SleepTalker December 2015


Volume 24 Number 8 Stony Brook, NY  <       December 2015       > 
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Dr. Marco Palmieri Visiting Professor STAR Periop Med Summit
Welcome CRNA Campaign for SB Peds Division News Dr. Jun Lin
New Young Arrivals New Publications PGA Holiday Parties
Pentyala Lab Med Student Groups Photography Corner Where is That?
Dr. T.J. Gan
    It gives me great pleasure to announce the appointment of Dr. Marco Palmieri as Director of the Center for Pain Management at Stony Brook. Dr. Palmeri is a Graduate of the New York College of Osteopathic Medicine. He completed a Residency in Anesthesiology at Stony Brook and subsequently a Fellowship in Pain Medicine at the Mount Sinai Medical Center in New York. He is a Diplomate of the American Board of Anesthesiology with added Qualifications in Pain Management. Dr. Palmieri is principal investigator on several studies involving safety and efficacy of drug delivery systems in chronic pain patients. He is also working on novel applications of Platelet Rich Plasma therapy, a technique that is showing some promise in reducing pain in a number of joint arthropathies. He has a particular interest in advanced interventional pain therapies including neuromodulation and spinal cord stimulation for the treatment of otherwise intractable neuropathic pain syndromes. Educationally, Dr. Palmieri is developing new programs for residents with an interest in pain medicine and is planning to develop a pain medicine fellowship at Stony Brook. Dr. Palmieri is a superb interventional pain management physician and anesthesiologist who has the skills and temperament to care for patients with difficult and challenging pain syndromes. Please join me in welcoming Dr. Palmieri to his new role.v
   Dr. Hilary P. Grocott, MD, FRCPC, FASE, Professor, Department of Anesthesia and Perioperative Medicine at the University of Manitoba is this month's Visiting Professor. Dr. Grocott obtained his medical education at the University of Saskatchewan and completed his anesthesia residency at the University of Manitoba. MD) in 1990. He then went to Duke University for a cardiothoracic anesthesiology and neuroscience fellowship where he worked with Dr. David Warner. In 1997, he joined the faculty of Duke University as an Assistant Professor of Anesthesiology and subsequently was promoted to full Professor. In 2007, Dr. Grocott relocated to the University of Manitoba as Professor in both the Departments of Anesthesia & Perioperative Medicine and Surgery.
   Dr. Grocott's research is focused on the impact of cardiopulmonary bypass on the brain. His experimental work examined mechanisms of cardiac surgery-associated cerebral injury and possible mechanisms of neuroprotection. Clinically, he has investigated the incidence, significance and etiology of cerebral injury after cardiac surgery. His work has led to several translational clinical studies involving novel neuroprotective compounds. Dr. Grocott's active investigations include participation in a multicenter study of cerebral oximetry monitoring in cardiac surgery, as well as a Canadian Institutes of Health Research funded trial investigating transfusion triggers in cardiac surgery (TRICS-III).
   Dr. Grocott spends about half of his time practicing anesthesia, caring for patients undergoing cardiac surgery at St. Boniface Hospital in Winnipeg. In addition to being a prolific author with over 250 publications and abstracts, he is currently Editor-In-Chief of the Canadian Journal of Anesthesia.
   Dr. Grocott will speak to the Residents at 5 PM on Tuesday, December 8 on "Postoperative Delirium: from Risk Factors to Management Strategies". His Grand Rounds presentation at 7 AM on Wednesday, December 9 is entitled "Protecting the Brain during High Risk Cardiac Surgery". 

Photo credit:
Dr. T.J. Gan
   Not infrequently, I hear compliments from patients, surgeons and staff on an incredible job our faculty, residents, nurse anesthetists and staff have done. I would like to find a way to acknowledge them and thought it would be appropriate to set up the Staff Appreciation and Recognition (STAR) section in our monthly departmental newsletter.
   If you have someone whom you would like to recognize, someone who has gone above and beyond his/her regular duties, or simply have done a job well, please send an e-mail to me or Dr. Jim Dilger. We would like to recognize them.
Heather Kametler
Dr. Jeremy Poppers
   Recently, Heather Kametler was instrumental in the care of a very sick and tenuous patient. The patient came to OR 8 for a c-section and possible ECMO. She had been diagnosed with peripartum cardiomyopathy the day before. As always, Heather was present and attentive to the needs of the anesthesia team and the patient before, during and after induction of anesthesia. She confirmed that I had everything I needed before the patient arrived in the room. She assisted in transferring the patient to the OR bed and placing monitors (including zoll pads) on the patient. Soon after induction of anesthesia and while I was in the middle of placing a central line, the patient unexpectedly developed fulminant pulmonary edema. I immediately asked for a TEE, and within a matter of seconds, the machine was in the room, connected to the server and a probe was connected and in my hand. As soon as the probe was in the patient, it was obvious that the patient's heart function had significantly deteriorated from the prior day's TTE which showed an LVEF of 20% and normal RV function to, now, an LVEF of <10% and severely decreased RV function. When I asked for epinephrine and milrinone drips to be added to the norepinephrine that was already running, Heather was right there priming the drips, again within seconds. Within a few minutes of instituting these interventions, the patient's right heart function had recovered significantly (from severe to mild dysfunction) and she had reached a steady state with regards to her hemodynamics. As always, care of any patient, but especially an unstable one, is a team effort. In this case, Heather's proactive nature and her amazingly efficient and prompt response to complex requests saved critical minutes in this case. I am stressing the importance of "seconds" because RV failure is a disease in which the difference between seconds and minutes can have significant implications on outcome. Heather's contribution to this case was immeasurable and should not go unrecognized.
Dr. Barry Florence
   A recent Press Ganey report included Patient Satisfaction comments about our Ambulatory Surgery Center. A patient mentioned Dr. Barry Florence by name and wrote: “A shining example of everything done right in a quality healthcare facility.”
   Save the date! The 11th annual Perioperative Medicine Summit will take place in sunny Scottsdale Arizona, Feb 25-27, 2016. The target audience includes anesthesiologists, hospitalists, advanced practice practitioners, surgeons, administrators and anyone interested in Pre-Operative and Perioperative medicine. This meeting offers updated evidence- based information on perioperative topics, a poster abstract session (submissions due Jan 4, 2016) and an opportunity to network with experts in the field. The Summit, under the auspices of Rush University, is co-sponsored by SPAQI (Society of Perioperative Assessment and Quality Improvement). The summit co-director is incoming SPAQI president Deborah Richman. Meeting registration and Information page.
John Fallon, CRNA
   Please welcome Ashley Zarkowski, CRNA, the newest member of the Department of Anesthesiology. Ashley is a graduate of the Molloy College School of Nursing, has worked several years in the medical ICU at long Island Jewish Medical Center and is a recent graduate of the Columbia University program in Anesthesia. Ashley has just returned from a two-week medical mission in Viet Nam.
   Stony Brook University launched the public phase of a seven-year, $600 million Campaign for Stony Brook. The capital campaign, led by the Stony Brook Foundation, is the largest in the history of the State University of New York. More than 30,000 individuals have already donated a total of $426 million and the Foundation expects to raise the remaining $176 million by July 2018. Our own Dr. Helene Benveniste, Vice Chair for Research, was a guest speaker at the opening celebration on November 21. She made an engaging presentation about glymphatics, sleep and Alzheimer’s disease.
   Congratulations to Aysha Hasan, M.D. on obtaining Pediatric Anesthesiology ABA board certification coming out of her fellowship and commencing her practice here at Stony Brook. All members of the Pediatric Division are fellowship trained, ABA and ABA sub-specialty board certified!
     Chief Resident Dr. Alexander Praslick, Peggy Seidman, M.D. and two medical students, Kristen Zach and Lauren Maloney attended the AAMC Medical Education meeting in Baltimore. They presented their poster: "Personal Protective Equipment Instruction through Simulated Contamination". The authors are shown along with colleagues Drs. Howard Fleit and Chandran Latha.
   Dr. Jun Lin, Associate Professor, been elected to full (active) membership in the Association of University Anesthesiologists (AUA). The mission of this academic organization, founded in 1953, is to "advance the Art and Science of Anesthesiology" through research, teaching and communication. New members must be nominated by an existing member and must be approved by vote of active members. Congratulations Dr. Lin on this well-deserved honor!
   Dr. Lin has been increasing his participation in the New York State Society for Anesthesiology. He was recently appointed to the PGA Sub-Committee on Residents Research Contest 2016-2017 and the PGA Sub-Committee on Scientific Panels 2016-2017. He is continuing to serve on the 2016 NYSSA Committee on Continuous Quality Improvement and Peer Review.
Congratulations and best wishes to the families of these young 'uns!
  • Kimberly Khan, CRNA, her husband Fazel and big brother Aaron welcomed Asher!
  • Natalie Newman, CRNA, her husband Chris Ferguson and big sister Tatiyana welcomed Malia!
  • Matthew Tito, MD, his wife Lindsay and big sister Ella welcomed Noah Matthew!
  • Nataliya Holod, CRNA and her husband Dmytro welcomed Stefania!
  • Anesthesia Technician Nancy Gonzalez, her husband Manuel and big brother Anthony welcomed Leo!
  • Chakraborty S, Rebecchi M, Kaczocha M, Puopolo M. Dopamine modulation of transient receptor potential vanilloid type 1 (TRPV1) receptor in dorsal root ganglia neurons. J Physiol. 2015 Nov 13.
  • Chandrakantan A, Gan TJ. Demonstrating Value: A Case Study of Enhanced Recovery. Anesthesiol Clin. 2015 Dec;33(4):629-50.
  • Song W, Guo F, Zhong H, Liu L, Yang R, Wang Q, Xiong L. Therapeutic window of globular adiponectin against cerebral ischemia in diabetic mice: the role of dynamic alteration of adiponectin/adiponectin receptor expression. Sci Rep. 2015 Nov 27;5:17310.
fig 1
Chakraborty et al. Fig 1
The Post Graduate Assembly (PGA) organized by the New York State Society of Anesthesiologists, takes place Dec. 11-15 in New York City. Our department will be represented with 20 Medically Challenging Cases, 6 Posters, 3 Focus Sessions, 1 Mini Workshop, 11 Problem-Based Learning Discussion, 6 Scientific Panels and 1 Workshop!
Please visit our Presenters while you are at the meeting. And, don't forget to take photos of department members standing in front of posters! We can use these in January's issue of SleepTalker, on our website and in the library display case.
Medically Challenging Cases
* Abrahams E, Izrailtyan I, Fernandez H, Jeremias A. Anesthetic Management of Intraoperative Left Ventricular Rupture During TAVR Requiring Conversion to Open AVR
* Alanes MY, Izrailtyan I, Lagade M. Intraoperative Anesthesia Management Alerts Surgery Team of Iatrogenic Bladder Perforation During TURP Procedure
* Cho B, Stuart W, Schabel J. Psychogenic Seizures After Epidural Local Anesthetic Administration
* Richman DC. Who Needs a Dental Clearance? A Multidisciplinary Approach to Surgical Success
* Gupta R, Shodhan S. Anaesthetic Considerations in the Allgrove Patient
* Gupta R. Gastric Content Regurgitation in Post Gastric Banding Patient Despite Adequate Preoperative Fasting
* Khmara K, Smith J, Oleszak S. Hypotension and Sudden Decrease of End-tidal CO2 During IVC Tumor Thrombectomy: PE, Gas Embolism or Total IVC obstruction?
* Kim E, Moller D. Anaphylactic Reaction Intraoperatively During Abdominal Aortic Aneurysm Repair
* Kagan M, Moon R, Asaad B. Genicular Block in a Patient with Osteoarthritis (presenting at NYSCARF)
* Kogan A, Fradlis A. Spinal Anesthesia for Caesarean Section in a Parturient with Cerebral Palsy
* Licata S, Taylor J, Fernandez H, Izrailtyan I. Use of 3D-TEE and Cerebral Oximetry Monitor in Optimizing Complex Redo Ascending Aorta Repair
* Llenes RP, Fradlis A, Lagade M, Izrailtyan I. Use of Transesophageal Echocardiography During Radical Nephrectomy for Invasive Renal Cell Carcinoma, Complicated by Severe Protamine-induced Allergic Response
* Llenes RP, McLarty A, Gupta S, Izrailtyan I. Clipping of the Left Atrial Appendage During Thoracotomy Enhanced by Intraoperative Transesophageal Echocardiography
* Moon R, Caces A, Izrailtyan I. Anesthetic Management of Acute Esophageal Bleeding at the Interventional Radiology Suite
* Nunziata R, Page C, Wang M. Emergent Intubation of a Morbidly Obese Patient with Distal Tracheal Mass
* Pak A, Oleszak S, Gupta S. A Rare Case of Postoperative SVC Obstruction After Cardiac Surgery
* Pak A, Oleszak S, McLarty A. BIVAD in the Setting of Multi-organ Failure Complicated by Multiple Thrombi
* Pollack J, Jacob Z, Richman D. Anesthetic Management of a Palliative Procedure in a Patient with Advanced Duchennes Muscular Dystrophy
* Pollack J, Stuart W, Abola R, Schabel J. Successful Epidural Analgesia in a Patient with Recent Epidural Blood Patch
* Pollack J, Stuart W, Reilly L, Oleszak P. Fiberoptic Scope Assisted Esophageal Temperature Probe Placement
* Costa A. Preoperative Assessment of Patients with Ventricular-Assist Devices Presenting for Noncardiac Surgery
* Gupta R, Roizen M. Effects of Preoperative Exercise on Perioperative and Postoperative Outcomes
* Landman U, Licata S. Pseudocholinesterase Deficiency in a Young Male
* Lee KB, Praslick A, Izrailtyan I. The Use of Cerebral Oximetry in the Management of Cerebral Perfusion During Hypothermic Circulatory Arrest for Aortic Arch Repair
* Lee KB. Using Apps to Connect Us in More Meaningful Ways: A Residency Pocket Guide
* Sadean MR. Increase of Time to Regain of Consciousness by Adding a Propofol Infusion to Sevoflurane or Desflurane Anesthesia
Focus Sessions
* Richman DC. Do Not Resuscitate
* Richman DC. Implantable Pumps
* Vitkun SA. Moderator: Selected Posters
Mini Workshop
* Rosenfeld KI. Postoperative Nausea and Vomiting: Practice Guideline Updates
Problem-Based Learning Discussions
* Adsumelli RS. Obstetric Analgesia in the Patient with Previous Back Surgery
* Adsumelli RS. Maternal Hemorrhage
* Beg T. Interventional Endoscopy: Who is Too Sick for the GI Suite?
* Moller DH. Massive Transfusion Protocol
* Moller DH. Trauma Team to the ER: New Trauma Resuscitation Guidelines
* Poovathoor SP. New Techniques for Fluid Management From OR to ICU
* Rosenfeld KI. Maximizing Scheduling and Operating Room Efficiency
* Saunders TA. Do Not Resuscitate Orders: Ethical Considerations for the Anesthesiologist
* Steinberg ES. The Pregnant Patient for Non-Obstetrical Surgery
* Stellaccio FS. Unusual Complications of Difficult Intubations in the Morbidly Obese: Recognition and Management
Scientific Panels
* Gan TJ. Sedation for Procedures: Personnel Assisted Driven?
* Gan TJ. Optimizing Postoperative Care
* Richman DC. The Patient with Obstructive Sleep Apnea
* Steinberg ES. The Pregnant Patient with Respiratory Disease
* Steinberg ES. 17th Annual Bragging Contest: Any Case You Have Done, I Have Done a Better One
* Stellaccio, FS. Practice Management (Panel Host)
* Stellaccio, FS. Difficult Airway Workshop.
   Dr. and Mrs. TJ Gan are hosting the annual Departmental Holiday Party on Friday, December 18, from 7 to 10 pm at Flowerfield. Kindly R.S.V.P. to Marisa Barone-Citrano by December 4. Flowerfield is located at 199 Mill Pond Road, in St. James.
   Back by popular demand, the second annual SnakePit Ugly Sweater Party will take place on Thursday, December 10 starting at 2 pm. Pull on your ugliest sweater, and stop by the SnakePit for some holiday treats and good cheer. This year, in conjunction with the party, we will be hosting a Food Drive to benefit Island Harvest, a food bank serving local families in need. The price of admission to the party is a donation to Island Harvest. There are boxes for donations of food and cash at the Snakepit from 01 – 21 December. Contact Jean Abbott for more details.
Ursula Landman
   The Stony Brook and NYIT COM Medical Student Anesthesia Interest Groups met in November. I presented an airway workshop to the NYIT-COM group on November 17. The students were very enthusiastic about this hands-on workshop and were able to practice intubation on the mannequins. On November 24, Dr. Stellaccio gave an excellent review and talk on malignant hyperthermia to the Stony Brook Anesthesia Interest Group. The students asked excellent questions. Many students are planning to attend the PGA in NYC.
Srinivas Pentyala
   Carlos Helguero, a graduate student who is working with me to create biocompatible and biomimetic bone, successfully presented his thesis proposal to a committee of experts. His exemplary work was well received by the committee and he was given the go-ahead to finish a few more pending experiments so as to submit his PhD thesis proposal by June 2016. Carlos is a Fulbright scholar from Ecuador and is a faculty member in Escuela Superior Politécnica del Litoral in Guayaquil, Ecuador. The work on this project has been accepted for presentation at the American Academy of Orthopedic Surgeons Conference (“3D-printed Implants and Jigs for Orthopedic Surgery” - abstract selected for podium presentation) and at the Orthopedic Research Society Conference (“Biocompatible and Biomimetic Artificial Bone” - abstract acceptance rate is 6.8% in 2015). Both conferences take place in Orlando in March 2016. The undergraduate students (John, Sunjit and Sahana) who are working on this project are also co-authors.
   John Pfail, a Junior undergrad who is working in my lab was the recipient of Stony brook University’s “Outstanding Academic Achievement Award”. This award is presented to undergraduate students who achieved a 4.0 GPA during the previous semester and have a minimum cumulative GPA of 3.85.
   Sunjit Parma, a Junior undergrad who works with me, is actively involved with “Volunteers Around the World”, an organization in which students work in other countries to provide medical help and care. The volunteers work in mobile medical clinics where they have the opportunity to interact with patients, conduct public health surveys, take vitals, shadow physicians, work in the pharmacy and teach local kids. Sunjit will be leading a group of volunteers on a Medical Outreach Trip to Panama.
   John Muller, a Master’s student at Boston University who worked with me for the past two years, successfully submitted his dissertation “A novel prostate Cancer Biomarker” as fulfillment of the requirement for his degree. John is currently interviewing for medical school and expects to enrol in an MD program next year.
   Sahana Pentyala, an undergraduate sophomore at our University who has been involved with several projects in our labs since her high school days, presented her research project on “Rapid biomarker identification method/kit” at the American Association of Physicians of Indian Origin (AAPI) Conference. She was awarded 2nd prize (beating presentations by medical students and residents!!) for her novel findings on diabetic nephropathy and the invention of a detection device. Sahana was awarded a plaque and a cash prize (she is not revealing the amount) by AAPI at their Gala dinner on November 22. She also received a Certificate of Recognition by Suffolk County Executive Steve Bellone and NY State Senator Jack Martins. Jim Dilger and I are advisors for Sahana on this project.
"Lake Massawippa" by Brian Cho
Jim Dilger
   The "Swing" sculpture, shown last month, is near South Campus. Take the South Campus entrance to the University (South Drive), go past the Dental School and turn right at the light (Marburger Drive). Just past the entrance to the Marine Sciences area, look to the right atop the hill. By the way, only one of these "Drives" is named for a former SBU president!

   The subject of this month's photo is located indoors but can be seen through the plate glass windows of the building it is in. There are several like it and I have, on occasion, seen the bicycle wheels turning. I'm not sure when they activate them. Happy hunting!

SleepTalker, the Stony Brook Anesthesiology Newsletter is published by the Department of Anesthesiology,
Stony Brook Medicine, Stony Brook, NY.
Tong Joo Gan, M.D., Chairman.
Editorial Board: James P. Dilger, Ph.D., Stephen A. Vitkun, M.D., M.B.A., Ph.D., Marisa Barone-Citrano.