73rd PostGraduate Assembly in Anesthesiology

Please Note: This session takes place on Thursday 12/12 from 7am-6pm and Friday 12/13 from 8-11am. 

Click here to view the full program.

TS-01 - PBLD-04 - Management of Mediastinal Mass - Dr. Campos

TS-02 - PGA73 Handout

SPECIALTY: Cancer

The PGA visitors may choose to tour the Josie Robertson Surgery Center during their visit to Memorial Sloan Kettering. The Josie Robertson Surgery Center opened in January 2016 and set a new standard for outpatient cancer surgery. JRSC is the first-of-its-kind freestanding facility on Manhattan’s Upper East Side, accommodating same-day outpatient and short stay surgical cases from the Breast, Gynecology, Head & Neck, Plastics & Reconstructive, and Urology services. The short stay procedures include unilateral and bilateral mastectomy with reconstruction, laparoscopic and robotic hysterectomy, thyroidectomy, nephrectomy, and laparoscopic and robotic prostatectomy, with clinical pathways designed for patients to go home the same day or with one overnight stay.

Guests to the Department of Anesthesiology at Montefiore Medical Center will be welcomed with breakfast and a brief departmental history, followed by an overview of its current staffing, structure and department highlights. For the remainder of the morning, our guests will shadow in the OR. Cases performed at the Moses Campus include Cardiothoracic, Neuro, Pediatric, General and Regional.  To wrap up the visit, there will be a Meet and Greet with the Chair and Vice Chairs of the Department. 

The PGA visitors can tour the Icahn School of Medicine at Mount Sinai Department of Anesthesiology during their visit to NYC. Mt. Sinai accommodates same-day outpatient and short stay surgical cases. This visit will review the OR Program, cardiac anesthesia, liver transplantation, an OR visit and a simulation program.

After completion of this session, the participant will be able to:

• Demonstrate basic pediatric life-support skills;
• Recognize the signs of impending respiratory failure and shock;
• Initiate treatment of impending and overt respiratory failure and shock;
• Identify and appropriately treat rhythm disturbances; 
• Demonstrate effective communication skills during a crisis situation with team members. 

Requirements for Certificate:

To receive a PALS certificate, the participant will have to successfully complete the course and pass a written and practical examination which will be administered at the end of the course.

Due to the requirement to review literature in advance, this workshop is limited to preregistration.

After completion of this session, the participant will be able to:

• Describe the pathophysiology and factors associated with  postoperative vomiting;
• Enumerate the associated factors for PONV;
• Design an anesthetic plan to minimize nausea and vomiting in patients at risk;
• Measure reduced occurrences of PONV and their patient populations.

MW-01 - PGA73

After completion of this session, the participant will be able to:

• Delineate the indications and contraindications to sedation for TAVR;
• Delineate the indications and contraindications to general anesthesia for TAVR;
• Create an algorithm that addresses the critical hemodynamic effects during TAVR and the treatments for these events.
• Perform an anesthesia assessment of TAVR patients that identifies whether GA or sedation is the preferred option.

After completion of this session, the participant will be able to:

• Define three styles of leadership and identify their best fit style;
• Execute new leadership qualities in their everyday anesthesiology practice;
• Identify the style of leadership of the hospital administration and or surgery departments.

After completion of this session, the participant will be able to:

• Enumerate the indications and contra-indication to intrathecal pump therapy;
• Create and use the consensus algorithm for intrathecal drug therapy in their practice;
• Create an algorithm to treat overdose situations. 

Panel Moderator:  Patricia Mack, M.D. 

Bradly J. Narr, M.D. - Invasive Gastroenterology:  Ensuring Appropriate Care

Diana Anca, M.D. - Anesthesiology Challenges in the Electrophysiology Suite 

Patricia Mack, M.D. - Radiation Safety for Anesthesiologists: Staying Safe in Interventional Radiology

After completion of this session, the participants will be able to:

• Plan a comprehensive system for the perioperative management of the medically complex patient scheduled for the Gastroenterology Suite;
• Develop a comprehensive anesthetic plan for the care of the patient undergoing an Electrophysiology Procedure which also mitigates the challenges of providing care in that environment.
• Construct systems to improve the safety of the clinicians providing care in the Interventional Radiology suite.

Panel Moderator:  David J. Wlody, M.D., FASA 

Richard M. Smiley, M.D., Ph.D. - Valvular Disease

David J. Wlody, M.D., FASA - Cardiomyopathy of Pregnancy

Klaus Kjaer, M.D. - Pulmonary Hypertension in Pregnancy

After completion of this session, the participants will be able to:

• Describe the epidemiology, presentation, and physiologic implications of coexisting cardiac diseases in pregnant patients;
• Discuss the interaction of pregnancy with coexisting cardiac diseases;
• Devise an anesthetic management plan for the patient with valvular heart disease, pulmonary hypertension and cardiomyopathy of pregnancy.

This activity contributes to the patient safety CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology’s (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0 requirements.

Panel Moderator:  Vijaya N. R. Gottumukkala, M.B., B.S., M.D., FRCA

Vijaya N. R. Gottumukkala, M.B., B.S., M.D., FRCA -Global Impact of Cancer

David Hyman, M.D. - New Medical Therapies for Cancer Patients: Overview and Implications for the Anesthesiologist

Gregory W. Fischer, M.D., FASA - Does Anesthetic Management Influence Outcomes in the Cancer Patient?

After completion of this session, the participants will be able to:

• Discuss the impact that cancer has on the health of our communities;
• Formulate an anesthesia plan that takes into account cancer and anti-cancer therapeutics;
• Enumerate new modalities and new treatments for cancer; 
• Describe the genetic basis and metabolic impact of cancer in surgical patients. 

After completion of this session, the participant will be able to:

• Apply the use of nerve stimulator techniques for upper and lower extremity blocks;
• Treat reflex sympathetic dystrophy with either intravenous anesthesia (Bier block) or nerve block
• Utilize ultrasound technology for upper and lower extremity blocks. 

W-02 PGA73 Handout

After completion of this session, the participant will be able to:

• Enumerate the principles of ultrasound applied to the assessment of the spine;
• Recognize the normal sonoanatomy of the spine;
• Perform a systematic ultrasound assessment of the spine in the sagittal and transverse planes;
• Identify a desired interspace;
• Identify the optimal needle insertion point;
• Determine the distance from the skin to the epidural or intrathecal spaces.

Panel Moderator: David L. Hepner, M.D., M.P.H. 

Bobbie-Jean Sweitzer, M.D., FACP - Cardiac Evaluation for Non-Cardiac Surgery

Jeanna D. Blitz, M.D., FASA - Frailty Guidelines

David L. Hepner, M.D., M.P.H. - Dual Anti-Platelet Therapy Guidelines

After completion of this session, the participants will be able to:

• Devise a plan for the pretesting of a cardiac patient for non-cardiac surgery;
• Apply appropriate frailty testing in the preoperative setting;
• Create algorithms for the perioperative management of antiplatelet therapy. 

Panel Moderator:  Audrée A. Bendo, M.D., M.S., FASA 

Deepak Sharma, M.B., B.S., M.D., D.M. - The Traumatic Brain Injury Patient

Apolonia E. Abramowicz, M.D., FASA - The INR Patient

Jess W. Brallier, M.D. - The Spine Patient

After the completion of this session, the participant will be able to:

• Identify procedure-related risks and potential complications in neurosurgical patients with different pathologies;
• Devise a multidisciplinary approach to expedite care and avoid complications in emergency traumatic brain injury, interventional neuroradiology, and elective spine surgery patients;
• Describe best practices for caring for patients requiring emergency neuro-interventional procedures using a multidisciplinary approach.

Panel Moderator:  David L. Reich, M.D. 

Patrick J. McCormick, M.D., MEng - The Augmented Anesthesiologist

Matthew A. Levin, M.D. - Moving Data Around the Enterprise:  Why the Anesthesiologist Should Be Part of the Solution

David L. Reich, M.D. - Getting the Heck Out of the OR: Why an Anesthesiologist is the Ideal Informatics Leader in a Health System

Ira S. Hofer, M.D. - Predicting Mortality and Other Things We'd Like to Avoid:  Is the Computer Better than an ASA Score?

After completion of this session, the participants will be able to:

• Define the basic "anatomy and physiology" of data flow in an electronic health enterprise that supports clinical operations;
• Use the basic principles of informatics to improve the practice of anesthesiology;
• Explain the ways in which machine learning has been implemented in clinical decision support and relate that to their own practice. 

Panel Moderator:   Evan G. Pivalizza, M.B., Ch.B., FFA

Larita Yvette Fouche-Webber, M.D. - Endovascular Balloon Occlusion of the Aorta (REBOA): Game Changer Trauma?

Evan G. Pivalizza, M.B., Ch.B., FFA - Use of Whole Blood as a Resuscitation Strategy

Radwan N. Safa, M.D., Ph.D. - The Role of Antifibrinolytics in Trauma Patients

At the completion of this session, the participant will be able to:

• Describe the principle and technique of new balloon occlusion techniques in trauma hemorrhage and discuss available outcome data;
• Apply new techniques to trauma patients based upon current military and civilian data;
• Create algorithms for the use of whole blood in trauma resuscitation;
• Define the coagulopathy of trauma and implement various treatments using transfusion protocols and pharmacology

Panel Moderator:  Basem B. Abdelmalak, M.D., FASA ​

Basem B. Abdelmalak, M.D., FASA - The Patient with Diabetes

Tricia E. Brentjens, M.D. - The Patient with Chronic Kidney Disease

Randolph J. Steadman, M.D., M.S. - The Patient with Chronic Kidney Disease

After completion of this session, the participants will be able to:

• Justify to other clinicians and/or administrators the rationale to proceed or delay surgery for hyperglycemia and/or high HbA1c;
• Determine the ideal timing for dialysis preoperatively based upon the risks associated with hyperkalemia and other abnormal metabolics in chronic kidney disease patients;
• Describe the impact of liver dysfunction and anesthetic choice on the outcome of non-transplant surgery.

After completion of this session, the participant will be able to:

• Enumerate the principles of ultrasound applied to the assessment of the spine;
• Recognize the normal sonoanatomy of the spine;
• Perform a systematic ultrasound assessment of the spine in the sagittal and transverse planes;
• Identify a desired interspace;
• Identify the optimal needle insertion point;
• Determine the distance from the skin to the epidural or intrathecal spaces.
  

Focus Session Moderator:  Randall H. Steadman, M.D., M.S.

Evan G. Pivalizza, M.B., CH.B., FFASA - The Patient with Previous Liver Transplant for Subsequent Surgery

Geraldine Diaz, D.O. - Management of Acute Perioperative Hepatic Failure

After completion of this session, the participant will be able to: 

• Discuss the potential peri-procedural problems of patients following hepatic transplantation 
• Develop an anesthetic plan to safely manage these patients;
• Recognize signs of impending hepatic failure
• Manage patients developing acute perioperative hepatic failure.

Focus Session Moderator: Apolonia E. Abramowicz, M.D., FASA

Deepak Sharma, M.B., B.S., M.D., DM - Awake Craniotomy: Pro

Alex Y. Bekker, M.D., Ph.D. - Awaker Craniotomy: Con: Defending the Traditional Asleep Craniotomy 

After completion of this session, the participant will be able to:

• Stratify patients as to who would be a candidate for awake craniotomy vs. asleep craniotomies;
• Develop an anesthetic plan for patients undergoing awake craniotomy;
• Develop an anesthetic plan for patients not suitable for awake craniotomy. 

Focus Session Moderator:  Vilma A. Joseph, M.D., M.P.H., FASA

Vilma A. Joseph, M.D., M.P.H., FASA - Patient Disparities

Alexsandra Bastien, M.D. -  Provider Disparities

After completion of this session, the participant will be able to:

• Identify the challenges of diversity between practitioners and how to overcome them;
• Describe how through education and overcoming bias, effective communication between healthcare providers and patients can be achieved;
• Demonstrate the impact of implicit bias on physicians and  patient care and discuss the possible effect of implicit bias on access to quality healthcare;
• Discuss supporting data on health care disparities. 

Focus Session Moderator:  Vinod Malhotra, M.D., FACA

Vinod Malhotra, M.D., FACA - Effective Strategies to Improve Efficiency and Patient Safety: How Do We Get the Focus on What Matters the Most?

David L. Hepner, M.D., M.P.H. - Staffing Effective Pre Anesthesia  Evaluation Center:  Who SHould Pay and is the Resource Allocation Worth It? 

After completion of this session, the participant will be able to:

• Describe the value in spending money on a pre-operative process;
• Demonstrate to administration the advantages of a formal preoperative clinic; 
• List the various factors that contribute to OR efficiency.

After completion of this session, the participant will be able to:

• Discuss the anesthetic implications of implantable cardiac defibrillators, pacemakers, left ventricular assist devices and artificial hearts;
• Create a list of anesthetic challenges and management strategies;
• Design a management algorithm for the patient with a cardiac implantable device having non-cardiac surgery;
• Make recommendations to consultant physicians and surgeons regarding the best choice for on or off-pump cardiac surgery.

After completion of this session, the participant will be able to:

• Acutely recognize local anesthetic toxicity;
• Create an evidence-based treatment algorithm for Local Anesthetic Toxicity using intralipid therapy;
• Appropriately address the patient and family after the local anesthetic toxicity complication.

After completion of this session, the participant will be able to:

• Enumerate anesthesia risk factors and possible complications that can arise from endovascular approaches;
• Create an anesthetic plan for an endovascular surgery patient that minimizes potential risks;
• Utilize a number of different options for postoperative analgesia in this population of patients.

After completion of this session, the participant will be able to:

• Define which medications may affect the coagulation pathway and thus complicate regional anesthesia;
• Create a policy for their department for cessation of anticoagulant drugs in anticipation of the use of regional anesthesia;
• Implement the use of tests may help to guide intraoperative therapy.

MW-08

After completion of this session, the participant will be able to:

• Identify common comorbidities in patient with kyphoscoliosis;
• Discuss concerns at caring for this patient in a NORA location;
• Formulate an anesthetic plan to care for the kypoplasty patient.

PBLD-01 Case - PGA73

After completion of this session, the participant will be able to:

• Identify various anesthetic and non-obstetrical surgery considerations throughout pregnancy;
• Formulate an anesthetic plan that takes into consideration the fetal and maternal effects of non-obstetric surgery during pregnancy;
• Manage the issues surrounding laparoscopic surgery in the patient. 

PBLD-02 - Case - PGA73

After completion of this session, the participant will be able to:

• Identify the signs and symptoms of Local Anesthetic Systemic Toxicity;
• Formulate a plan to treat Local Anesthetic Systemic Toxicity. 

PBLD-03 - Case - PGA73

After completion of this session, the participant will be able to:

• Identify risk factors for cardiac arrest in the pediatric population;
• Develop an emergency response plan for cardiac arrest in this ambulatory procedure. 

PBLD-04 - Case - PGA73

After completion of this session, the participant will be able to:

• Review the most recent guidelines regarding perioperative blood product transfusion;
• Identify barriers to the timely provision of adequate blood products in a case requiring massive transfusion;
• Implement a comprehensive transfusion protocol, including one addressing massive transfusions. 

PBLD-05 - Case - PGA73

After completion of this session, the participant will be able to:

• Discuss the mechanism of action by which ketamine exerts pain control;
• Identify the psychomimetic and physiologic effects of ketamine;
• Incorporate ketamine into a perioperative anesthetic and pain management plan. 

PBLD-06 - Case - PGA73

After completion of this session, the participant will be able to:

• Recognize signs and symptoms of postpartum hemorrhage;
• Identify indications for the use of tranexamic acid in maternal hemorrhage;
• Implement a program for the use of tranexamic acid in appropriate situations. 

PBLD-07 - Case - PGA73

After completion of this session, the participant will be able to;

• Identify the differences in guidelines and some practices related to endoscopic procedures among gastroenterologists and anesthesiologists;
• Propose strategies to address the challenges posed by these different practice expectations.

E-01 Engaging with the Experts

The Impaired Physician and The Aging Practitioner - Issues of Professionalism

Focus Session Moderator:  Michael P. Duffy, M.D., FASA

Michael P. Duffy, M.D., FASA - Recognizing Age Related Impairment and How to Deal With It?

Terrance M. Bedient, FACHE -The Impaired Physician: The DOH and Medical Society View

After completion of this session, the participant will be able to:

• Identify issues related to aging in a practitioner and how to address the issue;
• Identify and assess the impaired physician; 
• Interpret the current recommendations of the Department of Health’s Committee for Physician Health;
• Develop a plan to manage the aging or impaired physician 

Focus Session Moderator:  Basem B. Abdelmalek, M.D., FASA

Basem B. Abdelmalek, M.D., FASA - Tight Glucose Control in the Operating Room 

Deirdre C. Eschler, M.D. - Newer Diabetes Medications: What We Need to Know

After completion of this session, the participant will be able to:

• Describe the risks and benefits of tight control 
• Manage glucose in the perioperative phase and;
• Provide to patients perioperative instructions for the newer diabetic medications.

Focus Session Moderator:  Edmond Cohen, M.D.

Marcelo Gama de Abreu, M.D., Ph.D., DESA - One Lung Ventilation: Driving Pressure or Tidal Volume?

Wanda M. Popescu, M.D. - ERAS in Thoracic Surgery

After completion of this session, the participant will be able to:

• Formulate a plan for ventilation during one lung ventilation that minimizes risk for postoperative pulmonary complications; 

 • Describe the concept of ERAS for thoracic surgery and will be able to incorporate ERAS protocols into their practice of thoracic anesthesia.