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Review Course Lecture Supplement IARS 2018 REVIEW COURSE LECTURES 1 REVIEW COURSE LECTURES presented at the IARS 2018 Annual Meeting & International Science Symposium April 28 – May 1, 2018 | Chicago, Illinois ©2018 International Anesthesia Research Society. Unauthorized Use Prohibited. IARS 2018 REVIEW COURSE LECTURES 2 The material included in the publication has not undergone peer review or review by the Editorial Board of Anesthesia & Analgesia for this publication. Any of the material in this publication may have been transmitted by the author to IARS in various forms of electronic medium. IARS has used its best efforts to receive and format electronic submissions for this publication but has not reviewed each abstract for the purpose of textual error correction and is not liable in any way for any formatting, textual, or grammatical error or inaccuracy. ©2018 International Anesthesia Research Society. Unauthorized Use Prohibited. IARS 2018 REVIEW COURSE LECTURES 3 TABLE OF CONTENTS RCL-01 RCL-12 SOCCA: The Tele-Vision: Taking Care to the Patient Perioperative Venous Thromboembolism: A Review . 49 and Expanding the Scope of the Intensivist . 5 Ronald Gordon, MD, PhD Liza M. Weavind, MBBCh, FCCM, MMHC RCL-13 RCL-02 TAS: The Practicalities of Delivering Massive Perioperative Cardiac Risk Assessment and Management: Transfusions in Trauma Resuscitation . 52 The Internist’s Perspective . 9 Andrew Milne, MBChB, FRCA, DMCC Steven L. Cohn, MD, FACP, SFHM RCL-14 RCL-03 ASER: Enhanced Recovery Program: Key Components, What’s New with the Management of Vasodilatory Implementation and Outcomes . 58 Shock in the ICU? . 14 Tong Joo (TJ) Gan, MD, MHS, FRCA, MBA Ashish Khanna, MD, FCCP, FCCM RCL-15 RCL-04 Ultrasound Findings in Intraoperative Anesthesia for Children with Inborn Errors Anesthetic Emergencies . 61 of Metabolism: Opening Up the Black Box . 16 Julia B. Sobol, MD Johnny J. Kenth, BSc, MSc, MBBS, FRCA RCL-16 RCL-05 Blue Babies: How Do They Survive? . 67 Neurologic Complications Associated with Minal J. Menezes, PhD Neuraxial Regional Anesthesia . 17 Joseph M. Neal, MD RCL-17 Medicine for Care of Older Persons and Emergency RCL-06 Laparotomy: The Lessons and How We Can Improve Care . 70 SOCCA: Heart Failure with Preserved Ejection Geeta Aggarwal, MBBS, MRCP, FRCA, and Nial Quiney, MBBS, Fraction (HFpEF) as a Perioperative Risk Factor . 22 FRCA Aalok K. Kacha, MD, PhD RCL-18 RCL-07 Safety Reporting, Checklists, and Root Cause Analysis: Airway Management of the Obstetric Patient: What’s New? . 25 What Are They Good For? Absolutely Nothing? . 72 Sonia Vaida, MD Jonathan B. Cohen, MD, MS RCL-08 RCL-19 LVADs & Noncardiac Surgery: What To Do Principles of Lean Management and Systems When They Come to Your Operating Room . 28 Engineering for Anesthesiologists . 77 David W. Barbara, MD Jeanna Blitz, MD RCL-09 RCL-20 Cerebrospinal Fluid Drainage Catheters in Women in Medicine and Leadership: Glass Ceiling, Endovascular and Open Aortic Surgery . 31 Sticky Floors, and Everything in Between . 81 Maged Y. Argalious, MD, MSc, MBA, MEd, FASE Maya J. Hastie, MD RCL-10 RCL-21 Neurological Complications of Cardiovascular Diseases . .. 37 Biases in Education and Research and Avinash B. Kumar, MD, FCCM, FCCP Their Impact on Patient Safety . 84 Edward C. Nemergut, MD RCL-11 Perioperative Management of Hyperglycemia for RCL-22 Noncardiac Surgery: Who, How and Why? . 42 The Trials and Tribulations of ERABS: Elizabeth W. Duggan, MD Implementing ERAS in Bariatric Anesthesia! . 87 Naveen Eipe, MD continued on page 4 ©2018 International Anesthesia Research Society. Unauthorized Use Prohibited. IARS 2018 REVIEW COURSE LECTURES 4 TABLE OF CONTENTS, continued from page 3 RCL-23 Update on Healthcare Reform: The Impact of MACRA on the Practice of Anesthesia . 90 Alice A. Tolbert Coombs, MD, MPA, FCCP RCL-24 SPA: Perioperative Pain Management in Children with Sleep-Disordered Breathing: A Difficult Balancing Act . 97 Olubukola Nafiu, MD, FRCA, MS RCL-25 SASM: Postoperative Respiratory Depression: Who? When? How? Knowledge that Anesthesiologists Should Have . 99 Frances Chung, MBBS, FRCPC, and Toby N. Weingarten, MD RCL-26 Advanced Teaching Skills for the OR: How to Teach Effectively when Faced with High Clinical Workload and Lack of Time . 101 Marek Brzezinski, MD, PhD RCL-27 The Adult Patient with Congenital Heart Disease Presenting for Noncardiac Surgery . 105 Viviane Nasr, MD RCL-28 SAGA: The Dementia Brain: Considerations for Anesthesiologists . 108 Brenda G. Fahy, MD, MCCM, and Catherine Price, PhD, ABPP/CN ©2018 International Anesthesia Research Society. Unauthorized Use Prohibited. IARS 2018 REVIEW COURSE LECTURES 5 RCL-01 SOCCA: The Tele-Vision: Taking Care to the Patient and Expanding the Scope of the Intensivist Liza M . Weavind, MBBCh, FCCM, MMHC, Professor of Anesthesiology and Surgery, Associate Division Chief of Anesthesiology Critical Care Medicine, Associate Chief of Staff, Director of Tele-ICU, Vanderbilt University Medical Center, Nashville, Tennessee LEARNER OBJECTIVES (either in the ED or in an ICU outside of the ED) via Tele-ICU would make this an opportunity to leverage existing resources at After participating in this activity, the learner will be able to: academic hospitals. 1. Identify opportunities in Tele-ICU to improve patient care around the hospital; TELE-ICU 2. Review Tele-ICU outcomes in remote locations; The promise of Tele-ICU’s to address critical care staffing shortages 3. Examine internal and external barriers to advancing the Tele- by leveraging scarce intensivist resources to patients in distant Critical Care agenda; and locations to impact ICU mortality and length of stay, thus reducing cost of care and increasing ICU capacity, remains largely unfulfilled. 4. Discuss how to expand the reach of the Intensivist beyond the boundaries of the ICU. SCCM Adult Critical Care Statistics1: • 20 % of acute care admissions will be admitted to the ICU OBSERVATIONAL ICU IN THE ED Up to 58 percent of emergency department (ED) admissions result • 55,000 critically ill patients cared for per day in ICU in an ICU admission1. • 30% of all ICU admissions will require mechanical ventilation Increasing volume and acuity of critically ill patients presenting to • In 2010 there were 77 809 ICU beds, increased 15 % in 5 years emergency departments with time-sensitive pathophysiology who • Average LOS 3.8 days but with huge variability need ICU care is a fact of daily life in busy ED’s. This is occurring • Average mortality rate ranges from 10-29% with concurrent increased hospital crowding and delays in ICU • 35% shortfall of intensivists by 2020 with increasing demand for bed availability. Delay in care in the form of ICU stabilization critical care services and ongoing resuscitation has been associated with poor clinical outcomes for critically ill patients2. The increasing number of There is a myriad of reasons for the slow adoption of Tele-ICU’s, trained EM-Intensivists are now developing a new subspecialty in which include everything from high cost to implement and Emergency Critical Care to provide early diagnosis, resuscitation operationalize the system, payment structºure for the services and stabilization in specialized units in the ED for critically ill provided, hospital culture, credentialing and licensing barriers, patients. Those critically ill patients with undifferentiated pathology, change management and physician autonomy coupled with mixed who require further diagnostic evaluation and work-up or who evidence on effectiveness4,5. may have initially responded to resuscitation but remain at risk The capital cost to establish comprehensive teleICU capabilities for acute decompensation following admission to a general care (monitoring, two-way audio-visual connectivity, access to floor. These units are designed for acute, time limited intervention electronic medical record and staffing) are estimated to be around prior to patients being admitted to traditional ICU’s for ongoing $90,000 per ICU bed with an added $53,000 per ICU bed critical care needs and for acutely decompensated patients who per year for annual operating costs. The question often arises can have their pathophysiology reversed in a timely fashion (e.g.: as to whether the health outcome improvements warrant this heart failure secondary to missed dialysis, DKA or reversal of cost, particularly in light of the fact that there is no direct billing overdose requiring a few hours of mechanical ventilation). Early from providers for the care delivered. A recent study reviewing literature on these units have found that these ED ICU’s were the cost-effectiveness of Tele-ICU services found that hospitals occupied by patients who may not benefit from ICU admission with fewer resources and minimal access to intensivists would 3 and were housing palliative care patients . While this may not be benefit the most from these services6. The caveat to that would the patient population that the ED-Intensivists want to look after, be the fact that the service would probably be cost-prohibitive this does open up an opportunity to address critically ill patients in to these smaller hospitals. An ad hoc model to provide care on multiple organ failure, who are transferred to academic centers for consultation in smaller community hospitals may be a solution for higher levels of care, to be able to better assess their care needs them to reap the benefit of evidence-based care and best practices for resuscitation and goals of care. Utilizing this space for thorough provided by an intensivst, but without the prohibitive
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