven the identification of perioperative anxiety. Although these scales are reliable, they are clinically cumbersome. New, facile anxiety assessment tools have been correlated to research scales, offering the potential for routine clinical assessments. However, what clinical scales gain in efficiency is tempered by a loss in reliability. With improvements in anxiety identification, the treatment of pediatric perioperative anxiety has advanced. While midazolam is most commonly used, non-pharmacologic interventions have increased in popularity. Given the emergence of clinical anxiety scales and expanding anxiolytic treatments, this refresher course will detail the identification and treatment of pediatric perioperative anxiety. This refresher describes the relationship between research and clinical anxiety scales, followed by an account of traditional and innovative anxiolytics.

Objectives

1. Understand the advantages and limitations of clinically-relevant anxiety scales for the identification of perioperative anxiety.
2. Describe the effective utilization of newer, pharmacologic anxiolytics. 
3. Understand the role of immersive technologies in non-pharmacologic anxiolysis.

Resuscitation in Obstetric Patients; Cardiac Arrest in Pregnancy and Perimortem Cesarean Delivery

Ioannis Angelidis MD

Description

Resuscitation in obstetric care can be challenging for the physician. The most obvious difference from the standard adult resuscitation is that there are two patients that need to be cared for: the obstetric patient and the fetus. That, in conjunction with the physiologic changes in pregnancy, adds additional considerations to the care of this patient population. The course aims to review the physiologic changes in pregnancy, airway management, and mechanical ventilation in the obstetric patient, sepsis, hemorrhage, and trauma in pregnancy and maternal cardiac arrest and perimortem cesarean delivery. We will present the latest recommendations from the American Heart Association and the European Society of Cardiology.  

Objectives

1. Maternal cardiac arrest and perimortem cesarean delivery.
2. Resuscitation in obstetric care to include airway/mechanical ventilation, trauma, and hemorrhage.
3. Resuscitation in hypertensive disorders in pregnancy.

Basics of Coagulation – What every anesthesiologist needs to know 

Kelly Ural MD, FASA

Description

This panel will cover all things coagulation – from the clotting cascade to coagulopathies and point-of-care testing. The target audience is broad – it is all ASA members who face issues with bleeding and coagulation. It is designed to review the basics, with particular focus on point-of-care testing, factor concentrates, and managing coagulopathy.

Objectives

1. Interpret different laboratory and  point-of-care tests of coagulation.
2. Choose the most appropriate blood component/factor to correct coagulopathy.
3. List inherited and acquired clotting disorders and how to manage them in the perioperative period.

Approaches to Enhancing the Patient-Physician Relationship in the Perioperative Setting

Uchenna Umeh MD, FASA

Description

The patient-physician relationship is the foundation of patient care and of paramount importance in order to gather information, establish diagnoses, and create treatment plans. With the growing emphasis on patient-centered care, excellent patient engagement plays an increasing role in adequate health care delivery. Engaging patients in their care is needed to improve outcomes, particularly for patients with chronic medical conditions. Physicians are now increasing called to be aware of populations that have not traditionally received equitable care, including minorities, LGBTQ+, patients with disabilities, and those with limited English language proficiency. This session will guide the audience in understanding the skills necessary to maintain strong physician-patient relationships as well as examine how technology in healthcare, in the era of social media and artificial intelligence can both enhance and diminish these relationships in various clinical scenarios and with diverse and specialized patient populations.

Objectives

1. Examine the foundation of the patient-physician relationship and learn effective methods to improve physician-patient interactions in the perioperative setting.
2. Discuss how to leverage social media, artificial intelligence and digital technology to enhance patient- physician interactions.
3. Recognize how unconscious biases and poor cultural competency may lead to reduced patient satisfaction and diminish the patient-physician relationship.

The private equity takeover of anesthesia: what every anesthesiologist needs to know, and how it impacts the entire specialty

George Tewfik MD, FASA

Description

Private equity firms have purchased numerous anesthesia staffing companies and are a significant presence in medicine in numerous geographic locations around the United States. As their influence grows, many residents and attending anesthesiologists are still unfamiliar with the potential impacts that PE firms may have on their day-to-day practice. This is true for physicians who are employed directly by a PE-owned physician staffing firm, as well as those who may work for a group that is considering a sale. This lecture will review the historical trend of PE acquisitions of anesthesia groups, the differences between PE-owned groups and those absorbed into health care systems, and what the long-term impact may be of this ongoing trend.

Objectives

1. We will review the historical trend regarding the acquisition of anesthesiology groups by PE-owned firms.
2. We will discuss how PE-owned groups differ from other group management organizational structures.
3. We will discuss potential long term implications of the ongoing trend of PE acquisition of anesthesiology staffing firms.

Perioperative Management of Patients with Pheochromocytoma

Aibek Mirrakhimov MD

Description

Pheochromocytoma is an infrequent comorbid condition among patients presenting for surgery. However, it is associated with significant perioperative morbidity and mortality if un-diagnosed and appropriately managed. We will cover clinical presentation of pheochromocytoma, available diagnostic tests and their limitations. We will discuss preoperative preparation of such patients for surgery including the importance of alpha blockade. Anesthetic management of pheochromocytoma patients undergoing adrenalectomy and its postoperative management. Post session the learner will have:-understanding of clinical signs and symptoms of pheochromocytoma-preoperative diagnostic approach to diagnose pheochromocytoma-the role of preoperative alpha blockade, the available medications and side effects-intraoperative management of patients with pheochromocytoma-postoperative management of adrenalectomy.

Objectives

1. To review the biochemistry relevant to adrenal medulla and sympathetic paraganglia.
2. To review the clinical presentation and diagnosis of pheochromocytoma.
3. To discuss the anesthetic considerations relevant to pheochromocytoma patients.

Intraoperative processed EEG: A practical guide to interpretation and clinical application

Benjamin Gruenbaum MD, PhD

Description

Processed electroencephalography (EEG) offers valuable insights into brain activity during anesthesia, yet its full potential is often underutilized. This course will equip learners with the skills to interpret EEG signals effectively, going beyond reliance on a processed index number. Key points include recognition of rich information in raw EEG signals, understanding the clinical implications of avoiding burst suppression, and appreciating the challenges of interpreting EEG in vulnerable brains, such as elderly or critically ill patients. We will also discuss the importance of identifying and excluding artifacts as the first step in meaningful EEG analysis. By the end of the session, learners will be able to more confidently assess EEG data and gain a deeper understanding of brain monitoring.

Objectives

1. Describe the electrophysiologic mechanisms responsible for EEG changes with anesthesia.
2. Identify uses of EEG to guide anesthesia and its effect on outcomes.
3. Explore the limitations in using processed EEG to guide anesthetic management.

Preventing Perioperative Myocardial Injury

Christian Bohringer MD

Description

Reviews the pathophysiology of perioperative myocardial injury after non-cardiac surgery (MINS), covers diagnosis of myocardial injury as well as prevention from a pharmacological, transfusion, and surgical perspective, and covers recent evidence of prevention of further ischemic injury once MINS has been identified.

Objectives

1. Understand the pathophysiology of perioperative myocardial injury.
2. Learn to diagnose myocardial injury.
3. Understand how to prevent myocardial injury and to prevent further injury after it has been identified.

Perioperative delirium

Daniel Sessler MD

Description

Delirium occurs in 5-10% of surgical inpatients and is disturbing to patients, families, and medical staff. The etiology is probably surgical tissue injury and the consequent generalized inflammatory response. This lecture will review causes and several inexpensive and easy methods for reducing delirium risk.

Objectives

1. Understand the etiology of delirium and which patients are most at risk.
2. Understand methods of reducing delirium risk.

ICU Liberation and the Updated PADIS Guidelines: What is the Anesthesiologist's role?

Joy Chen MD, FASA, FCCM

Description

The Society of Critical Care Medicine’s (SCCM) Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, known as the PADIS Guidelines, will be updated in early 2025. These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing the triad of physical weakness, cognitive decline, and psychiatric impairments, known as Post-ICU syndrome, after patients survive critical illness. Severely ill patients often require surgery and depend upon the care of anesthesiologists. This refresher course will discuss the new PADIS guideline updates and how they might guide perioperative care and recommendations for anesthesiologists on how to facilitate the ABCDEF Bundle.

Objectives

1. Articulate the most current ICU Liberation research and guidelines, including the 2025 SCCM PADIS Guidelines update.
2. Review post-ICU syndrome and its impact on patients.
3. Discuss how anesthesiologists can facilitate ICU liberation and patient outcomes through implementation of the ABCDEF bundle.

Eeny, Meeny, Miny, Moe: Which Anesthetics Do I Choose For My Unstable Trauma Patient?

 Joy Chen MD, FASA, FCCM

Description

Traumatic injuries are a leading cause of morbidity and mortality in the United States and globally. Many injured patients require surgery and anesthesia, though the ideal choice and dosing of anesthetic induction and maintenance agents to optimize patient outcomes is not widely agreed upon. Sedative agents can lead to or worsen intraoperative hypotension in trauma patients who are already prone to hemodynamic instability, potentially exacerbating existing injuries. This session will summarize the existing data on commonly used anesthetic agents in trauma patients and identify any gaps in knowledge.

Objectives

1. Highlight morbidity and mortality statistics in trauma.
2. Elucidate the pharmacokinetic and pharmacodynamic changes of anesthetic medications that occur with hemorrhage.
3. Reveal the benefits and risks of commonly used anesthetic medications including propofol, etomidate, ketamine, dexmedetomidine, opioids, and volatile anesthetics in trauma.

Safety in Complex Adaptive Systems (Or, Anesthesia in the Real World)

Keith Ruskin MD, FASA

Description

Anesthesia professionals work in an unpredictable, rapidly changing environment in which they routinely diagnose and manage uncommon and life-threatening critical events. Although the healthcare system has traditionally been viewed as linear and predictable, the system changes in response to the collective interactions between people, events, and equipment. This process of adaptation and learning causes the perioperative environment to self-organize, and patterns of behavior may emerge that were not initially anticipated. Anesthesiologists deal with the “here and now,” making safety-critical decisions under time pressure and often without all the information that they need. Safety-II highlights the importance of recognizing the variability of clinical practice, learning why things go right and how resilience can prevent adverse events. This refresher course lecture will explain why the perioperative environment can be viewed as a “Complex Adaptive System” and offer specific recommendations for improving safety in the real world.

Objectives

1. Participants will effectively use available resources to manage unpredicted critical events.
2. Participants will implement strategies for reducing risk in complex adaptive systems such as the perioperative environment.

Preventing Perioperative Infections: Beyond Ancef 2g 

Leshawn Richards MD

Description

This presentation will highlight how much of what we do in anesthesia as a practice has been under the radar as an easily preventable source of infectious risk to patients. Key points: Review the impact of Healthcare-Associated Infections (HAI), Identify sources of infectious risk, Review strategies to minimize risk to patients. Relevance to the audience: Anesthesia professionals are directly involved with preventable sources of infectious risk to patients. What the learner will achieve post session: Learners will gain an understanding of the risk imposed to patients from the OR environment and from anesthesia providers and how to minimize the risk to patients.

Objectives

1. The operating room environment, the patient, and the anesthesia provider are reservoirs for harmful infection and we must prevent spread between these three sources.
2. Sanitizing your hands, injection ports, vials, and the environment are the most effective ways to prevent the spread of infection.
3. Professionalism is what you do when no one is watching. Minimizing exposure to infectious material should be more important than trying to do something as fast as possible. No time is saved when a patient gains a preventable infection.

Fluid Management for Anesthesiologists: How Much is Too Little?

Alexandra Belfar MD

Description

This lecture will cover current recommendations for perioperative fluid management with special emphasis on open abdominal procedures. An explanation of the rationale behind the international ERAS society's previous emphasis on restrictive fluid management and recommendations for goal-directed therapy will be presented, as well as the historical context of these recommendations and the progression of the literature on this topic.

Objectives

1. Understand the historical basis for previous recommendations for restrictive fluid management.
2. Place these recommendations in the context of current literature and data.
3. Learn to create and enact fluid plans that are most consistent with current outcomes-based research.

Artificial Intelligence can't kill you. Anything you want and should know about AI.

Joris Broeren MD

Description

In this lecture, AI will be demystified. ChatGPT, co-pilot and self driving cars look like magic, but they’re not. In the first part, a short introduction to the inner workings of the "hottest" types of AI (deep learning and generative AI) is presented in such a way that any anesthesiologist has a basic understanding of their main concepts. This is followed by an overview of the (potential) relevance of AI for the anesthesia practice, both in the pre-operative, as well as the perioperative phase. What are current limitations, and what are the most relevant new developments? Besides the obvious (or the possible) advantages, the barriers to, and drawbacks or even possible dangers of widespread implementation of AI in the medical field will be discussed. This includes legal implications. The primary goal of the lecture is to cut through the hype, and empower the attendees to evaluate future AI initiatives on their merits and possibilities instead of their hyped status.

Objectives

1. Understanding what machine learning and AI is.
2. Having a basic grasp of the underlying technique and requirements.
3. Understanding the limitations of AI, and ways to ameliorate these.

Mind the Gap: Addressing the Disparity in Outcomes between in Hospital vs Community Stroke

Thomas Floyd MD

Description

In-hospital stroke (IHS), including perioperative stroke, is associated with several-fold worse functional and mortality outcomes than is out of hospital or community onset stroke (OHS). In comparison, outcomes associated with in hospital cardiac arrest are roughly equivalent to that in the community. With all the resources close at hand, outcomes associated with IHS should not be worse than those associated with OHS, and in fact we should reasonably expect that they would be better. This rather shocking disparity is relatively unknown amongst our anesthesiology and intensivist colleagues. We intend to review frequency and etiology of procedure-specific strokes; potential contributors; cutting-edge knowledge in the management of stroke; current gaps in management of this population; and proposals to address this disparity.

Objectives

1. Obtain insight into the disparity in stroke outcomes after in hospital versus out of hospital stroke.
2. Understand the potential contributors to this disparity.
3. Consider and develop approaches to mitigate this disparity.

Breathless in Crisis: Understanding and Managing Dyspnea in Mechanically Ventilated Patients

Mogahed Hussein MD, MBBS, MSc

Description

Dyspnea remains a prevalent and distressing symptom in mechanically ventilated patients, with significant implications for short- and long-term outcomes. This session aims to provide an in-depth exploration of the pathophysiology and mechanisms underlying dyspnea in the critical care setting, emphasizing the dissociation between respiratory effort and perceived air hunger. We will examine challenges in assessing dyspnea, particularly in patients unable to self-report due to mechanical ventilation. Evidence-based approaches for managing dyspnea, including ventilatory adjustments, pharmacologic strategies, and non-pharmacologic interventions, will be discussed. The session will also address patient-centered strategies to alleviate anxiety and promote comfort, fostering improved outcomes and quality of care in the ICU.

Objectives

1. Understand the multifaceted pathophysiology of dyspnea, focusing on theories such as length-tension inappropriateness and efferent-afferent dissociation.
2. Identify effective methods for assessing dyspnea in critically ill, mechanically ventilated patients.
3. Analyze the clinical implications of dyspnea, including its association with anxiety, prolonged ventilation, and patient outcomes.

Decoding Regional Anesthesia: The Art and Anatomy Behind the Blocks

Rafael Lombardi MD

Description

Mastering the anatomy behind regional anesthesia is vital for safe and effective practice. This session dives into the applied anatomy of upper limb, truncal, and lower limb blocks, focusing on critical landmarks, ultrasound-guided techniques, and anatomical variations that impact block efficacy. Through engaging case discussions, interactive imaging reviews, and practical tips, participants will refine their understanding of nerve pathways, fascial planes, and key structures. Designed for anesthesiologists and residents seeking to enhance precision and minimize complications, this course provides actionable insights for clinical application. Post-session, attendees will confidently apply advanced anatomical knowledge to optimize block success and patient outcomes.

Objectives

1. Identify key anatomical landmarks and variations for upper limb, truncal, and lower limb blocks to improve block placement precision.
2. Apply ultrasound-guided techniques to differentiate nerves, vessels, muscles, and fascia in real-time clinical settings.
3. Evaluate anatomical considerations to minimize complications and enhance the success rate of regional anesthesia procedures.

Carotid Endarterectomy: Past, Present and Future!

Harendra Arora MD, FASA, MBA

Description

This Refresher Course Lecture will focus on the current state of clinical practice in the management of carotid artery disease. Specific medical and surgical indications for carotid artery stenting vs. carotid endarterectomy will be presented. The session will also focus on the long debated question of regional versus general anesthesia as the optimal anesthetic choice for carotid endarterectomy. Additionally, the efficacy of different neuromonitoring techniques and their advantages and disadvantages will be highlighted.

Objectives

1. Understand the specific medical and surgical indications for carotid artery stenting vs. carotid endarterectomy
2. Explore the current state of evidence that compares regional versus general anesthesia for carotid endarterectomy
3. Discuss the efficacy of different neuromonitoring techniques and their advantages and disadvantages