Monday, October 16, 2006 Guidry talks on patients, perceptions Panel: Anesthesiologists should be poised for disasters Panel addresses need for precaution with propofol use Almost a third of pediatric surgical patients are overweight or obese ASA Cadaver Workshops provide attendees with hands-on experience Media award winners represent print, television Guidry talks on patients, perceptions The outgoing ASA President wants to change the reality of anesthesiology by changing the lens with which society views it. Referring to the recent decision by a Missouri state judge ordering a board-certified anesthesiologist to oversee the administration of a “lethal cocktail,” Dr. Guidry expressed concern over the judge’s reference to the “death chamber as an ‘operations room.’” “We cannot let our patients perceive us as executioners,” Dr. Guidry said. “Remember, perception is reality.” Dr. Guidry continued on this thread, recounting the horrors of Hurricane Katrina and the subsequent story regarding an ENT surgeon and two nurses accused of killing four patients that came out of New Orleans’ Memorial Medical Center. “The full story of what happened there is not yet known and may never be,” Dr. Guidry said. “What is well accepted in the New Orleans’ medical community is that these three caregivers did not willingly harm their patients. Unfortunately, perception has become reality for this doctor and these two nurses.” Public perception and reality often diverge, but anesthesiologists must not focus on things they cannot control. Instead they must continue to do the right thing and work to save lives, he said. But it is also important to manage public perception as best as the specialty can, without relying solely on ASA’s public relations department. “We must accept that our every action … reflects on us all — every encounter with patients,” he said. For Dr. Guidry, this means that it’s all about the patient. Keeping this in mind, ASA has a bright future, Dr. Guidry added. “I leave knowing that our organization is in capable hands,” he said. “Thank you for the privilege of serving the ASA.” back to top back to ASA Daily News home Panel: Anesthesiologists should be poised for disasters Disasters from hurricanes the likes of Katrina, a SARS epidemic, a tsunami, an influenza pandemic or a terrorist attack are always on the hearts and minds of anesthesiologists. How anesthesiologists can become valued team members during such disasters took center stage at the Annual Meeting when a panel examined their possible roles in preparedness and effective disaster response, triage and clinical management. As Co-Director of the Surgical Intensive Care Unit at Bellevue Hospital, J. David Roccaforte, M.D., was called upon during the response to the 9-11 attacks in New York. While the hospital “got its share of admissions,” he said, “a lot of us were standing around waiting for the casualties to arrive.” According to Dr. Roccaforte, hospital staff took immediate steps to ready themselves, opening consumables, getting bays ready and moving patients out of the ICU. They were called upon to staff a pseudo treatment facility, rather an unclean warehouse, at Chelsea Pier, which had “zero consideration for the provision of anesthesia,” he said. Although this response was certainly predictable, Bellevue has made inroads in its disaster preparedness planning so that such a response takes place when merited, said Dr. Roccaforte, Assistant Professor at New York University. An example of when systems became overwhelmed was Katrina, he added. “We witnessed a disconnect between the public’s expectations of how we can provide care and what has to be done in terms of rationing,” Dr. Roccaforte said. David Baker, M.Phil., D.M., a Consultant in Anesthesia and Resuscitation with the Paris Emergency Medical Service, pointed to the public’s misunderstanding of the role of anesthesiologists. According to Dr. Baker, a British study showed that 60 percent of respondents didn’t know that anesthesiologists had to be medically qualified. “They thought that they were some kind of volunteer who was stunning patients with ether-soaked rags,” Dr. Baker joked. Ernesto A. Pretto, M.D., challenged attendees to think about their plans for possible disasters. “Disaster scenarios may require the skills of anesthesiologists in nontraditional roles. We need to update our skills if we are called upon to function seamlessly with first responders,” said Dr. Pretto, Professor of Clinical Anesthesiology at the University of Miami. Beyond performing anesthesia care and airway management, he said, anesthesiologists have the abilities to triage, stabilize and resuscitate casualties, diagnose and treat life-threatening nonsurgical conditions, manage acute pain, and alleviate pain and suffering among victims triaged to die. He suggested that anesthesiologists prepare themselves by participating in training programs in trauma, critical care or disaster preparedness. “Anesthesiologists are acute care physicians in disguise,” Dr. Pretto said. “We must come out of the O.R. closet in the U.S.” back to top back to ASA Daily News home Panel addresses need for precaution with propofol use While the advent of propofol resulted in its popular use among anesthesiologists, those outside the profession have as well been wooed by its advantages. Those clamoring to use propofol recognize its ability to quickly reach sedation and recovery in patients, but the drug also carries serious, less obvious risks. According to Beverly K. Philip, M.D., use of propofol can bring a depth of sedation that changes rapidly and profoundly with abrupt onset of airway obstruction and apnea and the lack of a specific antidote. Dr. Philip moderated a session on the use of propofol by nonanesthesiologists during a Saturday morning Panel. According to Dr. Philip, physicians and nurses trained in fields other than anesthesiology, such as gastroenterology, emergency medicine and surgery, are increasingly looking to propofol for sedation. “For a lot of people, propofol has turned out to be the angel of mercy, but for a lot of people, it’s the devil. It resolves patient and procedural problems, but it’s potentially harmful for patients. We need to get back to the core issue — maintaining patient safety,” said Dr. Philip, Professor of Anesthesia at Harvard Medical School, Boston. To assist anesthesiologists in achieving a level of safety beyond reproach, ASA developed a clear definition of sedation, which centers of the patient’s level of responsiveness. In moderate sedation/analgesia (conscious sedation), patients respond purposefully to verbal commands either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. With deep sedation/analgesia, patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. If the patient loses consciousness and the ability to respond purposefully, the anesthesia care is considered a general anesthesia. While other professions are working to develop their own guidelines with and without the assistance of anesthesiologists, she reminded attendees of the skills that anesthesiologists bring to the table. “The physician responsible for the use of propofol needs training in medical complications and needs to become proficient in airway management,” she said. Anesthesiologists are well aware of what can happen when those without such training take anesthesia into their own hands. Hector Vila Jr., M.D., reminded attendees of recent events in Florida. Highlighting six tragic propofol-related patient deaths, which took place in doctors’ offices between 2002 and 2005, he said that a recurrent theme was present. “There are surgeons and CRNAs and RNs involved. If we look at the causes, cardiac and respiratory arrest stand out,” said Dr. Vila, Anesthesiology Division Chief at H. Lee Moffitt Cancer Center at the University of South Florida College of Medicine, Tampa. He added that underlying factors in the deaths included each facility’s cardiovascular management, emergency policies, airway management and medication selection. Another physician from Florida, Rafael V. Miguel, M.D., noted that his state put a 90-day ban on office-based surgeries. “This decision opened up a gigantic can of worms. Plastic surgeons and general surgeons were up in arms. When Florida halted surgery, what happened? There were no deaths during that time,” said Dr. Miguel, who sits on the Florida Board of Medicine. For Dr. Miguel, what’s tragic is that while doctors appropriately lost their licenses, no nurse was disciplined in any of the Florida death cases. Ultimately, Florida became the first state to require an anesthesiologist for office-based general anesthesia, said Dr. Miguel, Professor of Anesthesiology at the University of South Florida, Tampa. An area where anesthesiologists are making inroads is pediatric MRI deep sedation. At Children’s Hospital, Washington, Raafat S. Hannallah, M.D., has organized a pediatric MRI/CT sedation team, which includes an anesthesiologist, sedation nurses and the radiation team. The selected nurses have a vast amount of training, including acute-care experience, appropriate certification and experience in an operating room with an anesthesiologist. An anesthesiologist is present for every case. Thanks to this model, anesthesiologists see more than 2,500 cases per year. However, Dr. Hannallah warns that nonanesthesiologists may look to other drugs for pediatric MRI sedation if they cannot rely upon propofol without an anesthesiologist. “Although many other specialties are asking ‘Who needs an anesthesiologist?’ I refer to Mark Warner’s Rovenstine Lecture from last year and say, ‘Who better than an anesthesiologist?’” said Dr. Hannallah, Professor of anesthesiology and pediatrics at George Washington University Medical Center. back to top back to ASA Daily News home Almost a third of pediatric surgical patients are overweight or obese Approximately 30 percent of pediatric surgical patients are overweight or obese, and 4.5 percent are morbidly obese, according to a new study presented at the Annual Meeting. Olubukola O. Nafiu, M.D., anesthesiology resident at the University of Michigan, Ann Arbor, reviewed the preoperative medical records of more than 6,000 children ages 2 to 18 between 2000 and 2004 at the University of Michigan Hospital. The data revealed that approximately one in three of the hospital’s pediatric surgical patients were either overweight or obese, and nearly 5 percent of the children were morbidly obese even by adult standards. The majority of the overweight children were between ages 8 and 12 years, and more boys were overweight than girls. Orthopedic and ear, nose and throat procedures were more commonly performed on overweight and obese patients than normal-weight peers. “Equally concerning,” Dr. Nafiu said, “is the relative lack of data on the perioperative risks faced by the pediatric overweight and obese population. The rising prevalence of obesity in children makes it mandatory to have studies that will identify the risks faced by these children so we can deliver quality anesthetic care to them.” In a related study, Amaresh Vydyanathan, M.D., anesthesiology resident at the Cleveland Clinic, found that overweight and obese adult patients were more likely to suffer from irregular heart rhythms, heart failure and respiratory problems following cardiac surgery, but were less likely to die from the surgery than nonoverweight patients with a lower BMI. back to top back to ASA Daily News home ASA Cadaver Workshops provide attendees with hands-on experience ASA’s Cadaver Workshops allowed small groups of participants to gain educational experience in a number of areas. Above, attendees worked with discography/annuloplasty and decompression, intrathecal infusion devices, and radiofrequency ablation. Other workshops covered continuous peripheral nerve catheters, transforaminal epidural injections, vertebroplasty, spinal cord stimulation, peripheral nerve stimulation, sympathetic and visceral blocks, facet joint and SI joint injections, epidural adhesiolysis, and head and neck blocks. back to top back to ASA Daily News home Media award winners represent print, television Reports on anesthesiology contributions to patient safety and modern anesthesia events have garnered the 2006 Philip S. Weintraub Media Awards given by ASA. This year’s media award winners are Joseph T. Hallinan of the Wall Street Journal and producers Matthew Fields, Karen McKinley and Maia Samuel of NBC’s Dateline. Reports on anesthesiology contributions to patient safety and modern anesthesia events have garnered the 2006 Philip S. Weintraub Media Awards given by ASA. Dateline producers educated their audience on the rare occurrence of anesthesia awareness in the September 21, 2005, segment “Modern Anesthesia.” Michael H. Entrup, M.D., was featured in a taped interview with reporter Hoda Kotb to provide information on awareness under general anesthesia, including the reasons for awareness events, ASA’s work to help prevent these events and steps physicians should take to acknowledge patient experiences. Hallinan was honored for his June 21, 2005, article “Heal Thyself — Once Seen as Risky, One Group of Doctors Changes Its Ways,” which focused on how anesthesiologists, ASA and the Anesthesia Patient Safety Foundation have increased patient safety and lowered liability premiums. Physicians featured in the article were anesthesiologists Casey D. Blitt, M.D., Karen B. Domino, M.D., Ellison K. Pierce, M.D., Robert K. Stoelting, M.D., and Russell T. Wall III, M.D. ASA recognizes that if informed about the many aspects of anesthesiology and pain medicine, people will be better able to ask specific questions and make informed decisions about their care should they require surgery. Up to four awards are presented each year for media presentations — on television or radio, print or Web — that inform and educate the public about the medical specialty of anesthesiology. back to top back to ASA Daily News home
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