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67th Annual PostGraduate Assembly in Anesthesiology

December 13 – December 17, 2013

Marriott Marquis, NewYork | USA

i2013 PGA67 Program • Sponsored by The New York State Society of Anesthesiologists, Inc.

David J. Wlody, M.D.PGA General ChairCommittee on Annual Sessions

Dear Colleagues:

For over sixty-six years, the PostGraduate Assembly (PGA) – theannual meeting of The NewYork State Society ofAnesthesiologists – has been a focal point for innovation andchange in the medical specialty of anesthesiology. The PGA iscurrently one of the largest annual gatherings foranesthesiologists worldwide, and a premier international meeting,as over thirty percent of attendees travel from outside the UnitedStates.

We welcome learners to share experiences with fellowpractitioners and scientists in the heart of NewYork City. Ourobjective is to provide an opportunity to interact with otherclinicians for the benefit of your patients, your practice, yourgraduate medical education program and your research. Throughyour feedback and other sources, we identify knowledge andpractice gaps within our specialty and address them through avariety of teaching techniques. We hope you find a teachingmethod suitable to your learning style, and welcome yoursuggestions for improvement. Teaching formats include lectures,hands-on workshops, mini-workshops, problem-based learningdiscussions, focus sessions and poster presentations.

Scientific Panels address knowledge and practice gaps chosenfrom a broad range of topics relevant to the clinician. The sessionsinclude interactive discussions, during which the panel addressesaudience questions and comments.

Focus Sessions give in-depth coverage of more specific topics andpro/con debates on controversial issues that are of interest toselect audiences.

Hands-OnWorkshops and MiniWorkshops are high intensity, closecontact sessions with expert instructors. This is your opportunityto seek out in depth information regarding a clinical competence.

Problem-Based Learning Discussions (PBLDs) are small group casediscussions with experienced clinicians. The goal of the PBLDs areto explore a specific clinical problem and learn through closeinteraction between the moderator and the participants.

The Resident Research Contest affords young investigators anopportunity to present their work to their peers at a majorinternational forum.

Scientific Exhibits, Poster Presentations and Medically ChallengingCase Reports allow attendees to discuss the latest scientificprogress in the specialty of anesthesiology, and review interestingcases.

Technical Exhibits enable attendees to explore available drugs,devices, equipment and services useful for their practice, andobtain further information from a multitude of vendors.

Hospital Visits take place on Thursday, one day prior to the start ofthe PGA. Arrangements are made with NewYork City areahospitals and medical schools to provide attendees with theopportunity to observe the facilities and equipment of majorinstitutions in NewYork City.

Social Events give you, and your guests, the chance to cap offintense days of learning, with memorable evenings filled withBroadway shows, the opera and the endless exciting restaurantsof NewYork City. The bright lights of Broadway beckon you. Takeadvantage of everything“the city that never sleeps”has to offer,during our 67th Annual Meeting!

Richard A. Beers, M.D.PGA Scientific Programs ChairCommittee on Annual Sessions

E N G L I S H I S T H E O F F I C I A L L A N G UAG E O F T H E P G A

ii NYSSA • 67th Annual PostGraduate Assembly in Anesthesiology • www.nyssa-pga.org

iii2013 PGA67 Program • Sponsored by The New York State Society of Anesthesiologists, Inc.

1945 (No Officeholder) E. A. Rovenstine, M.D. *1946 (No Officeholder) (No PGA Held)1947 (No Officeholder) E. A. Rovenstine, M.D. *1948 PaulW. Searles, M.D.* Lewis H.Wright, M.D. *1949 IrvingM. Pallin, M.D.* (ASAMeeting in NewYork)1950 H. Arthur Snell, M.D.* Lewis H.Wright, M.D. *1951 H. Arthur Snell, M.D.* E. M. Papper, M.D. *1952 E. M. Papper, M.D. * E. M. Papper, M.D. *1953 Harold F. Bishop, M.D. * E. M. Papper, M.D. *1954 Richard N. Terry, M.D. * S. G. Hershey, M.D. *1955 Albert M. Betcher, M.D. * S. G. Hershey, M.D. *1956 E. Dean Babbage, M.D. * S. G. Hershey, M.D. *1957 S. G. Hershey, M.D. * Louis R. Orkin, M.D.1958 Vincent J. Collins, M.D. * Louis R. Orkin, M.D.1959 John A. Kalb, M.D. * Louis R. Orkin, M.D.1960 Edwin Emma, M.D. * Merel H. Harmel, M.D.1961 Charles M. Landmesser, M.D. * Albert M. Betcher, M.D. *1962 Albert E. Chiron, M.D. * Albert M. Betcher, M.D. *1963 Carl J. Geiger, M.D. * James O. Elam, M.D. *1964 Louis R. Orkin, M.D. * Merel H. Harmel, M.D.1965 Victor J. Tofany, M.D. Benton D. King, M.D. *1966 William S. Howland, M.D. * Benton D. King, M.D. *1967 Richard Ament, M.D. * Benton D. King, M.D. *1968 Edgar H. Bachrach, M.D. * Joseph F. Artusio, Jr., M.D. *1969 Kenneth A. Kelly, Jr., M.D. Joseph F. Artusio, Jr., M.D. *1970 George A. Keating, M.D. * Joseph F. Artusio, Jr., M.D. *1971 Robert M. Lawrence, M.D. * William S. Howland, M.D. *1972 Sarah Joffe, M.D. * William S. Howland, M.D. *1973 H. KetchamMorrell, M.D. William S. Howland, M.D. *1974 Louis S. Blancato, M.D. * Sarah Joffe, M.D. *1975 William B. McCafferty, M .D. * Sarah Joffe, M.D. *1976 Erwin Lear, M.D. * Sarah Joffe, M.D. *1977 William D. Nugent, M.D. Paul J. Poppers, M.D.1978 Thomas K. Lammert, M.D. Paul J. Poppers, M.D.

The PostGraduate Assembly in Anesthesiology was initially established in 1945 as a biennial assembly. Its overwhelming successcaused the founding organizers to modify their objectives and they decided to hold the PGA annually beginning in 1947. In 1949, anASA meeting was held in NewYork in lieu of a PGA. The following is a chronological listing of NYSSA Presidents and PGA GeneralChairs, as well as Distinguished Service Award Recipients and NYSSA members who served as ASA Presidents.

Years NYSSA Presidents PGA General Chairs

NYSSA/PGA History

Years NYSSA Presidents PGA General Chairs

1979 JoyceM. McChesney, M.D. Paul J. Poppers, M.D.1980 Edward C. Sinnott, M.D. * HermanTurndorf, M.D.1981 JosephW. Kramarczyk, M.D. * HermanTurndorf, M.D.1982 Bernard Hollander, M.D. * HermanTurndorf, M.D.1983 James E. Graber, M.D. * Henrik H. Bendixen, M.D. *1984 Lee S. Binder, M.D. * Henrik H. Bendixen, M.D. *1985 Alexander L. Hastie, M.D. Henrik H. Bendixen, M.D. *1986 Gerald S.Weinberger, M.D. Henrik H. Bendixen, M.D. *1987 Charles J. Vacanti, M.D. Henrik H. Bendixen, M.D. *1988 I. Cary Andrews, M.D. * Mieczyslaw Finster, M.D.1989 Jared C. Barlow, M.D. Mieczyslaw Finster, M.D.1990 Marilyn M. S. Kritchman, M.D. Mieczyslaw Finster, M.D.1991 Patrick A. Fantauzzi, M.D. James E. Cottrell, M.D.1992 Herbert J. Fisch, M.D. * James E. Cottrell, M.D.1993 Peter B. Kane, M.D. James E. Cottrell, M.D.1994 Paul L. Goldiner, M.D. AlexanderW. Gotta, M.D.1995 Anthony A. Ascioti, M.D. AlexanderW. Gotta, M.D.1996 AlexanderW. Gotta, M.D. AlexanderW. Gotta, M.D.1997 James P. Burdick, M.D. Elizabeth A.M. Frost, M.D.1998 Margaret G. Pratila, M.D. Elizabeth A.M. Frost, M.D.1999 Michael S. Jakubowski, M.D. Elizabeth A.M. Frost, M.D.2000 Kenneth J. Freese, M.D. Elizabeth A.M. Frost, M.D.2001 Mark J. Lema, M.D., Ph.D. Mark J. Lema, M.D., Ph.D.2002 Phillip N. Fyman, M.D. Mark J. Lema, M.D., Ph.D.2003 Thel G. Boyette, M.D. Mark J. Lema, M.D., Ph.D.2004 Steven S. Schwalbe, M.D. VinodMalhotra, M.D.2005 Scott B. Groudine, M.D. VinodMalhotra, M.D.2006 MichaelH.Mendeszoon,M.D.,M.B.A.VinodMalhotra, M.D.2007 Richard A. Beers, M.D. Rebecca S. Twersky, M.D., M.P.H.2008 Robert S. Lagasse, M.D. Rebecca S. Twersky, M.D., M.P.H.2009 Alan E. Curle, M.D. Rebecca S. Twersky, M.D., M.P.H.2010 Paul H.Willoughby, M.D. Andrew D. Rosenberg, M.D.2011 Kathleen A. O’Leary, M.D. Andrew D. Rosenberg, M.D.2012 Salvatore G. Vitale, M.D. Andrew D. Rosenberg, M.D.2013 Michael B. Simon, M.D. David J.Wlody, M.D.

1996 (inaugural recipient) Erwin Lear, M.D. *1997 Edward C. Sinnott, M.D. *1998 Joseph F. Artusio, Jr., M.D. *1999 Albert M. Betcher, M.D. *2000 Louis R. Orkin, M.D.2001 Louis S. Blancato, M.D. *2002 Sarah Joffe, M.D. *2003 Mieczyslaw Finster, M.D.2004 Gertie F. Marx, M.D. *2005 Paul L. Goldiner, M.D.2006 James E. Cottrell, M.D.2007 Jared C. Barlow, M.D.2008 H. KetchamMorrell, M.D.2009 Peter B. Kane, M.D.2010 AlexanderW. Gotta, M.D.2011 Jack Egnatinsky, M.D.2012 Mark J. Lema, M.D., Ph.D.2013 Margaret G. Pratila, M.D.

NYSSA Distinguished Service Award History

1935/36 Harold C. Kelley, M.D. *1943/44 E. A. Rovenstine, M.D. *1957 IrvingM. Pallin, M.D. *1963 Albert M. Betcher, M.D. *1968 E. M. Papper, M.D. *1971 Robert G. Hicks, M.D. *1977 Richard Ament, M.D. *1982 Louis S. Blancato, M.D. *1985 H. KetchamMorrell, M.D.1987 Howard L. Zauder, M.D., Ph.D.2003 James E. Cottrell, M.D.2007 Mark J. Lema, M.D., Ph.D.

NYSSA’s ASA PresidentsWeproudly acknowledge those individualswhoduring their professionalcareer, while in NewYork State, rose through the ranks of The NewYorkState Society of Anesthesiologists, Inc., and its predecessor,TheNewYorkSociety of Anesthetists, to become President of The American Society ofAnesthesiologists:

* Deceased

Years ASA Presidents

Years Recipient Names

General InformationNYSSA 2013 Officers and Board of Directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12013 Committee on Annual Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5Statement of Educational Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Faculty Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6CME Certification Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7PGA Program Planner Disclosure Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Friday Overview and Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-30Saturday Overview and Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31-57NYSSA Resident and Fellow Section Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-33Resident Research Contest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46-47American Board of Anesthesiology Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57Sunday Overview and Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59-82Current Issues Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Monday Overview and Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83-102Tuesday Overview and Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103-116

Poster Presentation Times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117Poster Presentation Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118-119Poster Presentation Listings and Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120-175

Medically Challenging Case Report Times and Disclosures . . . . . . . . . . . . . . . . . . . . . . . . 177Medically Challenging Case Report Listings and Descriptions . . . . . . . . . . . . . . . . . 178-229

Scientific Exhibit Times and Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231Scientific Exhibits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231-232

Technical Exhibitor Alphabetical Listing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233Technical Exhibitor Company Descriptions and Booth Locations . . . . . . . . . . . . . . 234-239Technical Exhibitor Product Category Listing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240-242

Social Activities Listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243-245Faculty Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246-249Floor Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250-251

iv NYSSA • 67th Annual PostGraduate Assembly in Anesthesiology • www.nyssa-pga.org

Contents

There may have been changes since the publication of this Program Journal.Please check the Program Supplement insert for updated details.

12013 PGA67 Program • Sponsored by The New York State Society of Anesthesiologists, Inc.

President Michael B. Simon, M.D.,Wappingers Falls, NY

President Elect Lawrence J. Epstein, M.D., New Rochelle, NY

Vice-President Michael P. Duffy, M.D., Cazenovia, NY

Immediate Past President Salvatore G. Vitale, M.D., Niskayuna, NY

Secretary Vilma A. Joseph, M.D., M.P.H., Elmont, NY

Treasurer David S. Bronheim, M.D., Kings Point, NY

First Assistant Secretary Christopher L. Campese, M.D., M.A., CHCQM., Douglaston, NY

Second Assistant Secretary JungT. Kim, M.D., NewYork, NY

AssistantTreasurer Jason Lok, M.D.,Manlius, NY

ASA Director Scott B. Groudine, M.D., Latham, NY

ASA Alternate Director Paul H. Willoubhby, M.D., Setauket, NY

Speaker, House of Delegates Charles C. Gibbs, M.D., Rainbow Lake, NY

Vice Speaker, House of Delegates Tracey Straker, M.D., M.P.H.,Yonkers, NY

Director, NYSSA District #1 Lance W. Wagner, M.D., Belle Harbor, NY

Director, NYSSA District #2 Ingrid B. Hollinger, M.D., FAAP, New Canaan, CT

Director, NYSSA District #3 Melinda A. Aquino, M.D. Bronxville, NY

Director, NYSSA District #4 Lawrence J. Routenberg, M.D., Schenectady, NY

Director, NYSSA District #5 Jesus R. Calimlim, M.D., Jamesville, NY

Director, NYSSA District #6 Richard N. Wissler, M.D., Ph.D., Pittsford, NY

Director, NYSSA District #7 Rose Berkun, M.D.,Williamsville, NY

Director, NYSSA District #8 Steven B. Schulman, M.D., Syosset, NY

Delegate to MSSNY Steven S. Schwalbe, M.D., Leonia, NJ

Alternate Delegate to MSSNY Lawrence J. Routenberg, M.D., Schenectady, NY

Editor, NYSSA Sphere Jason Lok, M.D.,Manlius, NY

Chair, Academic Anesthesiology Cynthia A. Lien,M.D., NewYork, NY

General Chair, Annual Sessions Andrew D. Rosenberg, M.D., Roslyn Heights, NY

President, Resident and Fellow Section Shahryar Mousavi, M.D., Camillus, NY

Executive Director Stuart A. Hayman, M.S., Briarcliff Manor, NY

The NewYork StateSociety of Anesthesiologists, Inc.2013 Officers & Board of Directors

Michael B. Simon, M.D.President

Lawrence J. Epstein, M.D.President Elect

Michael B. DuffyVice-President

2 NYSSA • 67th Annual PostGraduate Assembly in Anesthesiology • www.nyssa-pga.org

2013 Committee on Annual SessionsDavid J.Wlody, M.D., General Chair (District #1)ADvISORSVinod Malhotra, M.D. (until Dec. 2015)Rebecca S. Twersky, M.D., M.P.H. (until Dec. 2018)Andrew D. Rosenberg, M.D. (until Dec. 2021)

HONORARY CHAIRSJames E. Cottrell, M.D.Mieczyslaw Finster, M.D.Elizabeth A. M. Frost, M.D.Alexander W. Gotta, M.D.Merel H. Harmel, M.D.Mark J. Lema, M.D., Ph.D.Paul J. Poppers, M.D.Herman Turndorf, M.D.

Scientific ProgramsSub-committeesRichard A. Beers, M.D., Overall Chair (District #5)Scientific PanelsRichard A. Beers, M.D., Chair (District #5)Audrée A. Bendo, M.D., Vice-Chair (District #1)COMMITTEE MEMBERSRose Berkun, M.D., (#7) *Edmond Cohen, M.D. (#2)Saundra Curry, M.D. (#2)Farida M. F. Gadalla, M.B., Ch.B. (#2)Hugh C. Hemmings, Jr.., M.D., Ph.D. (#2)Ingrid B. Hollinger, M.D., FAAP (#2)Gregory E. Kerr, M.D., M.B.A. (#2)Anuj Malhotra, M.D. (#2)Nader Nader, M.D., Ph.D. (#7)Kathleen A. O’Leary, M.D. (#7)Meg A. Rosenblatt, M.D. (#2)Steven B. Schulman, M.D. (#8) *Jay Shayevitz, M.D., M.S. (#6)Ketan Shevde, M.D. (#1)Linda J. Shore-Lesserson, M.D. (#3)Stephen A. Vitkun, M.D., M.B.A., Ph.D. (#8)MatthewWecksell, M.D. (#3)Michael B. Weinberger, M.D. (#2)David J. Wlody, M.D. (#1) ***Francine S. Yudkowitz, M.D., FAAP (#2) *** (ex-officio)** (ex-officio as CME & R Chair)*** (ex-officio as PGA General Chair)

Focus SessionsIngrid B. Hollinger, M.D., FAAP, Chair (District #2)DawnM. Sweeney, M.D., Vice-Chair (District #6)COMMITTEE MEMBERSApolonia E. Abramowicz, M.D. (#3)Alan E. Curle, M.D. (#6)Sudhir Diwan, M.D. (#2)Victor Filadora, M.D., M.B.A., (#7)Tessa Kate Huncke, M.D. (#2)Gregory E. Kerr, M.D., M.B.A. (#2)Jerrold Lerman, M.D. , FRCPC, FANZCA (#7)Deborah Richman, M.B., Ch.B. (#8)Bettina Smallman, M.D. (#5)Ivan Velickovic, M.D. (#1)

WorkshopsRose Berkun, M.D., Chair (District #7)Meg A. Rosenblatt, M.D., Vice-Chair (District #2)COMMITTEE MEMBERSEdmond Cohen, M.D. (#2)Clifford M. Gevirtz, M.D., M.P.H. (#2)James Osorio, M.D. (#2)Allan P. Reed, M.D. (#2)Jon D. Samuels, M.D. (#2)Linda J. Shore-Lesserson, M.D. (#3)Richard M. Sommer, M.D. (#2)Tony Tsai, M.D. (#2)

MiniWorkshopsClifford M. Gevirtz, M.D., M.P.H., Chair (District #2)P. Sebastian Thomas, M.D., Vice-Chair (District #5)COMMITTEE MEMBERSApolonia E. Abramowicz, M.D. (#3)Jasmine Bhatia, M.B., B.S. (#8)Edmond Cohen, M.D. (#2)Ghislaine Isidore, M.D. (#2)Subhash Jain, M.D. (#2)Joseph Marino, M.D. (#8)Kathleen Park, M.D. (#7)Alessia Pedoto, M.D. (#2)Bharathi Scott, M.D. (#8)Janine R. Shapiro, M.D. (#6)George Silvay, M.D., Ph.D. (#2)

Problem-Based Learning DiscussionsPatricia Fogarty Mack, M.D., Chair (District #2)Paul H.Willoughby, M.D., Vice-Chair (District #8)COMMITTEE MEMBERSMary Chisolm, M.D. (#2)Saundra E. Curry, M.D. (#2)John Hoyt, M.D. (#7)Carlos Lopez, III, M.D. (#5)Igor Muntyan, M.D. (#2)Kenneth B. Newman, M.D. (#4)Tracey Straker, M.D., M.P.H. (#3)Michael K. Urban, M.D., Ph.D. (#2)Ivan Velickovic, M.D. (#1)Stacey A. Watt, M.D. (#7)Samrat H. Worah, M.D. (#1)

Resident Research ContestCharlesW. Emala, Sr., M.S., M.D., Chair (District #2)Admir Hadzic, M.D., Ph.D. Vice-Chair (District#2)COMMITTEE MEMBERSMaria A. Bustillo, M.D. (#3)Samuel DeMaria, Jr., M.D. (#2)Suzanne B. Karan, M.D. (#6)Ira S. Kass, Ph.D. (#1)Ervant Nishanian, M.D. (#2)Jahan Porhomayon, M.D., FCCP (#6)Jeffrey H. Silverstein, M.D. (#2)Jing Song, M.D. (#3)Stacey A. Watt, M.D. (#7)

Scientific Exhibits & Poster PresentationsStephenA.vitkun,M.D.,M.B.A., Ph.D., Chair (District #8)Rhoda D. Levine, M.D. Vice-Chair (District #3)COMMITTEE MEMBERSApolonia E. Abramowicz, M.D. (#3)Stephen M. Breneman, M.D., Ph.D. (#6)Jung T. Kim, M.D. (#2)Galina Leyvi, M.D. (#3)Lixin Liu, M.D. (#8)Amanda Rhee, M.D. (#2)Divina Santos, M.D. (#3)Joseph Schianodicola, M.D. (#1)P. Sebastian Thomas, M.D. (#5)

International ScholarsElizabeth A. M. Frost, M.D., Co-Chair (District #3)Paul L. Goldiner, M.D., Co-Chair (District #2)COMMITTEE MEMBERSCheryl K. Gooden, M.D. (#2)Vinod Malhotra, M.D. (#2)Archana Mane, M.D. (#4)Irene P. Osborn, M.D. (#2)George Silvay, M.D., Ph.D. (#2)David J. Wlody, M.D. (#2) (ex-officio asPGA General Chair)

Stuart A. Hayman, M.S. (ex-officio as Executive Director)Debbie F. DiRago (ex-officio as Assistant Executive Director)

Technical ExhibitsElizabeth A. M. Frost, M.D., Chair (District #3)COMMITTEE MEMBERSMichael H. Mendeszoon, M.D., M.B.A. (#1)Stuart A. Hayman, M.S. (ex-officio as Executive Director)Debbie F. DiRago (ex-officio as Assistant Executive Director)

Executive GroupCommittee on AnnualSessionsGeneral ChairDavid J.Wlody, M.D.

Chair, Scientific ProgramsRichard A. Beers, M.D.

Vice Chair, Scientific ProgramsAudrée A. Bendo, M.D.

NYSSA PresidentMichael B. Simon, M.D.

NYSSA President ElectLawrence J. Epstein, M.D.

NYSSA Vice-PresidentMichael P. Duffy, M.D.

NYSSA TreasurerDavid S. Bronheim, M.D.

NYSSA Secretary (ex-officio)vilma A. Joseph, M.D., M.P.H.

NYSSA Continuing Medical Education & RemediationChair (ex-officio)Francine S. Yudkowitz, M.D., FAAP

Vice Chair, NYSSA Academic Anesthesiology (ex-officio)David L. Reich, M.D.

NYSSA Executive Director (ex-officio)Stuart A. Hayman, M.S.


General InformationRegistration

Advance Registrants are provided with pre-packagedenvelopes, which include badges; and where applicable, CMEdocumentation forms, mini workshop, workshop, problem-basedlearning discussion, and social activities tickets.Make sure thatyou have received the proper registrationmaterials. If youfind any discrepancies please bring it to our attentionimmediately.

HoursThe PGA Registration Area is located on the 4th floor of the NewYorkMarriott Marquis andwill be operational as follows:

Thursday, December 12 16:00 - 19:00Friday, December 13 07:00 - 19:00Saturday, December 14 07:00 - 16:00Sunday, December 15 07:00 - 16:00Monday, December 16 07:00 - 16:00Tuesday, December 17 07:00 - 16:00

The registration fee includes the following general sessions:• Scientific Panels• International Forum Session• Current Issues Forum• Memorial Lectures• Resident Research Contest• Exhibit Hall• Focus Sessions• NYSSA Resident and Fellow Section Meeting• Ancillary Sessions

Workshops, MiniWorkshops andProblem-Based Learning Discussions

The sales booth is located on the 4th floor of The NewYorkMarriott Marquis, in the PGA Registration Area.

Workshops are $150, except forW-01,W-06 andW-09, whichare $350; andW-04 which is $500.

MiniWorkshops and Problem-Based LearningDiscussions are $25, each.

Resale and Exchange Policy Tickets for resale must berelinquished prior to the start of the event and returned to thedesignated Ticket Booth in the PGA Registration Area located onthe 4th floor. Refunds will only be made if the ticket is re-sold.

Exchanges can only be made if the ticket to be exchanged isresellable, and is for an event that has yet to take place.

Resales and exchanges are facilitated on a first-come, first-servebasis.

Individuals who choose their own method of transportation forsocial events rather than that which is programmed and fail toconnect with the tour, do so at their own risk. The NYSSA/PGAcan not be held responsible for such losses, and in such instancesrefunds will not be authorized. Social Activities, theatre, concert,and opera tickets are non-refundable.

Refundswill be mailed after the PGA. Please retain receipts foryour records.

Are you an NYSSA Member?NYSSA is a medical specialty society, dedicated to providingcontinuing medical education to its members and advancing thepractice of anesthesiology. We are a component society of theAmerican Society of Anesthesiologists (ASA). To be eligible formembership, your principal professional activity must be in NewYork State. By becoming an NYSSA member, you join acommunity of over 3,000 NewYork State anesthesiologists andmore than 35,000 anesthesiologists nationwide.We advocate onbehalf of both patients and physicians in formulating standardsand guidelines, to advance the practice of anesthesiology.Together, NYSSA members provided a powerful and effectivevoice for our specialty, both in NewYork State and nationally.

Membership Advantages:• Complementary PGA General Registration• Legislative and legal representation in State government• Legal Resources - Kern Augustine Conroy & Schoppmann, P.C.• NYSSA Membership Directory• Speakers Bureau Spokespersons• NYSSA Quarterly Publication - Sphere• Public relations media outreach• Liaison with other medical and specialty societies• Financial and insurance program eligibility• Voice your opinion about changes affecting the practice ofanesthesiology

• Lobby and voice your views to your legislative representativeson issues of critical importance to the practice of anesthesiology

• Serve on committees• Headquarters staff and support

Becoming anNYSSAMemberTobecomeamember of NYSSA:• Call: 212-867-7140• Email: [email protected]• Scan this QR Codewith yourmobile device

Note:NYSSA isacomponentsocietyofASA.AllNYSSAmembersmustbeamemberofASA.

NYSSACategories andAnnual DuesMembership runs from January , – December 31.

Active: Anesthetists practicing inNYS $595.00

Retired:Members of NYSSAwho have been in good No feestanding for 10 years ormore.

Affiliate: Physicians/Scientists who do not $297.50practice clinical anesthesiology

Resident: Anesthesia Resident in NYS $50.00

Medical Student: No fee


General InformationScientific Exhibitswill be on display in the Rotunda Area(located on the 7th floor of The NewYork Marriott Marquis).These exhibits offer the latest in scientific progress, both indescriptive and visual forms. Consult the Table of Contentsand the Program Supplement for details. Exhibit days andhours are:

Saturday, December 14th • 10:00 to 16:00Sunday, December 15th • 10:00 to 16:00

Poster Presentationswill be on display in theRotundaArea (located on the 7th floor of The NewYork MarriottMarquis)

Medically Challenging Case Report Posterswill be ondisplay on the 6th floor (The NewYork Marriott Marquis). PosterPresentations and Medically Challenging Case Report Postershave been scheduled for viewing on specific days and times.Authors will be on hand to discuss their work with you. Refer tothe Table of Contents and Program Supplement Insert for furtherdetails regarding topics, authors, assigned days and times, asfollows:

Saturday, December 14th • 11:00 to 13:00 & 14:00 to 16:00Sunday, December 15th • 11:00 to 13:00 & 14:00 to 16:00Monday, December 16th • 11:00 to 13:00 & 14:00 to 16:00

Technical Exhibitswill be located on the 5th floor of theNewYork Marriott Marquis. Our exhibitors invite you toexamine their equipment, drugs, literature and services. Theirparticipation and support has helped to make this meetingpossible. The PGA Scientific Programs Committee hasscheduled a multitude of sessions so as to allow ample timefor you to visit the exhibits during the day.

For your convenience, a map of the Exhibit Hall appears in theProgram Supplement. Consult the Table of Contents andProgram Supplement for further information andaddendums. Exhibit days and hours are:

Saturday, December 14th • 10:00 to 18:00Sunday, December 15th • 09:00 to 15:00Monday, December 16th • 09:00 to 12:00

ComplimentaryCoffeeService in the PGAexhibit complex.Saturday, December 14th • 10:00 and 13:00Sunday, December 15th • 09:00 and 12:00Monday, December 16th • 09:00

Lunch Concession Service consisting of sandwiches, salads,snacks and soft drinks will be available for purchase andconveniently located in the PGA exhibit complex (5th floor),between the hours of 11:30 - 13:30 on Saturday and Sunday.

Speaker Abstracts and Reference SourcematerialsScientific Panel, Focus Session, MiniWorkshop, Problem-BasedLearning Discussion speakers have been asked to providesyllabus and reference information pertinent to the topics thattheywill be presenting. Syllabi and cases that were submittedwill be posted on the PGAWebsite and available for viewing atwww.call4abstracts.com/handouts/nyssa

PowerPoint displays, posters and video presentations are theexclusive property of the individual presenters and, inaccordance with intellectual property rights, can not bereproduced without the owners’permission. In addition,audio and/or video recording of a presentation, as well as thetaking of photographs, is strictly prohibited.

Speaker Ready Room The PGA Faculty Speaker ReadyRoom, is located in the Times Square Room, 7th floor of theNewYork Marriott Marquis and will be staffed from 07:00 -16:00, Friday, December 13th through Tuesday, December17th.

Notable AssociationsAmerican Association of Clinical DirectorsThe purpose of the AACD is to provide a forum foranesthesiologists whose primary responsibility isoperating roommanagement. The society offers physicianswith an interest in the business aspect of operating roommanagement an opportunity to share ideas with colleagues,meet anesthesiologists who have experience in this area, andshare in a common forum for the discussion of problems.

Anesthesia Patient Safety FoundationAPSF's Mission is to continually improve thepatients during anesthesia care by encouragingsafety research and education, patient safety programs andcampaigns, as well as, conducting a national andinternational exchange of information and ideas.

British Journal of AnaesthesiaThe British Journal of Anaesthesia is a monthlypeer-reviewed medical journal published by theOxford University Press on behalf of the Royal College ofAnaesthetists. It was established in 1923 and covers allaspects of anesthesia.

European Society of AnaesthesiologistsThe ESA aims for the highest standards ofpractice and safety in anesthesia, intensive care, emergencymedicine and pain treatment through education, researchand professional development throughout Europe. The ESAorganizes European Anesthesiology Congressesthroughout Europe. The meetings are attended bymembers and non-members representing more than 80countries from around the world.

World Institute of PainTheWorld Institute of Pain (WIP) provides aglobal forum for education, training, andnetworking for thousands of physicians whodedicate themselves to the worldwide phenomena of acuteand chronic pain syndromes.

Foundation for Anesthesia Education and ResearchFor more than 25 years, the Foundation forAnesthesia Education and Research hasworked to advance medicine througheducation and research in anesthesiology.FAER provides guidance and resources to physicianinvestigators and medical educators, focusing onanesthesiology-related issues in the sciences of clinicalpractice and disease biology.

Evaluation FormsDuring the course of this meeting, you may be asked toassist us in evaluating the various segments of the PGA.Weappreciate your time, effort and cooperation in completing,and returning these forms. Your comments will be takeninto consideration when planning future PGA programs.Please utilize the various collection facilities that have beenprovided for these forms or return them to any staffmember in the Registration Area or to the PGAHeadquarters Office on the 7th floor.

Syllabus MaterialPGA67materials can be accessed until November, 2014 at:

www.call4abstracts.com/handouts/nyssaor

www.nyssa-pga.org

PhotographyYour attendance at the NYSSA’s Annual PostGraduateAssembly in Anesthesiology authorizes the NYSSA to usephotography or video of you, with or without your name,for any lawful purpose, including publicity, illustration,advertising and web content.

PGA Staff HeadquartersThe Harlem Room, located on the 7th floor of the Marriott,will serve as the NYSSA/PGA Headquarters Office. The roomwill be open from 07:00 to 17:00 throughout the duration ofthe PGA.

NYSSA House of DelegatesConvenes on Saturday, December 14th at 11:00 andSunday, December 15th at 09:30, in the Marquis Ballroom,located on the 9th floor of the Marriott.

Mobile DevicesMobile devices must be in a muted, non-audio modeduring all PGA sessions.

Smoking PolicySmoking is not permitted at any PGA function.

DisclaimerThe NYSSA/PGA can not be held responsible for loss ofpersonal property.


General Information

NYSSA110 East 40th Street, Suite 300

NewYork, NY 10016212-867-7140 • [email protected] • www.nyssa-pga.org

Like us on Facebook Follow us onTwitter Check in at PGA67

ScanYourWayTo PGA!

Are You in Need of MOCA® Credits?You can receive both CME and MOCA® credits by attending the following PGA panels:

SP-01 The Adult with Chronic Disease: A Case-Based DiscussionSP-02 Anesthetic Management of the Child: A Problem-Based DiscussionSP-05 Gertie F. Marx Memorial Lecture: Today is theWorst Day of the Rest of Your Life: Maternal CatastrophiesSP-07 New Practice Recommendations: The Least I Need to KnowSP-10 Non-Cardiac Surgery in the Patient with Cardiovascular DiseaseSP-12 The ICU Patient Comes to the OR: Critical Care Medicine for the Non-IntensivistSP-23 Reflections on Professionalism in AnesthesiologySP-26 New Frontiers in Critical Care Medicine

Maintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of The American Board of Anesthesiology®. This patient safety activityhelps fulfill the patient safety CME requirement for Part II of the Maintenance of Certification in Anesthesiology Program® (MOCA) of The American Board of Anesthesiology®(ABA). Please consult the ABA website, www.theABA.org, for a list of all MOCA requirements.


vision:The NewYork State Society of Anesthesiologists, Inc. (NYSSA) throughits Committee on Continuing Medical Education and Remediation (CME&R)is an educational organization that is dedicated to enhancing the standardsand practice of the specialty by sponsoring quality, up-to-date and cutting-edge Continuing Medical Education (CME) activities designed to promoteeducation, research and scientific investigations, and promoting qualitypatient care by improving competence, performance, and patient outcomes,not only within the membership but also nationwide and extending to theinternational community. In addition, this organization is committed to theremediation of anesthesiologists identified and referred by the NewYorkState Department of Health Office of Professional Medical Conduct.

Purpose: The goals and objectives of NYSSA’s CME&R program are to:•Disseminate clinically useful, state-of-the-art, evidence-based, continuingmedical education information, as well as basic and clinical scientificresearch data to clinical practitioners, students, and researchers in the fieldof anesthesiology, pain management, critical care, and anesthesia practicemanagement.• Encourage and stimulate ongoing and new anesthesia-related researchprojects that will enhance and advance the specialty.• Remain current in our knowledge of the direction the field ofanesthesiology, pain management, critical care, and practice managementis following to be able to better develop programs to meet these newlyidentified needs.• Continually investigate and develop alternative methods to determine theeducational needs of the diverse health care professionals serviced by theCME&R NYSSA program.• Comply with the Accreditation Council for Continuing Medical Education’s(ACCME) new Updated Accreditation Criteria adopted in September 2006.• Be supportive and institute remediation programs for anesthesiologists inneed of remediation by continuing to be the designated ClinicalRemediation Organization in Anesthesiology for the NewYork StateDepartment of Health Office of Professional Medical Conduct.

Content: The scope of the NYSSA’s CME&R program is to provide acomprehensive integrated program designed to address the full spectrum ofperioperative medicine, anesthetic management, pain management, criticalcare, and anesthesia practice management both in hospital and non-hospitalsettings. Diverse educational aspects include, but are not limited to,perioperative evaluation, relief of pain and suffering, support of physiologichomeostasis, and cardiopulmonary resuscitation. Also included are activitiesdesigned to enhance knowledge of the changing healthcare marketplace andeconomic impact on the specialty of anesthesiology. Activities are alsodesigned to fulfill Maintenance of Certification in Anesthesiology (MOCA®)requirements of practicing anesthesiologists as required by the AmericanBoard of Anesthesiology.

Target Audience: The educational program is designed to address thecontinuing medical education needs of health care professionals worldwidewho are dedicated to the practice of all aspects of the field ofanesthesiology. These programs will specifically meet the needs ofanesthesiologists and intensivists in clinical practice and academia,physicians and PhD’s engaged in research, anesthesia residents and fellows,intensive care fellows, medical students, and individuals in the allied healthcare professions (certified nurse anesthetists, perioperative care nurses,anesthesia assistants, dentists, and respiratory therapists).

Types of Activities & ProgramModalities: The educational program isaccomplished by conducting an annual session of the Post-GraduateAssembly in Anesthesiology (PGA) each year in NewYork. This meeting is thesecond largest annual anesthesia meeting in the country. The programutilizes a wide range of educational platforms to meet the needs of itsparticipants and to fulfill the goals of the organization. Modalities include,but are not limited to, large plenary didactic sessions, interactive hands-onworkshops, small group problem-based learning discussions, smallinteractive focused group discussions, simulation modalities as well asscientific free papers and exhibits. The Committee on CME&R of the NYSSA iscommitted to ensuring the effectiveness of its programs throughevaluations, focus groups, feedback and follow-up analysis of impact onlearning and professional performance of its attendees. Additional venuesand modalities will continuously be explored for their beneficial contributionto the learning process.

Expected ProgramOutcomes: The NYSSA Committee on CME&R expectsthat its participants will either: Improve their competence by increasing theirfund of knowledge and/or skill sets

orImprove their performance by applying their newly-acquired knowledgeand/or skill sets in order to provide quality and safe patient care. It is thebelief of the Committee on CME&R that by improving competence andperformance, patient outcomes will be improved. As the ability to measurepatient outcomes of our participants become available, the Committee onCME&R will endeavor to utilize them to determine the impact of our CMEactivities on patient outcomes.

Statement of Educational Mission(Revised February 2013)

The PostGraduate Assembly in Anesthesiology (PGA)maintains that balance, independence and objectivity beapplied to each academic session. In accordance with ACCMEEssentials, Guidelines & Standards, all PGA speakers andprogram organizers have been asked to disclose anypotential conflicts of interest, this includes whetherpresenters have a commercial relationship with respect totheir presentations or program content. This information isnoted throughout the program journal, on the PGA web site,and will be on display in all meeting rooms with A/Vprojection. The views, opinions, policies or actions expressedby those who have provided materials for this meeting donot necessarily represent those of the PGA or The NewYorkState Society of Anesthesiologists, Inc. The PGA and theNYSSA assume no responsibility for, nor do we endorse, anycomments, recommendations or materials provided.

The NewYork State Society of Anesthesiologists, Inc., is accreditedby theAccreditation Council for ContinuingMedicalEducation to provide continuingmedical education for physicians.

The NewYork State Society of Anesthesiologists, Inc., designates thislive activity for amaximumof 46.5AMAPRACategory , Credits™.Physicians should claim only the credit commensurate withthe extent of their participation in the activity.

The AmericanMedical Association has determined thatphysicians not licensed in theUnited Stateswho participatein this CME activity are eligible for AMAPhysician’s RecognitionAwardCategory , Credits. For additional details log on to:www.ama-assn.org

Wehave been notified by theRoyal College of AnaesthetiststhatUKanaesthetistswho attend thismeeting can claimCEPDpoints at the rate of , point per hour, up to amaximumof 5points per day, and agrand total of nomore than 15points for this meeting.

TheAmericanOsteopathic Associationwill award credit inCategory 2of theAOACME program toD.O.’s upon receipt ofdocumentation of verification of attendance.

Continuing MedicalEducation

Faculty Disclosure


67th Annual

PostGraduate Assembly in Anesthesiology


Marriott Marquis, New York | USA

Program Planner Disclosure Statements:The following PGA Program planners, who are in a position toinfluence CME content, have indicated that they did not discloseany financial relationships, unless otherwise noted:

David J. Wlody, M.D., PGA General Chair

Richard A. Beers, M.D., Chair, Scientific Programs

Audrée A. Bendo, M.D., Vice-Chair, Scientific Programs

Ingrid B. Hollinger, M.D., FAAP, Chair, Focus Sessions

Dawn M. Sweeney, M.D., Vice-Chair, Focus Sessions

Rose Berkun, M.D., Chair, Workshops

Meg A. Rosenblatt, M.D., Vice-Chair, Workshops

Clifford M. Gevirtz, M.D., M.P.H., Chair, MiniWorkshops

P. Sebastian Thomas, M.D., Vice-Chair, MiniWorkshops

Patricia Fogarty Mack, M.D., Chair, Problem-Based LearningDiscussions

Paul H.Willoughby, M.D., Vice-Chair, Problem-Based LearningDiscussions

CharlesW. Emala, Sr., M.S., M.D., Chair, Resident Research ContestStephen A. Vitkun, M.D., M.B.A., Ph.D., Chair,

Scientific Exhibits & Poster Presentations

Robert N. Sladen, M.B., Ch.B., FCCM, Vice-Chair,Scientific Exhibits & Poster Presentations

Francine S. Yudkowitz, M.D., FAAP, Chair, Continuing MedicalEducation and Remediation

CME CertificationIn order for the NYSSA/PGA to maintain ACCME accreditation as aCME Provider, and to be in compliance with current AMA CMEcertification requirements for reporting and awarding CME credits,we are informing you of the following details regarding theverification of credits and issuance of Certificates of Attendance:• CME Certificateswill not be issued on-site at the meeting.• CME Certificates will be issued after the PGA, upon verificationof credits, as submitted to NYSSA Headquarters.

• Each Active, Affiliate and Retired Physician attendee will be issueda PGA67 CME Documentation Form.

• If pre-registered, the form will be in your registrationpacket.

•On-site registrants, will receive a form with their programmeeting materials, upon completion of the registrationprocess.

• At the conclusion of the meeting, tally the total number of yourCME credits, for the sessions which you attended. Make a copy ofthe form to keep with your records.

• Non-Educational sessions such as Committee and House ofDelegates meetings are not eligible for CME credit.

• Sign and date the form attesting to its accuracy, then send it bymail or fax to NYSSA Headquarters;

• To submit for your CME creditson-line, visit our website atwww.nyssa-pga.org and click on Submit PGA67 CMEDocumentation Form.

• NYSSA Staff will validate the CME credits that you earned.• A CME Certificate of Attendance will be issued and mailed in yourname, and will include the total credits that you achieved.

• The deadline for claiming PGA67 credits is June 30, 2014.

CME Certification Process

A certificate of attendance which international registrants may need, exclusive of CME credits, will be issued uponrequest at the PGAs Registration Area, on the fourth floor Promenade of the NewYorkMarriott Marquis.


Notes


67th Annual




Friday, December 13, 2013Times

Registration ................................................................................................................. 07:00

Hands-OnWorkshops................................................................. 07:00, 08:00 & 12:00

MiniWorkshops ......................................................................................... 07:45 & 11:45

Scientific Panels ......................................................................................... 09:00 & 13:00

Problem-Based Learning Discussions................................................ 11:45 & 15:45

Focus Sessions............................................................................................................ 15:45

Workshops,MiniWorkshops and Problem-Based Learning Discussionsrequire a ticket for entrance. Please refer to page 3 for fees.

Download the New Mobile Application!

Once downloaded, you can:• View the meeting schedule• Search for sessions, speakers & topics• Create a personal PGA itinerary• Explore the exhibit hall• Connect to social media• Get real-time alerts• Navigate the venue with maps• Complete session evaluations• Take session notes

FridayFriday

Please silenceyour mobile devices


Workshop | Friday, December 13, 2013All Day Session • 07:00 - 17:30 • Empire Complex • 7th Floor

Workshop — W-01

Pediatric Advanced Life Support (PALS)

Francine S. Yudkowitz, M.D., FAAPProfessor of Anesthesiology & PediatricsDirector, Pediatric AnesthesiaIcahn School of Medicine at Mount SinaiNewYork, NewYork

After completion of this session, the participant will be able to:• Demonstrate basic pediatric life-support skills;• Recognize the signs of impending respiratory failure and shock;• Initiate treatment of impending and overt respiratory failure and shock;• Identify and appropriately treat rhythm disturbances.

Requirements for Certificate:To receive a PALS certificate, the participant will have to successfully complete the course and pass awritten and practical examination which will be administered at the end of the course.Due to the requirement to review literature in advance, this workshop is limited to pre-registration.

Disclosures:Drs. Alexis, Dilos, Gooden, Hojsak and Yudkowitz did not disclose any financial relationships.

NOTE: This is a full-dayWorkshop. Lunch will not be provided.

Assisted by:Rhonda A. Alexis, M.D.Attending AnesthesiologistThe Children’s Hospital of PhiladelphiaDepartment of Anesthesiology and Critical CareMedicinePhiladelphia, Pennsylvania

Barbara M. Dilos, D.O.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Cheryl K. Gooden, M.D.Associate Professor of Anesthesiology and PediatricsIcahn School of Medicine at Mount SinaiNewYork, NewYork

Joanne Hojsak, M.D.Associate Professor of PediatricsChief, Pediatric Critical CareMount Sinai Kravis Children’s HospitalNewYork, NewYork

Friday

WorkshopModerator:


MiniWorkshop | Friday, December 13, 2013 | M-01 through M-04Morning Sessions • 07:45 - 08:45 • 4th Floor RoomsMiniWorkshop—M-01 - Odets Room

Management of Post Dural Puncture HeadacheSpeaker:Ivan A. velickovic, M.D.Director, Obstetric Anesthesiology | SUNY-Downstate Medical Center | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Discuss the management of accidental dural puncture in obstetrics;• Develop an evidence-based decision regarding the use of intrathecal catheters in the prevention andmanagement of PDPH;• Review the treatment of spinal headache, including therapeutic and prophylactic blood patch.

MiniWorkshop—M-02 -Wilder Room

Anesthetic Considerations for Solid Organ TransplantSpeaker:Koray E. Arica, M.D.Assistant Professor of Clinical Anesthesiology | SUNY-Downstate Medical Center | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Understand the pathophysiology of the end stage liver failure patient;• Enumerate three drugs that are particularly useful in patients without renal or liver function;• Develop strategies for intraoperative crisis that may develop during transplantation.

MiniWorkshop—M-03 - Ziegfeld Room

Ultrasound for Nerve BlocksSpeaker:Jungpin Chen, M.D., Ph.D.Senior Attending Anesthesiologist | Assistant Professor of Clinical Anesthesiology | Associate Director of Regional AnesthesiaSt. Luke's-Roosevelt Hospital Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Describe the physics of ultrasonography;• Enumerate the indications for ultrasound guidance;• Identify the topology of ultrasound images.

MiniWorkshop—M-04 - O’Neill Room

Anesthesia for Carotid and Intra-Cranial Vascular AbnormalitiesSpeaker:Irene P. Osborn, M.D.Associate Professor of Anesthesiology | Director, Neuroanesthesia | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Assess the use of short acting anesthetics for carotid endarterectomy;• Recognize the indications for carotid stenting;• Discuss anesthetic management for carotid stenting;• Delineate two possible complications that require urgent anesthetic intervention.

Disclosures: Drs. Arica, Chen and Velickovic did not disclose any financial relationships.Dr. Osborn receives material support from Covidien, Inc.

FridayFriday


Workshop | Friday, December 13, 2013Morning Session • 08:00 - 11:00 • Soho Complex • 7th Floor

Workshop — W-02

Ultrasound, Simulation and Stimulation for Peripheral Nerve BlocksStation I Nerve Blocks of the Upper Extremity - Ultrasound Technique

Station II Nerve Blocks of the Upper Extremity - Nerve Stimulator Technique

Station III Nerve Blocks of the Lower Extremity - Ultrasound and Nerve Stimulator Technique

Station Iv Simulation and Equipment for Performing Peripheral Nerve Blocks

WorkshopModerators: David B. Albert, M.D.Staff AnesthesiologistGramercy Surgery CenterNewYork, NewYork

Assisted by:

Robert A. Altman, M.D.Attending AnesthesiologistNYU-Langone Medical Center-Hospital for JointDiseasesNewYork, NewYork

Michael R. Anderson, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Arthur Atchabahian, M.D.Associate Professor of Clinical AnesthesiologyNYU-Langone Medical Center-Hospital for JointDiseasesNewYork, NewYork

Patrick Birmingham, M.D., FAAPProfessor of AnesthesiologyNorthwestern University Feinberg School ofMedicineDivision Head of Pain MedicineAssociate Chair, Department of AnesthesiologyAnn & Robert H. Lurie Children’s Hospital ofChicagoChicago, Illinois

Levon M. Capan, M.D.Professor of AnesthesiaNYU-Langone Medical CenterAssociate Director, AnesthesiaBellevue Hospital CenterNewYork, NewYork

Steve S. Chen, M.D.Assistant Professor of AnesthesiologySUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Brian T. Durkin, D.O.Assistant Professor of AnesthesiologyDirector, Center for Pain ManagementSUNY- Health Sciences Center at Stony BrookStony Brook, NewYork

Cynthia L. Feng, M.D.Assistant Professor of AnesthesiologyNYU-Langone Medical Center-Hospital for JointDiseasesNewYork, NewYork

Christina L. Jeng, M.D.Assistant Professor of Anesthesiology andOrthopaedicsIcahn School of Medicine at Mount SinaiNewYork, NewYork

Jung T. Kim, M.D.Associate Professor of AnesthesiologyVice Chair, Chief of ServiceDepartment of AnesthesiologyMedical Director, Perioperative Surgical ServicesNYU-Langone Medical CenterNewYork, NewYork

Sunmi Kim, M.D., B.S.Assistant Professor of AnesthesiologyNYU-Langone Medical CenterNewYork, NewYork

Eric M. Kitain, M.D.Chair, Department of AnesthesiologyNorwalk HospitalNorwalk, Connecticut

Mitchell Y. Lee, M.D., B.A.Assistant Professor of AnesthesiologyAssistant Residency DirectorNYU-Langone Medical CenterNewYork, NewYork

Danielle B. Ludwin, M.D.Assistant Professor of AnesthesiologyColumbia University, College of Physicians &SurgeonsNewYork, NewYork

Jovan Popovic, M.D., FRCPCAssistant Professor of AnesthesiologyNYU-Langone Medical CenterMedical Director, NYU Langone OutpatientSurgeryNewYork, NewYork

Meg A. Rosenblatt, M.D.Professor of Anesthesiology and OrthopaedicsDirector, Division of OrthopaedicAnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

George J. Spessot, M.D.Clinical Associate Professor of AnesthesiologyNYU-Langone Medical CenterAttending AnesthesiologistNYU-Langone Medical Center-Hospital for JointDiseasesNewYork, NewYork

Santhanam Suresh, M.D., FAAPAnesthesiologist-in-ChiefDepartment of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital ofChicagoChicago, Illinois

Tiffany R. Tedore, M.D.Assistant Professor of AnesthesiologyChief, Regional AnesthesiaNewYork-Presbyterian HospitalCornell University, Weill Cornell Medical CollegeNewYork, NewYork

Daniel B. Wambold, M.D.Attending AnesthesiologistThe Valley HospitalRidgewood, New Jersey

Richa Wardhan, M.D.Fellowship Director and Associate Director,Regional AnesthesiaDepartment of AnesthesiologyYale School of MedicineNew Haven, Connecticut

After completion of this session, the participant will be able to:• Apply the use of nerve stimulator techniques for upper and lower extremity blocks;• Treat reflex sympathetic dystrophy with either intravenous anesthesia (Bier block) or nerve block;• Utilize ultrasound technology for upper and lower extremity blocks.

Disclosures:Drs. Albert, Altman, Anderson, Atchabahian, Birmingham, Capan, Chen, Feng, Jeng, J.T. Kim, S. Kim, Kitain, Lee, Ludwin, Popovic,Rosenblatt, Spessot, Suresh,Wambold andWardhan did not disclose any financial relationships.Dr. Durkin receives honoraria from Sonosite.Dr. Tedore’s spouse receives a salary, and is a shareholder of TG Therapeutics.

NOTE: ThisWorkshop will be repeated Friday asW-03, Sunday asW-10 and Tuesday asW-18.

Friday

Mitchell H. Marshall, M.D.Clinical Associate Professor of AnesthesiologyNYU-Langone Medical CenterAttending AnesthesiologistNYU-Langone Medical Center-Hospital for Joint DiseasesNewYork, NewYork


Scientific Panel | Friday, December 13, 2013Morning Session • 09:00 - 11:30 • North Ballroom • 6th FloorScientific Panel — SP-01

The Adult with Chronic Disease: A Case-Based DiscussionMaintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of The American Board of Anesthesiology®.

This patient safety activity helps fulfill the patient safety CME requirement for Part II of the Maintenance of Certification in Anesthesiology Program®(MOCA) of The American Board of Anesthesiology®(ABA). Please consult the ABA website, www.theABA.org, for a list of all MOCA requirements.

Panel Moderator:Robert N. Sladen, M.B., Ch.B., FCCMProfessor and Vice Chair | Department of Anesthesiology | Chief, Division of Critical CareColumbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Describe the underlying pathophysiology and formulate a management plan for the intraoperative and

postoperative care of the patient with significant co-morbidities, including:• Cardiac disease, including atherosclerotic coronary artery disease;• Hepatic disease;• Metabolic syndrome and diabetes mellitus;• Chronic kidney disease (CKD).

Presentations:

The Patient with Heart Disease: Moderate Risk? Not in My Judgment!John E. Ellis, M.D.Adjunct Professor of Anesthesiology and Critical CareUniversity of Pennsylvania Perelman School of Medicine | Philadelphia, Pennsylvania

The Patient with Diabetes Mellitus: Do They Have a Secret Life?Joshua J. Sebranek, M.D.Section Head | Division of Cardiovascular and Thoracic Anesthesiology | Department of AnesthesiologyUniversity ofWisconsin School of Medicine and Public Health | Madison,Wisconsin

The Patient with Hepatic Disease: Does Life Depend Upon the Liver?vivek K. Moitra, M.D.Assistant Professor of Clinical Anesthesiology | Associate Program Director, Critical Care MedicineColumbia University, College of Physicians & Surgeons | NewYork, NewYork

The Patient with Chronic Kidney Disease: Is it Just Fluid Management?Robert N. Sladen, M.B., Ch.B., FCCM

Disclosures:Dr. Ellis is on the speakers bureau for Baxter International, Inc.Dr. Moitra and Sebranek did not disclose any financial relationships.Dr. Sladen receives honoraria from Orion Pharma Hutchinson Technologies.

FridayFriday


Scientific Panel | Friday, December 13, 2013Morning Session • 09:00 - 11:30 • South Ballroom • 6th Floor

Scientific Panel — SP-02

Anesthetic Management of the Child: A Problem-Based Discussion

Maintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of The American Board of Anesthesiology®.


Panel Moderator:Jerrold Lerman, M.D., FRCPC, FANCZAClinical Professor of Anesthesiology | Children’s Hospital of Buffalo | Buffalo, NewYorkClinical Professor of Anesthesiology | University of Rochester School of Medicine & Dentistry | Rochester, NewYork

After completion of this session, the participant will be able to:• Define and recognize the pediatric hallmarks of prematurity and clinically important implications for

anesthetic management.• Construct and discuss a plan for the perioperative care of pediatric patients with obstructive sleep apnea;• Discuss the identifying characteristics and perioperative management of pediatric patients with

neuromuscular disease;• List clinically important pediatric disease processes for which regional anesthetic techniques are useful.

Presentations:

The Child with Neuromuscular DiseasesJerrold Lerman, M.D., FRCPC, FANCZA

Scenarios Best Managed with Regional TechniquesSanthanam Suresh, M.D., FAAPAnesthesiologist-in-Chief | Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of Chicago | Chicago, Illinois

The Child with Obstructive Sleep ApneaMohamed A. Mahmoud, M.D.Staff Anesthesiologist | Associate Professor of Anesthesiology and PediatricsDirector, Radiology Anesthesia and Sedation | Cincinnati Children's Hospital Medical CenterCincinnati, Ohio

The Premie and The Ex-PremieFrancine S. Yudkowitz, M.D., FAAPProfessor of Anesthesiology & Pediatrics | Director, Pediatric AnesthesiaIcahn School of Medicine at Mount Sinai | NewYork, NewYork

Disclosures:Dr. Lerman receives consultant fees from Piramal, Inc., honoraria fromAbbott Laboratories and is a shareholder inManagement LLC.Drs. Mahmoud, Suresh and Yudkowitz did not disclose any financial relationships.

Friday


Scientific Panel | Friday, December 13, 2013Morning Session • 09:00 - 11:30 • Astor Ballroom • 7th Floor


Measuring Anesthesiologists' Performance:What You Need toKnow andWhat You Need to Show

Panel Moderator:Robert S. Lagasse, M.D.Professor of Anesthesiology | Director, Quality Management & Perioperative SafetyDepartment of Anesthesiology | Yale University School of Medicine | New Haven, Connecticut

After completion of this session, the participant will be able to:• Define and recognize the demand for performance measurements and the potential pitfalls, involved in the

process of collecting and analyzing performance data;• Discuss the impact of public policy on performance measurement at the local, state and national level;• Explain the importance of performance measurement under the Affordable Care Act;• Identify the roles of the Anesthesia Quality Institute, and the ASA, in performance measurement.

Presentations:

Anesthesia Quality Management and Health Care Policy: Do You People Talk toOne Another?Thomas R. Miller, Ph.D., M.B.A.Director of Health Policy Research | American Society of Anesthesiologists | Washington OfficeWashington, DC

The Pitfalls of Performance MeasurementRobert S. Lagasse, M.D.

The Anesthesia Quality Institute: Taking Control of Our DestinyRichard P. Dutton, M.D., M.B.A.Executive Director | Anesthesia Quality Institute | Park Ridge, Illinois

The Impact of the Affordable Care ActColleen E. O’Leary, M.D.Professor of Anesthesiology | SUNY-Update Medical University | Syracuse, NewYork

Disclosures:Drs. Dutton, Lagasse and Miller did not disclose any financial relationships.Dr. O’Leary is on the Board of Directors of the Lifetime Healthcare Companies.

FridayFriday


Scientific Panel | Friday, December 13, 2013Morning Session • 09:00 - 11:30 • Manhattan Ballroom • 8th Floor


Operating RoomManagement

Panel Moderators:VinodMalhotra, M.D. Michael P. Smith, M.D., M.S.Professor of Clinical Anesthesiology Past President, American Association of ClinicalProfessor of Anesthesiology in Clinical Urology Directors | Partner, Professional Anesthesia Service, Inc.Cornell University, Weill Cornell Medical College Summa Health System | Akron, OhioVice-Chair, Clinical Affairs | Department of AnesthesiologyClinical Director, Operating RoomsNewYork-Presbyterian Hospital | NewYork, NewYork

After completion of this session, the participant will be able to:• Describe the standardized definitions for procedure time and operating room utilization;• Discuss strategies for improving communication skills & creating a culture of safety in the perioperative setting;• Use specific examples of conflicts that may arise between administrators, surgeons, nursing, andanesthesiologists and discuss measures to approach and resolve these conflicts;

• Describe recent changes that have impacted safety and efficiency in the perioperative environment and liststrategies to meet these new challenges.

Presentations:

Comparing Apples to Apples: Standardizing OR MetricsMichael P. Smith, M.D., M.S.Past President, American Association of Clinical Directors | Partner, Professional Anesthesia Service, Inc.Summa Health System | Akron, Ohio

Organizational Culture and Safety: A View from "Down Under"Vanessa Beavis, M.B., B.Ch., FFA(SA), FANZCADirector, Perioperative Services & Clinical Support | Auckland City Hospital | Auckland, New Zealand

Effective Communication: Saving PatientsWithout Losing PatienceSunil Eappen, M.D.Assistant Professor of Anaesthesiology | HarvardMedical School Chief of AnesthesiologyMassachusetts Eye and Ear Infirmary | Assistant Professor of Anesthesiology, Perioperative andPainMedicineBrigham&Women’s Hospital | Boston, Massachusetts

RealWorld Scenarios in OR Management: Dealing with Changes...!VinodMalhotra, M.D.

Disclosures:Drs. Beavis, Eappen and Malhotra did not disclose any financial relationships.Dr. Smith may be eligible for a partial grant from Ofirmev®, and receives royalties from Cleveland Clinic.

Frid

ay


MiniWorkshops | Friday, December 13, 2013 | M-05 through M-08Mid-Day Sessions • 11:45 - 12:45 • 4th Floor Rooms

Mini Workshop — M-05 - Odets Room

Interventional Pain Management UpdateSpeaker:Michael L.Weinberger, M.D.Associate Clinical Professor of Anesthesiology | Columbia University, College of Physicians & SurgeonsDirector, Pain Management Center | NewYork Presbyterian Hospital - Columbia Campus | NewYork, NewYork

After completion of this session, the participant will be able to:• Enumerate the indications for intrathecal pumps and spinal cord stimulators;• Delineate the relative and absolute contraindications for spinal interventions;• Enumerate at least three complications which can arise from interventional approaches.

Mini Workshop — M-06 - Wilder Room

Management of Anesthesia Departments: The Good, The Bad andThe UGLYSpeaker:PhilipW. Lebowitz, M.D., M.B.A.Professor of Clinical Anesthesiology | Albert Einstein College of Medicine | Attending AnesthesiologistMontefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Delineate the challenges facing management during times of expanding caseload as well as decreasing caseload;• Formulate a plan for managing during change of ownership or contract;• Delineate a plan for managing difficult internal and external consumers.

Mini Workshop — M-07 - Ziegfeld Room

Anesthesia for Major Vascular SurgerySpeaker:GregoryW. Fischer, M.D.Assistant Professor of Anesthesiology and Cardiothoracic Surgery | Icahn School of Medicine atMount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Enumerate the possible complications that can arise from endovascular approaches;• Delineate anesthetic risk factors for the vascular patient;• Enumerate the possibilities for postoperative analgesia in this population of patients.

Mini Workshop — M-08 - O’Neill Room

Perioperative Coagulopathy Management UpdateSpeaker:Maria A. Bustillo, M.D.Associate Professor in Clinical Anesthesiology | Albert Einstein College of Medicine | Associate Director, NeuroanesthesiologyMontefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Define which medications may affect the coagulation pathway;• Delineate which medications may complicate regional anesthesia;• Define which tests may help to guide intraoperative therapy.

Disclosures: Drs. Bustillo, Fischer, Lebowitz andWeinberger did not disclose any financial relationships.

FridayFriday


Problem-Based Learning Discussions | Friday, December 13, 2013PBLD-01 through PBLD-08 | Mid-Day Sessions • 11:45 - 12:45 • 6th Floor Rooms

Problem-Based Learning Discussions — PBLD-01 - Majestic Room

Predicting and Managing Postoperative Atrial FibrillationSpeaker:David Amar, M.D.Professor of Anesthesiology | Cornell University, Weill Cornell Medical College | Director, Thoracic AnesthesiaMemorial-Sloan Kettering Cancer Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the epidemiology and scope of the occurrence of postoperative atrial fibrillation;• Review proven measures of prophylaxis for postoperative atrial fibrillation;• Employ acute therapy measures for postoperative atrial fibrillation;• Employ methods to prevent stroke associated with postoperative atrial fibrillation.

Problem-Based Learning Discussions — PBLD-02 - Music Box Room

The Pregnant Patient for Non-Obstetric SurgerySpeaker:Ellen S. Steinberg, M.D.Clinical Associate Professor of Anesthesiology, Obstetrics & Gynecology | SUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

After completion of this session, the participant will be able to:• Identify various anesthetic and non-obstetrical surgery considerations throughout pregnancy;• Formulate an anesthetic plan that takes into consideration the fetal and maternal effects of non-obstetric surgery during

pregnancy;• Manage the issues surrounding laparoscopic surgery in the parturient.

Problem-Based Learning Discussions — PBLD-03 - Winter Garden Room

LAST: Local Anesthetic Systemic ToxicitySpeakers:Danielle B. Ludwin,M.D.Assistant Professor of AnesthesiologyColumbia University, College of Physicians & SurgeonsNewYork, NewYork

After completion of this session, the participant will be able to:• Identify the signs and symptoms of Local Anesthetic Systemic Toxicity;• Formulate a plan to treat Local Anesthetic Systemic Toxicity.

Problem-Based Learning Discussions — PBLD-04 - Palace Room

Respiratory Distress in a Five Year Old After Inguinal HerniorrhaphySpeaker:Terry-Ann Chambers, M.D.Assistant Professor of AnesthesiologyAlbert Einstein College of Medicine/Montefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Identify concerns regarding postoperative respiratory compromise in the pediatric patient;• Formulate a plan to treat respiratory distress in the pediatric ambulatory surgery patient.

Disclosures:Drs. Amar, Bernstein, Chambers, Ludwin and Steinberg did not disclose any financial relationships.

Jeffrey Bernstein, M.D.Chief, Division of Obstetrical AnesthesiaAssistant Professor of AnesthesiologyAlbert Einstein College of Medicine/Montefiore Medical CenterBronx, NewYork

Friday


Problem-Based Learning Discussions — PBLD-05 - Shubert Room

Lung Isolation in the Patient with a Difficult Airway

Speakers:Guy Salomon, M.D.Attending AnesthesiologistGood SamaritanHospital | Suffern, NewYork

After completion of this session, the participant will be able to:• Discuss the indications, different options for, and management of one-lung ventilation;• Apply a plan for the management of simple thoracic cases;• Employ various options for one-lung ventilation in the context of the difficult airway.

Problem-Based Learning Discussions — PBLD-06 - Uris Room

How Low Can You Go: Transfusion Guidelines

Speaker:Joseph S. Yeh, M.D.Assistant Professor of Anesthesiology | NYU-Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Review the most recent guidelines regarding perioperative blood product transfusion;• Identify barriers to the timely provision of adequate blood products in a case requiring massive transfusion;• Implement a comprehensive transfusion protocol, including one addressing massive transfusions.

Problem-Based Learning Discussions — PBLD-07 - Plymouth Room

Fractured Humerus in a Patient on Clopidrogrel: ASRA Guidelines

Speaker:Yan Lai, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Review current ASRA guidelines regarding anticoagulation and antiplatelet therapy;• Select the appropriate anesthetic management plan in the anticoagulated patient.

Problem-Based Learning Discussions — PBLD-08 - Royale Room

Postoperative Brachial Plexus Injury: But the Surgeon Positionedthe Arms!!

Speaker:Joel M. Yarmush, M.D., M.P.A.Residency Program Director | NewYork Methodist Hospital | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Identify patient related and procedural related risk factors for peripheral nerve injury;• Formulate multidisciplinary team approach to prevent peripheral nerve injury;• Develop a multifaceted patient-centered approach to evaluating and treating a nerve injury should it occur.

Disclosures:Drs. Castillo, Lai, Salomon, Yarmush and Yeh did not disclose any financial relationships.

Maria Castillo, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount Sinai | NewYork, NewYork

FridayFriday


Workshop | Friday, December 13, 2013Mid-Day Session • 12:00 - 15:00 • Soho Complex • 7th Floor

Workshop — W-03






Assisted by:


Disclosures:Drs. Albert, Altman, Anderson, Atchabahian, Birmingham, Capan, Chen, Feng, Jeng, J.T. Kim, S. Kim, Kitain, Lee, Ludwin, Popovic,Rosenblatt, Spessot, Stefanovich, Suresh,Wambold andWardhan did not disclose any financial relationships.Dr. Durkin receives honoraria from Sonosite.Dr. Tedore’s spouse receives a salary and is a shareholder of TG Therapeutics.

NOTE: ThisWorkshop will be repeated on Sunday, asW-10, and Tuesday, asW-18

Friday










Jung T. Kim, M.D.Associate Professor of AnesthesiologyVice Chair, Chief of ServiceDepartment of AnesthesiologyMedical Director, Perioperative Surgical ServicesNYU-Langone Medical CenterNewYork, NewYork





Jovan Popovic, M.D., FRCPCAssistant Professor of AnesthesiologyNYU-Langone Medical CenterMedical Director, NYU Langone OutpatientSurgeryNewYork, NewYork



Santhanam Suresh, M.D., FAAPAnesthesiologist-in-ChiefDepartment of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital ofChicagoChicago, Illinois

Peter Stefanovich, M.D.Instructor in AnesthesiaDepartment of Anesthesia, Critical Care andPain MedicineMassachusetts General HospitalBoston, Massachusetts






Scientific Panel | Friday, December 13, 2013Afternoon Session • 13:00 - 15:30 • North Ballroom • 6th Floor


Gertie F. MarxMemorial LectureToday is theWorst Day of the Rest ofYour Life: Maternal Catastrophes

This panelwas created to honor the life, career andmemory of Professor Gertie F.Marx, the“Mother ofObstetricAnesthesia.”Gertiewas born in Frankfurt amMain, Germany. She studiedmedicine inGermany and Switzerland in themid 1930s, before emigrating to theUnited States. She trained at Beth IsraelMedical Center, where sheworked for 10years as an attending anesthesiologist. She then came to JacobiMedical Center and theAlbert Einstein School ofMedicine in the Bronx, becoming the first Director ofObstetric Anesthesiology at those institutions. She continued towork at Jacobi and Einstein for over 40 years, rising to the rank of Professor. Gertie dedicated her life to the“care ofmothers and their babies,”which she did throughboth her clinical care andher research. Gertie held just as strong acommitment to the education of anesthesia residents andmedical students, training untold numbers of obstetricanesthesiologists. To these students of anesthesia, Gertiewas themodel for pride, dedication andprofessionalism. Duringher illustrious career, Gertie receivedmanyhonors in theU.S., theU.K. and elsewhere. Shewas only the secondwoman inthe history of theASA to receive theASADistinguished Service Award.The last ofmany awards that Gertie received in herlife, was theDistinguished Service Award of theNYSSA.



Panel Moderator: David J.Wlody, M.D.Professor of Clinical Anesthesiology | Vice-Chair, Clinical AffairsDepartment of Anesthesiology | SUNY-Downstate Medical Center | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Describe the risk factors for maternal hemorrhage and discuss new surgical, pharmacologic and interventionalradiology techniques for treating;• Describe pathophysiology of amniotic fluid embolism syndrome;• Describe the pathophysiology and treatment of the most severe sequelae of pre-eclampsia, includingeclampsia, intracerebral hemorrhage, pulmonary edema and oliguria;

• Describe the process for evaluating the maternal airway, and formulate a plan for the management of therecognized difficult airway as well as the failed intubation.

Presentations:

HemorrhageRoulhac D. Toledano, M.D., Ph.D.Assistant Clinical Professor of Anesthesiology | SUNY-Downstate Medical CenterAttending Anesthesiologist | Lutheran Medical Center | Brooklyn, NewYork

Amniotic Fluid EmbolismRichard N.Wissler, M.D., Ph.D.Professor of Anesthesiology and Obstetrics & Gynecology | Director, Obstetric AnesthesiologyAssociateMedicalDirector, PerioperativeServices |UniversityofRochesterMedicalCenter |Rochester,NewYork

Complications of Pre-EclampsiaManuel C. Vallego, Jr., M.D., D.M.D.Professor of Anesthesiology |Director ofObstetric Anesthesia andObstetric Anesthesia Fellowship ProgramMedical Director, University of Pittsburgh Dental Anesthesia Program | Pittsburgh, Pennsylvania

The Failed AirwayMaya S. Suresh, M.D.Professor and Chair | Department of Anesthesiology | Baylor College of Medicine | Chief of AnesthesiologyBen Taub General Hospital | Houston, Texas

Disclosures:Drs. Suresh, Toledano, Vallejo, Wissler andWlody did not disclose any financial relationships.

FridayFriday

22 NYSSA • 67th Annual PostGraduate Assembly in Anesthesiology • www. nyssa-pga. org

Scientific Panel | Friday, December 13, 2013Afternoon Session • 13:00 - 15:30 • South Ballroom • 6th Floor


Frontiers in Neuroanesthesia

Panel Moderator:Audrée A. Bendo, M.D.Distinguished Professor and Executive Vice Chair | Department of AnesthesiologySUNY-Downstate Medical Center | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Develop a rational approach to anestheticmanagement and control of intracranial hypertension for sustentatorial

tumors and identify reasons for selecting an anesthetic techniquebasedon tumor location andpathology;• Describe the pathophysiology of associated conditions and implications for the perioperativemanagement of

patients undergoing functional neurosurgery;• Discuss the pathophysiology of associated conditions and implications for the perioperativemanagement of

patients undergoing endovascular neurosurgical techniques, with emphasis on the patientwith acute stroke;• Explain risk factors, prevention, clinical presentation and treatment of complications in neurosurgical patients.

Presentations:

Anesthesia for Patients with Sustentatorial Brain TumorsAudrée A. Bendo, M.D.

Functional Neurosurgical ProceduresAlexY. Bekker, M.D., Ph.D.Professor and Chair | Department of Anesthesiology | Chair, Perioperative Services CommitteeRutgers New Jersey Medical School | Newark, New Jersey

Endovascular Neurosurgical TechniquesZiska H. Anastasian, M.D.Assistant Professor of Clinical Anesthesiology | Columbia University, College of Physicians & SurgeonsNewYork, NewYork

Avoiding Complications in NeuroanesthesiaDaniel J. Cole, M.D.Professor of Anesthesiology | Vice Dean for Continuous Professional DevelopmentCollege of Medicine, Mayo Clinic | Chair, Department of Anesthesiology | Mayo Clinic ArizonaPhoenix, Arizona

Disclosures:Drs. Anastasian, Berke, Bendo and Cole did not disclose any financial relationships.

Friday


Scientific Panel | Friday, December 13, 2013Afternoon Session • 13:00 - 15:30 • Astor Ballroom • 7th Floor


New Practice Recommendations: The Least I Need to KnowMaintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of The American Board of Anesthesiology®.


Panel Moderator:Jeffrey L. Apfelbaum, M.D.Professor and Chair | Department Anesthesiology and Critical CareUniversity of Chicago Medicine | Chicago, Illinois

After completion of this session, the participant will be able to:• Discuss the impetus for, and process of, formulating guidelines for practice in the medical specialty of

anesthesiology;• List and cite the evidence behind the ASA recommendations for management of the failed airway;• List and cite the evidence behind the ASA recommendations for the prevention of OR fires;• List and cite the evidence behind the ASA recommendations for postanesthesia care;• Appraise the utility of these recommendations for application to the attendee’s own practice, and outline a

plan for their implementation.

Presentations:

An OverviewJeffrey L. Apfelbaum, M.D.

Managing the Difficult AirwayCarin A. Hagberg, M.D.Joseph C. Gabel Professor and Chair | Department of AnesthesiologyThe University of Texas Medical School at Houston | Director, Perioperative ServicesDirector, Advanced Airway Management | Memorial Hermann Hospital - Texas Medical CenterHouston, Texas

Postanesthesia CareJeffrey H. Silverstein, M.D.Vice Chair, Research | Department of Anesthesiology | Associate Dean, ResearchIcahn School of Medicine at Mount Sinai | NewYork, NewYork

Preventing OR FiresJan Ehrenwerth, M.D.Professor of Anesthesiology | Director, Vascular Anesthesia | Yale University School of MedicineNew Haven, Connecticut

Disclosures:Drs. Apfelbaum, Ehrenwerth and Silverstein did not disclose any financial relationships.Dr. Hagberg receives funded research support from Ambu Cadence Pharmaceuticals, Inc., Karl Endoscopy, Inc. and is an unpaidconsultant for Ammu®.

FridayFriday


Scientific Panel | Friday, December 13, 2013Afternoon Session • 13:00 - 15:30 • Manhattan Ballroom • 8th Floor


Technology in Anesthesia Practice

Panel Moderator:David L. Reich, M.D.HoraceW. Goldsmith Professor and Chair | Department of AnesthesiologyIcahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the technology and techniques available to monitor ventilation outside of the traditional OR

environment;• Explain best practices for the monitoring of neuromuscular blockade perioperatively;• Discuss new tools available for management of the difficult airway and evaluate the clinical usefulness for

one’s own practice;• Discuss the advantages and disadvantages of electronic anesthesia record systems and evaluate the clinical

utility of such a system for one’s own practice.

Presentations:

Monitoring Ventilation in Remote LocationsJames B. Eisenkraft, M.D.Professor of Anesthesiology | Icahn School of Medicine at Mount SinaiNewYork, NewYork

Neuromuscular Monitoring: Best PracticesCynthia A. Lien, M.D.Professor of Anesthesiology | Vice Chair for Academic Affairs | Director, Residency ProgramCornell University, Weill Cornell Medical College | Attending AnesthesiologistNewYork-Presbyterian Hospital | NewYork, NewYork

Electronic Anesthesia Record SystemsDavid L. Reich, M.D.

Tools for Managing the Difficult AirwayCarin A. Hagberg, M.D.Joseph C. Gabel Professor and Chair | Department of AnesthesiologyThe University of Texas Medical School at Houston | Director, Perioperative ServicesDirector, Advanced Airway Management | Memorial Hermann Hospital - Texas Medical CenterHouston, Texas

Disclosures:Drs. Eisenkraft, Lien and Reich did not disclose any financial relationships.Dr. Hagberg receives funded research support from Ambu Cadence Pharmaceuticals, Inc., Karl Endoscopy, Inc., and is an unpaidconsultant for Ambu®.

Friday


Focus Sessions | Friday, December 13, 2013 | FS-01 & FS-02Afternoon Session • 15:45 - 17:00 • 4th Floor Rooms

Focus Sessions— FS-01 • Odets Room • 4th Floor

Office-Based Anesthesia IssuesFocus SessionModerator:Patrick L. Sittler, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:Which Patients andWhat Procedures for Office-Based SettingsPatrick L. Sittler, M.D.

Update on Regulations Pertaining to Office-Based ProceduresMaria Galati, M.B.A.Vice-Chair, Administration |DepartmentofAnesthesiology | IcahnSchoolofMedicineatMountSinai |NewYork,NewYork

After completion of this session, the participant will be able to:• Discuss what procedures, and which patients, are suitable for office based procedures and which should not

be done in this venue;• Incorporate the new state regulations pertaining to office based anesthesia to their practice.

Focus Sessions— FS-02 • Wilder Room • 4th Floor

The Disruptive Physician, The Impaired Physician: The JointCommission and The Department of Health Guidelines andRecommendationsFocus SessionModerator:George G. Neuman, M.D.Professor of Anesthesiology | NewYork Medical CollegeDirector, Westchester Medical Center Advanced Physicians Services, PC | Valhalla, NewYork

Faculty Presentations:The Disruptive Physician: TJC and Institutional ApproachGeorge G. Neuman, M.D.

The Impaired Physician: The DOH and the Committee for Physician HealthTerranceM. Bedient, FACHEVice President,Medical Society of the State of NewYork | Director, Committee for PhysicianHealth | Albany, NewYork

After completion of this session, the participant will be able to:• Identify and assess the disruptive/impaired physician;• Interpret the current recommendations of the Department of Health’s committee for physician health;• Develop a plan to manage the disruptive/impaired physician in their institution/department.

Disclosures:Drs. Neuman and Sittler, Ms. Galati and Mr. Bedient did not disclose any financial relationships.

FridayFriday

26 NYSSA • 67th Annual PostGraduate Assembly in Anesthesiology • www. nyssa-pga. org


Focus Sessions— FS-03 • Ziegfeld Room • 4th Floor

Pre-Anesthesia Clinic for Day Surgery: Improving Clinical Care andDecreasing Expenses?

Focus SessionModerator:George Silvay, M.D., Ph.D.Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:The Cardiac Pre-Anesthesia ClinicGeorge Silvay, M.D., Ph.D.

The General Pre-Anesthesia ClinicZdravka Zafirova, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the features of a pre-anesthesia clinic;• Implement a pre-anesthesia clinic at their institutions;• Identify the population most likely to benefit from a pre-anesthesia clinic.

Focus Sessions— FS-04 • O’Neill Room • 4th Floor

New Concepts in Mechanical Ventilation

Focus SessionModerator:Alessia C. Pedoto, M.D.Attending Anesthesiologist | Memorial Sloan-Kettering Cancer Center | NewYork, NewYork

Faculty Presentations:Ventilation Strategies for the Operating RoomAlessia C. Pedoto, M.D.

New Concepts in ICU VentilationBrigid C. Flynn, M.D.Assistant Clinical Professor of Anesthesiology and Critical CareColumbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Incorporate new ventilating strategies into their ventilator management in the OR;• Discuss non-invasive ventilation;• Incorporate new ventilation strategies into ICU ventilation management.

Disclosures:Drs. Flynn, Pedoto, Silvay and Zafirova did not disclose any financial relationships.

Friday



Focus Sessions— FS-05 • Soho Complex • 7th Floor

Malignant Hyperthermia Update

Focus SessionModerator:Henry Rosenberg, M.D.Director, Department of Medical Education and Clinical Research | Saint Barnabas Medical Center | President, MHAUSLivingston, New Jersey

Faculty Presentations:

What is New in Testing for Malignant Hyperthermia andWho Should be Tested?Henry Rosenberg, M.D.

Update on Clinical Management of Malignant Hyperthermia or Patients at RiskJerrold Lerman, M.D., FRCPC, FANZCAClinical Professor of Anesthesiology | Children’s Hospital of Buffalo | Buffalo, NewYorkClinical Professor of Anesthesiology | University of Rochester School of Medicine & Dentistry | Rochester, NewYork

After completion of this session, the participant will be able to:• Discuss the importance of malignant hyperthermia in their practice;• Discuss the various testing methods for malignant hyperthermia;• Arrange for the appropriate test for diagnosing malignant hyperthermia;• Develop a malignant hyperthermia treatment plan for their institutions.

Focus Sessions— FS-06 • Astor Ballroom • 7th Floor

Update in Pain ManagementFocus SessionModerator:Lawrence J. Epstein, M.D.Associate Director, Division of Pain Management | Director, Outpatient Pain ManagementAssociate Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:Management of Vertebral Compression FracturesLawrence J. Epstein, M.D.

Opioids for Non-Malignant PainMichel Y. Dubois, M.D., DABPMJoyce H. Lowinson Professor of Pain Medicine and Palliative Care | Professor of AnesthesiologyNYU-Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the indications for opiates for non-malignant pain;• Discuss the evidence supporting the use of opiates for non-malignant pain;• Discuss the evidence for the safety of opiates for non-malignant pain;• Develop a plan to optimize pain management for non-malignant pain and prevention of diversion;• Develop a treatment plan for the management of osteoporotic fractures.

Disclosures:Drs. Dubois and Epstein did not disclose any financial relationships.Dr. Rosenberg receives consultant fees from Eagle Pharmaceuticals, Inc.Dr. Lerman receives consultant fees fromPiranga, Inc., honoraria fromAbbott Laboratories and is a shareholder inManagement LLC.

FridayFriday


Focus Sessions | Friday, December 13, 2013 FS-07 & FS-08Afternoon Sessions • 15:45 - 17:00 • various Rooms

Focus Sessions — FS-07 • Manhattan Ballroom • 8th Floor

Clinical Challenges in the Patient with Obstructive Sleep Apnea (OSA)Focus SessionModerator:Kathryn E. McGoldrick, M.D.Professor and Chair | Department of Anesthesiology | Westchester Medical Center | NewYork Medical CollegeValhalla, NewYork

Faculty Presentations:The Patient with Suspected OSA for Ambulatory SurgeryKathryn E. McGoldrick, M.D.

Postoperative Pain Management in the Patient with OSAEugene R. viscusi, M.D.Professor of Anesthesiology | Director, Acute Pain Management | Jefferson Medical CollegeThomas Jefferson University | Philadelphia, Pennsylvania

After completion of this session, the participant will be able to:• Discuss the pathophysiology of obstructive sleep apnea (OSA) in adults;• Assess the eligibility of patients with OSA for ambulatory anesthesia;• Develop an anesthetic plan for patients with OSA for ambulatory procedures;• Identify the problems of postoperative pain management in patients with OSA;• Develop a plan for postoperative pain management for patients with OSA in the in-patient and ambulatory

setting.

Focus Sessions — FS-08 • Columbia/Duffy Rooms • 7th Floor

Pro-Con Nitric Oxide (NO) Use in Anesthesia and ICUFocus SessionModerator:Robert N. Sladen, M.B., Ch.B., FCCMProfessor and Vice Chair | Department of Anesthesiology | Chief, Division of Critical CareColumbia University, College of Physicians & Surgeons | NewYork, NewYork

Faculty Presentations:ProRobert N. Sladen, M.B., Ch.B., FCCM

ConJosephW. Dooley, M.D.Associate Professor of Anesthesiology | University of Rochester School of Medicine | Rochester, NewYork

After completion of this session, the participant will be able to:• Discuss indications for the use of NO;• Discuss alternative treatments to the use of NO;• Develop rational treatment protocols for patients with pulmonary hypertension in the perioperative period.

Disclosures:Drs. Dooley and McGoldrick did not disclose any financial relationships.Dr. Sladen receives honoraria from Orion Pharma Hutchinson Technologies.Dr. Viscusi receives funded research support fromAcelRx Pharmaceuticals, Inc., Adolor Corporation, Cadence Pharmaceuticals, Inc.,Cumberland Pharmaceuticals, Inc. and Pacira Pharmaceuticals, Inc. He receives consultant fees fromAcelRx Pharmaceuticals, Inc.,Cadence Pharmaceuticals, Inc., Cubist Pharmaceuticals, Incline Therapeutics, Pacira Pharmaceuticals, Inc., Salix Pharmaceuticals,and is on the Cadence Pharmaceuticals, Inc. speakers bureau.

Friday

29

Problem-Based Learning Discussions | Friday, December 13, 2013PBLD-09 through PBLD-16 | Afternoon Sessions • 15:45 - 17:00 • 6th Floor Rooms


Peer Review and the Anatomy of a LawsuitSpeaker:vilma A. Joseph, M.D., M.P.H.Associate Professor of Clinical Anesthesiology | Albert Einstein College of Medicine | Bronx, NewYork

After completion of this session, the participant will be able to:• Describe medical-legal issues regarding confidentiality and the peer review process;• Describe the process of a hospital, state or federal investigation;• Analyze landmark court cases surrounding peer review issues;• Recognize the implications of being reported to the National Practitioner Databank;• Improve management of Quality and Performance Improvement issues.


Are ICU Ventilation Strategies Beneficial in the OR?Speaker:Anahita Dabo-Trubelja, M.D.Assistant Attending in Anesthesiology | Memorial Sloan-Kettering Cancer Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify the advantages and disadvantages of alternative ventilation strategies such as pressure controlled ventilation and

low tidal volume with increased PEEP;• Analyze the evidence regarding the implementation of these techniques in the non-thoracic surgical population;• Select the appropriate ventilation strategy for the general surgery patient.

Problem-Based Learning Discussions — PBLD-11 -Winter Garden Room

Latest Guidelines for the Perioperative Management of Patients withDrug-Eluting Stents Placed More Than One Year AgoSpeakers:Christopher Y. Tanaka, M.D.Attending Anesthesiologist | Division of Cardiothoracic AnesthesiologyMontefiore Medical Center | Assistant Professor of AnesthesiologyAlbert Einstein College of Medicine | Bronx, NewYork

After completion of this session, the participant will be able to:• Discuss the American College of Cardiology Guidelines regarding maintenance of anticoagulation during the perioperative

period in patients with drug-eluting stents;• Identify barriers to multi-specialty communication regarding preoperative medical conditions;• Institute a program to streamline the perioperative management of patients with chronic drug-eluting stents.


The Parturient with CardiomyopathySpeakers:Ivan A. velickovic, M.D.Director, Obstetric AnesthesiologySUNY-Downstate Medical Center | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Recognize the differential diagnosis of cardiac disease in pregnancy.• Formulate an anesthetic plan for a patient with peripartum cardiomyopathy.

Disclosures:Drs. Dabo-Trubelja, Garvin, Joseph, Pyram, Tanaka and Velickovic did not disclose any financial relationships.

Sean Garvin, M.D.Assistant Attending AnesthesiologistHospital for Special SurgeryClinical Assistant Professor of AnesthesiologyNewYork-Presbyterian HospitalCornell University, Weill Cornell Medical CollegeNewYork, NewYork

Chantal Pyram, M.D.Attending AnesthesiologistAlbert Einstein College of Medicine/Montefiore Medical CenterBronx, NewYork


FridayFriday



Supraglottic Airway for Tonsillectomy in Child with Sleep ApneaSpeaker:Elizabeth A. Demers Lavelle, M.D.Assistant Professor of Anesthesiology | SUNY-Upstate Medical University | Syracuse, NewYork

After completion of this session, the participant will be able to:• Recognize risk factors for sleep apnea in children;• Apply current guidelines for management of the child with sleep apnea;• Formulate an anesthetic plan utilizing a supraglottic airway for the child with sleep apnea.

Problem-Based Learning Discussions — PBLD-14 - Uris Room

Obstetric Analgesia in the Patient with Previous Back SurgerySpeakers:RishiMani S. N. Adsumelli, M.D., B.S., FFARCSAssociate Professor of AnesthesiologySUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

After completion of this session, the participant will be able to:• Identify the postoperative changes associated with various types of spinal surgery;• Design an obstetrical anesthetic plan with contingencies for the patient with a history of scoliosis repair.


Is There Still a Role for Deep Extubation?Speakers:Michael Rufino, M.D.Assistant Professor of AnesthesiologyAlbert Einstein College of Medicine | Bronx, NewYork

After completion of this session, the participant will be able to:• Identify patients and situations in which deep extubation might be considered appropriate;• Recognize the risks and benefits of proceeding with deep extubation after a surgical procedure.

Problem-Based Learning Discussions — PBLD-16 - Royale Room

Utility of Lumbar Plexus Block?Speakers:Jeff C. Gadsden, M.D., FRCPC, FANZCAAssistant Professor of Clinical AnesthesiologyColumbia University College of Physicians & SurgeonsDirector of Regional AnesthesiaResidency ProgramDirector St. Luke's and Roosevelt HospitalsNewYork, NewYork

After completion of this session, the participant will be able to:• Identify which patients would benefit from a lumbar plexus block;• Identify the possible complications of a lumbar plexus block;• Implement a program for pre- or postoperative lumbar plexus block placement.

Disclosures:Drs. Adsumelli, Cokinos, Demers Lavelle, Gadsden, Kosharskyy, Reddy and Rufino did not disclose any financial relationships.

Friday

Christine E. Cokinos, M.D.Assistant Professor of AnesthesiologySUNY-Health Sciences Center at Stony Brook | Stony Brook, NewYork

Boleslav Kosharskyy, M.D.Director, Anesthesia for Joint Replacement CenterAssociate Director, Pain CenterAssistant Professor of AnesthesiologyAlbert Einstein College ofMedicine/MontefioreMedical CenterBronx, NewYork

Shamantha G. Reddy, M.D.Assistant Professor of AnesthesiologyAlbert Einstein College of MedicineBronx, NewYork


Saturday, December 14, 2013Times

Registration ....................................................................................................................................... 07:00Hands-OnWorkshops .......................................................................... 07:30, 08:00, 09:00 & 12:00NYSSA Resident and Fellow Section Meeting....................................................................... 07:30MiniWorkshops.................................................................................................. 07:30 , 07:45 & 11:45Welcome Plenary Session:

Juilliard Jazz Ensemble............................................................................................................... 08:3029th Annual Robertazzi Memorial Panel ........................................................................... 09:00

Technical Exhibits ............................................................................................................................ 10:00Scientific Exhibits............................................................................................................................. 10:00Poster Presentations &Medically Challenging Case Reports .............................. 11:00 & 14:00Problem-Based Learning Discussions ...................................................................... 11:45 & 15:45Resident Research Contest .......................................................................................................... 12:30Scientific Panels ............................................................................................................................... 13:00Focus Sessions ...................................................................................................................................15:45

Additional Activities:NYSSA House of Delegates .......................................................................................................... 11:00Reference Committee .....................................................................................................................13:45American Board of Anesthesiology Program.........................................................................17:30


SaturdaySaturday

67th Annual





NewYork State Conference for Anesthesiology Residents and Fellows07:30 - 15:00 • Empire Complex • 7th Floor15:00 - 17:00 • Sky Lobby • 16th Floor

Looking to the Future: Pearls to SupplementYour Training

The NYSCARF meeting provides an opportunity for residents and fellows in anesthesiology to gain perspectiveon the future of their medical specialty. Leaders of both the ASA and NYSSA will speak on the anesthesiologist’srole in a changing world. Residents and fellows will have an opportunity to present and discuss their research.The program will include a simulation workshop, a discussion of changes anticipated to the Maintenance ofCertification in Anesthesiology® Program (MOCA), a comparison and contrast of academic and private practice,and a discussion from an experienced attorney regarding contract negotiation. The conference will concludewith a business meeting of the Resident and Fellows Section of the NYSSA, and an informal poster presentationsession. Medical students are welcome.

08:00 - 08:30 Continental Breakfast with the NYSSA LeadershipMichael B. Simon, M.D.President, NewYork State Society of Anesthesiologists, Inc.Regional Director, North American Partners in AnesthesiaPoughkeepsie, NewYork

Lawrence J. Epstein, M.D.President-Elect, NewYork State Society of Anesthesiologists, Inc.Associate Director, Division of Pain Management | Director, Outpatient Pain ManagementAssociate Professor of Anesthesiology | Icahn School of Medicine at Mount SinaiNewYork, NewYork

Michael P. Duffy, M.D.Vice-President, NewYork State Society of Anesthesiologists, Inc.Clinical Assistant Professor of Anesthesiology | Upstate Medical UniversityAttending Anesthesiologist | Crouse Irving Hospital | Syracuse, NewYork

08:30 - 09:00 Becoming Certified andMaintaining Certification: What You Need to KnowCynthia A. Lien, M.D.Professor of Anesthesiology | Vice Chair for Academic Affairs | Director, Residency ProgramCornell University, Weill Cornell Medical College | Attending AnesthesiologistNewYork-Presbyterian Hospital | NewYork, NewYork

09:00 - 09:30 Simulation: Its Increasing Role in Resident EducationAdam I. Levine, M.D.Professor of Anesthesiology, Otolaryngology, Structural and Chemical BiologyVice-Chair for Education | Program Director, Residency Training ProgramProgram Director, ASA Endorsed HELPS Simulation Program | Department of AnesthesiologyIcahn School of Medicine at Mount Sinai | NewYork, NewYork

09:30 - 10:00 Discussion: Choosing Between Academic and Private PracticeKenneth B. Newman, M.D.Attending Anesthesiologist | Senior Partner, Cross River Anesthesiology ServicesMount Kisco, NewYork

Samuel DeMaria, Jr., M.D.Associate Professor of Anesthesiology | Assistant Program Director, Academic AffairsAnesthesiology Residency Training Program, Director of ResearchIcahn School of Medicine at Mount Sinai | NewYork, NewYork


Saturday, December 14, 2013

Saturday

10:00 - 11:00 Resident Research Contest Presentations*CharlesW. Emala, Sr., M.S., M.D., ModeratorHenrik H. Bendixen Professor of Anesthesiology | Vice Chair for ResearchColumbia University, College of Physicians and Surgeons | NewYork, NewYork

11:00 - 11:30 Contracts Negotiations and Legal Pitfalls in Anesthesiology PracticeCharles J. Assini, Jr., Esq.Legislative Counsel | TheNewYork State Society of Anesthesiologists, Inc.Partner, Higgins, Roberts & Suprunowicz, PC | Schenectady, NewYork

11:30 - 12:00 Quality: CanWeMeasure It? Does It Matter?Peter M. Fleischut, M.D.Assistant Professor of Anesthesiology | Deputy Quality and Patient Safety OfficerCornell University, Weill Cornell Medical College | NewYork, NewYork

12:00 - 12:30 Accountable Care Organizations and the Economics of theMedical Practice of the FutureMaria Galati, M.B.A.Vice-Chair, Administration | Department of AnesthesiologyIcahn School of Medicine at Mount Sinai | NewYork, NewYork

12:30 - 13:15 Luncheon and Announcement of Research Contest PresentationWinnersJane C.K. Fitch, M.D.President, American Society of Anesthesiologists | John L. Plewes Professor & ChairDepartment of Anesthesiology | University of Oklahoma | Oklahoma City, Oklahoma

John P. Abenstein, MSEE, M.D.President-Elect, American Society of Anesthesiologists | Associate Professor of AnesthesiologyMayo Clinic | Rochester, Minnesota

13:00 - 15:00 Workshop: Simulation TrainingAdam I. Levine, M.D.Professor of Anesthesiology, Otolaryngology, Structural and Chemical BiologyVice-Chair for Education | Program Director, Residency Training ProgramProgram Director, ASA Endorsed HELPS Simulation Program | Department of AnesthesiologyIcahn School of Medicine at Mount Sinai | NewYork, NewYork

14:30 - 15:00 Resident and Fellow Section Business Meeting

15:00 - 17:00 Resident Poster Presentations/Discussion - Sky Lobby, 16th FloorKane O. Pryor, M.D., ModeratorAssistant Professor of Anesthesiology and PsychiatryCornell University, Weill Cornell Medical College | NewYork, NewYork


* After the winners are announced, the Resident Research Contest Presentations will be displayed on the 6th Floor promenade onSaturday from 12:30 until 13:00 on Monday.

Shahryar Mousavi, M.D., President, NYSSA Resident and Fellow Section

SaturdaySaturday


Saturday

Workshop | Saturday, December 14, 2013All Day Session • 07:30 - 17:00This workshop takes place off-site, at SUNY-Downstate Medical Center. Transportation is provided.

Workshop — W-04

Hands-On Cadaver, Ultrasound and LiveModel Regional AnesthesiaStation , Cadaver Interscalene and Supraclavicular BlocksStation 2 Cadaver Infraclavicular and Axillary BlocksStation 3 Cadaver Paravertebral BlocksStation 4 Cadaver Femoral BlockStation 5 Cadaver Sciatic and Popliteal BlocksStation 6 Model Ultrasound Interscalene and Supraclavicular BlockStation 7 Model Ultrasound Infraclavicular and Axillary BlocksStation 8 Model Ultrasound Guided Epidural and Spinal BlocksStation 9 Model Ultrasound Femoral BlocksStation 10 Model Ultrasound Sciatic and Popliteal BlocksWorkshop Co-Moderators: Stefan E. Lucas, M.D.

Assistant Professor in AnesthesiologyUniversity of Rochester School ofMedicine & Dentistry | Rochester, NewYork

Chester C. Buckenmaier, III, M.D., COL,MC, USAProgram Director, Defense and Veterans Center forIntegrative Pain ManagementRockville, Maryland

Jose C.A. Carvalho,M.D., Ph.D., FANZCA, FRCPCProfessor of Anesthesia, Obstetrics and GynecologyUniversity of Toronto | Director, Obstetric AnesthesiaMount Sinai Hospital Toronto, Ontario, Canada

Scott M. Croll, M.D., LTC, MC, USAAssistant Professor of AnesthesiologyUSUHS Chief, Anesthesiology DepartmentEvans Army Community Hospital | Fort Carson, Colorado

Workshop Description:Hands-On Cadaver, Ultrasound and Live Model Regional AnesthesiaWorkshop will be held in the state of the art anatomy lab locatedin the SUNY-Downstate Medical Center (Brooklyn, NewYork.) Round trip bus transportation is provided from the NewYork MarriottMarquis directly to SUNY-Downstate. You will be instructed in small groups with hands-on practice by world renowned faculty.

As a participant you can expect the following:• Cadavers expertly dissected to show anatomy;• Hands-on practice on dissected cadavers;• Ultrasound display on large LCD screens;• Ultrasound guided blocks demonstrated on live models;• Ultrasound guided blocks practiced on cadavers;• Participants will rotate between cadaver and live model stations

After completion of this session, the participant will be able to:• Demonstrate basic skills in ultrasound technology;• Apply ultrasound technology to perform peripheral and neuraxial blocks;• Relate cadaver anatomy of peripheral nerve structures to live-model sonoanatomy;• Discuss advantages and pitfalls of ultrasound guidance for paravertebral blocks;• Utilize ultrasound techniques to perform truncal field blocks (TAP block, ilioinguinal-iliohypogastric blocks).

Disclosures:Drs. Buckenmaier, Carvalho, Croll, Dimaculangan, Franco, Haber, Lucas and Patzkowski did not disclose any financialrelationships.

Carlo D. Franco, M.D.Professor of Anesthesiology andAnatomyRush University Medical CenterChair, Regional AnesthesiaJHS Hospital of Cook CountyChicago, Illinois

GaryW. Haber, M.D.Medical DirectorLinden Oaks Surgery CenterRochester, NewYork

Krystof J. Neumann, M.D.Assistant Professor of AnesthesiologyUniversity of Rochester School ofMedicine and DentistryRochester, NewYork

Ryan R. Shelton, M.D.Assistant Professor of AnesthesiologyUniversity of Rochester School ofMedicine & DentistryRochester, NewYork

Dennis P. Dimaculangan, M.D.Clinical Assistant Professor of AnesthesiologySUNY-Downstate Medical CenterBrooklyn, NewYork


MiniWorkshops | Saturday, December 14, 2013 | M-09 through M-12

Morning Sessions • 07:45 - 08:45 • 4th Floor Rooms

MiniWorkshop — M-09 - O’Neill Room - Starts at 07:30

FIRE in the OR,What Every Anesthesiologist Needs to KnowSpeaker:Terrance R. Burns, M.D.Assistant Clinical Professor of Anesthesiology | SUNY-Buffalo School of Medicine and Biomedical SciencesKaleida Millard Fillmore Gates | Buffalo, NewYork

After completion of this session, the participant will be able to:• Identify the three components needed for a fire to start;• Prioritize how to put out a fire;• Understand the different fire extinguisher types.

MiniWorkshop — M-10 - Odets Room

Neurophysiological MonitoringSpeaker:Stacie G. Deiner, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Delineate the parameters which are observed during anesthesia;• Enumerate the confounding factors which may interfere with the monitoring;• Delineate the current limitations of monitoring.

MiniWorkshop — M-11 -Wilder Room

Off-Pump Coronary Artery Bypass Surgery: Anesthetic ConsiderationsSpeaker:Bharathi Scott, M.D.Professor of Clinical Anesthesiology | SUNY-Health Sciences Center at Stony Brook | Stony Brook, NewYork

After completion of this session, the participant will be able to:• Describe the evolution of off-pump coronary artery bypass surgery;• Describe the indications, surgical technique and anesthetic challenges;• Discuss the safety and efficacy of this procedure;• Examine current literature comparing on- and off- pump coronary surgery.

MiniWorkshop — M-12 - Ziegfeld Room

Setting Up and Running a Pre-Anesthetic Assessment ClinicSpeaker:Daniel M. Lahm, M.D., M.B.A.Associate Professor of Clinical Anesthesiology | Associate Professor of Clinical Neurological SurgeryCornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Delineate the challenges in creating a pre-anesthesia clinic;• Discuss the systems used in the pre-anesthesia clinic;• Discuss the objectives of the pre-anesthesia clinic;• Discuss the staffing in the pre-anesthesia clinic.

Disclosures:Drs. Burns, Deiner, Lahm and Scott did not disclose any financial relationships.

SaturdaySaturday


Workshop | Saturday, December 14, 2013Morning Session • 08:00 - 11:00 • Manhattan Ballroom • 8th Floor

Workshop — W-05

Difficult Airway ManagementA Hands-On Demonstration

Workshop Co-Moderators: Allan P. Reed, M.D. Irene P. Osborn, M.D.Professor of Anesthesiology Associate Professor of AnesthesiologyIcahn School of Medicine at Mount Sinai Director, NeuroanesthesiaNewYork, NewYork Icahn School of Medicine at Mount Sinai

NewYork, NewYorkAssisted by:

ZanaBorovcanin,M.D.Associate Professor of AnesthesiologyDirector, Division of GeneralAnesthesiologyDirector, AdvancedAirwayManagementEducationUniversity of Rochester School ofMedicine andDentistryRochester, NewYork

LevonC. Capan,M.D.Professor of AnesthesiaNYU-Langone Medical CenterAssociate Director, AnesthesiaBellevue Hospital CenterNewYork, NewYork

Elvira Cho,M.D.Staff AnesthesiologistInterfaithMedical CenterBrooklyn, NewYork

StacieG. Deiner,M.D.Assistant Professor of AnesthesiologyIcahn School ofMedicine atMount SinaiNewYork, NewYork

Panchali Dhar,M.D.Assistant Professor of AnesthesiologyNewYork-Presbyterian HospitalNewYork, NewYork

Barbara M.Dilos, D.O.Assistant Professor of AnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Michael Frass,M.D.Professor of MedicineMedical University of ViennaVienna, Austria

Cheryl K. Gooden,M.D.Associate Professor of Anesthesiologyand PediatricsIcahn School of Medicine atMount SinaiNewYork, NewYork

Adam I. Levine,M.D.Professor of Anesthesiology,Otolaryngology, Structural andChemical BiologyVice-Chair for EducationProgramDirector, ResidencyTrainingProgramProgramDirector, ASA EndorsedHELPS Simulation ProgramDepartment of AnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Mitchell H.Marshall,M.D.Clinical Associate Professor ofAnesthesiologyNYU-Langone Medical CenterAttending AnesthesiologistNYU-Langone Medical Center-Hospitalfor Joint DiseasesNewYork, NewYork

StevenM.Neustein,M.D.Professor of AnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Daniel K. O’Neill,M.D.Assistant Professor of AnesthesiologyNYU-Langone Medical CenterNewYork, NewYork

Slawomir P. Oleszak,M.D.Associate Professor of AnesthesiologySUNY-Health Sciences Center at StonyBrookStony Brook, NewYork

RamRoth,M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Michael Rufino,M.D.Assistant Professor of AnesthesiologyAlbert Einstein College ofMedicineBronx, NewYork

JonD. Samuels,M.D.Assistant Professor of ClinicalAnesthesiologyJoan and Sanford I.Weill MedicalCollege of Weill Cornell UniversityNewYork, NewYork

John J. Schaefer, III, M.D.Professor of Anesthesia andPerioperativeMedicineMedical University of South CarolinaLewisW. Haskell Blackman EndowedChairDirector, Clinical Effectiveness andPatient Safety Center of ExcellenceHealthCare Simulation of SouthCarolinaCharleston, South Carolina

Prithi P. Singh,M.D.Clinical Associate Professor ofAnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Ralph L. Slepian,M.D.Associate Professor of AnesthesiologyMedical Director of Inpatient OperatingRooms & Post Anesthesia Care UnitCornell University,Weill CornellMedical CollegeNewYork, NewYork

Francis S. Stellaccio,M.D.Assistant Professor of AnesthesiologySUNY-Health Sciences Center atStony BrookStony Brook, NewYork

Tracey Straker,M.D.,M.P.H.Associate Professor of AnesthesiologyAlbert Einstein College ofMedicineBronx, NewYork

Sonia J.Vaida,M.D.Professor of Anesthesiology,Obstetrics and GynecologyVice-Chair, ResearchDirector, Obstetric AnesthesiaPenn State College ofMedicinePenn StateMilton S. HersheyMedicalCenterHershey, Pennsylvania

StephenA.Vitkun,M.D.,M.B.A.,Ph.D.SUNYDistinguishedTeaching ProfessorProfessor of Anesthesiology andViceChair (Special Projects)Professor of Pharmacological SciencesProfessor of Health SciencesSUNY-Health Sciences Center at StonyBrookStony Brook, NewYork

Charles B.Watson,M.D., FCCMClinical Associate Professor ofAnesthesiologyUniversity of ConnecticutFarmington, ConnecticutChair, Department of AnesthesiaDeputy Surgeon-in-ChiefBridgeport HospitalYale-NewHaven Health SystemBridgeport, Connecticut

After completion of this session, the participant will be able to:• Perform an appropriate airway evaluation;• Utilize numerous commercially available airway devices;• Apply the ASA Difficult Airway Practice Parameters in clinical scenarios.

Disclosures:Drs. Borovcanin, Capan, Cho, Deiner, Dhar, Dilos, Frass, Gooden, Marshall, Neustein, Oleszak, O’Neill, ReedRoth, Samuels, Singh, Stellaccio, Straker, Vaida, Vitkun andWatson did not disclose any financial relationships.Dr. Levine is on the speakers bureau and receives consultant fees fromMylan Pharmaceuticals.Dr. Osborn receives material support from Coadvice, Inc.Dr. Schaefer receives royalties from Lateral Medical Corp., and is an owner of Sim Tunes.

NOTE: ThisWorkshop will be repeated on Saturday asW-07.

Satu

rday


NotesSaturdaySaturday


Welcome Plenary Session | Saturday, December 14, 2013Morning Session • 08:30 - 11:30 • Broadway Ballroom • 6th Floor

Welcome Plenary Session — SP-09

Brief remarks by:• Jane C.K. Fitch, M.D. , 2013/2014 President, American Society of Anesthesiologists• Michael B. Simon, M.D., 2013 President, The NewYork State Society of Anesthesiologists, Inc.• David J.Wlody, M.D., PGA General Chair

The NYSSA Distinguished Service Award will be presented toMargaret G. Pratila, M.D.

29th AnnualR.W. Robertazzi Memorial Panel

(1912-1971)

Raphael “Ray”W. Robertazzi was an outstanding clinical anesthesiologist, and a pioneer in the development of the specialty,in New York City. He trained in Anesthesiology at New York Post Graduate Hospital, served in the United States Army duringWorld War II, and then returned to the Post Graduate Hospital as Director of Anesthesiology and Clinical Professor at NewYork University in the Department of Emery Rovenstine. He successfully blended clinical care and clinical research when hepublished his observations, and the results of his operating room studies. Ray Robertazzi was an inspirational role model tohis residents and students.

PGA67OPENING CEREMONY

JJuuiilllliiaarrdd JJaazzzz EEnnsseemmbblleeTaking audiences on a musical journey of NewYorkfrom the early jazz era to contemporary styles...

Featuring highly gifted Juilliard students

Satu

rday


Welcome Plenary Session | Saturday, December 14, 2013Morning Session • 08:30 - 11:30 • Broadway Ballroom • 6th Floor

Welcome Plenary Session — SP-09

Debating the Issues of the Day

Panel Moderator:Paul G. Barash, M.D.Professor of Anesthesiology | Yale University, School of Medicine | New Haven, Connecticut

After completion of this session, the participant will be able to:• Discuss the legal implications of published practice guidelines for the medical specialty of anesthesiology;• Explain the clinical advantages and disadvantages of brain activity monitors and define their role as a clinicaltool in anesthesia care;

• Discuss the benefits and pitfalls associated with the Surgical Care Improvement Project and the implications ofthis initiative upon the attendee’s own practice.

Presentations:

Practice Guidelines: Clinical Asset or Liability?Judith Jurin Semo, J.D.Judith Jurin Semo, PLLC | Washington, DC

Brain Activity Monitors: Do They Offer Clinical Value? PRO.AlexY. Bekker, M.D., Ph.D.Professor and Chair | Department of Anesthesiology | Chair, Perioperative Services CommitteeRutgers New Jersey Medical School | Newark, New Jersey

Brain Activity Monitors: Do They Offer Clinical Value? CON.Michael P. O’Connor, M.D.Professor of Anesthesia & Critical Care | Section Head, Critical Care Medicine | University of ChicagoChicago, Illinois

Focusing onWhat is Important to Our Patients: What Does SCIP Mean to You?Paul G. Barash, M.D.andRobert S. Lagasse, M.D.Professor of Anesthesiology | Director, Quality Management & Perioperative SafetyDepartment of Anesthesiology | Yale University School of Medicine | New Haven, Connecticut

Disclosures:Drs. Barash, Bekker, Lagasse, O’Connor and Ms. Jurin Semo did not disclose any financial relationships.

SaturdaySaturday


Workshop | Saturday, December 14, 2013All Day Session • 09:00 - 17:00 • Soho Complex • 7th Floor

Workshop — W-06

Advanced Cardiac Life-Support (ACLS)A Certification Course for Skilled Providers

WorkshopModerator: Stephen A. vitkun, M.D., M.B.A., Ph.D.SUNY Distinguished Teaching ProfessorProfessor of Anesthesiology and Vice Chair (Special Projects)Professor of Pharmacological SciencesProfessor of Health SciencesSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Assisted by:

W.Walter Backus M.D.Professor of Clinical Anesthesiology andPediatricsDirector, Perioperative ServicesDepartment of AnesthesiologySUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Jeanne Cavalieri, MPAS, RPACDirector of Clinical EducationClinical Assistant ProfessorDepartment of PA EducationSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

LindaM.Cimino, Ed.D.,M.S., CPNP,ANPInstructor in AnesthesiologyAssistant Professor of NursingAssistant Professor of Clinical HealthSciencesSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Donna Crapanzano, M.P.H., RPACClinical Assistant Professor Health ScienceProgramSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Malcolm Devine, NREMT-PACLS InstructorParamedic Faculty MemberSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Magdalena Godlewska, NREMT-PLecturer in Health SciencesSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Theodore Lamonica, NREMT-PLecturer in Health SciencesSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Aret Ozkan, NREMT-PLecturer in Health SciencesSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Chris Tremblay, NREMT-PLecturer in Health SciencesSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Paul A.Werfel, NREMT-PLong Island Regional ACLS FacultyParamedic Program Director and ClinicalInstructorSchool of Health Technology andManagementSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

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

• Apply the current guidelines and treatment protocols for Advanced Cardiac Life Support.• Demonstrate Basic Life Support skills.

Requirements for Certificate:To receive an ACLS Certificate, the participant will have to successfully complete the course and pass a written and practicalexamination, which will be administered at the end of the course.

This workshop is limited to pre-registration.

Disclosures:Drs. Backus and Vitkun, Ms. Cavalieri, Ms. Cimino, Ms. Crapanzano, Mr. Devine, Ms. Godlewska, Mr. Lamonica, Mr. Ozkan,Mr. Tremblay and Mr.Werfel did not disclose any financial relationships.

Note: This is a full day workshop. A lunch voucher will be provided.

Saturday


MiniWorkshops | Saturday, December 14, 2013 | M-13 through M-16Mid-Day Sessions • 11:45 - 12:45 • 4th Floor Rooms

MiniWorkshop—M-13 - Odets Room

The Critically Ill Cardiac Patient - Challenges and SolutionsSpeaker:Jennie Y. Ngai, M.D.Assistant Professor of Anesthesiology | Director, Cardiothoracic Anesthesiology FellowshipDivision of Cardiothoracic Anesthesiology | NYU Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Delineate the indications for assist devices;• Delineate three common complications from using assist devices;• Enumerate two pharmacologic approaches to the critically ill cardiac patient.


The Pregnant Patient for Non-Obstetric SurgerySpeaker:Jeffrey Zahn, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify the risk factors associated with surgery during pregnancy;• Enumerate the qualifiable rate of miscarriage;• Delineate the critical time periods for organogenesis during pregnancy.


Problems in the Office-Based Surgery PatientsSpeaker:Isabelle DeLeon-volpe, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Delineate three conditions which contraindicate anesthesia in the office;• Delineate the three most common causes of hospital admission from an office-based anesthetic;• Define the role of capnography in sedation cases.

MiniWorkshop—M-16 - O’Neill Room - Ends at 13:00

FIRE in the OR,What Every Anesthesiologist Needs to KnowSpeaker:Terrance R. Burns, M.D.Assistant Clinical Professor of Anesthesiology | SUNY-Buffalo School of Medicine and Biomedical SciencesKaleida Millard Fillmore Gates | Buffalo, NewYork

After completion of this session, the participant will be able to:• Identify the three components needed for a fire to start;• Prioritize how to put out a fire;• Understand the different fire extinguisher types.

Disclosures:Drs. Burns, DeLeon-Volpe, Ngai and Zahn did not disclose any financial relationships.

SaturdaySaturday


Problem-Based Learning Discussions | Saturday, December 14, 2013 |PBLD-17 through PBLD-24 | Mid-Day Sessions • 11:45 - 12:45 • 6th Floor Rooms


Emergency Management of Severe Brain InjurySpeakers:Staffan B.Wahlander, M.D.Associate Clinical Professor of AnesthesiologyColumbia University, College of Physicians & SurgeonsAssociate Director, Division of Critical CareAssociate Vice Chair, Resident EducationColumbia Presbyterian Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Manage increased intracranial pressure (ICP);• Discuss controversies that may arise regarding hyperventilation, blood pressure management, osmotherapy, barbiturates

and chemical paralysis;• Employ emergency anesthetic management of airways, fluid resuscitation balance and effects of anesthetics/muscle

relaxants on intracranial pressure in severe traumatic brain injury.


NewMurmur on Preop Exam: ShouldWe Proceed?Speaker:Jolie Narang, M.D.Associate Professor of Anesthesiology | Albert Einstein College of Medicine/Montefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Identify the conditions which might cause a previously undiagnosed murmur;• Formulate a plan for the anesthetic management of a patient with a newmurmur.

Problem-Based Learning Discussions — PBLD-19 -Winter Garden Room

Epidural Analgesia and DVT ProphylaxisSpeakers:Colleen E. McCally, M.D.Attending AnesthesiologistSouth Nassau Communities HospitalOceanside, NewYork

After completion of this session, the participant will be able to:• Discuss various modality of DVT prophylaxis;• Review potential complications of epidural analgesia in the setting of pharmacologic DVT prophylaxis;• Apply techniques that would result in a successful DVT prophylaxis in the patient receiving epidural analgesia.


What’s New in the Management of Subarachnoid HemorrhageSpeaker:Eduardo Galeano, M.D.Assistant Professor of Anesthesiology | Albert Einstein College of Medicine/Montefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Discuss the physiologic changes that occur in the setting of subarachnoid hemorrhage;• Identify indications for coiling versus clipping of intracranial aneurysms;• Develop an anesthetic plan for the management of the patient subarachnoid hemorrhage.

Disclosures:Drs. Galeano, Lee, McCally, Narang, Probst andWahlander did not disclose any financial relationships.

Stephen Probst, M.D.Assistant Professor of AnesthesiologyDivision Chief, Neuroanesthesia/ENT AnesthesiaSUNY Health Sciences Center at Stony BrookStony Brook, NewYork

David Lee, M.D.Assistant Attending Anesthesiologist | Hospital for Special SurgeryClinical Assistant Professor of AnesthesiologyCornell University, Weill Cornell Medical College | NewYork, NewYork

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Torsade After Hysterectomy: The Impact of Prolonged QT onAntiemesis GuidelinesSpeakers:Anuj Malhotra, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Review the mechanism of action of antiemetic medications;• Identify potential side effects and complications from antiemetic medications;• Formulate a comprehensive plan to limit postoperative nausea and vomiting.

Problem-Based Learning Discussions— PBLD-22 - Uris Room

Placental Abruption, Fetal Demise and HELLP Syndrome: PatientRefuses General Anesthesia: Is Regional Anesthesia Acceptable?Speaker:Roulhac D. Toledano, M.D., Ph.D.Assistant Clinical Professor of Anesthesiology | SUNY-Downstate Medical Center | Attending AnesthesiologistLutheran Medical Center | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Discuss the dilemma when patient wishes conflict with standard medical practice;• List conditions that predispose a parturient to disseminated intravascular coagulation (DIC);• Identify the risks and benefits of neuraxial blockade in this obstetric emergency;• Discuss risks and benefits of general anesthesia for cesarean delivery in this patient;• Devise a treatment plan for the patient with peripartum hemorrhage complicated by DIC.


Cardiac Arrest After Interscalene Block: Treatment GuidelinesSpeaker:Melinda A. Aquino, M.D.Assistant Professor of Anesthesiology and Pain ManagementAlbert Einstein College of Medicine | Bronx, NewYork

After completion of this session, the participant will be able to:• Recognize the complications of regional anesthesia for shoulder surgery;• Formulate a plan to treat cardiac toxicity due to local anesthetic.

Problem-Based Learning Discussions— PBLD-24 - Royale Room

The Diagnosis andManagement of a Malignant Hyperthermic ReactionSpeakers:Jerry Y. ChaoM.D.Assistant Professor of AnesthesiologyChildren’s Hospital at Montefiore/Montefiore Medical CenterBronx, NewYork

After completion of this session, the participant will be able to:• Identify patients at risk for malignant hyperthermia;• Recognize the signs of malignant hyperthermia;• Formulate and execute a plan for the management of a malignant hyperthermia reaction.

Disclosures:Drs. Aquino, Atchabahian, Chao, Lichtman, Malhotra and Toledano did not disclose any financial relationships.

AdamD. Lichtman, M.D. , FASEAssociate Professor of AnesthesiologyCornell University, Weill Cornell Medical CollegeNewYork, NewYork

Arthur Atchabahian, M.D.Associate Professor of Clinical AnesthesiologyNYU-Langone Medical Center-Hospital for Joint DiseasesNewYork, NewYork

SaturdaySaturday


Workshop | Saturday, December 14, 2013Mid-Day Session • 12:00 - 15:00 • Manhattan Ballroom • 8th Floor

Workshop — W-07

Difficult Airway ManagementA Hands-On Demonstration

Workshop Co-Moderators: Allan P. Reed, M.D. Irene P. Osborn, M.D.Professor of Anesthesiology Associate Professor of AnesthesiologyIcahn School of Medicine at Mount Sinai Director, NeuroanesthesiaNewYork, NewYork Icahn School of Medicine at Mount Sinai


After completion of this session, the participant will be able to:• Perform an appropriate airway evaluation;• Utilize numerous commercially available airway devices;• Apply the ASA Difficult Airway Practice Parameters in clinical scenarios.

Disclosures:Drs. Borovcanin, Capan, Cho, Deiner, Dhar, Dilos, Frass, Gooden, Marshall, Neustein, Oleszak, O’Neill, ReedRoth, Samuels, Singh, Stellaccio, Straker, Vaida, Vitkun andWatson did not disclose any financial relationships.Dr. Cohen receives honoraria from Cook Medical.Dr. Levine is on the speakers bureau and receives consultant fees fromMylan Pharmaceuticals.Dr. Osborn receives material support from Covidien, Inc.Dr. Schaefer receives royalties from Laerdal Medical Corp., and is an owner of Sim Tunes.

ZanaBorovcanin,M.D.Associate Professor of AnesthesiologyDirector, Division of GeneralAnesthesiologyDirector, AdvancedAirwayManagementEducationUniversity of Rochester School ofMedicine andDentistryRochester, NewYork

LevonC. Capan,M.D.Professor of AnesthesiaNYU-Langone Medical CenterAssociate Director, AnesthesiaBellevue Hospital CenterNewYork, NewYork

Elvira Cho,M.D.Staff AnesthesiologistInterfaithMedical CenterBrooklyn, NewYork

StacieG. Deiner,M.D.Assistant Professor of AnesthesiologyIcahn School ofMedicine atMount SinaiNewYork, NewYork

Panchali Dhar,M.D.Assistant Professor of AnesthesiologyNewYork-Presbyterian HospitalNewYork, NewYork

Barbara M.Dilos, D.O.Assistant Professor of AnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Michael Frass,M.D.Professor of MedicineMedical University of ViennaVienna, Austria

Cheryl K. Gooden,M.D.Associate Professor of Anesthesiologyand PediatricsIcahn School of Medicine atMount SinaiNewYork, NewYork

Adam I. Levine,M.D.Professor of Anesthesiology,Otolaryngology, Structural andChemical BiologyVice-Chair for EducationProgramDirector, ResidencyTrainingProgramProgramDirector, ASA EndorsedHELPS Simulation ProgramDepartment of AnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Mitchell H.Marshall,M.D.Clinical Associate Professor ofAnesthesiologyNYU-Langone Medical CenterAttending AnesthesiologistNYU-Langone Medical Center-Hospitalfor Joint DiseasesNewYork, NewYork

StevenM.Neustein,M.D.Professor of AnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Daniel K. O’Neill,M.D.Assistant Professor of AnesthesiologyNYU-Langone Medical CenterNewYork, NewYork

Slawomir P. Oleszak,M.D.Associate Professor of AnesthesiologySUNY-Health Sciences Center at StonyBrookStony Brook, NewYork

RamRoth,M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Michael Rufino,M.D.Assistant Professor of AnesthesiologyAlbert Einstein College ofMedicineBronx, NewYork

JonD. Samuels,M.D.Assistant Professor of ClinicalAnesthesiologyJoan and Sanford I.Weill MedicalCollege of Weill Cornell UniversityNewYork, NewYork

John J. Schaefer, III, M.D.Professor of Anesthesia andPerioperativeMedicineMedical University of South CarolinaLewisW. Haskell Blackman EndowedChairDirector, Clinical Effectiveness andPatient Safety Center of ExcellenceHealthCare Simulation of SouthCarolinaCharleston, South Carolina

Prithi P. Singh,M.D.Clinical Associate Professor ofAnesthesiologyIcahn School of Medicine atMount SinaiNewYork, NewYork

Ralph L. Slepian,M.D.Associate Professor of AnesthesiologyMedical Director of Inpatient OperatingRooms & Post Anesthesia Care UnitCornell University,Weill CornellMedical CollegeNewYork, NewYork

Francis S. Stellaccio,M.D.Assistant Professor of AnesthesiologySUNY-Health Sciences Center atStony BrookStony Brook, NewYork

Tracey Straker,M.D.,M.P.H.Associate Professor of AnesthesiologyAlbert Einstein College ofMedicineBronx, NewYork

Sonia J.Vaida,M.D.Professor of Anesthesiology,Obstetrics and GynecologyVice-Chair, ResearchDirector, Obstetric AnesthesiaPenn State College ofMedicinePenn StateMilton S. HersheyMedicalCenterHershey, Pennsylvania

StephenA.Vitkun,M.D.,M.B.A.,Ph.D.SUNYDistinguishedTeaching ProfessorProfessor of Anesthesiology andViceChair (Special Projects)Professor of Pharmacological SciencesProfessor of Health SciencesSUNY-Health Sciences Center at StonyBrookStony Brook, NewYork

Charles B.Watson,M.D., FCCMClinical Associate Professor ofAnesthesiologyUniversity of ConnecticutFarmington, ConnecticutChair, Department of AnesthesiaDeputy Surgeon-in-ChiefBridgeport HospitalYale-NewHaven Health SystemBridgeport, Connecticut

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Notes

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Ancillary Session | Saturday, December 14, 2013

Ancillary Session

Resident Research Contest

Program ChairCharlesW. Emala, Sr., M.S., M.D.Henrik H. Bendixen Professor of AnesthesiologyVice Chair for ResearchDepartment of AnesthesiologyColumbia University College of Physicians & SurgeonsNewYork, NewYork

ProgramVice -ChairAdmir Hadzic, M.D., Ph.D.Professor of Clinical AnesthesiaNewYork School of Regional AnesthesiaSt. Lukes-Roosevelt HospitalNewYork, NewYork

The Resident Research Contest is a unique program in continuing medical education. It provides an opportunityto introduce the international anesthesia community to some of the brightest young researchers in the specialty today.

Residents will orally summarize their work in a poster discussion format from 10:00 to 11:00 on Saturday, in the EmpireComplex. They will be available by their posters on the 6th floor Promenade from 12:30-14:30, to discuss their research,and answer questions.

Research Contest Presenter — R-01

The Development of a Quantitative Respiratory Depression Risk Assessment Algorithm for theSafe Use of Opioids in the Post-Anesthesia Care Unit

Presenter: Christopher Voscopoulos, M.D.Department of Anesthesiology | Brigham andWomen’s HospitalHarvard Medical School | Boston, Massachusetts

Co-Authors: Jordan BrayanovJenny FreemanEdward George


Kinetics of Ringer’s Lactate Solution in the Obese Patient Underwent Laparoscopic Bariatric Surgery

Presenter: Adrian Palacios Chavarria, M.D.Department of Anesthesiology and Critical Care MedicineThe American British Cowdray Medical Center I.A.P. | Mexico City, Mexico

Co-Authors: Guillermo DomínguezBernardo GutiérrezClaudia TomásJavier AnthónSofia LópezJulia Mikolajczuk



Utility of Failure in the Human Simulator on Long-Term Performance

Presenter: Andrew Goldberg, M.D.Department of Anesthesiology | Icahn School of Medicine at Mount SinaiNewYork, NewYork

Co-Authors: Eric SilvermanDaniel KatzStefan SamuelsonAdam LevineSamuel DeMaria, Jr.


Novel Chloride Channel Blockers Relax Airway Smooth Muscle: Potential New Tools to TreatBronchospasm

Presenter: Jennifer Danielsson, M.D.Department of AnesthesiologyColumbia University College of Physicians and Surgeons | NewYork, NewYork

Co-Authors: Alison RinderspacherWen FuYi ZhangDonaldW. LandryCharlesW. Emala, Sr.

Resident Research Committee:

Maria A. Bustillo, M.D. Suzanne B. Karan, M.D. Jeffrey H. Silverstein, M.D.Samuel DeMaria, Jr., M.D. Ira S. Kass, Ph.D. Jing Song, M.D.CharlesW. Emala, Sr., M.S., M.D. Ervant Nishanian, M.D., Ph.D. Stacey A.Watt, M.D.Admir Hadzic, M.D., Ph.D. Jahan Porhomayon, M.D.

Announcements and prizes will be awarded at the luncheon at 12:00 on Saturday in the Empire Room.

SaturdaySaturday


Scientific Panel | Saturday, December 14, 2013Afternoon Session • 13:00 - 15:30 • South Ballroom • 6th Floor


Non-Cardiac Surgery in the Patient with Cardiovascular Disease



Panel Moderator:John E. Ellis, M.D.Adjunct Professor of Anesthesiology and Critical Care | University of Pennsylvania Perelman School of MedicinePhiladelphia, Pennsylvania

After completion of this session, the participant will be able to:• Prescribe perioperative beta-blockers appropriately;• Discuss and implement institutional guidelines for the perioperative management of patients with implanted

cardiac rhythm devices;• Manage perioperative antiplatelet therapy (e.g., clopidogrel), especially for those patients at greatest risk for

perioperative thromboembolic events;• Decide on the role of cardiology consultation and echocardiography in management of patients with clinically

significant murmurs and/or known valvular heart disease.

Presentations:

Optimizing to Reduce Risk: Is It Just Beta-Blockers?John E. Ellis, M.D.

Implantable Cardiac Rhythm DevicesMarc E. Stone, M.D.Associate Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Balancing Thrombogenesis and Bleeding: Coronary Stents and Carotid DiseaseWandaM. Popescu, M.D.Associate Professor of Anesthesiology | Director, Thoracic Anesthesia DivisionCo-Director, Grand Rounds | Yale University School of Medicine | New Haven, Connecticut

Valvular DiseaseSteven N. Konstadt, M.D.Professor and Chair | Department of Anesthesiology | Maimonides Medical Center | Brooklyn, NewYork

Disclosures:Dr. Ellis is on the speakers bureau for Baxter International, Inc.Drs. Konstadt, Popescu and Stone did not disclose any financial relationships.

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Saturday

Scientific Panel | Saturday, December 14, 2013Afternoon Session • 13:00 - 15:30 • North Ballroom • 6th Floor


The Cutting Edge of Regional Anesthesia

Panel Moderator:Andrew D. Rosenberg, M.D.Clinical Professor of Anesthesiology and Orthopaedics | NYU-Langone Medical CenterInterimChair, Department of Anesthesiology | NYU-Langone Medical Center-Hospital for Joint DiseasesNewYork, NewYork

After completion of this session, the participant will be able to:• Discuss recent advances in regional anesthesia techniques for the upper extremity;• Discuss recent advances in regional anesthesia techniques for the lower extremity;• Discuss the perioperative management of patients having regional anesthesia and receiving anti-coagulant

therapy;• Discuss evidence from the medical literature that substantiates the use of ultrasound imaging technology

during regional block placement.

Presentations:

Lower Extremity BlocksMeg A. Rosenblatt, M.D.Professor of Anesthesiology and Orthopaedics | Director, Division of Orthopaedic AnesthesiologyIcahn School of Medicine at Mount Sinai | NewYork, NewYork

Upper Extremity BlocksBrian D. Sites, M.D.Associate Professor of Anesthesiology | Associate Professor of Orthopedic SurgeryGeisel School of Medicine at Dartmouth | Hanover, New Hampshire

Ultrasound Guided Blocks: Where's the Evidence?JosephM. Neal, M.D.Anesthesia Faculty | Virginia Mason Medical Center | Clinical Professor of AnesthesiologyUniversity ofWashington | Seattle, Washington

Anticoagulants and Regional Anesthesia: Where AreWe Now?Terese T. Horlocker, M.D.Professor of Anesthesiology and Orthopedics | Mayo Clinic in Rochester | Rochester, Minnesota

Disclosures:Drs. Horlocker, Neal, Rosenberg, Rosenblatt and Sites did not disclose any financial relationships.


Scientific Panel | Saturday, December 14, 2013Afternoon Session • 13:00 - 15:30 • Astor Ballroom • 7th Floor


The ICU Patient Comes to the OR: Critical Care Medicine for theNon-Intensivist



Panel Moderator:Douglas R. Coursin, M.D.Professor of Anesthesiology and Internal Medicine | University ofWisconsin School of Medicine and Public HealthMadison,Wisconsin

After completion of this session, the participant will be able to:• Summarize and apply recent advances in the management of ventilation and oxygenation of the critically ill

patient;• Describe optimal fluid management in the patient at risk for acute kidney injury or with acute renal failure;• Summarize recent information relating to the pathophysiology and treatment of sepsis and apply it to

practice;• Discuss the incidence of cognitive impairments and the assessment of cognitive outcomes in critically ill

patients and their impact on acute and long-term survival.

Presentations:

Ventilating and Oxygenating the Critically Ill PatientDouglas R. Coursin, M.D.

Update on the SCCM Surviving Sepsis Campaignvivek K. Moitra, M.D.Assistant Professor of Clinical Anesthesiology | Associate Program Director, Critical Care MedicineColumbia University, College of Physicians & Surgeons | NewYork, NewYork

Fluid Management and Preventing Acute Renal Failure: Are They the Same?Michael Nurok, M.B., Ch.B., Ph.D.Clinical Associate Professor of Anesthesiology | Director, Critical Care | Hospital for Special SurgeryNewYork, NewYork

Long-Term Cognitive Dysfunction After Critical IllnessMichael F. O’Connor, M.D.Professor of Anesthesia & Critical Care | Section Head, Critical Care Medicine | University of ChicagoChicago, Illinois

Disclosures:Dr. Coursin receives consultant fees from Diabetes Technology, Inc., and Roche Diagnostics.Drs. Moitra, Nurok and O’Connor did not disclose any financial relationships.

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Saturday


Focus Sessions | Saturday, December 14, 2013 | FS-09 & FS-10Afternoon Session • 15:45 - 17:00 • 4th Floor Rooms


Operating Room Efficiency: Optimizing Resource UtilizationWithout Compromising Patient SafetyFocus SessionModerator:VinodMalhotra, M.D.Professor of Clinical Anesthesiology | Professor of Anesthesiology in Clinical Urology |Weill Cornell Medical CollegeVice-Chair, Clinical Affairs | Department of Anesthesiology | Clinical Director, Operating RoomsNewYork-Presbyterian Hospital | NewYork, NewYork

Faculty Presentations:Patient SafetyVinodMalhotra, M.D.

Resource UtilizationMichael P. Smith, M.D., M.S.Past President, American Association of Clinical Directors | Partner, Professional Anesthesia Service, Inc.Summa Health System | Akron, Ohio

After completion of this session, the participant will be able to:• Discuss different approaches to increase OR-efficiency;• Discuss the risks to patient safety and how to avoid this complication;• Develop plans for their practice to increase operating room efficiency without compromising safety.


Anesthesia and the Developing Brain: An Update on Current Thinkingand PracticeFocus SessionModerator:Jerrold Lerman, M.D., FRCPC, FANZCAClinical Professor of Anesthesiology | Children’s Hospital of Buffalo | Buffalo, NewYork | Clinical Professor ofAnesthesiology | University of Rochester School of Medicine & Dentistry | Rochester, NewYork

Faculty Presentations:Animal DataJerrold Lerman, M.D., FRCPC, FANZCA

Implications for Pediatric AnesthesiaNancy L. Glass, M.D., M.B.A., FAAPProfessor of Anesthesiology and Pediatrics | Baylor College of Medicine | Director, Chronic Pain ServiceTexas Children’s Hospital | Houston, Texas

After completion of this session, the participant will be able to:• Discuss the animal data demonstrating negative effects of anesthetics on the developing brain;• Discuss the current knowledge regarding the possible negative effect of anesthetics on the developing brain

in humans;• Discuss the areas of research to elucidate the effect of anesthetics on the developing brain;• Discuss the ethical issues of not providing anesthetic care to infants;• Advise parents about their child’s impending surgery and anesthetic when asked about the effects of

anesthesia on their child.

Disclosures:Drs. Glass and Malhotra did not disclose any financial relationships.Dr. Lerman receives consultant fees from Piramal, Inc., honoraria fromAbbott Laboratories and is a shareholder inManagement LLC.Dr. Smith may be eligible for a partial grant from Ofirmev®, and receives royalties from Cleveland Clinic.

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Insight into Legal Process Using Case-Based Mock-Trials:Tips and Strategies for AnesthesiologistsFocus SessionModerator:James E. Szalados, M.D., M.B.A., Esq.Professor of Anesthesiology and Medicine | University of Rochester School of MedicineDirector, Surgical and Neuro - Critical Care | Rochester General Hospital | Attending AnesthesiologistCritical Care and Medicine | Unity Hospital | Counselor and Attorney at Law | The Szalados Law FirmRochester, NewYork | Of Counsel, Kern, Augustine, Conroy, and Schoppmann, PC.

Faculty Presentations:For the PlaintiffJames E. Szalados, M.D., M.B.A., Esq.

For the DefenseMichael J. Schoppmann, Esq.General Counsel, NYSSA | Kern Augustine Conroy & Schoppmann, P.C. | Westbury, NewYork

After completion of this session, the participant will be able to:• Discuss the administrative and legal requirements of informed consent;• Discuss the importance of documentation;• Discuss the importance of guidelines and protocols;• Develop defensive strategies to decrease the likelihood of being successfully sued for malpractice.

Focus Sessions— FS-12 • O’Neill Room • 4th Floor

Update in Cerebral Function MonitoringFocus SessionModerator:GregoryW. Fischer, M.D.Professor of Anesthesiology and Cardiothoracic Surgery | Icahn School of Medicine at Mount SinaiNewYork, NewYork

Faculty Presentations:Cerebral OximetryGregoryW. Fischer, M.D.

Integrated EEGMarc J. Bloom, M.D., Ph.D.Clinical Associate Professor of Anesthesiology | Director of Neuroanesthesia ProgramNYU-Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Compare/contrast various cerebral function monitors currently available for use;• Discuss the indications for use of the various cerebral function monitors available;• Develop a strategy of care for a patient who develops unacceptable changes in cerebral function under

anesthesia.

Disclosures:Drs. Bloom, Fischer, Szalados and Mr. Schoppmann did not disclose any financial relationships.

Saturday




Challenges in Regional AnesthesiaFocus SessionModerator:

Meg A. Rosenblatt, M.D.Professor of Anesthesiology and Orthopaedics | Director, Division of Orthopaedic AnesthesiologyIcahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:Regional Anesthesia in the Patient on AnticoagulationMichael R. Anderson, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Use of Antifibrinolytics in Orthopedic AnesthesiaYan Lai, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the use of regional anesthesia in patients on anticoagulation or requiring anticoagulation;• Develop a plan for use of regional anesthesia in patients on anticoagulation or requiring anticoagulation;• Discuss the issues surrounding use of antifibrinolytics in orthopedics;• Develop strategies for use of antifibrinolytics in orthopedic anesthesia.

Focus Sessions— FS-14 • Empire Complex • 7th Floor

The AnesthesiaWork Station and Safety Issues: Are Our Patients Safer?Focus SessionModerator:James B. Eisenkraft, M.D.Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:Machine SafetyJames B. Eisenkraft, M.D.

Intelligent MonitorsKeith J. Ruskin, M.D.Professor of Anesthesiology and Neurosurgery | Yale University, School of Medicine | New Haven, Connecticut

After completion of this session, the participant will be able to:• Discuss advantages and disadvantages of the new anesthesia machines;• Discuss the new development in monitoring;• Discuss equipment safety issues in anesthesia practice;• Develop a plan to safely integrate the new anesthesia machines and intelligent monitors into their practice;• Know the limitations of modern anesthesia machines and intelligent monitors, and apply this knowledge to

their practice.

Disclosures:Drs. Anderson, Eisenkraft, Lai and Rosenblatt did not disclose any financial relationships.Dr. Ruskin receives consultant fees from Masimo Corporation.

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Focus Sessions | Saturday, December 14, 2013Afternoon Session • 15:45 - 17:00 • 8th Floor Room

Focus Sessions— FS-15 • Manhattan Ballroom • 8th Floor

Pediatric Pain Management: What Is Best Practice?Focus SessionModerator:Santhanam Suresh, M.D., FAAPAnesthesiologist-in-ChiefDepartment of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicago, Illinois

Faculty Presentations:Regional MethodsSanthanam Suresh, M.D., FAAP

Pharmacological ApproachBettina Smallman, M.D.Associate Professor of AnesthesiologyDirector of Pediatric AnesthesiaSUNY-Upstate Medical UniversitySyracuse, NewYork

After completion of this session, the participant will be able to:• Discuss current methods of pain management in pediatric patients including both pharmacologic and regional methods;• Describe the medications used for pain relief in children in terms of pharmacokinetics, pharmacodynamics and adverse

side effects;• Discuss the risks and benefits of various types of regional anesthesia for pediatric patients;• Formulate an anesthetic plan for pain management in pediatric patients undergoing various types of surgical procedures.

Disclosures:Drs. Smallman and Suresh did not disclose any financial relationships.

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Problem-Based Learning Discussions | Saturday, December 14, 2013 |PBLD-25 through PBLD-32| Afternoon Sessions • 15:45 - 17:00 • 6th Floor Rooms

Problem-Based Learning Discussions— PBLD-25 - Majestic Room

Incorporating Simulation into Your Residency ProgramSpeaker:David G. Stein, M.D.Assistant Professor of Clinical Anesthesiology | Director, Simulation Education | Cornell University,Weill Cornell Medical CollegeNewYork, NewYork

After completion of this session, the participant will be able to:• Identify various types of “simulators”available to an anesthesiology residency program;• Recognize effective educational techniques;• Incorporate various simulation modalities into the educational program.

Problem-Based Learning Discussions— PBLD-26 - Music Box Room

Obstructive Sleep Apnea and Ambulatory SurgerySpeaker:Danielle B. Ludwin, M.D.Assistant Professor of Anesthesiology | Columbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the pathophysiology of Obstructive Sleep Apnea (OSA) in adults;• Make a presumptive diagnosis of OSA in undiagnosed patients;• Assess the eligibility of OSA patients for ambulatory surgery;• Evaluate the effects of anesthetics on patients with OSA;• Formulate postoperative pain control in OSA patients in an outpatient setting;• Establish the outpatient PACU monitoring and discharge criteria for OSA patients.

Problem-Based Learning Discussions— PBLD-27 -Winter Garden Room

The Pediatric Difficult Airway: No Larynx in View NowWhat Do I Do?Speakers:Gordana Stjepanovic, M.D.Clinical Assistant Professor of AnesthesiologyNYU-Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify criteria for difficult intubation in the pediatric age group;• Describe technologies available for difficult intubation in the pediatric age group;• Formulate management strategies for difficult intubation in the pediatric age group.

Problem-Based Learning Discussions— PBLD-28 - Palace Room

Pitfalls of Pulmonary HypertensionSpeaker:James A. Osorio, M.D.Assistant Professor of Anesthesiology | Cornell University, Weill Cornell Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify the etiologies and pathophysiology of pulmonary hypertension;• Identify factors that alter pulmonary vascular resistance;• Diagnose and manage perioperative complications in patients with pulmonary hypertension.

Disclosures:Drs. Ludwin, Osorio, Sharma, Stein and Stjepanovic did not disclose any financial relationships.

Aarti Sharma, M.D.Associate Professor of Clinical AnesthesiologyAssociate Director, Pediatric AnesthesiaNewYork-Presbyterian Hospital | NewYork, NewYork

SaturdaySaturday


Problem-Based Learning Discussions | Saturday, December 14, 2013Afternoon Sessions • 15:45 - 17:00 • 6th Floor Rooms

Problem-Based Learning Discussions— PBLD-29 - Shubert Room

Massive Transfusion ProtocolSpeaker:Peter M. Fleischut, M.D.Assistant Professor of Anesthesiology | Deputy Quality and Patient Safety OfficerCornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify new modalities of hemostasis;• Establish an appropriate anesthetic plan to manage the patient undergoing massive hemorrhage;• Develop a multidisciplinary massive transfusion protocol.


Eight Year Old Sickle Cell Patient for Emergency AppendectomySpeaker:Galina Leyvi, M.D.Associate Professor of Anesthesiology | Albert Einstein College of Medicine/Montefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Review anesthetic considerations of sickle cell disease;• Formulate a plan to provide anesthetic care to a child with sickle cell disease;• Develop a plan for postoperative pain management.

Problem-Based Learning Discussions— PBLD-31 - Plymouth Room

Anesthetic Management for EVARSpeaker:Jennifer Sandadi, M.D.Assistant Professor of Anesthesiology | Division of Cardiothoracic Intensive Care | NewYork-Presbyterian HospitalCornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Recognize the medical co-morbidities in the EVAR patient;• Develop a plan to manage the patient undergoing EVAR.


Anaphylaxis in the Operating RoomSpeaker:venkata Sampathi, M.D.Clinical Instructor in Anesthesiology | SUNY-Upstate Medical University | Syracuse, NewYork

After completion of this session, the participant will be able to:• Identify the differential diagnosis of post induction, preincision cardiovascular collapse;• Recognize the signs and symptoms of anaphylaxis under general anesthesia;• Develop a treatment plan for anaphylaxis.

Disclosures:Drs. Fleischut, Leyvi, Sampathi and Sandadi did not disclose any financial relationships.

Saturday


Ancillary Session | Saturday, December 14, 2013Evening Session • 17:30 - 18:30 • O’Neill Room • 4th Floor

Ancillary Session

American Board of Anesthesiology

The American Board of Anesthesiology® (ABA) will conduct two separate sessions to provide information andanswer questions about primary certification in anesthesiology and the Maintenance of Certification inAnesthesiology® Program (MOCA). The ABA® developed MOCA® so diplomates with a time-limitedanesthesiology certificate could maintain uninterrupted certification status.

Two information sessions will be held, in which presenters will review and discuss the following:

This Program is conducted by the American Board of Anesthesiology® and is independent of PGA67. You are not required toregister for the PGA if you only plan on attending this session.

Additionally, the ABA® will be exhibiting at the 67th Post Graduate Assembly. Please stop by the ABA® Booth to get details aboutprimary and subspecialty certification, aswell asMaintenance of Certification. ABA® staff can guide you through theABA®website andyour online personal portal account.

17:30 – 18:00Assessment Programs for

Primary Certification in Anesthesiology

• Comparison of the Part , and Part 2 Examinations• The traditional Part 2 Examination process,

including specific areas evaluated in theexamination, common problems encountered bycandidates, and discussion of the successfulcandidate

• ABA transition to the new Staged Examinationsassessment program, including overview of theBASIC, ADVANCED and APPLIED Examinations

18:00 – 18:30Maintenance of Certification inAnesthesiology Program (MOCA®)

• Part 1: Assessments of Professional Standing(Medical Licensure)

• Part 2: Lifelong Learning and Self-Assessment(CME activities)

• Part 3: Cognitive Examination and Prerequisites• Part 4: Practice Performance Assessment and

Improvement• Diplomates’ online portal accounts• MOCA-SUBS for maintenance of subspecialty

certification

Daniel J. Cole, M.D.Professor of AnesthesiologyVice Dean for Continuous Professional DevelopmentCollege of Medicine, Mayo ClinicMayo Clinic ArizonaPhoenix, Arizona

Cynthia A. Lien, M.D.Professor of AnesthesiologyVice Chair for Academic AffairsDirector, Residency ProgramCornell University, Weill Cornell Medical CollegeAttending AnesthesiologistNew York Presbyterian HospitalNew York, New York

FACULTY PRESENTATIONS:

SaturdaySaturday

Notes


Sun

day


Exhibit Raffle!

Visit the Exhibit Ha

ll on the

5th floorfor a chan

ce to win

great prizes!

Sunday, December 15, 2013Times

Registration ....................................................................................................................................... 07:00MiniWorkshops................................................................................................................ 07:45 & 11:45Hands-OnWorkshops .................................................................................................... 08:00 & 12:00Technical Exhibits ............................................................................................................................ 09:00Scientific Panels....................................................................................................08:30, 09:00 & 13:00Scientific Exhibits............................................................................................................................. 10:00Poster Presentations &Medically Challenging Case Reports .............................. 11:00 & 14:00Problem-Based Learning Discussions ...................................................................... 11:45 & 15:45Focus Sessions ...................................................................................................................15:00 & 15:45

Additional Activities:NYSSA House of Delegates .......................................................................................................... 09:30


67th Annual




Sunday



Sun

day

MiniWorkshops | Sunday, December 15, 2013 | M-17 through M-20Morning Sessions • 07:45 - 08:45 • 4th Floor Rooms


Problems in the PACUSpeaker:Elizabeth A. M. Frost, M.D.Clinical Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork


• Delineate state and national guidelines for PACU care;• Enumerate the more common complications in the PACU;• Devise approaches to minimize postoperative problems.


Anesthetic Challenges in the Morbidly ObeseSpeaker:Jon D. Samuels, M.D.Assistant Professor of Anesthesiology | Joan and Sanford I.Weill Medical College ofWeill Cornell University | NewYork, NewYork


• Delineate the approach to airway assessment and management;• Identify the intraoperative complications which may arise;• Enumerate at least three postoperative complications which may occur.


Thoracic Anesthesia UpdateSpeaker:Edmond Cohen, M.D.Professor of Anesthesiology | Director, Thoracic Anesthesia | Icahn School of Medicine at Mount Sinai | NewYork, NewYork


• Enumerate the indications for lung separation and thorascopy;• Determine which lung separation device is appropriate for the planned surgery;• Evaluate and treat intraoperative complications during thoracic surgery.

MiniWorkshop—M-20 - O’Neill Room

Obstetric EmergenciesSpeaker:Brett I. Danzer, M.D.Director, Obstetric Anesthesia | Long Island Jewish Medical Center | New Hyde Park, NewYork


• Identify the pathophysiologic changes and obstetric management of a parturient with HELLP syndrome;• Compare and contrast the anesthetic management and monitoring techniques used in dealing with a patient with

pregnancy induced hypertension.

Disclosures:Drs. Danzer, Frost and Samuels did not disclose any financial relationships.Dr. Cohen receives honoraria from Cook Medical.


Workshop | Sunday, December 15, 2013Morning Session • 08:00 - 11:00 • Soho Complex • 7th Floor

Workshop—W-08

Ultrasound for Vascular Access: AWorkshop

Workshop Co-Moderators:Nikolaos J. Skubas, M.D., FASE Anup Pamnani, M.D.Associate Professor of Anesthesiology Assistant Professor of AnesthesiologyDirector, Cardiac Anesthesia Cornell University, Weill Cornell Medical CollegeCornell University, Weill Cornell Medical College Attending AnesthesiologistNewYork, NewYork NewYork-Presbyterian Hospital


After completion of this session, the participant will be able to:• Demonstrate basic skills in ultrasound technology;• Utilize ultrasound technology for central venous and arterial access;• Optimize billing for ultrasound use in vascular access.

Disclosures:Drs. Fitzgerald, Kumar, Pamnani and Skubas did not disclose any financial relationships.Dr. Mittnacht receives honoraria from Abiomed.

Note: ThisWorkshop will be repeated on Tuesday asW-16.

Sunday

How to Optimize ImagingMeghannM. Fitzgerald, M.D.Assistant Professor of AnesthesiologyCornell University, Weill Cornell Medical CollegeNewYork, NewYork

Central Venous CannulationAnup Pamnani, M.D.

Arterial CannulationAlexander J. C. Mittnacht, M.D.Associate Professor of AnesthesiologyDirector, Pediatric Cardiac AnesthesiaIcahn School of Medicine at Mount SinaiNewYork, NewYork

Logistics and BillingNikolaos J. Skubas, M.D., FASE

Break-Out SessionsShreyajit R. Kumar, M.D.Assistant Professor of AnesthesiologyCornell University, Weill Cornell Medical CollegeNewYork, NewYork


Workshop | Sunday, December 15, 2013Morning Session • 08:00 am - 15:00 • Empire Complex • 7th Floor

Workshop—W-09

Intensive Interactive Echocardiography Review with the ExpertsA Hands-on Demonstration

WorkshopModerators:Steven N. Konstadt, M.D., M.B.A., FACC Alexander J. C. Mittnacht, M.D.Professor and Chair Associate Professor of AnesthesiologyDepartment of Anesthesiology Director, Pediatric Cardiac AnesthesiaMaimonides Medical Center Icahn School of Medicine at Mount SinaiBrooklyn, NewYork NewYork, NewYorkAssisted by:

Patricia M. Applegate, M.D.Associate Professor of Medicine and CardiologyLoma Linda University School of MedicineLoma Linda, California

Richard L. Applegate, II, M.D.Professor and Vice-ChairDepartment of AnesthesiologyMedical Director, Operating RoomLoma Linda University School of MedicineLoma Linda, California

Lynn A. Belliveau, M.D., M.P.H.Attending AnesthesiologistMaimonides Medical CenterBrooklyn, NewYork

Himani Bhatt, D.O., M.P.A.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Insung Chung, M.D.Assistant Professor of AnesthesiologyDivision of Cardiothoracic Anesthesia and CriticalCareIcahn School of Medicine at Mount SinaiNewYork, NewYork

Adam S. Evans, M.D., M.B.A.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Zak Hillel, M.D., Ph.D.Professor of Clinical AnesthesiologyColumbia University, College of Physicians &SurgeonsDirector, Cardiothoracic AnesthesiaSt. Luke’s-Roosevelt Hospital CenterNewYork, NewYork

Chirojit Mukherjee, M.D.Director, Cardiothoracic and Vascular FellowshipProgramDepartment of Anesthesia and Intensive Medicine IIHeart Center LeipzigUniversity of LeipzigLeipzig, Germany

WandaM. Popescu, M.D.Associate Professor of AnesthesiologyDirector, Thoracic Anesthesia DivisionCo-Director, Grand RoundsYale University School of MedicineNew Haven, Connecticut

Scott T. Reeves,M.D., M.B.A., FACC, FASEPresident- Elect, Society of CardiovascularAnesthesiologistsThe John E. Mahaffey, MD Professor & ChairDepartment of Anesthesia & PerioperativeMedicineMedical University of South CarolinaCharleston, South Carolina

Linda J. Shore-Lesserson, M.D., FASEProfessor of AnesthesiologyHofstra Northshore-Long Island Jewish School ofMedicineDirector, Cardiovascular AnesthesiologyNorthshore-Long Island Jewish Medical CenterNew Hyde Park, NewYork

Nikolaos J. Skubas, M.D., FASEAssociate Professor of AnesthesiologyDirector, Cardiac AnesthesiaCornell University,Weill Cornell Medical CollegeNewYork, NewYork

Christopher A. Troianos, M.D.Professor and ChairDepartment of AnesthesiologyTheWestern Pennsylvania HospitalPittsburgh, Pennsylvania

Giuseppev. Trunfio, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYorkDirector, Cardiac AnesthesiologyMaimonides Medical CenterBrooklyn, NewYork

MenachemWeiner, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Workshop Description:

As a participant you can expect the following:• Hands-on TEE computer simulation (recognize anatomy and pathology from standard TEE views with experts guidance);• Hands-on TEE simulator (Practice TEE with a state of the art TEE simulator);• Practice Transthoracic Echocardiography (TTE) with life human models (standard TTE views, emergency TTE examination)• Interesting case presentations about LV function, and valvular pathology;• Presentation on 3D TEE (basic principle and examples for use in daily practice) ;• Update on the most recently published guidelines and recommendation for basic and advanced perioperative TEE.What is new.


• Identify standard transesophageal echocardiographic (TEE) views of the heart (Computer and TEE simulator hands-on training);• Perform a quick focused transthoracic echocardiography exam for hemodynamically compromised patients (Life human models);• Obtain standard transthoracic echocardiography views (Life human models);• Understand the most current and newly released guidelines on performing a basic and comprehensive TEE exam (Expert lecture);• Recognize common valvular pathology (case presentation);• Determine ventricular function (case presentation);• Understand 3D TEE technology and possible indications in the peri-operative setting (Expert lecture).

Disclosures:Drs. P. Applegate, R. Applegate, Belliveau, Bhatt, Chung, Evans, Hillel, Mukerjee, Popescu, Reeves, Shore-Lesserson, Skubas,Troianos, Trunfio andWeiner did not disclose any financial relationships.Dr. Mittnacht receives honoraria from Abiomed.

Note: This is a full day workshop. A lunch voucher will be provided.

Sunday


Scientific Panel | Sunday, December 15, 2013Morning Session • 08:30 - 11:00 • Majestic/Music Box/Winter Garden Rooms • 6th Floor


Challenges in Acute Pain Therapy

Panel Moderator:Mark J. Lema, M.D., Ph.D.Professor and Chair | Department of Anesthesiology | SUNY-Buffalo School of Medicine and Biomedical SciencesChair, Department of Anesthesiology | Roswell Park Cancer Institute | Buffalo, NewYork

After completion of this session, the participant will be able to:• Effectively manage analgesia for adult patients in the postoperative period;• Explain themechanisms of and prevention strategies for chronic pain that develops after surgery or acute trauma;• Discuss effective perioperative pain management techniques for the opioid-dependent patient;• Effectively manage analgesia for the pediatric patient in the perioperative period.

Presentations:

Novel Approaches to Acute Pain in ChildrenRosalie F. Tassone, M.D., M.P.H.Associate Professor of Clinical Anesthesiology |University of Illinois at Chicago |Chicago, Illinois

Preventing Chronic Pain After Surgical ProceduresMark J. Lema, M.D., Ph.D.

Managing the Opioid-Dependent PatientJames Hitt, M.D., Ph.D.Clinical Professor of Anesthesiology | SUNY-Buffalo School of Medicine and Biomedical SciencesBuffalo, NewYork

Novel Approaches to Acute Pain in the Immediate Postoperative Period: AdultsEugene R. viscusi, M.D.Professor of Anesthesiology |Director, Acute Pain Management | Jefferson Medical CollegeThomas Jefferson University | Philadelphia, Pennsylvania

Disclosures:Drs. Hitt, Lema and Tassone did not disclose any financial relationships.Dr. Viscusi receives funded research support from AcelRx Pharmaceuticals, Inc., Adolor Corporation, Cadence Pharmaceuticals, Inc.,Cumberland Pharmaceuticals, Inc. and Pacira Pharmaceuticals, Inc. He receives consultant fees from AcelRxPharmaceuticals, Inc., Cadence Pharmaceuticals, Inc., Cubist Pharmaceuticals, Incline Therapeutics, Pacira Pharmaceuticals, Inc.,Salix Pharmaceuticals, and is on the Cadence Pharmaceuticals, Inc. speakers bureau.

Sunday


Scientific Panel | Sunday, December 15, 2013Morning Session • 08:30 - 11:00 • North Ballroom • 6th Floor


Malpractice or Miscommunication? Lessons Learned in Medical Liability

Panel Moderator:James E. Szalados, M.D., M.B.A., Esq.Professor of Anesthesiology and Medicine | University of Rochester School of MedicineDirector, Surgical and Neuro - Critical Care | Rochester General Hospital | Attending AnesthesiologistCritical Care and Medicine | Unity Hospital | Counselor and Attorney at Law | The Szalados Law FirmRochester, NewYork | Of Counsel, Kern, Augustine, Conroy, and Schoppmann, PC.

After completion of this session, the participant will be able to:• Discuss the reasons that patients file lawsuits,• Explain the stages and procedures of a lawsuit, and how to comport oneself after being named as a defendant;• Discuss the strategies that a plaintiff’s attorney will use to make a case;• Discuss clinical guidelines and their application as a means to reduce medical liability risk associated with

regional anesthesia.

Presentations:

Informed Consent LiabilityJudith Jurin Semo, J.D.Judith Jurin Semo, PLLC | Washington, DC

Minimizing Risks Associated with Regional AnesthesiaTerese T. Horlocker, M.D.Professor of Anesthesiology and Orthopedics | Mayo Clinic in Rochester | Rochester, Minnesota

When Bad Things Happen to Good Physicians: What to DoWhen SuedJames E. Szalados, M.D., M.B.A., Esq.

The Perspective of a Plaintiff's AttorneyStephen H. Mackauf, Esq.Partner and Head of Medical Malpractice DepartmentGair, Gair, Conason, Steigman, Mackauf, Bloom & Rubinowitz | NewYork, NewYork

Disclosures:Drs. Horlocker and Szalados, Mr. Mackauf and Ms. Jurin Semo did not disclose any financial relationships.

Sun

day


Sunday

Scientific Panel | Sunday, December 15, 2013Morning Session • 08:30 - 11:00 • South Ballroom • 6th Floor


Cardiac Anesthesia Update

Panel Moderator:Nancy A. Nussmeier, M.D., FAHAProfessor of Anesthesiology | Conflict of Interest Officer | SUNY Upstate Medical University | Syracuse, NewYork

After completion of this session, the participant will be able to:• Discuss the pathophysiology of heart failure and drugs useful for treating this condition in the perioperative

setting;• Discuss devices useful to treat heart failure in the cardiac surgical patient and their implications for anesthesia

practice and critical care medicine;• Discuss transcutaneous endovascular heart valve implantation techniques and the anesthetic management

and postoperative care of patients undergoing these procedures;• List methods to improve communication and enhance a culture of safety and teamwork in the cardiac

operating room setting.

Presentations:

Heart Failure: Drug TherapyGregoryW. Fischer, M.D.Professor of Anesthesiology and Cardiothoracic Surgery | Icahn School of Medicine at Mount SinaiNewYork, NewYork

Anesthetic Management for Transcatheter Heart Valve ImplantationSteven N. Konstadt, M.D.Professor and Chair | Department of Anesthesiology | Maimonides Medical Center | Brooklyn, NewYork

Heart Failure: DevicesMarc E. Stone, M.D.Associate Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Culture, Communication and Teamwork in the Cardiac Operating RoomNancy A. Nussmeier, M.D., FAHA

Disclosures:Drs. Fischer, Konstadt, Nussmeier and Stone did not disclose any financial relationships.


Scientific Panel | Sunday, December 15, 2013Morning Session • 08:30 - 11:00 • Astor Ballroom • 7th Floor


Teaching the Art and Science of Anesthesiology

Panel Moderator:Denham S.Ward, M.D., Ph.D.President and CEO, Foundation for Anesthesia Education and Research | Professor Emeritus of Anesthesiologyand Biomedical Engineering | University of Rochester Medical Center | Rochester, NewYorkAdjunct Professor of Anesthesiology | Tufts School of Medicine | Boston, Massachusetts

After completion of this session, the participant will be able to:• Explain the concept of expertise and the process for learning and teaching it;• Discuss ways to assess and evaluate expertise in anesthesiology resident and fellow trainees;• Explain the concept of “milestones”as defined by the ACGME and discuss how this concept relates to the

development of expertise in anesthesiology trainees;• Discuss the current Maintenance of Certification in Anesthesiology® (MOCA) process as defined by the

American Board of Anesthesiology and how expertise in the field is acquired through and evaluated by theMOCA® process.

Presentations:

Expertise: What Is It and How Do I Get It?Denham S.Ward, M.D., Ph.D.

Assessing for ExpertiseStephenM. Breneman, M.D., Ph.D.Associate Professor of Anesthesiology | Director, Perioperative Pain Service | Director, Center forSimulation in Anesthesia | Anesthesia Clinical Leader for eRecord | Department of AnesthesiologyUniversity of Rochester Medical Center School of Medicine and Dentistry | Rochester, NewYork

Expertise and the ACGME MilestonesJames R. Zaidan, M.D., M.B.A.Professor of Anesthesiology | Associate Dean for Graduate Medical Education | Department ofAnesthesiology | Emory University School of Medicine | Atlanta, Georgia

MOCA® and How to Not Become an "Experienced Non-Expert"Arnold J. Berry, M.D., M.P.H.Professor of Anesthesiology | Emory University School of Medicine | Atlanta, GeorgiaVice President for Scientific Affairs | American Society of Anesthesiologists | Park Ridge, Illinois

Disclosures:Drs. Berry, Breneman,Ward and Zaidan did not disclose any financial relationships.

Sunday


Scientific Panel | Sunday, December 15, 2013Morning Session • 08:30 - 11:00 • Columbia/Duffy Rooms • 6th Floor


Bleeding Management in Cardiovascular Surgery:An International Perspective

Panel Co-Moderators:Hugh C. Hemmings, Jr., M.D., Ph.D.Professor and Chair | Department of AnesthesiologyCornell University, Weill Cornell Medical CollegeAnesthesiologist-in-ChiefNewYork-PresbyterianWeill Cornell Medical CenterNewYork, NewYork

After completion of this session, the participant will be able to:• Discuss new knowledge useful to understanding the pathophysiology of perioperative coagulation disorders

in adult and pediatric patients undergoing cardiovascular surgery;• Appraise diagnostic modalities useful for guiding therapy of perioperative bleeding in adult and pediatric

patients;• Explain the appropriate clinical uses of fresh frozen plasma, cryoprecipitate and alternative therapies to treat

perioperative coagulopathy, including the volumes required for effective therapy;• Evaluate the evidence that supports current guidelines for management of perioperative bleeding and discuss

how these guidelines can improve patient outcomes.

Presentations:

Evidence for Hemostatic Therapy with Coagulation Factor ConcentratesKai Zacharowski, M.D., Ph.D., FRCADirector, Department of Anesthesiology, Intensive Care and Pain Therapy | Frankfurt University HospitalFrankfurt, Germany

Bleeding Management in Pediatric Cardiovascular Surgeryvaleria Perez de Sa, M.D., Ph.D., DEAAAssistant Professor of Anesthesiology | Department of Pediatric Anesthesia and Intensive CareChildren's Heart Center | Skane University Hospital | Lund, Sweden

Hemostatic Therapy in Cardiovascular Surgery: Perspective from the EuropeanGuidelinesSibylle Kozek-Langenecker, M.D.Professor and Chair | Department of Anesthesiology | General Intensive Care and Pain ManagementVienna Medical University | Vienna, Austria

The Roles of FFP and Cryoprecipitate as Hemostatic AgentsMarco Ranucci, M.D., FESCIRCCS Policlinico San Donato | Department of Anesthesiology | Milan, Italy

Disclosures:Dr. Hemmings did not disclose any financial relationships.Dr. Kozek-Langnecker has received honoraria for travel reimbursement and consulting fees from Baxter International Inc.,B. Braun Medical Inc., Biotest, CSL Behring, Fresenius Kabi AG, Mitsubishi Pharma, Novo Nordisk A/S, Pfizer Inc, Octapharma AG,TEM International and Verum Diagnostics.Dr. Perez de Sa receives consultant fees and honoraria from Covidien.Dr. Ranucci receives funded research support from CSL Behring, consultant fees from Grifols SA and Sorin Group and honorariafrom CSL Behring, Roche, Medtronic and Grifols.Dr. Zacharowski is on CSL Behring's speakers bureau.See Program Journal Supplement for Dr. Spahn’s disclosure.

Sunday

Donat Spahn, M.D., FRCAProfessor and Chair | Institute of AnesthesiologyUniversity Hospital ZurichZuric, Switzerland


Sun

day

Problem-Based Learning Discussions | Sunday, December 15, 2013PBLD-33 through PBLD-40 | Mid-Day Sessions • 12:00 - 13:00 • 6th Floor Rooms


Unusual Complications of Difficult Intubation in the Morbidly Obese:Recognition and ManagementSpeakers:Louis Brusco, Jr., M.D., FCCMVice-Chair, Department of Anesthesiology | Associate Medical DirectorSt. Luke's-Roosevelt Hospital Center | Co-Director, Surgical Intensive Care UnitDirector, Critical Care Anesthesiology | Medical Director, Post-Anesthesia Care UnitNewYork, NewYork


• Evaluate complications from a difficult intubation;• Identify and distinguish between pre-existing anatomical abnormalities and aberrations caused by therapeutic procedures;• Manage the patient with difficult intubation at each point in the process and be able to plan a new course of action.


The Current Recommendations for Perioperative Beta BlockadeSpeaker:Stewart J. Lustik, M.D., M.B.A.Professor of Anesthesiology | Vice-Chair, Clinical Affairs | Director, Anesthesia Technical ServicesUniversity of Rochester School of Medicine and Dentistry | Rochester, NewYork


• Identify the pro and con data regarding perioperative beta-blockade and perioperative outcomes;• Understand the physiology behind the beneficial and adverse effects of perioperative beta-blockade use;• Formulate an appropriate policy for use of perioperative beta-blockers.


Jet VentilationSpeaker:Tracey Straker, M.D., M.P.H.Associate Professor of Anesthesiology | Albert Einstein College of Medicine | Bronx, NewYork

After completion of this session, the participant will be able to:• Assess the airway of a patient with an airway mass;• Identify anesthetic concerns of laser surgery;• Describe the indications for and complications of jet ventilation;• Formulate an anesthetic plan for utilizing jet ventilation.


Maternal HemorrhageSpeakers:Shamantha G. Reddy, M.D.Assistant Professor of AnesthesiologyAlbert Einstein College ofMedicineBronx, NewYork

After completion of this session, the participant will be able to:• Recognize the implications of the different types of placental abnormalities on post partum hemorrhage;• Identify alternative methods for treating maternal hemorrhage (i.e. embolization);• Establish a plan for multidisciplinary communication and teamwork in the event of maternal hemorrhage.

Disclosures: Drs. Adsumelli, Brusco, Lustik, Reddy, Stellaccio and Straker did not disclose any financial relationships.

Francis S. Stellaccio, M.D.Associate Professor of Clinical AnesthesiaSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Rishimani S.N. Adsumelli, M.D., B.S., FFARCSAssociate Professor of AnesthesiologySUNY-Health Sciences Center at Stony BrookStony Brook, NewYork



Complications of Neuromuscular Blockade Reversal: ShouldReversal Be Given to All Patients?Speaker:Mark Abel, M.D.Attending Anesthesiologist | Lawrence Hospital | Bronxville, NewYork

After completion of this session, the participant will be able to:• Describe the physiology and pharmacology of neuromuscular blocking drugs and reversal agents;• Identify the risks of residual paralysis and reversal agents;• Manage the emergence from anesthesia in the patient who received neuromuscular blockade.


Neglected Retained Epidural Catheter Fragments - Benign? Or LegalQuicksand?Speaker:Divina J. Santos, M.D.Associate Professor of Clinical Anesthesiology and Obstetrics and Gynecology | Montefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Recognize risk factors for difficult removal of epidural catheter;• Identify the proper diagnostic procedures and directed physical exam to assess the patient with a retained catheter

fragment;• Formulate a comprehensive plan to care for the patient with retained epidural catheter.


Management of Intraoperative BronchospasmSpeaker:ReneeM. Mapes, D.O.Assistant Professor of Anesthesiology | SUNY-Buffalo School of Medicine and Biomedical Sciences | Buffalo, NewYork

After completion of this session, the participant will be able to:• Identify causes of bronchospasm in the intraoperative period;• Select an appropriate anesthetic plan for management of intraoperative bronchospasm;• Formulate a plan utilizing updated ventilator modalities to manage a patient with perioperative bronchospasm.


SPLAT: Massive Resuscitation for Blunt TraumaSpeakers:Mitchell Y. Lee, M.D.Assistant Professor of AnesthesiologyAssistant Residency Director | NYU-Langone Medical CenterNewYork, NewYork

After completion of this session, the participant will be able to:• Employ Advanced Trauma Life Support (ATLS) guidelines for initial resuscitation;• Assess controversies regarding hypotensive resuscitation;• Select fluid choices and transfusion triggers;• Identify endpoints of resuscitation.

Disclosures: Drs. Abel, Lee, Mapes, Moller and Santos did not disclose any financial relationships.

Sunday

Daryn H. Moller, M.D.Assistant Professor of Clinical AnesthesiologySUNY-Health Sciences Center at Stony BrookStony Brook, NewYork


Sun

day

MiniWorkshops | Sunday, December 15, 2013 | M-21 through M-24Mid-Day Sessions • 12:00 - 13:00 • 4th Floor Rooms

Mini Workshop — M-21 - Odets Room

Update on Complex Regional Pain SyndromeSpeaker:David A. Zylberger, M.D.Assistant Professor of Anesthesiology | Cornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Define the components of Complex Regional Pain Syndrome I and II;• Enumerate the diagnostic and therapeutic options for treatment;• Describe outcome data.

Mini Workshop — M-22 - Wilder Room

Update on Anesthesia for Spinal SurgerySpeaker:Michael K. Urban, M.D., Ph.D.Associate Clinical Professor of Anesthesiology | Cornell University, Weill Cornell Medical CollegeAttending Anesthesiologist | Hospital for Special Surgery | NewYork, NewYork


• Evaluate the proper monitoring and position required for spinal surgery;• Assess the need for cell-saver, autologous blood donation and hemodilution;• Enumerate the risk factors for postoperative visual loss;• Implement changes in practice to avoid postoperative visual loss.

Mini Workshop — M-23 - Ziegfeld Room

Anesthesia Outside the Operating RoomSpeakers:Jay R. Shayevitz, M.D, M.S., FAAPAttending Anesthesiologist | Director, Non-OR AnesthesiaMontefiore Medical CenterBronx, NewYork

After completion of this session, the participant will be able to:• Delineate the requirements for monitoring outside the operating room with emphasis on pediatrics;• Develop a plan to get back-up;• Delineate needs for safe anesthesia in extreme environments.

Mini Workshop — M-24 - O’Neill Room

Maintenance of Competency in Anesthesiology: Nuts and BoltsSpeaker:Cynthia A. Lien, M.D.Professor of Anesthesiology | Vice Chair for Academic Affairs | Director, Residency ProgramCornell University,Weill Cornell Medical College | Attending Anesthesiologist | NewYork-Presbyterian Hospital | NewYork, NewYork


• Delineate the new requirements for documenting CME in preparation for MOCA®;• Formulate a plan of study to prepare for MOCA® examinations;• Delineate the periodicity of MOCA®.

Disclosures:Drs. Gevirtz, Lien, Urban and Zylberger did not disclose any financial relationships.Dr. Shayevitz is a shareholder with Johnson & Johnson, GE.

CliffordM. Gevirtz, M.D., M.P.H.Medical DirectorSomnia Pain ManagementNewYork, NewYork


Workshop | Sunday, December 15, 2013Mid-Day Session • 12:00 - 15:00 • Soho Complex • 7th Floor

Workshop — W-10






Assisted by:


Disclosures:Drs. Albert, Altman, Anderson, Atchabahian, Birmingham, Capan, Chen, Feng, Jeng, J. Kim, S. Kim, Kitain, Lee, Ludwin, Popovic,Rosenblatt, Spessot, Stefanovich, Wambold andWardhan did not disclose any financial relationships.Dr. Durkin receives honoraria from Sonosite.Dr. Tedore’s spouse receives a salary and is a shareholder of TG Therapeutics.

NOTE: ThisWorkshop will be repeated asW-18 on Tuesday.

Sunday









Sheldon A. Isaacson, M.D.Associate Professor of AnesthesiologyDirector, Regional AnesthesiologySUNY-Upstate Medical UniversitySyracuse, NewYork


Jung T. Kim, M.D.Associate Professor of AnesthesiologyVice Chair, Chief of ServiceDepartment of AnesthesiologyMedical Director, Perioperative Surgical ServicesNYU Langone Medical CenterNewYork, NewYork



Mitchell Y. Lee, M.D., B.A.Assistant Professor of AnesthesiologyAssistant Residency DirectorNYU Langone Medical CenterNewYork, NewYork


Jovan Popovic, M.D., FRCPCAssistant Professor of Anesthesiology

NYU-Langone Medical CenterMedical Director, NYU Langone OutpatientSurgeryNewYork, NewYork



Peter Stefanovich, M.D.Instructor in AnesthesiaDepartment of Anesthesia, Critical Care andPain MedicineMassachusetts General HospitalBoston, Massachusetts






Sun

day

Scientific Panel | Sunday, December 15, 2013Afternoon Session • 13:00 - 15:30 • North Ballroom • 6th Floor


The Role of the Anesthesiologist in Perioperative Hemostatis

Panel Moderator:Kenichi Tanaka, M.D., M.Sc.Professor of Anesthesiology | University of Pittsburgh Medical Center | Pittsburgh, Pennsylvania

After completion of this session, the participant will be able to:• Explain the perioperative management of patients receiving anti-platelet therapy;• Discuss new and novel anticoagulants and their implications for regional anesthesia in the perioperative

patient;• Identify the appropriate laboratory monitoring for the new anticoagulants• Recommend reversal agents for the new anticoagulants.

Presentations:

Management of Anti-Platelet TherapyWandaM. Popescu, M.D.Associate Professor of Anesthesiology | Director, Thoracic Anesthesia DivisionCo-Director, Grand Rounds | Yale University School of Medicine | New Haven, Connecticut

Novel Anti-Coagulants and Regional AnesthesiaHonorio T. Benzon, M.D.Professor of Anesthesiology | Associate Chair, Academic Affairs and PromotionsNorthwestern University Medical Center | Chicago, Illinois

Update on the Management of Massive TransfusionBeth H. Shaz, M.D.Chief Medical Officer | NewYork Blood Center | NewYork, NewYork

Perioperative Factor Concentrate TherapyKenichi Tanaka, M.D., M.Sc.

Disclosures:Drs. Benzon, Popescu and Shaz did not disclose any financial relationships.Dr. Tanaka receives funded research support fro CSL Behring, consultant fees from Grifols TEM Systems and material supportfrom Fujimori Kogyo, Co., LTD.


Scientific Panel | Sunday, December 15, 2013Afternoon Session • 13:00 - 15:30 • South Ballroom • 6th Floor


Challenges in Thoracic Anesthesia

Panel Moderator:Edmond Cohen, M.D.Professor of Anesthesiology | Director, Thoracic Anesthesia | Icahn School of Medicine at Mount SinaiNewYork, NewYork

After completion of this session, the participant will be able to:• Discuss recent developments and treatment modalities in thoracic surgery;• Review the anatomy and surgical techniques associated with airway surgery, including tracheal resection and

reconstruction;• Discuss the perioperative anesthetic management of patients undergoing airway surgery, including

preoperative evaluation, airway management, and oxygenation and ventilation techniques;• Detail predictive factors for hypoxemia during one-lung ventilation and protective strategies to prevent

hypoxemia and lung injury during one-lung ventilation;• Identify options for post-operative pain management following open thoracotomy and video-assisted

thoracoscopic procedures and develop a plan to tailor post-operative pain control to specific patients in one’spractice;

• Discuss alternatives to thoracic epidural infusions for post-operative analgesia and recite the risks and benefitsassociated with these techniques.

Presentations:

Thoracic Surgery in the 21st CenturyRaja M. Flores, M.D.Professor of Cardiothoracic Surgery | Chief, Thoracic SurgeryIcahn School of Medicine at Mount Sinai | NewYork, NewYork

Anesthetic Challenges During Airway ProceduresPaul H. Alfille, M.D.Director, Thoracic Anesthesia Section | Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital | Boston, Massachusetts

Protective One-Lung Ventilation StrategiesEdmond Cohen, M.D.

Post-thoracotomy Pain Management: An Individually Tailored ApproachEugene R. viscusi, M.D.Professor of Anesthesiology | Director, Acute Pain Management | Jefferson Medical CollegeThomas Jefferson University | Philadelphia, Pennsylvania

Disclosures:Drs. Alfille and Flores did not disclose any financial relationships.Dr. Cohen receives honoraria from Cook Medical.Dr. Viscusi receives funded research support from AcelRx Pharmaceuticals, Inc., Adolor Corporation, Cadence Pharmaceuticals, Inc.,Cumberland Pharmaceuticals, Inc. and Pacira Pharmaceuticals, Inc. He receives consultant fees from AcelRxPharmaceuticals, Inc., Cadence Pharmaceuticals, Inc., Cubist Pharmaceuticals, Incline Therapeutics, Pacira Pharmaceuticals, Inc.,Salix Pharmaceuticals, and is on the Cadence Pharmaceuticals, Inc. speakers bureau.

Sunday


Sun

day

Scientific Panel | Sunday, December 15, 2013Afternoon Session • 13:00 - 15:30 • Astor Ballroom • 7th Floor


Organizing and Improving Anesthesiology Teams

Panel Moderator:Robert E. Johnstone, M.D.Professor of Anesthesiology | West Virginia University | Morgantown,West Virginia

After completion of this session, the participant will be able to:• Discuss the elements of a successful anesthesiologist-led team;• Explain how to create and sustain a successful anesthesiologist-led team in the perioperative setting;• Discuss how to motivate successful teams in a teaching setting;• Compare and contrast models of anesthesiologist-led teams within and outside the United States.

Presentations:

The Anesthesiologist-Led TeamJane C. K. Fitch, M.D.John L. Plewes Professor & Chair |Department of Anesthesiology |University of OklahomaOklahoma City, Oklahoma

How Do I Motivate Teaching Anesthesiologists toWork as a Team?KevinW. Roberts, M.D.Professor and Chair |Department of Anesthesiology |Albany Medical Center |Albany, NewYork

Anesthesiology Teams: The Perspective from Abroadvanessa Beavis, M.B., B.Ch., FFA(SA), FANZCADirector, Perioperative Services & Clinical Support | Auckland City Hospital | Auckland, New Zealand

Team Building Using Simulation TechniquesAdam I. Levine, M.D.Professor of Anesthesiology, Otolaryngology, Structural and Chemical Biology | Vice-Chair ofEducation | Program Director, Residency Training Program | Program Director, ASA Endorsed HELPSSimulation Program | Department of Anesthesiology | Icahn School of Medicine at Mount SinaiNewYork, NewYork

Transfers of Care in a Team EnvironmentRobert E. Johnstone, M.D.

Disclosures:Drs. Beavis, Fitch and Roberts did not disclose any financial relationships.Dr. Levine is on the speakers bureau and receives consultant fees from Mylan Pharmaceuticals.Dr. Johnstone receives honoraria from Anesthesiology News.


Scientific Panel | Sunday, December 15, 2013Afternoon Session • 13:00 - 15:30 • Manhattan Ballroom • 8th Floor


Issues in Interventional Pain Management

Panel Moderator:Timothy R. Deer, M.D.Clinical Professor of Anesthesiology | West Virginia University School of MedicinePresident and CEO, The Center of Pain Relief | Charleston,West Virginia

After completion of this session, the participant will be able to:• Discuss new implantable devices and new therapies for chronic pain patients;• Discuss recent evidence regarding the various treatment modalities for osteoporotic vertebral fractures;• Discuss recent issues impacting reimbursement for interventional pain procedures.

Presentations:

Osteoporotic Fractures: Vertebroplasty or Medical Management?Oscar A. DeLeon-Casasola, M.D.Professor of Anesthesiology and Medicine | Vice-Chair, Clinical Affairs | Department of AnesthesiologyUniversity of Buffalo | Chief, Pain Medicine and Professor of Oncology | Roswell Park Cancer InstituteBuffalo, NewYork

Reimbursement Issues in Pain ManagementStanleyW. Stead, M.D., M.B.A.Clinical Professor of Anesthesiology and Pain Medicine | University of California - DavisDavis, California | Chair, ASA Section on Professional Practice

New Innovations in Implantable Devices: Dorsal Root Ganglion, Burst, HighFrequency and Peripheral Nerve StimulationTimothy R. Deer, M.D.

A Critical Evaluation of Epidural Steroids: Where AreWe Now?CliffordM. Gevirtz, M.D., M.P.H.Medical Director | Somnia Pain Management | NewYork, NewYork

Disclosures:Drs. DeLeon-Casasola and Gevirtz did not disclose any financial relationships.Dr. Deer receives consultant fees from Bioness, Inc., Flowonix Medical, Jazz Pharmaceutical, Meditronic Inc., Spinal Modulation,St. Jude Medical, Inc. and Vertos Medical.Dr. Stead is CEO and owner of Stead Health Group, Inc.

Sunday


Sun

day

Focus Sessions | Sunday, December 15, 2013Afternoon Session • 15:00 - 17:00 • Marquis Ballroom“C” • 9th Floor

Focus Sessions— FS-16

Preparing For Retirement

Focus Session Co-Moderators:Albert J. Saubermann, M.D. Michael S. Jakubowski, M.D.Professor Emeritus of Anesthesiology Attending AnesthesiologistAlbert Einstein College of Medicine Ellis HospitalBronx, NewYork Schenectady, NewYork

Co-Chair, NYSSA Committee on RetirementNewYork, NewYork


Retirement - It's a Process Not An EventMichael F. Myers, M.D.Professor of Clinical PsychiatryImmediate Past Vice-Chair, EducationImmediate Past Director, Training Department of Psychiatry and Behavioral SciencesSUNY-Downstate Medical CenterBrooklyn, NewYork

Retirement - How to Find the Sweet SpotPaul Gitman, M.D.Associate Professor of MedicineHofstra Northshore-Long Island Jewish School of MedicineNew Hyde Park, NewYork

Why I Decided to Retire...or Not!Michael S. Jakubowski, M.D.

After completion of this session, the participant will be able to:• Identify the most common psychological challenges associated with retirement, and their effects on mental

and physical health;• Recognize the psychological impact of retirement on personal relations, marriage and committed relationships;• Examine personal conceptions of retirement and how they interact with one’s patient care and current practice;• Successfully employ effective strategies to enable oneself, patients and colleagues to prepare and master

successful retirement by overcoming emotional challenges;• Analyze the insights gleaned from an anesthesiologist in the process of retirement.

Disclosures:Drs. Gitman, Jakubowski, Myers and Saubermann did not disclose any financial relationships.


Focus Sessions | Sunday, December 15, 2013 | FS-17 & FS-18Afternoon Session • 15:45 - 17:00 • 4th Floor Rooms


Challenges in Neuroanesthesia

Focus SessionModerator:Irene P. Osborn, M.D.Associate Professor of Anesthesiology | Director, Neuroanesthesia | Icahn School of Medicine atMount SinaiNewYork, NewYork

Faculty Presentations:Fluid Management in NeurosurgeryIrene P. Osborn, M.D.

Anesthesia for Acute StrokeMatthew B.Wecksell, M.D.Assistant Professor of Anesthesiology | Albert Einstein College of Medicine | Director of Medical Student EducationMontefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Discuss the problems in providing anesthesia for acute stroke management;• Develop an anesthetic plan for patients requiring interventions for acute stroke;• Identify the issues surrounding fluid management in neurosurgery;• Develop a rational fluid management plan for neurosurgical procedures.


Misconduct in Research and Publication: How to Recognize It,How to Prevent ItFocus SessionModerator:Jeffrey H. Silverstein, M.D.Vice Chair, Research | Department of Anesthesiology | Associate Dean, Research | Icahn School of Medicine atMount Sinai | NewYork, NewYork

Faculty Presentations:Research: The Role of the IRBJeffrey H. Silverstein, M.D.

Publication: The Role of the Editor-in-ChiefHugh C. Hemmings, Jr., M.D., Ph.D.Professor and Chair | Department of Anesthesiology | Cornell University, Weill Cornell Medical CollegeAnesthesiologist-in-Chief | NewYork-PresbyterianWeill Cornell Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Define what is considered academic misconduct;• Discuss the role of the IRB in overseeing research;• Develop research proposals that conform to IRB guidelines;• Discuss the role of an editor-in-chief;• Develop a plan for submitting a manuscript that conforms to editorial guidelines.

Disclosures:Drs. Hemmings,Wecksell and Silverstein did not disclose any financial relationships.Dr. Osborn receives material support from Covidien, Inc.

Sunday


Sun

day

Focus Sessions | Sunday, December 15, 2013 | FS-19 & FS-20Afternoon Session • 15:45 - 17:00 • various Rooms


Perioperative Medicine: Glycemic Control, Beta-BlockadeFocus Session Moderator:Andrew B. Leibowitz, M.D.Professor of Anesthesiology and Surgery | Executive Vice Chair of AnesthesiologyCo-Director, Surgical Intensive Care Unit | Icahn School of Medicine at Mount Sinai | New York, New York

Faculty Presentations:Beta Blockade: UpdateAndrew B. Leibowitz, M.D.

Glycemic ControlLeila Hosseinian, M.D.Assistant Professor of Anesthesiology and Critical Care | Icahn School of Medicine at Mount SinaiNew York, New York

After completion of this session, the participant will be able to:• Discuss the current guidelines for pre-, intra- and postoperative glycemic control;• Recognize the consequences of poor glycemic control;• Develop strategies to maintain euglycemia in the perioperative period;• Discuss the issues surrounding SCIP guidelines on beta blockade in the perioperative period;• Develop a practical approach to implementing SCIP guidelines for perioperative beta blockade.


Current Issues Forum

Focus SessionModerator:David J.Wlody, M.D.Professor of Clinical Anesthesiology | Vice-Chair, Clinical AffairsDepartment of Anesthesiology | SUNY-Downstate Medical Center | Brooklyn, NewYork

Faculty Presentations:Changes in Payment Methodologies for Anesthesia ServicesMarc L. Leib, M.D., J.D.Chair, ASA Committee on Economics | Phoenix, Arizona

After completion of this session, the participant will be able to:• Define the value-based payment modifier;• Describe the initial implementation and how it will impact anesthesiologists;• Delineate the requirements for anesthesiologist participation in meaningful use incentives;• Project the impact of the progression from Stage , through Stage 3 of meaningful use, as it relates to anesthesia practice.

Disclosures:Drs. Hosseinian, Leib, Leibowitz andWlody did not disclose any financial relationships.


Focus Sessions | Sunday, December 15, 2013 | FS-21 & FS-22Afternoon Session • 15:45 - 17:00 • 7th Floor Rooms


Update on Thoracic AnesthesiaFocus SessionModerator:Edmond Cohen, M.D.Professor of Anesthesiology | Director, Thoracic Anesthesia | Icahn School of Medicine at Mount SinaiNewYork, NewYork

Faculty Presentations:Lung Isolation in the Patient with a Difficult AirwayEdmond Cohen, M.D.

Management of the Patient with a Giant Mediastinal MassPaul H. Alfille, M.D.Director, Thoracic Anesthesia Section | Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital | Boston, Massachusetts

After completion of this session, the participant will be able to:• Discuss the different options and techniques available for managing patients with a difficult airway needing

lung isolation;• Discuss the possible complications arising from various airway techniques in patients with a difficult airway;• Develop an anesthetic plan for the patients with a difficult airway requiring lung isolation;• Discuss the problem of a patient with a giant mediastinal mass;• Develop a plan of optimal management of the patient with morbid obesity for thoracic surgery.


Regulation and Accreditation Issues for Anesthesiologists:Annual Update

Focus SessionModerator:Robert S. Lagasse, M.D.Professor of Anesthesiology | Director, Quality Management & Perioperative SafetyDepartment of Anesthesiology | Yale University School of Medicine | New Haven, Connecticut

Faculty Presentations:Accreditation Issues: Update (TJC, DNV)Robert S. Lagasse, M.D.

Regulatory Update (CMS, State)Rebecca S. Twersky, M.D., M.P.H.Professor, Vice-Chair for Research | Department of Anesthesiology | Medical Director, Ambulatory Surgery UnitSUNY Downstate Medical Center | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Meet the accreditation standards applicable to anesthesiologists;• Weigh the different accreditation options for healthcare organizations in the United States;• Meet the documentation requirements of the CMS Conditions of Participation;• Develop a program in their practice to comply with all CMS documentation requirements.

Disclosures:Drs. Alfille, Lagasse and Twersky did not disclose any financial relationships.Dr. Cohen receives honoraria from Cook Medical.

Sunday


Sun

day

Focus Sessions | Sunday, December 15, 2013 | FS-23Afternoon Session • 15:45 - 17:00 • Manhattan Ballroom • 8th Floor

FS-23

Infection Control Issues Impacting Anesthesiology Practice

Focus SessionModerator:Richard A. Beers, M.D.Professor of Anesthesiology | SUNY-Upstate Medical University | Associate Chief, AnesthesiaVeteran’s Administration Medical Center | Syracuse, NewYork

Faculty Presentations:The AnesthesiaWorkspace: Keeping It CleanElliott S. Greene, M.D.Professor of Anesthesiology | Albany Medical College | Albany, NewYork

Surgical Site Infections: Our RoleAmanda J. Rhee, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Safe Injection PracticesEmily Lutterloh, M.D., M.P.H.Bureau of Healthcare Associated Infections | NewYork State Department of Health | Albany, NewYorkandErnest J. Clement, R.N., M.S.N., C.I.C.Infection Preventionist | Healthcare Epidemiology and Infection Control ProgramNewYork State Department of Health | Albany, NewYork

After completion of this session, the participant will be able to:• Review current infection prevention recommendations and safe injection practices as applicable to anesthesia

practice;• Discuss methods to implement infection prevention recommendations into practice.

Disclosures:Drs. Beers, Lutterloh, Rhee and Mr. Clement did not disclose any financial relationships.Dr. Greene receives royalties in support of patents regarding a safety needle catheter.


Problem-Based Learning Discussions | Sunday, December 15, 2013PBLD-41 through PBLD-48 | Afternoon Sessions • 15:45 - 17:00 • 6th Floor Rooms


Six Month Old for Inguinal Hernia Repair: Parents are Concerned AboutCognitive DysfunctionSpeakers:Arvind Chandrakantan, M.D., M.B., B.S.Assistant Professor of AnesthesiologySUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

After completion of this session, the participant will be able to:• Review the most recent literature regarding cognitive dysfunction in the pediatric population following anesthesia;• Identify patients thought to be at increased risk for cognitive dysfunction;• Formulate an appropriate response for a parent expressing concern about cognitive dysfunction.


When Does an Elevated Preoperative Glucose Require Treatment?Speaker:Saundra E. Curry, M.D.Clinical Professor of Anesthesiology | Columbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Describe the pathophysiology of hyperglycemia;• Recognize and be able to diagnose the complications of perioperative hyperglycemia.


The Adolescent Patient and the Right to Refuse CareSpeakers:Francine S. Yudkowitz, M.D., FAAPProfessor of Anesthesiology and PediatricsDirector, Pediatric Anesthesia | Icahn School of Medicine at Mount SinaiNewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the medicolegal issues regarding the adolescent’s right to refuse surgery;• Recognize which adolescent is “mature”enough to participate in the surgical/anesthesia decision making process;• Formulate a plan to deal with the adolescent who refuses surgery but the parents are consenting to proceed with the

surgery.


Respiratory Depression in the PACU: The Role of Non-Invasive VentilationSpeaker:Samrat H.Worah, M.D.Assistant Clinical Professor of Anesthesiology | SUNY-Downstate Medical Center | Brooklyn, NewYork


• Review various non-invasive ventilation modalities available for PACU;• Identify appropriate patients for the use of non-invasive ventilator assistance;• Establish guidelines for the use of non-invasive ventilation in the postoperative patient.

Disclosures:Drs. Chandrakantan, Curry, Davis, Makaryus,Worah and Yudkowitz did not disclose any financial relationships.

Sunday

Rany R. Makaryus, M.D.Assistant Professor of AnesthesiaSUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Renee L. Davis, M.D.Assistant Clinical Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork



Non-Surgical Approaches for the Herniated DiscSpeaker:LeenaMathew, M.B., B.S., M.D.Associate Professor of Anesthesiology | Columbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify etiologies of pain from herniated disc;• Describe various interventional techniques to address pain from herniated lumbar disc;• Formulate an interventional based plan for the management of a patient with herniated lumbar disc.


The Role of TEE in the General Operating RoomSpeaker:Ervant Nishanian, M.D.Assistant Professor of Anesthesiology | Columbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Recognize the indications for intraoperative TEE in the non-cardiac OR;• Identify the risks and benefits of TEE compared to pulmonary artery catheterization;• Formulate an anesthetic plan incorporating TEE for the appropriate patient.


Is Nitrous Oxide Obsolete?Speaker:Kane O. Pryor, M.D.Assistant Professor of Anesthesiology and Psychiatry | Cornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the potential risks and advantages of the use of nitrous oxide;• Identify which patients may be at increased risk from use of nitrous oxide;• Establish an anesthetic plan which does not require the use of nitrous oxide in at-risk patients.


Extubation of the Bariatric PatientSpeakers:Ram Roth, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Define morbid obesity and calculate body mass index;• Discuss the medical complications associated with morbid obesity;• Design an anesthetic for the specific needs of the morbidly obese patient undergoing bariatric surgery.

Disclosures:Drs. Chuda, Mathew, Nishanian, Pryor and Roth did not disclose any financial relationships.

Robert M. Chuda, M.D., M.B.A.Attending AnesthesiologistLenox Hill HospitalNewYork, NewYork

Sunday


Monday

Monday, December 16, 2013Times

Registration ....................................................................................................................................... 07:00Hands-OnWorkshops .................................................................................................... 08:00 & 12:00Scientific Panel - International Forum.......................................................................................09:00Technical Exhibits ............................................................................................................................ 09:0043rd Annual RovenstineMemorial Lecture......................................................................................10:45Poster Presentations &Medically Challenging Case Reports .............................. 11:00 & 14:00Problem-Based Learning Discussions ...................................................................... 11:45 & 15:45MiniWorkshops.................................................................................................................................11:45Scientific Panels ................................................................................................................................13:00Focus Sessions ...................................................................................................................................15:45


Note: Monday is the final day for Posters, Medically Challenging Case Reports and Technical Exhibits.

67th Annual






Mon

day

Workshop |Monday, December 16, 2013Morning Session • 08:00 - 11:00 • Empire Complex • 7th Floor

Workshop—W-11

Thoracic AnesthesiaWorkshop with Simulator and Cadaveric Torso

WorkshopModerator: Edmond Cohen, M.D.Professor of Anesthesiology | Director, Thoracic AnesthesiaIcahn School of Medicine at Mount Sinai | NewYork, NewYork

Assisted by:

After completion of this session, the participant will be able to:• Place left- and right-sided double lumen endobronchial tube, utilizing fiberoptic bronchoscopy;• Place various types of endobronchial blockers to provide one lung ventilation;• Apply techniques for successful lung separation in patients with a difficult airway;• Manage hypoxia in a patient with one-lung ventilation;• Manage postoperative analgesia in the post-lung resection patient.

Disclosures:Drs. Agro, Alfille, Capan, Castillo, DeMaria, Desiderio, Dumitru, Gooden, Neustein, O’Neill, Popescu, Schwartz, Silvay andWatsondid not disclose any financial relationships.Dr. Cohen receives honoraria from Cook Medical.Dr. Viscusi receives funded research support from AcelRx Pharmaceuticals, Inc., Adolor Corporation, Cadence Pharmaceuticals, Inc.Cumberland Pharmaceuticals, Inc. and Pacira Pharmaceuticals, Inc. He receives consultant fees from AcelRxPharmaceuticals, Inc., Cadence Pharmaceuticals, Inc., Cubist Pharmaceuticals, Incline Therapeutics, Pacira Pharmaceuticals, Inc.,Salix Pharmaceuticals, and is on the Cadence Pharmaceuticals, Inc. speakers bureau.

Felicie E. Agro, M.D.Professor and ChairDepartment of AnesthesiologyIntensive Care and Pain ManagementUniversity Campus Bio-MedicoRome, Italy

Paul H. Alfille, M.D.Director, Thoracic Anesthesia SectionDepartment of Anesthesia, Critical Careand Pain MedicineMassachusetts General HospitalBoston, Massachusetts

Levon M. Capan, M.D.Professor of AnesthesiaNYU-Langone Medical CenterAssociate Director, AnesthesiaBellevue Hospital CenterNew York, New York

Maria Castillo, M.D.Assistant Professor in AnesthesiologyIcahn School of Medicine at Mount SinaiNew York, New York

Samuel DeMaria, Jr., M.D.Associate Professor ofAnesthesiology | Assistant ProgramDirector, Academic AffairsAnesthesiology Residency TrainingProgram, Director of ResearchIcahn School of Medicine at MountSinai | NewYork, NewYork

Dawn Desiderio, M.D.Professor of Clinical AnesthesiologyCornell University, Weill Cornell MedicalCollegeClinical MemberMemorial Sloan-Kettering Cancer CenterNew York, New York

Marian Dumitru, M.D.Attending AnesthesiologistJamaica Hospital Medical CenterJamaica, New York

Cheryl K. Gooden, M.D.Associate Professor of Anesthesiologyand PediatricsIcahn School of Medicine at Mount SinaiNew York, New York

Steven M. Neustein, M.D.Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNew York, New York

Daniel K. O’Neill, M.D.Assistant Professor of AnesthesiologyNYU-Langone Medical CenterNew York, New York

Wanda M. Popescu, M.D.Associate Professor of AnesthesiologyDirector, Thoracic Anesthesia DivisionCo-Director, Grand RoundsYale University School of MedicineNew Haven, Connecticut

Andrew D. Schwartz, M.D.Instructor of AnesthesiologyIcahn School of Medicine at Mount SinaiStaff Anesthesiologist, James J. Peters VAMedical CenterEducation Director, HELPS SimulationCenterNewYork, NewYork

George Silvay, M.D., Ph.D.Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNew York, New York

Eugene R. Viscusi, M.D.Professor of AnesthesiologyDirector, Acute Pain ManagementJefferson Medical CollegeThomas Jefferson UniversityPhiladelphia, Pennsylvania

Charles B.Watson, M.D., FCCMClinical Associate Professor ofAnesthesiologyUniversity of ConnecticutFarmington, ConnecticutChair, Department of AnesthesiaDeputy Surgeon-in-ChiefBridgeport HospitalYale-New Haven Health SystemBridgeport, Connecticut


Monday

Workshop |Monday, December 16, 2013Morning Session • 08:00 - 11:00 • Soho Complex • 7th Floor

Workshop—W-12

Simulation Experience for the Difficult Airway, Crisis Management andTeamTraining

Workshop Co-Moderators:Adam I. Levine,M.D.Professor of Anesthesiology, Otolaryngology,Structural and Chemical Biology | Vice-Chair of EducationProgramDirector, ResidencyTraining ProgramProgramDirector, ASA Endorsed HELPS Simulation ProgramDepartment of AnesthesiologyIcahn School of Medicine atMount Sinai | NewYork, NewYork

Assisted by:

Amanda R. Burden, M.D.Assistant Professor of AnesthesiologyDirector Simulation ProgramCooper Medical School of RowanUniversityUMDNJ/RobertWood Johnson MedicalSchoolCamden, New Jersey

Yury Khelemsky, M.D.Assistant Professor in AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Ronald S. Levy, M.D., DABAProfessor of Anesthesiology,Neuroscience and Cell Biology, Division ofAnatomyDistinguished Teaching Professor & MarieHall ScholarDirector, Patient Simulation CenterDepartment of AnesthesiologyUniversity of Texas Medical BranchGalveston, Texas

Bryan P. Mahoney, M.D.Assistant Professor of AnesthesiologyOhio State UniversityColumbus, Ohio


Alan J. Sim, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiAssistant Program Director for ClinicalAffairs, Resident Training ProgramDivision of Liver TransplantationMount Sinai HELPS Simulation CenterNewYork, NewYork

Francine S. Yudkowitz, M.D., FAAPProfessor of Anesthesiology andPediatricsDirector, Pediatric AnesthesiaIcahn School of Medicine at Mount SinaiNewYork, NewYork

After completion of this session, the participant will be able to:• Apply skills of dynamic decision making, resource management, leadership and teamwork to a crisis scenario in the operating

room;• Demonstrate communication and leadership skills in working with different personalities and behaviors during a crisis

scenario.

Disclosures:Drs. Burden, DeMaria, Khelemsky, Levy, Mahoney, Schwartz, Sim and Yudkowitz did not disclose any financial relationships.Dr. Levine is on the speakers bureau and receives consultant fees fromMylan Pharmaceuticals.

NOTE: ThisWorkshop will be repeated asW-14, this afternoon.

Samuel DeMaria, Jr., M.D.Associate Professor of AnesthesiologyAssistant Professor Director, Academic AffairsAnesthesiology ResidencyTraining Program, Director ofResearch | Icahn School of Medicine atMount SinaiNewYork, NewYork


Mon

day

Notes


Monday

Scientific Panel |Monday, December 16, 2013Morning Session • 09:00 - 10:30 • Broadway Ballroom • 6th Floor


The faculty presenting this program are participating courtesy of theEuropean Society of Anaesthesiologists as part of a collaborativeeducational exchange with the PostGraduate Assembly inAnesthesiology.

This is a continuing series of annual forums to discuss anesthesia practicesthroughout the world.

Practice Guidelines in Anesthesiology: A European PerspectivePanel Moderator:Stefan De Hert, M.D., Ph.D.Clinical Professor of Anesthesiology and Pain Medicine | University of California - Davis | Davis, CaliforniaChair, ASA Section on Professional Practice

After completion of this session, the participant will be able to:• List the European guidelines on pre-operative evaluation for non-cardiac surgery, describing the major

differences between the European and US recommendations;• List the most important recommendations issued from the new ESA Guidelines on Severe Perioperative

Bleeding and discuss problems encountered during the perioperative management of patients treated withthe new oral anticoagulants;

• Discuss the clinical value of guidelines and standards, citing specific examples of selected practice guidelines.

Presentations:

European Guidelines on Preoperative Evaluation for Non-Cardiac SurgeryStefan De Hert, M.D., Ph.D.

European Guidelines on Severe Perioperative Bleeding: Special Focus on theManagement of New Oral AnticoagulantsCharles M. Samama, M.D., Ph.D., FCCPProfessor and Chair | Department of Anaesthesia and Intensive Care MedicineCochin University Hospital | Paris, France

Do Practice Guidelines Improve Patient Safety?Sven Staender, M.D., Ph.D.Chair, Task Force Patient Safety | European Society of AnaesthesiologyHead Department of Anaesthesiology and Intensive Care Medicine | Regional HospitalMaennedorf, Switzerland

Disclosures:Drs. DeHert and Staender did not disclose any financial relationships.Dr. Samama receives funded research support from Bayer AG, Bristol-Myers Squibb, Boehringer-Ingelheim, GlaxoSmithKline PLC,Haemonetics Corporation, LFB, Novo Nordisk A/S, Sanofi Pasteur SA andTEM International. He is on the speakers bureau forAbbott Laboratories, AstraZeneca, Bayer AG, Bristol-Meyers Squibb, Boehringer-Ingelheim, CSL Behring, Daichii, Fresenious-KabiCompany, GlaxoSmithKline PLC, LFB, Eli Lilly and Company, Pfizer, Inc., Rovi, Sanofi Pasteur SA and receives honoraria fromRoche Diagnostics and Sanofi Pasteur SA.

International Forum


Mon

day

Scientific Panel |Monday, December 16, 2013Morning Session • 10:45 - 11:45 • Broadway Ballroom • 6th Floor


43rd Annual

E.A. Rovenstine Memorial Lecture

(1895 - 1960)

This annual Memorial Lecture series, which began in 1971, is dedicated to honor the illustrious career of Dr. EmeryAndrew Rovenstine, who was Director of Anesthesiology Service from 1935 to 1960 at a place he proudly referredto as “My Bellevue,” which in his time was a charity hospital. He was also Professor of Surgery (Anesthesia) at TheNewYork University School of Medicine. Dr. Rovenstine was a loved and eminent clinician and teacher, who playeda major role in the development of academic anesthesia in the United States. In his lifetime, many great honorswere bestowed upon him. He served as President of The American Society of Anesthesiologists in 1943/44, and in1957 received that Society’s Distinguished Service Award. Dr. Rovenstine was the founder of the PostGraduateAssembly in Anesthesiology. A scholarly man who helped to developmany drugs, techniques andmachines to easepain, Dr. Rovenstine devoted himself to training other physicians in his specialty. He was considered, in his time, tobe the most knowledgeable anesthesiologist in the world.

Prior to the start of this lecture, there will be a brief ceremony to award the winners of the Resident Research Contest.

Introductions: David J. Wlody, M.D. , PGA General Chair

Richard A. Beers, M.D. , PGA Scientific Programs Chair

Typically, guest lecturers have been recognized world leaders and experts in Anesthesiology.This year we are pleased to present:

Reflections on Professionalism in AnesthesiologyMaintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of The American Board of Anesthesiology®.


Guest Lecturer: David H. Chestnut, M.D.Director of Medical Education | Gundersen Health SystemProfessor of Anesthesiology and Associate Dean for theWestern Academic CampusUniversity ofWisconsin School of Medicine and Public Health | La Crosse,Wisconsin

After completion of this session, the participant will be able to:• List the important attributes of professionalism for physicians;• Discuss contemporary issues in professionalism for physicians;• Discuss dilemmas in the teaching, encouragement and enforcement of professionalism for physicians.

Disclosure: Dr. Chestnut did not disclose any financial relationships.


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About the Lecturer...

DavidH. Chestnut,M.D., grewup in Selma, Alabama,where for 33 years his father taught biblical studies at SelmaUniversity (asmall, historically black, Christian college), andwhere hismother served as a public school teacher. Dr. Chestnut is a graduate ofSamfordUniversity and theUniversity of Alabama School ofMedicine. He obtainedhis residency training in both anesthesiology andobstetrics andgynecology atDukeUniversityMedical Center. In 1984, he joined the faculty of theUniversity of IowaCollege ofMedicine, and for three years he practicedboth anesthesiology andobstetrics andgynecology. In 1987, Dr. Chestnut began to devotehis clinical practice exclusively to anesthesiology,with an emphasis on obstetric anesthesia. While at theUniversity of Iowa, Dr. Chestnutdeveloped anNIH-funded laboratorymodel for the study of thematernal and fetal compensatory responses to various stresses (e.g.,sympathectomy, hemorrhage, hypoxia). His clinical research focusedon the effect of epidural analgesia on obstetric outcome. In 1992,hewas namedVice-Chair for Administration in theDepartment of Anesthesia at theUniversity of Iowa.

In 1994, Dr. Chestnutwas namedAlfredHabeebProfessor andChair of Anesthesiology, and Professor ofObstetrics andGynecology,at theUniversity of Alabama at Birmingham (UAB). During his 11-year tenure as Chair of Anesthesiology at UAB, Dr. Chestnut helpedlead that department to national and international prominence in the specialty of anesthesiology. In 2005, Dr. Chestnutwas appointedas the Edwin L. Overholt Director ofMedical Education for theGundersen LutheranHealth System in La Crosse,Wisconsin. That year, hewas also appointed as Professor of Anesthesiology andAssociateDean for theWesternAcademic Campus of theUniversity ofWisconsinSchool ofMedicine andPublic Health.

Dr. Chestnut is a diplomate of both theAmerican Board of Anesthesiology and theAmerican Board ofObstetrics andGynecology.He has served as President of the Society forObstetric Anesthesia and Perinatology (SOAP), and for three years he served as theAmerican Society of Anesthesiologists’liaison to theAmericanCollege ofObstetricians andGynecologists. For 12 years (1997-2009) Dr.Chestnut served as aDirector of theAmerican Board of Anesthesia (ABA). In 2009, he was appointed as the ExecutiveDirector forProfessional Affairs for theABA, andhewas also elected to the Board ofDirectors of theAmerican Board ofMedical Specialties (ABMS).He currently serves as amember of theABMSExecutive Committee. In February, 2013, theUniversity of AlabamaBoard ofTrusteesapproved a resolution establishing theDavidHill Chestnut EndowedProfessorship in Anesthesiology at UAB.

For 12 years Dr. Chestnut served asmember of the Editorial Board for the journal Anesthesiology, and for 11 years he served asEditor-in-Chief of theYear Book of Anesthesiology andPainManagement. He is also editor of Chestnut’s Obstetric Anesthesia:Principles and Practice. The fourth edition of this textbookwas published in 2009, and the fifth editionwill be published in 2014.

David andhiswife Janet have beenmarried for 30 years. Janet is a native of Norton, Kansas, and she is a graduate ofWheatonCollege andDukeUniversity. David and Janet are the parents of five children, ages 19-29 and they have four grandchildren. WhenDavidwas a boy he aspired to be a sports announcer. For the last four years he realized his childhooddreamwhile serving as the publicaddress announcer for his youngest son’s high school andAmerican Legionbaseball teams.

Past Rovenstine Memorial Lecturers2012 Stephen J. Thomas, M.D.

2011 Daniel I. Sessler, M.D.

2010 John C. Drummond, M.D.

2009 Lee A. Fleisher, M.D.

2008 Mark J. Lema, M.D., Ph.D.

2007 Steven L. Shafer, M.D.

2006 Mark A.Warner, M.D.

2005 Michael M. Todd, M.D.

2004 James E. Cottrell, M.D.

2003 Paul G. Barash, M.D.

2002 Michael F. Roizen, M.D.

2001 Tony L. Yaksh, Ph.D.

2000 Ronald D. Miller, M.D.

1999 BernardV.Wetchler, M.D.

1998 James F. Arens, M.D.

1997 Edward D. Miller, Jr., M.D.

1996 Norig Ellison, M.D.

1995 Robert K. Stoelting, M.D.

1994 Betty J. Bamforth, M.D.

1993 Mieczyslaw Finster, M.D.

1992 E.S. Siker, M.D.

1991 Joseph F. Artusio, Jr., M.D.

1990 Sol N. Shnider, M.D.

1989 Henrik H. Bendixen, M.D.

1988 Paul Janssen, M.D.

1987 Michael J. Cousins, M.D.

1986 JohnW. Severinghaus, M.D., F.F.A.R.C.S.

1985 Benjamin G. Covino, Ph.D., M.D.

1984 Peter G.Wasser, M.D.

1983 John F. Nunn, M.D., Ph.D.

1982 Henning Pontoppidan, M.D.

1981 E.M. Papper, M.D.

1980 Edmond I. Eger, II, M.D.

1979 Cedric Prys-Roberts, M.A., D.M., Ph.D.

1978 Leon E. Farhi, M.D.

1977 Alon P.Winnie, M.D., John C. Liebeskind, Ph.D.,John E. Adams, M.D. & Richard J. Miller, Ph.D.

1976 E.M. Papper, M.D., Richard J. Kitz, M.D.,Robert M. Epstein, M.D., John J. Bonica, M.D.& D. Bruce Scott, M.D.

1975 C. Phillip Larson, Jr., M.D., Stanley Dudrick, M.D.,H. Barrie Fairley, M.B., B.S., Richard I. Mazze, M.D.& Harvey B. Shapiro, M.D.

1974 HermanTurndorf, M.D., Myron B. Laver, M.D.,John F. Viljoen, M.D.,William C. Sheldon, M.D. &SaulWinegrad, M.D.

1973 Herbert Spiegel, M.D. & Ernest E. Rockey, M.D.

1972 Samuel Rosen, M.D.,William S. Kroger, M.D.& Blaine S. Noshold, Jr., M.D.

1971 E. M. Papper, M.D., Albert M. Betcher, M.D.,SolomonG. Hershey, M.D. & Richard J. Kitz, M.D.

Between1971 and1977 thismemorial lecture serieswas in panel format. In 1978 it becamea single-lecturer series.


Problem-Based Learning Discussions |Monday, December 16, 2013PBLD-49 through PBLD-56 | Mid-Day Sessions • 11:45 - 12:45 • 6th Floor Rooms


Perioperative Control of HypertensionSpeaker:

Sudheer K. Jain, M.D.Assistant Professor of AnesthesiologyNYU-Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Describe the pathophysiology of hypertension;• Describe the concept of tight control of blood pressure;• Identify the different medications used to control blood pressure;• Formulate an anesthetic plan for the patient with hypertension.


STAT Cesarean Section: Spinal versus GeneralSpeakers:

Yaakov Beilin, M.D.Professor of Anesthesiology, Obstetrics & Gynecology andReproductive Sciences | Co-Director, Obstetric AnesthesiaVice-Chair, Quality | Icahn School of Medicine at Mount SinaiNewYork, NewYork

After completion of this session, the participant will be able to:• Evaluate fetal heart rate tracings and understand the etiology of the different types of fetal heart rate patterns;• Explain how opioids and anesthetics affect the fetus and the interpretation of the fetal heart rate tracing;• Formulate a labor analgesia plan for the parturient with an ominous fetal heart rate tracing;• Recognize the effects of spinal and general anesthesia on mother and baby;• Formulate a management plan for an emergency cesarean section.


Perioperative Management with Implantable Devices:Pacemakers/Automatic Implantable Cardioverter-Defibrillators (AICD)Speaker:

Diana Anca, M.D.Assistant Professor of Clinical Anesthesiology | Columbia University, College of Physicians & SurgeonsAttending Anesthesiologist | St. Luke’s-Roosevelt Hospital Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Describe the current indications for pacemakers/AICDs type of devices and their functions;• Perform a preoperative evaluation of the patient with implantable devices (pacemakers/AICDs);• Formulate a plan for perioperative management of patients with pacemakers/AICDs.

Disclosures:Drs. Abramovitz and Beilin did not disclose any financial relationships.Dr. Anca receives royalties from Merit Endotek.Dr. Jain received an honoraria from Arizant Healthcare.

Sharon Abramovitz, M.D.Associate Professor of AnesthesiologyCornell University, Weill Cornell Medical CollegeAttending AnesthesiologistNewYork-Presbyterian Hospital | NewYork, NewYork

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Pain Management in the Drug Addicted PatientSpeaker:Stelian I. Serban, M.D.Assistant Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify drug addiction vs. drug tolerance vs. physical dependence;• Assess the analgesic options regarding postoperative pain management;• Identify analgesic requirements in the perioperative period;• Formulate an outpatient strategic analgesic plan.


Management of the Patient with Severe PONVSpeaker:

Daphne Pierre-Paul, M.D.Assistant Professor of Anesthesiology | Cornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify the risk factors for development of PONV;• Formulate a comprehensive plan for the safe and effective prophylaxis and management of PONV.


IV Acetaminophen: Patient SelectionSpeakers:

SimonYu, M.D.Assistant Professor of AnesthesiologyAlbert Einstein College of Medicine/Montefiore Medical CenterBronx, NewYork

After completion of this session, the participant will be able to:• Discuss the pharmacology, indications and contraindications for IV acetaminophen;• Identify patients in their practice who would benefit from the administration of IV acetaminophen.


Dexmedetomidine: A 21st Century AnestheticSpeaker:

John L. Ard, Jr., M.D.Assistant Professor of Anesthesiology | NYU-Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Enumerate the pharmacodynamics and pharmacokinetics of dexmedetomidine;• Recognize the side effects of dexmedetomidine;• Formulate a plan utilizing dexmedetomidine in the operating room and in other locations.


Non-Invasive Hemodynamic MonitoringSpeaker:James A. Osorio, M.D.Assistant Professor of Anesthesiology | Cornell University, Weill Cornell Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Review various modalities for non-invasive hemodynamic monitoring;• Select patients and procedures in which non-invasive hemodynamic monitoring would be advantageous.

Disclosures:Drs. Ard, Lin, Osorio, Pierre-Paul, Serban and Yu did not disclose any financial relationships.

Emily Lin, M.D.Regional Anesthesiology FellowSt. Luke’s-Roosevelt HospitalNewYork, NewYork

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MiniWorkshops |Monday, December 16, 2013 | M-25 through M-27Mid-Day Sessions • 11:45 - 12:45 • 4th Floor Rooms


FAER Grant: What are They and How Do I Get One?Speaker:Denham S.Ward, M.D., Ph.D.President and CEO, Foundation for Anesthesia Education and ResearchProfessor Emeritus of Anesthesiology and Biomedical EngineeringUniversity of Rochester Medical CenterRochester, NewYorkAdjunct Professor of AnesthesiologyTufts School of MedicineBoston, Massachusetts

After completion of this session, the participant will be able to:• List the types of FAER grants;• Understand the grant submission process;• Avoid the common mistakes that keep a grant application from being successful.


Anesthesia for Difficult Orthopedic Procedures

Speaker:Mitchell H. Marshall, M.D.Clinical Associate Professor of AnesthesiologyNYU-Langone Medical CenterAttending AnesthesiologistNYU-Langone Medical Center-Hospital for Joint DiseasesNewYork, NewYork

After completion of this session, the participant will be able to:• Identify which procedures are at increased risk for perioperative complications;• Identify procedures which would benefit from additional monitoring;• Identify strategies to decrease blood lost.


Private Pain Practice: Does It Have a Future and How to Do It?

Speakers:Joel Kreitzer, M.D.Associate Clinical Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

After completion of this session, the participant will be able to:• Identify which interventions are evidence-based and will be reimbursed;• Which interventions are not evidenced-based and will not be reimbursed;• Identify strategies to survive under the new healthcare reimbursement guidelines.

Disclosures:Drs. Freedman, Kreitzer, Marshall andWard did not disclose any financial relationships.

Gordon Freedman, M.D.Associate Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiPartner, Upper East Side Pain Medicine, PCNewYork, NewYork


Workshop |Monday, December 16, 2013Morning Session • 12:00 - 15:00 • Empire Complex • 7th Floor

Workshop—W-13

Hands-On Management of Pacemakers and ICDs

WorkshopModerator: Marc E. Stone, M.D.Associate Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Assisted by:

Himani Bhatt, D.O., M.P.A.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Amanda J. Rhee, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Marc A. Rozner, Ph.D., M.D.Departments of Anesthesiology &CardiologyThe University of TexasMD Anderson Cancer CenterHouston, Texas

After completion of this session, the participant will be able to:• Disable ICD’s with a magnet;• Use a standard pacemaker box;• Identify the basic programming options for permanent pacemakers that are currently available on the market.

Disclosures:Drs. Bhatt, Rhee, Rozner and Stone did not disclose any financial relationships.

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After completion of this session, the participant will be able to:• Apply skills of dynamic decision making, resource management, leadership and teamwork to a crisis scenario in the operating

room;• Demonstrate communication and leadership skills in working with different personalities and behaviors during a crisis

scenario.

Disclosures:Drs. Burden, DeMaria, Khelemsky, Levy, Mahoney, Schwartz, Sim and Yudkowitz did not disclose any financial relationships.Dr. Levine is on the speakers bureau and receives consultant fees from Mylan Pharmaceuticals.

Workshop |Monday, December 16, 2013Mid-Day Session • 12:00 - 15:00 • Soho Complex • 7th Floor

Workshop—W-14

Simulation Experience for the Difficult Airway, Crisis Management andTeamTraining

Workshop Co-Moderators:Adam I. Levine,M.D.Professor of Anesthesiology, Otolaryngology,Structural and Chemical Biology | Vice-Chair of EducationProgramDirector, ResidencyTraining ProgramProgramDirector, ASA Endorsed HELPS Simulation ProgramDepartment of AnesthesiologyIcahn School of Medicine atMount Sinai | NewYork, NewYork

Assisted by:Amanda R. Burden, M.D.Assistant Professor of AnesthesiologyDirector Simulation ProgramCooper Medical School of RowanUniversityUMDNJ/RobertWood Johnson MedicalSchoolCamden, New Jersey


Ronald S. Levy, M.D., DABAProfessor of Anesthesiology,Neuroscience and Cell Biology, Divisionof AnatomyDistinguished Teaching Professor &Marie Hall ScholarDirector, Patient Simulation CenterDepartment of AnesthesiologyUniversity of Texas Medical BranchGalveston, Texas

Bryan P. Mahoney, M.D.Assistant Professor of AnesthesiologyOhio State UniversityColumbus, Ohio


Alan J. Sim, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiAssistant Program Director for ClinicalAffairs, Resident Training ProgramDivision of Liver TransplantationMount Sinai HELPS Simulation CenterNewYork, NewYork

Francine S. Yudkowitz, M.D., FAAPProfessor of Anesthesiology andPediatricsDirector, Pediatric AnesthesiaIcahn School of Medicine at Mount SinaiNewYork, NewYork



Scientific Panel |Monday, December 16, 2013Afternoon Session • 13:00 - 15:30 • North Ballroom • 6th Floor


Anesthesia Professionals and the Use of AdvancedMedical Technologies: Recommendations forEducation, Training and Documentation

Panel Moderator:Robert K. Stoelting, M.D.President, Anesthesia Patient Safety Foundation | Professor and Chair | Indiana University School of Medicine | Indianapolis, Indiana

After completion of this session, the participant will be able to:• Identify the need for training in advancedmedical technology and discuss its clinical importance;• Discuss the implementation of training programs in advancedmedical technology for practicing clinicians and how itmight

improve patient safety;• Explain appropriate documentation of completion of advancedmedical technology training;• Discuss the implementation of a training program in advancedmedical technology into an anesthesia group engaged in

teaching trainees.

Presentations:

Summary of the APSF Advanced Medical Technology Training Safety Initiative: Why This is aProblem That Needs to be Addressed?AlfredW. Paulsen, MMSc., Ph.D., AA-C, CCEProfessor of Medical Sciences | Frank Netter M.D. School of Medicine | Professor of Biomedical Sciences School ofHealth Sciences | Chair of Anesthesia Sciences | Quinnipiac University | Hamden, Connecticut

Why is Advanced Medical Technology Training Important from a Clinician’s Perspective andHow will it Impact Practicing Clinicians?Jeffrey M. Feldman, M.D., MSEDivision Chief, General Anesthesia | Children's Hospital of Philadelphia | Professor of Clinical AnesthesiologyPerelman School of Medicine | University of Pennsylvania | Philadelphia, Pennsylvania

HowTechnology Training was Implemented Successfully in an Academic Anesthesia ProgramMichael A. Olympio, M.D.Professor of Anesthesiology |Wake Forest University School of Medicine |Winston-Salem, North Carolina

An Ideal Technology Training Program with Assessment and DocumentationNikolaus Gravenstein, M.D.The JeromeH.Modell, M.D. Professor of Anesthesiology | Professor of Neurosurgery and PeriodontologyUniversity of Florida College of Medicine | Gainesville, Florida

Continued Competence in the Use of Advanced Medical Technology: Pro/Con from a HospitalPerspectiveNancy G. Pratt, R.N., M.S.N.Chief Quality and Safety Officer | St. Joseph's Health | Irvine, California

Disclosures:Drs. Olympio, Paulsen and Stoelting did not disclose any financial relationships.Dr. Feldman receives consultant fees from Draeger Medical, Inc.Dr. Gravenstein receives consultant fees from Carefusion Teleflex and is a shareholder with Xhale NanoMedex Pharmaceuticals.Ms. Pratt receives salary from St. Joseph's Systems.

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Scientific Panel |Monday, December 16, 2013Afternoon Session • 13:00 - 15:30 • South Ballroom • 6th Floor


Update on Pediatric Anesthesia for the Non-Sub-Specialist

Panel Moderator:

Nancy L. Glass, M.D., M.B.A., FAAPProfessor of Anesthesiology and Pediatrics | Baylor College of Medicine |Director, Chronic Pain ServiceTexas Children’s Hospital |Houston, Texas

After completion of this session, the participant will be able to:• Discuss new strategies for managing postoperative pain in children;• Describe two clinical scenarios in which regional anesthesia may be the best choice for anesthetic

management of the pediatric patient, and explain the rationale for choosing regional anesthesia over otheranesthetic options;

• Discuss the anesthetic management of the child with Down syndrome who presents for tonsillectomy;• Discuss risk factors, preventative strategies and the management of emergence delirium in the pediatric

patient.

Presentations:

Update on Pain Management for ChildrenRosalie F. Tassone, M.D., M.P.H.Associate Professor of Clinical Anesthesiology | University of Illinois at Chicago | Chicago, Illinois

A Block Might Be the Best Choice Here...Nancy L. Glass, M.D., M.B.A., FAAP

The Obese Down Syndrome Patient for Tonsillectomy...Debnath Chatterjee, M.D.Assistant Professor of Anesthesiology | Children's Hospital ColoradoUniversity of Colorado School of Medicine | Aurora, Colorado

SheWoke Like a Scene Out of the Exorcist...Emergence Delirium, Premedicationsand Parental PresenceBettina Smallman, M.D.Associate Professor of Anesthesiology | Director of Pediatric AnesthesiaSUNY-Upstate Medical University | Syracuse, NewYork

Disclosures:Drs. Chatterjee, Glass, Smallman and Tassone did not disclose any financial relationships.


Scientific Panel |Monday, December 16, 2013Afternoon Session • 13:00 - 15:30 • Astor Ballroom • 7th Floor


New Frontiers in Critical Care Medicine



Panel Moderator:Robert N. Sladen, M.B., Ch.B., FCCMProfessor and Vice Chair | Department of Anesthesiology | Chief, Division of Critical CareColumbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Recite the hepatic circulatory changes in liver failure and how they may be modified by vasopressin or

transplantation;• Explain the role of new renal biomarkers in the early diagnosis of acute kidney injury;• Identify the indications, mechanics and impact of veno-venous extracorporeal membrane oxygenation (VV-ECMO)

in acute and chronic lung failure;• Discuss the principles behind and clinical application of the latest generation ventricular assist devices (VADs)

used to treat advanced decompensated heart failure.

Presentations:

New Frontiers in Liver FailureGebhardWagener, M.D.Associate Professor of Clinical Anesthesiology | Chief, Division of Vascular Anesthesia MemberDivisions of Critical Care Medicine and Liver Transplant AnesthesiaColumbia University College of Physicians and Surgeons | NewYork, NewYork

New Frontiers in Kidney FailureAndrew D. Shaw, M.B., FRCA, FCCMAssociate Professor of Anesthesiology and Critical Care MedicineDuke University Medical Center/DurhamVAMC | Durham, North Carolina

New Frontiers in Lung FailureDaniel Brodie, M.D.Associate Professor of Medicine | Columbia University College of Physicians and SurgeonsNewYork, NewYork

New Frontiers in Heart FailureRobert N. Sladen, M.B., Ch.B., FCCM

Disclosures:Dr. Brodie receives research support from Maquet Cardiovascular and is on the Medical Advisory Board of ALung Technologies.Dr. Shaw receives funded research support from Astute Medical and consultant fees from NxStage Medical, Inc., BaxterInternational Inc. and Coviden.Dr. Sladen receives honoraria from Orion Pharma Hutchinson Technologies.Dr. Wagener did not disclose any financial relationships.

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Focus Sessions |Monday, December 16, 2013 | FS-24 & FS-25Afternoon Session • 15:45-17:00 • 4th Floor Rooms


Oral Presentation of Selected Posters on Display at PGA67Focus SessionModerator:Stephen A. Vitkun, M.D., M.B.A., Ph.D.SUNY Distinguished Teaching Professor | Professor of Anesthesiology and Vice Chair (Special Projects)Professor of Pharmacological Sciences | Professor of Health Sciences | SUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

Posters & Authors Invited to Participate:MCC-7126 Perioperative Management of a vonWillebrand Disease Jehovah'sWitness: Balancing Belief and Safety

Gabrielle Bonilla, M.D. | Department of Anesthesiology | Elmhurst Hospital Center | Elmhurst, NewYork

P-9015 Application of Lean and Six Sigma Methodologies to Improve the Efficiency of the OperatingRoom- A Systematic ReviewAhmad Elsharydah, M.D., M.B.A. | Department of Anesthesiology and Pain MedicineUT Southwestern Medical Center | Dallas, Texas

MCC-7205 Anesthetic Management of Stickler SyndromeAhmed Haque, M.D. | Department of Anesthesiology | SUNY-Health Sciences Center at Stony BrookStony Brook, NewYork

P-9045 Hyperbaric Oxygenation Therapy Alleviates Chronic Constriction Injury Induced Neuropathic Pain Via Inhibitionsof Pro-Apoptosis Genes and Apoptosis in the Spinal CordQinggang Hu, M.D. | Department of Anesthesiology | Upstate University Hospital | Syracuse, NewYork

P-9166 Does the Impact of the Type of Anesthesia on Outcomes Differ by Patient Age and Comorbidity Burden?Thomas Danninger, M.D. | Department of Anesthesiology | Hospital for Special Surgery | NewYork, NewYork

After completion of this session, the participant will be able to:• Assess new research for validity;• Develop programs in their institutions for residents to participate in research;• Develop programs for their residents to be able to write submissions of their research work to national meetings.


PACU ComplicationsFocus SessionModerator:David S. Bronheim, M.D.Associate Professor of Anesthesiology and Surgery | Director, Post Anesthesia CareIcahn School of Medicine at Mount Sinai | NewYork, NewYork


RestlessnessDavid S. Bronheim, M.D.

Residual Neuromuscular BlockCynthia A. Lien, M.D.Professor of Anesthesiology | Cornell University, Weill Cornell Medical College | Attending AnesthesiologistNewYork-Presbyterian Hospital | NewYork, NewYork

After completion of this session, the participant will be able to:• Develop a differential diagnosis of restlessness in the PACU;• Develop a treatment plan based on the differential diagnosis of restlessness;• Discuss the clinical issues surrounding undetected postoperative neuromuscular blockade;• Integrate into their practice methods to avoid undetected postoperative residual neuromuscular blockade.

Disclosures:Drs. Bonilla, Bronheim, Danniger, Elsharydah, Haque, Hu, Lien and Vitkun did not disclose any financial relationships.


Focus Sessions |Monday, December 16, 2013 | FS-26 & FS-27Afternoon Session • 15:45-17:00 • various Rooms


History of Anesthesia VignettesFocus SessionModerator:Elizabeth A. M. Frost, M.D.Clinical Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:The Influence of NewYork Anesthesiologists on Anesthesia in The United StatesElizabeth A. M. Frost, M.D.

Development of Cardiac Anesthesia and Education in Cardiac Anesthesia in AsiaMinoru Nomura, M.D.Professor of Anesthesiology |Director, Cardiovascular Anesthesia | TokyoWomen's Medical University | Tokyo, Japan

After completion of this session, the participant will be able to:• Discuss the influence of NY on anesthesia in the US;• Discuss training in Asia for cardiac anesthesia;• Audience will be able to appreciate differences in training and practice between US and Asia which will allow

for better communication between practitioners from these areas.


Challenges in Obstetric AnesthesiaFocus SessionModerator:Yaakov Beilin, M.D.Professor of Anesthesiology, Obstetrics & Gynecology and Reproductive Sciences | Co-Director, Obstetric AnesthesiaVice-Chair, Quality | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:Anesthesia for External Cephalic VersionYaakov Beilin, M.D.

Morbid ObesityGilbert J. Grant, M.D.Associate Professor of Anesthesiology | Vice Chair for Academic Affairs | Director of Obstetric AnesthesiaNYU-Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the problems of obesity and pregnancy;• Develop a plan to manage the delivery of a morbidly obese patient.

Disclosures:Drs. Beilin, Frost, Grant and Nomura did not disclose any financial relationships.

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Focus Sessions |Monday, December 16, 2013 | FS-28 & FS-29Afternoon Session • 15:45-17:00 • 7th Floor Rooms


Perioperative Challenges in the Patient with Heart Disease

Focus SessionModerator:Paul G. Barash, M.D.Professor of Anesthesiology | Yale University, School of Medicine | New Haven, Connecticut

Faculty Presentations:Patient with StentPaul G. Barash, M.D.

Adult with Repaired Congenital Heart DiseaseMaya Jalbout Hastie, M.D.Assistant Professor of Anesthesiology | Associate Director, Adult Cardiothoracic Anesthesia Fellowship ProgramDivision of Cardiothoracic Anesthesiology | Columbia University, College of Physician and SurgeonsNewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the clinical issues related to the two main types of coronary stents;• Stratify the perioperative risks for patients with intracoronary stents;• Develop management strategies for patients with different types of intracoronary stents;• Discuss the most common sequelae of repaired congenital heart disease;• Developmanagement strategies for patientswith repaired congenital heart diseasewith orwithout residual lesions;• Develop management strategies for patients with Fontan physiology.


Medical EducationFocus SessionModerator:Janine R. Shapiro, M.D.Associate Dean, Faculty Development | Medical Director, Continuing Medical EducationProfessor of Anesthesiology | University of Rochester School of Medicine and Dentistry | Rochester, NewYork

Faculty Presentations:Helping Learners Develop Self-Directed Lifelong Learning SkillsJanine R. Shapiro, M.D.

Ensuring Competency During and After Anesthesiology TrainingCarolAnn B. Diachun, M.D.Associate Professor of Anesthesiology | Chair, Clinical Competency CommitteeUniversity of Rochester School of Medicine and Dentistry | Rochester, NewYork

After completion of this session, the participant will be able to:• Describe milestones for anesthesiology residency training;• Access specific assessment tools to measure milestones;• Describe the role of the components of the ABA MOCA® process for continued competency after training;• Understand the theoretical framework for self-regulated learning in medical education;• Apply this framework to a model for self-regulated learning that includes a cycle of four phases: planning, learning,

assessment and adjustment;• Appreciate the pivotal role that educators play in helping learners develops self-directed learning skills.

Disclosures:Drs. Barash, Diachun, Jalbout Hastie and Shapiro did not disclose any financial relationships.


Problem-Based Learning Discussions |Monday, December 16, 2013PBLD-57 through PBLD-64 | Afternoon Sessions • 15:45 - 17:00 • 6th Floor Rooms


Impact of Dexamethasone on Post-Op AnalgesiaSpeaker:

Jacques T. YaDeau, M.D., Ph.D.Associate Attending Anesthesiologist | Hospital for Special Surgery | Clinical Associate Professor of AnesthesiologyCornell University, Weill Cornell Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Review data regarding the impact of dexamethasone on post-operative analgesia;• Recognize side effects of dexamethasone;• Implement a plan utilizing dexamethasone in the appropriate patient.


Methadone and Ketamine: New Uses for Old MedicationsSpeaker:David J. Kopman, M.D.Assistant Professor of Anesthesiology | Cornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Review the use of several narcotic analgesics during major spine surgery;• Develop a patient care plan which incorporates the need for post-operative pain management in the intraoperative plan.


Stents, Drains and Clamps: De-Mystifying the AnestheticConsiderations for Thoraco-Abdominal Aneurysm RepairSpeaker:

Nikolaos J. Skubas, M.D., FASEAssociate Professor of Anesthesiology | Director, Cardiac Anesthesia | Cornell University, Weill Cornell Medical CollegeNewYork, NewYork

After completion of this session, the participant will be able to:• Identify the pathophysiology of spinal cord injury during thoraco-abdominal aortic aneurysm (TAAA) surgery with or

without aortic cross-clamping;• Identify the utility of different monitoring devices during TAAA surgery: cerebro-spinal fluid pressure, drainage and

paraplegia, echocardiography and stent application, central venous and pulmonary artery pressures, and cardiac function;• Describe the specific anesthetic and surgical considerations associated with endovascular stent insertion;• Formulate a plan for the use of partial cardiopulmonary bypass, if necessary, during TAAA repair.


I CannotPlaceanArterial Line: What Else theBloodPressureCuff CanTellYouSpeakers:Manuel L. Fontes, M.D.Professor of Anesthesiology | Duke University Medical CenterDurham, North Carolina

After completion of this session, the participant will be able to:• Classify hypertension according to subtypes;• Describe the pathophysiology of systolic hypertension and diastolic hypertension;• Formulate a plan for managing the hypertensive patient without the use of an A-Line.

Disclosures: Drs. Crane, Fontes, Kopman, Skubas and YaDeau did not disclose any financial relationships.

Amy E. Crane, M.D.Instructor in AnesthesiologyCornell University, Weill Cornell Medical CollegeNewYork, NewYork

Monday



Why Don’tWe All Get the Same Healthcare?Speaker:Gregory E. Kerr, M.D., M.B.A., FCCMAssociate Professor of Anesthesiology | Cornell University, Weill Cornell Medical CollegeMedical Director, Critical Care Services | NewYork- Presbyterian Hospital | NewYork, NewYork

After completion of this session, the participant will be able to:• Recognize various cultural differences in a patients approach to medical care and dealing with illness;• Formulate a plan for educating anesthesiology colleagues regarding issues of cultural diversity.


Maximizing Scheduling and Operating Room EfficiencySpeaker:

Kenneth I. Rosenfeld, M.D.Interim Chair, Department of Anesthesiology | Vice-Chair, Clinical Activities | Department of AnesthesiologyDirector of Perioperative Services | SUNY-Health Sciences Center at Stony Brook | Stony Brook, NewYork

After completion of this session, the participant will be able to:• Identify specific measurements to assess the efficiency of the operating room;• Determine the importance of appropriate OR time allocation;• Develop a plan to maximize OR efficiency in their own institution.


Statins and Perioperative Myocardial Infarction (MI)Speaker:Natalia S. Ivascu, M.D.Assistant Professor of Anesthesiology | Cornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Recognize patient risk factors for perioperative myocardial infarction (MI);• Identify effective pharmacologic strategies for cardio protection in the patient undergoing non-cardiac surgery;• Apply methods of detecting a postoperative MI;• Formulate an appropriate plan for managing the postoperative patient who is having an MI.


Severe Cervical Stenosis with Cord Compression in a Patient with RenalFailure: Cirrhosis and a Pulmonary Artery Pressure of 90/40Speakers:Patricia Fogarty Mack, M.D.Assistant Professor of Clinical AnesthesiologyCornell University, Weill Cornell Medical CollegeNewYork, NewYork

After completion of this session, the participant will be able to:• Understand various etiologies of pulmonary hypertension;• Determine the essential elements of preoperative evaluation in the patient with pulmonary hypertension;• Formulate a plan for the management of a critically ill patient requiring urgent neurologic surgery.

Disclosures:Drs. Fogarty Mack, Kerr, Ivascu and Sandadi did not disclose any financial relationships.Dr. Rosenfeld is on the Merck & Co., Inc. speakers bureau.

Jennifer Sandadi, M.D.Assistant Professor of AnesthesiologyDivision of Cardiothoracic Intensive CareNewYork-Presbyterian HospitalCornell University, Weill Cornell Medical CollegeNewYork, NewYorkM

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Tuesday

Tuesday, December 17, 2013Times

Registration ....................................................................................................................................... 07:00MiniWorkshops.................................................................................................................07:45 & 11:45Hands-OnWorkshops .................................................................................................... 08:00 & 12:00Scientific Panels.................................................................................................................09:00 & 13:00Problem-Based Learning Discussions ...................................................................................... 11:45Focus Sessions ...................................................................................................................................15:45


67th Annual






Tuesday

MiniWorkshops | Tuesday, December 17, 2013 | M-28 through M-30Morning Sessions • 07:45 - 08:45 • 4th Floor Rooms


Neuroanesthesia Update: Changes in Clinical Practice

Speaker:Apolonia E. Abramowicz, M.D.Associate Professor of Clinical Anesthesiology and Clinical Neurosurgery | Albert Einstein School of MedicineDirector, Neuroanesthesia | Montefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Identify new Neuroanesthesia Emergencies and review their systems-based and clinical management: acute ischemic and

hemorrhagic stroke;• Review the implications of new warfarin effect reversal agent and oral anticoagulants in the anesthetic management of

intracranial hemorrhage;• Assess the importance to Neuroanesthesiologists of recent national Cervical Spinal Cord Injury and Aneurysmal

Subarachnoid Hemorrhage Management Guidelines;• Discuss new interventional modalities in the treatment of intracranial aneurysms and their implications for

Neuroanesthesia practice;• Describe new applications of commonly used anesthetic drug combinations for procedure-mandated patient cooperation

(spinal cord stimulation, Co.Pa.Ge.A).


Neonatal Anesthesia Update

Speaker:Neeta R. Saraiya, M.D.Assistant Professor of Anesthesiology | Columbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the role of newer anesthetic agents in the neonatal period;• Discuss the requirements for postoperative observation in very young neonates;• Enumerate the common complications encountered in neonatal anesthesia.


Coagulation Challenges During Perioperative Period

Speaker:Tiffany R. Tedore, M.D.Assistant Professor of Anesthesiology | Chief, Regional Anesthesia | NewYork-Presbyterian HospitalCornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Evaluate the risk factors for perioperative thromboembolism;• Recognize the need for prophylaxis for deep vein thrombosis;• Identify the medications contributing to enhance thromboembolism;• List the tests to monitor anticoagulation activities;• Assess the implications on the neuroaxial procedures;• New agents for anti-coagulation will be reviewed with respect to their role in the settings of atrial fibrillation and acute

coronary syndromes and their impact on anesthetic management.

Disclosures:Drs. Abramowicz and Saraiya did not disclose any financial relationships.Dr. Tedore's spouse receives a salary and is a shareholder of TG Therapeutics.


Tuesday

Workshop | Tuesday, December 17, 2013Morning Session • 08:00 - 11:00 • Empire Complex • 7th Floor

Workshop — W-15

Beyond Direct Laryngoscopy:Fiberoptic and Other Techniques for Adult and Pediatric Management

WorkshopModerator: RichardM. Sommer, M.D.Vice Chair, Clinical Operations |Department of AnesthesiologyNYU-Langone Medical Center | NewYork, NewYork

Assisted by:

After completion of this session, the participant will be able to:• Perform airway evaluation, patient preparation and techniques of fiberoptic intubation, video laryngoscopy and

transtracheal jet ventilation for adult and pediatric patients.

Disclosures:Drs. Fermon, Jacobson, Jagannathan, Lax, Samuels, Sequiera, Sommer, Spessot, Sutin and Yarmush did not disclose anyfinancial relationships.Dr. Osborn receives material support from Covidien, Inc.Dr. Ruskin receives consultant fees from Masimo Corporation.

Charles M. Fermon, M.D.Professor of Anesthesiology (Clinical)NYU-Langone Medical CenterNewYork, NewYork

Kenneth H. Jacobson, M.D.Attending AnesthesiologistCook Children’s Medical CenterFortWorth, Texas

Narasimhan Jagannathan, M.D.Associate Professor of AnesthesiologyDirector of Anesthesia ResearchNorthwestern University Feinberg Schoolof MedicineAnn & Robert H. Lurie Children's Hospitalof ChicagoChicago, Illinois

Jerome Lax, M.D.Assistant Professor of Clinical AnesthesiologyNYU-Langone Medical CenterNewYork, NewYork

Irene P. Osborn, M.D.Associate Professor of AnesthesiologyDirector, NeuroanesthesiaIcahn School of Medicine at Mount SinaiNewYork, NewYork

Keith J. Ruskin, M.D.ProfessorofAnesthesiologyandNeurosurgeryYale University, School of MedicineNew Haven, Connecticut

Jon D. Samuels, M.D.Assistant Professor of Clinical AnesthesiologyJoan and Sanford I. Weill Medical CollegeofWeill Cornell UniversityNewYork, NewYork

Patricia M. Sequeira, M.D.Assistant Professor of AnesthesiologyNYU-Langone Medical CenterNewYork, NewYork

George J. Spessot, M.D.Clinical Associate Professor of AnesthesiologyNYU-Langone Medical CenterAttending AnesthesiologistNYU-Langone Medical Center-Hospital forJoint DiseasesNewYork, NewYork

KennethM. Sutin, M.D.Associate Professor, ClinicalAnesthesiology and Clinical SurgeryNYU-Langone Medical CenterAssistant Director, Critical CareBellevue HospitalNewYork, NewYork

Leslie N. Yarmush, M.D.Staff AnesthesiologistMichael E. DeBakey VA Medical CenterHouston, Texas


Tues

day

Workshop | Tuesday, December 17, 2013Morning Session • 08:00 - 11:00 • Soho Complex • 7th Floor

Workshop—W-16

Ultrasound for Vascular Access: AWorkshop

Workshop Co-Moderators:Nikolaos J. Skubas, M.D., FASE Anup Pamnani, M.D.Associate Professor of Anesthesiology Assistant Professor of AnesthesiologyDirector, Cardiac Anesthesia Cornell University, Weill Cornell Medical CollegeCornell University, Weill Cornell Medical College Attending AnesthesiologistNewYork, NewYork NewYork-Presbyterian Hospital


After completion of this session, the participant will be able to:• Demonstrate basic skills in ultrasound technology;• Utilize ultrasound technology for central venous and arterial access;• Optimize billing for ultrasound use in vascular access.

Disclosures:Drs. Fitzgerald, Kumar, Pamnani and Skubas did not disclose any financial relationships.Dr. Mittnacht receives honoraria from Abiomed.

How to Optimize ImagingMeghannM. Fitzgerald, M.D.Assistant Professor of AnesthesiologyCornell University, Weill Cornell Medical CollegeNewYork, NewYork

Central Venous CannulationAnup Pamnani, M.D.

Arterial CannulationAlexander J. C. Mittnacht, M.D.Associate Professor of AnesthesiologyDirector, Pediatric Cardiac AnesthesiaIcahn School of Medicine at Mount SinaiNewYork, NewYork

Logistics and BillingNikolaos J. Skubas, M.D., FASE

Break-Out SessionsShreyajit R. Kumar, M.D.Assistant Professor of AnesthesiologyCornell University, Weill Cornell Medical CollegeNewYork, NewYork


Tuesday

Scientific Panel | Tuesday, December 17, 2013Morning Session • 09:00 - 11:30 • North Ballroom • 6th Floor


Patient Blood Management: New Approaches to Old ProblemsPanel Moderator:Linda J. Shore-Lesserson, M.D., FASEProfessor of Anesthesiology | Hofstra Northshore-Long Island Jewish School of MedicineDirector, Cardiovascular Anesthesiology | Northshore-Long Island Jewish Medical Center | New Hyde Park, NewYork

After completion of this session, the participant will be able to:• Explain the term“patient blood management”and discuss optimal blood management in the perioperative

and critical care setting;• Identify the problems associated with the “shelf life”of banked RBC’s;• Explain the concept of “storage lesion” - its mechanisms, clinical implications – and the economic and medical

challenges of consistently providing “young” red blood cells.• Explain the advantages and disadvantages of point of care coagulation testing equipment, and how this

equipment can be used to improve perioperative patient care and minimize transfusion;• Summarize pharmacologic therapies available to treat coagulation disorders in the perioperative period.

Presentations:Focus on How to Develop and Implement a Preoperative Anemia ManagementProgramAryeh Shander, M.D., FCCM, FCCPChief, Departments of Anesthesiology, Critical CareMedicine, PainManagement and Hyperbaric MedicineEnglewood Hospital and Medical Center | Englewood, New JerseyClinical Professor of Anesthesiology, Medicine and Surgery | Icahn School of Medicine at Mount SinaiNewYork, NewYork

Evidence for Point of Care Coagulation Testing in the Surgical PatientKenichi Tanaka, M.D., M.Sc.Professor of Anesthesiology |University of Pittsburgh Medical Center | Pittsburgh, Pennsylvania

Does the Age of Transfused RBC's Matter?Idit Matot, M.D.Chair, Division of Anesthesiology, Critical Care and Pain | Tel Aviv Medical CenterProfessor of Anesthesiology | Sackler School of Medicine, Tel Aviv University | Tel Aviv, Israel

Drugs versus Blood to Treat BleedingMichael P. Eaton, M.D.Denham S.Ward Professor and Chair |Department of AnesthesiologyExecutive Director, Perioperative Services |University of Rochester School of Medicine and DentistryRochester, NewYork

Disclosures:Dr. Eaton receives funded research support from Grifols TEM Systems and receives consultant fees from Thrombate III® andGrifols TEM Systems.Drs. Matot and Shore-Lesserson did not disclose any financial relationships.Dr. Shander receives funded research support from CLS Behring, Masimo Corporation, OPK Biotech, LLC, US Department ofDefense and ZymoGenetics, Inc. Consultant fees from AMAG Pharmaceuticals, Inc., Baxter, CSL Behring, Defense AdvancedResearch Projects Agency (DARPA), Deerfield Institute, Inc., Gauss Surgical, HemoCue, Masimo Corporation, New Jersey StateDistrict Attorney, OPK Biotech, LLC, ZymoGenetics, Inc. and honoraria from Baxter, CSL Behring, Masimo Corporation,ZymoGenetics, Inc. He also has stock options with Gauss Surgical.Dr. Tanaka receives funded research support from CSL Behring, consultant fees from Grifols TEM Systems and material supportfrom Fujimori Kogyo, Co., LTD.


Tues

day

Scientific Panel | Tuesday, December 17, 2013Morning Session • 09:00 - 11:30 • South Ballroom • 6th Floor


Anesthetic Considerations for Ambulatory Surgery

Panel Moderator:Rebecca S. Twersky, M.D., M.P.H.Professor, Vice-Chair for Research | Department of Anesthesiology | Medical Director, Ambulatory Surgery UnitSUNY Downstate Medical Center | Brooklyn, NewYork

After completion of this session, the participant will be able to:• Discuss the safe management of obese patients who present for surgery in an ambulatory, or office-based

setting;• Discuss the concept of the perioperative surgical home and how ambulatory surgery fits with this model;• Discuss clinically important strategies to improve the quality of recovery after anesthesia in the ambulatory

surgery setting;• Discuss new advancements in the management of acute pain in the ambulatory setting.

Presentations:What is your BMI Cutoff for Morbid Obesity in an ASC and Office Practice?Tracey L. Stierer, M.D.Assistant Professor of Anesthesiology and Critical Care Medicine | Division Director of Clinical QualityDepartment of Anesthesiology and Critical Care Medicine | The Johns Hopkins University School ofMedicine | Baltimore, Maryland

New Directions for Ambulatory Surgery: The Perioperative Surgical HomeAlan E. Curle, M.D.Associate Professor of Clinical Anesthesiology | Director, Center for Perioperative MedicineUniversity of Rochester Medical Center | Medical Director of Perioperative Services | Highland HospitalRochester, NewYork

Improving Quality of Recovery After Ambulatory SurgeryGildasio S. De Oliveira Jr., M.D., MSCIAssociate Chair, Research | Department of Anesthesiology | Feinberg School of MedicineNorthwestern University | Chicago, Illinois

Acute Pain Management in the ASC: Anything New?Eugene R. Viscusi, M.D.Professor of Anesthesiology | Director, Acute Pain Management | Jefferson Medical CollegeThomas Jefferson University | Philadelphia, Pennsylvania

Disclosures:Drs. Curle, Stierer and Twersky did not disclose any financial relationships.Dr. De Oliveira receives funded research support from Baxter International Inc. and Cadence Pharmaceuticals, Inc. He is on thespeakers bureau for Baxter International Inc. and receives material support from Radiometer of America Inc.Dr. Viscusi receives funded research support from AcelRx Pharmaceuticals, Inc., Adolor Corporation, Cadence Pharmaceuticals, Inc.,Cumberland Pharmaceuticals, Inc. and Pacira Pharmaceuticals, Inc. He receives consultant fees from AcelRxPharmaceuticals, Inc., Cadence Pharmaceuticals, Inc., Cubist Pharmaceuticals, Incline Therapeutics, Pacira Pharmaceuticals, Inc.,Salix Pharmaceuticals, and is on the Cadence Pharmaceuticals, Inc. speakers bureau.


Tuesday

MiniWorkshops | Tuesday, December 17, 2013 | M-31 through M-33Mid-Day Sessions • 11:45 - 12:45 • 4th Floor Rooms


Ocular Effects of the Prone PositionSpeaker:Apolonia E. Abramowicz, M.D.Associate Professor of Clinical Anesthesiology and Clinical Neurosurgery | Albert Einstein School of MedicineDirector, Neuroanesthesia | Montefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Define the anatomic differences in the different forms of postoperative vision loss;• Delineate the factors that appear to be critical in contributing to the development of POVL;• Employ recommended strategies to minimize risk of prone position-related postoperative visual loss.


Update on Pediatric Outpatient AnesthesiaSpeaker:Rebecca N. Lintner, M.D.Director, Pediatric Anesthesia | Montefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Delineate the approach to airway assessment and management;• Identify the intraoperative complications which may arise;• Enumerate at least three postoperative complications which may occur.


Update on Controlling Postoperative Nausea and Vomiting (PONV)

Speaker:Kenneth I. Rosenfeld, M.D.Interim Chair, Department of Anesthesiology | Vice-Chair, Clinical Activities | Department of AnesthesiologyDirector of Perioperative Services | SUNY-Health Sciences Center at Stony Brook | Stony Brook, NewYork

After completion of this session, the participant will be able to:• Describe the pathophysiology of postoperative vomiting;• Enumerate the associated factors for PONV;• Compare and contrast the pharmacologic treatment option;• Formulate treatment options for the patient with PONV.

Disclosures:Drs. Abramowicz and Linter did not disclose any financial relationships.Dr. Rosenfeld is on the Merck & Co., Inc. speakers bureau.


Tuesday

Problem-Based Learning Discussions | Tuesday, December 17, 2013PBLD-65 through PBLD-72 | Mid-Day Sessions • 11:45 - 12:45 • 6th Floor Rooms


Full Stomach versus Full Esophagus: Should Your Upper GI EndoscopyBe Intubated?Speaker:Milica Markovic, M.D.Instructor in Anesthesiology | Cornell University, Weill Cornell Medical College | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the indications for intubation for upper endoscopy;• Evaluate the patient for upper endoscopy for risk of aspiration;• Utilize aspiration precautions in the patient at risk for aspiration.


Anesthesia for the Extremely Elderly PatientSpeakers:Bessie Kachulis, M.D.Assistant Professor of Anesthesiology | Division of Cardiothoracic AnesthesiologyColumbia University, College of Physicians & Surgeons | NewYork, NewYork

After completion of this session, the participant will be able to:• Identify physiologic changes associated with aging;• Perform a preoperative evaluation including the important elements related to the geriatric patient;• Assess risks and benefits of various anesthetic techniques in elderly patients;• Formulate a plan for the management of the elderly patient in the perioperative period.


Herbals and Alternate Medicine: Impact on Anesthesia CareSpeaker:Jan Boublik, M.D., Ph.D.Assistant Professor of Anesthesiology | NYU-Langone Medical CenterNewYork, NewYork

After completion of this session, the participant will be able to:• Identify various "alternative" vitamin and herbal medications commonly used by patients;• Discuss those herbal medications and vitamins that have interactions with commonly used anesthetics;• Develop a plan to preoperatively identify and modify the use of herbal medications by patients prior to anesthesia.


Managing the Patient with HELLP SyndromeSpeakers:Stephanie R. Goodman, M.D.Clinical Professor of AnesthesiologyColumbia University, College of Physicians & SurgeonsNewYork, NewYork

After completion of this session, the participant will be able to:• Diagnose the parturient with HELLP Syndrome;• Identify the anesthetic implications of HELLP Syndrome;• Manage the HELLP Syndrome patient in the peripartum period.

Disclosures:Drs. Goodman, Kachulis, Lee, Lopez and Markovic did not disclose any financial relationships.Dr. Boublik's spouse is Director of Health Economics and outcomes research at Pfizer, Inc.

Carlos J. Lopez, III, M.D.Assistant Professor of AnesthesiologySUNY-Upstate Medical UniversitySyracuse, NewYork

Allison J. Lee, M.D.Clinical Professor of AnesthesiologyColumbia University, College of Physicians & SurgeonsNewYork, NewYork


TuesdayProblem-Based Learning Discussions— PBLD-69 - Shubert Room

Adenotonsillectomy in the Child with Sleep Apnea SyndromeSpeaker:Cheryl K. Gooden, M.D.Associate Professor of Anesthesiology and Pediatrics | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Define and describe the pathophysiology of obstructive sleep apnea syndrome in the pediatric patient (OSA);• Identify risk factors for OSA in pediatric patients;• Recognize the basic features of polysomnography (PSG);• Formulate an anesthetic plan for this child;• Implement the clinical practice guidelines of the American Academy of Pediatrics and American Society of

Anesthesiologists on OSA.


Dexmedetomidine versus Propofol: Advantages and Limitations forProcedural Sedation versus the Intubated Patient in the Intensive CareUnitSpeakers:Keira P. Mason, M.D.Associate Professor of Anesthesia | Harvard Medical SchoolChildren’s Hospital Boston | Boston, Massachusetts

After completion of this session, the participant will be able to:• Review the pharmacokinetics and dynamics of each drug when applied as a sedative;• Understand the advantages and limitations of propofol and dexmedetomidine;• Enumerate the contraindications to dexmedetomidine and propofol usage;• Formulate a plan to decide which drug lends itself best to the clinical situation.


The Fluid and Ventilatory Management of the Patient with ARDS/TRALISpeaker:Shaji P. Poovathoor, M.D.Assistant Professor of Anesthesiology | SUNY-Health Sciences Center at Stony Brook | Stony Brook, NewYork

After completion of this session, the participant will be able to:• Identify patients at risk for ARDS/TRALI;• Implement ventilator and fluid strategies that will minimize the occurrence of ARDS/TRALI;• Apply techniques in the management of patients diagnosed with ARDS/TRALI.


Regional Anesthesia in the Patient with Pre-Existing NeuropathySpeaker:Ali N. Shariat, M.D.Assistant Professor of Anesthesiology | St. Luke's-Roosevelt Hospital Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the risks and benefits of regional anesthesia in patients with neuropathy;• Define the mechanisms of nerve damage as it relates to normal patient’s verses those with neuropathy;• Apply the new ASRA Guidelines for the Prevention of Neurological Injuries in their practice.

Disclosures:Drs. Gooden, Kelhoffer, Poovathoor and Shariat did not disclose any financial relationships.Dr. Mason receives funded research support from Hospira, Inc.

Eric R. Kelhoffer, M.D.Associate Clinical Member | Anesthesiology & Critical CareMemorial Sloan-Kettering Cancer Center | NewYork, New York


Tuesday

Workshop | Tuesday, December 17, 2013Mid-Day Session • 12:00 - 15:00 • Empire Complex • 7th Floor

Workshop — W-17

Regional Anesthesia for Surgery of the Head and Neck

Workshop Co-Moderators:Adam I. Levine, M.D.Professor of Anesthesiology, Otolaryngology,Structural and Chemical Biology | Vice-Chair of EducationProgramDirector, ResidencyTraining ProgramProgramDirector, ASA Endorsed HELPS Simulation ProgramDepartment of AnesthesiologyIcahn School of Medicine atMount Sinai | NewYork, NewYork

Assisted by:

After completion of this session, the participant will be able to:• Describe how to perform nerve blocks (for anesthesia and analgesia) of the head and neck, and the equipment used in

performing these blocks;• Compare different techniques when performing these blocks, especially for the supraorbital, supratrochlear, infraorbital

nerve and sphenopalatine ganglion blocks;• Compare the evidence for the use of these blocks for head and neck surgeries;• Describe the various ways to anesthetize the airway for bronchoscopic and limited pharyngeal surgery, airway

management;• Understand the indications, contraindications and complications associated with regional anesthesia and analgesia of the

head and neck.

Disclosures:Drs. DeMaria, Gritsenko, Khelemsky, Schwartz and Sim did not disclose any financial relationships.Dr. Levine is on the speakers bureau and receives consultant fees from Mylan Pharmaceuticals.

Karina Gritsenko, M.D.Resident, Department of AnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

Andrew D. Schwartz, M.D.Instructor of AnesthesiologyIcahn School of Medicine at Mount SinaiStaff Anesthesiologist, James J. Peters VA Medical CenterEducation Director, HELPS Simulation CenterNewYork, NewYork


Alan J. Sim, M.D.Assistant Professor of AnesthesiologyIcahn School of Medicine at Mount SinaiAssistant Program Director for Clinical Affairs,Resident Training ProgramDivision of Liver TransplantationMount Sinai HELPS Simulation CenterNewYork, NewYork



Tuesday

Workshop | Tuesday, December 17, 2013Mid-Day Session • 12:00 - 15:00 • Soho Complex • 7th Floor

Workshop — W-18




Station IV Simulation and Equipment for Performing Peripheral Nerve Blocks


Assisted by:


Disclosures:Drs. Albert, Altman, Anderson, Atchabahian, Birmingham, Capan, Chen, Feng, Jeng, J.T. Kim, S. Kim, Kitain, Lee, Ludwin, Popovic,Rosenblatt, Spessot, Wambold andWardhan did not disclose any financial relationships.Dr. Durkin receives honoraria from Sonosite.Dr. Tedore’s spouse receives a salary and is a shareholder of TG Therapeutics.

Robert A. Altman, M.D.Attending AnesthesiologistNYU-Langone Medical Center-Hospitalfor Joint DiseasesNewYork, NewYork


Arthur Atchabahian, M.D.Associate Professor of ClinicalAnesthesiologyNYU-Langone Medical Center-Hospitalfor Joint DiseasesNewYork, NewYork

PatrickBirmingham,M.D., FAAPProfessor of AnesthesiologyNorthwestern University FeinbergSchool of MedicineDivision Head of Pain MedicineAssociate Chair, Department ofAnesthesiologyAnn & Robert H. Lurie Children’s Hospitalof ChicagoChicago, Illinois

LevonM. Capan, M.D.Professor of AnesthesiaNYU-Langone Medical CenterAssociate Director, AnesthesiaBellevue Hospital CenterNewYork, NewYork

Steve S. Chen, M.D.Assistant Professor of AnesthesiologySUNY-Health Sciences Center at StonyBrookStony Brook, NewYork

Brian T. Durkin, D.O.Assistant Professor of AnesthesiologyDirector, Center for Pain ManagementSUNY- Health Sciences Center at StonyBrookStony Brook, NewYork

Cynthia L. Feng, M.D.Assistant Professor of AnesthesiologyNYU-Langone Medical Center-Hospitalfor Joint DiseasesNewYork, NewYork

Christina L. Jeng, M.D.Assistant Professor of Anesthesiologyand OrthopaedicsIcahn School of Medicine at Mount SinaiNewYork, NewYork

JungT. Kim, M.D.Associate Professor of ClinicalAnesthesiologyVice Chair, Chief of ServiceDepartment of AnesthesiologyMedical Director, Perioperative SurgicalServicesNYU-Langone Medical CenterNewYork, NewYork




Danielle B. Ludwin, M.D.Assistant Professor of AnesthesiologyColumbia University, College ofPhysicians & SurgeonsNewYork, NewYork

Jovan Popovic, M.D., FRCPCAssistant Professor of AnesthesiologyNYU-Langone Medical CenterMedical Director, NYU LangoneOutpatient SurgeryNewYork, NewYork

Meg A. Rosenblatt, M.D.Professor of Anesthesiology andOrthopaedicsDirector, Division of OrthopaedicAnesthesiologyIcahn School of Medicine at Mount SinaiNewYork, NewYork

George J. Spessot, M.D.Clinical Associate Professor ofAnesthesiologyNYU-Langone Medical CenterAttending AnesthesiologistNYU-Langone Medical Center-Hospitalfor Joint DiseasesNewYork, NewYork

Tiffany R. Tedore, M.D.Assistant Professor of AnesthesiologyChief, Regional AnesthesiaNewYork-Presbyterian HospitalCornell University, Weill Cornell MedicalCollegeNewYork, NewYork

Daniel B.Wambold, M.D.Attending AnesthesiologistThe Valley HospitalRidgewood, New Jersey

RichaWardhan, M.D.Fellowship Director and AssociateDirector, Regional AnesthesiaDepartment of AnesthesiologyYale School of MedicineNew Haven, Connecticut



Scientific Panel | Tuesday, December 17, 2013Afternoon Session • 13:00 - 15:30 • North Ballroom • 6th Floor


Fifteenth Annual Bragging Contest:Any Case You Have Done, I Have Done a Better OnePanel Moderator:CliffordM. Gevirtz, M.D., M.P.H.Medical Director | Somnia Pain Management | NewYork, NewYork

After completion of this session, the participant will be able to:• The participant will be able to describe the principles necessary to formulate an anesthetic management plan for complex

surgical procedures, patients with unusual co-morbidities and procedures performed in unusual locations.

Presentations:Representing: Albany Medical CenterLaura Leduc, M.D.Assistant Professor of Anesthesiology | Albany Medical Center | Albany, NewYork

Representing: Icahn School of Medicine at Mount SinaiAllan P. Reed, M.D.Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Diana H. Hekmat, M.D.Resident, Department of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Representing: NewYork-Presbyterian Hospital Cornell University, Weill Cornell Medical CollegeJon D. Samuels, M.D.Assistant Professor of Clinical Anesthesiology | Joan and Sanford I. Weill Medical College ofWeillCornell University | NewYork, NewYork

Representing: University of Rochester School of Medicine & DentistryJanine R. Shapiro, M.D.Associate Dean, Faculty Development | Medical Director, ContinuingMedical EducationProfessor of Anesthesiology | University of Rochester School of Medicine andDentistryRochester, NewYork

Representing: Veteran’s Integrated Service NetworkSteven Boggs, M.D., M.B.A.Senior Faculty | Icahn School of Medicine at Mount Sinai | NewYork, NewYork | Chief of AnesthesiologyJames J. Peters VA Medical Center | Bronx, NewYork

Representing: SUNY-Buffalo School of Medicine and Biomedical SciencesJulia B. Faller, D.O., M.S.Assistant Professor of Anesthesiology & Pain Medicine | Roswell Park Cancer InstituteClinical Instructor of Anesthesiology | Director, Anesthesiology Simulation ProgramSUNY-Buffalo School of Medicine and Biomedical Sciences | Buffalo, NewYork

Representing: SUNY-Health Sciences Center at Stony BrookChristopher J. Gallagher, M.D.Professor and Residency Director | Department of AnesthesiologySUNY-Health Sciences Center at Stony Brook | Stony Brook, NewYork

Disclosures:Drs. Boggs, Faller, Gallagher, Gevirtz, Hekmat, Leduc, Reed, Samuels and Shapiro did not disclose any financial relationships.

Tues

day


Focus Sessions | Tuesday, December 17, 2013 | FS-30 & FS-31Afternoon Session • 15:45 - 17:00 • 4th Floor Rooms


Blood Conservation: Update on Current PracticeFocus SessionModerator:Linda J. Shore-Lesserson, M.D., FASEProfessor of Anesthesiology | Hofstra Northshore-Long Island Jewish School of MedicineDirector, Cardiovascular Anesthesiology | Northshore-Long Island JewishMedical Center | NewHyde Park, NewYork

Faculty Presentations:A Comprehensive Blood Management ProgramLinda J. Shore-Lesserson, M.D., FASE

Risk of Anemia: Is It Independent of Blood Transfusion?Aryeh Shander, M.D., FCCM, FCCPChief, Departments of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric MedicineEnglewood Hospital and Medical Center | Englewood, New Jersey | Clinical Professor of Anesthesiology, Medicine and SurgeryIcahn School of Medicine at Mount Sinai | NewYork, NewYork

After completion of this session, the participant will be able to:• Discuss the risks of anemia and transfusion;• Discuss approaches to reduce the need for blood transfusion;• Incorporate blood management strategies into their practice;• Employ appropriate perioperative options for blood conservation.


Update on Cardiac Rhythm DevicesFocus SessionModerator:Marc E. Stone, M.D.Associate Professor of Anesthesiology | Icahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:The Perioperative Management of the Patient with a CIED: A Case Based DiscussionMark E. Stone, M.D.

The Perioperative Assessment and Evaluation of the Patient with a CIEDJennie Y. Ngai, M.D.Assistant Professor of Anesthesiology | Director, Cardiothoracic Anesthesiology FellowshipDivision of Cardiothoracic Anesthesiology | NYU Langone Medical Center | NewYork, NewYork

After completion of this session, the participant will be able to:• Describe the different types of devices, their functions, and current indications for pacemakers and ICDs;• Perform an appropriate perioperative evaluation of the patient with a pacemaker or ICD;• Formulate a plan for perioperative management of patients with implantable devices;• Identify procedures which may interfere with these devices such as lithotripsy, RFA.

Disclosures:Drs. Ngai, Shore-Lesserson and Stone did not disclose any financial relationships.Dr. Shander receives funded research support from CLS Behring, Masimo Corporation, OPK Biotech, LLC, US Department ofDefense and ZymoGenetics, Inc. Consultant fees from AMAG Pharmaceuticals, Inc., Baxter, CSL Behring, Defense AdvancedResearch Projects Agency (DARPA), Deerfield Institute, Inc., Gauss Surgical, HemoCue, Masimo Corporation, New Jersey StateDistrict Attorney, OPK Biotech, LLC, ZymoGenetics, Inc. and honoraria from Baxter, CSL Behring, Masimo Corporation,ZymoGenetics, Inc. He also has stock options with Gauss Surgical.

Tuesday


Focus Sessions | Tuesday, December 17, 2013 | FS-32Afternoon Session • 15:45 - 17:00 • 4th Floor


Challenges in Pediatric AnesthesiaFocus SessionModerator:Francine S. Yudkowitz, M.D., FAAPProfessor of Anesthesiology and Pediatrics | Director, Pediatric AnesthesiaIcahn School of Medicine at Mount Sinai | NewYork, NewYork

Faculty Presentations:Patient for T+A for Sleep Apnea: Ambulatory or DAS?Francine S. Yudkowitz, M.D., FAAP

One Month Old for MRI: Ambulatory or Admission to Monitored Setting PostJay R. Shayevitz, M.D., M.S., FAAPAttending Anesthesiologist | Director, Non-OR AnesthesiaMontefiore Medical Center | Bronx, NewYork

After completion of this session, the participant will be able to:• Discuss the indications for T+A and which patients require post-procedure monitoring;• Develop guidelines in their practice to manage children following T+A with OSA;• Discuss the medical issues of infants requiring anesthesia in the first few weeks of life;• Develop an anesthetic plan to safely manage children after anesthesia in the first few weeks of life.

Disclosures:Dr. Yudkowitz did not disclose any financial relationships.Dr. Shayevitz is a shareholder with Johnson & Johnson, GE.

Tuesday


Poster PresentationsStephen A. vitkun, M.D., M.B.A., Ph.D., Chair

Rotunda Area • 7th Floor • New York Marriott Marquis

• Be aware that Posters may not be positioned in numerical sequence in the Exhibition Area.

• Authors should be available to discuss their work during the following designated times.


Morning Session • 11:00 - 13:00

P-9002P-9004P-9006P-9007P-9010P-9012P-9014P-9015

P-9016P-9018P-9019P-9020P-9021P-9023P-9024P-9025

P-9027P-9028P-9030P-9032P-9034P-9035P-9036P-9037

P-9038P-9039P-9041P-9046P-9048P-9049P-9051P-9053

P-9054P-9055P-9056P-9058P-9059P-9062P-9063P-9212

Afternoon Session • 14:00 - 16:00

Sunday, December 15, 2013

Morning Session • 11:00 - 13:00 Afternoon Session • 14:00 - 16:00

Monday, December 16, 2013


P-9064P-9065P-9066P-9069P-9071P-9072P-9074P-9075

P-9076P-9077P-9079P-9081P-9083P-9086P-9088P-9089

P-9093P-9094P-9096P-9097P-9098P-9100P-9102P-9105

P-9106P-9109P-9112P-9113P-9115P-9118P-9120P-9121

P-9124P-9126P-9127P-9128P-9129

P-9003P-9005P-9008P-9011P-9013P-9017P-9026P-9029

P-9031P-9045P-9052P-9057P-9060P-9067P-9073P-9078

P-9080P-9082P-9095P-9101P-9103P-9104P-9107P-9108

P-9110P-9111P-9114P-9117P-9130P-9131P-9136P-9142

P-9143P-9147P-9149P-9155P-9157P-9159P-9161P-9167

P-9132P-9133P-9134P-9137P-9139P-9144P-9146P-9148

P-9152P-9153P-9154P-9156P-9163P-9166P-9168P-9169

P-9170P-9171P-9172P-9173P-9174P-9176P-9177P-9179

P-9181P-9189P-9193P-9195P-9197P-9198P-9199P-9200

P-9202P-9204P-9206P-9213P-9225P-9228P-9229

P-9001P-9009P-9022P-9033P-9040P-9042P-9043P-9044P-9050

P-9061P-9068P-9070P-9084P-9085P-9087P-9090P-9091P-9092

P-9116P-9122P-9123P-9125P-9135P-9138P-9140P-9141P-9145

P-9150P-9151P-9158P-9160P-9162P-9164P-9165P-9178P-9180

P-9184P-9185

P-9175P-9182P-9183P-9186P-9187P-9188P-9190P-9191P-9192

P-9194P-9196P-9201P-9203P-9205P-9207P-9209P-9210P-9211

P-9214P-9215P-9216P-9217P-9218P-9219P-9220P-9221P-9222

P-9223P-9224P-9226P-9227P-9230P-9231P-9232P-9233P-9234

P-9235


Poster PresentationsTitles, authors, institutions and descriptions will appear in numerical order from pages 120 through 175.

The written descriptions have been reproduced as submitted on-line by each author.

The PGA is not responsible for the accuracy of the contents.

Poster Presenter Primary Author Disclosures:

The primary authors listed from pages 120 through 175 did not disclose any financial relationships, except for the following:

P-9002 on page 120Dr. David Sclar has received grant support from, and/or has participated in speakers bureaus for, and/or has been anadvisory board member for 3M, Inc., Allergan, Inc.,Alza, Inc., Amgen, Inc., AstraZeneca, Inc., Australia Ministry of Health,Aventis, Inc.

P-9025 on page 125Dr. Johan Raeder’s multicenter study sponsored by fee per patient from Molnlycke Inc, the producer of the warmingblanket in the study.

P-9050 on page 131Howard S. Nearman M.D., M.B.A. and Donald Voltz are inventors of the AVN video laryngoscope. No financial support wasgiven for this study.

P-9052 on page 131Dr. Julie Thacker receives consulting fees paid by Premier. Dr. M. Mythen reports consulting fees paid to himself and hisinstitution by AQIX, grant support to his institution from Fresenius Kabi, lecture fees and travel support from BaxterInternational Inc. and B. Braun Medical Inc.

P-9105 on page 144Drs. Royal and Palmer are employees, officers and shareholders of AcelRx Pharmaceuticals.

P-9121 on page 147Dr. Hendrikus Lemmens received research funding from Merck Sharp & Dohme Corp. for his participation in one of thestudies included in this pooled analysis.Dr. R. Kevin Jones received research funding from Merck Sharp & Dohme Corp. for his participation.

P-9134 on page 150Dr. Michael Ramsay Research grant supported by Masimo.

P-9137 on page 151Dr. Eugene R. Viscusi, Brad Phipps and Nitin Joshi are employees of Incline Therapeutics, Inc., which has developed IONSYS(iontophoretic transdermal system).

P-9139 on page 151Dr. Eugene Viscusi, Brad Phipps, Ph.D., is an employee of Incline Therapeutics, Inc. which developed IONSYS (iontophoretictransdermal system).

P-9144 on page 153Dr. TiffanyWoo, Matthias Eikermann, Britta Brueckmann and Nobuo Sasaki received research funding from Merck Sharp &Dohme Corp., Whitehouse Station, NJ, USA. Peter Grobara is employee of MSD, Oss, The Netherlands. Michael K Li andTiffanyWoo are employees of Merck Sharp.


P-9154 on page 155Dr. David Sclar has received grant support from, and/or has participated in speakers bureaus for, and/or has been anadvisory board member for 3M, Inc., Allergan, Inc., Alza, Inc., Amgen, Inc., AstraZeneca, Inc., Australia Ministry ofHealth,Aventis, Inc.

P-9201 on page 167Drs. Palmer and Royal are employees, officers and shareholders of AcelRx Pharmaceuticals.

P-9202 on page 168Drs. Palmer and Royal are employees, officers, and shareholders of AcelRx Pharmaceuticals.

P-9203 on page 168All authors are employees and shareholders of AcelRx Pharmaceuticals. Drs. Palmer and Royal and Mr. Evashenk are alsoofficers of the company.



P-9207 on page 169Drs. Reikersdorfer, Gorski, and Atlee are employees and/or consultants who hold equity positions in Eso Technologies, Inc.Palatnik is a paid consultant to Eso Technologies, Inc.

P-9235 on page 175Dr. Thorsten Haas receives lecture fee from CSL Behring, Octapharma and TEM International. However, none of these tradenames were mentioned in the abstract.


P-9001 Case Report - Anesthetic Management for Laparoscopic Resection of Gastropulmonary Fistula

Primary Author: Christopher Liu, M.B., B.S., MMEDSingapore General Hospital | Singapore, Singapore

We report the successful conduct of anaesthesia for laparoscopic repair of a gastropulmonary fistula, a rare complicationthat can occur after bariatric surgery. Because of the rare incidence, there is limited literature on this. Given the increasingincidence of bariatric surgery as a result of increasing obesity rates, such complications may be more common in thefuture

P-9002 Predictors of Remifentanil Use in Surgical Patients with Renal or Hepatic Insufficiency, and/or Obesity inthe United States

Primary Author: David A. Sclar, B.Pharm., Ph.D.College of Pharmacy, Midwestern University | Glendale, AZ, United States

Remifentanil is a μ-opioid agonist analgesic that is metabolized via blood and tissue nonspecific esterases. It has a rapidonset, short duration of action, predictable pharmacokinetic/pharmacodynamic (PK/PD) profile (inclusive of patients withrenal or hepatic dysfunction, or obesity), and unlike fentanyl, has an absence of accumulation with repeated or prolongedadministration. These unique PK/PD features of remifentanil would be of benefit to surgical patients with hepatic or renaldisease, and/or obesity. However, results of this study show that remifentanil in combination with fentanyl is used signifcantlyless than fentanyl in these surgical patients and the probability of using this drug was significantly lower in patientsenrolled in Medicaid versus Medicare or private insurance. Predictors of remifentanil use did include elderly age, obesity,and Medicare as primary payer.

P-9003 Apnoeic Oxygenation for the Performance of Pan Endoscopy

Primary Author: Burkard Rudlof, M.D.Dept for Anesthesia | Wuppertal, Germany

Co-Author: Carmen Lauterbach, M.D.

Objective: To evaluate the efficacy of apnoeic oxygenation for the performance of pan-endoscopy. Study Design: Clinicalretrospective study. Setting: A university teaching hospital in Wuppertal, Germany. Subjects: 47 Patients who underwentpan-endoscopy under apnoeic oxygenation during a period of one year. Methods: After preoxygenation and induction ofanesthesia a 8 French catheter was introduced into the trachea for oxygensupply. Pan-endoscopy was carried out, aslong, as there were no signs of desaturation. The data were collected retrospectively from the anesthesia charts. Results:Apnea was well tolerated up to 45 minutes in most of the patients. In two patients the method was carried out incorrectand in one obese patient it was not possible, to get an acceptable oxygenation. Conclusion: With appropriate monitoring,sufficient nitrogen elution and proper pa-tient selection, we believe that this technique is superior to jet-ventilation andintuba-tion for pan-endoscopy allowing unimpeded operative visualization.

P-9004 Objective Voice Analysis Before and After Endotracheal Intubation

Primary Author: Martin K Sørensen, M.D., Ph.D.Centre of Head and Orthopaedics, Rigshospitalet | Copenhagen, Denmark

Co-Authors: Tina T. Durck, M.D. Niels Rasmussen, M.D., DmSciLars S. Rasmussen, M.D., Ph.D., DmSci

Transient hoarseness is a well known complication to endotracheal intubation. This may be due to traumatic edema ofthe vocal folds, which is reflected in an increase in the Multi-Dimensional Voice Program parameter Shimmer. The aim ofthis study was to evaluate whether the change in shimmer is unique or correlated to other selected voice parameters.The change in Jitter was shown to be closely correlated to the change in Shimmer possibly reflecting compensatoryvocal fold tensions.


P-9005 Comparison of the Outer diameter of the ‘Best-Fit’ Endotracheal Tube with MRI-Measured AirwayDiameter at the Cricoid Level

Primary Author: Ahmed Abdulmomen, M.D.King Saud University | Riyadh, Saudi Arabia

The aim of this investigation was to compare the outer diameter of the ‘best-fit’ ETT with the in-vivo-measured internaltransverse tracheal diameter using MRI. we concluded that the outer diameter of the ‘best-fit’ ETT was less than the ITD atthe cricoid level by 0.1-1.7mm. The correlation of the ‘best-fit’ ETT outer diameter with age was stronger than those withheight and weight

P-9006 Obstructive Sleep Apnea and Increased BMI are Independent Predictors for Transfer to a Step-Down UnitPost-Bariatric Surgery

Primary Author: Robert White, MSIVMontefiore Medical Center | Bronx, NY, United States

Co-Authors: Tal Cohen Singh Nair, M.D.Naum Shaparin, M.D.

This study shows that a pre-surgical diagnosis of obstructive sleep apnea (OSA) and increased BMI are independent riskfactors for transfer to a step down unit. Step-down units provide decreased patient: nurse ratios, more frequent vital signchecks, and a higher level of patient observation. Transfers reflect patient outcomes and clinical decisions undertaken toprevent morbidity and mortality, suggesting increased post-operative complications in the OSA and the higher BMI rangegroups.

P-9007 Simulation Training Enhances Resident Performance in Transesophageal Echocardiography

Primary Author: Natalie A Ferrero, M.D.University of North Carolina | Chapel Hill, NC, United States

Co-Authors: Emily Teeter, M.D. Harendra Arora, M.D.Susan M. Martinelli, M.D. Lavinia M Kolarczyk, M.D.Andrey V. Bortsov, M.D., Ph.D. David A. Zvara, M.D.Priya A. Kumar, M.D.

Transesophageal echocardiography (TEE) is increasingly used for intraoperative monitoring in both cardiac and noncardiacsurgeries. Investigators at University of North Carolina studied the efficacy of mannequin-based TEE simulators in technicalTEE skills training. Their results indicate that TEE simulation training is advantageous in teaching trainees to acquire highquality images when comparedto traditional training methods. Additionally, their data suggest that simulation trainingmay have the greatest impact when implemented early on in the learning process.

P-9008 Clinical Improvement Through Nonoperative Treatment of Adult Spinal Deformity: Who is Likely to Benefit?

Primary Author: Kseniya SlobodyanyukBaylor Scoliosis Center | Plano, TX, United States

Co-Authors: Caroline E. Poorman Justin S. SmithThemistocles S. Protopsaltis Richard HostinShay Bess Gregory M. MundisFrank J. Schwab Virginie Lafage

Adult spinal deformity (ASD) patients treated non-operatively were evaluated for clinical improvement at 1-year using theSRS-22 scale. Baseline and 1-year minimum clinically important differences (MCIDs) from normative data were calculated.80-90% of patients had a good outcome at follow-up. Patients with the least disability were most likely to show improvement.Radiographic measures were not predictive of outcome.


P-9009 View Regarding Stress at Work and Opinion About Prevention Programs-Survey of Around TwelveHundred Indian Anesthesiologists

Primary Author: Sumitra G. Bakshi, M.D.Tata Memorial Centre | Mumbai, India

Co-Authors: Jigishu V. Divatia, M.D. Sheila N. Myatra, M.D.Sadanna Kannan, M.Sc

Survey of around twelve hundred Indian anesthesiologists to understand their view regarding stress at work and opinionabout prevention programs

P-9010 Utility of Thromboelastography During Neuraxial Blockade in the Parturient with Thrombocytopenia

Primary Author: Jeffrey Huang, M.D.UCF | Orlando, FL, United States

Co-Authors: Nicholas Mckenna, M.D. Noah Babins, M.D.

This case series suggests neuraxial techniques in parturients can be performed with platelet count greater than 56,000mm-3 and a normal TEG result.

P-9011 Anesthesia for Inferior Vena Cava Thrombectomy and Pulmonary Thromboendarterectomy in a Patient with RenalTumor

Primary Author: Tonny Sarquis, M.D.Fundacion Clinica Shaio | Bogota, Colombia

Co-Authors: Carlos Triana - Schöonewolff, M.D. Mauricio Abello, M.D.

We present and discuss the intraoperative pharmacological strategy for the treatment of Pulmonary Hypertension andprotection of the right ventricular function in a patient with a renal cell tumor than infiltrates the Inferior Vena Cava andPulmonary Artery taken to pulmonary thrombendarterectomy.

P-9012 Tongue Protrusion as a Extubation Criteria in Pediatric Surgery

Primary Author: Yaqi Hu, MScSUNY Upstate Medical University | Syracuse, NY, United States

This single center observational study to investigate the utility and reliability of using tongue protrusion as a criterion forextubation readiness in the operation room setting. The use tongue protrusion as a criteria for extubation readinessresults in safe and effective extubation in pediatric general surgery patients. It results in less complication rates and shortertime required for extubation.

P-9013 Safety And Efficacy of Bispectral Index Monitoring for Percutaneous Thermal Ablation of Liver TumorsUnder Moderate Sedation

Primary Author: Alessandra Vari, M.D.,Ph.D.Sapienza University School of Medicine | Rome, Italy

Co-Authors: Mario Corona, M.D. Renato Argiro', M.D.Maria Rosignuolo, M.D. Alessandro D'Adamo, M.D.Mario Bezzi, M.D.

Percutaneous thermal ablation (PTA) is performed by radio-frequency (RFA) or micro waves (MW) induced thermal necro-sis. Both procedures require moderate/high level of analgesia and sedation to maintain patients distress-free, responsiveto commands and able to avoid sudden movements that can displace the needle. This study investigated the role ofBIS™spectral Index for optimal and safe sedation during liver PTA showing that BIS monitoring provides adequate sedation,hemodynamic stability, reduced use of opioids and optimal procedural conditions compared to standard verbal/clinicalassessment.


P-9014 Comparison of Postoperative Analgesic Requirements in Patients Undergoing Partial Hepatectomy andLiver Transplantation

Primary Author: Perene V. Patel, M.D.Mayo Clinic Florida | Jacksonville, FL, United States

Co-Authors: Stephen Aniskevich, M.D. Claudia C. Crawford, M.D.Prith Peiris, M.D. Timothy S. Shine, M.D.Klaus D. Torp, M.D. Sher-Lu Pai, M.D.

End stage liver disease requiring orthotopic liver transplantation (OLT) may alter the pharmacokinetic and pharmacodynamiceffects of medications metabolized by the liver. This retrospective study evaluated the postoperative opioid requirementsin patients undergoing partial hepatectomy and OLT. Our results demonstrate that OLT recipients had decreased postoperativeopioid requirements compared with partial hepatectomy patients on POD 1. There was no significant difference onPOD 0, 2, 3.

P-9015 Application of Lean and Six Sigma Methodologies to Improve the Efficiency of the Operating Room:A Systematic Review

Primary Author: Ahmad Elsharydah, M.D., M.B.A.UT Southwestern Medical Center | Dallas, TX, United States

Co-Authors: Christopher D. LeCheminant, M.D. Cheen K. Alkhatib, M.D.Tally Shimoni-Goldfarb, M.D.

Lean and six sigma (LSS) is a set of tools used by several industries and business for process improvement by eliminatingnon-value steps and waste and decrease defects and errors. Application of LSS in the OR management was reviewed inour study looking at different OR efficiency metrics and quality measures. The six selected and reviewed studies showedgood evidence of the effectiveness of LSS to improve OR efficiency and enhance OR staff and patient satisfaction.

P-9016 Does Extubation in the Post-Anesthesia Care Unit (PACU) vs. Operating Room (OR) Influence PatientThroughput: A Retrospective Analysis

Primary Author: Jack Bairamian, M.D.Nemours Children's Clinic | Jacksonville, FL, United States

Co-Authors: Stefanie Schrum, M.D. Suzanne Murphy, Ph.D.

Prolonged operating room (OR) turnover time is a significant contributing factor to case delay and OR inefficiency. ORextubation of patients can play a role in prolonging OR turnover time. Extubating patients in the Post-Anesthesia CareUnit (PACU) by anesthesia personnel can improve OR efficiency and accelerate OR turnover time. This is not a commonpractice, as our literature review revealed that only one other institution does extubation in the PACU. In this study, we dida retrospective analysis from our outpatient surgery center comparing data from two different time periods: Time , duringwhich patients were extubated in the PACU and Time 2 in which patients were extubated in the OR. Our analysis indicatesthat extubating in the PACU yielded much shorter times between leaving OR to start anesthesia for next case. Extubatingin the OR resulted in a much shorter PACU stay. However, anesthesia start to DC facility was similar regardless of OR vs.PACU extubation.

P-9017 The Use of IV Tylenol Decreases PACU Times in Gastric Bypass Patients

Primary Author: Herb Lee, M.D.JFK Medical Center | Edison, NJ, United States

IV Tylenol could decrease PACU times for gastric bypass patients by decreasing narcotic requirements


P-9018 Incidence and Factors Affecting Severe Pain After Upper Abdominal Surgery in Postanesthetic Care Unit

Primary Author: Arunotai Siriussawakul, M.D.Maharaj Nakhon Ratchasima Hospital | Nakhon Ratchasima, Thailand

Co-Authors: Jatuporn Thonsontia, M.D. Sukanya Jirachaipitak, M.D.Kloyjai Kanjanarai, M.D. Mallika AhujaVimolluck Sanansilp, M.D.

This retrospective study was designed to find out the incidence of first severe pain score after upper abdominal surgeryamong 685 patients receiving general anesthesia combined with epidural analgesia, and to determine consequences andfactors affecting severe pain intensity in Post-Anesthesia Care Unit (PACU). Incidence of severe first pain scores in ourinstitution was high. There were 134 patients (19.6%, 95% confident interval (CI) = 0.17, 0.23) reported severe first painscores. Patients who reported worse pain scores consumed more time in PACU. Nevertheless, discharge pain score andpatient satisfaction score were unfavorable when compare to the other group. As for risk factor of severe pain, BMI ≥ 25kg/m2 (adjusted odds ratio (OR) 1.62; 95%CI 1.04, 2.48), stomach and bowel surgery (OR 3.25, 95%CI 1.29, 8.22), andintermittent bolus method for epidural analgesia were associated with severe pain scores (OR 1.68, 95% CI 1.07, 2.63).

P-9019 History, Clinical Trial Results, and Future Direction of Hemoglobin-Based Oxygen Carriers (HBOC) in theMilitary and Civilian Populations

Primary Author: Kevin Chung, BANYU-Langone Medical Center | New York, NY, United States

Co-Author: Corey Scher, M.D.

On the battlefield and in the prehospital setting, where blood is often unavailable and medical resources are limited, thedevelopment of a blood substitute that can be used in initial resuscitation efforts to restore intravascular volume and preserveoxygen delivery could reduce early mortality and serve as a bridging treatment for wounded soldiers and trauma patientsuntil their arrival at medical facilities for blood transfusion and surgical intervention. Of the blood substitutes that have beenstudied, hemoglobin-based oxygen carriers (HBOC) appear to have the most promise, though none have received regulatoryapproval in the U.S. due to their adverse event profiles. Given the potential applications of HBOCs and their advantages overconventional blood products, the development of a safe and effective HBOC remains a worthwhile goal.

P-9020 Dexmedetomidine Versus Propofol Sedation in Total Joints Under Spinal Anesthesia

Primary Author: Robert Hsiung, M.D.Virginia Mason Medical Center | Seattle, WA, United States

Co-Authors: Thomas Engar, M.D. Willian Jang, M.D.

Dexmeditomidine was compared to propofol as an intraoperative sedative in total joint replacement surgery under spinalanesthesia. Dexmedetomidine was 4 times more likely to cause bradycardia, had no increased incidence of nausea/vomitingtreatment, and prolonged post-anesthesia care unit discharge times compared to propofol.

P-9021 Loss of Information During Transfer of Patient Care: Preliminary Results of a Simulation Project

Primary Author: Annette Rebel, M.D.University of Kentucky | Lexington, KY, United States

Co-Authors: Amy DiLorenzo, MA Paul A. Sloan, M.D.Regina Y. Fragneto, M.D. Faith M. Lukens, M.D.Zaki-Udin Hassan, M.D. Rana K. Latif, M.D.Gary Loyd, M.D. Randall M. Schell, M.D.

Assessment of Transition of Care using the patient simulator revealed loss of essential information during the process.


P-9022 Prophylactic Antibiotics: Combining Ciprofloxacin and Ceftriaxone Reduces Unplanned HospitalAdmissions Following Transrectal Ultrasound-Guided Prostate Biopsies

Primary Author: Ognjen Visnjevac, M.D.SUNY Buffalo | Buffalo, NY, United States

Co-Authors: Benjamin Luong, M.D. Michael Duff, M.D.Margaret E. Suraf Kent Chevli, M.D.

A prophylactic TRUS biopsy protocol including two classes of antibiotics (fluoroquinolone and cephalosporin) significantlyreduced post-biopsy sepsis and hospitalization rates. Further study of additional factors that may have contributed to thesuccess of the new protocol (i.e. patient compliance, regional antibiotic resistance rates) is warranted.

P-9023 Be Cool in the Face of Heat: Is it Malignant Hyperthermia or What?

Primary Author: Sharon Lee, M.D.Albany Medical Center | Albany, NY, United States

Co-Authors: Farzana Afroze, M.D. Anica Crnkovic, M.D.Helena Oechsner, M.D.

Malignant Hyperthermia (MH) is a rare life-threatening condition that classically presents during or after the administrationof volatile anesthetics and depolarizing muscle relaxants. Diagnosing this syndrome can sometimes be a challengebecause several other diagnoses can mimic the hypermetabolic state exhibited by MH. In this case, we will discuss howto distinguish between MH and other diagnoses in a septic patient with a baseline history of spastic cerebral palsy (CP)and seizures. We will also interpret lab values, especially creatine kinase (CK), in the setting of questionable MH and CP.Finally, we will review the ethical implications of incorrectly diagnosing a patient with MH and how to expertly advisemisinformed colleagues in a professional manner.

P-9024 Anesthesia Controlled Times in the Operating Room: Does Medical Student Involvement HinderAnesthesia Team Efficiency?

Primary Author: Royce Shou, BS, MSIIUM.D.NJ - New Jersey Medical School | Newark, NJ, United States

Co-Authors: Sergey Pisklakov, M.D. Cathy Schoenberg, BSNAnn John, MSII Ming Xiong, M.D.Alex Bekker, M.D.

This study aims to find whether medical student involvement in the operating room (OR) hinders anesthesia team efficiencyand to examine how such delays, if any, affect overall anesthesia controlled time (ACT). Two anesthesia team configurationswere compared: attending anesthesiologist with CRNA, and any configuration of attending, resident CA, and CRNA inwhich a medical student was involved in induction and/or intubation. Six intervals of ACTs were examined: four prior toanesthesia ready, two following surgery end. Anesthesia ready (AR) was defined as the moment when surgical positioningcould begin. 49 cases were examined. Intervals of OR Entry to AR (p = 0.006), Induction to AR (p = 0.005), and Intubationto AR (p = 0.30) were significant for student-caused decreases in efficiency.Why certain ACT intervals are affected by studentinvolvement can be attributed to the complexity of tasks performed within each interval. Although statistically significanttime differences were found in the pre-procedural period, these differences were not meaningful relative to entire caselength to the extent that extra time should be allocated to student-involved cases.

P-9025 Reduced Hypothermia and Improved Patient Thermal Comfort by Perioperative Use of a DisposableSelf-Warming Blanket- A randomized Multi-Center Trial

Primary Author: Johan Raeder, M.D., Ph.D.Aleris Specialist Ward | Motala, Sweden

Co-Authors: Karin Geertsen Elke Van GervenBengt Horn Alexander Torossian

Perioperative use of a new self-warming blanket reduces perioperative hypothermia and improves patient thermal comfortbefore and after elective adult surgery. However, still intraoperative rescue warming may be necessary in some few cases.


P-9026 Inhibition of Endocannabinoid Hydrolysis in a Neuropathic Model of Chronic Pain

Primary Author: Nicholas Adamson BarnesKolling Institute of Medical Research, Royal North Shore Hospital | Sydney, Australia

Co-Authors: Vanessa Mitchell Christopher Vaughan

It has recently been suggested that modulation of the bioavailability of the two major endocannabinoids anandamide(AEA) and 2-arachidonoylglycerol (2-AG), through their respective controlling enzymes FAAH and MAGL, may representan alternative analgesic strategy to the more globally acting cannabinoid receptor agonists. The present study comparesthe dual FAAH/MAGL inhibitor JZL-195 against a direct CB, agonist in a neuropathic model of chronic pain

P-9027 Effect of a Negative Pressure at Intercuff Space in Double Cuffed Endotracheal Tube

Primary Author: Bonwook Koo, M.D.Seoul National University Bundang Hospital | Seongnam-si, Korea, Republic of

Co-Authors: Jinhee Kim, M.D., Ph.D.. Sunghee Han, M.D.,Ph.D..Mi-hyun Kim, M.D.,Ph.D.. Jiseok Baik, M.D.

We designed a prototype endotracheal tube with double cuffs and a small intercuff hole connected to a negativepressure port and made a ,mm-sized hole between the cuffs, which is connected to an external port for applying thenegative pressure in the intercuff space. We spilled continuously the blue-dyed water on the upper cuff and applieda negative pressure in the intercuff space though the port for 10 minutes. And then we measured the volume ofdripped water below the lower cuff. And the leakage tests were performed at 7 different negative pressures (-40, -50,-60, -70, -80, -90 and -100 mmHg) using an external port at 4 different intracuff pressures (15, 20, 25 and 30 cmH2O).The double cuffed endotracheal tube with -90mmHg pressure in intercuff space completely prevented the waterfrom leakage at all intracuff pressures (15-30 cmH2O) in a 20mm-sized artificial trachea in vitro. Also, in case of applyingpositive ventilator, the pressure of blockage is lesser than not using it. And the negative pressure in intercuff spacewas only 3.8-5.9% of applying negative pressure.

P-9028 Myoclonal and Hypertensive Response to Etomidate During Induction of Anesthesia

Primary Author: Michael Maloney, M.D.SUNY Downstate Medical Center | Brooklyn, NY, United States

Co-Authors: Emily Savoca, BS Navdeep Nayyar, M.D.Ketan Shevde, M.D.

We report that etomidate administered without additional anesthetics or heavy sedation can cause undesirable myoclonalactivity, hypertension and tachycardia.

P-9029 A Comparison of Epidural Analgesia with Continuous Femoral Nerve Block After Unilateral Total Knee Artroplasty

Primary Author: Abdulkadir Atim, M.D.GATA | Ankara, Turkey

Co-Authors: Umut Kara, M.D. Omer Yanarates, M.D.Ali Sizlan, M.D. Ercan Kurt, M.D.

Our retrospective study demonstrates that continuous femoral nerve blockade using US guidance provides lower VASscores with a lower incidence of motor and sensorial blocks when compared with continuous epidural analgesia aftertotal knee arthroplassty. It is also Patient controlled epidural analgesia was associated with more nausea and vomitingthan CFNB. Pain at the popliteal space and at the medial aspect of the knee will be our focus in the future.


P-9030 Postoperative Acute Respiratory Distress Syndrome in Patients with Previous Exposure to Bleomycin

Primary Author: Richard Efem, M.S.Mayo Clinic | Rochester, MN, United States

Co-Authors: Benjamin Aakre, M.D. GregWilson, R.R.T.Daryl Kor, M.D. John Eisenach, M.D.

Historically, risk factors associated with postoperative acute exacerbation of idiopathic pulmonary fibrosis include: fractionof inspired oxygen, duration of surgery, amount of blood transfused, smoking, and an intraoperative fluid balance greaterthan 300 ml/hr. The purpose of this investigation is to quantify the impact of prior bleomycin exposure on the incidenceof post operative acute lung injury (PO-ALI) in the largest cohort of bleomycin-exposure surgical patients examined todate.

P-9031 Incidence, Outcome, and Risk Factors for Postoperative Pulmonary Complications in Patients WhoUnderwent Head and Neck Cancer Surgeries with Free Flap Reconstructions

Primary Author: Daniela Damian, M.D.UPMC | Pittsburgh, PA, United States

Co-Authors: Jacob Esquenazi Tetsuro Sakai, M.D., Ph.D.Jonas Johnson, M.D., FACS Umamaheswar Duvvuri, M.D., Ph.D.

Retrospective study conducted in an academic institution in order to assess the incidence, outcome and risk factors forpulmonary complication in patients who underwent head and neck surgery with flap reconstruction

P-9032 Acute Fatty Liver of Pregnancy

Primary Author: Patricia TenaHospital 12 Octubre | Madrid, Spain

Co-Authors: Rafael Arboleda Claudia OleaAngelines Guerra Amparo Urbina

Acute fatty liver of pregnancy (AFLP) is a rare maternal disease occurring in the third trimester of pregnancy with significantperinatal and maternal mortality. A promptly diagnosis and delivery are essential, besides an optimized management of thehepatic failure and complications associated.We present a case of AFLP in a 43 year-old-woman admitted in our critical careunit with postpartum hemorraghe due to severe coagulopathy.

P-9033 Pre-Operative Testing for Elective Surgery - Compliance with NICE Guidelines at Basildon Hospital,England

Primary Author: Rachel H Turner, M.B., B.S., B.ScRoyal Free Hospital, London | London, United Kingdom

Compliance to the UK NICE guidelines for pre-operative testing for elective surgery at Basildon Hospital, England isanalysed. Based on surgical grade, ASA grade, patient age and co-morbidities, certain tests should, and should not beperformed. Compliance was 69%, and 78% of non-compliance was due to over-testing, specifically with blood tests. It isrecommended that a modified version of the guideline should be made to guide nursing staff in the pre-operativeassessment clinic for tests for common surgical procedures.


P-9034 Effectiveness of an Impedance Threshold Device During Cardiopulmonary Resuscitation

Primary Author: Ricardo Dias, M.D.Centro Hospitalar de Lisboa Central | Lisbon, Portugal

Co-Authors: Jorge Nunes, M.D. António RibeiroAna Lufinha

The impedance threshold device (ITD) aims at improving venous return to the heart and cardiac output duringcardiopulmonary resuscitation (CPR). Previous studies reported improved survival to the emergency department admission.The authors aimed at defining if there was any ROSC benefit during advanced life support (ALS) performed by ourEmergency Medical Vehicle (EMV) team, through data comparison between a group of patients assisted with an ITD, anda similar group of patients assisted previously to the introduction of the device into the CPR protocol.

P-9035 Comparison of Clinical Performance of the I-Gel with LMA Proseal

Primary Author: Gaurav Chauhan, M.D.Aruna ASIF ALI Government Hospital | Delhi, India

Randomized double blinded control trial to compare the Insertion insertion characteristics of two different supraglotticdevices (I-gel and PLMA) and to report any associated complications.

P-9036 Effect of Intraoperative Intravenous Crystalloid Infusion on Postoperative Nausea and Vomiting AfterDiagnostic Gynaecological Laparoscopy: Comparison of 30ml/Kg And 10ml/Kg and to Report the Effect ofthe Menustral Cycle on the Incidence of Postoperative Nausea and Vomiting

Primary Author: Gaurav Chauhan, M.D.Aruna ASIF ALI Government Hospital | Delhi, India

Randomized double blinded control trial to observe the effect of intraoperative intravenous crystalloid infusion onpostoperative nausea and vomiting after diagnostic gynaecological laparoscopy: comparison of 30ml/kg and 10ml/kgand to report the effect of the menustral cycle on the incidence of postoperative nausea and vomiting.

P-9037 Neuroleptic Malignant Syndrome in a Parturient After Receiving Droperidol and Metoclopramide DuringCesarean Section

Primary Author: Connie YuStony Brook School of Medicine | Stony Brook, NY, United States

Co-Authors: Ahmed Haque, M.D. Joy Schabel, M.D.

Neurolepticmalignant syndrome developed in a pregnant patient following administration of droperidol andmetoclopramideduring a Cesarean section. Our case illustrates the clinical signs, symptoms, risk factors, mechanism of action andmanagement ofNMS.

P-9038 Bier Blocks with Guanethidine, Lidocaine and Methylprednisolone Versus Lidocaine andMethylprednisolone in the Treatment of CRPS

Primary Author: Robert Urbanowicz, M.D.Centre hospitalier de l'Université de Montréal | Montreal, QC, Canada

Co-Author: Grisell Vargas-Schaffer, M.D.

Bier blocks remain valid treatment options for patients with complex regional pain syndrome


P-9039 A Novel Use of the Veress Surgical Insufflation Needle for TAP Block on a Morbidly Obese Patient

Primary Author: Flower Austin, D.O.Pennslyvania State University Hershey Medical Center | Hershey, PA, United States

Co-Authors: Paul B. Menocci, M.D. Patrick M. McQuillan, M.D.Sanjib D. Adhikary, M.D.

Recognizing the limitation associated with recommending the use of Veress needle based up on a single case, we proposefurther use of this needle to evaluate its safety and efficacy in performing TAP blocks in patients where precise fascialplanes are difficult to visualize with US.

P-9040 An Inconvenient Allergy: Plastic Allergy in the Operating Room

Primary Author: Grace Huang, M.D.Mount Sinai | New York, NY, United States

Co-Author: Steven M. Neustein, M.D.

Plastic allergy in the operating room poses a challenge for the anesthesiologist. Endotracheal tubes are predominantlyplastic. Here we will explore the different types of endotracheal tubes and discuss the management of our patient with aplastic allergy.

P-9041 Identifying and Analyzing Patient Volume Fluctuations on Labor and Delivery

Primary Author: Maricela CastilloCornell University | Ithaca, NY, United States

Co-Authors: Matt Raible, MHA Candidate Hillary Shaw, MPASharon Abramovitz, M.D. Klaus Kjaer, M.D., M.B.A.

Accurate estimation of patient volume provides hospital leaders with the ability to appropriately match staff resources topatient needs. For this reason, it is important to be able to predict volume fluctuations as accurately as possible. In thisstudy, we analyzed the fluctuation in patient volume as well as the potential causes for the day-to-day variation in theLabor and Delivery (L&D) Unit. We found that patient volume in L&D fluctuated significantly during the month of April2013, a trend that was noted in all months from May 2012-May 2013. In order to smooth this fluctuation, we suggest adynamic scheduling model as a means to redirect patients to low volume days.

P-9042 Does the Anesthetic Management Has Effect in Biochemical Recurrence in Prostate Cancer?

Primary Author: Marissa Minutti-Palacios, M.D.Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán | Mexico DF, Mexico

Co-Authors: Karina Vázquez-Narvaez, M.D. Francisco Rodríguez-Covarrubias, M.D.Ricardo Castillejos-Molina, M.D.

Epidural anesthesia did not show advantage in preventing biochemical recurrence of prostate cancer.

P-9043 Obstruction of an Endotracheal Tube with the Sheath of a Flexible Bronchoscope

Primary Author: Ammar A. Alamarie, M.D.Upstate Medical University | Syracuse, NY, United States

Before performing a percutaneous tracheostomy, it is common for the surgical team to use bronchoscopy to survey theairway for structural abnormalities that could lead to complications. The anesthesia care provider must be aware of thesigns of upper-airway obstruction and be able to intervene in a timely matter to address problems that may arise duringthis procedure. Moreover, understanding flexible bronchoscopy and its relative contraindications is necessary by all thosewho provide care to a patient undergoing this procedure. We present a case of iatrogenic endotracheal tube obstructionwith a flexible bronchoscope.


P-9044 Use of Myocardial Perfusion Imaging for the Evaluation of Liver Transplant Candidates

Primary Author: Sally Baker, M.D.Penn State Hershey Medical Center | Hershey, PA, United States

Co-Author: Dmitri Bezinover, M.D., Ph.D.

Our retrospective study has shown thatMyocardial Perfusion Imaging for the evaluation of CAD in liver transplant candidates is avaluable tool that does not require stopping Beta blockers, and yet has the same or better positive predictive value in high riskpatients.

P-9045 Hyperbaric Oxygenation Therapy Alleviates Chronic Constriction Injury Induced Neuropathic Pain ViaInhibitions of Pro-Apoptosis Genes and Apoptosis in the Spinal Cord

Primary Author: Qinggang Hu, M.D.Upstate Medical University | Syracuse, NY, United States

Co-Authors: Qinghe Meng, M.D. Jacob Vohs, B.S.Sebastian Thomas, M.D. Zhongjin Yang, M.D.

1.The overly expressed pro-apoptosis genes and the subsequently increased the spinal apoptotic cells seemly contributeto the development of CCI-induced neuropathic pain. 2. The inhibitory role of HBO on spinal pro-apoptosis genes andapoptotic changes may be responsible for its beneficial effect on CCI-induced neuropathic pain.

P-9046 Randomised Controlled Comparison of Monitored Anesthesia Care Using Dexmedetomidine-Remifentanilvs. Propofol-Remifentanil During Hysteroscopy

Primary Author: Seong joo Park, M.D.Seoul National University Bundang Hospital | Seongnam-si, Gyeonggi-do, Korea, Republic of

Co-Authors: Jung hee Ryu, M.D., Ph.D. Jungwon Hwang, M.D., Ph.D.Sang-Hwan Do, M.D., Ph.D.

The combination of dexmedetomidine-remifentanil can reduce the incidence of respiratory depression and provide saferanesthesia compared with propofol-remifentanil for MAC during hysteroscopy.

P-9048 Evaluation of Cerebral Blood Flow Following Insertion of Supraglottic Airway Device

Primary Author: Frank A. Rasulo, M.D.Spedali Civili Di Brescia | Brescia, Italy

Co-Authors: Nicola Zugni, M.D. Arturo Toninelli, M.D.Nicola Latronico, M.D.

For many years endotracheal intubation (ETI) has been the gold standard for ventilation by advanced life support personnelduring cardiopulmonary resuscitation (CPR).1 In a recent study authors demonstrated that use of supraglottic airwayadjuncts in pigs undergoing CPR results in compression of the carotid arteries, thereby reducing cerebral blood flow(CBF).5 Based on our findings however, the insertion of a sovraglottic airway device and cuff inflation following inductionof anesthesia does not cause a significant reduction in FVmca and therefore cerebral blood flow. We have noticed a dropin cerebral blood flow velocity (FVmca) and an increase in Pulsatility index (PI) following induction of anesthesia.


P-9049 Does the Incidence of Sore Throat Postoperatively Increase with the Use of a Traditional Intubation Blade or aVideo Laryngoscope?

Primary Author: Caroline Daly, M.D.Albany Medical Center | Albany, NY, United States

Co-Authors: Dennis Cirilla II, DO Vadim Vaisman, M.D.Jason Ngo

The goal of this study was to determine whether the use of the video laryngoscope leads to a greater or lesser incidenceof sore throat when compared to traditional laryngoscope blades used for intubation. Patients who met inclusion criteriawere randomized to direct laryngoscopy or video laryngoscopy. This single-blinded prospective cohort study showedthat the only variables associated with post operative sore throat were gender (males 24.3% vs. females 43.2%, p=0.015)and provider (attendings 26.8% vs. CRNAs 52.3% vs. CA-3 residents 30%, p=0.012), regardless of which intubation toolwas used.

P-9050 The AVN Video Laryngoscope: A Pilot Study of a Novel Device to Facilitate Tracheal Intubation

Primary Author: Adam J. Haas, M.D.Aultman Hospital | Canton, OH, United States

Co-Authors: Howard Nearman, M.D., MBA Donald M. Voltz, M.D.

The AVN video larygoscope has a motorized articulating joint in the middle of the blade allowing the user to increase thecurvature of the blade and improve visualization of the glottic opening. Our IRB approved FDA pilot study of this devicefound that he AVN laryngoscope significantly improved the Cormack-Lehane grade view compared to standard videolaryngoscopy

P-9051 Significance of Microalbuminuria Levels in the Diagnosis of Sepsis

Primary Author: Ahmet Cosar, M.D.Gata | Ankara, Turkey

Significance of Microalbuminuria Levels in the Diagnosis of Sepsis in Intensive Care Unit Patients and It’s Relationshipwith other Biomarkers

P-9052 Evaluation of Fluid Utilization Among Hospitalized Patients Undergoing Elective Procedures for Colonand Hip/Knee Surgeries

Primary Author: Julie K. Thacker, M.D.Duke University | Durham, NC, United States

Co-Authors: Monty Mythen, M.B., B.S. William K. Mountford, Ph.D.Michelle R. Krukas, MA Frank R. Ernst, PharM.D., MS

The current study highlights the variability in fluid utilization among patients undergoing colon and primary hip/kneesurgeries in the United States.

P-9053 Doppler Velocimetric Changes Following Labour Epidural Anlgesia in Growth Restricted Fetuses withImpaired Umbilical Blood Flow: A Randomised Control Trial

Primary Author: Sukhen Samanta, M.D.All India Institute of Medical Sciences | New Delhi, India

Co-Author: Kajal Jain, M.D.

Doppler blood flow improved as seen by decreased value of various Doppler indices with epidural local anesthetic. Theanalgesic efficacy, neonatal outcome and maternal satisfaction was also reported to be better in epidural group incompare to tramadol analgesia group


P-9054 Surgical Correction of Scoliosis in a Patient with a Fontan

Primary Author: Abraham Grande Fernández12 de Octubre Hospital | Madrid, Spain

Co-Authors: Sandra de la Fuente Portilla Tania Franco CepedaÁngel Jerez Matas Paloma Rubio Pascual

An increasing number of patients with congenital heart diseases are reaching adulthood due to surgical and medicalimprovements. Fontan circulation patients represent an anesthesia challenge, specially during scoliosis correction for itshigh-risk perioperative complications.We report about a case of a 19 years old girl with a fontan circulation who underwentsurgery for posterior instrumentation secondary to scoliosis, and her successful outcome.

P-9055 Endothelial Function is Not Affected by Fresh or Storage-Aged Autologous Blood Transfusions in HealthyIndividuals

Primary Author: Khuram Ashraf, M.D.Emory University | Atlanta, GA, United States

Co-Authors: Graham Smith, B.Sc Salman Sher, M.B., B.S.Robert Neuman, M.D. John Roback, M.D., Ph.D.Arshed Quyyumi, M.D., FRCP, FACC

The transfusion of storage-aged (aged) packed red blood cells (pRBCs) is associated with worse outcomes. We haverecently demonstrated a decrease in endothelial function in anemic patients receiving aged compared to fresh bloodtransfusions, suggesting impairment of nitric oxide (NO) signaling. To further investigate this phenomenon, we testedendothelial function during transfusion of aged and fresh autologous pRBCs in healthy subjects, with the hypothesis thataged pRBCs will impair endothelial function.

P-9056 Bilateral Vocal Cord Paralysis After Endotracheal Intubation

Primary Author: Maria Teresa Gudin, M.D.Getafe University | Madrid, Spain

Co-Authors: Nalini Vadivelu Rocio Castellanos, M.D.Marisa Mariscal, M.D. M. Luz Pindado, M.D.

Vocal cord paralysis is a rare complication of endotracheal intubation. The mechanism can be by mechanical injury(dislocation or subluxation of arytenoids) or nerve injury. The latter can be produced by compression of an overinflatedcuff within the larynx. Early detection is very important A clinical case is reported.

P-9057 The Use of Fiber Optic Bronchoscope for Intubation Through Ilmas: A Manikin-Based Study

Primary Author: Meta Levstek, M.D.University Hospital 12 de Octubre | Madrid, Spain

Co-Authors: Adriana Calderón Barajas, M.D. Oscar Valencia Orgaz, M.D.Adolfo Garcia Gutierrez, M.D., Ph.D. Jorge Hernan Calle Ochoa, M.D.

The objectives of our study were to compare intubation times through three different ILMAs (Fastrach, Aura-I, AirQ) withfiber optic bronchoscope. The residents first had to place the ILMAs in a random and consecutive fashion and secondlyintubate through them with a fiber optic bronchoscope. In the results we saw that there was no statistically significantdifference in the time needed to intubate through different ILMAs (p 0.305). We found that with the years of experiencethe residents improved their times with the AirQ (p 0.020). Over all the residents preferred to intubate through AirQ ILMA.


P-9058 Abstract to Publication Rate in an International Society: Anesthesiology and Critical Care Medicine versusOther Specialties

Primary Author: Patrick J Hackett, M.D.University of California, Berkeley | Berkeley, CA, United States

Co-Authors: Marina Guirguis, BS Nozomi Sakai, BSTetsuro Sakai, M.D., Ph.D.

To analyze the rate at which abstracts presented at the ILTS meeting are published as full manuscripts and compare theperformance of anesthesiology/CCM researchers relative to researchers in other specialties.

P-9059 Pregabalin Overview and Its on Label and Off Label Uses

Primary Author: Diana Besleaga, M.D.Stony Brook University | Stony Brook, NY, United States

Co-Author: Brian Durkin, D.O.

Pregabalin which was first introduced in 2004 and approved by the United States Food and Drug Administration (FDA)has several on and off labeled uses. Currently, FDA approved uses for Pregabalin include adjunctive therapy for adultswith partial onset seizures, management of postherpetic neuralgia and neuropathic pain associated with spinal cordinjury and diabetic peripheral neuropathy, and the treatment of fibromyalgia. Some of the off labeled uses for Pregabalininclude generalized anxiety disorder, alcohol withdrawal, central post stoke pain, acute and postoperative pain, restlessleg syndrome, headaches, chronic prostatitis, overactive bladder, and chronic pain syndromes. This poster will further discusssome of these on and off labeled uses of Pregabalin.

P-9060 A Survey on Burnout Among Anesthesiology Trainees in Singapore

Primary Author: Yie Hui Lau, M.B., B.S., Masters of Medicine (Anaesthesiology)Singapore General Hospital | Singapore, Singapore

Co-Authors: Sze Ying Thong, M.B., B.S., Masters of Medicine (Anaesthesiology)Sin Yee Goh, M.B., B.S., Masters of Medicine (Anaesthesiology)Shin Yuet Chong, M.B., B.S., Masters of Medicine (Anaesthesiology)

A survey of burnout among Anaesthesiology trainees in Singapore

P-9061 Closing the Last Side Show

Primary Author: David Waisel, M.D.Boston Children's Hospital | Boston, MA, United States

The long-standing habit of clinicians going to look at anesthetized patients with interesting anomalies is a violation oftrust. Observing patients without their consent should only be done under specific conditions.


P-9062 Anesthesia During 2 Cases of Multisystem Langerhans Cell Histiocytosis in Infants

Primary Author: Rafael Arboleda, M.D.Hospital 12 de Octubre | Madrid, Spain

Co-Authors: Claudia Olea, M.D. Patricia Tena, M.D.Gema Pino, M.D. María D. Mendez, M.D.Paloma Pérez, M.D.

Langerhans cell histiocytosis (LCH) is a non-malignant proliferative disorder of bone-marrow-derived antigen presenting cells.Morbidity andmortality, along with response to chemotherapeutic treatment, are predicted based on involvement of riskorgans such as the hematopoietic system, liver, spleen and lung. Young age at presentation is associated with multisystem(MS) involvement.We present the main challenges during the anesthetic management of two patients with MS-LCH at 2 and3 months of age. The first case exhibited bone marrow (BM), liver and spleen compromise with secondary anemia,thrombocytopenia and derived coagulopathy requiring multiple blood products transfusions. The second case presentedwith BM and lung compromise with intraoperative and postoperative pneumothorax requiring multiple interventions.

P-9063 Correlation of Routinely Used Difficult Airway Predictors with Intubation Difficulty Scale During Storz D-Blade Laryngoscopy & Tracheal Intubation

Primary Author: Waffa Al-Alawi, M.B., B.S.JLN Medical College | Aligardh, India

Co-Authors: Azza Suleiman Zaher Al-Abri, M.B., B.S. Aida Al Qasmi, M.B., B.S.Azharuddin M. Malik, M.B., B.S.,M.D. Naresh Kaul, M.B., B.S.,M.D.Rashid M Khan, M.B., B.S.,M.D.

Most of the difficult airway predictors deal with tracheal intubation involving conventional curved or straight blade rigidlaryngoscopes (1, 2). In this pilot study we evaluated whether cumulative scores of 6 Anticipated Difficult Airway Score(ADAS) (Table 1) would show any correlation with the Intubation Difficulty Score (IDS) and Cormack & Lehane’s gradingusing Storz D-bladeTM videolaryngoscope for intubation.

P-9064 Postoperative Pain Relief & Blood Loss After Total Knee Replacement: A Study of the Attenuating Efficacyof Intra Extracapsular Bupivacaine InfiltrationWith andWithout Adrenaline

Primary Author: Nadia Al Dhab Khamis Al Badi, M.B., B.S.JLN Medical College | Aligardh, India

Co-Authors: Malik Azharuddin, M.B., B.S.,M.D. Ayman Abd El Hamid Gouda AhmedRashid M. Khan Naresh Kaul

Conclusion: Addition of adrenaline to bupivacaine during intra and extracapsular infiltration towards the end of TKRsurgery reduces blood loss by its vasoconstrictor effect leading to a better plug formation. It also decreases pain intensitysignificantly by decreasing absorption of bupivacaine leading to an increased neuronal uptake and thereby enhancedquality of analgesia.

P-9065 Outcome Analysis of Major Burn Patients After Admission to the Burns Intensive Care Unit in a TertiaryRegional Referral Center

Primary Author: Sze Ying ThongSingapore General Hospital | Singapore, Singapore

Co-Authors: Sin Yee Goh Shin Yi Ng

The aim of this study is to develop an objective and reliable predictive model for morbidity and mortality in major burnpatients. It may be useful in prognosis during early stages of care.


P-9066 Analgesia Provision for Pacemaker Insertion: An Unrecognised Need

Primary Author: Rachel AndersonRoyal Brompton Hospital | London, United Kingdom

Co-Authors: Julian WE Jarman, M.B., B.S., M.D., MRCP Sian I Jaggar, M.B., B.S. M.D., FRCA

Cardiac device implantation is a common procedure. However, there is no literature to provide evidence of the degree ofpain caused, or the analgesic requirements. We undertook a , month pilot evaluation in a high volume service to assessthe degree of pain suffered by patients and the analgesia currently provided. Pain was assessed under both static anddynamic conditions, as discharge from hospital requires activity, which is also generally advantageous for cardiacpatients. The majority of patients reported severe pain at some point during their admission. Analgesia provision waspoor, and all staff groups were involved in the failure of analgesia. Cardiologists did not wait long enough for localanaesthesia to take effect, anaesthetists were inconsistent in delivery of parenteral analgesics, and nursing staff failed toadminister prescribed drugs. This has led to a multidisciplinary approach to service improvement in this area.

P-9067 Anesthesia for ECT during the Methohexital Shortage

Primary Author: William J. Molinari, M.D.Northport VA Medical Center | Dix Hills, NY, United States

Co-Authors: Dominik Rosa, M.D. Brett Moses

Methohexital is considered the drug of choice for anesthetic induction for ECT since it is associated with adequate seizureduration, minimal side effects and a rapid recovery profile. In it's absence, co-induction with etomidate(.15-.2 mg/kg) andpropofol( .5-1mg/kg) was utilized for ECT with favorable results.

P-9068 The Effect of High Fidelity Simulation Training on the Ability of Registered Nurses and AnesthesiologyResidents to Recognize and Respond to Respiratory Arrest in the Post-Anesthesia Care Unit

Primary Author: David Kim, M.D.Temple University | Philadelphia, PA, United States

Co-Author: Janice Rossimini, RNCSAPAN

DATA COLLECTION The number of times the nurses participating in the study called anesthesia stat in the PACU wascompared to the number of calls initiated by PACU nurses not participating in the study. OUTCOMEMEASURES Our primaryendpoint was the number of anesthesia stat calls resulting in intubations in the PACU.

P-9069 Comparison between Kaolin Thromboelastography and Rapid Thromboelastography in LiverTransplantation

Primary Author: Shu Y. LuUniversity of Pittsburgh SOM | Pittsburgh, PA, United States

Co-Authors: Ezeldeen Abuelkasem, M.D., MSc Raymond M. Planinsic, M.D.Kenichi A. Tanaka, M.D., MSc Tetsuro Sakai, M.D.,Ph.D.

In 27 consecutive adult patients who underwent isolated LT, the use of rapid-TEG resulted in >60% time reduction inreaction activation compared to traditional kaolin-TEG. There is a significant strong correlation between MA valuesobtained from kaolin-TEG and rapid-TEG in both baseline and III+30 stages. No correlation was found with R, K, and α.Machine/operator based errors are much higher with rapid-TEG compared to kaolin-TEG.


P-9070 Transfer of Potential Pathogenic Bacterias from Mobile Phones to Hands of Health Care Workers (HCWS) inHospitals: A Cause for Concern?

Primary Author: Prof ChandralekhaAIIMS | Delhi, India

Co-Authors: Jyotsna Punj Prof Rama Choudhry

Three samples each were taken from HCWs at a tertiary care hospital in India - from mobile phones, from hands and fromsterile hands of HCWs after mock mobile phone call of one minute. The results revealed that there is transmission ofpotential pathogenic bacterias from mobile phones to even sterile hands which can be a potential hazard to both HCW ,their families and patients. Thus there is a need to formulate policies regarding use of mobile phones in hospitals byHCWs and their regulated use.

P-9071 Catecholamine Levels in Patients with Right-Sided Congenital Heart Disease Undergoing Cardiac SurgeryRequiring Cardiopulmonary Bypass

Primary Author: Erica D. Wittwer, M.D., Ph.D.Mayo Clinic | Rochester, MN, United States

Co-Authors: James J. Lynch, M.D. William J. Mauermann, M.D.

The catecholamine levels in adult patients with right-sided congenital heart disease undergoing cardiac surgery requiringcardiopulmonary bypass is not known. This study measured epinephrine, norepinephrine, and dopamine levels in 20such patients. Epinephrine and norepinephrine levels increased significantly on cardiopulmonary bypass while dopaminelevels did not. This result is consistent with the catecholamine response in non-congenital adults undergoing cardiopulmonarybypass.

P-9072 Effects of Supplemental Oxygen on Maternal And Neonatal Oxygenation for Elective Cesarean Section:A Randomized Controlled Trial

Primary Author: Arunotai Siriussawakul, M.D.Mahidol University | Bangkok, Thailand

Co-Authors: Namtip Triyasunant, M.D. Akarin Nimmannit, M.D.Promphon Hirunkanokpan, M.D. Sasiwalai Luang-Aram, M.D.Aungsumat Wangdee, R.N.

Three hundred and forty healthy parturients underwent elective cesarean section were studied with regard to the superiorityof supplemental oxygen in those receiving spinal anesthesia. All women were term and had singleton. All desaturationoccurred in 12 parturients who were assigned to room air group. Almost events (11/12) came along concurrent withhypotension. There were no significant differences between both groups for other maternal and neonatal variables.Based on our findings, supplemental oxygen should not be routinely given for uncomplicated elective cesarean section,except in the case of parturients who are at risk of intraoperative hypotension.

P-9073 Anesthetic Management for Cesarean Section in a Paraplegic Parturient with Multiple Comorbidities

Primary Author: Sarah E. Kadhim, M.D.West Virginia University | Morgantown, WV, United States

Co-Author: Lance Parks, DO

Pregnant patients with spinal cord injuries present unique anesthetic challenges. The following case report describes theanesthetic management of a primigravid female with a history of thoracic spinal cord injury and peripartum complicationsincluding urosepsis, decubitus ulcer, pulmonary embolus requiring treatment with heparin, and opioid tolerance. Specialconsiderations in obstetric cases with spinal cord injuries are also discussed.


P-9074 Evaluation of the Implementation of Patient Blood Management program in Spain.

Primary Author: Sonsoles Silva., M.D.Miguel Servet University Hospital | Zaragoza, Spain

Co-Authors: Colomina M.J., M.D. Basora C., M.D.Llau J.V., M.D. Bisbe E.Cassinello C., M.D. Duran L., M.D.

Background and Goal of Study: In order to know the availability of a specific Patient Blood Management (PBM) programin different hospitals in Spain, we designed a survey that included the features of the preoperative evaluation, the availability anddesign of different blood-saving techniques in each center and the limiting factors in implementation for different typesof scheduled surgery.

P-9075 Improving Temperature Management by Anaesthetists

Primary Author: Sian Jaggar, M.B., B.S. FRCA M.D.Royal Brompton Hospital | London, United Kingdom

Co-Author: Shona Love, M.B., B.S., FRCS, FRCA

The number of guidelines being produced is increasing exponentially. These aim to increase the standard of care providedto patients. However, compliance with such guidelines is frequently not assessed. We have reviewed compliance with anational guideline regarding peri-operative temperature management within our tertiary referral cardiothoracic unit.Over 4 years there has been improvement in the overall compliance in both adult and paediatric populations. However,despite easy access to all the relevant equipment 20-30% of patients still do not have care that adheres to the guidelines.There is a particular challenge associated with ensuring that staff who rotate through the unit from other hospitals reachthe same level of compliance as substantive staff.

P-9076 Role of Catastrophising in The Intensity of Postoperative Pain After TKA

Primary Author: Irina Grosu, M.D.Cliniques Saint Luc | Bruxelles, Belgium

Co-Authors: Emmanuel Thienpont, M.D. Patricia Lavand'homme, M.D., Ph.D.

Despite multimodal analgesia, total knee arthroplasty (TKA) is associated with severe postoperative pain. The studyassessed the role of pain catastrophizing (an exaggerated negative mental set associated with actual or anticipated painexperience) on pain at rest and at mobilisation after TKA.

P-9077 Posterior Reversible Encephalopathy Syndrome in aWoman with Eclampsia

Primary Author: Claudia OleaHospital Universitario 12 de Octubre | Madrid, Spain

Co-Authors: Patricia Tena Rafael ArboledaAngelines Guerra Amparo Urbina

The common finding of PRES in patients with eclampsia suggests that PRES is a core component of the pathogenesis ofeclampsia. Reversible vasogenic edema affecting the white matter in the posterior regions was the characteristic findingin magnetic resonance imaging (MRI) of the brain. Although the prognosis is favourable, treatment needs to be early andaggressive, with rapid control of the convulsions and arterial hypertension, with the aim of preventing ischemia and cerebralinfarct from developing. There is a need to be highly alert and to consider the diagnosis of RPLS in women presentingwith convulsions and other neurological symptoms.


P-9078 Misadventures with Nasogastric Tubes: Two Unrecognized Misplacements

Primary Author: Eliyahu Cooper, M.D.St. Joseph's Regional Medical Center | Paterson, NJ, United States

Co-Author: Seth Landa, M.D.

Two cases are presented in which a nasogastric tube was malpositioned and went undetected. In the first case, thenasogastric tube penetrated the pleural space via the left lung; in the second case it was located in the bronchus. In bothcases enteric feeding was started leading to respiratory complications which resolved over several days. Accurateconfirmation of nasogastric tube position should be an absolute requirement prior to use for enteric feeding.

P-9079 Elevated Lidocaine Serum Levels Following The Delivery of a Needle Free Device

Primary Author: Padma Gulur, M.D.Massachusetts General Hospital | Boston, MA, United States

Co-Authors: Chadi El Saleeby, M.D. Lisa D. Watt, PNPKatharine M. Koury, BA Ari R. Cohen, M.D.

There is increased concern regarding circulating levels of lidocaine immediately after the use of a needle free device withbuffered lidocaine. We conducted a study to assess lidocaine circulation after the use of a needle free device for thedelivery of a local anesthetic. 2 peripheral intravenous (IV) catheters were placed in the antecubital fossa of each arm.2mg of 1% buffered lidocaine was administered via the needle free device on the dorsum of the subject’s hand. Within 2minutes, a third IV was placed in the location of the lidocaine administration and 5mL of blood was collected from allthree sites. If blood samples returned positive for lidocaine, they were also collected , hour and 2 hours later. Toxic levelsof lidocaine and detectable lidocaine serum levels from blood drawn on the arm opposite the administration site werefound in certain subjects. We concluded that there may be systemic lidocaine levels with the administration of the needlefree device and these levels may reach the toxic range in adults. Further investigation will be required to determine if thisfinding has clinical significance especially considering the smaller body mass of children.

P-9080 Smart Phone and Tablet Instant Entry of Perioperative Regional Block Placement Information to EnhancePerioperative Pain Management of Patients

Primary Author: Sameet Syed, M.D.Houston Baptist University | Houston, TX, United States

Co-Authors: Saniya Syed Adil M. Mohiuddin, M.D.Shaul Cohen, M.D. Ali Razvi, M.D.

Smart Phone/Tablet Entry of Regional Block placement information into a patient's electronic medical record facilitatesbetter transfer of care. Streamlined integrated ICD codes within the form improves reimbursement for both academicand private practices alike.

P-9081 Prospective Observational Analysis of Ambient Operating Room Noise during Induction and Emergence -A QI Study

Primary Author: Andrey F. BilkoPenn State College of Medicine | Hershey, PA, United States

Co-Authors: Michael A. B. Akerley, D.O. Elbert MetsSonia J. Vaida, M.D. Julia Caldwell, M.D.

We report preliminary results of an ongoing prospective, observational study of ambient operating room noise duringinduction of and emergence from general anesthesia. Our findings indicate that average operating room backgroundnoise, during both induction of and emergence from anesthesia, was at a level that could possibly impede effectivecommunication and thus could result in an increased risk of anesthesia provider distraction and error. Our data showemergence to be the loudest period during the time that patients are in the operating room.


P-9082 Automated Reconciliation of Controlled Substances Dispensed from an Automated Anesthesia Drug Cartand an Anesthesia Information Management System

Primary Author: Richard H. Epstein, M.D.Jefferson Medical College | Philadelphia, PA, United States

Co-Author: David M Gratch, D.O.

We developed an interface between the database for our automated anesthesia drug dispensing carts and our anesthesiainformation managment system to reconcile controlled substance transactions between these systems. Feedback wasprovided to individual providers with discrepancies, resulting in a reduction in the percentage of patients where the drugbalances did not reconcile.

P-9083 Knowledge Assessment of Practical Nurses on the Measurement of Oxygen Saturation Level in ArterialBlood and Automatic Blood Pressure

Primary Author: Wannee Ongvisetpaiboon, B.Sc.Ramathibodi Hospital, Mahidol University | Bangkok, Thailand

Co-Authors: Pensiri Poomhirun Somchai Viengteerawat, M.D.Mali Rungreungvanich, M.D. Jittiya Watcharotayangul, M.D.

Short time workshops are useful and can be used to improve knowledge of practical nurses in measurement of arterialoxygen saturation and automated blood pressure.

P-9084 Complications of Malignant Hypopharyngeal Wall Neoplasms and Radiation on Airway Management

Primary Author: Mark W Saweris, St. George's University School of MedicineWoodhull Medical & Mental Health Center | Brooklyn, NY, United States

In this presentation, we review the case of a 64 year old African American patient undergoing an elective surgical procedurefor the repair of an umbilical hernia. The case could not proceed because of difficult intubation. Namely, the patient had astenosed and fibrotic airway secondary to extensive chemotherapy and radiotherapy for a malignant hypopharyngealcarcinoma. This complicated the surgical management of this patient. This case study explores the normal anatomy ofthe airway, how it was compromised, and its impact on intubation. Specifically, we consider the possibility that this electivesurgical procedure may have altered the consideration of alternative airway management techniques that may have bettermanaged his complicated airway. This includes fiberoptic intubation. Manipulation of the tip of the bronchoscope byadjustments at the handle could have properly identified the altered laryngeal "landmarks" that were obscured in this case.

P-9085 Case Report Pre-Arrest, Maternal Dyspnoea & Collapse

Primary Author: Shahrzad Pakkar Tadbiri, M.B., B.S., M.D., FRCAEaling Hospital | London, United Kingdom

Co-Author: Ramak Soleimani, M.D.

A 33 year old lady(para 0+1) with no past medical history presented at 37 weeks of gestation in active labour. 12 hourspost LSCS under regional anaesthesia, she complained of chills, diaphoresis and progressively worsening SOB. Hertemprature was 40 degree C, HR of 110 b/m, a Bp of 80/35 mm Hg and a RR of 40 b/m. Her Spo2 was 90-93% on airimproving with 100% o2 to 97%.O/E, she was noted to have reduced air entry on the right side, with bilateral basalcrepitations. Laboratory tests showed WBC of 14x10\9/L and CRP of 150.CXR revealed haziness in the right mid lowerzones. ABG showed severe hypoxemia. A CT pulmonary angiogram was ordered in the view of the relatively acutedeterioration, which did not reveal any evidence of pulmonary embolism, but showed massive right sided pleuraleffusion with underlying consolidation of the right lower lobe.She was shifted to the HDU, started on non-invasiveventilatory support with supplemental oxygen, initiated on Tazocin for broad spectrum cover of bronchopneumonia.The effusion was drained and a chest drain inserted. Pleural tap culture was positive for Chlamydiae pneumonia. Shewas discharged from HDU after 48h.


P-9086 Investigating Preoperative Medication Instructions and Patient Compliance

Primary Author: Johnathan R. Renew, M.D.Mayo Clinic Florida | Jacksonville, FL, United States

Co-Author: Marie De Ruyter, M.D.

Preoperative medication instructions and patient compliance were investigated via a standardized survey in an effort toimprove patients' preoperative encounter.

P-9087 Postpartum Preclampsia Complicated by Atypical Positional Headache

Primary Author: Mahendranauth Samaru, M.D.New York Presbyterian-Weill Cornell | New York, NY, United States

Co-Authors: Sharon Abramovitz, M.D. Klaus Kjear, M.D.Alaeldin Darwich, M.D.

PRES and RCVS are reversible with early recognition and treatment of hypertension in ICU setting. Delayed diagnosis mayresult in cerebral ischemia and infarction.

P-9088 Use of King System Sample Port T-Piece When Portex Fiberoptic Bronchoscope Swivel Adapter Fails andBronchial Dilatation via Tracheostomy Site

Primary Author: Sri Smitha Kanaparthy, M.D.Univ of Oklahoma Health Sciences Center | Oklahoma City, OK, United States

Co-Authors: Nicholas Katseres, MS III Jewel D. Montgomery, M.D.Amir Butt, M.B., B.S., M.P.H. Alberto J de Armendi, M.D., M.B.A.

Summary Beare-Stevenson Cutis Gyrata Syndrome is caused by a mutation affecting the fibroblast growth factor receptor-2which interferes with skeletal and skin development1. At birth craniosynostosis is present with cloverleaf shaped skull,proptosis, downward slanting palpebral fissures, low ears that are rotated backwards, choanal atresia, cutis gyrata,acanthosis nigricans, genital and anal abnormalities and underdeveloped jaw and middle third of the face. Abnormalitiesaffecting the airway include cervical spine, foramen magnum, choanal hypoplasia or atresia, and tracheal stenosis.2 Wepresent a patient with B-S S with LMB and highlight size mismatch between the Portex swivel and tracheostomy tube. Wesuggest use of an ETT mounted FOS to selectively intubate and dilate bronchomalacia.

P-9089 Case Report: Intraoperative Neurophysiologic Monitoring for Embolization of A Cavernous ICA Aneurysm

Primary Author: Marla L Matal, M.D., MPHSUNY Upstate Medical University | Syracuse, NY, United States

Co-Authors: Reza Gorji, M.D. Fenghua Li, M.D.Geoffrey Allott, BA, CNIM Eric M. Deshaies, M.D.

A 42 year old female underwent embolization of a cavernous ICA aneurysm with total intervenous anesthesia andintraoperative neurophysiologic monitoring. An acute loss of IONM parameters alerted the surgeons and anesthesiologistsof the ICA rupturing.

P-9090 Surgical Specialty and Preoperative Consultation Based on Commercial Health Insurance Claims

Primary Author: Stephan Thilen, M.D., MSUniversity of Washington | Seattle, WA, United States

Co-Authors: Anda Cornea, M.D., Ph.D. Elliott Lowy, Ph.D.EdwardWeaver, M.D., M.P.H. Miriam Treggiari, M.D., M.P.H., Ph.D.

Among 7624 commercially insured patients who underwent surgery in a fee-for-service setting, patients having orthopedicor neurological surgery were more likely to have preoperative consultations compared with those having general surgery- adjusted odds ratios (95% CI) of 2.6 (2.0-3.4) and 2.7 (1.5-4.9), respectively. Patients having gynecological surgery wereleast likely to have consultations, odds ratio 0.5 (0.3-0.9). The authors conclude that there is substantial practice variationamong surgical specialties with regard to the use of preoperative consultations that are not based on underlying risk.


P-9091 Tracheal intubation in the Lateral Position: An Observational Study on the Efficacy, Complications andLearning Curve

Primary Author: Yufan ChenSingapore General Hospital | Singapore, Singapore

Co-Authors: Sui An Lie Sze Ying ThongAndrew Kong

The need to perform intubations in the lateral position may be occasionally encountered by the anesthetist. However, itis not commonplace for anesthesia trainees to be trained in lateral intubations. A survey was conducted on a group ofanesthesia trainees with varying levels of experience on the ease at which lateral intubations were performed underdirect laryngoscopy with a Mackintosh blade.

P-9092 Body Composition Monitoring for Determination of Volume Status in Patients Undergoing GeneralAnaesthesia: A Preliminary Report

Primary Author: Matthäus Ernstbrunner, M.D.Fresenius Medical Care Deutschland GmbH | Bad Homburg, Germany, Germany

Co-Authors: Lisa Kostner Peter Wabel, M.D.Oliver Kimberger, Professor, Ph.D., M.D. Barbara Kabon, Professor, M.D.Manfred Hecking, M.D.

The Body Composition Monitoring (BCM, Fresenius Medical Care, Germany), a new whole-body bioimpedance spectroscopydevice, was tested to determine a change in the volume status in patients undergoing general anesthesia. PerioperativeBCM measurements yielded plausible results (a significant increase in Total BodyWater, in Extracellular Volume and inFluid Volume Overload)

P-9093 A Case of Anaphylaxis to Isoplex 4% During Cardiopulmonary Bypass

Primary Author: Claire BoyntonRoyal Brompton Hospital | London, United Kingdom

Co-Author: Sian jaggar

Anaphylactic reactions are unusual in the perioperative period.We present a rare case of anaphylaxis to Isoplex 4% duringcardiopulmonary bypass, with profound circulatory collapse.

P-9094 Perioperative Management of Hereditary Angioedema

Primary Author: Brandy Brewer, M.D.Albany Medical Center | Albany, NY, United States

Co-Authors: Jennifer Hamilton-Knuth, M.D. Jocelyn Celestin, M.D.

Hereditary Angioedema [HAE] is a disorder characterized by nonpruritic, nonpitting edema caused by a complementmediated increase in vascular permeability. In the setting of minor trauma, stress, dental procedures, infection and evendaily activities patients with HAE are at an increased risk of having an attack characterized by intermittent swelling of theskin, gastrointestinal tract or bronchial tree secondary to unchecked complement activation. The case presented discussesthe perioperative treatment plan developed for the management of an HAE attack in a patient with known Type I HAEscheduled for laparoscopic cholecystectomy for symptomatic cholelithiasis


P-9095 Community-wide Trends in Utilization and In-Hospital Mortality for Carotid Artery Stenting and CarotidEndarterectomy, 2006-2011: Results from the State Inpatient Database

Primary Author: Bess M. Storch, M.D.Cornell University | Ithaca, NY, United States

Co-Authors: Akshay U. Bhat, MEng Ramin Zabih, Ph.D.Jonathan M. Eskreis-Winkler, BA Peter M. Fleischut, M.D.Kane O. Pryor, M.D.

We use the Statewide Inpatient Database (SID) to investigate utilization, mortality, and disposition trends for percutaneouscarotid artery stenting (CAS) and carotid endarterectomy (CEA) over the six years ending in 2011. After an initial decreasebetween 2006 and 2007, CAS utilization has slightly increased, while utilization of CEA has steadily declined. In hospital mortalityin the CAS cohort wasmore than double that for CEA across all age groups, raising the possibility that community-widemortality outcome for CASmay be less favorable when compared to CEA thanmight be expected from clinical trial results.

P-9096 Efficacy of Vasopressin as a Primary Treatment for Refractory Hypotension in the Intraoperative Setting

Primary Author: Laila F. Makary, M.D.Dallas Veterans Affairs | Dallas, TX, United States ,University of Texas SouthWestern | Dallas, TX, United States

Co-Authors: Terri S. Jones, DNP Luis E. Ortiz, RN

Intra-operative refractory hypotension can be associated with undesirable complications such as stroke or myocardialinsufficiency. Determining the risk factors associated with its occurrence as well as the ability to control and treat thehypotension is crucial In our facility we did an observational retrospective chart review to all patients who received vasopressinintra-operatively as a treatment of refractory hypotension. We found that all of our patients were taking Antihypertensivemedications of which 48% were on mood stabilizers that may attribute to an increased risk of intra-operative hemodynamicinstability. We observed that all patients did not respond initially to the standard vasopressors but responded to one ortwo doses of vasopressin and were able to respond later to the usual vasopressors as a maintenance drip. This could beexplained by the modulation of adrenergic mediated response by V, receptor stimulation. We concluded that Vasopressincould be the ideal drug for rescuing and treating this refractory hypotension and maintain responsiveness to the pressorslater on.

P-9097 Fetal Bradycardia After Intrathecal Sufentanil Labor Analgesia: Prospective Study

Primary Author: Catarina C. Esteves, M.D.Centro Hospitalar Lisboa Central | Lisbon, Portugal

Combined spinal epidural analgesia (CSE) for labor pain relief has become increasingly popular over the last years. Theeffect of intrathecal sufentanil on the incidence of fetal heart rate (FHR) abnormalities remains controversial. FHRabnormalities including severe bradycardia have been reported following the administration of intrathecal opioidsduring the first stage of labor. In this prospective study in a total of 19 pregnant women, 4 fetuses developed FB after CSEwith sufentanil intrathecal. The FB reverted and there was no need for urgent caesarean. The incidence of FB after CSEwas of 21 % with a confidence interval of 95 % between 7 and 43 %. However due to the small size of the sample theseresults are not statistically significant. To confirm these observations we need to increase the sample size ideally to anumber above 300 or to obtain a control group. Fetal bradycardia after the CSE in labor is a reality that the anesthesiologistshould be conscious and prepared.

P-9098 The Most Important Articles Ever Published in the Specialty of Anesthesiology

Primary Author: Denise Hersey, MLS, MAWood Library-Museum of Anesthesiology | Park Ridge, IL, United States

Co-Authors: Karen Bieterman, MLIS Paul G. Barash, M.D.

Seminal articles in the specialty of Anesthesiology are "game changers" for both the specialty as well as medicine in general.By constructing a list of the 20 most seminal articles in Anesthesiology, the authors demonstrate that the major achievementsof modern Surgery could not have occurred without the accompanying vision of pioneers in Anesthesiology.


P-9100 Anesthesia Inpatient Obstetric Order Set

Primary Author: Kadia M. Bundu, M.D.Rutgers, New Jersey Medical School | Belleville, NJ, United States

Co-Authors: Marshall Lee, M.D. Paul Sandoval, M.D.Julie Nguyen, M.D. Ankit Jain, M.B., B.S.

Respiratory depression is a significant adverse effect of neuraxial opioids administered to post partum patients. The riskincreases in patients who receive concomitant oral or intravenous opioids within 12 to 24 hours after neuraxial opioidsadministration. A comprehensive inpatient order set specific for obstetric patients must be developed and available in allinstitutions where OB anesthesia services are provided. The order set must be concise to include alternative pain therapiesto parenteral or oral opioids in order to improve patient safety and satisfaction.

P-9101 Effect of Flumazenil, Aminophylline and Ephedrine on the Glutamate Transporter Type 3 Expressed InXenopus Oocyte: Interaction with Propofol

Primary Author: Hee Jung Baik, M.D., Ph.D.School of Medicine, EwhaWomans University | Seoul, Korea, Republic of

Co-Author: So Hyun Mun, M.S.

We investigated the effects of flumazenil, aminophylline and ephedrine on the activity of excitatory amino acid transportertype 3 (EAAT3), the major neuronal glutamate transporter, and the interaction with propofol effect on EAAT3 activity.We haveshown that aminophylline and ephedrine, but not flumazenil inhibit EAAT3 activity at clinically relevant concentrations.PKC and PI3K seem to be involved in these effects. Aminophylline and ephedrine abolished the increased activity of EAAT3 bypropofol. Our results represent a novel site of action for aminophylline and ephedrine to increase the glutamatergicneurotransmission.

P-9102 Interpatient Variables Contributing to Hypotension During Propofol Induction

Primary Author: Daniel TapiaPenn State Hershey | Hershey, PA, United States

Pre-induction use of fentanyl strongly contributes to hypotension after induction of anesthesia with propofol and isaccentuated in the frail, elderly, or debilitated, while pre-induction use of midazolam or high dose lidocaine diminishedthe incidcence of hypotension. Fluid preloading, fasting time, and expired volatile concentration had no effect on theincidence of hypotension.

P-9103 Estimating Teeth to Vocal Cord Distance by Height, Weight, and BMI

Primary Author: Daniel TapiaPenn State Hershey | Hershey, PA, United States

Height has the greatest accuracy for estimating teeth to vocal cord distance in adult patients and the equation height(meters) x 7 + 1.4 may be used to estimate this depth. An additional 6cm may be added to generate the endotrachealtube depth measured at the teeth with a 7.5 or 8.0mm tube, placing the cuff just past the vocal cords.

P-9104 Perioperative Transfusion as an Indicator for Outcomes in Joint Replacement

Primary Author: Amanda K. Brown, M.D.Medical Center of Central Georgia | Macon, GA, United States

To determine whether a relationship exists between perioperative transfusions and total knee and hip joint replacementoutcomes


P-9105 A Randomized, Double-Blind, Placebo-Controlled Trial of the Sufentanil Sublingual Microtablet SystemAfter Major Abdominal Surgery

Primary Author: Mike A. Royal, M.D., J.D., M.B.A.AcelRx Pharmaceuticals, Inc. | Redwood City, CA, United States

Co-Authors: Forrest G. Ringold, M.D. FACS Harold Minkowitz, M.D.Tong-Joo Gan, M.D. Pamela P. Palmer, M.D. Ph.D.

The Sufentanil Sublingual Microtablet System provides a viable and attractive alternative to traditional IV PCA analgesia.This study of the System demonstrates that it is a safe and effective modality for treating moderate-to-severe acute painafter major open abdominal surgery.

P-9106 Impact of Pro-Inflammatory Factors on Chronic Post-Surgical Pain After Fast-Track LaparoscopicColectomy

Primary Author: Patricia M Lavand'homme, M.D., Ph.D.St Luc Hospital UCL Medical School | Brussels, Belgium

Co-Authors: Nicolas Parisi, M.D. Fernande Lois, M.D.Alex Kartheuser, M.D.

The incidence of chronic pain after fast-track laparoscopic colectomy is similar to that of open colectomy (11%). The roleof preoperative pro-inflammatory state remains unclear but obesity does not seem to be a risk factor.

P-9107 Anaesthesia in an Infant After Acetaminophen Accidental Overdose: Case Report

Primary Author: Julio Ontoria Muriel, ResidentHospital La Paz | Madrid, SpainCo-Authors:

Marta Vazquez Moyano, Ph.D. Ana Maria Montero Feijoo, ResidentFrancisco Reinoso Barbero, Clinical Chief, M.D. Fernando Gilsanz Rodriguez, Professor, M.D.

Acetaminophen poisoning remains one of the more common drugs taken in overdose with potentially fatal consequences.Early recognition and prompt treatment with N-acetylcysteine can prevent hepatic injury. Although acetaminophen toxicityis not uncommon in children only single case reports for infants or neonatal overdose via each of the oral, intramuscular,and intravenous routes exist. We report a case of accidental overdose infusion acetaminophen in a preterm infant after aroutine cataract elective surgery and the uneventful anesthesia for the contralateral surgery three days later.

P-9108 Low Skill Nasal Fibreoptic Intubation

Primary Author: Daniel RobertsSt George's Hospital | London, United Kingdom

Co-Author: Davinder Garewel

We describe a low skill nasal fibreoptic intubation method that allows for the continued ventilation of the patient duringthe scoping process. It also produces more rapid navigation to the glottic area and improved initial views of the cords.


P-9109 Predictors of Inadequate Spinal Anesthesia for Non-Emergent Cesarean Delivery: A Retrospective Analysis of2,482 Cases

Primary Author: Ihab Kamel, M.D.Temple University School of Medicine | Philadelphia, PA, United States

Co-Authors: Huaqing Zhao, Ph.D. Paul Chiarulli, BSKelly Rowe, BA BrianWeston, BSTarik Yuce, BA Dimitrios Mastrogiannis, M.D., Ph.D.Rodger Barnette, M.D.

This study identifies body mass index and duration of surgery as predicators of inadequate spinal block after successfulspinal anesthetic placement during non-emergent cesarean delivery. Duration of surgery extending beyond 100 minutesis associated with 2.3 fold increase in the rate of inadequate spinal block while BMI above 25 is associated with a significantdecrease in the rate of inadequate spinal block during non-emergent cesarean delivery.

P-9110 “Are We Hurting Ourselves?”What is the Prevalence of Back Pain Among Anesthesia Providers?

Primary Author: Jonathan Anson, M.D.Penn State Hershey Medical Center | Hershey, PA, United States

Back injuries are a highly reported category of occupational injury in the health care setting. The daily tasks of an anesthesiaprovider, including pushing stretchers, transferring patients, and bending for procedures are potential risk factors fordeveloping back pain. A survey study was conducted to assess the incidence, risk factors, and other characteristics ofback pain in anesthesia providers.

P-9111 Audit and Analysis of Early Warning Scoring Systems and Rapid Response Teams in Obstetrics: MaternalSafety Improvement Initiative

Primary Author: Beata Evans, M.D.Stony Brook Medicine | Stony Brook, NY, United States

Co-Authors: Rishimani Adsumelli, M.B., B.S. Valeri Wong, B.SAntonietta Lynch, RNC

We implemented Early warning scoring systems and Rapid response call teams for Obstetric patient population. Theobjective of this study is to audit and analysis of “OB RRT overhead calls” as part of continuing quality improvement.Retrospective review of the data from years 2011 and 2012 is selected for this analysis. Sources of information are Logsfrom RRT team, the OB EWS scores 6 and greater from EMR and chart review. The analysis will be presented.

P-9112 "Successful Treatment of a Patient with Narcotic Dependency Using an Individualize Approach to PainManagement"

Primary Author: Eric DeVeaux, M.D.Stony Brook University Hospital | Stony Brook, NY, United States

Co-Authors: Irina Lokshina Patricia Tsui

The following is a case report of an unemployed 42 year old male with a past medical history signifcant for lymphomastatus-post chemotherapy leading to neuropathy, diffuse bilateral upper and lower extremity pain, depression, bipolardisorder, high cholesterol, low testosterone and hypothyroidism who was dependent on 240mg of Methadone andOxycodone daily prior to being treated at Stony Brook Medical Center Pain Practice. On being admitted to the pain practice,an individualized pain management plan was adapted that addressed all areas of the patient's health in addition to hispain. Through patience and a strong commitment from both the patient andmedical team to adhere to the painmanagementplan, 8 months after initiating treatment the patient was successfully weaned to Methadone 40mg daily, Oxycodone wasdiscontinued, regular follow-ups with a psychiatrist and primary care physician were achieved, a job was obtained, andgreater patient satisfaction with the pain management plan was reported.


P-9113 Systems Based Quality Improvement Initiative for the Safety of Out-of-Operating Room Intubations

Primary Author: Maisie M. Tsang, M.D.St. Joseph's Regional Medical Center | Paterson, NJ, United States

Co-Authors: Lindsay Cammarata, M.D. Padmaja Upadya, M.D.Anisha Krottapalli

Systems Based Quality Improvement Initiative for the Safety of Out-of-Operating Room Intubations - observing pre- andpost-intervention availability of out-of-operating room intubation equipment to improve resident satisfaction andpatient safety.

P-9114 Plasma Nociceptin Levels Vary During and After Cardiopulmonary Bypass

Primary Author: Gregory E. Weller, M.D., Ph.D.Penn State Hershey Medical Center | Hershey, PA, United States

Co-Authors: Jonathan B. Derr, MS Cameron P. Richards, M.D.Anita K. Malhotra, M.D. Kane M. High, M.D.

Nociceptin is an opioid neuropeptide that is known to be involved in inflammation, immunomodulation, and cardiovascularcontrol. Using a fluorescent ELISA technique, plasma nociceptin was measured in human patients undergoing CABG withcardiopulmonary bypass (CPB), at each of four timepoints (pre-CPB, post-CPB, 4 hrs post-op, and 24 hrs post-op). Plasmanociceptin concentrations decreased during CPB, then rebounded to significantly higher than baseline values at the 4hrand 24hr post-op time points. Nociceptin should be considered as a potential biomarker for CPB-related systemic inflammation.

P-9115 Audit of Critical Incidents for Paediatric Cardiac Catheterisation in Singapore

Primary Author: Yan Ru Tan, M.B., B.S.KKWomen's and Children's Hospital | Singapore, Singapore

In the event of increasing number of paediatric cardiac catheterizations done in Singapore, we did an audit on the criticalincidents that have occurred in our hospital for the last 15 years. The overall incidence of events is 7.1%, and the populationat highest risk is neonate with critical pulmonary stenosis coming for ballooning. Diagnostic catheterization has a relativerisk of 1.8 times for critical incidents compared to the interventional procedure group. Hypoxia and arrhythmias are thetwo most frequent types of critical incidents that have occurred. With the knowledge of incidence and spectrum ofcomplications occurring during general anaesthesia in children undergoing cardiac catheterization, it can help to provideinsights and enable formulation of effective preventive strategies.

P-9116 Visible Epiglottis: Does it Matter?

Primary Author: Emily Birdsall, M.D.Temple University School of Medicine | Philadelphia, PA, United States

Co-Author: Jyosthna Reddy, M.D.

In our case, the patient with a visible epiglottis had easy mask ventilation with an oral airway and an easy intubation.However, because of the rare incidence and subsequent lack of data, no clear correlation was identified between"Mallampati Class Zero" findings on examination and ease of mask ventilation or intubation.


P-9117 Exposure to a High Fidelity Simulation of Cardiovascular Physiology Improves First-Year Medical Students’Performance on the Cardiopulmonary Physiology Final Written Examination

Primary Author: Lori Meyers, M.D.Mount Sinai Hospital | New York, NY, United States

Co-Authors: Adam Levine, M.D. Marybeth Fontana, M.D.Schaffernocker Troy, M.D. Scott WinfieldDavid Way, Med Bryan Mahoney, M.D.

Our study has shown an improvement in medical student performance on their cardiovascular physiology final writtenexamination following exposure to a High Fidelity Simulation (HFS) supplement to their standard curriculum comparedto their peers. Exposure to simulation may in itself prove to be a motivating variable when provided during the non-clinicalyears of medical education. Therefore, HFS as teaching tool can be an important adjunct for medical students even duringthe basic science curriculum.

P-9118 Continuous Positive Airway Pressure with Facemask vs. Manual Ventilation During Induction ofAnesthesia in Obese Patients

Primary Author: Claudia Tomás, M.D.ABC Medical Center | Mexico, Mexico

Co-Authors: Guillermo Dominguez Bernardo Gutiérrez, M.D.Miguel Herrera Adrian Palacios, M.D.Marisol Hernández, M.D.

We compared manual ventilation and CPAP in the induction of anesthesia in 28 obese pacientes scheduled for bariatricsurgery. Manual ventilation was performed without exceeding 15 cmH₂O of pressure of the airway, maintaining SpO₂above 90% for 5 minutes. In CPAP group, face mask was sealed, then we closed the pressure relief valve achievingpositive pressure between 10cmH₂O and 15 cm H₂ O for 5 minutes. We measure pvCO2 and EtCO2 before and afterintubation. We create a visual analog scale of 4 degrees to assess gastric insufflation. There is a trend to a statisticallysignificant difference in the gastric distension between the groups with the lowest frequency in the CPAP group(p = 0.079). More studies are needed to determine this. We found significant difference in both the pvCO2 and EtCO2.We conclude that the use of CPAP by face mask at a pressure of 10-15 cm H₂O in obese patients is as least as safe asconventional maneuver because it maintains hemodynamic stability and also allows the anesthesiologist greaterefficacy in the management of the airway, in case of two-hand ventilation.

P-9120 Clinical Significance of Retromental Space for the Discrimination of Difficult Laryngoscopy

Primary Author: Seung Gyu Jeon, M.D.Seoul National University Bundang Hospital | Seongnam-si, Korea, Republic of

Co-Authors: Seongjoo Park, M.D. Hyo Seok Na, M.D., Ph.D.Sunghee Han, M.D., Ph.D. Jinhee Kim, M.D., Ph.D.

Difficult laryngoscopy had significantly smaller retromental area at neck extension position compared to EL group suggestingthat small retromental space could be a clinical marker for difficult laryngoscopy.

P-9121 Efficacy of Sugammadex for Rocuronium- or Vecuronium-Induced Blockade Reversal: A Pooled Analysis

Primary Author: Hendrikus LemmensKlinik für Anaesthesiologie der Technischen | Munich, Germany

Co-Authors: Hein Fennema TiffanyWooR Kevin Jones Manfred BlobnerKarin Khuenl-Brady Armin Szegedi

Results of this pooled analysis of 1755 patients from 26 randomized studies confirm that sugammadex administered atrecommended doses provides rapid and predictable reversal of both rocuronium and vecuronium-induced moderateand deep neuromuscular blockade (NMB), as well as immediate NMB reversal 3 min after rocuronium. Sugammadexresults in statistically and clinically significantly more rapid reversal of moderate and deep blockade, versus neostigmineor spontaneous recovery.


P-9122 Methylene Blue Encephalopathy. A Commonly Overlooked Complication?

Primary Author: Rachel M. Sloan, M.D.University of Kentucky | Lexington, KY, United States

Co-Authors: Shaun McKenzie, M.D. Eugene A. Hessel, M.D.Cortney Y. Lee, M.D. David A. Sloan, M.D.

There were 3 cases at the University of Kentucky where methylene blue infusion for parathyroidectomy was complicatedby postopertive delirium. Each of these patients were taking SRIs at the time of operation. The post-operativeencephalopathy that appeared following methylene blue infusion in patients who take SRIs may be a manifestation ofserotonin toxicity.

P-9123 Ex-Utero Intrapartum Treatment (EXIT) of a Large Congenital Cystic Adenomatoid Malformation (CCAM):Fetal Considerations and Anesthetic Management

Primary Author: Kimberly R Blasius, M.D.UNC | Chapel Hill, NC, United States

Co-Author: Matthias W Konig, M.D.

Ex-Utero Intrapartum Treatment (EXIT) of a Large Congenital Cystic Adenomatoid Malformation (CCAM): FetalConsiderations and Anesthetic Management

P-9124 Variation in Incidence of Postoperative Nausea and Vomiting (PONV) and Post-Discharge Nausea andVomiting (PDNV) Between a Voluntary Registry, Patient Recall and a Prospective Trial

Primary Author: Frank Overdyk, MSEE, M.D.North Shore- LIJ | Manhasset, NY, United States

Co-Authors: Oonagh Dowling, Ph.D. Judith Aronsohn, M.D.Ezra Kassin, M.D. John DiCapua, M.D.

Clinical registries provide the opportunity to measure adverse outcomes and optimize best practices but may be proneto underreporting. This poster examines disparities between the incidence of post operative and post discharge nauseaand vomiting between a clinical registry, patient recollection and satisfaction, and the literature.

P-9125 Impact of Etomidate Administration During Abdominal Surgery on the Hypothalamic - Pituitary - Adrenal Axis

Primary Author: Jean-Jacques YimbouCUB Hopital Erasme | Brussel, Belgium

The incidence of Relative Adrenal Insufficiency (RAI), based on a short corticotropin stimulation test, following the use ofetomidate or propofol for induction of anesthesia before laparotomy was studied. The incidence of RAI trended upwardsin the etomidate group compared with the propofol group but did not reach statistical significance.

P-9126 The Impact of the Propofol Shortage on Anesthesiologist Behavior

Primary Author: Seth Akst, M.D., M.B.A.GeorgeWashington University | Washington, DC, United States

Co-Authors: Annie Mooser Joseph MarcotteRaksha Bangalore James Dunne, M.D.Babak Sarani, M.D.

The recent propofol shortages both concerned and challenged anesthesiologists, but despite the attention they gainedthere is little literature about their impact. We studied the practice patterns of anesthesiologists at the GeorgeWashington University Hospital during a propofol shortage towards the end of 2012.


P-9127 Presence of Arterial Line Does Not Improve Response Time to Proper Management of Simulated PulselessElectrical Activity

Primary Author: Jonathan Lipps, M.D.Mount Sinai | New York, NY, United States

Co-Authors: Bryan Mahoney, M.D. Kenneth Moran, M.D.Peter DeSocio, M.D. Scott WinfieldYury Khelemsky, M.D.

This study is a prospective, randomized controlled trial of 20 senior anesthesiology residents who underwent high fidelitysimulation of PEA upon induction of general anesthesia. Subjects were randomized to have access to either noninvasiveblood pressure monitoring or an arterial line during the scenario. Our data show that the presence of an arterial line didnot improve management of cardiogenic shock leading to PEA.

P-9128 Smart Phone and Tablet Instant Entry of Intra-Operative Transesophageal Echocardiographic Evaluationto Enhance Perioperative Management of Patients for Cardiovascular and General Cases


Co-Authors: Saniya Syed, undergraduate student Ali A. Razvi, M.D.Adil Moihuddin, M.D. Shaul Cohen, M.D.

Instantaneous Smart Phone/Tablet Entry of TEE findings into the patient's electronic medical record facilitates comprehensivetransfer of care, and is a great tool for improving financial remuneration in both academic and private practices.

P-9129 Factors Affecting Postpartum Hemorrhage During Cesarean Section

Primary Author: Rungphetch SuyawejMahidol University | Bangkok, Thailand

Co-Author: Vichai Ittichaikulthol, M.D.

Maternal age, indications for surgery and infants weight were associated with postpartum hemorrhage after caesareansection.

P-9130 Depth of Anaesthesia Monitoring in the Cardiac Catheter Laboratory

Primary Author: Shona M. Love, M.B., Ch.B., FRCARoyal Brompton Hospital | London, United Kingdom

Co-Author: Sian I Jaggar, M.B., B.S. M.D. FRCA

Depth of anaesthesia monitoring in patients undergoing general anaesthesia in the cardiac catheter laboratory: thechange in practice following the introduction of national guidelines.

P-9131 Design and Use of Simulation Based OSCE to Assess Anesthesia Knowledge and Skills

Primary Author: Daniel C Sizemore, M.D.West Virginia University | Morgantown, WV, United States

Co-Authors: David Wilks, M.D. Richard Driver, M.D.Brian Grose, M.D. Ahmed Attaallah, M.D.

We describe the development and implementation of a series of performance based objective structured clinicalexaminations, the method used to set minimum passing standards and the utilization of these OSCE's in the evaluation ofanesthesiology residents at various levels of training.We also describe the importance of this tool moving forward in theACGME Next Accreditation System andmilestone project.


P-9132 Is No-Cost TSE "Mask" Useful for Patients with Severe Diseases Under Deep Propofol Sedation DuringColonoscopy?

Primary Author: Sylviana Barsoum, M.D.Rutgers - Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Vincent DeAngelis, M.D. Shaul Cohen, M.D.Trishna Upadhyay, M.D. Kang Rah, M.D.Stefanie Berman, M.D. Tejal Mehta, M.D.Gina George, DO Melissa Wu, M.D.James Tse, M.D., Ph.D.

Patients undergoing colonoscopy routinely receive IV sedation and O2 via nasal cannula. Over-sedation and/or airwayobstruction may cause respiratory depression and severe desaturation, especially in high-risk patients with severecomorbidities. A simple plastic sheet was shown to improve oxygenation by transforming an ineffective nasal cannula toa face tent (TSE "Mask") in deeply-sedated patients during upper endoscopy. This technique has been used in EndoscopySuite. We review 325 patients who underwent colonoscopy. Data show that TSE "Mask" improves oxygenation andreduces severe desaturation in healthy patients (ASA Status I-II) and high-risk patients with severe diseases (ASA III-IV)under deep propofol sedation during colonoscopy. This simple face tent also decreases the need for assisted bag-maskventilation in high-risk patients during colonoscopy. It increases FiO2 without raising nasal cannula O2 flow. Althoughthis face tent can be used as a rescue device when patient's oxygenation deteriorates, it should be routinely used prior tosedation. It takes only a few seconds to prepare a TSE "Mask" and may improve patient safety at no cost.

P-9133 The Impact of the Propofol Shortage on Time to Start of Operation

Primary Author: Babak Sarani, M.D.GeorgeWashington University | Washington, DC, United States

Co-Authors: Annie Mooser, BA Joseph Marcotte, BSRaksha Bangalore, BS Richard A. M.D., Ph.D.James Dunne, M.D. Seth Akst, M.D.

A retrospective study was performed to determine the impact of the shortage of propofol on time to start of operation.We compared induction with sevoflurane against propofol in the time before/after the propofol shortage. 2053 patientswere enrolled. There was no difference in time to start of operation between induction agents on univariate or multivariateanalysis. We conclude that future shortage of propofol may not significantly impact operating room efficiency.

P-9134 Accuracy in Noninvasive and Continuous Hemoglobin Monitoring Trends During Liver Transplantation

Primary Author: Michael A. E. Ramsay, M.D., FRCABaylor University Medical Center | Dallas, TX, United States

Co-Author: Elaine E. Lagow, RN, CCRC

A convenience sample of patients scheduled for liver transplantation were enrolled in a study to determine the accuracyof noninvasive, continuous hemoglobin monitoring compared to standard central lab automated hematology analyzer.Could real-time data on changes in hemoglobin during dynamic conditions such as high blood loss liver transplantationbe useful in guiding blood management?

P-9135 Airway Management in Morbidly Obese Patient with Upper Airway Obstruction After Hot Food

Primary Author: Kristina Natan, M.D.NYU Langone Medical Center | Corona, NY, United States

47 yr old male with PMHx of obesity, hypertension, hyperlipidemia, and paranoid delusions who presented to emergencydepartment with acute changes in voice after eating hot roast beef sandwich. A scope by ENT revealed supraglottic wateredema with mucosal burns involving the epiglottis and bilateral aretenoids right greater than left and obstructing glottisinlet. Patient with difficult airway required awake nasal fiberoptic intubation for impending respiratory failure secondary toedema due to scalding burn. This case will focus on discussion of acute airway edema and management of airway burn.


P-9136 Anesthesiology Services After Five PM: Strategizing a Staffing Model to Meet Increased Demand

Primary Author: Eric Cheon, M.D.Weill Cornell Medical Center | New York, NY, United States

Co-Authors: Anisha Kharkar Jonathan M. Eskreis-WinklerAngela Selzer, M.D. Eric Brumberger, M.D.Vinod Malhotra, M.D. Peter M Fleischut, M.D.

The demand for anesthesiology staff past 5PM was felt to have increased at our institution over the time period of 2011to 2013. Using an anesthesia information management system, we quantified and analyzed volume changes in bothmain operating room and non-operating room sites after 5PM. We identified that the need for anesthesia personnel after5PM exceeded scheduled staff. Furthermore, staffing demand consistently peaked with specific days of the week andmonths of the year. Based on these findings, a new evening staffing model was proposed to meet demand and eliminatereliance on volunteer late staff.

P-9137 Design Improvements to Fentanyl ITS for Postoperative Pain Management

Primary Author: Eugene R. Viscusi, M.D.Incline Therapeutics, Inc. | Redwood City, CA, United States

Co-Authors: Harold Minkowitz, M.D. Brad Phipps, Ph.D.Nitin Joshi, Ph.D.

Fentanyl ITS (IONSYS) is a small iontophoretic transdermal system indicated for the short-term management of acutepostoperative pain in adult patients requiring opioid analgesia during hospitalization. Fentanyl ITS delivers 40 mcg offentanyl when activated by the patient with a double-press of the dose button. A new version has been developed, consistingof two parts: a Controller and a Drug Unit. The new design improves stability and usability HCP, while maintaining all keyfeatures: ease of use, no programming errors, and patient mobility.

P-9138 Thoracic Epidural Blood Patch Therapy for Spontaneous Intracranial Hypotension in an Adolescent

Primary Author: Sri Smitha Kanaparthy, M.D.Children's Hospital and Medical Center | Omaha, NE, United States

Co-Author: Mohanad Shukry, M.D.

SIH is an infrequently documented cause of headache in the pediatric population, but must be considered as an etiologyof postural headache in children and adolescents. 2,3,4,5When conservative medical management is proven unsuccessful,EBP is frequently the next step in treatment.2 Thoracic epidural blood patch therapy may prove to be more effective thanlumbar EBP, as well as both therapeutic and diagnostic in cases where typical neuroimaging findings are not present.

P-9139 Fentanyl ITS vs. Morphine IV PCA: Meta-Analysis Evaluating Patient and Investigator Global Assessmentsof Satisfaction

Primary Author: Eugene R. Viscusi, M.D.Incline Therapeutics, Inc. | Redwood City, CA, United States

Co-Author: Brad Phipps, Ph.D.

In a meta-analysis of 7 randomized, controlled trials, fentanyl iontophoretic transdermal system (fentanyl ITS; IONSYS)received ‘excellent’ Global Assessment ratings of satisfaction with post-operative pain management by patients andinvestigators more frequently than morphine intravenous patient-controlled analgesia (IV PCA) in the overall populationand across demographic and surgery type subgroups.


P-9140 Perioperative Preparation for the Anticipated Difficult Airway Patient

Primary Author: Sam Nia, M.D.UM.D.NJ | Newark, NJ, United States

Co-Authors: Orion Hine, M.D. Scott Goldhaber, D.O.

While anesthesiologists perform many tasks, the airway is always of prime concern. When a difficult airway is identified allthose involved in the care of the patient should be notified. We hope that the use of a preoperative airway checklist willminimize adverse events in managing the airway.

P-9141 Myxedema Coma Presenting as Transient Lower Extremity Paralysis

Primary Author: Deepali Gupta, M.D.SUNY Downstate Medical Center | Brooklyn, NY, United States

Co-Authors: Adam Chao, M.D. Helene Logginidou, M.D.

Myxedema coma is a rare but life-threatening complication of hypothyroidism. It occurs so infrequently that the actualprevalence is unknown. (1) It is usually precipitated by some type of secondary insult including infection, hypothermia, orother systemic illnesses. We present a patient with myxedema coma that was initially misdiagnosed as cervical myelopathywith cord compression. She initially presented with acute infection/sepsis secondary to a gangrenous lower extremity.Following surgery she was found to have paralysis of her left lower extremity, which was misdiagnosed as secondary tocervical myelopathy and cord compression. This misdiagnosis was made due to her previous medical history. The diagnosisof myxedema coma can be missed or delayed when there are other precipitating factors as well as patient co-morbidities. Itis imperative to make a timely diagnosis and initiate treatment. (1,2)

P-9142 Use of Neuropathic Agents for the Management of Chemotherapy-Induced Peripheral Neuropathy

Primary Author: Ammar A. Alamarie, M.D.Upstate Medical University | Syracuse, NY, United States

Chemotherapy induced peripheral neuropathy is debilitating and causes significant amount of pain. Gabapentin hasbeen used for neuropathic pain, but the combination of other neuropathic agents,and understanding their pharmocodynamicprofiles; can be beneficial when treating chemotherapy induced peripheral neuropathy

P-9143 The isolated Zebrafish Heart as a Model to Investigate the Basic Mechanisms of Cardiac Side Effects ofModern Anesthetics

Primary Author: Michael Schmidt, M.D., Ph.D.Dalhousie University | Halifax, NS, Canada

Co-Authors: Matthew R. Stoyek, Ph.D. Student Roger P. Croll, Ph.D.Florentin M. Wilfart, Ph.D. Student Frank M. Smith, Ph.D.

In addition to their neurological actions, anesthetics also have cardiovascular effects, which become increasingly relevantin aging patient populations where such effects increase complication risks. Results from this study support the use ofthe zebrafish heart as a new model to study cardiac effects of modern anesthetics and their specific functional mechanisms.Identification of these mechanisms will aid in the development of novel targets for cardiac and non-cardiacorgan-protective therapies in an effort to make anesthesia safer.


P-9144 Randomized, Assessor-Blinded Evaluation of Impact on Residual Blockade and Perioperative SurgicalTimepoints of Sugammadex versus Usual Care

Primary Author: TiffanyWoo, MSMassachusetts General Hospital | Boston, MA, United States

Co-Authors: Matthias Eikermann, M.D. Britta Brueckmann, M.D.Nobuo Sasaki, M.D. Peter Grobara, MScMichael K. Li, BS

In this study, adult patients (n=151) undergoing abdominal surgery received sugammadex (2 or 4 mg/kg) or usual care(neostigmine/glycopyrrolate according to center practice) to reverse rocuronium-induced neuromuscular blockade(NMB). Sugammadex significantly reduced the incidence of residual NMB (defined as T4T, ratio ÿ0.9) in the post-anesthesiacare unit (0% in sugammadex group vs 43% in usual care group; P ÿ 0.0001). In addition, the time from study drugadministration to patient being considered ready for operating room discharge was 21% shorter in the sugammadex groupvs the usual care group (14.7 vs 18.6 min, P=0.021). Sugammadex was generally well tolerated.

P-9145 Successful One-Lung Ventilation in a Patient with the Fontan Circulation Undergoing ThoracoscopicProcedure

Primary Author: Wassim RamzyWestchester Medical Center | Valhalla, NY, United States

Co-Author: Draginja Cvetkovic

Over the course of the past four decades survival of patients with Fontan circulation has improved and today they canpresent for noncardiac surgery anesthesia care. In patients with Fontan circulation pulmonary blood flow is passive andanesthetic management is directed at reducing pulmonary vascular resistance. One-lung ventilation (OLV) can haveunfavorable effects on the Fontan circulation due to hypoxia, hypercarbia and increased airway pressure. We present acase of successful OLV in a patient with the Fontan circulation and describe our perioperative management.

P-9146 Pulmonary Hypertension and Postoperative Outcome in Geriatric Patients for Repair of Hip Fracture

Primary Author: Giselle Torres, M.D.Maimonides | Brooklyn, NY, United States

Co-Authors: Piyush Gupta, M.D. Robert Lacivita, M.D.Darlene Saberito, RN Peter Homel, Ph.D.Kaplana Tyagaraj, M.D. Jack Choueka, M.D.

Pulmonary hypertension is a known independent risk factor for morbidity andmortality for patients undergoing non cardiacsurgery. Previous studies have shown that patients with pulmonary hypertension have increased post-op morbidity andmortality, require prolonged postoperative ventilation and longer intensive care stay. Our study specifically evaluates cardiorespiratory postoperative complications in elderly patients with pulmonary hypertension with repair of hip fracture. Theresults of our study show that severe pulmonary hypertension is a statistically significant increased risk factor fordevelopment of postoperative complications, while mild- moderate pulmonary hypertension is not.

P-9147 Cystic Hygroma in an Infant - An Anaesthetic Challenge

Primary Author: Maria João L Vilaça, M.D.Hospital Prof Dr Fernando Fonseca | Amadora, Portugal

Co-Authors: Isabel Bonifácio, M.D. Filipa Coelho, M.D.Ana Faísco, M.D. Neuza Ferreira, M.D.

The children with large cervical Cystic Hygroma can be a true challenge to the anesthesia provider: not only the airwaymanagement can be complicated but many other issues should be attended carefully.


P-9148 Epiglottic Hematoma: A Rare Incident After Intubation

Primary Author: Ana Filipa Carvalho, M.D.Centro Hospitalar de Vila Nova de Gaia/ Espinho EPE | Portugal, Portugal

Co-Authors: Inês Carrapatoso Carmen Pereira, M.D.Carla Bentes, M.D.

The epiglottis hematoma associated with tracheal intubation is rare.We report a case of linear intubation with a complicationas a stridor after extubation. In opperating room was diagnosed a eppiglotic hematoma, with reintubation of necessityand permanence in postanesthesia care.

P-9149 Anesthesia Duration, Hemodynamic Stability and Mid-Term Outcome After Cardiac Surgery

Primary Author: Sonsoles Silva, M.D.Dr Negrin University Hospital | Las Palmas GC, Spain

Co-Authors: Carlos Culebras, M.D. Carlos Culebras-López, BSJosefa López-Nordelo, BS Juncal Irurita, M.D. Ph.D.Juan Jose Cabal, M.D. Antonia Vina, M.D.Maria Irurita, M.D. Ph.D.

The duration of anesthesia may have an impact in ICU complications and midterm outcome. We studied retrospectively50 survivors of cardiac surgery (50% coronary bypass grafts; 50% valvular replacements), 76% males, mean age 60 y-o,BMI 26 ±10 g/m2; Most patients were in NYHA functional class II (62%) or III (28%) and had normal ejection fraction. Themean duration of surgery stages was anesthesia 240 ±72, cardiopulmonary bypass 65 ±27, myocardial ischaemia 100 ±55minutes. ASA (American Society of Anesthesiologists) physical status classification system score was 2 (66%), 3 (26%) and4 (8%). NYHA functional class (p 0.019,); cardiopulmonary bypass (p ÿ0.001) andmyocardial ischaemia duration (p ÿ 0.001)proved the only significant pre-surgical and surgical variables related to anesthesia duration. The use of intra-aorticballoon pump (p 0.02), prolonged ICU stay (p 0.02), blood transfusions (p 0.001), adrenaline requirements (p 0.004), highermean heart (p 0.02) and respiratory (p 0.02) rates revealed as the post surgical parameters influencing mid-term outcome.Although prolonged anesthesia increases ICU complications it has no impact on early mortality.

P-9150 Improving the OR Handoff Process Using the IMPORTANCE Mnemonic

Primary Author: Tanmay Shah, M.D., M.B., B.S.Rutgers-NJMS | Newark, NJ, United States

Co-Authors: Shelly Sharma, M.D. Shawn Puri, M.D.Anant Parikh, M.D. Chaitanya Challa, M.D.Vanny Le, M.D.

Patient turnover in the operating room is a significant patient safety concern in the field of anesthesia. Often, key informationis not conveyed or forgotten which can lead to serious comprise of patient safety. Because there is no effective standardizedprotocol for the turn over process, we feel that our mnemonic “IMPORTANCE”will provide all the key information needed,delivered in a concise and efficient manner.

P-9151 Post Anesthesia Care Unit Training and Evaluation for Anesthesiology Residents

Primary Author: Loveleen Reddy, M.D.Rutgers | Newark, NJ, United States

Co-Authors: Ali Akmal, M.D. Jose Otero, M.D.

CA-1 residents begin managing the PACU long before they have had any formal teaching during their PACU rotation intheir CA-2 year. We decided to present a PowerPoint presentation on common issues in the PACU and also directed theCA-1s to relevant articles on PACU management during their orientation. Prior to any formal teaching, the CA-1 residentswere given a pretest. All CA-1 residents showed improvement on their post-test which was given two weeks after thepresentation and directed reading. The formal didactic session helped the CA-1s feel much more prepared to manage thePACU and will now be implemented into our program.


P-9152 A Novel Sedation Regimen: Administration of Intranasal Remifentanil for Pediatric Dental Sedation forAdjunct Sedation

Primary Author: Amita Kundra, M.D.University at Buffalo | Buffalo, NY, United States

Co-Authors: Christopher Heard, M.D. Thayne Gardner

Intranasal (IN) Remifentanil administration can be a useful as an adjunct as it has a more rapid onset and can be repeatedas needed. However optimal dose strategy still needs to be determined.

P-9153 Cerebral Hygromas in a Patient with Severe CNS Hypotension Status Post Dural Puncture Headache

Primary Author: John R. Brooks, M.D.Albany Medical Center | Albany, NY, United States

Co-Author: Yashar Ettekal, M.D.

We report CNS hygromas obtained in MRI imaging of the brain in a patient with post dural puncture headache.

P-9154 Use of Remifentanil, Fentanyl, or the Combination in Surgical Procedures in the United States: Predictorof Use and a Cost-Minimization Analysis

Primary Author: David A. Sclar, B.Pharm., Ph.DCollege of Pharmacy, Midwestern University | Glendale, AZ, United States

This study was designed to evaluate predictors of use of remifentanil, fentanyl, or the combination, and to compare andcontrast aggregate expenditures for anesthesia and postoperative analgesics used in surgical procedures employingthese drugs. National cross-sectional and longitudinal data were abstracted. Surgical procedures were classified into 8categories. Remifentanil alone or in combination with fentanyl was more likely to be used versus fentanyl alone in specificsurgical classifications and in patients with specific underlying disease state processes (hepatic and renal disease, diabetes,and hypertension). In 6 of 8 categories of surgery no significant difference in adjusted mean aggregate expendituresfor anesthesia (charge or cost) was discerned.

P-9155 Public Health and Anaesthesia: Innovative Partnership in the Pre-Anaesthetic Service for SuccessfulPre-Operative Smoking Cessation

Primary Author: Pawan Pernu, M.D.North Lincs and Goole Hospitals Foundation Trust | Scunthorpe, United Kingdom

Co-Author: Sandeep Saxena, M.D., FRCA

Public Health and Pre anaesthesia assessment partnerships can prove very helpful in delivering initiatives such as smokingcessation.

P-9156 Using Open SourceWeb Framework for Remote Anesthesiology Data Visualization

Primary Author: Donald Voltz, M.D.Aultman Hospital | Twinsburg, OH, United States

Co-Authors: Alfred Pinchak, M.D. Matthew Joy, M.D.

A system that allows for local or remote viewing of patient data and exploring newways to present this data can enhancedpatient care. To effectively do this, we have developed a data abstraction layer and coupled this to a data presentation layerto allow for web-based anesthesiology data. This framework has been developed to explore novel ways of data presentationfor anesthesiology and explore platform independent remote aggregation and viewing of patient data. The use of such asystem allows for standardization in data display not constrained by a given manufacture of monitor or AIMS and allowsfor the development of remote, web-based monitoring of patients under anesthesia irrespective of the monitoring type.


P-9157 Recognising Acute Illness in Ante-Natal and Post-Natal Period: A Snapshot Survey of Practise

Primary Author: Pawan Pernu, M.D.Hull York Medical School | Hull, United Kingdom

Co-Authors: Carly Farrow Sandeep Saxena, M.D. FRCA

Early and timely recognition of acutely ill obstetric patients remains a challenging task despite introduction of EarlyWarning Scoring systems in the UK.

P-9158 Emergency Transportation Kits: A Systems-Based Practice Initiative

Primary Author: Moshe Schiffmiller, M.D.Rutgers - NJMS | Newark, NJ, United States

Co-Authors: Usha Saldanha, M.D. Johan Reyes, M.D.

Standardization of Emergency Transportation Kits for the transport of the critically ill, ventilator -dependent patient willallow anesthesia providers to react to both standard and emergent situations that may arise unexpectedly during thesepotentially precarious intervals of anesthesia care.

P-9159 Extending Cover for Hospital Wards in Recognising ‘At Risk’ patients: Comparison of the Use of 2 NurseLed Teams From a Critical Care and Non Critical Care Background

Primary Author: Pawan Pernu, M.D.Hull York Medical School | Hull, United Kingdom

Co-Authors: Sara Wynn Sandeep Saxena, M.D., FRCA

Innovative nurse led teams to help recognise, treat and optimally manage patients at risk seem to need a specialist skillmix. The closest model for these seems to be Intensive Care nursing.

P-9160 Gas Man Derived Compartmental vs Lerou Physiological Model for Sevoflurane

Primary Author: Mihai R Sadean, M.D.UHMC SUNY at Stony Brook | Stony Brook, NY, United States

The acceptable approximation of the end tidal concentrations by the Gas Man derived compartmental model comparedto the Lerou physiological model, that was previously clinically validated, is promising to its use in the study of volatileanesthetic agents.

P-9161 The SAMBA Clinical Outcomes Registry (SCOR!)

Primary Author: Lucinda Everett, M.D.Dartmouth Hitchcock Medical Center | Lebanon, NH, United States

Co-Authors: Douglas Merrill, M.D., M.B.A. Peter Glass, M.B., Ch.B.

The initial 65,468 cases in the SAMBA Clinical Outcomes Registry (SCOR!) are described, with an analysis of seriousadverse events and common sequelae important to ambulatory anesthesia. Serious adverse events were rare in thisdataset. Factors impacting emetic sequelae and pain are discussed.

P-9162 Gas Man Derived Compartmental and Lerou Physiological Model vs Lu Et Al Clinical Data for Sevoflurane

Primary Author: Mihai R. Sadean, M.D.UHMC SUNY at Stony Brook | Stony Brook, NY, United States

The Gas Man derived compartmental model has to be used with caution when predicting effect site concentrations ofsevoflurane.


P-9163 Liver Transplantation in Two Patients on Dual Anti Platelet Therapy

Primary Author: Rosario Garcia, M.D.Stanford University Medical School | Palo Alto, CA, United States

Co-Authors: Vanessa Moll, M.D., Ph.D. Hendrikus Lemmens, M.D., Ph.D.

Managing a patient with coronary stents undergoing liver transplantation present a great challenge with the dilemma ofhow to manage antiplatelet therapy perioperatively and the risks of coagulopathy and major blood loss during and aftersurgery.

P-9164 Safe Monitored Anesthesia Care in a Neurorehabilitation Hospital

Primary Author: Romana Persichetti, M.D.Jewish Hospital | Rome, Italy

Co-Authors: Claudio Cannaviello, M.D. Maria Sergio, M.D.Sandro Michelini, M.D. Adriano Micci, M.D.

The authors present their experience onmonitored anesthesia care for endoscopic gastrostomy in 62 patients with neurologicaldysfunction, performed in a nonoperating room location.

P-9165 Postoperative Dizziness and Arterial Tone in Patients Undergoing Total Joint Arthroplasty

Primary Author: Thomas Danninger, M.D.Hospital for Special Surgery | New York, NY, United States

Co-Authors: Marcus DiLallo, BA Sumudu S. Dehipawala, BScTanja Slacek, DM.D. Nigel E. Sharrock, M.D.Stavros G. Memtsoudis, M.D.

Patients undergoing total joint arthroplasty frequently experience symptoms of orthostatic intolerance (OI), which represents amajor obstacle to early ambulation and functional recovery and may contribute to an increased fall risk. Augmentationindex (AI) measures late systolic reflection waves which are a measure of large arterial tone, a reduction in AI thereforerepresents vasodilatation. In this study, wewere able to show a significant change in AI after total hip and knee arthroplasty. Thedrop in AI did not occur until resolution of the neuraxial anesthetic, suggesting that the effects are notmediated by the neuraxialanesthetic but possibly due to injury related metabolite influence. This was accompanied with a significant change indizziness peaking on POD1.

P-9166 Does the Impact of the Type of Anesthesia on Outcomes Differ by Patient Age and Comorbidity Burden?

Primary Author: Suzuko Suzuki, M.D.Hospital for Special Surgery | New York, NY, United States

Co-Authors: Rehana Rasul, MA Jashvant Poeran, M.D., Ph.D.Thomas Danninger, M.D. Christopher L. Wu, M.D.Madhu Mazu, M.D., Ph.D. Vassilios Vougioukas, M.D.Stavros Memtsoudis, M.D., Ph.D.

It remains unclear whether a benefit of neuraxial anesthesia can be found in subpopulations of patients with variousdegrees of comorbidity burden and age. In this study, neuraxial anesthesia was associated with decreased odds for majorcomplications after joint arthroplasty for all patient groups. The addition of a general technique largely negated the benefitsin all groups but in the young (<65 years) and middle aged (65-74 years) group without cardiopulmonary disease.


P-9167 Herbal Medication Use at Robert Wood Johnson University Hospital

Primary Author: Sana Patel, M.D.Columbia University | New York, NY, United States

Co-Authors: Sana Shaikh, M.D. Kathryn Faloba, B.S.Renu Chhokra, M.D. Antonio Chiricolo, M.D.Anushree Doshi, B.A. Daniel Ramos, B.S.Kang Rah, M.D.

We surveyed 203 patients during their pre-admission testing to assess the use of herbal medication and their disclosurerates. Compared to the 19% of adults that disclosed in previous surveys, only 9.9% of our patients were taking herbalsupplements. Of this 9.9%, only 25% disclosed their supplement use without specific prompting. It is unclear why 75% ofour patients did not easily disclose their use of herbal supplements; it may be due to comfort discussing alternativemedicationwith their conventional doctor.

P-9168 A Rare But Real Complication: Epidural Abscess

Primary Author: Maria C. RodriguesHospital de São Bernardo - Centro Hospitalar de Setúbal | Setúbal, Portugal

Co-Authors: Bárbara Ribeiro Ana BatistaLuis Liça Alejandro MartínJoão S. Duarte

Epidural abscess is a rare but serious complication of neuraxial blockade and the anesthesiologist should be aware of itssigns, symptoms and management since the delay in diagnosis and treatment can result in permanent neurologic deficitand death. We describe a case of a 75-year-old man who was diagnosed with an epidural abscess after a lumbar epiduralcatheter was placed uneventfully to treat the pain associated with lower limb ulcers.

P-9169 Acute Surgical Pain Models: Systematic Evaluation and Narrative Review

Primary Author: Neil Singla, M.D.Lotus Clinical Research | Pasadena, CA, United States

Co-Authors: Paul J. Desjardins Phoebe D. Chang, Ph.D.

Over the past 60 years, pioneers in acute pain research have posed, debated and resolved several key methodologicalquestions. However, unresolved methodological issues in this field still exist and will continue to increase the incidence offalse negative findings. Surgical procedures have unique clinical characteristics that influence their suitability as researchmodels. The knowledge garnered through past purposeful studies have been successfully applied to the dental andbunion models. However a significant gap exists in the application of these principles to the JRS and STS models. Here wefound that dental impaction and bunionectomy models had higher assay sensitivity than the JRS and STS models. It isprobable that this finding is secondary to the superior experimental conditions under which the dental and bunion modelsare executed (utilization of few centers, ability to limit surgical, anesthetic and postoperative variability). By implementingand critically evaluating new techniques, the knowledge garnered from the work of previous analgesic methodologistsmay be expanded to improve the assay sensitivity of the JRS and STS models.

P-9170 To Investigation of Effect on Chronic Pain of Systemic Disaesa in the Hysterectomy Surgery

Primary Author: Elif Baki, M.D.AKU | Afyon, Turkey

Co-Authors: Remziye Sivaci, M.D. Serdar Kokulu, M.D.Gulengul Koken, M.D. Yuksel Ela

The aim of the present study was to investigate whether systemic disease or not systemic disease decreases chronicpostoperative pain events Sixty two patients (aged 20-70 years) scheduled for elective histerectomy under generalanesthesia In the postoperative periods, VAS values were higher in group S. The mean 24-h analgesic consumptionwas highest in group S. General anesthesia with nitrous oxide may be a good choice for postoperative analgesia.


P-9171 Investigate the Development of Hypothyroidism with Chronic Exposure to Anesthetic Gases in Volunteers

Primary Author: Hacer TemizAKU | Afyon, Turkey

Co-Authors: Remziye Sivaci Elif BakiSerdar Kokulu Yuksel Ela

A number of harmful effects of inhalation anesthetics researches have been reported previously. Blood samples wereexposed to inhalation anesthetics electrochemiluminescence immunoassay method determined by the average of thegroup FT3 and FT4 values were significantly lower compared with the control group (p = 0.000 for FT3, FT4, p = 0.018).The results obtained in this study,may create health risks in personnel exposed to inhalation anesthetics professionaldemonstrate

P-9172 Continous Epidural Infusion of Ropivacaine-Fentanyl-Epinephrine for Post-C/S Pain: What is the OptimalConcentration of Ropivacaine?

Primary Author: Sylviana Barsoum, M.D.Rutgers Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Renu Chhokra, M.D.Daniel Ramos, B.S. Mark Stein, M.D.Shruti Shah, M.D. Adil Mohiuddin, M.D.Sahebjit Bhasin Arpan Patel, B.S.Christine W Hunter, M.D.

To assess if the addition of opioids and epinephrine to local anesthetics improves the quality of epidural analgesia whileminimizing motor block, we compared the effect of four concentrations of ropivacaine mixed with fentanyl andephinephrine for epidural PCA in 48 parturients post C/S. We found the addition of fentanyl and epinpephrine to theoptimal epidural-PCA concentration of 0.025% ropivacaine for post C/S analgesia had minimal side effects and withoutinterfering with ambulation.

P-9173 Does the Addition of Phenylephrine to Prophylactic IV Ephedrine Further Reduce the Incidence ofHypotension From Intrathecal Ropivacaine for C/S?

Primary Author: Kang Rah, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Shruti Shah, M.D.Sameet Syed, M.D. Scott Mellender, M.D.Daniel Ramos, B.S. Stefanie Berman, M.D.Christine W. Hunter, M.D.

The use of prophylactic IV ephedrine is effective for prevention of hypotension from spinal anesthesia for cesarean section.The objective of this study was to determine whether the addition of phenylephrine to prophylactic IV ephedrine furtherreduces the incidence of hypotension from intrathecal ropivacaine for C/S.We determined that the addition of phenylephrineto IV prophylactic ephedrine did not further reduce the incidence of hypotension from intrathecal ropivacaine for C/S.Furthermore, we found the IV administration of phenylephrine with ephedrine was associated with a higher incidence ofvomiting.


P-9174 ShouldWe Offer Epidural-PCA Analgesia with Ambulation for Multiparae for Labor Pain?

Primary Author: Diane Ridley, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Kang Rah, M.D. Ashraf Sakr, M.D.Daniel Ramos, B.S. Shaul Cohen, M.D.Kathryn Faloba, B.S. Avinash Kudupudi, B.S.Christine W. Hunter, M.D.

This study was aimed to assess if epidural PCA analgesia with ambulation, which is regularly offered to primiparea,should also be offered to multiparae who usually have lower durations of labor. Within our cohort of 408 labor patients,we found that although multiparae experienced overall shorter PCEA infusion times, there were no differences betweenthe groups with respect to the request for or duration of ambulation.

P-9175 Evaluate to Effects of General and Regional Anesthesia on DNA Damage

Primary Author: Yasar SivaciAKU | Afyon, Turkey

Co-Authors: Remziye Sivaci Deniz SunnetciCanan Balci Hakan Savli

Various anesthetics and stress-provoking procedures such as regional anesrhesia result in apoptotic cell death during surgery.RNA Isolation and Quantitative RT-PCR:From blood samples of each patient the RNeasy Mini Kit (Qiagen, Valencia, CA,USA) and total RNA was isolated was treated with DNase I. RevertAid Gene expression levels in post-operative andpre-operation, based on the expression levels of REST (Relative Expression Software Tool) program was calculated. Twogenes (BCL2 and BAX) expression levels of post-operation in general (44 patients) and rejiyonel (13 patients) anesthesiaon the patient groups studied. In the study,patients undergoing general anesthesia and anti-apoptotic BCL2 geneexpression levels of pro-apoptotic BAX was decreased in the group receiving regional anesthesia increased the levels ofexpression of these two genes. There are no resulting from administered mixed general anesthesia. But, regionalanesthesia result in enhanced susceptibility to developmental anesthetic celluler apoptotic function.

P-9176 Does a Previous Neuraxial Procedure Affect Subsequent Epidural Success Rate in Obstetric Patients?

Primary Author: Scott Mellender, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shruti Shah, M.D. Shaul Cohen, M.D.Alann Solina, M.D. Kathryn Faloba, B.S.Anushree Doshi, B.A. Stefanie Berman, M.D.Christine W Hunter, M.D.

We conducted a prospective, IRB approved study to assess the incidence of technical problems and the efficiency ofepidural block in parturients with or without a previous history of neuraxial procedure who received epidural ropivacaineanalgesia with fentanyl and epinephrine adjuvants. We determined that a previous history of neuraxial procedureincreased the incidence of one side anesthesia and visible paresthesia, which are significantly reduced with a mixture ofepidural fentanyl, ropivacaine, and epinephrine.


P-9177 A Comparison of Combined Spinal-Epidural-PCA Analgesia with Continuous Epidural-PCA Analgesia Alone forLabor Pain

Primary Author: Tejal Mehta, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Antonio Chiricolo, M.D. Shaul Cohen, M.D.Sylviana Barsoum, M.D. Kathryn Faloba, B.S.Avinash Kudupudi, B.S. Daniel Ramos, B.S.Kang Rah, M.D. Adil Mohiuddin, M.D.Christine W Hunter, M.D.

This study assessed if adding spinal sufentanil with ropivacaine to the routine epidural - PCA ropivacaine-sufentanilepinephrine with ambulation could improve our neuraxial analgesia technique for labor pain. There were 136 parturientsrequesting epidural analgesia for labor pain and randomized to two groups with or without intrathecal sufentanil. Wefound that the addition of spinal analgesia with ambulation for labor pain provided shorter time to full satisfaction withoutaffecting the quality of the block, side effects and patient satisfaction.

P-9178 Preventing Neurovascular and Musculoskeletal Injuries in the Anesthetized Patient Through the Implementationof a Surgical Positioning Checklist

Primary Author: Sadiah Siddiqui, M.D.Rutgers - NJMS | Newark, NJ, United States

Co-Authors: John Charoonbara, M.D. Patrick Discepola, M.D.Heidi Boules, M.D. Daisy Munoz, M.D.Melissa Davidson, M.D.

We would like to take a team approach to patient positioning that involves the OR staff, inclusive of circulators, nurses,surgeons, and anesthesiologists. Our goal is to have all operating room personnel aware and be active proponents ofproper patient positioning in order to minimize injury by implementing a Surgical Positioning Checklist.

P-9179 Does Epidural-PCA with Ambulation Reduce the Incidence of Bladder Catheterization During Labor?

Primary Author: Shaul Cohen, M.D.

Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Kang Rah, M.D. Antonio Chiricolo, M.D.Heather Skiff, D.O. Daniel Ramos, B.S.Anushree Doshi, B.A. Kathryn Faloba, B.S.Dora Zuker, M.D. Stefanie Berman, M.D.

The purpose of the study was to determine whether reducing epidural ropivacaine concentration, which allows ambulation,can reduce incidence of parturient bladder catheterization. The participants were 1038 parturients in active labor whoreceived epidurals in one of three concentrations of ropivacaine, sufentanil and epinephrine were included. We foundthat epidural PCA with ambulation reduced bladder catheterization with no effect on outcome.

P-9180 Introduction of a Surgical Safety Checklist into a High-Risk University Obstetric Operating Room

Primary Author: Grace Shih, M.D.University of Kansas Medical Center | Kansas City, KS, United States

Introduction of a perioperative checklist in the operating room of labor and delivery improved communication amongstaff. In addition, the checklist was reassuring to the patient.


P-9181 Opioid-Induced Pruritus from Epidural PCA for Labor and Post-C/S Pain: CanWe Find a Predictable Cause from aPrevious Parturient History?

Primary Author: Pavel Shapiro, B.S.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Adil Mohiuddin, M.D.Kang Rah, M.D. Antonio Chiricolo, M.D.Shruti Shah, M.D. Daniel Ramos, B.S.Christine W. Hunter, M.D.

In our retrospective study, we included 215 women scheduled for labor and post C/S epidural PCA analgesia to assesspossible causes of pruritus. We found that a history of bronchial asthma, hay fever, allergy to dust and air particles, previoushistory of neuraxial opoid induced pruritis and its severity and pregnancy induced pruritis and its severeity were associatedwith significantly higher incidence of epidural PCA opoid induced pruritis in these patients.

P-9182 Use of Lidocaine Patch 5% for Chronic Pain Resulting from Osteoarthritis of the Knee - Retrospective Study

Primary Author: Catarina C. Esteves, M.D.Centro Hospitalar Lisboa Central | Lisbon, Portugal

Lidocaine patch 5% (L 5%) is recommended as a first line treatment for localized neuropathic pain. Their use in thetreatment of a variety of pain conditions, primary neuropathic and mixed has been described as being effective and safe.Retrospective study of 23 selected patients with chronic osteoarthritis disease(OA) of the knee was carried between 1/09and 7/13. Patients were proposed for the use of (L 5%) in mono or mixed therapy. Their pain was classified as nociceptiveor mixed pain. After one month, the therapeutic efficacy of the drug was evaluated, and continued in patients whopresented satisfactory results to therapy. Of the 22 patients with knee OA pain enrolled in the study (one was excluded)63 % had mixed type of pain and 37 % nociceptive pain. It was observed a pain relief of 79 and 75 % in patients withmixed and nociceptive pain, respectively. Of all patients with OA pain, 27% remains with this therapy and of these, 50%of patients with nociceptive pain do it as monotherapy. No adverse effects were reported. In conclusion the (L 5%)proved to be a valid and safe therapeutic option in relieving OA knee pain with nociceptive or mixed component.

P-9183 Minimal Tracheal Depth of a Tube Exchange Catheter During Exchange of Supraglottic Airway Devices forEndotracheal Tubes

Primary Author: Shawn M. Falitz, M.D.Penn State Hershey | Hershey, PA, United States

Co-Authors: John Picard, BA Priti G. Dalal, M.D.Sonia J. Vaida, M.D. Arne O. Budde, M.D.

Minimal Tracheal Depth of a Tube Exchange Catheter during Exchange of Supraglottic Airway Devices for EndotrachealTubes

P-9184 Effects of Acute Normovolaemic Haemodilution (ANH) on Perioperative Coagulation and Platelet Function inTotal Hip Replacement

Primary Author: Eunhee Chun, M.D.Seoul National University Bundang Hospital | Seong-nam si, Gyonggi-do, Korea, Republic of

Co-Authors: SH Do, M.D. HJ Shin, M.D.

ANH induced the hypocoagulable state, and the post-retransfusion parameters of ROTEM andWBA showed similar patterncompared with values after ANH.


P-9185 Hypertensive Events in Parathyroidectomy: Is There an Advantage in the Use of Local Anesthesia vs. GeneralAnesthesia?

Primary Author: Gourg Atteya, M.D.Yale Center for Analytical Sciences | New Haven, CT, United States

Co-Authors: Charlene Reamar Bondoc Feng Dai, Ph.D.Susan Dabu-Bondoc, M.D.

Performing parathyroidectomy procedures with local anesthesia under MAC does not appear to reduce rates of perioperativehypertensive events, even in the setting of less patient risk factors or comorbidities, when compared to those performedunder general anesthesia.

P-9186 Effect of Spraying 0.25% Levobupivacaine on the Postoperative Pain Scores and Patient Controlled Analgesia(PCA) After Robot Assisted Thyroidectomy : Prospective, Randomized and Controlled Trial

Primary Author: Ahyoung OhSeoul National University Bundang Hospital | Seong-nam, Korea, Republic of

Co-Authors: Bon-Wook Gu Eun-Hee Cheon

Robotically assisted thyroidectomy (RAT) is frequently performed due to its excellent cosmesis and recovery profiles.However, postoperative pain in anterior chest area after RAT is remained as concerns due to extent tissue dissection andtension during the operation. The aim of this study is to evaluate the anterior chest pain and the effect of levobupivacainespraying on postoperative pain control after RAT via bilateral axillo-breast approach. Levobupivacaine spray in flap dissectionat the end surgery effectively reduced postoperative pain scores and PCA consumption without adverse events after RAT.

P-9187 Comparison of Postdischarge Nausea & Vomiting (PDNV) and Postdischarge Pain (PDP) in ParathyroidectomyProcedures performed under Local anesthesia vs. General anesthesia

Primary Author: Susan Dabu-Bondoc, M.D.NYU-Langone Medical Center | New York, CT, United States

Co-Authors: Hosni Mikhael, M.D. Gourg Atteya, M.D.Sarah Anne Bondoc Feng Dai, Ph.D.

In this study the rates of postdischarge nausea and vomiting (PDNV), as well as, the rates of postdischarge pain (PDP)appear to be no different in neck procedures involving the parathyroid when performed under MAC versus general anesthesia.

P-9188 Urologic Patients of a Portuguese Hospital: An Anesthetic Perspective

Primary Author: Ana MartinsCHVN Gaia/Espinho | VN Gaia, Portugal

Co-Authors: Ana Carvalho Nuno PereiraDiana Gomes Lurdes Preto

Summary: The urological procedures represent 10-20% of total anesthetic acts and they are preformed in patients withgreat variability of age and comorbidities. The evolution of anesthetic-surgical techniques has allowed the execution ofmore complex interventions, making the anesthetic assessment and planning evenmore important. To access our urologicpatients we performed retrospective descriptive study during 3 months. As described in the literature, most of ourpatients have several comorbidities. Most elderly patients are assessed in consultation previously, but 39% of patientswith serious diseases were not referred pre-anesthetic evaluation. There is a growing tendency increase turnover ofpatients, which requires that patients come in the day before or on the day of surgery. Most of late admitedpatients(64%)don’t have prior anesthetic evaluation. Preoperative evaluation is the key for a good preoperative preparationand intraoperative handling. When done in the outpatient clinic, it allows for better analysis and further investigation,improving the quality of the preparation and decreasing hospital costs.


P-9189 Comparison of Patient Satisfaction Between Two Pre-Operative Evaluation Center Models

Primary Author: Kuan-ChungWu, B.S.Massachusetts General Hospital | Boston, MA, United States

Co-Authors: Eden Brand, M.P.H. Kelsey McCarty, M.S., M.B.A.Adam Carinci, M.D. James Rathmell, M.D.

Massachusetts General Hospital opened a new, orthopedic patient-specific pre-operative center (PEC) in addition to theMain PEC. The goal of the new PEC model is to streamline the assessment and improve patient experience. The patientexperience in both the Main PEC and the new PEC are evaluated and compared quantitatively in this study.

P-9190 National Assessment of Practice Patterns in Unanticipated Failures of Direct Laryngoscopy

Primary Author: James E. Littlejohn, M.D., Ph.D.New York-Presbyterian Hospital/Weill Cornell Medical College | New York, NY, United States

Co-Authors: Kane O. Pryor, M.D. Peter M. Fleischut, M.D.Ralph Slepian, M.D.

This study aimed to ascertain the preferred adjunct utilized by practicing anesthesiologists to achieve endotracheal intubationin the unanticipated failure of direct laryngoscopy (DL).We surveyed 22,504 practicing anesthesiologists via ASA email listservein December 2012 with a 5.3% response rate. Comfort levels in four categories of adjuncts to secure endotracheal intubationwere assessed andmeasured on a 1-5 scale: blind, supraglottic (as a conduit for intubation), fiberoptic bronchoscope (FB), andvideo laryngoscopes (VL) and change in comfort levels were compared statistically. Majority of respondents reported their skillsimproved in supraglottic (65.2%), fiberoptic (44.6%) and video laryngoscopy (90.2%), and stayed the same in blind techniques(50.8%). Comfort level from residency to current practice increased across all categories. Themost drastic increase in comfortwas with VL. This has implications in the training and development of future anesthesiologists, both for incorporation of newerdevices into curricula surrounding airway emergencies, as well as ensuring FB skills are not lost due to potential futureunderutilization.

P-9191 Streamlining Electronic Anesthetic Records to Patient’s Electronic Medical Record and the Impact on Cost

Primary Author: Zachary A. Turnbull, M.D.Columbia University | New York, NY, United States

Co-Authors: Juliet Jackson, M.D. Christian Tope, BSWei Wei Xu Mitchell F. Berman, M.D.David K. Vawdrey, Ph.D. MadhuMazu, M.D., Ph.D.Stavros G. Memtsoudis, M.D., Ph.D. Peter M. Fleischut, M.D.

Our anesthetic record and EMR are from different vendors requiring the printing of paper records post anesthesia to giveaccess to other providers. Upon discharge, paper records are scanned into the EMR. We hypothesized that linkingpatient’s electronic anesthetic record directly to the EMR would enable other providers immediate access to anestheticinformation improving patient hand-off and significantly reducing printing costs. Portable Document Format (PDF) wasgenerated and stored electronically using software that provides a centralized storage space linked to each patient’s EMR,making it available for immediate transmittal. Assuming no increase in case volume and purchase of requisite suppliesand equipment for implementation of the new system, elimination of paper records resulted in a predicted savings of$67,603, expected to increase with case volume. These efforts were cost effective in improving patient care by streamlininganesthetic information, improving efficiency, and delivering all providers with immediate, qualitative data.


P-9192 Innocent Fever Associated with Epidural Catheter in Labor Analgesia: Case Report


Co-Authors: Ana Carvalho Ana PereiraLiliana Dias Diana Gomes

Fever during labor can be due to an infectious or non-infectious etiology. The main infectious cause is the acutechorioamnionitis that is associated with an high risk of maternal and neonatal morbidity. Epidural anesthesia is themost common causes of non-infeccious fever during labor particularly in nulliparous. The epidural analgesia is aneffective procedure used in almost every pregnant in labor in our hospital. The fever during labor associated withepidural analgesia appears to be a benign condition without infectious risk to the neonate. The management andoutcome of these condition is different from the infectious and difficult to distinguish. The main objective of thisposter is to share this case and review the subject.

P-9193 Effects of Real-Time Data Integration Technology on Compliance with Postoperative Documentation

Primary Author: Zachary A. Turnbull, M.D.Hospital for Special Surgery | New York, NY, United States

Co-Authors: Susan L. Faggiani, RN, BA, CPHQ Jonathan M. Eskreis-Winkler, BAChristian Tope, BS Niloo SobhaniIlirjan Decka Madhu Mazu, M.D., Ph.D.Stavros G. Memtsoudis, M.D., Ph.D. Peter M. Fleischut, M.D.

Due to disparate electronic medical record (EMR) systems (anesthesia and in-patient records), data integration via a centralplatform was vital to accurately identify patients requiring post anesthesia evaluations. Effectiveness of this interventionon compliance was measured. A post-anesthesia evaluation report was designed to identify patients with recently completedanesthesia records, but lacked a post anesthesia evaluation EMR note. Chart reviews conducted over 4 months ofpre/post intervention were analyzed. Results revealed compliance increased significantly from 83% to 96% (p <.001)and was sustained , year later. This increase in compliance was sustainable as compared to a recent month, April 2013.Patient safety was enhanced more readily accessible post anesthesia evaluations.

P-9194 Factors Contributing to Anesthetic Care for Total Hip Arthroplasty: An Analysis of Data from the AnesthesiaQuality Institute

Primary Author: Andrew N Lazar, MA, BSHospital for Special Surgery | New York, NY, United States

Co-Authors: Chad Lazar Licia K Gaber-Baylis, BASusan L Faggiani, RN, BA, CPHQ Gregory P. Giambrone, MSMadhu Mazu, M.D., Ph.D. Stavros G. Memtsoudis, M.D., Ph.D.Peter M. Fleischut, M.D.

Using the Anesthesia Quality Institute (AQI) database, the largest national anesthesia database, data were obtained andthe patterns of anesthesia practice for total hip arthroplasties were analyzed. Data collected from the AQI databasebetween January 2010 and February 2013 were analyzed. Total hip arthroplasty cases were isolated, categorized, andanalyzed by general, regional, or neuraxial anesthesia. A total of 63,184 cases of total hip arthroplasty were identified. Ofthese cases, 62%, 32%, and 6% were performed under general, neuraxial, and regional anesthesia, respectively. Data indicategeneral anesthesia is used in the majority of total hip arthroplasty cases nationwide. Further, data indicate a largeamount of variation in anesthesia techniques.


P-9195 Predictors of Anesthetic Care for Carotid Endarterectomy

Primary Author: Andrew N Lazar, MA, BSHospital for Special Surgery | New York, NY, United States

Co-Authors: Chad M. Lazar Licia K. Gaber-Baylis, BASusan L Faggiani, RN, BA, CPHQ Gregory P. Giambrone, M.S.Madhu Mazu, M.D., Ph.D. Stavros G Memtsoudis, M.D., Ph.D.Peter M. Fleischut, M.D.

The objective of this study is to determine whether provider, patient, and/or hospital characteristics influence the type ofanesthesia used during these CEA procedures by examining data from the Anesthesia Quality Institute (AQI) database.During this retrospective analysis, data were used from the AQI database ranging from January 2010 to February 2013.Cases involving CEA procedures were isolated and type of anesthesia provided was determined. Additional data, includingpatient demographics, length of anesthesia time, type and quantity of anesthesia providers, and type of medical facility,were collected and analyzed utilizing appropriate statistical techniques. CEA was performed in 22,365 patients and primarytype of anesthesia, general or regional, was obtained. The majority of cases (89%) were performed in community hospitals;56% of general anesthesia cases and 61% of regional anesthesia cases were performed atmedium-sized community hospitals.After initial data analysis, it was determined that the majority of carotid endarterectomy cases were performed usinggeneral anesthesia, however additional analyses are necessary.

P-9196 The Epidemiology of Postpartum Hemorrhage: United States 1998 to 2010

Primary Author: Peter M. Fleischut, M.D.Hospital for Special Surgery | New York, NY, United States

Co-Authors: Licia K. Gaber-Baylis, BA Jonathan M Eskreis-Winkler, BAMadhu Mazu, M.D., Ph.D. Stavros G. Memtsoudis, M.D., Ph.D.

Postpartum hemorrhage (PPH) remains a major concern for anesthesiologists caring for obstetrical patients. Despite theavailability of population-based data on this issue from 1990-2006(1), there is a paucity of recent information describingthe incidence of this complication in the United States. We accessed data collected by NIS between 1998 and 2010.Patients undergoing either vaginal delivery or a Cesarean section were identified utilizing appropriate ICD-9 procedureand DRG codes. The rates of Cesarean section increased from 21% in 1998 to 33% in 2010 (P<0.0001). The rate of PPHwas 2.8% in 1998 and 2.9% in 2010 (P<0.0001), with 74.6% and 77.8% related to uterine atony, respectively(P<0.0001). The incidence of PPH has remained at approximately 3% of all deliveries and is associated with uterineatony in over three quarters of cases. The incidence of uterine atony after Cesarean sections has more than doubledbetween 1998 and 2010.

P-9197 Organization and Execution of a Multi-Disciplinary Operating Room Fire Simulation: Lessons Learned

Primary Author: Debnath Chatterjee, M.D.Children's Hospital Colorado | Aurora, CO, United States

Co-Authors: Karin Underberg, RN Timothy M. Crombleholme, M.D.Gee Mei Tan, MMed

Organization and execution of a multi-disciplinary operating room fire simulation: Lessons learned Debnath ChatterjeeM.D., Karin Underberg RN, Timothy Crombleholme M.D., Gee Mei Tan MMed Children’s Hospital Colorado/University ofColorado School of Medicine, Aurora, CO.We report our experience in the organization and execution of a multi-disciplinaryoperating room (OR) fire simulation. Ten simultaneous fire simulations were conducted in the OR suite followed by amass evacuation. The fire simulation was well received by all OR personnel and resulted in several system changesincluding addition of carbon dioxide extinguishers to the OR suite and advocating for a modification of the surgical timeout to assess the risk of fire.


P-9198 Implementation of Alert in the Electronic Medical Record Reduces Incidence of Non-OR Blood Transfusions forHb > 8.0 g/dL

Primary Author: James E. Littlejohn, M.D., Ph.D.New York Presbyterian/Weill-Cornell Medical College | New York, NY, United States

Co-Authors: Sean D. Till, BS Robert Green, M.D.Michael Nguyen Peter M. Fleischut, M.D.

In an effort to adhere to transfusion guidelines, feedback technology was integrated with the computerized physicianorder entry (CPOE) system to improve compliance. A simple alert was developed and implemented in the electronicmedical record (EMR) to trigger when packed red blood cells (RBCs) were ordered for a patient whose last measuredhemoglobin level (Hb) was > 9.0 g/dL. As a result of this trigger, the incidence of RBC transfusion for Hb > 8.0 g/dLwas reduced significantly at a university affiliated academic medical center.

P-9199 Community-wide Trends in Utilization and In-Hospital Mortality for Endovascular and Open Repair of UnrupturedAbdominal Aortic Aneurysm, 2006-2011: Results from the State Inpatient Database

Primary Author: Bess M. Storch, M.D.Cornell University | Ithaca, NY, United States

Co-Authors: Akshay U. Bhat, MEng Ramin Zabih, Ph.D.Jonathan M. Eskreis-Winkler, BA Peter M. Fleischut, M.D.Kane O. Pryor, M.D.

We use the Statewide Inpatient Database (SID) to investigate utilization, mortality, and disposition trends for endovascular(EVAR) and open repair of unruptured abdominal aortic aneurysm over the six years ending in 2011. EVAR utilizationprogressively increased, while utilization of open repair steadily declined. In hospital mortality in the EVAR cohort waslower than open repair for all age groups. Consistent with prospective trials, community wide mortality outcomes stronglyfavor EVAR.

P-9200 Consistent Use of Labor Epidural Analgesia in a Multiethnic Population: Effect of Encouraging Equal Access to AllPatients

Primary Author: Isaac Lowenwirt, M.D.New York Hospital Queens | Flushing, NY, United States

Co-Authors: Peter Silverberg, M.D. Shaul Cohen, M.D.Patricia Pierre, B.S.N. Daniel Ramos, B.S.Adil Mohiuddin, M.D. Pavel Shapiro, B.S.Kang Rah, M.D. Yehuda Fuseilov, B.S.Daniel W. Skupski, M.D.

This study looked for differences in the application of labor epidural analgesia along with analgesia outcomes in ourmultiethnic population with prompt and equal access to education and placement of the epidural. When equal access toepidural analgesia was available, all ethnic groups chose epidural analgesia in similar proportions. Socioeconomic factorsand level of education were not associated with differences in the use of epidural.

P-9201 A Review of Adverse Events from the Phase 3 Program of the Sufentanil Sublingual Microtablet System


Co-Authors: Harold Minkowitz, M.D. Forrest G. Ringold, M.D. FACSTimothy Melson, M.D. David L Boyer, M.D.Pamela P. Palmer, M.D. Ph.D.

The Sufentanil Sublingual Microtablet System is a viable alternative to traditional IV PCA. This review of the Phase 3development data demonstrates the tolerability of the sublingual approach with sufentanil compared with placebo or IVPCA morphine.


P-9202 Sufentanil Sublingual Microtablet System: Onset of Action


Co-Authors: Harold Minkowitz, M.D. Forrest G. Ringold, M.D. FACSTimothy Melson, M.D. David L. Boyer, M.D.Pamela P. Palmer, M.D. Ph.D.

The Sufentanil Sublingual Microtablet System allows patient to self-administer sufentanil 15 mcg. In terms of painresponse, onset of action is by 30 min and statistically superior by 45 minutes.

P-9203 A Randomized, Double-Blind, Placebo-Controlled, Phase 2 Dose Finding Study of Sufentanil SublingualMicrotablets for Acute Traumatic Pain

Primary Author: Pamela P. Palmer, M.D. Ph.D.AcelRx Pharmaceuticals, Inc. | Redwood City, CA, United States

Co-Authors: Mark Evashenk Martha NeubauerMike A. Royal, M.D. , J.D., M.B.A.

The Sufentanil Sublingual Microtablet 30 mcg administered via a single dose applicator may be a promising non-invasive,rapid onset treatment for acute pain, particularly for acute trauma in battlefield conditions.

P-9204 A Randomized, Double-Blind, Placebo-Controlled Trial of the Sufentanil Sublingual Microtablet System afterMajor Orthopedic Surgery

Primary Author: Mike A Royal, M.D. , J.D., M.B.A.AcelRx Pharmaceuticals, Inc. | Redwood City, CA, United States

Co-Authors: Harold Minkowitz, M.D. Maurice Jove, M.D.David W. Griffin, M.D. Timothy Melson, M.D.Pamela P. Palmer, M.D., Ph.D.

The Sufentanil Sublingual Microtablet System provides an attractive alternative to traditional IV PCA analgesia, iseasy for healthcare professionals to set-up and for patients to use. After major orthopedic surgery, it was efficaciousand well tolerated for managing moderate-to-severe acute pain.

P-9205 Sufentanil Sublingual Microtablet System: Duration of Action

Primary Author: Mike A. Royal, M.D., JD, MBAAcelRx Pharmaceuticals, Inc. | Redwood City, CA, United States

Co-Authors: Timothy Melson, M.D. Harold Minkowitz, M.D.Forrest G. Ringold, M.D. David L. Boyer, M.D.Pamela P. Palmer, M.D., Ph.D.

The Sufentanil Sublingual Microtablet System delivering sufentanil 15 mcg sublingually provides an alternative patientself-administered analgesia modality which is easy for healthcare professionals to set-up and patients to use. Duringmaintenance clinical use, the mean inter-dose interval ranged from 80 to 100 minutes.

P-9206 What to Expect from the Unpredictable

Primary Author: Eva M Antunes, M.D.Centro Hospitalar Lisboa Central | Lisboa, Portugal

Co-Authors: Leina I. Spencer, M.D. Francisco L. Matos, M.D.Augusta Carneiro, M.D. Isabel Fragata, M.D.

What to expect from a subarachnoid block in patients with severe deformities of the spine.


P-9207 Oxygenation Measurements of Blood-Filled Cardiac Structures Using Esophageal Approach

Primary Author: Christian G. Reikersdorfer, M.D., BSBMEEso Technologies, Inc. | Middleton, WI, United States

Co-Authors: Stephen Gorski, BSEE Eugene Palatnik, MSEEElena Bezrukova, MSBME Edwin Mathews, M.D.Kent Haselow, M.D. John Atlee, M.D.

A new method for minimally invasive measurement of oxygenation of blood-filled cardiac structures via the esophagus isdescribed, including preliminary trending results for measurement of central venous and systemic (left atrial) oxygena-tion. The ESOP device with its ability to measure oxygenation in blood-filled cardiac structures could eventually provide apromising alternative to more invasive methods of venous oximetry.

P-9209 Endobronchial Blocker in a Ludwig's Angina Complicated by Mediastinitis. Case Report.

Primary Author: Margarida F GonçalvesCentro Hospitalar Lisboa Central | Lisbon, Portugal

Co-Authors: Marta Adriano Carina GouveiaLeina Spencer Francisco L. Matos, M.D.

Ludwig's angina is a rare, potentially life-threatening cellulitis involving the sub-lingual, sub-mental, and sub-mandibularspaces. Ensure the airway is a priority and a challenge for anaesthetic management. The reported case shows the importanceof training and experience of the Anesthesiologist inmanaging the fiberoptic bronchoscope and selective pulmonary ventilationdevices, which may be needed for an emergent situation in the emergency room, and not only in elective situations.

P-9210 Oxide of Mercury Poisoning - Case Report

Primary Author: Ines C. AlmeidaCentro Hopitalar Vila Nova de Gaia | Vila Nova de Gaia, Portugal

Co-Authors: Nuno Losa Alirio GouveiaCarmen Pereira Carla NogueiraPaula Castelões

We report a clinical case of mercuric oxide (HgO) powder ingestion. Mercury Oxide poisoning is uncommon. There arefew reports on mercury poison, and most importantly, on its management. We believe that mercury and coal inhalationwere the main determinants on patient outcome, resulting in severe multiorgan dysfunction and ARDS. DMPS is thechelating agent of choice and dialitic therapy should be considered in all patients with inorganic mercury poisoning.

P-9211 Iatrogenic Post-Intubation Tracheal: A Case Report

Primary Author: Ana Filipa Carvalho, M.D.Centro Hospitalar Vila Nova de Gaia e Espinho | Vila Nova de gaia, Portugal

Co-Authors: Alírio Gouveia, M.D. Carmen Pereira, M.D.Inês Carrapatoso, M.D. Manuela Vieira, M.D.

This case report presented an iatrogenic post-intubation tracheal rupture treated by surgery. It illustrates the effectiveness ofthe surgical therapeutic strategy of a large tracheal injury. Selection of treatment for post-intubation TR must remainindividualized.


P-9212 Regional Analgesia in Labor: A Retrospective Study

Primary Author: Ana Cristina R SilvaCentro Hospitalar de Lisboa Ocidental | Lisbon, Portugal

Co-Authors: Inês Carvalho Mafalda CoutinhoSónia Franco Luis Saldanha

Neuroaxial analgesic techniques in labor have been increasing throughout the world and have proven to be the mosteffective and safe pain relief. This retrospective study performed at the Hospital São Francisco Xavier, over 2 years, intendedto ascertain the number of pregnant women who did not benefit from this type of analgesia and which reasons led tonon-implementation of these techniques. It was found that in a total of 412 births only 7.8% did not undergo regionalanalgesia during labor which was due mainly to advanced labor and refusal. It was concluded that despite the number ofpregnant women who benefits from this type of analgesia be significant (92.2%), the Anesthesiology Department continuesto try to improve it by periodically sessions and distributing brochures to all pregnant women, so that they all can effectivelyand safely benefit from the implementation of these techniques.

P-9213 Disposable Laryngeal Tube S - A Randomized Comparison of Two Insertion Techniques Performed by NoviceUsers

Primary Author: Paul Kessler, M.D., Ph.D.JW Goethe-University | Frankfurt, Germany

Co-Authors: Sigrid Kessler, M.D. Christian Byhahn

A modified insertion technique of the disposable laryngeal tube S reduced the time required for successful insertion ofan LTS-D when performed by first-time users. Also, insertion within a 45sec time frame was significantly more frequentwith the modified technique, i.e. allowing placement of the LTS-D within two cycles of cardiopulmonary resuscitation.Since all users were novices, we could not determine a learning curve. Although likely, however, it remains speculative atthis stage if the time required for insertion could be further reduced with increasing clinical experience and training

P-9214 Medication Discrepancies by Anesthesia Residents: A Program Director and Resident Survey

Primary Author: Kalpana Tyagaraj, M.D.Maimonides Medical Center | Brooklyn, NY, United States

Co-Authors: Natalie E Younger, M.D. Jason Yu, M.D.

Despite existing protocols in place to deter medication diversion, the potential for abuse among anesthesiologistsremains alarmingly high. An anonymous and voluntary survey was distributed to 50 anesthesiology programsthroughout the eastern United States. The results of this survey show considerable homogeneity in program-directorand resident views regarding substance abuse and the continued presence of repeated medication discrepanciesamongst anesthesiology residents. In addition, most program directors and residents consider repeated medicationdiscrepancies by anesthesiology residents a measure of professionalism.

P-9215 Malignant Hyperthermia: To Be or Not To Be

Primary Author: Mari K. Baldwin, M.D.St. Lukes Roosevelt Medical Center | New York, NY, United States

Co-Author: Neda Sadeghi, M.D.

69 year old woman with no previous anesthetic problems has a possible MH episode in the OR. After treatment- withoutdantrolene- how should she be considered for future anesthetics and what label should she have?


P-9216 Intrathecal Drug Delivery Systems (IDDS) Compared to Systemic Pain Medication Management forCancer-Related Pain: Pain Relief and Opioid Side Effects

Primary Author: Spencer H. Menees, M.D.Mayo Clinic | Rochester, MN, United States

Co-Authors: Halena M. Gazelka, M.D. William M. Hooten, M.D.Tim J. Lamer, M.D.

In this study, the majority of patients with cancer pain who underwent IDDS implant experienced reductions in oral MED,improved NRS, and improved side effects. The observations of this study confirm the findings of previous clinical trials inconsecutive series of patients treated at a tertiary medical center. The favorable changes in oral MED and NRS providesignificant preliminary data for future prospective trials involving community-derived cohorts of patients with cancerpain.

P-9217 General Anesthesia in Pediatric Mastocytosis: How Safe It Is?

Primary Author: Margarida F. GonçalvesCentro Hospitalar do Algarve | Portimão, Portugal

Co-Authors: Ana F. Carvalheiro Ana M. CarneiroLeina Spencer Teresa Rocha, M.D.

Systemic mastocytosis is a rare disorder of mast cells which carries considerable risk in the perioperative period. Variousprecautions must be taken to avoid known provoking factors and hazardous drugs in patients who are required to undergosurgical procedures. In this report, we contribute to this experience by reviewing the anesthetic management of apediatric patient with mastocytosis.

P-9218 Adenoid Cystic Carcinoma Presenting as Swyer-James-Mcleod Sydrome - A Puzzle to the Anesthesiologist

Primary Author: Joana MarquesCentro Hospitalar Lisboa Central, EPE | Lisbon, Portugal

Co-Authors: Rafael Pires Ana M. CarneiroJosé L. Ferreira, M.D.

Adenoid Cystic Carcinomas (ACC) are malignant tumors that can originate in any site where mucous gland exists. In thiscase report, we present an asymptomatic patient, in whom the diagnosis was considered after a complication duringanesthetic approach. Thus, we emphasize the role that the anesthesiologist may have in the early diagnosis of certainpathologies.

P-9219 Resident and Staff Attitudes Toward Postoperative Visits Before and After Instituting a Postoperative Visit Service

Primary Author: Joshua C. VacantiBrigham andWomen's Hospital | Boston, MA, United States

Co-Authors: Frances B. Garfield, Ph.D. Bhavani S. Kodali, M.D.Xiaoxia Liu, MS Joseph M. Garfield, M.D.

In this before-and-after study, we examined resident and staff attitudes toward postoperative visits before and after thecreation of a dedicated postoperative visit service. Analysis of survey results demonstrated a statistically significantincrease in support for both postoperative visits and a dedicated postoperative service four years after implementation ofsuch a service. The vast majority of clinicians in our department valued these visits, considered them necessary and feltthat a PACU evaluation is not an acceptable substitute for a postoperative visit after discharge from the recovery room.


P-9220 Postoperative Epidural Analgesia for Major Abdominal Surgery - What Is the Optimal Ropivacaine Concentration?

Primary Author: Joana MarquesCentro Hospitalar Lisboa Central, EPE | Lisbon, Portugal

Co-Authors: Ana M. Carneiro Carina GouveiaRafael Pires Sandra Dias

Epidural analgesia is an effective technique for pain control in the postoperative phase of major abdominal surgery. Aretrospective study was conducted to evaluate the postoperative analgesia achieved through an epidural catheterperfusion of ropivacaine at 0.1%, 0.15% and 0.2%, combined with morphine.

P-9221 Perioperative Dysrhythmias: A Systematic Review

Primary Author: Ammar A. Alamarie, M.D.State University of New York Upstate | Syracuse, NY, United States

Co-Authors: Fenghua Li, M.D. Robert Calimlim, M.D.

Perioperative Cardiac Dsyrhythmias is a vital topic that must be addressed, revisited, and stressed to our current workforce of anesthesia care providers. Our patients are getting sicker, and with modernization of medicine, longevity is nowan option. It is imperative to understand this subject and current evidence based literature.

P-9222 Anaesthetic Management of a Patient with Myasthenia Gravis for Abdominal Surgery

Primary Author: Ana Filipa CarvalhoCentro Hospitalar Vila Nova de Gaia Espinho, | Vila Nova de Gaia, Portugal

Co-Authors: Carmen Pereira Inês CarrapatosoLurdes Preto

The peri-operative management of a patient with myasthenia gravis poses a significant challenge to the anesthesiologist.In this case report, we presented total intravenous anesthesia management of a patient with myasthenia gravis whoprogresed uneventful intra and postoperative period.

P-9223 Autonomic Dysreflexia in a Pregnant with Spinal Cord Injury

Primary Author: Ana Filipa Carvalho, M.D.Centro Hospitalar Vila Nova de Gaia Espinho | Vila Nova de Gaia, Portugal

Co-Authors: Carmen Pereira, M.D. Inês Carrapatoso, M.D.Alda Costa, M.D.

Autonomic dysreflexia (ADR) is a syndrome of imbalanced reflex sympathetic discharge occurring in patients with spinalcord injury (SCI) at or above the level of splanchnic sympathetic outflow (T6). We present the case of a 33 year-old, gesta2, para 0. Caucasian female at 35 weeks gestation, with a history of T4 SCI secondary to car crush a 12 years prior, whodeveloped ADR during preterm labor and received spinal anesthesia for cesarean section. Spinal anesthesia may be superiorto epidural anesthesia for providing hemodynamic protection against ADR during cesarean section.


P-9224 Three Recent Cases of ACE-I Related Angioedema Causing Severe Airway Obstruction

Primary Author: Aliraza Dinani, M.D.Rutgers Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Aysha Hasan, M.D. Christian McDonough, M.D.Shaul Cohen, M.D. Antonio Chiricolo, M.D.Rose Alloteh, M.D. Kang Rah, M.D.Christine W. Hunter, M.D. Shruti Shah, M.D.

We reported 3 cases of angioedema secondary to ACE-I use which caused severe airway obstruction requiring endotrachealintubation. Significant improvement in outcome was found with expediting time from ER to OR for airway management whenintubation is necessary. Treatment with C, esterase inhibitor concentrate (suppress the local over-production of bradykinin) orFFP (degredation of excess bradykinin by Kininase II) have both been shown to be effective in ACE-I related angioedema andhereditary angioedema.

P-9225 Cardiac Complications and Strokes in Vascular Surgical Patients. What are We Missing?

Primary Author: Sudarshan Setty, M.D.Montefiore Medical Center | Bronx, NY, United States

Co-Authors: Nathalie M. Abitbol Singh Nair, M.D.Sujatha Ramachandran, M.D.

We found a relatively high incidence of perioperative cardiac and vascular complications in patients undergoing low riskvascular surgeries especially surgery for AV fistulae. If our findings are confirmed in larger studies we may have to riskstratify AV fistula surgery differently

P-9226 Neuraxial Analgesia in Parturients with Lumbar Tattoos

Primary Author: Maria C. RodriguesHospital de São Bernardo - Centro Hospitalar de Setúbal | Setúbal, Portugal

Co-Authors: Bárbara Ribeiro Tânia SeixasJoana Azevedo Alejandro Martín

Over the last years there has been an increase in the number of parturients with tattoos in the midline of the lower back.The security of puncture through these tattooed regions is unknown, with many authors expressing concern about thepossibility of serious complications, such as arachnoiditis and epidermoid tumors. The anesthesiologist should decidewhether or not to perform the technique, bearing in mind that to date there are no reports of complications in this context,although there is no evidence that an epidural in these circumstances is totally secure.

P-9227 Anesthetic Management of Pheochromocytoma - Case Report

Primary Author: Rafael M Pires, M.D.Centro Hospitalar de Lisboa Central | Lisboa, Portugal

Co-Authors: Ana Carneiro, M.D. Joana Marques, M.D.Margarida Gonçalves, M.D.

Pheochromocytomas are rare tumors arising from chromaffin cells in the adrenal medulla or in other paraganglia of thesympathetic nervous system. The anesthetic management of pheochromocytoma is complicated and challenging. In thiscase report, we present the successful management of a 52 year-old female patient with a pheochromocytoma, whounderwent a left adrenalectomy with a favorable outcome.


P-9228 Successful Methods of Securing the Airway in the Context of a Difficult Airway Management Team (DAMT)

Primary Author: Phillip Adams, D.O.University of Pittsburgh | Pittsburgh, PA, United States

Co-Authors: Ricky Harika, M.D. Joseph Quinlan, M.D.Joseph Darby, M.D.

Difficult Airway Management Team (DAMT) responses over a five year period were assessed to determine the most successfulmethod of secured airway acquisition. Despite the introduction of numerous airway tools and adjuncts, conventional directlaryngoscopy is the method with the highest success rate.

P-9229 Chronic Calcineurin Inhibition Impairs Recovery from Isoflurane Anesthesia and Visuospatial Learning Performance

Primary Author: Paul S Garcia, M.D., Ph.D.Emory University | Atlanta, GA, United States

Co-Authors: Christopher M. Ma, BS Jonathan A. Fidler, BSJennifer L. Gooch, Ph.D.

Using a laboratory model we explore the role of calcineurin in modifying recovery from general anesthesia.

P-9230 Theta and Gamma Oscillations Typical of Thalamocortical Dysrhythmia in Patients with Trigeminal Neuralgia Pain

Primary Author: Prashanth ReddyNYU | New York, NY, United States

Our interest is in the role of the brain in chronic pain, specifically in the brain’s ability in generation or modulation ofpainful sensations in the absence of peripheral nociceptive input. Such pain may be related to abnormal spontaneousrhythms that are generated by intrinsic electrical activity in the thalamocortical system. Here, we present results indicatingthe likelihood that trigeminal neuralgia may share some characteristics with TCD and thus open a new avenue in thecentral source of pain in Trigeminal Neuralgia.

P-9231 Juvenil Nasopharyngeal Angiofibroma: A Successful Case Report


Co-Authors: Ana Carvalho Liliana DiasAna Pereira Diana CostaLurdes Preto

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor occurring in adolescent and young adult maleswhich develop characteristically in the posterior lateral wall of the nasopharynx. These tumors are characterized by aslow, progressive and locally invasive growth and high vascularised nature. We reported an anesthetic and surgicalsuccess. The major possible complications: difficult airway approach and major bleeding were considered andmeasures were taken to prevent and solve them. Fibroscopic intubation for difficult airway; short and thick venouscatheters for rapid infusion of blood and fluids; controlled hypotension with remifentanil were important measures todeal with possible complication of the procedure. The pre-operative embolization limited the intraoperative bleedingthat, in this case, can be considered minimal (600mL) when compared with other reported cases (4800 +/- 1600 mL).Resection of JNA must be considered a major procedure with many anesthetic challenges.


P-9232 Crisis Outside the Operating Room: Getting Back to Our Safe Zone

Primary Author: Sarah E. Kadhim, M.D.West Virginia University | Morgantown, WV, United States

Co-Author: Melissa S. Flanigan, D.O.

Interventional radiology aneurysmal coiling is one of our offsite assignments. A standard general anesthetic with arterialline is usually performed. In this particular scenario, there was an undetected closure device failure that led to severehemorrhagic shock. Radiology team did not intervene so the anesthesia team transferred the patient to an operatingroom in order to adequately resuscitate the patient. Since the patient was continuing to decompensate, vascular surgerywas emergently consulted by the anesthesiologist to remedy the situation. A stent was placed, artery repaired, andstabilization followed. Clearly vigilance, teamwork and insistence by the anesthesia team saved this patients life.

P-9233 Col. Ralph Tovell, M.D. and the Office of the Chief Surgeon inWorld War II

Primary Author: David Waisel, M.D.Boston Children's Hospital | Boston, MA, United States

Col. Ralph Tovell, M.D., was lauded for his success in obtaining resources for World War II anesthesiologists in theEuropean Theater of Operations. This paper explores one possible mechanism that contributed to his success.

P-9234 Relationship Between Preferred Spoken Language (English vs. Non-English) and Postoperative Length of StayAfter Total Knee Replacement

Primary Author: Robert White, MSIVMontefiore Medical Center | Bronx, NY, United States

Co-Authors: Tal Cohen Singh Nair, M.D.Naum Shaparin, M.D.

Health care inequalities represent a major problem in our current health care system. This study investigates theassociation between the inability to speak the dominant language (English) and the total postoperative length of stay forpatients that underwent total knee replacement. Results show a non-significant increased trend for longer length of stayfor non-English speakers who required the use of an interpreter service when compared to native speakers and thosewho did not require use of a translator; non-significance likely reflects insufficient statistical power.

P-9235 Improvements in Bleeding Management for Pediatric Craniosynostosis Surgery

Primary Author: Thorsten HaasPerioperative & Pain Medicine, Boston Children's Hospital | Boston, MA, United States

Co-Authors: Susan Goobie Nelly SpielmannMarkus Weiss Markus Schmugge

The implementation of a bleeding management based on routine usage of TXA, visco-elastic testing (thromboelastometry)and targeted administration of purified coagulation factors was associated with a considerable reduction of intraoperativetransfused allogeneic blood products in our retrospective analysis. In addition, overall mean costs for bleeding managementper patient were decreased. It is of high interest to perform further studies in this context in order to determine and justifysafe and reliable laboratory thresholds and treatment algorithms to further reduce perioperative transfusion requirements.


Notes


Titles, authors, institutions and descriptions will appear in numerical order from pages178 through229.The written descriptions have been reproduced as submitted on-line by each author.The PGA is not responsible for the accuracy of the contents.

Medically Challenging Case Report Poster Author Disclosure: The primary authors listed from pages178 through229 did not disclose any financial relationships, except for the following: MCC-7019 on page 181—Dr. Moss is a paidconsultant with Salix Pharmaceuticals whomarkets methylnaltrexone; also receives royalties from the University of Chicago as an inventor.

Medically Challenging Case Report PostersStephen A. vitkun, M.D., M.B.A., Ph.D. , Chair


• Be aware that Medically Challenging Case Report Posters may not be positioned in numerical sequence in the Exhibition Area.

• Authors should be available to discuss their work during the following designated times.





MCC-7002MCC-7003MCC-7004MCC-7007MCC-7008MCC-7010MCC-7012MCC-7013




MCC-7055MCC-7057MCC-7058MCC-7061











MCC-7203MCC-7210MCC-7222MCC-7226





MCC-7195MCC-7197MCC-7198MCC-7201MCC-7204MCC-7205






MCC-7116MCC-7118MCC-7123MCC-7124MCC-7127





MCC-7228MCC-7229MCC-7230


MCC-7002 Anaesthesia for Coarctation Repair in a 1.2 kg Preterm Neonate with Extreme Low Birth Weight andGestational Age of 33Weeks

Primary Author: Renuka Arumainathan, M.B.,Ch.B.Royal Brompton and Harefield NHS Foundation Trust | London, United Kingdom

Co-Author: Sian Isobel Jagger, M.B.,B.S

Coarctation of the aorta is a narrowing of the aortic isthmus. Untreated, it causes several complications, including heartfailure, circulatory collapse and increasing left ventricular wall stress.Medical management can be employed in the first instance to improve cardiovascular stability, and to allow the infant togrow, but ultimately the definitely treatment is surgical correction. Management of the haemodynamic changes associatedwith the coarctation repair presents many challenges for the anaesthetist, particularly on application of and after releaseof the aortic cross-clamp. In addition, anaesthesia for the critically ill low birth weight infant can pose many difficultiesdue to immature organ systems. A comprehensive team-based pre-operative approach and meticulous planning are crucialfor a safe peri-operative course.

MCC-7003 Case Report: Anaesthesia for Whole Lung Lavage in a Patient with a Pneumothorax

Primary Author: Zihui Tan, M.B.,Ch.B.Singapore General Hospital | Singapore, Singapore

Co-Author: Ruban A/L Poopalalingam, M.B.,B.S.

This case report presents a challenging situation where a pneumothorax complicates anaesthesia for whole lung lavagein a patient with pulmonary alveolar proteinosis.

MCC-7004 Mirror Syndrome - Maternofetal Hydrops and Anesthetic Management

Primary Author: Ezekiel Tayler, D.O.Albany Medical Center | Albany, NY, United States

Co-Author: Cheryl DeSimone, M.D.

Mirror syndrome is a rare obstetric entity where a mother "mirrors" the edema of the hydropic fetus and placenta.Pathogenesis of the condition is still unknown. It is hypothesized that it could be due to a maternal inflammatoryresponse from trophoblastic debris or increased placental production of proteins leading to vascular leakage. Increasedmaternal morbidity and mortality is seen with Mirror syndrome, and the only treatment is to deliver the hydropic fetus ifcorrection of the underlying fetal abnormality is not possible. We present a case of a parturient with Mirror syndromeand the anesthetic management.

MCC-7006 3D Echocardiography Guiding Management During Intracardiac Thromboembolectomy

Primary Author: Eugene KimStony Brook Medicine | Stony Brook, NY, United States

Co-Authors: Christopher Tam, M.D. Sandeep Gupta, M.D.Igor Izrailtyan, M.D.

Although no evidence-based management guidelines for right heart intracardiac thromboemboli exist, surgicalthromboembolectomy remains as a valuable option for certain patients. We present a case where intraoperative 3Dechocardiography was utilized to guide decision-making for right pulmonary artery thromboembolectomy.


MCC-7007 Vagal Nerve Stimulator: Anesthetic Considerations for Obstetric Surgery

Primary Author: Ali M AkmalRutgers - New Jersey Medical School | Newark, NJ, United States

Co-Authors: Sean McGuirt, B.A. Sergey V Pisklakov, M.D.

Vagal nerve stimulation is becoming an increasingly common adjunctive therapy for medically refractory epilepsy. Theindications for which include refractory epilepsy. As the number of approved indications increases it has become morecommon to see these devices in the general population. This is a case of a 23 year old female G,PO who is 35 weekspresents for transverse lie for elective induction. In light of the airway considerations and the surgical implications of atransverse lie cesarean section the authors of this case report argue that general anesthesia is the preferred technique forthe obstetric population with a vagal nerve stimulator.

MCC-7008 Anesthesia Management in a Patient with Unsuspected Profound Metabolic Alkalosis and ElectrolyteAbnormalities Caused by Ingestion of Baking Soda

Primary Author: Gang Zheng, M.D.University of Texas MD Anderson Cancer Center | Houston, TX, United States

Co-Authors: Jose M. Soliz, M.D. Jeffrey Lim, M.D.

Litter is known the impacts of alternative medicine to anesthesia management. This case presents a patient who waslong-term managed by a nature doctor for colon cancer. His remedy constituted a combination of herbs and baking soda.The history was not elicited preoperatively. His intraoperative arterial blood gas revealed unexpected profound metabolicalkalosis and multiple electrolyte abnormalities. Refractory hypotension and attenuated response to vasopressors andintolerant anesthetics make it difficult to maintain hemodynamic stability during anesthesia. The mechanisms betweenalkalosis/electrolyte derangement and anesthetic intolerance remains unclear at this time. Without known of baselinemetabolic and electrolyte values made the case difficult in determine of endpoint of electrolyte correction. Alternativeremedies could significantly increase risks of perioperative mortality and morbidity. All the physicians should obtain acomplete list of alternative remedies when interviewing patients.

MCC-7009 The Practice Pattern in Choosing Left-Sided Double Lumen Tubes Size

Primary Author: Medhat Hannallah, M.D.Georgetown University Hospital | Washington, DC, United States

Co-Authors: Whitney Johnson, B.S. Pranay Krishnan, M.D.

This study retrospectively examined the anesthesia records of 27 patients who had undergone thoracic surgery requiringthe use of left DLTs whose size was empirically chosen. Each patient’s left main-stem bronchial diameter was measuredon chest CT scans to determine the suitability of the chosen DLT size in relation to the measured left main-stem bronchialdiameter. In 10 patients the diameter of the tip of the DLT exceeded or was equal to the bronchial diameter. The findingsof this study suggests that when the choice of DLT size is based upon clinical experience there is a significant potential forchoosing a large DLT relative to the size of the patient’s airway.

MCC-7010 Postpartum Hemorrhage in a Patient with Abruptio Placentae and Couvelaire Uterus

Primary Author: Kimberly I McClelland, M.P.H.Howard University College of Medicine | Washington, DC, United States

Co-Authors: Clairmont E. Griffith, M.D. David J. Holliday, M.D.

The successful management of suspected abruptio placentae is dependent on a variety of factors, including the patient'sco-morbidities, obstetric history and toxicology status, as well as the anesthesiologist’s ability to rapidly respond tounanticipated sequelae. Here, we present the case of a 37-year-old G8P2143 with a past medical history of polysubstanceabuse, PPROM, chorioamnionitis, Group B β-streptococcus (GBS)-positive pregnancy/delivery and bipolar disorder whopresented to L&D with chief complaints of uterine contractions and severe abdominal pain. She had no vaginal bleeding.We will examine the role of the anesthesiologist in managing unexpected clinical and laboratory findings similar to thosepresented in this case.


MCC-7011 Submental Intubation in a Patient with Multiple Midfacial Fractures

Primary Author: Jia Huang, M.D.Bellevue Hospital Center/NYU School of Medicine | New York, NY, United States

Due to edema of the oropharynx and the tongue, the orotracheal tube was removed over a tube exchanger. Next, areinforced endotracheal tube was inserted orotracheally under Glidescope guidance. The OMFS team then made a tractbetween the skin and the floor of the mouth, and the free end of the reinforced tube was pulled through the tract.Patient tolerated the procedure, intraoperative course was uneventful. At the end of the surgery, patient was reintubatedorotracheally. He was extubated without complication in the ICU on POD #4.

MCC-7012 Anesthesia for Extrapulmonary Sequestration

Primary Author: Zachary R. SimpsonUniversity of Kentucky | Lexington, KY, United States

Co-Author: Arundath Reddy, M.B.,B.S.

An extrapulmonary sequestration is a solid or cystic mass of non-functioning lung tissue with an aberrant arterial supply.A 30 day old neonate was anesthetized for a thorocotomy and excision of an extrapulmonary sequestration. The patientwas difficult to ventilate, had a large pleural effusion, and required lung isolation, which made this case an anestheticchallenge.

MCC-7013 Management of an Obese Parturient with Goodpasture's and Hughes Syndromes

Primary Author: Lance Parks, D.O.West Virginia University | Morgantown, WV, United States

Co-Author: Eric Massey, M.D.

A 27 year old primigravida presents at 37 weeks 4 days gestation with a past medical history significant forGoodpasture's syndrome, Hughes syndrome, seizure disorder, morbid obesity, and a history of cardiac arrest necessitatingECMO. She has had multiple deep vein thromboses and a pulmonary embolism prior to conception, as well as numerousadmissions throughout pregnancy for increased dyspnea and respiratory distress. In spite of this she continued to smoketwo packs of cigarettes per day. Her pregnancy was also complicated with intrauterine growth restriction and gestationaldiabetes. The patient was admitted for observation when non-reassuring fetal heart tones were noted during a prenatalvisit and she was tentatively scheduled for a Cesarean section conditional on fetal vigor. Her home enoxaparin waschanged to a heparin drip at admission. Anesthetic considerations to be discussed include implications of a pregnancycomplicated by Goodpasture's and Hughes syndromes, timing of neuraxial instrumentation with regards to discontinuationof anti-coagulation agents, and modulating risk of DVT in the perioperative period.

MCC-7014 Postoperative Pain Management in Patient with Opioid-Induced Hyperalgesia

Primary Author: Nicholas J. Bremer, M.D.NYU Langone Medical Center | New York, NY, United States

Post-operative Pain Managment in Patient with Opioid-induced Hyperalgesia: A Case Report of Utilizing PostoperativePatient-controlled Epidural Analgesia in Lower Extremity Surgery.

MCC-7016 Takotsubo Cardiomyopathy Following Liver and Kidney Transplantation

Primary Author: George C. Hsu, M.D.Thomas Jefferson University | Philadelphia, PA, United States

Takotsubo cardiomyopathy infrequently occurs to susceptible patients undergoingmajor surgery. It mimics acute coronarysyndrome and is a diagnosis of exclusion. Takotsubo cardiomyopathy is usually transient and prognosis favorable. Goodpain control and sedation may help prevent development of Takotsubo cardiomyopathy in patients at risk undergoingmajor surgery.


MCC-7017 Intraoperative Acute Neurogenic Pulmonary Edema and Myocardial Stunning During EndoscopicFenestration and Shunt Revision

Primary Author: Kristen E. Dragan, M.D.West Virginia University | Morgantown, WV, United States

Co-Authors: Ahmed F. Attaallah, M.D.,Ph.D. William Patten, M.D.

Neurogenic stunned myocardium (NSM) is a syndrome of cardiac dysfunction after a neurological insult. It is commonlyobserved after aneurysmal subarachnoid hemorrhage but is increasingly being reported after other neurological events.The underlying mechanism of NSM is believed to be a hypothalamic-mediated sympathetic surge causing weakenedcardiac contractility and even direct myocardial damage. We report a case of NSM that occurred intraoperatively in apediatric patient undergoing endoscopic fenestration and shunt revision. We observed an acute increase in heart rateand arterial blood pressure due to ventricular distention with the endoscopic irrigation fluid, which was shortly followedby pulmonary edema.We will address the importance of neurogenic pulmonary edema and NSM as possible intraoperativecomplications resulting from increased intracranial pressure. We will discuss the early identification and treatment ofNSM, and will review the current information of the brain-cardiac connection.

MCC-7018 Splenic Rupture After Elective Cesarean Section

Primary Author: Mitko Kocarev, M.D.Harrogate District Hospital | Harrogate, United Kingdom

Co-Authors: Simon Holbrook, M.B.,B.S. Sarah Marsh, M.B.,B.S.

We present a case of splenic injury after an uneventful elective cesarean delivery that resulted in major hemorrhagerequiring splenectomy. A splenic injury should be considered when there is unidentified bleeding following an abdominalprocedure.

MCC-7019 Methylnaltrexone Restores GI Motility in a Cardiac Surgery Patient

Primary Author: Jonathan Moss, M.D.,Ph.D.The University of Chicago | Chicago, IL, United States

Co-Authors: Michael Esposito, M.D. Omar Qureshi, M.D.Avery Tung, M.D.

This is a case report of a cardiac surgical patient with GI dysmotility for 14 days leading to abdominal distention andrespiratory compromise. He was successfully treated with a single dose of methylnaltrexone, a peripheral opioid antagonistused in palliative care.

MCC-7020 Increased Spinal Needle Vulnerability Within the Patient Following Troubleshooting andWithdrawal

Primary Author: Christopher R. Ursillo, M.D.CGF Anesthesia Associates, P.C. | Buffalo, NY, United States

Co-Authors: Douglas Kahn, M.D. StaceyWatt, M.D.

A case report involving breakage of a spinal needle during withdrawal of the needle following intrathecal injection for anelective cesarean section. The residual needle fragment remained inside the patient confirmed by x-ray. Followingneurosurgical consultation, it was decided to continue with the planned procedure and remove the needle fragmentafterwards.


MCC-7021 Coronary Occlusion Secondary to Aortic Valve Patient-Prosthesis Mismatch

Primary Author: Juan A. Ramos, M.D.Mayo Clinic | Jacksonville, FL, United States

Co-Author: Eduardo S. Rodrigues, M.D.

Aortic stenosis is the most common valvular disorder and the third most prevalent form of cardiovascular disease in thewestern world. Surgical aortic valve replacement is the current gold standard therapy for aortic stenosis, which anesthesi-ologists need to be familiar with. We present a case of Coronary occlusion following aortic valve replacement secondaryto valve patient-prosthesis mismatch and its peri-operative management. An important consideration of AVR surgery isvalve prosthesis-patient mismatch, defined as: an effective prosthetic aortic valve area, which after insertion, is less thanthat of a normal human valve. Virtually all prosthetic heart valves are smaller than normal and thus, VP-PM has becomean accepted part of valve replacements. A rare and severe complication after aortic valve replacement is coronary occlu-sion, in the setting of valve prosthesis-patient mismatch, by the valve prosthesis. The later may be secondary to VP-PM, orrather a consequence of the efforts to implant the largest feasible prosthesis to avoid VP-PM.

MCC-7022 Hysterectomy in a Steinert and Pulmonary Hypertension Patient

Primary Author: Ruben Velasco AlmodovarHospital General Universitario De Ciudad Real | Ciudad Real, Spain

Co-Authors: Juan Jose Ruiz Lopez Carlos Alberto Jaramillo TasconMilagros Pretel Merlo Jose Miguel Valverde Mantecon

We present a woman with Steinert disease and secondary pulmonary arterial hypertension due to pulmonary embolism,scheduled for hysterectomy and lymphadenectomy through laparotomy. Spinal and epidural combined anesthesia wasperformed to prevent invasive management of the airway. During the surgery the patient had two episodes of desaturationthat were solved with the use of inhaled epoprostenol. Finally, the patient was transferred to the critical care unit withoutany others incidents. In this case we try to describe the pathophysiology and clinical anesthetic management of twodiseases that appear synchronously in this patient (Steinert myotonic dystrophy and Pulmonary arterial Hypertension)and also the novel use of inhaled epoprostenol as an alternative to other treatments already described as intraoperativeiNO.

MCC-7023 The Role of TEE in Detection and Management of IVC Tumor Embolization to the Pulmonary Circulation

Primary Author: Negmeldeen F. Mamoun, M.D.Cleveland Clinic | Cleveland, OH, United States

Co-Authors: Jia W. Lin, M.D. Jose L. Navia, M.D.

Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney; it is associated with inferior vena caval(IVC) extension in 4-10% of the cases. Transesophageal echocardiography (TEE) is used intraoperatively during resectionof RCC in patients with IVC extension, because the tumor can embolize during surgical manipulation. In this case report,we present a case in which TEE had a big impact on management, it alerted us to the embolization of the IVC tumor tothe pulmonary circulation few minutes before hemodynamic instability occurred. TEE enabled instantaneous detectionof the tumor embolization, which allowed faster management and contributed to a favorable patient outcome. Werecommend continual TEE monitoring for all patients undergoing resection of RCC extending into the IVC and RA, thiswould help with earlier detection and management of complications, which will probably contribute to decreasingmorbidity and mortality associated with management of those high risk patients.

MCC-7024 Stress Induced Cardiomyopathy After Intra Operative Negative Pressure Pulmonary Edema

Primary Author: Prameela KondaNew York Methodist Hospital | Brooklyn, NY, United States

Negative pressure pulmonary edema is not a quite uncommon event. Perioperative Stress induced cardiomyopathy ismore uncommon but not rare. Both of these events happening at the same time is very rare. We are presenting a case ofsuch a combination of events.


MCC-7025 The Use of Isofluorane in the Terminatation of Refractory Status Spilepticus

Primary Author: Avichai Dukshtein, M.D.Maimonides Medical Center | Brooklyn, NY, United States

Co-Authors: Piyush Gupta, M.D. Giselle Torres, M.D.

Generalized tonic/clonic seizures unresponsive to conventional therapies predispose one to poorly oxygenate and ventilate.The subsequent development of acidemia and it's known consequences (for example cardiovascular excitability, arrythmiaand collapse) raise immediate concern for promptly securing the airway and restoring normal acid-base physiology.

MCC-7026 Colonoscopy Adventures: Are Those Lung Sounds or Bowel Sounds?

Primary Author: Michael J. FitzPatrick, M.D.Albany Medical Center | Albany, NY, United States

Co-Author: Ryan Gibb, M.D.

A patient with a previous esophagectomy presents to the GI clinic with a bowel obstruction. During the colonoscopy thepatient regurgitates and there is a concern for aspiration. The patient is hypoxic post procedure but has no complaints.An aspiration work up reveals a diaphragmatic hernia in which colon has herniated into the left thoracic cavity. The herniationwas likely secondary to an increased intraabdominal pressure associated with a bowel obstruction and exacerbated by acolonoscopy. The patient then went for emergency surgery to correct the herniation.

MCC-7027 Intraoperative Tako Tsubo Cardiomyopathy During Carotid Body Tumor Excision: An indication forTherapeutic Use of Levosimendan

Primary Author: Gaurav Chauhan, M.D.Aruna Asif Ali Government Hospital | Delhi, India

We present a case of 52-year-old female was scheduled for excision of chemodectoma. One hour into surgery, as thetumor was manipulated, the patient developed cardiac arrest in asystole. After the heart was revived, ECG showed deepT-wave inversion and central venous pressue was 26 cm H2O. At ICU admission, physical examination, laboratory investigationand imaging studies revealed cardiogenic shock due to dilated cardiomyopathy of left ventricle, assumed to be caused byTako-tsubo syndrome. Vassopressors were discontinued and were sustituted for intra-aortic balloon counterpulsation(IABP) and Levosimendan infusion. The patient showed good response to treatment with complete recovery. To ourknowledge, there are no reported cases of intra-operative cardiogenic shock due to Tako-Tsubo syndrome during carotidbody tumor excision in which Levosimendan and IABP are employed for acute phase.

MCC-7028 Anesthetic Management of a Parturient with a Cerebral Cavernoma for Cesarean Section

Primary Author: Carmen A Alcala, StudentStony Brook University Hospital | Stony Brook, NY, United States

Co-Author: Ahmed Haque, M.D. Schabel Joy, M.D.

This case report describes a young primigravida with a history of a cavernoma who presented at the labor and deliverysuite for anesthethic and obstetric management. A primary ceserean section was performed and anesthetic managementis described.

MCC-7029 Paratracheal Cyst Rupture: A False Alarm for Tracheal Rupture


We present a case of 55-year-old man, ASA I, who was scheduled for elective subacromial arthroscopic rotator cuff repairunder general anesthesia with USG guided interscalene block. Post-operative period was complicatedwith developmentof subcutaneous emphysema.


MCC-7030 Metoclopramide Induced Akathisia


A 45 year old male patient, ASA physical status I, pre - operatively administered inj. Metoclopramide 10 mg I.V. developedrestlessness, agitation and exhibited movements of the arms and legs (crossing and uncrossing of the legs). Symptomssubsided after administration of inj. Midazolam 1.5 mg I.V.We believe that drugs commonly administered in the perioperativeperiod have the potential of inducing akathisia. We should keep a high index of suspicion of akathisia with use ofMetclopramide.

MCC-7031 Meralgia Paresthetica After Total Hip Arthroplasty in Supine Position


We present a case of 62-year-old woman, was scheduled for elective total hip arthroplasty of right hip joint under spinalanesthesia which was complicated by Meralgia paresthetica in post-operative period.

MCC-7032 Parsonage-Turner Syndrome after Interescalene Block for Diagnostic Arthroscopic Surgery of Shoulder Joint.


Parsonage-Turner syndrome may lead to chronic debilitating disease and extensive clinical and neurological examinationis important to exclude any neurological complications due to regional anaesthesia or the surgery performed as they canplace the anesthesiologist at legal risk

MCC-7033 Anaesthetic Anagement of Patient with Systemic Lupus Erythematosus and Thrombocytopenia for VaginalHysterectomy


The case report highlights the complications that can be expected and important guidelines and considerations to followduring the conduct of anesthesia in a patient with SLE

MCC-7034 Severe Hypotension During General Anaesthesia in a Patient on Chronic High Dose Tamsulosin Therapy


We report a case of 65-year-old man undergoing an elective face lift operation. He was taking Tamsulosin 0.8 mg OD andDutasteride 0.5 mg OD since last 3 years for benign prostatic hypertrophy (BPH). Tamsulosin, a α-1 selective adrenergicreceptor (α -1-AR) antagonist, is used as first-line drug for BPH. He developed persistent hypotension during the maintenancephase of anaesthesia while receiving O2/N2O and 1% Isoflurane. High index of vigilance for unexpected hypotension isimportant in patients, who are treated with selective α -1-AR blockers, undergoing surgery. If hypotension occurs,vasopressors that act directly on α -1-AR could be more effective.

MCC-7035 Ipsilateral Horner's Syndrome Associated with Epidural Anaesthesia in a Emergency Cesarean Section


Neuaxial blocks are associated with a number of inadvertent complications. We present a case of 25 year old female, gavida ,para 1, presented in active labor at 39 weeks gestation who experienced ipsilateral horner's syndrome following epiduralanesthesia for emergency LSCS.


MCC-7036 How to Diffuse a Ticking Bomb: Management of Carcinoid Crisis

Primary Author: Christina Wang, M.D.Baylor College of Medicine | Houston, TX, United States

We present a case of a 62 year old Caucasian male with a history significant for obesity, OSA on BIPAP, HTN, pulmonaryHTN, and DMwho was undergoing resection of a primary mesenteric carcinoid tumor. He had two episodes of intraoperativecarcinoid crises, one during tumor manipulation and another after tumor removal. In this case, we describe how ourpatient was managed during these crises and how use of epinephrine can be an acceptable and effective method ofmanagement.

MCC-7038 Airway Development Status-Post Gunshot Wound (GSW) to the Shoulder with Expanding Hematoma andCartilage Disruption

Primary Author: Kimberly I McClelland, M.P.H.Howard University College of Medicine | Washington, DC, United States

Co-Authors: Clairmont E. Griffith, M.D. David J. Holliday, M.D.Girum D. Hailedingle, M.D.

A major concern in trauma patient evaluation is sufficient airway preservation, especially if difficult airway managementis required. A difficult airway is classified by the ASA as“the clinical situation in which a conventionally trained anesthesiologistexperiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both.” (1)Various airway stabilization methods have been studied in similar clinical scenarios, with maxillofacial and neck injuries(2-6), and with optimal imaging techniques for the rapid identification of trauma effects (7). However, the added complicationof sudden airway constriction and unusual bullet trajectory make this case particularly unique. According to Radiology,the bullet entering the right shoulder traversed Zone II of the neck, fractured the hyoid bone, ricocheted off of thepatient’s mandible and exited, while creating an actively bleeding hematoma within the neck whose expansion eventuallyconstricted the patient’s airway. Additionally, lack of mucosal violation from the bullet trajectory explains the lack ofblood in the oral cavity during physical exam.

MCC-7039 Anesthesia for Esophagogastroduodenoscopy in a Patient with Santa Ana Hemoglobinopathy

Primary Author: Medhat Hannallah, M.D.Georgetown University Hospital | Washington, DC, United States

Co-Author: Anna Budde, M.A.

A 45 yr-old male with Santa Ana hemoglobinopathy underwent esophagogastroduodenoscopy (EGD). In these patientsthe pulse oximeter underestimates arterial oxygen saturation. This patient’s pulse oximeter's reading was ±85% with orwithout supplemental oxygen. This report describes the condition and discusses anesthesia considerations for EGD withoutreliable pulse oximetry.

MCC-7040 Anesthetic Management of a Child with Harlequin Ichthyosis

Primary Author: Pamela K. Wendel, M.D.Hospital for Special Surgery | New York, NY, United States

Co-Author: Kathryn R. DelPizzo, M.D.

Harlequin Ichthyosis (HI) is a rare congenital disorder of the epidermis development leading to skin contraction. Thisleads to increased susceptibility to infection and dehydration as well as problems with thermal regulation. A five-year oldmale with HI underwent an operation under general anesthesia. Intra-operative monitor choice and securing of theendotracheal tube were focused on minimizing skin disruption. Special care was given to positioning and eye protection.Temperature was closely monitored and controlled. The case was ultimately uncomplicated and the patient was extubated.


MCC-7041 A Successful Management of a Pregnant Patient with Severe Pulmonary Hypertension and EisenmengerSyndrome

Primary Author: Michael J. Pedro, M.D.SUNY Downstate | Brooklyn, NY, United States

Co-Authors: Jason Kreiner, M.D. Steven Hu, M.D.

Eisenmengger syndrome is one of the rare conditions for which pregnancy is said to be contraindicated.The risk of morbidityand mortality during pregnancy is due to the increased intravascular volume, decreased systemic vascular resistance, andincreased oxygen consumption superimposed on the altered cardiovascular anatomy and a non-compliant pulmonaryartery. These normal physiologic changes of pregnancy worsen the right to left intracardiac shunt and result in worseninghypoxemia. Currently no one regimen has been defined as the standard of care for the medical managment ofEisenmenger’s Syndrome. In our case, general anesthesia with an ETT was found to be successful. We pre-oxygenatedwith 100% O2 and then performed RSI with succinylcholine and propofol. For maintenance Sevoflurane was used. Also ofimportance, we were giving pushes of Levophed to increase SVR and limit right to left shunting. The patient was extubatedseveral days later in the ICU and was able to return home weeks later.

MCC-7042 Anesthetic Management for Repeat Cesearan Section in a Patient with Rheumatic Heart Disease withMultivalvular Involvement

Primary Author: Jill S. CooleyUniversity of Arkansas for Medical Sciences | Little Rock, AR, United States

Co-Authors: Mohamed Ismaeil, M.D. Ala Klimova, M.D.

This is a report of a medically challenging obstetric case describing the anesthetic management for a repeat cesareansection in a parturient with severe Rheumatic Heart Disease.

MCC-7043 Your Last Case Add-on: ICU to OR Then Discharge to Senior Prom

Primary Author: Natalia Klosak, M.D.University of Florida | Gainesville, FL, United States

Co-Authors: Jeffrey White, M.D. Joshua Phillips, C.R.N.A

An 18yo male with NYHA Class III nonischemic cardiomyopathy and left ventricular ejection fraction (LVEF) of 15%required urgent EGD. We selected a monitored anesthetic (MAC) using only etomidate. We consider etomidate to be anexcellent anesthetic agent for MAC in patients with limited hemodynamic reserve.

MCC-7044 Autoimmune Hemolytic Anemia in Patients Undergoing Aortic Valve Replacement: Anesthetic Considerationsand Management

Primary Author: Carol Eisenstat, M.D.SUNY Stony Brook University | Stony Brook, NY, United States

Co-Authors: Thomas V. Bilfinger, M.D. Frank C. Seifert, M.D.Igor Izrailtyan, M.D.

Autoimmune hemolytic anemia may pose a significant anesthetic challenge in patients undergoing cardiac surgeryinvolving cardiopulmonary bypass. This presentation highlights two cases of autoimmune hemolytic anemia in patientsundergoing successful aortic valve replacement and discusses the peri-operative considerations crucial in optimal anestheticmanagement of patients with warm- and cold-reactive AIHA.


MCC-7045 Malaria in Pregnancy

Primary Author: Filipa Horta e Silva, M.D.Centro Hospitalar Lisboa Ocidental | Lisbon, Portugal

Co-Authors: Inês Carvalho Daniel Alves, M.D.Ana Isabel André, M.D. Luis Saldanha, M.D.

This is a case of complicated malaria in pregnancy with multiorgan disfunction. It was decided to undertake an emergentcesarean section under general anestesia. In critical care unit she developed a moderate ARDS complicated by nosocomialpneumonia needing invasive mechanical ventilation.

MCC-7046 ARDS After Craniotomy: A Case for ECMO?

Primary Author: Logan Reeves, M.D.University of Kentucky | Lexington, KY, United States

Co-Author: Scott McCardle, M.D.

A 31 year old female with a large sellar mass suffers an aspiration event after craniotomy and partial resection of herintracranial tumor. She developed severe ARDS and septic shock, with significant difficulty with oxygenation and ventilation.Her increased intracranial pressure from her residual tumor and hydrocephalus presented the ICU team with conflictinggoals of hyperventilation to decrease ICP and permissive hypercapnea and lung protective ventilation for ARDS. Rescuetherapies for ARDS, including inhaled epoprostenol, were initiated while the potential of ECMO was also discussed. Thiscase reviews rescue therapies as well as the use of ECMO for severe cases of ARDS, and discusses whether ECMO potentiallyshould have been employed in this case.

MCC-7047 Intraoperative Elevated Bispectral Index Values in a Patient with a History of Seizure Disorder

Primary Author: John D. McDonald, M.D.Mayo Clinic | Jacksonville, FL, United States

Co-Author: Sher-Lu Pai, M.D.

During a routine anesthetic of a woman with a history of seizure disorder, elevated intra-operative bispectral index valuesindicating an awake state are noted. This case and its content explore the broad differential diagnosis as well as suggestedmanagement of this clinical scenario.

MCC-7048 Anesthetic Considerations for Cesarean Section in the Setting of Klippel-Trénaunay-Weber Syndrome (KTWS)

Primary Author: Robert S . Schoaps, B.S.OU Medical Center | Oklahoma City, OK, United States

Co-Author: Abhinav Madamangalam, M.D.

This medically-challenging case report will elaborate on the clinical features of Klippel-Trénaunay-Weber Syndrome(KTWS), resultant complications, as well as the anesthetic implications of regional and general anesthesia in a patientwith this rare disorder.


MCC-7049 Orofacial Tumor Obstructing the Airway

Primary Author: Adriana Calderón Barajas, M.D.University Hospital Doce de Octubre | Madrid, Spain

Co-Authors: Meta Levstek, M.D. Oscar Valencia Orgaz, M.D.Adolfo Garcia Gutierrez, M.D.,Ph.D. Jorge Hernan Calle Ochoa, M.D.

We present a case of 79 year old female with history of orofacial angiomatosis. Due to the worsening of her clinical statuswith dyspnoea, macroglossia and hematoma of the tongue, a tracheostomy under general anesthesia was considerednecessary. We decided to realize awake nasotracheal intubation with the fiber optic bronchoscope with the patient in sittingposition to secure the airway. First we proceeded to the airway preparation of the nasal cavity with topical anesthesia andlater we used“spray as you go”technique. After confirming the correct placement of the endotracheal tube general anesthesiawas induced. The tracheostomy concluded without any incidents and the patient was transferred to PACU maintainingspontaneous ventilation.

MCC-7050 Rapid Correction of Severe Metabolic Acidosis - A Cause of Apnea?


Co-Author: Oriana Ng Diana Chan

Rapid correction of an underlying, chronic metabolic acidosis can possibly result in postoperative apnea.

MCC-7051 Elective Operation Cancellation on the Day of Surgery in a Major Tertiary Hospital


Cancellation of operation on the day of intended surgery has major implications for the patient, operating room staff andoperating theater efficiency. Our study attempts to identify the reasons for cancellation in our institution.

MCC-7052 Case Report- Lazarus Syndrome After Prolonged Resuscitation


Co-Author: Shin Yi Ng

Autoresuscitation has implications on the certification of death and the decision to cease resuscitation. We report a caseof Lazarus syndrome.

MCC-7053 Neuraxial Anesthesia in a Spina Bifida Occultaparturient

Primary Author: Puja Shah, M.D.SUNY Downstate | Brooklyn, NY, United States

Co-Author: Lawrence Lai, M.D.

This is a case of a 33 year old G4P1021 parturient with a past medical history of obesity, insulin dependent diabetes mellitus,and spina bifida occulta (level unknown) at 38 weeks that received an epidural for anesthesia in the Labor and Deliveryunit without complications. Patients with SBO have an increased potential for dural puncture, nerve injury, and inadequateblock. However, neuraxial anesthesia is thought to be relatively safe in patients with SBO, and future randomized prospectivetrials will strengthen current knowledge base.


MCC-7054 Semi-Sitting Craniotomy in Intracardiac Shunt Patient

Primary Author: Lakshmi N Kurnutala, M.D.Wexner Medical Center, Ohio State University | Columbus, OH, United States

Co-Authors: Gurneet Sandhu, M.D. Demicha Rankin, M.D.Nicoleta Stoicea, M.D. Lanette Rickborn, B.A.Sergio D. Bergese, M.D.

Because of consideration for venous air embolism in patients with a known patent foramen ovale (PFO) most posteriorfossa surgeries are performed in the prone or lateral position. Still few neurosurgeons prefer a semi-sitting position dueto benefits outweighing the risks. The decision to proceed in this fashion can be challenging; we would like to share ourexperience.

MCC-7055 Utility of Thromboelastography in Post Partum Hemorrhage

Primary Author: Mohammad M Piracha, M.D.New York PresbyterianWeill Cornell Medical Center | New York, NY, United States

Co-Authors: James Littlejohn, M.D.,Ph.D. Alaeldin Darwich, M.D.

Thromboelastography in the setting of postpartum hemorrhage can be a valuable asset in providing goal directed therapywith minimizing unnecessary blood product transfusion.

MCC-7056 Intrathoracic Fire during a Mitral Valve Replacement

Primary Author: Gabriel Goodwin, M.D.Montefiore Medical Center | Bronx, NY, United States

69M for redo-sternotomy/mitral valve replacement. After the sternotomy, a small pneumothorax occurred. Electrocauterywas used, leading to an intrathoracic fire.

MCC-7057 Intraoperative Management of Pancreatic Insulinoma Resection in 24 F with MEN Type , Syndrome

Primary Author: Hima PoonatiSUNY Downstate | Brooklyn, NY, United States

Co-Authors: Georgette Alexis, M.D. Luis Maracaja

24 year old female with MEN type , syndrome underwent Insulinoma resection for frequent and severe hypoglycemicepisodes. Anesthestic management during partial pancreatectomy is discussed.

MCC-7058 Aortocaval Fistula: Massive Blood Loss and Therapeutic Vancomycin Levels

Primary Author: John-Robert La Porta, M.D.Albany Medical Center | Albany, NY, United States

Co-Author: Scott Groudine, M.D.

A case report of anesthetic management of a patient with an aortocaval fistula and massive blood loss. Additionally, wenoted therapeutic vancomycin blood levels after the loss and replacement of approximately three blood volumes.


MCC-7059 Anesthetic Management of Blunt Thoracic Aortic Trauma

Primary Author: Howard Ching, M.D.NYU | New York, NY, United States

A 44 year old male motorcyclist with no past medical history was brought to an outside hospital after he was foundpinned beneath a van after a MVA of motorcycle vs van. He was initially hemodynamically stable with GCS 15. CT scanwas significant for traumatic thoracoabdominal dissecting aneursym. The patient subsequently became unstable in theED with BPs to 60/40s, requiring intubation and Levophed gtt. Emergent diagnostic laparoscopy did not show any bleeding.He received 6 units of PRBCs and 4 units of FFP, was hemodynamically stable after surgery and was transferred to our hospitalfor further surgical evaluation. He arrived on esmolol, fentanyl and rocuronium drips, and was taken to the OR for emergentthoracic endovascular aortic repair. This case presentation discusses the diagnosis, classification and management ofblunt thoracic aortic injuries.

MCC-7060 The Anesthetic Management of an Infant with Trifunctional Protein Deficiency

Primary Author: Natalie R. Barnett, M.D.Mount Sinai Hospital | New York, NY, United States

Co-Author: Scott Lipson, M.D.

Mitochondrial trifunctional protein deficiency is a rare metabolic disorder of fatty acid beta oxidation. We present a caseof a seven month old female with known mitochondrial trifunctional protein deficiency for upper gastrointestinalendoscopy with percutaneous placement of a gastrostomy tube. Given the rarity of this disorder, it is important tounderstand the metabolic derangements caused by the deficiency of trifunctional protein and to plan accordingly foranesthetic administration.

MCC-7061 Third Liver Transplant of a Patient with Severe Tricuspid Regurgitation. DoWe Need a TEE?

Primary Author: Sudheera Kokkada Sathyanarayana, M.D.Montefiore Medical Center/Albert Einstein College of Medicine | Bronx, NY, United States

Co-Author: Marina Moguilevitch, M.D.

29 year-old female with h/o recurrent autoimmune hepatitis, chronic rejection, two prior failed liver transplantations,chronic renal faillure requiring HD presented for combined liver-kidney transplant. After induction of anesthesia, placementof Swan-Ganz catheter was unsuccessful. Intraoperative TEE showed significant TR . Surgery lasted 10 hours and required45 units PRBC, 20 liters cell saver blood, and 50 units different blood products. Patient was successfully extubated secondday after the surgery and left the hospital in two weeks.

MCC-7062 Residual Muscle Weakness after Succinylcholine Infusion

Primary Author: Geng Li, M.D., Ph.D.Massachusetts General Hospital | Boston, MA, United States

Co-Author: JingpingWang, M.D., Ph.D.

Succinylcholine is the only depolarizing neuromuscular block agent that is still being used in modern anesthesia practice.It possesses the unique features of a rapid onset of effect (within ,min) and an ultrashort duration of action (about 10minto recover 90% muscle strength). Repeat small boluses or infusion of succinylcholine are still choices of muscle relaxantfor surgical procedures that require brief but intense paralysis. However because of its short duration, neuromuscularmonitoring is not routinely applied in clinical setting. Here we present with 2 cases of succinylcholine infusion withpostop complaints consistent with residual muscle weakness.

MCC-7063 Complications of EDAS in Moyamoya Disease

Primary Author: Ryan Potosky, M.D.NYU-Langone Medical Center | New York, NY, United States

A 49 year old female with Moyamoya disease and hypertension currently taking aspirin presented for EDAS. Her bloodpressure was extremely labile and she developed a post operative epidural hematoma required emergent evacuation.The patient's right hemiparesis improved dramatically with acute rehab.


MCC-7064 A Case of ECT in a Pregnant Patient

Primary Author: Kenneth M. Fomberstein, M.D.Yale New Haven Hospital | New Haven, CT, United States

Co-Author: Lars Helgeson, M.D.

A 20 year-old female at 24 weeks gestational age presented for ECT in the PACU. ASA and fetal heart rate monitors wereapplied with normal readings. Methohexital & succinylcholine were used for induction. Decelerations to the 60swere noted after 2:30 minutes of seizure. Midazolam was administered and the seizure aborted after 2:50 minutes. TheFHR tracing became difficult to obtain so the patient was taken to the OR where FHR was reacquired at 124. The patientwas observed, then extubated. Subsequent ECT treatments were induced with propofol with seizure durations less than90 seconds with no episodes of fetal bradycardia.

MCC-7066 Airway Management of a Patient with Ludwig's Angina

Primary Author: Joseph T. Largi, M.D.NYU School of Medicine | New York, NY, United States

Co-Author: Thor R. Lidasan, M.D.

A healthy 34 year old female presenting with a difficult airway secondary to ludwig's angina who required airwaymanagementin the operating roomwith an awake nasal fiberoptic intubation.

MCC-7067 A Failed Attempt to Place a Carotid Stent

Primary Author: Carlos Soto, M.D.NYUMC | New York, NY, United States

The case focuses on the peri-operativemanagement of TIAs and Strokes with particular attention paid to the anesthesiologist'srole in such management.

MCC-7068 Inducing a Patient with Intracranial Hemorrhage and LVAD implantation

Primary Author: Jeffrey Wu, M.D.Kings County Hospital Center | Brooklyn, NY, United States

Co-Authors: Neville Campbell, M.D. Georgette Alexis, M.D.

Though anesthesia and surgery is reportedly safe for patients with LVADs, hospitals not staffed with LVAD specialists needto have anesthesiologists aware of the hemodynamic and coagulation implications of patients equipped with LVADs. Wepresent a case of acute ICH in a patient with an LVAD on anticoagulation, who needed emergent airway protection.

MCC-7070 Amniotic Fluid Embolism in a Parturient: A Case Report

Primary Author: Mohammad Salam, M.D.Kings County Hospital Center | Brooklyn, NY, United States

Co-Authors: Vijay Verma, M.D. Ruben Pagan, M.D.Benjamin George, M.D.

Amniotic Fluid Embolism (AFE) is a rare but potentially fatal syndrome that is unique to pregnancy, and is one of the lead-ing causes of maternal mortality in the US and worldwide. We report a case of a 23 year old female, P0010 @ 40+1 weeksGA who was admitted with term labor in SROM. Subsequently in L&D, patient became unresponsive, hypotensive,bradycardic, with nonpalpable pulses and went into cardiac arrest for less than one minute before return of spontaneouscirculation. Patient was intubated and then taken to OR for emergent C section for fetal bradycardia. Approximately, thirtyminutes into the procedure, patient was noted to have copious amounts of pink frothy secretions coming through theETT and oral pharynx, along with hematuria and oliguria. Upon fascia closing, subcutaneous tissue and incision edgesalso noted to be oozing with no specific areas of bleeding. In light of patient’s clinical features, working diagnoses of pulmonaryedema, along with DIC, possibly from amniotic fluid embolism + PE, with ARI were made. Patient subsequently expired inICU next day. Autopsy findings are diagnostic of AFE.


MCC-7071 Point of Care Rotational Thromboelastometry Guided Reversal of Warfarin Overdose with ProthrombinComplex Concentrate in a Left Ventricular Assist Device Patient with Intracranial Hemorrhage

Primary Author: Michelle Pasamba, M.D.Weill Cornell Medical College | New York, NY, United States

Co-Authors: James E. Littlejohn, M.D.,Ph.D. Anup Pamnani, M.D.

A 36 year old man with non-ischemic cardiomyopathy (EF 8%), with implanted left ventricular assist device (LVAD) andsevere right heart dysfunction presented with large intra-axial intraparenchymal hematoma due to being supratherapeuticon warfarin. We utilized a 3 component prothrombin-complex-concentrate (PCC) to rapidly and successfully reversecoagulopathy to facilitate hematoma evacuation without causing a thromboembolic event or precipitating right heartfailure. Rotational thromboelastometry (ROTEM), a point of care coagulation test, allowed us to promptly diagnosecoagulopathy at the bedside in the operating room and effectively titrate coagulation products.

MCC-7072 Madelung's Disease: How to Overcome a Difficult Airway Situation?

Primary Author: Inês M. CarvalhoCentro Hospitalar de Lisboa Ocidental | Lisboa, Portugal

Co-Authors: Sara Tomé Patricia OliveiraIria Figueira Miguel Neto

Madelung's disease or benign symmetric lipomatosis type I is an uncommon disease, characterized by the growth ofnon-encapsulated and painless lipomas, preferably located in the neck, scapular region and the proximal part of theupper and lower limbs. The Madelung's disease is associated with large anatomical deformation, neuropathy, hyper-uricemia, liver disease and malignant tumors of the airways and digestive tract (1).

MCC-7073 Case Report : Post-Traumatic Pulmonary Pseudocyst

Primary Author: Mathias Emmerich, M.D.Krankenhaus Bad Oeynhausen | Bad Oeynhausen, Germany

Co-Author: Tiesmeier Jens, M.D.

Post-traumatic pulmonary pseudocysts occur due to the transmission of kinetic energy to the lung parenchyma. Youngindividuals are more commonly affected, as their chest walls are more elastic. Thoracic CT scan is the method of choicefor early diagnosis. If mechanical ventilation is required, high peak pressure should be avoided. Prophylactic antibioticscould be given. Close monitoring of progression is necessary in order to avoid further complications, such as pneumothoraxorinfection. The lesions usually resolve spontaneously.

MCC-7074 Placement of Sengstaken-Blakemore (S-B) Tube for Management of Acute Massive Variceal HemorrhageDuring Orthotopic Liver Transplantation

Primary Author: Joshua C Bailey, M.D.Mayo Clinic | Jacksonville, FL, United States

Co-Author: Beth L. Ladlie, M.D.

Vascular isolation of the liver during orthotopic liver transplantation is associated with increases of inferior vena caval andportal venous pressures that predispose patients, who are already at risk for variceal bleeds due to portal hypertension, tofurther bleeding. We present a case in which massive hemorrhage due to esophageal varices in a patient undergoingorthotopic liver transplant was successfully controlled by the intraoperative placement of a Sengstaken-Blakemore tube.


MCC-7075 Thymectomy for Myasthenia Gravis: To Paralyze or Not

Primary Author: Beata M. Evans, M.D.Stony Brook Medicine | Stony Brook, NY, United States

Co-Authors: Slawomir P. Oleszak, M.D. Renata A. Kowal, M.D.Thomas Bilfinger, M.D.

24 year-old male was scheduled for thymectomy. He was diagnosed with myasthenia gravis and diabetes type I as a child.The only therapy helping his weakness was steroids. Unfortunately, this treatment worsened his diabetes and wasdiscontinued. As a result generalized weakness and limitations in physical performance recurred. ROS: generalizedfatigue, one or both eyes ptosis CT of chest demonstrated thymus in the upper mediastinum, otherwise normal Afterstandard monitors and aline placement he underwent smooth IV induction. Vocal cords and upper part of trachea weresprayed with 2% lidocaine using atomizer. Under direct visualization of the open cords patient was intubated with ETT8.0 atraumatically. Muscle relaxants were not given at all. Hydrocortisone stress dose was given. For maintenancecombination of desflurane, propofol, fentanyl and ketamine were used. After the surgery patient demonstrated adequate TVand MV and was extubated in the OR and transferred to PACU. Post-operative course was uneventful. Our patient didnot experience any postoperative weakness and was discharge home early.

MCC-7076 Trigger Point Injection Resolves Chronic Knee Pain in a Teenager

Primary Author: Badie Mansour, M.D.Oklahoma University Medical Center | Oklahoma City, OK, United States

Co-Authors: Solomon Pearce, D.O. Blake Christensen, D.O.Garrett Wright, M.D. GretchenWienecke, M.D.

Summary: A trigger point injection using normal saline resolved chronic knee pain in our teenage patient.

MCC-7077 Postural Type Headache Responds to Trigger Point Injection

Primary Author: Badie Mansour, M.D.Oklahoma University Medical Center | Oklahoma City, OK, United States

Co-Authors: Solomon Pearce, D.O. James Stephen, D.O.Jeremy Haney, M.D. GretchenWienecke, M.D.

Summary: A 35 year-old female developed a postural-like headache and dizziness after sinus surgery that was treatedsuccessfully with trigger point injections using normal saline.

MCC-7078 Perioperative Carcinoid Crisis Despite High Dose Octreotide Prophylaxis and Treatment

Primary Author: Eric Tesoriero, D.O.Wake Forest Bapitist Health | Winston Salem, NC, United States

Co-Authors: Michael A. Olympio, M.D. Peter J Miller, M.D.

58 year old female with a history of metastatic carcinoid tumor presents for unilateral ureteral stent change, previouslyinserted for hydroureteronephrosis due to retroperitoneal tumor. Her symptoms from the carcinoid tumor had beencontrolled with octreotide LAR. During her three prior anesthetics, her course was complicated by carcinoid crisis duringureteral tumor manipulation. She was admitted the evening before surgery for octreotide loading bolus and continuousinfusion. Despite prophylaxis, she developed hypotensive carcinoid crisis immediately after induction of general anesthesiaand before incision, which was treated with additional high dose octreotide boluses and low dose vasopressors.


MCC-7079 Percutaneous Right Ventricular Assist Device (RVAD) Placement: A Review of Intraoperative AnestheticManagement and the Utility of TEE.

Primary Author: Christopher W. Tam, M.D.Stony Brook University Hospital | Stony Brook, NY, United States

Co-Authors: Allison McClarty, M.D. Thomas Bilfinger, M.D.Harold Fernandez, M.D. Igor Izrailtyan, M.D.

64 year old patient with ischemic cardiomyopathy with worsening congestive heart failure s/p LVAD placement. Pt. developedacute right heart failure ultimately requiring percutaneous placement of RVAD.We will review the anesthetic managementand utility of TEE in these cases.

MCC-7080 A Case of Anaphylaxis to Isoplex 4% During Cardiopulmonary Bypass

Primary Author: Claire Boynton, M.B.,B.S.Royal Brompton Hospital | London, United Kingdom

Co-Author: Sian Jaggar

Anaphylactic reactions are unusual in the perioperative period.We present a rare case of anaphylaxis to Isoplex 4% duringcardiopulmonary bypass, with profound circulatory collapse

MCC-7081 A Rare Complication of Labour Analgesia

Primary Author: Filipa Horta e Silva, M.D.Centro Hospitalar Lisboa Ocidental | Lisbon, Portugal

Co-Authors: Inês Carvalho, M.D. Luis Saldanha, M.D.

This case is about a 35-year-old pregnant patient with indication to initiate labour analgesia. A combined spinal-epiduraltechnique was done and an accidental subdural block may have occurred. The possibility of a mixed subdural/subarachnoidblock was also part of the differential diagnosis, acknowledging the atypical presentation of this case.

MCC-7082 Transversus Abdominus Plane Blockade for the Control of Neuropathic Pain during Pregnancy:A Case Report

Primary Author: Shane Lee, M.D.University of Rochester Medical Center | Rochester, NY, United States

Co-Author: Daryl Smith, M.D.

Neuropathic pain can be difficult to treat, of particular concern is the treatment of the gravid patient. Here we describenon-obstetric, neuropathic pain being treated with a TAP block, during pregnancy.

MCC-7083 Primary Cesarean Delivery Complicated by Headache: The Incidental Finding of a Cerebral Aneurysm

Primary Author: Won Chee, M.D.Montefiore Medical Center Albert Einstein College of Medicine | Bronx, NY, United States

Possible diagnoses of headache during pregnancy include subarachnoid hemorrhage from cerebral aneurysm rupture, agrave concern for perioperative management. However, the incidental finding of unruptured cerebral aneurysm can bemanaged obstetrically and anesthetically. General anesthesia can be used but carries with it the risk of difficulty with airwaycontrol and hypertension during intubation and emergency. Epidural technique can facilitate gradual hemodynamicchange and intraoperative neurologic monitoring, but dural puncture may cause an intense headache which might preventrecognition of an intracerebral bleed. Therefore, spinal anesthesia was chosen for reliability despite abrupt onset ofhemodynamic change. It is sobering to consider how many of our patients who undergo anesthesia daily may have cerebralaneurysms that are unknown to us or to the patients and present the risk of perioperative rupture.


MCC-7084 Anesthetic Management of Neonatal Tracheal Rupture

Primary Author: Tricia Vecchione, M.D.,M.P.H.Montefiore Medical Center | Bronx, NY, United States

Co-Author: Glenn Mann, M.D.

Neonatal tracheal injury and rupture is a rare complication of endotracheal intubation (ETT)1,2 and traumatic deliveries.3,4Although perforation of the trachea is thought to be caused by a difficult intubation, sometimes the trauma of deliverycan cause tracheal injury which is only made worse by intubation attempts or positive pressure ventilation (PPV). Wepresent a case of neonatal tracheal injury following a difficult delivery that presented with pneumomediastinum andsubcutaneous emphysema prior to intubation.

MCC-7085 Emergency Cesarean Section in Pre-Term Eclampsia and HELLP Syndrome in Parturient with MalignantHyperthermia

Primary Author: Devitri Moti, D.O.SUNY Downstate Med. Ctr. | Brooklyn, NY, United States

Co-Authors: Tricia Mahabir, D.O. Marina Svyatets, M.D.

Pre-eclampsia- eclampsia has a widely varied presentation. The emergent presentation of a patient with eclampsia andHELLP syndrome with significant co-morbidities such as malignant hyperthermia requires an anesthetic plan that willensure the safe administration of general total intravenous anesthesia with endotracheal intubation in a potentially difficultairway.

MCC-7086 Anesthetic Management of a Parturient with Klippel-Trenaunay Syndrome on Therapeutic Anticoagulation

Primary Author: Monica Ata, D.O.West Virginia University | Morgantown, WV, United States

Co-Author: Melissa Flanigan, D.O.

Abstract: A 34 year-old parturient with a history of Klippel-Trenaunay Syndrome presents to our facility in preterm laborand extensive DVT of her LLE. She was anticoagulated with heparin and consultation for labor analgesia requested. Upondiscontinuation of heparin and reaching normal coagulation values, an intrathecal duramorph with a low-dose isobaricbupivacaine was administered. She received adequate analgesia during her labor without complications.

MCC-7087 Does NSAID Intake Affect the Effectiveness of Epidural Blood Patches?

Primary Author: Kimberly Fischer, M.D.Montefiore Medical Center, the University Hospital for Albert Einstein College of MedicineNewYork, NY, United States

Co-Author: Shamantha Reddy, M.D.

A 27 year-old-female receives a blood patch for a postdural puncture headache. Despite successful placement of theblood patch, the patient’s positional headache persisted. The patient received multiple doses of Motrin both before andafter the blood patch was placed, perhaps preventing the blood patch from successfully treating the dural puncture.

MCC-7088 The Use of the Molt Mouth Gag to Assist in Awake Fiberoptic Intubation of a Developmentally ChallengedPatient Presenting with Severe Trismus

Primary Author: Ihab Kamel, M.D.Temple University | Philadelphia, PA, United States

Co-Authors: Jessica Luke, D.O. Matthew Grimaldi, M.D.Joseph Mulligan, D.M.D.

The Molt mouth gag may be used to assist in the awake fiberoptic intubation of the developmentally challenged patientpresenting with severe trismus.


MCC-7089 Post-Operative Hypotension in a Patient Receiving Low-Dose Prednisone (5mg/day): Addisonian Crisis?

Primary Author: Sarah Herbst, M.D.Yale-New Haven Hospital | New Haven, CT, United States

Co-Authors: Ryan Chadha, M.D. Brian Mirante, M.D.Paul Barash, M.D.

A 61-year-old male on chronic low-dose prednisone following kidney transplantation develops asymptomatic hypotension inthe PACU after undergoing a thirty-minute muscle biopsy for rhabdomyolysis under general anesthesia with stableintra-operative hemodynamics. His hypotension only transiently responds to fluid boluses and pressors, but stabilizesafter administration of stress dose steroids. The diagnosis of acute adrenal insufficiency is confirmed post-operatively bya low morning cortisol level drawn during an episode of urosepsis, and stress dose steroid therapy is recommended forall future procedures.

MCC-7090 Labor Pain and Bony Cancer Pain: Is There One Mode of Analgesia for Both?

Primary Author: Kimberly Fischer, M.D.Montefiore Medical Center, the University Hospital for Albert Einstein College of MedicineNew York, NY, United States

Co-Author: Jeffrey Bernstein, M.D.

A 33 year-old G,P0 female with stage IV breast cancer and extensive osseous metastatic spinal disease had an L3/L4epidural placed for labor. While her labor pain was well controlled, the epidural did not provide analgesia for her bonyback pain. It is likely that her epidural could have been used to provide analgesia for both her labor and cancer painsimultaneously. A discussion about labor epidurals and cancer pain follows, with specific attention focused on safety andtypes of anesthetics appropriate in this situation.

MCC-7091 Push Pin Pushed Too Far

Primary Author: Yarnell Lafortune, M.D.Albany Medical Center | Albany, NY, United States

Co-Author: Branko Furst, M.D.

Foreign body aspiration is common in the pediatric population. Though mostly seen in those less than 3 years old, it canalso present as an emergency and life-threatening event in a teenager. The retrieval of an aspirated foreign body is usuallyperformed with the use of a rigid bronchoscope with low morbidity and mortality. Fewer than 2% of patients requirethoracotomy. The anesthesiologist must include the possibility of one-lung ventilation and/or thoracotomy duringpre-anesthetic planning.

MCC-7092 Preoperative Respiratory Management Compromises Ability for Tracheal Repair with One Lung Ventilation.

Primary Author: Timothy J. Burroughs, M.D.University of Cincinnati | Cincinnati, OH, United States

Co-Authors: Lance Hoffman, M.D. Anne Marie WaltersWilliam E. Hurford, M.D.

A significant tracheal defect requiring a right thoracotomy surgical approach for repair necessitated specialized ventilationtechniques. One lung ventilation in the ICU had significant consequences in the operating room. Ultimately, intra-operativelung isolation was not possible due to the preoperative ventilatory strategy, and the procedure was performed during periodsof apnea.


MCC-7093 Early Non Cardiac Surgery in a Patient on Dual Antiplatelet Therapy

Primary Author: Romana PersichettiSan Camillo Hospital | Rome, Italy

Co-Authors: Elisabetta Di Caro, M.D. Gabriele Ricci, M.D.Pierluigi Marini, M.D. Remo Orsetti, M.D.

A bridging protocol was carried out in a 65 year-old man with recent implantation of drug eluting stent and dualantiplatelet therapy before elective non cardiac surgery

MCC-7094 A Simple and Low-Cost Nasal CPAP/CF Mask/Circuit Prevented Oxygen Desaturation in a Morbidly ObesePatient with OSA under MAC during Cystoscopy with Insertion of Ureteral Stent

Primary Author: Sagar S. Mungekar, M.D.Rutgers Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Kang Rah, M.D. Shaul Cohen, M.D.Rose Alloteh, M.D. James Tse, M.D.,Ph.D.

A 74 yo morbidly obese woman (BMI 56 kg/m²) with metastatic carcinoma presented for cystoscopy and ureteral stentplacement for an obstructed ureter. She had multiple comorbidities including bradycardia (requring a pacemaker), DVT,OSA, and COPD (needing NC O₂). Her O₂ Sat was 96% on NC O₂ 4 L/min. Pulmonology consult recommended using BPAPif she was under sedation.We assembled a nasal CPAP mask/circuit using an infant face mask with fully inflated air cushionand an adult breathing circuit attached to an anesthesia machine. The nasal mask was secured with head straps to obtaina tight seal. She breathed comfortably with the pop-off valve adjusted to provide CPAP (2-5 cm H₂O) and a mixture of O₂(6 L/min) and air (2 L/min) (0.8 FiO₂). Deep sedation was induced with 30 mg bolus and infusion (125 mcg/kg/min) ofpropofol. She maintained spontaneous respirations and 99-100% SaO₂. She tolerated the procedure well. This nasalmask/circuit takes 2-3 min to assemble using existing anesthesia equipment. It improves oxygenation in obese patientswith OSA. It can also be used to pro-actively prevent desaturation by assisting ventilation. It may improve patient safetyat a low cost.

MCC-7095 Intra-operative Subcutaneous Emphysema and Hypercarbia without Pneumothorax During LaparoscopicCholecystectomy

Primary Author: Adham Zayed, M.D.Elmhurst Hospital Center | Queens, NY, United States

Co-Author: Gabriel Bonilla, M.D.

An ASA 2 70 year old female underwent laparoscopic cholecystectomy under general anesthesia. Sudden intraoperativehypercarbia occurred that was not corrected by increased mechanical minute ventilation. Subsequent physical examrevealed crepitus, likely from a subcutaneous dissection of CO2 from abdominal insufflation. Subcutaneous emphysemashould strongly be considered in the differential for hypercarbia in laparoscopic cases.

MCC-7096 Massive Bleeding During Nephrectomy and Inferior Vena Cava Tumor Thrombectomy

Primary Author: Sherwin Park, M.D.Stony Brook University Hospital | Stony Brook, NY, United States

Co-Authors: Anjali Dogra, M.D. Igor Izrailtyan, M.D.

Renal cell carcinoma associated with inferior vena cava (IVC) tumor thrombus is an uncommon clinical presentation.Radical nephrectomy and IVC tumor thrombectomy complicated by massive hemorrhage required close communicationbetween the surgical and anesthesia teams for successful resuscitation and perioperative management.


MCC-7097 Peri-operative Glycemic Control for Preterm infant with Pransient Neonatal Hyperglycemia andGastroschisis

Primary Author: Sirirat Rattana-arpa, M.D.Phonthong Hospital | Roi et, Thailand

Co-Author: Arunotai Siriussawakul, M.D.

Neonatal hyperglycemia is a common complication during the first week of life in preterm infant. This condition is causedby several factors. Anesthesiologist should consider surgical emergency and patient condition before go on surgery. Inthis report, we present a case of low birth weight pretermmale infant with gastroschisis who schedule for staged gastroschisisrepair under general anesthesia. The proper perioperative glycemic control of the patient is reviewed and strategies forintraoperative care are discussed.

MCC-7098 Ilioinguinal-Iliohypogastric Block is Superior to TAP Block for Post Cesarean Analgesia: A Side by SideComparison in Two Patients

Primary Author: Anthony Lopez, M.D.Wexner Medical Center at The Ohio State University | Columbus, OH, United States

Co-Author: John Coffman, M.D.

Case report of two patients who each required a rescue block for post cesarean analgesia in the PACU. In each case, theplan was to perform bilateral ilioinguinal-iliohypogastric (IIIH) block, but due to patient factors we performed IIIH blockon one side and TAP block on the other side, enabling side-by-side comparisons of the two blocks.

MCC-7099 Acute Loss of Electrophysiological Monitoring Post-Induction of General Anesthesia in a Patient UndergoingElective Carotid Endarterectomy

Primary Author: William Caldwell, D.O.Albert Einstein- Montefiore | Bronx, NY, United States

Co-Author: Jolie Narang, M.D.

An 81-year-old female who presents to Montefiore Medical Center for elective left carotid endarterectomy suffers suddenloss of neurophysiologic monitoring post induction of general anesthesia.

MCC-7100 Inadvertent Perforation of Superior Vena Cava and Entrapment of a Central Venous Catheter in PatientUndergoing Cyst Resection

Primary Author: Wesam F. AndraousStonybrook University Hospital | Stonybrook, NY, United States

Co-Authors: Igor Izrailtyan, M.D. Thomas Bilfinger, M.D.

Injury to the superior vena cava can be associated with hemodynamic instability and could be fatal, close coordinationbetween all OR teams to minimize any impact to the patients’ health is required.

MCC-7101 Challenge of Central Venous Access with Simultaneous Mechanical CPR (Thumper)


Co-Authors: Bharathi Scott, M.D. Syed Shah, M.D.

Central venous access placement is a common procedure. Incidence of an arterial puncture during a central venousaccess placement is 3-15%. In order to minimize an arterial puncture ultrasound technology, examination of thetransduced waveform and analysis of blood sample is recommended. This case was an emergent case. We were limitedby the cardiothorasic surgery to the site of venous access while mechanical CPR was under way. Upon placement ofthe right internal jugular cordis we did examine the wave form and it appeared to be venous. However, we wereunable to prevent all the complications. There is limited information in the literature on the safest placement of acentral line during CPR with mechanical chest compressions. Real time two dimensional ultrasound guidance is superior toblind, landmark guided techniques. However this does not necessarily apply to emergent cases.


MCC-7102 Successful Delivery of a Parturient with Hereditary Haemorrhagic Telangiectasia (HHT)


Co-Authors: Ursula Landman, D.O. Ellen Steinberg, M.D.Rishimani Adsumelli, M.D.

HHT brings a challenge to any provider especially so during pregnancy. Increase in blood volume associated withpregnancy distends the AVMs. Right to left shunt increases the risk of high output cardiac failure. Large AVMs increasethe possibility of paradoxical emboli whether from air (e.g. epidural placement), amniotic fluid, thrombi or septic particles.Although no spontaneous epidural bleeding has been described with HHT, the possibility of abnormal spinal and epiduralvasculature remains. In our case we decided against neuraxial analgesia. We provided fentanyl PCA for analgesia duringlabor. General anesthesia was planned for cesarean section. Our choice of analgesia was conducive to a safe vaginal delivery.As seen, themanagement of HHT in a parturient is challenging. The success of patients with HHT hinges upon the coordinatedcare and multidisciplinary approach between obstetrics, hematology, medicine and anesthesia.

MCC-7103 Anesthetic Management of a Heparinized Parturient with Atrial Septal Defect

Primary Author: Jonathan Teets, M.D.NYU-Langone Medical Center | New York, NY, United States

Co-Authors: Walid Alrayashi, M.D. David Furgiuele, M.D.

A 29 year old parturient with atrial septal defect anticoagulated with heparin TID was admitted for labor management.Due to the risk of bleeding from neuraxial techniques a general anesthetic was administered. This case reviews thecardiovascular physiologic changes of pregnancy and the risks associated with unrepaired congenital heart defects inthe parturient.

MCC-7104 Resistant Hypertension and Implantable Pulse Generators in the Operating Room

Primary Author: Deepa Asokan, M.D.Rutgers - NJMS | Newark, NJ, United States

Co-Authors: Sergey V. Pisklakov, M.D. Jyotsna V Rimal, M.D.

Resistant hypertension is defined as the inability to achieve a blood pressure less than 140/90 (or 130/80 in patients withchronic kidney disease and/or diabetes) with the use of three maxed out oral anti-hypertensive agents, including adiuretic. Baroreflex activation therapy (BAT) is considered an effective alternate solution. BAT modulates the autonomicnervous system to restore sympathovagal balance, reducing arterial stiffness and resistance and increasing venouscapacitance and renal natriuresis.

MCC-7105 Pulmonary Vein Obstruction after Double Lung Transplant: Case Report and Review

Primary Author: Adriana Calderón Barajas, M.D.University Hospital Doce de Octubre | Madrid, Spain

Co-Authors: C. Olea I. MartínezM.I. Real, M.D. F. Pérez-CerdáP. Gámez, M.D.

We present a case of a patient diagnosed of alpha-1-antitrypsin deficiency who received bilateral lung transplant from anextrahospitalary non-heart-beating donor. In the immediate postoperative period a lobar infarct was observed due toobstruction of the inferior pulmonary vein that was damaged during harvest. A transesophageal echocardiographyallowed a quick diagnosis and treatment by pulmonary lobectomyminimizing the consequences of this rare complication oflung transplantation ABSTRACT Vascular complications, including the obstruction with or without thrombosis of thepulmonary veins can compromise the success of lung transplantation. Transesophageal Echocardiography (TEE) playsan important role in the diagnosis of these entities allowing a proper assessment of the morphology and the flow of thepulmonary veins.


MCC-7106 Spinal Anesthesia for Urgent Below Knee Amputation in an 83 Year Old Patient with Severe AorticStenosis, HOCM, Mitral Stenosis, Pulmonary HTN, CAD, Atrial Fibrillation, Recent TIA, and on Anticoagulant TTherapy

Primary Author: Michael H Entrup, M.D.Geisinger Medical Center | Danville, PA, United States

Co-Authors: S. Mark Poler, M.D. Lei Li, M.D.

Spinal Anesthesia in an 83 Year Old Patient with Severe Aortic Stenosis, HOCM, Mitral Stenosis, Pulmonary HTN, CAD,Atrial Fibrillation, Recent TIA, and on Anticoagulant Therapy.

MCC-7107 Is It Worth The Risk? Regional Anesthesia For Rendu Osler Weber Syndrome / Hereditary HemorrhagicTelangiectasia (HHT)

Primary Author: Joana Alves, M.D.University Hospital of Santa Maria | Lisbon, Portugal

Co-Authors: Rita Santos, M.D. Emanuel Almeida, M.D.João Silva, M.D.

HHT is an autosomal dominant vascular dysplasia associated with epistaxis and rupture of arteriovenous malformations(AVMs) of gastrointestinal tract, liver, lungs and central nervous system. Anesthetic approach of these patients must takeinto account specific considerations, in order to prevent hemorrhagic complications.We report a successful clinical case ofa patient with HHT proposed for urgent inguinal hernia reduction under spinal anaesthesia.

MCC-7108 An Usual Thing That Is Rare To Happen - Priapism After Epidural-Blockade: Has It Ever Happened To You?

Primary Author: Joana Alves, M.D.University Hospital of Santa Maria | Lisbon, Portugal

Co-Authors: Rita Santos, M.D. Emanuel Almeida, M.D.Ana Paulino, M.D. João Silva, M.D.

Priapism after neuraxial anesthesia for endo-urologic procedures is a rare but important complication, which can hamperor even postpone the procedure. It is our purpose to present a case of a hypertensive patient posted for elective penileand perineal urethroplasty and revisit the different possible therapeutic approaches to intra-operative priapism.

MCC-7109 EXIT Procedure - Lessons Learned

Primary Author: Yarnell Lafortune, M.D.Albany Medical Center | Albany, NY, United States

Co-Authors: Farzana Afroze, M.D. Melissa Ehlers, M.D.

The EXIT procedure requires extensive planning and communication between the multidisciplinary team involved. Theultimate goal of maternal and fetal safety is accomplished with adequate uterine relaxation, uteroplacental circulationand fetal immobility to help airway handling.

MCC-7110 First Exposure to Anesthesia Aids in Diagnosis of Laryngeotracheal Stenosis.

Primary Author: Minal Joshi, M.D.NY Methodist Hospital | Brooklyn, NY, United States

Co-Authors: Devasena Manchikalapati, M.D. Stanley Santoreli, M.D.Joel Yarmush, M.D. Joseph SchianodiCola, M.D.

Rarely exposure to anesthesia may uncover an underlying airway pathology. In our case, this infant’s first exposure toanesthesia facilitated the diagnosis of laryngotracheal stenosis. This case demonstrates that expecting the unexpectedmay be a worthwhile endeavor indeed.


MCC-7111 Paraparesis: A Devastating Complication of Thoracoabdominal Aortic Surgery: Case Report

Primary Author: Lorena Gómez, M.D.H.U. Dr Peset | Valencia, Spain

Co-Authors: M. Jose Hernández Juan Soliveres, M.D.M. Teresa Richart, M.D. Josep Balaguer, M.D.José Manuel Seller Jorge Sánchez, M.D.Cristina Solaz, M.D.

Paraparesis and paraplegia complicate surgical repair of thoracic and thoracoabdominal aneurysms. They are associatedwith an increase in mortality rate, require resource-intensive rehabilitation and chronic care, and result in a major burdenfor patients, families, and society. Modern aortic repair techniques use many modalities aimed at reducing the risk ofspinal cord ischemia inherent with surgical management. One of these modalities is lumbar cerebrospinal fluid drainage.Despite optimizing spinal cord blood flow through CSF drainage, paraparesis and paraplegia can appear.

MCC-7112 Ultrasound-Guided Single Injection Fascia Iliaca Compartment Block as Primary Anesthetic for Total HipReplacement

Primary Author: Ryan T. Gualtier, M.D.NYU-Langone Medical Center | New York, NY, United States

Co-Author: Dhiraj Jagasia, M.D.

The fascia iliaca compartment block has routinely been used by anesthesiologists as a technique for blocking the femoraland lateral cutaneous nerves. This is the first case report of a patient undergoing a total hip replacement utilizing the fasciailiaca block as the primary intra-operative anesthetic. The patient in this case was comfortable throughout the procedureand did not require any narcotics, anti-emetics, or hemodynamic agents in the recovery room.

MCC-7113 Perioperative Approach of Citrullinemia - Case Report

Primary Author: Emanuel Almeida, M.D.University Hospital of Santa Maria | Lisbon, Portugal

Co-Authors: Joana Alves, M.D. José Alberto Sebastião, M.D.Mercedes Ferreira, M.D.

Citrullinemia is a metabolic disorder which compromises normal urea cycle. The clinical presentation usually occurs in theneonatal period, manifested by severe hyperammonemic coma and courses with paroxysmal decompensation which canbe triggered by factors that cause metabolic stress, including several factors associated with the anesthetic-surgicalapproach (from the perioperative fasting to the surgical stress induced hormonal release). It is our purpose to present acase of a child with known diagnosis of citrullinemia and review the specifics of anesthetic approach in these patients.

MCC-7114 Controlled Hypotension in Child with Sickle Cell Disease - Harm or Benefit?

Primary Author: Emanuel Almeida, M.D.University Hospital of Santa Maria | Lisbon, Portugal

Co-Authors: Joana Alves, M.D. José Alberto Sebastião, M.D.Mercedes Ferreira, M.D.

The placement of a cochlear implant is a therapeutic solution for patients with irreversible hearing deficit. The success ofthis meticulous surgical technique dictates the necessity of a rigorous anesthetic approach, based on a permissive controlledhypotension, which provides a clean surgical field. Patients with sickle cell disease undergoing this kind of surgery, inwhom hypotension is a known precipitating factor of acute crises and worsening of their basal chronic widespreadvascular dysfunction, present themselves as a challenge to the anesthesiologist, requiring a more thorough approach. Itis our purpose to present a case of a child with sickle-cell disease, undergoing cochlear implant placement, discussing thepossible benefits and harms of it’s anesthetic approach.


MCC-7115 A New and Low-Cost Nasal CPAP/CF Mask/Circuit Prevented Oxygen Desaturation in a Morbidly ObesePatient with OSA under MAC during EGD with Dilation of Post-Gastric Banding Gastric Outlet Stricture

Primary Author: Sylviana Barsoum, M.D.Rutgers - Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Trishna Upadhyay, M.D. Kang Rah, M.D.Rose Alloteh, M.D. John Denny, M.D.Shaul Cohen, M.D. James Tse, M.D.,Ph.D.

Patients undergo upper GI endoscopy (EGD) routinely receive IV sedation and nasal cannula O2. Over-sedation or airwayobstruction may cause severe desaturation in obese patients with obstructive sleep apnea (OSA). We develop a nasalCPAP/CF (continuous flow) mask/circuit using an infant face mask with fully inflated air cushion and an adult breathingcircuit attached to an anesthesia machine. This nasal mask is secured with head strips to obtain a tight seal. Mixing O2 (6L/min) and air (2 L/min) provides 0.8 FiO2. Pop-off valve is adjusted to maintain CPAP (2-5 cm H2O).We report a challengingcase of a morbidly obese 40 y/o male (BMI 52 kg/m2) with OSA under MAC for EGD with dilation of post-gastric bandinggastric outlet stricture. Deep sedation was induced with small boluses of propofol (total 150 mg) and maintained withinfusion (150 mcg/kg/min). He tolerated EGD well and maintained spontaneous respiration and 99-100% O2 Sat. Thisnasal mask/circuit takes 2-3 min to assemble using existing anesthesia equipment. It can be used to proactively preventdesaturation by assisting ventilation without interrupting EGD. It may improve patient safety at a low cost.

MCC-7116 Aortoenteric Fistula in a Patient Presented with Massive Hemoptysis and Bloody Diarrhea

Primary Author: Sohail K Mahboobi, M.D.Lahey Hospital & Medical Center | Burlington, MA, United States

A 78 years old male patient developed sudden onset of hemoptysis and massive bloody diarrhea. He had an open aorticaneurysm repair one year ago. After initial resuscitation a CT angiogram performed and showed a pseudoaneurysm ofaorta with a possible aortoenteric fistula with third segment of duodenum. He was urgently transferred to OR andunderwent right axillo bifemoral bypass with redo repair of aortic aneurysm and the repair of aortoenteric fistula. Duringthe case hypogastric artery started bleeding from deep in pelvis and patient showed myocardial ischemia with STsegment elevation. Massive transfusion and attempts to restore blood pressure with vasoactive agents started. Patientdeveloped PEA and resuscitated according to ACLS protocol. Surgeons found bleeding source and blood pressuregradually improves with ST segments gradually coming to baseline. He was transferred to SICU and successfully extubatedand later discharged home in a stable condition.

MCC-7117 Minimally Invasive Extraction of Intracardiac Debris with the AngioVac System


Co-Authors: Adil Mohiuddin, M.D. Shaul Cohen, M.D.Saniya Syed, Student Ali Razvi

AngioVac Vortex Cannula is a minimally invasive alternative for removal of undesirable intravascular and intracardiacmaterial such as clot, thrombus, tumor, myxoma and vegetation while maintaining flow during extracorporeal circulation.Our experience with the two AngioVac cases should help familiarize other clinicians with this trending innovative proce-dure.

MCC-7118 Unanticipated Cardiovascular Collapse Following Intravenous Cefazolin Administration for an Off-pumpCoronary Artery Vein Grafting

Primary Author: Brian Slater, M.D.Mount Sinai Hospital | New York, NY, United States

A 60 year old male was admitted for an off pump coronary artery bypass vein grafting for three vessel coronary arterydisease. He was induced uneventfully with midazolam, etomidate, rocuronium and 0.5% inhaled isoflurane. Several minuteslater he received 2gm of cefazolin. Immediately the blood pressure dropped precipitously and peak airway pressures rosedramatically. Cardio-pulmonary resuscitation was initiated. Using a transesophageal echocardiography probe revealedhyperdynamic ventricles with under filling of the heart and thus could make a diagnosis of anaphylaxis rather thancardiogenic shock. Appropriate treatment with epinephrine, norepinephrine, vasopressin, antihistamines and steroidsrestored spontaneous circulation. Serum tryptase levels were drawn within one hour of cardiovascular collapse and foundto be >400 ug/L. The patient made an uneventful recovery.


MCC-7119 Anesthetic Management of Mitral Valve Repair in a Patient with Sickle Cell Disease

Primary Author: Sapna Ravindranath, M.D.New York Methodist Hospital | Brooklyn, NY, United StatesNewYork PresbyterianMedical Center,Weill Medical College of Cornell University | NewYork, NY, United States

Co-Authors: Adam D Lichtman, M.D. Joel Yarmush, M.D.Joseph SchianodiCola, M.D. Jonathan DWeinberg, M.D.

Patients with homozygous sickle cell disease undergoing cardiac operations with CPB can be optimally managed byavoiding hypothermia, acidosis, hypoxia, and low flow states. Such strategies as exchange transfusion and normothermiccardioplegia are beneficial.

MCC-7120 A Simple Nasal Mask for Pre-Oxygenation and Assisted Mask Ventilation in a Patient with a Small andDistorted Lower Jaw Secondary to Resection/Radiotherapy of Metastatic Head and Neck Cancer duringInduction of General Anesthesia

Primary Author: James TseRutgers - Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Aliraza Dinani, M.D. Denes Papp, M.D.Rachana Tyagi, M.D. Rose Alloteh, M.D.

Patients with distorted lower jaw may have a poor facemask fit and difficult mask ventilation during induction of generalanesthesia. We develop a simple nasal mask using an infant facemask with fully inflated air cushion and head strap holder. A78 y/o male with severe cardiopulmonary disease presented for emergency T3-T4 laminectomy and decompression ofspinal cord compression. He had metastatic lung cancer and was s/p LUL resection and resection/radiotherapy ofmetastatic head and neck cancer. His had a Class II airway and his trachea was at midline. He had a poor facemask fit dueto poor dentition and small and distorted lower jaw. After pre-oxygenation with a nasal mask (10 L/min O2 flow), generalanesthesia was induced with fentanyl (50 mcg), propofol (150 mg) and rocuronium (50 mg). Nasal mask ventilation waseasy with lower jaw thrust. Endotracheal intubation was also easily accomplished with a video laryngoscopy. He toleratedthe procedure well. This simple nasal mask takes a few seconds to assemble using existing anesthesia equipment. Itimproves mask ventilation in the patient with poor facemask fit. It may improve patient safety at no extract cost.

MCC-7121 Perioperative and Anesthetic Management of a Patient with Pheochromocytoma for BilateralAdrenalectomy

Primary Author: Lindsay N Cammarata, M.D.,M.P.H.St Joseph's Regional Medical Center | Paterson, NJ, United StatesSaint Michael's Medical Center | Newark, NJ, United States

Co-Author: Jeffrey Lake, D.O.

A 45 year-old male with a past medical history of diabetes, hypertension, and medullary thyroid cancer presented withsigns and symptoms of pheochromocytoma (MEN II syndrome). He was medically managed for 1.5 weeks, brought to theOR for laparoscopic bilateral adrenalectomy, and the case was cancelled after severe sympathetic stimulation followedinduction. The patient was further optimized for another 3.5 weeks, returned to the OR, and experienced a similar courseof events.

MCC-7122 How DidWe Find That There?

Primary Author: G. Matthew Garcia, D.O.St. Joseph's Regional Medical Center | Paterson, NJ, United States

Co-Author: Padmaja Upadya, M.D.

We present a case report of iatrogenic foreign body in the left main stem bronchus causing mucus secretions enough toincrease peak airway pressures and decrease tidal volumes. When the temperature probe was initially placed into thebronchus it caused no decrease in tidal volume or airway obstruction; however, after several hours this foreign body reactioncaused the lining of the bronchus to secrete enough mucus to cause a left sided pulmonary obstruction.


MCC-7123 Ventriculoperitoneal Shunt Insertion Complicated By Massive Arterial Bleeding and Pneumothorax

Primary Author: Farrukh Aziz Ansari, M.D.Bellevue Hospital | New York, NY, United States

Co-Author: Sanford Miller, M.D.

Case of a 54 yo M undergoing a placement of a Right occipital ventriculoperitoneal shunt, which is complicated byintraoperative pneumothorax, lacerated left inferior epigastric artery and left testicular artery, with subsequent 4 Literblood loss. Patient was extubated the following day with no adverse sequelae noted.

MCC-7124 Surgical and Airway Management of Uncontrolled Arterial Bleeding Following Dental Procedures.

Primary Author: Remek Kocz, M.D., M.S.University at Buffalo | Buffalo, NY, United States

Co-Authors: Janell Aguirre, B.Sc. Nas Sediqi, D.D.S.Ognjen Visnjevac, M.D.

Two cases are presented in which arterial hemorrhage occurred after an uncomplicated dental procedure, resulting inairway compromise. Subsequent management was achieved via prolonged intubation and arterial embolization. The efficacyof embolization is compared to surgical and nonsurgical methods of arterial hemorrhage control, focusing on airwaymanagement, hospital and ICU length of stay, ventilator days, occurrence of pneumonia, and sedation strategies. Nosignificant differences are found among these approaches, indicating that arterial embolization is a modality that shouldbe considered in the setting of dental procedure-related bleeding and resulting airway obstruction.

MCC-7125 Plastic Bronchitis in a 5 Year Old Boy with Fontan Physiology

Primary Author: NathanWaxer, D.O.RCRMC | Moreno Valley, CA, United States

Co-Author: Wes Zahler, D.O.

Plastic bronchitis is a rare and unusual disease that is characterized by large, pale tan, bronchial casts with rubber-likeconsistency that develop in the tracheobronchial tree and cause airway obstruction. The casts are differentiated into typeI inflammatory casts, that are often acute in presentation and associated with bronchial disease, and type II acellular casts,that are often chronic or recurrent. Numerous systemic illnesses are associated with plastic bronchitis, including patientswith palliated congenital heart disease[i] but often no underlying cause can be identified.[ii] Mortality can be as high as50% with limited treatment options including high-molecular-weight heparin, nebulized N-acetylcysteine, dornase-alpha,urokinase, tissue-type plasminogen activator, low dose oral azithromycin, low fat diet, fenestration of the Fontan circuitand thoracic duct ligation.[iii], [iv] In this case, a 5 year old boy with Fontan physiology developed a worsening respiratorycondition related to plastic bronchitis.

MCC-7126 Peri-Operative Management of a VonWillebrand Disease Jehovah's Witness: Balancing Belief and Safety

Primary Author: Gabriel Bonilla, M.D.Elmhurst Hospital Center | Elmhurst, NY, United States

Co-Author: Charlie Lu, M.D.

A 66 y/o Jehova's Witness with type , von Willebrand Type and hypertension presents for a transphenoidal pituitaryadenoma resection. The patient elicits a history of abnormal bleeding - hematoma post knee arthroscopy. The patientstates his transfusion wishes are consistent with theWatchtower Bible and Tract Society of Pennsylvania. After a discussionwith the patient, hematology, and surgery, von Willebrand Factor/Factor VIII concentrate 60u/kg IV is given an hourpreoperatively. It is redosed intraoperatively after difficult hemostasis during sinus endoscopy. An additional dose ofVWF/Factor VIII concentrate and DDAVP 20 mcg IV is administered intraoperatively. Deliberate hypotension is used to limitbleeding and improve surgical field visualization. The EBL was 700 mL, more than was anticipated. Cell saver, approved bythe patient, was utilized. The patient continued to receive VWF/Factor VIII concentrate post-operatively for 3 days.


MCC-7127 Spinal Anesthesia for Emergent Cesarean Section in a Parturient with HELLP Syndrome and Cerebral Palsy

Primary Author: Penina Y Dienstag, M.D.SUNY Downstate | Brooklyn, NY, United States

Co-Authors: Abraham Schreiber, M.D. Steven Minear, M.D.

A 24yo G,P0 with spastic cerebral palsy was seen for routine obstetric care at term and was noted to have new onsetelevated blood pressure as well as elevated transaminases. As she was remote from delivery and the presentation wassuspicious for HELLP syndrome an emergent cesarean section was performed under spinal anesthesia.

MCC-7128 Anesthetic Care in Patient with Osler-Weber-RenduSyndrome: A Case Report

Primary Author: Ana FaiscoHospital Professor Doutor Fernando Fonseca | Amadora, Portugal

Co-Authors: Maria Vilaça Filipa CoelhoFábio Almeida Neuza FerreiraIsabel Oliveira

Description of a Osler-Rendu-Weber syndrome case report and its anesthetic challenges.

MCC-7129 A Simple and No-Cost Nasal CPAP Mask/Circuit Improved Oxygenation in a Patient with Hemoglobin Bassettand Low Baseline Oxygen Saturation under MAC during Dilation/Curettage and Hysteroscopy

Primary Author: William Grubb, M.D.Rutgers Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Candy K. Anim, M.D. Anne Novak, C.R.N.A.Rose Alloteh, M.D. Kang Rah, M.D.James Tse, M.D.,Ph.D.

A 74 y/o obese female (5’8”, 240 lb, BMI 37 kg/m2) presented for D&C and hysteroscopy for endometrial hyperplasia andvaginal bleeding. She previously had a complicated hospital course during an episode of pancreatitis requiring prolongedintubation and difficult weaning from respirator. An elective hernia repair was cancelled due to low baseline O2 saturation(Sat) of 85%. Workup revealed that she had Bassett hemoglobin. Her O2 Sat decreased from 85% to 83% after receivingmidazolam (1 mg) and lying down.We assembled a nasal CPAP mask/circuit using an infant mask and adult breathing circuitattached to anesthesia machine. She breathed comfortably with mixture of O2 (6 L/min) and air (2 L/min) (0.8 FiO2) andher O2 Sat increased to 96%. Deep sedation was induced with midazolam and dexmedetomidine. She maintainedspontaneous respiration and 96-97% O2 Sat. She received IV acetaminophen infusion and ketorolac and tolerated procedurewell. She was weaned off O2 and discharged home with her baseline O2 Sat (85%). This nasal mask/circuit improvesoxygenation and pro-actively prevents desaturation in obese patients. It may improve patient safety at no extra cost.

MCC-7130 Post-dural Puncture Headache (PDPH), An Alternative Cause of Posterior Reversible EncephalopathySyndrome (PRES)

Primary Author: Ali Kandil, D.O.Saint Barnabas Medical Center | Livingston, NJ, United States

Co-Authors: Robert Dorian, M.D. ShaunWagoner, D.O.Richard Monti, M.D.

Posterior reversible encephalopathy syndrome (PRES) is a relatively new phenomenon that was previously only discussedin the radiology literature. However, more and more cases have surfaced, providing a more detailed understanding of thedisease process. Post-dural puncture headaches (PDPH) have not been well described as a cause of PRES. This case reportdescribes an iatrogenic dural puncture, leading to a PDPH, which ultimately produced PRES.


MCC-7131 Hypertrophic Lingual Tonsils Causing Severe Obstructive Sleep Apnea in a Ten Year Old Boy

Primary Author: Kadia M Bundu, M.D.Rutgers, New Jersey Medical School | Belleville, NJ, United States

Co-Authors: Anuradha Patel, M.D. Huma Quraishi, M.D.

Undiagnosed lingual tonsillar hypertrophy as a possible cause of hyponasal speech in children. Effective communicationand perioperative planning between anesthesia personnel and Ear, Nose and Throat surgeon for appropriate management ofan expected difficult airway is prudent. Being able to formulate a plan for fiberoptic intubation in a awake and sittingposition in a child with lingual tonsillar hypertrophy is important and challenging due to the anatomic and physiologiceffect of hypertrophic lingual tonsils.

MCC-7132 Autoimmune Challenge: A Case Report

Primary Author: Leina Spencer, M.D.Centro Hospitalar de Lisboa Central | Lisboa, Portugal

Co-Authors: Carina Gouveia, M.D. Margarida Gonçalves, M.D.Joana Marques, M.D.

A 74 year-old male patient with history of Myasthenia Gravis and Autoimmune Hemolytic Anemia undergoing majorsurgery under general anesthesia. Perioperative management of these clinical entities rest under the scope of theanesthesiologist’s practice and represent a challenge that can be overcome with an adequate preanesthetic evaluationand multidisciplinary clinical approach.

MCC-7134 The Elusive Quadricuspid Aortic Valve


Co-Authors: Saniya Syed Adil Mohiuddin, M.D.Ali Razvi, M.D. Shaul Cohen, M.D.

The anomalous aortic valve (AV) in our case had a cryptic structural flaw, which eluded discovery until a multi-view valvefocused examination pinpointed the physical defect causing the regurgitation. This case highlights the challenges ofmanaging a valvular defect of unknown pathological etiology, and emphasizes how imperative it is to reexamine culpritvalves thoroughly in multiple planes before planning appropirate surgical intervention.

MCC-7135 Negative Pressure Pulmonary Edema due to Acute Epiglotitis

Primary Author: Carina Gouveia, M.D.Centro Hospitalar de Lisboa Central | Lisboa, Portugal

Co-Authors: Margarida Gonçalves, M.D. Leina Spencer, M.D.Rafael Pires, M.D.

A 47 year-old patient with upper airway obstruction due to Acute Epiglotitis with the need for an emergency tracheostomydevelops Negative Pressure Pulmonary Edema over the course of a few hours. These two rather uncommon clinical entitiesrequire a high suspicion index and a fast therapeutic approach and should be kept in mind in the emergency room settingwhen accessing an upper airway obstruction without an otherwise obvious cause.


MCC-7136 Awake Fiberoptic Intubation in the OR for a Patient with Metastatic Hypoglossal Cancer Presenting withStridor

Primary Author: Michael Fakhry, M.D.NYUMC | New York, NY, United States

The patient is a 67 year old male with a history of left sided glossal squamous cell carcinoma s/p hemiglossectomy, Lselective neck dissection, XRT and a tracheostomy (since removed), as well as a recurrence of this cancer 2 months agorequiring a radical neck dissection a pectoralis flap, who presented with one week of worsening dyspnea and stridor.Upon arrival to the ER, he was in acute respiratory distress with audible stridor, a respiratory rate of 30, and an oxygensaturation in the low 80's. He was placed on a non-rebreather oxygen mask and given nebulized 2% lidocaine beforebeing transferred to the OR. Once there, he received a successful awake fiberoptic intubation with a 5.5mm ETT (his glotticopening was only 2-3mm, presumably due to edema secondary to malignancy).

MCC-7137 Anesthetic Management of Pseudotumor Cerebri in a Gravid Patient Undergoing Optic Nerve Fenestration

Primary Author: Ruben X. Pagan, M.D.SUNY Downstate | Brooklyn, NY, United States

Co-Authors: Lawrence Lai, M.D. David Vahedi, M.D.Mohammad Salam, M.D. Vijay Verma, M.D.Jaclyn M Ferro, M.D.

A pregnant patient diagnosed with Pseudotumor cerebri (PTC) requires close monitoring of intracranial pressure (ICP).Pregnancy can exacerbate symptoms of ICP, but there is no medical indication to terminate a pregnancy for someonediagnosed with this condition. The patient in this case received general anesthesia for optic nerve fenestration withintra-operative fetal monitoring, successfully. No signs ofmaternal or fetal distress occurred intra-operatively. Postoperatively thepatient was discharged home and successfully gave birth at 39weeks gestationwithout any complication.

MCC-7138 Epidermolysis Bullosa: Anesthetic Concerns and Considerations

Primary Author: Maisie M. TsangSt. Joseph's Regional Medical Center | Paterson, NJ, United States

Co-Author: Padmaja Upadya, M.D.

Pediatric Epidermolysis Bullosa patient for out-patient dental procedure - anesthetic concerns and considerations.

MCC-7139 Hepatocellular Carcinoma in an Adult Patient with Heterotaxy with Polysplenia Syndrome - Case Report

Primary Author: Thejovathi Edala, M.D.UAMS | Little Rock, AR, United States

Co-Author: Abdelnaem Esamelden S, M.D.

In conclusion, this case report should alert the possibility of an interrupted IVC with altered vascular arrangement whichcould complicate the placement of central venous catheter for assessing fluid resuscitation, performance of the resectionand anastomosis during surgery. The chest X-ray needs to be cautiously interpreted while checking for the correctplacement of invasive catheters. The surgeons relatively require more duration for the surgery as tissue handling and theorientation would be difficult to interpret. Placement methodology of surgical instruments for surgical procedure alsorequired modification for suitable exposure of the tissue. Handling of the liver tissue lead to hemodynamic changesprobably because of vessels kinking (inferior vena cava) and thus lesser venous return. In view of prolonged surgery,temperature should be monitored and temperature actively maintained using warm fluid, warming mattresses &blanket. Optimizing hemodynamics and fluid administration is crucial in patients undergoing hepatic resection such asin our patient .


MCC-7140 Cardiac Arrest after Tourniquet Deflation in a Cardiac Compromised Patient with Subsequent TourniquetRe-Inflation

Primary Author: Meneka DaveRutgers New Jersey Medical School | Newark, NJ, United States

Co-Authors: Ross Moore, M.D. Christian Estrada, M.D.

Orthopedic cases with tourniquet placement for extended periods of time can be challenging in elderly patients withsubstantial cardiovascular comorbidities. We present a case of an 85 year old female with severe underlying cardiovasculardisease who developed hyperkalemia, hypotension and subsequent cardiac arrest after right lower extremity tourniquetdeflation. It is well documented that following tourniquet deflation hypotension and hyperkalemia can have seriouscardiac implications, even more pronounced in the elderly due to their compromised sympathetic response anddiminished cardiovascular reserve.We discuss several interventions that can help optimize intraoperative fluid managementandmay attenuate hemodynamic instability following tourniquet release.

MCC-7141 Psychogenic Non-epileptic Seizures in the Recovery Unit

Primary Author: Juan A. Ramos, M.D.Mayo Clinic | Jacksonville, FL, United States

Co-Author: Sorin J Brull, M.D.

Psychogenic non-epileptic seizures (PNES) are an obscure topic in the peri-operative setting. They are sudden andtime-limited motor and cognitive disturbances which mimic epileptic seizures. However they are not associated withorganic central nervous system dysfunction but are rather psychogenically mediated. PNES are more likely thanepilepsy in the peri-operative setting, and thus should be considered early in the differential diagnosis of postoperativeshaking. Early diagnosis and management may prevent iatrogenic morbidity. We present a case of seizure activity inthe post-anesthesia care unit (PACU) diagnosed subsequently as PNES. Treatment recommendations for PNES aremostly anecdotal; psychiatric interventions being the hallmark of treatment. These should be individualized accordingto the underlying psychiatric disorder. Anesthetic recommendations are scarce, but include techniques involving theminimum required quantities of preferably short-acting agents, along with high levels of peri-operative psychologicalsupport, and most importantly, constant reassurance for these patients.

MCC-7142 Anesthesia for Symptomatic Chiari , Malformation in a Laboring Patient: Case Report

Primary Author: Tarang Safi, M.D.Montefiore Medical Center | Bronx, NY, United States

Co-Author: Juan Davila-Velazquez, M.D.

26 y/o G,PO at 40wk gestation with a history of symptomatic Chiari , malformation presents in labor requesting analgesia.Data regarding the use of different anesthetic techniques and their respective safety profiles in patients with Chiari ,malformation is scarce. Epidural catheter was successfully placed for labor analgesia and subsequently used for cesareansection. No neurological symptoms reported post-op.

MCC-7143 Management of a Patient with Partial Trisomy 7p, A Very Rare Genetic Abnormality

Primary Author: Monica Ata, D.O.West Virginia University | Morgantown, WV, United States

Co-Author: Melissa Flanigan, D.O.

A 14 year-old female with a very rare genetic disorder, partial trisomy 7p, presented with abdominal pathology and wastaken to the operating room stat. Due to limited literature on partial trisomy 7p, an anesthetic plan was formulated, andpatient emerged from general anesthesia and recovered in stable condition.


MCC-7144 TEE Guided Anesthetic Management of Left Ventricular Outflow Tract Obstruction Due to Severe Sub-AorticStenosis with Mitral and Aortic Valve Insufficiency

Primary Author: Hunt Blackledge, D.O.UMMC | Jackson, MS, United States

Co-Author: Luiz De Lima, M.D.

42 year old female with aortic stenosis, HTN, and mitral regurgitation who presented with a chief complaint of chest pain.On TTE and TEE she was found to have a tubular, muscular, and fibrous membrane causing severe sub aortic stenosis witha gradient of 170mmHG by echo Doppler. The membrane extended circumferentially to the mitral valve and to the entireleft ventricular outflow tract and also extended to the 3 cusps of the aortic valve. This pathologic membrane caused anobstructed left ventricular outflow tract as well as mitral and aortic valve insufficiency. Anesthesia was obtained withGETA. Preoperative arterial and peripheral IV line placement and anxiolysis was achieved in the holding area. Particulardetailed planning for induction of anesthesia was necessary to avoid worsening outflow tract obstruction and potentialcardiac collapse. The surgery was performed successfully with overall improvement in the patient’s pathology and functionalstatus.

MCC-7145 Use of Heliox and Fiberoptic Intubation in a Case of Acute Upper Airway Obstruction

Primary Author: Aaron Primm, M.D.NYU Langone Medical Center | New York, NY, United States

21 year-old M s/p LeFort I and b/l sagittal split osteotomy who experienced facial edema and acute upper airway obstruc-tion in the SICU. Patient was stabilized with Heliox before awake nasal fiberoptic intubation.

MCC-7146 Acute Liver Disease in Pregnancy on a Sunday Call: From Presentation to Delivery in 90 Minutes

Primary Author: Plinio P. Silva, M.D.,M.P.H.Albany Medical Center | Albany, NY, United States

Co-Author: Cheryl DeSimone, M.D.

Liver disease in pregnancy is rare and prompt diagnosis and treatment decrease risks of potentially devastating outcomesfor both the mother and the fetus. Here we describe the case of a patient who presented with acute fatty liver of pregnancy(AFLP) with multi-organ involvement on a Sunday. We discuss diagnosis and management of liver disease in pregnancy,the importance of prompt diagnosis, management and the constraints and outcomes associated with the "weekendeffect".

MCC-7147 Congenital Diaphragmatic Hernia Repair in 7 Day Old Male

Primary Author: Timothy P. Sims, M.D.NYU | New York, NY, United States

Congenital diaphragmatic hernia repair in 7-day-old male under GETA. Case initially attempted under thorascopicapproach but due to worsening acid base status converted to open. Patient ultimately had hernia successfully reducedunder open operative repair and acid base status markedly improved after patient repositioning.

MCC-7148 Management of Severe Acute Subcutaneous Emphysema Following Pancreatic Necrosectomy

Primary Author: Alexander Praslick, M.D.Stony Brook University | Stony Brook, NY, United States

Co-Authors: Diana Besleaga, M.D. Philip Bao, M.D.Igor Izrailtyan, M.D.

We present a case of massive subcutaneous emphysema and pneumoperitoneum occurring 12 days postoperatively aftersurgery for acute necrotizing pancreatitis. The patient was brought for emergent exploratory laprotomy in mild respiratorydistress, and was intubated using direct laryngoscopy. The subcutaneous air was relieved by the surgical creation of asubcutaneous window. We compare published cases of subcutaneous emphysema and discuss various treatmentoptions, specifically airway management, surgical decompression, and in mild cases, close monitoring and expectantmanagement.


MCC-7149 Anti-N-methyl-D-aspartate (NMDA) Receptor Encephalitis: Report of a Typical and Atypical Presentation andImplications for the Anesthesiologist

Primary Author: Claas Siegmueller, M.D.UCSF | San Francisco, CA, United States

Co-Author: Wendy Smith, M.D.

Anti-NMDAR encephalitis is an increasingly recognized, likely still under-diagnosed, severe autoimmune-mediated disease,typically presenting in younger women with ovarian teratomas. Surgical tumor removal promises the best chances ofrecovery over adjuvant immuno- and chemotherapy. The anesthesia practitioner is likely to encounter these patientsrequiring tumor surgery or ICU care. As diagnostic confirmation can be delayed, the disease has to be considered early inpatients of typical age with characteristic symptoms, recognizing the possibility of an atypical presentation. Anestheticdrugs acting on the NMDA receptor such as Ketamine and N2O should be avoided.

MCC-7150 Bilateral Sequential Brachial Plexus Blocks for Bilateral Radius Fractures

Primary Author: Chanchal Mangla, M.D.New York Methodist Hospital | Brooklyn, NY, United States

Co-Authors: Joel M. Yarmush, M.D. Sangeeta Kamath, M.D.Aaron Chyfetz, M.D. JonathanWeinberg, M.D.

We used chlorprocaine in our first block in anticipation of needing a larger total volume of local anesthetic in the twoblocks. The combination of chlorprocaine and bupivacaine is sometimes used in our institution and not previously reported inthe literature for bilateral blocks. It also allows for extra volume if needed for supplementation. After two and a half hours,we felt that there was sufficient clearance of drug to allow the second block to proceed. A supraclavicular approach waschosen for the second block because of a compressed nerve bundle and we felt that we wanted to limit the total volumeto 30 ml. Incidentally, the patient had jaw pain postoperatively and a heretofore unknown jaw fracture was found.

MCC-7151 Severe Hydrocephalus Secondary to Intraventricular Hemorrhage, Complicated by Cardiovascular Collapseand NeurogenicP edema - A Case Report and Anesthetic Challenges

Primary Author: Sudheera Kokkada Sathyanarayana, M.D.Montefiore Medical Center/ Albert Einstein College of Medicine | Bronx, NY, United States

Co-Authors: Annie Lynn Penaco, M.D. Jerry K. Chao, M.D.

5 year old female child with rapidly worsening severe hydrocephalus presented for revision VP shunt. Perioperative coursewas complicated by cardiac arrest and neurogenic pulmonary edema promptly responding to diuretics and surgicalintervention- we present a case report and anesthetic challenges.

MCC-7152 Sepsis Leads to Heart Failure in Antepartum with MS

Primary Author: Ruben Alexander, M.D.SUNY Downstate Medical Center | Brooklyn, NY, United States

Co-Authors: David Mandell, M.D. Helene Logginidou, M.D.

Sepsis precipitates right heart failure in antepartum patient with significant mitral valve stenosis


MCC-7153 What Challenges DoWe Face in a Patient with Tuberous Sclerosis?

Primary Author: Ana Rita BorgesCentro Hospitalar e Universitário de Coimbra | Coimbra, Portugal

Co-Authors: Ana Lopes Filipa MadeiraJoana Cortesão Lúcia Quadros

Tuberous sclerosis is a rare autosomal dominant syndrome with important anesthetic implications. We present a casereport of a 17 years old patient proposed for bilateral partial nephrectomy.

MCC-7154 Anesthetic Management of a Pediatric Patient with GM, Gangliosidosis

Primary Author: Derrick Chandler, M.D.,Ph.D.Univeristy of Mississippi Medical Center | Jackson, MS, United States

Co-Authors: Todd Versteegh, M.D. Ramarao Takkallapalli, M.D.

This case report is of a 9 month old female with PMH of congenital kyphosis, and GM, presenting for CT/MRI of brain andcervical spine. Pre-operative assessment showed noisy breathing on physical exam. Anesthetic management of patientduring CT/MRI consisted of GETA. Patient remained stable during the procedure with no intra-op complications. Afterextubation, airway appeared obstructed with brief period of decreased O2 saturation (60%) and bradycardia. Afteradministration of atropine patient was still difficult to ventilate. Patient was reintubed in the MRI suite and transported toPACU with supplemental oxygen. While in the PACU the patient remained stable and was extubated , hour later.

MCC-7155 Anesthesia Considerations for Patient With Peripartum Cardiomyopathy

Primary Author: Oscar A. Lopez, M.D.NYU | New York, NY, United States

42 yo female G7P6017 with a history of dilated Cardiomyopathy (EF: 35-40%) diagnosed at 28 weeks gestation andchronic HTN, who presents at 36 3/7 weeks gestation for urgent c-section with BTL for non-reassuring heart tracing withinduction of labor.

MCC-7156 Successful Intubation In a Trauma Patient with Cervical Spine Fracture via the King VisionTM VideoLaryngoscope

Primary Author: Donna Bracken, M.D.New York Presbyterian/Weill Cornell Medical Center | New York, NY, United States

Co-Author: Jon D. Samuels, M.D.

This is a 66 year old male patient admitted to the trauma service after pedestrian struck, who incurred multiple injuriesincluding C, fracture with extension into foramen magnum. He was taken to the operating room for ORIF of his left ankleand right tibia nailing. He arrived wearing a rigid cervical collar, which was removed; he was subsequently orally intubatedwith the King Vision video laryngoscope utilizing in-line stabilization. The intubation attempt was easy, atraumatic, andwas achieved in less than 15 seconds.


MCC-7157 Anesthetic Management of a Mediastinal Teratoma

Primary Author: Telianne ChonRiverside County Regional Medical Center | Moreno Valley, CA, United States

Co-Authors: Albert Kelly, D.O. Norma Dominguez, D.O.

The presence of a symptomatic, large mediastinal mass presents as an unique airway challenge, which requires carefulperioperative planning for an uneventful outcome. An otherwise healthy female presents with a teratoma compressingon mediastinal vessels and airway structures. The goals during induction are to keep an open dialogue with the patient,maintain spontaneous ventilation, placement of the endotracheal tube under direct visualization via flexiblebronchoscopy, the use a reinforced endotracheal tube, and obtaining invasive venous and arterial access for intraoperativemonitoring. Well planning with a calm and controlled atmosphere resulted in successful induction and surgical outcome.

MCC-7158 Use of Awake Video Laryngoscopy for Anticipated Difficult Airway in a High Risk Obstetric Patient

Primary Author: Sam Nia, M.D.Rutgers | Newark, NJ, United States

Co-Author Shridevi Pandya Shah, M.D.

A patient with multiple medical comorbidities presenting for a repeat cesarean section having an anticipated difficult airwaymanaged with an awake Glidescope technique.

MCC-7159 Whole Lung Lavage for Pulmonary Alveolar Proteinosis

Primary Author: Jennifer A. Macpherson, M.D.University of Rochester | Rochester, NY, United States

This is a case of pulmonary alveolar proteinosis in a patient with a history of chronic metal dust exposure. Our patient wasa 48 yo male, 166 cm, 74 Kg, with a PMHx of HTN, GERD, chronic cough, 2 year history of interstitial lung disease ofunclear origin, and exposure to metal dust. He presented to an outside hospital in respiratory failure and was transferredto our hospital for treatment. BAL revealed PAS +, milky fluid, the diagnosis of PAP was made, and he was later taken tothe OR with right lung whole lung lavage on HD # 9. A left sided 37 Fr DLT was placed and fluid instillation/drainage tubingwas attached to the right lumen. After one cycle of fluid instillation/drainage it was necessary to reinflate the right lungdue to rapid desaturation into the 70s, as his other lung was also compromised. This cycle was repeated 16 times over 5hours until fluid return was somewhat clear. He was extubated on HD #19 and discharged on HD #35 .

MCC-7160 Nasopharyngoscopic Evaluation of a Potential Difficult Airway in a Patient with Raised intracranial Pressure (ICP)

Primary Author: Lakshmi N KurnutalaWexner Medical Center, Ohio State University | Columbus, OH, United States

Co-Authors: Gurneet Sandhu, M.D. Sergio D. Bergese, M.D.

Airway management in a patient with potential difficult airway is always challenging. Patients with a history of head andneck cancer and radiation that causes friability may be prone to bleeding adding to an already challenging airway.Elevated ICP associated with a potential difficult airway is an even more challenging situation. Patients with a potentialdifficult airway are routinely managed by awake fiberoptic intubation (FOI). This procedure may be associated with signif-icant coughing, straining and hemodynamic lability with detrimental effects on intracranial pressure (ICP) and cerebralperfusion pressure (CPP). We would like to present a case report on management of a patient with intracranial tumor andraised ICP in the setting of potential difficult airway due to laryngeal cancer s/p resection and radiation.


MCC-7161 Emergent Awake Tracheostomy for Airway Obstruction from Neck Mass

Primary Author: Brian Raffel, D.O.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Daniel Ramos, B.S.Alann Solina, M.D. Gina George, D.O.Antonio Chiricolo, M.D. Kang Rah, M.D.

A 62 y/o female was admitted to RWJUHMICU for management of a large left neck mass that was narrowing the supraglotticairway and displacement of the trachea. An awake intubation in the operating roomwith the trauma surgical team present incase of emergent tracheostomy was decided. In the OR, multiple attempts via direct laryngoscopy, glidescope laryngoscopy,and fiberoptic intubation were attempted but unsuccessful. The patient’s O2 saturation began to decline. After the traumasurgical team attempted wire placement for retrograde intubation and was unsuccessful, an awake tracheostomy wasperformed. IV sedation andmuscle relaxant cannot be administered in this situation when the airway could not be secured.

MCC-7162 Cardiovascular Instability in a Preeclamptic Patient after CSE

Primary Author: David Delatte, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Shruti Shah, M.D.Mark Stein, M.D. Christine W. Hunter, M.D.

Severe preeclamptic patient was found to have altered mental status, respiratory arrest and severe hypotension andbradycardia following routine combined spinal and epidural for elective cesarean section.

MCC-7163 It is Just an Eye Case! Delayed Awakening After Retro-Bulbar Block

Primary Author: Renu Chhokra, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Adil Mohiuddin, M.D.Shruti Shah, M.D. Daniel Ramos, B.S.Anushree Doshi, B.A. Kang Rah, M.D.

We report a case of delayed awakening in a woman scheduled for Vitrectomy in our outpatient surgi-center. She wassedated with 100mg IV Propofol followed by retrobulbar block with 6ml of local anesthetic (mixture of 3ml of 4%Lidocaine and 2.5ml of 0.75% Bupivacaine, 0.5 ml of Hyaluronidase) and became apneic 5 min later. She stayed unconsciousfor 30min in OR with HR 44-50/ min. She was transferred to PACU where she was restless and confused for few hours. Shewas hemodynamically stable after brief bradycardia that responded to atropine , mg, but she remained unconscious anddid not respond to deep stimulus for 25 min after block. We suspect she had intrathecal injection of local anesthetic.

MCC-7164 Amniotic Fluid Embolism (AFE) during C/S for Parturient with Anti-Phospholipid Antibody Syndrome (APS)

Primary Author: Ankit Kapadia, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Shruti Shah, M.D.Antonio Chiricolo, M.D. Avinash Kudupudi, B.S.Daniel Ramos, B.S. Anushree Doshi, B.A.Kang Rah, M.D.

39 year old G3P2 at 36 weeks twin gestation with PMH of antiphospholipid antibody syndrome prophylactically treatedwith lovenox and ASA discontinued 24 prior to admission underwent scheduled C-section for breech presentation. Aftersuccessful delivery of both babies under epidural anesthesia, patient became hypotensive and unresponsive and continuedto bleed profusely with uterine atony. The patient’s clinical symptoms raised suspicion for an amniotic fluid embolism. Anairway was immediately established using RSI and the patient was placed under general anesthesia for removal of heratonic uterus. After massive fluid resuscitation and correction of coagulopathy, the patient stabilized and was transferredto the SICU. Four days later, she was discharged from the hospital without further complications.


MCC-7165 Internal Maxillary Artery Embolization

Primary Author: Shruti Shah, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Mark Stein, M.D.Alann Solina, M.D. Anushree Doshi, B.A.Daniel Ramos, B.S. Kang Rah, M.D.Gaurav Gupta, M.D. Christine W Hunter, M.D.

An 83 year old man with a complicated past medical history presented to the ED with sudden onset oropharyngealbleeding and required one unit PRBC. Though stable on arrival, he became hypotensive and unresponsive and continuedbleeding before undergoing a procedure. He was a difficult airway that required extensive support throughout theprocedure. Ultimately, he successfully underwent an internal maxillary artery embolization and was transferred to theSICU. He was extubated two days later and was discharged home in stable condition.

MCC-7166 Intracranial Hemorrhage in Pregnancy

Primary Author: Ana Cristina R. SilvaCentro Hospitalar de Lisboa Norte | Lisbon, Portugal

Co-Authors: José M. Duarte Inês CarvalhoDiana Henriques Fátima Gonçalves

Intracerebral hemorrhage from a vascular malformation in pregnancy is a rare but serious condition with a high rate ofmaternal and fetal mortality. We report the case of a 39 year old pregnant at 39th week of gestational age with suddenepisode of severe headache with left hemiparesis, vomit and coma, GCS 4 (O,V,M2). CT scan revealed extensive cerebralhematoma. Caesarean section was performed under general anesthesia simultaneously with decompressive craniectomy,with complete removal of the hematoma. Cerebral angiography performed later detects a large deep rightbasal-nuclei arteriovenous malformation. Patient was discharged on the 46th postoperative day with GCS 15, with lefthemiparesis, left homonymous hemianopsia and neglect. We concluded that in case of emergency the challenge is toensure intraoperative hemodynamic stability, good uteroplacental perfusion, normal ventilation and avoid increasedintracranial pressure in order to ensure an optimal maternal and fetal well-being.

MCC-7167 Accidental Intrathecal Buprenorphine Injection

Primary Author: Adil Mohiuddin, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Kang Rah, M.D.Antonio Chiricolo, M.D. Kathryn Faloba, B.S.Achillina Rianto, B.S. Renu Chhokra, M.D.Stefanie Berman, M.D.

A healthy 29-year-old female was admitted to Labor and Delivery suite and requested continuous lumbar epidural analgesia.The patient was accidentally injected with an overdose of 0.3mg buprenorphine that resulted in suddent muscle weaknessand sleepiness but did not cause apnea, coma, or seizures and did not necessitate treatment. This case further demonstratesthe relative safety of epidural administration of a large dose of highly lipid soluble buprenorphine without the fear ofaccidental intrathetcal injection. Nevertheless, the routine aspiration for CSF test dose and titration of opioid analgesicshould be practiced.


MCC-7168 Frank Blood Aspiration from Epidural Catheter Following Negative Test Dose Injection

Primary Author: Aysha Hasan, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors:Arpita Ghosh, M.D. Shaul Cohen, M.D.Antonio Chiricolo, M.D. Anushree Doshi, B.A.Daniel Ramos, B.S. Adil Mohiuddin, M.D.Christine W Hunter, M.D.

Our patient had an uneventful placement of epidural catheter followed by a test dose and three supplemental doses oflocal anesthetic (5 ml of 2% lidocaine with epinephrine 5 mcg/ml and fentanyl 5 m/ml) without any adverse reaction. Withthe aspiration prior to the fourth supplemental 5 ml dose, blood was noted throughout the length of the epiduralcatheter. There was no adverse reaction. Adequate surgical analgesia was obtained from the doses already given to thepatient.

MCC-7169 Epidural Analgesia for Parturient with Fetal Demise Complicated with Abruption Placenta and DIC

Primary Author: Dora Zuker, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shaul Cohen, M.D. Anushree Doshi, B.A.Kang Rah, M.D. Antonio Chiricolo, M.D.Stefanie Berman, M.D. Renu Chhokra, M.D.Christine W Hunter, M.D.

Regional anesthesia is contraindicated for patients with significant coagulation abnormalities. We report a case of abruptioplacenta complicated with preeclampsia, fetal demise, excessive blood loss and consumption coagulopathy. Epiduralblock for labor and delivery was placed using sufentanil, mixed with epinephrine without any complications. When fetaldemise is complicated with severe hypovolemia, abruptio placenta should be suspected and spinal or epidural blocksshould be avoided.

MCC-7170 Intubate Blue? Extubate Pink?

Primary Author: Jeff HalonenRiverside County Regional Medical Center | Moreno Valley, CA, United States

This case report is about a newborn in respiratory distress and hypoxia requiring intubation. The newborn desaturatedafter multiple successful endotracheal intubations and improved with extubation each time. This case report will discussour management, the differential diagnosis, how all of the comorbidities played apart in the disease process and the treatmentin this case. The purpose of this report is to briefly discuss the differentials, with discussion about how these played a partin this case. The outcome of this study was a infant being discharged home from the hospital on day twenty five of lifewith no apparent deficits despite a great potential for harm or even death after just minutes of life.

MCC-7171 Intraoperative Hyperthermia as Initial Presentation of Babesiosis Acquired Through Blood Transfusion

Primary Author: Melanie Liu, M.D.Yale New Haven Hospital | New Haven, CT, United States

Co-Author: Marcelle Blessing, M.D.

Babesiosis has become one of the most frequent transfusion-transmitted infections in the United States and can causefevers up to 40 °C as well as severe hemolytic anemia. A 66-year-old woman presenting for total abdominal hysterectomyand bilateral salpingo-oophorectomy sustained a 3°C rise in body temperature (36.4 to 39.4°C) immediately followinginduction of general endotracheal anesthesia, leading to cancellation of surgery and unexpected ICU stay due to concernfor malignant hyperthermia. Subsequent work-up revealed a previously undiagnosed active Babesiosis infection, whichwas treated. The patient returned several weeks later and underwent an uneventful procedure. This case highlights theneed for prompt recognition and treatment of intraoperative hyperthermia, prudent and evidence-based use of bloodproducts given the risks of administration, and improved blood supply storage and screening in B. microti-endemic areas.


MCC-7172 New Onset Blindness, Altered Mental Status, and Hypertensive Emergency: Could this be PosteriorReversible Encephalopathy Syndrome?

Primary Author: Kimberly Fischer, M.D.Montefiore Medical Center, the University Hospital for Albert Einstein College of MedicineNew York, NY, United States

Co-Author: Jay S Berger, M.D.,Ph.D.

A 53 year-old woman is admitted to the Surgical Intensive Care Unit with elevated blood pressure and new onset blindnessassociated with acutely altered mental status. CT head and MRI brain show classic pathological patterns consistent withposterior reversible encephalopathy syndrome (PRES). A discussion about PRES follows.

MCC-7173 Repeat Cesarean Delivery Under General Anesthesia with TAP Blocks in a Patient with Type IV OsteogenesisImperfecta

Primary Author: Jeremy Pick, M.D.New York PresbyterianWeill Cornell Medical Center | New York, NY, United States

Co-Authors: Milica Markovic, M.D. Alaeldin Darwich, M.D.

Anesthetic management of OI cases are complicated by difficult airway management and difficulty of regional technique.On two separate occasions we utilized two forms of video laryngoscopes to facilitate minimal neck manipulation duringendotracheal intubation. In addition, we showed that in our patient the use of transversus abdominal plane (TAP) blockreduced the amount of post-operative intravenous dilaudid usage.

MCC-7174 Severe Hyperkalemia During a Major Urologic Procedure

Primary Author: Chunhua LiAlbany Medical Center | Albany, NY, United States

Co-Author: Michael Sandison, M.D.

An adult patient developed severe hyperkalemia during robotic assisted laparoscopic radical cystoprostatectomy thatrequired changes of surgical plan and immediate postoperative hemodialysis.

MCC-7175 A Case of Undiagnosed Pheochromocytoma in a Patient with Intraoperative Hypertensive Crises

Primary Author: Mohammad Zalzala, M.D.SUNY Downstate | Brooklyn, NY, United States

Co-Author: An T Phan, M.D.

We describe a case of undiagnosed pheochromocytoma in a 63-year-old female who developed intraoperative hypertensionand tachycardia resistant to multiple antihypertensives while undergoing a laparoscopic paraesophageal hernia repair.

MCC-7176 Intra-op Tension Pneumothorax with Stable Hemodynamics During a Contralateral Chest Wall Resection

Primary Author: Shahryar Mousavi, M.D.SUNY Upstate UH | Syracuse, NY, United States

Co-Author: Zhong-Jin Yang, M.D.

53 years old obese female with the history of metastatic hemangiopericytoma of right thigh was scheduled to have left chestwall resection for intractable pain due to metastatic lesions of the ribs. She was diagnosed to have tension pneumothorax inthe middle of the case needed emergent chest tube placement.


MCC-7177 A Challenging Pediatric Double-Lung Transplant (DLT)

Primary Author: Jean G Hentz, M.D.HUS | Strasbourg, France

Co-Authors: Olivier Helms, M.D. Annick Steib, M.D.Paul-Michel Mertes, M.D.

We describe the challenging DLT of adult lungs in a 16 year-old boy with end-stage respiratory failure.

MCC-7178 Emergent Frontal Lobe Craniotomy in a Patient with Severe Uncontrolled Symptomatic Hypothyroidism

Primary Author: Andrew Bogart, M.D.Boston Medical Center | Boston, MA, United States

Co-Authors: Roberto Ballivian, M.D. Richard Pedro, D.O.

A severely hypothyroid patient presenting with headache and right sided partial hemiparesis was found to have a largefrontal lobe mass with a midline shift. The mass needed urgent debulking. Challenges to the anesthesiologist includedinduced hypotension, and preventing myocardial depression with the use of volatile anesthetics.

MCC-7180 A Multidisciplinary Approach to Developing a Protocol for Safe OR Management of a Patient with a History ofSulfite Anaphylaxis

Primary Author: Ansara M. Vaz, M.D.New York-Presbyterian Hospital | New York, NY, United States

Co-Authors: Antigone Grasso, M.B.A. Nicholas Cavalieri, M.D.Beryl C. Muniz, R.N. Laura Maglione, R.N.Alissa J. Ritter Louise MerrimanLai Chin, B.S. Rafiqu Khaled, B.S.Peter M. Fleischut, M.D. Vinod Malhotra, M.D.

An interdisciplinary team created a sulfite-free protocol for products used in a patient with previously diagnosed sulfitesensitivity to successfully facilitate a surgical procedure.

MCC-7181 Medically Challenging Case: Hyperfibrinolysis after Sudden Operative Hemorrhage

Primary Author: Mary So, M.D.New York-Presbyterian Hospital | New York, NY, United States

Co-Authors: Jennifer Sandadi, M.D. James E. Littlejohn, M.D.,Ph.D.Andrew N. Lazar, M.A. Chad M. LazarPeter M. Fleischut, M.D.

Management of a coagulopathy following major intra-operative hemorrhage in a patient with a complex cardiac and renalhistory was successfully achieved with immediate bedside results using a rotational thromboelastometry point of caredevice.


MCC-7182 Intraoperative Dexmedetomidine Induced Polyuric Syndrome

Primary Author: David Ninan, D.O.Riverside County Regional Medical Center | Moreno Valley, CA, United States

Co-Authors: Shannon Granger, D.O. Ronald Lazar, M.D.Alfred Ma, M.D.,Ph.D. Alice Tsao, M.D.Albert Kelly, D.O. Brian Keyes, D.O.Norma Dominguez, D.O.

A case study of Dexmedetomidine induced intraoperative polyuria. Dexmedetomidine is an alpha-2-agonist which alsoblocks arginine-vasopressin release. The presentation also discusses other similar case reports.

MCC-7183 A Look at Madelung's Disease and Airway Management

Primary Author: Shannon Granger, D.O.Riverside County Regional Medical Center | Moreno Valley, CA, United States

Co-Authors: David Ninan, D.O. Alfred Ma, M.D., Ph.D.Ronald Lazar, M.D. Norma Dominguez, D.O.Albert Kelly, D.O. Brian Keyes, D.O.Alice Tsao, M.D.

Case presentation of a patient with Madelung's disease and a discussion of the relevant literature surrounding the anestheticmanagement of this disease.

MCC-7184 Intubation with Video Laryngoscope Causing Pharyngeal Injury and Airway Bleeding in a Patient onAnticoagulation Therapy

Primary Author: Brian S. Cho, M.D.Stony Brook Medicine | Stony Brook, NY, United States

Co-Authors: Catherine Gruffi, M.D. Elliot Regenbogen, M.D.Daryn Moller, M.D. Igor Izrailtyan, M.D.

A 58-year-old female with atrial fibrillation on anticoagulation therapy underwent radiofrequency ablation under generalanesthesia with video laryngoscope intubation. The patient was later found to have suffered an injury to the right tonsillarregion resulting in significant bleeding and subsequent obstruction of the endotracheal tube with blood clots causingimpaired mechanical ventilation.

MCC-7185 Traumatic Laryngotracheal Separation

Primary Author: Cecilia Peña, M.D.Medical College of Wisconsin | Milwaukee, WI, United States

Co-Authors: Leonardo Martinez Rowe, M.D. Jennifer Hickman, M.D.

Laryngeal trauma accounts for less than 1% of emergency department cases (1:30,000), andmost cases of laryngotrachealinjury occur in the adult population. Such injuries are rare in the pediatric larynx. Here we present a case of an adolescent boywith a potentially lethal penetrating gunshot wound causing a nearly complete transaction of the trachea. Management ofsuch injuries focuses on the stabilization andmaintenance of the airway and circulation. This child sustained separation of theanterior half of the trachea from the posterior aspect. It is significant to note the potential elusiveness of the diagnosisconsidering he remained hemodynamically stable on room air. Prompt attention, diagnosis, and planning of an awakefiberoptic intubation in the operating roomwere imperative for airway management and survival of this child.


MCC-7186 Placenta Accreta Diagnosed 15 Days Following Primary Cesarean Section

Primary Author: Aliraza Dinani, M.D.Rutgers-Robert Wood Johnson University Hospital | New Brunswick, NJ, United States

Co-Authors: Shruti Shah, M.D. Anushree Doshi, B.A.Shaul Cohen, M.D. Daniel Ramos, B.S.Jan Kim, M.D. Christine W Hunter, M.D.

This study presents a 27 y/o G,P, s/p uncomplicated primary c/s at 39 weeks gestation for failure to progress under epidur-al anesthesia who presented to the ER 15 days postop due to continued vaginal bleeding. She was found to have retainedplacental tissue by the obstetric team. The tissue was removed piecemeal under ultrasound guidance and the estimatedblood loss during the process was 500 mL. Given clinical presentation and operative and pathologic findings the diagnosisof placenta accreta was made. Anesthetic considerations for a patient presenting with vaginal bleeding 15 days followingC/S include the risk of obstetric hemorrhage, potential need for invasive hemodynamic monitoring, and possibility of mas-sive blood transfusion.

MCC-7187 A Sudden Cardiac Arrest During Cesarean Section In A Healthy Parturient Successfully Managed By RapidResponse Team

Primary Author: Isaac Lowenwirt, M.D.New York Hospital Queens | Flushing, NY, United States

Co-Authors: Shruti Shah, M.D. Shaul Cohen, M.D.Daniel Ramos, B.S. Kang Rah, M.D.Antonio Chiricolo, M.D. Stefanie Berman, M.D.

We report a case of a parturient with abrupt cardiovascular collapse with acute drop in ETCO2 and rapid complete recoverywhich support a diagnosis of venous air embolism. The temporal relationship of uterine exteriorization maneuvers which hasbeen shown to alter the gradient allowing for net air entrainment and the cardiovascular event is further support for avenous air embolism diagnosis. Cardiac arrest from a venous air embolism, which was immediately resuscitated and wassuccessfully managed, allowed her to recover completely. Team Blue, specifically assigned to obstetric floor can improveoutcome of parturients who require resuscitation.

MCC-7188 Anesthetic Management of a Patient with Isaac's Syndrome

Primary Author: Nazish K HashmiUniversity of Arkansas for Medical Sciences | Little Rock, AR, United States

Co-Author: Sushma Thapa, M.D.

Isaac’s syndrome or neuromyotonia is a disorder of peripheral nerves, which manifests as muscle cramps, stiffness,pseudomyotonia and myokymia. Patients with this syndrome who undergo general anesthesia demonstrate increasedsusceptibility to muscle relaxants. The use of neuromuscular blockers in these patients may result in delayed recovery ofmuscle strength and may even trigger malignant hyperthermia. We describe a case of patient with Isaac’s syndrome, whoreceived total intravenous anesthesia for an ERCP without any complications.


MCC-7189 A Simple Nasal CPAP Mask/Circuit Improved Oxygenation and Prevented Desaturation in an Obese Patientwith OSA under MAC for Irrigation and Debridement of Bilateral Posterior Calf Ulcer

Primary Author: Christine W Hunter, M.D.Rutgers - Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Trishna Upadhyay, M.D. Kang Rah, M.D.Sylviana Barsoum, M.D. Rose Alloteh, M.D.Gina George, D.O. James Tse, M.D.,Ph.D.

Patients under MAC receive O2 via nasal cannula (NC). Over-sedation or airway obstruction may cause severe desaturation(Desat), especially in obese patients with obstructive sleep apnea (OSA). We develop a nasal CPAP mask/circuit using aninfant face mask and an adult breathing circuit attached to an anesthesia machine. A 71 y/o obese male (BMI 45 kg/m2)with atrial fibrillation, coronary arterial disease and OSA presented for irrigation and debridement of bilateral posterior calfulcer under local anesthesia. He could not tolerate a facial CPAP during sleep. After pre-oxygenated with a face tent (4L/min NC O2 and a TSE “Mask”), O2 Sat increased from 96% to 100%. Deep sedation was achieved with IV propofol (50mg) and infusion (125 mcg/kg/min). A nasal mask was secured with head straps and Pop-off valve was adjusted to deliverCPAP of 5 cm H2O with mixture (0.8 FiO2) of O2 (5-7 L/min) and air (2 L/min). He tolerated the procedure well andmaintained spontaneous respiration and 99-100% O2 Sat. This nasal CPAP mask/circuit takes 2-3 min to assemble. Itimproves oxygenation and pro-actively prevents Desat in OSA patients. It may improve patient safety at a low cost.

MCC-7190 Perioperative Management of Paravertebral Paraganglioma - A Case Report

Primary Author: Bárbara A RibeiroCentro Hospitalar de Setúbal | Setúbal, Portugal

Co-Authors: Joana Azevedo Ana BatistaGuilherme Domingos João Silva Duarte

Paraganglioma resection may lead to life-threatening complications, and its management is a challenge to the skill of theanesthesiologist. Regarding this case we review some of the challenging aspects.

MCC-7191 Anesthetic Management of a Patient with Bardet-Biedl Syndrome

Primary Author: Bárbara A RibeiroCentro Hospitalar de Setúbal | Setúbal, Portugal

Co-Authors: Maria Rodrigues Tânia SeixasRaquel Louzada

Bardet-Biedl syndrome is a rare autosomal recessive disease. In patients with this syndrome, there could be potentialproblems with the airway, cardiovascular and renal systems. With this case report we undertook a review of the currentliterature on the anesthetic managment of this rare syndrome.

MCC-7192 Eisenmenger's Syndrome and Pregnancy


Co-Authors: Natalie Ganceres, M.D. Shaul Cohen, M.D.Saniya Syed Adil Mohiuddin, M.D.

Optimizing care in patient's with Eisenmenger's Syndrome is always a challenge. In this case report we highlight preoperativeoptimization in a gravid patient with Eisenmenger's Syndrome for a favorable perioperative course and prognosis.


MCC-7193 Ibutilide Induced Torsade de Pointes.

Primary Author: Robert McClain, M.D.Mayo Clinic | Jacksonville, FL, United States

Co-Author: Steven Porter, M.D.

We present a case of torsade de pointes during the administration of Ibutilide for pharmacologic cardioversion ofsymptomatic atrial fibrillation and discuss the risk factors for development and treatment of ibutilide-induced torsade depointes.

MCC-7194 A Case of a Broken Heart

Primary Author: Jeff Cerny, M.D.MD Anderson Cancer Center | Houston, TX, United States

Co-Authors: Joel Berger, C.R.N.A. Cezar Iliescu, M.D.Alicia Kowalski, M.D. Farzin Goravanchi, M.D.Nancy Perrier, M.D.

This case highlights the necessity of including stress-induced cardiomyopathies within the differential of an acute coronarysyndrome, especially one occurring during the perioperative period.

MCC-7195 Diaphragmatic Pacemaker Implantation in a Patient with Amyotrophic Lateral Sclerosis: Discussion ofIntraoperative Anesthetic Management and Mechanical Ventilation

Primary Author: Christopher Tam, M.D.Stony Brook University Hospital | Stony Brook, NY, United States

Co-Authors: Ahmed Haque, M.D. Shaji Poovathoor, M.D.Deborah Richman, M.B.,Ch.B. Dana Telem, M.D.

Diaphragmatic Pacemaker Implantation in a patient with progressive ALS with worsening respiratory dysfunction. We willdiscuss our intraoperative anesthetic management and successful wean from mechanical ventilation.

MCC-7196 Anesthetic Management of Rhizomelic Chondrodysplasia Punctata - A Rare Congenital Disorder.

Primary Author: Ankit Jain, M.B.,B.S.RUTGERS- New Jersey Medical School | Newark, NJ, United States

Co-Author: Shridevi Pandya Shah, M.D.

Rhizomegalic Chondrodysplasia is a rare congenital anomaly and hence very limited clinical knowledge of anestheticmanagement is available. We present in this case report a difficult airway scenario that we encountered in a patient whounderwent anesthesia four times at different stages of life. Differential growth of the head led to difficulty in managing theairway of this patient.

MCC-7197 Transfemoral Transcatheter Aortic Valve Replacement (TAVR) in a Patient with HIT: Discussion ofIntraoperative Anticoagulation Management with Bivalirudin (Angiomax)


Co-Author: Bharathi Scott, M.D.

We present a case of a 74 year old male with past medical history of heparin induced thrombocytopenia type II resultingin bilateral below knee amputations for transfemoral transcatheter aortic valve replacement. We will discuss our successfulintraoperative anticoagulation management with Bivalirudin (Angiomax).


MCC-7198 What is this Mass Located in the Right Ventricle?


Co-Author: Bharathi Scott, M.D.

Patient is a 39 year old male who was admitted to our hospital for diabetic ketoacidosis complicated by non-ST-elevationmyocardial infarction and was found incidentally on transthoracic echocardiography (TTE) to have a right ventricularmass. We present a case of an atypical location of a cardiac mass in the right ventricle and will demonstrate intraoperativetransesophageal echocardiography (TEE) images.

MCC-7199 A New and Low-Cost Nasal CPAP/CF Mask/Circuit Improved Oxygenation of an Obese Patient with OSA andUnexpected Tracheomalacia under MAC during Bronchoscopy

Primary Author: Rose Alloteh, M.D.Rutgers - Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Carolyn Kloepping, M.D. Neethu Kumar, M.D.Kang Rah, M.D. John Denny, M.D.Shaul Cohen, M.D. Christine W Hunter, M.D.James Tse, M.D.,Ph.D.

Ambulatory patients undergoing flexible bronchoscopy routinely receive topical anesthesia, IV sedation and nasal cannula(NC) O2. Over-sedation or airway obstruction may cause severe desaturation, especially in obese patients with OSA. Wedevelop a simple nasal CPAP mask/circuit using an infant mask and an adult breathing circuit. A 36 y/o male (BMI 40kg/m2) with asthma, Behcet’s disease and OSA presented for outpatient bronchoscopy to evaluate a new RUL infiltrate.After lidocaine and albuterol nebulizer treatment and topical anesthesia, a nasal mask/circuit was secured with headstraps and connected to an anesthesia machine. After pre-oxygenation with 10 L/min O2 flow, deep sedation wasinduced with propofol (total 100 mg) and infusion (150 mcg/kg/min). He maintained spontaneous respiration and O2 Satincreased from 96% to 100%. He was found to have severe tracheomalacia (>80% compression) at mid-trachea. Assistednasal ventilation with PIP (15-20 cm H2O), distended the lumen and bronchoscope advanced easily. He resumedspontaneous respiration and maintained 99-100% O2 Sat (0.6-0.8 FiO2). He tolerated the procedure well and wasdischarged home.

MCC-7200 Hyperacute Thrombus During Angiography for Coiling of a Cerebral Aneurysm Necessitates EmergentChange in Hemodynamic Goals

Primary Author: Scott Kernan, M.D.University of Kentucky | Lexington, KY, United States

Co-Author: Jeremy Dority, M.D.

Hyperacute thrombosis during angiography and coiling of intracerebral aneurysm including intraarterial treatment andhemodynamic goals.

MCC-7201 Duchenne Muscular Dystrophy: The Older Patient

Primary Author: Ahmed R. Haque, M.D.Stony Brook University | Stony Brook, NY, United States

Co-Author: Francis S. Stellaccio, M.D.

DMD, first described in the 1860s, is due to a defect on the X chromosome that results in the flawed production ofthe dystrophin protein which leads to muscle fiber instability. With advancements in cardiac and respiratory supportsystems, life expectancy has increased and currently has an estimated median survival of 31 years. With DMDpatients reaching higher ages, anesthesiologists must take into account an increasing list of co-morbidities. Our casedescribes the anesthetic management of a 31 year oldmale with a history of Duchennemuscular dystrophy s/p tracheostomy,cardiomyopathy, asthma, and gallstone pancreatitis coming for an ERCP and dilation of gastrostomy tract.


MCC-7202 Profound Systemic Reaction after Bone Cement Application in Total Knee Arthroplasty

Primary Author: Robert LaCivita, M.D.Maimonides Medical Center | Brooklyn, NY, United States

Co-Authors: Avichai Dukshtein, M.D. Piyush Gupta, M.D.

A case of anaphylaxis following bone cement application in an elective total hip arthroplasty. Aggressive vasopressor therapyand antihistamine treatments improved symptomatology, and case proceeded. An elevated histamine and tryptase levelduring the episode suggested the diagnosis of anaphylaxis in the setting of profound hypotension and perioral edema.

MCC-7203 A Simple and Low-Cost Nasal CPAP Mask/Circuit Improved Oxygenation of a High-Risk Obese Patient withOSA under MAC for TEE

Primary Author: Shaul Cohen, M.D.Rutgers - Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Darrick Chyu, M.D. Ankit Kapadia, M.D.John Denny, M.D. Kang Rah, M.D.Rose Alloteh, M.D. Christine W Hunter, M.D.James Tse, M.D.,Ph.D.

Patients receive IV sedation and nasal cannula (NC) O2 during transesophageal ecocardiography (TEE) in Echo Suite.Over-sedation or airway obstruction may cause severe desaturation, especially in obese patients with obstructive sleepapnea (OSA). We develop a nasal CPAP mask/circuit to improve oxygenation in OSA patients. A 84 y/o obese male (BMI 34kg/m2) with new-onset atrial fibrillation, coronary artery disease (s/p CABG), HTN, DM and OSA was undergoing TEE underMAC. O2 Sat was 89-91% with NC O2 (5 L/min) and increased to 93-94% after converting NC to TSE “mask”. We assembled anasal CPAP mask/circuit using an infant face mask and a flexible connector attached to a bag-mask. It was secured withhead straps to obtain a tight seal. He breathed comfortably with 10 cm H2O PEEP and 10 L/min O2 flow. After pre-oxygenation,O2 Sat increased to 95-96%. Deep sedation was induced with etomidate (4 mg) followed by propofol (40 mg). He toleratedTEE well and maintained spontaneous respiration and 93-96% O2 Sat throughout. This nasal CPAP mask/circuit improvesoxygenation and pro-actively prevents desaturation in OSA patients. It may improve patient safety at a low cost.

MCC-7204 Solution to a Patient Too Contracted to Appropriately Assess


Co-Author: Martin Szafran, M.D.

Our case describes a 74-year-old male with a past medical history of Parkinson’s disease and lewy body dementia whopresented to our institution with a severe left hand contracture that resulted in a palmar infection secondary to thepressure of overgrown fingernails digging into the skin. Orthopedic evaluation for possible surgical intervention torelieve the pressure was greatly limited by the severe pain associated with mild manipulation of the hand. A novelintervention was chosen by our pain service, which involved the placement of a supraclavicular block with indwellingcatheter to achieve pain control. A baseline infusion of local anesthetic was delivered complemented by periodicboluses that were administered prior to dressing changes, wound cultures, assessments and manipulations of thehand. This unique approach to acute pain management in this setting proved to be advantageous since it allowed forproper preoperative assessment by the surgeons and the ability for the patient to be medically optimized.


MCC-7205 Anesthetic Management of Stickler Syndrome


Co-Author: Anna Kogan, D.O.

Stickler Syndrome, also known as hereditary arthro-ophthalmopathy, is an autosomal dominantly inherited connectivetissue disorder that is estimated to affect , in 7500 to 9000 newborns. The root cause of the syndrome is a mutation in thetype II and type XI which cause orofacial abnormalities such as a flattened facial appearance, ocular abnormalities result-ing in severe nearsightedness, glaucoma, cataracts and retinal detachment, auditory abnormalities resulting in hearingloss, and musculoskeletal abnormalities that result in hypermobile joints, arthritis, abnormal curvatures of the spine, andincreased risk of mitral valve prolapse and aortic root dilation. Our case describes the anesthetic management of a 7 yearold male with a history of Stickler's Syndrome, asthma, dysphagia, and gastroesophageal reflux that presented with fever,abdominal pain, and emesis that required emergent surgical intervention for a suspected acute appendicitis.

MCC-7206 Anesthetic Management of the Parturient Status Post Konno Procedure


Co-Author: Irina Lokshina, M.D.

Our case describes the anesthetic management of a 31 year old parturient with a history of complex congenital heartdisease that presented in labor at 39.3 weeks. At the age of 10, the patient had an open heart procedure in her nativecountry that involved closure of a ventricular septal defect and an aortic valvuloplasty most likely due to tetralogy of fallot.Subsequently, at the age of 27, the patient underwent a Konno procedure and an aortic valve bioprosthesis was placeddue to severe aortic valve stenosis and a long segment of subvalvular stenosis. Due to the patient’s extensive history, anepidural was placed after lengthy discussion with the cardiovascular team. Initial bolus and maintenance dosage wastitrated accordingly, and air was avoided when placing the epidural due to the patient’s septal defects.

MCC-7207 Peripartum Cardiomyopathy

Primary Author: Putta Shankar Bangalore Annaiah, M.D.New York Methodist Hospital | Brooklyn, NY, United States

Co-Authors: Arun Kalava, M.D. Amy Crane, M.D.JonathanWeinberg, M.D. Joel Yarmush, M.D.Joseph Schianodicola, M.D.

A 35 year old, G3P0, morbidly obese (BMI of 42.57 kg/m2) African American woman at 32 weeks of gestation. Her pastmedical history was significant for chronic hypertension and a recent motor vehicle accident.The patient complained ofdyspnea at rest requiring increasing oxygen supplementation. 2D echocardiogram done at bedside showed a leftventricular ejection fraction of 10%.a right internal jugular pulmonary artery (PA) catheter were inserted. Central venouspressure of 13 mm Hg and PA pressure of 33/27 mm Hg were noted. A milrinone infusion was started. The patient wastransferred to the operating room (OR) for emergency cesarean section with cardiopulmonary bypass standby.Transesophageal echocardiography was utilized to guide intraoperative anesthetic management. The baby was deliveredwith Apgar scores of 9 and 9 at , and 5 minutes, respectively. In this case, a good outcome was obtained for both motherand baby in large part because of the rapid recognition of the problem and the prompt assembly of a team designed torapidly stabilize the patient and deliver the baby.

MCC-7208 Failed Laryngoscopy During Rapid Sequence Intubation in a Learning Disabled, 20Weeks Pregnant Patient:What Next?

Primary Author: Carrie L. Hamby, M.D.Mount Sinai | New York, NY, United States

Co-Authors: Michael Marotta, M.D. Yury Khelemsky, M.D.

A 27 year old learning disabled female who is 20 weeks pregnant presents for emergency surgery. After a failed rapidsequence intubation, the anesthesiology team pursues a modified awake fiberoptic intubation in this uncooperativepregnant patient.


MCC-7209 How To Handle An Eagle - Case Report of the Anesthetic Management of an Eagle’s Syndrome

Primary Author: Carmen Pereira, M.D.CHVNG/E | Vila Nova de Gaia, Portugal

Co-Authors: Ana Filipa Carvalho, M.D. Inês Carrapatoso, M.D.Diana Gomes, M.D.

Eagle Syndrome is a rare disorder consisting of an abnormal elongated styloid process associated with dysphagia, foreignbody sensation and otalgia (the classic form) or with dissection of the carotid artery causing a transient ischemic event or astroke (the vascular form). We present a 57 year old man with elongated styloid process and bilateral dissection of carotidartery who had a stroke. He was later proposed for the surgical bilateral resection of the styloid processes. The manipulationof the barorreceptors on the internal aspect of the carotid artery can induce hypertensive variations which can be veryharmful. We choose intravenous anesthesia and invasive blood pressure monitoring as well as regional cerebral oxygensaturation (SrO2) in addition to the standard ASA monitoring in order to maintain hemodynamic stability and normalcerebral perfusion pressure throughout the entire procedure.

MCC-7210 Medically Challenging Case Report: Elective Occlusion of a Giant Brain Aneurysm with Flow Diverting PipelineStent Placement and Intra-Procedural Treatment of Thrombus Formation

Primary Author: Sean M. Neal, D.O.University of Rochester - Strong Memorial Hospital | Rochester, NY, United States

Co-Author: Amie Hoefnagel, M.D.

Discussion Any time a new procedure is being implemented at an institution for the first time the anesthesiologist must beprepared for any possible outcome by having a detailed discussion and planning session with all members of the team. Inthis particular case, teamwork and cautious attention to detail allowed for the successful management of an acutethrombus formation inside of the parent pipeline stent. Complications: • Aneurysm rupture <1% • Parent artery stenosis3-6% • In-stent thrombosis 3% • Failure to occlude the aneurysmal sac <1% at 90 days • Transient ischemic attack or stroke~5% • Need for second device ~1-5% Mangement: • Acute in-stent thrombus formation treatment is with Integrilin orTirofiban, both of which are glycoprotein IIb/IIIa inhibitors. • Intra-op Heparin • ASA and Plavix, minimum of 6 monthsConclusion Pipeline stenting is a new and improved treatment of giant cerebral aneurysms. It requires careful planningfrom an anesthesia standpoint to maintain blood pressure variability to a minimum while at the same time preparing toassist surgical team in emergent treatment of acute in-stent thrombus formation.

MCC-7211 Rupture of a Carotid Cavernous Aneurysm during a Transsphenoidal Resection of a Hemorrhagic PituitaryMass

Primary Author: Katherine Chiu, M.D., M.B.A.Stony Brook University Hospital | Stony Brook, NY, United States

Co-Authors: Mark Kim, M.D. Stephen Probst, M.D.Martin Szafran, M.D.

Management of acute massive bleeding from rupture of an unknown carotid cavernous aneurysm during a transsphenoidalresection of a hemorrhagic pituitary mass.

MCC-7212 Rett Syndrome and Anesthetic Management

Primary Author: Ana Rita BorgesCentro Hospitalar e Universitário de Coimbra | Coimbra, Portugal

Co-Authors: Paulo Roberto Ferreira Carla SilvaJoana Gonçalves Lúcia Quadros

Rett syndrome is a neurological disease that affects females. It’s characterized by a progressive degeneration in motor,cognitive and social development. Mental retardation, axial hypotonia, muscle wasting, abnormal continuous trunk andlimb movements, micrognathia, vasomotor hypractivity are some of the syndrome features with anesthetic implications.We present the case report of a female, 40 years-old, ASA III, proposed for multiple dental extractions.


MCC-7213 Cardioversion in a Patient with Increased Echogenicity on TEE?

Primary Author: Samir Shah, M.D.Stony Brook University Hospital | Middle Island, NY, United States

69 year old male with PMH of paroxysmal atrial flutter, emphysema, lung cancer with metastasis to brain, active pneumonia,presenting with atrial flutter. Cardioverted in the ED, but reverted back. Now rate controlled with diltiazem drip. DuringTEE under propofol sedation, patient was found to have increased echogenicity between right main pulmonary arterybranch, ascending aorta, and left atrium. Should the patient be cardioverted in light of this finding?

MCC-7214 Prolonged Neonatal Apnea After a General Anesthetic

Primary Author: Usman Shah, M.D.Stony Brook University Medical Center | Stony Brook, NY, United States

Co-Author: Arvind Chandrakantan, M.D.

A case of prolonged neonatal apnea after a general anesthetic that was related to severe electrolyte disturbances.Spontaneous respirations returned after correction and adequate hydration.

MCC-7215 A Pediatric Case of Foreign Body Aspiration

Primary Author: Preeti Narayan, M.D.SUNY Downstate Medical Center | Brooklyn, NY, United States

Co-Author: Helen Lauro, M.D.

FB aspiration among children is common all over the world. Asphyxiation from inhaled FB is a leading cause of accidentaldeath in children <4 years of age. We present a case of a 13-month-old child who was in severe respiratory distress afteraspiration of almonds requiring emergent intubation.

MCC-7216 Anesthetic Management of the Obstetric Patient for C-Section Delivery of Baby with a Known AbdominalWall Defect

Primary Author: Ann C. Monahan, M.D.Montefiore | New York, NY, United States

Co-Author: Shamantha Reddy, M.D.

Caring for the obstetric patient with a pregnancy with a fetal abdominal wall defect requires a multidisciplinary effortand the obstetric anesthesiologist should participate from an early point. Understanding associated risks to the baby inaddition to maternal comorbidities will help the anesthesiologist care for both mother and child. Planned cesarean sectionor trial of labor may be planned for the patient; however, the obstetric anesthesiologist must always be prepared for achange of plan in these often unstable pregnancies.

MCC-7217 Pneumothorax During Laparoscopic Fundoplication

Primary Author: Carmen PereiraCHVNG/E | Vila Nova de Gaia, Portugal

Co-Authors: Ana Filipa Carvalho Inês CarrapatosoNuno Oliveira Manuela Paiva

Laparoscopic fundoplication can successfully eliminate GERD symptoms and improve quality of life. The postoperative benefitsof laparoscopic approach and the technologic advances allowmore sophisticated surgical procedures to be performed bylaparoscopy. There are also specific concerns associated with pneumoperitoneum and positioning (respiratory andcardiovascular), and specific complications like pneumothorax and subcutaneous emphysema.We present 2 case reports ofpneumothorax during laparoscopic fundoplication, one with subcutaneous emphysema and the other with stainedhemodynamic compromise after deflation of the pneumoperitoneum. In both cases treatment consisted of an intercostaltube. It is important to be aware of the risk for development of pneumothorax during laparoscopic procedures. MonitoringEtCO2 and airway pressures allows for a quick identification of a pneumothorax when there’s a sudden and brisk increase ofboth these parameters.


MCC-7218 A Heart Breaking Pregnancy: A Case of Takotsubo Cardiomyopathy in a Pregnant Woman

Primary Author: Ann C. Monahan, M.D.Montefiore | New York, NY, United States

Co-Authors: Shane Huch, M.D. Shamantha Reddy, M.D.

Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient left ventricular regional wall motionabnormalities, apical ballooning appearance, chest pain or dyspnea, electrocardiographic changes and minor elevations ofcardiac enzyme level in the absence of coronary artery disease.We describe a rare case of a pregnant woman who developedTakotsubo syndrome during the first trimester of pregnancy and was later safely administered neuroaxial anesthesia forlabor anesthesia.

MCC-7219 Cauda Equina Syndrome Following Combined Spinal and Epidural Anesthesia: A Case Report.

Primary Author: Ana Filipa CarvalhoCentro Hospitalar Vila Nova de Gaia Espinho | Vila Nova de Gaia, Portugal

Co-Authors: Inês Carrapatoso Carmen PereiraClaudia Dourado

To describe a case of complete neurological recovery from cauda equina syndrome lasting three months following spinalanesthesia with levobupivacaine and epidural anesthesia with ropivacaine.

MCC-7220 Anesthetic Management in Mitochondrial Disease: A Case Report of an Adult Patient with OverlappingMERRF and Kearns-Sayre Syndrome

Primary Author: Alexander Praslick, M.D.Stony Brook University | Stony Brook, NY, United States

Co-Authors: Michael F Paccione, M.D. Neera Tewari, D.O.

Patients with mitochondrial diseases are uniquely challenging for the anesthesiologist. The relative rarity of these disordersmakes systematic study of their anesthetic complications difficult, and there are no practice guidelines available to advisetheir care. Most of the reported cases are from the pediatric anesthesia literature. We report the successful management ofan adult patient with overlapping Myoclonic Epilepsy and Ragged Red Fibers (MERRF) and Kearns-Sayre syndrome (KSS)who underwent general anesthesia for the removal of multiple lipomas. Special attention was paid to minimizing metabolicstress perioperatively, and potential sensitivity to paralytics and other anesthetic drugs.

MCC-7221 Brugada Syndrome and Anesthetic Considerations for Perioperative Management

Primary Author: Maria A. Kimovec, M.D.Advocate Christ Medical Center | Oak Lawn, IL, United StatesUniversity of Illinois College of Medicine at Chicago | Chicago, IL, United States

Co-Authors: Frank Zimmerman, M.D. Rebecca Grutsch, M.D.

The Brugada syndrome is an inherited sodium ion channelopathy that causes unexpected sudden cardiac arrest. This casereport reviews the pathophysiology, genetics and variation of the disease and highlights the anesthetic agents, medicationsand stressors that can unmask the syndrome.

MCC-7222 Anesthetic Management of a Patient with Cervical Epidural Hematoma and Full Stomach.

Primary Author: Sapna Ravindranath, M.D.New York Methodist Hospital | Brooklyn, NY, United States

Co-Authors: Andrew Beyzman, M.D. Joel Yarmush, M.D.Joseph SchianodiCola, M.D.

Spontaneous cervical epidural hematoma is a rare diagnosis. The patients with with full stomach are difficult to theanesthesiologists. An awake fiberoptic intubation avoids undue neck movements and also protects against aspiration.An emergent surgical evacuation may improve the neurological and functional outcomes.


MCC-7223 Fat Embolism During Hip Fracture Repair

Primary Author: Douglas SchechterNYU School of Medicine | Forest Hills, NY, United States

This is a case of an 84 year old man who underwent hip fracture repair. The patient had an intra-operative fat embolsimwhich resulted in persistent altered mental status and poor respiratory function. Areas of discussion will include: 1.Thepathophysiology of fat embolism. 2. Early signs and symptoms which may manifest themselves after a fat embolism occurs.3. An updated review of the current treatment strategies for fat embolism.

MCC-7224 Intravascular Migration of a Previously Functioning Labor Epidural Catheter: A Rare Complication thatRequires Vigilance

Primary Author: Andraous Wesam, M.D.SUNY Stony Brook | Stony Brook, NY, United States

Co-Author: Rishimani Adsumelli, M.D., F.C.A.R.C.S.I.

Inadequate/no analgesia following repeated boluses through a previously well- functioning labor epidural catheter can bedue to catheter migration and unintentional intravenous injection of local anesthetics resulting in significant morbidity. Ourcase report describes a parturient who was evaluated for inadequate pain relief following 3 hours of well-functioningepidural. She reported dizziness and ringing in the ears following the bolus with local anesthetic. The air test dose confirmedintravascular placement. Literature review of this serious adverse event, pitfalls of test dose and need for sensory blockevaluation when breakthrough pain occurs will be presented.

MCC-7225 A Patient with Osteogenesis Imperfecta Presents for His 168th Orthopedic Procedure!


Co-Authors: Jeffrey Matson, C.R.N.A. Telly Psaradellis, M.D.

A patient with osteogenesis imperfecta presented with a femur fracture - the patient's 168th orthopedic surgery! Anestheticconcerns andmanagement were discussed and included susceptibility to malignant hyperthermia, difficult airway and cervicalspine issues, platelet dysfunction, chronic opiod use, positioning difficulties, aortic and valvular abnormalities and basilarinvagination and hydrocephalus in certain patients.

MCC-7226 Intraoperative Polyuria Secondary to Dexmedetomidine Use During a Craniotomy

Primary Author: Jeremiah Jeffers, M.D.West Virginia University | Morgantown, WV, United States

Co-Author: Dennis Allen, M.D.

Intraoperative polyuria during a craniotomy, complicated by dexmedetomidine use an a component of balanced anesthesia.

MCC-7227 Total Intravenous Anesthesia in the Heart Room: A Case of Presumed Vasoplegia in a Patient with KnownMalignant Hyperthermia Undergoing Coronary Artery Bypass Grafting and Aortic Valve Replacement

Primary Author: Nazish K. HashmiUniversity of Arkansas for Medical Sciences | Little Rock, AR, United States

Co-Authors: Andrea Kay Correll, M.D. Esamelden Abdelnaem, M.D.

We present the case of a patient with a history of malignant hyperthermia who underwent coronary artery bypass graftingand aortic valve replacement under total intravenous anesthesia. His case was complicated by post bypass vasoplegiawhich responded to treatment with vasopressin and methylene blue.


MCC-7228 Pre-Propofol Infusion Syndrome (Pre-PRIS) in a Critically Ill Patient

Primary Author: Sreekanth R. Cheruku, M.D.Cleveland Clinic Foundation | Cleveland Heights, OH, United States

We report the case of a critically ill patient who developed an elevation in biomarkers associated with propofol infusionsyndrome without any of the organ system manifestations such as cardiac or renal failure. Prompt discontinuation ofpropofol after recognizing these signs resulted in normalization of biomarkers without further progression of the syn-drome.

MCC-7229 Consideration of Submental Intubation in a Complicated Trauma Patient with a Mandibular Fracture


Co-Authors: Adam Block, D.O. Bart Nierzwicki, M.D.

In patients with craniomaxillofacial trauma and contraindications to nasotracheal intubation, a submental tracheal intubationshould be considered as an useful alternative. The submental approach allows the surgeon full access to the face and dentitionwith ease of placement and low morbidity.

MCC-7230 Medically Challenging Case Poster

Primary Author: Frederick Powell, M.D.,Ph.D.Boston Medical Center | Boston, MA, United States

Co-Authors: Anna Kurian, M.D. Michael Kim, M.D.

Case Summary: Clinical case presentation of patient with low pseudocholinesterase quanities in addition to atypicalpseudocholinesterase. This case was further complicated by a presentation very similar to Phase 2 succinylcholine blockade.Patient was given neostigmine and glycopyrrolate in an effort to elucidate whether or not medication mislabeling mayhave contributed in the case. Patient had a aggressive improvement inmuscular strength post administration. This presentationis an interesting case with overlapping clinical implications with an emphasis on how to effectively diagnosepseudocholinesterase deficiency introaperatively.


Notes


Saturday, December 14, 2013 10:00 - 16:00

Sunday, December 15, 2013 10:00 - 16:00

Scientific Exhibits will be judged for awards on Sunday, December 15th, by the following Committee Members:

Apolonia E. Abramowicz, M.D. Galina Leyvi, M.D. Divina SantosStephen M. Breneman, M.D. Lixin Liu, M.D. Joseph Schianodicola, M.D.Jung T. Kim, M.D. Amanda Rhee, M.D. P. Sebastian Thomas, M.D.

Ribbons may be awarded in the followig categories:

Best Instructional ExhibitBest Scientific Exhibit

Best Exhibit for Clinical ApplicationSpecial Award

Honorable Mention

The written exhibit descriptions have been reproduced as submitted online by each exhibitor.The PGA is not responsible for the accuracy of the contents.

Scientific Exhibit Primary Author Disclosures:

The primary authors listed from pages 231 through 232 did not disclose any financial relationships, except for the following:

S-8004 on page 232Drs. I. Brodkin and A. Thierbach hold a small equity position in RostrumMedical Innovations - the company thatmanufactures the devices (VQM-tm) used for measuring enthalpy of respiratory gases.

S-8001 Smart Phone Internet Teaching of Simple Techniques to Improve Oxygenation in Patients UnderMAC: Modified TSE ”Mask” to Reduce the Risk of Fire Hazard and TSE-Alloteh Nasal CPAP/CFMask/Circuit for Patients with Obstructive Sleep Apnea

Primary Author: James Tse, M.D.,Ph.D.Rutgers - Robert Wood Johnson Medical School | New Brunswick, NJ, United States

Co-Authors: Vincent DeAngelis, M.D. Rose Alloteh, M.D. Darrick Chyu, M.D.Shaul Cohen, M.D. Sylviana Barsoum, M.D. Carolyn Kloepping, M.D.Kang Rah, M.D. Stefanie Berman, M.D. Aliraza Dinani, M.D.William Grubb, M.D. Candy Anim, M.D. ChristineW Hunter, M.D.Sagar S. Mungekar, M.D. Trishna Upadhyay, M.D. Aysha Hasan, M.D.

Desaturation is common in patients receiving MAC and nasal cannula O2. Raising NC O2 flow to improveoxygenation increases risk of fire hazard by pooling O2 under surgical drapes. This exhibit demonstrates howto increase FiO2 and prevent O2 from pooling under surgical drapes by using a fluid-shield surgical mask. Itdemonstrates how to assemble a nasal CPAP/CF mask/circuit to improve oxygenation of sedated patientswith OSA during EGD and other procedures. It shows how to improve ETCO2 monitoring for early detectionof respiratory depression and/or airway obstruction. It consists of hand-on demonstrations on a manikin andwebsite.

Scientific ExhibitsStephen A. vitkun,M.D., M.B.A., Ph.D., Chair



S-8002 Acute Surgical Pain Models: Systematic Evaluation and Narrative Review

Primary Author: Neil SinglaLotus Clinical Research | Pasadena, CA, United States

Co-Authors: Paul J. Desjardins Phoebe Chang, Ph.D.

When analgesic clinical trials produce negative findings, it is important to consider the influence of experimentalerror on that result. While efforts to optimize methodologies in chronic pain investigations have begun in earnest,less work has been performed on acute pain. Analgesics are typically tested through a spectrum of models, eachwith its unique characteristics that must be considered in order to optimize study design and conduct. This reviewdescribes the clinical and experimental characteristics of four commonly employed surgicalmodels: dental, bunion,joint replacement and soft tissue surgeries and examines each model in order to make objective comparisons.

S-8003 The Challenges in Anesthesia Workflow During the Implantation of Electronic AnesthesiaInformation Management System (AIMS)

Primary Author: Ahmed F. Attaallah, M.D.,Ph.D.Anesthesiology | Morgantown, WV, United States

Co-Author: Eric "Jake" Lindstrom, C.R.N.A

Anesthesia Information Management Systems (AIMS) replace paper records and integrate with operating roomscheduling and nurses; in addition to the hospital Electronic Medical Records (EMR). Our anesthesia module alsoincludes automated anesthesia professional billing component. While EMR and AIMS are designed to simplifyand improve patient care, there are several potential problems that can be associated with them.We will discussthe issues related to the AIMS implementation process and the challenges we encountered.We will also focus onanesthesia subspecialties such as obstetric, regional, and off-site anesthesia workflows; and share our experiencewith others who are contemplating its implementation.

S-8004 A Novel Volumetric Method of Monitoring Ventilation-Perfusion Spatial Matching

Primary Author: Igor Brodkin, M.D.Klinikum Idar-Oberstein | Idar-Oberstein, Germany

Co-Authors: Neal W. Fleming, M.D.,Ph.D. Andreas Thierbach, M.D.

Respiratory gases gain enthalpy (heat content) during normal breathing. We present a novel bed side real timemeasurement of a change in enthalpy of the respiratory gases in adults receiving positive pressure ventilation.Second only to temperature and humidity of the inspired gases, alterations in the volume of the gas returningfrom ventilated and well perfused alveoli appears to have dominant influence on the enthalpy change of therespiratory gases. This change is proposed as a non-invasive indicator of volumetric matching between thealveolar ventilation and perfusion (effective alveolar ventilation).

S-8005 Operating RoomManagement Software: A Novel Solution that Helps Empower Optimization Resources

Primary Author: Harold Arkoff, M.D.Saint Vincent Hospital | Worcester, MA

ORMS Team Builder optimizes the hospital's overall cost efficiency, professional staff management, JHACOcompliance, and the delivery of high-quality care that garners high patient satisfaction ratings and strongreimbursement rates.


Technical Exhibitor ListingA Royal Treasure, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145abeo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302AcelRx Pharmaceuticals, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244Ambu Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313American Academy of Anesthesiologist Assistants (AAAA) . . . . . .106American Anesthesiology, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229American Society of Anesthesiologists (ASA) . . . . . . . . . . . . . .118, 119Analogic Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239Anchor Medical Supply, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103Anesthesia Associates, Inc. (AincA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120Anesthesia Business Consultants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .234Anesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305Anesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241Anesthesiology News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .208Arizant Healthcare Inc., a 3M company . . . . . . . . . . . . . . . . . . . .133, 134Armstrong Medical Industries, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236

Berall VL (Video Laryngoscope) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104

Cadence Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303, 304CASMED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209, 210Centurion Medical Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213CIVCO Medical Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255Clarus Medical LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301Cook Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .325Covidien . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .246, 247, 248, 249, 250, 251Cumberland Medical Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220Cumberland Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221, 222Cutco Cutlery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107Cyber Relax/ACIGI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110, 111

Disposcope USA LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127Dr. Jensen’s Anesthesiology Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240Draeger Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319, 320, 321Dupaco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254

Edwards Lifesciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243Elsevier, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201BEmCare Anesthesia Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .317

Flexicare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123FUJIFILM SonoSite, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230, 231

Gauss Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105GE Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306, 307, 308Gilman Ciocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237Grifols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

Havel’s Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214Horizon Pharma, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207Hospira . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312

I-Flow, LLC, a Kimberly-Clark Health Care Company . . . . . . . . . . . . .318Infinite Therapeutics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137Intermedix ARM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .211Intersurgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Karl Storz Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315Kern Augustine Conroy & Schoppmann, P.C. . . . . . . . . . . . . . . . . . . .204King Faisal Specialist Hospital and Research Center . . . . . . . . . . . . .146

LexcoWealth Management, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215ALiDCO, Ltd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128LippincottWilliams &Wilkins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225, 226LivingWell Solutions, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109LocumTenens.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259

Masimo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216, 217, 218, 219MBS Insurance Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205McKesson Business Performance Services . . . . . . . . . . . . . . . . . . . . . .261Medcomflow S.A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125Medical Liability Mutual Insurance Company (MLMIC) . . . . . . . . . .245Medical Management Resources (MMRI) . . . . . . . . . . . . . . . . . . . . . . .131Mediflex Surgical Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153Med-IQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114Merck & Co . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235Mindray North America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115, 116, 117Moog Medical Devices Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .206Mylan Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257

Nihon Kohden America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215CNonin Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .316North American Partners in Anesthesia (NAPA) . . . . . . . . . . . .232, 233Northwest Anesthesia Seminars, Inc. . . . . . . . . . . . . . . . . . . . . . .227, 228Novamed USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242

Oceanus Insurance Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124Olympus America Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .326OpenTempo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136Origin Healthcare Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201, 201AOxford University Press . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140

Pajunk Medical Systems LP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260Parker Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122Philips Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150, 151Pinnacle Partners in Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112Plexus Information Systems, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256Preferred Physicians Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .322Productive Scheduling Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132Pulsion Medical Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224

QGenda, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

rEVO Biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135Revolutionary Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152

Salmon Medical Innovations, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212Sheridan Healthcare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121Siemens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215BSociety for Ambulatory Anesthesia (SAMBA) . . . . . . . . . . . . . . . . . . .113Somnia Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215Spectra Medical Devices, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129SPi Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252

TeamHealth Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223Teleflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .309, 310, 311TEM Systems, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258Terason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130The American Board of Anesthesiology, Inc. . . . . . . . . . . . . . . . . . . . .102Truphatek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253

UBS Financial Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203UltraScope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138United States Army Health Care Team . . . . . . . . . . . . . . . . . . . . . . . . . .141

Verathon Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .238

Zotec Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .323, 324


Company Descriptions and BoothsA Royal Treasure, LLC ........................................................145Sun City Center, FLWe are a company that specializes in Corporate Gifts andEmployee Incentives. We take the opportunity to exhibit ourline of Fine High Fashion Jewelry at conventions all over theUnited States, while offering an unprecedented lifetimewarranty, loss and theft insurance and full replacement value.Come and visit us # 145. Hurry one of a kind items go fast.

abeo ....................................................................................302Irving, TX

AcelRx Pharmaceuticals, Inc. ............................................244Redwood City, CASublingual PCA device

Ambu Inc. ...........................................................................313Glen Burnie, MDTogether, Ambu Inc. and King Systems have become a leadingUS supplier of disposable airway management products. Thisportfolio includes a wide range of disposable face masks,breathing circuits and laryngeal tubes used to maintain thepatient’s airway in critical care settings, such as during generalanaesthesia or in intensive care units.

AmericanAcademyofAnesthesiologistAssistants(AAAA) ....................................................................................106Richmond, VAThe American Academy of Anesthesiologist Assistants is thenational organization dedicated to the ethical advancementof the Anesthesiologist Assistant profession and to excellencein patient care through education, advocacy, and promotionof the Anesthesia Care Team.

American Anesthesiology, Inc. .........................................229Sunrise, FL

Anesthesia Services and Products ...................................305Oxford, PAAnesthesia Services and Products (www.asap-inc.com) is a full-line specialty Anesthesia Distributor offering disposablesupplies and capital equipment. Airtraq is a cost effective,portable guided video intubation device. Disposable andreusable patient monitoring cables, disposable ECG leads andblood pressure cuffs. The Epidural Positioning Device (EPD)allows you to position patients correctly and comfortably byencouraging cervical, thoracic and lumbar flexion whilemaintaining a solid and stable position. We offer MACOreusable and disposable fiber-optic laryngoscope blades andthe Allied portable ventilation, CO2 absorbent and suctiondevice.

AmericanSocietyofAnesthesiologists (ASA)..............118, 119Park Ridge, IL

Analogic Ultrasound..........................................................239Peabody, MAAnalogic’s BK Medical and Ultrasonix are leading providers ofpremium performance ultrasound for anesthesiologists. Ournew product portfolio offers procedure-driven ultrasoundtechnologies and a broad range of transducers. The SonixGPSPositioning System and SonixShine Needle Enhancementtechnology have been designed to assist with training anddifficult procedures. Our Quantum technology deliversexcellent image quality with superb contrast resolution andpenetration.

Anchor Medical Supply, Inc...............................................103NewYork, NY

Anesthesia Associates, Inc. (AincA) ..................................120San Marcos, CAAnesthesia Associates, Inc. (AincA) manufactures reusableanesthesia and respiratory care products. These include MRIand custom Jet Ventilators, fiber-optic and conventionallaryngoscopes, video stylets, and aids for difficult intubation.Also available are many breathing circuits and components,special adapters, custom designs, nerve stimulators, anddigital / analog Respirometers. www.AincA.com. Over 55 Yearsof Manufacturing!

Anesthesia Business Consultants.....................................234Jackson, MIAnesthesia Business Consultants, LLC provides billing &practice management services for anesthesia and painmanagement providers, featuring OneSourceAnesthesia, themobile systems architecture supporting the entireperioperative process andF,RSTUse, our revolutionary productto secure Meaningful Use through complete EHR. The heart ofour offerings is ABC’s proprietary practice managementsoftware, F,RSTAnesthesia™. Our solutions provide accurate,prompt and complete billing and revenue cycle management.Our exclusive focus improves your cash flow and profitability.

Anesthesia Tools, Inc. ........................................................241Bedford, VAPenlon Anesthesia MachineLaryngoscopes

Anesthesiology News ........................................................208NewYork, NYAnesthesiology News (AN), the best-read publication for thespecialty is mailed monthly to all 46,135 anesthesiologists andanesthesiology residents in the United States. This medicalnewspaper offers extensive coverage of major clinicalmeetings affecting the specialty and feature articles on topicsrelevant to practicing anesthesiologists. AN also presents in-depth clinical reviews written by thought leaders,cutting-edge practice management articles, medicaleducation and CME activities.

Arizant Healthcare Inc., a 3M company ...................133, 134Saint Paul, MNArizant Healthcare Inc., a 3M company, pioneered the conceptof forced-air patient warming with the introduction of 3M™Bair Hugger™ therapy in 1987. Today, our ground-breakingtemperature management product portfolio also includes the3M™ Bair Paws™ system, 3M™ Ranger™ blood and fluidwarming systems and the 3M™ SpotOn™ temperaturemonitoring system.

ArmstrongMedical Industries, Inc. ..................................236Lincolnshire, ILCarts, wireless, aluminum or steel, custom or standard, keylessentry or key-locking, latex free, Bronchoscopy carts,emergency Broselow Pediatric Resuscitation carts andcomplete system.

Berall vL (video Laryngoscope) .......................................104Brooklyn, NYBerall Video Laryngoscope: portable, hand-held, batterypowered, lightweight, disposable Mac blade, real time HD andvideo functions, CMOS image sensors with 300,000 pixels, 3.5'LCD screen, TV-out capability.


Cadence Pharmaceuticals.........................................303, 304San Diego, CA

CASMED......................................................................209, 210Branford, CT

CenturionMedical Products .............................................213Williamston, MICenturion Medical Products develops unique products andcustom procedure trays with critical input from end users.Product offering includes the SorbaView® SHIELD cathetersecurement system, SorbaView® Ultimate IJ dressing system,patented SnagFree® Instruments, Foley Anchor securementdevice, Eme-Bag®, and the biodegradable Eco-Eme-Bag™.Centurion specializes in creating sterile custom proceduretrays, featuring the CVC Zone Bundle – a central line insertionbundle with everything you need — in the desired sequence— to prevent CLABSIs and improve outcomes.

CIvCOMedical Solutions ..................................................255S. Kalona, IAUltrasound needle guidance, Custom brackets and Guides, aswell as Probe covers.

Clarus Medical LLC.............................................................301Minneapolis, MNAirway scopes for intubating and airway management. Shikani,Levitan and Video Scope.

CookMedical......................................................................325Bloomington, IN

Covidien.....................................246, 247, 248, 249, 250, 251Boulder, CO

CumberlandMedical Affairs .............................................220Nashville, TNCaldolor® (ibuprofen) Injection is indicated in adults for themanagement of mild to moderate pain, the management ofmoderate to severe pain as an adjunct to opioid analgesics,and for the reduction of fever. Caldolor has been proven safeand effective when administered pre-, intra- and post-operatively and is the first FDA-approved IV NSAID for thetreatment of both pain and fever. Caldolor is marketed byCumberland Pharmaceuticals Inc. based in Nashville, TN.

Cumberland Pharmaceuticals ..................................221, 222Nashville, TNCaldolor® (ibuprofen) Injection is indicated in adults for themanagement of mild to moderate pain, the management ofmoderate to severe pain as an adjunct to opioid analgesics,and for the reduction of fever. Caldolor has been proven safeand effective when administered pre-, intra- and post-operatively and is the first FDA-approved IV NSAID for thetreatment of both pain and fever. Caldolor is marketed byCumberland Pharmaceuticals Inc. based in Nashville, TN.

Cutco Cutlery......................................................................107Olean, NYCutco Cuttery, culinary tools, cookware, flatware, by the world’sfinest cutlery - backed by our forever guarantee.

Cyber Relax/ACIGI......................................................110, 111Fremont, CACyber relax massage chair, the no. , massage chair.

Disposcope USA LLC..........................................................127Princeton, NJDisposcope is a stylet with a camera on the tip, it provides thefunctions of a Laryngoscope, Video-assisted Laryngoscope,Fibroptic scope and simple Broncoscope. It is a lightweight,cost-effective and portable system.

Dr. Jensen’s Anesthesiology Board ..................................240Iowa City, IA

Draeger Medical ................................................319, 320, 321Telford, PAAnesthesiaWorkstationsAIMS Software

Dupaco ...............................................................................254Oceanside, CAProneView® Protective Helmet and Mirror System providessuperior head and eye protection with soft contoured cushion.Meets AORN guidelines and ASA /APSF practice advisories.Opti-Gard® patient eye protector protects patients eyes fromtrauma and unintentional contact during surgery.Chin-UP® provides support to help keep MAC patient airwaysopen.ProneCam® uses soft comfortable cushion with cameramonitoring system to check patient face and eye safety duringprone procedures.ECT airway allows ECT patient to breath continually duringshock therapy while providing bite block at the molars.

Edwards Lifesciences.........................................................243Irvine, CA

Elsevier, Inc. .....................................................................201BPhiladelphia, PA

EmCare Anesthesia Services .............................................317Horsham, PAWith more than 30 years of experience managing cost-effective anesthesia programs, EmCare Anesthesia Services canmeet your hospital's need for an experienced, highly trainedanesthesiology staff. Backed by extensive national resources,EmCare affiliated anesthesiologists and certified registerednurse anesthetists (CRNAs) provide reliable anesthesiologyservices.

EmCare’s success is based on its commitment to qualityphysician leadership backed with comprehensive supportprograms that allow physicians to focus on patients and qualityclinical medicine.

Flexicare, Inc.......................................................................123Irvine, CAFlexicare is a leading UK manufacturer of medical devices,including airway management, anesthesia and oxygen deliveryand monitoring systems. Flexicare is excited to exhibit theirrange of products, such as BritePro Solo – the completedisposable laryngoscope system (blade, handle andlightsource in a single sterile pack), Laryngeal Masks, ET tubesand Dual Capnography products and accessories among otherinnovative solutions. With over 35 years of experience indesign, development and manufacturing of medical devices,Flexicare has developed a world-class reputation.

FUJIFILM SonoSite, Inc. .............................................230, 231Bothell, WAFUJIFILM SonoSite, Inc., the world leader in bedside and point-of-care ultrasound, delivers solutions that meet imaging needsof the medical community. With its acquisition of VisualSonics’ultra high-frequency micro imaging technology, SonoSitecontinues to influence the future of medical ultrasound in boththe clinical and preclinical markets.

Gauss Surgical....................................................................105Los Altos, CAGauss Surgical has developed a mobile platform for real-timemonitoring of fluids and blood during surgery.


GE Healthcare ....................................................306, 307, 308Madison,WIGE is making a new commitment to health.Healthymagination will change the way we approachhealthcare, with more than 100 innovations all focused onaddressing three critical needs: lowering costs, touching morelives and improving quality.For more information, visit: www.gehealthcare.com

Gilman Ciocia ....................................................................237Poughkeepsie, NY

Grifols .................................................................................202RTP, NCThrombate 3 (antithrombin III) indicated for hereditaryantithrombin deficiency.

Havel’s Inc...........................................................................214Cincinnati, OH

Horizon Pharma, Inc. .........................................................207Doylestown, PADuexis: A novel tablet formulation containing a fixed-dosecombination of ibuprofen and famotidine in a single pill.

Hospira ...............................................................................312Lake Forest, ILHospira is the world’s leading provider of injectable drugs andinfusion technologies. The company is headquartered in LakeForest, Ill., and has approximately 16,000 employees. Learnmore at www.hospira.com. For more information, stop byHospira’s booth or call 1-877-946-7747 to learn the latestregarding Precedex™ (dexmedetomidine HCl Injection) andVoluven® (6% Hydroxyethyl starch 130/0.4 in 0.9% sodiumchloride injection) — See full prescribing information.

I-Flow, LLC, a Kimberly-Clark Health Care Company ......318Lake Forest, CA

Infinite Therapeutics .........................................................137Kingston, NHInfinity brand luxury massage chairs.

Intermedix ARM.................................................................211Warren, MIAnesthesia Billing and Practice Management

Intersurgical .......................................................................139Liverpool, NYIntersurgical® offers a wide range of high-quality andinnovative products including: QuadraLite®, an anatomical,“feather light touch”, no odor, easy-to-use anesthesia mask andi-gel®, the supraglottic airway with an integrated bite blockand gastric channel which secures the airway naturally with anon-inflating cuff, reduces trauma and improves patient safetyand outcome. EndoFlex® endotracheal tubes provide control ofthe tube right where you need it without extra parts in aninexpensive easy-to-use product. Intersurgical – Quality,innovation and choice!

Karl Storz Endoscopy.........................................................315El Segundo, CA

Kern Augustine Conroy & Schoppmann, P.C. ..................204Westbury, NYLegal Services

King Faisal Specialist Hospital and Research Center ..... 146Toronto, CanadaThe King Faisal Specialist Hospital and Research Centre(General Organization) (KFSH&RC-Gen Org) is a tertiary care,state of the art Hospital situated in the cities of Riyadh andJeddah, Kingdom of Saudi Arabia and accredited by the JointCommission International Accreditation (JCIA). Our combinedbed capacity of 1,331 is dispersed over three locations.KFSH&RC is the national referral of sub-specialties forOncology, Organ Transplantation, Cardiovascular Diseases,Neurosciences and Genetic Diseases with postgraduateeducation programs that support both Residency andFellowship Training. Expansion projects are planned, includingthe development of a Pediatric Care Hospital, a dedicatedOncology & Liver Centre and a Biotechnology Centre.

LexcoWealth Management, Inc. ....................................215ATarrytown, NYLexcoWealth Management is an independent RegisteredInvestment Advisor specializing in comprehensive financialplanning and asset protection strategies for anesthesiologists.

LiDCO, Ltd...........................................................................128London, UK

LippincottWilliams &Wilkins ...................................225, 226NewYork, NYLippincottWilliams &Wilkins is a leading publisher of medicaltextbooks and journals.

LivingWell Solutions, Inc...................................................109Plainview, NYLife insurance, disability insurance, health insurance, long termcare insurance, employee benefits, and retirement plans.

LocumTenens.com .............................................................259Alpharetta, GALocumTenens.com is a full-service staffing firm servingphysicians, CRNAs, NPs and PAs searching for locum tenensand permanent job opportunities, and healthcare facilitieslooking to solve employment shortages.

Masimo.......................................................216, 217, 218, 219Irvine, CAMasimo is a global medical technology company that developsand manufactures innovative noninvasive monitoringtechnologies, including medical devices and a wide array ofsensors that may enable earlier detection and treatment ofpotentially life-threatening conditions. A key medicaltechnology innovator, Masimo is responsible for the inventionof award-winning noninvasive technologies that arerevolutionizing patient monitoring, including Masimo SET®pulse oximetry, Masimo rainbow SET® noninvasive andcontinuous hemoglobin (SpHb®), acoustic respiration rate(RRa™), and Masimo SafetyNet™, and SEDLine® (EEG-based)Brain Function Monitors.

MBS Insurance Services.....................................................205Boonton, NJWe are a full service insurance agency and healthcareconsulting company with over 30 years experience.

McKesson Business Performance Services ......................261Alpharetta, GAMcKesson, processing over 2.5 million cases annually for over3,200 anesthesiologists, is uniquely qualified to take yourfinancial performance to the next level. Reimbursement cuts,coding changes and tougher compliance rules significantlyundermine revenue. McKesson has been addressing theseissues for more than 25 years with our market –leading medicalbilling and practice management solutions foranesthesiologists. Anesthesiologists understand thatMcKesson’s solutions can help them grow revenue, controlcosts, improve coding and documentation, ensure cleanclaims, optimize reimbursement and minimize regulatory risks.Accelerate the flow of funds and strategize for future growthopportunities with McKesson. [email protected]/anesthesiologyservices

Med-IQ ................................................................................114Baltimore, MAComplimentary continuing medical education activities forphysicians, nurses, and pharmacists.

Medcomflow S.A. ...............................................................125Metuchen, SpainThe totaltrack VLM, VideoLaryngeal Mask, is the first airwaydevice that allows ventilation and intubation and viceversa.


Medical LiabilityMutual Insurance Company (MLMIC)....245NewYork, NYProfessional liability insurance for physicians, surgeons, andhospitals.

Medical Management Resources (MMRI) ........................131East Syracuse, NYMMRI is a premier provider of billing and practicemanagement services to the medical profession. We promotea culture of innovation, teamwork and individuality within ourcompany. Our commitment to integrity, compliance, staffdevelopment and client satisfaction guarantees long lastingrelationships!

Mediflex Surgical Products ...............................................153Islandia, NYThe new airway assist from Mediflex Surgical Products isdesigned to facilitate endotracheal tube insertion.

Merck & Co Pharmaceuticals ............................................235Whitehouse Station, NJ

Mindray North America ....................................115, 116, 117Mahwah, NJ

MoogMedical Devices Group...........................................206Salt Lake City, UTMoog Inc. is a worldwide designer, manufacturer, andintegrator of precision control components and systems. MoogMedical Devices Group / Curlin Infusion-Zevex Enteral offers afull line of infusion pumps and enteral pump devices alongwith disposable administration sets and accessories. Ourpumps combine the convenience of small size ambulatorypumps with the sophistication of hospital devices.

Mylan Inc. ...........................................................................257Basking Ridge, NJMylan Specialty, a subsidiary of Mylan Inc. (NASDAQ: MYL), is aspecialty pharmaceutical company focused on thedevelopment, manufacturing and marketing of prescriptiondrug products for general anesthesia and for the treatment ofrespiratory diseases, life-threatening allergic reactions andpsychiatric disorders. For more information, please visitwww.mylanspecialty.com.

Nihon Kohden America...................................................215CFoothill Ranch, CAPerioperative & defensive monitoring solution.

NoninMedical ....................................................................316Plymouth, MNNonin Medical, the inventor of finger pulse oximetry,specializes in noninvasive physiological monitoring solutions.Nonin distributes its pulse and regional oximeters,capnographs, sensors and software in more than 125 countriesand has more than 100 OEM partners worldwide.www.nonin.com

North American Partners in Anesthesia (NAPA) .....232, 233Melville, NYFounded in 1986, North American Partners in Anesthesia(NAPA) is the leading single specialty anesthesia managementcompany in the United States. NAPA is comprised of the mostrespected clinical staff, providing thousands of patients withsuperior and attentive care. The company is known forpartnering with hospitals and other health care facilities acrossthe nation to provide anesthesia services and perioperativeleadership that maximize operating room performance,enhance revenue, and demonstrate consistent patient andsurgeon satisfaction ratings. For more information, please visitwww.NAPAanesthesia.com.

Northwest Anesthesia Seminars, Inc. ......................227, 228Pasco,WANorthwest Anesthesia Seminars in joint sponsorship withBaylor Healthcare Systems, Dallas, TX. for continuing MedicalEducation, provides conferences and workshops for physicianand other advanced medical care providers. Each conference(unique for each location) as well as focused workshops areheld in over 130 locations a year, some simultaneously,allowing participants to select each day’s courses based onindividual need.

Novamed USA ....................................................................242Elmsford, NYNOVAMED USA strives to provide innovations in critical carewith products focused on airway management, temperaturemonitoring and patient warming.2013 features include:

For a safer MR Suite, NOVALITE MRI Fiber Optic Laryngoscopeswith a complete selection of certified safe reusable and singleuse blades.For total patient access and a $avings on the OR spend, KOALAconductiveWarming System provides the reusable underbodyanswer to patient warming - eliminating costly disposables. Forimproved illumination, NOVALITE LED Laryngoscopes set anew standard with 100% Stainless Single Use blades andhandles.For monitoring heart / breath sounds and measuring corebody temperature, LIFESOUND and NOVATEMP are recognizedNOVAMED brand names unparalleled for accuracy andreliability.

Oceanus Insurance Company ...........................................124West Hartford, CTOceanus Insurance crafts flexible, custom-designed coveragefor Anesthesiologists and CRNAs. And, since we are owned byour policy-holders, we maintain greater control over pricing,coverage and risk management programs offered. Call us tosee how we can save your practice money!

Olympus America Inc.........................................................326Center Valley, PA

OpenTempo........................................................................136Williston, VTOpenTempo™, provides enterprise scheduling and practicemanagement tools expressly built to supportAnesthesiologists, CRNA's, Residents and perioperative staff inboth private and departmental practices. OpenTempo providesusers with real-time access to call, shift and daily case scheduleinformation via their mobile devices. OpenTempo also includesa comprehensive time-tracking and payroll managementsystem, featuring touchscreen kiosks. We will demonstrateOpenTempo with your users, rules and settings on ourproduction environment free of charge and without priorcommitment to completely prove that our product is right foryou.

Origin Healthcare Solutions...................................201, 201AWindsor, CT

Oxford University Press.....................................................140NewYork, NYOxford University Press publishes some of the most highlyrespected and prestigious anaesthesia books and journals inthe world, including BJA and Continuing Education inAnaesthesia, Critical Care & Pain. Visit our booth to browse andpurchase books at a 20% discount, and to pick up free journalcopies.


PajunkMedical Systems LP...............................................260Norcross, GA

Parker Medical ...................................................................122Highlands Ranch, COParker Medical develops and markets innovative airwaymanagement products designed to facilitate rapid, easy,accurate and safe intubations. Parker recently introduced acomplete new line of Parker ThinCuff endotracheal tubes.These DEHP-free tubes have the patented Parker Flex-Tip. Ourother current products include a complete line of Parker Flex-It® directional stylets, disposable silicone Parker LaryngealMask Devices, and a complete line of lightweight, anatomicallycorrect, AirSim intubation training mannequins made byTruCorp.

Philips Healthcare .....................................................150, 151Andover, MAAnesthesia MonitorsAnesthesia MachineUltrasound

Pinnacle Partners in Medicine ..........................................112Dallas, TXPinnacle Partners in Medicine is one of the largest anesthesiaand pain medicine groups in the nation providing a widespectrum of services at major hospitals and other clinical sites.Our practices include diverse cases performed by well-respected physicians in premier facilities. Pinnacle's successgives us the fortitude to offer industry-leading compensationand benefit packages in locations which afford outstandinglifestyle opportunities.

Plexus Information Systems, Inc. .....................................256Westwood, MAPlexus Information Systems, Inc. (Plexus IS) is a subsidiary ofPlexus Management Group, the largest anesthesiamanagement organization in the New England region. PlexusIS developed Anesthesia Touch™, a comprehensive AnesthesiaInformation Management System (AIMS) that works on boththe traditional desktop environment as well as a mobileplatform such as the Apple iPad.

Anesthesia Touch is a full featured software product that givesAnesthesia providers the power to manage informationelectronically in the perioperative environment. The interface isclean, intuitive, and highly customizable. In addition to usingautomated documentation of physiologic and machine data,Anesthesia Touch provides intelligent clinical decision supportsuch as allergy alerts, antibiotic redosing, and best practicecompliance reminders.

Preferred Physicians Medical............................................322Shawnee Mission, KSPreferred Physicians Medical (PPM) provides malpracticeinsurance exclusively to anesthesiologists. For over 25 years,PPM has developed a national reputation for aggressivelydefending its insureds, providing proactive anesthesia specificrisk management and superior customer service. Owned bythe anesthesiologists we insure, PPM’s sole focus is you andprotecting your professional reputation. www.ppmrrg.com

Productive Scheduling Solutions.....................................132Chicago, ILEZ Call is a highly intuitive, completely configurable, webbased scheduling program. Designed by an anesthesiologistfor anesthesiologists, EZ Call creates balanced schedulesaccording to your group's specific rules and requirements.

PulsionMedical Inc. ...........................................................224Powell, OHPicco: less invasive advanced hemodynamic monitoringPulsioFlex Monitoring Platform: flexible perioperativemonitoring

QGenda, Inc........................................................................126Atlanta, GAQGenda is the leader in automated on-call physicianscheduling software. QGenda's features include automatedrule based scheduling, easy-to-use drag & drop interface,syncing to mobile devices, integration across outside softwaresystems, centralization of schedules and marrying RVUs.QGenda is fully web-based and offers outstanding customerservice and on-going support and training.

rEvO Biologics....................................................................135Framingham, MAATryn, recombinant antithrombin concentrate.

Revolutionary Medical Devices ........................................152Tucson, AZAirway management device incorporating sniff position, jawthrust, head elevation and ramp.

SalmonMedical Innovations, LLC ....................................212Bethesda, MDFor use during patient Laryngoscopy and Tracheal Intubation

Help protect your patient from dental injuries duringendotracheal intubation. This medical-grade, elastic,hypoallergenic, and latex free foam strip is designed to stretchand conform while providing the flexibility to maneuverintubations with ease, even for the most difficult intubations.

DentaSafe helps prevent costly damage to the upper incisors,which are the most frequently affected teeth duringintubation. Single use, disposable foam strip attaches to theflange of the laryngoscope blade and prevents direct contactbetween the metallic blade and the patient’s upper teeth.

DentaSafe can assist in patient intubation, making it muchsafer, smoother, and quicker. Avoid costly expenses andlawsuits associated with patient dental injuries.

Sheridan Healthcare, Inc. ..................................................121Sunrise, FL

Siemens............................................................................215BValley Stream, NYSiemens' ACUSON Freestyle™ ultrasound system is the world'sfirst wireless, cable-free ultrasound system designed for use inprocedural guidance. Find your freedom!

Society for Ambulatory Anesthesia (SAMBA) .................113Chicago, ILFounded in 1985, the Society for Ambulatory Anesthesia(SAMBA) enjoys a membership of over 1,500 physicians whoactively practice ambulatory anesthesia, other healthprofessionals with an interest in ambulatory anesthesia, andresidents in training. The goals of the Society are:• To advance the practice of ambulatory anesthesia in allambulatory venues• To encourage high ethical and professional standards and byfostering and encouraging education and research• To provide professional guidance for the practice ofambulatory anesthesia

Spectra Medical Devices, Inc.............................................129Wilmington, MA

SPi Healthcare....................................................................252Tinley Park, ILSPi Healthcare is your committed partner for end-to-endrevenue cycle management and specialized health informationmanagement. For nearly three decades, we have helped ourclients work through tough situations and overcome complexchallenges.We roll up our sleeves in partnership with everyclient, at every level of our organization, to help our clientsreduce costs so they can provide quality care.


Somnia Anesthesia ............................................................215New Rochelle, NYSomnia Anesthesia optimizes anesthesia services for healthcarefacilities throughout the country by combining clinicalexcellence with unparalleled management acumen. Ownedand operated by anesthesiologists since 1996, Somnia providesa turnkey, solutions-based approach to anesthesiamanagement.With an extensive in-house infrastructure and asingle-minded focus on anesthesiology, Somnia builds andmanages local anesthesia teams that consistently deliver thehighest quality patient care, enhance operating roomperformance, increase revenues, and achieve full surgeon andpatient satisfaction. For more information visit:www.somniainc.com.

TeamHealth Anesthesia ....................................................223Palm Beach Gardens, FLTeamHealth Anesthesia provides comprehensiveanesthesiology and pain management services for hospitals,surgery centers, and pain management groups throughout theU.S.

Teleflex ...............................................................309, 310, 311Durham, NC

TEM Systems, Inc................................................................258Durham, NCROTEM® delta, a whole blood Hemostasis Analyzer has 5 pre-packaged assays to look at the viscoelastic properties of theclot in “real-time.”The temograms produced provide clinicalinformation that along with other relevant laboratory data andclinical impression can assist physicians with better bloodmanagement decisions for their patients.

Terason ...............................................................................130Burlington, MATerason’s new light-weight, power-packed uSmart 3200TUltrasound System is a fusion of cutting-edge technology andease-of-use. The newest member of the Terason family weighsjust under 5 lbs., provides razor-sharp image quality, and isequipped with the features and functionality users expect fromthe Terason name. It provides invaluable tools for a busypractice, including a 128GB Solid State hard drive, SmartGestures, an Adaptive Touch Screen, uConnect™ remotecapabilities, and a fast boot-up time.

The American Board of Anesthesiology, Inc....................102Raleigh, NCThe American Board of Anesthesiology (ABA) examines andcertifies physicians who complete an accredited program ofanesthesiology training in the United States and voluntarilyapply to the Board for certification or maintenance ofcertification. Please visit the ABA booth to get details aboutprimary certification in anesthesiology, subspecialtycertification, and Maintenance of Certification inAnesthesiology Program (MOCA). ABA staff can guide youthrough the ABA website (www.theABA.org) and yourphysician portal account.

Truphatek ...........................................................................253Ashland, MOVideo LaryngoscopeConventional Laryngoscope blades and handles

UBS Financial Services.......................................................203Bedminster, NJAt the McMahonWealth Management group, we believe that aclear, actionable plan helps address all aspects of our clients'financial life. By providing advice beyond investing, we are ableto include all the pieces of your financial picture within a plan,and together, create solutions to help achieve your goals.

UltraScope..........................................................................138Charlotte, NCUltraScope stethoscopes provide cardiology performance inextremely noisy environments. Lightweight, shatter proofheads are hand painted. Customized engraving, painting andcorporate logo options are available. Try the Classic model, forhard of hearing (or our “mature users”). Deep quantitydiscounts at the booth. LifetimeWarranty.

United States Army Health Care Team .............................141Picatinny Arsenal, NJThe United States Army Medical Department has manyprograms available to Health Care Professionals. We provide agreat financial package and continuing educational programsfor Health Care Professionals. Our mission is to provideinformation regarding part-time opportunities in the UnitedStates Army Reserves and guide civilian health careprofessionals through every step of the process.

verathonMedical...............................................................238Bothell, WA

Zotec Partners............................................................323, 324Carmel, INZotec Partners is a revenue cycle management solutionscompany with a proven track record of solving real world,bottom-line challenges for the nation’s leading anesthesiagroups. As an industry leader in medical billing and practicemanagement software and services, Zotec Partners iscommitted to the continual pursuit of excellence in theanesthesiology revenue cycle management industry, anddelivers effective solutions through innovative software,personalized service and measurable client results. Thecompany’s software and services are used by 5,500 physiciansin 45 states.


Product Category ListingActive PatientWarmingArizant Healthcare Inc., a 3M company . . . . . . . . . . . . . . . .133, 134

AirwayManagementAmbu Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313Anesthesia Associates, Inc. (AincA) . . . . . . . . . . . . . . . . . . . . . . . .120Anesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . .305Anesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241Armstrong Medical Industries, Inc. . . . . . . . . . . . . . . . . . . . . . . . . .236Berall VL (Video Laryngoscope) . . . . . . . . . . . . . . . . . . . . . . . . . . . .104Clarus Medical LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301Cook Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .325Covidien . . . . . . . . . . . . . . . . . . . . . . . . . .246, 247, 248, 249, 250, 251Dupaco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254Flexicare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123Intersurgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139Karl Storz Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315Medcomflow S.A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125Mediflex Surgical Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153Novamed USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242Parker Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122Revolutionary Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . .152Salmon Medical Innovations, LLC . . . . . . . . . . . . . . . . . . . . . . . . . .212Teleflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .309, 310, 311Truphatek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253Verathon Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .238

AnalyticsOrigin Healthcare Solutions . . . . . . . . . . . . . . . . . . . . . . . . .201, 201A

Anesthesia EquipmentAnesthesia Associates, Inc. (AincA) . . . . . . . . . . . . . . . . . . . . . . . .120Anesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . .305Anesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241Armstrong Medical Industries, Inc. . . . . . . . . . . . . . . . . . . . . . . . . .236Berall VL (Video Laryngoscope) . . . . . . . . . . . . . . . . . . . . . . . . . . . .104GE Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306, 307, 308Intersurgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139Karl Storz Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315Medcomflow S.A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125Pajunk Medical Systems LP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260Parker Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122Philips Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150, 151Revolutionary Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . .152

Anesthesia InformationManagement SystemPlexus Information Systems, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . .256

Anesthesia MachinesAnesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241Draeger Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319, 320, 321GE Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306, 307, 308Philips Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150, 151

Anesthesia Management CompanyNorth American Partners in Anesthesia (NAPA) . . . . . . . .232, 233

Anesthesia Services (Clinical)Pinnacle Partners In Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112

Billing Servicesabeo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302Anesthesia Business Consultants . . . . . . . . . . . . . . . . . . . . . . . . . .234Gilman Ciocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237Intermedix ARM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .211McKesson Business Performance Services . . . . . . . . . . . . . . . . .261Medical Management Resources (MMRI) . . . . . . . . . . . . . . . . . .131Origin Healthcare Solutions . . . . . . . . . . . . . . . . . . . . . . . . .201, 201ASPi Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252Zotec Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .323, 324

BloodManagement SystemsGauss Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105Masimo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216, 217, 218, 219TEM Systems, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258

Blood/FluidWarming SystemsArizant Healthcare Inc., a 3M company . . . . . . . . . . . . . . . .133, 134Masimo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216, 217, 218, 219

Carts/TraysArmstrong Medical Industries, Inc. . . . . . . . . . . . . . . . . . . . . . . . . .236Centurion Medical Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213

Catheters/NeedlesAmbu Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313Centurion Medical Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213Cook Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .325Edwards Lifesciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243I-Flow, LLC, a Kimberly-Clark Health Care Company . . . . . . . .318Pajunk Medical Systems LP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260

Certifying BoardThe American Board of Anesthesiology, Inc. . . . . . . . . . . . . . . .102

CircuitsAmbu Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313Anesthesia Associates, Inc. (AincA) . . . . . . . . . . . . . . . . . . . . . . . .120Flexicare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123Intersurgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139

Computer SoftwareGauss Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105OpenTempo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136Philips Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150, 151Plexus Information Systems, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . .256Productive Scheduling Solutions . . . . . . . . . . . . . . . . . . . . . . . . . .132

Continuing EducationMed-IQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114Northwest Anesthesia Seminars, Inc. . . . . . . . . . . . . . . . . . .227, 228

CutleryCutco Cutlery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107

Disposable ECG LeadsAnesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . .305

EchoGenic NeedlesHavel’s Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214

Epidural Positioning ChairAnesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . .305


Fiber Optic LaryngoscopesAmbu Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313Anesthesia Associates, Inc. (AincA) . . . . . . . . . . . . . . . . . . . . . . . .120Anesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . .305Anesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241Berall VL (Video Laryngoscope) . . . . . . . . . . . . . . . . . . . . . . . . . . . .104Clarus Medical LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301Disposcope USA LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127Flexicare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Karl Storz Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315Novamed USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242

Financial ServicesAnesthesia Business Consultants . . . . . . . . . . . . . . . . . . . . . . . . . .234Gilman Ciocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237LexcoWealth Management, Inc. . . . . . . . . . . . . . . . . . . . . . . . . .215ALivingWell Solutions, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109MBS Insurance Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205UBS Financial Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203

Gas IndicatorsNihon Kohden America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215C

Healthcare ConsultingMBS Insurance Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205

Infusion PumpsI-Flow, LLC, a Kimberly-Clark Health Care Company . . . . . . . .318

InsuranceGilman Ciocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237LivingWell Solutions, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109MBS Insurance Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205

JewelryA Royal Treasure, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145

LaryngoscopesAmbu Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313Anesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241Armstrong Medical Industries, Inc. . . . . . . . . . . . . . . . . . . . . . . . . .236Berall VL (Video Laryngoscope) . . . . . . . . . . . . . . . . . . . . . . . . . . . .104Clarus Medical LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301Disposcope USA LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127Flexicare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123Karl Storz Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315Medcomflow S.A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125Novamed USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242Truphatek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253

Massage ChairsCyber Relax/ACIGI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110, 111Infinite Therapeutics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137

Medical Liability InsuranceMBS Insurance Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205Medical Liability Mutual Insurance Company (MLMIC) . . . . . .245Oceanus Insurance Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124Preferred Physicians Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .322

Membership OrganizationSociety for Ambulatory Anesthesia (SAMBA) . . . . . . . . . . . . . . .113

Monitoring - Blood PressureCovidien . . . . . . . . . . . . . . . . . . . . . . . . . .246, 247, 248, 249, 250, 251Philips Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150, 151Pulsion Medical Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224

Monitoring - Critical CareCovidien . . . . . . . . . . . . . . . . . . . . . . . . . .246, 247, 248, 249, 250, 251Edwards Lifesciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243Flexicare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123Masimo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216, 217, 218, 219Nihon Kohden America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215CNovamed USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242Pulsion Medical Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224

Monitoring - PatientAnesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . .305Covidien . . . . . . . . . . . . . . . . . . . . . . . . . .246, 247, 248, 249, 250, 251Flexicare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123GE Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306, 307, 308Masimo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216, 217, 218, 219Nihon Kohden America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215CNonin Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316Novamed USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242Philips Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150, 151Pulsion Medical Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224

Nerve LocatorsI-Flow, LLC, a Kimberly-Clark Health Care Company . . . . . . . .318Pajunk Medical Systems LP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260

Pain ManagementAcelRx Pharmaceuticals, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244Ambu Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313Analogic Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239Anesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . .305Anesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241CIVCO Medical Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255Cyber Relax/ACIGI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110, 111I-Flow, LLC, a Kimberly-Clark Health Care Company . . . . . . . .318Infinite Therapeutics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137Pajunk Medical Systems LP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260Philips Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150, 151Pinnacle Partners In Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112Teleflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .309, 310, 311

Patient Eye ProtectionDupaco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254

Patient PositioningDupaco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254

PharmaceuticalsCadence Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . .303, 304Cumberland Medical Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220Cumberland Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . .221, 222Grifols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202Horizon Pharma, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207Hospira . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312Merck & Co . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235Mylan Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257rEVO Biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135

Physician Scheduling SoftwareQGenda, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

Placement ServicesEmCare Anesthesia Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .317King Faisal Specialist Hospital and Research Center . . . . . . . .146Sheridan Healthcare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121

PortableventilatorAnesthesia Services and Products . . . . . . . . . . . . . . . . . . . . . . . . .305


Practice Managementabeo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302Anesthesia Business Consultants . . . . . . . . . . . . . . . . . . . . . . . . . .234EmCare Anesthesia Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317Intermedix ARM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .211MBS Insurance Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205McKesson Business Performance Services . . . . . . . . . . . . . . . . .261Medical Management Resources (MMRI) . . . . . . . . . . . . . . . . . .131Origin Healthcare Solutions . . . . . . . . . . . . . . . . . . . . . . . . .201, 201AProductive Scheduling Solutions . . . . . . . . . . . . . . . . . . . . . . . . . .132QGenda, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126Sheridan Healthcare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121Somnia Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215

PublishersAnesthesiology News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208Elsevier, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201BLippincottWilliams &Wilkins . . . . . . . . . . . . . . . . . . . . . . . . .225, 226Oxford University Press . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140

Pulse OximetersAnesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241Covidien . . . . . . . . . . . . . . . . . . . . . . . . . .246, 247, 248, 249, 250, 251Nonin Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316

Record KeepingDraeger Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319, 320, 321GE Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306, 307, 308Productive Scheduling Solutions . . . . . . . . . . . . . . . . . . . . . . . . . .132

RecruitingEmCare Anesthesia Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317King Faisal Specialist Hospital and Research Center . . . . . . . .146LocumTenens.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259North American Partners in Anesthesia (NAPA) . . . . . . . .232, 233Sheridan Healthcare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121TeamHealth Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223

Regional/Cerebral OximetryNonin Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .316

Scheduling SoftwareProductive Scheduling Solutions . . . . . . . . . . . . . . . . . . . . . . . . . .132

Softwareabeo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302Anesthesia Tools, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241Draeger Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319, 320, 321Gauss Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105Medical Management Resources (MMRI) . . . . . . . . . . . . . . . . . .131OpenTempo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136Origin Healthcare Solutions . . . . . . . . . . . . . . . . . . . . . . . . .201, 201APlexus Information Systems, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . .256Productive Scheduling Solutions . . . . . . . . . . . . . . . . . . . . . . . . . .132QGenda, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

Sorbaview Shield Catheter Securement SystemCenturion Medical Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213

Staff SchedulingOpenTempo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136

Staffing ServicesEmCare Anesthesia Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .317King Faisal Specialist Hospital and Research Center . . . . . . . .146LocumTenens.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259QGenda, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

StethoscopesUltraScope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138

Stimulators - PeripheralAnesthesia Associates, Inc. (AincA) . . . . . . . . . . . . . . . . . . . . . . . .120I-Flow, LLC, a Kimberly-Clark Health Care Company . . . . . . . .318

Temperature MonitoringArizant Healthcare Inc., a 3M company . . . . . . . . . . . . . . . .133, 134

UltrasoundAnalogic Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239CIVCO Medical Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255FUJIFILM SonoSite, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230, 231GE Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306, 307, 308Philips Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150, 151Siemens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215BTerason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130

Ultrasound Needle GuidanceCIVCO Medical Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255

video LaryngoscopesVerathon Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .238


S-01 Opera at The Metropolitan Opera HouseEugene Onegin, composed by Peter Ilyich Tchaikovsky.7:30 pm (19:30), Metropolitan Opera House - LincolnCenter (63rd Street and Broadway). Orchestra Seating.$257 per person.

S-02 Concert at the PhilharmonicRafael Frühbeck de Burgos conducts Beethoven andStrauss. 7:30 pm (19:30), Avery Fisher Hall - Lincoln Center(63rd Street & Broadway). Orchestra Seating.$113 per person.

S-10 Broadway Behind the Scenes - NEW!The Behind the Scenes experience will include a guidedtour of one of New York’s busiest costume studios. Thisaward-winning studio tour will provide an inside look attoday’s most acclaimed costumes for stage, film andtelevision. In addition, guests will go behind the scenesto view award-winning examples of set designs.After we see what the Broadway babies are wearing, wetake them through the theatre district to experience thepulse of New York. Our expert guides will walk ourguests through the history of Broadway and how thearea has changed in its 100-year history. From thehistorical significance of the district, its architecturalrelevance to the city and its continued creativecollaboration with the city’s many artists, this is a truelearning experience for theatre lovers. Guests canexperience first-hand the challenges and joys of puttingon 8 shows a week, and see the theatre world from anew perspective! Leave Marriott Marquis at 9:30 amreturn by 1:00 pm (09:30-13:00). $240.00 per person.(includes tour guide, deluxe motor-coachtransportation, behind the scenes specialist; visit of acostume studio + studio designer)

S-11 Garment District Tour – Shopping ExperienceNewYork is home to the fashion industry and is ashopper's paradise. Begin your shopping adventure withyour licensed shopping guide who will give you a briefhistory of NYC fashion. Visit the Garment District, go to a

showroom or sample sale, and shop like an industryinsider. Go behind the scenes and see buildings thathouse the likes of Donna Karan and Halston, alsounderstand how this booming district impacts fashionall over the world. Looking for incredible fabric for aproject, missing a hard to find button, have crafty kidsand need creative presents? The Garment district has itall, from discounted designer duds, to endless fabric andnotions shops.Cash only! Leave Marriott Marquis at 9:30 am and returnby 1:30 pm (09:30-13:30). $105 per person (includestransportation, admission and guide).

S-12 ATaste of NewYork City NeighborhoodsToday, you will be guided through the many culinarydelights that NYC has to offer. As you adventure throughthe delicacies of NewYork, our licensed tour guide willshare the history of each neighborhood and the food thatmakes it so unique.We will visit dairy stores where freshmozzarella cheese is made by hand, a true NewYork"cupcake cafe" where everyone's inner child will bedelighted, and a quintessentially NewYork bagel shop.How about a slice of pizza?We still have a trip to theexotic with a stroll through Chinatown, taking in atraditional Chinese market. Leave Marriott Marquis at10:00 am return by 2:00 pm (10:00 - 14:00). $85 perperson. (includes transportation, guide and tasting).

S-13 Opera at The Metropolitan Opera HouseDer Rosenkavalier, composed by Richard Strauss.7:00 pm (19:00), Metropolitan Opera House - LincolnCenter (63rd Street and Broadway) Orchestra Seating.$218 per peson.

S-14 Alvin Ailey DanceThe Alvin Ailey American Dance Theater has grown fromthe now fabled performance in March 1958, at the 92ndStreet Y in New York City. Led by Alvin Ailey and a groupof young African-American modern dancers, thatperformance changed forever the perception ofAmerican dance. 8:00 pm (20:00), City Center - 130West56th Street (Between 6th and 7th Avenues). OrchestraSeating. $105 per person.

* Includes $25 theatre ticket fee and 10% weekend surcharge

Social ActivitiesThe 67th PostGraduate Assembly has arranged for a special program of entertainment that includes Broadway Shows,New York City tours, concerts, opera, jazz, dance and holiday shopping.

Introducing the newest addition to our program:To purchase theater tickets please visit http://bit.ly/Broadway_Tkts_PGA67

Thursday, December 12, 2013

Fr iday, December 13, 2013


S-20 Shopping atWoodbury CommonPremiumOutlets

Over 220 designer stores populate this hamlet of shoppingin New York. Located about , hour from Manhattan,Woodbury Common is a shopaholic’s dream. You’ll findplenty of great deals here, and not just on clothing.Average discounts range from 25-60% and our group willreceive special coupons for additional reductions. Lightrefreshments will be provided and food courts areavailable at the shopping center. Leave Marriott Marquisat 8:30 am return by 3:30 pm (08:30-15:30). $90 perperson. (includes transportation, discounts and guide).

S-21 AMidtown Architectural Experience - NEW!This tour covers a section of Midtown Manhattan thatcontains a number of landmark buildings spanning 100years, from historic architectural styles to the more modernBank of America at One Bryant Park.We will visit the following buildings, while learning abouttheir fascinating architecture and history.n The NewYork City Public Libraryn Grand Central Terminaln MetLife Buildingn The Empire State Buildingn The Chrysler Buildingn TheWaldorf-Astorian St. Bartholomew Churchn The original G.E. Buildingn Heron Towern The Chippendale Skyscrapern The IBM BuildingLeave Marriott Marquis 9:00 am return by 1:00 pm (09:00-13:00). $75 per person. (includes deluxe motor-coachtransportation, Architecture Specialist Tour Guide)

S-22 Rockefeller Center Tour: The Greatest Studios &The Greatest view!

The tour will start at NBC Studios where guests will learnabout the early days in radio. Your NBC Page will tell youabout some of the network's early sound effect techniquesand NBC's transition into television. Then take a trip downmemory lane to see where the network has been andwhere they are today. The tour gives you the opportunityto enter and visit some ofour most famous studios, including:n Studio 3B - Home of NBC Nightly Newsn Studio 3K - Home of Datelinen Studio 8H - Home of Saturday Night LiveThe group will tour Rockefeller Center, and head all theway to the ”Top of the Rock,”where they will have anunparalleled view of Manhattan. They will be able to see allof the remarkable skyscrapers, bridges and the beauty ofCentral Park! Leave Marriott Marquis at 9:00 am return by1:00 pm (09:00 - 13:00). $85 per person.

S-23 Radio City Music Hall “Christmas Spectacular”A NewYork City holiday favorite featuring the world famousRockettes. A magical blend of music, dance and pageantryto celebrate the season.11:30 am (11:30), Radio City Music Hall, 50th Street andAvenue of the Americas (6th Avenue). Orchestra Seating.$150 per person.

S-24 Concert at the PhilharmonicRafael Frühbeck de Burgos conducts Beethoven and Strauss8:00 pm (20:00), Avery Fisher Hall - Lincoln Center(63rd Street & Broadway). Orchestra Seating.$122 per person.

S-30 Statue of Liberty & Ellis Island TourYou will be transferred down to Battery Park where you’llboard the ferry to Ellis Island. At Ellis Island, visitors aretransported back through the portals of time, to discoverthe fate of more than 12 million immigrants who passedthrough the doors of Ellis Island between 1892 and 1954.Ellis Island is one of the most popular tourist attractions inNew York City. En route to the Island you will pass by theStatue of Liberty where your tour guide will share theremarkable history of this iconic landmark. Refreshmentsmay be purchased. Leave Marriott Marquis 8:30 amReturn by 1:30 pm (08:30-13:30). $90 per person.(includes deluxe motor-coach transportation, tour guide,ferry service and admission).

S-31 9/11 Memorial & Downtown TourEnjoy NewYork by taking Downtown by foot. Visit the 9/11Memorial, which opened to the public on September 12,2011. Once there, visitors will see the two enormouswaterfalls and reflecting pools. See OneWorld Trade Center,which is the tallest building in NYC. From here, we go on toSt. Paul's Chapel, the oldest church in the city, past City Hall,Wall Street and the NewYork Stock Exchange. Then it's onto Battery Park, from there you can see NewYork Harbor,the Statue of Liberty and Ellis Island. Leave MarriottMarquis 9:30 am and return by 1:30 pm (09:30 - 13:30).$75 per person. (includes transportation, admission andguide).

S-32 Behind the Scenes at Lincoln Center &Metropolitan Opera Learning Center - NEW!

During this hour, meet with and be entertained by a well-known performer. Then, take a behind-the-scenes tour ofLincoln Center, where you will learn about this greatcultural institution. Leave Marriott Marquis 10:00 amreturn by 1:30 pm (10:00-13:30) $190.00 per person.(includes deluxe motor-coach transportation, tour guide).





S-33 “The Nutcracker Ballet”The world’s most beloved ballet by Tchaikovsky hasbecome an annual New York holiday tradition for adultsand children of all ages. 5:00 pm (17:00), David H. KochTheater - Lincoln Center (63rd Street and Broadway).Orchestra Seating. $167 per person.

S-34 Radio City Music Hall “Christmas Spectacular”A NewYork City holiday favorite featuring the world famousRockettes. A magical blend of music, dance and pageantryto celebrate the season.5:00 pm (17:00), Radio City Music Hall, 50th Street andAvenue of the Americas (6th Avenue). Orchestra Seating.$150 per person.

S-40 Harlem by NightVisit the historic, soulful and vibrant neighborhood ofHarlem. Start with a brief tour of the neighborhood,followed by an authentic soul food dinner in a localneighborhood eatery. Then it’s off to The Cotton Club foran evening of fun and excitement. The Cotton Club is afamous night club in New York City which operated duringProhibition. The club featured many of the greatest AfricanAmerican entertainers of the era, such as Cab Calloway, EllaFitzgerald, Louis Armstrong, Nat King Cole and BillieHoliday. A 13 piece swing & jazz band will hit the stage,with three 50 minute sets which will get you on your feet!Leave Marriott Marquis 7:00 pm return by 11:00 pm(19:00-23:00) $175 per person. (includes deluxe motor-coach transportation, tour guide, dinner, club admissionand two drinks.)



Disclaimer: Some of the events listed may be sold out, and are subject to change.


Faculty IndexAbdulmomen, Ahmed......................................121Abel, Mark.........................................................69Abenstein, John P. .............................................33Abramovitz, Sharon ...........................................90Abramowicz, Apolonia E. ........................104, 109Adams, Phillip..................................................174Adamson Barnes, Nicholas .............................126Adsumelli, Rishimani S. N...........................30, 68Agro, Felice E.....................................................84Akmal, Ali ........................................................179Akst, Seth ........................................................148Al Badi, Nadia Al Dhab Khamis ......................134Al-Alawi, Waffa ..............................................134Alamarie, Ammar ............................129, 152, 172Albert, David B. .............................12, 20, 71, 113Alcala, Carmen ................................................183Alexis, Rhonda A. ..............................................10Alexander, Ruben ............................................210Alfille, Paul H.........................................73, 79, 84Alloteh, Rose ...................................................222Almeida, Emanuel ...........................................201Almeida, Ines...................................................169Altman, Robert A...........................12, 20, 71, 113Alves, Joana....................................................200Amar, David .......................................................18Anastasian, Zirka H. .........................................22Anca, Diana .......................................................90Anderson, Michael R...............12, 20, 53, 71, 113Anderson, Rachel ............................................135Andraous, Wesam...........................................198Ansari, Farrukh ................................................204Anson, Jonathan .............................................145Antunes, Eva....................................................168Apfelbaum, Jeffrey L.........................................23Applegate II, Richard L. .....................................62Applegate, Patricia M. ......................................62Aquino, Melinda A. ...........................................43Arboleda, Rafael..............................................134Ard Jr., John L. ..................................................91Arica, Koray E. ...................................................11Arkoff, Harold ..................................................232Arumainathan, Renuka....................................178Ashraf, Khuram................................................132Asokan, Deepa ................................................199Assini, Jr., Charles J..........................................33Ata, Monica.............................................195, 208Atchabahian, Arthur ................12, 20, 43, 71, 113Atim, Abdulkadir..............................................126Attaallah, Ahmed ............................................232Atteya, Gourg ..................................................163Austin, Flower .................................................129

Backus, W. Walter ............................................40Baik, Hee Jung ................................................143Bailey, Joshua .................................................192Bairamian, Jack...............................................123Baker, Sally ......................................................130Baki, Elif...........................................................158Bakshi, Sumitra ...............................................122Baldwin, Mari..................................................170

Bangalore Annaiah, Putta Shankar .................224Barash, Paul G. ..........................................39, 100Barnett, Natalie...............................................190Barsoum, Sylviana...........................150, 159, 202Beavis, Vanessa ..........................................16, 74Bedient, Terrance M. ........................................25Beers, Richard A..........................................80, 88Beilin, Yaakov ..............................................90, 99Bekker, Alex Y. .............................................22, 39Belliveau, Lynn A...............................................62Bendo, Audree A. ..............................................22Benzon, Honorio T..............................................72Bernstein, Jeffrey..............................................18Berry, Arnold J...................................................66Besleaga, Diana ..............................................133Bhatt, Himani...............................................62, 93Bilko, Andrey ...................................................138Birdsall, Emily..................................................146Birmingham, Patrick ......................12, 20, 71, 113Blackledge, Hunt .............................................209Blasius, Kimberly.............................................148Bloom, Marc J. ..................................................52Bogart, Andrew ...............................................217Boggs, Steven..................................................114Bonilla, Gabriel..........................................98, 204Borges, Ana Rita......................................211, 225Borovcanin, Zana.........................................36, 44Boublik, Jan.....................................................110Boynton, Claire ........................................141, 194Bracken, Donna ...............................................211Bremer, Nicholas .............................................180Breneman, Stephen M. .....................................66Brewer, Brandy ................................................141Brodie, Daniel....................................................97Brodkin, Igor ....................................................232Bronheim, David S.............................................98Brooks, John....................................................155Brown, Amanda...............................................143Brusco Jr., Louis ................................................68Buckenmaier III, Chester C. ...............................34Bundu, Kadia ...........................................143, 206Burden, Amanda R...............................85, 94, 206Burns, Terrence R. .......................................35, 41Burroughs, Timothy..........................................196Bustillo, Maria A. ........................................17, 47

Calderon Barajas, Adriana ......................188, 199Caldwell, William............................................198Cammarata, Lindsay........................................203Capan, Levon M...........12, 20, 36, 44, 71, 84, 113Carvalho, Ana Filipa ................154, 169, 172, 227Carvalho, Inas..................................................192Carvalho, Jose C. A. ..........................................34Castillo, Maria Dolores ...............................19, 84Castillo, Maricela ............................................129Cavalieri, Jeanne...............................................40Cerny, Jeff .......................................................221Chambers, Terry-Ann.........................................18Chandler, Derrick .............................................211Chandrakantan, Arvind......................................81

Chandralekha, Prof ..........................................136Chao, Jerry Y......................................................43Chatterjee, Debnath ..................................96, 166Chauhan, Gaurav .............................128, 183, 184Chee, Won.......................................................194Chen, Junping....................................................11Chen, Steve S. ...............................12, 20, 71, 113Chen, Yufan .....................................................141Cheon, Eric.......................................................151Cheruku, Sreekanth .........................................229Chestnut, David H..............................................88Chhokra, Renu .................................................213Ching, Howard.................................................190Chiu, Katherine................................................225Cho, Brian ........................................................218Cho, Elvira....................................................36, 44Chon, Telianne.................................................212Chuda, Robert M. ..............................................82Chun, Eunhee...................................................162Chung, Insung....................................................62Chung, Kevin....................................................124Cimino, Linda M. ...............................................40Clement, Ernest J. .............................................80Cohen, Edmond..........................44, 60, 73, 79, 84Cohen, Shaul ...........................................161, 223Cole, Daniel J. .............................................22, 57Cooley, Jill .......................................................168Cooper, Eliyahu................................................138Cosar, Ahmet ...................................................131Coursin, Douglas B. ..........................................50Crane, Amy E. ..................................................101Crapanzano, Donna ...........................................40Croll, Scott M. ..................................................34Curle, Alan E....................................................108Curry, Saundra E. ...............................................81

Dabo-Trubelja, Anahita .....................................29Dabu-Bondoc, Susan .......................................163Daly, Caroline ..................................................131Damian, Daniela..............................................127Danielsson, Jennifer .........................................47Danninger, Thomas..........................................157Danzer, Brett I. ...................................................60Dave, Meneka .................................................208Davis, Renee L...................................................81De Hert, Stefan..................................................87De Leon-Volpe, Isabelle ....................................41De Oliveira Jr., Gildasio S. ..............................108Deer, Timothy R. ................................................75Deiner, Stacie G. ...................................35, 36, 44Delatte, David..................................................213DeLeon-Casasola, Oscar A................................75DeMaria, Jr., Samuel ........32, 47, 84, 85, 94, 112Demers Lavelle, Elizabeth A..............................30Desiderio, Dawn P. ............................................84DeVeaux, Eric ..................................................145Devine, Malcolm ...............................................40Dhar, Panchali..............................................36, 44Diachun, Carol Ann B. ....................................100Dias, Ricardo ...................................................128


Dienstag, Penina .............................................205Dilos, Barbara M. ..................................10, 36, 44Dimaculangan, Dennis P. ...................................34Dinani, Aliraza .........................................173, 219Dooley, Joseph W..............................................28Dragan, Kristen................................................181Dubois, Michel Y................................................27Duffy, Michael P.................................................32Dukshtein, Avichai...........................................183Dumitru, Marian ................................................84Durkin, Brian T. ..............................12, 20, 71, 113Dutton, Richard P. .............................................15

Eappen, Sunil ....................................................16Eaton, Michael P. .............................................107Edala, Thejovathi.............................................207Efem, Richard ..................................................127Ehrenwerth, Jan ................................................23Eisenkraft, James B.....................................24, 53Eisenstat, Carol ...............................................186Ellis, John E. ..............................................13, 48Elsharydah, Ahmad....................................98, 123Emala, Charles W. .................................33, 46, 47Emmerich, Mathias .........................................192Entrup, Michael ...............................................200Epstein, Lawrence J. ...................................27, 32Epstein, Richard...............................................139Ernstbrunner, Matthaus...................................141Esteves, Catarina.....................................142, 162Evans, Adam S. .................................................62Evans, Beata............................145, 193, 198, 199Everett, Lucinda...............................................156

Faisco, Ana......................................................205Fakhry, Michael ...............................................207Falitz, Shawn ...................................................162Faller, Julia Barber ..........................................114Feldman, Jeffrey M. ..........................................95Feng, Cynthia.................................12, 20, 71, 113Fermon, Charles M. .........................................105Ferrero, Natalie ...............................................121Fischer, Gregory W. ...............................17, 52, 65Fischer, Kimberly .............................195, 196, 216Fitch, Jane C. K......................................33, 38, 74Fitzgerald, Meghann M. ............................61, 106FitzPatrick, Michael .........................................183Fleischut, Peter M. ..............................33, 56, 166Flores, Raja M. ..................................................73Flynn, Brigid C....................................................26Fogarty Mack, Patricia.....................................102Fomberstein, Kenneth .....................................191Fontes, Manuel L. ...........................................101Franco, Carlo D. ................................................34Frass, Michael ............................................36, 44Freedman, Gordon .............................................92Frost, Elizabeth A. M. ..................................60, 99

Gadsden, Jeff C. ...............................................30Galati, Maria ...............................................25, 33Galeano, Eduardo E. ..........................................42Gallagher, Christopher J. ................................114Garcia, G. Matthew. ........................................203Garcia, Paul .....................................................174

Garcia, Rosario ................................................157Garvin, Sean ......................................................29Gevirtz, Clifford M. ......................................70, 75Gitman, Paul ......................................................76Glass, Nancy L.............................................51, 96Godlewska, Magdalena ....................................40Goldberg, Andrew .............................................47Gomez, Lorena.................................................201Goncalves, Margarida .............................169, 171Gooden, Cheryl K.....................10, 36, 44, 84, 111Goodman, Stephanie R....................................110Goodwin, Gabriel.............................................189Gouveia, Carina ...............................................206Grande Fernandez, Abraham...........................132Granger, Shannon............................................218Grant, Gilbert J..................................................99Gravenstein, Nikolaus .......................................95Greene, Elliott S. ...............................................80Gritsenko, Karina.............................................112Grosu, Irina ......................................................137Grubb, William ................................................205Gualtier, Ryan ..................................................201Gudin, Maria Teresa........................................132Gulur, Padma ...................................................138Gupta, Deepali.................................................152

Haas, Adam.....................................................131Haas, Thorsten ................................................175Haber, Gary W. ..................................................34Hackett, Patrick ...............................................133Hadzic, Admir ..............................................46, 47Hagberg, Carin A. ........................................23, 24Halonen, Jeff...................................................215Hamby, Carrie ..................................................224Hannallah, Medhat..................................179, 185Haque, Ahmed...........................98, 222, 223, 224Hasan, Aysha...................................................215Hashmi, Nazish........................................219, 228Hekmat, Diana H. ............................................114Hemmings Jr., Hugh C.................................67, 77Hentz, Jean......................................................217Herbst, Sarah...................................................196Hersey, Denise.................................................142Hillel, Zak...........................................................62Hitt, James .......................................................63Hojsak, Joanne..................................................10Horlocker, Terese T. ....................................49, 64Horta e Silva, Filipa .................................187, 194Hosseinian, Leila ...............................................78Hsiung, Robert.................................................124Hsu, George.....................................................180Hu, Qinggang.............................................98, 130Hu, Yaqi ...........................................................122Huang, Grace...................................................129Huang, Jeffrey.................................................122Huang, Jia .......................................................180Hunter, Christine..............................................220

Isaacson, Sheldon A..........................................71Ivascu, Natalia S. ............................................102

Jacobson, Kenneth H. .....................................105Jagannathan, Narasimhan..............................105

Jaggar, Sian.....................................................137Jain, Ankit .......................................................221Jain, Sudheer K. ................................................90Jakubowski, Michael S. ....................................76Jalbout Hastie, Maya......................................100Jeffers, Jeremiah ............................................228Jeng, Christina L............................12, 20, 71, 113Jeon, Seung Gyu .............................................147Johnstone, Robert E. .........................................74Joseph, Vilma A. ..............................................29Joshi, Minal.....................................................200Jurin Semo, Judith ......................................39, 64

Kachulis, Bessie ..............................................110Kadhim, Sarah .........................................136, 175Kamel, Ihab..............................................145, 195Kanaparthy, Sri Smitha............................140, 151Kandil, Ali ........................................................205Kapadia, Ankit .................................................213Karan, Suzanne B. .............................................47Kass, Ira S..........................................................47Kelhoffer, Eric R. ..............................................111Kernan, Scott...................................................222Kerr, Gregory E.................................................102Kessler, Paul ....................................................170Khelemsky, Yury...................................85, 94, 112Kim, David .......................................................135Kim, Eugene.....................................................178Kim, Jung T. ...................................12, 20, 71, 113Kim, Sunmi ....................................12, 20, 71, 113Kimovec, Maria ...............................227, 228, 229Kitain, Eric M.................................12, 20, 71, 113Klosak, Natalia ................................................186Kocarev, Mitko.................................................181Kocz, Remek ....................................................204Kokkada Sathyanarayana, Sudheera ......190, 210Konda, Prameela .............................................182Konstadt, Steven N. ..............................48, 62, 65Koo, Bonwook..................................................126Kopman, David J. ............................................101Kosharskyy, Boleslav .........................................30Kozek-Langenecker, Sibylle...............................67Kreitzer, Joel......................................................92Kumar, Shreyajit R. ....................................61, 106Kundra, Amita..................................................155Kurnutala, Lakshmi..................................189, 212

La Porta, John-Robert .....................................189LaCivita, Robert ...............................................223Lafortune, Yarnell ....................................196, 200Lagasse, Robert S..................................15, 39, 79Lahm, Daniel......................................................35Lai, Yan ........................................................19, 53Lamonica, Theodore ..........................................40Largi, Joseph ...................................................191Lau, Yie Hui .....................................................133Lavand'homme, Patricia ..................................144Lax, Jerome .....................................................105Lazar, Andrew..........................................165, 166Lebowitz, Philip W.............................................17Leduc, Laura ....................................................114Lee, Allison J...................................................110Lee, David L. ......................................................42


Lee, Herb .........................................................123Lee, Mitchell Y.........................12, 20, 69, 71, 113Lee, Shane.......................................................194Lee, Sharon......................................................125Leib, Marc L.......................................................78Leibowitz, Andrew B. ........................................78Lema, Mark J.....................................................63Lemmens, Hendrikus .......................................147Lerman, Jerrold .....................................14, 27, 51Levine, Adam I.............33, 36, 44, 74, 85, 94, 112Levstek, Meta..................................................132Levy, Ronald S. ............................................85, 94Leyvi, Galina ......................................................56Li, Chunhua......................................................216Li, Geng............................................................190Lichtman, Adam D. ............................................43Lien, Cynthia A. .........................24, 32, 57, 70, 98Lin, Emily ...........................................................91Lintner, Rebecca N. .........................................109Lipps, Jonathan ...............................................149Littlejohn, James.....................................164, 167Liu, Christopher ...............................................120Liu, Melanie.....................................................215Lopez III, Carlos J. ...........................................110Lopez, Anthony ................................................198Lopez, Oscar ....................................................211Love, Shona .....................................................149Lowenwirt, Isaac .....................................167, 219Lu, Shu.............................................................135Lucas, Stefan E..................................................34Ludwin, Danielle B. ...........12, 18, 20, 55, 71, 113Lustik, Stewart Jay............................................68Lutterloh, Emily C. .............................................80

Mackauf, Stephen H. ........................................64Macpherson, Jennifer .....................................212Mahboobi, Sohail ............................................202Mahmoud, Mohamed A. ..................................14Mahoney, Bryan P. .......................................85, 94Makary, Laila ...................................................142Makaryus, Rany R. ...........................................81Malhotra, Anuj ..................................................43Malhotra, Vinod...........................................16, 51Maloney, Michael............................................126Mamoun, Negmeldeen....................................182Mangla, Chanchal ...........................................210Mansour, Badie ...............................................193Mapes, Renee M...............................................69Markovic, Milica..............................................110Marques, Joana ......................................171, 172Marshall, Mitchell H. ........12, 20, 44, 71, 92, 113Martins, Ana....................................163, 165, 174Mason, Keira ..................................................111Matal, Marla ...................................................140Mathew, Leena..................................................82Matot, Idit........................................................107McCally, Colleen E............................................42McClain, Robert...............................................221McClelland, Kimberly ..............................179, 185McDonald, John ..............................................187McGoldrick, Kathryn E. .....................................28Mehta, Tejal ....................................................161Mellender, Scott ..............................................160

Menees, Spencer ............................................171Meyers, Lori.....................................................147Miller, Thomas R. ..............................................15Minutti-Palacios, Marissa...............................129Mittnacht, Alexander J. C. ..................61, 62, 106Mohiuddin, Adil...............................................214Moitra, Vivek K. ..........................................13, 50Molinari, William ............................................135Moller, Daryn H. ................................................69Monahan, Ann.........................................226, 227Moss, Jonathan...............................................181Moti, Devitri ....................................................195Mousavi, Shahryar ....................................33, 216Mukherjee, Chirojit............................................62Mungekar, Sagar .............................................197Myers, Michael F. ..............................................76

Narang, Jolie.....................................................42Narayan, Preeti................................................226Natan, Kristina ................................................150Neal, Joseph M.................................................49Neal, Sean.......................................................225Neuman, George G............................................25Neumann, Krystof J...........................................34Neustein, Steven M. .............................36, 44, 84Newman, Kenneth B .........................................32Ngai, Jennie Y. ..........................................41, 115Nia, Sam..................................................152, 212Ninan, David....................................................218Nishanian, Ervant ........................................47, 82Nomura, Minoru ................................................99Nurok, Michael..................................................50Nussmeier, Nancy A..........................................65

O'Connor, Michael F. ...................................39, 50Oh, Ahyoung ....................................................163Olea, Claudia ...................................................137O'Leary, Colleen E..............................................15Oleszak, Slawomir P. ...................................36, 44Olympio, Michael A...........................................95O'Neill, Daniel K. ...................................36, 44, 84Ongvisetpaiboon, Wannee..............................139Ontoria Muriel, Julio .......................................144Osborn, Irene P.........................11, 36, 44, 77, 105Osorio, James A. .........................................55, 91Overdyk, Frank .................................................148Ozkan, Aret ........................................................40

Pagan, Ruben ..................................................207Pakkar Tadbiri, Shahrzad .................................139Palacios Chavarria, Adrian ...............................46Palmer, Pamela................................................168Pamnani, Anup ..........................................61, 106Park, Seong joo................................................130Park, Sherwin ..................................................197Parks, Lance.....................................................180Pasamba, Michelle..........................................192Patel, Perene ...................................................123Patel, Sana ......................................................158Paulsen, Alfred W..............................................95Pedoto, Alessia C. .............................................26Pedro, Michael ................................................186Peña, Cecilia....................................................218

Pereira, Carmen.......................................225, 226Perez de Sa, Valeria ..........................................67Pernu, Pawan...........................................155, 156Persichetti, Romana ................................157, 197Pick, Jeremy ....................................................216Pierre-Paul, Daphne...........................................91Piracha, Mohammad .......................................189Pires, Rafael ....................................................173Poonati, Hima ..................................................189Poovathoor, Shaji P. .........................................111Popescu, Wanda M. ........................48, 62, 72, 84Popovic, Jovan...............................12, 20, 71, 113Porhomayon, Jahan...........................................47Potosky, Ryan...................................................190Powell, Frederick .............................................229Praslick, Alexander..................................209, 227Pratt, Nancy G. ..................................................95Primm, Aaron...................................................209Probst, Stephen .................................................42Pryor, Kane O. ..............................................32, 82Pyram, Chantal M..............................................29

Raeder, Johan .................................................125Raffel, Brian.....................................................213Rah, Kang ........................................................159Ramos, Juan............................................182, 208Ramsay, Michael .............................................150Ramzy, Wassim ...............................................153Ranucci, Marco..................................................67Rasulo, Frank ...................................................130Rattana-Arpa, Sirirat .......................................198Ravindranath, Sapna ...............................203, 227Rebel, Annette.................................................124Reddy, Loveleen...............................................154Reddy, Prashanth.............................................174Reddy, Shamantha G. ..................................30, 68Reed, Allan P........................................36, 44, 114Reeves, Logan .................................................187Reeves, Scott T. .................................................62Reich, David L....................................................24Reikersdorfer, Christian...................................169Renew, Johnathan...........................................140Rhee, Amanda J. ........................................80, 93Ribeiro, Barbara...............................................220Ridley, Diane....................................................160Roberts, Daniel................................................144Roberts, Kevin W...............................................74Rodrigues, Maria.....................................158, 173Rosenberg, Andrew D. ......................................49Rosenberg, Henry ..............................................27Rosenblatt, Meg A. ...........12, 20, 49, 53, 71, 113Rosenfeld, Kenneth I. ..............................102, 109Roth, Ram ..............................................36, 44, 82Royal, Mike......................................144, 167, 168Rozner, Marc A. ................................................93Rudlof, Burkard................................................120Rufino, Michael ....................................30, 36, 44Ruskin, Keith J...........................................53, 105

Sadean, Mihai.................................................156Safi, Tarang .....................................................208Salam, Mohammad .........................................191Salomon, Guy ....................................................19


Samama, Charles M..........................................87Samanta, Sukhen ............................................131Samaru, Mahendranauth ................................140Sampathi, Venkata ............................................56Samuels, Jon D. ....................36, 44, 60, 105, 114Sandadi, Jennifer ......................................56, 102Santos, Divina J. ..............................................69Saraiya, Neeta R. ............................................104Sarani, Babak ..................................................150Sarquis, Tonny .................................................122Saubermann, Albert J. ......................................76Saweris, Mark .................................................139Schaefer III, John J. ...................................36, 44Schechter, Douglas..........................................228Schiffmiller, Moshe .........................................156Schmidt, Michael ............................................152Schoaps, Robert ..............................................187Schoppmann, Michael J....................................52Schwartz, Andrew D......................84, 85, 94, 112Sclar, David..............................................120, 155Scott, Bharathi...................................................35Sebranek, Joshua J...........................................13Sequeira, Patricia M........................................105Serban, Stelian I. ..............................................91Setty, Sudarshan .............................................173Shah, Puja........................................................188Shah, Samir .....................................................226Shah, Shruti.....................................................214Shah, Tanmay ..................................................154Shah, Usman ...................................................226Shander, Aryeh ........................................107, 115Shapiro, Janine R. ...................................100, 114Shapiro, Pavel..................................................162Shariat, Ali N...................................................111Sharma, Aarti ....................................................55Shaw, Andrew D................................................97Shayevitz, Jay R. .......................................70, 116Shaz, Beth H. .....................................................72Shelton, Ryan R. ...............................................34Shih, Grace ......................................................161Shore-Lesserson, Linda J. .................62, 107, 115Shou, Royce.....................................................125Siddiqui, Sadiah ..............................................161Siegmueller, Claas...........................................210Silva, Ana Cristina...................................170, 214Silva, Plinio......................................................209Silva, Sonsoles ........................................137, 154Silvay, George..............................................26, 84Silverstein, Jeffrey H.............................23, 47, 77Sim, Alan J. ........................................85, 94, 112Simon, Michael B. .......................................32, 38Simpson, Zachary ............................................180Sims, Timothy ..................................................209Singh, Prithi P...............................................36, 44Singla, Neil..............................................158, 232Siriussawakul, Arunotai ..........................124, 136Sites, Brian D.....................................................49Sittler, Patrick L. ........................................25, 108Sivaci, Yasar ....................................................160Sizemore, Daniel .............................................149Skubas, Nikolaos J......................61, 62, 101, 106Sladen, Robert N. ..................................13, 28, 97Slater, Brian.....................................................202Slepian, Ralph L...........................................36, 44

Sloan, Rachel...................................................148Slobodyanyuk, Kseniya....................................121Smallman, Bettina.......................................54, 96Smith, Michael P .........................................16, 51So, Mary ..........................................................217Sommer, Richard M.........................................105Song, Jing..........................................................47Sorensen, Martin.............................................120Soto, Carlos .....................................................191Spahn, Donat.....................................................67Spencer, Leina .................................................206Spessot, George J. ................12, 20, 71, 105, 113Staender, Sven ..................................................87Stead, Stanley W...............................................75Stefanovich, Peter .......................................20, 71Stein, David G. ..................................................55Steinberg, Ellen S..............................................18Stellaccio, Francis S. .............................36, 44, 68Stierer, Tracey L. ..............................................108Stjepanovic, Gordana ........................................55Stoelting, Robert K. ...........................................95Stone, Marc E................................48, 65, 93, 115Storch, Bess.............................................142, 167Straker, Tracey .......................................36, 44, 68Suresh, Maya S. ................................................21Suresh, Santhanam ........................12, 14, 20, 54Sutin, Kenneth M. ...........................................105Suyawej, Rungphetch......................................149Suzuki, Suzuko...................................................98Syed, Sameet ..................138, 149, 202, 206, 220Szalados, James E.......................................52, 64

Tam, Christopher.....................178, 194, 221, 222Tan, Yan Ru......................................................146Tan, Zihui .........................................................178Tanaka, Christopher Y........................................29Tanaka, Kenichi .........................................72, 107Tapia, Daniel....................................................143Tassone, Rosalie F. ......................................63, 96Tayler, Ezekiel ..................................................178Tedore, Tiffany R....................12, 20, 71, 104, 113Teets, Jonathan...............................................199Temiz, Hacer ....................................................159Tena, Patricia ...................................................127Tesoriero, Eric ..................................................193Thacker, Julie ..................................................131Thilen, Stephan ...............................................140Thong, Sze Ying.......................................134, 188Toledano, Roulhac D....................................21, 43Tomas, Claudia ................................................147Torres, Giselle..................................................153Tremblay, Chris ..................................................40Troianos, Christopher ........................................62Trunfio, Giuseppe V............................................62Tsang, Maisie ..........................................146, 107Tse, James...............................................203, 231Turnbull, Zachary .....................................164, 165Turner, Rachel ..................................................127Twersky, Rebecca S...................................79, 108Tyagaraj, Kalpana............................................170

Urban, Michael K. .............................................70Urbanowicz, Robert .........................................128Ursillo, Christopher..........................................181

Vacanti, Joshua...............................................171Vaida, Sonia J. ............................................36, 44Vallejo Jr., Manuel C. ........................................21Vari, Alessandra ..............................................122Vaz, Ansara......................................................217Vecchione, Tricia..............................................195Velasco Almodovar, Ruben..............................182Velickovic, Ivan A. .......................................11, 29Vilaca, Maria Joao ..........................................153Viscusi, Eugene R. ...........28, 63, 73, 84, 108, 151Visnjevac, Ognjen............................................125Vitkun, Stephen A....................36, 40, 44, 98, 109Voltz, Donald ...................................................155Voscopoulos, Christopher J...............................46

Wagener, Gebhard ............................................97Wahlander, Staffan B. .......................................42Waisel, David ..........................................133, 175Wambold, Daniel D. ......................12, 20, 71, 113Wang, Christina...............................................185Ward, Denham S. ........................................66, 92Wardhan, Richa.............................12, 20, 71, 113Watson, Charles....................................36, 44, 84Watt, Stacey A. .................................................47Waxer, Nathan ................................................204Wecksell, Matthew B........................................77Weinberger, Michael L. .....................................17Weiner, Menachem...........................................62Weller, Gregory ...............................................146Wendel, Pamela ..............................................185Werfel, Paul A. ..................................................40Wesam, Andraous...........................................228White, Robert ..........................................121, 175Wissler, Richard N.............................................21Wittwer, Erica..................................................136Wlody, David J. ......................................38, 78,88Woo, Tiffany ....................................................153Worah, Samrat H...............................................81Wu, Jeffrey......................................................191Wu, Kuan-Chung .............................................164

Ya Deau, Jacques T.........................................101Yarmush, Joel M. ..............................................19Yarmush, Leslie N............................................105Yeh, Joseph S. ..................................................19Yimbou, Jean-Jacques....................................148Yu, Connie........................................................128Yu, Simon...........................................................91Yudkowitz, Francine S. ......10, 14, 81, 85, 94, 116

Zacharowski, Kai...............................................67Zafirova, Zdravka...............................................26Zahn, Jeffrey .....................................................41Zaidan, James R................................................66Zalzala, Mohammad........................................216Zayed, Adham..................................................197Zheng, Gang ....................................................179Zuker, Dora ......................................................215Zylberger, David A. ............................................70


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NYSSA • 67th Annual PostGraduate Assembly in Anesthesiology • www.nyssa-pga.org

Notes

252

NovaMed-USA was founded on the principle ofcollaborative imagination and ingenuity that ultimately

produces innovation. NovaMed-USA innovationshave provided significant clinical benefits

as well as economic savings to theworldwide healthcare community.

NovaMed USA Innovations

Wireless Cardio-Pulmonary AuscultationMRI Compatible LaryngoscopyMRI Compatible Power Source

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At CSL Behring, we are committed to saving lives and improving the quality of life for peoplewith rare and serious diseases worldwide. Through our continued focus on innovation, we areleaders in the development of new and enhanced plasma-derived biotherapies. Our 100-yearheritage of quality and safety makes us a reliable supplier offering the industry’s most robust

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AVAILABLE IN50 mL AND 100 mL SIZES

VISIT BOOTH #312FOR MORE INFORMATION

For more information, contact your Hospira representativeat 1-877-9HOSPIRA (1-877-946-7747) or visit www.hospira.com.

Hospira, Inc. 275 North Field Drive, Lake Forest, IL 60045P13-4065/R1-8.25x10.75-Oct., 13

Look Beyond the Ordinary.Experience the Extraordinary.

Visit Booth #23067th Annual PostGraduate Assemblyin AnesthesiologyDecember 14-16, 2013Marriott Marquis, New York

Visit the SonoSite exhibit to

experience imaging at the point of

care and to learn how advanced

ultrasound technologies are

revolutionizing the way regional

anesthesia is practiced today.

Learn, too, about our new Frontier

Program for Medical Schools and

Graduating Residents that

facilitates access to ultrasound

systems and related support.

www.sonosite.com

AxoTrack, AxoTrack Technology, and AxoTrack Needle Guidance Technology are registered trademarks of Soma

Access Systems LLC. FUJIFILM SonoSite, Inc. the SonoSite logo and other trademarks not owned by third

parties are registered and unregistered trademarks of FUJIFILM SonoSite, Inc. in various jurisdictions. All other

trademarks are the property of their respective owners. ©2013 FUJIFILM SonoSite, Inc. All rights reserved.

MKT02561 11/2013

The Root of BrainFunction MonitoringA more complete picture starts with more complete data

Root is CE Marked. © 2013 Masimo Corporation. All rights reserved.

For professional use. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse events.

Visit Masimo booth #216-219 to learn more.

SedLine brain function monitoring for the Root™ patient monitoring platform that helps clinicians

improve anesthetic management by enabling more individualized titration

> Flexible measurement expansion through Masimo Open Connect™ (MOC-9™)—enables our SedLine®

brain function monitoring

> 4 simultaneous EEG channels provide continuous assessment of information about both sides of the brain

> A single sophisticated algorithm provides accurate, reliable information about a patient’s response to anesthesia

> Instantly interpretable, high-visibility display of Masimo’s breakthrough rainbow®

and SET®

measurements from Masimo’s

Radical-7®

handheld monitor

www.masimo.com

The innovative Veinsite is the only portable, completely hands-free, NIR device to

potentially enhance patient outcomes with difficult peripheral vascular access.

This intuitive headset allows clinicians to detect difficult to see veins, valves, bi-

furcations, and possible infiltrations on patient types ranging from neonates to

elderly, darker skin, obese, as well as those with compromised vasculature.

Manufactured by VueTek Scientific • 22 Shaker Rd., PO Box 934 • Gray, ME 04039 • (207) 657-6565 • www.vuetekscientific.com

VueTek Scientific and Veinsite names, logos and tag lines are trademarks of VueTek Scientific, LLC. Made In USA

®

®

Redefining Vascular ImagingPortable, Hands-Free, Vein Illumination

Visit us at NYSSA in New YorkBooth #108

OPTIMAL IV ACCESS • FE WER AT TEMPTS • LESS TIME & MONEY

■ Decrease multiple IV stick attempts

■ Visualize valves, bifurcations, venous return& possible infiltrations

■ Improve site selection

■ Decrease unnecessary central lines/PICCs

■ Decrease costly CLABSIs/complications

■ Decrease hospital operational costs

■ Increase nurse efficiency and compliance

■ Increase patient satisfaction scores

■ Fewer treatment delays

Veinsite Potential Benefits

Add your good name to our growing list of ASA “standard of care” clinicians. Call us toll free today at 800.562.5589and join other select anesthesiologists who have already secured ownership in their professional reputations.

Since 1987, Preferred Physicians Medical (PPM) has exclusively insuredanesthesiologists and their practices. Our policyholders also own PPM,so helping our physician owners manage their risk is a cornerstone ofwhat makes us unique.

PPM maintains a substantial database of more than 11,000 adverse anesthesiaevents and uses this information to identify areas of risk, monitor developingloss trends, and provide cutting-edge, timely and practical anesthesia-specificrisk management advice and strategies like:

On-site risk management seminars for our policyholders and their staffpresented by PPM in-house claims attorneys.

Exclusive online access to best practice protocols and documentation;white papers; current and archived issues of Anesthesia & Law, our riskmanagement newsletter; and other useful information.

Immediate email notification via Anesthesia Alerts of issuessuch as widespread drug contamination, drug shortagesand significant changes to ASA standards.

24/7/365 telephone access to our experiencedattorneys and claims specialists for the expertrisk management advice you need, wheneveryou need it.

Call PPM today to learn more about how ourextensive risk management program can helpyou protect your reputation.

9000 West 67th Street Shawnee Mission, KS 66202-3656 800-562-5589 ppmrrg.com

Protect yourhard-earned reputationby managing risk.

Pure InsPIratIon. solId lIthIum.

Come see the fIrstmajor advanCement In

Co2 absorbentteChnologysInCe 1924.

Visit us at booth #240

spiralith.com

*HFMA staff and volunteers determined that Anesthesia Department Management has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this service.

We offer customized employment opportunities tomeet your professional goals and personal lifestyle.

Visit NAPA’s exhibit at PGA/67 and learn more about our:Devotion to quality patient careFocus on local anesthesia leadershipLeadership training programs and initiativesAdvantage of nationwide relocation opportunities

For more information, contact our clinical recruiters [email protected] or 516.945.3388

NAPA is the leading single specialty anesthesia management company in the United States.

Postgraduate Assembly inAnesthesiology PGA/67

Booths 232 & 233December 13 – 17, 2013

Marriott Marquis, New York, USA

Enterto Win!Stop by our booths fora chance to win aniPad miniduring exhibition hours.

Our Unmatched Anesthesia Experience. Your OR’s Advantage.NAPAanesthesia.com

TELEFLEX believes in the power ofdistinct strengths united by a commonsense of purpose. By housing thebrands you rely on under one roof,we are building, nurturing andevolving the vital parts at the heartof healthcare innovation.

Teleflex, Arrow, Hudson RCI, LMA and Rusch are trademarks or registered

trademarks of Teleflex Incorporated or its affiliates.

© 2013 Teleflex Incorporated. All rights reserved. 2013-2336

309-311

Join usat booth

s

309-311

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