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For Black History Month, Dr. Ludwig Lin is honored to speak with someone who’s been through all of it. Dr. Marilyn Hill Harper, raised in the South, educated at a HBCU and then training in the Midwest, joined the prestigious UCSF faculty in the 1970s, at a time when both women and Black physicians were rare. Her story is ever relevant.

To read the UCSF profile on Dr. Harper, click here.

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Host: Rita Agarwal, MD, FAAP, FASA

Guests: Rakhi Dayal, MD, and Amber Borucki, MD

Welcome to another episode of Vital Times, the California Society of Anesthesiologists’ Podcast with your host Dr. Rita Agarwal.

Pain is the most common reason that people seek medical care and since the beginning of time, we have searched for better ways to treat pain. For many years opium and its derivatives were the mainstay of pain management, with local anesthetics making an appearance in this country in the past century or so. While scientists, physicians, researchers, and industry have sought to find better medications and approaches, the onset of the opioid crises in early 2000s really sped up that mandate. The FDA has committed resources and funding to help these new treatments and as a result there are now several new drugs on the market.

Joining me today to explore these new modalities are Dr. Rahki Dayal who is a Professor at the University of California, Irvine, double board-certified in anesthesiology and pain medicine. She chairs the Pain Committee for the California Society of Anesthesiologists and is the Program Director of Pain Medicine at UCI. Dr. Amber Borucki is an Associate Professor of Anesthesiology at Stanford University and a pediatric anesthesiologist and pain specialist from Stanford School of Medicine. She is also the newly elected Sectrtary/Treasurer of the Society for Pediatric Pain Medicine.

On January 30 the FDA approved a new non-opioid pan medication for moderate to severe pain. In the past few years several new classes and types of medications have also been approved for use. These include Zynrelef-a combination of bupivacaine ( a long acting local anesthesthetic ) and meloxicam ( a long lasting NSAID), and Vocacapsacian a prodrug to capasacian that in at ;east one study has been shown to provide up to 96 hours of pain relief , when injected locally after bunionectomy surgery.

Join us as we explore these medications and the newly released suzetrigine (Journavx) with our 2 experts.

References

https://www.fda.gov/news-events/press-announcements/fda-approves-novel-non-opioid-treatment-moderate-severe-acute-pain

A new long-acting analgesic formulation for postoperative pain management.

Zhang W, Wu M, Shen C, Wang Z, Zhou X, Guo R, Yang Y, Zhang Z, Sun X, Gong T.Int J Pharm. 2024 Oct 25;664:124599. doi: 10.1016/j.ijpharm.2024.124599. Epub 2024 Aug 16.PMID: 39154917 Bupivacaine + meloxicam-~3 days duration-also for bunionectomy

Safety and Efficacy of Vocacapsaicin for Management of Postsurgical Pain: A Randomized Clinical Trial.

Shafer SL, Teichman SL, Gottlieb IJ, Singla N, Minkowitz HS, Leiman D, Vaughn B, Donovan JF.Anesthesiology. 2024 Aug 1;141(2):250-261. doi: 10.1097/ALN.0000000000005027.PMID: 38662910

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There have been a lot of questions recently regarding the appropriateness of patients scheduled for care in an ambulatory surgical center (ASCs). It appears that sicker and more complex patients are being scheduled for care in an ASC, and many anesthesiologists are increasingly concerned about the safety of anesthetizing these patients in locations that may lack resources to escalate care if needed. In today’s episode we are going to discuss some of these issues with two experts in ambulatory to help navigate this quandary. Welcome Drs. Christina Menor and Basem Abdelmalak.

The discussion was fascinating and informative. Starting with why surgeons and proceduralists may want to schedule patients in an ASC, to factors that might affect the decision to safely care for a particular patient in a particular location. Along the way specific examples of patients with complicated medical conditions were presented and discussed in depth.

For full guest bios and resources discussed during the podcast, click here.

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Drs. Charles Hummel and Jason Cheng explain the origin story behind their involvement in founding the drive toward collegiality for a major healthcare system in California, Kaiser Permanente. Take a listen and be inspired by the immense possibilities when physicians join forces in the name of empathy and humanity.

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Your host Dr. Rita Agarwal is joined today by two outstanding guests who have an interest in preventing and treating women’s pain. Drs. Anita Gupta and Stephanie Cizek.

At the California Society of Anesthesiologists’ Annual Meeting in Anaheim, in April 2024, there were several posters authored by Dr. Anita Gupta looking at the literature surrounding IUD insertion pain and potential treatments for that pain. Several months later the new CDC recommendations were released recommending improved pain management techniques in patients undergoing IUD placement. Around the same time there was increased media attention to IUD related pain and the fact that women’s pain has historically often been dismissed, minimized or ignored. In this episode, we discuss all of this and more!

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Your host Dr. Rita Agarwal is joined by two wonderful guests to talk about climate change and what anesthesiologists can do about it.

Climate change is one of the defining challenges of our time with far reaching implications. There is evidence of the increasing numbers of deaths directly related to heat in the USA, but even more across the rest of the world. This doesn’t include deaths related to the consequences of climate change such as more profound and extreme weather events, rising sea level, disruptions to ecosystems and agriculture, drought, and famine. Addressing climate change involves action at local, national, global levels and includes the efforts of individuals, society, businesses, governments, and health care and other institutions.

Both guests are individuals who are committed to addressing efforts to reduce greenhouse gases at the individual, institutional, and local levels.

Dr. McGain is an MBBS and PhD who practices in anesthesia and intensive care at Western Health, St Albans, Victoria, Canada and in Australia as the Associate Dean of Sustainable Healthcare at the university of Melbourne. Dr McGain has spoken and published over 100 articles on the topic of greenhouse gases, reducing carbon footprint and bringing the scientific method to comparing the environmental impact of different practices. In fact, it was as a result of an editorial that he and Drs. Gordon and Debnath Chatterjee wrote, and a presentation from my other guest Dr. Lin, that Dr. Rita Agarwal finally stopped using nitrous oxide for mask induction in children after 30 + years of practice. She had given up desflurane, embraced low flow gases, and minimizing volatile agents, but honestly thought you would have to pry nitrous oxide out of her cold dead hands, before she stopped using it. They convinced her otherwise and hopefully will convince all of you as well

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With ketamine being very prominent in the news recently, lots of questions arise about its use. Is it safe enough to be used the way it is? Why are patients being prescribed it? What are the safety guidelines, and are they being met?
The California Society of Anesthesiologists’ Vital Times Podcast talks with anesthesiologists and pain specialists Drs. Amber Borucki, Rakhi Dayal and Rita Agarwal to talk this over. This is a must-listen for everyone.

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Cryoneurolysis has rapidly evolved and refined itself as a viable technology for postoperative and chronic pain. Its specifications mean greater efficacy for certain scenarios, and active research means its application is about to enter warp-speed. In this episode of Vital Times, we speak with Dr. John Finneran, of UCSD, who is actively conducting research trials with this technique. Get up to date and get inspired.