Scientific Program

Sessions:

General surgery
Cardiac surgery
Spine surgery
Laparoscopic surgery
Neurosurgery
Craniofacial surgery
Otolaryngology surgery

Abstract

Meralgia paresthetica causes dysesthesias and burning in the anterolateral thigh. Surgical treatment includes nerve transection or decompression. Finding the nerve in surgery is very challenging. We first conducted a cadaveric study to better understand the variabilities in the anatomy of the lateral femoral cutaneous nerve (LFCN). Twenty embalmed cadavers were used, the LFCN relationship to different fascial planes, and the distance from the anterior superior iliac spine (ASIS) were recorded. A complete fascial canal was found to surround the nerve completely. The canal starts at the inguinal ligament proximally and follows the nerve beyond its terminal branches. The nerve could be anywhere from 6•5 cm medial to the ASIS to 6 cm lateral to the ASIS. The variability in the course of the LFCN can create difficulty in surgical exposure. The newly defined LFCN canal renders exposure even more challenging. Since 2011, we have used pre-operative ultrasound-guided wire localization (USWL) in 19 cases to facilitate finding the nerve intraoperatively. Data was collected prospectively with recording of the timing from skin incision to identifying the LFCN; this will be referred to as the skin-to-nerve time. Regarding the patient series, in 2 cases, the localization was incorrect. In the 17 cases where the LFCN was correctly localized, the skin-to-nerve time ranged from 3 minutes to 19 minutes. The mean was 8.5 minutes, and the median was 8 minutes. Preoperative USWL is a useful technique that minimizes the time needed to find the LFCN. For the less experienced surgeon, it is extremely valuable. For the experienced surgeon, it can identify anatomical abnormalities such as duplicate nerves, which may not be readily recognizable without ultrasound. Collaboration between the surgeon and the radiologist is very important especially in the early cases.

Biography

Dr. Hanna completed Neurosurgery residency at the University of Rennes, in France, in 1999 and a Neurosurgery residency in the USA at Thomas Jefferson University hospital in Philadelphia. He further specialized in spine and nerves by completing a spine fellowship at Washington University in St. Louis USA, and a combined spine and nerve fellowship at Mayo Clinic, Rochester USA. In 2009 he joined the University of Wisconsin as an assistant professor of Neurosurgery. He became passionate about developing better treatments to improve the functional recovery of patients. He recently published three research papers investigating the use of nerve grafts, in combination with other treatments, for scaffolds to promote axonal growth after spinal cord injury. He also published a surgical guide book on the operative exposures of spinal nerves as well as a book on nerve cases. Dr. Hanna continues research and publications in the field of nerves.

Speaker
Amgad hanna University of Wisconsin, USA

Abstract

The curative impact of nasal surgery on patients undergoing septal and turbinate surgery for obstructive sleep apnea (OSA) has been minimal. New models of nasal airflow mechanics have shed important light on key functional elements of nasal obstruction. Based on this information, we evaluated middle meatal and nasal surgery targeting areas of maximum nasal airflow as an appropriate treatment option for patients with OSA. Methods: An IRB-approved study was performed including consecutive adult patients with the diagnosis of “obstructive sleep apnea” who underwent nasal surgery by a single rhinologic surgeon during a 36-month period. Nasal surgery included: uncinectomy, anterior ethmoidectomy, reduction of a middle turbinate concha bullosa, shaving of the lateral aspect of an enlarged middle turbinate, endoscopic septoplasty, submucosal radiofrequency ablation of the inferior turbinate and septal swell body, and nasal valve repair. The primary outcome measure was change in apnea-hypopnea index (AHI). Additional outcome measures included change in body mass index and oxygen-saturation (O2)-nadir. Results: 42 patients were identified with pre- and postoperative polysomnography results. Average preoperative AHI was 31.0; Range 6.3 – 97 to postoperative mean of 16.4; Range 0.3 – 79.2 (n=42; p<0.0001). However, O2-nadir and BMI remained relatively stable (∆ O2-nadir -0.1; ∆BMI 0.2). Surgical cure rate was 45.6%. No surgical complications occurred in this cohort. Conclusions: As suggested by computational fluid dynamics, targeted middle meatal surgery, swell body ablation, and nasal valve repair, concurrent with septal and inferior turbinate surgery, further optimizes nasal surgery for OSA. Our surgical protocol is the first to demonstrate significant reduction in AHI for patients with OSA regardless of the severity of BMI.

Biography

Dr. Peter J Catalano is an Otolaryngology Specialist in Brighton, Massachusetts. He graduated with honors from Mount Sinai School Of Medicine Of City University Of New York in 1985. Having more than 32 years of diverse experiences, especially in OTOLARYNGOLOGY, Dr. Peter J Catalano affiliates with many hospitals including St Elizabeth's Medical Center, Massachusetts General Hospital, and cooperates with other doctors and specialists in medical group Steward Medical Group

Speaker
peter catalano Steward Health Care, USA

Abstract

Craniofacial malformation, whether congenital or acquired, are pathologies that affect the human being in their physical, emotional and psychosocial development and involves an interdisciplinary management. The craniofacial malformation is a challenge for the professional, especially in the diagnosis and surgical treatment, since it can lead to important functional and aesthetic alterations for the patient's growth and development. Its knowledge and understanding leads to seek the best treatment alternatives in order to re-establish the structures in their proper position through surgical procedures, or also through the education and learning that the patient must have to achieve the adequate function of these structures, that will favor this growth and development as well as help with the integration of the person into society, which today is demanding. Craniofacial surgery has undergone transcendental changes with new techniques and the emergence of new surgical technologies that lead to a better surgical result and allows a shorter, safer and predictable procedure. These new treatment alternatives allow the dedicated professional to craniofacial surgery to go forward and reach new heights in the surgical area, as the goal is to achieve functional and aesthetic excellence through a balance and harmony of all facial structures

Biography

María del Carmen Navas-Aparicio is a professor of craniofacial surgery at Hospital Nacional de Niños, Universidad de Costa Rica

Speaker
María del Carmen Navas-Aparicio Hospital Nacional de Niños, Universidad de Costa Rica, USA

Abstract

Rationale: Despite the positive initial outcomes emerging from preclinical and early clinical investigation of biomaterial injection therapy as a treatment for heart failure (HF), the lack of knowledge concerning the mechanism of action remains a major shortcoming that limits the efficacy of treatment design and modification to maximize benefit. Objective: To capture previously unobtainable measurements of cardiac function and form by inducing clinically relevant HF in large animals and incorporate acquired data for in vivo, ex vivo and in silico states. This data would contribute significantly towards understanding the mechanism of action underlying successful biomaterial injection therapy. Methods and Results: By combining high-resolution ex vivo MRI and histology with state-of-the-art computational model simulations, we sought to elucidate the mechanism of action of intra-myocardial biopolymer injections as a novel treatment for ischemic HF in swine. Within eight weeks of treatment, there were significant reductions in unloaded left ventricular (LV) volumes (16.0 ± 6.3 mL vs 27.0 ± 8.9 mL [controls], p < 0.05) and sarcomere lengths (1.66 ± 0.15 µm vs 1.79 ± 0.16 µm [controls], p < 0.001). The ex vivo data were incorporated in detailed geometric computational models that realistically simulate in vivo pressure-volume loops based on in vivo recorded measurements. Systolic contractility in the models of treated animals (ejection fraction = 41.9 ± 4.0%) was substantially improved compared to untreated HF controls (32.6 ± 1.1%). The treated animal models predicted very small myofiber strain (and corresponding stresses) in the vicinity of the solidified biopolymer that is sustained for up to 13 mm away from the implant. Conclusions: These findings strongly suggest that the solidified biopolymer material acts as an LV mid-wall constraint that significantly reduces adverse LV remodeling compared to untreated HF controls without causing negative secondary outcomes to cardiac function.

Biography

Prof. Guccione completed his Ph.D in Engineering Sciences (Bioengineering) in 1990 from the University of California at San Diego and postdoctoral studies in Biomedical Engineering in 1993 from the Johns Hopkins University in Baltimore, Maryland. He is Professor of Surgery at the University of California at San Francisco. Prof. Guccione has published 100+ papers in peer-reviewed journals and serves as a consultant for the Dassault Systèmes Living Heart Project.

Speaker
Julius Guccione University of California, San Francisco, USA

Abstract

A simple classification divides surgical research history into two periods: the first spans the centuries from Antiquity to the Early Modern and the second from the Early Modern to the present.From what we know, the first ‘‘operations’’ were trepanations. Most evidence dates trepanation to 3000 BC, butother sources date the practice as far back as 10,000 years.The first real efforts at research were anatomical in nature. Herophilus of Calcedon (280 BC) and Erasistratus of Chios (304–250 BC) were among the first to pursue anatomicalresearch. The first figure of note in the Contemporary Era was John Hunter. Born near Glasgow in 1728, Hunter was interested in comparative anatomy and in the natural history of disease. He was a true research surgeon whose inquiries often led to experiments and to operations. The 19th century witnessed the birth of the first surgical and research trainingprogram in Europe thanks to Bernard von Langebeck, professor of surgery at theUniversity of Berlin. To date, only nine research surgeons have been awarded the Nobel Prize inPhysiology or Medicine. Alexander Fleming, who received the Nobel Prize in1945 for the discovery of penicillin, had been trained as a surgeon but neverpracticed surgery and was primarily regarded as a bacteriologist.

Biography

Marco Picichè completed his degree in Medicine at University of Florence in 1995 and Cardiac Surgery Residency at University of Rome Tor Vergata in 2000. He has worked as an Assistant at Saint Luc Hospital, Catholic University of Louvain, Brussels from 1999 to 2001 and as a Clinic Head/Hospital Assistant at University of Clermont-Ferrand (2003–2004) and in Montpellier from 2004 to 2007. He held regular teaching appointments at University of Montpellier School of Medicine, obtained certification by the French Board in Cardiac Surgery (Paris, 2007), earned his Research Master in Surgical Science (Paris, 2007). In Canada, he authored a research project on ‘‘Noncoronary collateral circulation’’ which was submitted to the annual research competition at Québec Heart & Lung Institute, Laval University, and received the competition’s highest grant. In September 2011, he completed his PhD in Therapeutic Innovations from University of Paris-Sud. He is the Editor in Chief of the book: Dawn and Evolution of Cardiac Procedures: Research Avenues in Cardiac Surgery and Interventional Cardiology. Currently, he is a Consultant Cardiac Surgeon in Italy.

Speaker
Marco Piciche San Bortolo Hospital, Italy

Abstract

Currently laparoscopic surgery (LS) represents one of the largest medical segments worldwide with millions of LS procedures performed annually. It is expected to reach global market for LS devices about 10 billion by 2018, driven by growing demand for minimally invasive procedures, increased availability of highly trained surgeons, and growing popularity of single-incision LS and robotic surgery. In addition, nowadays LS was applied to many categories of patients, including old population and newborns, obese individuals, patients with respiratory and cardiovascular risk factors, advanced cancer cases, acute and other emergency conditions with overall limitations of initial over-caution for LS in the past. In order to perform LS necessary a surgical space in the abdominal cavity, this is created by intraperitoneal insufflation of carbon dioxide (CO2) with pressure up to 20 mmHg. CO2 is insufflated by continuous gas flow during LS. Subsequently a large amount of CO2 insufflated during long lasting LS depending on a necessary rate of intraperitoneal pressure and gas flow speed to create an optimal working space. In addition different body positions are used in order to choose an optimal working space depending on localizations of surgical field in different organs of upper or lower parts of abdominal and pelvic cavities. All these factors, mainly CO2 insufflation, intraperitoneal pressure, body positions especially in cases of long lasting LS can change parameters of blood gas and acid base, oxygen/oximetry homeostasis, and hemodynamics, as well as alter function of respiratory and cardio-vascular systems, blood circulation in the abdominal and pelvic cavities and parenchimatous organs, venous return from inferior extremities. Therefore, in this presentation pathophysiology of side effects of CO2-pneumoperitoneum, which can be connected to excessive insufflation of CO2 into the abdominal cavity and increased intraperitoneal pressure, as well as a patient’s involuntary position during LS, will be thoroughly analyzed and discussed in order to outline prevention issues of intra-and post-operative complications.

Biography

Prof.Dr. Ospan A Mynbaev has completed his PhD and ScD studies in Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Russian Health Ministry in cooperation with Petrovsky Russian National Center of Surgery and Lomonosov Moscow State University followed with postdoctoral studies in Belgian universities (KULeuven, Ghent University, VUB). Mynbaev established an international alliance of researchers from basic sciences and medical practitioners named “The International Bureau of Human Body Design &Biomodeling” at Moscow Institute of Physics and Technology(State University). Recently, he has developed several unique tools: 1).Diagnostic and treatment tool of uterine scar defects after cesarean delivery; 2).Artificial heart for online laboratory; 3).Artificial lung for ventilation during laparoscopic procedures; 4). CO2-pneumoperitoeum simulation tool during laparoscopic surgery; 5).Training kit for cosmetologists and plastic surgeons. All of these tools don’t have any analogues in the current literature. Mynbaev has published >80 articles and well recognized as researcher and lecturer, he serves also as an editor, editorial board member and reviewer of many international journals and also as an active faculty of scientific societies.

Speaker
Ospan Mynbaev Moscow Institute of Physics and Technology (State University), Russia

Abstract

Patient Blood Management is defined by the Society for the Advancement of Blood Management as the “timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcome”. Patient Blood Management (PBM) has been shown to improve patient outcomes and decrease cost. This lecture will describe PBM techniques that can be applied in the perioperative period. These include preoperative assessment and management of anemia and hemostatic abnormalities, and intraoperative techniques to minimize blood loss. Many of these techniques can be applied in the postoperative period as well

Biography

Dr. Sheldon Goldstein received his MD degree from Drexel-Hahnemann Medical College in Philadelphia, PA. He is Board Certified in Internal Medicine and Anesthesiology, with subspecialty training in Cardiothoracic Anesthesia, and is Associate Professor of Anesthesiology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York. Dr. Goldstein is the Physician Lead for the Certificate Course in Patient Blood Management sponsored by the Society for the Advancement of Blood Management. He is also the CEO of Coagulation Sciences LLC, a company developing the Multiple Coagulation Test System (MCTSTM), a platform to rapidly assess the etiology of coagulopathies.

Speaker
Sheldon Goldstein Montefiore Medical Center, USA

Abstract

Patient Blood Management is defined by the Society for the Advancement of Blood Management as the “timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcome”. Patient Blood Management (PBM) has been shown to improve patient outcomes and decrease cost. PBM is especially challenging in the trauma patient, who may be bleeding severely. This lecture will describe the use of Massive Transfusion Protocols (MTP) in patients with severe hemorrhage, as well as the use of test-guided transfusion decisions. In addition, the use of products to support hemostasis including pharmaceuticals, hemostatic blood products and pharmaceutical grade coagulation proteins will be reviewed.

Biography

Dr. Sheldon Goldstein received his MD degree from Drexel-Hahnemann Medical College in Philadelphia, PA. He is Board Certified in Internal Medicine and Anesthesiology, with subspecialty training in Cardiothoracic Anesthesia, and is Associate Professor of Anesthesiology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York. Dr. Goldstein is the Physician Lead for the Certificate Course in Patient Blood Management sponsored by the Society for the Advancement of Blood Management. He is also the CEO of Coagulation Sciences LLC, a company developing the Multiple Coagulation Test System (MCTSTM), a platform to rapidly assess the etiology of coagulopathies.

Speaker
Sheldon Goldstein Montefiore Medical Center, USA

Abstract

Pain management is increasingly recognized as an important aspect of high-quality care and an integral component of patient satisfaction.We evaluated a multi-component intervention to improve pain management in the immediate postoperative period with the goal of improving the quality of patient recovery. We measured the intervention's impact on 1) time to pain relief; 2) length of stay in the post-anesthesia care unit (PACU); and 3) patient satisfaction with pain management as measured by how often patients reported that pain was always controlled in the PACU. The intervention included two components: 1) an educational program on pain management for frontline clinical nurses in the PACU and 2) a clinical pain pathway on multimodal analgesia for both narcotic-naïve and narcotic-dependent patients undergoing surgery. Patient PACU surveys showed a decrease in the percent of chronic pain patients who required more than 60 minutes to achieve adequate pain relief (32.7% before the intervention down to 21.3% after). PACU stay prolongation as a result of uncontrolled pain for chronic pain patients decreased from 45.2% to 25.7% after the intervention. The average time from a patient's PACU arrival to his/her discharge criteria being met decreased by 53 minutes after the intervention. The combined intervention of a clinical pain pathway and interactive teaching workshopshortened PACU length of stay; reduced the time to reach pain control; and improved overall patient satisfaction. This combined intervention improved our management of acute post-surgical pain, especially for chronic pain patients

Biography

Irini Hanna has just finished her third year of college at the University of Maryland-College Park. She is a pre-dental, Economics major. She has done research with the Anesthesiology Department at The Johns Hopkins University Hospital, focusing on pain management for the past three years. She has assisted on research relating to: the ERAS protocol (Enhanced Recovery After Surgery), weaning patients off of opioids during the perioperative period, as well as a nurse education program to improve postoperative pain management.

Speaker
Irini Maria Hanna Johns Hopkins University, USA

Abstract

Monitored Anesthesia Care (MAC) sedation used in conjunction with surgeon provided local anesthesia at the surgical incisionis the preferred anesthetic technique for Minimally Invasive Endoscopic Spine surgery. This anesthetic technique uses standard ASA monitoring (EKG, BP, Pulse Oximetry, Capnography) along with supplemental oxygen via nasal cannula that doubles as a CO2 monitor to track patient respiration. The goal of anesthesia is to provide comfort and sedation to a responsive patient with minimal change in their cardiorespiratory function. With our patients positioned prone for the procedure, maintaining airway patency is of the utmost importance. This is achieved by careful titration of a short acting sedative hypnotic (midazolam) with a short acting analgesic opioid (typically fentanyl) to supplement a local anesthetic infiltration of the surgical site. Careful titration and patient monitoring is critical to patient safety and has the added benefit of allowing the patient to communicate with the surgeon throughout the procedure, allowing an extra element of patient safety compared to deep sedation ora general anesthetic technique. Verbal reassurance by the Anesthesiologist canbe used to reduce patient anxiety, and a responsive patient has the added benefit of being able to provide feedback to the surgeon as the procedure continues. If the patient is experiencing discomfort, the Surgeon can use additional local anesthetic within safety limits of the drug being used, and the Anesthesiologist can deliver additional analgesic/sedation medications for patient comfort.Experience shows that conscious sedation is optimal for patient comfort and safety for this procedure, and has an added advantage ofminimal post-operative recovery from anesthesia. If the level of sedation is deepened to the extent that verbal communication is lost, most of the advantages of sedation/analgesia are lost and the risk of the technique approximates those of general anesthesia with an unprotected and uncontrolled airway (1). Vigilant monitoring and careful attention of the patient’s level of consciousness has shown to be safe for more than 10,000 Minimally Invasive Endoscopic Spine surgeries performed at the center.

Biography

Dr Anthony Yeung is a board certified Orthopedic Spine Surgeon who specializes in diagnosing and treating the causes of back pain and sciatica from painful degenerative conditions of the lumbar spine, particularly herniated discs, bulging discs with annular tears, and foraminal stenosis. His techniques have proven to be very effective in relieving both back and leg pain, elusive to many spine specialists because his technique targets and visualizes the pain generator with his endoscope, using imaging as a guide, but confirming the pain source with diagnostic and therapeutic injections. He is the first to use endoscopically guided lasers and is the developer of the FDA approved Yeung Endoscopic Spine System

Speaker
Anthony Yeung Desert intitute of spine care, USA

Abstract

Most abdominal operations are gradually replaced by endoscopy. The remaining open surgeries are done with several variations, of which many are based on traditions rather than on evidence. Cesarean Section will remain one of the only abdominal operations and definitely the most frequent one. Therefore it is of utmost importance to constantly evaluate the different steps for its necessity and for the best way of performance in order to suggest an optimal Cesarean Section for universal use and give example to other operations. The modified Joel-Cohen method results in a shorter incision to delivery time and lower rate of febrile morbidity when compared to the traditional Pfannenstiel incision. The uterus should be opened transversely after pushing the bladder down. Exteriorization of the uterus after the delivery makes stitching easier and avoids unnecessary bleeding. Suturing the uterus with one layer only results in stronger scars and reduced pain, because the more stitching material left behind, more foreign body reaction might weaken the scar. Leaving both peritoneum layers open reduces adhesions and results in reduced need for painkillers and closure should be avoided in all other surgical disciplines as well, including endoscopy. The fascia being sutured continuously with first knot underneath the fascia prevents irritation in the sub-cutis. Since the introduction of this evidence-based simplified method, it has been evaluated by scores of peer-reviewed publications from different countries. Without exception, all showed various advantages of this method. Only 10 instruments and three sutures are needed, which simplifies the workload of nurses. In order to standardize this operation as well as any other open surgery, it is important to use constantly the same needles and instruments. Big needle is necessary for the uterus, as fewer steps are done and therefore less foreign body reaction. Similar evaluations should be done in every surgical method.

Biography

Prof. Dr. Michael Stark is specialized in Obstetrics and Gynecology. His main interest is gynecological oncology. He is the President of the New European Surgical Academy (NESA), an international inter-disciplinary surgical academy. Prof. Stark was the scientific advisor of the European novel Tele-surgical system, scientific and medical advisor of the ELSAN, a 120 hospital group in France and is a guest scientist at the Charite’s University hospital in Berlin. In 2011, Prof. Stark was nominated as the Medico Del Anno (Doctor of the Year) in Italy, and is an Honorary Member of the French, Polish, Russian and Italian Gynecological Associations. In the years 1983-2000 he was the director of Ob/Gyn department of the Misgav Ladach Hospital in Jerusalem, and between 2001 and 2009 the chairman of Gynecology at the HELIOS, European Hospital Group. He was visiting Professor at the Universities of Toronto, Moscow, Beijing, Milan, Adana, Uppsala and New York.

Speaker
Michael Stark The New European Surgical Academy,Germany

Abstract

Ovarian cancer is commonly diagnosed after dissemination and is accompanied by a poorer overall prognosis. Treatment incorporates a multimodal approach, utilizing various combinations of surgery and chemotherapy. For those women with advanced-stage tumors, newer therapeutic strategies may help prolong survival and increase the chance for cure. The addition of HIPEC to CRS improves overall survival rates for both primary and recurrent EOC.

Biography

Dr. Evgenia halkia is a Director of Gynecologic Oncology clinic, Director of Surgical Clinic, HIPEC- Unit (Hyperthermic Intraperitoneal Chemotherapy) for peritoneal malignancy.

Speaker
Evgenia halkia Kapodistrian University of Athens, Greece

Abstract

Teaching materials include text books, videos, operative techniques, hands on training, wet labs and more recently simulation. Simulation is an extremely important modern tool to train, improve performance and avoid mishaps. It is used by all airlines, sports training, driving and now surgical training. Intervention techniques are taught on Dummies s, especially minimally invasive, endoscopic and robotic techniques. Results: Effective teaching requires a good mentor, one who can demonstrate a method repeatedly and correctly.Hands on training is effective, and develops confidence. Simulation can do the same. It is expensive to produce. It is extremely useful in teaching techniques rarely performed, and in institutions with low volume.The E learning modules can help the student to perform the procedure a number of times, learn every step and gain confidence. The disadvantage is the actual instrument handling and tissue feel are absent. Conclusions. There are many old and new methods of surgical mentorship, with advantages and disadvantages. Modern technology permits learning without hands on and hand held training of the old times.

Biography

Dr. Sampathkumar Retd. prof and head of Departmentt of CTVS, AIIMS and Senior Consultant at Max super speciality hospital.

Speaker
A Sampathkumar AIIMS, India

Abstract

Those who do not learn from their history are condemned to repeat it. This statement of wisdom also applies to the history of medicine, which I love so much and which is close to my heart. I have learnt the history of medicine, covering the periodtill the middle of last century, through the enormous literature available on the subject. Being a surgeon, historical progress of surgery was of special interest to me. I obtained my basic medical degrees in 1959.Anything after that is contemporary history for me; something I witnessed or was an integral part of it. I have evidence, records and vivid memories of these six decades in which I actively practiced surgery. I started as a general surgeon, and I retired as one. As destiny would have it, circumstances provided me with opportunities where I had to deal with surgical problems of every system of the body, and sometimes, under most handicapped circumstances. These challenges made me rise to the occasion. The result is that I had the experience of journey through the progress of surgery during these sixty years, and my pleasure of keeping the concept of general surgery alive, in the age of specialization and super-specialization. My interests in medical education and my involvement in curriculum development made me to explore newer concepts in medical education, based on the historical developments and the demands of changing times. My presentation will cover this journey through slides and anecdotes, hopefully in 20-30 minutes, depending on the time allotted to me.

Biography

Prof. Parashar is a 1959 Medical graduate of G. R. Medical College Gwalior, India. In 1962, he obtained the degree of ‘Master of Surgery’ [M.S.] from Vikram University, India. He started his academic and clinical career as Demonstrator/ Registrar in surgery. Later he proceeded to England to complete his advanced surgical training and obtained the Fellowship of Royal College of Surgeons in Edinburgh in 1966. [FRCS] On his return to India after five years of training,he joined Goa Medical College, India, as Assistant Professor in 1969, and became full Professor and Head of department of Surgery in 1978. While in Goa he receivedawards of ‘Doctor of the Year’ [1973] and ‘Best Clinical Teacher’ [1975]. In 1979, when he organized Silver Jubilee Conference of International College of Surgeons in Goa, he was conferred Fellowship of International College of Surgeons. [FICS] In 1986 he received Fellowship of American College of Surgeons. [FACS] In 1981, he joined King Faisal University in Saudi Arabia, [later renamed as Dammam University] as Professor of Surgery and as Consultant Surgeon at King Fahd teaching hospital of the University. He also held addition appointments as Director for Internship training program and later as Director for post-graduate training program in surgery. After thirty-three years at Dammam University, he retired in 2013, as ‘Emeritus Professor’. During this period, he played active role in establishing new colleges for Medicine, Nursing, and Pharmacy in the kingdom; and in developing undergraduate medical curriculum and postgraduate training programs. He made important contributions to Saudi Council, as an examiner and as member of the board in Eastern province of KSA. He has more than seventy scientific publications in Indian,Saudi and International Journals. He has been examiner in many Indian and Saudi universities; as well as for Fellowships in Surgery of Saudi Boards and Arab Boards. He is International Editor for Journal of Medicine and Medical Sciences, Journal of Family and Community Medicine, of University of Dammam, Saudi Arabia. Recently he delivered a Keynote addresses at Surgery-2015 conference in Dubai in October, at International conference on Surgical Nursing at Kuala Lumpur, Malaysia in October 2016, and in Annual conference of Physicians at Gwalior, India, in November 2016. His next key-note address is scheduled at International conference of Surgery-Anesthesia in Rome in June 2018. As a Social activist, has been Founder member and later Chairman of Indian International School in Eastern province of Saudi Arabia; established in 1983, starting with just 80 students and 12 teachers. Today this school has 18,000 students and 600 teachers. He received, ‘Distinguished Indian Citizen’; award from Indian community in Saudi Arabia. He has also received many International Awards from NRI welfare Society of India and India International Friendship Society. These are; Hind Rattan Award [2005], Bharat Gaurav Award [2007], Medical Excellence Award and Life Time Achievement Award [2009], Glory of India Gold Medal [2009], Global Indian Achievers Award at Indo-British Friendship banquet in London, [2010]. He has published two books on surgery by Scientific Publishing Group which are available on their website as E-Books, free of cost. They are: ‘Surgery: the way I teach; and ‘Atlas of Surgery’. He has also published three books on Philosophy, Twists and Turns of Destiny [English], Scattered Gems [English] and Bikhre Moti [Hindi]. All are available on Amazon.com His latest philosophical publication entitled ‘Rhythm of our Hearts’ is currently in press and is expected to be released next month.

Speaker
Shyam K. Parashar University of Dammam, India

Abstract

Deep sternal surgical site infection is an uncommon infection with an incidence rate of 1.5 %. It is one of the feared complications in patients undergoing cardiac surgery. Predicting their occurrence is essential for future prevention. Prevention and better treatment of sternal wound must be a major goal in assuring the highest quality of cardiovascular life. A patient’s risk for major Staph. Aureus infection after cardiac surgery can be reasonably predicted using pre-operative patientcharacteristics. However, most patients who eventually develop post-operative infections do not belong to the high –risk category. Preoperative prophylactic measures (such as, Universal decolonization with mupirocin and chlorhexidine, pre-operative judicious administration of correct antibiotics with correct dose in appropriate time) should therefore target the entire patient population to efficiently decrease the risk of infection. Today I discuss a rare case of DSWI due to MRSA which occurred beyond twelve months after CABG surgery. Here I focus on identifying potentially modifiable risks for major infections, like weight reduction and / or smoking cessation efforts, continuous IV insulin therapy and interventions targeting staphylococcus aureus. A 45 year old man with PMH of Obesity,IDDM,HTN, ESRD on HD via Left arm AVF came to an outpatient office with complaints of substernal chest pain for two weeks duration. The patient noticed a sternal bulge for the last two weeks too. Later on, his sternal margins were apart and non-bloody, purulent drainage was coming out of the swelling. Since his CABG surgery, patient underwent multiple non-cardiac surgeries including right toe amputationand left arm AVF placement and eventually started on Hemodialysis six months before this presentation. Exploration of mid sternotomy wound, drainage of deep sternal wound abscess, wound debridement for infected sinus tracts and removal of necrotic tissue and all infected (protruding) wires were performed except one. Intraoperatively taken wound culture including bone marrow aspiration culture grew MRSA. After 7 days treatment with VAC device, the patient was returned to the operating room for surgical closure of the sternal wound. Patient was discharged from the hospital on intravenous Vancomycin with Hemodialysis and rifampin 600 mg orally daily for a duration of six weeks because of retained wire and chronic osteomyelitis.

Biography

Dr. Shagufta Ahsan completed her MBBS degree in 2000 from Dhaka Medical College,Bangladesh. After completion of her medical degree, Dr. Ahsan underwent Internal Medicine residency and Infectious Diseases fellowship trainings in the USA. She published multiple papers in reputed journals. Dr. Ahsan has worked with the Journal of Medical Case Reports as a reviewer and Organizing Committee member for the conference: Case Reports 2018, Euroscicon Ltd, London,UK.

Speaker
shagufta ahsan Atlanti Care Regional Medical Center, USA

Abstract

Asian eyelids have several characteristics that distinguish them from the eyelids of people from European and African descent. These include: 1) low, poorly defined or absent lid creases, 2) pronounced fullness to the upper and lower lids, 3) narrow palpebral fissures and 4) epicanthal folds. The extent to which these anatomic variants are present, determines the height and prominence or absence altogether of the upper lid crease in the Asian eyelid. Asian blepharoplasty is the most common Cosmetic Surgery procedure done in the Far East, with many variants noted. The discussion will include the patient selection, preparation, anesthesia, and surgical technique utilized in the operation for the creation of the double eyelid in the patient.

Biography

Adolfo Napolez M.D. graduated from Southern Illinois University School of Medicine followed by a General Surgery Residency at West Penn Hospital in Pittsburgh, Pennsylvania, and followed that up with a Burn Surgery Chief Residency at Cook County Hospital in Chicago, Illinois and finally a two year Fellowship in General Cosmetic Surgery, highlighting Asian Cosmetic Surgery. He is a member of the American Academy of Cosmetic Surgery, American Society of Cosmetic Breast Surgery, as well as a member of the California Academy of Cosmetic Surgery. Dr. Napolez has published articles in 5 different Medical Journals, as well as a chapter Author in a textbook on Asian Facial Cosmetic Surgery. He has twice been selected as one of America’s Top Surgeons in Cosmetic Surgery, as well as a Top Doctor in Plastic Surgery Practice Magazine. Dr. Napolez presented at the 6th 5CC and is scheduled to speak later this year in both Manchester, United Kingdom and Toronto, Canada

Speaker
Adolfo Napolez Southern Illinois University School of Medicine, USA

Abstract

We had done comparative study on vaginal flap, buccal mucosa graft and labia minora graft for female urethral reconstruction for urethral stricture Methods Female patients with urethral stricture were divided into three groups (A,B,C). In group A Vaginal flap, group B-buccal mucosaonlay graft and in group C- labia minora graft was done for urethral reconstruction and assessed as improvement in symptom score and calibration by 14 F catheter at the end of 1st , 3rd , 6th month and one year Results Out of total 16 patients with mean age of 49.91 years,Twelve patients had mid urethral and four had distal urethral stricture were divided into Group A (n=6), group B(n=6) and group C(n=4). Improvement of urinary stream was found 100%( 6/ 6pts) in group A, 66.66%( 4/6) in group B and 50%( 2/4 pts) in group C. Calibration with 14 F catheter was successful in all pts of group A, 66.66% of group B at the 3 mths follow up. Two patients of group B require dilatation at 3 months follow up.2/4 patients who underwent labia minora graft reconstruction landed up in retention again, required repeated dilatations even after 6 month follow up. Patients of group A (50%) had complain of some post void dribblingbut not troublesome to patients Conclusion Urethroplasty in females using anterior vaginal wall flap and buccal mucosa dorsal onlay graft showed good long term results for urethral stricture.

Biography

Deepti B Sharma is a faculty of surgery at NSCB Medical College.

Speaker
Deepti B Sharma NSCB Medical College, India

Abstract

Fentanyl, a synthetic opioid is used routinely in anesthesia practice before induction of anesthesia as a premedicant to ameliorate the sympathetic response to laryngoscopy and intubation. Occasionally the bolus injection of fentanyl leads to reflex coughing, the reported incidences are quite variable depending on dose and route of administration. Bohrer et al reported that incidence of fentanyl induced cough (FIC) was 46% in patients receiving 7 µg/kg of fentanyl through a central venous catheter while it was only 28% in a study by Puha et al after a 1.5µg/kg IV dose of fentanyl injected through a peripheral cannula. Spectrum of fentanyl induced cough is quite variable ranging from a brief, benign, and self-limiting type in most patients to a explosive and spasmodic in few patients, requiring immediate intervention. Increase intracranial, intraocular, and intra-abdominal pressures due to reflex coughing can be hazardous in patients undergoing surgery specially in neurosurgical and ophthalmic procedures. There are numerous methods to prevent the FIC, including pharmacological and non-pharmacological methods like intravenous lignocaine, huffing manoeuvre, terbutaline inhalation, IV clonidine, IV dazocine etc. Incidence is less in smokers and old age patients while gender and presence of asthma and COPD has no effect.

Biography

I am working as associate professor at department of anesthesiology, Mahatma Gandhi Medical College, Jaipur(India). I have more than 14 publications in indexed international and national journals.

Speaker
Vipin Goyal Mahatma Gandhi Medical College India

Abstract

The Double Eyelid Procedure is one that is potentially fraught with unfavorable results as well as numerous complications due to the fact it is a procedure based predominantly on symmetry, precision and tissue characteristics with errors measured in millimeters. Coupled with significant expectations often times unrealistic from the patient’s perspective. Who may routinely view a normal, expected outcome as an unfavorable result. Potentially unfavorable results can range from crease size dissatisfaction, relapse to a single eyelid, asymmetry, multiple creases as well as high or thick fold. Whereas, possible complications can range from ectropion, ptosis, ocular injury, hypertrophic scarring, milia as well as suture granuloma. There is probably no other facial cosmetic surgical procedure that is more dependent on exactness and precision, coupled with patient expectations and visibility then the Double Eyelid operation.

Biography

Adolfo Napolez M.D. graduated from Southern Illinois University School of Medicine followed by a General Surgery Residency at West Penn Hospital in Pittsburgh, Pennsylvania, and followed that up with a Burn Surgery Chief Residency at Cook County Hospital in Chicago, Illinois and finally a two year Fellowship in General Cosmetic Surgery, highlighting Asian Cosmetic Surgery. He is a member of the American Academy of Cosmetic Surgery, American Society of Cosmetic Breast Surgery, as well as a member of the California Academy of Cosmetic Surgery. Dr. Napolez has published articles in 5 different Medical Journals, as well as a chapter Author in a textbook on Asian Facial Cosmetic Surgery. He has twice been selected as one of America’s Top Surgeons in Cosmetic Surgery, as well as a Top Doctor in Plastic Surgery Practice Magazine. Dr. Napolez presented at the 6th 5CC and is scheduled to speak later this year in both Cairo, Egypt and Vancouver, Canada.

Speaker
Adolfo Napolez Southern Illinois University School of Medicine, USA

Abstract

Caesarean section is a common operation, performed either as an emergency or as an elective procedure. Ever since the first caesarean section was carried out, countless modifications of the technique have been made in order to improve its outcome. Some details have been less significant but others have presented major changes. One is the transverse incision introduced by Pfannenstiel at the end of the 19th century, which was used as the standard procedure. Another technique that belongs to this category is the ‘ Misgav Ladach ’ method, which was developed in Jerusalem by Michael Stark and is now in use in many countries. This method differs from classical methods and is based on a modified laparotomy as described for hysterectomy by Sidney Joel-Cohen, as well as other modified steps. When using the Pfannenstiel incision, the ilioinguinal and iliohypogastric nerves might occasionally be involved, followed by long-lasting numbness around the scar. Some patients experience long-term, radiating, invalidating pain, which can be relieved sometimes only surgically. The transverse Joel-Cohen incision, as incorporated in the Misgav Ladach method, is higher and the muscle separation is away from their insertion, away from the site of the iliohypogastric and ilioinguinal nerves and therefore there is a reduced risk of causing damage. We report here our short term and long term resulty in more than ten years of expecience. Short term results: The Misgav Ladach method of cesarean section has advantages over the Pfannenstiel method in so far as it is significantly quicker to perform, with diminished postoperative pain and less use of postoperative analgesics. The recovery of physiologic function is faster. No differences were found in intraoperative bleeding, maternal morbidity, scar appearance, uterus postoperative involution and the assessment of the inflammation response to the operative technique. Long term results: Research examining long-term outcomes after childbirth performed with different techniques of caesarean section have been limited and do not provide information on morbidity and neuropathic pain. The study compares two groups of patients submitted to the 'Traditional' method using Pfannenstiel incision and patients submitted to the 'Misgav Ladach' method ≥ 5 years after the operation. We find better long-term postoperative results in the patients that were treated with the Misgav Ladach method compared with the Traditional method. The results were statistically better regarding the intensity of pain, presence of neuropathic and chronic pain and the level of satisfaction about cosmetic appearance of the scar.

Biography

Dragan Belci was graduated in Padova in 1995. Has completed the speciality of gynecology and obstetrics, the subspecialiy of gynecology oncology and the PhD. Actually he is the Head of the Department of gynaecology and obstetrics in General hospital Pula in Croatia. He is also active member of NESA (New European Surgical Academy). He participate in the FIGO –NESA workshop in Dakar, Senegal with main goals to implement the technique of cesarean section and ten step vaginally hysterectomy. The mission and workshop in Africa was concentrated to reduce the mortality and morbidity of the women during the operative procedure. He has also published more than 15 papers in the field of operative technique of cesarean section and in gynecology oncology. His Departement have the accreditation of the NESA for performing the Misgav Ladach cesarean section and to teach the other this operative technique.

Speaker
Dragan Belci General Hospital Pula, Croatia

Abstract

Postoperative abdominal adhesion formation is a serious and common postoperative complication and an entire desease. The study was supported by barrier theory, which claims that an artificial separation of traumatised intra-operationally surfaces could prevent its consolidation thus scarring. Polymer cellulose gels are biocompatible and inexpensive solution for adhesion prevention. Cellulose gels can be used standalone or as a basic component for a various complex implantable substances. Such drugs may include anestetics, anti-inflammatory drugs, immunomodulators, cytostatics, antiseptics and antibiotics. Gels and its combinations can be introduced into abdominal cavity during minimally-invasive surgeries via injections. For example, it is reasonable to avert further adhesion formation after adhesiolysis on pelvic organs in the context of a tubo-peritoneal infertility treatment. Also, complex gel compounds can be produced "ex tempore" from basic components, according to a patient's condition and needs. Gel's viscosity will not be affected if additives will be added in small volumes, so effectiveness of all components does not decrease. Compounds can be adopted for a different scenarios in cardiovascular surgery, neurosurgery, traumatology, operative gynecology, otolaryngology, cosmetic medicine, urinology, oncology etc. The authors performed series of experiments, showing effectiveness and safety of cellulose gels. It was considered that cellulose gels and its compounds can be used for prevention both primary and secondary adhesions. According to its results, cellulose gels don't have toxicity, teratogenic or oncogenic effects. Cellulose gels offers also great variability of chemical modifications, leads to biologically and physically optimal options.

Biography

Viacheslav A. Lipatov is Professor of the Department of Operative Surgery and Topographic Anatomy, head of the Experimental surgery and oncology laboratory of the Kursk State Medical University, Kursk, Russia. Chairman of the Kursk regional branch of Russian Union of Young Scientists. Russian national coordinator of International Adhesion Society.

Speaker
Viacheslav Lipatov Kursk State Medical University, Russia

Abstract

Back ground: The use of laparoscope in surgical removal of gall bladder became one of the most popular surgical procedures and abdominoplasty which was used from long time even during 1900,mostly done as a separate surgical procedure in our research we combined both procedures in the patients subjected to the study Methods: Thirty two patients presented to our hospital with abdominal wall laxity and symptomatic cholelithiasis. All of them wanted to undergo a cosmetic procedure (abdominoplasty) to reduce the abdominal wall laxity. They were also diagnosed to have cholelithiasis and had intermittent episodes of pain in the right upper quadrant of the abdomen. The ports for laparoscopic cholecystectomy were made in such a way that all the ports sites were under the elevated skin flap that was excised during abdominoplasty, and there was no scar in the upper abdomen. Results: The procedure was completed without leaving any telltale signs of laparoscopic cholecystectomy, and this led to a better cosmetic result from the patients’ point of view. Conclusion: On conclusion we recommend to ask for abdominal ultrasound examination for all patients coming for abdominoplasty especially following weight loss after surgery for morbid obesity even if the patient is asymptomatic. We recommend the use of the technique which we used for port placement as it is convenient, easy, and has no side effects on patients in comparison with other techniques

Biography

Ahmed Abdelmonem is faculty of General surgery at Mansoura University, Egypt.

Speaker
Ahmed Abdelmonem Mansoura University, Egypt

Abstract

Modified Bentall procedure has become an elective treatment for combined aortic valve and ascending aorta replacement, whereas bleeding remains as a major complication of this procedure. We developed Bentall procedure to reduce the intra and postoperative complications.Patients and Methods: Between March 2009 and October 2015, 28 patients (21 male, 7 female; mean age 48±14 years; range 17-77 years) underwent composite valve graft replacements. All patients had an aneurysm of the ascending aorta (mean diameter 6.7 ± 0.4 cm) with aortic valve diseases. Patients with ascending aortic dissection were excluded. Results:No patients died during surgery or within hospitalization. The average cardiopulmonary bypass (CPB) time was 83.5 ± 30.3 minutes and the average aortic cross-clamp time was 63.82 ± 56.50 minutes. Complications were observed in two patients (7.2%) that were hematoma and cardiac arrhythmia which both of them were controlled. In 26 (92.8%) of patients were not found any perioperative complications. The mean length of stay in the intensive care unit (ICU) and hospital were 3.4 ± 1.5 days and 11.44 ± 3.8 days, respectively. The mean volume of postoperative drainage was 841.9 ± 567 ml. Conclusions: Results demonstrate that our technique can be done with low morbidity and mortality. It has several advantages over other graft replacement techniques such as less bleeding, shorter CPB and aortic cross-clamping time, and lower rates of mortality.

Biography

I am AtefehGhorbanzadeh, the 7th year student of Medicine, Mashhad University of medical science. I will be graduated next year. I am an active member of research committee and I have experience in different field of researches and also participated in a lot of seminar. In addition, my favorite major for residency is surgery, especially cardiothoracic surgery. I have published several articles in this field and I am already working on some projects.

Speaker
Atefeh Ghorbanzadeh mashhad university of medical science, Iran

Abstract

Background: Minimally invasive pediatric cardiac surgery has been slow to gain pace due to limited surgical exposure and long learning curve. We have started performing transverse sternal split (TSS) to improve the surgical exposure with advantage of mini incision in tetralogy of Fallot(TOF) and in this paper we reviewed our short and mid -term result. Methods: From January-2015 to July-2017, 23 patients (14 male) with mean age 29.27±9.18 months and mean weight 12.1±1.99Kg underwent TOF repair using TSS. Patients are divided into two groups depending upon year of operation (Group 1A & 1B =before & after January-16). Pre-operative, intraoperative and post-operative data were collected and they were compared with standard midline sterotomy group (Group 2). Results: There was no mortality or significant morbidity in the postoperative period or during follow up. Mean cross clamp time and CPB time were significantly lower in Group 1B (67.58 ± 9.35&100.67 ± 15.50) compared to Group 1A (76.27±12.66&113.54±23.62) but still higher than group 2(56.32±17.33& 75.12±20.95).There was no significant residual defect and 85% patients were weaned off from ventilation within 16 hours of surgery. Cosmetic result was satisfactory with no incidence of sternal dehiscence and all were in NYHA class I at mean follow-upof 23.72±2.61 months. Conclusions: The TSS is a good alternative for repair of TOF in selected patients with satisfactory cosmetic results without compromising the surgical exposure or quality of repair. With increase in expertise, the operative duration can be decreased but still it remains higher than the sternotomy approach.

Biography

Kartik Patel is a cardiac surgeon in U N Mehta Institute of Cardiology,India

Speaker
Kartik Patel U N Mehta Institute of Cardiology,India

Abstract

Introduction Incision is to cut the skin so as to expose or gain access to the desired tissue. Scalpel has been widely used for skin incisions. Electrocautery is an alternative option practiced these days for making skin incisions. This study aims to find out the difference in pain following the skin incision with scalpel or electrocautery in emergency appendectomy. Methods A prospective, cross sectional comparative study was done at Bir Hospital. 76 consecutive patients who underwent emergency appendectomy under spinal anaesthesia for acute appendicitis were included who fulfilled the inclusion and exclusion criteria. There were 38 patients in scalpel and electrocautery group each. The ethical approval was taken from IRB , NAMS and written informed consent was taken from each patient before enrolling in the study. Data analysis was done with SPSS software version 11.5 . P value <0.05 was considered statistically significant. Results The mean VAS score was significantly less in scalpel group as compared to cutting diathermy group at post operative 12 hours (scalpel 4.8±1.6 vs diathermy 3.4±1.4 , P <0.001) , 24 hours (scalpel 3.5±1.2 vs diathermy 2.3±1.0 , P <0.001) and 48 hours(scalpel 2.3±1.1 vs diathermy 1.5±0.8 , P 0.001). There was no significant difference in frequency of on demand analgesia in the two groups. The demand for analgesia in post operative 0-6 hours was 47.3% vs 39.4%(P 0.48) ,>6-12 hours was 18.4% vs 13.1% (P 0.52), >12-24 hours, 18.4% vs 18.4% (P 1.0) and >24-48 hours was 7.8%vs 10.5% (P 0.69) in scalpel and diathermy group respectively. Conclusion The study shows that the post operative pain as assessed by visual analogue scale score is significantly less in the group receiving skin incision with electrocautery as compared to the group receiving skin incision with scalpel in patients undergoing emergency appendectomy.

Biography

Dr. Anip Joshi completed his undergraduate in Medicine from prestigious Institute of Medicine in 2007. He worked as a Research Fellow in Oxford University Research team at Patan Hospital and gained experience in Clinical trials of international standards. He has obtained Basic and Advanced Research training from Nepal Health Research Council. In addition he has also obtained Advanced training in Biostatistics. He went to complete his surgical residency in 2014 and was awarded Master of Surgery from National Academy of Medical Sciences. Dr. Joshi has presented scientific papers in numerous national and international conferences. He has recently been awarded with Travel Scholarship from International Society of Surgery to participate in World Congress of Surgery 2017 in Switzerland. Dr. Joshi is a skillful surgeon and believes in delivering quality and affordable surgery to the patients. He aims to improve the quality of surgical service in his institution and his country.

Speaker
Anip Joshi Bir Hospital, National Academy of Medical Sciences, Nepal

Abstract

Small cut in the skin or minimal incision for doing cardiac surgery is a need in current era both in adult and pediatric populations. Though adult minimally invasive cardiac surgery has got its way but pediatric minimally invasive cardiac surgery is still struggling due to the small caliber vessel size and disease complexity. And of course, cost is an additional predominant factor when it is considered in developing countries. Considering cost and cosmesis in pediatric population we tried to develop our own way of maintaining it in Bangladesh. We report our experience with manubrium sparing lower mini-sternotomy incision (5-6 cm) in pediatric populations primarily preschool age children for doing closure of septal defects in 30 patients. All were under cross-clamping of aorta with cardioplegic arrest. The mean bypass time was 52±12.05 minutes. The mean cross clamp time was 26.33±4.18 minutes. All patients recovered without adverse events except one who has got a neurological event on second postoperative day but has recovered in six months. They were fast tracked to recovery and extubated after 3.17±0.75 hours. The mean intensive care unit stay was 6.17±0.75 hours. The mean hospital stay was 5±0.75 days. The Lower mini-sternotomy approach was used successfully in all patients. Our experience confirms that this technique offers satisfactory cosmetic results, stable sternal reconstruction, good surgical exposure, minimal interference with respiratory mechanics and minimal pain allowing a speedy recovery.

Biography

Dr Mohammad Ziaur Rahman has completed his MBBS at the age of 25 years from Sir Salimullah Medical College, Dhaka, Bangladesh and Masters in Cardiothoracic Surgery from Dhaka University in 2011. He has published more than 15 papers in reputed journals and been serving as Assistant Professor and Consultant in National Heart Foundation Hospital, Dhaka, Bangladesh. Currently, He is deputed to National University Hospital, Singapore as Minimally Invasive and Aortic surgery fellow for last six months.

Speaker
Mohammad Ziaur Rahman National Heart Foundation Hospital & Research Institute, singapore

Abstract

Port site herniation is one of the serious complications of laparoscopic surgery, which decreases its benefits. The closure of the fascia defect on port site is an important problem of laparoscopic surgery, especially in obese patients. We aimed to compare needle grasper fascia closure.

Biography

Turgut Donmez was graduated from Istanbul University Cerrahpasa Medical Faculty in 1997 and completed his Residency in General Surgery in 2003 in the same faculty hospital. He has been working at Lutfiye Nuri Burat State Hospital. He has expertise in laparoscopic and thyroid surgery

Speaker
Turgut Donmez Lutfiye Nuri Burat State Hospital, Turkey

Sessions:

General anesthesia
Regional anesthesia
Pediatric anesthesia
Anesthesia risks and complications
Pain management

Abstract

EEG monitoring is also important in pediatric anesthesia to maintain adequate level of hypnosis. For adult patients, BIS monitor can be available to assess the level of hypnosis. However, BIS monitor predicts the level of hypnosis from three or four EEG sub-parameters calculated from the latest 1 minute of EEG signal combined with the coefficients obtained from a multivariate analysis of EEG database. That database seemed to contain the data obtained from adult patients only. Furthermore, it is well known that EEG during natural sleep or during anesthesia in infants or children changes with their development and they are not the same as those in adults. As the result, BIS values do not adequately indicate the level of hypnosis in infants or children.

Biography

Satoshi Hagihira graduated Osaka University Medical School in 1985 and he finished Doctoral course at Osaka University Graduate School of Medicine in 1990. He has published more than 50 papers in reputed journals. He majors in thoracic anesthesia including airway management. He is now a clinical professor at Kansai Medical University. He has been studied EEG during anesthesia for about 20 years. He developed a original software to gather raw EEG as well as EEG derived parameters including BIS from the BIS monitor A2000/XP/VISTA and studied the change of EEG during anesthesia.

Speaker
Satoshi Hagihira Kansai Medical University, Japan

Abstract

Addiction and morbidity from opioid misuse has become epidemic in the USA. The reasons are complex and varied, however exposure or access to opioids as adolescent is often a starting point. Studies have shown that children are often prescribed substantially more opioids than they use in the USA. Families are rarely counseled regarding safe storage and disposal of these medications. Adolescents who report using opioids in a manner other than how they were prescribed (non-medical use of opioids), overwhelmingly report getting the drugs from their own left-over prescriptions, a family member’s prescription or prescriptions found in their friend’s medicine cabinets. In the last decade or so the number of accidental opioid poisoning in toddlers has also increased, again due to medication that are left out and not properly secured. Education is one of the critical components of battling this epidemic. Physicians and other prescribers need education on what appropriate opioid doses are, alternative medications, and how long pain from acute injury or surgery is expected to last. Families need education on how to store these medications safely, and how to dispose of them. Pharmacies need education about local DEA approved disposal sites and recommendations for safe return or disposal of these medications.

Biography

Dr. Agarwal completed her MD at Baylor College of Medicine, in Houston, Tx. She went on to do her residency in anesthesia there and a fellowship in Pediatric Anesthesia at The Children’s Hospital, Denver. She has been very active in education, and was the Pediatric Anesthesia Fellowship Director at the Children’s Hospital Colorado and The Director of the Colorado Review of Anesthesiology for Surgicenters and Hospitals. She has been extremely involved with multiple national organizations, serving on their Boards and Education Committee. She is currently the Chair of the Section on Anesthesiology and Pain Medicine of the American Academy of Pediatrics, Vice President of the Society for Pediatric Pain Medicine, an ex-officio member of the Society for Pediatrics Anesthesiology Board of Directors and a member of multiple national Committees.

Speaker
Rita Agarwal Stanford University School of Medicine, USA

Abstract

On July 15th, 1868, the world lost a legendary medical personality. William Thomas Green Morton, MD, is considered the pioneer of painless surgery. At that time Dr. Morton was only 48 years old. He was an American dentist who first publicly demonstrated the use of inhaled ether as a surgical anesthetic. Morton is best remembered for administering ether to a patient undergoing successful surgery at the Massachusetts General Hospital on October 16th 1846. Morton perhaps was not the “inventor” but certainly the “revealer” of inhalational anesthesia. The invention of surgical anesthesia was the first major contribution that American medical science made to the world and it is probably still the greatest of America’s many medica discoveries and surgical anesthesia and analgesia have become an accepted standard in surgical and medical care.

Biography

I trained as an MD in Pisa and Rome I was interested in science and I was also interested in people and enjoyed interacting with them. I chosed Turin for my residency because it has been the cradle of the Italian anesthesia culture.During clinical rotations in hospitals I became fascinated by the impact of cultural practices on medicine. In observing how medicine was practiced differently in different contexts, I began to ask how it had developed and why it was done that way. I had discovered a new intellectual passion: studying medicine through the lens of history. Of all milestones and achievements in medicine, conquering pain is one of the very few that has potentially affected every human being in the world.

Speaker
Giulia Petrini AOU City of Science and Health, Italy

Abstract

Awake craniotomy (AC) with intraoperative brain mapping, allows for maximum tumor resection while monitoring neurological function.Used for lesions involving the eloquent areas of the brain, such as Broca's, Wernicke’s, or the primary motor area. • Common techniques - monitored anesthesia care (MAC), using an unprotected airway, or the asleep-awake-asleep (AAA) technique, using a partially or totally protected airway. Comparative analysis between the MAC and AAA technique in a consecutive series of patients undergoing the removal of an eloquent brain lesion is being presented.

Biography

Punita Tripathi was a practicing Cardiac Anesthesiologist at India’s premier medical institute the All India Institute of Medical Sciences (AIIMS), New Delhi, before coming over to USA in 1996. There after she completed her residency in Anesthesiology from Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA in 2002. Since 2002 she is on faculty at Johns Hopkins University, Baltimore, MD. For the past five years she has been Director of Neurosurgical Anesthesia at Johns Hopkins Bayview Medical Center and has been actively involved in writing protocols for Awake Craniotomy and Anesthesia for Neurosurgical cases. Her areas of interests are Neurosurgical Anesthesia, Thoracic Anesthesia and Obstetric Anesthesia. She has authored papers in reputable journals and written book chapters.

Speaker
Punita Tripathi Johns Hopkins Medicine, USA

Abstract

The Post Anesthetic Care Unit (PACU) is an essential element in ensuring a successful operative experience. Recovery from surgery is dependent on a transition from the intensive focus of the operating room to safe care in the hospital ward or home after surgery. The key area in this transition is the Post Anesthetic Care Unit. It is the PACU that patient fully “awakens” or recovers from anesthesia. Cardiovascular and respiratory function have to be maintained, neurological recovery has to be assured, and stable vital signs have to be maintained along with the ability to recover a pre-operative level of functioning. In addition, pain issues as well as post-operative nausea have to be addressed. In an effort to facilitate throughput each type of surgery is establishing protocol to aid in rapid recovery, minimize chance of hospital readmission once discharged. What are the keys to ensuring patient safety during this period?

Biography

Amballur David John M.D. is Assistant Professor of Anesthesia and Critical Care Medical at the Johns Hopkins University School of Medicine; and Director of Student Education at Johns Hopkins Bayview Medical Center, Baltimore USA. He received his B.A. from Harvard University, Cambridge MA and his M.D. from New York Medical College, Valholla, NY. He trained in Internal Medicine Residency at Metro West Medical Center, Framingham MA. Training continued with residency in Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore Maryland with sub specialization fellowship in Cardiac Anesthesiology and Fellowship in Cardiac Anesthesiology at the Massachusetts General Hospital, Boston MA. He was formerly instructor at Harvard Medical School, Boston MA prior to his current appointment at Johns Hopkins. Dr. John is on serval Editorial Boards and has published numerous articles and book chapters. His area of expertise include Cardiopulmonary Rescescitation, Airway Management, Neuroanesthesia, Geriatrics, and the Post Anesthetic Care Unit.

Speaker
A.D.John Johns Hopkins Medical Institutions, USA

Abstract

Microsurgical flaps are required when a pedicled flap cannot reach or is inadequate in size to provide soft tissue coverage of an abdominal defect. Methods:10 consecutive patients successfully underwent complex abdominal wall reconstruction (AWR) using mesh or biologics and microsurgical flaps, at Cleveland Clinic,between 2014-2016.(Age range: 34-78 years, mean 56.4): (Female: 3, Male: 7), (BMI range: 28.0-36.1, mean: 27.35), (skin defect area range: 300-750 cm2, mean: 548 cm2). Close collaboration with anesthesiateam intraoperatively and perioperatively was made for all cases. In addition, patient-reported outcomes were analyzed using a validated a hernia- related quality of life survey (HerQles)to assess abdominal wall function. Results:5 Latissimusdorsimyocutaneous flaps, 4 anterolateral thigh flaps and one combined anterolateral and vastuslateralis flap were used. Inferior epigastric vessels were used as recipient in 8 patients. In two patients, AV loop construct was needed. 8patients received concomitant synthetic mesh and posterior components separation with transverse abdominis release, one received anterior components separation and biologic mesh. One patient underwent mesh removal due to infection and microsurgical flap only. All microsurgical flaps survived. No abdominal compartment syndrome was noted. Minor wound healing complications occurred in two patients. No hernia was noted during the follow-up period. Average follow-up period was 15.2 months (range: 9-36 mo.). Preoperative HerQles score range: 16-33, mean 22.2). Postoperative HerQles score range: 38-75, mean: 57.9). Baseline HerQles scores were compared to those obtained at minimum 9 months status post complex AWR. Conclusions:Microsurgical flap reconstruction remains to be a valuable tool for complex AWR with or without mesh repair. Collaboration and cooperation between Anesthesia and Surgery teams are mandatory for successful outcomes in these complex cases. The 12-question quality of life survey, HerQles, demonstrated significant improvements on various aspects of daily living activities.

Biography

Raffi Gurunluoglu received his medical degree at Marmara University Medical School, Istanbul, 1991. At the same university, he completed 6-year integrated plastic surgery training program, 1997. He pursued his career in Cleveland, U.S.A and Austria studying reconstructive microsurgery. He obtained an Anatomy doctorate, Marmara University Institute of HealthSciences, Istanbul, 2003. He appointed chief plastic surgeon, Denver Health Medical Center, University of Colorado, 2006. He promoted full professorshipin 2013. He was then recruited to Cleveland Clinic, Department of Plastic Surgery, 2014. He also is a professor of surgery at the Case Western University. Dr.Gurunluoglu has both European Board of Plastic, Reconstructive and Aesthetic Surgery (2004) and American Board of Plastic Surgery (2014). He has published extensively (135 articles). These range from technical innovations to clinical case series, clinical as well as research articles. Dr.Gurunluoglualso presented nationally and internationally in various plastic surgery meetings as invited speaker. His surgical interest includes breast surgery and reconstruction, complex abdominal wall reconstruction, lower extremity trauma and reconstruction, facial reconstructive surgery, and reconstructive microsurgery.

Speaker
Raffi Gurunluoglu Cleveland Clinic, USA

Abstract

Sacroiliac Joint is the source of Chronic Low Back pain in 13-25% of cases. Its diagnosis and treatment is a challenge, the most accurate method of diagnosis is the diagnostic local anaesthetics injection. Clinical assessment is only guidance but the response to the diagnostic local anaesthetic injection is the most important diagnostic evidence that the Sacroiliac joint is the source of the pain. Low back pain originating from the sacroiliac joint will lead to a low quality of life interfering with the patient’s general activity, mood, sleep, and enjoyment of life.

Biography

Mohannad El-Rakshy is a Consultant in Anaesthetics, Intensive care and A Senior Consultant in pain management in NOETHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION TRUST since 1995.• He is a Fellow of the Faculty of Pain Medicine of the Royal College of Anaesthetists, FFPMRCA 2010.He is a Consultant in Pain management in the Centre for Pain Medicine in Castle Hill Hull for 8 years and Consultant in chronic pain management in University Hospitals North Midlands , Staffordshire, United Kingdom.He is a speaker and a chairperson in the ASAICS (Alexandria Society of Anaesthesia And Intensive Care).He has attended enormous number of workshops and conferences.

Speaker
Mohannad El-Rakshy Northern Lincolnshire and Goole NHS foundation Trust,UK

Abstract

Background: Regional anesthesia for post-thyroidectomy pain management has recently become as a new trend that provides a good quality of analgesia with more prolonged duration and lesser side effects than IV analgesia. Aim of the study: We aimed to assess the bilateral superficial cervical plexus block (BSCB) versus local wound infiltration (LWI) after thyroid surgery with regard to postoperative analgesic efficacy. Patients & Methods: Sixty adult patients of both sexes scheduled for elective thyroid surgery were randomly categorized into three equal groups. In the first group no regional block was performed (group-C), in the second group (group-L) the wound was infiltrated with 0.5% bupivacaine at the end of surgery, and the third group (group-B) received BSCB immediately after the induction of general anesthesia. Pain intensity was evaluated by the eleven-category numerical rating scale (NRS) and the four-category verbal rating scale (VRS) at the first hour after surgery, and then every 4 hours for the 24 hours postoperatively. Results: NRS and VRS mean scores were significantly lower in groups (L) and (B) compared with the (C) group. The mean (± SD) of postoperative NRS scores was 3.82 (± 0.65), 2.01 (± 0.61), and 1.36 (± 0.70) in the (C), (L), and (B) groups respectively. The corresponding values measured by VRS were 2.49 (± 0.20), 1.71 (± 0.22), and 1.55 (± 0.23). Conclusion: Although both techniques are effective for post-thyroidectomy pain management during the first postoperative 24 hours, BSCB provides a better analgesia and effectively decreases postoperative pethedine consumption more than LWI.

Biography

Mohammed Naji has completed his MBBS at the age of 27 years from University of Benghazi , Libya . and postgraduate studies from The Arab Board of Medical specility. He has published more than 20 papers in reputed journals .

Speaker
mohmad nage University of Benghazi, Libya

Abstract

This prospective, parallel-arm randomised controlled trial was conducted on 300 parturients who were divided into two groups; group 1(Fentanyl group, n=150) who received 50 μg by slow intravenous infusion and group 2 (Pethidine group, n=150) who received 100mg by IMI. Maternal outcome in terms of reduction of pain intensity, labor dynamics, adverse effects and acceptability, and fetal-neonatal outcome in terms of Apgar scores, neonatal requirements for resuscitation, umbilical artery pH and initiation of breastfeeding. Data was collected and tabulated. Results: There was no significant difference between both groups regarding pain scores initially and over three hours following opioid administration (p>0.05) with highly significant differences between pain scores at 1, 2 and 3 hours from the initial pain score in both groups (p<0.001). Higher women in the pethidine group experienced nausea & vomiting which mandates subsequent administration of antiemetics (p<0.001). higher neonates in the pethidine group experienced low Apgar scores at one minute, longer time (> 1 minute) to establish respiration, need for resuscitation, low umbilical artery pH (<7.2), transfer to NICU and difficulties with initiation and maintenance of breast-feeding (p<0.001). Conclusion: Intravenous Fentanyl is comparable to intramuscular pethidine when used for labor analgesia. Deleterious effects of maternally-administered pethidine have been proven.

Biography

Osama is an Assistant professor of Obstetrics, Gynecology Anesthesiology and Critical Care at Menoufia University, Egypt

Speaker
osama elkilani Menoufia University, Egypt

Abstract

To assess the main indications for Emergent Traumatic Laparotomy Surgeries, role of preoprative Ultrasound, and outcomes of surgery.Total Number of 100 cases had undergone emergent laparotmy has been retrosepctively studied. N=100 cases, 96% males, 4% females, mean age: 31 years, the average length of hospital stay is one week. Ultasound has been used in 34% of the cases, and it was accurate in 76.47% of the cases. More than two thirds of the cases who underwent urgent laparotomy during Benghazi Civil War were due to gunshots and explosive injuries (57% and 20% respectively) whereas RTA and Stabbing were the least common causes by (12% and 10% respectively). Moreover, just less than one third (31%) of the cases has multiple abdominal organ injuries, in contrast, approximately quarter of the cases (23%) has underwent negative laparotomy. However, the most affected organs were Small intestine (19%), spleen (12%), liver and large intestines (6%) Major vessels, kidneys and stomach (1%).In addition, Infection was the most significat complication in 35% of cases, while bleeding accounted for 11% . Regarding to outcomes, Mortality rate was 19% and complications occurred in 69%. In conclusion, middle aged men during wars are vulnerable to emrgent laparotmy due to gunshots and explosives and at a considerable risk of abdominal injuuries with a 19% risk of death and a high risk of complications. Ultrasound is considerably effective in detecting abdomial injuries

Biography

Dr.Ahmed Al-Mutajawel 35 years old, has completed his MB.ChB from Benghazi University, Libya. He is currently enrolled in post-graduate studies studies in General Surgery at the Benghazi University, and has passed the 1st part of Libyan board in General Surgery. He is interested in areas of Trauma and Emergent Surgeries.

Speaker
Ahmed Mohammed Omar Almutajawel Arabian Gulf Oil Company Benghazi, Libya

Abstract

Egyptian hieroglyphs show the story of Isis, reviving her husband Osiris using mouth-to-mouth ventilation. (1) Still other Egyptian texts advocated hanging drowned victims upside down, compressing and releasing the thorax with the goal to ventilate and revive the patient. (2) Ongoing education and training are key elements to equip anesthesia team members with the skills and knowledge they need to handle untimely and unexpected life-threatening scenarios in the perioperative setting. A reconstruction of an ancient Egyptian mouth-opening instrument is presented. In the cult of the dead, this instrument played a role which can be compared to the function of a modern laryngoscope. Excellent CPR, defibrillation, post-resuscitation care, and hospital care will provide for the highest survival rate possible for sudden cardiac arrest and ROSC = return of spontaneous circulation, or the return of a sustained pulse after a period of cardiac arrest. From January 2002 to December 2009… 20,000 Admitted cases of attended injuries were (31.8%). Most admissions were below the age of 30 years (58.4%). Male to female ratio was 3:1. Falls were the most common injuries (43.6%), followed by transport accidents (31.1%). More than half of deaths (56.4%) were due to transport accidents We need to develop in hospital wide policy for resuscitation Regular emergency cardiopulmonary arrest skills education, including the use of checklists, and mock codes are ways to validate that team members understand their responsibilities and are competent to help if an arrest occurs in the OR Unfortunately, the majority of people in Egypt witnessing cardiac arrest do not perform CPR. Unfortunately, we have scarce data, about the incidence and outcome of cardiac arrest both, witnessed and un-witnessed EgRC was registered with ministry of social affairs on 13 April, 2001. EgRC is affiliated to many local and international organizations The center for resuscitation was established within the premises of the Faculty of Medicine in Assiut university supervised by the head and staff of Anaesthesia Department backed by the full-hearted support of the President of Assiut University . During the activity of The Second Conference of Anaesthesia and Intensive Care in Assiut University, November 2000 a meeting was held between the EMC members, the President of Assiut University and the Chairman of Anaesthesia and Intensive Care department, Assiut Faculty of Medicine. It was agreed to carry out practical steps towards the foundation of Assiut ALS Training Center. The center was established within the premises of the Faculty of Medicine supervised by the head and staff of Anaesthesia Department backed by the full-hearted support of the President of Assiut University. Egyptian Resuscitation Council (EgRC), which was officially announced in April 2001, worked tirelessly over 9 months to keep the equipments and arrangement of the center at the standards of ERC.

Biography

Dr. Osama Ali Mohamed Ibraheim is presently working as a Professor in Department of Anaesthesia and Intensive Care, College of Medicine at Assiut University, Egypt. He has almost 24 years of experience in different fields of Anesthesia. He had undergone different types of Anesthesia during Residency period. His working experience is surgical intensive care, hepatobiliary anesthesia and resuscitation, Ultrasound guided regional anesthesia techniques, Anesthesia for Spinal surgeries and different orthopedics. He had more than 20 research publications in his name. He is also obtained Anesthetics Registration in 1988 and also obtained Consultant in Anesthetics Registration in Saudi Arabia.

Speaker
Osama Ali Ibraheim Assiut University, Egypt

Abstract

General anesthesia has been in clinical use for over two centuries. However, significant uncertainty remains about the potential for long-term harm associated with their application.Anesthesia is often necessary for children at any age and is considered a safe intervention. However, experimental studies in animals (rodents, primates, etc..) suggest the possibility of neurotoxicity in the developing brain exposed to anesthetics by inducing apoptosis or interfering with neurogenesis. This negative effect is dose-dependent and seen in periods of early development. Long-term neurocognitive changes in learning, memory, attention, and behavior were observed later in life. It is extremely difficult to link these laboratory findings to clinical practice. Large cohort retrospective studies remain inconclusive. There is no clear evidence that exposure to anesthetic drugs up to the age of 3 years is associated with neurocognitive behavioral deficits. Currently, three prospective studies (GAS, PANDA, and MASK studies) are underway to shed light on these issues. Until then, no change in pediatric anesthesia practice should be done.

Biography

Yaacov Gozal received his M.D. at the University Paul Sabatier, Toulouse, France. He completed a residency in Anesthesiology and Critical Care Medicine at Purpan University Hospital, Toulouse, France, and then another residency in Anesthesiology at the Hebrew University-Hadassah Medical School, Jerusalem, Israel. He is an Associate Professor of Anesthesiology and Chair of the Departmentof Anesthesiology, Perioperative Medicine and Pain Treatment at Shaare Zedek Medical Center, Jerusalem, Israel. He has authored more than 110 papers published in prestigious journals. He is an editorial board member for the Journal of Pharmacology and Toxicology.

Speaker
Gozal Yaacov Shaare Zedek Medical Center, Israil

Abstract

Many people have anesthesia fears. They want to know ‘how does my anesthesiologist know how much to give me?’ How do I avoid getting too much? Before the brain monitor, anesthesiologists relied on changes in heart rate and blood pressure. But this is information from the bottom of your brain. Anesthetics affect the part behind your forehead. The number from your forehead tells the anesthesiologist how your brain is responding to medication like propofol. This number means you can control your individualized dose based entirely upon your specific needs. Brain monitors are found in 75% of US hospitals, yet only used 25% of the time. The cost of the brain monitor sensor is not greater than most hospitals charge for 2 Tylenol. The brain monitor scale is 0-100, the lower the number, the more ‘asleep’ you are. Neither the cost nor the difficulty of use are serious obstacles to having your anesthesiologist use the best available technology to prevent anesthesia over medication. A scientific 2009 study showed 16 million of the 40 million American patients (40%) having major surgery under anesthesia receive too much every year, resulting in postoperative brain fog. American patients do not routinely receive anesthesia with a brain monitor. The goal of my nonprofit Goldilocks Anesthesia Foundation is making brain monitoring a standard of care for major surgery under anesthesia. When patients ask to have a brain monitor, they get often ‘push back,’ like “We don’t need that.” Your best response should be, “I have to live with the long-term consequences of your short-term care. Please use one.” Although challenging, patients should make this request before they are lying on a gurney to take them into surgery. Why is routine brain monitoring, the best available 21st century technology to prevent over medication, still not widely used? In 2000, I published a statistically significant 30% reduction in drug use when a brain monitor was used compared to not having one. Drug companies want to sell more, not less, drugs. Drug companies also provide substantial financial support (money) to the national anesthesia society. There appears to be a conflict of interest between you the patient, the drug companies and the national anesthesia society.

Biography

Dr. Friedberg started his medical career practicing the subspecialty of cardiac (open heart) anesthesia for 5 years at Hoag Memorial Hospital Presbyterian Hospital. During that time, he introduced the Swan Ganz catheter and cardiac output computer to the heart team. With Dr. Friedberg administering the anesthesia, for the first time in the program's history the heart surgeons were able to know the patient's cardiac output and peripheral resistance immediately when coming off the bypass pump. The results were groundbreaking for both surgeons and patient outcomes.

Speaker
Barry friedberg Goldilocks Anesthesia Foundation, USA

Abstract

Continuous movement of the chest wall due to breathing may add to the difficulties in controlling pain for thoracic procedures. Regional anesthesia can significantly improve the quality of the pain control and reduce the complications from inadequate analgesia.Neuraxial blocks such as thoracic epidural or paravertebral blocks are commonly performed for analgesia for thoracic surgeries. These procedures have traditionally been performed with the landmark technique and may have serious complications such as pneumothorax, spinal cord injury, etc. Also these may not provide complete analgesia to the anterior chest wall because of the mixed innervation from the thoracic spinal nerves and the brachial plexus via pectoral nerves, long thoracic and thoracodorsal nerves. With the increasing availability of ultrasound equipment, there has been a recent introduction of peripheral nerve blocks (PEC I, PEC II, Serratus anterior plane block) performed under ultrasound guidance. These blocks rely on injecting local anesthetic in a plane between the thoracic muscles (pectorals, serratus anterior and latissimus dorsi) and provide reliable analgesia for anterior chest wall procedures such as breast surgeries, pacemaker insertion, latissimus dorsi flap reconstruction, rib fractures, etc. My talk will focus on emerging ultrasound guided peripheral nerve blocks for procedures on anterior chest wall, their coverage, basic anatomy, indications and contraindications.

Biography

Dr. Praveen Maheshwari is currently working as an Assistant Professor in the Departmentof Anesthesiology, University of Oklahoma Health Sciences Center, USA, a multispecialty,tertiary care hospital and is the only Level 1 trauma center in the state of Oklahoma. Heis a Diplomate of American Board of Anesthesiology and National Board ofEchocardiography. He has been actively involved with teaching and mentorship ofstudents, residents, and fellows. He has been a member of numerous departmental andhospital committees. He is a question writer for American Society of Anesthesiology and ajunior editor for American Board of Anesthesiology. He has done several presentations at regional, national and internationalmeetings. He has numerous peer reviewed publications. He is an editorial board memberand is a peer reviewer for several Anesthesiology journals.

Speaker
Praveen Maheshwari University of Oklahoma,USA

Abstract

Airway management is bread and butter for anesthesia practice. Diagnosis and the management of airway related conditions and complications are essential to the practice of anesthesia provider. Clinical airway examination is crucial to identify any airway difficulty. Ultrasonography in conjunction to hands on management of the airway may offer several benefits. With the widespread availability of ultrasound, its role in clinical decision making and interventions in airway management is increasing. The use of ultrasonography may supplement the airway management by assisting the recognition as well as the management of airway difficulty, for e.g., localization of cricothyroid membrane and/or tracheal rings, performance of nerve blocks for awake intubation, estimation of the risk of aspiration by gastric volume and contents assessment, rule out pneumothorax in emergency situations, etc. My talk will focus on update on use of ultrasound in field of airway management for clinical decision making and interventions. It will elaborate use of ultrasound in finding intubation and ventilation problems as well as its help in managing those patient via cricothyroidotomy, tracheostomy and nerve blocks for awake intubation

Biography

Dr. Parul Maheshwari is currently working as an Assistant Professor in the Department ofAnesthesiology, University of Oklahoma Health Sciences Center, USA, a multispecialty,tertiary care hospital and is the only Level 1 trauma center in the state of Oklahoma. She is aDiplomate of American Board of Anesthesiology and National Board of Echocardiography.She has been extensively involved with teaching and mentorship of students, residents,and fellows. She has been a member of departmental and hospital committees. She is aneditorial board member for Journal of International Archives of Clinical AnesthesiaResearch and has numerous peer reviewed publications.

Speaker
Parul Maheshwari University of Oklahoma Health Science Center, USA

Abstract

The American Society of Anesthesiologists (ASA) physical status is a universal classification system that helps clinicians categorize their patients preoperatively. However there is a lack of both inter-rater and intra-rater reliability among clinicians for the ASA physical status classification. Our study focuses on testing these reliabilities within pediatric anesthesia providers in the cancer setting. Methods In our retrospective cohort study, a total of 1177 anesthesia records were reviewed. The cohort included all pediatric patients (≤ 18 years old) diagnosed with either retinoblastoma or neuroblastoma who had two or more anesthesia procedure within a 14 day time period. Results The cohort included 1177 anesthesia records of cancer patients (≤ 18 years old), who had two or more procedures- under anesthesia- within a 14 day time period. Overall the ASA physical status score among two different anesthesia providers for the same patient treated at different times, had very little inter-rater reliability, κ = -.042 (95% CI: -.17; .09). Of the 1177 patient anesthesia records, only 25% had two or more ASA physical status score assigned by the same anesthesiologist within a 14 day time period. There was moderate intra-rater reliability κ = .48 (95% CI: .29; .68) for patients who were assigned an ASA physical status score by the identical anesthesia provider at different times points within a 14 day period. Conclusion In contrast to observations in earlier studies, findings indicate poor agreement in inter-rater reliability. Although there was moderate agreement in intra-rater reliability, one would expect to find stronger, even perfect, intra-rater reliability. These findings suggest the need to develop a specific physical status classification system directed toward patients with a systemic illness such as cancer in both young and adult patients.

Biography

2017 marks my twelfth year on faculty at Memorial Sloan Kettering Cancer Center; I am grateful to serve as a clinician at a world-renowned cancer hospital alongside experts in medicine and academia. In addition to my clinical duties as an associate attending in the Department of Anesthesia and Critical Care Medicine, I serve myriad leadership roles and functions. I am Chair of Anesthesia Quality Assurance (QA) and serve as a co-chair on the hospital root cause analysis committee. I am the Director of Robotic Anesthesia and serve on both our Clinical Practice Committee and platform committees for two of our surgical floors in Memorial Hospital. On the state level, I serve dual roles on the New York State Society of Anesthesiologists where I am on the QA committee for the state and serve as alternate delegate for the District of Manhattan. On a national level, I am an oral board examiner for the American Board of Anesthesiology.

Speaker
Luis E Tollinche Memorial Sloan Kettering Cancer Center, USA

Abstract

Introduction: The term “major knee surgery” includes anterior cruciate ligament reconstruction, knee arthrolysis and total knee replacement. Although some improvement has been made in current surgery techniques, postoperative pain in this kind of procedures is still a problem. There are several analgesic options, each one with its own characteristics, but we still lack of a supreme approach for postoperative pain in this kind of surgery. Objectives: expose the available evidence in current analgesic techniques for major knee surgery with focus in total knee replacement and regional anesthesia. A brief anatomy review is also given. Materials and methods: a search was carried out in medical data bases (PubMed and Cochrane) and anesthesiology journals (Regional Anesthesia and Pain Medicine, Anesthesiology Journal, British Journal of Anesthesiology, among others). Search terms were as follows: total knee replacement, regional anesthesia, IPACK, HDLIA, abductor channel block, femoral nerve block. Discussion: the different techniques are exposed in their performance and characteristics. Each one's pros and cons are discussed. Conclusions: there is no gold standard for total knee replacement postoperative analgesia since any of the techniques combines early ambulation and effective analgesia. The election criteria for any of the analgesic options should be made according the physicians background. Combination of different analgesic techniques seems to be an attractive option, but there is still lack of evidence to support their systematic indication.

Biography

Iam staff anesthesiologist at Clinica Universitaria Reina Fabiola for 3 years, since then I’ve successfully developed the Postoperative Pain Unit and treated almost 300 patients with different analgesic modalities including continuous peripheral nerve blocks, patient controlled analgesia and epidural catheters.

Speaker
santi sanchez Clinica Universitaria Reina Fabiola, Argentina

Abstract

Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery(3,6) The key elements of ERAS protocols include standardized analgesic and anesthetic regimens and early mobilization. Tonsillectomy in pediatric patients especially the one with obstructive sleep apnea (OSA) presents a challenging situation for the pediatric anesthesiologist and otolaryngologist. Using local anesthetic infiltration in the tonsillar bed by the surgeon, and Dexmedetomidine intranasal as premedication, and intravenous intra-op, has been shown to be safe as well as successful in decreasing volatile gas needs, opioid requirement, and shorter PACU recovery. Methods Prior to data collection approval from our institution's internal review board for this retrospective review was obtained (IRB HM20005468). Patients age 0-17 who underwent adenotonsillectomy from 2010 - 2015 under the pilot protocol had their records reviewed, and control group of patients comprised of patients who underwent adenotonsillectomy by a different surgeon not utilizing the pilot protocol. Patient who had concurrent procedures other than bilateral myringotomy tubes, inferior turbinate cautery or direct laryngoscopy were excluded. Patient records were reviewed for use of intranasal and intravenous Dexmedetomidine in conjunction with infiltration of local anesthetic in the peritonsillar bed by the surgeon. This protocol is used by a single practicing otolaryngologist and a single practicing anesthesiologist at our institution. Preoperative data including demographics, indication for adenotonsillectomy were collected as well as intra- and post- operative data and medication utilization. Patient demographics are shown in Table 1. Protocol Protocol is begun approximately 30- 45 minutes prior to planned induction with the administration of 2mcg/mL dexmedetomidine via the intranasal route using a microatomizer. Once in the operating room the patient is induced using sevoflurane and oxygen/nitrous. An IV is then placed and anesthesia maintained using sevoflurane and 0.2-0.5 mg/kg intravenous dexmedetomidine. All patients are given 0.5 mcg/kg dexamethasone intraoperatively to a max of 10 mcg per request of out otolaryngology team. Patients are also given IV acetaminophen 15 mg/kg and ondansetron 0.1mg/kg intraoperatively. Post-operatively patients are given standing orders for ibuprofen and acetaminophen in the PACU. Results Percentage of patients who had obstructive sleep apnea were similar between pilot protocol and control groups. Intraoperatively patients in pilot protocol received less Fentanyl and had a lower average end tidal sevoflurane levels. Patients aged 2 - 12 who underwent pilot protocol as compared to control group received fewer doses of opiates and ibuprofen during their hospital stay (Chart 1). Rates of readmission, bleeding were similar between control and pilot protocol groups. No reintubations were noted in either the Dexmedetomidine or control group. Discussion The pilot protocol using intranasal and intravenous Dexmedetomidine in combination with infiltration of local anesthetic is a safe and effective for pediatric patients undergoing adenotonsillectomy. The decreased usage of narcotics both intra- and post- operatively, facilitating a early discharge home of a comfortable patient. We have achieved with our general anesthesia multi modal approach strategy, fast recovery and safe patient outcome.

Biography

Dr. Iolanda Russo-Menna is an anesthesiologist in Richmond, Virginia and is affiliated with VCU Medical Center. She received her medical degree from Sapienza University of Rome and has been in practice for more than 20 years.

Speaker
Iolanda Russo Menna VCU-HS Medical school, USA

Abstract

The geometry and morphology of pediatric and neonatal airways have been widely revised over the past few years. Some interesting studies have shown that the peculiar anatomy of the airways, especially in the infant and premature infants, involves the choice of suitable and safe endotracheal tubes. It has also been shown that general anesthesia and the drugs used to perform it can determine significant geometric variations and may affect correct mechanical ventilation

Biography

Dr. Dario Galante is a pediatric, neonatal and obstetric anesthesiologist of the University Department of Anesthesia and Intensive Care, University Hospital Ospedali Riuniti of Foggia, Italy. Author of many publications indexed on PuBMed, member and Editor in Chief of editorial boards and peer-reviewer of many international journals. He is expert in ultrasound regional anesthesia and President and founder of SIAATIP, Società Italiana di Anestesia, Analgesia e Terapia Intensiva Pediatrica , President and founder of SUA - The Society for Ultrasound in Anaesthesia - Italian Chapter and Società Italiana di Partoanalgesia (www.partoanalgesia.it). He is also member board director of PAICSAT (Pediatric Anesthesia and Intensive Care Society and Applied Technologies). He invented a new innovative technique in simultaneous noninvasive hemodynamic monitoring and ventilation through proseal laringeal mask airway and transesophageal doppler called “TED-PLMA Technique”, and a new innovative ultrasound abdominal block called

Speaker
Dario Galante Italian Society of Pediatric Anesthesia and Pedaitric Intensive Care, Italy

Abstract

SPOILER ALERT: POSTOP PAIN COMES FROM INTRA-OP PAIN! The brain cannot respond to information it does not receive. However, if the only manner in that we believe the brain has been protected from pain is the absence of heart rate (HR) or blood pressure (BP) response to skin incision, then pain management will always be a problem post-operatively. HR & BP are primary brain stem functions with unreliable guides to cerebral cortical response. Pain and consciousness are higher, cortical functions. Trending EMG as a secondary BIS trace provides a real time, useful guide to the presence or absence of cortical response to skin incision or multiple local anesthetic injections. For elective surgery cases, please watch YouTube Going under with Goldilocks anesthesia to see how to create a stable CNS propofol level to block negative ketamine side effects. Incrementally titrate propofol to 606,000 patients, I report NO hospital admissions for postoperative pain management. As a bonus, opioid avoidance produced the lowest published PONV rate (0.6%) in an Apfel-defined, high risk patient population without use of anti-emetics. Friedberg BL: Propofol-ketamine technique, dissociative anesthesia for office surgery: a five-year review of 1,264 cases. Aesth Plast Surg 1999;23:70-74, subsequently cited by Apfel PONV ch. in both 2010 & 2015 eds. of Miller's Anesthesia! To recap, allowing surgeons to perform a skin incision (btw, procedure irrelevant) without NMDA block, is allowing the inadvertent infliction of pain, resulting in the need for multi-modal postop pain management. Our duty, as anesthesiologists, is prevention of pain. Why continue to subject patients to pain when $0.70 worth of ketamine given preemptively can do so much good? Consider watching 14" YouTube Goldilocks anesthesia lecture now having been watched >1100X worldwide for more information. Disclaimer: Neither I, nor my nonprofit Goldilocks Foundation, receive financial support from BIS maker. PS EMG spikes persist in the presence of neuromuscular block (NMB) &/or BOTOX

Biography

Dr. Friedberg started his medical career practicing the subspecialty of cardiac (open heart) anesthesia for 5 years at Hoag Memorial Hospital Presbyterian Hospital. During that time, he introduced the Swan Ganz catheter and cardiac output computer to the heart team. With Dr. Friedberg administering the anesthesia, for the first time in the program's history the heart surgeons were able to know the patient's cardiac output and peripheral resistance immediately when coming off the bypass pump. The results were groundbreaking for both surgeons and patient outcomes.

Speaker
Barry friedberg Goldilocks Anesthesia Foundation,USA

Abstract

In recent years, there have been many advances using ultrasound to visualize the airway and related structures (1). Airway regional techniques are essentially used for providing airway anesthesia for awake direct laryngoscopy or fibro-optic intubation. The three major neural supply to the airway are: Trigeminal, Glossopharyngeal and Vagus (Image). Blocking these individual nerves usually provide more profound anesthesia than simple local anesthetic (LA) topicalization and will reduce the total dose. Objective of this presentation is to discuss some of the techniques of blocking the nerves of the airway and whether using ultrasound as a nerve localization method can be helpful. Glossopharyngeal nerve innervates the oropharynx, soft palate, posterior portion of the tongue and the pharyngeal surface of the epiglottis. Block on this nerve will provide an anesthetize passage for endotracheal tube (ETT) as well as abolishes the gag reflex. This nerve can be anesthetized using either intraoral or extraoral approaches. USG for the extraoral has been described for patients with chronic pain (2). However it can be easily blocked as it crosses the palatoglossal arch. Superior Laryngeal Nerve provides sensation to the base of the tongue, posterior surface of the epiglottis, aryepiglottic fold and the arytenoids. Block of this nerve has been used as a sole technique for intubation and can be done at the level of the thyrohyoid membrane inferior to the cornu of the hyoid bone. USG is useful especially when finding landmarks become difficult (3,4). Recurrent Laryngeal Nerve, which provides sensory innervation to the vocal folds and the trachea, can be easily blocked by the transtracheal block. US has been useful in finding landmarks to perform this block (5). Block of this nerve can prevent coughing and bucking in reaction to presence of the ETT. Nasal passage is anesthetized by blocking the palatine and ant. ethmoidal nerves.

Biography

Dr. Sassan Sabouri, an instructor at Harvard Medical School, is a graduate from medical school in Shahid Beheshti Medical University (SBMU) in Tehran, Iran. First, he finished his anesthesiology residency in SBMU. He has gained his major experience by practicing anesthesia in different cities across Iran for 10 years. In 2006, he started his residency in General Surgery in Temple University in Johnstown PA and then Anesthesiology Residency in New York State University at Buffalo NY, where he became one of the chief residents. After graduation from residency he became one of the staff at the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital (MGH), MA. His clinical innovations are primarily focused on regional anesthesia. Collaboratively, he started General Surgery Regional Service in MGH in May 2012. He has had multiple abstracts and presentations in the USA as well as internationally in Iran and India.

Speaker
Sabouri A. Sassan Harvard Medical School, USA

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