March 4-6. Texas Anesthesia Conference for Obstetrics CONCURRENT WORKSHOPS. Difficult Airway Workshop. Ultrasound-Guided Workshop

Transcription

1 Texas Anesthesia Conference for Obstetrics March 4-6 CONCURRENT WORKSHOPS Difficult Airway Workshop Thursday, March 3, :30 a.m. - 6:15 p.m. Ultrasound-Guided Workshop Thursday, March 3, :00 a.m. - 12:15 p.m. Hilton Houston Post Oak 2001 Post Oak Boulevard Houston, Texas Sponsored by Baylor College of Medicine Presented by Department of Anesthesiology

2 TACO 2011 Difficult Airway Workshop Activity Directors Activity Co-Directors Activity Managers, and Ashutosh Wali, MD, FFARCSI Uma Munnur, MD David Madrigal, MHA, CCMEP and Annette Brieno Needs and Target Audience Department of Anesthesiology, Baylor College of Medicine developed the Difficult Airway Workshop to educate, highlight, and teach various concepts and new devices in difficult airway management. The planning committee reviewed comments and surveys from previous workshop participants who indicated the value of the workshop. The committee also reviewed recent national scientific evidence and peer-reviewed articles to determine the need for increased education and hands-on training in the management of pediatric and adult difficult airways. Sources demonstrating the need for improved performance in the management of the difficult airway (DA) include the American Society of Anesthesiologists (ASA), Obstetric Anesthesia Closed Claims Project Database, and standardized collection of case summaries from professional liability insurance companies closed claims files. National and international anesthesiologists, and emergency medicine physician experts in airway management will provide practical tips and updates during the course and in the interactive group sessions at the workshop. Anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), emergency medicine physicians, and other allied health professionals assisting with airway management should attend. Educational Methods and Objectives Through the use of lectures, case presentations, panel discussion, a syllabus and hands-on workshop sessions, the participant should be able to: Describe factors that predispose patients to difficult intubation and/or ventilation. Discuss preoperative assessment methods to identify patients difficult to intubate. Discuss the use of airway devices in the various steps of the ASA Difficult Airway Algorithm in appropriate clinical situations. Discuss the new airway devices and methods to help manage difficult airways. Describe and discuss the features, advantages, limitations, and applications of new supraglottic ventilatory devices available for difficult airway management. Evaluation Evaluation by questionnaire will address program content, presentation, and possible bias. Accreditation/Credit Designation Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Baylor College of Medicine designates this educational activity for a maximum of 5.50 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. The hands-on sessions of this activity are not designated and/or eligible for CME credit.

3 thursday, March 3, :30 AM Registration and Continental Breakfast 7:00 Welcome and Introduction Chairman Department of Anesthesiology Professor of Anesthesiology and Obstetrics and Gynecology Division Chief of Obstetrics and Gynecology Anesthesiology ASA Algorithm, Preoxygenation, and Difficult Laryngoscopy Moderator: Ashutosh Wali, MD, FFARCSI 7:05 Pre-operative Assessment and Prediction of Difficult Airway Alice Oswald, MD 7:30 ASA Difficult Airway Algorithm Preview and Review 7:55 Difficult Laryngoscopy: Role of Videolaryngoscope Carin A. Hagberg, MD 8:15 Break Difficult Mask Ventilation and Extubation Strategies Moderator: 8:25 Strategies for Optimizing Preoxygenation Chris Christodoulou, MD 8:50 Difficult Mask Ventilation Carin A. Hagberg, MD 9:15 Laryngeal Mask Airway: Special Considerations Chandy Verghese, MD 9:40 Extubation and Airway Exchange Catheters Thomas C. Mort, MD 10:05 Break 10:20 HANDS-ON WORKSHOP: MORNING SESSION* Moderators: Ashutosh Wali, MD, FFARCSI,, and Uma Munnur, MD Preparation of the Airway Eschmann Stylet Flexible Scopes - Adult and Pediatric - Double Lumen Tube - Bronchial Blockers Optical Stylets - Levitan Scope - Shikani Stylet - Video Intubation Scope 11:50 Lunch (provided) New Devices in Airway Management Moderator: Uma Munnur, MD 1:00 New Gadgets in Airway Management Ashutosh Wali, MD, FFARCSI 1:25 Cricothyroidotomy Dave Nanan, MD 1:50 Break Videolaryngoscopes - GlideScope - McGrath Video Laryngoscope - C-MAC - Air Traq - Pentax - King Vision Unique Challenges: Emergency Room, Pediatrics, Invasive Airway Access, and Airway Registry Moderator: Ashutosh Wali, MD, FFARCSI 2:05 Pre-hospital and Emergency Room: Special Considerations Richard V. Aghababian, MD 2:35 The Pediatric Airway: Special Considerations Laura Torres, MD 3:00 The Traumatized Airway: Management Sally Raty, MD 3:25 Follow-up of the Difficult Airway Patient: Difficult Airway Registry Lorraine Foley, MD 3:50 Panel Discussion 4:15 Break 4:30 HANDS-ON WORKSHOP: AFTERNOON SESSION* (Groups A & B will reverse assignments from morning session) 6:00 Evaluation 6:15 Adjourn *The hands-on sessions of this activity are not designated and/or eligible for CME credit. Supraglottic Airways - Laryngeal Mask Airway - Air Q - I-Gel Combitube and Easy Tube King LT/LTS Jet Ventilation Retrograde Wire Intubation Pig Trachs/Mannekin - Cricothyroidotomy

4 TACO 2011 Ultrasound -Guided Workshop Activity Director Activity Co-Directors Activity Managers Connie K. Tran, MD, and Jaime Ortiz, MD David Madrigal, MHA, CCMEP and Annette Brieno Needs and Target Audience Department of Anesthesiology, Baylor College of Medicine developed the Ultrasound-Guided Workshop to educate, highlight and teach various concepts of ultrasound guidance placement of neuraxial blocks and central venous lines. The planning committee reviewed the current survey to indicate the value of the workshop. The committee also reviewed recent national scientific evidence and peer-reviewed articles to determine the need for increased education and hands-on training in ultrasound-guided techniques. Sources demonstrated the need for improved performance in enhancing the success rate of regional blocks and central line placement and to reduce the risks of complications. Experts in ultrasound-guided techniques will provide practical tips and updates during the workshop and in the interactive group sessions at the workshop. Anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), and other allied health professionals should attend. Educational Methods and Objectives Through the use of lectures, presentations, a syllabus, and hands-on workshop sessions, the participant should be able to: Describe the use of ultrasound to identify epidural and spinal anatomy. Describe the application of ultrasound-guided techniques in regional anesthesia. Describe the use of ultrasound as a tool for the placement of central line, peripheral intravascular and arterial lines. Evaluation Evaluation by questionnaire will address program content, presentation, and possible bias. Accreditation/Credit Designation Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Baylor College of Medicine designates this educational activity for a maximum of 3.0 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. The hands-on session of this activity is not designated and/or eligible for CME credit.

5 thursday, March 3, :00 AM Registration and Continental Breakfast 7:20 Welcome and Introduction and Connie K. Tran, MD Review of Ultrasound and Clinical Applications of Ultrasound-Guided Techniques Moderator: Connie K. Tran, MD and Jaime Ortiz, MD 7:40 Ultrasound Principles: Physics and Basic Applications of Ultrasound Jaime Ortiz, MD 8:15 The Use of Ultrasound in Neuraxial Placement 8:45 Transversus Abdominis Plane (TAP) Block versus Epidural Block for Postoperative Pain Control after Cesarean Section Neil Bailard, MD 9:15 Ultrasound-Guided Vascular Access Raja Palvadi, MD 9:45 Update on Local Anesthetic Toxicity Connie K. Tran, MD 10:15 Break 10:30 Hands-On Workshop SESSION* Moderators: Connie K. Tran, MD, Jaime Ortiz, MD, Raja Palvadi, MD, and Neil Bailard, MD Basics of Ultrasound: Ultrasound-Guided Needle Visualization Gel Model, Tofu Model Practical Applications (Human Model) Ultrasound-Assisted Neuraxial Techniques (Spinal, Epidural) Ultrasound-Guided Transversus Abdominis Plane (TAP) Block Thoraco-Abdominal Block (Human Model) Paravertebral Block Ultrasound-Guided Vascular Access Central Line Placement, Arterial Line Placement, Peripheral Line Placement 12:00 Evaluation 12:15 Adjourn *The hands-on session of this activity is not designated and/or eligible for CME credit.

6 Texas Anesthesia Conference for Obstetrics Activity Director Activity Co-Director Activity Managers Quisqueya T. Palacios, MD David Madrigal, MHA, CCMEP and Annette Brieno Needs and Target Audience Department of Anesthesiology, Baylor College of Medicine developed the Texas Anesthesia Conference in Obstetrics (TACO) 2011 based on the 2010 TACO Conference evaluations and surveys of previous participants, the 2009 and 2010 In-Training Examinations and MOCA Keywords. The content was also based on national society and scientific meetings and peer-reviewed publications. The conference will highlight the relevancy of the Practice Guidelines in Obstetric Anesthesia, tips to optimize epidural labor analgesia, the use of ultrasound in labor epidural placement and achieving competency. The conference will also focus on the growing epidemic of obesity and practical tips from literature. The conference will also address recent issues affecting the provision of anesthesia in light of shortages of key anesthetic agents, and the changing views of vaginal birth after Cesarean Section and JCAHO alert on maternal mortality. The conference will provide new ideas on crisis management and Rapid Response teams in management of critical situations in obstetrics, an update on Closed Claims in obstetrics, and disclosure of adverse events and preparing for Trial and Deposition. Anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) should attend. Educational Methods and Objectives Through the use of lectures, case presentations, panel discussions, and question and answer sessions, the participant should be able to: Describe the role of ultrasound for spine demarcation before placement of neuraxial blocks. Explain the American Society of Anesthesiologists updated practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. Employ lessons learned from the ASA Closed Claims Database Project regarding obstetric anesthesia mishaps to improve patient safety and decrease provider malpractice. Describe and discuss the determinants and factors associated with failed intubation and management strategies in obstetric patients. Explain the American Society of Anesthesiologists obstetric anesthesia practice guidelines regarding fasting regimens in pregnant women factoring in the individual patient and other research studies. Evaluation Evaluation by questionnaire will address program content, presentation, and possible bias. Accreditation/Credit Designation Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Baylor College of Medicine designates this educational activity for a maximum of 24.5 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. The presentation, Full Disclosure of Adverse Events to Patients, has been designated by Baylor College of Medicine for.50 credit of education in medical ethics and/or professional responsibility. The presentation, Preparing for Trial and Deposition (Right versus Wrong Answer), has been designated by Baylor College of Medicine for.75 credit of education in medial ethics and/or professional responsibility.

7 friday, March 4, :00 AM Registration and Continental Breakfast 6:55 Welcome and Introduction Chairman Department of Anesthesiology Professor of Anesthesiology and Obstetrics and Gynecology Division Chief of Obstetrics and Gynecology Anesthesiology Practice Guidelines: Labor Analgesia Techniques Old and New Thoughts Moderator: 7: ASA Practice Guidelines for Obstetric Anesthesia: Still Relevant? Lawrence C. Tsen, MD 7:35 Loss of Resistance Technique: Air vs Saline Old or New Debate? Scott Segal, MD 7:55 Ultrasound for Labor Epidural Analgesia: When is Competency Reached? 8:30 Epidural Equinox: Ten Tips to Optimize Your Epidural Labor Analgesia Technique Lawrence C. Tsen, MD 9:00 Is Combined-Spinal Epidural Analgesia Indicated for All Laboring Patients? Scott Segal, MD 9:30 Break No Drugs/New Dilemmas/Old Drugs/Blocks Revisited Moderator: Chawla La Toya Mason, MD 9:50 Drug Shortages: No Pentothal, Propofol, Succinylcholine, Fentanyl, or Morphine Stat Section, Now What? Connie K. Tran, MD 10:10 Ketamine for Instrumental Vaginal Delivery, Intra and Postpartum Pain Management Jose M. Rivers, MD 10:40 Optimizing Oxytocin Use for Cesarean Delivery Lawrence C. Tsen, MD 11:10 Transversus Abdominis Plane (TAP) Block for Post-Cesarean Delivery Analgesia 11:30 Panel Discussion 12:00 Break HOSTED LUNCHEON: Chronic Pain After Cesarean Delivery Myth Or Real? Moderator: 12:20 Introduction of Keynote Speaker 12:30 Chronic Pain After Cesarean Delivery New Thoughts and Research Ruth Landau, MD 1:30 Question and Answer Session Intake During Labor, Infection, VBAC, Uterine Rupture Moderator: Jose Rivers, MD 2:15 Would You Like Fries with That? An Update on PO Intake During Labor Jill M. Mhyre, MD 2:45 Practice Advisory for the Prevention, Diagnosis and Management of Infectious Complications Associated with Neuraxial Techniques Barbara Leighton, MD 3:15 What s New in Obstetric Anesthesia? Practical Tips from the Literature Jill M. Mhyre, MD 3:45 Break 4:00 Changing Views on Vaginal Birth After Cesarean Delivery (VBAC) Christina M. Davidson, MD 4:30 Recognition of Uterine Rupture and Anesthesia for VBAC Chawla LaToya Mason, MD 5:00 Panel Discussion 5:30 Adjourn

8 6:30 AM Registration/Buffet Breakfast Saturday, March 5, 2011 The High-Risk Parturient, Morbid Obesity Reproductive Technologies Moderator: 7:00 New Trends in the Management of the High Risk Parturient J. Sudharma Ranasinghe, MD 7:30 The Growing Epidemic of Morbid Obesity 8:00 Anesthesia for Assisted Reproductive Technologies Lawrence C. Tsen, MD 8:30 Panel Discussion 8:50 Break Patient Safety: Improving Outcomes Moderator: Alice Oswald, MD 9:10 Declining Use of GA in Obstetrics: Maintaining Advanced Airway Skills 9:40 Dilemmas: Private Practice Versus Academic Practice Quisqueya T. Palacios, MD 10:00 Anesthesia-Related Maternal Mortality: Improving Outcomes Jill M. Mhyre, MD 10:30 Maternal Resuscitation: Early Warning Systems, Rapid Response, Team and Protocols Uma Munnur, MD 11:00 Break/Exhibits 11:15 The ABCs of Postpartum Hemorrhage: Management 11:45 WHO and JCAHO Alert: Reducing Maternal Morbidity Mortality Secondary to Postpartum Hemorrhage Jose M. Rivers, MD 12:15 Panel Discussion 12:45 Lunch (on your own) Quality Assurance Team Training, GA Fetal Neurotoxicity Moderator: Quisqueya T. Palacious, MD 1:45 Should We Introduce Surgical Safety Checklist in Obstetrics to Reduce Morbidity and Mortality? Alice Oswald, MD 2:15 Active Components of Effective Training in Obstetric Emergencies Shobana Chandrasekhar, MD 2:45 Code in OB Suite: Update on Crisis Resource Management Jill M. Mhyre, MD 3:15 Break/Exhibits 3:30 Taps and Mishaps: The Catheter That Misbehaved Sloan Youngblood, MD 4:00 General Anesthesia: Toxic to the Fetal Brain? Scott Segal, MD 4:30 Panel Discussion 5:00 Adjourn Sunday, March 6, :30 AM Continental Breakfast Medico-legal and Ethical Issues Moderator: Ashutosh Wali, MD, FFARCSI 8:00 Update on Closed Claims Studies in Obstetrics Barbara Leighton, MD 8:30 Full Disclosure of Adverse Events to Patients Barbara Leighton, MD 9:00 Preparing for Trial and Deposition (Right versus Wrong Answer) James R. Banfield, JD, BS 9:45 Break Obstetric Anesthesia Nightmares Moderator: 10:10 Obstetric Anesthesia Nightmares J. Sudharma Ranasinghe, MD 10:50 Fever and Epidural Anesthesia: Still a Hot Topic? Scott Segal, MD 11:15 Amniotic Fluid Embolism New Perspectives Ashutosh Wali, MD, FFARCSI 11:45 Panel Discussion 12:15 Evaluation 12:30 Adjourn

9 Visiting faculty Richard V. Aghababian, MD Professor of Emergency Medicine University of Massachusetts Medical School Worcester, Massachusetts Chris Christodoulou, MD Undergraduate Program Director University of Manitoba Winnipeg, Canada Daniel J. Cook, MD Anesthesiologist Cookgas LLC St. Louis, Missouri Lorraine Foley, MD Winchester Hospital Boston, Massachusetts Carin A. Hagberg, MD Joseph C. Gabel Professor and Chair Department of Anesthesiology The University of Texas Medical School at Houston Houston, Texas Ruth Landau, MD Professor and Director of Obstetric Anesthesiology and Clinical Genetics Anesthesiology and Pain Medicine University of Washington Seattle, Washington Barbara Leighton, MD Professor of Anesthesiology Professor of Obstetrics and Gynecology Washington University School for Medicine St. Louis, Missouri Yin Lim, MD Anesthesia Attending Staff Medical Center of Delaware Media, Pennsylvania Jill M. Mhyre, MD Assistant Professor Department of Anesthesiology University of Michigan Health System Ann Arbor, Michigan Thomas C. Mort, MD Senior Associate, Anesthesiology Associate Director, Surgical ICU Associate Professor of Anesthesiology and Surgery UCONN Founder Hartford Hospital Simulation Center Medical Director, Simulation Center Hartford, Connecticut David N. Nanan, MD Anesthesiologist Anesthesia Associates Beaumont, Texas Muhammed A. Nasir, MD Anaesthesiologist Luton and Dunstable NHS Foundation Trust University of London, United Kingdom John Allen Pacey, MD, FRCS(C) Honorary Professor of Anesthesia University of British Columbia Canada J. Sudharma Ranasinghe, MD Associate Professor of Anesthesiology University of Miami Miller School of Medicine Associate Director of OB Anesthesia Jackson Memorial Medical Center Miami, Florida Scott Segal, MD Chairman, Department of Anesthesia Tufts University School of Medicine Boston, Massachusetts Lawrence C. Tsen, MD Associate Professor of Anesthesia Harvard Medical School Brigham and Women s Hospital Boston, Massachusetts Associate Professor Director, Obstetric Anesthesia Department of Anesthesiology Magee-Women s Hospital of UPMC Pittsburgh, Pennsylvania Chandy Verghese, MD Consultant Anaesthetist LMA Research Centre Department of Anaesthesia Royal Berkshire Hospital Reading Berkshire, United Kingdom Baylor College of Medicine faculty Neil Bailard, MD James R. Banfield, JD, BS Shobana Chandrasekhar, MD Christina M. Davidson, MD Chawla LaToya Mason, MD Uma Munnur, MD Jaime Ortiz, MD Alice Oswald, MD Quisqueya T. Palacios, MD Raja Palvadi, MD Sally Raty, MD Jose M. Rivers, MD Laura Torres, MD Connie K. Tran, M.D. Ashutosh Wali, MD, FFARCSI Sloan Youngblood, MD

10 Fee, Registration and Confirmation Information Refer to the registration form for the fee schedule. Your registration will not be processed until payment is received. Your registration will be confirmed. If you have not received confirmation at least five business days before the activity start date, contact the OCME immediately. If you plan to register on-site, contact OCME at least 24 hours in advance to confirm activity status and space availability. The OCME reserves the right to limit the number of participants in an activity and will not be responsible for any expenses incurred by an individual whose registration is not confirmed and for whom space is not available. To register/pay online visit the activity websites and follow instructions. You must register for workshops and/or conference separately. Difficult Airway Workshop: BaylorCME.org/CME/1449W1 Ultrasound-Guided Workshop: BaylorCME.org/CME/1449W2 TACO Conference: BaylorCME.org/CME/1449M Conference Location and Accommodations Hilton Houston Post Oak 2001 Post Oak Blvd. Houston, TX Accommodations should be arranged directly with the Hilton Houston Post Oak by calling or going online to: IAHWSHH-BTC /index.jhtml?WT.mc_id=POG. Please identify yourself with the Baylor College of Medicine Texas Anesthesia Obstetrics Conference when making reservations in order to benefit from the special group rate ($152 single/double). A limited number of rooms have been reserved at the special rate on a space available basis. The deadline to receive the special rate is February 9, 2011, unless the room block has already been filled. RESERVE YOUR ROOM EARLY. For Further Information Contact Baylor College of Medicine Phone: Office of CME Fax: One Baylor Plaza, MS: BCM cme@bcm.edu Houston, TX Visit our Website located at BaylorCME.org for information about other Baylor College of Medicine CME activities. Disclosure In order to meet the requirements of the Accreditation Council for Continuing Medical Education it is the policy of Baylor College of Medicine that all individuals who are in a position to control the content of a CME activity (activity director, planning committee members, and faculty) disclose relevant financial relationships with commercial interests. All identified conflicts of interest are managed to help ensure that the educational material is scientifically based, accurate, and objectively presented. Specific disclosure will be made to the participants prior to the educational activity. Cancellation/Refund Policy Requests for registration refunds must be in writing and received by the Office of Continuing Medical Education (OCME) at least 10 business days before the activity begins. The date the request is received by the OCME will be considered the cancellation date. Requests received after the refund deadline will not be processed. Cancellations are subject to a $50 administrative fee deducted from the registration fee paid to cover guarantees and other expenses. Requests should be mailed to the OCME or faxed to The OCME reserves the right to cancel activities, not less than 10 business days before the scheduled date, if extenuating circumstances make it necessary. Registrants will be notified at the contact number indicated on the registration form followed by written notification. If an activity is cancelled, OCME s liability is limited to the registration fee paid. Note: If payment is made by check, a social security number is required to process the refund.

11 TACO 2011 Registration Form Please use the following registration form to provide your personal information, regardless of the conference and/or workshop(s) you are attending. Name: Affiliation: Address: City: State: Zip: Phone: Fax: Specialty: Prof. Lic. (No./State): Emergency Contact Name/Phone: Please register for any and all conferences below, that you wish to attend: Neither the Difficult Airway Workshop nor the Ultrasound-Guided Workshop meet the AMA requirements for designating new procedures and skills training for credit. You must register for the TACO Conference, Difficult Airway Workshop, and Ultrasound-Guided Workshop separately: Difficult Airway Workshop: BaylorCME.org/CME/1449W1 Ultrasound-Guided Workshop: BaylorCME.org/CME/1449W2 TACO Conference: BaylorCME.org/CME/1449M DIFFICULT AIRWAY WORKSHOP Thursday, March 3 Registration Fees: On/Before 2/3/11 After 2/3/11 On/Before 2/3/11 After 2/3/11 Physician $600 $625 Baylor Faculty $200 $250 BCM Resident/Fellow* $175 $225 Non-BCM Resident/Fellow* $200 $250 *Verification required. Fax within 24 hours of registration to Physician $450 $475 Baylor Faculty $200 $250 BCM Resident/Fellow* $450 $475 Non-BCM Resident/Fellow* $200 $250 *Verification required. Fax within 24 hours of registration to Method of Payment (Your registration must be PREPAID) Non-BCM CRNA* $550 $575 BCM CRNA* $175 $225 Non-BCM SRNA* $200 $250 BCM SRNA* $175 $225 CRNA AANA No. (required for AANA credit) ULTRASOUND-GUIDED WORKSHOP Thursday, March 3 Registration Fees: On/Before 2/3/11 After 2/3/11 On/Before 2/3/11 After 2/3/11 Physician $625 $650 Baylor Faculty $200 $250 BCM Resident/Fellow* $175 $225 Non-BCM Resident/Fellow* $200 $250 *Verification required. Fax within 24 hours of registration to Non-BCM CRNA* $400 $450 BCM CRNA* $175 $225 Non-BCM SRNA* $200 $250 BCM SRNA* $175 $225 CRNA AANA No. (required for AANA credit) TEXAS ANESTHESIA CONFERENCE FOR OBSTETRICS Friday-Sunday, March 4-6 Registration Fees: On/Before 2/3/11 After 2/3/11 On/Before 2/3/11 After 2/3/11 Non-BCM CRNA* $550 $575 BCM CRNA* $175 $225 Non-BCM SRNA* $200 $250 BCM SRNA* $175 $225 CRNA AANA No. (required for AANA credit) Check or money order (in U.S. funds) made payable to: Baylor College of Medicine Visa MasterCard Discover Amex $ Total amount enclosed Card No. Exp. Date: Name on the Card: Authorized Signature: With credit card payment, you may fax completed registration form to Return completed form and payment to: Baylor College of Medicine Office of CME (1449) P.O. Box 4708 Houston, Texas Special Requests Contact BCM OCME if you have any dietary needs (specify below) or any ADA accommodation needs. To register/pay online, visit the activity website at BaylorCME.org/CME/1449 and follow the instructions. FOR OFFICIAL USE ONLY CK CC LB Cash Date: Amount: