NYSORA - The New York School of Regional Anesthesia: July 2014 - Newsletter

July 2014 - Newsletter
================================================================================
admin on 30/07/2014 14:35:00


NYSORA - Affiliated 12 months Fellowship Training in Regional Anesthesia in
Belgium
NYSORA announces a unique educational opportunity in Belgium for a qualified
candidate: 12 months NYSORA Fellowship - The New York School of Regional
Anesthesia- affiliated Fellowship in Regional Anesthesia leading to the NYSORA
Diploma upon successful completion. The fellowship position is starting Nov 1,
2014 through October 30th 2015 in affiliation with the Department of
Anesthesiology at ZOL – Ziekenhuis Oost-Limburg, Belgium in a new ultra-modern
facility and with one of the most progressive orthopedic surgery centers in
Europe. The fellowship will focus on wide range of clinical regional anesthesia,
ultrasound anatomy, with opportunity to participate in NYSORA lead research,
writing camps, and teaching at international NYSORA-sponsored workshops and
symposia http://www.nysora.com/.
For additional information, salary and logistics - please send your letter of
interest and CV to catherine@nysora.com. For this unique educational/carrier
opportunity, Dutch-speaking candidates from Belgium and Netherlands will be
given priority, although candidates with completed medical school and
anesthesiology residency from throughout the EU will also be considered.
Fellowship Directors: Catherine Vandepitte, MD, Dimitri Dylst, MD
Fellowship coordinators/mentors: Luc Van Keer, MD, Jeroen Vanmelkebeek MD,
Admir Hadzic, MD
Ana Lopez and John Laur instructing workshop sessions at NYSORA
In this issue:
Quick Reference Guide for Regional Anesthesia in the Anticoagulated Patient
NYSORA subspecialty focus workshop highlight - Pediatric Regional Anesthesia
Personal Perspective from NYSORA Latin America
Featured Educational Video - Ultrasound-Guided Interscalene Brachial Plexus
Block
NYSORA September Symposium
NYSORA Middle East 2015
International Symposium on Regional Anesthesia, Pain and Perioperative Medicine
Abu Dhabi, 26-28 March, 2015
The Symposium will focus on comprehensive review of new developments in
anesthesiology, pain and perioperative medicine. To accomplish its educational
mission in the Middle East, NYSORA will offer a multitude of highly versatile
and focused workshops.
Registration opens Friday 01 August 2014
Read more
Quick Reference Guide for Regional Anesthesia in the Anticoagulated Patient
The number of anticoagulant medications being used in clinical practice has
increased dramatically over the last few years as several new drugs have
received approval from the United States Food and Drug Administration (FDA) for
a variety of antithrombotic indications. Not only have these newer medications
been quickly added to hospital formularies, they have also been increasingly
prescribed in the outpatient setting for a variety of reasons:
direct-to-consumer advertising, attractive route and dosing schedules, and
obviation of required routine laboratory evaluation to assess therapeutic
efficacy. Consequently, anesthesia providers are regularly encountering patients
who take these medications in the perioperative setting.
This has challenged clinicians to remain knowledgeable about the
pharmacokinetics of these drugs and their associated risks when regional
anesthesia or analgesia techniques are considered. Unfortunately, current
published anticoagulation guidelines for regional anesthesia and analgesia have
not yet addressed many of these newer medications and, when recommendations are
available, they often differ depending on the resource. Not only does this
increase the complexity of clinical decision-making, it may also increase the
risks for the patient given the likelihood that their provider may be unfamiliar
with these new antithrombotic therapies and perform a regional anesthetic, and
more specifically neuraxial procedures or deep plexus blocks, when the
likelihood of bleeding complications is increased.
When faced with a patient who has recently taken an anticoagulant medication
for which published guidelines are lacking, clinicians must independently
decide, based on their understanding of pharmacokinetics and pharmacodynamics,
how long this medication should be stopped before preceding with certain
regional anesthesia and analgesia procedures without an unacceptable increase in
the risks of bleeding complications. Additionally, following the performance of
a neuraxial or deep plexus block procedure, including the removal of an
indwelling catheter, clinicians must determine how long of a delay is required
until the next dose of this medication can be administered.
At our institution, clinicians were often challenged to accurately and quickly
make decisions when confronted with similar clinical scenarios. Because the
potential complications associated with the performance of neuraxial or deep
plexus block procedures can be devastating when residual anticoagulant
medication effects exist, these types of procedures were often avoided due to a
perceived increased risk of complications, even in patients with significant
comorbidities in whom regional anesthesia may have been preferred.
In 2012, with the goal of simplifying the process by which anesthesiologists at
our institution determine whether a patient being treated with anticoagulant
medications was at an unacceptably increased risk of bleeding complications
following the performance of a regional technique, a guideline reference chart
was created by consolidating the available published guidelines from the
American Society of Regional Anesthesia (ASRA)1 and the European Society of
Anesthesiology (ESA)2. For anticoagulant agents that lacked formal published
guidelines pharmacokinetic data (drug half-life) was used to estimate the
recommended time interval between the last dose of a drug and the performance of
a neuraxial or deep plexus procedure; it was generally assumed that 5 half-lives
were necessary to achieve near complete resolution of drug effect. Longer
durations were recommended if the clearance of a drug might be affected by renal
insufficiency.
Since inception the reference chart has undergone several updates either as new
recommendations were released or as new anticoagulant medications received FDA
approval. It was first presented outside of our institution at a problem-based
learning discussion during the annual NYSORA symposium in 2012. The most recent
version of the reference chart (Figure 1) includes the recent recommendation
from both ASRA and the FDA to allow at least four hours between the performance
of a neuraxial procedure (such as epidural catheter removal) and the
administration of the next dose of enoxaparin.3
The ubiquitous availability of this anticoagulation reference chart has allowed
clinicians at our institution to more quickly and accurately determine if a
patient is at an unacceptably increased risk of bleeding following a regional
anesthetic procedure based on the currently available guidelines and/or
pharmacologic data. It has become routinely used across the four hospitals
within our health care system, not just by anesthesia providers, but also by
clinicians in multiple specialties since the universal pre-procedure checklist
at our institution now includes a step to review and consider the patient's
current coagulation status before any invasive procedure. By consolidating this
information into one easy to reference location we believe we have improved the
efficiency of our operating rooms as well as the safety of our patients both
within and beyond the walls of our operating rooms.
References:
1) Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT,
Brown DL, Heit JA, Mulroy MF,     Rosenquist RW, Tryba M, Yuan CS. Regional
anesthesia in the patient receiving antithrombotic or thrombolytic     therapy:
American Society of Regional Anesthesia and Pain Medicine Evidence-Based
Guidelines (Third Edition).     Reg Anesth Pain Med. 2010 Jan-Feb;35(1):64-101.
2) Gogarten W, Vandermeulen E, Van Aken H, Kozek S, Llau JV, Samama CM;
European Scoeity of     Anaesthesiology. Regional anaesthesia and antithrombotic
agents: recommendations of the European Society of     Anaesthesiology. Eur J
Anaesthesiol. 2010 Dec;27(12):999-1015
3) Updated recommendations to decrease risk of spinal column bleeding and
paralysis in patients on low molecular     weight heparins, 
http://www.asra.com/fda-annoucement-11-6-13.pdf, Nov.2013.
Daryl Henshaw, MD
J. Douglas Jaffe, D.O.
Robert S. Weller, MD
Robert S. Weller, Daryl Henshaw and J. Douglas Jaffe
Wake Forest School of Medicine Department of Anesthesiology Section of Regional
Anesthesia and Acute Pain Management Winston Salem, NC 27157
NYSORA subspecialty focus workshop highlight - Pediatric Regional Anesthesia
In an effort to meet the demands of our delegates for basic and advanced
workshops in a variety of specialized topics, this year the first Pediatric
Regional Workshop will be held at NYSORA 2014. This workshop will focus on basic
ultrasound based regional anesthesia techniques designed for novices and
intermediate skill level practitioners who desire to learn more about the blocks
provided every day in a busy pediatric practice. Delegates will become familiar
with basic principles of ultrasonography and needle maneuvering, applied
anatomy, and will scan pediatric models. Colleagues who are more advanced will
be grouped together to allow for more rapid progression of topics and more
advanced learning.
Course Instructors: Karen Boretsky MD and Steven Orebaugh MD
For more information visit NYSORA.com
NYSORA Latin America Personal Perspective
Javier Espinosa and Fellow ESOP scholar Alejandra Delgado
"¡Pura vida NYSORA!" would be a very traditional way to say "Hello!" My name
is Javier Sevilla Espinoza and I am also a NYSORA ESOP Scholar. I study
Anesthesiology in Costa Rica as a resident in the national hospital, Rafael
Ángel Calderón Guardia. My hospital is located in San Jose, the capital city.
It is one of the three major public hospitals that work with the social
security.
The pain management in Costa Rica is a little different from the rest of the
world. Anesthesiologists take care of the postoperative pain, while chronic pain
is usually treated by physicians focused on palliative medicine. Nowadays it is
changing due to regional anesthesia which offers new options for pain
management.
Javier at NYORA Latin America in Florianopolis, Brasil
In my hospital regional anesthesia covers spinal blocks, epidural catheters,
and regional blocks guided by neurostimulator (usually for upper limb). We do
not have access to ultrasound. The anesthesiologists who have more experience
with regional anesthesia are the ones who purchase their own ultrasound
machines. In private medicine, ultrasound equipment is more prevalent for use in
regional anesthesia.
Javier performing a Nerve stimulator - guided infraclavicular block on a 1 year
old
Learning opportunities on ultrasound-guided regional anesthesia are limited at
home. So in order to learn more we have to travel to other countries. I had the
opportunity to attend the 1st NYSORA Latin America Symposium on Regional
Anesthesia and Perioperative Medicine in Florianopolis. It was a great
experience to get familiarized with regional anesthesia and all its benefits.
The lecturing classes were very interesting and provided useful tips for
everyday practice. The US workshops helped in acquiring the skills necessary for
using the needle and US. Also, I had the chance to meet splendid people,
doctors, professors, teachers, and friends, such as Dr. Helayel, Dr. Bollini,
Dr. Hadzic, Dr. Gadsden, Dr. Shibata, and many others.
Delegates in session at 1st NYSORA Latin America Symposium
In my opinion regional anesthesia is a great option we can offer patients, not
only for anesthesia but also as analgesia. However, not having an ultrasound
machine available greatly limits our daily practice. Even so, I hope that in the
near future, our patients will enjoy the benefits of this technique.
Program Chairs of 1st NYSORA Latin America Symposium, Florianapolis Brazil,
Spring 2014
Featured Educational Video - Ultrasound-Guided Interscalene Brachial Plexus
Block
NYSORA Symposiums and Workshops
1
NYSORA Symposium
New York City, NY
September 20-21, 2014
Open
2
NYSORA Boutique Workshop
New York City, NY
October 25-26, 2014
Open
3
NYSORA Boutique Workshop
New York City, NY
December 6-7, 2014
Open
4
NYSORA Inspire Seminar
Mont-Tremblant, Quebec
Jan 29 - Feb 01, 2015
Open
5
NYSORA Middle East
Abu Dhabi, UAE
March 26 - 28, 2015
Open
6
NYSORA Latin America
Cartagena, Colombia
April 9 - 12, 2015
Open
Sponsored Content