60th ANNUAL REFRESHER COURSE LECTURES

Presented October 17-21, 2009 during the Annual Meeting of the American Society of Anesthesiologists

These reviews have not undergone peer or editorial review.

2009 by the American Society of Anesthesiologists, Inc.

Course navigation and comments

The project is organized from the main file, startrcl.pdf Bookmarks on the left side of the presentation are organized by learning tracks. Selecting an author will bring up that presenters summary of their presentation in the right hand panel. Selecting the title of the presentation in the right hand panel will navigate to the outline summary of the presentation. In this outline summary reverse navigation back to startrcl.pdf is provided *** The 2009 Refresher Course Lecture extensively uses Adobe Acrobat search technology. Accordingly, unless Acrobat Pro or the free Acrobat Reader (versions 7 and above) is used, this feature as well as other presentation of visual materials will not provide a complete user experience. NOTE: When using the search function within the program a security message may appear "This document is trying to load the Catalog Index \RCL_Search_Index.pdx. If you trust this document you can click on Load to allow loading of this index." One should select to load the Index file. The 2009 program is 200MB. If necessary the contents of the USB drive can be moved to other media but it is important to maintain the file/folder relationships Folder/startrcl.pdf/RCL09_Src Mac Users NOTE: Apple released the newest iteration of its operating system, Snow Leopard (10.6). This project has not been tested using version 10.6.

8/31/09

2009 OFFICERS AMERICANSOCIETYOFANESTHESIOLOGISTS President: PresidentElect: ImmediatePastPresident: FirstVicePresident: VicePresidentforScientific Affairs: VicePresidentfor ProfessionalAffairs: Secretary: Treasurer: Assistant Secretary: AssistantTreasurer: SpeakeroftheHouse ofDelegates: ViceSpeakeroftheHouse ofDelegates: RogerA.Moore,M.D. AlexanderA.Hannenberg,M.D. JeffreyL.Apfelbaum,M.D. MarkA.Warner,M.D. CharlesW.Otto,M.D.

RobertE.Johnstone,M.D.

GregoryK.Unruh,M.D. JohnM.Zerwas,M.D. ArthurM.Boudreaux,M.D. JamesD.Grant,M.D. JohnP.Abenstein,M.D.

StevenL.Sween,M.D.

Ambulatory Anesthesia j
Current Controversies in Adult Outpatient Anesthesia j
Jeffrey L. Apfelbaum, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 115 University of Chicago Pritzker School of Medicine Chicago, Illinois Lecture Objectives: 1) Gain an understanding of current controversial issues in adult outpatient anesthesia, including preoperative evaluation, preparation and patient selection, laboratory screening, practical discharge criteria and choice of optimal cost effective agents and/or techniques; 2) Understand ways to resolve these controversies.

Ambulatory Anesthesia: A Primer for the Occasional Practitioner j

Thomas W. Cutter, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415 University of Chicago Chicago, Illinois Lecture Objectives: 1) Participants will understand what procedures may be performed on ambulatory patients with various comorbidities in specific types of facilities and by what providers; 2) Partici-pants will appreciate the preoperative, intraoperative and postoperative issues that are paramount to ensure efficiency and patient safety; 3) Participants will learn various anesthetic techniques for some of the more common ambulatory procedures.

Effective Management of PONV and Pain in Ambulatory Settings j

Tong J. Gan, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 Duke University Medical Center Durham, North Carolina Lecture Objectives: 1) Understand the mechanisms for the development of PONV and pain; 2) Appreciate the various pharmacological modal-ities for the management of pain and PONV; 3) Learn the effective treatment strategies for these problems in ambulatory anesthesia.

Preoperative Evaluation of the Adult Ambulatory Patient j

Barbara S. Gold, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 University of Minnesota Medical Center Minneapolis, Minnesota Lecture Objectives: 1) Review the essential components of a focused preanes-thetic evaluation; 2) Examine different processes for perform-ing timely and efficient evaluations; 3) Apply evidence-based guidelines in a thoughtful manner; 4) Understand how preanesthetic evaluations can support regulatory and quality initiatives.

The Adult Patient With Morbid Obesity and/or Sleep Apnea Syndrome for Ambulatory Surgery j
Girish P. Joshi, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 University of Texas Southwestern Medical Center Dallas, Texas Lecture Objectives: 1) Learn preoperative evaluation and preparation of the morbidly obese and sleep apnea patients; 2) Appreciate the perioperative challenges in these patients; 3) Justify appro-priate selection of these patients for ambulatory surgical procedures, including bariatric surgery; 4) Understand anesthe-tic considerations that minimize perioperative risks in these patients; 5) Identify criteria for discharge home of these outpatients.

The Geriatric Outpatient: Postoperative Cognitive Dysfunction and Other Concerns j

Kathryn E. McGoldrick, M.D.** . . . . . . . . . . . . . . . . . . . . . . . 502 Westchester Medical Center Valhalla, New York Lecture Objectives: 1) Gain information about demographic projections and their implications for surgical volume and perioperative outcomes; 2) Understand geriatric pharmacokinetics and pharma-codynamics in the context of outpatient surgery; 3) Learn methods to prevent common perioperative complications in the elderly; 4) Appreciate the similarities and differences between delirium and postoperative cognitive dysfunction.

The Anesthesiologist As Administrator: Failing and Succeeding As an Ambulatory Medical Director j

Douglas G. Merrill, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 402 The University of Iowa Iowa City, Iowa Lecture Objectives: 1) Learn techniques to improve the safety of the ambulatory surgical setting and the role of the Medical Director in that process; 2) Learn how to monitor outcomes to drive improve-ment in practice as a means to reduce error and expense; 3) Gain insights in the challenges to management of personnel in union and non-unionized ambulatory surgery settings; 4) Gain insights into the advantages and disadvant-ages of working for an anesthesia group, a large for-profit corporation, a non-profit entity, a community private ASC, and an academic institution.

Ultrasound-Guided Regional Anesthesia for Ambulatory Surgery j

Meg A. Rosenblatt, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 326 Mount Sinai School of Medicine New York, New York Lecture Objectives: 1) Appreciate the advantages and limitations of integrating ultrasound-guided regional anesthesia into a busy ambulatory practice; 2) Understand which ultrasound-guided blocks are useful in ambulatory patients; 3) Know the steps to safely and efficiently perform these blocks.

Office-Based Anesthesia: Challenges and Successes j

Rebecca Twersky, M.D., M.P.H.** . . . . . . . . . . . . . . . . . . . . . . 328 SUNY Downstate Medical Center Brooklyn, New York Lecture Objectives: 1) Learn about patient safety and outcomes in office-based anesthesia; 2) Appreciate appropriate patient and procedure selection; 3) Learn the suitable choices for anesthesia techniques in OBA; 4) Understand practice management for OBA.

Cardiac Anesthesia a
Perioperative Blood Pressure: A New Look at an Old Problem a
Solomon Aronson, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324 Duke University Durham, North Carolina Lecture Objectives: 1) Understand hypertension perioperative risk by sub-classification; 2) Review mechanism of acute circulatory hypertension syndrome; 3) Present evidence-based data supporting the sweet spot or target BP during surgery.

TEE for the Occasional Cardiac Anesthesiologist a

Michael K. Cahalan, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 216 University of Utah Salt Lake City, Utah Lecture Objectives: 1) Present a basic TEE examination that will allow the occasional cardiac anesthesiologist to use TEE effectively during cardiac surgery; 2) Review the published evidence on the impact of TEE in improving the management and outcome of patients undergoing cardiac surgery.

New Developments in Thoracic Anesthesia a

Edmond Cohen, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 The Mount Sinai Medical Center New York, New York Lecture Objectives: 1) Understand the indications and the methods of lung separ-ation including the patient with a difficult airway; 2) Learn the intraoperative management of hypoxemia during one-lung ventilation and strategies for protective lung ventilation; 3) Address the current status of lung volume reduction surgery, pulmonary valves placement and thoracoscopy; 4) Review the present and future of modulating the pulmonary circulation.

Myocardial Ischemia and Postoperative Monitoring a

John E. Ellis, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334 University of Pennsylvania Philadelphia, Pennsylvania Lecture Objectives: 1) Understand the implications of new AHA/ACC guidelines on perioperatiave care of patients with known or suspected coronary artery disease; 2) Learn to manage patients receiving beta blockers, statins, and antiplatelet drugs; 3) Risk-stratify or diagnose patients with myocardial ischemia or infarction.

Preoperative Assessment of the Patient With Cardiac Disease a

Lee A. Fleisher, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319 University of Pennsylvania Philadelphia, Pennsylvania Lecture Objectives: 1) Understand the current guidelines on the preoperative evaluation and preparation of the patient with cardiac disease undergoing noncardiac surgery.

Update on Cardiac Anesthesia a

Glenn P. Gravlee, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 University of Colorado Denver Aurora, Colorado Lecture Objectives: 1) Understand new surgical trends for congestive heart failure and anesthetic implications; 2) Review new coagulation therapy trends in cardiac surgery.

Cardiovascular Pharmacology a
Roberta L. Hines, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Yale University School of Medicine New Haven, Connecticut Lecture Objectives: 1) Describe the pharmacology and application of treatment for vasodilatory shock; 2) Discuss the role of atrial natriuretic peptide in the management of congestive heart failure; 3) Diagnose pulmonary hypertension and identify its impact on right ventricular performance; 4) Emphasize the use of inhaled vasodilators in the treatment of RV failure and pulmonary hypertension.

Cerebral Protection During Cardiac Surgery a

Charles W. Hogue, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304 The Johns Hopkins Hospital Baltimore, Maryland Lecture Objectives: Understand the spectrum of manifestations of cerebral injury after cardiac surgery, the proposed mechanisms for this disorder, and an evidence-based approach for reducing its frequency.

Anesthesia for Valvular Heart Surgery a

William E. Johnston, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 407 Scott and White Hospital Temple, Texas Lecture Objectives: 1) Understand the pathophysiology of valvular heart lesions including mitral stenosis and regurgitation, aortic stenosis and regurgitation, hypertrophic cardiomyopathy; 2) Discuss anesthetic management of patients with valvular heart disease presenting for noncardiac surgery and management of perioperative hypotension and low cardiac output in the patient with valvular heart disease.

Anesthesia for Patients With Valvular Heart Disease for Non-Cardiac Surgery a
Steven N. Konstadt, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Maimonides Medical Center New York, New York Lecture Objectives: 1) Use case studies to describe an approach to the patient with valvular heart disease who is undergoing non-cardiac surgery; 2) Understand the pathophysiology of the lesion, perform an appropairiate preoperative evaluation, and formulate the anesthetic goals and therapeutic options.

Abdominal Aortic Aneurysm Repair and Endovascular Stenting a

David A. Lubarsky, M.D., M.B.A.** . . . . . . . . . . . . . . . . . . . . . 120 University of Miami Miller School of Medicine Miami, Florida Lecture Objectives: 1) Understand the physiology of AAA surgery, appreciate the latest data on beta blocker use and other pharmacologic protection; 2) Understand the comparison between open AAA repair and endovascular repair.

Central Venous Pressure and Pulmonary Artery Pressure Monitoring a

Jonathan B. Mark, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 Duke University Medical Center Durham, North Carolina Lecture Objectives: 1) Recognize complications of central venous and pulmonary artery catheterization and adopt procedures that will reduce the risk of these adverse events; 2) Understand the technical considerations and physical principles that allow accurate measurement of intravascular pressures; 3) Learn to recognize characteristic waveforms of central venous and pulmonary artery pressure and will learn how these are altered in disease states; 4) Review current evidence for pulmonary artery catheterization and its effect on patient outcome.

Strategies for Blood Conservation in Cardiac Surgery a

C. David Mazer, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 University of Toronto St. Michaels Hospital Toronto, Ontario, Canada Lecture Objectives: 1) Learn about the pharmacologic strategies for blood conservation in cardiac surgery including anti-fibrinolytic therapies and pro-coagulant complexes; 2) Understand transfusion risks and management of blood transfusion.

Management of the Patient With Pulmonary Hypertension and Right Ventricular Failure a
George F. Rich, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 510 University of Virginia Charlottesville, Virginia Lecture Objectives: 1) Understand the differences between the pulmonary circulation/right ventricle and the systemic circulation/left ventricle; 2) Identify factors that alter pulmonary vascular resistance; 3) Discuss the diagnosis and treatment of pulmonary hypertension; 4) Discuss the evaluation and treatment of right ventricular failure.

Regional Versus General Anesthesia for Vascular Surgery Patients a

Peter Rock, M.D., M.B.A.** . . . . . . . . . . . . . . . . . . . . . . . . . . 323 University of Maryland School of Medicine Baltimore, Maryland Lecture Objectives: 1) Understand the effects of regional and general anesthesia on the perioperative stress response; 2) Discuss advantages and disadvantages of regional and general anesthesia in vascular surgery patients; 3) Review the literature relevant to the effect of the type of anesthesia on perioperative outcomes.

Perioperative Pacemaker and Defibrillator Management: Why the Controversy? a

Marc A. Rozner, Ph.D., M.D.** . . . . . . . . . . . . . . . . . . . . . . . . 423 University of Texas MD Anderson Cancer Center Houston, Texas Lecture Objectives: 1) Understand the operation of an implantable cardiac pulse generator; 2) Learn to distinguish a pacemaker from an ICD; 3) Examine x-ray codes to identify the manufacturer of a cardiac generator; 4) Discuss the care of a patient with an implanted cardiac pulse generator; 5) Discuss issues related to manufacturer alerts and recalls for implanted cardiac generators and leads.

Utility of TEE in the Integrated Management of Patients Undergoing Valvular Heart Surgery a
Robert M. Savage, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Cleveland Clinic Cleveland, Ohio Lecture Objectives: 1) Trends in population and valvular heart disease influencing future; 2) New developments likely to influence management of patients; 3) Comprehensive and integrated management of valve surgery patients; 4) Critical issues in the intraoperative management of valve surgery patients; 5) Organization of the TEE exam in valve surgery.

Utility of TEE in Non-Cardiac Surgery a

Stanton K. Shernan, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Brigham and Womens Hospital Boston, Massachusetts Lecture Objectives: Understand how perioperative transesophageal echocardiography can be used as a monitor of cardiac performance and diagnostic tool in patients undergoing non-cardiac surgical procedures.

Hematologic Challenges in Cardiothoracic and Vascular Surgery a

Linda J. Shore-Lesserson, M.D.* . . . . . . . . . . . . . . . . . . . . . . . 206 Montefiore Medical Center New York, New York Lecture Objectives: 1) Understand the balance between bleeding and clotting in physiologic homeostasis; 2) Appreciate the risks of bleeding in cardiac surgery and its current management; 3) Discuss heparin-induced thrombocytopenia and management of patients taking anti-platelet drugs in cardiac and non-cardiac surgical applications.

Critical Care Medicine b

Basic Science Review: Respiratory Physiology and Gas Exchange b
Luca M. Bigatello, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Massachusetts General Hospital Boston, Massachusetts Lecture Objectives: 1) Learn the physiology of normal and abnormal gas exhange in the lungs; 2) Apply this physiology in the clinical management of common causes of respiratory failure in the perioperative setting; 3) Understand respiratory mechanics, how they change under anesthesia, and how they change with various disease states.

What Every Anesthesiologist Should Know About Sepsis-and Why b

Clifford S. Deutschman, M.D.** . . . . . . . . . . . . . . . . . . . . . . . 420 University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Lecture Objectives: 1) Understand the physiology of sepsis; 2) Learn the commonalities between sepsis-induced changes in organ and cell function and those induced by anesthesia; 3) Learn strategies for the support of septic patients as they apply to the perioperative period.

Integrating Evidence-Based Medicine Into Perioperative Care b

Brenda G. Fahy, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 University of Kentucky College of Medicine Lexington, Kentucky Lecture Objectives: 1) Outline the principles of evidence-based medicine with emphasis of perioperative care; 2) Identify those areas of medicine where evidence-based approaches aid in making decisions; 3) Provide examples of improved outcomes associated with the application of evidence-based medicine to the perioperative setting.

Mechanical Ventilatory Support: What Every Anesthesiologist Should Know b

Michael A. Gropper, M.D., Ph.D.* . . . . . . . . . . . . . . . . . . . . . . 123 University of California San Francisco San Francisco, California Lecture Objectives: 1) Understand the mechanisms of ventilator associated lung injury; 2) Learn strategies for ventilating patients in the ICU and OR; 3) Appreciate the indications for the different modes of mechanical ventilation, and learn how to apply them in the perioperative setting; 4) Understand the limitations of OR/Anesthesia machine ventilators.

Agitation and Delirium: What Do I Do? b

William E. Hurford, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 University of Cincinnati Cincinnati, Ohio Lecture Objectives: 1) Understand the causes of delirium and agitation in perioperative patients; 2) Learn clinical approaches to evaluate these patients; 3) Learn strategies for the management of these patients in the perioperative setting, especially in the PACU.

Pulmonary Hypertension: Physiology and Intraoperative Management b

Eric Jacobsohn, M.B.,Ch.B.**. . . . . . . . . . . . . . . . . . . . . . . . . 134 University of Manitoba Winnipeg, Manitoba, Canada Lecture Objectives: 1) Learn the common causes of pulmonary hypertension; 2) Understand the pathophysiology of pulmonary hypertension; 3) Appreciate the differences between different anesthetic techniques and strategies for the management of these patients.

Perioperative Gas Exchange and Acid Base Management b

Mark T. Keegan, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Mayo Clinic College of Medicine Rochester, Minnsota Lecture Objectives: 1) Understand the changes in lung mechanics and gas exchange during general anesthesia and in the immediate post-operative period; 2) Learn the management of patients who are difficult to oxygenate or ventilate in the operating room; 3) Appreciate the different causes of acid-base abnormalities in the perioperative setting, and understand the evaluation and management of these disorders.

Coagulation Abnormalities Made Easy b

Linda Lin Liu, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 University of California, San Francisco San Francisco, California Lecture Objectives: 1) Explain the modern view of the coagulation cascade; 2) List the most common and important causes of abnormal coagulation; 3) Define an algorithm to manage coagulopathic patients, and discuss its application in various clinical settings; 4) Identify agents that are used to modulate coagulation, and discuss their appropriate clinical use.

Adapting ACLS to the Perioperative Period b

Gerald A. Maccioli, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 American Anesthesiology of North Carolina Raleigh, North Carolina Lecture Objectives: 1) Understand the differences between the perioperative setting and the scenarios for which ACLS was developed; 2) Learn the scenarios unique to the perioperative setting, for which ACLS provides little or no guidance; 3) Learn about the application of adapted ACLS algorithms to perioperative patients.

Understanding Clinical Hemodynamics b

Michael F. OConnor, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 409 The University of Chicago Chicago, Illinois Lecture Objectives: 1) Understand circulatory physiology and how it changes with anesthesia and various shock states; 2) Learn how to systematically evaluate a patient with hypotension; 3) Learn how to make maximal use of information from various clinical monitors in the management of the patient with an unstable circulation.

Perioperative Care of the Patient With Renal Dysfunction: You Can Make a Difference b
Robert Sladen, M.B.,Ch.B.* . . . . . . . . . . . . . . . . . . . . . . . . . . 238 College of Physicians and Surgeons of Columbia University New York, New York Lecture Objectives: 1) Understand the implications of renal dysfunction and renal failure on outcome; 2) Learn the perioperative renal physiologic response to anesthesia and surgery; 3) Understand the pathogenesis of acute renal failure and dysfunction; 4) Learn about various strategies to protect the kidneys from injury, and the evidence that supports their use.

Brain Injury: What Do I Need to Know? b

Michael Souter, M.B.,Ch.B.* . . . . . . . . . . . . . . . . . . . . . . . . . 405 University of Washington Seattle, Washington Lecture Objectives: 1) Learn the mechanisms of brain injury; 2) Understand the implications of brain injury on perioperative management; 3) Learn the various strategies for the management of brain injured patients in the perioperative period.

Transfusion Therapy: Optimal Use of Blood Products b

Stephen D. Surgenor, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 207 Lebanon, New Hampshire Lecture Objectives: 1) Learn the most recent guidelines and indications for the transfusion of red cells, fresh frozen plasma, and platelets; 2) Appreciate how storage changes these products. Learn about the complications that can arise from these changes; 3) Learn about the complications of transfusion.

Risk, Uncertainty, and Medical Decision-Making: How Can We Make Better Decisions? b
Avery Tung, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 The University of Chicago Chicago, Illinois Lecture Objectives: 1) Review characteristics of human decision-making under conditions of irreducible risk and uncertainty; 2) Examine how such characteristics affect decision-making in medicine; 3) Explore strategies for using evidence and experience to make better decisions.

The Latest in ICU Technology: Can It Help Me in the Operating Room? b

Michael H. Wall, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509 Barnes-Jewish Hospital St. Louis, Missouri Lecture Objectives: 1) Learn about new technology in the ICU, including various hemodynamic monitors. Appreciate the strengths and weaknesses of each; 2) Learn about the appropriate use of these devices and how they are likely to be incorporated into perioperative medicine; 3) Explore and understand how these devices will change the practice of anesthesia.

Basic Science Review: Modulating Cell Deaththe Future of Anesthesia and Critical Care? b
Yoram G. Weiss, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 Hadassah Hebrew University Medical School Jerusalem, Israel Lecture Objectives: 1) Understand the importance of cell death pathways in health and disease; 2) Learn the importance of modulating these pathways in diseases which cause inflammation in the lungs.

Fundamentals of Anesthesia m
PACU Emergencies m
Maged Y. Argalious, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 419 Cleveland Clinic Lerner College of Medicine Cleveland, Ohio Lecture Objectives: 1) Identify management strategies for various PACU emergencies; 2) Develop precautionary measures to reduce their occurrence.

Perioperative Management of the Diabetic Patient m

Daniel R. Brown, M.D., Ph.D.** . . . . . . . . . . . . . . . . . . . . . . . 209 Mayo Clinic Rochester, Minnesota Lecture Objectives: 1) Define diabetes mellitus and review associated end-organ pathology; 2) Discuss anesthetic implications of diabetes and management of acute glycemic complications; 3) Review current literature addressing inpatient glycemic control and patient outcomes.

As We Heal the Body Do We Harm the Brain? m

Deborah J. Culley, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 Brigham and Womens Hospital Boston, Massachusetts Lecture Objectives: 1) Understand vulnerability factors for adverse cognitive outcomes in elders undergoing surgical procedure: abnormal physiology, genetic predisposition, inflammation, drugs, sleep disturbances, pain and frailty; 2) Understand vulnerability factors for adverse cognitive outcomes in elders in the ICU: abnormal physiology, genetic predisposition, inflammation, drugs, sleep disturbances, pain and frailty; 3 ) Learn what anesthesiologists should consider to decrease the risk of postoperative cognitive morbidity in elders.

Trauma Anesthesiology m
Richard P. Dutton, M.D., M.B.A.* . . . . . . . . . . . . . . . . . . . . . . 221 University of Maryland School of Medicine Baltimore, Maryland Lecture Objectives: 1) Understand the unique features of trauma anesthesiology; 2) Understand the basic approach to emergency airway management; 3) Understand resuscitation from hemorrhagic shock; 4) Understand the implications of severe traumatic brain injury for the anesthesiologist and intensivist.

Perioperative Consideration for the Morbidly Obese m

Thomas J. Ebert, M.D., Ph.D.* . . . . . . . . . . . . . . . . . . . . . . . . 224 Medical College of Wisconsin Milwaukee, Wisconsin Lecture Objectives: 1) Understand the pathophysiology of morbid obesity and how it affects perioperative anesthetic management; 2) Review the issues related to airway management of the morbidly obese patient, including postioning, preoxygenation, intubation and ventilation; 3) Discuss therapeutic strategies for post-operative pain management in the obese patient that is challenged by co-existing diseases including OSA.

Advances in Intravenous Anesthesia m

Talmage D. Egan, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426 University of Utah School of Medicine Salt Lake City, Utah Lecture Objectives: Understand how new concepts, drugs and technology are changing the practice of intravenous anesthesia and making total intravenous anesthesia a popular alternative for the provision of general anesthesia.

Heart Failure-What You Need to Know for Perioperative Management m

John H. Eisenach, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 Mayo Clinic Rochester, Minnesota Lecture Objectives: 1) Review the classification of HF; 2) Review the causes of HF; 3) Be able to diagnose HF in the pre-op holding area; 4) Conceptualize the pathogenesis and treatment strategy; 5) Review the perioperative goals in HF.

Hazards of the Anesthesia Workstation m

James B. Eisenkraft, M.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . 317 Mount Sinai School of Medicine New York, New York Lecture Objectives: 1) Understand how use of the anesthesia workstation can result in critical incidents and adverse outcomes; 2) Appreciate safety features of contemporary systems; 3) Develop strategies to promote safer use of the anesthesia workstation.

Endocrine Emergencies m
William R. Furman, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Vanderbilt University School of Medicine Nashville, Tennessee Lecture Objectives: Understand the pathophysiology and perioperative treatment of patients with emergency conditions due to adrenal insufficiency, pituitary hemorrhage, thyroid storm, and pheochromocytoma.

Physics in Anesthesiology (Basic Science Review) m

Jeffrey B. Gross, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 University of Connecticut School of Medicine Farmington, Connecticut Lecture Objectives: 1) Understand basic principles of pressure and flow measurement; 2) Understand the principles of anesthetic vaporizers and flowmeters; 3) Understand the operation of open, semi-open, semi-closed and closed breathing systems; 4) Understand basic principles and calculations for administering closed circuit anesthesia.

Current Concepts in the Management of the Difficult Airway m

Carin A. Hagberg, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 The University of Texas Medical School at Houston Houston, Texas Lecture Objectives: 1) Discuss the clinical applications and describe the basic operation of new airway devices; 2) Recognize the use of these devices in management of the difficult airway; 3) Apply both nonsurgical and surgical airway devices in emergent setting with particular focus on the difficult or failed airway, emphasizing rescue strategies.

Pharmacokinetics and Pharmacodynamics That Make Sense m

Kenward B. Johnson, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 433 University of Utah Salt Lake City, Utah Lecture Objectives: 1) Appreciate key concepts in pharmacokinetics and pharmacodynamics that influence the answer to What is an appropriate dose for my patient? 2) Understand important considerations of biophase in predicting drug effect; 3) Appreciate how the use of computer simulation can be used to produce a picture of anticipated drug levels and drug effect.

Strategies for Success in One-Lung Anesthesia m

Jerome M. Klafta, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430 University of Chicago Medical Center Chicago, Illinois Lecture Objectives: 1) Recognize common and uncommon causes of lung separation failure and employ strategies for success; 2) Integrate evidence-based recommendations for management of one-lung ventilation; 3) Describe approaches to lung separation in patients with difficult airways.

Drug Interactions for the Anesthesiologist m

P. A. Klock, Jr., M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 University of Chicago Chicago, Illinois Lecture Objectives: 1) Understand the mechanisms of drug interactions; 2) Learn examples of important perioperative drug interactions; 3) Discover print and electronic resources that help physicians deal with drug interactions.

Hemodynamic Monitoring From CVP to Pulse Contour Analysis m

Andrew B. Leibowitz, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 219 Mount Sinai School of Medicine New York, New York Lecture Objectives: 1) Understand the physiologic basis of various hemodynamic monitors; 2) Be aware of their clinical applications; 3) Know the evidence with regard to these monitors effect on clinical outcome.

Anaphylaxis and Adverse Drug Reactions m

Jerrold Levy, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428 Emory University School of Medicine Altlanta, Georgia Lecture Objectives: 1) Review the different life-threatening allergic and adverse drug reactions a clinician may encounter; 2) Understand different mechanisms of anaphylaxis and discuss agents most often responsible for reactions including drugs, blood products, and environmental agents including latex; 3) Discuss therapeutic approaches to the treatment and prevention of anaphylactic reactions.

The Neuromuscular Transmission: New Developments That May Change Your Practice m
Cynthia A. Lien, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Weill Cornell Medical College New York, New York Lecture Objectives: 1) Review new findings on the physiology of neuromuscular transmission; 2) Examine the impact of these findings on our understanding of neuromuscular blockade; 3) Explore the pharmacology of new neuromuscular blocking and reversal agents.

Consciousness, Awareness, and Anesthesia m

George Mashour, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 University of Michigan Medical School Ann Arbor, Michigan Lecture Objectives: 1) Understand the basic neural correlates of consciousness; 2) Learn how general anesthetics affect the neural correlates of consciousness; 3) Understand the incidence, risk factors, and prevention of awareness during general anesthesia.

Technological Challenges for the Anesthesiologist During Disasters m

Joseph H. McIsaac, III, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . 416 University of Connecticut Hartford, Connecticut Lecture Objectives: 1) Understand the vulnerabilities of the technical infrastructure necessary for modern practice; 2) Understand techniques to mitigate against cyber attack and the effects of electro-magnetic pulse; 3) Articulate ways of practicing medicine despite prolonged power failure (months to years).

Update on Transfusion Medicine m

Ronald D. Miller, M.D.*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 University of California, San Francisco San Francisco, California Lecture Objectives: 1) Indications for blood transfusions in differing clinical situations; 2) Analysis of transfusion-caused and -related death; 3) Non fatal complications of transfusions; 4) Influence of the duration of blood storage; 5) The future of synthetic blood; 6) International comparison of blood transfusion practice.

Perioperative Management of the Patient With Pulmonary Hypertension m

Ronald G. Pearl, M.D., Ph.D.** . . . . . . . . . . . . . . . . . . . . . . . . 203 Stanford University Stanford, California Lecture Objectives: 1) Understand the etiologies, pathophysiology and pharmacology of pulmonary hypertension; 2) Use this information to diagnose and manage perioperative complications in patients with pulmonary hypertension.

Mechanism of Inhaled Anesthetic Action in the Brain: Why We Know So Much and Understand So Little m
Misha Perouansky, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 504 University of Wisconsin Madison, Wisconsin Lecture Objectives: 1) Understand the development of research in anesthetic mechanism and the current state of relevant factual knowledge; 2) Gain insight into the current understanding of anesthetic actions in the brain that lead to the major desirable anesthetic endpoints: amnesia, unconsciousness, immobility; 3) Limitations of our current understanding and the inherent difficulties of research in this area; 4) Familiarization with current research strategies on the molecular, cellular, network and whole animal levels which generated the available knowledge and that will be used to advance our understanding.

Approach to the Patient Who May Have a Bleeding Disorder m

Charise T. Petrovitch, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 137 VA Medical Center Washington, District of Columbia Lecture Objectives: 1) Understand the basic mechanisms of coagulation; 2) Appre-ciate some of the commonly acquired bleeding disorders; 3) Develop an approach to the patient who might have a bleeding disorder, both in the preoperative period and during the intraoperative time frame.

Current Concepts in Orthopedic Anesthesia m

Andrew D. Rosenberg, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . 106 New York University Hospital for Joint Diseases New York, New York Lecture Objectives: 1) Understand the basics of ultrasound and how to perform regional anesthesia utilizing ultrasound; 2) Describe the use of spinal cord monitoring techniques during a spine procedure; 3) Discuss the issue of postoperative visual loss and spine surgery.

Awake Intubations Made Easy! m

William H. Rosenblatt, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . 126 Yale University School of Medicine New Haven, Connecticut Lecture Objectives: 1.) Describe which patients are best managed with awake intubation 2.) Describe a 6-point plan to facilitate and complete awake intubation 3.) Apply non-invasive blocks for complete airway analgesia.

Temperature Monitoring: Consequences and Prevention of Mild Perioperative Hypothermia m

Daniel I. Sessler, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 The Cleveland Clinic Cleveland, Ohio Lecture Objectives: 1) Learn about: a) Temperature monitoring; b) Normal thermoregulation; c) The effects of neuraxial and general anesthesia on thermoregulation; d) Perioperative heat balance; e) Hypothermiainduced complications.

Cognition and Delirium m

Jeffrey H. Silverstein, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Mount Sinai School of Medicine New York, New York Lecture Objectives: 1) Understand the aging processes affecting the central nervous system; 2) Understand the diagnosis and management of postoperative delirium; 3) Understand the current art and science of postoperative cognitive dysfunction.

Preoperative Evaluation and Preparation m

BobbieJean Sweitzer, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 310 University of Chicago Chicago, Illinois Lecture Objectives: 1) Improve development and implementation of preoperative evaluation processes and guidelines; 2) Learn about evidence-based evaluation, testing and management strategies; 3) Apply knowledge learned to preoperative clinical settings, day of surgery evaluation, and joint efforts with primary care, specialists and/or surgical colleagues; 4) Use the suggested guidelines and proposals for a broad spectrum of patients in a variety of settings.

New Drug Delivery Systems m

Eugene R. Viscusi, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507 Thomas Jefferson University Philadelphia, Pennsylvania Lecture Objectives: 1) Appreciate the unmet needs of existing technologies; 2) Understand new and emerging drugs and delivery systems; 3) Be able to apply new drugs and delivery systems to clinical practice.

Perioperative Management of the Patient With Respiratory Disease m

David O. Warner, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Mayo Clinic Rochester, Minnesota Lecture Objectives: 1) Understand the mechanisms causing pulmonary complications; 2) Learn how to prepare patients with pulmonary disease for surgery; 3) Appreciate the latest management techniques to prevent and treat pulmonary complications.

Perioperative Positioning Problems You Hope You Never Have m

Mark A. Warner, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Mayo Clinic College of Medicine Rochester, Minnesota Lecture Objectives: Understand the probable etiologies and typical outcomes of common as well as unusual complications associated with patient positioning problems.

Neuroanesthesia c
Intraoperative Awareness, Best Practice: Its Not Just Science c
Incidence and Prevention of Intraoperative Awareness: The Science Daniel J. Cole, M.D.** - Moderator. . . . . . . . . . . . . . . . . . . . . 233 Mayo Clinic College of Medicine Phoenix, Arizona The ASA Practice Advisory for Intraoperative Awareness and Brain Function Monitoring Jeffrey L. Apfelbaum, M.D.** University of Chicago Pritzker School of Medicine Chicago, Illinois The Impact of Brain Function Monitors on Medicolegal Risk Karen B. Domino, M.D., M.P.H.** University of Washington School of Medicine Seattle, Washington Be Aware: Patient Advocacy Groups Carol Weihrer* Anesthesia Awareness Campaign, Inc. Reston, Virginia Lecture Objectives: Understand and apply to practice: 1) The scientific literature regarding the incidence and prevention of intraoperative awareness; 2) The ASA practice advisory on brain function monitoring in prevention of intraoperative awareness; 3) Patient advocacy and medicolegal influences.

Perioperative Cerebral Homeostasis in Neurosurgical Patients: Physiology and Application c

Audre A. Bendo, M.D.** Moderator . . . . . . . . . . . . . . . . . . 129 SUNY Downstate Medical Center Brooklyn, New York Intraoperative Brain Protection Piyush M. Patel, M.D.** University of California, San Diego San Diego, California Fluids and Metabolic Management Donald S. Prough, M.D.** The University of Texas Medical Branch Galveston, Texas Influence of Cerebral Blood Flow, Pressure and Anesthetics Christian P. Werner, M.D.* Johannes Gutenberg University Mainz Mainz, Germany Lecture Objectives: 1) Understand the physiology and metabolic conditions that require careful attention and management in neurosurgical patients; 2) Understand the influence of cerebral blood flow, pressure and anesthetics on cerebral homeostasis and outcome; 3) Learn the physiologic basis for perioperative brain protection and current status of clinical trials; 4) Develop a rational approach for prevention and treatment of perioperative homestatic disorders.

Anesthesia for Spine Surgery c

Susan Black, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 University of Alabama School of Medicine Birmingham, Alabama Lecture Objectives: 1) Understand the anesthetic issues unique to complex spine surgery; 2) Understand the role of intraoperative monitoring and the anesthetic management for optimal neurologic monitoring; 3) Understand the potential complications and their avoidance.

Fragile BrainsThe Very Young and the Old c

James E. Cottrell, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 SUNY Downstate Medical Center Brooklyn, New York Lecture Objectives: 1) Understand the special risks that anesthesia presents to patients with fragile brains; 2) Learn to consider precautions that might lower those risks.

Brain Failure in Aging and the Perioperative Period c

Gregory J. Crosby, M.D.*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Harvard Medical School Boston, Massachusetts Lecture Objectives: Understand the neurobiology and cognitive consequences of normal brain aging and dementia (Alzheimers disease); 2) Learn to use this information as a basis for examining how perioperative events can make a brain with marginal function fail.

Misunderstandings in Neuroanesthesia: How May I Hurt Thee, Let Me Count the Ways c
John C. Drummond, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 213 University of California, San Diego San Diego, California Lecture Objectives: Have an awareness of elements of physiology and pharmacology relevant to neuroanesthesia that are commonly misunderstood and that have adverse effects on patients undergoing neurosurgery.

Neurovascular Disease: Anesthetic Concerns and Management c

William L. Lanier, Jr., M.D.** Moderator . . . . . . . . . . . . . . . 229 Mayo Clinic Rochester, Minnesota Patient With Intracranial Aneurysm Adrian W. Gelb, MBChB** University of California, San Francisco San Francisco, California Patient With Carotid Artery Disease Jeffrey J. Pasternak, M.D.** Mayo Clinic Rochester, Minnesota Patient for Interventional Neuroradiology William L. Young, M.D.** University of California, San Francisco San Francisco, California Lecture Objectives: 1) Identify effective strategies for anesthetic evaluation and perioperative management of intracranial aneurysms and carotid artery disease and their complications; 2) Understand anesthetic concerns and management for surgical and endovascular treatments.

Cervical Spine Motion, Cervical Spine Surgery and the Unstable Neck c
Michael M. Todd, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 University of Iowa Hospitals Iowa City, Iowa Lecture Objectives: Understand cervical spine anatomy and motion and be able to apply that understanding to improve decision-making and care of patients with abnormalities of the cervical spine, particularly patients with spinal instability.

Anesthesia for Functional Neurosurgery c

Barbara M. Van de Wiele, M.D.** . . . . . . . . . . . . . . . . . . . . . . 139 David Geffen School of Medicine Los Angeles, California Lecture Objectives: 1) Review indications for and modalities used for perioperative functional brain mapping; 2) Understand how functional brain mapping influences choice of anesthetic technique; 3) Learn about key issues for preoperative preparation, anesthesia management strategies, and optimizing safety and satisfaction of patients undergoing intraoperative functional brain mapping.

Anesthesia for Craniotomy c

David S. Warner, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508 Duke University Medical Center Durham, North Carolina Lecture Objectives: 1) Learn the evidence-based advantages of evolving anesthetic techniques in neurosurgery; 2) Understand the rationale for anesthetic choice for specific neurosurgical procedures.

Obstetric Anesthesia d
Neonatal Resuscitation d
Valerie A. Arkoosh, M.D., M.P.H.** . . . . . . . . . . . . . . . . . . . . . 404 University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Lecture Objectives: 1) Predict which fetuses are likely to require resuscitation; 2) Describe the transition from fetal to neonatal physiology; 3) Describe the recent changes in the NALS algorithm.

Patient Safety and Improved Communication Skills in Obstetric Anesthesia d

David J. Birnbach, M.D., M.P.H.**. . . . . . . . . . . . . . . . . . . . . . 101 UM-JMH Center for Patient Safety Miami, Florida Lecture Objectives: Describe the ways in which improved communication among members of the labor and delivery team can improve outcome and decrease risk in obstetric anesthesia.

Anesthetic Management of the Morbidly Obese Parturient d

Brenda A. Bucklin, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 University of Colorado Denver Aurora, Colorado Lecture Objectives: 1) Describe the additional cardiopulmonary alterations superimposed on the normal physiologic changes of pregnancy in the morbidly obese parturient; 2) Formulate an anesthetic plan for the management of the morbidly obese parturient.

Problems in Obstetric Anesthesia: Blood Pressure, Blood Loss, and Blood Patch d
David H. Chestnut, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 314 Gundersen Lutheran Health System La Crosse, Wisconsin Lecture Objectives: 1) Develop strategies for the prevention and treatment of hypotension during regional anesthesia for cesarean delivery; 2) Select and describe an appropriate regional anesthesia technique for cesarean delivery in preeclamptic women; 3) Describe the management of parturients at risk for obstetric hemorrhage, including uterine rupture and placenta previa/accreta; 4) Describe the treatment of postdural puncture headache, including therapeutic and prophylactic epidural blood patch.

Management of the Parturient With Cardiovascular Disease d

Lisa M. Councilman, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 305 Texas A&M Health Science Center Temple, Texas Lecture Objectives: 1) Describe the anesthetic implications of cardiovascular disease in the pregnant patient, including congenital heart disease, ischemic heart disease, and peripartum cardio-myopathy; 2) Formulate an appropriate anesthetic plan for pregnant patients with cardiac disease.

Post Dural Puncture Headache: How to Keep It the Patients Headache d

Robert R. Gaiser, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Lecture Objectives: 1) Describe the pathophysiology of PDPH; 2) Identify risk fac- tors for PDPH; 3) Develop a plan for the prevention of PDPH; 4) Develop a therapeutic plan for the treatment of PDPH.

Anesthetic Management of the Preeclamptic Patient d

Joy Hawkins, M.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 University of Colorado Denver School of Medicine Aurora, Colorado Lecture Objectives: 1) Describe the underlying pathophysiology of preeclampsia and the other hypertensive disorders of pregnancy; 2) Formulate an anesthetic management plan for labor and cesarean delivery in the preeclamptic patient.

Epidural Analgesia for Labor-Safety and Success d

Barbara L. Leighton, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Washington University Saint Louis, Missouri Lecture Objectives: Describe epidural placement techniques and the selection of local anesthetics that increase the safety and likelihood of success of labor analgesia.

Obstetric Emergencies and Anesthetic Management d

Craig M. Palmer, M.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 University of Arizona College of Medicine Tucson, Arizona Lecture Objectives: 1) Understand the pathophysiology of common obstetric emergencies; 2) Learn to recognize parturients at risk for complications; 3) Review the recognition of the non-reassuring FHR trace, in-uteroresuscitation, and indications for delivery; 4) Learn new options for management of obstetric emergencies and anesthetic considerations.

Anesthesia for the Pregnant Patient Undergoing Nonobstetric Surgery d

Mark A. Rosen, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503 University of California, San Francisco San Francisco, California Lecture Objectives: 1) Discuss the potential teratogenicity of anesthetics; 2) Formulate an anesthetic plan for surgery performed during pregnancy; 3) Discuss the anesthetic management of in-utero surgery including EXIT procedures.

Coagulopathy and Postpartum Hemorrhage Implications for Treatment d

Barbara M. Scavone, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 127 Northwestern University Feinberg School of Medicine Chicago, Illinois Lecture Objectives: 1) Gain a greater understanding of the coagulopathy that often accompanies postpartum hemorrhage; 2) Describe recent recommendations regarding treatment of postpartum hemorrhage and its accompanying coagulopathy.

Anesthetic Effects on the Fetus and Newborn d

B. Scott Segal, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418 Harvard Medical School Boston, Massachusetts Lecture Objectives: Describe the possible adverse effects of maternal analgesia and anesthesia on the fetus and newborn.

Anesthesia for Cesarean Delivery d

Lawrence C. Tsen, M.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Harvard Medical School Boston, Massachusetts Lecture Objectives: Describe the trends affecting the incidence of cesarean delivery; 2) Discuss options that anesthesia providers can use to prevent cesarean delivery; 3) Discuss anesthetic technique failures immediately prior to or during operative deliveries and develop preventative and therapeutic measures; 4) Discuss optimal anesthetic cocktails for intraoperative and postoperative success.

Anesthetic Management of the Pregnant Patient With Human Immunodeficiency Virus d

David J. Wlody, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 State University of New York Brooklyn, New York Lecture Objectives: 1) Describe the epidemiology, pathophysiology, and treatment of HIV during pregnancy; 2) Formulate an appropriate anesthe-tic plan for the management of the parturient with HIV.

Neuraxial Labor Analgesia and Pregnancy Outcome: Fact and Fiction d

Cynthia A. Wong, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 Northwestern University Feinberg School of Medicine Chicago, Illinois Lecture Objectives: Describe the effects, if any, of neuraxial labor analgesia on the progress of labor, rate of cesarean section, and need for instrumental delivery.

Pain Medicine i
Update on Pharmacological Management of Pain i
Honorio T. Benzon, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330 Northwestern University Feinberg School of Medicine Chicago, Illinois Lecture Objectives: 1) Update the pharmacology of opioids, antidepressants, anticonvulsants, and skeletal muscle relaxants in relation to pain management; 2) Discuss the efficacy and side effects of opioids, antidepressants, and anticonvulsants; 3) Present evidence-based recommendations on the pharmacologic management of the different pain syndromes.

Intrathecal Drug Delivery for Chronic Pain: Indications, Management and Complications i
Asokumar Buvanendran, M.D.* . . . . . . . . . . . . . . . . . . . . . . . 113 Rush University Medical Center Chicago, Illinois Lecture Objectives: 1) Understand the rationale and the pharmacological basis for the intrathecal drug therapy; 2) Optimize patient selection and trials options for intrathecal drug therapy; 3) Review the surgi-cal implant of the intrathecal drug delivery system; 4) Examine common complications and trouble-shooting patients with intrathecal drug delivery system; 5) Review the consensus guidelines on the pharmacological agent of choice for intrathecal drug delivery.

Opioids and the Law: Towards Balanced Practice i

David L. Caraway, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422 Center for Pain Relief, Tri-State Huntington, West Virginia Lecture Objectives: Appreciate the controversies and challenges associated with dispensing of opioid analgesics for the treatment of chronic pain.

Diagnosis and Treatment of Cancer-Related Pain i

Oscar A. De Leon-Casasola, M.D.** . . . . . . . . . . . . . . . . . . . . 425 Roswell Park Cancer Institute Buffalo, New York Lecture Objectives: 1) Review the fundamental steps for evaluating cancer pain in patients; 2) Discuss the available therapies for managing cancer pain; 3) Develop a plan for evaluating and treating cancer pain patients.

Spinal Cord, Peripheral Nerve, and Peripheral Nerve Field Stimulation for the Treatment of Pain i
Timothy R. Deer, M.D.*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 The Center for Pain Relief Charleston, West Virginia Lecture Objectives: Understand the proper use and indications of spinal cord, peripheral nerve and novel applications of stimulating the nervous system.

Pain: Mechanism and Activity at the Spinal Cord i

James C. Eisenach, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 Wake Forest University School of Medicine Winston Salem, North Carolina Lecture Objectives: Understand the central role of the spinal cord in pain transmission and how this explains the different approches to pain treatment used in different settings.

Diagnosis and Management of Myofascial Pain i

F. Michael Ferrante, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 David Geffen School of Medicine at UCLA Los Angeles, California Lecture Objectives: Understand the role of history and physical diagnosis underlying the treatment of myofascial pain along with the potential role of neurotoxins as therapeutic agents.

Spinal Injections for the Diagnosis and Treatment of Chronic Pain i

Marc A. Huntoon, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Mayo Clinic Rochester, Minnesota Lecture Objectives: 1) Understand the current role for spinal injections in diagnosing and treating pain; 2) Articulate the problem of false positive blocks and their impact on management of chronic pain; 3) Develop strategies for incorporating spinal blocks into contemporary practice.

Treatment of Compression Fractures by the Anesthesiologist: Kyphoplasty and Vertebroplasty i

Philip S. Kim, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Center for Pain Medicine Bryn Mawr, Pennsylvania Lecture Objectives: 1) Understand the comprehensive overview of the procedures; 2) Appreciate the distinct advantages and disadvantages of each procedure; 3) Learn the appropriate indications and techniques of each procedure.

Complex Regional Pain Syndrome: Diagnosis and Management i

Timothy R. Lubenow, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . 432 Rush University Medical Center Chicago, Illinois Lecture Objectives: 1) Understand the nomenclature of CRPS type 1 and type 2; 2) Be able to explain the pathophysiology of CRPS as it is currently understood; 3) Describe the treatment alternatives of CRPS.

Evaluating Outcomes in Pain Medicine i

Sean C. Mackey, M.D., Ph.D.* . . . . . . . . . . . . . . . . . . . . . . . . 406 Stanford University Medical Center Stanford, California Lecture Objectives: 1) Understand the importance and role of evaluating outcomes in pain medicine; 2) Understand the variety of different instruments available for the pain clinician and researcher to assess pain outcomes.

Minimally Invasive Techniques for Treating Discogenic Pain i

Nagy Mekhail, M.D., Ph.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 320 Cleveland Clinic Cleveland, Ohio Lecture Objectives: 1) Understand the differences between acute and chronic pain and between neuropathic and nociceptive pain; 2) Realize the basis, effectiveness of neurostimulation for chronic pain; 3) Recognize the diagnostic criteria and treatment options for degenerative disc disease.

Changes in the Landscape for Reimbursement in Pain Medicine i

Douglas G. Merrill, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 506 The University of Iowa Iowa City, Iowa Lecture Objectives: 1) Understand new aspects of regulation (Federal, State and payer) that will affect pain medicine practice and income; 2) Understand the anticipated changes in CPT rules and codes that will affect pain medicine practice; 3) Understand the impact of a compliance plan on pain medicine practice.

Ultrasonography in Pain Medicine i

Samer N. Narouze, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Cleveland Clinic Cleveland, Ohio Lecture Objectives: 1) Become familiar with the basics of ultrasound; 2) Review the good and poor indications of ultrasonography in pain medicine; 3) Discuss the advantages and limitations of ultrasonography relative to other imaging modalities.

Complications in Pain Medicine i

James P. Rathmell, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 Massachusetts General Hospital Boston, Massachusetts Lecture Objectives: 1) Discuss complications associated with image-guided intervention in pain medicine and incorporate strategies to avoid these complications.

An Algorithmic Approach to Neuropathic Pain i

Richard L. Rauck, M.D.*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Wake Forest University Baptist Medical Center Winston-Salem, North Carolina Lecture Objectives: 1) Understand the algorythmic approach to neuropathic pain; 2) Learn pharmacologic and non-pharmacologic approaches to managing neuropathic pain; 3) Review mechanisms and pathophysiology of neuropathic pain.

Pediatric Anesthesia g
Anesthesia for the Patient With Congenital Heart Disease for Noncardiac Surgery g
Dean B. Andropoulos, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . 501 Baylor College of Medicine Houston, Texas Lecture Objectives: 1) Understand the pathophysiology of common congenital heart diseases and its impact on anesthetic management for non-cardiac surgery; 2) Understand the most common non-cardiac surgical procedures in patients with congenital heart disease; 3) Understand the updated SBE prophylaxis guidelines from the American Heart Association.

A Child With a Difficult Airway: What Do I Do Next? g

Carolyn F. Bannister, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Emory University Atlanta, Georgia Lecture Objectives: 1) Discuss means of predicting the difficult airway in a child; 2) Understand methods of dealing with the difficult pediatric airway; 3) Discuss techniques for handling the unanticipated difficult pediatric airway.

Pediatric Advanced Cardiac Life Support: 2009 Update g

Jayant K. Deshpande, M.D., M.P.H.** . . . . . . . . . . . . . . . . . . . 325 Vanderbilt School of Medicine Nashville, Tennessee Lecture Objectives: 1) Discuss epidemiology of pediatric cardiac arrest including perioperative cardiac arrest in children; 2) Present the highlights of the AHA PALS guidelines; 3) Discuss implications and use of the guidelines in the perioperative care of children.

Grown-ups With Pediatric Diseases: Your Pediatric Anesthesiologist to the Rescue! g

Randall P. Flick, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 Mayo Clinic Rochester, Minnesota Lecture Objectives: Understand the mangement pediatric disorders that may be seen in the adult population.

Can You Stop That Delirious Child in Pain From Vomiting in the PACU? A Practical Guide for PACU Issues g
Zeev N. Kain, M.D., M.B.A.** . . . . . . . . . . . . . . . . . . . . . . . . . 217 University of California Irvine, California Lecture Objectives: 1) Understand the epidemiology and pathophysiology of common postoperative complications that children may experience in the PACU; 2) Learn about assessment and management of pediatric postoperative complications such as pain, emergence delirium, nausea and vomiting and wheezing; 3) Understand the underlying conceptual framework behind the decision of discharging a child with conditions such as postoperative apnea in a former preterm infant and children who underwent surgery such tonsillectomy and adenoidectomy.

Sedation/Analgesia Outside the Operating Room for Diagnostic and Therapeutic Procedures in Infants and Children g
Richard F. Kaplan, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Childrens National Medical Center Washington, District of Columbia Lecture Objectives: 1) Review Joint Commission, ASA and AAP guidelines for sedation/analgesia of pediatric patients outside the operating room; 2) Discuss appropriate monitors, equipment, personnel, recovery and drugs used during sedation/analgesia; 3) Discuss the appropriate use of propofol for sedation by anesthesia and nonanesthesia providers.

Anesthetizing Children: Little People, Big Problems! g

Jerrold Lerman, M.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Women and Childrens Hospital of Buffalo Rochester, New York Lecture Objectives: 1) Understand developmental differences in children regarding fears and anxiety of surgery; 2) Provide a model for premedicating children, parental presence, induction techniques for children with and without co-existing disorders; 3) Preoperative considerations, induction strategies; 4) Assessing the difficult and normal airway, complex child, extubation and recovery.

Challenges in Pediatric Ambulatory Anesthesia g

Linda J. Mason, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318 Loma Linda University Medical Center Loma Linda, California Lecture Objectives: 1) Identify current anesthetic management strategies for the pediatric outpatient, including management of the child with an upper respiratory tract infection (URI), the child with sleep apnea with criteria for outpatient tonsillectomy and what is the youngest age acceptable for outpatient surgery.

Anesthetizing the Neonate for Surgical Emergencies: Avoiding Common Errors g

Lynne G. Maxwell, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 The Childrens Hospital of Philadelphia Philadelphia, Pennsylvania Lecture Objectives: 1) Understand physiologic, pharmacokinetic and pharmacodynamic difference between the newborn and older infant; 2) Identify common perioperative issues that must be addressed in planning for newborn surgery including considerations important in preoperative evaluation/ preparation; 3) Using these elements formulate successful anesthetic management strategies for common newborn surgical emergencies to avoid common errors.

Anesthetic Management of Common Pediatric Emergencies g

Allison K. Ross, M.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Duke University Medical Center Durham, North Carolina Lecture Objectives: 1) Understand preoperative issues for common pediatric emergencies; 2) Identify intraoperative complications that may occur in common pediatric emergencies.

Neuroanesthesia: Basic Principles and Perioperative Management in Children g

Sulpicio G. Soriano, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 316 Harvard Medical School Boston, Massachusetts Lecture Objectives: 1) Learn the basic principles needed for the safe practice of neuroanesthesia in children; 2) Understand the effects of anesthetics on cerebral physiology in the pediatric population; 3) Discuss the clinical management of children affected with neurological conditions.

Ultrasound Guidance for Regional Anesthesia in Infants, Children and Adolescents: Seeing Is Believing! g
Santhanam Suresh, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . 308 Northwestern Universitys Feinberg School of Medicine Chicago, Illinois Lecture Objectives: 1) Understand the current evidence for use of ultrasound guidance for pediatric regional anesthesia; 2) Application of ultrasound guidance for central neuraxial blocks including caudal and epidural analgesia; 3) Ultrasound guided peripheral nerve blocks including upper extremity, lower extremity and truncal blocks for common surgical procedures.

Acute Pain Management in Infants, Children, and Adolescents g

Joseph D. Tobias, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 University of Missouri Columbia, Missouri Lecture Objectives: 1) Understand the reasons for the undertreatment of pediatric pain; 2) Describe the current scales and tools used for the assessment of pain in infants and children; 3) Understand the options for pain management in infants and children including acetaminophen, non-steroidal anti-inflammatory agents, opioids and regional anesthetic techniques.

Professional Issues k
Responding to: Youre Inefficient, Work Faster k
Amr E. Abouleish, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 University of Texas Medical Branch Galveston, Texas Lecture Objectives: 1) Have a basic understanding on how anesthesia care is billed and paid; 2) Understand how surgical duration effects clinical productivity of anesthesiologists; 3) Understand the differences and similarities of turnover time and OR throughput; 4) Understand what determines staffing requirements for anesthesiology departments.

The ASA Closed Claims Project and Its Registries: Value to Patients and Pocketbook k
The Anesthesia Awareness Registry Karen B. Domino, M.D., M.P.H.** - Moderator . . . . . . . . . . . . 313 University of Washington School of Medicine Seattle, Washington The ASA Closed Claims Project Robert A. Caplan, M.D.** Virginia Mason Medical Center Seattle, Washington The Postoperative Visual Loss Registry Lorri A. Lee, M.D.** University of Washington Seattle, Washington Lecture Objectives: 1) Understand the current areas of liability and patient safety for anesthesiologists; 2) Understand factors associated with ischemic optic neuropathy in prone spine surgery; 3) Under-stand etiology, prevention, and patient experiences with anesthesia awareness.

A Fire in the OR: It Could Happen to You! k

Jan Ehrenwerth, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Yale University School of Medicine New Haven, Connecticut Lecture Objectives: 1) Become familiar with the risks of fires in the operating room; 2) Detail strategies on how to decrease the risk of an operating room fire; 3) Sumamrize a plan for how to care for the patient if a fire should occur; 4) Distinguish between the various types of medical lasers and their implications for the anesthesiologist.

Statistical and Incident-Based Quality Analysis k

John C. Frenzel, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505 M.D. Anderson Cancer Center Houston, Texas Lecture Objectives: 1) Describe the difference between statistical and incident based quality analysis; 2) Create process flow diagrams and map current state processes to data contained in the AIMS; 3) Use existing practice guidelines and site specific AIMS data to create guideline compliance metrics; 4) Articulate the tolls and steps required to create a process map and data feedback loop in a quality program; 5) Anticipate common roadblocks to implementation and craft strategies to deal with these issues.

Changing Physician Behavior: Must We Accept the Herding Cats Metaphor? k

Nancy L. Glass, M.D., M.B.A.**. . . . . . . . . . . . . . . . . . . . . . . . 237 Baylor College of Medicine Houston, Texas Lecture Objectives: 1) Understand the role of motivation in affecting physicians behavior; 2) Gain an understanding of several effective ways of getting physicians to cooperate with needed changes in practice; 3) Understand why new initiatives and practices are so difficult to initiate successfully; 4) Understand a model for introducing change that takes into consideration the unique motivations of physicians; 5) Understand why most change initiatives fail, and troubleshoot such initiatives in his/her own institution using this model; 6) Gain a new tools in changing the behavior of difficult colleagues.

Occupational Hazards for Anesthesiologists k

Jonathan D. Katz, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Yale University School of Medicine New Haven, Connecticut Lecture Objectives: 1) Learn about some of the occupational hazards to which anesthesiologists are frequently exposed; 2) Become familiar with sources of disability and mortality among anesthesiolog-ists; 3) Develop an understanding of strategies to protect themselves from occupationally acquired disease and maintain their personal health.

How to Avoid Recruiting the Problem Trainee (and What to Do Once You Have One) k
Catherine M. Kuhn, M.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Duke University Medical Center Durham, North Carolina Lecture Objectives: 1) Evaluate candidates for training positions more effectively; 2) Identify markers for success and failure in their training programs; 3) Develop strategies for the identification and remediation of problem trainees.

The Joint Commission: What You Need to Know & What You Need to Show k
Robert S. Lagasse, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 Montefiore Medical Center New York, New York Lecture Objectives: 1) Become familiar with relevant Joint Commission standards, National Patient Safety Goals (NPSGs), Sentinel Event Alerts (SEAs), and Universal Protocol; 2) Learn how to stay up-to-date with current standards, NPSGs, and SEAs; 3) Understand the survey process and your role; 4) Know how to appeal a surveyor decision or submit a corrective action to the Joint Comission.

Efficiency, Quality and Patient Safety in the Perioperative Arena k

Vinod Malhotra, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421 Weill Medical College of Cornell University New York, New York Lecture Objectives: Discuss multifaceted responsibility and tools or OR management to provide quality care to patients in a safe environment and to do this efficiently for the institution.

Leveraging Operating Room Experience for Hospital Throughput and Quality Management k
Brian M. Parker, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412 Cleveland Clinic Lerner College of Medicine Cleveland, Ohio Lecture Objectives: 1) Understand the operational similarities for both operating room and hospital throughput; 2) List barriers that exist for hospital throughput and how these issues can affect both the operating room and PACU; 3) List strategies and operational techniques for improving overall hospital throughput and efficiency, and to monitor implementation success; 4) Under-stand the options for presenting and displaying institutional throughput and quality data using business intelligence techniques; 5) Understand the value of using a dashboard for displaying relevant data that can be managed to improve operational efficiencies.

The Basics of Anesthesia Information Management Systems (AIMS)How to Choose and How to Use! k
David L. Reich, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333 Mount Sinai School of Medicine New York, New York Lecture Objectives: 1) The basic functions of the electronic medical record as it applies to the OR; 2) Uses of the data that will benefit the hospital and the practice; 3) The financial and regulatory pressures that will drive the hospital to implement electronic medical records in the OR; 4) The ways that electronic records change practioner behaviors; 5) Strategies for using AIMS data to be a perioperative leader.

Using Communication Technology to Improve Patient Safety k

Keith Ruskin, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429 Yale University School of Medicine New Haven, Connecticut Lecture Objectives: 1) Undertand how improving communication can improve patient safety; 2) Choose the appropriate tools to facilitate information transfer in a clinical setting; 3) Learn about the latest software and handheld devices to access clinical information at the point of care.

The Anesthesia Workforce: Supply and Demand Now and in the Near Future k
Armin Schubert, M.D., M.B.A.*. . . . . . . . . . . . . . . . . . . . . . . . 301 Cleveland Clinic Lerner College of Medicine Cleveland, Ohio Lecture Objectives: 1) Learn the composition of the US anesthesia workforce; 2) Understand the sources of supply to the anesthesia workforce; 3) Integrate factors important to demand for anesthesia services into a composite view of the anesthesia workforce; 4) Learn about the impact of current and near future trends on workforce supply and demand.

Health Law 2009: Essentials for Every Anesthesiologist k

Christopher Spevak, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Georgetown University Medical Center Washington, District of Columbia Lecture Objectives: Provide a broad overview of current trends in health law affecting anesthesiologists: medical negligence, fraud and abuse and employment law. A case-based method will be utilized to highlight the trends.

Chemical Dependency and Anesthesiology k

John Tetzlaff, M.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Anesthesiology Institute Cleveland, Ohio Lecture Objectives: 1) Understand the risk of substance abuse in anesthesia providers; 2) Appreciate the chemical profile of this addiction; 3) Understand some of the causes; 4) Learn the limitations of detection; 5) Appreciate the issues with prevention; 6) Under-stand the benefits and limitations of random testing.

Beyond Informed Consent: Ethical Dilemmas in Anesthesiology for the 21st Century k
Gail A. Van Norman, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 222 University of Washington Seattle, Washington Lecture Objectives: 1) Understand legal and ethical differences between withdrawal of life support, physician-assisted suicide, and euthanasia; 2) Appreciate arguments for and against physician participation in lethal injection; 3) Appreciate some of the legislative initiatives that have sought to involve anesthe-siologists specifically as executioners; 4) Understand controversies in organ transplantations, including medical definitions of death how accurate are they -- and legislative initiatives to shift the United States to an opt out organ procurement system; 5) Learn what roles they can play in legislative initiatives surrounding organ transplantation.

Anesthesia Information Management Systems k

Michael M. Vigoda, M.D., M.B.A.** . . . . . . . . . . . . . . . . . . . . 104 University of Miami Miller School of Medicine Miami, Florida Lecture Objectives: 1) Identify 3 basic functions of AIMS; 2) Describe recent studies, which focus on users experiences with AIMS, analysis of large databases facilitated by AIMS and users enhancements to existing AIMS products.

Regional Anesthesia h
Local Anesthetics: Basic Mechanisms and Clinical Implications h
Charles B. Berde, M.D., Ph.D.* . . . . . . . . . . . . . . . . . . . . . . . . 408 Childrens Hospital of Boston Boston, Massachusetts Lecture Objectives: 1) Understand the basic mechanisms relevant to local anesthetic effects; 2) Appreciate how current local anesthetic research impacts daily clinical practice; 3) Appreciate the progress on development of new local anesthetic formulations.

Acute Pain: Pathophysiology and Clinical Implications h

Timothy J. Brennan, M.D., Ph.D.** . . . . . . . . . . . . . . . . . . . . . 201 University of Iowa Iowa City, Iowa Lecture Objectives: 1) Understand the mechanisms causing surgical pain and factors related to its severity; 2) Learn how current research will potentially impact clinical practice.

Local Anesthetics and Additives: Dogma Versus Data h

John F. Butterworth, IV, M.D.** . . . . . . . . . . . . . . . . . . . . . . . 118 Indiana University School of Medicine Indianapolis, Indiana Lecture Objectives: 1) Understand local anesthetic and additive mechanisms from a clinical perspective; 2) Learn the data supporting common beliefs about the clinical application of local anesthetics and additives.

Multimodal Analgesia for Perioperative Pain Management: Evidence-Based h

Asokumar Buvanendran, M.D.* . . . . . . . . . . . . . . . . . . . . . . . 236 Rush University Medical Center Chicago, Illinois Lecture Objectives: 1) Learn drugs used for multimodal analgesia; 2) Understand how multimodal analgesia improves other analgesic techniques in the perioperative period.

Lower Extremity Regional Anesthesia: Update on Nerve Stimulation and Ultrasound Techniques h
Admir Hadzic, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Columbia University New York, New York Lecture Objectives: 1) Learn practical, state-of-the-art lower extremity nerve block techniques; 2) Understand specific clinical applications for single-injection and continuous nerve block techniques and perioperative management necessary for their successful clinical application; 3) Understand complications of lower extremity blocks and means to prevent them; 4) Learn the rational choice of local anesthetic solutions and additives and equipment to accomplish lower extremity nerve blocks.

Regional Anesthesia for Total Joint Replacement: Pathways to Success h

James R. Hebl, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Mayo Clinic College of Medicine Rochester, Minnestoa Lecture Objectives: 1) Learn how clinical pathways may improve perioperative outcomes after total joint arthroplasty; 2) Understand the role of regional anesthesia and multimodal analgesia in the development of clinical pathways; 3) Appreciate how clinical pathways may influence economic outcomes.

Blood and Pus: Hemorrhagic and Infectious Complications of Neuraxial Anesthesia h

Terese T. Horlocker, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Mayo Medical School Rochester, Minnesota Lecture Objectives: 1) Learn how perioperative anticoagulation impacts neuraxial regional anesthesia; 2) Understand the risk factors that increase the likelihood of perioperative infectious complications of neuraxial techniques.

Continuous Peripheral Nerve Blocks: Past, Present, and Future h

Brian M. Ilfeld, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 University of California, San Diego San Diego, California Lecture Objectives: 1) Learn techniques to optimize perineural catheter placement and infusion management; 2) Apprciate perineural infusion benefits; 3) Understand possible complications and ways to minimize their frequency; 4) Learn about future trends in inpatient and ambulatory continuous perineural infusion techniques.

Acute Pain to Chronic PainIs There a Link? If So, Can We Break It? h
Mark J. Lema, M.D., Ph.D.**. . . . . . . . . . . . . . . . . . . . . . . . . . 322 State University of New York at Buffalo Buffalo, New York Lecture Objectives: 1) Learn the reasons why acute pain may impact the development of chronic pain; 2) Appreciate the evidence supporting and contradicting the linkage between acute and chronic pain; 3) Understand how and if anesthesiologists can impact the development of chronic postoperative pain.

Regional Anesthesia and Analgesia: Does It Really Improve Outcomes? h

Spencer S. Liu, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 Hospital for Special Surgery New York, New York Lecture Objectives: 1) Understand how regional techniques positively affect perioperative physiology; 2) Learn under what conditions regional techniques truly affect outcome; 3) Appreciate those conditions where outcome is unaffected by anesthetic choice.

Practical Regional Anesthesia: Making It Work in the Real World h

Michael F. Mulroy, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Virginia-Mason Medical Center Seattle, Washington Lecture Objectives: Understand practice tips to improve regional anesthesia efficiency and effectiveness in the production pressure real world.

Upper Extremity Regional Anesthesia: Essentials for Your Practice h

Joseph M. Neal, M.D.** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Virginia Mason Medical Center Seattle, Washington Lecture Objectives: 1) Learn those techniques that can improve block success; 2) Understand the nuances of pharmacology as they apply to upper extremity blocks; 3) Appreciate the prevention and treatment of block-related complications.

The Acute Pain ServiceThe Possibilities Are Endless h

Richard W. Rosenquist, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . 511 University of Iowa Iowa City, Iowa Lecture Objectives: 1) Learn the neuraxial and peripheral regional anesthetic techniques for interventional acute pain medicine; 2) Understand how these techniques might improve patient outcome; 3) Appreciate the complications inherent to these techniques.

Ultrasound-Guided Regional Anesthesia: Let Vision Guide You h

Brian D. Sites, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512 Dartmouth Medical School Hanover, New Hampshire Lecture Objectives: 1) Learn the novel practice of ultrasound-guided regional anesthesia; 2) Understand several basic techniques for upper and lower extremity block; 3) Appreciate important limitations of ultrasoundguided regional anesthesia.

Acute Pain Medicine: Novel Analgesic Techniques h

Eugene R. Viscusi, M.D.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 Thomas Jefferson University Philadelphia, Pennsylvania Lecture Objectives: 1) Understand options for acute pain control that go beyond epidural analgesia and multimodal approaches; 2) Learn those new techniques for drug delivery; 3) Appreciate the indications and pitfalls of these novel options for analgesia.

60th ANNUAL REFRESHER COURSE LECTURE PROGRAM Saturday, October 17, 2009
Morial Convention Center, New Orleans, Louisiana
Time Room 283-285
Patient Safety and Improved Communication Skills in Obstetric Anesthesia D. Birnbach, M.D., M.P.H.** d 101

Room 286-287
A Child With a Difficult Airway: What Do I Do Next? C. Bannister, M.D.*

Room 288-290
Current Controversies in Adult Outpatient Anesthesia J. Apfelbaum, M.D.**

Room 291-292
Update on Cardiac Anesthesia G. Gravlee, M.D.**

Room 293-294
Perioperative Cerebral Homeostasis in Neurosurgical Patients: Physiology and Application A. Bendo, M.D.** P. Patel, M.D.**

Room 295-296

Room 298-299

8:00 8:50 a.m. -

Pulmonary Hypertension: Regional Anesthesia for Total Physiology and Intraoperative Joint Replacement: Pathways Management to Success E. Jacobsohn, M.B.,Ch.B.** J. Hebl, M.D.** b 134 h 140

108

115

122

9:10 10:00 a.m.

Perioperative Management of Treatment of Compression Epidural Analgesia for Laborthe Patient With Respiratory Fractures by the Safety and Success Disease Anesthesiologist: Kyphoplasty B. Leighton, M.D.** D. Warner, M.D.** and Vertebroplasty P. Kim, M.D.* d 116 m 102 i 109 Coagulation Abnormalities Made Easy L. Liu, M.D.** A Fire in the OR, It Could Happen to You! J. Ehrenwerth, M.D.** Anesthesia for Patients With Valvular Heart Disease for Non-Cardiac Surgery S. Konstadt, M.D.** a 117

Mechanical Ventilatory Support: What Every Anesthesiologist Should Know M. Gropper, M.D., Ph.D.* b 123 Upper Extremity Regional Anesthesia: Essentials for Your Practice J. Neal, M.D.** h 124

D. Prough, M.D.** C. Werner, M.D.* c 129

How to Avoid Recruiting the Brain Failure in Aging and the Problem Trainee (and What to Perioperative Period Do Once You Have One) G. Crosby, M.D.* C. Kuhn, M.D.** k 135 c 141

10:20 11:10a.m.

Drug Interactions for the Anesthesiologist P. Klock, Jr., M.D.**

Fragile BrainsThe Very Young and the Old J. Cottrell, M.D.**

103

110

130

136

11:30 12:20 p.m.-

Anesthesia Information Management Systems M. Vigoda, M.D., M.B.A.**

Utility of TEE in Non-Cardiac Surgery S. Shernan, M.D.*

Local Anesthetics and Additives: Dogma Versus Data J. Butterworth, IV, M.D.** h 118

Consciousness, Awareness, and Anesthesia G. Mashour, M.D.**

104

111

125 The Adult Patient With Morbid Obesity and/or Sleep Apnea Syndrome for Ambulatory Surgery G. Joshi, M.D.* j 131 Blood and Pus: Hemorrhagic and Infectious Complications of Neuraxial Anesthesia T. Horlocker, M.D.** h 132 Approach to the Patient Who May Have a Bleeding Disorder C. Petrovitch, M.D.** m 137

1:00 1:50 p.m.-

Basic Science Review: Respiratory Physiology and Gas Exchange L. Bigatello, M.D.** b 105

Sedation/Analgesia Outside the Operating Room for Diagnostic and Therapeutic Procedures in Infants and Children R. Kaplan, M.D.** g 112 Intrathecal Drug Delivery for Chronic Pain: Indications, Management and Complications A. Buvanendran, M.D.* i 113 Perioperative Positioning Problems You Hope You Never Have M. Warner, M.D.** m 114

Ultrasonography in Pain Medicine S. Narouze, M.D.*

Awake Intubations Made Easy! W. Rosenblatt, M.D.*

119

126

2:10 3:00 p.m.-

Current Concepts in Orthopedic Anesthesia A. Rosenberg, M.D.*

Abdominal Aortic Aneurysm Repair and Endovascular Stenting D. Lubarsky, M.D., M.B.A.** a 120

Coagulopathy and Postpartum Hemorrhage Implications for Treatment B. Scavone, M.D.** d 127

106

The Neuromuscular Transmission: New Developments That May Change Your Practice C. Lien, M.D.** m 138 Anesthesia for Functional Neurosurgery B. Van de Wiele, M.D.**

3:20 4:10 p.m.

Risk, Uncertainty, and Medical Decision Making: How Can We Make Better Decisions? A. Tung, M.D.** b 107

Occupational Hazards for Anesthesiologists J. Katz, M.D.**

Spinal Injections for the Diagnosis and Treatment of Chronic Pain M. Huntoon, M.D.* i 128

121

Anesthetic Management of the Pregnant Patient With Human Immunodeficiency Virus D. Wlody, M.D.** d 133

139

60th ANNUAL REFRESHER COURSE LECTURE PROGRAM Sunday, October 18, 2009
Morial Convention Center, New Orleans, Louisiana
Time Room 283-285
Acute Pain: Pathophysiology and Clinical Implications T. Brennan, M.D., Ph.D.**

Room 286-287
Current Concepts in the Management of the Difficult Airway C. Hagberg, M.D.*

Room 288-290
Preoperative Evaluation of the Adult Ambulatory Patient B. Gold, M.D.**

Room 291-292
Beyond Informed Consent: Ethical Dilemmas in Anesthesiology for the 21st Century G. Van Norman, M.D.** k 222

Room 293-294
Neurovascular Disease: Anesthetic Concerns and Management W. Lanier, Jr., M.D.** A. Gelb, MBBCh** J. Pasternak, M.D.** W. Young, M.D.**

Room 295-296
New Developments in Thoracic Anesthesia E. Cohen, M.D.*

8:00 8:50 a.m. -

201

208

215

234

9:10 10:00 a.m.

Perioperative Gas Exchange and Acid Base Management M. Keegan, M.D.**

Perioperative Management of the Diabetic Patient D. Brown, M.D., Ph.D.**

TEE for the Occasional Cardiac Anesthesiologist M. Cahalan, M.D.**

Anesthetic Management of the Preeclamptic Patient J. Hawkins, M.D.**

An Algorithmic Approach to Neuropathic Pain R. Rauck, M.D.*

202

209

216

223

229

235

10:20 11:10 a.m.-

Perioperative Management of the Patient With Pulmonary Hypertension R. Pearl, M.D., Ph.D.** m 203

Anesthetic Management of the Morbidly Obese Parturient B. Bucklin, M.D.**

Can You Stop That Delirious Child in Perioperative Consideration for the Pain From Vomiting in the PACU? A Morbidly Obese Practical Guide for PACU Issues T. Ebert, M.D., Ph.D.* Z. Kain, M.D., M.B.A.** g 217 m 224

Cardiovascular Pharmacology R. Hines, M.D.**

Multimodal Analgesia for Perioperative Pain Management: Evidence-Based A. Buvanendran, M.D.* h 236

210

230

11:30 12:20p.m.

Anesthetizing the Neonate for Surgical Emergencies: Avoiding Common Errors L. Maxwell, M.D.* g 204

Cognition and Delirium J. Silverstein, M.D.*

Spinal Cord, Peripheral Nerve, and Peripheral Nerve Field Stimulation for the Treatment of Pain T. Deer, M.D.* i 218

Endocrine Emergencies W. Furman, M.D.**

Post Dural Puncture Headache: How to Keep It the Patients Headache R. Gaiser, M.D.** d 231

Changing Physician Behavior: Must We Accept the Herding Cats Metaphor? N. Glass, M.D., M.B.A.** k 237

211

225

1:00 1:50p.m.

Anesthetic Management of Common Pediatric Emergencies A. Ross, M.D.**

Chemical Dependency and Anesthesiology J. Tetzlaff, M.D.**

Hemodynamic Monitoring From CVP to Pulse Contour Analysis A. Leibowitz, M.D.**

Central Venous Pressure and Pulmonary Artery Pressure Monitoring J. Mark, M.D.** a 226

Practical Regional Anesthesia: Making It Work in the Real World M. Mulroy, M.D.**

Perioperative Care of the Patient With Renal Dysfunction: You Can Make a Difference R. Sladen, M.B.,Ch.B.* b 238

205

212

219

232

2:10 3:00p.m.

Hematologic Challenges in Cardiothoracic and Vascular Surgery L. Shore-Lesserson, M.D.* a 206

Misunderstandings in Neuroanesthesia: How May I Hurt Thee, Let Me Count the Ways J. Drummond, M.D.** c 213

Anesthesia for Cesarean Delivery L. Tsen, M.D.**

220

Lower Extremity Regional Anesthesia: Update on Nerve Stimulation and Ultrasound Techniques A. Hadzic, M.D.* h 227 Anesthetizing Children: Little People, Big Problems! J. Lerman, M.D.** g 228

Intraoperative Awareness, Best Practice: Its Not Just Science D. Cole, M.D.** J. Apfelbaum, M.D.**

Diagnosis and Management of Myofascial Pain F. Ferrante, M.D.*

i K. Domino, M.D., M.P.H.** C. Weihrer *

239

3:20 4:10p.m.

Transfusion Therapy: Optimal Use of Blood Products S. Surgenor, M.D.**

Health Law 2009: Essentials for Every Anesthesiologist C. Spevak, M.D.**

Trauma Anesthesiology R. Dutton, M.D., M.B.A.*

Utility of TEE in the Integrated Management of Patients Undergoing Valvular Heart Surgery R. Savage, M.D.** a 240

207

214

221

233

60th ANNUAL REFRESHER COURSE LECTURE PROGRAM Monday, October 19, 2009
Morial Convention Center, New Orleans, Louisiana
Time Room 283-285
The Anesthesia Workforce: Supply and Demand Now and in the Near Future Armin Schubert, M.D., M.B.A* k 301

Room 286-287
Adapting ACLS to the Perioperative Period G. Maccioli, M.D.**

Room 288-290
The ASA Closed Claims Project and Its Registries: Value to Patients and Pocketbook K. Domino, M.D., M.P.H.** R. Caplan, M.D.** L. Lee, M.D.**

Room 291-292
Challenges in Pediatric Ambulatory Anesthesia L. Mason, M.D.**

Room 293-294
Perioperative Blood Pressure - A New Look at an Old Problem S. Aronson, M.D.*

Room 295-296
Update on Pharmacological Management of Pain H. Benzon, M.D.*

8:00 8:50 a.m. -

307

318

324

330

9:10 10:00 a.m.

Effective Management of PONV and Pain in Ambulatory Settings T. Gan, M.D.*

Ultrasound Guidance for Regional Anesthesia in Infants, Children and Adolescents: Seeing Is Believing! S. Suresh, M.D.* g 308

Preoperative Assessment of the Patient With Cardiac Disease L. Fleisher, M.D.**

Pediatric Advanced Cardiac Life Support: 2009 Update J. Deshpande, M.D., M.P.H.**

Anesthesia for Spine Surgery S. Black, M.D.**

302

313

319

325

331

10:20 11:10 a.m.-

As We Heal the Body Do We Harm the Brain? D. Culley, M.D.**

Continuous Peripheral Nerve Blocks: Past, Present, and Future B. Ilfeld, M.D.*

Problems in Obstetric Anesthesia: Blood Pressure, Blood Loss, and Blood Patch D. Chestnut, M.D.** d 314

Minimally Invasive Techniques for Treating Discogenic Pain N. Mekhail, M.D., Ph.D.**

Ultrasound-Guided Regional Anesthesia for Ambulatory Surgery M. Rosenblatt, M.D.**

Temperature Monitoring: Consequences and Prevention of Mild Perioperative Hypothermia D. Sessler, M.D.* m 332

303

309

320

326

1:00 1:50p.m.

Cerebral Protection During Cardiac Surgery C. Hogue, M.D.*

Preoperative Evaluation and Preparation B. Sweitzer, M.D.**

Pain: Mechanism and Activity at the Spinal Cord J. Eisenach, M.D.*

Physics in Anesthesiology (Basic Science Review) J. Gross, M.D.**

Agitation and Delirium: What Do I Do? W. Hurford, M.D.**

304

310

315

321

327

The Basics of Anesthesia Information Management Systems (AIMS) - How to Choose and How to Use! D. Reich, M.D.** k 333 Myocardial Ischemia and Postoperative Monitoring J. Ellis, M.D.*

2:10 3:00 p.m.-

Management of the Parturient With Cardiovascular Disease L. Councilman, M.D.**

Update on Transfusion Medicine R. Miller, M.D.*

Neuroanesthesia: Basic Principles Acute Pain to Chronic PainIs There and Perioperative Management in a Link? If So, Can We Break It? Children M. Lema, M.D., Ph.D.** S. Soriano, M.D.** g 316 h 322

Office-Based Anesthesia: Challenges and Successes R. Twersky, M.D., M.P.H.**

305

311

328

334

3:20 4:10 p.m..

Basic Science Review: Modulating Cell Death - the Future of Anesthesia and Critical Care? Y. Weiss, M.D.** b 306

The Joint Commission: What You Need to Know and What You Need to Show R. Lagasse, M.D.** k 312

Hazards of the Anesthesia Workstation J. Eisenkraft, M.D.**

Regional Versus General Anesthesia for Vascular Surgery Patients P. Rock, M.D., M.B.A.** a 323

Complications in Pain Medicine J. Rathmell, M.D.**

Acute Pain Medicine: Novel Analgesic Techniques E. Viscusi, M.D.*

317

329

335

60th ANNUAL REFRESHER COURSE LECTURE PROGRAM Tuesday, October 20, 2009
Morial Convention Center, New Orleans, Louisiana
Time Room 283-285
Responding to: Youre Inefficient, Work Faster A. Abouleish, M.D.**

Room 286-287
Anesthesia for Valvular Heart Surgery W. Johnston, M.D.**

Room 288-290
Neuraxial Labor Analgesia and Pregnancy Outcome: Fact and Fiction C. Wong, M.D.** d 413

Room 291-292
PACU Emergencies M. Argalious, M.D.**

Room 293-294
Diagnosis and Treatment of Cancer Related Pain O. De Leon-Casasola, M.D.**

Room 295-296
Acute Pain Management in Infants, Children, and Adolescents J. Tobias, M.D.*

8:00 8:50 a.m. -

401

407

419

425

431

9:10 10:00 a.m.

The Anesthesiologist As Administrator: Failing and Succeeding As an Ambulatory Medical Director D. Merrill, M.D.** j 402 Grown-ups With Pediatric Diseases: Your Pediatric Anesthesiologist to the Rescue! R. Flick, M.D.** g 403

Local Anesthetics: Basic Mechanisms and Clinical Implications C. Berde, M.D., Ph.D.* h 408

Cervical Spine Motion, Cervical Spine Surgery and the Unstable Neck M. Todd, M.D.** c 414

What Every Anesthesiologist Should Know About Sepsis and Why C. Deutschman, M.D.** b 420

Advances in Intravenous Anesthesia T. Egan, M.D.*

Complex Regional Pain Syndrome: Diagnosis and Mangement T. Lubenow, M.D.*

426

432

10:20 11:10 a.m.-

Understanding Clinical Hemodynamics M. OConnor, M.D.**

Ambulatory Anesthesia: A Primer for the Occasional Practitioner T. Cutter, M.D.*

Efficiency, Quality and Patient Safety in the Perioperative Arena V. Malhotra, M.D.**

Obstetric Emergencies and Anesthetic Management C. Palmer, M.D.**

Pharmacokinetics and Pharmacodynamics That Make Sense K. Johnson, M.D.** m 433

409

415

421

427

1:00 1:50 p.m.

Neonatal Resuscitation V. Arkoosh, M.D., M.P.H.**

Strategies for Blood Conservation in Cardiac Surgery C. Mazer, M.D.*

Technological Challenges for the Anesthesiologist During Disasters Joseph H. McIsaac III, M.D., M.S.*

Opioids and the Law: Towards Balanced Practice D. Caraway, M.D.**

Anaphylaxis and Adverse Drug Reactions J. Levy, M.D.*

404

410

416

422

428

2:10 3:00 p.m.-

Brain Injury: What Do I Need to Know? M. Souter, M.B.,Ch.B.*

Heart Failure-What You Need to Know for Perioperative Management J. Eisenach, M.D.** m 411

Regional Anesthesia and Analgesia: Does It Really Improve Outcomes? S. Liu, M.D.** h 417

Perioperative Pacemaker and Defibrillator Management: Why the Controversy? M. Rozner, Ph.D., M.D.** a 423

Using Communication Technology to Improve Patient Safety K. Ruskin, M.D.**

405

429

3:20 4:10 p.m.-

Evaluating Outcomes in Pain Medicine S. Mackey, M.D., Ph.D.*

Leveraging Operating Room Experience for Hospital Throughput and Quality Management B. Parker, M.D.** k 412

Anesthetic Effects on the Fetus and Newborn B. Segal, M.D.**

Integrating Evidence-based Medicine Into Perioperative Care B. Fahy, M.D.**

Strategies for Success in OneLung Anesthesia J. Klafta, M.D.**

406

418

424

430

60th ANNUAL REFRESHER COURSE LECTURE PROGRAM Wednesday, October 21, 2009
Morial Convention Center, New Orleans, Louisiana

Time

Room 283-285
Anesthesia for the Patient With Congenital Heart Disease for Noncardiac Surgery D. Andropoulos, M.D.**

Room 286-287
Statistical and Incident-Based Quality Analysis J. Frenzel, M.D.**

Room 288-290
The Latest in ICU Technology: Can It Help Me in the Operating Room? M. Wall, M.D.**

8:00 8:50 a.m.-

501

505

509

9:10 10:00 a.m.

The Geriatric Outpatient: Postoperative Cognitive Dysfunction and Other Concerns K. McGoldrick, M.D.**

Changes in the Landscape for Reimbursement in Pain Medicine D. Merrill, M.D.**

Management of the Patient With Pulmonary Hypertension and Right Ventricular Failure G. Rich, M.D.**

502

506

510

10:20 11:10a.m. a.m.

Anesthesia for the Pregnant Patient Undergoing Nonobstetric Surgery M. Rosen, M.D.**

New Drug Delivery Systems E. Viscusi, M.D.*

The Acute Pain ServiceThe Possibilities Are Endless R. Rosenquist, M.D.*

503

507

511

11:30 12:20 p.m.

Mechanism of Inhaled Anesthetic Action in the Brain: Why We Know So Much and Understand So Little M. Perouansky, M.D.**

Anesthesia for Craniotomy D. Warner, M.D.**

Ultrasound-Guided Regional Anesthesia: Let Vision Guide You B. Sites, M.D.*

504

508

512

REFRESHER COURSE LECTURES

Disclosure Information Asterisks printed next to a presenters name mean: * This speaker has indicated that he or she does have a significant financial relationship with the manufacturer of a commercial product or provider of a commercial service that may be discussed in this presentation. The presenter will describe that relationship before beginning the presentation. ** This speaker has indicated that he or she has no significant financial relationship with the manufacturer of a commercial product or provider of a commercial service that may be discussed in this presentation.