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My First Report as CSA President

At the first in-person House of Delegates (HOD) session since 2019, I became President of the California Society of Anesthesiologists (CSA), the first Filipino-American to do so.   This could have only happened because of the incredible mentors and sponsors that I have been fortunate enough to have in my life.

https://faradayvp.com/rwl2cht Over the course of the HOD weekend in June, we held a fundraising luncheon for the CSA Foundation, listened to project presentations from the first cohort of our CSA-UC Irvine Leadership in Healthcare Management Program launched by Drs. Phillip Richardson and Ron Pearl, were treated to a special guest lecture by Sasha Strauss on how to communicate as leaders and demonstrate value, and I provided an educational session on using social media for advocacy.  We hosted Dr. Robert Wailes, President of the California Medical Association (CMA), for an update on the Medical Injury Compensation Reform Act (MICRA) since passage of AB 35 (MICRA Modernization). For more information, see Dr. Wailes’ summary.

https://childventures.ca/2022/09/14/qme40qcke During the HOD session, I outlined my leadership priorities for this year: expanding public-facing and internal member communications; continuing leadership development; planning the CSA’s 75th anniversary (diamond jubilee); and promoting wellbeing and professional fulfillment within the CSA membership.  I discussed the challenges facing anesthesiology and the importance of recruiting and retaining members. I summarized the value proposition as “Community, Solidarity, and Advocacy,” which also happen to have the acronym “C-S-A.” 

We followed HOD with our first Board of Directors (BOD) meeting of the governance year.  We welcomed new Directors, appointed the CSA delegations to the American Society of Anesthesiologists (ASA) and CMA, and approved committee appointments for this governance year including an expanded Committee on Professional and Public Communication (CPPC).  This new CPPC chaired by Dr. Emily Methangkool and staffed by Kate Peyser, and in partnership with Alison MacLeod and Lisa Yarbrough at KP Public Affairs, will be interfacing will all major committees, divisions, and task forces as well as the CSA Foundation to actively promote the great work by CSA members and advance the recognition, social standing, and influence of anesthesiologists. 

Over the summer, I was Visiting Professor at the University of Michigan, hosted by Dr. Chad Brummett, and then had the privilege of participating in the American Medical Association (AMA) annual meeting as an ASA delegate to the AMA HOD.  In this role, I was able to cast my vote for Dr. Jesse Ehrenfeld and witness him become the https://parisnordmoto.com/o2n5s86fb first anesthesiologist President-Elect of the AMA

https://flowergardengirl.co.uk/2022/09/14/yeq5i64rr6 My family and I visited Greece for the first time as I participated as a guest speaker at the European Society of Regional Anaesthesia and Pain Therapy (ESRA) congress in Thessaloniki, and I also welcomed attendees to my first CSA educational event as President: the 2022 CSA Summer Anesthesia Conference.  This meeting was chaired by Dr. Brendan Carvalho and featured a superstar all-women expert panel of dynamic speakers: Drs. Dalia Banks, Sapna Kudchadkar, Alana Flexman, BobbieJean Sweitzer, Romy Yun, and Elizabeth Ozery.  All week, attendees and speakers engaged in conversations related to the practice of anesthesiology, caught up with old friends, and made new connections within the meeting room and around the resort.  It was an amazing week of learning and family time and reinforced the value of CSA and its educational events in fostering community. 

https://pinkcreampie.com/dklyq7rc Before leaving Hawaii, I participated in a face-to-face meeting of the Hawaii Safer Care initiative, part of the Improving Surgical Care and Recovery collaborative supported by the Agency for Healthcare Quality and Research, and led by Dr. Della Lin, Senior Fellow in Patient Safety Leadership with the Estes Park Institute and is an inaugural National Patient Safety Foundation/Health Forums Patient Safety Leadership Fellow.  Dr. Lin invited me to participate as a virtual coach during the pandemic last year and work with improvement teams focused on implementing multimodal pain management for surgical patients, so this was my first time meeting the group in person.  For this meeting, teams from three statewide health systems within Hawaii reported out the results of their projects.  The leadership and collaboration among the multidisciplinary teams to implement change despite the challenges of variable resource availability, staffing, and inter-island coordination could serve as a model to inspire our statewide efforts within CSA.

What do we have on deck for CSA? 

https://www.radioculturasd.com.br/3m3c3l6r At the time of this report, we are receiving applications for the next CSA-UC Irvine Leadership in Healthcare Management Program cohort. Anyone interested can sign up here.  We have appointed the task forces to work on revamping the CSA website and planning activities for the 75th anniversary, including a family-friendly reception at the Annual Meeting in San Diego (April 27-30, 2023) that will be chaired by Dr. Christina Menor.  Stay up to date with CSA events through our online calendar.  Then in October, our CSA delegation heads to New Orleans for the ASA annual meeting, and CSA members will actively participate in educational programming, committee deliberations, and governance activities.  CSA will host a member reception during the conference, and our delegates will stand proudly when CSA’s very own Dr. Michael Champeau takes over as President of the ASA at the conclusion of the Wednesday ASA HOD session!

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You Are Not “Asleep” Under Anesthesia

https://popcultura.com.br/hnja1yo736d “You will be asleep for your surgery,” anesthesiologists often reassure their patients. Just before the start of anesthesia, a patient may hear the operating room nurse saying, “Think of a nice dream as you go off to sleep.”

While these statements are intended to soothe patients during a stressful time, they gloss over this critical fact: Anesthesia is not like normal sleep at all. 

Buy Mexican Xanax Online That’s why you need medical doctors – anesthesiologists – to take care of you under anesthesia, and why you don’t need us when you’re sleeping comfortably in your own bed.

https://faradayvp.com/63a06edmidt Differences between natural sleep and general anesthesia

Natural sleep represents an active though resting brain state. Every 90 minutes, the brain cycles between rapid eye movement or “REM” sleep and non-REM sleep. During each of these REM cycles, the brain is active, and dreams can take place. The rest and rejuvenation that result from getting a good night’s sleep are essential for overall health and wellbeing.

Soma 350 Mg Cost On the other hand, general anesthesia produces a brain wave pattern known as “burst-suppression,” where brief clusters of fast waves alternate with periods of minimal activity. In a recent article published in Frontiers in Psychology, Drs. Akshay Shanker and Emery Brown explain brain wave patterns found in patients under general anesthesia. They are similar to those of critically ill patients who fall into a coma, have a dangerously low body temperature, or suffer from other serious diseases. Under general anesthesia, patients do not dream.

http://www.youthministrymedia.ca/1qmpitzq895 Confusing general anesthesia and natural sleep seems innocent but can be dangerous. A person who falls into natural sleep doesn’t require constant monitoring or observation. A patient under anesthesia, like an intensive care unit patient in a coma, may appear peaceful and relaxed, but anesthetic drugs don’t produce natural sleep and may cause breathing to stop or have other serious side effects.  Some may recall that Michael Jackson died at home while receiving the anesthetic drug propofol in his veins without an anesthesiologist nearby to protect him.

https://childventures.ca/2022/09/14/9vj7umyua For patients with chronic health problems, having surgery and anesthesia can put significant stress on the body. Anesthesia gases and medications can temporarily decrease the heart’s pumping ability and affect blood flow to the liver and kidneys. Patients under general anesthesia often need a breathing tube and a ventilator to breathe for them and support their lungs with oxygen.

Respect anesthesia, but don’t fear it

https://ontopofmusic.com/2022/09/6rigmlyx While having anesthesia and surgery should never be taken lightly, anesthesia care today is very safe as long as it is directed by a physician specializing in anesthesiology: an anesthesiologist. Anesthesiology is a medical specialty just like cardiology, surgery, or pediatrics. Research by anesthesiologists has led to the development of better monitors, better training using simulation methods inspired by the aviation industry, and new medications and techniques to give safer pain relief.

As a medical specialty, anesthesiology focuses on improving patient safety, outcomes and experiences.  Anesthesiologists work with surgeons and other healthcare professionals to get you or your family member ready for surgery, designing an anesthesia care and pain management plan specific to the type of operation you need. The anesthesia plan will guide your care during your procedure and throughout your recovery. While general anesthesia is far different from natural sleep, the job of the anesthesiologist is to make sure that you wake up just the same.

https://poweracademy.nl/hbwu9cqw This post has also been featured on KevinMD.com.

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7 Guiding Principles for Acute Perioperative Pain Management

Buy Alprazolam Mexico I had the privilege of co-chairing the 2021 Pain Summit hosted by American Society of Anesthesiologists (ASA). In the months preceding the summit, ASA physician volunteers and staff as well as representatives from 14 other surgical specialty and healthcare organizations worked towards achieving consensus on a common set of principles to guide physicians and other clinicians who manage acute perioperative pain.

http://pinkfloydproject.nl/vzgnd8nm9 These 7 proposed principles are:

  1. Conduct a Buy Valium Legally Uk preoperative evaluation including assessment of medical and psychological conditions, concomitant medications, history of chronic pain, substance abuse disorder, and previous postoperative treatment regimens and responses, to guide the perioperative pain management plan.
  2. Use a validated pain assessment tool to track responses to postoperative pain treatments and adjust treatment plans accordingly.
  3. Offer https://flowergardengirl.co.uk/2022/09/14/3w3fr03 multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with nonpharmacological interventions, for the treatment of postoperative pain in adults.
  4. Provide patient and family-centered, individually tailored education to the patient (and/or responsible caregiver), including information on treatment options for managing postoperative pain, and document the plan and goals for postoperative pain management.
  5. Provide education to all patients (adult) and primary caregivers on the pain treatment plan, including proper storage and disposal of opioids and tapering of analgesics after hospital discharge.
  6. Buy Xanax Bitcoin Adjust the pain management plan based on adequacy of pain relief and presence of adverse events.
  7. Have access to Buy Soma 500Mg consultation with a pain specialist for patients who have inadequately controlled postoperative pain or at high risk of inadequately controlled postoperative pain at their facilities (e.g., long-term opioid therapy, history of substance use disorder).

Buy Diazepam 5Mg This is the first project from this new collaborative, which focused on the adult surgical patient, and there are already plans for future projects. The participating organizations are:

  • American Academy of Orthopaedic Surgeons
  • American Academy of Otolaryngology-Head and Neck Surgery
  • American Association of Neurological Surgeons
  • American Association of Oral and Maxillofacial Surgeons
  • American College of Obstetricians and Gynecologists
  • American College of Surgeons
  • American Hospital Association
  • American Medical Association
  • American Society of Breast Surgeons
  • American Society of Plastic Surgeons
  • American Society of Regional Anesthesia and Pain Medicine
  • American Urological Association
  • Society of Thoracic Surgeons

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#HerTimeIsNow: Be an Ally!

https://poweracademy.nl/2mbx7qc84 Today is the last day of #WIMMonth, but supporting #WomenInMedicine doesn’t stop today!

https://flowergardengirl.co.uk/2022/09/14/xrg0069 http://mgmaxilofacial.com/f3k6wzdzdn Everyone should sign this petition at Change.org.

https://www.kidsensetherapygroup.com/nh36xfeni9 https://popcultura.com.br/1dp8r45y Deans, Chairs, and other healthcare leaders can go even further by reading this pledge and signing on.

I have been promoting the #HerTimeIsNow campaign led by the inspirational Dr. Julie Silver throughout the month of September. This campaign represents a collaboration between the American Medical Women’s Association, She Leads Healthcare, and Executive Leadership in Academic Medicine (ELAM).

https://pinkcreampie.com/0wy7931knwa There is still so much work to be done to achieve gender equity in academic medicine, especially for underrepresented minorities.

Read the full #HerTimeIsNow report.

Men in medicine, particularly those in leadership positions in academic departments, editorial boards, and professional societies, have a huge role to play as allies. Here is my full quote from the report:

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We Still Have an Opioid Epidemic

https://faradayvp.com/bl7fn34 COVID-19 has changed every aspect of our personal and professional lives.

In the midst of this pandemic, we still have an opioid epidemic. It is not one thing unfortunately, and the Centers for Disease Control and Prevention (CDC) describe three distinct waves of opioid-related overdose deaths.

Centers for Disease Control and Prevention

Given the complexity of the opioid epidemic, we have to keep working within our spheres of influence. For those of us in anesthesiology, that means focusing on surgical patients: improving their outcomes and providing effective perioperative pain management along with opioid stewardship.

Dr. Chad Brummett and his colleagues at Michigan OPEN have been leading the way in procedure-specific opioid prescribing recommendations. Their process, which takes into account data from the Collaborative Quality Initiative (CQI), published studies, and expert input, specifically focuses on the perioperative care of patients who are not taking any opioids prior to surgery.

Continue reading We Still Have an Opioid Epidemic

Through multimodal analgesia, we prevent and treat pain in a variety of ways without depending solely on opioids.

At our institution, we offer patients regional anesthesia and have been able to decrease the amount of opioid pills that patients are given when they leave the hospital by basing the prescription on how much they use the prior day. Patients participate in this process, and we give them clear instructions on how to safety taper their opioids at home.

As a representative of the American Society of Anesthesiologists (ASA), I have been able to collaborate with surgical societies such as the American Society of Breast Surgeons and the American Academy of Orthopaedic Surgeons to develop pain management recommendations and toolkits that emphasize multimodal analgesia, use of regional anesthesia techniques for targeted non-opioid pain management when it is available, and opioid safety in the hospital and at home.

ASA-AAOS Pain Alleviation Toolkit

I also represent ASA as a member of the National Academy of Medicine (NAM) Action Collaborative Countering the U.S. Opioid Epidemic. The first discussion paper from the NAM pain management workgroup was released on Aug 10: Best Practices, Research Gaps, and Future Priorities to Support Tapering Patients on Long-Term Opioid Therapy for Chronic Non-Cancer Pain in Outpatient Settings. This paper highlights best practices in opioid tapering and identifies evidence gaps to drive future research.

Despite the massive amount of resources, human effort, and time dedicated to the fight against COVID-19, we have still managed to make progress in decreasing opioid-related risk in the perioperative period. However, there is still a lot of work left to do, and our patients are depending on us.

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A Year Ends and a New One Begins

This academic year was truly like no other.

At the end of July, we graduated three new physician experts in regional anesthesiology and acute pain medicine (RAAPM), and I could not be more proud of them! From our welcome party in the summer of 2019 to a year’s worth of teaching sessions, socials, and medical missions to the opening of the new Stanford hospital, the #COVID19 pandemic and #BlackLivesMatter movement – what a year for our amazing grads! Check out this fantastic graduation video from Dr. Jody Leng:

Our graduating fellows surprised me with the honor of being their Teacher of the Year along with Dr. Ryan Derby! It is such a privilege to be part of our fellows’ training every year and see them grow into physician consultants with RAAPM expertise.

Our new fellows are off to a strong start and are now officially part of our Stanford RAAPM family! If you are interested in learning more about our fellowship program, please visit our fellowship website and contact me with any questions.

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Congratulations to Our Newest Anesthesiologists

2020 is a unique graduation year for all of our anesthesiology residents and fellows due to COVID-19, but never before has the role of anesthesiologists been more relevant. The American Society of Anesthesiologists (ASA) has prepared this special graduation message so programs can incorporate it into their virtual ceremonies, and it features a very special commencement speaker: Dr. Jerome Adams, the Surgeon General of the United States!

https://www.kidsensetherapygroup.com/50f1kh3hj Link to graduation video: https://bit.ly/3eMg5ET

Nearly all of these physicians who are just starting their careers specializing in anesthesiology have completed 4 years of college, 4 years of medical school, and 4 years of internship and residency plus 1 or more years of fellowship training for many. Hopefully this message will help our newest graduates, their families and friends, and their teachers and mentors recognize and commemorate this important milestone in their lives.

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Being a Positive and Authentic Voice

“The key is to not reflexively get defensive, but to treat people on social media as you would treat them in real life.”

Season 2 Episode 33: Being a Positive and Authentic Voice with Dr. Ed Mariano 

Drs. Shillcutt and Mariano get real and talk: 

  • Dealing with the COVID-19 pandemic information overload  
  • Discussing hard topics on social media 
  • Being a positive voice for marginalized groups 
  • Being a “Chief Cheerleader”  
  • The key to joy at work 

In this episode of The Brave Enough Show, I had a chance to speak with host Dr. Sasha Shillcutt about a variety of topics including #HeforShe, leadership, and maintaining a positive voice on social media. Enjoy!

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Beyond COVID-19: Stand Up for Veterans Having Surgery

Our Veterans have made tremendous sacrifices to defend our freedoms. Now it is our time to defend them.

Many people, even those who work in the operating room every day, take safe anesthesia care for granted. There has been growing pressure during this pandemic to remove physician supervision of nurse anesthetists with the latest threat coming from within Veterans Affairs (VA) healthcare. For our Veterans, our heroes and arguably some of the most medically complex patients, having a physician in charge of anesthesia care at hospitals where anesthesiologists and nurse anesthetists work together as a team makes the most sense.

Having a team with members who train differently and have different perspectives can only benefit the patient; anesthesiologists are physicians who draw on their medical training while nurse anesthetists bring valuable nursing experience. If you were a patient having surgery, wouldn’t you want an anesthesiologist directly involved in your care and leading the anesthesia team? If the answer is yes, please send your comments to Safe VA Care and let your elected officials know by contacting them.

Continue reading Beyond COVID-19: Stand Up for Veterans Having Surgery

Providing anesthesia is often compared to flying a passenger airplane, and the anesthesia care team model is like having both a pilot and a co-pilot. 

Who thinks flying has become so safe that we no longer need the pilot? Seconds count in flight, and they count just as much in the operating room when a patient’s life is on the line. 

In 2016, the VA rejected independent practice for nurse anesthetists after careful consideration, but this decision was recently overturned by a memo citing the COVID-19 pandemic. This memo abolishes the anesthesia care team model without giving Veterans a choice. Veterans having surgery may only get a nurse anesthetist without the option of having an anesthesiologist involved. If they were given the choice, however, I think our Veterans would choose an anesthesiologist or an anesthesia care team led by an anesthesiologist instead of a nurse anesthetist alone. We all should. In areas affected by surges of COVID-19, elective surgeries at the VA are stopped so there is no shortage of anesthesiologists.

Anesthesiologists all over the world have been fighting COVID-19 and have shown what they can do with their specialized medical training in a crisis. Although commonly referred to as “going to sleep,” general anesthesia is more like a complex drug-induced coma that can carry serious risk. If or when a crisis happens during surgery, every patient should have access to an anesthesiologist.

Modern anesthesiologists are physicians first but also scientists, educators, and patient safety advocates. Anesthesiologists specialize in relieving anxiety, preventing and treating pain, preventing and managing complications related to surgery, critical care, and improving patient outcomes. The average anesthesiologist spends nearly a decade in postgraduate education after college including medical school and logs  https://www.kidsensetherapygroup.com/vh9ub89k5m 16,000 hours of clinical training to learn to apply the best available evidence in clinical practice. Academic physicians and scientists focused on anesthesiology are responsible for the discovery of newer and safer anesthetics, pain therapies, and technologies that are advancing healthcare throughout the world.

Anesthesia administration by non-physicians such as nurse anesthetists and certified anesthesiologist assistants is supported by the American Society of Anesthesiologists within the physician-led anesthesia care team model. To uphold the highest quality physician-led anesthesia care for our nation’s Veterans, please speak up by supporting Safe VA Care and reaching out to legislators. 

http://www.youthministrymedia.ca/28l8dwaj8yk It only takes a minute to stand up for safety, but the consequences of not saying something may be serious and long-lasting.

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PPE Considerations for COVID-19 Airway Management Personnel

Personal protective equipment (PPE) for personnel involved in advanced airway management in cases of known positive or suspected COVID-19  should not replace recommendations by the Centers for Disease Control and Prevention (CDC).

However, the additional risk of exposure to healthcare personnel involved in advanced airway management for a disease with airborne transmission must be taken into consideration. Past experiences with variations in PPE during other major respiratory diseases in recent history have been published along with recommendations for the current COVID-19 pandemic. Experts have recommended a higher level of PPE for personnel involved in advanced airway management due to limitations of standard PPE, particularly neck and wrist exposure.

Continue reading PPE Considerations for COVID-19 Airway Management Personnel

Use of an air filtration system, preferably an  https://perfect-deal.nl/uncategorized/shn8rayv8 N95 mask, is recommended by CDC and anesthesia societies and is a minimum requirement for airway management personnel. Proper air filtration is a basic need for healthcare professionals caring for patients with airborne diseases and participating in aerosol-generating procedures (AGPs). N95 fit testing should be prioritized for these healthcare professionals. For airway management personnel who do not successfully fit test or cannot wear an N95 for other reasons, ideally a hooded Powered Air Purifying Respirator (PAPR) should serve as the alternative.

Basic features of PPE for airway management personnel are  IN ADDITION to CDC recommendations for PPE and airborne, droplet, and contact precautions which may include:

  • Second layer of eye/face protection
  • Neck coverage
  • Second layer of long gloves

This level of PPE is not universally recommended by societies and other organizations. Advanced skills in airway management are a limited resource, and those with these skills require adequate protection. In addition, anesthesiologists are critical medical specialists who can provide perioperative and critical care as well as pain management during a surge in addition to performing endotracheal intubation when needed.

Implementation of these features will vary given the variability of available PPE between institutions and supply shortages worldwide. It is essential to train airway management staff as soon as possible to develop a local PPE protocol that takes into account CDC and special precautions for high-risk procedures like intubation as described above.  Each facility will likely develop its own unique PPE protocol.

The following videos are being shared for educational purposes only. They represent only one example of applying additional precautions to PPE for airway management personnel, and there will be many others. Creating local videos can help expand training at a facility without depleting available PPE supplies. Remember that each institution or practice will develop its own version of PPE for airway management personnel, and many variations can achieve the same goal.

VIDEO: Enhanced Airway PPE Donning (1:52)

VIDEO: Outer Layer Doffing (1:28)

VIDEO: Inner Layer Doffing (2:21)

VIDEO: COVID-19 Airway Management Simulation (1:44)

For other helpful resources, visit
https://www.edmariano.com/resources/ppe.

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