August 2013 - Newsletter

The time flies quickly and we are just a 3 weeks away from the NYSORA's 12th Annual Symposium. We are excited to report that the attendance this year has significantly grown, and several new exhibitors will be sharing their latest with the delegates. All in all, we believe that this years' NYSORA Annual Symposium will be yet another milestone. Be sure to register for the NYSORA's Manhattan cruise as that is where all the fun will be on Saturday night. There will be music and dancing, incredible views and much socializing; so be sure to reserve your spot soon and make it on board with us.

This newsletter features an interview with Dr. Stavros Memtsoudis about his latest research on outcomes after major orthopedic surgery and beyond. Also featured is a short story about NYSORA's another philanthropic mission, this time in Indonesia. In collaboration with Dr. Susilo Chandra and his team, NYSORA has purchased and donated 500 books to Indonesian colleagues to facilitate education in regional anesthesia and peripheral nerve blocks. Dr. Chandra shared a few photographs from this mission from his homeland.

Here's a few flash news from NYSORA for this month:

Please do check the NYSORA Latin America website and consider joining us at the 1st NYSORA Latin America Symposium: "Bridging North And South Americas". This first symposium is planned as "who is who" in regional anesthesia and will feature expanded didactic program, several levels of regional anesthesia workshops, as well as a dedicated workshop for NYSORA instructors and NYSORA ESOP Scholars (NYSORA Educational Scholar Outreach Program). The registration is now opened and we already have received a number of registrants unusually early!

NYSORA-Asia program for 2014 has been now finalized. Please check NYSORA Asia website

NYSORA announces a series of TOP ultrasound guided nerve block and vascular access workshops in NYC starting December 2013. Please visit NYSORA website to check the program, speakers and dates.

Stavros G. Memtsoudis, MD, PhD

Dr. Stavros G. Memtsoudis, is a board-certified in both anesthesiology and critical care medicine, joined HSS after completing subspecialty training in critical care medicine, cardiac, and thoracic anesthesiology. His expertise lies in the perioperative care of patients with advanced cardiovascular and pulmonary disease. Scientifically, Dr. Memtsoudis has an interest in the fields of cardiopulmonary physiology and national database outcomes research, and has published articles in these fields. Trained in perioperative transesophageal echocardiography, he is interested in the application of this technology outside the cardiac operating room. Dr. Memtsoudis serves as an Attending Anesthesiologist, Hospital for Special Surgery, he is a Clinical Professor of Anesthesiology, Weill Cornell Medical College and Clinical Professor of Public Health, Weill Cornell Medical College. NYSORA's Newsletter Editor Tim Peters took some time to interview Dr. Memtsoudis and chat about his latest wave of cutting-edge research.

I have been involved with perioperative outcomes research for a quite a while now, because I am fascinated with the question of why some patients have complications and others do not and if we can predict who will have them. After spending some time working on risk factor analyses, I really wanted to know if what we as anesthesiologists do can actually change outcomes. After all, many of us practice every day with the assumption that we make a difference, but proof for this is hard to come by. After years of utilizing various large databases to perform population based analyses, I finally was fortunate enough to work with a team of epidemiologists and programmers as well as find the right database that would allow me to answer this all important question. I have to tell you that I really did not expect the results.

Many of us have long talked about the benefits associated with regional anesthesia and some have published very interesting data. Our problem as a specialty, however, has to a large extent been that we are not very good in convincing others outside our specialty about the importance of what it is that we do. The key to changing this, in my mind, is examining outcomes that are universally seen as important by all clinicians and policy makers, not just anesthesiologists. I think we really have made great strides towards this goal with recent publications suggesting that regional anesthesia may positively affect long term cancer outcomes, decrease the risk of chronic pain and diminish the risk of perioperative complications while improving economic outcomes. Therefore, I believe that the future of regional anesthesia is exciting. In order to remain credible however, our next challenge will be to elucidate the mechanisms by which regional anesthesia confers benefits in patients outcomes.

As James Bond said :"Never say never"...and as he always survives all craziness to "Die another Day", I have to assume that he is right. As we all know there are contraindications to regional anesthesia and complications associated with neuraxial techniques. I would however go so as to say that given the fact that we found that only 25% of patients actually received a neuraxial anesthetic for joint arthroplasty, a big opportunity for growth exists and neuraxial anesthesia needs to be at least considered in every patient. Before we can talk about the standard of care however, there remain a number of questions to be answered that could not be clarified in our study. For example, we will have to find out if the use of neuraxial anesthesia is not just a surrogate marker of overall better or at last different patient care that may result in better outcomes. Further, we need to clarify if neuraxial anesthesia is equally beneficial in all patient groups, i.e. are young and healthy patients equally as likely to benefit from neuraxial anesthesia compared to older and sicker folks. The latter question is currently being investigated by our group.

Unfortunately, data on the impact of peripheral nerve blocks on outcomes are even more rare than those looking at neuraxial anesthesia. However, I do believe that nerve blocks may indeed beneficially affect perioperative outcomes as they share some of the same physiological effects on the organism as neuraxial anesthetics. This is indeed a field that we are currently performing a number of investigations in. In a recent study, we were able to show that the use of peripheral nerve blocks was associated with a decreased need for mechanical ventilation and ICU admissions in patients with sleep apnea. We are alos looking at the effect of brachial plexus blocks on outcomes.

5. Your recent abstract unrelated to this project also pointed out that there may be a greater incidence of hemorrhagic complications related to know Rexall anesthesia with needles of larger sizes parentheses i.e. epidural versus spinal needles. Can you share some information on this as well?

This information is important, as we cannot neglect the fact that complications do occur and can be devastating. In one of our own recent analyses of over 100,000 neuraxial anesthetics we found that the incidence of hematomas is indeed rare but surprisingly more common (i.e. 1: 10.000) than previously thought.

I think that we need to remain critical in our attempts to study the impact of regional anesthesia on outcomes and include analyses regarding complications. We do not want to fall into the trap frequently seen with various medications that are being pushed based on some initially very positive trials only to be criticized later that safety data were not adequate. Given the fact regional anesthesia has been around for many decades I do not think that we will find many surprises, but as medicine ids highly dynamic with patients getting older and sicker and the use of anticoagulants exploding, we need to constantly reassess.

As all of us I guess, I love spending time with my family. My wife Melanie and I have 3 kids, Sophia (7), Nikolas (4) and Melina (1) who love the outdoors. I also enjoy cooking and don't mind a big mess doing it. Being a huge soccer fan, one thing I will not miss for anything in the world is my weekly Sunday 7.30 am soccer game with my friends. Traveling to Europe, especially to my home country Greece, is something I try to do at least once a year.

A few pics of Dr. Memtsoudis away from work at play with his family:

NYSORA donates books on regional anesthesia to Indonesia

Continuing it philanthropic efforts throughout developing world, NYSORA donated 500 books to anesthesiologists in Indonesia. The books were purchased by NYSORA and shipped from the USA in 2011 and distributed to anesthesia providers throughout Indonesia islands at various CME programs through 2013.

The donated books were handed to all delegates In Manado, On October 19, 2011, at the Indonesian College and the Indonesian Society of Anesthesiologists and Intensive Therapy Meeting.

The first edition, Module I will be featured December 7-8, 2013 in New York, NY.

Make sure to reserve your spot if you want to jumpstart the use of ultrasound in your practice as the attendance will be strictly limited.

Registration and location details will be forthcoming in the September Newsletter.

“The new edition builds on the success of the first edition. It does so by emphasizing the fundamental principles on which regional anaesthesia is based. Ultrasound can only be applied once these fundamentals are known and practiced, and the overall tone of the book reflects that. The author states that where best practice was not known, anatomy was emphasized, rather than recommend a block. We wholeheartedly recommend this book.”

The Journal of the American Medical Association had a very favorable review of the new NYSORA textbook in their July 18 issue.

Here are a few excerpts:

The full review is at http://jama.jamanetwork.com.

“The list of peripheral nerve blocks is substantial and covers upper extremity, lower extremity, and truncal nerve blocks. Although some clinicians will want to skip directly to the section dealing specifically with ultrasound-guided nerve blocks, readers should not overlook the chapters on nerve stimulation and surface landmark techniques; these dynamic chapters cover a significant amount of anatomical pearls relevant to ultrasound-guided techniques. Plenty of “Tips” are located throughout each chapter. A short section discusses ultrasound basics and techniques for optimizing images. Readers new to the use of ultrasound will find these chapters particularly helpful.”

“There are an impressive number of regional anesthesia books on the market, and they all have their value. But when it comes to learning regional anesthesia, it's the subtleties of performing blocks that is key. No book comes closer to teaching the art of regional anesthesia than this one does. The previous edition was published in 2004, and a lot has been added to this edition. Apart from dedicating half the book to ultrasound techniques, whole sections are devoted to cadaver and ultrasound images and surface anatomy. In short, this is the only book one needs to learn and become proficient in performing regional anesthesia.”