Presentation Ideas

[periopdoc]

As part of my fellowship, I have the "opportunity" to present four times this year to our combined Cardiology, Cardio-thoracic Surgery, and Cardiac Anesthesia conference.

As I was thinking about this today, I thought, "man what a great opportunity to convey the importance of anesthesiologists to a group of docs who likely see us as the proverbial break-taking, coffee-swilling, faux docs of lore."

But then I got stuck... Sure I have a pretty good idea of what we do and how important it is, but how to best portray this in an interesting way to a group of docs that has little interest in what we actually do????

So I am throwing it out there for suggestions.

The floor is open ...

- pod

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[2win]

As part of my fellowship, I have the "opportunity" to present four times this year to our combined Cardiology, Cardio-thoracic Surgery, and Cardiac Anesthesia conference.

As I was thinking about this today, I thought, "man what a great opportunity to convey the importance of anesthesiologists to a group of docs who likely see us as the proverbial break-taking, coffee-swilling, faux docs of lore."

But then I got stuck... Sure I have a pretty good idea of what we do and how important it is, but how to best portray this in an interesting way to a group of docs that has little interest in what we actually do????

So I am throwing it out there for suggestions.

The floor is open ...

- pod

I would choose a controversial subject like - Plavix and anesthesia "clearance"...
Hard....GLTY

 

[periopdoc]

I thought about getting up and saying something along the lines of

On behalf of anesthesiologists everywhere, I would like to thank you for all the years of helpful advice that you have provided for us by reminding you to avoid ischemia, arrhythmia, and congestion. Good day.

But I wasn't sure that would really accomplish what I am setting out to do.

Somewhere around the end of the year I will probably try to talk about what kinds of advice ARE beneficial to us when taking a patient to the OR.

- pod

 

[2win]

I thought about getting up and saying something along the lines of



But I wasn't sure that would really accomplish what I am setting out to do.

Somewhere around the end of the year I will probably try to talk about what kinds of advice ARE beneficial to us when taking a patient to the OR.

- pod

Pod - you made my day!

 

[fakin' the funk]

As part of my fellowship, I have the "opportunity" to present four times this year to our combined Cardiology, Cardio-thoracic Surgery, and Cardiac Anesthesia conference.

As I was thinking about this today, I thought, "man what a great opportunity to convey the importance of anesthesiologists to a group of docs who likely see us as the proverbial break-taking, coffee-swilling, faux docs of lore."

But then I got stuck... Sure I have a pretty good idea of what we do and how important it is, but how to best portray this in an interesting way to a group of docs that has little interest in what we actually do????

So I am throwing it out there for suggestions.

The floor is open ...

- pod

Just an initial jab...
POCD post-CPB
Periop TEE interpretation
Anesthetics & myocardial molec biology (all that fun propofol/PKC/ischemic preconditioning stuff?)

 

[aredoubleyou]

just a thought. Maybe something along the lines of what various specialties are asking for/ wanting when a cardiology clearance is requested. Surgeons simply want to know if the patient will survive the surgery. Anesthesiologists, who are charged with making that happen, would beneit from a 'snapshot' of the patient, ie last echo report, last stress test report, an assesment if the pt is optimized. Too often, especially the small private cards guys, send in a faxed cover page stating the patient is cleared for surgery- no other info irregardless of how many stents, MIs, CHF exacerbations, etc is in the pts history. Another thing, which is more controversial, is a presentation on how spinal anesthesia can be just as dangerous as general in certain situations, so the cardiologist saying "cleared for surgery, would benefit from spinal anesthesia" is not benign..and they should suggest techniques that they dont understand (although I wouldnt add that part).

 

[Bertelman]

Just an initial jab...
POCD post-CPB
Periop TEE interpretation
Anesthetics & myocardial molec biology (all that fun propofol/PKC/ischemic preconditioning stuff?)

I'm not sure I'd have the balls as a fellow to stand up and present TEE to a group of cardiologists, likely the same group that I rotated with that year to learn TEE.

 

[coprolalia]

I think you should use it as a general opportunity to remind cardiologists that we understand physiology and, in pursuing doing this, you can review extensive literature on cardiac and renal preconditioning of anesthesia meds. This is still a somewhat controversial topic, but it may help them to understand that writing "keep MAP at 80, minimize tachycardia, and maintain good UOP" are not sufficient, accepted, generally encouraged, or even necessarily factually or scientifically valid concerns and comments for a pre-operative cardiology consult.

http://bja.oxfordjournals.org/cgi/reprint/91/4/551

http://bja.oxfordjournals.org/cgi/reprint/91/4/552

http://www.ionchannels.org/showabstract.php?pmid=15025946&redirect=yes&terms=cardiac+preconditioning

http://www.ncbi.nlm.nih.gov/pubmed/12131097

-copro

 

[dhb]

I would talk about how cardiac output and blood pressure are affected by anesthetic agents and how they vary in respect of each other: lower blood pressure often results in higher cardiac output.
But higher cardiac output does not equate better end-organ perfusion and we don't have a monitor that can allow us to balance that in real time.

 

[coprolalia]

I would talk about how cardiac output and blood pressure are affected by anesthetic agents and how they vary in respect of each other: lower blood pressure often results in higher cardiac output.
But higher cardiac output does not equate better end-organ perfusion and we don't have a monitor that can allow us to balance that in real time.

Yes, we do:

http://www.edwards.com/products/pacatheters/CCOmboVolumetrics.htm

We just don't routinely use it.

-copro

 

[IN2B8R]

Two sensible options:

An educational talk would be something that all groups would benefit from: i.e., peri-op surgery in patients with cardiac stents and current recommendations. What to do when a stent has recently been placed and a patient needs emergent/urgent surgery? How is a discussion regarding this scenario ought to play out between the anesthesiologist, cardiologist and the surgeon (as well as the patient). This topic is relevant to all three specialties and clearly will gain the attention of most, if not all of those who will attend your talk. If, on the other hand, you are the humorous type and wish to add "non-scientific," historical stuff, then pick any civil war movie and show a clip of how it was done in the old days: patient biting on a stick, bottle of EtOH being forced down the patient's esophagus, and four burly handlers pinning the patient down as the leg is being amputated and surgery is progressing.... Contrast that to the cool and smooth propofol induction (and no, not the one that Michael Jackson just received) and you may get a few laughs. Feel free to invite a few orthopods to the same talk, as they often stand to gain benefit from knowing how different things were back then in contrast to the current "anesthesia-on" light switch that they often like to flick on nowadays. Hope this helps!

--Best Regards

 

[dhb]

Yes, we do:

http://www.edwards.com/products/pacatheters/CCOmboVolumetrics.htm

We just don't routinely use it.

-copro

What information on cellular perfusion do you get from it?

 

[lfesiam]

Two sensible options:

An educational talk would be something that all groups would benefit from: i.e., peri-op surgery in patients with cardiac stents and current recommendations. What to do when a stent has recently been placed and a patient needs emergent/urgent surgery? How is a discussion regarding this scenario ought to play out between the anesthesiologist, cardiologist and the surgeon (as well as the patient). This topic is relevant to all three specialties and clearly will gain the attention of most, if not all of those who will attend your talk. If, on the other hand, you are the humorous type and wish to add "non-scientific," historical stuff, then pick any civil war movie and show a clip of how it was done in the old days: patient biting on a stick, bottle of EtOH being forced down the patient's esophagus, and four burly handlers pinning the patient down as the leg is being amputated and surgery is progressing.... Contrast that to the cool and smooth propofol induction (and no, not the one that Michael Jackson just received) and you may get a few laughs. Feel free to invite a few orthopods to the same talk, as they often stand to gain benefit from knowing how different things were back then in contrast to the current "anesthesia-on" light switch that they often like to flick on nowadays. Hope this helps!

--Best Regards

ether in 1846

not too far out 1900

 

[geogil]

I love the operating attire. Why yes, I think I will just waltz in wearing my suit and tie. Germs? That's something a foolish german named Koch cares about, and that crackpot Frenchman Pasteur.

 

[Bertelman]

I love the operating attire. Why yes, I think I will just waltz in wearing my suit and tie. Germs? That's something a foolish german named Koch cares about, and that crackpot Frenchman Pasteur.

Don't forget about Semmelweis.

I also once read an anecdote about Osler. He was convinced of renal involvement in a death of one of his patients, but the family declined autopsy. He did what any of us would have done- extracted he offending organ transrectally, and confirmed his suspicions. Family never knew.

To be honest, I'm convinced Osler is responsible for maybe half of what is attributed to him, but it's fun times nonetheless.

 

[coprolalia]

What information on cellular perfusion do you get from it?

You said "end-organ perfusion"... okay if you want to move the goalposts. But, nonetheless, I still think lactate levels and ABG's with a reported base deficit and hemoglobin level can be done easily intraop that provide you a good perspective on what the "cellular" perfusion happens to be. And, with an iStat it's pretty much "real time", or at least as real time as is clinically relevant.

Now, if you're going to ask me if I can tell how much blood is going to the renal vascular bed versus the splanchnic circulation versus the liver... I'm going to ask you, if you have the numbers that show there is any "shock" going on - at least to the extent that it's going to cause some end-organ damage - what does it matter? You need to increase perfusion - period.

-copro

 

[dhb]

You need to increase perfusion - period.

-copro

How?
By elevating the blood pressure or the cardiac output?... or both?

 

[coprolalia]

How?
By elevating the blood pressure or the cardiac output?... or both?

Or giving blood... or increasing O2 delivery (by increasing FiO2 or PEEP)... or putting them on an inotrope... or starting an antibiotic for someone you think is in sepsis while surgeons get source control... or finding and reversing an acidosis...



-copro

 

[dhb]

Now who's moving the goalposts?