The Changing Practice of Anesthesia Hotel Nikko, San Francisco, CA

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1 The Changing Practice of Anesthesia Hotel Nikko, San Francisco, CA September 11 13, 2009 THE CHANGING PRACTICE OF ANESTHESIA is designed to update the clinician on some of the most significant advances in the field of anesthesia. These changes include new developments in general and specialized areas of perioperative medicine, anesthesia, and critical care. We have also included case-based discussion and specialized workshops. In addition, three optional interactive workshops conducted on September 10: Anesthesia Simulator Training Workshop, Hands-On Difficult Airway Management Workshop, Ultrasound Regional Anesthesia Workshop. EDUCATIONAL OBJECTIVES Upon completion of the educational activity participants should be able Understand the mechanism of action, and evidence-based use of non-narcotic Discuss use of incisional catheters/local anesthetics for post-op pain. Increase skill level in the performance of standard regional blocks with ultrasound Update on the most recent evidence regarding massive transfusion protocols and describe the misuses and uncertain benefit of recombinant factor Understand the medicolegal issues associated with pre-op pregnancy testing and existing data on teratogenic effects of anesthestic Understand the anesthetic risks and benefits for pregnant patients undergoing non-obstetric surgery, including cardiac and neurosurgical Update on newly evolving facts related to postdischarge nausea and vomiting with emphasis on Emend, a new NKI receptor Review risks, benefits, and controversies surrounding several drugs introduced into clinical practice over the last few years including methylnaltrexone, gadolinium, clevidipine, and Be familiar with the current functional characteristics and practice guidelines of commonly used internal defibrillators and Describe the role that closed loop anesthesia delivery may play in anesthesia care and why anesthesiologists cannot be replaced by Discuss the perioperative management of videoscopic assisted thoracoscopy, an increasingly common procedure in community hospitals, from both anesthesia and surgical Update on insulin management for IDDM patients, with specific goals of avoiding DKA and Discuss current social issues affecting the practice of anesthesia including: prevalence and management of PTSD, environmental sustainability of energy and equipment use patterns in operating room Discuss and debate the risks and benefits of perioperative beta blockade in the light of recent clinical Understand the theoretical basis and practical applications of intralipid infusions for treatment of systemic anesthesia Discuss the evidence-based practice on the use of ultrasound for vascular access and diagnosing Compare fiberoptic laryngoscopy techniques and equipment; better recognize options for difficult airways Complete OR tasks with better body Discuss the controversy surrounding benefit of EEG depth of anesthesia monitoring and spinal Define professional and unprofessional behaviors and learn simple techniques to deal successfully with difficult situations and/or individuals. ACCREDITATION The University of California, San Francisco School of Medicine (UCSF) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. UCSF designates this educational activity for a maximum of 17.0 AMA PRA Category 1 Credit(s)TM. Anesthesia Simulator Training Workshop (MAN1001A/B), for a maximum of 4 AMA PRA Category 1 Credit(s)TM, Hands-On Difficult Airway Management Workshop (MAN1001C) for a maximum of 8 AMA PRA Category 1 Credit(s)TM and the Ultrasound Regional Anesthesia Workshop (MAN1001D/E), for a maximum of 4 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. This CME activity meets the requirements under California Assembly Bill 1195, continuing education and cultural and linguistic competency. Approval is pending from the American Association of Nurse Anesthetists (AANA) for the Changing Practice of Anesthesia (MAN10001) for TBA CE credits, Anesthesia Simulator Workshop. (MAN1001A/B) for TBA CE credits, the Hands-On Difficult Airway Management Workshop (MAN1001C) for TBA CE credits and the Ultrasound Regional Anesthesia Workshop (MAN1001D/E) TBA CE credits. For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA category 1 credit issued by organizations accredited by the ACCME.

2 UCSF Department of Anesthesia and Perioperative Care PARTICIPATING FACULTY AND STAFF Pedram Aleshi, MD Health Sciences Assistant Clinical Professor Christian C. Apfel, MD, PhD Associate Professor Perioperative Clinical Research Core Matthias Behrends, MD Assistant Professor In Residence Philip Bickler, MD, PhD Professor Martin S. Bogetz, MD Ryan J. Bradley, MD Clinical Instructor Marek Brzezinski, MD, PhD Assistant Professor Claire M. Brett, MD Daniel H. Burkhardt, MD Associate Professor Lundy Campbell, MD Assistant Clinical Professor Lydia Cassorla, MD, MBA Clinical Professor Anesthesia and Perioperative Care Adam B. Collins, MD Associate Professor of Anesthesia Elizabeth A. Donegan, MD Associate Clinical Professor Kenneth Drasner, MD Andrew T. Gray, MD, PhD Professor of Anesthesia Alicia Gruber Kalamas, MD Assistant Clinical Professor Anesthesia and Perioperative Care Jasleen Kukreja, MD, MPH Assistant Professor of Surgery Merlin D. Larson, MD Professor Anesthesia and Perioperative Care Eric Y. Lin, MD Assistant Clinical Professor Martin J. London, MD Warren R. Mckay, MD Clinical Professor Thomas C. Neylan, MD Associate Professor in Residence Department of Psychiatry, Director PTSD Program Manuel C. Pardo, MD Professor of Anesthesia and Perioperative Care Cheng S. Quah, MD Assistant Professor David Robinowitz, MD Assistant Professor of Anesthesiology Mark D. Rollins, MD, PhD Assistant Professor in Residence Patricia A. Roth, MD Medical Director, Anesthesia OR Support Services Kathryn Rouine-Rapp, MD Medical Director, Mt. Zion and Parnassus Prepare Robert J. Rushakoff, MD Clinical Professor of Medicine Susan Ryan, PhD, MD Clinical Professor Conference Program Director Francis V. Salinas, MD Staff Anesthesiologist Virginia Mason Medical Center Mark A. Schumacher, MD, PhD Associate Professor Robin M. Shaw, MD, PhD Assistant Professor of Medicine/Cardiology Investigator, Cardiovascular Research Institute Laura Siedman, MD Clinical Professor of Anesthesia Robin Stackhouse, MD Clinical Professor of Anesthesia Pekka Talke, MD Professor in Residence John M. Taylor, MD Health Sciences Assistant Clinical Professor Donald M. Taylor, MD, PhD Assistant Professor in Residence Art W. Wallace, MD, PhD Professor of Anesthesiology and Perioperative Care Spencer Yost, MD Professor Kristine Watson, MPT Senior Physical Therapist Maurice Zwass, MD Professor of Anesthesia and Pediatric faculty

3 Office of Continuing Medical Education MAN09001 UCSF Box 0742, LH-450 San Francisco, CA R E G I S T E R T O D A Y! For more information or to register online, visit our website at You may also reach us by calling the Office of Continuing Medical Education at 415/ or info@ocme.ucsf.edu GENERAL INFORMATION Pre-registration is preferred to ensure that registrants receive CME Certificate at the course. HOW TO ENROLL $ 495 Physicians $ 425 CRNAs (include AANA #) $ 225 Residents, Interns, Student CRNAs (Include a letter from the Program Director) Physicians in training must include a letter of verification from training program with registration to qualify for reduced tuition fee. ADDITIONAL WORKSHOP FEES Registration is only available by calling 415/ >Anesthesia Simulator: MAN1001A/B Workshop session is limited to 3 people am/pm. $450 Simulator Course Only $400 If attending the Changing Practice of Anesthesia >Hands On Difficult Airway Management: MAN1001C Workshop session is limited to 48 people. $395 Physicians/CRNA >Ultrasound Regional Anesthesia: MAN1001D/E Workshop session is limited to 24 people am/pm. $175 Physicians/CRNA Payment can be made by Visa, MasterCard, American Express or check. Register via: Online Mail Complete registration form and send payment to: UCSF Office of CME P.O. Box San Francisco, CA Fax Fax registration form to: 415/ (please include your credit card #) Phone UCSF Office of CME 415/ REFUNDS Cancellations received in writing before the first day of the course will be refunded, less a $75 administrative fee. No refunds will be made on cancellations received after that date. PAPERLESS We will no longer be distributing a printed syllabus for this course. Registrants will have access to all talks on a conference website pre and post conference. Those interested in following along can bring their laptops (there will be electrical outlets in the main hall). We will also have printers for those who wish to print selected talks. CONFERENCE LOCATION Enjoy San Francisco s renowned attractions such as the historic cable cars, shopping in Union Square, or visit San Francisco s culinary hub at the Ferry Building. The Hotel Nikko is just steps from Union Square and the Theatre District. A block of guestrooms has been reserved at the at a special UCSF discounted conference rate of $249. The contracted cut off date is August 29, 2009, or until the group room block is filled, whichever comes first. After this date, rooms will be provided on a space-available basis only. If you prefer to phone in your reservation, please identify yourself as a member of this conference to receive the special rate. Reservations on-line use booking code: SUCANE. If you prefer to telephone in your reservation, call 415/ , please identify yourself as a member of this UCSF conference to receive the special rate. By staying at the host hotel, you help the University of California meet its contractual obligations and keep future registration fees reasonable. Please take this into consideration when making your accommodation decisions. HOTEL POLICIES Reservations must be cancelled at least 24 hours in advance or a one-night s stay {and applicable taxes} will be charged. A credit card number is required to confirm your reservation. Check-in is 3:00pm and Check-out is 12:00 noon. Reservation requests made after August 29, 2009, will be honored at the conference room rates on a spaceavailable basis. Room rates are subject to all state and local taxes (currently %, subject to change without notice). RENTAL CAR Hertz is offering special rates for participants of this conference; simply call and refer to identification number 03BW0128 or call your travel agent. You may also make reservations at Advance reservations are recommended. AIR TRANSPORTATION Special arrangements have been made with Montgomery Travel. Call or complete UCSF form on In addition to offering lower rates than published airfares, ticketed passengers may take advantage of the 24 hour emergency service. There is a $35 service fee. UCSF OCME has negotiated special fares with American and United Airlines for our course attendees. You may use the following tour codes to book on your own at American Airlines US Code: or United Airlines Code: 510CF

4 September 11 13, 2009 The Changing Practice of Anesthesia Hotel Nikko San Francisco, California Pre-course Workshops: September 10, 2009 Anesthesia Simulator Training Workshop Hands-On Difficult Airway Management Workshop Ultrasound Regional Anesthesia Workshop Department of Anesthesia and Perioperative Care University of California, San Francisco University of California San Francisco

5 The Changing Practice o THURSDAY SEPTEMBER 10, 2009 >ANESTHESIA SIMULATOR TRAINING WORKSHOP: MAN1001A/B Department of Anesthesia Center for Health Care Simulation, San Francisco General Hospital (SFGH) Workshop sessions are limited to 3 participants per session. Session One: 9:00am 1:00pm. Session Two: 1:30PM 5:30pm. Registration Fees: $ if not attending MAN10001 course, $ if attending MAN10001 course. Registration is ONLY available by calling 415/ Course Director Manuel C. Pardo, Jr., MD and Adam B. Collins, MD Faculty Adam B. Collins, MD, Manuel C. Pardo Jr., MD and Julin Tang, MD, PhD COURSE DESCRIPTION This program is designed to provide the practitioner with an update on the management of perioperative medical crises. Details of medical management will be discussed, as well as proper crisis management behaviors. This half-day course format includes a one-hour lecture followed by three realistic OR simulations. In each scenario, one participant will act as the main anesthesia provider in the management of a simulated perioperative crisis. Other participants will be asked to play a role in the clinical scenario, such as scrub nurse or anesthesia tech. Scenarios will be videotaped and reviewed immediately afterwards in a debriefing conference. For educational objectives and course schedule please see >HANDS ON DIFFICULT AIRWAY MANAGEMENT WORKSHOP: MAN1001C Hotel Nikko, San Francisco Workshop sessions are limited to 48 participants. Faculty to registrant ratio is 1:4. Registration Fee $395. Session 8am 5pm. Registration is ONLY available by calling 415/ Course Directors Patricia Roth, MD and Robin Stackhouse, MD COURSE DESCRIPTION This workshop is designed to update practitioners on the latest airway data, equipment and techniques. It will begin with a series of talks and demonstrations that detail various situations in which an airway cannot be established through conventional means, including a discussion of appropriate methods and tools that can be used in difficult airway management. This will be immediately followed by a hands-on training workshop where participants will practice these techniques using many types of airway management equipment on mannequins to further sharpen and refresh their skills. For educational objectives and course schedule please see >ULTRASOUND REGIONAL ANESTHESIA WORKSHOP: MAN1001D/E Hotel Nikko, San Francisco Workshop sessions are limited to 24 participants per session. Registration Fees: $175. Session One: 7:30am 12:00pm. Session Two: 12:30pm 5:00pm. Registration is ONLY available by calling 415/ Course Directors Dr. Andrew T. Gray, MD, MPH COURSE DESCRIPTION The purpose of this activity is to provide the practitioner with the necessary skills to successfully use ultrasound for regional blocks and vascular access. Instruction includes both didactic and hands-on sessions and covers basic and advanced uses for ultrasound imaging. Each student will use ultrasound equipment for scanning using live and phantom models. For educational objectives and course schedule please see FRIDAY SEPTEMBER 11, :00am Registration and Breakfast 8:00 Welcome and Announcements REGIONAL BLOCKS AND ACUTE PAIN MANAGEMENT Moderator: Daniel Burkhardt 8:05 Non-opioid Analgesics for Perioperative Management Mark Schumacher 8:30 Ultrasound Guidance of Peripheral Nerve Catheter Placement Francis Salinas 8:55 Catheters for Regional Blocks: Transitioning to Home Francis Salinas, Daniel Burkhardt

6 f Anesthesia September 11 13, 2009 Hot 9:20 DISCUSSION TRANSFUSION CONTROVERSIES Moderator: Elizabeth A. Donegan 9:35 A New Standard of Care in Massive Transfusion Eric Lin 10:00 The Misuse of Factor VII Elizabeth A. Donegan 10:25 DISCUSSION 10:35 BREAK THE PREGNANT PATIENT Moderator: Mark Rollins 11:00 Pre-op Pregnancy Testing Ryan Bradley 11:15 Anesthetic Considerations for Non-Obstetric Surgery During Pregnancy Mark Rollins 11:40 Neurologic Complications in Obstetrics Pedram Aleshi 12: 05 DISCUSSION 12:15pm LUNCH {on your own} POST-OPERATIVE NAUSEA AND VOMITING Moderator: Alicia Kalamas 1:45 Emend: Expanding the Armamentarium for PONV Alicia Kalamas 2:00 Preventing and Treating Post-Discharge Nausea and Vomiting Christian Apfel 2:30 DISCUSSION A SURVEY: MEDICATIONS RELEVANT TO ANESTHESIA PRACTICE Moderator: Alicia Kalamas 2:40 Methylnaltrexone, Gadolinium, TNF Inhibitors, Clevidipine Matthias Behrends, Alicia Kalamas 3:25 BREAK PACEMAKER/ICDS 3:45 Internal Defibrillators & Pacers: Negotiating An Evolving Landscape Lydia Cassorla MCSLEEPY: A SAFE AND APPROPRIATE DIRECTION FOR THE FUTURE? Moderator: Martin Bogetz 4:30 DISCUSSANTS Pro: Manuel Pardo Con: Merlin Larson 5:00 ADJOURN 5:15 WINE TASTING RECEPTION SATURDAY SEPTEMBER 12, :00am Registration and Breakfast 8:00 Annoucements PEDIATRIC ANESTHESIA Moderator: Laura Siedman 8:05 The Pediatric Obesity Epidemic: Anesthetic Implications David Robinowitz 8:30 Patient Selection: Not in My Ambulatory Center! Laura Siedman 8:50 DISCUSSION THORACIC ANESTHESIA: VATS Moderator: Cheng Quah 9:00 Minimally Invasive Thoracic Surgery: The Surgical Perspective Jasleen Kukreja

7 el Nikko, San Francisco 9:25 Anesthetic Management of VATs versus Thoracotomy Cheng Quah 9:50 DISCUSSION 10:05 BREAK MANAGEMENT OF THE INSULIN DEPENDENT DIABETIC Moderator: Kathryn Rouine-Rapp 10:25 Current Issues in Type 1 Diabetes Management Robert Rushakoff 10:50 Intra-operative Management: Avoiding DKA Kathryn Rouine-Rapp 11:15 DISCUSSION POST-TRAUMATIC STRESS DISORDER Moderator: Marek Brzezinski 11:30 PTSD- Stress Disorder: Assessment, Diagnosis and Treatment Thomas Neylan 11:50 Perioperative Considerations in Patients with Posttraumatic Stress Disorder Marek Brzezinski 12:15pm DISCUSSION 12:30 LUNCH {on your own} PERIOPERATIVE BETA-BLOCKADE: LIBERAL USE SAVES LIVES Moderator: Kathryn Rouine-Rapp 2:00 DISCUSSANTS Pro: Arthur Wallace Con: Martin London 2:30 Détente: Can We Agree on a Beta-Blocker Practice? Kathryn Rouine-Rapp ENVIRONMENTAL PRACTICES 2:45 Out of Sight, Out of Mind? Talking Trash in the Era of Sustainability Spencer Yost 3:15 BREAK RESCUE FROM DISASTER Anesthesia and Society Moderator: John Taylor 3:35 Intralipid Resuscitation for Systemic Anesthetic Toxicity Ken Drasner 4:05 Hypotension in the PACU: Ultrasound Diagnostic Assistance John Taylor 4:25 Case Management: Perioperative EKGs- When to Worry Robin Shaw, John Taylor 5:00 ADJOURN SUNDAY SEPTEMBER 13, :00am Registration and Breakfast 8:00 {Participants may attend one workshop} 1. Difficult Cases in Regional Anesthesia Philip Bickler, Adam Collins, Warren McKay 2. When Tempers Flare: Professionalism in the OR Marek Brzezinski, Martin Bogetz 3. Better Body Mechanics for Anesthesia Providers Kristine Humphrey, Donald Taylor 4. Difficult Airway Cart & Equipment - A Case Based Approach Patricia Roth 5. New/Established Monitoring: Effective Use and Interpretation Lundy Campbell, Pekka Talke 9:45 BREAK 10:15 {Participants may attend one workshop} 1. Difficult Cases in Regional Anesthesia Philip Bickler, Adam Collins, Warren McKay 2. Pediatric Cases Claire Brett, Maurice Zwass 3. Better Body Mechanics for Anesthesia Providers Kristine Humphrey, Donald Taylor 4. Difficult Airway Cart & Equipment - A Case Based Approach Patricia Roth 5. New/Established Monitoring: Effective Use and Interpretation Lundy Campbell, Pekka Talke 12:00pm EVALUATIONS AND ADJOURN

8 COURSE REGISTRATION FORM The Changing Practice of Anesthesia September 11 13, 2009 Hotel Nikko, San Francisco Mail To: UCSF Office of CME P.O. Box 45368, San Francisco CA Fax 415/ Registration Information 415/ Course Information 415/ Dr. Mr. Mrs. Ms. Last Name First M.I. Degree Specialty Address City State Zip Daytime Phone Fax Would you like to be on our priority list? Yes No Address Label Code {see address label: example, A, B, C, D, etc.} Date of birth to be used as OCME registrant number: / / X X Please indicate if you have any special needs: o Month Day Year MAN10001 Registration Fees: $495 Physicians $425 CRNAs AANA # $225 Residents, Interns, Student CRNAs {Include a letter from the Program Director} Please charge my Visa MasterCard Amex for $ Checks payable to UC Regents. To register for all pre-course workshops to be held on September 10 please call 415/ Card Number Expiration Date Name on Card {Please Print} Authorized Signature Refund Policy: Cancellations received in writing before the first day of the course will be refunded, less a $75 administrative fee. No refunds will be made on cancellations received after that date.