Department of Anesthesia and Anesthesia Perioperative Care News

Spring 2018 | Vol. 18

Matthias Braehler, MD, PhD (inset), and Linda Liu, MD (above) oversee the departments QI efforts. Also in this issue: ■■ Message from the Chair Residents Become Part of the UCSF ■■ Research: Helen Kim, PhD, MPH Health QI Solution ■■ Education: he UCSF Department of Anesthesia and Perioperative Care has embraced A New ACGME-Accredited UCSF Health and UCSF Graduate Medical Education (GME) efforts to Fellowship in Regional Pain incentivize hands-on design and implementation of quality improvement (QI) ■■ Staff Profile: T projects during residency training. The goal: ensure UCSF anesthesia residents finish Lance Pangilinan Advances the Art and Science of their training with a thorough understanding of QI, while making an immediate and Respiratory Therapy measurable contribution to improving the quality and safety of care. ■■ Ask the Expert: Second-year residents (R3s) lead the projects with the guidance of Linda Liu, MD, Benn Lancman, MBBS who oversees the department’s efforts and two faculty mentors: Matthias Braehler, ■■ New Faculty MD, PhD, and Alexandra Anderson, MD. In 2016, an anesthesia resident team ■■ New Residents successfully instituted a program to reduce post-operative nausea and vomiting ■■ Awards, Publications, Grants (PONV), which they presented at the Western Anesthesia Resident’s Conference. This year’s team is working to ensure that the medical center’s anesthesiologists quickly ■■ In Memoriam implement emerging guidelines for reversing neuromuscular blockades. ■■ Announcements “The residents pick the projects, but we make sure they align with departmental ■■ Department Events goals and we provide residents with resources,” says Liu. “The projects build on a strong culture of quality and patient safety that the medical center and GME have fostered.” continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 1 Message from the Chair Celebrating the Visionaries

ith the losses of Drs. Bill Hamilton, Ted Eger, and Ernie W Guy, 2017 was a difficult year for our Department and specialty. Dr. Guy was among the initial UCSF Anesthesia faculty hired after the Department was established in 1958, having been UCSF Medical Center recruited by Dr. Stuart Cullen from the University of Iowa. He QI Solution became the Chief of Anesthesia continued from front cover at SFGH from 1959–1973. In Building on a Culture of Patient Safety 1967, Dr. Hamilton was then recruited from the University Resident QI projects have been in place at UCSF Medical Center of Iowa to follow Dr. Cullen as for almost a decade and have garnered national recognition for the Chair of Anesthesia at UCSF, their early engagement of learners in improvement work and for the building on Dr. Cullen’s initial successes to expand close partnership between GME and the health system. Residents the Department’s clinical, research, and educational receive a small financial reward for successfully completed projects missions, while recruiting top notch talent whose and, this year, the number of projects by residents across specialty work would yield important advances to the field. areas grew to 32. Among Dr. Hamilton’s recruits was Dr. Ted Eger, who “The process helps residents learn what it would go on to establish the concept of MAC, and means to be a provider in this generation where whose seminal research on anesthetic uptake and ‘systems thinking’ is a critical competency,” says distribution was still ongoing in 2017. We celebrated Niraj Sehgal, MD, MPH, vice-president and chief Dr. Eger’s achievements at a memorial symposium on quality officer for UCSF Health. “Residents February 2, 2018. observe and experience our systems failures more While these losses have been devastating, we have than anyone; they should be actively engaged in been inspired by the hard work and dedication of these designing the solutions to make us safer.” great people. Each was committed to advancing the Resident teams begin with submission of a field and to teaching the next generation(s) of proposed project to an internal review board that anesthesiologists. Rooted firmly in this rich history, includes medical center and GME leadership. Niraj Sehgal, MD, MPH today we continue to strengthen our clinical enterprise, “While we want to make sure the projects align improve the educational experience of our learners, with Medical Center goals, the review process is and make important research discoveries, while striving more about helping to set up the projects and the residents for for a diverse, equitable, and inclusive environment for success,” says Sehgal. all of our patients, staff, learners, and faculty. As the entire UCSF Health System has become steeped in lean This issue describes some of this work. In the methodology, the process has evolved. Residents create project clinical arena, we report how advanced imaging is descriptions in a structured template, designed to find consensus being used to improve outcomes for trauma patients, on a problem that needs solving and on the problem drivers – as well as how ongoing quality improvement efforts are before brainstorming a solution. Through multiple iterations, the improving clinical outcomes overall. We highlight the mentors and the board help ensure each project has attainable work of Lance Pangilinan, a valued member of our goals for improving care in a patient population. respiratory care therapist group at ZSFG since 2011. The PONV Project In the education domain, we focus on our newly established ACGME Acute Pain and Regional Last year’s anesthesia resident team ultimately settled on PONV, Anesthesiology fellowship, now in its first year. Finally, because “A random audit of baseline data from the preceding year our research section describes Dr. Helen Kim’s found we were only treating high-risk patients for PONV about breakthrough work on the connection between 48 percent of the time,” says resident Phil Aguilar, MD. cerebral cavernous malformations (CCMs), and The team set a goal that UCSF anesthesiologists would identify bacteria in the gut. all patients at high risk for PONV and administer at least 2 anti- As always, thank you for reading – we welcome your emetics to those patients preoperatively or intraoperatively 70 feedback and appreciate your ongoing support. percent of the time. To properly identify the patients, the residents used a widely used, four-factor risk score: Non-smoker; female; a Sincerely, history of PONV or motion sickness; and the need for postoperative Michael A. Gropper, MD, PhD opioids. Patients with at least three of the factors are considered Chair, UCSF Anesthesia and Perioperative Care high risk. continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 2 “One challenge we had was that first- To sustain improvement, the group year residents may not know about this has made sure that the reminder cards risk assessment and our electronic and extra drugs will remain in the carts, health record [EHR] had no automatic and the buttons in the EHR will also prompts during preoperative charting,” remain. In addition, resident Andrew says resident Lisa Sun, MD. Bishara, MD, is using the data to create a Residents Lisa Sun, MD, and Jack Jeng, MD Thus, the residents worked with a machine learning predictive algorithm for Grand Rounds in July, including technology team to highlight the risk PONV in the EHR. explaining how and why they arrived at factors in the EHR during the preoperative “[PONV awareness] has become more what they believed would be the simplest assessment and then the QI team taught ingrained in how people think and that’s possible approach to achieve their goal. the entire department how to document the key thing,” says Aguilar. That is: For every patient who receives both risk assessment and the admi- a non-depolarizing muscle relaxant, nistering of anti-emetics in the EHR. Reversing Neuromuscular Blockade success is defined as either, a) docu- The QI team also: menting with a quantitative monitor that The 2017 project aims to ensure that ■■ Presented three lectures on PONV risk the patient is fully recovered, or b) if a UCSF anesthesia providers reverse monitor is not available or if a patient is assessment and mitigation at the patients who have had non-depolarizing beginning of the year and repeated the not fully recovered, then the patient must neuromuscular blocking agents, unless receive reversal medication. information multiple times during patients have passed a standard of Grand Rounds. “Reports from our EHR system are strength using a quantitative monitor. really impressive and with the help of our ■■ Created a reference card for all Failing to reverse a weakened respiratory tech folks, we’ve been able to completely anesthesia carts, which lays out the system – or not confirming that the redesign documentation, which makes risk factors, and specifies the number patient is fully recovered – risks tracking project goals much easier, and types of anti-emetics for each aspiration, post-operative pneumonia without increasing the time spent. In situation, along with proper dosage, and reintubation. In addition, multiple fact, in some cases we’ve been able to side effects and costs. studies have associated failure to reverse reduce the amount of clicks,” says Jeng. ■■ Reminded all residents, via a weekly with prolonged length of stay. “And documenting is a great reminder page, to document their risk “That’s why there is a big push for the that this is what you should be doing assessment and mitigation efforts. ASA to make this a standard of care,” every case. Our hope is that awareness says Anderson. ■■ Added extra medications to carts to will change practice.” “At the beginning of the year, Matthias make as many options as possible He adds that support from depart- Braehler gave a lecture about current easily accessible. ment leadership and the investment of research and best practices,” says residents – who do a huge proportion of ■■ Checked their data every two months resident Jack Jeng, MD. “We wanted to and used the findings to provide cases every year – are important make sure there was no disconnect success factors. “We [the residents] are feedback to the entire department on between what we learn and what we do.” how it was doing. the ones doing the work. If we’re in Planning began in January, with agreement that this is the best potential By the end of the year, 79 percent of project rollout beginning in July. Much of change, it is more likely to happen.” high-risk patients were receiving at least the initial six months was spent hashing “The residents have been amazing,” two anti-emetics prophylactically. out how best to measure outcomes and says Anderson. “They figured out all the Anecdotally, the PACU nurses felt there how, based on the available literature, to specifics of what they would need and was less PONV and when residents collect and track the data. communicated effectively with the IT began tracking the amount of rescue “Last year, based on our criteria, we people to create a build that promotes anti-emetics, the rates had come down did the right thing 71.6 percent of the compliance and enables us to track to 10-15 percent. time, so with the GME QI committee, we progress.” “Even with zero risk factors, there is decided we would aim for a 10 percent still a 10 percent chance of nausea in relative improvement, to almost 79 A Commitment to QI PACU,” says Aguilar. percent,” says Jeng. “The anesthesia faculty and residents are As they began to shape their project, very dedicated to this program and have the residents found inconsistent influenced other improvement work compliance might have had as much to within and outside their department,” do with a failure to document than with Sehgal says. “Michael Gropper, Linda actually not reversing, says Anderson. Liu, Matt Aldrich and others deserve a Thus a goal of the project was to not just ton of credit for helping cultivate and properly check and reverse all patients spread systems thinking.” who need it, but to also document work “The success of these projects and being done. the support of the department has us To bring all residents on board, the thinking more broadly about QI and team presented their project during about expanding QI opportunities and incentives for the entire department,” Resident Phil Aguilar, MD, says Liu. n presenting PONV at WARC 2017

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 3 Research Research Opens Window for Prevention of Cerebral Cavernous Malformations

n May 2017, epidemiologist Helen mutation is especially prevalent in Kim, PhD, MPH, and her colleagues Hispanic families with ties to the published a breakthrough study in Southwestern United States. Kim’s I Nature that was the first to establish a collaborator and co-leader, Leslie connection between cerebral cavernous Morrison, MD, a neurologist from the malformations (CCMs), a disorder of University of New Mexico, recruited blood vessels in the brain, and the the familial CCM patients with the microbiome – bacteria in the gut. The CCM1/KRIT1 Q455X mutation. article, “Endothelial TLR4 and the “We’ve known for a long time that Microbiome Drive Cerebral Cavernous patients who have the same gene Malformations,” caused a stir because it mutation, who are of similar age, or even to further explore the relevance of these suggested there might from the same family, can have completely findings in the cohort of familial CCM be a way to prevent different disease presentations. One patients that she has been studying. these malformations, person could have many brain lesions and In parallel, the Penn team devised a which can cause life- be completely asymptomatic, while their series of experiments in their mouse threatening hemorrhagic relative with a similar number of lesions models – including analyzing bacteria strokes, seizures, could have a long history of seizures, in mouse feces – which led them to headaches and/or headaches or a hemorrhagic stroke. identifying a gram negative bacterium neurological deficits. So we hypothesized that there must be whose presence correlated with their An associate additional genetic or environmental mice developing CCM lesions. Changing professor in the modifiers of CCM disease severity.” the gut bacteria using antibiotics and UCSF Department of Working from that fecal transplants or anti-TLR4 blocking Anesthesia and hypothesis, the UCSF team ran a agents dramatically prevented the mice Perioperative Care genome-wide panel from developing lesions. “These results Helen Kim, PhD, MPH and director of the of half a million genetic variants in are super exciting as they imply that department’s Center for 180 CCM subjects, and focused on changing the gut bacteria can have a Cerebrovascular Research (CCR), 56 inflammatory and immune response profound effect on CCM lesion Kim is also the co-leader of the NIH- genes, looking for an association of formation,” says Kim. funded Brain Vascular Malformation common variants in these genes with Consortium study on cerebral cavernous history of hemorrhage, total number Next Step: malformations. The study is now in its of lesions and total number of large Advance Human Studies ninth funded year and has been following lesions. “The strongest findings and Now the challenge is to test this patients with familial CCM and collecting ones that survived correction for multiple hypothesis in humans, something Kim’s detailed clinical, imaging, genotype and testing were genetic variants in the team is uniquely prepared to do as part gene expression data. By contributing toll-like receptor 4 (TLR4) and CD14 of its ongoing CCM study. data from patients with familial CCM, genes, which code for proteins that “In collaboration with the Penn group, Kim’s team played a major role in work together to recognize pathogens we will collect and analyze stool demonstrating why the animal findings and activate the innate immune specimens from study participants and highlighted in the Nature article offer real response,” says Kim. use RNA sequencing to determine promise for prevention in humans. Simultaneously, a team at the whether certain bacteria are present at University of Pennsylvania led by Mark higher frequency and if those bacteria Overlapping Findings Lead to Kahn, MD, had uncovered TLR4 as an are correlated with greater lesion Fruitful Collaboration important upstream activator of a burden in humans with CCM,” says Kim. In 2014, Kim and her team published an signaling pathway they showed is “If they are, it suggests that if you article in Cerebrovascular Diseases, necessary for CCM lesion formation in change a person’s microbiome by diet or which suggested that common genetic their mouse models. “They recognized antibiotics, you may be able to prevent variation in inflammatory and immune the limitations of their mouse models… new lesion formation in familial cases. response genes influences disease [including] that their neonatal mice only This would be groundbreaking as there is severity in familial CCM patients who all develop lesions in the hind brain and, currently no approved medical therapy carry the same disease-causing mutation well, animals are not humans,” says Kim. for treating patients with familial or in CCM1/KRIT1 (Q455X). This gene That’s when they contacted Kim’s team continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 4 Cerebrovascular Education Research A New ACGME-Accredited continued from previous page sporadic forms of CCM.” Regional Anesthesia and Acute She adds that several observations in humans suggest that the microbiome may be an important Pain Medicine Fellowship environmental modifier of CCM disease severity. his year, the UCSF Department of Anesthesia and In another 2014 paper published by Kim’s group, Perioperative Care became one of the first in the country they found an inverse correlation between to establish an ACGME-accredited fellowship in Regional cardiovascular risk factors, in particular obesity, T Anesthesia and Acute Pain. and risk of greater lesions. Clinical faculty member Pedram Aleshi, MD, oversees the “At the time, the results seemed paradoxical but fellowship and was instrumental in its creation. Iman Hadaya, MD, diet studies have shown that obese individuals have is the School’s first official ACGME fellow in this sub-specialty. lower levels of gram-negative bacteria in the gut than We profile them below. lean individuals,” says Kim. This could provide a biological explanation for the observed correlation – that leaner patients with more gram-negative bacteria Pedram Aleshi: in their gut – the type of bacteria that activates the TLR4 signaling pathway – have a greater number of Regional Anesthesia Specialist, CCM lesions. Patient Advocate “In our next phase, we hope to get funding to test A few years ago, a group of regional these hypotheses further in humans,” says Kim. She anesthesia physicians from academic and her collaborators are currently conducting a pilot institutions in the United States and study in which they are collecting microbiome Canada, began discussing the idea of samples from familial CCM patients. getting ACGME accreditation for a regional “This work is especially exciting, because, in anesthesia and acute pain fellowship. All parallel, two research groups came to the same were from institutions that already had a conclusion,” says Kim. “That indicates we are on the fellowship in place, but felt ACGME right path, and brings us closer to a potential medical accreditation was a logical next step. They therapy that could have life-changing implications for defined what such a fellowship should look patients living with CCM.” n like and applied, with overall ACGME “This work is approval coming in October 2016 and a especially exciting, deadline in early December for individual program applications. Pedram Aleshi, MD because, in parallel, “That gave us less than a month and a half to get our own application in,” says two research Pedram Aleshi, MD, of the UCSF Department of Anesthesia and groups came to the Perioperative Care and a member of the group. UCSF was one of same conclusion.” only nine programs in the country to have its application approved for 2017. — Helen Kim, PhD, MPH Accreditation changes a fellowship that had been in place for a number of years. Perhaps the most significant change is an increased emphasis on acute pain and on multimodal pharmacologic approaches to treat it. “We have a much larger arsenal of tools to treat pain after complex surgeries, and with the opioid crisis, this is especially important,” says Aleshi. “Using that arsenal effectively demands another level of expertise and our fellows will be much better trained in this aspect of treating pain.” These types of changes, says Aleshi, will be a boon for prospective fellows and for the sub-specialty more generally. “Once you’re ACGME fellowship-trained, hiring institutions have a much clearer idea of what they’re getting and the quality of graduates of fellowships improves tremendously.” Seeing Anesthesia Through Patients’ Eyes In addition to his duties overseeing the regional anesthesia and acute pain fellowship and the department’s regional anesthesia service, Aleshi – originally from Iran before he moved to California continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 5 with patients. At UCSF Health, Sliwka is Regional Anesthesia the executive medical director of Patient continued from previous page Experience and chief physician experience officer. Not only do the two during high school – is well known for the frequently discuss patient experience, attention he pays to his patients’ but after attending a patient experience. In June 2017, he won the communication course his wife designed, UCSF Great Experience Award, a Aleshi pushed for tailoring the course to monthly award that honors caregivers for anesthesia providers. their attention to patients and their “We’ve now offered that [tailored] families. course twice,” he says. “Each time we He was nominated because a patient had 14-15 people and most thought it – a single mom, worried about her kids – was great and very helpful.” wrote him a long letter, expressing her His goal now is to measure the impact gratitude for the personal, caring the course has on patient experience. He Iman Hadaya, MD approach he took to administering her completed a pilot study in which he anesthesia. “I feel those few minutes surveyed patients to compare the before surgery are a great opportunity to experience of those who had anesthesia Iman Hadaya: connect with people and make their from providers who had taken the The First ACGME Fellow in Regional worst day a much, much better training versus providers who had not. Anesthesia and Acute Pain experience,” says Aleshi. Those providers who took the course did Iman Hadaya, MD, grew up in Southern In part, he attributes his attention to much better. Aleshi also devised California, in a family steeped in health this aspect of care to his personality and anesthesia-related questions for the care. Her father is a urologist; one sibling training. “The physician staying calm Press-Ganey survey the hospital has is a dentist, another a pharmacist. comes from within and…when I talk to been using for the last few years. “It had always been my plan to go into patients in the OR, some residents say “My good days are when I make more medicine and, during medical school at my voice and being there is half an connections with people. That emotional UC Irvine, I was quickly pulled toward anesthetic for a patient,” he laughs. His correction is gratifying and I love anesthesia,” she says. “I really liked the fellowship training in OB anesthesia also knowing that I’ve made a difference in physiology aspect – the immediate is a factor. “You’re taking care of awake how my patients feel, how they go to gratification of giving a drug and seeing a patients, who are in distress and I think sleep and wake up,” he says. part of my interest comes from that, from reaction, the kind of thing you don’t see learning how important it is to calm in many other fields.” someone down when they’re under As she began residency, she thought stress,” he says. she’d concentrate on critical care, But he says conversations with his something in which she’d had more wife, Diane Sliwka, MD, have been training and exposure, but as time went instrumental in his thinking more deeply on, she found regional anesthesia and about how to effectively communicate acute pain work even more gratifying because of the ability to deliver quick pain relief to patients and their gratitude for that relief. “I still like doing critical care and general OR work, but I really enjoy how regional pain patients are so aware of what you’re able to provide for them,” says Hadaya. The fellowship, which Hadaya began in August 2017, will include doing structured acute and chronic pain rotations at UCSF Parnassus, UCSF Mission Bay, some at Kaiser South San Francisco and some at ZSFG. “UCSF is a big advocate for all residents to be fellowship-trained and I think it’s important because it gives you a more attractive, overall skill set no matter where you decide to practice,” says Hadaya. “I’m sure this will be a rich experience in regional training. Dr. Aleshi is awesome and I’m glad I get to stay at UCSF for at least another year or two.” n

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 6 Staff Profile Lance Pangilinan Advances the Art and Science of Respiratory Therapy

n the spring of 2017, Lance Pangilinan, developed a real passion for being part carbon dioxide (CO2) in the respiratory RRT, was awarded the ZSFG of the respiratory field. “I grew to love it,” gases. “As CO2 builds, acidity starts to Respiratory Care Services (RCS) he says. “I think it’s because I was drop and it can cause altered mental I PHIL Award for outstanding clinical working in an environment where I can status and cause a patient to code; by practice. According to the FACES practice evidence-based medicine and keeping CO2 in a safe range, we can Foundation, which sponsors the award, see the full effect it has on patients.” prevent patients from coding” he says. the PHIL Award is the only nationally To that end, Pangilinan was part of a recognized hospital-based program Moving Into Research team testing various capnography dedicated to honoring outstanding Contributing to the evidence base has monitoring devices for accuracy. “All of respiratory therapists. become increasingly important to them worked well, but one was superior,” Since 2011, Pangilinan has been a Pangilinan, who has been involved with a says Pangilinan. valued member of the Priscilla Chan number of studies. Compression volume and Mark Zuckerberg San Francisco has been one important focus area. Helping New Residents with General Hospital and Trauma Center’s “When we ventilate patients, it’s Ventilation Department of Respiratory Care Services important to get accurate compression Pangilinan says that respiratory (RCS). In addition, as a part of the volume readings, but not all ventilators therapists also have an important role to RCS research team, he has co-authored are the same,” he says. “We did a study play in familiarizing new residents with five published abstracts and two peer that found some of the ventilators protocols for delivering safe ventilation. reviewed publications on control of measure compression volume differently “Our QA director, Rich Kallet, who compression volume loss during and if we don’t factor in a loss in helped develop the protocol for ARDS mechanical ventilation, incorporation of compression volume, we can under- and has had a number of important capnography with mask oxygen delivery ventilate patients.” His hope is that papers, leads these classes,” says systems and the efficacy of aerosolized studies like this can make RTs more Pangilinan. “As an institution, we know prostacyclin to treat hypoxemia in severe aware of the tools they are using so they these protocols well and we’re here to Acute Respiratory Distress Syndrome can better serve their patients. help residents understand how to (ARDS). In addition, he presented two Another area of research Pangilinan apply them.” abstracts at the 2016 International has become involved with is capno- Pangilinan says the ZSFG RTs’ pride Respiratory Congress. graphy – monitoring the concentration of in their professionalism and in their “It’s an amazing feeling,” says commitment to ongoing learning has Pangilinan, of winning the PHIL Award. earned the trust of their physician and “It wasn’t expected and I appreciate my CRNA colleagues. “Residents put a lot of peers for making me the recipient. It’s faith in us to help them and I’m proud still very surreal to be recognized across that they sometimes look for our help the nation as one of best respiratory with lifesaving treatments,” he says. n therapists.” Family Tradition Leads to Lance Pangilinan, RRT (second from left) and the RCS research team. Career in RT Pangilinan was not locked in on respiratory therapy when he began his freshman year at San Francisco State University, after growing up in Daly City and attending high school in San Francisco. “Like a lot of first-year college students, I didn’t know what I wanted to do, though I did think it would be something in the medical field,” he says. “My mom and sister are nurses and several family members are RTs in the Bay Area.” After completing what at the time was a two-year program, he began working at ZSFG in 2011. It was there he

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 7 Ask the Expert Benn Lancman, MBBS

Benn Lancman, MBBS, is director of trauma anesthesia at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). The American Society of Anesthesiologists, through the Society of Cardiovascular Anesthesiologists, is How is advanced trying to create standards for how many imaging changing the IVs than we could have done blind. TEE procedures per year are adequate to maintain a proper skill level. It’s definitely baseline skill set for This facilitates surgery in a more efficient and timely fashion. a concern because without proper trauma anesthesia? experience, people can misinterpret the TEE data and this can negatively influence In the majority of serious trauma The use of TEE is also on the rise, treatment decisions. There are really cases, speed is critical, as is the need because there is increasing evidence two parts to the challenge: How do we to more deeply understand the many that it allows us to assess so many get the pictures? And who will interpret variables that contribute to safe, high- more variables. In any trauma case, the pictures? quality care in injured patients. That’s anesthesiologists are interested in To be clear: we’re not trying to replace why both point-of-care ultrasound the delivery of oxygen to tissues. diagnostic scans that cardiologists do or (POCUS) and trans-esophageal Traditionally, we’ve used blood pressure to replace their role in diagnosing cardiac echocardiography (TEE) are quickly as a surrogate for cardiac output, but disease. Our focus is on clinical becoming indispensable skills. pressure does not always equate with questions to address trauma, where speed is essential. A diagnostic TEE POCUS flow. In a traumatically injured patient, blood pressure can be an unreliable takes 30-40 minutes; we have a different Over the last 10-15 years, how we correlate for flow, so our decision about lens in that we’re trying to rapidly assess approach vascular access during trauma how to treat needs to consider additional dynamic factors and act on them. has changed. Traditionally, when getting variables like ongoing blood loss, direct We need to get our trainees and an arterial line we’re taught to feel for the cardiac injury, the types of anesthetic attendings the necessary experience, pulse in the wrist, and if it’s strong agents we’re using, patient comorbidities but because ZSFG is not a cardiac getting it in isn’t really a problem. But – a multitude of considerations. Often, center, it can be a challenge to get trauma patients are often bleeding and in the only way to get a rapid assessment providers enough TEE exams to meet shock. They can be hypotensive and of the different facets involved in the benchmark. One part of the solution, tachycardic. These factors all contribute delivering oxygen to tissues is visualize therefore, is high-fidelity simulators, to making it near impossible to insert an the heart with echo. which do a fantastic job of simulating arterial line using a blind technique. This That – and the literature’s support for the psychomotor and cognitive steps. isn’t even considering the number of use of focused TEE for major Trans-thoracic echo will also be an patients who have extremity injuries, hemodynamic instability – is why, over important piece, because it provides which can significantly limit the potential the last 15 years or so, there’s been a big many more opportunities to non- access sites. By using POCUS, the pulse push to make sure anesthesiologists are invasively look at images of the heart. doesn’t matter. You can see the vessel capable of using TEE in the operative We are getting to the point where on the ultrasound screen and we’re not setting. For traumatic patients receiving we’re comfortable using emergent TEE; relying on tactile sensation. POCUS is massive transfusions, it’s a critical tool it’s no longer the realm of enthusiasts becoming an indispensable tool for the for assessing ongoing volume status and like myself, but becoming standard for rapid reliable insertion of venous and tailoring the resuscitation to the patient. any anesthesiologist. In fact, beyond arterial lines in our sickest patients. trauma, I expect we will also eventually Providing Education, Experience In addition, at places like ZSFG, it’s use echo for focused preoperative not uncommon for our patients to have The question becomes how to make exams in high-risk patients undergoing other chronic diseases or complications, sure all trauma anesthesiologists get elective procedures. Today we listen to so venous access for blood or other the training and experience they need. the heart and lungs with a stethoscope, resuscitation fluid can be challenging, Certainly, vascular access using but if we have a tool we’re just as even on a good day. Ultrasound enables POCUS is now considered standard of comfortable with that gives us much us to go from being able to find no care and our residents get a sufficient higher quality, more detailed information vessels to palpate to being able to find level of exposure to use ultrasound about the cardiorespiratory system, deeper vessels and insert much larger for that purpose, but TEE is a little why not use that? n more complicated.

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 8 New Faculty

Career Faculty

Christopher Abrecht, MD Claudia Benkwitz, MD, PhD Assistant Clinical Professor Associate Professor Joined Faculty August 2017 Joined Faculty October 2017 MEDICAL SCHOOL ADVANCED DEGREE New York University PhD, University of Bonn and Wuerzburg, INTERNSHIP Germany Internal Medicine MEDICAL SCHOOL California Pacific Medical Center University of Bonn and Wuerzburg, RESIDENCY Germany Anesthesiology INTERNSHIP Brigham and Women’s Hospital Pediatrics FELLOWSHIP Janet Weis Children’s Hospital Pain Medicine RESIDENCIES UCSF Anesthesiology, University of Wuerzburg, Germany Anesthesiology, Harvard Medical School Carolina Bagga, MD FELLOWSHIPS Associate Physician Diplomate Research Fellow Joined Faculty December 2017 University of Wuerzburg, Germany MEDICAL SCHOOL Pediatric Anesthesiology Stanford University School of Medicine New York University School of Medicine Advanced Training in Pediatric Cardiac Anesthesia INTERNSHIP Stanford University School of Medicine Anesthesiology PREVIOUS EMPLOYMENT UCSF Research Scientist RESIDENCY University of Wuerzburg, Germany Anesthesiology Instructor UCSF Lucile Packard Children’s Hospital FELLOWSHIP Assistant Professor Pediatric Anesthesiology Monroe Carell Children’s Hospital Stanford University School of Medicine Vanderbilt University PREVIOUS EMPLOYMENT Attending Anesthesiologist Amber Borucki, MD Anesthesia Medical Group of Santa Cruz Assistant Clinical Professor Joined Faculty August 2017 Odmara Barreto-Chang, MD, PhD MEDICAL SCHOOL Clinical Instructor and Research Fellow, Rush Medical College Training in Clinical Research INTERNSHIP (TICR) Program Internal Medicine Joined Faculty August 2017 University of Illinois College of Medicine at ADVANCED DEGREE Advocate Christ Medical Center PhD, Neurosciences RESIDENCY Stanford University School of Medicine Anesthesiology MEDICAL SCHOOL University of Chicago Stanford University School of Medicine FELLOWSHIPS INTERNSHIP Pediatric Anesthesiology General Surgery Boston Children’s Hospital Stanford University School of Medicine Combined Pediatric & Adult Pain Fellowship Boston Children’s Hospital RESIDENCY Brigham & Women’s Hospital Anesthesiology Beth Israel Deaconess Medical Center UCSF PREVIOUS EMPLOYMENT Pediatric and Adult Anesthesiologist Reno Tahoe Anesthesia St. Mary’s Regional Medical Center

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 9 Erika Brinson, MD Nu (Cindy) Chai, MD Clinical Instructor Assistant Clinical Professor Non-ACGME Liver Transplant Anesthesia and Perioperative Care and Anesthesiology Fellow Neurology Joined Faculty August 2017 Joined Faculty May 2017 MEDICAL SCHOOL MEDICAL SCHOOL University of Nevada School of Medicine Dartmouth Medical School INTERNSHIP INTERNSHIP UCSF California Pacific Medical Center RESIDENCY RESIDENCY Anesthesiology Adult Neurology UCSF Johns Hopkins School of Medicine FELLOWSHIP FELLOWSHIP Critical Care Medicine Pain Medicine UCSF UCSF PREVIOUS EMPLOYMENT Atisa Britton, MD Interventional Pain Attending Assistant Clinical Professor Veterans’ Affairs Hospital, Fresno Joined Faculty August 2017 Health Sciences Clinical Assistant Professor MEDICAL SCHOOL UCSF Fresno Boston University School of Medicine INTERNSHIP Zhe Chen, MD Anesthesiology Assistant Clinical Professor UCSF Joined Faculty October 2017 MEDICAL SCHOOL RESIDENCY Anesthesiology New York University School of Medicine UCSF INTERNSHIP FELLOWSHIP Internal Medicine / Preliminary Program OB Anesthesiology Pennsylvania Hospital UCSF RESIDENCIES Opthalmology Marc Buren, MD New York University Medical Center and Clinical Instructor Manhattan Eye, Ear and Throat Hospital Joined Faculty July 2017 Anesthesiology Icahn School of Medicine at Mount Sinai MEDICAL SCHOOL FELLOWSHIP Albany Medical College Pediatric Anesthesiology INTERNSHIP University of Illinois at Chicago UCSF PREVIOUS EMPLOYMENT RESIDENCY Assistant Professor of Clinical Anesthesiology Anesthesiology University of Illinois at Chicago UCSF Pediatric Anesthesiology Medical Staff Shriners Hospital for Children in Chicago Josemine Carey, MD Clinical Instructor Lusine Danakian, MD Joined Faculty November 2017 Clinical Instructor MEDICAL SCHOOL Joined Faculty August 2017 UCSF MEDICAL SCHOOL INTERNSHIP UCSF Internal Medicine INTERNSHIP Kaiser Permanente, Oakland Anesthesiology RESIDENCY UCSF Anesthesiology RESIDENCY UCSF Anesthesiology UCSF

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 10 Alexander Dubelman, MD Valerie Jackson, MPH, PhD Assistant Clinical Professor Pain Psychologist, UCSF Pain Joined Faculty August 2017 Management Center MEDICAL SCHOOL Joined Faculty August 2017 UCLA EDUCATION INTERNSHIP PhD, Clinical Psychology Internal Medicine California School Of Professional Cedars Sinai Medical Center Psychology MPH Epidemiology RESIDENCY Columbia University Mailman School Of Anesthesiology Public Health UCSF Post-doctoral Fellowship PREVIOUS EMPLOYMENT Stanford University Medical Center Staff Anesthesiologist Pain Management Center Salinas Valley Memorial Hospital, CA Community Hospital of the Monterey Peninsula Alexandra Kisilevsky, MD, PhD, MSc Clinical Instructor Matthew Dudley, MD Non-ACGME Neuroanesthesiology Fellow Clinical Instructor Joined Faculty January 2018 Joined Faculty July 2017 ADVANCED DEGREES MEDICAL SCHOOL MSc, Forensic Science Wayne State University School of Medicine University of Strathclyde, Scotland PhD, Neuroscience INTERNSHIP University of Calgary, Canada Anesthesiology UCSF MEDICAL SCHOOL University of Calgary, Canada RESIDENCY Anesthesiology RESIDENCY UCSF Anesthesiology University of British Columbia, Canada FELLOWSHIP Critical Care Medicine PREVIOUS EMPLOYMENT UCSF Clinical Instructor University of British Columbia Heather Hervey-Jumper, MD Anesthesiologist Vancouver General Hospital Assistant Clinical Professor Joined Faculty September 2017 Rishi Kothari, MD MEDICAL SCHOOL Clinical Instructor The Ohio State University School of Non-ACGME Liver Transplant Medicine Anesthesiology Fellow INTERNSHIP Joined Faculty August 2017 University of Michigan MEDICAL SCHOOL RESIDENCY Icahn School of Medicine at Mount Sinai Anesthesiology INTERNSHIP University of Michigan Anesthesiology PREVIOUS EMPLOYMENT Icahn School of Medicine at Mount Sinai Clinical Instructor RESIDENCY University of Michigan Anesthesiology Veterans Affairs Hospital of Ann Arbor Icahn School of Medicine at Mount Sinai

Vanessa Hoy, MD Marilyn Michelow, MD Clinical Instructor Assistant Clinical Professor Non-ACGME Pediatric Cardiac Joined Faculty November 2017 Anesthesiology Fellow MEDICAL SCHOOL MEDICAL SCHOOL Weill Cornell Medical College St. George’s University, Grenada INTERNSHIP INTERNSHIP Anesthesiology Preliminary Internal Medicine Brigham and Women’s Hospital Upstate Medical University, Syracuse RESIDENCY RESIDENCY Anesthesiology Anesthesiology Brigham and Women’s Hospital Upstate Medical University, Syracuse FELLOWSHIP FELLOWSHIP Critical Care Medicine Pediatric Anesthesiology UCSF University Hospital Cleveland Medical Center Case Western Reserve University

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 11 John Monks, MD Prasad Shirvalkar, MD, PhD Assistant Professor Assistant Clinical Professor Joined Faculty September 2017 Joined Faculty October 2017 MEDICAL SCHOOL ADVANCED DEGREE Duke University School of Medicine PhD, Icahn School of Medicine at Mount INTERNSHIP Sinai Internal Medicine MEDICAL SCHOOL UCSF Icahn School of Medicine at Mount Sinai RESIDENCY INTERNSHIP Anesthesiology, UCSF Neurology PREVIOUS EMPLOYMENT New York Presbyterian-Weill Cornell College and Attending Anesthesiologist Memorial Sloan Kettering Cancer Center East Bay Anesthesiology Medical Group RESIDENCY Alta Bates Summit Medical Center Neurology New York Presbyterian-Weill Cornell College and Megha Parekh, MD Memorial Sloan Kettering Cancer Center Clinical Instructor FELLOWSHIPS Non-ACGME Trauma & Acute Care Fellow Post-doctoral Fellowship, Neuroscience Joined Faculty October 2017 Rockefeller University MEDICAL SCHOOL Pain Medicine Georgetown University School of UCSF Medicine INTERNSHIP Wendy Smith, MD Otolaryngology-Head and Neck Surgery Assistant Clinical Professor UCSF Joined Faculty November 2017 MEDICAL SCHOOL RESIDENCIES Otolaryngology-Head and Neck Surgery Stony Brook University Medical Center UCSF INTERNSHIP Anesthesiology Anesthesiology UCSF UCSF RESIDENCY Ann Cai Shah, MD Anesthesiology Assistant Clinical Professor UCSF Joined Faculty August 2017 FELLOWSHIPS MEDICAL SCHOOL Critical Care Medicine Harvard Medical School UCSF INTERNSHIP Cardiac Anesthesiology Anesthesiology UCSF UCSF RESIDENCY Solina Tith, MD Anesthesiology Associate Physician Diplomate UCSF Joined Faculty October 2017 MEDICAL SCHOOL FELLOWSHIP Pain Medicine Oregon Health and Science University UCSF INTERNSHIP Anesthesiology and Pain Medicine University of Washington RESIDENCY Anesthesiology and Pain Medicine University of Washington PREVIOUS EMPLOYMENT Acting Assistant Professor University of Washington

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 12 Visiting Faculty New Residents CLASS OF 2020 Tyler Law, MS, MD Visiting Clinical Instructor Global Health Anesthesiology Fellow HEAL Initiative Global Health Fellowship Joined faculty July 2017 ADVANCED DEGREE MS, Health Policy, Planning and Financing London School of Economics Syed Sanjay Danielle David London School of Hygiene Ali Belani Binler Bluhm and Tropical Medicine MEDICAL SCHOOL Queen’s University, Kingston, Canada RESIDENCY Anesthesiology (Including 2-year resident certificate course in Global Health) University of Toronto

Linda Zhou, MBBS Jared Amy Catherine Chris Visiting Assistant Professor Brown Chen Chiu Cosden Joined Faculty November 2017 MEDICAL SCHOOL University of Otago, New Zealand RESIDENCY Anesthesiology Various Hospitals in New Zealand, including Michael Anjali Nellie Jasmine The Wellington Public Hospital, Curtis Dixit Forman Fu Hutt Valley Hospital, and Wanganui Hospital FELLOWSHIP Cardiothoracic Anesthesia Wellington Public Hospital, New Zealand PREVIOUS EMPLOYMENT Consultant Anesthetist Wellington Public Hospital, New Zealand Kathryn Erica Won Liz Iwata Langnas Lee Liu

Kevin Benjamin Dylan Vivian Ma Marsh Masters Pham

Elliot Ashley David Schwartz Sharp Steinhardt

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 13 Honors, Awards & Appointments

Philip Kurien, MD The National Academies of Sciences, Faculty Fall 2017 CAMPUS APPOINTMENT Engineering and Medicine (NASEM) Christopher Abrecht, MD  Department of Anesthesia and Consensus report, “Pain Management Perioperative Care Severinghaus CAMPUS APPOINTMENT and the Opioid Epidemic: Balancing Assistant Professor, 2016-2018 Department of Anesthesia and Societal and Individual Benefits and Perioperative Care Pain QI Champion Risks of Prescription Opioid Use,” Benn Lancman, MBBS released July 2017. Available to the (with Julin Tang, MD) Pedram Aleshi, MD public at the NASEM Website. CAMPUS AWARD CAMPUS AWARD SFGH Foundation Hearts Grant UCSF Health Great Experience Award Julin Tang, MD  (June 2017) Tranesophageal Echocardiography (with Benn Lancman, MBBS) Simulator to Improve the Care for CAMPUS AWARD Charlene Blake, MD,  PhD Traumatically Injured Patients SFGH Foundation Hearts Grant CAMPUS AWARD Tranesophageal Echocardiography Excellence in Teaching Award Merlin Larson, MD Simulator to Improve the Care for EXTRAMURAL APPOINTMENT The Academy of Medical Educators Traumatically Injured Patients. Chairman of Task Force on History, UCSF School of Medicine California Society of Anesthesiologists Jessica Tashjian, MD EXTRAMURAL APPOINTMENT CAMPUS APPOINTMENT Catherine Chen, MD, MPH Chairman of Liaison Committee, Wood UCSF School of Medicine Teaching CAMPUS APPOINTMENT Library Museum of Anesthesiology, Scholars Program Core Faculty Member, UCSF Philip R. Schaumburg, Illinois Lee Institute for Health Policy Studies Elizabeth Whitlock, MD,  MS EXTRAMURAL AWARD Jacqueline Leung, MD, MPH EXTRAMURAL AWARD OptumLabs Data Warehouse Research EXTRAMURAL HONOR 2017 International Anesthesia Research Credit ($60,000) Interviewed for Anesthesiology Journal Society (IARS) Meeting podcast (Click here to listen) Marla Ferschl, MD Best Clinical Abstract Award “Persistent Pain is Associated with CAMPUS APPOINTMENT Jennifer Lucero, MD Director, Fetal Anesthesia Service Accelerated Memory Decline and CAMPUS APPOINTMENTS Dementia in a Longitudinal Cohort of UCSF School of Medicine Seema Gandhi, MD Elders.” Differences Matter Community CAMPUS AWARD Journal of the American Medical Ambassador UCSF Sustainability Award Association (JAMA), Reuters, & NYT features, “Association Between Persistent Dr. Gandhi’s work aims to reduce Dorre Nicholau, MD,  PhD waste generated from daily operations Pain and Memory Decline and Dementia CAMPUS AWARD in a Longitudinal Cohort of Elders” in the UCSF ORs. She explored three 2016-2017 UCSF School of Medicine areas of concern: operating room (OR) Foundation for Anesthesia Education and Maxine Papadakis Award for Faculty energy use, perioperative waste and Research (FAER) Mentored Research Professionalism and Respect anesthesia gas reduction. Training Grant CAMPUS APPOINTMENT Oliver Radke, MD,  PhD Dr. Whitlock’s study uses epidemiologic Member, UCSF School of Medicine data from the Health and Retirement EXTRAMURAL APPOINTMENT Faculty Council (2017-2020) Study (a publicly-funded study of aging Doktor Medicinae Habilitatus in America which has followed over Adrian Gelb, MB ChB University of Dresden, Germany 37,000 elders throughout late life) to look CAMPUS AWARD at the cognitive change people 2017-2019 Edward A. Dickson Gabriel Sarah, MD experience both before and after heart Faculty Emeritus Professorship CAMPUS APPOINTMENT procedures UCSF School of Medicine High Intensity George Gregory, MD Teaching Position, Medical Student Arthur Wood, MD Longitudinal Coach CAMPUS HONOR CAMPUS APPOINTMENT The George A. Gregory Global Health Member, UCSF Academic Senate, UCSF School of Medicine Endowment Established Committee on Academic Freedom John A. Watson Scholar Member, UCSF School of Medicine Irfan Kathiriya, MD, PhD Faculty Council (2016-2019) Wei Zhou, MD,  PhD EXTRAMURAL AWARD CAMPUS APPOINTMENT Hellman Family Award for Early Mark Schumacher, PhD, MD Department of Anesthesia and Career Faculty EXTRAMURAL APPOINTMENT Perioperative Care Severinghaus Member, Committee on Pain Assistant Professor, 2016-2018 Management and Regulatory Strategies to Address Prescription Opioid Abuse

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 14 Steven Hur, MD  Andrew Bishara, MD  Residents (Anesthesia Residency Class of 2019) (Anesthesia Residency Class of 2018) Ashish Agrawal, MD  McLean House II, MD  Jane Yu, MD  (Anesthesia Residency Class of 2017, (Anesthesia Residency Class of 2019) (Anesthesia Residency Class of 2018) 2017-2018 Anesthesia Critical Care “Informing Pediatric Surgeons About Medicine Fellow) WARC 2017 Anesthesia-Related Neurotoxicity: An CAMPUS AWARD UCSF Anesthesia residents authored the Educational Intervention’s Effect On UCSF Clinical and Translational Science following presentations at the WARC Elective Surgeries In Children Under One Institute (CTSI) Research Funding 2017 meeting, held at OHSU. Year Of Age” “Comparison Of Two Techniques To Allison Thoeny, MD  Measure Optic Nerve Sheath Diameter “Airway Fire During Jet Ventilation and (Anesthesia Residency Class of 2017) In Patients At Risk For Increased CO2 Laser” “Intraoperative Management Of Intracranial Pressure.” Steven Hur, MD  Hypoglycemia In A Patient With (Anesthesia Residency Class of 2019) Nesidioblastosis: A Case Report” Gregory Chinn, MD  Valeria Cárcamo-Cavazos, MD  Tom Wang, MD  (Anesthesia Residency Class of 2017) (Anesthesia Residency Class of 2019) (Anesthesia Residency Class of 2019) CAMPUS AWARD Michael Jung, MD  Allison Thoeny, MD  Mark A. Rosen Award for Resident (Anesthesia Residency Class of 2019) Scholarship (Anesthesia Residency Class of 2017) “Allergic Acute Coronary Syndrome: A “It’s A Pheo...Baby! Perioperative Rare Case Of Near Fatal Intraoperative Jeffrey Kim, MD  Management Of A Catecholamine Anaphylaxis” (Anesthesia Residency Class of 2017) Secreting Tumor In An Infant With Heart CAMPUS AWARD Mastoora Nasiri, MD  Failure” (Anesthesia Residency Class of 2017) Stuart C. Cullen Award for Excellence Matt Careskey, MD  in Clinical Anesthesia “An Unusual Hyperechoic Structure Seen (Anesthesia Residency Class of 2017) Adjacent To The Pulmonic Valve With “Lipomatosis Presenting As Stridor In A Masood Memarzadeh, MD  Intraoperative Transesophageal Newborn” (Anesthesia Residency Class Echocardiography” Elaine Nguyen, MD  of 2017 and 2017-2018 Pediatric Jacob Cecil, MD  (Anesthesia Residency Class of 2017) Anesthesia Fellow) (Anesthesia Residency Class of 2019) CAMPUS AWARD “Mea Culpa—Was All That Really “Case Report: Respiratory Failure, Jeffrey A. Katz Award for Work Ethic Necessary? Central Anticholinergic Metabolic Acidosis, And Fluid Overload and Professionalism in Patient Care Syndrome: A Late Diagnosis For A Caused By Bladder Fluid Irrigation Quickly Reversible Pathology” During Holmium Laser Removal Of The Michael Wu, MD  Shona Lee, MD  Prostate” (Anesthesia Residency Class of 2018) (Anesthesia Residency Class of 2019) EXTRAMURAL AWARD Andrew Vargas, MD  2017 Society for Obstetric Anesthesia (Anesthesia Residency Class of 2019) “Perioperative Stroke In Patient Undergoing EC-IC Bypass For and Perinatology (SOAP) Meeting “Cerebral Oxygen Desaturation Moyamoya: A Delicate Balance” Most Outstanding Case Report Award Associated With Sternal Retraction Angela Wight, MD  “Thrombosed Mechanical Heart Valves During Coronary Artery Bypass Grafting” (Anesthesia Residency Class of 2018) Requiring Emergent Cesarean Delivery Josemine Carey, MD  and Extracorporeal Membranous (Anesthesia Residency Class of 2017) “Predictive Factors Associated With A Oxygenation” Successful Clinical Outcome From “Cooled Radiofrequency Ablation For Radiofrequency Ablation Of The Dr. Wu prepared his case report under Pain Associated With Avascular Necrosis Genicular Nerves For The Treatment Of the guidance of Assistant Professor Atisa Of Femoral Head In Children” Chronic Knee Pain Due To Osteoarthritis” Britton, MD (then an OB Anesthesiology Esther Lee, MD  L. Mclean House II, MD  Fellow), Assistant Professor Jessica (Anesthesia Residency Class of 2018) Tashjian, MD, and Associate Professor (Anesthesia Residency Class of 2019) Tina Yu, MD  Pedram Aleshi, MD. (Anesthesia Residency Class of 2018) “Refractory Intraoperative Hypoxemia Secondary To Tracheal Bronchus” Anesthesia and Perioperative “Improving Compliance To Evidence- Alec Peniche, MD (Anesthesia Based Anti-Emetic Prophylaxis For Care Resident-Led UCSF Patient Residency Class of 2018) Care Fund Proposal Awarded Patients At High Risk For Post-Operative Nausea And Vomiting” “There Is A Fracture, Do We Need To Fix “Provide Non-Pharmacological It? An Unusual Injury After Intubation” Anxiolysis In The Perioperative Setting Charles Aguilar, MD  Using Evidence-Based Music/Media (Anesthesia Residency Class of 2018) Marisa Hernandez-Morgan, MD  Therapy With Mobile Modules” Esther Lee, MD  (Anesthesia Residency Class of 2017) (Anesthesia Residency Class of 2018) Michael Jung, MD  “Toxic Flowers And Aconite Poisoning: Jason Lang, MD  A Case Of Critical Illness After Chinese (Anesthesia Residency Class of 2019) (Anesthesia Residency Class of 2018) Herbal Tea” Sandeep Sabhlok, MD  Michael Jung, MD, MBA  (Anesthesia Residency Class of 2018) (Anesthesia Residency Class of 2019)

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 15 “Triple Threat: Hemiplegic Migraine, Preparation/Intervention Intraoperatively Interference with Neuromodulation Paradoxical Vocal Cord Dysfunction And to Improve Patient Comfort During Spinal Devices in the Operating Room“ Postoperative Seizure In A Patient Cord Stimulator Implant” Undergoing ERCP” January 2018 North American Keeley Dohmeier, MD  Lisa Sun, MD  Neuromodulation Society (Anesthesia Residency Class of 2018) (2016-2017 Anesthesia Pain Fellow) (NANS) Meeting January 2017 North American “Urgent Awake Fiberoptic Intubation For Neuromodulation Society Meeting Neelesh Anand, MD  Acute Airway Obstruction: Lessons Abstract “High-Frequency 10 kHz Spinal (2017-2018 Anesthesia Pain Fellow) Learned In Airway Management” Cord Stimulation Used to Treat EXTRAMURAL AWARD Jay Rajan, MD  Refractory, Chronic Pancreatitis Pain” 1st Place Poster: Burst Stimulation (Anesthesia Residency Class of 2019) Reducing Pain and Degree of Alec Peniche, MD  Amputation in Peripheral Vascular January 2017 North American (Anesthesia Residency Class of 2018) Disease: A Case Report Neuromodulation Society January 2017 North American 2018 North American Neuromodulation (NANS) Meeting Neuromodulation Society Meeting Society (NANS) Meeting Abstract “Integrating Intrathecal Pump A record number of abstracts were Patient Activator into Postoperative Pain accepted from UCSF Anesthesia Management: Lessons and Challenges” Respiratory Care Residents and Fellows at the January 2017 NANS Meeting. Ann Shah, MD  Services Division (Anesthesia Residency Class of 2016, Christopher Abrecht, MD  Byron Decuire, RRT III 2016-2017 Anesthesia Pain Fellow) (2016-2017 Anesthesia Pain Fellow) January 2017 North American CAMPUS APPOINTMENT January 2017 North American Inaugural Member, Neuromodulation Society Meeting Neuromodulation Society Meeting UCSF School of Medicine Abstract “Case Series: DRG Stimulation Abstract “Salvage Using In Situ Differences Matter Program Salvage for Failed SCS in Patients with Electrodes from Traditional Paresthesia- CRPS” CAMPUS AWARD Based Manufacturers: A Case Series” UCSF Office of Diversity and Outreach, Prasad Shirvalkar, MD, PhD  Deepali Dhar, MD  Diversity and Inclusion Certification (2016-2017 Anesthesia Pain Fellow) (2016-2017 Anesthesia Pain Fellow) UCSF Office of Diversity and Outreach January 2017 North American January 2017 North American Chancellor’s Leadership Forum Neuromodulation Society Meeting Neuromodulation Society Meeting Diversity Video Feature (April) Abstract “Managing Electrical Abstract “Use of Psychological Eula Lewis, BS, RRT, CTTS, AE-C CAMPUS AWARD (with Stephanie Tsao, NP) California Society of Anesthesiologists SFGH Foundation Hearts Grant District Directors, Delegates, and Alternate Delegates from the UCSF “GOOD NIGHT: Obstructive Sleep Department of Anesthesia and Perioperative Care Apnea (OSA) Group Medical Visit for the District 6 San Francisco Health Network (SFHN)” EXTRAMURAL HONOR Name Office Term Expiration Featured in the American Association Lee-Lynn Chen Director 2019 for Respiratory Care (AARC) Christina Inglis-Arkell Delegate 2020 Times Magazine Seema Gandhi Delegate 2020 Lance Pangilinan RRT-ACCS, RCP Adrian Gelb Delegate 2020 EXTRAMURAL AWARD Matthias Braehler Delegate 2018 FACES Foundation PHIL Award for Matt Haight Delegate 2018 Outstanding Clinical Practice Gabriel Sarah Delegate 2018 Manuel Pardo Delegate 2019 Claas Siegmueller Delegate 2019 Staff Wendy Woo Alternate 2020 Claire Harmon Alexandra Anderson Alternate 2020 Research Administration Manager David Shimabukuro Alternate 2020 CAMPUS AWARD Joshua Cohen Alternate 2018 UCSF Office of Diversity and Outreach, Valli Mummaneni Alternate 2018 Diversity and Inclusion Certification Muhammad Shaikh Alternate 2018 Cynthia Chin Melanie Henry Alternate 2019 Residency Program Coordinator Thoha Pham Alternate 2020 CAMPUS AWARD District 9 UCSF School of Medicine Star Achievement Award Name Office Term Expiration Jan Hirsch Director 2020

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 16 Peer Reviewed Publications

Abrecht CR, Brovman EY, Greenberg P, Song E, Bickler PE, Feiner JR, Lipnick MS, Batchelder P, Cross LJM, O’Kane CM, McDowell C, Elborn JJ, Rathmell JP, Urman RD. A Contemporary MacLeod DB, Severinghaus JW. Effects of Acute, Matthay MA, McAuley DF. Erratum to: Medicolegal Analysis of Outpatient Medication Profound Hypoxia on Healthy Humans: Implications Keratinocyte growth factor in acute lung injury to Management in Chronic Pain. Anesth Analg. 2017 for Safety of Tests Evaluating Pulse Oximetry or reduce pulmonary dysfunction – a randomised Nov;125(5):1761-1768. Tissue Oximetry Performance. Anesth Analg. 2017 placebo-controlled trial (KARE): study protocol. Jan;124(1):146-153. Trials. 2017 May 11;18(1):214. Abrecht CR, Greenberg P, Song E, Urman RD, Rathmell JP. A Contemporary Medicolegal Bokoch MP, Hiramoto JS, Lobo EP, Shalabi A. Crouser ED, Matthay MA. Endothelial Damage Analysis of Implanted Devices for Chronic Pain Rapid Ventricular Pacing for Landing Zone During Septic Shock: Significance and Implications Management. Anesth Analg. 2017 Precision During Thoracic Endovascular Aortic for Future Therapies. Chest. 2017 Jul;152(1):1-3. Apr;124(4):1304-1310. Arch Repair: A Case Series. J Cardiothorac Vasc Czikora I, Alli AA, Sridhar S, Matthay MA, Pillich Anesth. 2017 Mar 29. Adelmann D, Kronish K, Ramsay MA. H, Hudel M, Berisha B, Gorshkov B, Romero MJ, Anesthesia for Liver Transplantation. Anesthesiol Bosch L, Fernández-Candil J, León A, Gambús Gonzales J, Wu G, Huo Y, Su Y, Verin AD, Fulton D, Clin. 2017 Sep;35(3):491-508. PL. Influence of general anaesthesia on the Chakraborty T, Eaton DC, Lucas R. Epithelial brainstem. Rev Esp Anestesiol Reanim. Sodium Channel- Mediates the Protective Effect Agrawal PB, Wang R, Li HL, Schmitz-Abe K, 2017 Mar;64(3):157-167. of the TNF-Derived TIP Peptide in Pneumolysin- Simone-Roach C, Chen J, Shi J, Louie T, Sheng S, Induced Endothelial Barrier Dysfunction. Front Towne MC, Brainson CF, Matthay MA, Kim CF, Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Immunol. 2017 Jul 21;8:842. Bamshad M, Emond MJ, Gerard NP, Kleyman TR, Siew ED, Bagshaw SM, Bittleman D, Cruz D, Endre Gerard C. Epithelial Sodium Channel ENaC is a Z, Fitzgerald RL, Forni L, Kane-Gill SL, Hoste E, Deer TR, Pope JE, Hayek SM, Bux A, Buchser E, Modifier of the Long Term Non-progressive Koyner J, Liu KD, Macedo E, Mehta R, Murray P, Eldabe S, De Andrés JA, Erdek M, Patin D, Grider Phenotype Associated with F508del CFTR Nadim M, Ostermann M, Palevsky PM, Pannu N, JS, Doleys DM, Jacobs MS, Yaksh TL, Poree L, Mutations. Am J Respir Cell Mol Biol. 2017 Jul 14. Rosner M, Wald R, Zarbock A, Ronco C, Kellum Wallace MS, Prager J, Rauck R, DeLeon O, Diwan JA; Acute Disease Quality Initiative Workgroup 16. S, Falowski SM, Gazelka HM, Kim P, Leong M, Alam A, Suen KC, Hana Z, Sanders RD, Maze M, Acute kidney disease and renal recovery: Levy RM, McDowell Ii G, McRoberts P, Naidu R, Ma D. Neuroprotection and neurotoxicity in the consensus report of the Acute Disease Quality Narouze S, Perruchoud C, Rosen SM, Rosenberg developing brain: an update on the effects of Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. WS, Saulino M, Staats P, Stearns LJ, Willis D, dexmedetomidine and xenon. Neurotoxicol Teratol. 2017 Feb 27. Krames E, Huntoon M, Mekhail N. The 2017 Jan 6. pii: S0892-0362(17)30016-8. Polyanalgesic Consensus Conference (PACC): Chen LM, Chen LL, Chapman JS. In Reply. Alexander MD, Halbach V, Nicholson A, Recommendations on Intrathecal Drug Infusion Obstet Gynecol. 2017 Jan;129(1):208. Settecase F, Darflinger RJ, Amans MR. Systems Best Practices and Guidelines. Transvenous ethanol sclerotherapy of feeding Chun LF, Moazed F, Calfee CS, Matthay MA, Neuromodulation. 2017 Feb;20(2):96-132. arteries for treatment of a dural arteriovenous Gotts JE. Pulmonary toxicity of e-cigarettes. Denlinger LC, Phillips BR, Ramratnam S, Ross K, fistula. J Neurointerv Surg. 2017 Mar;9(3):e12. Am J Physiol Lung Cell Mol Physiol. 2017 Aug Bhakta NR, Cardet JC, Castro M, Peters SP, 1;313(2):L193-L206. Amirdelfan K, Webster L, Poree L, Sukul V, Phipatanakul W, Aujla S, Bacharier LB, Bleecker McRoberts P. Treatment Options for Failed Back Claman D, Sunwoo B. Improving Accuracy of ER, Comhair SA, Coverstone A, DeBoer M, Surgery Syndrome Patients With Refractory Home Sleep Apnea Testing. J Clin Sleep Med. Erzurum SC, Fain SB, Fajt M, Fitzpatrick AM, Chronic Pain: An Evidence Based Approach. Spine 2017 Jan 15;13(1):9-10. Gaffin J, Gaston B, Hastie AT, Hawkins GA, (Phila Pa 1976). 2017 Jul 15;42 Suppl 14:S41-S52. Holguin F, Irani AM, Israel E, Levy BD, Ly N, Collins S, Dykes P, Bates DW, Couture B, Meyers DA, Moore WC, Myers R, Opina MT, Peters Artigas A, Camprubí-Rimblas M, Tantinyà N, Rozenblum R, Prey J, O’Reilly K, Bourie PQ, Dwyer MC, Schiebler ML, Sorkness RL, Teague WG, Bringué J, Guillamat-Prats R, Matthay MA. C, Greysen SR, Smith J, Gropper M, Dalal AK. Wenzel SE, Woodruff PG, Mauger DT, Fahy JV, Inhalation therapies in acute respiratory distress An informatics research agenda to support patient Jarjour NN; National Heart, Lung, and Blood syndrome. Ann Transl Med. 2017 Jul;5(14):293. and family empowerment and engagement in Institute’s Severe Asthma Research Program-3 care and recovery during and after hospitalization. Bickler P, Feiner J, Rollins M, Meng L. Investigators. Inflammatory and Comorbid J Am Med Inform Assoc. 2017 Jun 17. Tissue Oximetry and Clinical Outcomes. Anesth Features of Patients with Severe Asthma and Analg. 2017 Jan;124(1):72-82. Collins SA, Rozenblum R, Leung WY, Morrison CR, Frequent Exacerbations. Am J Respir Crit Care Stade DL, McNally K, Bourie PQ, Massaro A, Med. 2017 Feb 1;195(3):302-313. Bickler PE, Cannesson M, Shelley KH. Trends Bokser S, Dwyer C, Greysen RS, Agarwal P, and Challenges in Clinical Monitoring: Papers Denlinger LC, Phillips BR, Ramratnam S, Ross K, Thornton K, Dalal AK. Acute care patient portals: From the 2015 IAMPOV Symposium. Anesth Analg. Bhakta NR, Cardet JC, Castro M, Peters SP, a qualitative study of stakeholder perspectives on 2017 Jan;124(1):2-3. Phipatanakul W, Aujla S, Bacharier LB, Bleecker current practices. J Am Med Inform Assoc. ER, Comhair SA, Coverstone A, DeBoer M, 2017 Apr 1;24(e1):e9-e17. Erzurum SC, Fain SB, Fajt M, Fitzpatrick AM, continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 17 Publications Forsberg A, Cervenka S, Jonsson Fagerlund M, ECLIPSE Investigators.; LifeLines Investigators.; Rasmussen LS, Zetterberg H, Erlandsson Harris H, SPIROMICS Research Group.; International COPD continued from previous page Stridh P, Christensson E, Granström A, Schening Genetics Network Investigators.; UK BiLEVE Gaffin J, Gaston B, Hastie AT, Hawkins GA, A, Dymmel K, Knave N, Terrando N, Maze M, Investigators.; International COPD Genetics Holguin F, Irani AM, Israel E, Levy BD, Ly N, Borg J, Varrone A, Halldin C, Blennow K, Farde L, Consortium. Genetic loci associated with chronic Meyers DA, Moore WC, Myers R, Opina MT, Peters Eriksson LI. The immune response of the human obstructive pulmonary disease overlap with loci for MC, Schiebler ML, Sorkness RL, Teague WG, brain to abdominal surgery. Ann Neurol. 2017 lung function and pulmonary fibrosis. Nat Genet. Wenzel SE, Woodruff PG, Mauger DT, Fahy JV, Mar 2. 2017 Mar;49(3):426-432. Jarjour NN; National Heart, Lung, and Blood Gambus P, Shafer SL. Artificial Intelligence for Huang DT, Angus DC, Moss M, Thompson BT, Institute’s Severe Asthma Research Program-3 Everyone. Anesthesiology. 2017 Nov 22. Ferguson ND, Ginde A, Gong MN, Gundel S, Investigators. Inflammatory and Comorbid Hayden DL, Hite RD, Hou PC, Hough CL, Iwashyna Features of Patients with Severe Asthma and Gattinoni L, Pesenti A, Matthay M. Understanding TJ, Liu KD, Talmor DS, Yealy DM; Reevaluation of Frequent Exacerbations. Am J Respir Crit Care blood gas analysis. Intensive Care Med. 2017 Systemic Early Neuromuscular Blockade Protocol Med. 2017 Feb 1;195(3):302-313. May 11. Committee and the National Institutes of Health Detsky AS, Gropper MA. Why Physician Leaders Geddie ML, Kohli N, Kirpotin DB, Razlog M, National Heart, Lung, and Blood Institute of Health Care Organizations Should Participate in Jiao Y, Kornaga T, Rennard R, Xu L, Schoerberl B, Prevention and Early Treatment of Acute Lung Direct Patient Care. Ann Intern Med. 2017 Mar Marks JD, Drummond DC, Lugovskoy AA. Injury Network Investigators. Design and Rationale 7;166(5):376-377 Improving the developability of an anti-EphA2 of the Reevaluation of Systemic Early single-chain variable fragment for nanoparticle Neuromuscular Blockade Trial for Acute Epiu I, Tindimwebwa JV, Mijumbi C, Chokwe TM, targeting. MAbs. 2017 Jan;9(1):58-67. Respiratory Distress Syndrome. Ann Am Thorac Lugazia E, Ndarugirire F, Twagirumugabe T, Soc. 2017 Jan;14(1):124-133. Dubowitz G. Challenges of Anesthesia in Low- Gotts JE, Abbott J, Fang X, Yanagisawa H, and Middle-Income Countries: A Cross-Sectional Takasaka N, Nishimura SL, Calfee CS, Matthay Huppert LA, Matthay MA. Alveolar Fluid Survey of Access to Safe Obstetric Anesthesia in MA. Cigarette Smoke Exposure Worsens Clearance in Pathologically Relevant Conditions: In East Africa. Anesth Analg. 2017 Endotoxin-Induced Lung Injury and Pulmonary Vitro and In Vivo Models of Acute Respiratory Jan;124(1):290-299. Edema in Mice. Nicotine Tob Res. 2017 Mar 9. Distress Syndrome. Front Immunol. 2017 Apr 7;8:371. Famous KR, Delucchi K, Ware LB, Kangelaris KN, Hamilton BC, Kukreja J, Ware LB, Matthay MA. Liu KD, Thompson BT, Calfee CS; ARDS Protein Biomarkers Associated with Primary Kallet RH, Zhuo H, Ho K, Lipnick MS, Gomez A, Network. Acute Respiratory Distress Syndrome Graft Dysfunction Following Lung Transplantation. Matthay MA. Lung Injury Etiology and Other Subphenotypes Respond Differently to Am J Physiol Lung Cell Mol Physiol. 2017 Factors Influencing the Relationship Between Randomized Fluid Management Strategy. Am J Jan 27:ajplung.00454.2016. Dead-Space Fraction and Mortality in ARDS. Respir Crit Care Med. 2017 Feb 1;195(3):331-338. Respir Care. 2017 Oct;62(10):1241-1248. Hendrickson CM, Abbott J, Zhuo H, Liu KD, Calfee Feiner JR, Weiskopf RB. Evaluating Pulmonary CS, Matthay MA. Higher Mini-BAL Total Protein Kallet RH, Zhuo H, Yip V, Gomez A, Lipnick MS. Function: An Assessment of PaO2/FIO2. Crit Care Concentration in Early ARDS Predicts Faster Spontaneous Breathing Trials and Conservative Med. 2017 Jan;45(1):e40-e48. Resolution of Lung Injury Measured by More Sedation Practices Reduce Mechanical Ventilation Ventilator Free Days. Am J Physiol Lung Cell Mol Duration in Subjects With ARDS. Respir Care. Fernandez-Bustamante A, Frendl G, Sprung J, Physiol. 2017 Feb 17:ajplung.00381.2016. 2017 Oct 10. Kor DJ, Subramaniam B, Martinez Ruiz R, Lee JW, Henderson WG, Moss A, Mehdiratta N, Colwell Hobbs BD, de Jong K, Lamontagne M, Bossé Y, Kallet RH, Burns G, Zhuo H, Ho K, Phillips JS, MM, Bartels K, Kolodzie K, Giquel J, Vidal Melo Shrine N, Artigas MS, Wain LV, Hall IP, Jackson Pangilinan LP, Yip V, Gomez A, Lipnick MS. MF. Postoperative Pulmonary Complications, VE, Wyss AB, London SJ, North KE, Franceschini Severity of Hypoxemia and Other Factors That Early Mortality, and Hospital Stay Following N, Strachan DP, Beaty TH, Hokanson JE, Crapo Influence the Response to Aerosolized Prostacyclin Noncardiothoracic Surgery: A Multicenter Study by JD, Castaldi PJ, Chase RP, Bartz TM, Heckbert SR, in ARDS. Respir Care. 2017 Aug;62(8):1014-1022. the Perioperative Research Network Investigators. Psaty BM, Gharib SA, Zanen P, Lammers JW, Keene JD, Jacobson S, Kechris K, Kinney GL, JAMA Surg. 2017 Feb 1;152(2):157-166. Oudkerk M, Groen HJ, Locantore N, Tal-Singer R, Foreman MG, Doerschuk CM, Make BJ, Curtis JL, Rennard SI, Vestbo J, Timens W, Paré PD, Festic E, Carr GE, Cartin-Ceba R, Hinds RF, Rennard SI, Barr RG, Bleecker ER, Kanner RE, Latourelle JC, Dupuis J, O’Connor GT, Wilk JB, Banner-Goodspeed V, Bansal V, Asuni AT, Talmor Kleerup EC, Hansel NN, Woodruff PG, Han MK, Kim WJ, Lee MK, Oh YM, Vonk JM, de Koning HJ, D, Rajagopalan G, Frank RD, Gajic O, Matthay Paine R 3rd, Martinez FJ, Bowler RP, O’Neal WK; Leng S, Belinsky SA, Tesfaigzi Y, Manichaikul A, MA, Levitt JE. Randomized Clinical Trial of a COPDGene and SPIROMICS Investigators. Wang XQ, Rich SS, Barr RG, Sparrow D, Litonjua Combination of an Inhaled Corticosteroid and Biomarkers Predictive of Exacerbations in the AA, Bakke P, Gulsvik A, Lahousse L, Brusselle GG, Beta Agonist in Patients at Risk of Developing SPIROMICS and COPDGene Cohorts. Am J Respir Stricker BH, Uitterlinden AG, Ampleford EJ, the Acute Respiratory Distress Syndrome. Crit Care Med. 2017 Feb 15;195(4):473-481. Bleecker ER, Woodruff PG, Meyers DA, Qiao D, Crit Care Med. 2017 Feb 24. Lomas DA, Yim JJ, Kim DK, Hawrylkiewicz I, Sliwinski P, Hardin M, Fingerlin TE, Schwartz DA, Postma DS, MacNee W, Tobin MD, Silverman EK, continued on next page Boezen HM, Cho MH; COPDGene Investigators;

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 18 Publications Lopez AM, Agusti M, Gambus P, Pons M, Anglada Melia U, Gabarron E, Agustí M, Souto N, Pineda P, T, Valero R. A randomized comparison of the Fontanet J, Vallverdu M, Jensen EW, Gambus P. continued from previous page Ambu AuraGain versus the LMA supreme in Comparison of the qCON and qNOX indices for the Koch SR, Lamb FS, Hellman J, Sherwood ER, patients undergoing gynaecologic laparoscopic assessment of unconsciousness level and noxious Stark RJ. Potentiation and tolerance of toll-like surgery. J Clin Monit Comput. 2017 stimulation response during surgery. J Clin Monit receptor priming in human endothelial cells. Dec;31(6):1255-1262. Comput. 2017 Dec;31(6):1273-1281. Transl Res. 2017 Feb;180:53-67.e4. Manuel SP, Spitzer T2, Ishizawa Y. Preoperative Meng L, McDonagh DL, Berger MS, Gelb AW. Laffey JG, Matthay MA. Fifty Years of Research autologous blood donation in healthy bone marrow Anesthesia for awake craniotomy: a how-to guide in ARDS. Cell-based Therapy for Acute Respiratory donors contributes to pre-procedure anemia. Bone for the occasional practitioner. Can J Anaesth. Distress Syndrome. Biology and Potential Marrow Transplant. 2017 Aug;52(8):1191-1193. 2017 Feb 8. Therapeutic Value. Am J Respir Crit Care Med. Markley JC, Rollins MD. Non-Neuraxial Labor Miaskowski C, Mastick J, Paul SM, Topp K, Smoot 2017 Aug 1;196(3):266-273. Analgesia: Options. Clin Obstet Gynecol. 2017 B, Abrams G, Chen LM, Kober KM, Conley YP, Lawton SK, Xu F, Tran A, Wong E, Prakash A, Feb 17. Chesney M, Bolla K, Mausisa G, Mazor M, Wong Schumacher M, Hellman J, Wilhelmsen K. M, Schumacher M, Levine JD. Chemotherapy- Martinez CH, Diaz AA, Meldrum C, Curtis JL, N-Arachidonoyl Dopamine Modulates Acute Induced Neuropathy in Cancer Survivors. Cooper CB, Pirozzi C, Kanner RE, Paine R 3rd, Systemic Inflammation via Nonhematopoietic J Pain Symptom Manage. 2017 Jan 4. pii: Woodruff PG, Bleecker ER, Hansel NN, Barr RG, TRPV1. J Immunol. 2017 Aug S0885-924(16)31243-X. Marchetti N, Criner GJ, Kazerooni EA, Hoffman 15;199(4):1465-1475. EA, Ross BD, Galban CJ, Cigolle CT, Martinez FJ, Muffly M, Honkanen A, Singleton M. In Response. Lee BH, Braehler M. Use of test dose allows early Han MK; SPIROMICS Investigators. Age and Small Anesth Analg. 2017 Mar 17. detection of subdural local anesthetic injection Airway Imaging Abnormalities in Subjects with Muniyappa A, Goldschlager N, Patzelt M, Krall TJ, with lumbar plexus block. J Clin Anesth. and without Airflow Obstruction in SPIROMICS. Tang JF. Pseudoventricular tachycardia during 2017 Feb;37:111-113. Am J Respir Crit Care Med. 2017 Feb drilling and screw placement in a cervical 15;195(4):464-472. Leligdowicz A, Conroy AL, Hawkes M, Zhong K, vertebra. J Electrocardiol. 2017 Jun 8. Lebovic G, Matthay MA, Kain KC. Validation of Matthay MA, Pati S, Lee JW. Concise Review: Neice AE, Behrends M, Bokoch MP, Seligman two multiplex platforms to quantify circulating Mesenchymal Stem (Stromal) Cells: Biology and KM, Conrad NM, Larson MD. Prediction of Opioid markers of inflammation and endothelial injury in Preclinical Evidence for Therapeutic Potential for Analgesic Efficacy by Measurement of Pupillary severe infection. PLoS One. 2017 Apr Organ Dysfunction Following Trauma or Sepsis. Unrest. Anesth Analg. 2017 Mar;124(3):915-921 18;12(4):e0175130. Stem Cells. 2017 Feb;35(2):316-324. Nickerson JW, Pettus K, Wheeler KE, Hallam C, Leslie M, Paradis E, Gropper MA, Kitto S, Reeves Matthay MA, Abman SH. Exosome-Based Bewley-Taylor DR, Attaran A, Gelb AW. Access to S, Pronovost P. An Ethnographic Study of Health Therapy for Bronchopulmonary Dysplasia. controlled medicines for anesthesia and surgical Information Technology Use in Three Intensive Am J Respir Crit Care Med. 2017 Sep 28. care in low-income countries: a narrative review of Care Units. Health Serv Res. 2017 Jan 25. Matthay MA, McAuley DF, Ware LB. Clinical trials international drug control systems and policies. Leslie M, Paradis E, Gropper MA, Milic MM, in acute respiratory distress syndrome: challenges Can J Anaesth. 2017 Mar;64(3):296-307. Kitto S, Reeves S, Pronovost P. A Typology and opportunities. Lancet Respir Med. 2017 Park M, Hsu CY, Go AS, Feldman HI, Xie D, Zhang of ICU Patients and Families from the Clinician Jun;5(6):524-534. X, Mifflin T, Waikar SS, Sabbisetti VS, Bonventre Perspective: Toward Improving Communication. Matthay MA. Extracellular Vesicle Transfer JV, Coresh J, Nelson RG, Kimmel PL, Kusek JW, Health Commun. 2017 Jun;32(6):777-783. from Mesenchymal Stromal Cells Modulates Rahman M, Schelling JR, Vasan RS, Liu KD; Lim S, Lucero J. Obstetric and Anesthetic Macrophage Function in Acute Lung Injury: Chronic Renal Insufficiency Cohort (CRIC) Study Approaches to External Cephalic Version. Basic Science and Clinical Implications. Am J Investigators.; CKD Biomarkers Consortium. Anesthesiol Clin. 2017 Mar;35(1):81-94. Respir Crit Care Med. 2017 Jun 22. Urine Kidney Injury Biomarkers and Risks of Cardiovascular Disease Events and All-Cause Lipnick MS, Bulamba F, Ttendo S, Gelb AW. McAuley DF, Cross LM, Hamid U, Gardner E, Death: The CRIC Study. Clin J Am Soc Nephrol. Elborn JS, Cullen KM, Dushianthan A, Grocott MP, The Need for a Global Perspective on 2017 Mar 2. pii: CJN.08560816. Task-Sharing in Anesthesia. Anesth Analg. Matthay MA, O’Kane CM. Keratinocyte growth 2017 Sep;125(3):1049-1052. factor for the treatment of the acute respiratory Rocha C, Mendonça T, Silva ME, Gambús P. distress syndrome (KARE): a randomised, Erratum to: Individualizing propofol dosage: a London MJ, Schwartz GG, Hur K, Henderson WG. double-blind, placebo-controlled phase 2 trial. multivariate linear model approach. J Clin Monit Association of Perioperative Statin Use With Lancet Respir Med. 2017 Jun;5(6):484-491. Comput. 2017 Feb;31(1):239. Mortality and Morbidity After Major Noncardiac Surgery. JAMA Intern Med. 2017 Feb Mehta S, Burns KE, Machado FR, Fox-Robichaud Rodriguez-Roisin R, Han MK, Vestbo J, Wedzicha 1;177(2):231-242. AE, Cook DJ, Calfee CS, Ware LB, Burnham EL, JA, Woodruff PG, Martinez FJ. Chronic Kissoon N, Marshall JC, Mancebo J, Finfer S, Respiratory Symptoms with Normal Spirometry. London MJ. Preoperative Administration of Hartog C, Reinhart K, Maitland K, Stapleton RD, A Reliable Clinical Entity? Am J Respir Crit Care Angiotensin-converting Enzyme Inhibitors or Kwizera A, Amin P, Abroug F, Smith O, Laake JH, Med. 2017 Jan 1;195(1):17-22. Angiotensin II Receptor Blockers: Do We Have Shrestha GS, Herridge MS. Gender Parity in Enough “VISION” to Stop It? Anesthesiology. Critical Care Medicine. Am J Respir Crit Care Med. continued on next page 2017 Jan;126(1):1-3. 2017 Feb 27.

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 19 Publications Southwell DG, Osorio JA, Liverman CS, Weiskopf RB, Cook RJ. Understanding Friedman LM, Naidu RK, Poree LR, Henry MM, non-inferiority trials and tests for the continued from previous page Jacques L. Intrathecal catheter-associated non-statistician: when to use them and how Rogers AJ, Contrepois K, Wu M, Zheng M, inflammatory mass in a neurofibromatosis type-1 to interpret them. Transfusion. 2017 Peltz G, Ware LB, Matthay MA. Profiling of ARDS patient receiving fentanyl and bupivacaine. Feb;57(2):240-243. Pulmonary Edema Fluid Identifies a Metabolically Surg Neurol Int. 2017 Jul 25;8:159. Weiskopf RB, Beliaev AM, Shander A, Guinn NR, Distinct Subset. Am J Physiol Lung Cell Mol Srejic U, Larson P, Bickler PE. Little Black Boxes: Cap AP, Ness PM, Silverman TA. Addressing the Physiol. 2017 Mar 3:ajplung.00438.2016. Noncardiac Implantable Electronic Medical Devices unmet need of life-threatening anemia with Roubinian NH, Looney MR, Keating S, Kor DJ, and Their Anesthetic and Surgical Implications. hemoglobin-based oxygen carriers. Transfusion. Lowell CA, Gajic O, Hubmayr R, Gropper M, Anesth Analg. 2017 Jul;125(1):124-138. 2017 Jan;57(1):207-214. Koenigsberg M, Wilson GA, Matthay M, Toy P, Strickland CD, Eberhardt SC, Bartlett MR, Nelson Xi Y, Kim T, Brumwell AN, Driver IH, Wei Y, Tan V, Murphy EL; TRALI Study Group. Differentiating J, Kim H, Morrison LA, Hart BL. Familial Cerebral Jackson JR, Xu J, Lee DK, Gotts JE, Matthay MA, pulmonary transfusion reactions using recipient Cavernous Malformations Are Associated with Shannon JM, Chapman HA, Vaughan AE. Local and transfusion factors. Transfusion. 2017 Adrenal Calcifications on CT Scans: An Imaging lung hypoxia determines epithelial fate decisions Jul;57(7):1684-1690. Biomarker for a Hereditary Cerebrovascular during alveolar regeneration. Nat Cell Biol. 2017 Schell-Chaple HM, Liu KD, Matthay MA, Condition. Radiology. 2017 Mar 20:161127. Aug;19(8):904-914. Sessler DI, Puntillo KA. Effects of IV Sweerus K, Lachowicz-Scroggins M, Gordon E, Zemans RL, Matthay MA. What drives neutrophils Acetaminophen on Core Body Temperature and LaFemina M, Huang X, Parikh M, Kanegai C, to the alveoli in ARDS? Thorax. 2017 Hemodynamic Responses in Febrile Critically Fahy JV, Frank JA. Claudin-18 deficiency is Jan;72(1):1-3. Ill Adults: A Randomized Controlled Trial. associated with airway epithelial barrier Crit Care Med. 2017 Jul;45(7):1199-1207 Zhao C, Yang X, Su EM, Huang Y, Li L, Matthay dysfunction and asthma. J Allergy Clin Immunol. MA, Su X. Signals of vagal circuits engaging with Sendagire C, Lipnick MS, Kizito S, Kruisselbrink 2017 Jan;139(1):72-81.e1. AKT1 in 7 nAChR+CD11b+ cells lessen E. coli R, Obua D, Ejoku J, Ssemogerere L, Nakibuuka J, Tang AT, Choi JP, Kotzin JJ, Yang Y, Hong CC, and LPS-induced acute inflammatory injury. Kwizera A. Feasibility of the modified sequential Hobson N, Girard R, Zeineddine HA, Lightle R, Cell Discov. 2017 Apr 11;3:17009. organ function assessment score in a resource- Moore T, Cao Y, Shenkar R, Chen M, Mericko P, constrained setting: a prospective observational Zhao Z, Wickersham N, Kangelaris KN, May AK, Yang J, Li L, Tanes C, Kobuley D, Võsa U, study. BMC Anesthesiol. 2017 Jan 26;17(1):12. Bernard GR, Matthay MA, Calfee CS, Koyama T, Whitehead KJ, Li DY, Franke L, Hart B, Ware LB. External validation of a biomarker and Shavit CW, Rollins MD, Ferschl MB. Maternal Schwaninger M, Henao-Mejia J Morrison L, clinical prediction model for hospital mortality in convulsion during high-dose sevoflurane Kim H, Awad I, Zheng X, Kahn ML. Endothelial acute respiratory distress syndrome. Intensive anaesthesia for open foetal surgery. Br J Anaesth. TLR4 and the microbiome drive cerebral Care Med. 2017 Aug;43(8):1123-1131. 2017 Apr 1;118(4):634-635. cavernous malformations. Nature. 2017 May 18;545(7654):305-310. Zhou R, Bickler P. Interaction of Isoflurane, Tumor Sinskey JL, Rollins MD, Whitlock E, Moon- Necrosis Factor- and -Amyloid on Long-term Grady AJ, Vu L, Feiner JR, Ferschl MB. Incidence Thornton KC, Schwarz JJ, Gross AK, Anderson Potentiation in Rat Hippocampal Slices. Anesth and Management of Umbilical Artery Flow WG, Liu KD, Romig MC, Schell-Chaple Analg. 2017 Feb;124(2):582-587. Abnormalities during Open Fetal Surgery. H, Pronovost PJ, Sapirstein A, Gropper Fetal Diagn Ther. 2017 Aug 22. MA, Lipshutz AKM; Project Emerge Collaborators. Zhu JY, Heidersbach A, Kathiriya IS, Garay BI, Preventing Harm in the ICU-Building a Culture Ivey KN, Srivastava D, Han Z, King IN. The E3 Skubas NJ, London MJ. We Should Train for of Safety and Engaging Patients and Families. ubiquitin ligase Nedd4/Nedd4L is directly Strain. Anesth Analg. 2017 Feb;124(2):386-387 Crit Care Med. 2017 Sep;45(9):1531-1537 regulated by microRNA 1. Development. 2017 Smith SM, Dworkin RH, Turk DC, Baron R, Mar 1;144(5):866-875. Vacas S, Degos V, Maze M. Fragmented Sleep Polydefkis M, Tracey I, Borsook D, Edwards RR, Enhances Postoperative Neuroinflammation Zinter MS, Orwoll BE, Spicer AC, Alkhouli MF, Harris RE, Wager TD, Arendt-Nielsen L, Burke LB, but Not Cognitive Dysfunction. Anesth Analg. Calfee CS, Matthay MA, Sapru A. Incorporating Carr DB, Chappell A, Farrar JT, Freeman R, Gilron 2017 Jan;124(1):270-276. Inflammation into Mortality Risk in Pediatric Acute I, Goli V, Haeussler J, Jensen T, Katz NP, Kent J, Respiratory Distress Syndrome. Crit Care Med. Kopecky EA, Lee DA, Maixner W, Markman JD, Vide S, Costa CM, Gambus PL, Amorim PP. 2017 Feb 28. McArthur JC, McDermott MP, Parvathenani L, Raja Effects of Ketamine on Pupillary Reflex Dilation: SN, Rappaport BA, Rice AS, Rowbotham MC, A Case Report. 2017 Sep 26. Zygourakis CC, Lee J, Barba J, Lobo E, Lawton Tobias JK, Wasan AD, Witter J. The potential role MT. Performing concurrent operations in academic Wang EY, Dixson J, Schiller NB, Whooley MA. of sensory testing, skin biopsy, and functional vascular neurosurgery does not affect patient Causes and Predictors of Death in Patients With brain imaging as biomarkers in chronic pain outcomes. J Neurosurg. 2017 Jan 20:1-7. Coronary Heart Disease (from the Heart and Soul clinical trials: IMMPACT considerations. J Pain. Study). Am J Cardiol. 2017 Jan 1;119(1):27-34. 2017 Feb 27. pii: S1526-5900(17)30481-9.

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 20 Active Research Grants

Roland Bainton Catherine Chen Monica Harbell Christina Inglis-Arkell Principal Investigator Principal Investigator Anesthesia Department, Principal Investigator Anesthesia Department, Mt. Zion Health Fund, 10/1/2016–9/30/2018 Mt. Zion Health Fund, 7/1/2017–6/30/2018 9/1/2017–8/31/2018 Anesthesia Department Clinical 4/3/2017–3/31/2018 Anesthesia Department Postoperative Opioid-Prescribing Research Award Assessment of Postoperative Opioid Research Award Patterns, Multimodal Analgesia, and $35,867 Usage After Ambulatory Surgery at $41,000 the Prescription Opioid Epidemic Mount Zion Surgery Center $40,000 Principal Investigator $12,935 UCSF Program for Breakthrough Mt. Zion Health Fund, 5/1/2017–4/30/2018 Biomedical Research New Frontiers Lee-lynn Chen Michael Jung, Steven Hur, Research Grant, Point-Of-Care Ultrasound (POCUS) McLean House 1/16/2018–1/15/2019 Principal Investigator Training for MZ Anesthesia Providers Interrogating the Biologic Cost Mt. Zion Health Fund, $9,630 UCSF Patient Care Fund, of Robust Chemoprotection of 8/1/2017–7/31/2018 7/1/2017–6/30/2018 the Brain: Using ICA to Identify Perioperative Pathways Program Tomoki Hashimoto Music Therapy Based Perioperative Novel Genomic Markers of Data Dashboards Anxiolysis Neuro-Protection and Age-Related $40,000 Principal Investigator $7,000 CNS Pathogenesis NIH/NINDS, 9/1/2013–5/31/2018 $121,793 Anne Donovan The Role of Mast Cells in the Irfan Kathiriya Pathophysiology of Intracranial Charlene Blake Principal Investigator Aneurysm Principal Investigator $1,726,306 Principal Investigator Anesthesia Department, Anesthesia Department, 7/1/2016–6/30/2018 7/1/2017–6/30/2018 Anesthesia Department, Principal Investigator Anesthesia Department Clinical Anesthesia Department Research 7/1/2016–6/30/2018 Anesthesia Department, Research Award Award Anesthesia Department Clinical 7/1/2016–6/30/2018 $27,052 $80,000 Research Award Anesthesia Department New $28,008 Directions Award Richard Fidler Principal Investigator $10,000 Hellman Family Award, Michael Bokoch Principal Investigator 7/1/2017–6/30/2019 Judith Hellman Developmental Origins of Congenital Principal Investigator UC Center for Accelerated Innovation, 9/1/2016–8/31/2018 Heart Disease Anesthesia Department, Principal Investigator UC Center for Accelerated Innovation $50,000 7/1/2017–6/30/2018 San Francisco Foundation, $200,000 1/1/2015–ongoing Anesthesia Department Clinical Helen Kim Research Award San Francisco Foundation Award $39,990 Adrian Gelb $325,000 Principal Investigator NIH/NINDS, 7/1/2013–6/30/2018 Principal Investigator Principal Investigator Marek Brzezinski Predictors of spontaneous cerebral Dickson Emeritus Professorship International Anesthesia Research AVM hemorrhage Principal Investigator Award, 7/1/2017–6/30/19 Society, 7/1/2015–6/30/2018 $2,297,210 UCSF Chancellor Fund, Fostering Quality and Safety in Endothelial Inflammatory Pathways 5/1/2015–ongoing Anesthetic Practice in the in Septic Vasculopathy and Developing World Principal Investigator Single-Entry-Website for Organ Injury NIH/NINDS, 5/15/2017–4/30/2022 $10,000 UCSF Faculty $750,000 Long-term Outcomes in Unruptured $15,000 Principal Investigator Brain Arteriovenous Malformation Zhonghui Guan Patients Massachusetts General Hospital, Catherine Chen Principal Investigator 8/8/2016–9/30/2018 $3,076,884 FAER, 1/1/2017–12/31/2018 NIH/NINDS, 9/30/2012–8/31/2018 Species Inspired Research for Co-Investigator Unintended Consequences of Epigenetic regulation in Innovative Treatments (SPIRIT) University of Pennsylvania, Routine Preoperative Testing in neuropathic pain $326,000 7/1/2017–4/30/2018 Cataract Surgery Patients $947,160 NIH/NIGMS, 7/1/2017–6/30/2022 TLR4 and the Microbiome in $175,000 CCM Disease Principal Investigator Comprehensive Anesthesia Research $132,598 Principal Investigator Anesthesia Department, Training Anesthesia Department, 7/1/2016–6/30/2018 $1,375,243 Principal Investigator 7/1/2017–6/30/2018 Anesthesia Department Research UCSF REAC, 7/1/2017–6/30/2018 Award Anesthesia Department PET Characterization of Inflammation Research Award $80,000 in Patients with Cerebral Cavernous $40,000 Principal Investigator Malformations NIH/NINDS, 7/1/2017–6/30/2022 $50,000 Regulation of Nerve Injury-induced Gene Expression in Neuropathic Pain $1,733,595 continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 21 Grants Mark Latronica Bin Liu Mervyn Maze continued from previous page Principal Investigator Principal Investigator Co-Principal Investigator Anesthesia Department, UCSF Parker Institute for Cancer UCSF REAC, 7/1/2016–6/30/2018 Helen Kim 7/1/2017–6/30/2018 Immunotherapy, 7/1/2017–6/1/2019 The Effects of Exercise Anesthesia Department Research Synthetic Notch T Cells Co-Leader “Prehabilitation” on Cognitive and Award $518,000 Functional Recovery after Surgery in NIH/NINDS, 9/30/2014–7/31/2019 $34,996 Older Adults Brain Vascular Malformation Vivace Therapeutics Inc., $40,000 Consortium–Project 1: Modifiers of 3/1/2017–ongoing Disease Severity and Progression in Michael Lawton Research Award Claus Niemann Cerebral Cavernous Malformation Principal Investigator $1,000,000 $561,268 NIH/NINDS, 9/30/2014–7/31/2019 Principal Investigator Director Brain Vascular Malformation Martin London Oregon Health & Science University, NIH/NINDS, 9/30/2014–7/31/2019 Consortium: Predictors of Clinical 1/1/2016–12/31/2018 Course Principal Investigator Brain Vascular Malformation Donor Management Research $6,796,554 Anesthesia Department, Institute Consortium–Administrative Unit 7/1/2015–6/30/2018 $521,313 $1,988,668 Jae-Woo Lee Anesthesia Department Research Award Jonathan Pan Sakura Kinjo Principal Investigator $5,500 Principal Investigator NIH/NHLBI, 5/1/2017–1/31/2021 Principal Investigator Anesthesia Department, Human Mesenchymal Stem Cell James Marks Anesthesia Department, 7/1/2017–6/30/2019 Microvesicles for the Treatment of 7/1/2016–6/30/2018 Acute Lung Injury Principal Investigator Anesthesia Department Research Anesthesia Department Clinical NIH/NIAID, 2/1/2013–1/31/2018 Research Award $2,219,548 Award Generation of therapeutic antibodies $34,702 $50,000 Jacqueline Leung for serotype F botulism $5,448,316 Ludmila Pawlikowska Jens Krombach Principal Investigator NIH/NIA, 6/1/2015–5/31/2018 Principal Investigator Co-Leader Principal Investigator NIH/NCI, 9/24/2014–8/31/2019 The Effects of Light vs Deep NIH/NINDS, 9/30/2014–7/31/2019 UCSF-ZSFG Risk Reduction Award, Antibody Technology Research Anesthesia on Postoperative Brain Vascular Malformation 7/1/2016–6/30/2018 Center Cognitive Outcomes Consortium–Genetic and Statistical Improvement & Expansion of an $5,779,613 Integrated Electronic Checklist $444,033 Analysis Core (GSAC) $416,197 System for Routine and Emergency Principal Investigator Principal Investigator Anesthesia Procedures NIH/NIA, 3/1/2017–2/28/2019 NIH/NIAID, 6/1/2014–5/31/2018 $125,000 Lawrence Poree Acute Preoperative Sleep Disruption Trispecific Monoclonal Antibody for and Postoperative Delirium Botulinum Neurotoxin Intoxication Therapy Principal Investigator Daisuke Kudo $438,536 St. Jude Medical Business Services $1,336,571 Brain Aneurysm Foundation, Inc., 3/1/2017–3/9/2019 10/1/2017–9/30/2018 Michael Lipnick Principal Investigator A Post-Approval Study to Evaluate Contribution of Microbiota in the DNA 2.0 Inc, 2/5/2013–2/5/2018 Targeted SCS (DRG) Stimulation for Principal Investigator Pathophysiology of Intracranial Improve the CHO Expression of the Management of Moderate to Hellman Fellows Fund, Aneurysm a scFv Fragment that is moving Severe Chronic, Intractable, Pain 7/1/2016–6/30/2018 $30,000 towards the clinic optimizing the of the Lower Limbs due to CRPS Anesthesia & Global Health Equity: DNA sequence of the scFv Types I and II (TARGET) Creating a Model for Research Philip Kurien and/or leader sequence $206,536 and Medical Education $0 Principal Investigator $49,812 Arun Prakash Budde Anesthesia Department, Principal Investigator 7/1/2017–6/30/2018 Bin Liu Nanotherapeutics, Principal Investigator Anesthesia Department 3/1/2017–8/31/2018 NIH/NIGMS, 2/1/2015–1/31/2019 Research Award Principal Investigator Technology Transfer for the Role of Innate Immune Cells and NIH/NCI, 8/6/2012–7/31/2018 $50,000 Production of NX01, NX02, NX11, Pathways in Ventilated Lung Internalizing human antibody- XB10, XB18 and XB23 Antibody Ischemia Reperfusion targeted nanosized siRNA Specific Domains $790,560 Benn Lancman therapeutics $1,043,375 and Julin Tang $1,607,090 Principal Investigator Mervyn Maze Anesthesia Department, San Francisco General Hospital Principal Investigator 7/1/2017–6/30/2018 Foundation, 7/1/2017–6/30/2018 UCSF-Pfizer CTI, Anesthesia Department Research Transesophageal Principal Investigator 11/16/2016–11/15/2018 Award Echocardiography Simulator NIH/NIGMS, 9/1/2013–8/31/2018 Site-Specific Immune Activation $80,000 $98,156 Inflammation resolving mechanism by Novel Antibody dysregulation in postoperative $550,750 cognitive decline $1,212,399

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UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 22 Grants Mark Schumacher Jessica Tashjian Xiaobing Yu continued from previous page Principal Investigator Principal Investigator Principal Investigator Anesthesia Department, Anesthesia Department, Anesthesia Department, Jeffrey Sall 7/1/2017–6/30/2018 7/1/2017–6/30/2018 7/1/2016–6/30/2018 Anesthesia Department Research Anesthesia Department Clinical Anesthesia Department Clinical Principal Investigator Award Research Award Research Award NIH/NIGMS, 3/1/2015–2/29/2020 $80,000 $12,930 $17,996 Testosterone’s role in sex-specific outcomes after early anesthesia $1,524,496 Una Srejic Arthur Wallace Eunice Zhou Principal Investigator Principal Investigator Principal Investigator Principal Investigator Anesthesia Department, NCIRE, 3/1/2012–3/1/2018 Merrimack Pharmaceuticals, UC Davis, 1/1/2017–12/31/2019 7/1/2015–6/30/2018 Perioperative Outcomes 8/1/2016–7/31/2018 Prevention of Cerebral Injury in Anesthesia Department Clinical Epidemiologic Consortium Cross Reactive Human mAbs to Pediatric Diabetic Ketoacidosis Research Award $150,000 Tumor Associated Antigens $28,600 $20,000 $300,000 Principal Investigator Principal Investigator ECOM Medical, 8/1/2016–7/31/2019 Tasley Pharmaceuticals, Inc., Hua Su Wei Zhou 8/17/2017–8/17/2022 Impedance Cardiography: Clinical Evaluation of Endotracheal Pre-CTA for A Double-Blind, Principal Investigator Principal Investigator Cardiac Output Monitor (ECOM) Randomized and Placebo-Controlled NIH/NINDS, 1/1/2014–12/31/2018 Anesthesia Department, Study to Evaluate the Safety and Hemodynamics of Cerebral $10,000 7/1/2017–6/30/2018 Efficacy of T89 in Preventing Arteriovenous Malformations Anesthesia Department Research Acute Mountain Sickness (AMS) $1,633,785.65 Arthur Wallace Award During Rapid Ascent $61,341 $1,500 Principal Investigator Principal Investigator NIH/NHLBI, 1/16/2015–12/31/2018 Obelab, 8/1/2016–7/31/2019 Principal Investigator International Anesthesia Research Andrew Schober Cell Type-Specific Influences on Clinical Testing of NIRS for HHT Pathogenesis Quantitative Assessment of Society, 7/1/2016–6/30/2018 Principal Investigator $1,582,037 Depression and PTSD The Roles and Applications of Anesthesia Department, $100,000 Orexin/Hypocretin System in 7/1/2017–6/30/2019 Anesthesia Anesthesia Department Clinical $150,000 Research Award $40,000

Honor Roll of Donors Donors of up to $100 Donors of $100 – $999 Donors of $1000 – $9,999 Ms. Catherine Cheng Mr. Phillip E. Evans Dr. Jue Wang Arthur William Wallace, MD Barry D. Bergquist, MD Dorothy Ford Bainton, MD and Cedric R. Bainton, MD Michael A. Matthay, MD Paul G. Preston, MD Donors of $10,000 or more Thien Y. Ng, MD Dr. and Mrs. John R. Rasmussen Mrs. Gail R. and Dr. Ronald D. Miller John W. Holl, MD Mr. Daniel G. Solomon Community Foundation of Orange and Sullivan Vladimir Nekhendzy, MD PHSA Corporation Mulago Foundation Hua Su, MD Mr. William B. Kerr Vivace Therapeutics, Inc. John W. Holl, MD Dr. and Mrs. Dean B. Andropoulos Hellman Foundation Mr. Joshua M. Cohen Barry D. Bergquist, MD

Thomas M. Grove, MD Katherine M. and John R. Moyers Dr. and Mrs. Terry Stephen Vitez Mr. Daniel G. Solomon Sinel Wilfand & Vinci, CPAs, Inc. and Ms. Rachel S. Rosenblatt Dr. and Mrs. Adrian W. Gelb

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 23 In Memoriam

William “Bill” Kennon Hamilton, MD 1922–2017

William (Bill) Kennon Hamilton, MD, was born December 15, 1922 in Guthrie Center, Iowa and died peacefully June 29, 2017, in Carmichael, California, having lived a long, useful, and productive life. Bill earned his B.A. (1943) and M.D degrees (1946) from the University of Iowa. Following an internship, he entered the United States Army and served in Germany in the 97th General Hospital as Chief of Anesthesia. He returned to the University of Iowa and completed his anesthesia residency from 1949-1951, and subsequently joined their Anesthesia faculty. At the age of 35, he was appointed Chair of the University of Iowa Anesthesia Department. Early in his career, a At left: Bill and Shyrlee Hamilton polio epidemic in Iowa greatly affected him and spawned a lifelong interest in pulmonary physiology and pulmonary care, and in the development of intensive care units, then a new Dr. Hamilton was one of concept. His research interests included the effects of anesthetics on the venous system and measures to make the first academic anesthesia anesthesia more effective and safe. In 1967, he joined the department chairs to faculty of the University of California, San Francisco as provide anesthesia faculty Professor and Chair of the Department of Anesthesia, a with both financial support position he maintained until 1983. As the Chair of Anesthesia at UCSF, Dr. Hamilton built the and time for research. department into one of the premier Anesthesia Departments in In 1983, Dr. Hamilton became the first Vice Dean for Clinical the world. While maintaining his commitment to superior Affairs at the University of California, San Francisco, serving as patient care, teaching, and research, he greatly increased the a liaison between the medical school and the hospital. He was number of faculty to meet the academic and clinical needs of enormously successful in helping advance the academic and the University. clinical missions of both entities. As a result, the relationship Bill’s commitment was first and foremost to the care of between the hospital and medical school flourished. This has patients. Despite his administrative commitments, he continued significantly benefited future generations of clinicians and, to provide anesthesia for patients and was often asked to do more importantly, patients. so for faculty members and their families. To foster continued Dr. Hamilton was an outstanding teacher. His insight into advances in clinical care, he taught the importance of problems and ability to help students learn, not only for the integrating physiology and pharmacology into the daily practice day, but for the future, was exemplary. He received many of anesthesia and intensive care, as well as the need to do accolades for his outstanding contributions to medicine, but research that improved the care of patients. the awards he most cherished were “teaching awards.” Dr. Hamilton was one of the first academic anesthesia In 1992 Bill retired from the University to spend time with his department chairs to provide anesthesia faculty with both wonderful and equally charismatic wife of 46 years Shyrlee, financial support and time for research. By doing so, he served who was Bill’s best friend and confidant. She contributed to his as a scientific bridge between clinical care and research. success in many ways. Unfortunately, Shyrlee died in 2002, Before the terms existed, Dr. Hamilton “thought outside the which left a significant void in Bill’s life. When asked what he box” to support “translational” “bench to bedside” research. was doing in retirement he said, “Making music in two concert With an unwavering focus on exemplary patient care, he sent bands, golfing three times a week, napping in the afternoons faculty to other centers to learn new techniques and allowed most days.” some faculty to work in other clinical departments with like Bill was a great mentor, teacher, clinician, administrator, and goals in mind. friend. He supported and developed many young (and some Dr. Hamilton also influenced the practice and teaching of old) faculty and allowed them to flourish. His guidance and anesthesia in many other countries, including Canada. leadership will be sorely missed. Many physicians from these countries came to San Francisco Dr. Hamilton is survived by his son and daughter-in-law to work and study with him and his faculty. They returned Douglas and Rebecca Hamilton, of Sacramento, CA, by home and became outstanding clinicians and teachers, chairs his daughter Deborah Hamilton, of Lagunitas, CA, and by of anesthesia departments, and deans of medical schools. his grandchildren Courtney and Andrew Hamilton, of Thus, through his dedication to teaching and learning, he Sacramento, CA. influenced medicine, not only in the United States, but also in many other countries. continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 24 Dr. Hamilton memorium continued from previous page Some personal remembrances from those whose lives were touched by Dr. Hamilton include: From Ronald D. Miller, MD (Chair, UCSF Anesthesia, 1984 – 2009 and UCSF Anesthesia Residency Class of 1968) Bill Hamilton was a wonderful person and leader. He lived about 4 city blocks from me, so we shared rides to UCSF routinely. Those rides provided the background and atmosphere for some highly educational and meaningful Eger with lab colleagues, 1964 conversations. We played lots of golf together in Marin. Lots of in-depth conversations resulted. Our debates were wonderful Eger spent his final two for me. He tried to “do what was right” more intensely than anyone I have ever known. decades as an investigator From Joyce Wahr, MD (UCSF Anesthesia Residency Class pursuing the mechanism of 1982) of action of inhaled I ADORED Bill Hamilton. I started as a resident there in 1981, anesthetics, one of the and had the best time of my life! And Bill Hamilton was front oldest mysteries in and center for my experience. pharmacology. From Michael Gropper, MD, PhD (Current Chair, UCSF Anesthesia and Perioperative Care) general internist, when an epiphany during an externship Many of us recall Bill’s engaging personality, and deep directed him to a career in anesthesia instead: assisting with commitment to the department, school and university. Under the care of a patient receiving the anesthetic thiopental by Bill’s guidance, the department thrived, continuing its ascent to infusion, the patient’s breathing gradually slowed and finally become the premier department in the country. In addition to stopped, whereupon Eger discovered that he could move air in his own important contributions, Bill successfully recruited a and out of the patient’s lungs by squeezing the anesthesia number of clinician scientists. Bill enhanced all three missions circuit, thus keeping him alive. This power of controlling a of the department, recruiting top talent and building our person’s breathing, coupled with the haunting memory of his research portfolio, and oversaw significant clinical growth. own sense of suffocation during anesthesia, inspired him to He also played a key role in the department establishing embark on a career in anesthesiology. He was determined to leadership in critical care. improve on what he had experienced as a child. Following a one-year internship at St. Luke’s Hospital in Chicago, Dr. Eger began residency training at the University Edmond I Eger II, MD, 1930–2017 of Iowa with a new baby and wife, Dollie Ross Eger, in tow (after 25 years of marriage, they divorced in 1983). Under the Edmond I. “Ted” Eger, II, the anesthesiologist and scientist who leadership of Iowa’s Dr. Stuart Cullen, Dr. Eger began pioneered development of modern inhaled anesthetics, died publishing his first research papers and also began working peacefully at his home in Tiburon, California, on August 26, with another anesthesia resident, Dr. John Severinghaus, who 2017, one week shy of his 87th birthday. Dr. Eger’s research is successfully challenged Dr. Eger’s initial notions about the the basis for the safe use of modern inhaled anesthetics physiology of uptake and distribution. Dr. Eger followed him to administered to more than 300 million patients every year. His UCSF to work as his research fellow and spent the next 50 death was due to pancreatic cancer. years applying precise mathematical detail to answer the Edmond I Eger II was born Sept. 3, 1930, in Chicago, the questions that Dr. Severinghaus had posed while they were son of an advertising executive. The young Ted Eger received residents. ether anesthesia at ages 6 and 10, experiences that would Working at the University of California, San Francisco, haunt him and guide him into a career to improve anesthesia Dr. Eger methodically characterized the effects of drugs used care. In both cases, he felt restrained, suffocated, and drawn in anesthetic practice. This work began with halothane and into a black vortex as consciousness disappeared. methoxyflurane in the 1960s and extended to enflurane and Eger graduated from Hyde Park High School at the age of isoflurane in the 1970s, and to desflurane in the 1990s. Early in 15, having led his school checker team to two consecutive his career, Eger (and Lawrence Saidman) were challenged by victories in the All-Chicago Checker Championship. He Severinghaus to develop a standard measure of anesthetic graduated in the lower 20 percent of the class, however, and potency. Severinghaus handed Eger a bottle of something after his first (and only) day of selling women’s shoes, he called halopropane. “He asked me to find out if it was any resolved to improve his study habits. He enrolled in Roosevelt good,” says Eger. “And when I asked him how, exactly, he College and was able to transfer to the University of Illinois one shrugged and told me I would figure it out.” That bottle of year later, from which he graduated Phi Beta Kappa with a halopropane would prove useless as an anesthetic, but it was major in chemistry and a minor in mathematics. Later that year, the perfect vehicle for Eger to learn how to compare one he enrolled in Northwestern Medical School, from which he anesthetic to another. Their studies introduced the concept of graduated in 1955. He had expected to pursue a career as a continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 25 Dr. Egar memorium continued from previous page

“MAC” for the “minimum alveolar concentration” of anesthetic required to prevent movement in response to surgical stimulation. Eger also characterized the processes governing the onset, uptake, and distribution of inhaled anesthetics into the lungs and body tissues, including the brain, and how quickly anesthetics are removed at the end of anesthesia. This provided precise guidance on how to administer inhaled anesthetics safely and effectively during surgery. Dr. Eger developed these concepts for the anesthetics available in the 1960s, and then used these concepts to identify new drugs From Cindy Chin, UCSF Anesthesia and Perioperative Care meriting commercial development: isoflurane, sevoflurane, and desflurane. Residency Coordinator Eger’s research, with numerous collaborators, led to I would like to share this picture of Dr. Eger taken with his wife more than 500 peer-reviewed publications, including nine of at the Class of 2011’s graduation party. I will miss him dearly! the 100 most frequently cited anesthesia-related publications. His research trainees include the editors-in-chief of An avid lover of nature, Eger hiked throughout the Sierra Anesthesiology and Anesthesia and Analgesia; two medical Nevada and completed the entire John Muir Trail three times; school deans; four recipients of the Distinguished Service one of his favorite places was Yosemite’s Half Dome, which Award from the American Society of Anesthesiologists; four he last climbed on his 75th birthday with his entire family. recipients of the Excellence in Research Award from the Dr. Eger is survived by his wife of 21 years, Dr. Lynn Spitler; American Society of Anesthesiologists; and 24 chairs of four children, Cris Cadence Waste, Dr. Doreen J. Eger, departments of anesthesiology. Dr. Eger has received Edmond Eger III, and Dr. Renee R. Eger; two step-children, numerous awards for his research and leadership roles in Dr. Diane Anderson and Paul Spitler; seven grandchildren, six anesthesia, including the Distinguished Service Award (1991) step-grandchildren, and a half-brother, Larry Eger. and the Excellence in Research Award from the American Dr. Eger’s obituary provided by Steven L. Shafer, MD, Society of Anesthesiology, and is an Elected Fellow of the and Lynn Spitler, MD. Royal College of Surgeons, London. In 2010, he gave the Second Annual John W. Severinghaus Lecture in Translational Following are some personal remembrances from Science (“After You Please”). those whose lives were touched by Dr. Eger: Eger is the author, co-author, or co-editor of seven books. The first,Anesthetic Uptake and Action, published in 1975, From Michael Bokoch, MD, PhD, Assistant Professor, remains the definitive description of the principles of anesthetic UCSF Anesthesia and Perioperative Care, UCSF Anesthesia pharmacology. The last, The Wondrous Story of Anesthesia, edited with Lawrence Saidman and Roderick Westhorpe, and Perioperative Care Residency Class of 2015 provides a definitive history. In 1990, Dr. Eger was interviewed What a joy and inspiration to have met and learned from by former Chair of Anesthesia at UCSF, Dr. William K. Hamilton, Dr. Eger – and had an oral board stem from him! Makes me feel for the Wood Library’s John W. Pender Collection of the Living lucky indeed to be part of this incredible UCSF family. History of Anesthesiology. Fifty-five years ago, Eger founded From David J. Cullen MD, MS, Former Chair of and subsequently supported the Western Anesthesia Residents Anesthesiology, Tufts University and St. Elizabeth’s Conference, an annual meeting hosted by departments of anesthesia located in the western US inviting Anesthesia Medical Center, UCSF Anesthesia Residency Class of 1969 Residents to present results of their research. This Conference (Chief Resident) has thrived and grown over the years to a vibrant annual Ted Eger was the most influential, important, and substantive meeting well-attended by residents, department chairs, and mentor in my entire lifetime of 77 years (so far). anesthesia research faculty. The conference recently honored As a medical student at the University of Michigan, 1961-65, Eger by naming an annual lectureship after him. I was initially curious about anesthesia when I learned a Eger spent his final two decades as an investigator pursuing monograph had been written about anesthesiology by a man the mechanism of action of inhaled anesthetics, one of the named Stuart Cullen. Having the same last name, but being oldest mysteries in pharmacology. He gave a legendary series unrelated (unlike my dear colleague, Bruce Cullen), I was of lectures on anesthetic uptake and distribution to the first- intrigued and completed a one month anesthesia elective in my year anesthesia residents at UCSF. Eger discovered tantalizing senior year which convinced me to pursue training in clues about how fundamentally different various anesthetics anesthesiology. During my residency interview in1964 with Dr. are, while also proving that anesthetics have less person-to- Robert Dripps, Department Chair at the University of person variability than do other drugs. He showed that modern Pennsylvania, he told me there were only 3 top departments in inhaled anesthetics can anesthetize any animal at doses similar the country at that time; Penn, Columbia, and UCSF. Coming to those in humans, that plants and even the most primitive from Detroit, choosing San Francisco over Philadelphia and forms of life, blue-green algae, can be anesthetized. No other New York was an easy decision, and, most fortunately, led to drug behaves like this. But despite these clues and decades of my relationship with Ted Eger. work, the puzzle of exactly how anesthetics work remains unsolved. continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 26 Dr. Egar memorium continued from previous page Starting residency in July, 1966, I soon realized what a remarkable training program I had entered because so much of the teaching, guidance and directed learning was based on the new discoveries establishing a scientific foundation for administering anesthesia more safely, led by Drs. Severinghaus and Eger. I developed an understanding of uptake and distribution, equipotency, and the early attempts to discern the mechanism/s by which anesthesia works. The technical skills, neat tricks, the art of the many facets of problem solving all were important too. But Ted’s work clearly led us to understand what every general anesthetic (almost always using one or another inhalation anesthetic) was based on; i.e. a far more fundamental and scientific basis which greatly enhanced our understanding of what we were doing to the “black box” that is the brain, about which so little was known at time. Thus, I applied for, and was accepted as Ted’s research Eger at the Harvard/MGH Ether Dome (photo courtesy of MGH) fellow for 1967-68 which also included full access to all the wonders of the Cardiovascular Research Institute, especially a truly wonderful mentor, friend, and colleague. He will be Dr. Severinghaus and his lab. I mention this because, with sorely missed. Ted’s guidance, mentorship, direction, leadership, and From Janet A. Dewan PhD, MS, CRNA, Associate Nurse inspiration, I was able to develop research protocols which piqued my own interest and which he supported, such as the Anesthesia Program Director, Northeastern University interaction between the inhalation anesthetics and hypoxia, I was fortunate to enjoy professional time and relaxed dinners hypo and hypercarbia, and severe anemia. In turn, I also with Dr. Eger when he lectured at the AANA meetings. I have participated fully in Ted’s pioneering and extraordinary studies been quoting him, posting his articles, since 1981, when I first of the many effects of inhalation anesthetics in human taught Uptake and Distribution of Inhaled Anesthetics to Nurse volunteers, conducted at UCSF, and with N. Ty Smith at Anesthesia Students. Although I still reference him proudly in Stanford. The level of technical sophistication used in these the inhalation anesthesia sequence, I now have added material studies was so far beyond anything I could have imagined. from The Wondrous Story of Anesthesia to his influences, and Over time, many of these technical achievements have become use it in my History of Anesthesia lectures. His signed copy of clinical standards of care. that book is one of my anesthesia treasures. He taught me so much about data analysis and extracting Reading his work is enlightening on many levels but my relevant information from the literature. Importantly, he instilled lasting memory of his greatest influence on me as a teacher of in me the need for critical thinking, always questioning why we anesthetists stems from a personal encounter a few years ago made the clinical decisions we made, and often asking me to at a meeting. I saw what a spontaneously open to ideas justify, if I could, why I did what I did when he supervised my scientist and human he was. I told Dr. Eger that every year clinical work. There should be a justifiable answer for almost when my new graduate nursing students come to our program every detail involved in the choices one made to provide the I ask, in the first class, that they all take out a piece of paper safest and most effective anesthetic possible, given the and write down how they think general anesthesia works. I end circumstances. When no good answer could be provided, he up with a variety of semi pharmacologic/physiologic prompted us to research the literature, or else to think about explanations, and some more spiritual ones. I save these and how to study the question. This approach served me well at graduation time ask the students if their ideas have throughout my entire career. changed...emphasizing there is still a mystery. When I told this To sum up, because of Ted’s influence, my learning curve to Dr. Eger I thought he might chuckle visualizing the beginning soared that year beyond my wildest expectations, allowing student attempt at expressing understanding of a phenomenon me to continue research studies during my 3rd year of not completely explained. But, no he immediately and residency, and while in the Air Force for 2 years, and enabled enthusiastically said “Oh keep doing that, one of them may my recruitment to Massachusetts General Hospital and have an insight that is needed. “ I saw in him a man, who Harvard Medical School as an academic anesthesiologist and knows much more about the actions of anesthetics than I ever critical care intensivist for many years. I have no doubt that my will, but who looked at every opportunity as one to uncover career would have been far less interesting and successful new ideas, even from beginning students who have never without the tools implanted in me by Ted Eger. I am sure the delivered an anesthetic. I read my students’ theories with a same can be said for every one of Ted’s fellows, let alone the more open and inquisitive mind, now, because of his comment. innumerable residents he taught directly, and the worldwide Thank you Dr. Eger for making a complex topic influence his research, teaching and publications have had on understandable, for recognizing the vast continuum of our specialty. He truly was a giant in advancing our specialty knowledge, evidence and skill that has evolved into the and we were all so fortunate to live, work and thrive under his anesthesia practice we have today, and for making us all see influence. In addition, he was a “mensch” of the highest order, there are discoveries yet to come. continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 27 Dr. Egar memorium continued from previous page the Distinguished Service Award. He was elected Fellow to the Royal Colleges of Surgeons in both London and Ireland. And From Stuart Forman, MD, Professor of Anesthesia, Ted, seemingly ageless, is still going strong, mentoring another Massachusetts General Hospital generation of Academic Anesthesiologists. In 2007, I had the honor of hosting Ted Eger at MGH as our Ether Day Grand Rounds speaker. Ted also insisted on From Claire Harmon, UCSF Anesthesia and Perioperative delivering a second talk in the Ether Dome entitled “A Personal Care Research Administration Manager History of Anesthesia”, in which he described his professional My contact with Ted Eger consisted mostly of helping him and journey and love for our clinical specialty and research to a rapt the team of investigators complete annual progress reports and standing-room-only audience. The photo Steve included in his renewal applications for his NIH program project grant, Sites email (above) was taken in the Ether Dome at that event. and Mechanisms of Inhaled Anesthetic Actions. My boss Upon receiving Steve’s email, I located my introductory and I also met regularly with Dr. Eger to go over the grant’s comments for Ted’s Ether Dome talk. Here is the text of my finances. It was in one of these meetings that I discovered that comments as they related to Ted’s career, as of 2007: Dr. Eger and I had similar tastes in books. From that point until Professor Edmond “Ted” Eger trained in Chicago and the grant ended several years later, he and I exchanged books then served several years as a physician in the military before regularly, and I always enjoyed our discussions about them. moving to San Francisco to pursue an Academic I appreciated that we were simply two enthusiasts. Anesthesiology career. Ted has made an astounding number of contributions to our understanding of anesthetic pharmacology From Brian Hite, MD, UCSF Anesthesia Residency during his more than four decades at UCSF. He literally Class of 2000 “wrote the book” on anesthetic uptake and distribution. In 1965 Yes. I think I did the last closed circuit anesthetic at Moffit Professor Eger and his colleagues at UCSF took a firm stand, with him in 1999-2000. He taught me old school anesthesia. defining a specific clinical endpoint, “lack of movement in I even mastered the inhaled desflurane induction. Yes, we will response to a standard noxious stimulus,” and used this intubate the trachea and ventilate the patients lung with anchoring point to measure and compare the potency of mechanical respirator. various inhaled agents. “Minimal alveolar concentration” or From Evan Koch, CRNA, MSN: “MAC” remains THE standard by which anesthetic potency is measured, and the stimulus-response paradigm has enriched Ted Eger taught without ever intending to. He caused people our understanding of how to meaningfully measure anesthetic to question things. He gently inspired people to reach beyond depth. Of course, Ted has not restricted his scholarship to the anything they ever thought could be accomplished. And Ted clinical actions of anesthetics. He has spearheaded was ecumenical. “The Wondrous Story of Anesthesia” was investigations of anesthetic mechanisms, and he continues to the first history to include both CRNAs and anesthesiologists, lead a very productive Program Project Grant applying a Ted’s way of saying that both groups have been responsible systems neurobiology approach to the problem. Along the for advancing the art and science of anesthesia. Ted was way, Ted has written numerous books, published over 500 widely admired by CRNAs. He spoke at national and regional peer reviewed papers, and created a legacy of trainees that meetings many times. The American Association of Nurse include Lawrence Saidman, Robert Stoelting, Bruce Cullen, Anesthetists presented Ted with its Public Service in Michael Cahalan, and many other national and international Anesthesia Award for his good work, friendship, and honesty. leaders in Anesthesia research and education. The ASA has Ted Eger was a true mentor to our entire profession, and he will be missed. honored Ted with both the Excellence in Research Award and continued on next page

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 28 Dr. Egar memorium continued from previous page From Hannah Kwon, UCSF Anesthesia and Perioperative Care Residency Class of 2009 Dr. Ted Eger...possibly one of the most memorable attendings during my residency training. Even at almost 80 years old (at the time), he continued to come into the ORs to teach us personally. I still remember his introductory lecture to us CA-1s about inhaled anesthetics and him speaking about how we uptake the inhaled agent through our lungs, it enters our circulation and then in our brains, and then “magic happens.” He pushed us all as first year anesthesia residents to do things we were uncomfortable with, to challenge us and show us the true limits of various anesthesia techniques. was struck by his candor and introspection in describing his I was just another resident in training there, but I feel so journey. lucky to have experienced this GIANT and his love for teaching One of my favorite lines here: “Research should equal fun.” first hand. What an amazing man. RIP Dr. Eger. He reminded us about this from time to time, both in words and by example. From Esther Lee, MD, UCSF Anesthesia and Perioperative Care Residency Class of 2018 From Ronald D. Miller, MD, Professor Emeritus, UCSF The UCSF Anesthesia Class of 2018 will always remember the Anesthesia and Perioperative Care, Chair, UCSF Anesthesia wit, humor, tact and sharpness of Dr. Eger during his lectures and Perioperative Care, 1984-2009 on inhaled anesthetics. Forever grateful to have learned from Ted Eger, Bill Hamilton and I lived near each other in Marin one the greatest giants in anesthesia. County. During the gasoline shortages in the l970s, we shared From Errol Lobo, MD, PhD, Professor, UCSF Anesthesia a ride to and from work at UCSF. This means that the 3 of us had many lengthy and Perioperative Care, UCSF Anesthesia and Perioperative conversations; I only wish those conversations had been Care Residency Class of 1992 recorded. I and we will miss them both. When we come in as residents or new faculty, we are still impressionable, and most of us incorporate some of the traits From William North, CRNA: (characteristics), some good of our attendings and mentors. In I met Dr. Eger at Charity Hospital in New Orleans in 1983. He my third week as a resident at UCSF, Professor Eger was my was a genius in his field. attending. It was a time when all residents did their pre-ops as From Steven L. Shafer, MD, Professor of Anesthesiology, patients were usually admitted the night before their scheduled surgery. I had this one patient who was scheduled for a knee Perioperative And Pain Medicine, Stanford University replacement, and when I attempted to do my pre-op, I Ted was among the leaders of a generation of clinical scientists encountered the surgical attending for the case. He did not like who transformed our specialty from an art to a science. Some the fact that I had an afro and a beard, so as I entered the of this generation have passed. Some of this generation are still patient’s room, he berated me calling me the “N” word and with us. Of those, some are even on this list! Thank you for more. As a new resident, I was traumatized and wanted nothing your decades of work creating the scientific specialty of to do with the case. Even though Professor Eger may not have modern anesthesia. understood the implications of the ugly “N” word for me, he We will miss Ted, the scientist, clinician, teacher, and friend. told me to raise my head up and never to submit to bullies and Ted’s contributions will live on. Tomorrow, when you to give the best anesthetic of my young anesthetic career and anesthetize your patient with isoflurane, sevoflurane (yes, he would be present every moment of the case. This event and sevoflurane), or desflurane, when you adjust the partial Professor Eger’s response to it made me tougher and gave me pressure to 1 MAC, when you use the principles of anesthetic more respect for my chosen specialty – anesthesiology. uptake and distribution to awaken your patient, pause for a Professor Eger could have taken the easy route and got the moment of joy that one of us, Ted Eger, contributed so much to assignment changed as most others would. I never did thank the safety of our practice and wellbeing of our patients. Dr. Eger, but I will never forget this event. From Jenson Wong, MD, Associate Professor, UCSF From Rachel McKay, MD, Professor, UCSF Anesthesia and Anesthesia and Perioperative Care, UCSF Anesthesia and Perioperative Care, UCSF Residency Class of 1998 Perioperative Care Residency Class of 2005 Dr. Eger valued his interactions with motivated learners of all I was really sad and surprised to hear about Ted. I thought I’d sorts (even faculty), but he especially enjoyed having the share this selfie I took with him at graduation this year. I took opportunity to teach and interact with the anesthesia residents. the pic to share it with my mom, who knew Ted when she was I thought others might appreciate this transcript of the working in Joan Kendig’s lab at Stanford in the 1990s and early Second Annual John Severinghaus Lecture on Translational 2000s. Science, given at the ASA in 2009. Although at the time From San Yuan, MD, UCSF Anesthesia and Perioperative everyone was aware of his resourcefulness, and significant contributions to the fields of anesthesia and surgery, honestly I Care Residency Class of 1988: continued on next page

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I am deeply sadden by this news; another giant of anesthesia has fallen! I still remember the night when we all went over to his house on Twin Peaks to discuss the Nitrous Oxide’s effect on methionine synthetase. True gentlemen and scholars are hard to come by nowadays. And Ted typifies that image. From David Zvara, MD, Professor and Chair, University of North Carolina at Chapel Hill Thank you for sending this. I knew Ted. He was a remarkable physician and colleague. He greeted each person with delight, Ernest Guy, MD, 1921–2017 an open heart, and an open mind. Ernest Philip Guy, age 96, died peacefully in his home on September 5, 2017. He is survived by his wife of 73 years, Patty, and daughters Phyllis and Patricia, as well as many advocate position to challenge your thinking. This approach nieces and nephews. Ernie was the son of Rev. and Mrs. often frustrated the receiver but helped the student learn the R. E. Guy of Jackson, Tennessee; he was the ‘middle of the lesson. He greeted each person with delight, an open heart, pack’ and the last surviving sibling of their seven children. and an open mind. To say he will be missed is an under- After graduation from Union University in Jackson, statement; but, more importantly, he will be remembered. Tennessee, Ernie joined the Army Air Corp, becoming a flight instructor. Fulfillment of his lifelong dream of being a doctor Dr. Guy’s obituary provided by his family. began when he entered medical school at University of Following are some persoal remembrances from Tennessee followed by his residency at John Gaston Hospital in Memphis, Tennessee. He entered a general practice Dr. Guy’s UCSF colleagues: partnership with his brother-in-law in Henderson, Tennessee. From Terry Vitez, MD, UCSF Anesthesia Residency Class Five years later, he decided to specialize in Anesthesia and was of 1974 accepted at University of Iowa. When the Chairman of the He was one of our favorites. He had a unique way of Anesthesia department moved to chair the department at the approaching problems and was always supportive of the University of California, San Francisco (UCSF), Ernie was invited to join the new staff. He became Chief of Anesthesia residents. and Chief of Staff at the San Francisco General Hospital From C. Philip Larson, MD, UCSF Anesthesia Residency (SFGH) in his role as Associate Professor at UCSF, providing Class of 1962; Former Vice Chair of Anesthesia and Chief of on-the-job training to residents in Anesthesia while managing the SFGH emergency services. During that time, he worked on Anesthesia at SFGH; Former Chair, Anesthesia at Stanford various committees planning for and re-designing a new He was a great faculty member and teacher. He spent many hospital, updating hospital policies, and helping hospital years at SFGH and really was an important contributor to the management through a tumultuous political time. He was often anesthesia service there. I am sending you a contribution to the invited by the American Board of Anesthesiology to be an Dept Research Fund in his memory. examiner, certifying new Anesthesiologist. After 18 years in From Richard Barber, MD, UCSF Anesthesia Faculty San Francisco, Ernie joined the DeKalb Anesthesia Group in 1967-1979 Decatur, Georgia, retiring in 1985 to make beautiful wood Ernie was a dear friend, a superb clinical anesthetist, and the furniture and to pursue his love of gardening, creating a most ingenious and dedicated teacher I was ever privileged to masterpiece in his own yard. work with. He was truly one of a kind. He was as dedicated to Always a devout Christian, Ernie was an ordained Deacon his faith and supportive of his church as he was to his role as serving in churches as well as teaching Sunday School physician and teacher. Heaven will be made better by his classes. He was a Trustee of the Golden Gate Baptist Seminary presence. My deepest sympathy to his family. in Sausalito, California, working to expand the educational program and raising funds to ensure the future of the Seminary. From Richard Weiskopf, MD, UCSF Anesthesia He often challenged traditional approaches in an effort to Residency Class of 1969, UCSF Anesthesia Fellowship expand the churches’ and the seminary’s thinking to keep 1970-1971, UCSF Anesthesia and Perioperative Care Faculty them modern while maintaining essential Christian values. Whether working in the university or private practice, or Senate Emeritus serving his religious community, among his many talents, Ernie Guy was an excellent clinician, educator, and role model. teaching was possibly his greatest. Whether you were his He was also a kind, generous person. I was fortunate to be a student, his child, his nephew or niece, or a member of his resident when he was Chief of Service at SFGH, and learned a Sunday School class, his methodology was to take the devil’s great deal from him, about many things.

UCSF Department of Anesthesia and Perioperative Care | Anesthesia News | Spring 2018 | 30 Anesthesia Department Events Anesthesia Saturday News Grand Rounds is published by the UCSF May 19, 2018 Department of Anesthesia and Perioperative Care 8 Hours of CME/CUE Credit Four 2-hour Sessions: 500 Parnassus Avenue ■■ Pediatric Anesthesia MUE 4th Floor, Box 0648 San Francisco, CA 94143-0648 ■■ Obstetric Anesthesia 415/476-4244 ■■ Anesthesia Critical Care ■■ Trauma / Emergency Anesthesia http://anesthesia.ucsf.edu Global Health Recent Work Link to more information and registration: Send all inquiries to https://anesthesia.ucsf.edu/events/ UCSFAnesthesiaNews in Guatemala anesthesia-saturday-grand-rounds @ucsf.edu and Tanzania As part of Operation Rainbow, UCSF Previous Events DEPARTMENT CHAIR Anesthesia and Perioperative Care AND EDITOR-IN-CHIEF: Professor Errol Lobo, MD, PhD, H. Barrie Fairley Seminar Michael Gropper, MD, PhD class of 2018 residents Michael Wu, in Respiratory Care MD,  PhD and Esther Lee, MD,  EDITOR: and Mercy Vigil, CRNA, recently Dedication Ceremony Morgen Ahearn volunteered to provide anesthesia Access the presentation here: PRINCIPAL WRITER: for orthopedic surgeries in https://anesthesia.ucsf.edu/ Huehuetenango, Guatemala. For Andrew Schwartz news/h-barrie-fairley-seminar- Dr. Wu, the trip was one of the intensive-respiratory-care- DESIGNER: highlights of his residency – something dedication-ceremony Laura Myers Design he thinks everyone should be a part of at some point. PHOTOGRAPHERS: UCSF Anesthesia and Perioperative Christine Jegan Care Visiting Clinical Instructor and HEAL Initiative Global Health Fellow Susan Merrell Tyler Law, MD,  helped teach a SAFE Marco Sanchez, UCSF (Safer Anesthesia from Education) Documents and Media Obstetric Anesthesia Course in Tanzania (September). The three-day ©2018 The Regents of the course was taught to over 40 nurse University of California anesthetists, who often work as the sole anesthesia provider in a rural area. A one-day Train of Trainers (TOT) course for Tanzanian physician John Severinghaus anesthesia faculty and residents was Pioneers of Anesthesia also held. This course was designed to impart the fundamentals of how to Lecture, “Eight Sages teach a SAFE course — so that when Over 5 Centuries Share the international faculty left, these Oxygen’s Discovery” physicians would be equipped to run Access the presentation recording here: further iterations of the course. SAFE-OB has been run in dozens of https://lecture.ucsf.edu/ets/ countries, reaching hundreds of Catalog/Full/0fb68472f87049b6aa1 providers, and aims to teach 73be45d892c3521 standardized, high-yield, locally relevant content. n

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